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Yuzefpolskaya M, Bohn B, Ladanyi A, Pinsino A, Braghieri L, Carey MR, Clerkin K, Sayer GT, Latif F, Koji T, Uriel N, Nandakumar R, Uhlemann AC, Colombo PC, Demmer RT. Alterations in Sarcopenia Index are Associated with Inflammation, Gut and Oral Microbiota among Heart Failure, Left Ventricular Assist Device and Heart Transplant Patients. J Heart Lung Transplant 2024:S1053-2498(24)01660-7. [PMID: 38744352 DOI: 10.1016/j.healun.2024.04.069] [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: 11/09/2023] [Revised: 03/28/2024] [Accepted: 04/27/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Sarcopenia, characterized by loss of muscle mass and function, is prevalent in heart failure (HF) and predicts poor outcomes. We investigated alterations in sarcopenia index (SI), a surrogate for skeletal muscle mass, in HF, left ventricular assist device (LVAD) and heart transplant (HT), and assessed its relationship with inflammation and digestive tract (gut and oral) microbiota. METHODS We enrolled 460 HF, LVAD and HT patients. Repeated measures pre/post procedures were obtained prospectively in a subset of LVAD and HT patients. SI (serum Creatinine/Cystatin C) and inflammatory biomarkers (C-reactive protein, interleukin-6, tumor necrosis factor-alpha) were measured in 271 and 622 blood samples, respectively. Gut and saliva microbiota were assessed via 16S rRNA sequencing among 335 stool and 341 saliva samples. Multivariable regression assessed the relationship between SI and i) New York Heart Association class; ii) pre- vs. post-LVAD or HT; iii) biomarkers of inflammation and microbial diversity. RESULTS Median (interquartile range) natural logarithm (ln)-SI was -0.13 (-0.32,0.05). Ln-SI decreased across worsening HF class, further declined at 1-month after LVAD and HT and rebounded over time. Ln-SI was correlated with inflammation (r=-0.28, p<0.01), and gut (r=0.28, p<0.01) and oral microbial diversity (r=0.24, p<0.01), these associations remained significant after multivariable adjustment in the combined cohort but not for all individual cohorts. Presence of the gut taxa Roseburia inulinivorans was associated with increased SI. CONCLUSIONS SI levels decreased in symptomatic HF and remained decreased long-term after LVAD and HT. In the combined cohort, SI levels covaried with inflammation in a similar fashion and significantly related to overall microbial (gut and oral) diversity, including specific taxa compositional changes.
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Affiliation(s)
- Melana Yuzefpolskaya
- Division of Cardiovascular Medicine, Department of Cardiology, New York Presbyterian Hospital, Columbia University, New York, New York.
| | - Bruno Bohn
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, MN, USA
| | - Annamaria Ladanyi
- Division of Cardiovascular Medicine, Department of Cardiology, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Alberto Pinsino
- Division of Cardiovascular Medicine, Department of Cardiology, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Lorenzo Braghieri
- Division of Cardiovascular Medicine, Department of Cardiology, Cleveland Clinic, Cleveland, OH
| | - Matthew R Carey
- Division of Cardiovascular Medicine, Department of Cardiology, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Kevin Clerkin
- Division of Cardiovascular Medicine, Department of Cardiology, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Gabriel T Sayer
- Division of Cardiovascular Medicine, Department of Cardiology, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Farhana Latif
- Division of Cardiovascular Medicine, Department of Cardiology, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Takeda Koji
- Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Nir Uriel
- Division of Cardiovascular Medicine, Department of Cardiology, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Renu Nandakumar
- Biomarkers Core Laboratory, Irving Institute for Clinical and Translational Research, Columbia University Irving Medical Center, New York, New York
| | - Anne-Catrin Uhlemann
- Division of Infectious Diseases and Microbiome and Pathogen Genomics Core, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Paolo C Colombo
- Division of Cardiovascular Medicine, Department of Cardiology, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, MN, USA; Division of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA.
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Farwati M, Braghieri L, Abdulhai FA, Dabbagh M, Alkhalaileh FA, Younis A, Tabaja C, Farwati A, Amin M, Santangeli P, Nakagawa H, Saliba WI, Kanj M, Callahan TD, Bhargava M, Baranowski B, Rickard J, Sroubek J, Lee J, Tchou PJ, Wazni OM, Hussein AA. Cryoballoon pulmonary vein isolation versus radiofrequency ablation of the pulmonary veins and left atrial posterior wall: Patient-reported outcomes. Pacing Clin Electrophysiol 2024; 47:595-602. [PMID: 38523591 DOI: 10.1111/pace.14943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/05/2024] [Accepted: 01/23/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Data are lacking on patient-reported outcomes (PRO) following cryoballoon ablation (CBA) versus radiofrequency ablation (RFA). We sought to evaluate QoL and clinical outcomes of cryoballoon pulmonary vein isolation only (CRYO-PVI-ONLY) versus RFA with PVI and posterior wall isolation (RF-PVI+PWI) in a large prospective PRO registry. METHODS Patients who underwent AF ablation (2013-2016) at our institution were enrolled in an automated, prospectively maintained PRO registry. CRYO-PVI-ONLY patients were matched (1:1) with RF-PVI+PWI patients based on age, gender, and type of AF (paroxysmal vs. persistent). QoL and clinical outcomes were assessed using PRO surveys at baseline and at 1-year. The atrial fibrillation symptom severity scale (AFSSS) was the measure for QoL. Additionally, we assessed patient-reported clinical improvement, arrhythmia recurrence, and AF burden (as indicated by AF frequency and duration scores). RESULTS A total of 296 patients were included (148 in each group, 72% paroxysmal). By PRO, a significant improvement in QoL was observed in the overall study population and was comparable between CRYO-PVI-ONLY and RF-PVI+PWI (baseline median AFSSS of 11.5 and 11; reduced to 2 and 4 at 1 year, respectively; p = 0.44). Similarly, the proportion of patients who reported improvement in their overall QoL and AF related symptoms was high and similar between the study groups [92% (CRYO-PVI-ONLY) vs. 92.8% (RF-PVI+PWI); p = 0.88]. Arrhythmia recurrence was significantly more common in the CRYO-PVI-ONLY group (39.7%) compared to RF-PVI+PWI (27.7 %); p = 0.03. Comparable results were observed in paroxysmal and persistent AF. CONCLUSION CRYO-PVI-ONLY and RF-PVI+PWI resulted in comparable improvements in patient reported outcomes including QoL and AF burden; with RF-PVI+PWI being more effective at reducing recurrences.
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Affiliation(s)
- Medhat Farwati
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lorenzo Braghieri
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Farah A Abdulhai
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marwan Dabbagh
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Firas A Alkhalaileh
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arwa Younis
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chadi Tabaja
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amr Farwati
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mustapha Amin
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pasquale Santangeli
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hiroshi Nakagawa
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid I Saliba
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas D Callahan
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mandeep Bhargava
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Baranowski
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - John Rickard
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jakub Sroubek
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Justin Lee
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patrick J Tchou
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Braghieri L, Olivas-Martinez A, Silvestri EG, Karatasakis A, Li S, Mahr C, Bravo C. The Impact of the 2018 Allocation System Change on Patients Bridged With Durable Left Ventricular Assist Device: An Updated UNOS Registry Analysis. ASAIO J 2024; 70:456-459. [PMID: 38207111 DOI: 10.1097/mat.0000000000002115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Affiliation(s)
- Lorenzo Braghieri
- From the Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - Edwin Grajeda Silvestri
- Department of Internal Medicine, University of Miami Miller School of Medicine, Palm Beach Campus, Atlantis, Florida
| | - Aris Karatasakis
- Division of Cardiology, Department of Internal Medicine, University of Washington Medical Center, Seattle, Washington
| | - Song Li
- Division of Cardiology, Department of Internal Medicine, University of Washington Medical Center, Seattle, Washington
| | - Claudius Mahr
- Division of Cardiology, Department of Internal Medicine, University of Washington Medical Center, Seattle, Washington
| | - Claudio Bravo
- Division of Cardiology, Department of Internal Medicine, University of Washington Medical Center, Seattle, Washington
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Badwan OZ, Braghieri L, Skoza W, Agrawal A, Menon V, Tang WHW. When should we consider SGLT-2 inhibitors in patients with acute decompensated heart failure? Cleve Clin J Med 2024; 91:47-51. [PMID: 38167393 DOI: 10.3949/ccjm.91a.23034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- Osamah Z Badwan
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | | | - Warren Skoza
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Venu Menon
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH; Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH; Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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Braghieri L, Younis A, Tabaja C, Santangeli P, Taigen T, Saliba WI, Wazni OM, Hussein AA. Quality of Life Outcomes of Atrial Fibrillation Ablation in Heart Failure With Preserved or Mildly Reduced Left Ventricular Systolic Function. Am J Cardiol 2023:S0002-9149(23)01414-5. [PMID: 38160919 DOI: 10.1016/j.amjcard.2023.12.030] [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: 10/09/2023] [Revised: 11/27/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Lorenzo Braghieri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
| | - Arwa Younis
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Chadi Tabaja
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Pasquale Santangeli
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Tyler Taigen
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Walid I Saliba
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ayman A Hussein
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
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6
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Hariri E, Matta M, Layoun H, Badwan O, Braghieri L, Owens AP, Burton R, Bhandari R, Mix D, Bartholomew J, Schumick D, Elbadawi A, Kapadia S, Hazen SL, Svensson LG, Cameron SJ. Antiplatelet Therapy, Abdominal Aortic Aneurysm Progression, and Clinical Outcomes. JAMA Netw Open 2023; 6:e2347296. [PMID: 38085542 PMCID: PMC10716735 DOI: 10.1001/jamanetworkopen.2023.47296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
Importance Preclinical studies suggest a potential role for aspirin in slowing abdominal aortic aneurysm (AAA) progression and preventing rupture. Evidence on the clinical benefit of aspirin in AAA from human studies is lacking. Objective To investigate the association of aspirin use with aneurysm progression and long-term clinical outcomes in patients with AAA. Design, Setting, and Participants This was a retrospective, single-center cohort study. Adult patients with at least 2 available vascular ultrasounds at the Cleveland Clinic were included, and patients with history of aneurysm repair, dissection, or rupture were excluded. All patients were followed up for 10 years. Data were analyzed from May 2022 to July 2023. Main Outcomes and Measures Clinical outcomes were time-to-first occurrence of all-cause mortality, major bleeding, or composite of dissection, rupture, and repair. Multivariable-adjusted Cox proportional-hazard regression was used to estimate hazard ratios (HR) for all-cause mortality, and subhazard ratios competing-risk regression using Fine and Gray proportional subhazards regression was used for major bleeding and composite outcome. Aneurysm progression was assessed by comparing the mean annualized change of aneurysm diameter using multivariable-adjusted linear regression and comparing the odds of having rapid progression (annual diameter change >0.5 cm per year) using logistic regression. Results A total of 3435 patients (mean [SD] age 73.7 [9.0] years; 2672 male patients [77.5%]; 120 Asian, Hispanic, American Indian, or Pacific Islander patients [3.4%]; 255 Black patients [7.4%]; 3060 White patients [89.0%]; and median [IQR] follow-up, 4.9 [2.5-7.5] years) were included in the final analyses, of which 2150 (63%) were verified to be taking aspirin by prescription. Patients taking aspirin had a slower mean (SD) annualized change in aneurysm diameter (2.8 [3.0] vs 3.8 [4.2] mm per year; P = .001) and lower odds of having rapid aneurysm progression compared with patients not taking aspirin (adjusted odds ratio, 0.64; 95% CI, 0.49-0.89; P = .002). Aspirin use was not associated with risk of all-cause mortality (adjusted HR [aHR], 0.92; 95% CI, 0.79-1.07; P = .32), nor was aspirin use associated with major bleeding (aHR, 0.88; 95% CI, 0.76-1.03; P = .12), or composite outcome (aHR, 1.16; 95% CI, 0.93-1.45; P = .09) at 10 years. Conclusions In this retrospective study of a clinical cohort of 3435 patients with objectively measured changes in aortic aneurysm growth, aspirin use was significantly associated with slower progression of AAA with a favorable safety profile.
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Affiliation(s)
- Essa Hariri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
- Division of Cardiology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Milad Matta
- Cardiovascular Medicine, Section of Vascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Habib Layoun
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Osamah Badwan
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lorenzo Braghieri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - A. Phillip Owens
- Department of Internal Medicine, Division of Cardiovascular Health and Disease, University of Cincinnati, Ohio
| | - Robert Burton
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rohan Bhandari
- Cardiovascular Medicine, Section of Vascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Doran Mix
- Department of Surgery, Division of Vascular Surgery, University of Rochester Medical Center, New York
| | - John Bartholomew
- Cardiovascular Medicine, Section of Vascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - David Schumick
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute of Case Western Reserve University, Cleveland, Ohio
| | - Ayman Elbadawi
- Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Stanley L. Hazen
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute of Case Western Reserve University, Cleveland, Ohio
- Department of Cardiovascular Medicine, Section of Preventive Cardiology, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lars G. Svensson
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Scott J. Cameron
- Cardiovascular Medicine, Section of Vascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute of Case Western Reserve University, Cleveland, Ohio
- Department of Hematology, Taussig Cancer Institute, Cleveland, Ohio
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Braghieri L, Kaur S, Black CK, Cremer PC, Unai S, Kapadia SR, Mentias A. Endocarditis after Transcatheter Aortic Valve Replacement. J Clin Med 2023; 12:7042. [PMID: 38002656 PMCID: PMC10672470 DOI: 10.3390/jcm12227042] [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: 09/11/2023] [Revised: 10/07/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) use is gaining momentum as the mainstay for the treatment of aortic stenosis compared to surgical aortic valve replacement (SAVR). Unfortunately, TAVR-related infective endocarditis (TAVR-IE) is expected to be detected more and more as a result of the ever-expanding indications in younger patients. Given the overall poor prognosis of TAVR-IE, it is imperative that clinicians familiarize themselves with common presentations, major risk factors, diagnostic pitfalls, therapeutic approaches, and the prevention of TAVR-IE. Herein, we review all of the above in detail with the most updated available literature.
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Affiliation(s)
- Lorenzo Braghieri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (L.B.); (C.K.B.)
| | - Simrat Kaur
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.K.); (P.C.C.); (S.U.); (S.R.K.)
| | - Christopher K. Black
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (L.B.); (C.K.B.)
| | - Paul C. Cremer
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.K.); (P.C.C.); (S.U.); (S.R.K.)
| | - Shinya Unai
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.K.); (P.C.C.); (S.U.); (S.R.K.)
| | - Samir R. Kapadia
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.K.); (P.C.C.); (S.U.); (S.R.K.)
| | - Amgad Mentias
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.K.); (P.C.C.); (S.U.); (S.R.K.)
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Pinsino A, Carey MR, Husain S, Mohan S, Radhakrishnan J, Jennings DL, Nguonly AS, Ladanyi A, Braghieri L, Takeda K, Faillace RT, Sayer GT, Uriel N, Colombo PC, Yuzefpolskaya M. The Difference Between Cystatin C- and Creatinine-Based Estimated GFR in Heart Failure With Reduced Ejection Fraction: Insights From PARADIGM-HF. Am J Kidney Dis 2023; 82:521-533. [PMID: 37086965 DOI: 10.1053/j.ajkd.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/02/2023] [Indexed: 04/24/2023]
Abstract
RATIONALE & OBJECTIVE The clinical implications of the discrepancy between cystatin C (cysC)- and serum creatinine (Scr)-estimated glomerular filtration rate (eGFR) in patients with heart failure (HF) and reduced ejection fraction (HFrEF) are unknown. STUDY DESIGN Post-hoc analysis of randomized trial data. SETTING & PARTICIPANTS 1,970 patients with HFrEF enrolled in PARADIGM-HF with available baseline cysC and Scr measurements. EXPOSURE Intraindividual differences between eGFR based on cysC (eGFRcysC) and Scr (eGFRScr; eGFRdiffcysC-Scr). OUTCOMES Clinical outcomes included the PARADIGM-HF primary end point (composite of cardiovascular [CV] mortality or HF hospitalization), CV mortality, all-cause mortality, and worsening kidney function. We also examined poor health-related quality of life (HRQoL), frailty, and worsening HF (WHF), defined as HF hospitalization, emergency department visit, or outpatient intensification of therapy between baseline and 8-month follow-up. ANALYTICAL APPROACH Fine-Gray subdistribution hazard models and Cox proportional hazards models were used to regress clinical outcomes on baseline eGFRdiffcysC-Scr. Logistic regression was used to investigate the association of baseline eGFRdiffcysC-Scr with poor HRQoL and frailty. Linear regression models were used to assess the association of WHF with eGFRcysC, eGFRScr, and eGFRdiffcysC-Scr at 8-month follow-up. RESULTS Baseline eGFRdiffcysC-Scr was higher than +10 and lower than-10mL/min/1.73m2 in 13.0% and 35.7% of patients, respectively. More negative values of eGFRdiffcysC-Scr were associated with worse outcomes ([sub]hazard ratio per standard deviation: PARADIGM-HF primary end point, 1.18; P=0.008; CV mortality, 1.34; P=0.001; all-cause mortality, 1.39; P<0.001; worsening kidney function, 1.31; P=0.05). For a 1-standard-deviation decrease in eGFRdiffcysC-Scr, the prevalences of poor HRQoL and frailty increased by 29% and 17%, respectively (P≤0.008). WHF was associated with a more pronounced decrease in eGFRcysC than in eGFRScr, resulting in a change in 8-month eGFRdiffcysC-Scr of-4.67mL/min/1.73m2 (P<0.001). LIMITATIONS Lack of gold-standard assessment of kidney function. CONCLUSIONS In patients with HFrEF, discrepancies between eGFRcysC and eGFRScr are common and are associated with clinical outcomes, HRQoL, and frailty. The decline in kidney function associated with WHF is more marked when assessed with eGFRcysC than with eGFRScr. PLAIN-LANGUAGE SUMMARY Kidney function assessment traditionally relies on serum creatinine (Scr) to establish an estimated glomerular filtration rate (eGFR). However, this has been challenged with the introduction of an alternative marker, cystatin C (cysC). Muscle mass and nutritional status have differential effects on eGFR based on cysC (eGFRcysC) and Scr (eGFRScr). Among ambulatory patients with heart failure enrolled in PARADIGM-HF, we investigated the clinical significance of the difference between eGFRcysC and eGFRScr. More negative values (ie, eGFRScr>eGFRcysC) were associated with worse clinical outcomes (including mortality), poor quality of life, and frailty. In patients with progressive heart failure, which is characterized by muscle loss and poor nutritional status, the decline in kidney function was more pronounced when eGFR was estimated using cysC rather than Scr.
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Affiliation(s)
- Alberto Pinsino
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center; Division of Critical Care Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
| | - Matthew R Carey
- Department of Medicine, Columbia University Irving Medical Center
| | - Syed Husain
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center; Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center
| | - Jai Radhakrishnan
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center
| | - Douglas L Jennings
- Department of Pharmacy, Columbia University Irving Medical Center; Department of Pharmacy Practice, Long Island University College of Pharmacy, New York
| | - Austin S Nguonly
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center
| | - Annamaria Ladanyi
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center
| | - Lorenzo Braghieri
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center; Department of Medicine, Cleveland Clinic, Cleveland, OH
| | - Koji Takeda
- Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center
| | | | - Gabriel T Sayer
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center
| | - Nir Uriel
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center
| | - Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center
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Tabaja C, Younis A, Santangeli P, Madden R, Taigen T, Farwati M, Hayashi K, Braghieri L, Rickard J, Klein BM, Paul A, Dresing TJ, Martin DO, Bhargava M, Kanj M, Sroubek J, Nakagawa H, Saliba WI, Wazni OM, Hussein AA. Catheter ablation of atrial fibrillation in elderly and very elderly patients: safety, outcomes, and quality of life. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01659-w. [PMID: 37848806 DOI: 10.1007/s10840-023-01659-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) risk increases with age. We aim to assess the efficacy and safety of catheter ablation in the older population. METHODS All patients undergoing AF ablation (2013-2021) at our institution were enrolled in a prospectively maintained registry. The primary endpoint was AF recurrence. Patients were divided into 3 groups: non-elderly (< 65 years), elderly (65-75 years), and very elderly (> 75 years). Patient surveys at baseline and during follow-up were used to calculate quality of life (QoL) metrics: the AF severity score as well as the AF burden. RESULTS A total of 7020 patients were included (42% non-elderly, 42% elderly, and 16% very elderly). Periprocedural major complications were low (< 1.5%) and similar in all groups besides pericardial effusion which was more frequent with older age and similar between the elderly and very elderly. At 3 years, AF recurrence for persistent AF (PersAF) was highest in the very elderly group (48%), followed by the elderly group (42%), and was the lowest in the non-elderly group (36%). In paroxysmal AF (PAF), there was no difference in AF recurrence between the elderly and non-elderly, while the very elderly remained associated with a significantly increased risk. Multivariable Cox analysis confirmed these findings (PersAF; elderly: HR = 1.23, P = 0.003; very elderly: HR = 1.44, P < 0.001) (PAF; elderly: HR = 1.04, P = 0.62; very elderly: HR = 1.30, P = 0.01). Catheter ablation resulted in a significant improvement in quality of life, irrespective of age group. CONCLUSION Catheter ablation in elderly and very elderly patients is safe, efficacious, and associated with QoL benefits. Overall, major complications were minimal and did not differ significantly between age groups, with the exception of pericardial effusions which were higher in the elderly and very elderly compared to non-elderly adults. Very elderly patients had a higher rate of AF recurrence when compared with elderly or non-elderly patients. Nevertheless, ablation resulted in a remarkable improvement in QoL and a reduction of AF burden and AF symptoms with a similar magnitude, irrespective of age.
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Affiliation(s)
- Chadi Tabaja
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Arwa Younis
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Pasquale Santangeli
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Ruth Madden
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Tyler Taigen
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Medhat Farwati
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Katsuhide Hayashi
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Lorenzo Braghieri
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - John Rickard
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Benjamin M Klein
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Aritra Paul
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Thomas J Dresing
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - David O Martin
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Mandeep Bhargava
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Mohamed Kanj
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Jakub Sroubek
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Hiroshi Nakagawa
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Walid I Saliba
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Oussama M Wazni
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA.
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Badwan O, Mirzai S, Skoza W, Hawk F, Braghieri L, Persits I, Krishnaswamy A, Puri R, Kapadia SR. Clinical outcomes following tricuspid transcatheter edge-to-edge repair with PASCAL: A meta-analysis. Int J Cardiol 2023; 389:131194. [PMID: 37473817 DOI: 10.1016/j.ijcard.2023.131194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/11/2023] [Accepted: 07/14/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Patients with severe tricuspid regurgitation (TR) exhibit high morbidity and mortality. Tricuspid transcatheter edge-to-edge repair (T-TEER) is a rapidly evolving strategy to address the unmet clinical need of severe TR therapies. OBJECTIVE Organize the current body of evidence on outcomes following use of the PASCAL (Edwards Lifesciences) system for T-TEER. METHODS For this meta-analysis, we searched the MEDLINE/PubMed, Embase, and Cochrane databases for keywords ["tricuspid"] and ["transcatheter" or "edge-to-edge"] and ["PASCAL" or "leaflet repair" or "valve repair"] from the database inception until January 11, 2023. Primary outcomes of interest were procedural success, mortality, New York Heart Association (NYHA) functional class, 6-min walking distance (6MWD), and TR severity. RESULTS A total of 549 patients undergoing PASCAL or PASCAL Ace T-TEER were included. The mean age ranged from 71.0 to 80.3 years, with 25.0 to 63.6% females. The follow-up duration ranged from 30 days to 1 year. The success rate was 83.5% (409/490). There was improvement in symptoms based on NYHA classification (at 1- to 6-months; NYHA ≥3 RR 0.27 [95% CI 0.19-0.39]; p < 0.001) and 6MWD (at 1-month; 50.96 [95% CI 32.34-69.59]; p < 0.001) post-procedure. On imaging, there was improvement in TR severity post-procedure (at 1- to 12-months; ≥ severe TR 0.21 [95% CI 0.14-0.31]; p < 0.001), which remained significant with each study removed. CONCLUSION PASCAL for T-TEER is associated with high procedural success rates along with improvements in NYHA functional class, TR severity, 6MWD, and patient-reported outcomes.
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Affiliation(s)
- Osamah Badwan
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States of America
| | - Saeid Mirzai
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States of America
| | - Warren Skoza
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States of America
| | - Fahad Hawk
- Division of Cardiovascular Medicine, University of South Florida College of Medicine, Tampa, FL, United States of America
| | - Lorenzo Braghieri
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States of America
| | - Ian Persits
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States of America
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States of America.
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11
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Braghieri L, Badwan OZ, Reed G, Menon V, Ziada K, Kapadia SR. Dual Antiplatelet Therapy Duration After Percutaneous Coronary Interventions of Left Main Coronary Artery Disease: A Meta-Analysis. Am J Cardiol 2023; 205:422-424. [PMID: 37660668 DOI: 10.1016/j.amjcard.2023.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Lorenzo Braghieri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Osamah Z Badwan
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Grant Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Venu Menon
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Khaled Ziada
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
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12
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Badwan OZ, Skoza W, Mirzai S, Bansal A, Braghieri L, Karmali RH, Nero N, Harb SC, Puri R, Kapadia S. Clinical Outcomes After Caval Valve Implantation for Severe Symptomatic Tricuspid Regurgitation: A Meta-Analysis. Am J Cardiol 2023; 205:84-86. [PMID: 37595412 DOI: 10.1016/j.amjcard.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/18/2023] [Accepted: 07/04/2023] [Indexed: 08/20/2023]
Affiliation(s)
- Osamah Z Badwan
- Departments of Internal Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Warren Skoza
- Departments of Internal Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Saeid Mirzai
- Departments of Internal Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Agam Bansal
- Departments of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lorenzo Braghieri
- Departments of Internal Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rehan H Karmali
- Departments of Internal Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Neil Nero
- Medical Library, Cleveland Clinic Floyd D. Loop Alumni Library, Cleveland, Ohio
| | - Serge C Harb
- Departments of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rishi Puri
- Departments of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir Kapadia
- Departments of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
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13
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Braghieri L, Skoza WA, Badwan OZ, Alvarez P. What is the most appropriate management of patients with acute decompensated heart failure who develop in-hospital hypotension? Cleve Clin J Med 2023; 90:625-631. [PMID: 37783499 DOI: 10.3949/ccjm.90a.22095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Affiliation(s)
| | - Warren A Skoza
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | - Osamah Z Badwan
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | - Paulino Alvarez
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH; Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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14
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Stöhr EJ, Ji R, Mondellini G, Braghieri L, Akiyama K, Castagna F, Pinsino A, Cockcroft JR, Silverman RH, Trocio S, Zatvarska O, Konofagou E, Apostolakis I, Topkara VK, Takayama H, Takeda K, Naka Y, Uriel N, Yuzefpolskaya M, Willey JZ, McDonnell BJ, Colombo PC. Pulsatility and flow patterns across macro- and microcirculatory arteries of continuous-flow left ventricular assist device patients. J Heart Lung Transplant 2023; 42:1223-1232. [PMID: 37098374 PMCID: PMC11078160 DOI: 10.1016/j.healun.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Reduced arterial pulsatility in continuous-flow left ventricular assist devices (CF-LVAD) patients has been implicated in clinical complications. Consequently, recent improvements in clinical outcomes have been attributed to the "artificial pulse" technology inherent to the HeartMate3 (HM3) LVAD. However, the effect of the "artificial pulse" on arterial flow, transmission of pulsatility into the microcirculation and its association with LVAD pump parameters is not known. METHODS The local flow oscillation (pulsatility index, PI) of common carotid arteries (CCAs), middle cerebral arteries (MCAs) and central retinal arteries (CRAs-representing the microcirculation) were quantified by 2D-aligned, angle-corrected Doppler ultrasound in 148 participants: healthy controls, n = 32; heart failure (HF), n = 43; HeartMate II (HMII), n = 32; HM3, n = 41. RESULTS In HM3 patients, 2D-Doppler PI in beats with "artificial pulse" and beats with "continuous-flow" was similar to that of HMII patients across the macro- and microcirculation. Additionally, peak systolic velocity did not differ between HM3 and HMII patients. Transmission of PI into the microcirculation was higher in both HM3 (during the beats with "artificial pulse") and in HMII patients compared with HF patients. LVAD pump speed was inversely associated with microvascular PI in HMII and HM3 (HMII, r2 = 0.51, p < 0.0001; HM3 "continuous-flow," r2 = 0.32, p = 0.0009; HM3 "artificial pulse," r2 = 0.23, p = 0.007), while LVAD pump PI was only associated with microcirculatory PI in HMII patients. CONCLUSIONS The "artificial pulse" of the HM3 is detectable in the macro- and microcirculation but without creating a significant alteration in PI compared with HMII patients. Increased transmission of pulsatility and the association between pump speed and PI in the microcirculation indicate that the future clinical care of HM3 patients may involve individualized pump settings according to the microcirculatory PI in specific end-organs.
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Affiliation(s)
- Eric J Stöhr
- School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, UK; Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York.
| | - Ruiping Ji
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Giulio Mondellini
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Lorenzo Braghieri
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York; Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Koichi Akiyama
- Department of Medicine, Division of Cardiothoracic Surgery, Columbia University Irving Medical Center, New York, New York; Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Francesco Castagna
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York; Cardiology Division, Montefiore Medical Center, New York, New York
| | - Alberto Pinsino
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - John R Cockcroft
- School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, UK; Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Ronald H Silverman
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
| | - Samuel Trocio
- Department of Neurology, Columbia University Irving Medical Center, New York, New York
| | - Oksana Zatvarska
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Elisa Konofagou
- Department of Biomedical Engineering, Columbia University Irving Medical Center, New York, New York
| | - Iason Apostolakis
- Department of Biomedical Engineering, Columbia University Irving Medical Center, New York, New York
| | - Veli K Topkara
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Hiroo Takayama
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Koji Takeda
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Yoshifumi Naka
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Nir Uriel
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Joshua Z Willey
- Department of Neurology, Columbia University Irving Medical Center, New York, New York
| | - Barry J McDonnell
- School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
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15
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Badwan O, Skoza W, Braghieri L, Persits I, Klein AL. When should pharmacologic therapies be used for uremic pericarditis? Cleve Clin J Med 2023; 90:549-554. [PMID: 37657836 DOI: 10.3949/ccjm.90a.23003] [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] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Affiliation(s)
- Osamah Badwan
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | - Warren Skoza
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | | | - Ian Persits
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | - Allan L Klein
- Director, Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH; Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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16
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Tabaja C, Younis A, Santageli P, Farwati M, Braghieri L, Nakagawa H, Saliba WI, Madden R, Bouscher P, Kanj M, Callahan TD, Martin D, Bhargava M, Chung M, Baranowski B, Nakhla S, Sroubek J, Lee J, Taigen T, Wazni OM, Hussein AA. Impact of obesity on catheter ablation of atrial fibrillation: Patient characteristics, procedural complications, outcomes, and quality of life. J Cardiovasc Electrophysiol 2023; 34:1648-1657. [PMID: 37493505 PMCID: PMC11078572 DOI: 10.1111/jce.15987] [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: 04/19/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Obesity is a well-known risk factor for atrial fibrillation (AF). We aim to evaluate the effect of baseline obesity on procedural complications, AF recurrence, and symptoms following catheter ablation (CA). METHODS All consecutive patients undergoing AF ablation (2013-2021) at our center were enrolled in a prospective registry. The study included all consecutive patients with available data on body mass index (BMI). Primary endpoint was AF recurrence based on electrocardiographic documentation. Patients were categorized into five groups according to their baseline BMI. Patients survey at baseline and at follow-up were used to calculate AF symptom severity score (AFSS) as well as AF burden (mean of AF duration score and AF frequency score; scale 0: no AF to 10: continuous and 9 frequencies/durations in between). Patients were scheduled for follow-up visits with 12-lead electrocardiogram at 3, 6, and 12 months after ablation, and every 6 months thereafter. RESULTS A total of 5841 patients were included (17% normal weight, 34% overweight, 27% Class I, 13% Class II, and 9% Class III obesity). Major procedural complications were low (1.5%) among all BMI subgroups. At 3 years AF recurrence was the highest in Class III obesity patients (48%) followed by Class II (43%), whereas Class I, normal, and overweight had similar results with lower recurrence (35%). In multivariable analyses, Class III obesity (BMI ≥ 40) was independently associated with increased risk for AF recurrence (hazard ratio, 1.30; confidence interval, 1.06-1.60; p = .01), whereas other groups had similar risk in comparison to normal weight. Baseline AFSS was lowest in normal weight, and highest in Obesity-III, median (interquartile range) 10 (5-16) versus 15 (10-21). In all groups, CA resulted in a significant improvement in their AFSS with a similar magnitude among the groups. At follow-up, AF burden was minimal and did not differ significantly between the groups. CONCLUSION AF ablation is safe with a low complication rate across all BMI groups. Morbid obesity (BMI ≥ 40) was significantly associated with reduced AF ablation success. However, ablation resulted in improvement in QoL including reduction of the AFSS, and AF burden regardless of BMI.
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Affiliation(s)
- Chadi Tabaja
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arwa Younis
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pasquale Santageli
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Medhat Farwati
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lorenzo Braghieri
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hiroshi Nakagawa
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid I Saliba
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ruth Madden
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patricia Bouscher
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas D Callahan
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - David Martin
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mandeep Bhargava
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mina Chung
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Baranowski
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shady Nakhla
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jakub Sroubek
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Justin Lee
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tyler Taigen
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Braghieri L, Badwan OZ, Skoza W, Fares M, Menon V. Evaluating troponin elevation in patients with chronic kidney disease and suspected acute coronary syndrome. Cleve Clin J Med 2023; 90:483-489. [PMID: 37527874 DOI: 10.3949/ccjm.90a.23012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
Many patients with chronic kidney disease have chronically elevated cardiac troponin levels, and if they present with symptoms suggesting an acute coronary syndrome, it is often difficult to determine if this is the correct diagnosis. This article briefly reviews the major challenges in diagnosing acute coronary syndrome in patients with chronic kidney disease, describes the mechanisms and prognostic significance of troponin elevation in chronic kidney disease, and provides a diagnostic algorithm to risk-stratify patients with chronic kidney disease who have troponin elevation and suspected acute coronary syndrome.
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Affiliation(s)
| | - Osamah Z Badwan
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | - Warren Skoza
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | - Maan Fares
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH; Associate Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Venu Menon
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH; Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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Akintoye E, Saijo Y, Braghieri L, Badwan O, Patel H, Dabbagh MM, El Dahdah J, Jellis CL, Desai MY, Rodriguez LL, Grimm RA, Griffin BP, Popović ZB. Impact of Age and Sex on Left Ventricular Remodeling in Patients With Aortic Regurgitation. J Am Coll Cardiol 2023; 81:1474-1487. [PMID: 37045517 PMCID: PMC9982944 DOI: 10.1016/j.jacc.2023.02.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/17/2023] [Accepted: 02/09/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Current guidelines for aortic regurgitation (AR) recommend the same linear left ventricular (LV) dimension for intervention regardless of age and sex. OBJECTIVES The purpose of this study was to evaluate the impact of age and sex on the degree of LV remodeling and outcomes. METHODS We included consecutive patients with severe AR who were serially monitored by echocardiogram between 2010 and 2016. The 2 main endpoints were as follows: 1) LV end-systolic volume indexed to body surface area (LVESVi) and LV end-diastolic volume indexed to body surface area; and 2) adverse events (AE). We evaluated the longitudinal rate of LV remodeling and determined the association between LV volume and AE by age and sex. RESULTS A total of 525 adult patients (26% women) with a median echocardiogram follow-up of 2.0 years (IQR: 1.0-3.6 years) were included. At baseline, older patients (age ≥60 years) had smaller LV volumes compared with younger patients (age <60 years), eg, the mean LVESVi was 27.3 mL/m2 vs 32.3 mL/m2, respectively. Similarly, women had smaller LV volumes compared with men (mean LVESVi was 23.3 mL/m2 vs 32.4 mL/m2). On serial evaluation, older patients and women maintained smaller LV volumes compared with younger patients and men, respectively. There were 210 (40%) AE during follow-up. The optimal discriminatory threshold for AE varies by age and sex, eg, the LVESVi threshold was highest for young men (50 mL/m2), intermediate for older men (35 mL/m2), and lowest for women (27 mL/m2). CONCLUSIONS On serial evaluation, older patients and women with chronic AR maintained smaller LV volumes than younger patients and men, respectively, and develop AE at lower LV volumes.
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Affiliation(s)
- Emmanuel Akintoye
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA. https://twitter.com/eakintoyeMD
| | - Yoshihito Saijo
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lorenzo Braghieri
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Osamah Badwan
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hardik Patel
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - M Marwan Dabbagh
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joseph El Dahdah
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christine L Jellis
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA. https://twitter.com/ChrisJellisMD
| | - Milind Y Desai
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA. https://twitter.com/DesaiMilindY
| | - L Leonardo Rodriguez
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Richard A Grimm
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA. https://twitter.com/BrianGriffinMD
| | - Zoran B Popović
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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Honnekeri B, Karmali R, Syed AB, Majid M, Alzahrani A, Braghieri L, Badwan O, Akintoye E, Klein AL. A CLINICAL ROLLER-COASTER: TRAUMATIC MYOPERICARDITIS FOLLOWING AN AMUSEMENT PARK RIDE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04075-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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20
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Nadeem A, Karmali R, Chen V, Majid M, Sajja H, Badwan O, Braghieri L, Akintoye E, Klein AL. CONSTRICTIVE CALCIFIC MYOPERICARDITIS AS A RARE COMPLICATION OF CYSTIC FIBROSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04107-4] [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: 03/06/2023]
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21
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Lumish HS, Cagliostro B, Braghieri L, Bohn B, Mondellini GM, Antler K, Feldman V, Kleet A, Murphy J, Tiburcio M, Fidlow K, Jennings D, Sayer GT, Takeda K, Naka Y, Demmer RT, Aaron JG, Uriel N, Colombo PC, Yuzefpolskaya M. Driveline Infection in Left Ventricular Assist Device Patients: Effect of Standardized Protocols, Pathogen Type, and Treatment Strategy. ASAIO J 2022; 68:1450-1458. [PMID: 35239537 PMCID: PMC9469917 DOI: 10.1097/mat.0000000000001690] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Driveline infection (DLI) is common after left ventricular assist device (LVAD). Limited data exist on DLI prevention and management. We investigated the impact of standardized driveline care initiatives, specific pathogens, and chronic antibiotic suppression (CAS) on DLI outcomes. 591 LVAD patients were retrospectively categorized based on driveline care initiatives implemented at our institution (2009-2019). Era (E)1: nonstandardized care; E2: standardized driveline care protocol; E3: addition of marking driveline exit site; E4: addition of "no shower" policy. 87(15%) patients developed DLI at a median (IQR) of 403(520) days. S. aureus and P. aeruginosa were the most common pathogens. 31 (36%) of DLI patients required incision and drainage (I&D) and 5 (5.7%) device exchange. P. aeruginosa significantly increased risk for initial I&D (HR 2.7, 95% CI, 1.1-6.3) and recurrent I&D or death (HR 4.2, 95% CI, 1.4-12.5). Initial I&D was associated with a significant increased risk of death (HR 2.92 (1.33-6.44); P = 0.008) when compared to patients who did not develop DLI. Implementation of standardized driveline care protocol (E2) was associated with increased 2-year freedom from DLI compared to nonstandardized care (HR 0.36, 95% CI, 0.2-0.6, P < 0.01). Additional preventive strategies (E3&E4) showed no further reduction in DLI rates. 57(65%) DLI patients received CAS, 44% of them required escalation to intravenous antibiotics and/or I&D. Presence of P. aeruginosa DLI markedly increased risk for I&D or death. Conditional survival of patients progressing to I&D is diminished. Standardized driveline care protocol was associated with a significant reduction in DLI, while additional preventive strategies require further testing.
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Affiliation(s)
- Heidi S. Lumish
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Barbara Cagliostro
- Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center, New York, New York
| | - Lorenzo Braghieri
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Bruno Bohn
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Giulio M. Mondellini
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Karen Antler
- Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center, New York, New York
| | - Vivian Feldman
- Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center, New York, New York
| | - Audrey Kleet
- Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center, New York, New York
| | - Jennifer Murphy
- Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center, New York, New York
| | - Melie Tiburcio
- Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center, New York, New York
| | - Kathryn Fidlow
- Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center, New York, New York
| | - Douglas Jennings
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Gabriel T. Sayer
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Koji Takeda
- Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center, New York, New York
| | - Yoshifumi Naka
- Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center, New York, New York
| | - Ryan T. Demmer
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Justin G. Aaron
- Department of Medicine Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York
| | - Nir Uriel
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Paolo C. Colombo
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
- Paolo C. Colombo and Melana Yuzefpolskaya contributed equally to this study
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
- Paolo C. Colombo and Melana Yuzefpolskaya contributed equally to this study
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22
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Braghieri L, Jennings DL, Bohn B, Habal M, Pinsino A, Mondellini GM, Ladanyi A, Latif F, Clerkin K, Restaino S, Kurlansky P, Takeda K, Naka Y, Demmer RT, Sayer GT, Uriel N, Colombo PC, Yuzefpolskaya M. Temporal shifts in safety and efficacy profile of mycophenolate mofetil 2 g versus 3 g daily early after heart transplantation. Pharmacotherapy 2022; 42:697-706. [DOI: 10.1002/phar.2724] [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] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/10/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Lorenzo Braghieri
- Department of Internal Medicine Cleveland Clinic Cleveland Ohio USA
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
| | - Douglas L. Jennings
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
| | - Bruno Bohn
- Division of Epidemiology and Community Health University of Minnesota Minneapolis Minnesota USA
| | - Marlena Habal
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
| | - Alberto Pinsino
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
| | - Giulio M. Mondellini
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
| | - Annamaria Ladanyi
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
| | - Farhana Latif
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
| | - Kevin Clerkin
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
| | - Susan Restaino
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
| | - Paul Kurlansky
- Department of Surgery, Division of Cardiac Surgery Columbia University New York New York USA
| | - Koji Takeda
- Department of Surgery, Division of Cardiac Surgery Columbia University New York New York USA
| | - Yoshifumi Naka
- Department of Surgery, Division of Cardiac Surgery Columbia University New York New York USA
| | - Ryan T. Demmer
- Division of Epidemiology and Community Health University of Minnesota Minneapolis Minnesota USA
- Department of Epidemiology, Mailman School of Public Health Columbia University Irving Medical Center New York New York USA
| | - Gabriel T. Sayer
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
| | - Nir Uriel
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
| | - Paolo C. Colombo
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
| | - Melana Yuzefpolskaya
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
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23
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Pinsino A, Fabbri M, Braghieri L, Bohn B, Gaudig AJ, Kim A, Takeda K, Naka Y, Sayer GT, Uriel N, Demmer RT, Faillace RT, Husain SA, Mohan S, Colombo PC, Yuzefpolskaya M. The difference between cystatin C- and creatinine-based assessment of kidney function in acute heart failure. ESC Heart Fail 2022; 9:3139-3148. [PMID: 35762103 DOI: 10.1002/ehf2.13975] [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: 08/06/2021] [Revised: 04/03/2022] [Accepted: 05/08/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS Acute heart failure (HF) is associated with muscle mass loss, potentially leading to overestimation of kidney function using serum creatinine-based estimated glomerular filtration rate (eGFRsCr ). Cystatin C-based eGFR (eGFRCysC ) is less muscle mass dependent. Changes in the difference between eGFRCysC and eGFRsCr may reflect muscle mass loss. We investigated the difference between eGFRCysC and eGFRsCr and its association with clinical outcomes in acute HF patients. METHODS AND RESULTS A post hoc analysis was performed in 841 patients enrolled in three trials: Diuretic Optimization Strategy Evaluation (DOSE), Renal Optimization Strategies Evaluation (ROSE), and Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARRESS-HF). Intra-individual differences between eGFRs (eGFRdiff ) were calculated as eGFRCysC -eGFRsCr at serial time points during HF admission. We investigated associations of (i) change in eGFRdiff between baseline and day 3 or 4 with readmission-free survival up to day 60; (ii) index hospitalization length of stay (LOS) and readmission with eGFRdiff at day 60. eGFRCysC reclassified 40% of samples to more advanced kidney dysfunction. Median eGFRdiff was -4 [-11 to 1.5] mL/min/1.73 m2 at baseline, became more negative during admission and remained significantly different at day 60. The change in eGFRdiff between baseline and day 3 or 4 was associated with readmission-free survival (adjusted hazard ratio per standard deviation decrease in eGFRdiff : 1.14, P = 0.035). Longer index hospitalization LOS and readmission were associated with more negative eGFRdiff at day 60 (both P ≤ 0.026 in adjusted models). CONCLUSIONS In acute HF, a marked difference between eGFRCysC and eGFRsCr is present at baseline, becomes more pronounced during hospitalization, and is sustained at 60 day follow-up. The change in eGFRdiff during HF admission and eGFRdiff at day 60 are associated with clinical outcomes.
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Affiliation(s)
- Alberto Pinsino
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA.,Division of Critical Care Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Matteo Fabbri
- Department of Medicine, NYC Health + Hospitals/Jacobi, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lorenzo Braghieri
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Bruno Bohn
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Andrea Kim
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Koji Takeda
- Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Yoshifumi Naka
- Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Gabriel T Sayer
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Nir Uriel
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Robert T Faillace
- Department of Medicine, NYC Health + Hospitals/Jacobi, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Syed A Husain
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, NY, USA
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
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Braghieri L, Bohn B, Jennings D, Mondellini G, Kim A, Ladanyi A, Clerkin K, Latif F, Takeda K, Naka Y, Sayer G, Uriel N, Demmer R, Colombo P, Yuzefpolskaya M. Association of Gut Bacterial Beta Glucuronidase Activity with Mycophenolate Mofetil Induced Cytopenia. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.287] [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: 10/18/2022] Open
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Pinsino A, Braghieri L, Nguonly A, Carey M, Mohan S, Kim A, Mondellini G, Jennings D, Naka Y, Takeda K, Faillace R, Sayer G, Uriel N, Colombo P, Yuzefpolskaya M. Cystatin C- versus Creatinine-Based Assessment of Kidney Function in Advanced Heart Failure: Insights from REVIVAL. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.142] [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: 10/18/2022] Open
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26
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Bohn B, Pinsino A, Braghieri L, Kim A, Nandakumar R, Uhlemann A, Takeda K, Naka Y, Sayer G, Uriel N, Paster B, Demmer R, Colombo P, Yuzefpolskaya M. Association Between Oral Microbiome, Inflammation, Endotoxemia, and Heart Failure Severity. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1646] [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] Open
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27
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Bravo CA, Fried JA, Willey JZ, Javaid A, Mondellini GM, Braghieri L, Lumish H, Topkara VK, Kaku Y, Witer L, Takayama H, Takeda K, Sayer G, Uriel N, Demmer RT, Naka Y, Yuzefpolskaya M, Colombo PC. Presence of Intracardiac Thrombus at the Time of Left Ventricular Assist Device Implantation Is Associated With an Increased Risk of Stroke and Death. J Card Fail 2021; 27:1367-1373. [PMID: 34161806 DOI: 10.1016/j.cardfail.2021.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Heart failure predisposes to intracardiac thrombus (ICT) formation. There are limited data on the prevalence and impact of preexisting ICT on postoperative outcomes in left ventricular assist device patients. We examined the risk for stroke and death in this patient population. METHODS AND RESULTS We retrospectively studied patients who were implanted with HeartMate (HM) II or HM3 between February 2009 and March 2019. Preoperative transthoracic echocardiograms, intraoperative transesophageal echocardiograms and operative reports were reviewed to identify ICT. There were 525 patients with a left ventricular assist device (median age 60.6 years, 81.8% male, 372 HMII and 151 HM3) included in this analysis. An ICT was identified in 44 patients (8.4%). During the follow-up, 43 patients experienced a stroke and 55 died. After multivariable adjustment, presence of ICT increased the risk for the composite of stroke or death at 6-month (hazard ratio [HR] 1.82, 95% confidence interval [CI] 1.00-3.33, P = .049). Patients with ICT were also at higher risk for stroke (HR 2.45, 95% CI 1.14-5.28, P = .021) and death (HR 2.36, 95% CI 1.17-4.79 P = .016) at 6 months of follow-up. CONCLUSIONS The presence of ICT is an independent predictor of stroke and death at 6 months after left ventricular assist device implantation. Additional studies are needed to help risk stratify and optimize the perioperative management of this patient population.
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Affiliation(s)
- Claudio A Bravo
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York; Department of Medicine, Division of Cardiology, University of Washington, Washington
| | - Justin A Fried
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York
| | - Joshua Z Willey
- Department of Neurology, Columbia University, New York, New York
| | - Azka Javaid
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York
| | - Giulio M Mondellini
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York
| | - Lorenzo Braghieri
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York
| | - Heidi Lumish
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York
| | - Veli K Topkara
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York
| | - Yuji Kaku
- Department of Surgery, Division of Cardiac Surgery, Columbia University, New York, New York
| | - Lucas Witer
- Department of Surgery, Division of Cardiac Surgery, Columbia University, New York, New York
| | - Hiroo Takayama
- Department of Surgery, Division of Cardiac Surgery, Columbia University, New York, New York
| | - Koji Takeda
- Department of Surgery, Division of Cardiac Surgery, Columbia University, New York, New York
| | - Gabriel Sayer
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York
| | - Nir Uriel
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York
| | - Ryan T Demmer
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York; Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Yoshifumi Naka
- Department of Surgery, Division of Cardiac Surgery, Columbia University, New York, New York
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York
| | - Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York.
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28
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Yuzefpolskaya M, Bohn B, Javaid A, Mondellini GM, Braghieri L, Pinsino A, Onat D, Cagliostro B, Kim A, Takeda K, Naka Y, Farr M, Sayer GT, Uriel N, Nandakumar R, Mohan S, Colombo PC, Demmer RT. Levels of Trimethylamine N-Oxide Remain Elevated Long Term After Left Ventricular Assist Device and Heart Transplantation and Are Independent From Measures of Inflammation and Gut Dysbiosis. Circ Heart Fail 2021; 14:e007909. [PMID: 34129361 DOI: 10.1161/circheartfailure.120.007909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Trimethylamine N-oxide (TMAO)-a gut-derived metabolite-is elevated in heart failure (HF) and linked to poor prognosis. We investigated variations in TMAO in HF, left ventricular assist device (LVAD), and heart transplant (HT) and assessed its relation with inflammation, endotoxemia, oxidative stress, and gut dysbiosis. METHODS We enrolled 341 patients. TMAO, CRP (C-reactive protein), IL (interleukin)-6, TNF-α (tumor necrosis factor alpha), ET-1 (endothelin-1), adiponectin, lipopolysaccharide, soluble CD14, and isoprostane were measured in 611 blood samples in HF (New York Heart Association class I-IV) and at multiple time points post-LVAD and post-HT. Gut microbiota were assessed via 16S rRNA sequencing among 327 stool samples. Multivariable regression models were used to assess the relationship between TMAO and (1) New York Heart Association class; (2) pre- versus post-LVAD or post-HT; (3) biomarkers of inflammation, endotoxemia, oxidative stress, and microbial diversity. RESULTS ln-TMAO was lower among HF New York Heart Association class I (1.23 [95% CI, 0.52-1.94] µM) versus either class II, III, or IV (1.99 [95% CI, 1.68-2.30], 1.97 [95% CI, 1.71-2.24], and 2.09 [95% CI, 1.83-2.34] µM, respectively; all P<0.05). In comparison to class II-IV, ln-TMAO was lower 1 month post-LVAD (1.58 [95% CI, 1.32-1.83] µM) and 1 week and 1 month post-HT (0.97 [95% CI, 0.60-1.35] and 1.36 [95% CI, 1.01-1.70] µM). ln-TMAO levels in long-term LVAD (>6 months: 1.99 [95% CI, 1.76-2.22] µM) and HT (>6 months: 1.86 [95% CI, 1.66-2.05] µM) were not different from symptomatic HF. After multivariable adjustments, TMAO was not associated with biomarkers of inflammation, endotoxemia, oxidative stress, or microbial diversity. CONCLUSIONS TMAO levels are increased in symptomatic HF patients and remain elevated long term after LVAD and HT. TMAO levels were independent from measures of inflammation, endotoxemia, oxidative stress, and gut dysbiosis.
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Affiliation(s)
- Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology (M.Y., A.J., G.M.M., L.B., A.P., D.O., A.K., M.F., G.T.S., N.U., P.C.C.), Columbia University Irving Medical Center, New York, NY
| | - Bruno Bohn
- Biomarkers Core Laboratory, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (B.B., R.T.D.)
| | - Azka Javaid
- Department of Medicine, Division of Cardiology (M.Y., A.J., G.M.M., L.B., A.P., D.O., A.K., M.F., G.T.S., N.U., P.C.C.), Columbia University Irving Medical Center, New York, NY
| | - Giulio M Mondellini
- Department of Medicine, Division of Cardiology (M.Y., A.J., G.M.M., L.B., A.P., D.O., A.K., M.F., G.T.S., N.U., P.C.C.), Columbia University Irving Medical Center, New York, NY
| | - Lorenzo Braghieri
- Department of Medicine, Division of Cardiology (M.Y., A.J., G.M.M., L.B., A.P., D.O., A.K., M.F., G.T.S., N.U., P.C.C.), Columbia University Irving Medical Center, New York, NY
| | - Alberto Pinsino
- Department of Medicine, Division of Cardiology (M.Y., A.J., G.M.M., L.B., A.P., D.O., A.K., M.F., G.T.S., N.U., P.C.C.), Columbia University Irving Medical Center, New York, NY
| | - Duygu Onat
- Department of Medicine, Division of Cardiology (M.Y., A.J., G.M.M., L.B., A.P., D.O., A.K., M.F., G.T.S., N.U., P.C.C.), Columbia University Irving Medical Center, New York, NY
| | - Barbara Cagliostro
- Dpartment of Surgery, Division of Cardiac Surgery (B.C., K.T., Y.N.), Columbia University Irving Medical Center, New York, NY
| | - Andrea Kim
- Department of Medicine, Division of Cardiology (M.Y., A.J., G.M.M., L.B., A.P., D.O., A.K., M.F., G.T.S., N.U., P.C.C.), Columbia University Irving Medical Center, New York, NY
| | - Koji Takeda
- Dpartment of Surgery, Division of Cardiac Surgery (B.C., K.T., Y.N.), Columbia University Irving Medical Center, New York, NY
| | - Yoshifumi Naka
- Dpartment of Surgery, Division of Cardiac Surgery (B.C., K.T., Y.N.), Columbia University Irving Medical Center, New York, NY
| | - Maryjane Farr
- Department of Medicine, Division of Cardiology (M.Y., A.J., G.M.M., L.B., A.P., D.O., A.K., M.F., G.T.S., N.U., P.C.C.), Columbia University Irving Medical Center, New York, NY
| | - Gabriel T Sayer
- Department of Medicine, Division of Cardiology (M.Y., A.J., G.M.M., L.B., A.P., D.O., A.K., M.F., G.T.S., N.U., P.C.C.), Columbia University Irving Medical Center, New York, NY
| | - Nir Uriel
- Department of Medicine, Division of Cardiology (M.Y., A.J., G.M.M., L.B., A.P., D.O., A.K., M.F., G.T.S., N.U., P.C.C.), Columbia University Irving Medical Center, New York, NY
| | - Renu Nandakumar
- Biomarkers Core Laboratory, Irving Institute for Clinical and Translational Research (R.N.)
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology (S.M.), Columbia University Irving Medical Center, New York, NY.,Department of Epidemiology, Mailman School of Public Health (S.M., R.T.D.), Columbia University Irving Medical Center, New York, NY
| | - Paolo C Colombo
- Department of Medicine, Division of Cardiology (M.Y., A.J., G.M.M., L.B., A.P., D.O., A.K., M.F., G.T.S., N.U., P.C.C.), Columbia University Irving Medical Center, New York, NY
| | - Ryan T Demmer
- Department of Epidemiology, Mailman School of Public Health (S.M., R.T.D.), Columbia University Irving Medical Center, New York, NY.,Biomarkers Core Laboratory, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (B.B., R.T.D.)
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29
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Yuzefpolskaya M, Lumish HS, Javaid A, Cagliostro B, Mondellini GM, Bohn B, Sweat A, Onat D, Braghieri L, Takeda K, Naka Y, Sayer GT, Uriel N, Aaron JG, Montassier E, Demmer RT, Colombo PC. Association of preoperative infections, nasal Staphylococcus aureus colonization and gut microbiota with left ventricular assist device outcomes. Eur J Heart Fail 2021; 23:1404-1415. [PMID: 33964186 DOI: 10.1002/ejhf.2215] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 01/22/2021] [Revised: 03/29/2021] [Accepted: 05/04/2021] [Indexed: 01/05/2023] Open
Abstract
AIMS Infections are common following left ventricular assist device (LVAD) implantation and predict adverse events. Infections are frequent prior to LVAD implantation although their impact on postoperative outcomes remains unknown. Gut and nasal microbial imbalance may predispose to mucosal colonization with pathogens. Herein, we investigated the predictive role of pre-LVAD infections, and explored the association of nasal Staphylococcus aureus (SA) colonization and gut microbiota, on postoperative outcomes. METHODS AND RESULTS Overall, 254 LVAD patients were retrospectively categorized based on pre-LVAD infection status: Group 1, bacterial/fungal bloodstream infection (BSI); Group 2, other bacterial/fungal; Group 3, viral; and Group 4, no infection. In a subset of patients, nasal SA colonization (n = 140) and pre-LVAD stool (n = 25) were analysed using 16S rRNA sequencing. A total of 75 (29%) patients had a pre-LVAD infection [Group 1: 22 (29%); Group 2: 41 (55%); Group 3: 12 (16%)]. Pre-LVAD BSIs were independent predictors of 1-year postoperative mortality and infections [Group 1 vs. 4: hazard ratio (HR) 2.70, P = 0.036 vs. HR 1.8, P = 0.046]. In an unadjusted analysis, pre-LVAD infections other than BSIs, INTERMACS profile ≤2, higher serum creatinine, lower serum albumin and nasal SA colonization were also significantly associated with postoperative infections. Patients with early post-LVAD infections exhibited decreased microbial diversity (P < 0.05). CONCLUSIONS Pre-LVAD infections are common. BSIs independently predict postoperative mortality and infections. Additional studies are needed to confirm our findings that pre-LVAD SA nasal colonization and gut microbial composition can help stratify patients' risk for infectious complications after LVAD implantation.
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Affiliation(s)
- Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Heidi S Lumish
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Azka Javaid
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Barbara Cagliostro
- Division of Cardiac Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Giulio M Mondellini
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Bruno Bohn
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Austin Sweat
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Duygu Onat
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Lorenzo Braghieri
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Koji Takeda
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Yoshifumi Naka
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Gabriel T Sayer
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Justin G Aaron
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Emmanuel Montassier
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, USA.,Université de Nantes, Microbiotas Hosts Antibiotics and Bacterial Resistances (MiHAR), and Department of Emergency Medicine, CHU de Nantes, Nantes, France
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
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30
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Stöhr EJ, Ji R, Akiyama K, Mondellini G, Braghieri L, Pinsino A, Cockcroft JR, Yuzefpolskaya M, Amlani A, Topkara VK, Takayama H, Naka Y, Uriel N, Takeda K, Colombo PC, McDonnell BJ, Willey JZ. Cerebral vasoreactivity in HeartMate 3 patients. J Heart Lung Transplant 2021; 40:786-793. [PMID: 34134913 DOI: 10.1016/j.healun.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 05/04/2021] [Accepted: 05/09/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND While rates of stroke have declined with the HeartMate3 (HM3) continuous- flow (CF) left ventricular assist device (LVAD), the impact of non-pulsatile flow and artificial pulse physiology on cerebrovascular function is not known. We hypothesized that improved hemodynamics and artificial pulse physiology of HM3 patients would augment cerebrovascular metabolic reactivity (CVR) compared with HeartMate II (HMII) CF-LVAD and heart failure (HF) patients. METHODS Mean, peak systolic and diastolic flow velocities (MFV, PSV, MinFV, respectively) and cerebral pulsatility index were determined in the middle cerebral artery (MCA) before and after a 30 sec breath-hold challenge in 90 participants: 24 healthy controls; 30 HF, 15 HMII, and 21 HM3 patients. RESULTS In HM3 patients, breath-holding increased MFV (Δ8 ± 10 cm/sec, p < .0001 vs baseline) to levels similar to HF patients (Δ9 ± 8 cm/sec, p > .05), higher than HMII patients (Δ2 ± 8 cm/sec, p < .01) but lower than healthy controls (Δ13 ± 7 cm/sec, p < .05). CF-LVAD altered the proportion of systolic and diastolic flow responses as reflected by a differential cerebral pulsatility index (p = .03). Baseline MFV was not related to CVR (r2 = 0.0008, p = .81). However, CF-LVAD pump speed was strongly inversely associated with CVR in HM II (r2 = 0.51, p = .003) but not HM3 patients (r2 = 0.01, p = .65). CONCLUSIONS Compared with HMII, HM3 patients have a significantly improved CVR. However, CVR remains lower in HM3 and HF patients than in healthy controls, therefore suggesting that changes in cerebral hemodynamics are not reversed by CF-LVAD therapy. Further research on the mechanisms and the long-term impact of altered cerebral hemodynamics in this unique patient population are warranted.
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Affiliation(s)
- Eric J Stöhr
- School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom; Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, New York.
| | - Ruiping Ji
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, New York
| | - Koichi Akiyama
- Department of Medicine, Division of Cardiac, Vascular & Thoracic Surgery, Columbia University Irving Medical Center, New York City, New York; Department of Anesthesia, Yodogawa Christian Hospital, Osaka City, Osaka, Japan
| | - Giulio Mondellini
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, New York
| | - Lorenzo Braghieri
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, New York
| | - Alberto Pinsino
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, New York
| | - John R Cockcroft
- School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom; Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, New York
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, New York
| | - Amrin Amlani
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, New York
| | - Veli K Topkara
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, New York
| | - Hiroo Takayama
- Department of Medicine, Division of Cardiac, Vascular & Thoracic Surgery, Columbia University Irving Medical Center, New York City, New York
| | - Yoshifumi Naka
- Department of Medicine, Division of Cardiac, Vascular & Thoracic Surgery, Columbia University Irving Medical Center, New York City, New York
| | - Nir Uriel
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, New York
| | - Koji Takeda
- Department of Medicine, Division of Cardiac, Vascular & Thoracic Surgery, Columbia University Irving Medical Center, New York City, New York
| | - Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, New York
| | - Barry J McDonnell
- School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Joshua Z Willey
- Department of Neurology, Columbia University Irving Medical Center, New York City, New York
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31
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Brener MI, Hamid NB, Fried JA, Masoumi A, Raikhelkar J, Kanwar MK, Pahuja M, Mondellini GM, Braghieri L, Majure DT, Colombo PC, Yuzefpolskaya M, Sayer GT, Uriel N, Burkhoff D. Right Ventricular Pressure-Volume Analysis During Left Ventricular Assist Device Speed Optimization Studies: Insights Into Interventricular Interactions and Right Ventricular Failure. J Card Fail 2021; 27:991-1001. [PMID: 33989781 DOI: 10.1016/j.cardfail.2021.04.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 02/05/2021] [Revised: 03/30/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Interventricular interaction, which refers to the impact of left ventricular (LV) function on right ventricular (RV) function and vice versa, has been implicated in the pathogenesis of RV failure in LV assist device (LVAD) recipients. We sought to understand more about interventricular interaction by quantifying changes in the RV systolic and diastolic function with varying LVAD speeds. METHODS AND RESULTS Four patients (ages 22-69 years, 75% male, and 25% with ischemic cardiomyopathy) underwent a protocolized hemodynamic ramp test within 12 months of LVAD implantation where RV pressure-volume loops were recorded with a conductance catheter. The end-systolic PV relationship and end-diastolic PV relationship were compared using the V20 and V10 indices (volumes at which end-systolic PV relationship and end-diastolic PV relationship reach a pressure of 20 and 10 mm Hg, respectively). The ∆V20 and ∆V10 refer to the change in V20 and V10 from the minimum to maximum LVAD speeds. RV PV loops demonstrated variable changes in systolic and diastolic function with increasing LVAD speed. The end-systolic PV relationship changed in 1 patient (patient 2, ∆V20 = 23.5 mL), reflecting a decrease in systolic function with increased speed, and was unchanged in 3 patients (average ∆V20 = 7.4 mL). The end-diastolic PV relationship changed with increasing speed in 3 of 4 patients (average ∆V10 = 12.5 mL), indicating an increase in ventricular compliance, and remained unchanged in one participant (patient 1; ∆V10 = 4.0 mL). CONCLUSIONS Interventricular interaction can improve RV compliance and impair systolic function, but the overall effect on RV performance in this pilot investigation is heterogeneous. Further research is required to understand which patient characteristics and hemodynamic parameters influence the net impact of interventricular interaction.
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Affiliation(s)
- Michael I Brener
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital in New York, New York, New York.
| | - Nadira B Hamid
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital in New York, New York, New York
| | - Justin A Fried
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital in New York, New York, New York
| | - Amirali Masoumi
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital in New York, New York, New York
| | - Jayant Raikhelkar
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital in New York, New York, New York
| | - Manreet K Kanwar
- Cardiovascular Institute at Alleghany Health Network in Pittsburgh, Pennsylvania
| | - Mohit Pahuja
- Division of Cardiology, MedStar Georgetown University/Washington Hospital Center in Washington, DC
| | - Giulio M Mondellini
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital in New York, New York, New York
| | - Lorenzo Braghieri
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital in New York, New York, New York
| | - David T Majure
- Division of Cardiology, Weill Cornell University-New York Presbyterian Hospital in New York, New York
| | - Paolo C Colombo
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital in New York, New York, New York
| | - Melana Yuzefpolskaya
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital in New York, New York, New York
| | - Gabriel T Sayer
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital in New York, New York, New York
| | - Nir Uriel
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital in New York, New York, New York
| | - Daniel Burkhoff
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital in New York, New York, New York; Cardiovascular Research Foundation in New York, New York
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32
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Braghieri L, Pinsino A, Bohn B, Takeda K, Naka Y, Sayer G, Uriel N, Demmer R, Colombo P, Yuzefpolskaya M. The Association of Sarcopenia with Gut Dysbiosis and Inflammation in Heart Failure, LVAD and Heart Transplant Patients. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1795] [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: 11/24/2022] Open
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33
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Gaudig A, Pinsino A, Braghieri L, Wang Y, Mondellini G, Hastie J, Panzer O, Takeda K, Naka Y, Sayer G, Uriel N, Yuzefpolskaya M, Colombo P. Non-Invasive Estimation of Pulse Pressure in HeartMate 3 Patients. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.327] [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] Open
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34
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Braghieri L, Pinsino A, Bohn B, Mondellini G, Takeda K, Naka Y, Sayer G, Uriel N, Demmer R, Colombo P, Yuzefpolskaya M. The Association of Renal Dysfunction with Gut Dysbiosis in Heart Failure, LVAD and Heart Transplant Patients - A Mediation Analysis. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1796] [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: 11/27/2022] Open
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35
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Mondellini G, Qi J, Braghieri L, Pinsino A, Kim A, Melie T, Feldman V, Takeda K, Naka Y, Sayer G, Uriel N, Diaz I, Yuzefpolskaya M, Hoffman K, Colombo P. Effects of ACE Inhibitors, Angiotensin Receptor Blockers and Angiotensin Receptor-Neprilysin Inhibitors on Survival Free from Gastrointestinal Bleeding in HeartMate 3 Patients - A Marginal Structural Modeling Analysis. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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36
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Lumish H, Chaudhary E, Cagliostro B, Javaid A, Mondellini G, Braghieri L, Sweat A, Murphy J, Pinsino A, Takeda K, Naka Y, Sayer G, Uriel N, Aaron J, Colombo P, Yuzefpolskaya M. Pseudomonas aeruginosa Infection Predicts Need for Surgical Incision and Drainage in LVAD Patients with Driveline Infection. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1935] [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: 11/25/2022] Open
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37
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Braghieri L, Pinsino A, Mondellini G, Finnigan K, Takeda K, Naka Y, Clerkin K, Habal M, Latif F, Farr M, Sayer G, Uriel N, Colombo P, Yuzefpolskaya M, Jennings D. Effect of Mycophenolate Mofetil Dosing on 6-month Risk of Acute Cellular Rejection, Leukopenia and CMV Viremia in Heart Transplant. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.369] [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] Open
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38
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Alishetti S, Braghieri L, Jennings DL, Uriel N, Colombo PC, Yuzefpolskaya M. Angiotensin receptor neprilysin inhibitor use in patients with left ventricular assist devices: A single-center experience. Int J Artif Organs 2021; 45:118-120. [PMID: 33467950 DOI: 10.1177/0391398821989066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Though left ventricular assist devices (LVADs) are an increasingly common therapy for ACC/AHA Stage D heart failure, the optimal medical therapy for patients with LVADs is not known. We sought to evaluate the safety and efficacy of angiotensin receptor neprilysin inhibitor (ARNi) therapy in our single center LVAD patient experience. We evaluated patients implanted with LVADs at Columbia University Irving Medical Center between August 2010 and May 2019, and who were treated with an ARNi for at least 3 months. Thirty patients met this criteria. Eighteen (60%) patients transitioned to an ARNi from an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB), while all were on a beta blocker (BB) at the time of ARNi initiation. The primary outcome, NT-proBNP levels at time of initiation and 3 and 6 month follow up, significantly decreased from a median of 1265 pg/mL at initiation to 750 pg/mL at 3 months and 764 pg/mL at 6 months (p = 0.01). No significant change was seen in serum creatinine, BUN, or potassium levels.
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Affiliation(s)
- Shudhanshu Alishetti
- Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Lorenzo Braghieri
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Douglas L Jennings
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York, NY, USA.,Arnold and Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, New York, NY, USA
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York, NY, USA
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39
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Trancuccio A, Mazzanti A, Kukavica D, Marino M, Monteforte N, Bloise R, Braghieri L, Memmi M, Morini M, Napolitano C, Priori S. Mutation site-specific risk profile in patients with Type 1 Long QT Syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Type 1 Long QT Syndrome (LQT1) is an arrhythmogenic disorder, caused by loss-of-function mutations on KCNQ1 gene, coding for Kv7.1 potassium channel. Although LQT1 is described as the most benign form of LQTS, patients still experience arrhythmic events and there is an unmet need for personalized risk stratification. Attempts have been made to correlate the location of mutations with outcome, but the results are unequivocal.
Purpose
We provide in the present study a new mutation site-specific risk profile obtained from a large cohort of LQT1 patients.
Methods
We gathered data on 963 patients with the diagnosis of LQT1 and divided the Kv7.1 channel into 5 functional regions: the N-terminus (NT), the voltage sensor (VS, including transmembrane segments S1 to S4), the cytoplasmic loops (CL), the pore (PO, including the transmembrane segments S5, S6 and the S5-S6 extracellular linker), the C-terminus (CT).
Results
We studied 963 LQT1 patients: 518 (54%) females; average age 20±17 years; mean QTc at baseline ECG 465±38ms. During a mean follow-up of 8±7 years, 172 (18%) patients experienced arrhythmic events: 31 (3%) experienced one or more cardiac arrests, while 141 (15%) experienced one or more syncopal spells. We identified 188 different variants in the KCNQ1 gene, with the following distribution: 15 (8%) in the NT, 33 (18%) in the VS, 27 (14%) in the CL, 43 (23%) in the PO, 70 (37%) in the CT. The frequency of pathogenic variants per number of amino acids (a.a.) was higher in the CL region, as compared to the other domains (1 mutation every 1.4 a.a.). The duration of QTc interval was significantly longer for patients with mutations in the PO region (473±40 ms) and in the CL region (468±38 ms) as compared to the other regions (p<0.01).
Importantly, in a multivariate analysis PO and CL regions were associated with a higher probability of experiencing arrhythmic events (OR 2.89, 95% CI 1.95–4.29, p=0.019 and OR 1.61, 95% CI 1.0–2.49, p=0.05, respectively. Figure) than the other regions. Interestingly, the risk was independent from QTc interval duration.
Conclusions
Mutations affecting the PO and the CL region of the Kv7.1. channel are associated with a higher probability of experiencing arrhythmic events. This finding is clinically relevant, because it will allow for a more personalized, mutation site-specific risk stratification.
Mutation site and arrhythmic events
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Italian Ministry of Research and University Dipartimenti di Eccellenza 2018–2022 grant to the Molecular Medicine Department (University of Pavia)
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Affiliation(s)
| | | | | | - M Marino
- ICS Maugeri - IRCCS, Pavia, Italy
| | | | - R Bloise
- ICS Maugeri - IRCCS, Pavia, Italy
| | | | - M Memmi
- ICS Maugeri - IRCCS, Pavia, Italy
| | - M Morini
- ICS Maugeri - IRCCS, Pavia, Italy
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40
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Brailovsky Y, Javaid A, Mondellini G, Braghieri L, Tiburcio M, Uriel N, Sayer G, Topkara V, Takeda K, Naka Y, Demmer R, Yuzefpolskaya M, Colombo P. Elevated Outpatient C-Reactive Protein Independently Predicts Stroke and Gastrointestinal Bleeding in LVAD Patients. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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41
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Hupf J, Onat D, Javaid A, Mondellini G, Braghieri L, Clerkin K, Griffin J, Latif F, Restaino S, Habal M, Farr M, Takeda K, Naka Y, Sayer G, Uriel N, Demmer R, Colombo P, Yuzefpolskaya M. Association of Plasma Trimethylamine-N-oxide and Serum Endothelin-1 with Cardiac Allograft Vasculopathy in Heart Transplant Recipients. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.888] [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: 10/24/2022] Open
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42
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Brailovsky Y, Mondellini G, Javaid A, Braghieri L, Kleet A, Shargarodskaya R, Raikhelkar J, Pineda M, Fried J, Kim D, Takeda K, Naka Y, Sayer G, Uriel N, Goldsmith R, Colombo P, Yuzefpolskaya M. Pre LVAD CPET as Predictor of INTERMACS Profile and Early Outcomes Post LVAD. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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43
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Brailovsky Y, Javaid A, Mondellini G, Braghieri L, Murphy J, Uriel N, Sayer G, Topkara V, Takeda K, Naka Y, Demmer R, Yuzefpolskaya M, Colombo P. Elevated Outpatient C-Reactive Protein Independently Predicts All-Cause Mortality in LVAD Recipients. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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44
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Mondellini G, Pinsino A, Braghieri L, Javaid A, Lin E, Cagliostro B, Pineda M, Fried J, Topkara V, Takeda K, Naka Y, Sayer G, Uriel N, Radhakrishnan J, Demmer R, Colombo P, Yuzefpolskaya M. Serum Cystatin C as a Predictor of Early Outcomes and Long-Term Mortality in Contemporary LVAD Patients. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.763] [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: 11/27/2022] Open
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45
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Carillo CB, Fried J, Mondellini G, Javaid A, Lumish H, Willey J, Topkara V, Braghieri L, Kaku Y, Witer L, Takayama H, Takeda K, Naka Y, Uriel N, Yuzefpolskaya M, Colombo P. Pre-Operative Intracardiac Thrombus is Associated with Increased Risk of Stroke and Death in CF-LVAD Patients. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1079] [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: 10/24/2022] Open
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46
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Braghieri L, Mondellini G, Javaid A, Kim A, Fried J, Masoumi A, Topkara V, Antler K, Sayer G, Uriel N, Takayama H, Naka Y, Takeda K, Colombo P, Yuzefpolskaya M. Upfront RVAD Strategy and Early Clinical Outcomes in LVAD Patients. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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47
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Jennings D, Pinsino A, Mahoney I, Sweat A, Mondellini G, Braghieri L, Hupf J, Gaine M, Latif F, Restaino S, Clerkin K, Topkara V, Farr M, Takeda K, Naka Y, Sayer G, Uriel N, Colombo P, Yuzefpolskaya M. Use of Serum Cystatin C versus Creatinine for Estimation of Renal Function and Valganciclovir Dosing in Heart Transplant Recipients. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.869] [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: 10/24/2022] Open
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48
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Alishetti S, Mondellini G, Braghieri L, Javaid A, Antler K, Tiburcio M, Takeda K, Naka Y, Sayer G, Uriel N, Demmer R, Colombo P, Yuzefpolskaya M, Jennings D. Angiotensin Receptor Neprilysin Inhibition in Patients with Left Ventricular Assist Devices. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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49
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Mazzanti A, Maragna R, Vacanti G, Monteforte N, Bloise R, Marino M, Braghieri L, Gambelli P, Memmi M, Pagan E, Morini M, Malovini A, Ortiz M, Sacilotto L, Bellazzi R, Monserrat L, Napolitano C, Bagnardi V, Priori SG. Interplay Between Genetic Substrate, QTc Duration, and Arrhythmia Risk in Patients With Long QT Syndrome. J Am Coll Cardiol 2018; 71:1663-1671. [DOI: 10.1016/j.jacc.2018.01.078] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/31/2018] [Accepted: 01/31/2018] [Indexed: 12/16/2022]
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