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Schechter MA, Watson MJ, Feger BJ, Southerland KW, Mishra R, Dibernardo LR, Kuchibhatla M, Schroder JN, Daneshmand MA, Patel CB, Rogers JG, Milano CA, Bowles DE. Elevated Cardiac Troponin I in Preservation Solution Is Associated With Primary Graft Dysfunction. J Card Fail 2015; 22:158-62. [PMID: 26365053 DOI: 10.1016/j.cardfail.2015.08.339] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 07/27/2015] [Accepted: 08/20/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although primary graft dysfunction (PGD) is a leading cause of mortality and morbidity early post-heart transplant, relatively little is known regarding mechanisms involved in PGD development. METHODS AND RESULTS We examined the relationship between cardiac troponin I (cTnI) concentrations in the preservation solution from 43 heart transplant procedures and the development of PGD. Donor hearts were flushed with cold preservation solution (University of Wisconsin [UW] or Custodiol) and stored in the same solution. cTnI concentrations were measured utilizing the i-STAT System and normalized to left ventricular mass. Recipient medical records were reviewed to determine PGD according to the 2014 ISHLT consensus conference. Nineteen patients developed PGD following cardiac transplantation. For both UW and Custodiol, normalized cTnI levels were significantly increased (P = .031 and .034, respectively) for those cases that developed PGD versus no PGD. cTnI levels correlated with duration of ischemic time in the UW group, but not for the Custodiol group. Donor age and donor cTnI (obtained prior to organ procurement) did not correlate with preservation cTnI levels in either UW or Custodiol. CONCLUSIONS Increased preservation solution cTnI is associated with the development of PGD suggesting preservation injury may be a dominant mechanism for the development of PGD.
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Affiliation(s)
- Matthew A Schechter
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael J Watson
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Bryan J Feger
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Kevin W Southerland
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Rajashree Mishra
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Louis R Dibernardo
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Maragatha Kuchibhatla
- Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina; Center of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
| | - Jacob N Schroder
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Mani A Daneshmand
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Chetan B Patel
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Joseph G Rogers
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Carmelo A Milano
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Dawn E Bowles
- Department of Surgery, Duke University Medical Center, Durham, North Carolina.
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102
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Felker GM, Mentz RJ, Adams KF, Cole RT, Egnaczyk GF, Patel CB, Fiuzat M, Gregory D, Wedge P, O’Connor CM, Udelson JE, Konstam MA. Tolvaptan in Patients Hospitalized With Acute Heart Failure. Circ Heart Fail 2015; 8:997-1005. [DOI: 10.1161/circheartfailure.115.002259] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- G. Michael Felker
- From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (G.M.F., R.J.M., C.B.P., M.F., C.M.O’C.); Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill (K.F.A.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (R.T.C.); The Heart and Vascular Center, The Christ Hospital, Cincinnati, OH (G.F.E.); Cardiovascular Clinical Science Foundation, Boston, MA (D.G., P.W.); and The Cardiovascular Center,
| | - Robert J. Mentz
- From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (G.M.F., R.J.M., C.B.P., M.F., C.M.O’C.); Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill (K.F.A.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (R.T.C.); The Heart and Vascular Center, The Christ Hospital, Cincinnati, OH (G.F.E.); Cardiovascular Clinical Science Foundation, Boston, MA (D.G., P.W.); and The Cardiovascular Center,
| | - Kirkwood F. Adams
- From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (G.M.F., R.J.M., C.B.P., M.F., C.M.O’C.); Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill (K.F.A.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (R.T.C.); The Heart and Vascular Center, The Christ Hospital, Cincinnati, OH (G.F.E.); Cardiovascular Clinical Science Foundation, Boston, MA (D.G., P.W.); and The Cardiovascular Center,
| | - Robert T. Cole
- From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (G.M.F., R.J.M., C.B.P., M.F., C.M.O’C.); Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill (K.F.A.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (R.T.C.); The Heart and Vascular Center, The Christ Hospital, Cincinnati, OH (G.F.E.); Cardiovascular Clinical Science Foundation, Boston, MA (D.G., P.W.); and The Cardiovascular Center,
| | - Gregory F. Egnaczyk
- From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (G.M.F., R.J.M., C.B.P., M.F., C.M.O’C.); Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill (K.F.A.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (R.T.C.); The Heart and Vascular Center, The Christ Hospital, Cincinnati, OH (G.F.E.); Cardiovascular Clinical Science Foundation, Boston, MA (D.G., P.W.); and The Cardiovascular Center,
| | - Chetan B. Patel
- From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (G.M.F., R.J.M., C.B.P., M.F., C.M.O’C.); Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill (K.F.A.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (R.T.C.); The Heart and Vascular Center, The Christ Hospital, Cincinnati, OH (G.F.E.); Cardiovascular Clinical Science Foundation, Boston, MA (D.G., P.W.); and The Cardiovascular Center,
| | - Mona Fiuzat
- From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (G.M.F., R.J.M., C.B.P., M.F., C.M.O’C.); Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill (K.F.A.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (R.T.C.); The Heart and Vascular Center, The Christ Hospital, Cincinnati, OH (G.F.E.); Cardiovascular Clinical Science Foundation, Boston, MA (D.G., P.W.); and The Cardiovascular Center,
| | - Douglas Gregory
- From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (G.M.F., R.J.M., C.B.P., M.F., C.M.O’C.); Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill (K.F.A.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (R.T.C.); The Heart and Vascular Center, The Christ Hospital, Cincinnati, OH (G.F.E.); Cardiovascular Clinical Science Foundation, Boston, MA (D.G., P.W.); and The Cardiovascular Center,
| | - Patricia Wedge
- From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (G.M.F., R.J.M., C.B.P., M.F., C.M.O’C.); Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill (K.F.A.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (R.T.C.); The Heart and Vascular Center, The Christ Hospital, Cincinnati, OH (G.F.E.); Cardiovascular Clinical Science Foundation, Boston, MA (D.G., P.W.); and The Cardiovascular Center,
| | - Christopher M. O’Connor
- From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (G.M.F., R.J.M., C.B.P., M.F., C.M.O’C.); Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill (K.F.A.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (R.T.C.); The Heart and Vascular Center, The Christ Hospital, Cincinnati, OH (G.F.E.); Cardiovascular Clinical Science Foundation, Boston, MA (D.G., P.W.); and The Cardiovascular Center,
| | - James E. Udelson
- From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (G.M.F., R.J.M., C.B.P., M.F., C.M.O’C.); Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill (K.F.A.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (R.T.C.); The Heart and Vascular Center, The Christ Hospital, Cincinnati, OH (G.F.E.); Cardiovascular Clinical Science Foundation, Boston, MA (D.G., P.W.); and The Cardiovascular Center,
| | - Marvin A. Konstam
- From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (G.M.F., R.J.M., C.B.P., M.F., C.M.O’C.); Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill (K.F.A.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (R.T.C.); The Heart and Vascular Center, The Christ Hospital, Cincinnati, OH (G.F.E.); Cardiovascular Clinical Science Foundation, Boston, MA (D.G., P.W.); and The Cardiovascular Center,
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103
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Stewart GC, Kittleson MM, Cowger JA, Johnson FL, Patel CB, Mountis MM, Patel PC, Rame JE, Testani J, Guglin ME, Teuteberg JJ, Stevenson LW. Who wants a left ventricular assist device for ambulatory heart failure? Early insights from the MEDAMACS screening pilot. J Heart Lung Transplant 2015; 34:1630-3. [PMID: 26321249 DOI: 10.1016/j.healun.2015.07.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 06/30/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Garrick C Stewart
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michelle M Kittleson
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Chetan B Patel
- Division of Cardiology, Duke University, Durham, North Carolina
| | - Maria M Mountis
- Division of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Parag C Patel
- Division of Cardiology, University of Texas Southwestern, Dallas, Texas
| | - J Eduardo Rame
- Heart and Vascular Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey Testani
- Heart and Vascular Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maya E Guglin
- Division of Cardiology, University of South Florida, Tampa, Florida
| | - Jeffrey J Teuteberg
- Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lynne W Stevenson
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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104
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Kiernan MS, Joseph SM, Katz JN, Kilic A, Rich JD, Tallman MP, Van Buren P, Lyons JJ, Bethea B, Eckman P, Gosev I, Lee SS, Soleimani B, Takayama H, Patel CB, Uriel N. Sharing the care of mechanical circulatory support: collaborative efforts of patients/caregivers, shared-care sites, and left ventricular assist device implanting centers. Circ Heart Fail 2015; 8:629-35. [PMID: 25991805 DOI: 10.1161/circheartfailure.114.001767] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Michael S Kiernan
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.).
| | - Susan M Joseph
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Jason N Katz
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Ahmet Kilic
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Jonathan D Rich
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Mark P Tallman
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Peter Van Buren
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - James J Lyons
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Brian Bethea
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Peter Eckman
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Igor Gosev
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Sangjin S Lee
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Behzad Soleimani
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Hiroo Takayama
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Chetan B Patel
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Nir Uriel
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
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Cooper LB, Lu D, Mentz RJ, Rogers JG, Milano CA, Felker GM, Schroder JN, Hernandez AF, Patel CB. Cardiac Transplantation for Older Patients: Characteristics and Outcomes in the Septuagenarian Population. J Card Fail 2015. [DOI: 10.1016/j.cardfail.2015.06.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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106
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Krishnamurthy Y, Cooper LB, Lu D, Schroder JN, Rogers JG, Milano CA, Hernandez AF, Patel CB. Trends and Outcomes of Patients with Adult Congenital Heart Disease With Pulmonary Hypertension Listed for Orthotopic Heart Transplantation in the United Network for Organ Sharing Database. J Card Fail 2015. [DOI: 10.1016/j.cardfail.2015.06.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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107
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Meza JM, Krishnamurthy Y, Blue L, Schroder J, Patel CB, Milano CA, Daneshmand MA. Long Term Support of Acute, Refractory Cardiogenic Shock with an Extracorporeal, Continuous Flow Ventricular Assist Device: A Seven Year Experience. J Card Fail 2015. [DOI: 10.1016/j.cardfail.2015.06.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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108
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Clement ME, Maziarz EK, Schroder JN, Patel CB, Perfect JR. Scedosporium apiosermum infection of the "Native" valve: Fungal endocarditis in an orthotopic heart transplant recipient. Med Mycol Case Rep 2015; 9:34-6. [PMID: 26288748 PMCID: PMC4534754 DOI: 10.1016/j.mmcr.2015.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 11/17/2022] Open
Abstract
Scedosporium apiospermum is an increasingly appreciated pathogen in immunosuppressed patients. We present a case of S. apiospermum endocarditis in a 70-year-old male who had undergone orthotopic heart transplant. Echocardiogram demonstrated a 1.4 cm tricuspid valve vegetation. He underwent valve replacement, complicated by fatal massive post-operative haemorrhage. Valve cultures grew S. apiospermum. To our knowledge, our case is the first reported instance of endocarditis caused by S. apiospermum in a recipient of a cardiac transplant.
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Affiliation(s)
- Meredith E Clement
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC USA
| | - Eileen K Maziarz
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC USA
| | - Jacob N Schroder
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Chetan B Patel
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - John R Perfect
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC USA
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109
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Affiliation(s)
- Robert W McGarrah
- From Division of Cardiology, Department of Medicine (R.W.M., T.A., C.B.P.), Duke Molecular Physiology Institute (R.W.M.), Duke Clinical Research Institute (T.A., C.B.P.), and Division of Medical Genetics (D.D.K.), Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Tariq Ahmad
- From Division of Cardiology, Department of Medicine (R.W.M., T.A., C.B.P.), Duke Molecular Physiology Institute (R.W.M.), Duke Clinical Research Institute (T.A., C.B.P.), and Division of Medical Genetics (D.D.K.), Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Dwight D Koeberl
- From Division of Cardiology, Department of Medicine (R.W.M., T.A., C.B.P.), Duke Molecular Physiology Institute (R.W.M.), Duke Clinical Research Institute (T.A., C.B.P.), and Division of Medical Genetics (D.D.K.), Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Chetan B Patel
- From Division of Cardiology, Department of Medicine (R.W.M., T.A., C.B.P.), Duke Molecular Physiology Institute (R.W.M.), Duke Clinical Research Institute (T.A., C.B.P.), and Division of Medical Genetics (D.D.K.), Department of Pediatrics, Duke University Medical Center, Durham, NC.
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110
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Krishnamoorthy A, Tonks RW, Adams PA, Felker GM, Patel CB, Mentz RJ. Enrollment in Heart Failure Clinical Trials: Insights Into Which Entry Criteria Exclude Patients. J Card Fail 2015; 21:608-9. [PMID: 25921523 DOI: 10.1016/j.cardfail.2015.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 04/04/2015] [Accepted: 04/17/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Arun Krishnamoorthy
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
| | - Robert W Tonks
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Patricia A Adams
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - G Michael Felker
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Chetan B Patel
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Robert J Mentz
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
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111
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Menachem JN, Swaminathan AC, Bashore TM, Ward CC, Rogers JG, Milano CA, Patel CB. Initial Experience of Left Ventricular Assist Device Support for Adult Patients with Transposition of the Great Vessels. CONGENIT HEART DIS 2015; 10:382-6. [DOI: 10.1111/chd.12264] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Jonathan N. Menachem
- Department of Internal Medicine; Division of Cardiology; Hospital of the University of Pennsylvania; Philadelphia Pa USA
| | - Aparna C. Swaminathan
- Department of Internal Medicine; Division of Cardiothoracic Surgery; Division of Cardiology; Duke University Medical Center; Durham NC USA
| | - Thomas M. Bashore
- Department of Internal Medicine; Division of Cardiothoracic Surgery; Division of Cardiology; Duke University Medical Center; Durham NC USA
| | - Cary C. Ward
- Department of Internal Medicine; Division of Cardiothoracic Surgery; Division of Cardiology; Duke University Medical Center; Durham NC USA
| | - Joseph G. Rogers
- Department of Internal Medicine; Division of Cardiothoracic Surgery; Division of Cardiology; Duke University Medical Center; Durham NC USA
| | - Carmelo A. Milano
- Department of Internal Medicine; Division of Cardiothoracic Surgery; Division of Cardiology; Duke University Medical Center; Durham NC USA
| | - Chetan B. Patel
- Department of Internal Medicine; Division of Cardiothoracic Surgery; Division of Cardiology; Duke University Medical Center; Durham NC USA
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112
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Ganapathi AM, Hirji SA, Wang A, Patel CB, Gaca JG, Schroder JN. Bridge to Long-Term Mechanical Circulatory Support With a Left Ventricular Assist Device: Novel Use of Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2015; 99:e91-3. [DOI: 10.1016/j.athoracsur.2014.12.087] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 12/03/2014] [Accepted: 12/16/2014] [Indexed: 10/23/2022]
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113
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Schechter MA, Patel CB, Blue LJ, Welsby I, Rogers JG, Schroder JN, Milano CA. Improved early survival with a nonsternotomy approach for continuous-flow left ventricular assist device replacement. Ann Thorac Surg 2014; 99:561-6. [PMID: 25499477 DOI: 10.1016/j.athoracsur.2014.08.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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] [Received: 03/20/2014] [Revised: 08/06/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Even in the modern era of continuous-flow left ventricular assist devices (CF LVADs), device replacement may be required. Nonsternotomy (NS) approaches are being used more commonly for replacement procedures. Outcomes after this less invasive approach compared with those after a reoperative sternotomy (RS) have not been extensively studied. Furthermore, the clinical impact of concurrent cardiac procedures during device replacement has not been examined. METHODS From 2005 to 2013, all consecutive implantable LVAD procedures were reviewed, and those using CF devices as both the initial and replacement device were identified. These CF LVAD replacement procedures were divided into those using an RS and those using an NS approach. Periprocedural morbidity and mortality were compared between the groups. RESULTS A total of 42 CF LVAD replacements were performed in 39 patients, with 20 using an RS approach and 22 using an NS approach. Eleven of the 20 replacement procedures performed by RS included a concurrent cardiac procedure. Relative to the RS cohort, the NS approach was associated with shorter cardiopulmonary bypass time, reduced length of mechanical ventilation, decreased transfusion requirements, less inotropic support, decreased incidence of right ventricular (RV) dysfunction, and shorter intensive care unit (ICU) and overall hospital stays. An NS approach was also associated with improved 30- and 90-day survival (100% versus 79.0% in the RS group; p = 0.048). RS replacement procedures appeared to be associated with increased morbidity, regardless of whether they included concurrent cardiac procedures. CONCLUSIONS Patients who did not require an RS approach and who underwent CF LVAD replacement through an NS approach had improved survival and reduced morbidity compared with those who required an RS.
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Affiliation(s)
- Matthew A Schechter
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Chetan B Patel
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Laura J Blue
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Ian Welsby
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Joseph G Rogers
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jacob N Schroder
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Carmelo A Milano
- Department of Surgery, Duke University Medical Center, Durham, North Carolina.
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114
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Mentz RJ, Tulsky JA, Granger BB, Anstrom KJ, Adams PA, Dodson GC, Fiuzat M, Johnson KS, Patel CB, Steinhauser KE, Taylor DH, O’Connor CM, Rogers JG. The palliative care in heart failure trial: rationale and design. Am Heart J 2014; 168:645-651.e1. [PMID: 25440791 DOI: 10.1016/j.ahj.2014.07.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 07/24/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The progressive nature of heart failure (HF) coupled with high mortality and poor quality of life mandates greater attention to palliative care as a routine component of advanced HF management. Limited evidence exists from randomized, controlled trials supporting the use of interdisciplinary palliative care in HF. METHODS PAL-HF is a prospective, controlled, unblinded, single-center study of an interdisciplinary palliative care intervention in 200 patients with advanced HF estimated to have a high likelihood of mortality or rehospitalization in the ensuing 6 months. The 6-month PAL-HF intervention focuses on physical and psychosocial symptom relief, attention to spiritual concerns, and advanced care planning. The primary end point is health-related quality of life measured by the Kansas City Cardiomyopathy Questionnaire and the Functional Assessment of Chronic Illness Therapy with Palliative Care Subscale score at 6 months. Secondary end points include changes in anxiety/depression, spiritual well-being, caregiver satisfaction, cost and resource utilization, and a composite of death, HF hospitalization, and quality of life. CONCLUSIONS PAL-HF is a randomized, controlled clinical trial that will help evaluate the efficacy and cost effectiveness of palliative care in advanced HF using a patient-centered outcome as well as clinical and economic end points.
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115
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Patel CB, DeVore AD, Felker GM, Wojdyla DM, Hernandez AF, Milano CA, O'Connor CM, Rogers JG. Characteristics and outcomes of patients with heart failure and discordant findings by right-sided heart catheterization and cardiopulmonary exercise testing. Am J Cardiol 2014; 114:1059-64. [PMID: 25212547 DOI: 10.1016/j.amjcard.2014.07.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 07/02/2014] [Accepted: 07/02/2014] [Indexed: 11/25/2022]
Abstract
There are limited data integrating findings on right-sided cardiac catheterization and cardiopulmonary exercise testing in ambulatory patients with heart failure. In this study, 187 outpatients with HF referred to the Duke Medical Center for consideration of advanced HF therapies were retrospectively evaluated. All patients had undergone right-sided cardiac catheterization and cardiopulmonary exercise testing; the median cardiac index (CI) was 2.0 L/min/m2 (interquartile range 1.7 to 2.3), and the median peak oxygen consumption was 11.3 ml/kg/min (interquartile range 9.2 to 13.8). Despite aggressive medical therapy, medical management had failed in 97 patients (52%) at 18 months, defined as left ventricular assist device implantation, cardiac transplantation, or death. After multivariate adjustment, factors associated with failure of optimal medical management included percentage achieved of predicted peak oxygen consumption, low CI (i.e., <2 L/min/m2), left ventricular size, and exercise time. Patients with discordant findings on right-sided cardiac catheterization and cardiopulmonary exercise testing were common, occurring in 88 patients (47%). The most common profile was preserved CI but reduced functional capacity, and these patients remained at high risk for requiring advanced therapies, whereas patients with reduced CIs but preserved exercise capacity were uncommon. In conclusion, low CI was independently associated with higher rates of death, transplantation, and left ventricular assist device implantation in this study. Also, patients with preserved CIs at rest but poor functional capacity, so-called cardiac insufficiency, were commonly encountered and had poor outcomes with medical management.
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116
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Cooper LB, Patel CB, Schulte PJ, Kelly JP, Samsky MD, Felker GM, Milano CA, Rogers JG. Clinical Characteristics and Long Term Outcomes in Septuagenarians Undergoing Cardiac Transplantation. J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.06.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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117
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Krishnamoorthy A, Vakamudi S, Watson MH, Byrns JS, Rajagopal S, Felker GM, Rogers JG, Patel CB. Hemodynamic Response to Continuous Outpatient Milrinone Infusion in Advanced Heart Failure Patients with Mixed Pulmonary Hypertension. J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.06.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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118
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DeVore AD, Patel CB, Wojdyla DM, Felker GM, Hernandez AF, Milano CA, O'Connor CM, Rogers JG. Clinical Characteristics and Outcomes of Patients with Discordant Findings at Right Heart Catheterization and Cardiopulmonary Exercise Testing. J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.06.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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119
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Patel CB, Cowger JA, Zuckermann A. A contemporary review of mechanical circulatory support. J Heart Lung Transplant 2014; 33:667-74. [DOI: 10.1016/j.healun.2014.02.014] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/10/2014] [Accepted: 02/13/2014] [Indexed: 01/16/2023] Open
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Wang TS, Hellkamp AS, Patel CB, Ezekowitz JA, Fonarow GC, Hernandez AF. Representativeness of RELAX-AHF Clinical Trial Population in Acute Heart Failure. Circ Cardiovasc Qual Outcomes 2014; 7:259-68. [DOI: 10.1161/circoutcomes.113.000418] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Teresa S. Wang
- From the Duke Clinical Research Institute (T.S.W., C.B.P., A.F.H.) and Department of Medicine (T.S.W., A.S.H., C.B.P., J.A.E., A.F.H.), Duke University Medical Center, Durham, NC; Division of Cardiology, Manankowski Alberta Heart Institute, Alberta, Canada (J.A.E.); and UCLA Division of Cardiology, University of California at Los Angeles Medical Center, (G.C.F.)
| | - Anne S. Hellkamp
- From the Duke Clinical Research Institute (T.S.W., C.B.P., A.F.H.) and Department of Medicine (T.S.W., A.S.H., C.B.P., J.A.E., A.F.H.), Duke University Medical Center, Durham, NC; Division of Cardiology, Manankowski Alberta Heart Institute, Alberta, Canada (J.A.E.); and UCLA Division of Cardiology, University of California at Los Angeles Medical Center, (G.C.F.)
| | - Chetan B. Patel
- From the Duke Clinical Research Institute (T.S.W., C.B.P., A.F.H.) and Department of Medicine (T.S.W., A.S.H., C.B.P., J.A.E., A.F.H.), Duke University Medical Center, Durham, NC; Division of Cardiology, Manankowski Alberta Heart Institute, Alberta, Canada (J.A.E.); and UCLA Division of Cardiology, University of California at Los Angeles Medical Center, (G.C.F.)
| | - Justin A. Ezekowitz
- From the Duke Clinical Research Institute (T.S.W., C.B.P., A.F.H.) and Department of Medicine (T.S.W., A.S.H., C.B.P., J.A.E., A.F.H.), Duke University Medical Center, Durham, NC; Division of Cardiology, Manankowski Alberta Heart Institute, Alberta, Canada (J.A.E.); and UCLA Division of Cardiology, University of California at Los Angeles Medical Center, (G.C.F.)
| | - Gregg C. Fonarow
- From the Duke Clinical Research Institute (T.S.W., C.B.P., A.F.H.) and Department of Medicine (T.S.W., A.S.H., C.B.P., J.A.E., A.F.H.), Duke University Medical Center, Durham, NC; Division of Cardiology, Manankowski Alberta Heart Institute, Alberta, Canada (J.A.E.); and UCLA Division of Cardiology, University of California at Los Angeles Medical Center, (G.C.F.)
| | - Adrian F. Hernandez
- From the Duke Clinical Research Institute (T.S.W., C.B.P., A.F.H.) and Department of Medicine (T.S.W., A.S.H., C.B.P., J.A.E., A.F.H.), Duke University Medical Center, Durham, NC; Division of Cardiology, Manankowski Alberta Heart Institute, Alberta, Canada (J.A.E.); and UCLA Division of Cardiology, University of California at Los Angeles Medical Center, (G.C.F.)
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121
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Khazanie P, Hammill BG, Patel CB, Eapen ZJ, Peterson ED, Rogers JG, Milano CA, Curtis LH, Hernandez AF. Trends in the use and outcomes of ventricular assist devices among medicare beneficiaries, 2006 through 2011. J Am Coll Cardiol 2014; 63:1395-404. [PMID: 24486278 DOI: 10.1016/j.jacc.2013.12.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [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: 09/24/2013] [Revised: 12/09/2013] [Accepted: 12/11/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study sought to examine trends in mortality, readmission, and costs among Medicare beneficiaries receiving ventricular assist devices (VADs) and associations between hospital-level procedure volume and outcomes. BACKGROUND VADs are an option for patients with advanced heart failure, but temporal changes in outcomes and associations between facility-level volume and outcomes are poorly understood. METHODS This is a population-based, retrospective cohort study of all fee-for-service Medicare beneficiaries with heart failure who received an implantable VAD between 2006 and 2011. We used Cox proportional hazards models to examine temporal changes in mortality, readmission, and hospital-level procedure volume. RESULTS Among 2,507 patients who received a VAD at 103 centers during the study period, the in-hospital mortality decreased from 30% to 10% (p < 0.001), the 1-year mortality decreased from 42% to 26% (p < 0.001), and the all-cause readmission was frequent (82% and 81%; p = 0.70). After covariate adjustment, in-hospital and 1-year mortality decreased (p < 0.001 for both), but the all-cause readmission did not change (p = 0.82). Hospitals with a low procedure volume had higher risks of in-hospital mortality (risk ratio: 1.72; 95% confidence interval [CI]: 1.28 to 2.33) and 1-year mortality (risk ratio: 1.55; 95% CI: 1.24 to 1.93) than high-volume hospitals. Procedure volume was not associated with risk of readmission. The greatest cost was from the index hospitalization and remained unchanged ($204,020 in 2006 and $201,026 in 2011; p = 0.21). CONCLUSIONS Short- and long-term mortality after VAD implantation among Medicare beneficiaries improved, but readmission remained similar over time. A higher volume of VAD implants was associated with lower risk of mortality but not readmission. Costs to Medicare have not changed in recent years.
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Affiliation(s)
- Prateeti Khazanie
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Bradley G Hammill
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Chetan B Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Zubin J Eapen
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Joseph G Rogers
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Carmelo A Milano
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Lesley H Curtis
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
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Schechter MA, Patel CB, Rogers JG, Milano CA. Temporary extracorporeal left ventricular assist device support for implantable left ventricular assist device replacement cases. J Thorac Cardiovasc Surg 2014; 147:e46-8. [PMID: 24472316 DOI: 10.1016/j.jtcvs.2013.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/31/2013] [Accepted: 12/05/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | - Chetan B Patel
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Joseph G Rogers
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Carmelo A Milano
- Department of Surgery, Duke University Medical Center, Durham, NC.
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Affiliation(s)
- Teresa S. Wang
- From the School of Medicine (T.S.W.), Division of Cardiology (A.F.H., G.M.F., J.G.R., C.B.P.), and Division of Cardiothoracic Surgery (C.A.M.), Duke University Medical Center, Durham, NC
| | - Adrian F. Hernandez
- From the School of Medicine (T.S.W.), Division of Cardiology (A.F.H., G.M.F., J.G.R., C.B.P.), and Division of Cardiothoracic Surgery (C.A.M.), Duke University Medical Center, Durham, NC
| | - G. Michael Felker
- From the School of Medicine (T.S.W.), Division of Cardiology (A.F.H., G.M.F., J.G.R., C.B.P.), and Division of Cardiothoracic Surgery (C.A.M.), Duke University Medical Center, Durham, NC
| | - Carmelo A. Milano
- From the School of Medicine (T.S.W.), Division of Cardiology (A.F.H., G.M.F., J.G.R., C.B.P.), and Division of Cardiothoracic Surgery (C.A.M.), Duke University Medical Center, Durham, NC
| | - Joseph G. Rogers
- From the School of Medicine (T.S.W.), Division of Cardiology (A.F.H., G.M.F., J.G.R., C.B.P.), and Division of Cardiothoracic Surgery (C.A.M.), Duke University Medical Center, Durham, NC
| | - Chetan B. Patel
- From the School of Medicine (T.S.W.), Division of Cardiology (A.F.H., G.M.F., J.G.R., C.B.P.), and Division of Cardiothoracic Surgery (C.A.M.), Duke University Medical Center, Durham, NC
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Samsky MD, Patel CB, Owen A, Schulte PJ, Jentzer J, Rosenberg PB, Felker GM, Milano CA, Hernandez AF, Rogers JG. Ten-year experience with extended criteria cardiac transplantation. Circ Heart Fail 2013; 6:1230-8. [PMID: 24088293 DOI: 10.1161/circheartfailure.113.000296] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Extended criteria cardiac transplant (ECCT) programs expand the transplant pool by matching donors and recipients typically excluded from the transplant process because of age or comorbidity. There is a paucity of data examining long-term outcomes with this strategy. METHODS AND RESULTS Between January 2000 and December 2009, adult patients undergoing isolated heart transplant were prospectively classified as ECCT based on prespecified criteria. Baseline characteristics and outcomes were compared between ECCT and standard criteria cardiac transplant recipients. Two Cox proportional hazards models were developed. The first to identify clinical variables contributing to survival between the 2 groups, and the second to determine the additional risk associated with assignment to ECCT. Among the 454 patients who underwent heart transplant, 84 (18.5%) were ECCT. Compared with the patients who underwent standard criteria cardiac transplant, ECCT patients were older (median, 66.6 years versus 53.2 years; P<0.001), with higher frequency of diabetes mellitus (46.4% versus 24.6%; P<0.001) and chronic kidney disease (median estimated glomerular filtration rate, 55 versus 61.6 mL/min; P=0.001). After adjustment for baseline characteristics, standard criteria cardiac transplant survival was higher than ECCT at 1 (89% versus 86%; P=0.18) and 5 (77% versus 66%; P=0.035) years. In a multivariate model that included listing criteria, creatinine (hazard ratio, 1.05 per 0.1 mg/dL; 95% confidence interval, 1.02-1.09; P=0.001) was a significant predictor of post-transplant mortality. CONCLUSIONS ECCT is an acceptable alternative for advanced heart failure therapy in select patients. Age and renal dysfunction are important determinants of long-term survival and post-transplant morbidity.
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Affiliation(s)
- Marc D Samsky
- Duke University Medical Center, and the Duke Clinical Research Institute, Durham, NC
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125
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Wang TS, Hellkamp A, Patel CB, Ezekowitz JA, Hernandez AF. Generalizability of RELAX-AHF Clinical Trial Patients to a Large US Registry. J Card Fail 2013. [DOI: 10.1016/j.cardfail.2013.06.090] [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: 12/01/2022]
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126
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Drazner MH, Velez-Martinez M, Ayers CR, Reimold SC, Thibodeau JT, Mishkin JD, Mammen PP, Markham DW, Patel CB. Relationship of Right- to Left-Sided Ventricular Filling Pressures in Advanced Heart Failure. Circ Heart Fail 2013; 6:264-70. [DOI: 10.1161/circheartfailure.112.000204] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [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: 11/16/2022]
Abstract
Background—
Although right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP) are correlated in heart failure, in a sizeable minority of patients, the RAP and PCWP are not tightly coupled. The basis of this variability in the RAP/PCWP ratio, and whether it conveys prognostic value, is not known.
Methods and Results—
We analyzed the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial database. Baseline characteristics, including echocardiographic assessment of right ventricular (RV) structure and function, and invasively measured hemodynamic parameters, were compared among tertiles of the RAP/PCWP ratio. Multivariable Cox proportional hazard models assessed the association of RAP/PCWP ratio with the primary ESCAPE outcome (6-month death or hospitalization [days]) adjusting for systolic blood pressure, blood urea nitrogen, 6-minute walk distance, and PCWP. The RAP/PCWP tertiles were 0.27 to 0.4 (tertile 1); 0.41 to 0.615 (tertile 2), and 0.62 to 1.21 (tertile 3). Increasing RAP/PCWP was associated with increasing median right atrial area (23, 26, 29 cm
2
, respectively;
P
<0.005), RV area in diastole (21, 27, 27 cm
2
, respectively;
P
<0.005), and pulmonary vascular resistance (2.4, 2.9, 3.6 woods units, respectively;
P
=0.003), and lower RV stroke work index (8.6, 8.4, 5.5 g·m/m
2
per beat, respectively;
P
<0.001). RAP/PCWP ratio was associated with death or hospitalization within 6 months (hazard ratio, 1.16 [1, 1.4];
P
<0.05).
Conclusions—
Increased RAP/PCWP ratio was associated with higher pulmonary vascular resistance, reduced RV function (manifest as a larger right atrium and ventricle and lower RV stroke work index), and an increased risk of adverse outcomes in patients with advanced heart failure.
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Affiliation(s)
- Mark H. Drazner
- From the Division of Cardiology, Department of Internal Medicine (M.H.D., M.V.M., S.C.R., J.T.T., J.D.M., P.P.A.M., D.W.M.), and Department of Biostatistics (C.R.A.), University of Texas Southwestern Medical Center, Dallas, TX; and Division of Cardiology, Duke University Medical Center, Durham, NC (C.B.P.)
| | - Mariella Velez-Martinez
- From the Division of Cardiology, Department of Internal Medicine (M.H.D., M.V.M., S.C.R., J.T.T., J.D.M., P.P.A.M., D.W.M.), and Department of Biostatistics (C.R.A.), University of Texas Southwestern Medical Center, Dallas, TX; and Division of Cardiology, Duke University Medical Center, Durham, NC (C.B.P.)
| | - Colby R. Ayers
- From the Division of Cardiology, Department of Internal Medicine (M.H.D., M.V.M., S.C.R., J.T.T., J.D.M., P.P.A.M., D.W.M.), and Department of Biostatistics (C.R.A.), University of Texas Southwestern Medical Center, Dallas, TX; and Division of Cardiology, Duke University Medical Center, Durham, NC (C.B.P.)
| | - Sharon C. Reimold
- From the Division of Cardiology, Department of Internal Medicine (M.H.D., M.V.M., S.C.R., J.T.T., J.D.M., P.P.A.M., D.W.M.), and Department of Biostatistics (C.R.A.), University of Texas Southwestern Medical Center, Dallas, TX; and Division of Cardiology, Duke University Medical Center, Durham, NC (C.B.P.)
| | - Jennifer T. Thibodeau
- From the Division of Cardiology, Department of Internal Medicine (M.H.D., M.V.M., S.C.R., J.T.T., J.D.M., P.P.A.M., D.W.M.), and Department of Biostatistics (C.R.A.), University of Texas Southwestern Medical Center, Dallas, TX; and Division of Cardiology, Duke University Medical Center, Durham, NC (C.B.P.)
| | - Joseph D. Mishkin
- From the Division of Cardiology, Department of Internal Medicine (M.H.D., M.V.M., S.C.R., J.T.T., J.D.M., P.P.A.M., D.W.M.), and Department of Biostatistics (C.R.A.), University of Texas Southwestern Medical Center, Dallas, TX; and Division of Cardiology, Duke University Medical Center, Durham, NC (C.B.P.)
| | - Pradeep P.A. Mammen
- From the Division of Cardiology, Department of Internal Medicine (M.H.D., M.V.M., S.C.R., J.T.T., J.D.M., P.P.A.M., D.W.M.), and Department of Biostatistics (C.R.A.), University of Texas Southwestern Medical Center, Dallas, TX; and Division of Cardiology, Duke University Medical Center, Durham, NC (C.B.P.)
| | - David W. Markham
- From the Division of Cardiology, Department of Internal Medicine (M.H.D., M.V.M., S.C.R., J.T.T., J.D.M., P.P.A.M., D.W.M.), and Department of Biostatistics (C.R.A.), University of Texas Southwestern Medical Center, Dallas, TX; and Division of Cardiology, Duke University Medical Center, Durham, NC (C.B.P.)
| | - Chetan B. Patel
- From the Division of Cardiology, Department of Internal Medicine (M.H.D., M.V.M., S.C.R., J.T.T., J.D.M., P.P.A.M., D.W.M.), and Department of Biostatistics (C.R.A.), University of Texas Southwestern Medical Center, Dallas, TX; and Division of Cardiology, Duke University Medical Center, Durham, NC (C.B.P.)
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127
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Patel CB, Suarez J, Felker GM, Becker R, Hernandez AF, Rogers JG. Response to Letter Regarding Article, “Mechanisms of Bleeding and Approach to Patients With Axial-Flow Left Ventricular Assist Devices”. Circ Heart Fail 2012. [DOI: 10.1161/circheartfailure.112.971283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Chetan B. Patel
- Duke Clinical Research Institute and Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Jorge Suarez
- Duke Clinical Research Institute and Department of Medicine, Duke University School of Medicine, Durham, NC
| | - G. Michael Felker
- Duke Clinical Research Institute and Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Richard Becker
- Duke Clinical Research Institute and Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Adrian F. Hernandez
- Duke Clinical Research Institute and Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Joseph G. Rogers
- Duke Clinical Research Institute and Department of Medicine, Duke University School of Medicine, Durham, NC
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128
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Piacentino V, Ganapathi AM, Stafford-Smith M, Hsieh MK, Patel CB, Simeone AA, Rogers JG, Milano CA. Utility of concomitant tricuspid valve procedures for patients undergoing implantation of a continuous-flow left ventricular device. J Thorac Cardiovasc Surg 2012; 144:1217-21. [DOI: 10.1016/j.jtcvs.2012.07.064] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 07/02/2012] [Accepted: 07/26/2012] [Indexed: 10/27/2022]
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Patel CB, MacKinnon ML, Smith AD, Felker GM, Vikraman-Sushama D, Sudan DL, Rosenberg PB, Hernandez AF, Milano CA, Rogers JG. Successful organ donation after long-term circulatory support with nonpulsatile mechanical support. Am J Transplant 2012; 12:1962-3. [PMID: 22594645 DOI: 10.1111/j.1600-6143.2012.04105.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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130
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Affiliation(s)
- Tariq Ahmad
- From the Division of Cardiovascular Medicine, Department of Medicine (T.A., C.B.P., J.G.R.), Division of Cardiac and Thoracic Surgery, Department of Surgery (C.A.M.), and Duke Clinical Research Institute (C.B.P., J.G.R.), Duke University Medical Center, Durham, NC
| | - Chetan B. Patel
- From the Division of Cardiovascular Medicine, Department of Medicine (T.A., C.B.P., J.G.R.), Division of Cardiac and Thoracic Surgery, Department of Surgery (C.A.M.), and Duke Clinical Research Institute (C.B.P., J.G.R.), Duke University Medical Center, Durham, NC
| | - Carmelo A. Milano
- From the Division of Cardiovascular Medicine, Department of Medicine (T.A., C.B.P., J.G.R.), Division of Cardiac and Thoracic Surgery, Department of Surgery (C.A.M.), and Duke Clinical Research Institute (C.B.P., J.G.R.), Duke University Medical Center, Durham, NC
| | - Joseph G. Rogers
- From the Division of Cardiovascular Medicine, Department of Medicine (T.A., C.B.P., J.G.R.), Division of Cardiac and Thoracic Surgery, Department of Surgery (C.A.M.), and Duke Clinical Research Institute (C.B.P., J.G.R.), Duke University Medical Center, Durham, NC
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131
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Abstract
Axial-flow LVADs have become an integral tool in the management of end-stage heart failure. Consequently, nonsurgical bleeding has emerged as a major source of morbidity and mortality in this fragile population. The mechanisms responsible for these adverse events include acquired von Willebrand disease, GI tract angiodysplasia formation, impaired platelet aggregation, and overuse of anticoagulation therapy. Because of ongoing concerns for pump thrombosis and thromboembolic events, the thrombotic/bleeding paradigm has led to a difficult clinical dilemma for those managing patients treated with axial flow LVADs. As the field progresses, advances in the understanding of the pathological mechanisms underlying bleeding/thrombosis risk, careful risk stratification, and potential use of novel anticoagulants will all play a role in the management of the LVAD patient.
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Affiliation(s)
- Jorge Suarez
- Duke Clinical Research Institute and the Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
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132
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Patel CB, Vajpayee P, Singh G, Upadhyay RS, Shanker R. Contamination of potable water by enterotoxigenic Escherichia coli: qPCR based culture-free detection and quantification. Ecotoxicol Environ Saf 2011; 74:2292-2298. [PMID: 21840050 DOI: 10.1016/j.ecoenv.2011.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 07/20/2011] [Accepted: 07/23/2011] [Indexed: 05/31/2023]
Abstract
Tourists visiting to endemic zones may acquire Enterotoxigenic Escherichia coli (ETEC) infection resulting into diarrhea due to consumption of contaminated potable waters. In this study, a qPCR assay (SYBR Green), targeting LT1 and ST1 genes was designed to quantify ETEC in potable waters derived from civic water supply. The assay could detect lowest 1CFU/PCR targeting LT1/ST1 gene from ten-fold diluted culture of the reference strain (E. coli MTCC 723) and is ten-fold more sensitive than the conventional PCR. The quantification of the ETEC in potable waters collected from civic supply of a major city of the northern India exhibiting high flow of tourists reveals that all the sites that ran along sewage line were contaminated by the ETEC. Contamination was due to percolation of sewage. The assay could be used for the regular monitoring of potable water in places exhibiting heavy flow of tourists to prevent ETEC induced diarrhea.
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Affiliation(s)
- C B Patel
- Environmental Toxicology Group, CSIR-Indian Institute of Toxicology Research, Post Box 80, Mahatma Gandhi Marg, Lucknow 226001 UP, India
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133
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Abstract
Individuals afflicted with advanced systolic heart failure who have become unresponsive to standard medical and electrical therapies are categorized as having American Heart Association stage D heart failure. The high mortality rates for medically treated stage D heart failure have not improved in the last 10 years, and patients at this advanced stage require either palliative measures or surgical management of heart failure. In recent years, surgically implanted ventricular assist devices (VADs) have become available for long-term use and are now commonly used as a therapy for advanced heart failure. The data generated from this early experience have clearly shown that VADs improve survival and quality of life in patients with advanced heart failure when implanted as a temporary measure or as long-term support. However, with a growing heart failure population, there is much work to be done to continually improve VAD technology, patient selection criteria, and postimplantation management to define the optimal role for assist devices in the management of systolic heart failure.
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Affiliation(s)
- Chetan B Patel
- Division of Cardiology, Duke University Medical Center, Durham, NC 27710, USA
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134
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Ahmad T, Mentz RJ, Felker GM, Milano CA, Rogers JG, Patel CB. Recurrence of heart failure symptoms after LVAD placement due to bradycardia-induced inflow obstruction. J Heart Lung Transplant 2011; 31:111-3. [PMID: 21996349 DOI: 10.1016/j.healun.2011.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 08/05/2011] [Accepted: 09/02/2011] [Indexed: 11/30/2022] Open
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135
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Cattano D, Valleggi S, Cavazzana AO, Patel CB, Ma D, Giunta F. Xenon exposure in the neonatal rat brain: effects on genes that regulate apoptosis. Minerva Anestesiol 2011; 77:571-578. [PMID: 21617619] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND In the developing rodent brain, exposure to volatile anesthetics causes widespread neuronal apoptosis in several regions of the brain. Increasing evidence points to a possible neuroprotective role for the anesthetic gas xenon, following neuronal injury. To address this gap in understanding, we explored the transcriptional consequences of xenon in the brains of postnatal day 7 (P7) rats exposed to xenon compared to those of air-breathing animals, with particular emphasis on the mRNA transcript levels of Akt and c-Jun N-terminal kinase kinase 1 (JNKK1), which are important for cell survival and the activation of extrinsic neuroapoptotic pathways, respectively. METHODS P7 Sprague/Dawley rats were exposed to air (75% nitrogen, 25% oxygen) or xenon (75% xenon, 25% oxygen) for 120 min (N=6/group). Forebrains were harvested for reverse transcription polymerase chain reaction, which enabled quantification of Akt and JNKK1 mRNA transcripts. Suppression subtractive hybridization was used to explore the "genetic signature" of xenon exposure. RESULTS Compared to control air-breathing animals, xenon-breathing rats exhibited a 0.7-fold decrease in Akt mRNA expression (P<0.01) and a 1.6-fold increase in JNKK1 mRNA levels (P<0.05). CONCLUSION The concomitant decrease in the Akt mRNA expression level and increase in the JNKK1 mRNA transcript level provide evidence that xenon has a neuroapoptotic effect in the developing rodent forebrain. Given these results, further study into the paradoxical neuroprotective and neuroapoptotic effects of xenon is warranted.
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Affiliation(s)
- D Cattano
- Department of Anesthesiology, University of Texas Medical School at Houston, Houston, TX 77054, USA.
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136
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137
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Abstract
β-Adrenergic and angiotensin II type 1A receptors are therapeutic targets for the treatment of a number of common human diseases. Pharmacological agents designed as antagonists for these receptors have positively affected the morbidity and mortality of patients with hypertension, heart failure, and renal disease. Antagonism of these receptors, however, may only partially explain the therapeutic benefits of β-blockers and angiotensin receptor blockers given the emerging concept of functional selectivity or biased agonism. This new pharmacological paradigm suggests that multiple signaling pathways can be differentially modified by a single ligand-receptor interaction. This review examines the functional selectivity of β-adrenergic and angiotensin II type 1A receptors with respect to their ability to signal via both G protein-dependent and G protein-independent mechanisms, with a focus on the multifunctional protein β-arrestin. Also highlighted are the concept of "biased signaling" through β-arrestin mediated pathways, the affect of ligand/receptor modification on such biased agonism, and the implications of functional selectivity for the development of the next generation of β-blockers and angiotensin receptor blockers.
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138
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Chen DF, Reinsmoen NL, Clark A, Burgess BO, Egnaczyk GF, Patel CB, Milano C, Rogers JG. 7-P: Heart Transplantation of Sensitized Patients. Hum Immunol 2010. [DOI: 10.1016/j.humimm.2010.06.055] [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: 12/01/2022]
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139
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Affiliation(s)
- Chetan B. Patel
- Institute of Chemical Technology, University of Mumbai, Matunga Mumbai, India
| | - Vilas G. Gaikar
- Institute of Chemical Technology, University of Mumbai, Matunga Mumbai, India
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140
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141
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Patel CB. Consider using diffusion tensor imaging in Geron phase I trial. AJNR Am J Neuroradiol 2009; 30:E97. [PMID: 19386734 DOI: 10.3174/ajnr.a1632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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142
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Oswal S, Patel CB, Malek NI. Synthesis and Radical Copolymerization of Ethyl Acrylate and Butyl Acrylate with N-[4-N'-(Phenylamino-carbonyl) phenyl] maleimide. INT J POLYM MATER PO 2007. [DOI: 10.1080/00914030600701918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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143
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Abstract
Despite advances in the development of anti-hyperglycaemic drugs and a greater focus on cardiovascular risk modification for patients with diabetes, cardiovascular disease remains the most common complication of type 2 diabetes. Since their initial availability in 1997, the thiazolidinediones have become one of the most commonly prescribed classes of medications for type 2 diabetes. In addition to glucose control, the thiazolidinediones have a number of pleiotropic effects on myriad traditional and non-traditional risk factors for cardiovascular disease, and hold promise with regard to modification of cardiovascular risk. In a recently reported large-scale clinical trial, pioglitazone was associated with improved cardiovascular outcomes in patients with type 2 diabetes and prevalent atherosclerotic disease. In this review, we summarise the experimental, preclinical and clinical data regarding the effects of the thiazolidinediones on cardiovascular risk factors and clinical outcomes.
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Affiliation(s)
- Chetan B Patel
- Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA
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144
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Dave AN, Shah FA, Sagar RP, Raval HB, Patel CB, Agrawal GR. Ovarian yolk sac tumor. Indian J Radiol Imaging 2005. [DOI: 10.4103/0971-3026.28788] [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: 11/04/2022] Open
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145
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Abstract
BACKGROUND Single lung transplantation (SLT) and bilateral lung transplantation (BLT) are routinely performed in patients with primary pulmonary hypertension (PPH) and secondary pulmonary hypertension (SPH). It is unclear which procedure is preferable. We reviewed our experience with lung transplants for PPH and SPH to determine if any advantage exists with SLT or BLT for either PPH or SPH. METHODS We reviewed the outcomes of all lung transplants performed for PPH or SPH for 4.5 years (July 1995 to January 2000). Survival was reported by the Kaplan-Meier method, and log rank analysis was used to determine significance. Statistical analyses of clinical data were performed using analysis of variance and chi2 analysis. RESULTS A total of 57 recipients met criteria for pulmonary hypertension with a mean pulmonary artery pressure of greater than or equal to 30 mm Hg. There were 15 patients with PPH and 40 patients with SPH. There were 6 patients who had SLTs and 9 patients who had BLTs in the PPH group; and there were 9 patients who had SLTs and 21 patients who had BLTs in the SPH group. We found a survival advantage for PPH patients who underwent BLTs at all time points up to 4 years (100% vs 67%; p < or = 0.02). There was no clear advantage to SLTs or BLTs for SPH. At 4 years there was a trend toward improved survival with SLTs (91% vs 75%) in SPH patients with a mean pulmonary artery pressure less than or equal to 40 mm Hg (p < or = 0.11) with equivalent survival (80%) in patients with a mean pulmonary artery pressure greater than or equal to 40 mm Hg. There was also a trend toward improved survival in patients with a mean pulmonary artery pressure greater than or equal to 40 mm Hg (PPH and SPH) with BLTs (88% vs 62%; p = 0.19). The incidence of rejection, infection, and other complications was comparable between SLTs and BLTs in each group. CONCLUSIONS We believe that BLT is the procedure of choice for PPH. The procedure of choice is less clear for SPH. Patients with SPH and a mean pulmonary artery pressure greater than 40 mm Hg may benefit from a BLT and those with a mean pulmonary artery pressure less than or equal to 40 mm Hg may do better with an SLT; however, no clear advantage is seen.
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Affiliation(s)
- J V Conte
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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146
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Loeb DM, Evron E, Patel CB, Sharma PM, Niranjan B, Buluwela L, Weitzman SA, Korz D, Sukumar S. Wilms' tumor suppressor gene (WT1) is expressed in primary breast tumors despite tumor-specific promoter methylation. Cancer Res 2001; 61:921-5. [PMID: 11221883] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
We analyzed Wilms' tumor suppressor 1 (WT1) expression and its regulation by promoter methylation in a panel of normal breast epithelial samples and primary carcinomas. Contrary to previous reports, WT1 protein was strongly expressed in primary carcinomas (27 of 31 tumors) but not in normal breast epithelium (1 of 20 samples). Additionally, the WT1 promoter was methylated in 6 of 19 (32%) primary tumors, which nevertheless expressed WT1. The promoter is not methylated in normal epithelium. Thus, although tumor-specific methylation of WT1 is established in primary breast cancer at a low frequency, other transcriptional regulatory mechanisms appear to supercede its effects in these tumors. Our results demonstrate expression of WT1 in mammary neoplasia, and that WT1 may not have a tumor suppressor role in breast cancer.
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Affiliation(s)
- D M Loeb
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231, USA
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147
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Bhatt SB, Patel CB, Tan IK. Triggering demand valve ventilators. J Cardiothorac Vasc Anesth 1996; 10:304-6. [PMID: 8850416 DOI: 10.1016/s1053-0770(96)80273-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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148
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Tan IK, Bhatt SB, Patel CB. Metabolic stress and dobutamine. Crit Care Med 1996; 24:181-3. [PMID: 8565531 DOI: 10.1097/00003246-199601000-00040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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149
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Robinson JM, Pilot-Matias TJ, Pratt SD, Patel CB, Bevirt TS, Hunt JC. Analysis of the humoral response to the flagellin protein of Borrelia burgdorferi: cloning of regions capable of differentiating Lyme disease from syphilis. J Clin Microbiol 1993; 31:629-35. [PMID: 8384628 PMCID: PMC262832 DOI: 10.1128/jcm.31.3.629-635.1993] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Selected regions of the Borrelia burgdorferi flagellin gene (fla) that exhibit high or low homology with related genes from other bacterial species were amplified by the polymerase chain reaction and expressed as fusion proteins in Escherichia coli. Purified fusion proteins were assayed for antibody reactivity in a microtiter plate enzyme-linked immunosorbent assay with sera from Lyme disease patients as well as syphilitic and normal sera. Immunoglobulin G antibody from Lyme disease patient sera reacted predominantly with the central portion of the protein. The region of the flagellin protein encompassing amino acids 64 to 311 detected nearly all of the immunoglobulin G-positive Lyme sera and only reacted with 1 of 26 syphilis patient serum samples. In contrast, 12 of 26 syphilis patient serum samples and 2 of 47 normal serum samples reacted with the amino terminus of the flagellin protein, whereas 4 of 26 syphilis patient serum samples and 7 of 47 normal serum samples reacted with the carboxyl terminus. The central region containing amino acids 64 to 311 may be employed diagnostically to differentiate antibodies to B. burgdorferi from antibodies to Treponema pallidum. In addition, this region also was recognized by immunoglobulin M in the Lyme patient sera, indicating its potential usefulness as a marker for early Lyme disease.
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Affiliation(s)
- J M Robinson
- Infectious Disease and Immunology, Abbott Laboratories, Abbott Park, Illinois 60064
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150
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Abstract
Cardiopulmonary effects of 500 ml of 20% iv fat emulsion (Intralipid) infusion in two groups of patients who required mechanical ventilation were evaluated in our Critical Care Center. Group 1 included ten patients void of signs or symptoms of sepsis. Group 2 consisted of ten patients exhibiting clinical and laboratory signs and symptoms of sepsis. Data were measured before and immediately after Intralipid infusion and when serum lipemia cleared. Intralipid infusion precipitated a significant increase in venous admixture (Qsp/Qt) from 13.7 +/- 3.6 (SEM) to 18.0 +/- 6.5% and from 22.0 +/- 4.8 to 25.8 +/- 7.0% in groups 1 and 2, respectively. Mean pulmonary artery pressure (MPAP) increased from 22.7 +/- 4.2 to 29.2 +/- 8.1 mm Hg and 26.4 +/- 6.8 to 28.0 +/- 4.0 mm Hg in groups 1 and 2, respectively. When serum lipemia cleared, Qsp/Qt and MPAP returned to preinfusion levels. We conclude that Intralipid infusion increases pulmonary artery pressure and venous admixture in critically ill patients. These changes are temporary and coincidental with serum lipemia rather than presence or absence of sepsis. Adequate levels of oxygenation should be confirmed during Intralipid infusion in patients with borderline oxygenation.
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Affiliation(s)
- B Venus
- Department of Critical Care Medicine, Memorial Medical Center of Jacksonville, FL 32216
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