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Al Yami B, Sattar Y, Alruwaili W, Manasrah N, Victor V, Basit J, Bdiwi M, Titus A, Patel NN, Alharbi AA, Song D, Raina S, Alraies MC. Readmission Trends and Outcomes of Transcatheter Edge-to-Edge Repair of Mitral Regurgitation With and Without Anemia. Cureus 2024; 16:e59101. [PMID: 38803785 PMCID: PMC11128358 DOI: 10.7759/cureus.59101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Anemia is associated with worse clinical outcomes in cardiac patients. We aim to investigate the clinical outcomes and readmission rates in anemic patients undergoing transcatheter edge-to-edge repair (TEER) for severe mitral valve regurgitation (MR). METHODS The National Readmissions Database (NRD) from 2015 to 2018 was queried using the ICD-10 codes to identify patients admitted for TEER. Patients were divided into anemic and non-anemic sub-groups. Univariate and multivariate analyses were performed. Cardiovascular outcomes were assessed between cohorts at index admission and readmissions at 30, 90, and 180 days. STATA v.17 was used for analysis (StataCorp LLC, Texas, USA). RESULTS Our final cohort included 28,995 patients who had undergone TEER in the United States between 2016 and 2019. About 1,434 (4.9%) had a diagnosis of anemia. The mean age of patients who had TEER with anemia and TEER without anemia was 76.9 ± 10.8 vs. 77.7 ± 10.2, respectively. In the adjusted model, anemic patients had higher odds of acute kidney injury (AKI) (aOR 2.21; 95% [CI 1.81-2.6; p<0.001]), HF (aOR 1.75; 95% [CI 1.28-2.3; p<0.001]), myocardial infarction (MI) (aOR 1.54; 95% [CI 1.01-2.33; p<0.041]), major adverse cardiac and cerebrovascular events (MACCE) (aOR 1.72; 95% [CI 1.2-9-2.3; p<0.001]), and net adverse event (aOR 1.85; 95% [CI 1.32-2.59; p<0.001]). The anemic group's readmission rate was overall higher at 30, 90, and 180 days from 2016 to 2019. CONCLUSION Anemia was associated with increased adverse clinical outcomes and more extended hospital stays in patients with anemia who had undergone TEER procedures compared to the non-anemic group.
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Affiliation(s)
- Bandar Al Yami
- Internal Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Yasar Sattar
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Waleed Alruwaili
- Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, USA
| | - Nouraldeen Manasrah
- Internal Medicine, Medical College of Georgia, Augusta University, Augusta, USA
| | - Varun Victor
- Internal Medicine, Canton Medical Education Foundation, Canton, USA
| | - Jawad Basit
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, PAK
- Department of Cardiology, Holy Family Hospital, Rawalpindi, PAK
| | - Mustafa Bdiwi
- Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USA
| | - Anoop Titus
- Internal Medicine, Saint Vincent Hospital, Worcester, USA
| | - Neel N Patel
- Internal Medicine, New York Medical College/Landmark Medical Center, Valhalla, USA
- Medicine, B. J. Medical College, Ahmedabad, IND
| | | | - David Song
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York, USA
| | - Sameer Raina
- Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, USA
| | - M Chadi Alraies
- Cardiology, Wayne State University Detroit Medical Center, Detroit, USA
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Bennati L, Giambruno V, Renzi F, Di Nicola V, Maffeis C, Puppini G, Luciani GB, Vergara C. Turbulent blood dynamics in the left heart in the presence of mitral regurgitation: a computational study based on multi-series cine-MRI. Biomech Model Mechanobiol 2023; 22:1829-1846. [PMID: 37400622 PMCID: PMC10613156 DOI: 10.1007/s10237-023-01735-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/04/2023] [Indexed: 07/05/2023]
Abstract
In this work, we performed a computational image-based study of blood dynamics in the whole left heart, both in a healthy subject and in a patient with mitral valve regurgitation. We elaborated multi-series cine-MRI with the aim of reconstructing the geometry and the corresponding motion of left ventricle, left atrium, mitral and aortic valves, and aortic root of the subjects. This allowed us to prescribe such motion to computational blood dynamics simulations where, for the first time, the whole left heart motion of the subject is considered, allowing us to obtain reliable subject-specific information. The final aim is to investigate and compare between the subjects the occurrence of turbulence and the risk of hemolysis and of thrombi formation. In particular, we modeled blood with the Navier-Stokes equations in the arbitrary Lagrangian-Eulerian framework, with a large eddy simulation model to describe the transition to turbulence and a resistive method to manage the valve dynamics, and we used a finite element discretization implemented in an in-house code for the numerical solution.
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Affiliation(s)
- Lorenzo Bennati
- Department of Surgery, Dentistry, Pediatrics, and Obstetrics/Gynecology, University of Verona, Piazzale Ludovico Antonio Scuro 10, 37134, Verona, Italy
| | - Vincenzo Giambruno
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics, and Obstetrics/Gynecology, University of Verona, Piazzale Stefani 1, 37126, Verona, Italy
| | - Francesca Renzi
- Department of Surgery, Dentistry, Pediatrics, and Obstetrics/Gynecology, University of Verona, Piazzale Ludovico Antonio Scuro 10, 37134, Verona, Italy
| | - Venanzio Di Nicola
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics, and Obstetrics/Gynecology, University of Verona, Piazzale Stefani 1, 37126, Verona, Italy
| | - Caterina Maffeis
- Department of Surgery, Dentistry, Pediatrics, and Obstetrics/Gynecology, University of Verona, Piazzale Ludovico Antonio Scuro 10, 37134, Verona, Italy
| | - Giovanni Puppini
- Department of Radiology, University of Verona, Piazzale Stefani 1, 37126, Verona, Italy
| | - Giovanni Battista Luciani
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics, and Obstetrics/Gynecology, University of Verona, Piazzale Stefani 1, 37126, Verona, Italy
| | - Christian Vergara
- LaBS, Dipartimento di Chimica, Materiali e Ingegneria Chimica "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy.
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Hayashi O, Nakamura S, Sugiura T, Hasegawa S, Tsuka Y, Takahashi N, Kikuchi S, Matsumura K, Okumiya T, Baden M, Shiojima I. Diagnostic accuracy and clinical usefulness of erythrocyte creatine content to predict the improvement of anaemia in patients receiving maintenance haemodialysis. BMC Nephrol 2023; 24:1. [PMID: 36597041 PMCID: PMC9808937 DOI: 10.1186/s12882-022-03055-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The improvement of anaemia over time by erythropoiesis stimulating agent (ESA) is associated with better survival in haemodialysis patients. We previously reported that erythrocyte creatine content, a marker of erythropoietic capacity, was a reliable marker to estimate the effectiveness of ESA. The aim of this study was to examine the accuracy and clinical usefulness of erythrocyte creatine content to predict the improvement of anaemia in haemodialysis patients. METHODS ESA dose was fixed 3 months prior to the enrollment and was maintained throughout the study period. Erythrocyte creatine content and haematologic indices were measured at baseline in 92 patients receiving maintenance haemodialysis. Haemoglobin was also measured 3 months after. Improvement of anaemia was defined as ≥ 0.8 g/dL change in haemoglobin from baseline to 3 months. RESULTS Erythrocyte creatine content was significantly higher in 32 patients with improvement of anaemia compared to 60 patients with no improvement of anaemia (2.47 ± 0.74 vs. 1.57 ± 0.49 μmol/gHb, P = 0.0001). When 9 variables (erythrocyte creatine content, ESA dose, reticulocyte, haptoglobin, haemoglobin at baseline, serum calcium, intact parathyroid hormone, transferrin saturation and serum ferritin) were used in the multivariate logistic regression analysis, erythrocyte creatine emerged as the most important variable associated with the improvement of anaemia (P = 0.0001). The optimal cut-off point of erythrocyte creatine content to detect the improvement of anaemia was 1.78 μmol/gHb (Area under the curve: 0.86). Sensitivity and specificity of erythrocyte creatine content to detect the improvement of anaemia were 90.6% and 83.3%. CONCLUSION Erythrocyte creatine content is a reliable marker to predict the improvement of anaemia 3 months ahead in patients receiving maintenance haemodialysis.
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Affiliation(s)
- Ohki Hayashi
- Department of Nephrology and Cardiology, Takarazuka Hospital, 2-1-2 Nogami, Takarazuka, 665-0022 Hyogo, Japan
| | - Seishi Nakamura
- Department of Nephrology and Cardiology, Takarazuka Hospital, 2-1-2 Nogami, Takarazuka, 665-0022 Hyogo, Japan
| | - Tetsuro Sugiura
- grid.410783.90000 0001 2172 5041Department of Internal Medicine II, Kansai Medical University, Osaka, Japan
| | - Shun Hasegawa
- Department of Nephrology and Cardiology, Takarazuka Hospital, 2-1-2 Nogami, Takarazuka, 665-0022 Hyogo, Japan
| | - Yoshiaki Tsuka
- Department of Nephrology and Cardiology, Takarazuka Hospital, 2-1-2 Nogami, Takarazuka, 665-0022 Hyogo, Japan
| | - Nobuyuki Takahashi
- grid.410783.90000 0001 2172 5041Department of Nephrology, Kansai Medical University Kori Hospital, Osaka, Japan
| | - Sanae Kikuchi
- grid.410783.90000 0001 2172 5041Department of Internal Medicine II, Kansai Medical University, Osaka, Japan
| | - Koichiro Matsumura
- grid.258622.90000 0004 1936 9967Cardiovascular Medicine, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Toshika Okumiya
- Department of Medical Laboratory Science, Kochi Gakuen University, Kochi, Japan
| | - Masato Baden
- Department of Nephrology and Cardiology, Takarazuka Hospital, 2-1-2 Nogami, Takarazuka, 665-0022 Hyogo, Japan
| | - Ichiro Shiojima
- grid.410783.90000 0001 2172 5041Department of Internal Medicine II, Kansai Medical University, Osaka, Japan
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Prema J, Kurien AA. Hemoglobin Casts in Kidney Biopsies: Etiological Spectrum. Indian J Nephrol 2023; 33:46-49. [PMID: 37197049 PMCID: PMC10185015 DOI: 10.4103/ijn.ijn_454_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/17/2021] [Accepted: 01/09/2022] [Indexed: 05/19/2023] Open
Abstract
Intravascular hemolysis, which is the destruction of red blood cells in circulation, can cause acute kidney injury as the hemoglobin released by the lysed cells is toxic to the tubular epithelial cells. We performed a retrospective analysis of 56 cases of hemoglobin cast nephropathy reported at our institution to analyze the etiological spectrum causing this rare disease. The mean patient age was 41.7 (range: 2-72 years), and the male-to-female ratio was 1.8:1. All patients presented with acute kidney injury. The etiologies include rifampicin-induced, snake bite, autoimmune hemolytic anemia, falciparum malarial infection, leptospiral infection, autoimmune hemolytic anemia, sepsis, non-steroidal anti-inflammatory drugs, ingestion of termite oil, heavy metal poisoning, wasp sting, and valvular heart disease with severe mitral regurgitation. We demonstrate a wide spectrum of conditions associated with hemoglobin casts in the kidney biopsy. Hemoglobin immunostain is required to establish the diagnosis.
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Affiliation(s)
- Jansi Prema
- Department of Pathology, Renopath, Center for Renal and Urological Pathology, Chennai, Tamil Nadu, India
| | - Anila A Kurien
- Department of Pathology, Renopath, Center for Renal and Urological Pathology, Chennai, Tamil Nadu, India
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Evaluation of recombinant human erythropoietin responsiveness by measuring erythrocyte creatine content in haemodialysis patients. BMC Nephrol 2021; 22:413. [PMID: 34895154 PMCID: PMC8666014 DOI: 10.1186/s12882-021-02623-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 11/26/2021] [Indexed: 11/26/2022] Open
Abstract
Background One of the main causes of anaemia in patients with end-stage renal disease is relative deficiency in erythropoietin production. Eythropoiesis stimulating agent (ESA), a potent haematopoietic growth factor, is used to treat anaemia in haemodialysis patients. The effect of ESA is usually assessed by haematological indices such as red blood cell count, haemoglobin concentration and haematocrit, but erythrocyte indices do not provide information of the rapid change in erythropoietic activity. As erythrocyte creatine directly assess erythropoiesis, the aim of this study was to evaluate the effect of ESA in haemodialysis patients by measuring the erythrocyte creatine content. Methods ESA dose was fixed 3 months prior to the enrollment and was maintained throughout the entire study period. Erythrocyte creatine was measured with haematologic indices in 83 haemodialysis patients. Haemoglobin was also measured 3 months after. Results ESA dose (152.4 ± 62.9 vs. 82.2 ± 45.5 units/kg/week, P = 0.0001) and erythrocyte creatine (2.07 ± 0.73 vs. 1.60 ± 0.41 μmol/gHb, p = 0.0003) were significantly higher in 27 patients with haemoglobin <10 g/dL compared to 56 patients with haemoglobin ≥10 g/dL. There was a fair correlation between ESA dose and the concentration of creatine in the erythrocytes (r = 0.55, P < 0.0001). Increase in haemoglobin (>0.1 g/dL) was observed in 37 patients, whereas haemoglobin did not increase in 46 patients. Erythrocyte creatine levels were significantly higher in those patients with an increase in haemoglobin compared to those without (2.04 ± 0.64 vs. 1.52 ± 0.39 μmol/gHb, p < 0.0001). When 8 variables (ESA dose, erythropoietin resistance index, C-reactive protein, intact parathyroid hormone, iron supplementation, presence of anaemia, erythrocyte creatine and reticulocyte) were used in the multivariate logistic analysis, erythrocyte creatine levels emerged as the most important variable associated with increase in haemoglobin (Chi-square = 6.19, P = 0.01). Conclusion Erythrocyte creatine, a useful marker of erythropoietic capacity, is a reliable marker to estimate ameliorative effectiveness of ESA in haemodialysis patients.
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