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Gupta R, Bermudez F, Vora T, Homayouni N, Weissman G, Kadakkal A, Afari-Armah N, Rao S, Lam PH, Rodrigo ME, Hofmeyer M, Krishnan M, Balsara K, Najjar SS, Sheikh FH. Surveillance Imaging and Management of Cardiac Sarcoidosis After Advanced Heart Failure Therapies. Am J Cardiol 2024:S0002-9149(24)00311-4. [PMID: 38663574 DOI: 10.1016/j.amjcard.2024.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 04/20/2024] [Accepted: 04/20/2024] [Indexed: 05/07/2024]
Affiliation(s)
- Richa Gupta
- XXX, Medstar Washington Hospital Center, Washington DC, District of Columbia; XXX, Georgetown University School of Medicine, Washington, DC, District of Columbia
| | - Francisca Bermudez
- XXX, Georgetown University School of Medicine, Washington, DC, District of Columbia
| | - Tania Vora
- XXX, MedStar Health, Baltimore, Maryland
| | - Navid Homayouni
- XXX, Medstar Washington Hospital Center, Washington DC, District of Columbia; XXX, Georgetown University School of Medicine, Washington, DC, District of Columbia
| | - Gaby Weissman
- XXX, Medstar Washington Hospital Center, Washington DC, District of Columbia; XXX, Georgetown University School of Medicine, Washington, DC, District of Columbia
| | - Ajay Kadakkal
- XXX, Medstar Washington Hospital Center, Washington DC, District of Columbia
| | - Nana Afari-Armah
- XXX, Medstar Washington Hospital Center, Washington DC, District of Columbia; XXX, Georgetown University School of Medicine, Washington, DC, District of Columbia
| | - Sriram Rao
- XXX, Medstar Washington Hospital Center, Washington DC, District of Columbia; XXX, Georgetown University School of Medicine, Washington, DC, District of Columbia
| | - Phillip H Lam
- XXX, Medstar Washington Hospital Center, Washington DC, District of Columbia; XXX, Georgetown University School of Medicine, Washington, DC, District of Columbia
| | - Maria E Rodrigo
- XXX, Medstar Washington Hospital Center, Washington DC, District of Columbia
| | - Mark Hofmeyer
- XXX, Medstar Washington Hospital Center, Washington DC, District of Columbia; XXX, Georgetown University School of Medicine, Washington, DC, District of Columbia
| | - Mrinalini Krishnan
- XXX, Medstar Washington Hospital Center, Washington DC, District of Columbia; XXX, Georgetown University School of Medicine, Washington, DC, District of Columbia
| | - Keki Balsara
- XXX, Medstar Washington Hospital Center, Washington DC, District of Columbia; XXX, Georgetown University School of Medicine, Washington, DC, District of Columbia
| | - Samer S Najjar
- XXX, Georgetown University School of Medicine, Washington, DC, District of Columbia; XXX, MedStar Health, Baltimore, Maryland
| | - Farooq H Sheikh
- XXX, Medstar Washington Hospital Center, Washington DC, District of Columbia; XXX, Georgetown University School of Medicine, Washington, DC, District of Columbia.
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Shah P, Agbor-Enoh S, Lee S, Andargie TE, Sinha SS, Kong H, Henry L, Park W, McNair E, Tchoukina I, Shah KB, Najjar SS, Hsu S, Rodrigo ME, Jang MK, Marboe C, Berry GJ, Valantine HA. Racial Differences in Donor-Derived Cell-Free DNA and Mitochondrial DNA After Heart Transplantation, on Behalf of the GRAfT Investigators. Circ Heart Fail 2024; 17:e011160. [PMID: 38375637 PMCID: PMC11021168 DOI: 10.1161/circheartfailure.123.011160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/07/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND Black heart transplant patients are at higher risk of acute rejection (AR) and death than White patients. We hypothesized that this risk may be associated with higher levels of donor-derived cell-free DNA (dd-cfDNA) and cell-free mitochondrial DNA. METHODS The Genomic Research Alliance for Transplantation is a multicenter, prospective, longitudinal cohort study. Sequencing was used to quantitate dd-cfDNA and polymerase chain reaction to quantitate cell-free mitochondrial DNA in plasma. AR was defined as ≥2R cellular rejection or ≥1 antibody-mediated rejection. The primary composite outcome was AR, graft dysfunction (left ventricular ejection fraction <50% and decrease by ≥10%), or death. RESULTS We included 148 patients (65 Black patients and 83 White patients), median age was 56 years and 30% female sex. The incidence of AR was higher in Black patients compared with White patients (43% versus 19%; P=0.002). Antibody-mediated rejection occurred predominantly in Black patients with a prevalence of 20% versus 2% (P<0.001). After transplant, Black patients had higher levels of dd-cfDNA, 0.09% (interquartile range, 0.001-0.30) compared with White patients, 0.05% (interquartile range, 0.001-0.23; P=0.003). Beyond 6 months, Black patients showed a persistent rise in dd-cfDNA with higher levels compared with White patients. Cell-free mitochondrial DNA was higher in Black patients (185 788 copies/mL; interquartile range, 101 252-422 133) compared with White patients (133 841 copies/mL; interquartile range, 75 346-337 990; P<0.001). The primary composite outcome occurred in 43% and 55% of Black patients at 1 and 2 years, compared with 23% and 27% in White patients, P<0.001. In a multivariable model, Black patient race (hazard ratio, 2.61 [95% CI, 1.35-5.04]; P=0.004) and %dd-cfDNA (hazard ratio, 1.15 [95% CI, 1.03-1.28]; P=0.010) were associated with the primary composite outcome. CONCLUSIONS Elevated dd-cfDNA and cell-free mitochondrial DNA after heart transplant may mechanistically be implicated in the higher incidence of AR and worse clinical outcomes in Black transplant recipients. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02423070.
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Affiliation(s)
- Palak Shah
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart and Vascular Institute, Falls Church VA
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
| | - Sean Agbor-Enoh
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore MD
- Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda MD
| | - Seiyon Lee
- Volgenau School of Engineering, George Mason University, Fairfax VA
| | - Temesgen E. Andargie
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda MD
| | - Shashank S. Sinha
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart and Vascular Institute, Falls Church VA
| | - Hyesik Kong
- Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda MD
| | - Lawrence Henry
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart and Vascular Institute, Falls Church VA
| | - Woojin Park
- Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda MD
| | - Erick McNair
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart and Vascular Institute, Falls Church VA
| | - Inna Tchoukina
- The Pauley Heart Center, Virginia Commonwealth University, Richmond VA
| | - Keyur B. Shah
- The Pauley Heart Center, Virginia Commonwealth University, Richmond VA
| | - Samer S. Najjar
- Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington Hospital Center, Washington DC
| | - Steven Hsu
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore MD
| | - Maria E. Rodrigo
- Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington Hospital Center, Washington DC
| | - Moon Kyoo Jang
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda MD
| | - Charles Marboe
- Department of Pathology, New York Presbyterian University Hospital of Cornell and Columbia, New York, New York, USA
| | | | - Hannah A. Valantine
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Stanford University School of Medicine, Palo Alto, CA
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3
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Maini M, Anderson KM, Seplowe M, Crowell NA, Pitcher C, Scally R, Weintraub WS, Najjar SS, Groninger H, Rao A. Disease-State Understanding and Experience of Patients Receiving Continuous Intravenous Inotropic Support as Palliative Therapy: A Multicenter Survey. J Palliat Med 2024. [PMID: 38564223 DOI: 10.1089/jpm.2023.0670] [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: 04/04/2024] Open
Abstract
Background: The use of continuous intravenous inotropic support (CIIS) as palliative therapy in patients with advanced heart failure (HF) has increased over the past decade. CIIS improves New York Heart Association (NYHA) functional class but does not impact survival. Objective: The objective of this study was to examine patients' understanding of the therapeutic intent of CIIS, prognostic awareness, and quality of life with CIIS. Design: We conducted a prospective, cross-sectional, multicenter study of patients with advanced HF receiving CIIS as palliative therapy between 2020 and 2022. Settings/Subjects: An investigator-developed survey instrument was administered to outpatients on CIIS in the United States via telephone. Measurements: Survey data were analyzed using descriptive and inferential statistics. Results: Forty-eight patients, 63% male, 81% African American/Black, with a mean age of 68.9 (standard deviation 12.3) years, participated in this study. The majority of patients responded that they expected CIIS to make them feel better (79%) and increase longevity (75%), but few expected that CIIS would cure their HF (19%). Patients described their overall quality of life on CIIS as not better/worse (19%), somewhat better (46%), and significantly better (35%) and reported high treatment satisfaction (87% were at least somewhat satisfied). Conclusions: In this study, patients report improved quality of life with CIIS as palliative therapy. Patients on CIIS as palliative therapy expected increased survival on CIIS, which is incongruent with current evidence. Further studies on how we can improve care processes so that patients have accurate prognostic and disease-state awareness, and receive goal concordant care, are warranted.
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Affiliation(s)
- Mansi Maini
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, USA
| | - Kelley M Anderson
- Department of Nursing, Georgetown University School of Nursing, Washington, DC, USA
| | - Matthew Seplowe
- Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Nancy A Crowell
- Department of Nursing, Georgetown University School of Nursing, Washington, DC, USA
| | - Clark Pitcher
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, USA
| | - Rebecca Scally
- Department of Nursing, Georgetown University School of Nursing, Washington, DC, USA
| | - William S Weintraub
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, USA
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | - Samer S Najjar
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, USA
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | - Hunter Groninger
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, USA
- Section of Palliative Care, MedStar Washington Hospital Center, Washington, DC, USA
| | - Anirudh Rao
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, USA
- Section of Palliative Care, MedStar Washington Hospital Center, Washington, DC, USA
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4
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Rao A, Maini M, Anderson KM, Crowell NA, Gholami SS, Foley Lgsw C, Violanti D, Singh M, Sheikh FH, Najjar SS, Groninger H. Benefits and Harms of Continuous Intravenous Inotropic Support as Palliative Therapy: A Single-Institution, Retrospective Analysis. Am J Hosp Palliat Care 2024; 41:50-55. [PMID: 36812883 DOI: 10.1177/10499091231160162] [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] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Use of continuous intravenous inotropic support (CIIS) strictly as palliative therapy for patients with ACC/AHA Stage D (end-stage) Heart Failure (HF) has increased significantly. The harms of CIIS therapy may detract from its benefits. To describe benefits (improvement in NYHA functional class) and harms (infection, hospitalization, days-spent-in-hospital) of CIIS as palliative therapy. Methods: Retrospective analysis of patients with end-stage HF initiated on CIIS as palliative therapy at an urban, academic center in the United States between 2014-2016. Clinical outcomes were extracted, and data were analyzed using descriptive statistics. Seventy-five patients, 72% male, 69% African American/Black, with a mean age 64.5 years (SD = 14.5) met study criteria. Mean duration of CIIS was 6.5 months (SD = 7.7). Most patients (69.3%) experienced improvement in NYHA functional class from class IV to class III. Sixty-seven patients (89.3%) were hospitalized during their time on CIIS, with a mean of 2.7 hospitalizations per patient (SD = 3.3). One-third of patients (n = 25) required at least one intensive care unit (ICU) admission while on CIIS therapy. Eleven patients (14.7%) experienced catheter-related blood stream infection. Patients spent an average of 20.6% (SD = 22.8), approximately 40 days, of their time on CIIS admitted to the study institution. Patients on CIIS as palliative therapy report improvement in functional class, survive 6.5 months following initiation, but spend a significant number of days in the hospital. Prospective studies quantifying the symptomatic benefit and the direct and indirect harms of CIIS as palliative therapy are warranted.
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Affiliation(s)
- Anirudh Rao
- Georgetown University School of Medicine, Washington, DC, USA
- Section of Palliative Care, Department of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Mansi Maini
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - Nancy A Crowell
- Georgetown University School of Nursing, Washington, DC, USA
| | | | - Carroll Foley Lgsw
- Section of Palliative Care, Department of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Diana Violanti
- Department of Pharmacy, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Manavotam Singh
- Advanced Heart Failure Program, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | - Farooq H Sheikh
- Georgetown University School of Medicine, Washington, DC, USA
- Advanced Heart Failure Program, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | - Samer S Najjar
- Advanced Heart Failure Program, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | - Hunter Groninger
- Georgetown University School of Medicine, Washington, DC, USA
- Section of Palliative Care, Department of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
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5
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Grinstein J, Sinha SS, Goswami RM, Patel PA, Cyrille-Superville N, Neyestanak ME, Feliberti JP, Snipelisky DF, Devore AD, Najjar SS, Jeng EI, Rao SD. Variation in Hemodynamic Assessment and Interpretation: A Call to Standardize the Right Heart Catheterization. J Card Fail 2023; 29:1507-1518. [PMID: 37352965 DOI: 10.1016/j.cardfail.2023.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/17/2023] [Accepted: 06/05/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Invasive hemodynamic measurement via right heart catheterization has shown divergent data in its role in the treatment of patients with heart failure (HF) and cardiogenic shock. We hypothesized that variation in data acquisition technique and interpretation might contribute to these observations. We sought to assess differences in hemodynamic acquisition and interpretation by operator subspecialty as well as level of experience. METHODS AND RESULTS Individual-level responses to how physicians both collect and interpret hemodynamic data at the time of right heart catheterization was solicited via a survey distributed to international professional societies in HF and interventional cardiology. Data were stratified both by operator subspecialty (HF specialists or interventional cardiologists [IC]) and operator experience (early career [≤10 years from training] or late career [>10 years from training]) to determine variations in clinical practice. For the sensitivity analysis, we also look at differences in each subgroup. A total of 261 responses were received. There were 141 clinicians (52%) who self-identified as HF specialists, 99 (38%) identified as IC, and 20 (8%) identified as other. There were 142 early career providers (54%) and late career providers (119 [46%]). When recording hemodynamic values, there was considerable variation in practice patterns, regardless of subspecialty or level of experience for the majority of the intracardiac variables. There was no agreement or mild agreement among HF and IC as to when to record right atrial pressures or pulmonary capillary wedge pressures. HF cardiologists were more likely to routinely measure both Fick and thermodilution cardiac output compared with IC (51% vs 29%, P < .001), something mirrored in early career vs later career cardiologists. CONCLUSIONS Significant variation exists between the acquisition and interpretation of right heart catheterization measurements between HF and IC, as well as those early and late in their careers. With the growth of the heart team approach to management of patients in cardiogenic shock, standardization of both assessment and management practices is needed.
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Affiliation(s)
- Jonathan Grinstein
- Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois.
| | - Shashank S Sinha
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax Virginia
| | - Rohan M Goswami
- Division of Transplant, Research and Innovation, Mayo Clinic in Florida, Jacksonville Florida
| | - Priyesh A Patel
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina
| | | | - Maryam E Neyestanak
- Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois
| | - Jason P Feliberti
- University of South Florida Heart and Vascular Institute, Transplant Cardiology, Tampa, Florida
| | - David F Snipelisky
- Section of Heart Failure & Cardiac Transplant Medicine, Cleveland Clinic Florida, Weston, Florida
| | - Adam D Devore
- Division of Cardiology and Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Samer S Najjar
- Medstar Heart and Vascular Institute, Baltimore Maryland
| | - Eric I Jeng
- Department of surgery, Division of cardiovascular surgery, University of Florida, Gainesville, Florida
| | - Sriram D Rao
- Medstar Washington Hospital Center, Division of Cardiology, Georgetown University, Department of Medicine, Washington DC
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6
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Rao A, Maini M, Seplowe M, Crowell NA, Pitcher C, Scally R, Weintraub WS, Najjar SS, Groninger H, Anderson KM. Health-Related Quality of Life in Patients with Advanced Heart Failure Receiving Continuous Intravenous Inotropic Support: A Multi-Center Survey. Am J Cardiol 2023; 205:231-233. [PMID: 37611415 DOI: 10.1016/j.amjcard.2023.07.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/21/2023] [Accepted: 07/30/2023] [Indexed: 08/25/2023]
Affiliation(s)
- Anirudh Rao
- Department of Medicine, Georgetown University School of Medicine, Washington, DC; Section of Palliative Care, Department of Medicine, MedStar Washington Hospital Center, Washington, DC.
| | - Mansi Maini
- Department of Medicine, Georgetown University School of Medicine, Washington, DC
| | - Matthew Seplowe
- Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Nancy A Crowell
- Department of Nursing, Georgetown University School of Nursing, Washington, DC
| | - Clark Pitcher
- Department of Medicine, Georgetown University School of Medicine, Washington, DC
| | - Rebecca Scally
- Department of Nursing, Georgetown University School of Nursing, Washington, DC
| | - William S Weintraub
- Department of Medicine, Georgetown University School of Medicine, Washington, DC; MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC
| | - Samer S Najjar
- Department of Medicine, Georgetown University School of Medicine, Washington, DC; MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC
| | - Hunter Groninger
- Department of Medicine, Georgetown University School of Medicine, Washington, DC; Section of Palliative Care, Department of Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Kelley M Anderson
- Department of Nursing, Georgetown University School of Nursing, Washington, DC
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7
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Zaghlol R, Ghazzal A, Radwan S, Ahmed S, Zaghlol L, Hofmeyer M, Rodrigo ME, Kadakkal A, Lam PH, Rao S, Weintraub WS, Molina E, Sheikh FH, Najjar SS. VENTRICULAR ARRHYTHMIAS IN END-STAGE HEART FAILURE PATIENTS ON AMBULATORY INOTROPIC THERAPY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00896-3] [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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8
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Chaudhry S, DeVore AD, Vidula H, Nassif M, Mudy K, Birati EY, Gong T, Atluri P, Pham D, Sun B, Bansal A, Najjar SS. Left Ventricular Assist Devices: A Primer For the General Cardiologist. J Am Heart Assoc 2022; 11:e027251. [PMID: 36515226 PMCID: PMC9798797 DOI: 10.1161/jaha.122.027251] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Durable implantable left ventricular assist devices (LVADs) have been shown to improve survival and quality of life for patients with stage D heart failure. Even though LVADs remain underused overall, the number of patients with heart failure supported with LVADs is steadily increasing. Therefore, general cardiologists will increasingly encounter these patients. In this review, we provide an overview of the field of durable LVADs. We discuss which patients should be referred for consideration of advanced heart failure therapies. We summarize the basic principles of LVAD care, including medical and surgical considerations. We also discuss the common complications associated with LVAD therapy, including bleeding, infections, thrombotic issues, and neurologic events. Our goal is to provide a primer for the general cardiologist in the recognition of patients who could benefit from LVADs and in the principles of managing patients with LVAD. Our hope is to "demystify" LVADs for the general cardiologist.
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Affiliation(s)
- Sunit‐Preet Chaudhry
- Division of CardiologyAscension St. Vincent Heart CenterIndianapolisIN,Ascension St. Vincent Cardiovascular Research InstituteIndianapolisIN
| | - Adam D. DeVore
- Department of Medicine and Duke Clinical Research InstituteDuke University School of MedicineDurhamNC
| | - Himabindu Vidula
- Division of Heart Failure and TransplantUniversity of Rochester School of Medicine and DentistryRochesterNY
| | - Michael Nassif
- Division of Heart failure and TransplantSaint Luke’s Mid America Heart InstituteKansas CityMO
| | - Karol Mudy
- Division of Cardiothoracic SurgeryMinneapolis Heart InstituteMinneapolisMN
| | - Edo Y. Birati
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and SurgeryPadeh‐Poriya Medical Center, Bar Ilan UniversityPoriyaIsrael
| | - Timothy Gong
- Center for Advanced Heart and Lung DiseaseBaylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical CenterDallasTX
| | - Pavan Atluri
- Division of Cardiovascular SurgeryUniversity of PennsylvaniaPhiladelphiaPA
| | - Duc Pham
- Center for Advanced Heart FailureBluhm Cardiovascular Institute, Northwestern University, Feinberg School of MedicineChicagoIL
| | - Benjamin Sun
- Division of Cardiothoracic Surgery, Abbott Northwestern HospitalMinneapolisMN
| | - Aditya Bansal
- Division of Cardiothoracic Surgery, Department of SurgeryOchsner Clinic FoundationNew OrleansLA
| | - Samer S. Najjar
- Division of Cardiology, MedStar Heart and Vascular InstituteMedstar Medical GroupBaltimoreMD
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9
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Shah P, Agbor-Enoh S, Bagchi P, deFilippi CR, Mercado A, Diao G, Morales DJ, Shah KB, Najjar SS, Feller E, Hsu S, Rodrigo ME, Lewsey SC, Jang MK, Marboe C, Berry GJ, Khush KK, Valantine HA. Circulating microRNAs in cellular and antibody-mediated heart transplant rejection. J Heart Lung Transplant 2022; 41:1401-1413. [PMID: 35872109 PMCID: PMC9529890 DOI: 10.1016/j.healun.2022.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/17/2022] [Accepted: 06/22/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Noninvasive monitoring of heart allograft health is important to improve clinical outcomes. MicroRNAs (miRs) are promising biomarkers of cardiovascular disease and limited studies suggest they can be used to noninvasively diagnose acute heart transplant rejection. METHODS The Genomic Research Alliance for Transplantation (GRAfT) is a multicenter prospective cohort study that phenotyped heart transplant patients from 5 mid-Atlantic centers. Patients who had no history of rejection after transplant were compared to patients with acute cellular rejection (ACR) or antibody-mediated rejection (AMR). Small RNA sequencing was performed on plasma samples collected at the time of an endomyocardial biopsy. Differential miR expression was performed with adjustment for clinical covariates. Regression was used to develop miR panels with high diagnostic accuracy for ACR and AMR. These panels were then validated in independent samples from GRAfT and Stanford University. Receiver operating characteristic curves were generated and area under the curve (AUC) statistics calculated. Distinct ACR and AMR clinical scores were developed to translate miR expression data for clinical use. RESULTS The GRAfT cohort had a median age of 52 years, with 35% females and 45% Black patients. Between GRAfT and Stanford, we included 157 heart transplant patients: 108 controls and 49 with rejection (50 ACR and 38 AMR episodes). After differential miR expression and regression analysis, we identified 12 miRs that accurately discriminate ACR and 17 miRs in AMR. Independent validation of the miR panels within GRAfT led to an ACR AUC 0.92 (95% confidence interval [CI]: 0.86-0.98) and AMR AUC 0.82 (95% CI: 0.74-0.90). The externally validated ACR AUC was 0.72 (95% CI: 0.59-0.82). We developed distinct ACR and AMR miR clinical scores (range 0-100), a score ≥ 65, identified ACR with 86% sensitivity, 76% specificity, and 98% negative predictive value, for AMR score performance was 82%, 84% and 97%, respectively. CONCLUSIONS We identified novel miRs that had excellent performance to noninvasively diagnose acute rejection after heart transplantation. Once rigorously validated, the unique clinical ACR and AMR scores usher in an era whereby genomic biomarkers can be used to screen and diagnose the subtype of rejection. These novel biomarkers may potentially alleviate the need for an endomyocardial biopsy while facilitating the initiation of targeted therapy based on the noninvasive diagnosis of ACR or AMR.
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Affiliation(s)
- Palak Shah
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart and Vascular Institute, Falls Church, Virginia; Genomic Research Alliance for Transplantation (GRAfT), Bethesda, Maryland.
| | - Sean Agbor-Enoh
- Genomic Research Alliance for Transplantation (GRAfT), Bethesda, Maryland; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Pramita Bagchi
- Volgenau School of Engineering, George Mason University, Fairfax, Virginia
| | | | - Angela Mercado
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Gouqing Diao
- Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Dave Jp Morales
- Heart Failure & Transplantation, Stanford University, Palo Alto, California
| | - Keyur B Shah
- The Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Samer S Najjar
- Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington Hospital Center, Washington, District of Columbia
| | - Erika Feller
- Heart Failure & Transplantation, University of Maryland, Baltimore, Maryland
| | - Steven Hsu
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Maria E Rodrigo
- The Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Sabra C Lewsey
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Moon Kyoo Jang
- Genomic Research Alliance for Transplantation (GRAfT), Bethesda, Maryland; Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Charles Marboe
- Department of Pathology, New York Presbyterian University Hospital of Cornell and Columbia, New York, New York, New York
| | - Gerald J Berry
- Stanford University School of Medicine, Palo Alto, California
| | - Kiran K Khush
- Stanford University School of Medicine, Palo Alto, California
| | - Hannah A Valantine
- Genomic Research Alliance for Transplantation (GRAfT), Bethesda, Maryland; Stanford University School of Medicine, Palo Alto, California
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10
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Rao A, Singh M, Maini M, Anderson KM, Crowell NA, Henderson PR, Gholami SS, Sheikh FH, Najjar SS, Groninger H. Bridge to nowhere: A retrospective single-center study on patients using chronic intravenous inotropic support as bridge therapy who do not receive surgical therapy. Front Cardiovasc Med 2022; 9:918146. [PMID: 36110411 PMCID: PMC9468486 DOI: 10.3389/fcvm.2022.918146] [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: 04/12/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Many patients with advanced heart failure (HF) are administered chronic intravenous inotropic support (CIIS) as bridge to surgical therapy; some ultimately never receive surgery. We aimed to describe reasons patients “crossover” from CIIS as bridge therapy to palliative therapy, and compare end-of-life outcomes to patients initiated on CIIS as palliative therapy. Methods Single-institution, retrospective cohort study of patients on CIIS as bridge or palliative therapy between 2010 and 2016; data obtained through review of health records and multi-disciplinary selection meeting minutes, was analyzed using descriptive and inferential statistics. Results Of 246 patients discharged on CIIS as bridge therapy, 37 (16%) (male n = 28, 76%; African American n = 22, 60%) ultimately never received surgery. 67 matched patients on CIIS as palliative therapy were included for analysis (male n = 47, 70%; African American n = 47, 70%). The most common reasons for “crossover” from CIIS as bridge therapy to palliative therapy were frailty (n = 10, 27%), cardiac arrest (n = 5, 13.5%), and progressive non-cardiac illnesses (n = 6, 16.2%). A similar percentage of patients in the bridge (n = 28, 76%) and palliative (n = 48, 72%) groups died outside the hospital (P=0.66); however, fewer bridge patients received hospice care compared to the palliative group (35% vs 69%, P < 0.001). Comparing patients who died in the hospital, bridge patients (n = 9; 100%) were more likely to die in the intensive care unit than palliative patients (n = 8; 42%) (P < 0.001). Conclusion Patients on CIIS as bridge therapy who do not ultimately receive surgical therapy “crossover” to palliative intention due to frailty, or development of or identification of serious illnesses. Nevertheless, these “bridge to nowhere” patients are less likely to receive palliative care or hospice and more likely to die in the intensive care unit than patients on CIIS as palliative therapy.
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Affiliation(s)
- Anirudh Rao
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, United States
- Section of Palliative Medicine, Department of Medicine, MedStar Washington Hospital Center, Washington, DC, United States
- *Correspondence: Anirudh Rao
| | - Manavotam Singh
- MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States
| | - Mansi Maini
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, United States
| | - Kelley M. Anderson
- Georgetown University School of Nursing and Health Studies, Washington, DC, United States
| | - Nancy A. Crowell
- Georgetown University School of Nursing and Health Studies, Washington, DC, United States
| | - Paul R. Henderson
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, United States
| | - Sherry S. Gholami
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, United States
| | - Farooq H. Sheikh
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, United States
- MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States
| | - Samer S. Najjar
- MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States
| | - Hunter Groninger
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, United States
- Section of Palliative Medicine, Department of Medicine, MedStar Washington Hospital Center, Washington, DC, United States
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11
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Zaghlol R, Ghazzal A, Radwan S, Zaghlol L, Hamad A, Chou J, Ahmed S, Hofmeyer M, Rodrigo ME, Kadakkal A, Lam PH, Rao SD, Weintraub WS, Molina EJ, Sheikh FH, Najjar SS. Beta-blockers and Ambulatory Inotropic Therapy. J Card Fail 2022; 28:1309-1317. [PMID: 35447337 DOI: 10.1016/j.cardfail.2022.03.352] [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] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 03/19/2022] [Accepted: 03/20/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Continuous infusion of ambulatory inotropic therapy (AIT) is increasingly used in patients with end-stage heart failure (HF). There is a paucity of data concerning the concomitant use of beta-blockers (BB) in these patients. METHODS We retrospectively reviewed all patients discharged from our institution on AIT. The cohort was stratified into 2 groups based on BB use. The 2 groups were compared for differences in hospitalizations due to HF, ventricular arrhythmias and ICD therapies (shock or antitachycardia pacing). RESULTS Between 2010 and 2017, 349 patients were discharged on AIT (95% on milrinone); 74% were males with a mean age of 61 ± 14 years. BB were used in 195 (56%) patients, whereas 154 (44%) did not receive these medications. Patients in the BB group had longer duration of AIT support compared to those in the non-BB group (141 [1-2114] vs 68 [1-690] days). After adjusting for differences in baseline characteristics and indication for AIT, patients in the BB group had significantly lower rates of hospitalizations due to HF (hazard ratio [HR] 0.61 (0.43-0.86); P = 0.005), ventricular arrhythmias (HR 0.34 [0.15-0.74]; P = 0.007) and ICD therapies (HR 0.24 [0.07-0.79]; P = 0.02). CONCLUSION In patients with end-stage HF on AIT, the use of BB with inotropes was associated with fewer hospitalizations due to HF and fewer ventricular arrhythmias.
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Affiliation(s)
- Raja Zaghlol
- From the Division of Internal Medicine, Georgetown/Medstar Washington Hospital Center, Washington, D.C
| | - Amre Ghazzal
- From the Division of Internal Medicine, Georgetown/Medstar Washington Hospital Center, Washington, D.C
| | - Sohab Radwan
- From the Division of Internal Medicine, Georgetown/Medstar Washington Hospital Center, Washington, D.C
| | - Louay Zaghlol
- From the Division of Internal Medicine, Georgetown/Medstar Washington Hospital Center, Washington, D.C
| | - Ahmad Hamad
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jiling Chou
- Department of Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Hyattsville, Maryland
| | - Sara Ahmed
- Advanced Heart Failure Program, MedStar Heart and Vascular Institute, Washington, D.C
| | - Mark Hofmeyer
- Advanced Heart Failure Program, MedStar Heart and Vascular Institute, Washington, D.C
| | - Maria E Rodrigo
- Advanced Heart Failure Program, MedStar Heart and Vascular Institute, Washington, D.C
| | - Ajay Kadakkal
- Advanced Heart Failure Program, MedStar Heart and Vascular Institute, Washington, D.C
| | - Phillip H Lam
- Advanced Heart Failure Program, MedStar Heart and Vascular Institute, Washington, D.C
| | - Sriram D Rao
- Advanced Heart Failure Program, MedStar Heart and Vascular Institute, Washington, D.C
| | - William S Weintraub
- Advanced Heart Failure Program, MedStar Heart and Vascular Institute, Washington, D.C
| | - Ezequiel J Molina
- Advanced Heart Failure Program, MedStar Heart and Vascular Institute, Washington, D.C
| | - Farooq H Sheikh
- Advanced Heart Failure Program, MedStar Heart and Vascular Institute, Washington, D.C
| | - Samer S Najjar
- Advanced Heart Failure Program, MedStar Heart and Vascular Institute, Washington, D.C..
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12
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Patel PA, Rao S, Goswami RM, Snipelisky D, Cyrille-Superville NB, Jeng E, Sinha SS, Feliberti JP, DeVore A, Najjar SS, Grinstein J. DIFFERENCES IN HEMODYNAMIC MEASUREMENT AND INTERPRETATION BETWEEN HEART FAILURE AND INTERVENTIONAL CARDIOLOGISTS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01222-0] [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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13
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Singh M, Krishnan M, Ghazzal A, Halushka M, Tozzi JE, Bunning RD, Rodrigo ME, Najjar SS, Molina EJ, Sheikh FH. From Hip to Heart: A Comprehensive Evaluation of an Infiltrative Cardiomyopathy. CJC Open 2021; 3:1392-1395. [PMID: 34901809 PMCID: PMC8640576 DOI: 10.1016/j.cjco.2021.06.010] [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: 04/10/2021] [Accepted: 06/15/2021] [Indexed: 11/28/2022] Open
Abstract
Infiltrative cardiomyopathies are an increasingly recognized cause of heart failure warranting systematic evaluation. Given overlap of clinical and imaging findings among etiologies of infiltrative cardiomyopathies, comprehensive evaluation, including a history and physical examination, advanced cardiac imaging, and sometimes endomyocardial biopsy, is required for diagnosis. We report a case of infiltrative cardiomyopathy in which endomyocardial biopsy confirmed diagnosis of cobalt-induced cardiomyopathy. The novel teaching points highlighted by this case report include identification of heavy-metal toxicity as a cause of infiltrative cardiomyopathy, and the outline of a diagnostic approach and management for cobalt-induced cardiomyopathy.
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Affiliation(s)
- Manavotam Singh
- Advanced Heart Failure, MedStar Heart and Vascular Institute, Washington, DC, USA
| | - Mrinalini Krishnan
- Advanced Heart Failure, MedStar Heart and Vascular Institute, Washington, DC, USA
| | - Amre Ghazzal
- Advanced Heart Failure, MedStar Heart and Vascular Institute, Washington, DC, USA
| | - Marc Halushka
- Department of Pathology, John Hopkins University, Baltimore, Maryland, USA
| | - James E Tozzi
- Department of Orthopedic Surgery, Medstar Washington Hospital Center, Washington, DC, USA
| | - Robert D Bunning
- Department of Physical Medicine and Rehabilitation, MedStar National Rehabilitation Hospital, Washington, DC, USA
| | - Maria E Rodrigo
- Advanced Heart Failure, MedStar Heart and Vascular Institute, Washington, DC, USA
| | - Samer S Najjar
- Advanced Heart Failure, MedStar Heart and Vascular Institute, Washington, DC, USA
| | - Ezequiel J Molina
- Department of Cardiothoracic Surgery, MedStar Heart and Vascular Institute, Washington, DC, USA
| | - Farooq H Sheikh
- Advanced Heart Failure, MedStar Heart and Vascular Institute, Washington, DC, USA
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14
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Samsky MD, Milano CA, Pamboukian S, Slaughter MS, Birks E, Boyce S, Najjar SS, Itoh A, Reid B, Mokadam N, Aaronson KD, Pagani FD, Rogers JG. The Impact of Adverse Events on Functional Capacity and Quality of Life After HeartWare Ventricular Assist Device Implantation. ASAIO J 2021; 67:1159-1162. [PMID: 33927085 PMCID: PMC8478694 DOI: 10.1097/mat.0000000000001378] [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] [Indexed: 11/26/2022] Open
Abstract
Left ventricular assist devices (LVADs) improve quality of life (QoL) and functional capacity (FC) for patients with advanced heart failure. The association between adverse events (AEs) and changes in QoL and FC are unknown. Patients treated with the HeartWare ventricular assist device (HVAD) with paired 6-minute walk distance (6MWD, n = 263) and Kansas City Cardiomyopathy Questionnaires (KCCQ, n = 272) at baseline and 24 months in the ENDURANCE and ENDURANCE Supplemental Trial databases were included. Patients were stratified based upon occurrence of clinically significant AEs during the first 24 months of support and analyzed for the mean change in 6MWD and KCCQ. The impact of AE frequency on change in 6MWD and KCCQ from baseline to 24 months was evaluated. Of the AEs examined, only sepsis was associated with an improvement in 6MWD (109 m vs. 16 m, p = 0.002). Patients without improvement in 6MWD test from baseline to 24 months had significantly more AEs than those with FC improvement (p = 0.0002). Adverse events did not affect the KCCQ overall summary score. In this analysis, patients with fewer AEs had greater improvement in FC during the 24-month follow up. The frequency of AEs did not have a significant impact on QoL after LVAD implantation.
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Affiliation(s)
- Marc D Samsky
- From the Duke University Medical Center, Durham, North Carolina
| | | | | | | | - Emma Birks
- University of Louisville, Louisville, Kentucky
| | | | | | | | - Bruce Reid
- Intermountain Medical Center, Murray, Utah
| | | | | | | | - Joseph G Rogers
- From the Duke University Medical Center, Durham, North Carolina
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15
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Molina EJ, Ahmed S, Jain A, Lam PH, Rao S, Hockstein M, Kadakkal A, Hofmeyer M, Rodrigo ME, Najjar SS, Sheikh FH. Outcomes in patients with smaller body surface area after HeartMate 3 left ventricular assist device implantation. Artif Organs 2021; 46:460-470. [PMID: 34516000 DOI: 10.1111/aor.14065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/05/2021] [Accepted: 09/03/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Due to anatomic and physiologic concerns, prior generations of the left ventricular assist devices (LVAD) have frequently been denied to patients with small body size. However, outcomes in patients with small body surface area (BSA) following HeartMate 3 (HM3) LVAD implantation remain relatively unknown. METHODS A cohort of 220 patients implanted at a single center was divided into two groups: BSA ≤1.8 m2 (small BSA, n = 37) and BSA >1.8 m2 (large BSA, n = 183). We investigated baseline characteristics and clinical outcomes including survival and incidence of adverse events. RESULTS Small BSA patients were older (60 vs. 57 years), more likely female (60% vs. 20%), had a lower body mass index (24 vs. 32 kg/m2 ), lower incidence of diabetes (32% vs. 51%), history of stroke (5% vs. 19%), and left ventricular thrombus (0% vs. 11%). They had smaller left ventricular end diastolic diameter (64.8 vs. 69.3 mm). Pump speed and pump flows at discharge were lower in the small BSA group. Survival at 1 year and 2 years was 86% versus 87% and 86% versus 79% for small versus large BSA groups (p = 0.408), respectively. The rates of adverse events were similar between groups and there were no cases of confirmed pump thrombosis. The incidence of readmissions for low flow alarms was higher in the small BSA group (0.55 vs. 0.24 EPPY). CONCLUSIONS These findings demonstrate comparable outcomes in patients with small body size and suggest that this parameter should not be an exclusion criterion on patients who are otherwise candidates for HM3 LVAD implantation.
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Affiliation(s)
- Ezequiel J Molina
- Department of Cardiac Surgery, Medstar Heart and Vascular Institute, Washington, DC, USA.,Georgetown University School of Medicine, Washington, DC, USA
| | - Sara Ahmed
- Department of Cardiology, Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington, DC, USA
| | - Amiti Jain
- Department of Cardiac Surgery, Medstar Heart and Vascular Institute, Washington, DC, USA
| | - Phillip H Lam
- Georgetown University School of Medicine, Washington, DC, USA.,Department of Cardiology, Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington, DC, USA
| | - Sriram Rao
- Department of Cardiology, Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington, DC, USA
| | - Michael Hockstein
- Department of Critical Care Medicine, Medstar Washington Hospital Center, Washington, DC, USA
| | - Ajay Kadakkal
- Department of Cardiology, Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington, DC, USA
| | - Mark Hofmeyer
- Georgetown University School of Medicine, Washington, DC, USA.,Department of Cardiology, Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington, DC, USA
| | - Maria E Rodrigo
- Georgetown University School of Medicine, Washington, DC, USA.,Department of Cardiology, Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington, DC, USA
| | - Samer S Najjar
- Georgetown University School of Medicine, Washington, DC, USA.,Department of Cardiology, Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington, DC, USA
| | - Farooq H Sheikh
- Georgetown University School of Medicine, Washington, DC, USA.,Department of Cardiology, Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington, DC, USA
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16
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Shah P, Agbor-Enoh S, Tunc I, Hsu S, Russell S, Feller E, Shah K, Rodrigo ME, Najjar SS, Kong H, Pirooznia M, Fideli U, Bikineyeva A, Marishta A, Bhatti K, Yang Y, Mutebi C, Yu K, Kyoo Jang M, Marboe C, Berry GJ, Valantine HA. Response by Shah et al to Letter Regarding Article, "Cell-Free DNA to Detect Heart Allograft Acute Rejection". Circulation 2021; 144:e198-e199. [PMID: 34491771 DOI: 10.1161/circulationaha.121.055697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Palak Shah
- Genomic Research Alliance for Transplantation (GRAfT), Bethesda, MD (P.S., S.A-E., I.T., S.H., E.F., K.S., M.E.R., S.S.N., H.K., U.F., A.B., A.M., K.B., Y.Y., M.K.J., C.Marboe, G.J.B., H.A.V.).,Department of Heart Failure and Transplantation, Inova Heart and Vascular Institute, Falls Church, VA (P.S.)
| | - Sean Agbor-Enoh
- Genomic Research Alliance for Transplantation (GRAfT), Bethesda, MD (P.S., S.A-E., I.T., S.H., E.F., K.S., M.E.R., S.S.N., H.K., U.F., A.B., A.M., K.B., Y.Y., M.K.J., C.Marboe, G.J.B., H.A.V.).,Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD (S.A-E., I.T., S.H., H.K., M.P., U.F., A.B., A.M., K.B., Y.Y., C.Mutebi, M.K.J., H.A.V.).,Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD (S.A-E.)
| | - Ilker Tunc
- Genomic Research Alliance for Transplantation (GRAfT), Bethesda, MD (P.S., S.A-E., I.T., S.H., E.F., K.S., M.E.R., S.S.N., H.K., U.F., A.B., A.M., K.B., Y.Y., M.K.J., C.Marboe, G.J.B., H.A.V.).,Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD (S.A-E., I.T., S.H., H.K., M.P., U.F., A.B., A.M., K.B., Y.Y., C.Mutebi, M.K.J., H.A.V.)
| | - Steven Hsu
- Genomic Research Alliance for Transplantation (GRAfT), Bethesda, MD (P.S., S.A-E., I.T., S.H., E.F., K.S., M.E.R., S.S.N., H.K., U.F., A.B., A.M., K.B., Y.Y., M.K.J., C.Marboe, G.J.B., H.A.V.).,Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD (S.A-E., I.T., S.H., H.K., M.P., U.F., A.B., A.M., K.B., Y.Y., C.Mutebi, M.K.J., H.A.V.)
| | - Stuart Russell
- Department of Medicine, Duke University School of Medicine, Durham, NC (S.R.)
| | - Erika Feller
- Genomic Research Alliance for Transplantation (GRAfT), Bethesda, MD (P.S., S.A-E., I.T., S.H., E.F., K.S., M.E.R., S.S.N., H.K., U.F., A.B., A.M., K.B., Y.Y., M.K.J., C.Marboe, G.J.B., H.A.V.).,University of Maryland Medical Center, Baltimore, MD (E.F.)
| | - Keyur Shah
- Genomic Research Alliance for Transplantation (GRAfT), Bethesda, MD (P.S., S.A-E., I.T., S.H., E.F., K.S., M.E.R., S.S.N., H.K., U.F., A.B., A.M., K.B., Y.Y., M.K.J., C.Marboe, G.J.B., H.A.V.).,Virginia Commonwealth University, Richmond, VA (K.S.)
| | - Maria E Rodrigo
- Genomic Research Alliance for Transplantation (GRAfT), Bethesda, MD (P.S., S.A-E., I.T., S.H., E.F., K.S., M.E.R., S.S.N., H.K., U.F., A.B., A.M., K.B., Y.Y., M.K.J., C.Marboe, G.J.B., H.A.V.).,MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington DC (M.E.R., S.S.N.)
| | - Samer S Najjar
- Genomic Research Alliance for Transplantation (GRAfT), Bethesda, MD (P.S., S.A-E., I.T., S.H., E.F., K.S., M.E.R., S.S.N., H.K., U.F., A.B., A.M., K.B., Y.Y., M.K.J., C.Marboe, G.J.B., H.A.V.).,MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington DC (M.E.R., S.S.N.)
| | - Hyesik Kong
- Genomic Research Alliance for Transplantation (GRAfT), Bethesda, MD (P.S., S.A-E., I.T., S.H., E.F., K.S., M.E.R., S.S.N., H.K., U.F., A.B., A.M., K.B., Y.Y., M.K.J., C.Marboe, G.J.B., H.A.V.).,Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD (S.A-E., I.T., S.H., H.K., M.P., U.F., A.B., A.M., K.B., Y.Y., C.Mutebi, M.K.J., H.A.V.)
| | - Mehdi Pirooznia
- Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD (S.A-E., I.T., S.H., H.K., M.P., U.F., A.B., A.M., K.B., Y.Y., C.Mutebi, M.K.J., H.A.V.)
| | - Ulgen Fideli
- Genomic Research Alliance for Transplantation (GRAfT), Bethesda, MD (P.S., S.A-E., I.T., S.H., E.F., K.S., M.E.R., S.S.N., H.K., U.F., A.B., A.M., K.B., Y.Y., M.K.J., C.Marboe, G.J.B., H.A.V.).,Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD (S.A-E., I.T., S.H., H.K., M.P., U.F., A.B., A.M., K.B., Y.Y., C.Mutebi, M.K.J., H.A.V.)
| | - Alfiya Bikineyeva
- Genomic Research Alliance for Transplantation (GRAfT), Bethesda, MD (P.S., S.A-E., I.T., S.H., E.F., K.S., M.E.R., S.S.N., H.K., U.F., A.B., A.M., K.B., Y.Y., M.K.J., C.Marboe, G.J.B., H.A.V.).,Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD (S.A-E., I.T., S.H., H.K., M.P., U.F., A.B., A.M., K.B., Y.Y., C.Mutebi, M.K.J., H.A.V.)
| | - Argit Marishta
- Genomic Research Alliance for Transplantation (GRAfT), Bethesda, MD (P.S., S.A-E., I.T., S.H., E.F., K.S., M.E.R., S.S.N., H.K., U.F., A.B., A.M., K.B., Y.Y., M.K.J., C.Marboe, G.J.B., H.A.V.).,Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD (S.A-E., I.T., S.H., H.K., M.P., U.F., A.B., A.M., K.B., Y.Y., C.Mutebi, M.K.J., H.A.V.)
| | - Kenneth Bhatti
- Genomic Research Alliance for Transplantation (GRAfT), Bethesda, MD (P.S., S.A-E., I.T., S.H., E.F., K.S., M.E.R., S.S.N., H.K., U.F., A.B., A.M., K.B., Y.Y., M.K.J., C.Marboe, G.J.B., H.A.V.).,Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD (S.A-E., I.T., S.H., H.K., M.P., U.F., A.B., A.M., K.B., Y.Y., C.Mutebi, M.K.J., H.A.V.)
| | - Yanqin Yang
- Genomic Research Alliance for Transplantation (GRAfT), Bethesda, MD (P.S., S.A-E., I.T., S.H., E.F., K.S., M.E.R., S.S.N., H.K., U.F., A.B., A.M., K.B., Y.Y., M.K.J., C.Marboe, G.J.B., H.A.V.).,Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD (S.A-E., I.T., S.H., H.K., M.P., U.F., A.B., A.M., K.B., Y.Y., C.Mutebi, M.K.J., H.A.V.)
| | - Cedric Mutebi
- Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD (S.A-E., I.T., S.H., H.K., M.P., U.F., A.B., A.M., K.B., Y.Y., C.Mutebi, M.K.J., H.A.V.).,Wayne State University School of Medicine, Detroit MI (C.Mutebi)
| | - Kai Yu
- National Cancer Institute, Rockville, MD (K.Y.)
| | - Moon Kyoo Jang
- Genomic Research Alliance for Transplantation (GRAfT), Bethesda, MD (P.S., S.A-E., I.T., S.H., E.F., K.S., M.E.R., S.S.N., H.K., U.F., A.B., A.M., K.B., Y.Y., M.K.J., C.Marboe, G.J.B., H.A.V.).,Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD (S.A-E., I.T., S.H., H.K., M.P., U.F., A.B., A.M., K.B., Y.Y., C.Mutebi, M.K.J., H.A.V.)
| | - Charles Marboe
- Genomic Research Alliance for Transplantation (GRAfT), Bethesda, MD (P.S., S.A-E., I.T., S.H., E.F., K.S., M.E.R., S.S.N., H.K., U.F., A.B., A.M., K.B., Y.Y., M.K.J., C.Marboe, G.J.B., H.A.V.).,Department of Pathology, New York Presbyterian University Hospital of Cornell and Columbia, New York (C.Marboe)
| | - Gerald J Berry
- Genomic Research Alliance for Transplantation (GRAfT), Bethesda, MD (P.S., S.A-E., I.T., S.H., E.F., K.S., M.E.R., S.S.N., H.K., U.F., A.B., A.M., K.B., Y.Y., M.K.J., C.Marboe, G.J.B., H.A.V.).,Stanford University School of Medicine, Palo Alto, CA (G.J.B., H.A.V.)
| | - Hannah A Valantine
- Genomic Research Alliance for Transplantation (GRAfT), Bethesda, MD (P.S., S.A-E., I.T., S.H., E.F., K.S., M.E.R., S.S.N., H.K., U.F., A.B., A.M., K.B., Y.Y., M.K.J., C.Marboe, G.J.B., H.A.V.).,Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD (S.A-E., I.T., S.H., H.K., M.P., U.F., A.B., A.M., K.B., Y.Y., C.Mutebi, M.K.J., H.A.V.).,Stanford University School of Medicine, Palo Alto, CA (G.J.B., H.A.V.)
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17
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Sheikh FH, Craig PE, Ahmed S, Torguson R, Kolm P, Weintraub WS, Molina EJ, Najjar SS, Mohammed SF. Characteristics and Outcomes of Patients with Inflammatory Cardiomyopathies Receiving Mechanical Circulatory Support: An STS-INTERMACS Registry Analysis. J Card Fail 2021; 28:71-82. [PMID: 34474157 DOI: 10.1016/j.cardfail.2021.07.025] [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] [Received: 04/29/2021] [Revised: 07/03/2021] [Accepted: 07/28/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Durable mechanical circulatory support (MCS) therapy improves survival in patients with advanced heart failure. Knowledge regarding the outcomes experienced by patients with inflammatory cardiomyopathy (CM) who receive durable MCS therapy is limited. METHODS AND RESULTS We compared patients with inflammatory CM with patients with idiopathic dilated CM enrolled in the STS-INTERMACS registry. Among 19,012 patients, 329 (1.7%) had inflammatory CM and 5978 had idiopathic dilated CM (31.4%). The patients with inflammatory CM were younger, more likely to be White, and women. These patients experienced more preoperative arrhythmias and higher use of temporary MCS. Patients with inflammatory CM had a higher rate of early adverse events (<3 months after device implant), including bleeding, arrhythmias, non-device-related infections, neurologic dysfunction, and respiratory failure. The rate of late adverse events (≥3 months) was similar in the 2 groups. Patients with inflammatory CM had a similar 1-year (80% vs 84%) and 2-year (72% vs 76%, P = .15) survival. Myocardial recovery resulting in device explant was more common among patients with inflammatory CM (5.5% vs 2.3%, P < .001). CONCLUSIONS Patients with inflammatory CM who received durable MCS appear to have a similar survival compared with patients with idiopathic dilated CM despite a higher early adverse event burden. Our findings support the use of durable MCS in an inflammatory CM population.
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Affiliation(s)
- Farooq H Sheikh
- Department of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC; Georgetown University School of Medicine, Washington, DC.
| | - Paige E Craig
- Department of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC
| | - Sara Ahmed
- Department of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC
| | | | - Paul Kolm
- Department of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC
| | - William S Weintraub
- Department of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC
| | - Ezequiel J Molina
- Department of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC; Georgetown University School of Medicine, Washington, DC
| | - Samer S Najjar
- Department of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC; Georgetown University School of Medicine, Washington, DC
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18
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Abstract
Left ventricular assist devices (LVAD) are increasingly being used as destination therapy in patients with Stage D heart failure. It has been reported that a majority of patients who receive a durable LVAD (dLVAD) present in cardiogenic shock due to decompensated heart failure (ADHF‐CS). As it stands, there is no consensus on the optimal management strategy for patients presenting with ADHF. Bridging with intra‐aortic balloon pumps (IABPs) continues to be a therapeutic option in patients with hemodynamic instability due to cardiogenic shock. The majority of data regarding the use of IABP in cardiogenic shock come from studies in patients presenting with acute myocardial infarction with cardiogenic shock and demonstrates that there is no benefit of routine IABP use in this patient population. However, the role of IABPs as a bridge to dLVAD in ADHF‐CS has yet to be determined. The hemodynamic changes seen in acute myocardial infarction with cardiogenic shock are known to be different and more acutely impaired than those presenting with ADHF‐CS as evidenced by differences in pressure/volume loops. Thus, data should not be extrapolated across these 2 very different disease processes. The aim of this review is to describe results from contemporary studies examining the use of IABPs as a bridge to dLVAD in patients with ADHF‐CS. Retrospective evidence from large registries suggests that the use of IABP as a bridge to dLVAD is feasible and safe when compared with other platforms of temporary mechanical circulatory support. However, there is currently a paucity of high‐quality evidence examining this increasingly important clinical question.
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Affiliation(s)
| | - Farooq H Sheikh
- Georgetown University School of Medicine Washington DC.,MedStar Washington Hospital Center Washington DC.,MedStar Heart and Vascular Institute Washington DC
| | - Sara Ahmed
- MedStar Washington Hospital Center Washington DC
| | - Samer S Najjar
- Georgetown University School of Medicine Washington DC.,MedStar Washington Hospital Center Washington DC.,MedStar Heart and Vascular Institute Washington DC
| | - Ezequiel J Molina
- Georgetown University School of Medicine Washington DC.,MedStar Washington Hospital Center Washington DC.,MedStar Heart and Vascular Institute Washington DC
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19
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Genuardi MV, Moss N, Najjar SS, Houston BA, Shore S, Vorovich E, Atluri P, Molina M, Chambers S, Sharkoski T, Hsich E, Estep JD, Owens AT, Alexander KM, Chaudhry SP, Garcia-Cortes R, Molina E, Rodrigo M, Wald MDJ, Margulies KB, Hanff TC, Zimmer R, Kilic A, Mclean R, Vidula H, Dodd K, Blumberg EA, Mazurek JA, Goldberg LR, Alvarez-Garcia J, Mancini D, Teuteberg JJ, Tedford RJ, Birati EY. Coronavirus disease 2019 in heart transplant recipients: Risk factors, immunosuppression, and outcomes. J Heart Lung Transplant 2021; 40:926-935. [PMID: 34140222 PMCID: PMC8131557 DOI: 10.1016/j.healun.2021.05.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 12/21/2020] [Revised: 04/28/2021] [Accepted: 05/11/2021] [Indexed: 12/14/2022] Open
Abstract
Background COVID-19 continues to inflict significant morbidity and mortality, particularly on patients with preexisting health conditions. The clinical course, outcomes, and significance of immunosuppression regimen in heart transplant recipients with COVID-19 remains unclear. Methods We included the first 99 heart transplant recipients at participating centers with COVID-19 and followed patients until resolution. We collected baseline information, symptoms, laboratory studies, vital signs, and outcomes for included patients. The association of immunosuppression regimens at baseline with severe disease were compared using logistic regression, adjusting for age and time since transplant. Results The median age was 60 years, 25% were female, and 44% were white. The median time post-transplant to infection was 5.6 years. Overall, 15% died, 64% required hospital admission, and 7% remained asymptomatic. During the course of illness, only 57% of patients had a fever, and gastrointestinal symptoms were common. Tachypnea, oxygen requirement, elevated creatinine and inflammatory markers were predictive of severe course. Age ≥ 60 was associated with higher risk of death and the use of the combination of calcineurin inhibitor, antimetabolite, and prednisone was associated with more severe disease compared to the combination of calcineurin inhibitor and antimetabolite alone (adjusted OR = 7.3, 95% CI 1.8-36.2). Among hospitalized patients, 30% were treated for secondary infection, acute kidney injury was common and 17% required new renal replacement therapy. Conclusions We present the largest study to date of heart transplant patients with COVID-19 showing common atypical presentations and a high case fatality rate of 24% among hospitalized patients and 16% among symptomatic patients.
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Affiliation(s)
- Michael V Genuardi
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Noah Moss
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Supriya Shore
- Cardiovascular Division, University of Michigan, Ann Arbor, MI
| | - Esther Vorovich
- Division of Cardiology, Northwestern University, Chicago, IL
| | - Pavan Atluri
- Department of Cardiothoracic Surgery, University of Pennsylvania, Pennsylvania
| | - Maria Molina
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan Chambers
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tiffany Sharkoski
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eileen Hsich
- Heart and Vascular Institute at the Cleveland Clinic and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jerry D Estep
- Heart and Vascular Institute at the Cleveland Clinic and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH
| | - Anjali T Owens
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin M Alexander
- Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | | | | | | | | | - MDc Joyce Wald
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kenneth B Margulies
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas C Hanff
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ross Zimmer
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Rhondalyn Mclean
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Himabindu Vidula
- Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Katherine Dodd
- Division of Cardiology, Northwestern University, Chicago, IL
| | - Emily A Blumberg
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy A Mazurek
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lee R Goldberg
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jesus Alvarez-Garcia
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Donna Mancini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeffrey J Teuteberg
- Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | | | - Edo Y Birati
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular division, Poriya Medical Center, Bar Ilan University, Israel
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20
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Birati EY, Najjar SS, Tedford RJ, Houston BA, Shore S, Vorovich E, Atluri P, Urgo K, Molina M, Chambers S, Escobar N, Hsich E, Estep JD, Alexander KM, Teuteberg JJ, Chaudhry SP, Ravichandran A, DeVore AD, Margulies KB, Hanff TC, Zimmer R, Kilic A, Wald JW, Vidula H, Martens J, Blumberg EA, Mazurek JA, Owens AT, Goldberg LR, Alvarez-Garcia J, Mancini DM, Moss N, Genuardi MV. Characteristics and Outcomes of COVID-19 in Patients on Left Ventricular Assist Device Support. Circ Heart Fail 2021; 14:e007957. [PMID: 33813838 PMCID: PMC8059761 DOI: 10.1161/circheartfailure.120.007957] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Supplemental Digital Content is available in the text. Background: The coronavirus disease 2019 (COVID-19) pandemic continues to afflict millions of people worldwide. Patients with end-stage heart failure and left ventricular assist devices (LVADs) may be at risk for severe COVID-19 given a high prevalence of complex comorbidities and functional impaired immunity. The objective of this study is to describe the clinical characteristics and outcomes of COVID-19 in patients with end-stage heart failure and durable LVADs. Methods: The Trans-CoV-VAD registry is a multi-center registry of LVAD and cardiac transplant patients in the United States with confirmed COVID-19. Patient characteristics, exposure history, presentation, laboratory data, course, and clinical outcomes were collected by participating institutions and reviewed by a central data repository. This report represents the participation of the first 9 centers to report LVAD data into the registry. Results: A total of 40 patients were included in this cohort. The median age was 56 years (interquartile range, 46–68), 14 (35%) were women, and 21 (52%) were Black. Among the most common presenting symptoms were cough (41%), fever, and fatigue (both 38%). A total of 18% were asymptomatic at diagnosis. Only 43% of the patients reported either subjective or measured fever during the entire course of illness. Over half (60%) required hospitalization, and 8 patients (20%) died, often after lengthy hospitalizations. Conclusions: We present the largest case series of LVAD patients with COVID-19 to date. Understanding these characteristics is essential in an effort to improve the outcome of this complex patient population.
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Affiliation(s)
- Edo Y Birati
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia.,Perelman School of Medicine and Cardiovascular Outcomes, Quality, and Evaluative Research Center (E.Y.B.), University of Pennsylvania, Philadelphia.,Cardiovascular Division, Poriya Medical Center, Bar-Ilan University, Israel. (E.Y.B.)
| | - Samer S Najjar
- MedStar Washington Hospital Center, Washington, DC (S.S.N.)
| | - Ryan J Tedford
- Medical University of South Carolina, Charleston, SC (R.J.T., B.A.H.)
| | - Brian A Houston
- Medical University of South Carolina, Charleston, SC (R.J.T., B.A.H.)
| | - Supriya Shore
- Cardiovascular Division, University of Michigan, Ann Arbor (S.S.)
| | - Esther Vorovich
- Division of Cardiology, Northwestern University, Chicago, IL (E.V.)
| | - Pavan Atluri
- Department of Cardiothoracic Surgery (P.A.), University of Pennsylvania, Philadelphia
| | - Kimberly Urgo
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Maria Molina
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Susan Chambers
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Nicole Escobar
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Eileen Hsich
- Heart and Vascular Institute at the Cleveland Clinic and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, OH (E.H., J.D.E.)
| | - Jerry D Estep
- Heart and Vascular Institute at the Cleveland Clinic and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, OH (E.H., J.D.E.)
| | - Kevin M Alexander
- Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine, CA (K.M.A., J.J.T.)
| | - Jeffrey J Teuteberg
- Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine, CA (K.M.A., J.J.T.)
| | - Sunit-Preet Chaudhry
- St Vincent Medical Group, St Vincent Heart Center, Indianapolis, IN (S.-P.C., A.R.)
| | - Ashwin Ravichandran
- St Vincent Medical Group, St Vincent Heart Center, Indianapolis, IN (S.-P.C., A.R.)
| | - Adam D DeVore
- Duke Clinical Research Institute and Department of Medicine, Duke University School of Medicine, Durham, NC (A.D.D.)
| | - Kenneth B Margulies
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Thomas C Hanff
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Ross Zimmer
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, PA (A.K.)
| | - Joyce W Wald
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Himabindu Vidula
- Division of Cardiology, University of Rochester School of Medicine and Dentistry, NY (H.V., J.M.)
| | - John Martens
- Division of Cardiology, University of Rochester School of Medicine and Dentistry, NY (H.V., J.M.)
| | - Emily A Blumberg
- Division of Infectious Diseases (E.A.B.), University of Pennsylvania, Philadelphia
| | - Jeremy A Mazurek
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Anjali T Owens
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Lee R Goldberg
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Jesus Alvarez-Garcia
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (J.A.-G., D.M.M., N.M.)
| | - Donna M Mancini
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (J.A.-G., D.M.M., N.M.)
| | - Noah Moss
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (J.A.-G., D.M.M., N.M.)
| | - Michael V Genuardi
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
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21
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Agbor-Enoh S, Shah P, Tunc I, Hsu S, Russell S, Feller E, Shah K, Rodrigo ME, Najjar SS, Kong H, Pirooznia M, Fideli U, Bikineyeva A, Marishta A, Bhatti K, Yang Y, Mutebi C, Yu K, Jang MK, Marboe C, Berry GJ, Valantine HA. Cell-Free DNA to Detect Heart Allograft Acute Rejection. Circulation 2021; 143:1184-1197. [PMID: 33435695 PMCID: PMC8221834 DOI: 10.1161/circulationaha.120.049098] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND After heart transplantation, endomyocardial biopsy (EMBx) is used to monitor for acute rejection (AR). Unfortunately, EMBx is invasive, and its conventional histological interpretation has limitations. This is a validation study to assess the performance of a sensitive blood biomarker-percent donor-derived cell-free DNA (%ddcfDNA)-for detection of AR in cardiac transplant recipients. METHODS This multicenter, prospective cohort study recruited heart transplant subjects and collected plasma samples contemporaneously with EMBx for %ddcfDNA measurement by shotgun sequencing. Histopathology data were collected to define AR, its 2 phenotypes (acute cellular rejection [ACR] and antibody-mediated rejection [AMR]), and controls without rejection. The primary analysis was to compare %ddcfDNA levels (median and interquartile range [IQR]) for AR, AMR, and ACR with controls and to determine %ddcfDNA test characteristics using receiver-operator characteristics analysis. RESULTS The study included 171 subjects with median posttransplant follow-up of 17.7 months (IQR, 12.1-23.6), with 1392 EMBx, and 1834 %ddcfDNA measures available for analysis. Median %ddcfDNA levels decayed after surgery to 0.13% (IQR, 0.03%-0.21%) by 28 days. Also, %ddcfDNA increased again with AR compared with control values (0.38% [IQR, 0.31-0.83%], versus 0.03% [IQR, 0.01-0.14%]; P<0.001). The rise was detected 0.5 and 3.2 months before histopathologic diagnosis of ACR and AMR. The area under the receiver operator characteristic curve for AR was 0.92. A 0.25%ddcfDNA threshold had a negative predictive value for AR of 99% and would have safely eliminated 81% of EMBx. In addition, %ddcfDNA showed distinctive characteristics comparing AMR with ACR, including 5-fold higher levels (AMR ≥2, 1.68% [IQR, 0.49-2.79%] versus ACR grade ≥2R, 0.34% [IQR, 0.28-0.72%]), higher area under the receiver operator characteristic curve (0.95 versus 0.85), higher guanosine-cytosine content, and higher percentage of short ddcfDNA fragments. CONCLUSIONS We found that %ddcfDNA detected AR with a high area under the receiver operator characteristic curve and negative predictive value. Monitoring with ddcfDNA demonstrated excellent performance characteristics for both ACR and AMR and led to earlier detection than the EMBx-based monitoring. This study supports the use of %ddcfDNA to monitor for AR in patients with heart transplant and paves the way for a clinical utility study. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02423070.
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Affiliation(s)
- Sean Agbor-Enoh
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Department of Medicine, The Johns Hopkins School of Medicine, 1830 East Monument Street, Baltimore, MD
- Division of Intramural Research, National Heart, Lung and Blood Institute, 10 Center Drive, 7S261, Bethesda Maryland, 20982
| | - Palak Shah
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Department of Heart Failure and Transplantation, Inova Heart and Vascular Institute, Falls Church, VA
| | - Ilker Tunc
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Division of Intramural Research, National Heart, Lung and Blood Institute, 10 Center Drive, 7S261, Bethesda Maryland, 20982
| | - Steven Hsu
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Department of Medicine, The Johns Hopkins School of Medicine, 1830 East Monument Street, Baltimore, MD
| | - Stuart Russell
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Erika Feller
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- University of Maryland Medical Center, Baltimore, MD
| | - Keyur Shah
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Virginia Commonwealth University, Richmond, VA
| | - Maria E. Rodrigo
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington DC
| | - Samer S. Najjar
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington DC
| | - Hyesik Kong
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Division of Intramural Research, National Heart, Lung and Blood Institute, 10 Center Drive, 7S261, Bethesda Maryland, 20982
| | - Mehdi Pirooznia
- Division of Intramural Research, National Heart, Lung and Blood Institute, 10 Center Drive, 7S261, Bethesda Maryland, 20982
| | - Ulgen Fideli
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Division of Intramural Research, National Heart, Lung and Blood Institute, 10 Center Drive, 7S261, Bethesda Maryland, 20982
| | - Alfiya Bikineyeva
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Division of Intramural Research, National Heart, Lung and Blood Institute, 10 Center Drive, 7S261, Bethesda Maryland, 20982
| | - Argit Marishta
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Division of Intramural Research, National Heart, Lung and Blood Institute, 10 Center Drive, 7S261, Bethesda Maryland, 20982
| | - Kenneth Bhatti
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Division of Intramural Research, National Heart, Lung and Blood Institute, 10 Center Drive, 7S261, Bethesda Maryland, 20982
| | - Yanqin Yang
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Division of Intramural Research, National Heart, Lung and Blood Institute, 10 Center Drive, 7S261, Bethesda Maryland, 20982
| | - Cedric Mutebi
- Division of Intramural Research, National Heart, Lung and Blood Institute, 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Wayne State University School of Medicine, Detroit MI
| | - Kai Yu
- National Cancer Institute, Rockville, MD
| | - Moon Kyoo Jang
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Division of Intramural Research, National Heart, Lung and Blood Institute, 10 Center Drive, 7S261, Bethesda Maryland, 20982
| | - Charles Marboe
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Department of Pathology, New York Presbyterian University Hospital of Cornell and Columbia, New York, New York, USA
| | - Gerald J. Berry
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Stanford University School of Medicine, Palo Alto, CA
| | - Hannah A. Valantine
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Division of Intramural Research, National Heart, Lung and Blood Institute, 10 Center Drive, 7S261, Bethesda Maryland, 20982
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Guo A, Alnsasra H, Medvedofsky D, Najjar SS, Srichai MB. Rare Case of Coincident Quadricuspid Pulmonic Valve and Suprapulmonic Ridge. JACC Case Rep 2020; 2:2196-2198. [PMID: 34317137 PMCID: PMC8299973 DOI: 10.1016/j.jaccas.2020.09.049] [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] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/22/2020] [Indexed: 10/27/2022]
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Singh M, Ghazzal A, Krishnan M, Kadakkal A, Hofmeyer M, Lam PH, Rodrigo ME, Kitahara H, Halushka MK, Molina EJ, Najjar SS, Sheikh FH. From Hip to Heart: Cobalt-induced Cardiomyopathy Requiring Cardiac Transplantation. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.463] [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: 10/23/2022]
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Saeed O, Colombo PC, Mehra MR, Uriel N, Goldstein DJ, Cleveland J, Connors JM, Najjar SS, Mokadam NA, Bansal A, Crandall DL, Sood P, Jorde UP. Effect of aspirin dose on hemocompatibility-related outcomes with a magnetically levitated left ventricular assist device: An analysis from the MOMENTUM 3 study. J Heart Lung Transplant 2020; 39:518-525. [PMID: 32340871 DOI: 10.1016/j.healun.2020.03.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 02/29/2020] [Accepted: 03/01/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Aspirin (ASA) anti-platelet therapy is mandated with left ventricular assist devices (LVADs) to prevent hemocompatibility-related adverse events (HRAEs). However, the optimal dose of ASA with HeartMate 3 (HM3) LVAD is unknown. METHODS In an exploratory analysis of HM3-supported patients in the MOMENTUM 3 study (NCT02224755), 2 groups were analyzed: usual-dose (325 mg) and low-dose (81 mg) ASA with anti-coagulation targeted to an international normalized ratio of 2.0 to 3.0. Exclusion criteria included patients not receiving either ASA 81 mg or 325 mg, those with HRAEs ≤7 days after device implantation, and those receiving >1 anti-platelet agent. The primary end-point was survival free from HRAEs (non-surgical bleeding, pump thrombosis, stroke, and peripheral arterial thromboembolic events) at 2 years. RESULTS Overall, 321 HM3 patients (usual-dose: n = 141, low-dose: n = 180) were included in this analysis. Usual-dose group patients were younger (57 ± 13 vs 60 ± 12 years, p = 0.035) and less often assigned destination therapy (55% vs 67%, p = 0.029) than low-dose ASA. At 2 years, a similar proportion of patients in the usual- and low-dose groups (43.4% vs 45.3%, p = 0.94) met the primary end-point. There were no differences in survival free from hemorrhagic (usual-dose: 54.4% vs low-dose: 51.7%, p = 0.42) or thrombotic (usual-dose: 76.8% vs low-dose: 75.7%, p = 0.92) events. CONCLUSIONS Usual- and low-dose ASA revealed similar rates of bleeding and thrombotic events in HM3 LVAD-supported patients within the MOMENTUM 3 trial. Whether ASA therapy provides any meaningful therapeutic effect in patients treated by the HM3 LVAD remains to be determined.
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Affiliation(s)
- Omar Saeed
- Department of Medicine and Department of Cardiothoracic and Vascular Surgery, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, New York
| | - Paolo C Colombo
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Mandeep R Mehra
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nir Uriel
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Daniel J Goldstein
- Department of Medicine and Department of Cardiothoracic and Vascular Surgery, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, New York
| | - Joseph Cleveland
- Department of Surgery, University of Colorado Hospital, Aurora, Colorado
| | - Jean M Connors
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Samer S Najjar
- Department of Medicine, Medstar Washington Hospital Center, Washington, District of Columbia
| | | | - Aditya Bansal
- Department of Surgery, Ochsner Medical Center, New Orleans, Louisiana
| | - Daniel L Crandall
- Division of Cardiology Department of Medicine, Abbott, Chicago, Illinois
| | - Poornima Sood
- Division of Cardiology Department of Medicine, Abbott, Chicago, Illinois
| | - Ulrich P Jorde
- Department of Medicine and Department of Cardiothoracic and Vascular Surgery, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, New York.
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Kiernan MS, Najjar SS, Vest AR, Birks EJ, Uriel N, Ewald GA, Leadley K, Patel CB. Outcomes of Severely Obese Patients Supported by a Centrifugal-Flow Left Ventricular Assist Device. J Card Fail 2020; 26:120-127. [DOI: 10.1016/j.cardfail.2019.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/16/2019] [Accepted: 10/29/2019] [Indexed: 11/29/2022]
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Bansal A, Uriel N, Colombo PC, Narisetty K, Long JW, Bhimaraj A, Cleveland JC, Goldstein DJ, Stulak JM, Najjar SS, Lanfear DE, Adler ED, Dembitsky WP, Somo SI, Crandall DL, Chen D, Connors JM, Mehra MR. Effects of a fully magnetically levitated centrifugal-flow or axial-flow left ventricular assist device on von Willebrand factor: A prospective multicenter clinical trial. J Heart Lung Transplant 2019; 38:806-816. [DOI: 10.1016/j.healun.2019.05.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 01/13/2023] Open
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Vora TA, Afari-armah N, Hofmeyer M, Sheikh FH, Rodrigo M, Molina E, Boyce SW, Najjar SS, Majure DT, Mohammed SF. Heart Failure Hospitalizations in a Contemporary LVAD Population. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.168] [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: 11/15/2022]
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Rogers JG, Pagani FD, Tatooles AJ, Bhat G, Slaughter MS, Birks EJ, Boyce SW, Najjar SS, Jeevanandam V, Anderson AS, Gregoric ID, Mallidi H, Leadley K, Aaronson KD, Frazier OH, Milano CA. Intrapericardial Left Ventricular Assist Device for Advanced Heart Failure. N Engl J Med 2017; 376:451-460. [PMID: 28146651 DOI: 10.1056/nejmoa1602954] [Citation(s) in RCA: 529] [Impact Index Per Article: 75.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mechanical circulatory support with a left ventricular assist device (LVAD) is an established treatment for patients with advanced heart failure. We compared a newer LVAD design (a small intrapericardial centrifugal-flow device) against existing technology (a commercially available axial-flow device) in patients with advanced heart failure who were ineligible for heart transplantation. METHODS We conducted a multicenter randomized trial involving 446 patients who were assigned, in a 2:1 ratio, to the study (centrifugal-flow) device or the control (axial-flow) device. Adults who met contemporary criteria for LVAD implantation for permanent use were eligible to participate in the trial. The primary end point was survival at 2 years free from disabling stroke or device removal for malfunction or failure. The trial was powered to show noninferiority with a margin of 15 percentage points. RESULTS The intention-to treat-population included 297 participants assigned to the study device and 148 participants assigned to the control device. The primary end point was achieved in 164 patients in the study group and 85 patients in the control group. The analysis of the primary end point showed noninferiority of the study device relative to the control device (estimated success rates, 55.4% and 59.1%, respectively, calculated by the Weibull model; absolute difference, 3.7 percentage points; 95% upper confidence limit, 12.56 percentage points; P=0.01 for noninferiority). More patients in the control group than in the study group had device malfunction or device failure requiring replacement (16.2% vs. 8.8%), and more patients in the study group had strokes (29.7% vs. 12.1%). Quality of life and functional capacity improved to a similar degree in the two groups. CONCLUSIONS In this trial involving patients with advanced heart failure who were ineligible for heart transplantation, a small, intrapericardial, centrifugal-flow LVAD was found to be noninferior to an axial-flow LVAD with respect to survival free from disabling stroke or device removal for malfunction or failure. (Funded by HeartWare; ENDURANCE ClinicalTrials.gov number, NCT01166347 .).
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Affiliation(s)
- Joseph G Rogers
- From Duke University School of Medicine, Durham, NC (J.G.R., C.A.M.); University of Michigan, Ann Arbor (F.D.P., K.D.A.); Advocate Christ Medical Center, Oak Lawn (A.J.T., G.B.), and University of Chicago Medicine (V.J.) and Northwestern Memorial Hospital (A.S.A.), Chicago - all in Illinois; University of Louisville, Louisville, KY (M.S.S., E.J.B.); MedStar Heart Institute, Washington, DC (S.W.B., S.S.N.); University of Texas Health Science Center (I.D.G.) and Texas Heart Institute (H.M., O.H.F.), Houston; and HeartWare, Framingham, MA (K.L.)
| | - Francis D Pagani
- From Duke University School of Medicine, Durham, NC (J.G.R., C.A.M.); University of Michigan, Ann Arbor (F.D.P., K.D.A.); Advocate Christ Medical Center, Oak Lawn (A.J.T., G.B.), and University of Chicago Medicine (V.J.) and Northwestern Memorial Hospital (A.S.A.), Chicago - all in Illinois; University of Louisville, Louisville, KY (M.S.S., E.J.B.); MedStar Heart Institute, Washington, DC (S.W.B., S.S.N.); University of Texas Health Science Center (I.D.G.) and Texas Heart Institute (H.M., O.H.F.), Houston; and HeartWare, Framingham, MA (K.L.)
| | - Antone J Tatooles
- From Duke University School of Medicine, Durham, NC (J.G.R., C.A.M.); University of Michigan, Ann Arbor (F.D.P., K.D.A.); Advocate Christ Medical Center, Oak Lawn (A.J.T., G.B.), and University of Chicago Medicine (V.J.) and Northwestern Memorial Hospital (A.S.A.), Chicago - all in Illinois; University of Louisville, Louisville, KY (M.S.S., E.J.B.); MedStar Heart Institute, Washington, DC (S.W.B., S.S.N.); University of Texas Health Science Center (I.D.G.) and Texas Heart Institute (H.M., O.H.F.), Houston; and HeartWare, Framingham, MA (K.L.)
| | - Geetha Bhat
- From Duke University School of Medicine, Durham, NC (J.G.R., C.A.M.); University of Michigan, Ann Arbor (F.D.P., K.D.A.); Advocate Christ Medical Center, Oak Lawn (A.J.T., G.B.), and University of Chicago Medicine (V.J.) and Northwestern Memorial Hospital (A.S.A.), Chicago - all in Illinois; University of Louisville, Louisville, KY (M.S.S., E.J.B.); MedStar Heart Institute, Washington, DC (S.W.B., S.S.N.); University of Texas Health Science Center (I.D.G.) and Texas Heart Institute (H.M., O.H.F.), Houston; and HeartWare, Framingham, MA (K.L.)
| | - Mark S Slaughter
- From Duke University School of Medicine, Durham, NC (J.G.R., C.A.M.); University of Michigan, Ann Arbor (F.D.P., K.D.A.); Advocate Christ Medical Center, Oak Lawn (A.J.T., G.B.), and University of Chicago Medicine (V.J.) and Northwestern Memorial Hospital (A.S.A.), Chicago - all in Illinois; University of Louisville, Louisville, KY (M.S.S., E.J.B.); MedStar Heart Institute, Washington, DC (S.W.B., S.S.N.); University of Texas Health Science Center (I.D.G.) and Texas Heart Institute (H.M., O.H.F.), Houston; and HeartWare, Framingham, MA (K.L.)
| | - Emma J Birks
- From Duke University School of Medicine, Durham, NC (J.G.R., C.A.M.); University of Michigan, Ann Arbor (F.D.P., K.D.A.); Advocate Christ Medical Center, Oak Lawn (A.J.T., G.B.), and University of Chicago Medicine (V.J.) and Northwestern Memorial Hospital (A.S.A.), Chicago - all in Illinois; University of Louisville, Louisville, KY (M.S.S., E.J.B.); MedStar Heart Institute, Washington, DC (S.W.B., S.S.N.); University of Texas Health Science Center (I.D.G.) and Texas Heart Institute (H.M., O.H.F.), Houston; and HeartWare, Framingham, MA (K.L.)
| | - Steven W Boyce
- From Duke University School of Medicine, Durham, NC (J.G.R., C.A.M.); University of Michigan, Ann Arbor (F.D.P., K.D.A.); Advocate Christ Medical Center, Oak Lawn (A.J.T., G.B.), and University of Chicago Medicine (V.J.) and Northwestern Memorial Hospital (A.S.A.), Chicago - all in Illinois; University of Louisville, Louisville, KY (M.S.S., E.J.B.); MedStar Heart Institute, Washington, DC (S.W.B., S.S.N.); University of Texas Health Science Center (I.D.G.) and Texas Heart Institute (H.M., O.H.F.), Houston; and HeartWare, Framingham, MA (K.L.)
| | - Samer S Najjar
- From Duke University School of Medicine, Durham, NC (J.G.R., C.A.M.); University of Michigan, Ann Arbor (F.D.P., K.D.A.); Advocate Christ Medical Center, Oak Lawn (A.J.T., G.B.), and University of Chicago Medicine (V.J.) and Northwestern Memorial Hospital (A.S.A.), Chicago - all in Illinois; University of Louisville, Louisville, KY (M.S.S., E.J.B.); MedStar Heart Institute, Washington, DC (S.W.B., S.S.N.); University of Texas Health Science Center (I.D.G.) and Texas Heart Institute (H.M., O.H.F.), Houston; and HeartWare, Framingham, MA (K.L.)
| | - Valluvan Jeevanandam
- From Duke University School of Medicine, Durham, NC (J.G.R., C.A.M.); University of Michigan, Ann Arbor (F.D.P., K.D.A.); Advocate Christ Medical Center, Oak Lawn (A.J.T., G.B.), and University of Chicago Medicine (V.J.) and Northwestern Memorial Hospital (A.S.A.), Chicago - all in Illinois; University of Louisville, Louisville, KY (M.S.S., E.J.B.); MedStar Heart Institute, Washington, DC (S.W.B., S.S.N.); University of Texas Health Science Center (I.D.G.) and Texas Heart Institute (H.M., O.H.F.), Houston; and HeartWare, Framingham, MA (K.L.)
| | - Allen S Anderson
- From Duke University School of Medicine, Durham, NC (J.G.R., C.A.M.); University of Michigan, Ann Arbor (F.D.P., K.D.A.); Advocate Christ Medical Center, Oak Lawn (A.J.T., G.B.), and University of Chicago Medicine (V.J.) and Northwestern Memorial Hospital (A.S.A.), Chicago - all in Illinois; University of Louisville, Louisville, KY (M.S.S., E.J.B.); MedStar Heart Institute, Washington, DC (S.W.B., S.S.N.); University of Texas Health Science Center (I.D.G.) and Texas Heart Institute (H.M., O.H.F.), Houston; and HeartWare, Framingham, MA (K.L.)
| | - Igor D Gregoric
- From Duke University School of Medicine, Durham, NC (J.G.R., C.A.M.); University of Michigan, Ann Arbor (F.D.P., K.D.A.); Advocate Christ Medical Center, Oak Lawn (A.J.T., G.B.), and University of Chicago Medicine (V.J.) and Northwestern Memorial Hospital (A.S.A.), Chicago - all in Illinois; University of Louisville, Louisville, KY (M.S.S., E.J.B.); MedStar Heart Institute, Washington, DC (S.W.B., S.S.N.); University of Texas Health Science Center (I.D.G.) and Texas Heart Institute (H.M., O.H.F.), Houston; and HeartWare, Framingham, MA (K.L.)
| | - Hari Mallidi
- From Duke University School of Medicine, Durham, NC (J.G.R., C.A.M.); University of Michigan, Ann Arbor (F.D.P., K.D.A.); Advocate Christ Medical Center, Oak Lawn (A.J.T., G.B.), and University of Chicago Medicine (V.J.) and Northwestern Memorial Hospital (A.S.A.), Chicago - all in Illinois; University of Louisville, Louisville, KY (M.S.S., E.J.B.); MedStar Heart Institute, Washington, DC (S.W.B., S.S.N.); University of Texas Health Science Center (I.D.G.) and Texas Heart Institute (H.M., O.H.F.), Houston; and HeartWare, Framingham, MA (K.L.)
| | - Katrin Leadley
- From Duke University School of Medicine, Durham, NC (J.G.R., C.A.M.); University of Michigan, Ann Arbor (F.D.P., K.D.A.); Advocate Christ Medical Center, Oak Lawn (A.J.T., G.B.), and University of Chicago Medicine (V.J.) and Northwestern Memorial Hospital (A.S.A.), Chicago - all in Illinois; University of Louisville, Louisville, KY (M.S.S., E.J.B.); MedStar Heart Institute, Washington, DC (S.W.B., S.S.N.); University of Texas Health Science Center (I.D.G.) and Texas Heart Institute (H.M., O.H.F.), Houston; and HeartWare, Framingham, MA (K.L.)
| | - Keith D Aaronson
- From Duke University School of Medicine, Durham, NC (J.G.R., C.A.M.); University of Michigan, Ann Arbor (F.D.P., K.D.A.); Advocate Christ Medical Center, Oak Lawn (A.J.T., G.B.), and University of Chicago Medicine (V.J.) and Northwestern Memorial Hospital (A.S.A.), Chicago - all in Illinois; University of Louisville, Louisville, KY (M.S.S., E.J.B.); MedStar Heart Institute, Washington, DC (S.W.B., S.S.N.); University of Texas Health Science Center (I.D.G.) and Texas Heart Institute (H.M., O.H.F.), Houston; and HeartWare, Framingham, MA (K.L.)
| | - O H Frazier
- From Duke University School of Medicine, Durham, NC (J.G.R., C.A.M.); University of Michigan, Ann Arbor (F.D.P., K.D.A.); Advocate Christ Medical Center, Oak Lawn (A.J.T., G.B.), and University of Chicago Medicine (V.J.) and Northwestern Memorial Hospital (A.S.A.), Chicago - all in Illinois; University of Louisville, Louisville, KY (M.S.S., E.J.B.); MedStar Heart Institute, Washington, DC (S.W.B., S.S.N.); University of Texas Health Science Center (I.D.G.) and Texas Heart Institute (H.M., O.H.F.), Houston; and HeartWare, Framingham, MA (K.L.)
| | - Carmelo A Milano
- From Duke University School of Medicine, Durham, NC (J.G.R., C.A.M.); University of Michigan, Ann Arbor (F.D.P., K.D.A.); Advocate Christ Medical Center, Oak Lawn (A.J.T., G.B.), and University of Chicago Medicine (V.J.) and Northwestern Memorial Hospital (A.S.A.), Chicago - all in Illinois; University of Louisville, Louisville, KY (M.S.S., E.J.B.); MedStar Heart Institute, Washington, DC (S.W.B., S.S.N.); University of Texas Health Science Center (I.D.G.) and Texas Heart Institute (H.M., O.H.F.), Houston; and HeartWare, Framingham, MA (K.L.)
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Jani SM, Ahmed S, Sheikh FH, Molina EJ, Najjar SS, Majure DT. Pleural Effusions Requiring Drainage Following LVAD Implantation: Potential Contributor to Prolonged Length of Stay. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sheikh FH, Majure DT, Ahmed S, Rodrigo ME, Jani SM, Hofmeyer M, Boyce SW, Najjar SS. Obesity Does Not Impact 1 Year Survival After LVAD Implantation. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Townsend RR, Wilkinson IB, Schiffrin EL, Avolio AP, Chirinos JA, Cockcroft JR, Heffernan KS, Lakatta EG, McEniery CM, Mitchell GF, Najjar SS, Nichols WW, Urbina EM, Weber T. Recommendations for Improving and Standardizing Vascular Research on Arterial Stiffness: A Scientific Statement From the American Heart Association. Hypertension 2015; 66:698-722. [PMID: 26160955 DOI: 10.1161/hyp.0000000000000033] [Citation(s) in RCA: 919] [Impact Index Per Article: 102.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Birks EJ, McGee EC, Aaronson KD, Boyce S, Cotts WG, Najjar SS, Pagani FD, Hathaway DR, Najarian K, Jacoski MV, Slaughter MS. An examination of survival by sex and race in the HeartWare Ventricular Assist Device for the Treatment of Advanced Heart Failure (ADVANCE) Bridge to Transplant (BTT) and continued access protocol trials. J Heart Lung Transplant 2015; 34:815-24. [DOI: 10.1016/j.healun.2014.12.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 11/27/2014] [Accepted: 12/17/2014] [Indexed: 01/15/2023] Open
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Scuteri A, Morrell CH, Orrù M, Strait JB, Tarasov KV, Ferreli LAP, Loi F, Pilia MG, Delitala A, Spurgeon H, Najjar SS, AlGhatrif M, Lakatta EG. Longitudinal perspective on the conundrum of central arterial stiffness, blood pressure, and aging. Hypertension 2014; 64:1219-27. [PMID: 25225210 DOI: 10.1161/hypertensionaha.114.04127] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [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: 01/11/2023]
Abstract
The age-associated increase in arterial stiffness has long been considered to parallel or to cause the age-associated increase in blood pressure (BP). Yet, the rates at which pulse wave velocity (PWV), a measure of arterial stiffness, and BP trajectories change over time within individuals who differ by age and sex have not been assessed and compared. This study determined the evolution of BP and aortic PWV trajectories during a 9.4-year follow-up in >4000 community-dwelling men and women of 20 to 100 years of age at entry into the SardiNIA Study. Linear mixed effects model analyses revealed that PWV accelerates with time during the observation period, at about the same rate over the entire age range in both men and women. In men, the longitudinal rate at which BP changed over time, however, did not generally parallel that of PWV acceleration: at ages>40 years the rates of change in systolic BP (SBP) and pulse pressure (PP) increase plateaued and then declined so that SBP, itself, also declined at older ages, whereas PP plateaued. In women, SBP, diastolic BP, and mean BP increased at constant rates across all ages, producing an increasing rate of increase in PP. Therefore, increased aortic stiffness is implicated in the age-associated increase in SBP and PP. These findings indicate that PWV is not a surrogate for BP and that arterial properties other than arterial wall stiffness that vary by age and sex also modulate the BP trajectories during aging and lead to the dissociation of PWV, PP, and SBP trajectories in men.
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Affiliation(s)
- Angelo Scuteri
- From the Hospital San Raffaele Pisana-Istituto Ricovero e Cura a Carattere Sceintifico (IRCCS), Rome, Italy (A.S.); Laboratory of Cardiovascular Science, National Institute of Aging, Baltimore, MD (C.H.M., J.B.S., K.V.T., H.S., E.G.L.); Loyola University Maryland, Baltimore (C.H.M.); Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche, c/o Cittadella Universitaria di Monserrato, Monserrato, Cagliari, Italy (M.O., L.A.P.F., F.L., M.G.P., A.D.); Johns Hopkins School of Medicine, Baltimore, MD (M.A.); and MedStar Heart Institute, Washington, DC (S.S.N.)
| | - Christopher H Morrell
- From the Hospital San Raffaele Pisana-Istituto Ricovero e Cura a Carattere Sceintifico (IRCCS), Rome, Italy (A.S.); Laboratory of Cardiovascular Science, National Institute of Aging, Baltimore, MD (C.H.M., J.B.S., K.V.T., H.S., E.G.L.); Loyola University Maryland, Baltimore (C.H.M.); Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche, c/o Cittadella Universitaria di Monserrato, Monserrato, Cagliari, Italy (M.O., L.A.P.F., F.L., M.G.P., A.D.); Johns Hopkins School of Medicine, Baltimore, MD (M.A.); and MedStar Heart Institute, Washington, DC (S.S.N.)
| | - Marco Orrù
- From the Hospital San Raffaele Pisana-Istituto Ricovero e Cura a Carattere Sceintifico (IRCCS), Rome, Italy (A.S.); Laboratory of Cardiovascular Science, National Institute of Aging, Baltimore, MD (C.H.M., J.B.S., K.V.T., H.S., E.G.L.); Loyola University Maryland, Baltimore (C.H.M.); Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche, c/o Cittadella Universitaria di Monserrato, Monserrato, Cagliari, Italy (M.O., L.A.P.F., F.L., M.G.P., A.D.); Johns Hopkins School of Medicine, Baltimore, MD (M.A.); and MedStar Heart Institute, Washington, DC (S.S.N.)
| | - James B Strait
- From the Hospital San Raffaele Pisana-Istituto Ricovero e Cura a Carattere Sceintifico (IRCCS), Rome, Italy (A.S.); Laboratory of Cardiovascular Science, National Institute of Aging, Baltimore, MD (C.H.M., J.B.S., K.V.T., H.S., E.G.L.); Loyola University Maryland, Baltimore (C.H.M.); Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche, c/o Cittadella Universitaria di Monserrato, Monserrato, Cagliari, Italy (M.O., L.A.P.F., F.L., M.G.P., A.D.); Johns Hopkins School of Medicine, Baltimore, MD (M.A.); and MedStar Heart Institute, Washington, DC (S.S.N.)
| | - Kirill V Tarasov
- From the Hospital San Raffaele Pisana-Istituto Ricovero e Cura a Carattere Sceintifico (IRCCS), Rome, Italy (A.S.); Laboratory of Cardiovascular Science, National Institute of Aging, Baltimore, MD (C.H.M., J.B.S., K.V.T., H.S., E.G.L.); Loyola University Maryland, Baltimore (C.H.M.); Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche, c/o Cittadella Universitaria di Monserrato, Monserrato, Cagliari, Italy (M.O., L.A.P.F., F.L., M.G.P., A.D.); Johns Hopkins School of Medicine, Baltimore, MD (M.A.); and MedStar Heart Institute, Washington, DC (S.S.N.)
| | - Liana Anna Pina Ferreli
- From the Hospital San Raffaele Pisana-Istituto Ricovero e Cura a Carattere Sceintifico (IRCCS), Rome, Italy (A.S.); Laboratory of Cardiovascular Science, National Institute of Aging, Baltimore, MD (C.H.M., J.B.S., K.V.T., H.S., E.G.L.); Loyola University Maryland, Baltimore (C.H.M.); Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche, c/o Cittadella Universitaria di Monserrato, Monserrato, Cagliari, Italy (M.O., L.A.P.F., F.L., M.G.P., A.D.); Johns Hopkins School of Medicine, Baltimore, MD (M.A.); and MedStar Heart Institute, Washington, DC (S.S.N.)
| | - Francesco Loi
- From the Hospital San Raffaele Pisana-Istituto Ricovero e Cura a Carattere Sceintifico (IRCCS), Rome, Italy (A.S.); Laboratory of Cardiovascular Science, National Institute of Aging, Baltimore, MD (C.H.M., J.B.S., K.V.T., H.S., E.G.L.); Loyola University Maryland, Baltimore (C.H.M.); Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche, c/o Cittadella Universitaria di Monserrato, Monserrato, Cagliari, Italy (M.O., L.A.P.F., F.L., M.G.P., A.D.); Johns Hopkins School of Medicine, Baltimore, MD (M.A.); and MedStar Heart Institute, Washington, DC (S.S.N.)
| | - Maria Grazia Pilia
- From the Hospital San Raffaele Pisana-Istituto Ricovero e Cura a Carattere Sceintifico (IRCCS), Rome, Italy (A.S.); Laboratory of Cardiovascular Science, National Institute of Aging, Baltimore, MD (C.H.M., J.B.S., K.V.T., H.S., E.G.L.); Loyola University Maryland, Baltimore (C.H.M.); Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche, c/o Cittadella Universitaria di Monserrato, Monserrato, Cagliari, Italy (M.O., L.A.P.F., F.L., M.G.P., A.D.); Johns Hopkins School of Medicine, Baltimore, MD (M.A.); and MedStar Heart Institute, Washington, DC (S.S.N.)
| | - Alessandro Delitala
- From the Hospital San Raffaele Pisana-Istituto Ricovero e Cura a Carattere Sceintifico (IRCCS), Rome, Italy (A.S.); Laboratory of Cardiovascular Science, National Institute of Aging, Baltimore, MD (C.H.M., J.B.S., K.V.T., H.S., E.G.L.); Loyola University Maryland, Baltimore (C.H.M.); Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche, c/o Cittadella Universitaria di Monserrato, Monserrato, Cagliari, Italy (M.O., L.A.P.F., F.L., M.G.P., A.D.); Johns Hopkins School of Medicine, Baltimore, MD (M.A.); and MedStar Heart Institute, Washington, DC (S.S.N.)
| | - Harold Spurgeon
- From the Hospital San Raffaele Pisana-Istituto Ricovero e Cura a Carattere Sceintifico (IRCCS), Rome, Italy (A.S.); Laboratory of Cardiovascular Science, National Institute of Aging, Baltimore, MD (C.H.M., J.B.S., K.V.T., H.S., E.G.L.); Loyola University Maryland, Baltimore (C.H.M.); Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche, c/o Cittadella Universitaria di Monserrato, Monserrato, Cagliari, Italy (M.O., L.A.P.F., F.L., M.G.P., A.D.); Johns Hopkins School of Medicine, Baltimore, MD (M.A.); and MedStar Heart Institute, Washington, DC (S.S.N.)
| | - Samer S Najjar
- From the Hospital San Raffaele Pisana-Istituto Ricovero e Cura a Carattere Sceintifico (IRCCS), Rome, Italy (A.S.); Laboratory of Cardiovascular Science, National Institute of Aging, Baltimore, MD (C.H.M., J.B.S., K.V.T., H.S., E.G.L.); Loyola University Maryland, Baltimore (C.H.M.); Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche, c/o Cittadella Universitaria di Monserrato, Monserrato, Cagliari, Italy (M.O., L.A.P.F., F.L., M.G.P., A.D.); Johns Hopkins School of Medicine, Baltimore, MD (M.A.); and MedStar Heart Institute, Washington, DC (S.S.N.)
| | - Majd AlGhatrif
- From the Hospital San Raffaele Pisana-Istituto Ricovero e Cura a Carattere Sceintifico (IRCCS), Rome, Italy (A.S.); Laboratory of Cardiovascular Science, National Institute of Aging, Baltimore, MD (C.H.M., J.B.S., K.V.T., H.S., E.G.L.); Loyola University Maryland, Baltimore (C.H.M.); Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche, c/o Cittadella Universitaria di Monserrato, Monserrato, Cagliari, Italy (M.O., L.A.P.F., F.L., M.G.P., A.D.); Johns Hopkins School of Medicine, Baltimore, MD (M.A.); and MedStar Heart Institute, Washington, DC (S.S.N.)
| | - Edward G Lakatta
- From the Hospital San Raffaele Pisana-Istituto Ricovero e Cura a Carattere Sceintifico (IRCCS), Rome, Italy (A.S.); Laboratory of Cardiovascular Science, National Institute of Aging, Baltimore, MD (C.H.M., J.B.S., K.V.T., H.S., E.G.L.); Loyola University Maryland, Baltimore (C.H.M.); Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche, c/o Cittadella Universitaria di Monserrato, Monserrato, Cagliari, Italy (M.O., L.A.P.F., F.L., M.G.P., A.D.); Johns Hopkins School of Medicine, Baltimore, MD (M.A.); and MedStar Heart Institute, Washington, DC (S.S.N.).
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Bottomley PA, Panjrath GS, Lai S, Hirsch GA, Wu K, Najjar SS, Steinberg A, Gerstenblith G, Weiss RG. Metabolic rates of ATP transfer through creatine kinase (CK Flux) predict clinical heart failure events and death. Sci Transl Med 2014; 5:215re3. [PMID: 24337482 DOI: 10.1126/scitranslmed.3007328] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Morbidity and mortality from heart failure (HF) are high, and current risk stratification approaches for predicting HF progression are imperfect. Adenosine triphosphate (ATP) is required for normal cardiac contraction, and abnormalities in creatine kinase (CK) energy metabolism, the primary myocardial energy reserve reaction, have been observed in experimental and clinical HF. However, the prognostic value of abnormalities in ATP production rates through CK in human HF has not been investigated. Fifty-eight HF patients with nonischemic cardiomyopathy underwent ³¹P magnetic resonance spectroscopy (MRS) to quantify cardiac high-energy phosphates and the rate of ATP synthesis through CK (CK flux) and were prospectively followed for a median of 4.7 years. Multiple-event analysis (MEA) was performed for HF-related events including all-cause and cardiac death, HF hospitalization, cardiac transplantation, and ventricular-assist device placement. Among baseline demographic, clinical, and metabolic parameters, MEA identified four independent predictors of HF events: New York Heart Association (NYHA) class, left ventricular ejection fraction (LVEF), African-American race, and CK flux. Reduced myocardial CK flux was a significant predictor of HF outcomes, even after correction for NYHA class, LVEF, and race. For each increase in CK flux of 1 μmol g⁻¹ s⁻¹, risk of HF-related composite outcomes decreased by 32 to 39%. These findings suggest that reduced CK flux may be a potential HF treatment target. Newer imaging strategies, including noninvasive ³¹P MRS that detect altered ATP kinetics, could thus complement risk stratification in HF and add value in conditions involving other tissues with high energy demands, including skeletal muscle and brain.
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Affiliation(s)
- Paul A Bottomley
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Jani SM, Sheikh FH, Rahimi F, Majure DT, Hofmeyer M, Ruiz G, Najjar SS, Boyce S, Molina EJ. Outcomes of Patients Placed on VA ECMO Stratified by Indication. J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.06.245] [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: 10/25/2022]
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Povsic TJ, Najjar SS, Prather K, Zhou J, Adams SD, Zavodni KL, Kelly F, Melton LG, Hasselblad V, Heitner JF, Raman SV, Barsness GW, Patel MR, Kim RJ, Lakatta EG, Harrington RA, Rao SV. EPC mobilization after erythropoietin treatment in acute ST-elevation myocardial infarction: the REVEAL EPC substudy. J Thromb Thrombolysis 2014; 36:375-83. [PMID: 23700090 DOI: 10.1007/s11239-013-0944-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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] [Indexed: 12/27/2022]
Abstract
Erythropoietin (EPO) was hypothesized to mitigate reperfusion injury, in part via mobilization of endothelial progenitor cells (EPCs). The REVEAL trial found no reduction in infarct size with a single dose of EPO (60,000 U) in patients with ST-segment elevation myocardial infarction. In a substudy, we aimed to determine the feasibility of cryopreserving and centrally analyzing EPC levels to assess the relationship between EPC numbers, EPO administration, and infarct size. As a prespecified substudy, mononuclear cells were locally cryopreserved before as well as 24 and 48-72 h after primary percutaneous coronary intervention. EPC samples were collected in 163 of 222 enrolled patients. At least one sample was obtained from 125 patients, and all three time points were available in 83 patients. There were no significant differences in the absolute EPC numbers over time or between EPO- and placebo-treated patients; however, there was a trend toward a greater increase in EPC levels from 24 to 48-72 h postintervention in patients receiving ≥30,000 U of EPO (P = 0.099 for CD133(+) cells, 0.049 for CD34(+) cells, 0.099 for ALDH(br) cells). EPC numbers at baseline were inversely related to infarct size (P = 0.03 for CD133(+) cells, 0.006 for CD34(+) cells). Local whole cell cryopreservation and central EPC analysis in the context of a multicenter randomized trial is feasible but challenging. High-dose (≥30,000 U) EPO may mobilize EPCs at 48-72 h, and baseline EPC levels may be inversely associated with infarct size.
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Affiliation(s)
- Thomas J Povsic
- Duke Clinical Research Institute, Duke University Medical Center, Box 103208, Durham, NC, 27710, USA,
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Ben-Shlomo Y, Spears M, Boustred C, May M, Anderson SG, Benjamin EJ, Boutouyrie P, Cameron J, Chen CH, Cruickshank JK, Hwang SJ, Lakatta EG, Laurent S, Maldonado J, Mitchell GF, Najjar SS, Newman AB, Ohishi M, Pannier B, Pereira T, Vasan RS, Shokawa T, Sutton-Tyrell K, Verbeke F, Wang KL, Webb DJ, Willum Hansen T, Zoungas S, McEniery CM, Cockcroft JR, Wilkinson IB. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol 2013; 63:636-646. [PMID: 24239664 DOI: 10.1016/j.jacc.2013.09.063] [Citation(s) in RCA: 1203] [Impact Index Per Article: 109.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/13/2013] [Accepted: 09/22/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The goal of this study was to determine whether aortic pulse wave velocity (aPWV) improves prediction of cardiovascular disease (CVD) events beyond conventional risk factors. BACKGROUND Several studies have shown that aPWV may be a useful risk factor for predicting CVD, but they have been underpowered to examine whether this is true for different subgroups. METHODS We undertook a systematic review and obtained individual participant data from 16 studies. Study-specific associations of aPWV with CVD outcomes were determined using Cox proportional hazard models and random effect models to estimate pooled effects. RESULTS Of 17,635 participants, a total of 1,785 (10%) had a CVD event. The pooled age- and sex-adjusted hazard ratios (HRs) per 1-SD change in loge aPWV were 1.35 (95% confidence interval [CI]: 1.22 to 1.50; p < 0.001) for coronary heart disease, 1.54 (95% CI: 1.34 to 1.78; p < 0.001) for stroke, and 1.45 (95% CI: 1.30 to 1.61; p < 0.001) for CVD. Associations stratified according to sex, diabetes, and hypertension were similar but decreased with age (1.89, 1.77, 1.36, and 1.23 for age ≤50, 51 to 60, 61 to 70, and >70 years, respectively; pinteraction <0.001). After adjusting for conventional risk factors, aPWV remained a predictor of coronary heart disease (HR: 1.23 [95% CI: 1.11 to 1.35]; p < 0.001), stroke (HR: 1.28 [95% CI: 1.16 to 1.42]; p < 0.001), and CVD events (HR: 1.30 [95% CI: 1.18 to 1.43]; p < 0.001). Reclassification indices showed that the addition of aPWV improved risk prediction (13% for 10-year CVD risk for intermediate risk) for some subgroups. CONCLUSIONS Consideration of aPWV improves model fit and reclassifies risk for future CVD events in models that include standard risk factors. aPWV may enable better identification of high-risk populations that might benefit from more aggressive CVD risk factor management.
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Affiliation(s)
- Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
| | - Melissa Spears
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Chris Boustred
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Margaret May
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Simon G Anderson
- Institute of Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Emelia J Benjamin
- National Heart Lung and Blood Institute and Boston University's Framingham Heart Study, Cardiology Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Pierre Boutouyrie
- INSERM U 970, Paris-Descartes University, Hopital Europeen Georges Pompidou, Assistance Publique Hopitaux de Paris, Paris, France
| | - James Cameron
- Monash Cardiovascular Research Centre, MonashHEART and Monash University Department of Medicine (MMC), Melbourne, Australia
| | - Chen-Huan Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - J Kennedy Cruickshank
- King's College & King's Health Partners, St. Thomas' & Guy's Hospital, London, United Kingdom
| | - Shih-Jen Hwang
- Branch of Population Sciences, Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Edward G Lakatta
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Stephane Laurent
- INSERM U 970, Paris-Descartes University, Hopital Europeen Georges Pompidou, Assistance Publique Hopitaux de Paris, Paris, France
| | - João Maldonado
- Instituto de Investigação e Formação Cardiovascular, Penacova, Portugal
| | | | - Samer S Najjar
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland; MedStar Heart Research Institute, Washington, DC
| | - Anne B Newman
- Center for Aging and Population Health, Pittsburgh, Pennsylvania
| | - Mitsuru Ohishi
- Department of Geriatric Medicine, Osaka University, Osaka, Japan
| | - Bruno Pannier
- Centre d'Investigations Preventives et Cliniques, Paris, France
| | - Telmo Pereira
- Escola Superior de Tecnologia da Saúde de Coimbra, Coimbra, Portugal
| | - Ramachandran S Vasan
- National Heart Lung and Blood Institute and Boston University's Framingham Heart Study, Department of Medicine, Boston University, Boston, Massachusetts
| | - Tomoki Shokawa
- Department of Molecular and Internal Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Francis Verbeke
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Kang-Ling Wang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - David J Webb
- University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Tine Willum Hansen
- Research Center for Prevention and Health, Glostrup Hospital, Glostrup and Steno Diabetes Center, Glostrup, Denmark
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Carmel M McEniery
- Clinical Pharmacology Unit, University of Cambridge, Cambridge, United Kingdom
| | | | - Ian B Wilkinson
- Clinical Pharmacology Unit, University of Cambridge, Cambridge, United Kingdom
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AlGhatrif M, Strait JB, Morrell CH, Canepa M, Wright J, Elango P, Scuteri A, Najjar SS, Ferrucci L, Lakatta EG. Longitudinal trajectories of arterial stiffness and the role of blood pressure: the Baltimore Longitudinal Study of Aging. Hypertension 2013; 62:934-41. [PMID: 24001897 PMCID: PMC3880832 DOI: 10.1161/hypertensionaha.113.01445] [Citation(s) in RCA: 276] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Carotid-femoral pulse wave velocity (PWV), a marker of arterial stiffness, is an established independent cardiovascular risk factor. Little information is available on the pattern and determinants of the longitudinal change in PWV with aging. Such information is crucial to elucidating mechanisms underlying arterial stiffness and the design of interventions to retard it. Between 1988 and 2013, we collected 2 to 9 serial measures of PWV in 354 men and 423 women of the Baltimore Longitudinal Study of Aging, who were 21 to 94 years of age and free of clinically significant cardiovascular disease. Rates of PWV increase accelerated with advancing age in men more than women, leading to sex differences in PWV after the age of 50 years. In both sexes, not only systolic blood pressure (SBP) ≥140 mm Hg but also SBP of 120 to 139 mm Hg was associated with steeper rates of PWV increase compared with SBP<120 mm Hg. Furthermore, there was a dose-dependent effect of SBP in men with marked acceleration in PWV rate of increase with age at SBP ≥140 mm Hg compared with SBP of 120 to 139 mm Hg. Except for waist circumference in women, no other traditional cardiovascular risk factors predicted longitudinal PWV increase. In conclusion, the steeper longitudinal increase of PWV in men than women led to the sex difference that expanded with advancing age. Age and SBP are the main longitudinal determinants of PWV, and the effect of SBP on PWV trajectories exists even in the prehypertensive range.
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Affiliation(s)
- Majd AlGhatrif
- Laboratory of Cardiovascular Science, Biomedical Research Center, 251 Bayview Blvd, Suite 100, Room 09B116, Baltimore, MD 21224.
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Marine JE, Shetty V, Chow GV, Wright JG, Gerstenblith G, Najjar SS, Lakatta EG, Fleg JL. Prevalence and prognostic significance of exercise-induced nonsustained ventricular tachycardia in asymptomatic volunteers: BLSA (Baltimore Longitudinal Study of Aging). J Am Coll Cardiol 2013; 62:595-600. [PMID: 23747767 DOI: 10.1016/j.jacc.2013.05.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 04/26/2013] [Accepted: 05/06/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study sought to determine the clinical predictors and prognostic significance of exercise-induced nonsustained ventricular tachycardia (NSVT) in a large population of asymptomatic volunteers. BACKGROUND Prior studies have reported variable risk associated with exercise-induced ventricular arrhythmia. METHODS Subjects in the BLSA (Baltimore Longitudinal Study of Aging) free of known cardiovascular disease who completed at least 1 symptom-limited exercise treadmill test between 1977 and 2001 were included. NSVT episodes were characterized by QRS morphology, duration, and rate. Subjects underwent follow-up clinical evaluation every 2 years. RESULTS The 2,099 subjects (mean age: 52 years; 52.2% male) underwent a mean of 2.7 exercise tests, in which 79 (3.7%) developed NSVT with exercise on at least 1 test. The median duration of NSVT was 3 beats (≤5 beats in 84%), and the median rate was 175 beats/min. Subjects with (vs. without) NSVT were older (67 ± 12 years vs. 51 ± 17 years, p < 0.0001) and more likely to be male (80% vs. 51%, p < 0.0001) and to have baseline electrocardiographic abnormalities (50% vs. 17%, p < 0.0001) or ischemic ST-segment changes with exercise (20% vs. 10%, p = 0.004). Over a mean follow-up of 13.5 ± 7.7 years, 518 deaths (24.6%) occurred. After multivariable adjustment for age, sex, and coronary risk factors, exercise-induced NSVT was not significantly associated with total mortality (hazard ratio: 1.30; 95% confidence interval: 0.89 to 1.90; p = 0.17). CONCLUSIONS Exercise-induced NSVT occurred in nearly 4% of this asymptomatic adult cohort. This finding increased with age and was more common in men. After adjustment for clinical variables, exercise-induced NSVT did not independently increase the risk of total mortality.
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Affiliation(s)
- Joseph E Marine
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 20892, USA
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Panjrath GS, Bottomley P, Lai S, Hirsch GA, Katherine W, Najjar SS, Gerstenblith G, Weiss RG. IMPAIRED ENERGETICS AND HEART FAILURE: RATES OF ADENOSINE TRIPHOSPHATE TRANSFER THROUGH CREATINE KINASE PREDICT CLINICAL HEART FAILURE EVENTS AND DEATH. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)62115-4] [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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Canepa M, Strait JB, Abramov D, Milaneschi Y, AlGhatrif M, Moni M, Ramachandran R, Najjar SS, Brunelli C, Abraham TP, Lakatta EG, Ferrucci L. Contribution of central adiposity to left ventricular diastolic function (from the Baltimore Longitudinal Study of Aging). Am J Cardiol 2012; 109:1171-8. [PMID: 22257709 DOI: 10.1016/j.amjcard.2011.11.054] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [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: 10/13/2011] [Revised: 11/30/2011] [Accepted: 11/30/2011] [Indexed: 01/20/2023]
Abstract
We examined the relations of central adiposity with left ventricular (LV) diastolic dysfunction in men and women who participated in the Baltimore Longitudinal Study of Aging, a prospective community-based study of older persons. The sample for this cross-sectional analysis included 399 women and 370 men. Central adiposity was estimated using the waist circumference (WC) and global adiposity using the body mass index (BMI). Using data from a comprehensive echocardiographic study that included tissue Doppler imaging, diastolic function was graded according to 3 parameters (E/A ratio, E/Em ratio, and left atrial volume index). In the logistic regression models adjusted for age, gender, cardiovascular risk factors, and hemodynamic parameters, WC and BMI were both independently associated with LV diastolic dysfunction. However, when both WC and BMI were in the same model, only WC remained significantly associated with LV diastolic dysfunction (odds ratio 1.04, 95% confidence interval 1.01 to 1.08, p = 0.02). In the gender-stratified analyses, WC was significantly associated with LV diastolic dysfunction-independently of BMI-in women (odds ratio 1.08, 95% confidence interval 1.04 to 1.14, p <0.001) but not in men (odds ratio 1.00, 95% confidence interval 0.95 to 1.05, p = 0.91). Additional adjustment for LV mass index failed to modify these relations. In conclusion, the adverse effect of central adiposity on LV diastolic function was independent of general adiposity and more pronounced among women. The effect of visceral adiposity on LV diastolic dysfunction would benefit from confirmation in longitudinal studies.
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Affiliation(s)
- Marco Canepa
- Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA.
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Mitchell GF, Verwoert GC, Tarasov KV, Isaacs A, Smith AV, Yasmin, Rietzschel ER, Tanaka T, Liu Y, Parsa A, Najjar SS, O'Shaughnessy KM, Sigurdsson S, De Buyzere ML, Larson MG, Sie MPS, Andrews JS, Post WS, Mattace-Raso FUS, McEniery CM, Eiriksdottir G, Segers P, Vasan RS, van Rijn MJE, Howard TD, McArdle PF, Dehghan A, Jewell ES, Newhouse SJ, Bekaert S, Hamburg NM, Newman AB, Hofman A, Scuteri A, De Bacquer D, Ikram MA, Psaty BM, Fuchsberger C, Olden M, Wain LV, Elliott P, Smith NL, Felix JF, Erdmann J, Vita JA, Sutton-Tyrrell K, Sijbrands EJG, Sanna S, Launer LJ, De Meyer T, Johnson AD, Schut AFC, Herrington DM, Rivadeneira F, Uda M, Wilkinson IB, Aspelund T, Gillebert TC, Van Bortel L, Benjamin EJ, Oostra BA, Ding J, Gibson Q, Uitterlinden AG, Abecasis GR, Cockcroft JR, Gudnason V, De Backer GG, Ferrucci L, Harris TB, Shuldiner AR, van Duijn CM, Levy D, Lakatta EG, Witteman JCM. Common genetic variation in the 3'-BCL11B gene desert is associated with carotid-femoral pulse wave velocity and excess cardiovascular disease risk: the AortaGen Consortium. ACTA ACUST UNITED AC 2011; 5:81-90. [PMID: 22068335 DOI: 10.1161/circgenetics.111.959817] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Carotid-femoral pulse wave velocity (CFPWV) is a heritable measure of aortic stiffness that is strongly associated with increased risk for major cardiovascular disease events. METHODS AND RESULTS We conducted a meta-analysis of genome-wide association data in 9 community-based European ancestry cohorts consisting of 20 634 participants. Results were replicated in 2 additional European ancestry cohorts involving 5306 participants. Based on a preliminary analysis of 6 cohorts, we identified a locus on chromosome 14 in the 3'-BCL11B gene desert that is associated with CFPWV (rs7152623, minor allele frequency=0.42, β=-0.075±0.012 SD/allele, P=2.8×10(-10); replication β=-0.086±0.020 SD/allele, P=1.4×10(-6)). Combined results for rs7152623 from 11 cohorts gave β=-0.076±0.010 SD/allele, P=3.1×10(-15). The association persisted when adjusted for mean arterial pressure (β=-0.060±0.009 SD/allele, P=1.0×10(-11)). Results were consistent in younger (<55 years, 6 cohorts, n=13 914, β=-0.081±0.014 SD/allele, P=2.3×10(-9)) and older (9 cohorts, n=12 026, β=-0.061±0.014 SD/allele, P=9.4×10(-6)) participants. In separate meta-analyses, the locus was associated with increased risk for coronary artery disease (hazard ratio=1.05; confidence interval=1.02-1.08; P=0.0013) and heart failure (hazard ratio=1.10, CI=1.03-1.16, P=0.004). CONCLUSIONS Common genetic variation in a locus in the BCL11B gene desert that is thought to harbor 1 or more gene enhancers is associated with higher CFPWV and increased risk for cardiovascular disease. Elucidation of the role this novel locus plays in aortic stiffness may facilitate development of therapeutic interventions that limit aortic stiffening and related cardiovascular disease events.
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Affiliation(s)
- Gary F Mitchell
- Cardiovascular Engineering Inc., 1 Edgewater Drive, Norwood, MA 02062, USA.
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Chantler PD, Melenovsky V, Schulman SP, Gerstenblith G, Becker LC, Ferrucci L, Fleg JL, Lakatta EG, Najjar SS. Use of the Frank-Starling mechanism during exercise is linked to exercise-induced changes in arterial load. Am J Physiol Heart Circ Physiol 2011; 302:H349-58. [PMID: 22003052 DOI: 10.1152/ajpheart.00147.2011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [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: 11/22/2022]
Abstract
Effective arterial elastance(E(A)) is a measure of the net arterial load imposed on the heart that integrates the effects of heart rate(HR), peripheral vascular resistance(PVR), and total arterial compliance(TAC) and is a modulator of cardiac performance. To what extent the change in E(A) during exercise impacts on cardiac performance and aerobic capacity is unknown. We examined E(A) and its relationship with cardiovascular performance in 352 healthy subjects. Subjects underwent rest and exercise gated scans to measure cardiac volumes and to derive E(A)[end-systolic pressure/stroke volume index(SV)], PVR[MAP/(SV*HR)], and TAC(SV/pulse pressure). E(A) varied with exercise intensity: the ΔE(A) between rest and peak exercise along with its determinants, differed among individuals and ranged from -44% to +149%, and was independent of age and sex. Individuals were separated into 3 groups based on their ΔE(A)I. Individuals with the largest increase in ΔE(A)(group 3;ΔE(A)≥0.98 mmHg.m(2)/ml) had the smallest reduction in PVR, the greatest reduction in TAC and a similar increase in HR vs. group 1(ΔE(A)<0.22 mmHg.m(2)/ml). Furthermore, group 3 had a reduction in end-diastolic volume, and a blunted increase in SV(80%), and cardiac output(27%), during exercise vs. group 1. Despite limitations in the Frank-Starling mechanism and cardiac function, peak aerobic capacity did not differ by group because arterial-venous oxygen difference was greater in group 3 vs. 1. Thus the change in arterial load during exercise has important effects on the Frank-Starling mechanism and cardiac performance but not on exercise capacity. These findings provide interesting insights into the dynamic cardiovascular alterations during exercise.
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Affiliation(s)
- Paul D Chantler
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland 21225, USA
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Wain LV, Verwoert GC, O'Reilly PF, Shi G, Johnson T, Johnson AD, Bochud M, Rice KM, Henneman P, Smith AV, Ehret GB, Amin N, Larson MG, Mooser V, Hadley D, Dörr M, Bis JC, Aspelund T, Esko T, Janssens ACJW, Zhao JH, Heath S, Laan M, Fu J, Pistis G, Luan J, Arora P, Lucas G, Pirastu N, Pichler I, Jackson AU, Webster RJ, Zhang F, Peden JF, Schmidt H, Tanaka T, Campbell H, Igl W, Milaneschi Y, Hottenga JJ, Vitart V, Chasman DI, Trompet S, Bragg-Gresham JL, Alizadeh BZ, Chambers JC, Guo X, Lehtimäki T, Kühnel B, Lopez LM, Polašek O, Boban M, Nelson CP, Morrison AC, Pihur V, Ganesh SK, Hofman A, Kundu S, Mattace-Raso FUS, Rivadeneira F, Sijbrands EJG, Uitterlinden AG, Hwang SJ, Vasan RS, Wang TJ, Bergmann S, Vollenweider P, Waeber G, Laitinen J, Pouta A, Zitting P, McArdle WL, Kroemer HK, Völker U, Völzke H, Glazer NL, Taylor KD, Harris TB, Alavere H, Haller T, Keis A, Tammesoo ML, Aulchenko Y, Barroso I, Khaw KT, Galan P, Hercberg S, Lathrop M, Eyheramendy S, Org E, Sõber S, Lu X, Nolte IM, Penninx BW, Corre T, Masciullo C, Sala C, Groop L, Voight BF, Melander O, O'Donnell CJ, Salomaa V, d'Adamo AP, Fabretto A, Faletra F, Ulivi S, Del Greco FM, Facheris M, Collins FS, Bergman RN, Beilby JP, Hung J, Musk AW, Mangino M, Shin SY, Soranzo N, Watkins H, Goel A, Hamsten A, Gider P, Loitfelder M, Zeginigg M, Hernandez D, Najjar SS, Navarro P, Wild SH, Corsi AM, Singleton A, de Geus EJC, Willemsen G, Parker AN, Rose LM, Buckley B, Stott D, Orru M, Uda M, van der Klauw MM, Zhang W, Li X, Scott J, Chen YDI, Burke GL, Kähönen M, Viikari J, Döring A, Meitinger T, Davies G, Starr JM, Emilsson V, Plump A, Lindeman JH, Hoen PAC', König IR, Felix JF, Clarke R, Hopewell JC, Ongen H, Breteler M, Debette S, Destefano AL, Fornage M, Mitchell GF, Smith NL, Holm H, Stefansson K, Thorleifsson G, Thorsteinsdottir U, Samani NJ, Preuss M, Rudan I, Hayward C, Deary IJ, Wichmann HE, Raitakari OT, Palmas W, Kooner JS, Stolk RP, Jukema JW, Wright AF, Boomsma DI, Bandinelli S, Gyllensten UB, Wilson JF, Ferrucci L, Schmidt R, Farrall M, Spector TD, Palmer LJ, Tuomilehto J, Pfeufer A, Gasparini P, Siscovick D, Altshuler D, Loos RJF, Toniolo D, Snieder H, Gieger C, Meneton P, Wareham NJ, Oostra BA, Metspalu A, Launer L, Rettig R, Strachan DP, Beckmann JS, Witteman JCM, Erdmann J, van Dijk KW, Boerwinkle E, Boehnke M, Ridker PM, Jarvelin MR, Chakravarti A, Abecasis GR, Gudnason V, Newton-Cheh C, Levy D, Munroe PB, Psaty BM, Caulfield MJ, Rao DC, Tobin MD, Elliott P, van Duijn CM. Genome-wide association study identifies six new loci influencing pulse pressure and mean arterial pressure. Nat Genet 2011; 43:1005-11. [PMID: 21909110 PMCID: PMC3445021 DOI: 10.1038/ng.922] [Citation(s) in RCA: 331] [Impact Index Per Article: 25.5] [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: 02/10/2011] [Accepted: 08/04/2011] [Indexed: 12/19/2022]
Abstract
Numerous genetic loci influence systolic blood pressure (SBP) and diastolic blood pressure (DBP) in Europeans 1-3. We now report genome-wide association studies of pulse pressure (PP) and mean arterial pressure (MAP). In discovery (N=74,064) and follow-up studies (N=48,607), we identified at genome-wide significance (P= 2.7×10-8 to P=2.3×10-13) four novel PP loci (at 4q12 near CHIC2/PDGFRAI, 7q22.3 near PIK3CG, 8q24.12 in NOV, 11q24.3 near ADAMTS-8), two novel MAP loci (3p21.31 in MAP4, 10q25.3 near ADRB1) and one locus associated with both traits (2q24.3 near FIGN) which has recently been associated with SBP in east Asians. For three of the novel PP signals, the estimated effect for SBP was opposite to that for DBP, in contrast to the majority of common SBP- and DBP-associated variants which show concordant effects on both traits. These findings indicate novel genetic mechanisms underlying blood pressure variation, including pathways that may differentially influence SBP and DBP.
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Affiliation(s)
- Louise V Wain
- Department of Health Sciences, University of Leicester, Leicester, UK
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Jun JC, Drager LF, Najjar SS, Gottlieb SS, Brown CD, Smith PL, Schwartz AR, Polotsky VY. Effects of sleep apnea on nocturnal free fatty acids in subjects with heart failure. Sleep 2011; 34:1207-13. [PMID: 21886358 PMCID: PMC3157662 DOI: 10.5665/sleep.1240] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
STUDY OBJECTIVES Sleep apnea is common in patients with congestive heart failure, and may contribute to the progression of underlying heart disease. Cardiovascular and metabolic complications of sleep apnea have been attributed to intermittent hypoxia. Elevated free fatty acids (FFA) are also associated with the progression of metabolic, vascular, and cardiac dysfunction. The objective of this study was to determine the effect of intermittent hypoxia on FFA levels during sleep in patients with heart failure. DESIGN AND INTERVENTIONS During sleep, frequent blood samples were examined for FFA in patients with stable heart failure (ejection fraction < 40%). In patients with severe sleep apnea (apnea-hypopnea index = 65.5 ± 9.1 events/h; average low SpO₂ = 88.9%), FFA levels were compared to controls with milder sleep apnea (apnea-hypopnea index = 15.4 ± 3.7 events/h; average low SpO₂ = 93.6%). In patients with severe sleep apnea, supplemental oxygen at 2-4 liters/min was administered on a subsequent night to eliminate hypoxemia. MEASUREMENTS AND RESULTS Prior to sleep onset, controls and patients with severe apnea exhibited a similar FFA level. After sleep onset, patients with severe sleep apnea exhibited a marked and rapid increase in FFA relative to control subjects. This increase persisted throughout NREM and REM sleep exceeding serum FFA levels in control subjects by 0.134 mmol/L (P = 0.0038). Supplemental oxygen normalized the FFA profile without affecting sleep architecture or respiratory arousal frequency. CONCLUSION In patients with heart failure, severe sleep apnea causes surges in nocturnal FFA that may contribute to the accelerated progression of underlying heart disease. Supplemental oxygen prevents the FFA elevation.
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Affiliation(s)
- Jonathan C. Jun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Luciano F. Drager
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Hypertension Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil
| | - Samer S. Najjar
- Heart Failure Service, Washington Hospital Center, Washington, DC
| | - Stephen S. Gottlieb
- Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Cynthia D. Brown
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia, Charlottesville, VA
| | - Philip L. Smith
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alan R. Schwartz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vsevolod Y. Polotsky
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Forman DE, Rich MW, Alexander KP, Zieman S, Maurer MS, Najjar SS, Cleveland JC, Krumholz HM, Wenger NK. Cardiac care for older adults. Time for a new paradigm. J Am Coll Cardiol 2011; 57:1801-10. [PMID: 21527153 DOI: 10.1016/j.jacc.2011.02.014] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 01/27/2011] [Accepted: 02/01/2011] [Indexed: 12/14/2022]
Affiliation(s)
- Daniel E Forman
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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Watson NL, Sutton-Tyrrell K, Rosano C, Boudreau RM, Hardy SE, Simonsick EM, Najjar SS, Launer LJ, Yaffe K, Atkinson HH, Satterfield S, Newman AB. Arterial stiffness and cognitive decline in well-functioning older adults. J Gerontol A Biol Sci Med Sci 2011; 66:1336-42. [PMID: 21768503 DOI: 10.1093/gerona/glr119] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Stiffness of the central arteries in aging may contribute to cerebral microvascular disease independent of hypertension and other vascular risk factors. Few studies of older adults have evaluated the association of central arterial stiffness with longitudinal cognitive decline. METHODS We evaluated associations of aortic pulse wave velocity (centimeters per second), a measure of central arterial stiffness, with cognitive function and decline in 552 participants in the Health, Aging, and Body Composition (Health ABC) study Cognitive Vitality Substudy (mean age ± SD = 73.1 ± 2.7 years, 48% men and 42% black). Aortic pulse wave velocity was assessed at baseline via Doppler-recorded carotid and femoral pulse waveforms. Global cognitive function, verbal memory, psychomotor, and perceptual speed were evaluated over 6 years. RESULTS After adjustment for demographics, vascular risk factors, and chronic conditions, each 1 SD higher aortic pulse wave velocity (389 cm/s) was associated with poorer cognitive function: -0.11 SD for global function (SE = 0.04, p < .01), -0.09 SD for psychomotor speed (SE = 0.04, p = .03), and -0.12 SD for perceptual speed (SE = 0.04, p < .01). Higher aortic pulse wave velocity was also associated with greater decline in psychomotor speed, defined as greater than 1 SD more than the mean change (odds ratio = 1.42 [95% confidence interval = 1.06, 1.90]) but not with verbal memory or longitudinal decline in global function, verbal memory, or perceptual speed. Results were consistent with mixed models of decline in each cognitive test. CONCLUSIONS In well-functioning older adults, central arterial stiffness may contribute to cognitive decline independent of hypertension and other vascular risk factors.
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Affiliation(s)
- Nora L Watson
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15213-3545, USA.
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Madero M, Wassel CL, Peralta CA, Najjar SS, Sutton-Tyrrell K, Fried LF, Boer IHD, Shlipak MG, Newman AB, Hausman D, Sarnak MJ, Kritchevsky SB, Ix JH. Markers of mineral metabolism are not associated with aortic pulse wave velocity in community-living elderly persons: the Health Aging and Body Composition study. Am J Hypertens 2011; 24:755-61. [PMID: 21436791 DOI: 10.1038/ajh.2011.43] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Disorders in mineral metabolism are associated with risk for cardiovascular disease (CVD) events in patients with kidney disease as well as in the general population. This risk is thought to be mediated, in part, through the mechanism of stiffening of the arteries. METHODS The objective of this study was to evaluate the relationships between serum calcium, phosphorus, intact parathyroid hormone (iPTH), and 25-hydroxyvitamin D levels and arterial pulse wave velocity (aPWV) among 2,229 community-dwelling elderly persons participating in the Health Aging and Body Composition (Health ABC) study. RESULTS The mean age of the participants was 72 years; 52% were woman, 39% were black, and 17% had chronic kidney disease (CKD) (estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2)). In parallel unadjusted analyses, the following associations were observed: 2.86% greater aPWV per 12 ng/ml (s.d.) lower 25-hydroxyvitamin D (95% confidence interval -4.38%, -1.31%), 3.04% greater aPWV per 28 pg/ml (s.d.) higher iPTH (95% confidence interval 1.42-4.68%), and 2.37% lower aPWV per 0.5 mg/dl (s.d.) higher phosphorus (95% confidence interval -3.90% to - 0.81%). Except for phosphorus, these associations were attenuated and rendered no longer statistically significant after adjustment for demographic risk factors, clinical site, season, medications and other CVD risk factors. The results were similar in men and women and were not dependent on the presence of CKD. CONCLUSIONS Among well-functioning community-dwelling elderly persons, only serum phosphorus was associated with aPWV; and this association was in the opposite direction of the one hypothesized. Factors other than vascular stiffening may mediate the relationship between disordered mineral metabolism and CVD events in community-living elders.
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