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Aslam MI, Gruslova AB, Almomani A, Nolen D, Elliott JJ, Jani VP, Kottam A, Porterfield J, Heighten C, Anderson AS, Valvano JW, Feldman MD. Modification of a Transvalvular Microaxial Flow Pump for Instantaneous Determination of Native Cardiac Output and Volume. J Card Fail 2023; 29:1369-1379. [PMID: 37105397 DOI: 10.1016/j.cardfail.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND The current Impella cardiopulmonary (CP) pump, used for mechanical circulatory support in patients with cardiogenic shock (CS), cannot assess native cardiac output (CO) and left ventricular (LV) volumes. These data are valuable in facilitating device management and weaning. Admittance technology allows for accurate assessment of cardiac chamber volumes. OBJECTIVES This study tested the ability to engineer admittance electrodes onto an existing Impella CP pump to assess total and native CO as well as LV chamber volumes in an instantaneous manner. METHODS Impella CP pumps were fitted with 4 admittance electrodes and were placed in the LVs of adult swine (n = 9) that were subjected to 3 different hemodynamic conditions, including Impella CP speed adjustments, administration of escalating doses of dobutamine and microsphere injections into the left main artery to result in cardiac injury. CO, according to admittance electrodes, was calculated from LV volumes and heart rate. In addition, CO was calculated in each instance via thermodilution, continuous CO measurement, the Fick principle, and aortic velocity-time integral by means of echocardiography. RESULTS Modified Impella CP pumps were placed in swine LVs successfully. CO, as determined by admittance electrodes, was similar by trend to other methods of CO assessment. It was corrected for pump speed to calculate native CO, and calculated LV chamber volumes trended as expected in each experimental protocol. CONCLUSIONS We report, for the first time, that an Impella CP pump can be fitted with admittance electrodes and used to determine total and native CO in various hemodynamic situations. CONDENSED ABSTRACT Transvalvular mechanical circulatory support devices such as the Impella CP do not have the ability to provide real-time information on native cardiac output (CO) and left ventricular (LV) volumes. This information is critical in device management and in weaning in patients with cardiogenic shock. We demonstrate, for the first time, that Impella CP pumps coupled with admittance electrodes are able to determine native CO and LV chamber volumes in multiple hemodynamic situations such as Impella pump speed adjustments, escalating dobutamine administration and cardiac injury from microsphere injection.
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Affiliation(s)
- M Imran Aslam
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Aleksandra B Gruslova
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Ahmed Almomani
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Drew Nolen
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - James J Elliott
- Department of Laboratory Animal Resources, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Vivek P Jani
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anil Kottam
- BridgeSource Medical Corporation, Austin, Texas
| | | | | | - Allen S Anderson
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Jonathan W Valvano
- Department of Electrical Engineering, University of Texas at Austin, Austin, Texas
| | - Marc D Feldman
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
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Zaremba SMM, Cook WB, Anderson AS. ' It was called a grab bag and nobody wanted to grab them': Teachers' perceptions of school lunches during the COVID-19 pandemic - a regional case study. J Public Health Res 2023; 12:22799036231193071. [PMID: 37622100 PMCID: PMC10446468 DOI: 10.1177/22799036231193071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/16/2023] [Indexed: 08/26/2023] Open
Abstract
Background The COVID-19 pandemic brought changes to primary school lunches leading to concerns over nutritional quality and uptake of lunches by vulnerable children. Regional data from Tayside, Scotland, showed that only 55% of children who were eligible for free school meals took these (normal uptake pre-pandemic was 66%). The current work aimed to identify teachers' perceptions of meal provisioning in primary schools during the first year of the COVID-19 pandemic. Design and methods A cross-sectional online survey was carried out among primary school teachers across Tayside, Scotland. Using an online survey (21 questions combining multiple choice formats and open text) and interviews, primary school teachers shared their views on food quality, quantity, meal choices and factors influencing uptake of primary school lunches. Interviews were recorded, transcribed and thematically analysed with respect to factors influencing consumption. Results The survey was completed by 41 teachers and 8 participated in a follow up interview. Around one-third (29%) of primary school teachers believed the quality of lunches had decreased and cited poor appearance of food, use of takeaway containers and food wastage. The lunch format was viewed negatively principally relating to the substitution of hot lunches with cold sandwiches, portion sizes, choice and perceived value for money. Concerns were expressed about acceptability and how far the meals contributed to food security. Conclusions Further work on food provisioning is needed in order to identify ways to provide a nutritional safety net for vulnerable children.
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Affiliation(s)
- SMM Zaremba
- Division of Population Health & Genomics, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK
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Pelzer KM, Zhang KC, Lazenby KA, Narang N, Churpek MM, Anderson AS, Parker WF. The Accuracy of Initial U.S. Heart Transplant Candidate Rankings. JACC Heart Fail 2023; 11:504-512. [PMID: 37052549 PMCID: PMC10790705 DOI: 10.1016/j.jchf.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 12/16/2022] [Accepted: 02/01/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND The U.S. heart allocation system ranks candidates with only 6 treatment-based categorical "statuses" and ignores many objective patient characteristics. OBJECTIVES This study sought to determine the effectiveness of the standard 6-status ranking system and several novel prediction models in identifying the most urgent heart transplant candidates. METHODS The primary outcome was death before receipt of a heart transplant. The accuracy of the 6-status system was evaluated using Harrell's C-index and log-rank tests of Kaplan-Meier estimated survival by status for candidates listed postpolicy (November 2018 to March 2020) in the Scientific Registry of Transplant Recipients data set. The authors then developed Cox proportional hazards models and random survival forest models using prepolicy data (2010-2017). The predictor variables included age, diagnosis, laboratory measurements, hemodynamics, and supportive treatment at the time of listing. The performance of these models was compared with the candidate's 6-status ranking in the postpolicy data. RESULTS Since policy implementation, the 6-status ranking at listing has had moderate ability to rank-order candidates (C-index: 0.67). Statuses 4 and 6 had no significant difference in survival (P = 0.80), and status 5 had lower survival than status 4 (P < 0.001). Novel multivariable prediction models derived with prepolicy data ranked candidates correctly more often than the 6-status rankings (Cox proportional hazards model C-index: 0.76; random survival forest model C-index: 0.74). Objective physiologic measurements, such as glomerular filtration rate, had high variable importance. CONCLUSIONS The treatment-based 6-status heart allocation system has only moderate ability to rank-order candidates by medical urgency. Predictive models that incorporate physiologic measurements can more effectively rank-order heart transplant candidates by urgency.
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Affiliation(s)
- Kenley M Pelzer
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Kevin C Zhang
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Kevin A Lazenby
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Nikhil Narang
- Advocate Heart Institute, Advocate Christ Medical Center, Oak Lawn, Illinois, USA; Department of Medicine, University of Illinois-Chicago, Chicago, Illinois, USA
| | - Matthew M Churpek
- Department of Medicine, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Allen S Anderson
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - William F Parker
- Department of Medicine, University of Chicago, Chicago, Illinois, USA; MacLean Center for Medical Ethics, University of Chicago, Chicago, Illinois, USA.
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4
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Tibrewala A, Wehbe RM, Wu T, Harap R, Ghafourian K, Wilcox JE, Okwuosa IS, Vorovich EE, Ahmad FS, Yancy C, Pawale A, Anderson AS, Pham DT, Rich JD. Hyponatremia Is a Powerful Predictor of Poor Prognosis in Left Ventricular Assist Device Patients. ASAIO J 2022; 68:1475-1482. [PMID: 35696712 PMCID: PMC9908070 DOI: 10.1097/mat.0000000000001691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Serum sodium is an established prognostic marker in heart failure (HF) patients and is associated with an increased risk of morbidity and mortality. We sought to study the prognostic value of serum sodium in left ventricular assist device (LVAD) patients and whether hyponatremia reflects worsening HF or an alternative mechanism. We identified HF patients that underwent LVAD implantation between 2008 and 2019. Hyponatremia was defined as Na ≤134 mEq/L at 3 months after implantation. We assessed for differences in hyponatremia before and after LVAD implantation. We also evaluated the association of hyponatremia with all-cause mortality and recurrent HF hospitalizations. There were 342 eligible LVAD patients with a sodium value at 3 months. Among them, there was a significant improvement in serum sodium after LVAD implantation compared to preoperatively (137.2 vs. 134.7 mEq/L, P < 0.0001). Patients with and without hyponatremia had no significant differences in echocardiographic and hemodynamic measurements. In a multivariate analysis, hyponatremia was associated with a markedly increased risk of all-cause mortality (HR 3.69, 95% CI, 1.93-7.05, P < 0.001) when accounting for age, gender, co-morbidities, use of loop diuretics, and B-type natriuretic peptide levels. Hyponatremia was also significantly associated with recurrent HF hospitalizations (HR 2.11, 95% CI, 1.02-4.37, P = 0.04). Hyponatremia in LVAD patients is associated with significantly higher risk of all-cause mortality and recurrent HF hospitalizations. Hyponatremia may be a marker of ongoing neurohormonal activation that is more sensitive than other lab values, echocardiography parameters, and hemodynamic measurements.
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Affiliation(s)
- Anjan Tibrewala
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Ramsey M. Wehbe
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Tingqing Wu
- Clinical Trials Unit, Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Rebecca Harap
- Department of Surgery, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois
| | - Kambiz Ghafourian
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Jane E. Wilcox
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Ike S. Okwuosa
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Esther E. Vorovich
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Faraz S. Ahmad
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Clyde Yancy
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Amit Pawale
- Department of Surgery, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois
| | - Allen S. Anderson
- Department of Medicine, Division of Cardiology, University of Texas at San Antonio, San Antonio, Texas
| | - Duc T. Pham
- Department of Surgery, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois
| | - Jonathan D. Rich
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
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Pillarisetti J, Cheema MS, Haloot J, Panday M, Badin A, Mehta A, Anderson AS, Prasad A. Cardiac Complications of COVID-19: Incidence and Outcomes. Indian Heart J 2022; 74:170-177. [PMID: 35490848 PMCID: PMC9050189 DOI: 10.1016/j.ihj.2022.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 04/10/2022] [Accepted: 04/26/2022] [Indexed: 01/08/2023] Open
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Abbasi MA, Blake AM, Sarnari R, Lee D, Anderson AS, Ghafourian K, Khan SS, Vorovich EE, Rich JD, Wilcox JE, Yancy CW, Carr JC, Markl M. Multiparametric Cardiac Magnetic Resonance Imaging Detects Altered Myocardial Tissue and Function in Heart Transplantation Recipients Monitored for Cardiac Allograft Vasculopathy. J Cardiovasc Imaging 2022; 30:263-275. [PMID: 36280267 PMCID: PMC9592247 DOI: 10.4250/jcvi.2022.0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/26/2022] [Accepted: 05/02/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cardiac allograft vasculopathy (CAV) is a complication beyond the first-year post-heart transplantation (HTx). We aimed to test the utility of cardiac magnetic resonance (CMR) to detect functional/structural changes in HTx recipients with CAV. METHODS Seventy-seven prospectively recruited HTx recipients beyond the first-year post-HTx and 18 healthy controls underwent CMR, including cine imaging of ventricular function and T1- and T2-mapping to assess myocardial tissue changes. Data analysis included quantification of global cardiac function and regional T2, T1 and extracellular volume based on the 16-segment model. International Society for Heart and Lung Transplantation criteria was used to adjudicate CAV grade (0–3) based on coronary angiography. RESULTS The majority of HTx recipients (73%) presented with CAV (1: n = 42, 2/3: n = 14, 0: n = 21). Global and segmental T2 (49.5 ± 3.4 ms vs 50.6 ± 3.4 ms, p < 0.001;16/16 segments) were significantly elevated in CAV-0 compared to controls. When comparing CAV-2/3 to CAV-1, global and segmental T2 were significantly increased (53.6 ± 3.2 ms vs. 50.6 ± 2.9 ms, p < 0.001; 16/16 segments) and left ventricular ejection fraction was significantly decreased (54 ± 9% vs. 59 ± 9%, p < 0.05). No global, structural, or functional differences were seen between CAV-0 and CAV-1. CONCLUSIONS Transplanted hearts display functional and structural alteration compared to native hearts, even in those without evidence of macrovasculopathy (CAV-0). In addition, CMR tissue parameters were sensitive to changes in CAV-1 vs. 2/3 (mild vs. moderate/severe). Further studies are warranted to evaluate the diagnostic value of CMR for the detection and classification of CAV.
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Affiliation(s)
- Muhannad A. Abbasi
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Allison M. Blake
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Roberto Sarnari
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel Lee
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Allen S. Anderson
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Kambiz Ghafourian
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Sadiya S. Khan
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Esther E. Vorovich
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Jonathan D. Rich
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Jane E. Wilcox
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Clyde W. Yancy
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - James C. Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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7
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Ran G, Chung K, Anderson AS, Gibbons RD, Narang N, Churpek MM, Parker WF. Between-center variation in high-priority listing status under the new heart allocation policy. Am J Transplant 2021; 21:3684-3693. [PMID: 33864733 PMCID: PMC8729112 DOI: 10.1111/ajt.16614] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 01/14/2021] [Revised: 03/24/2021] [Accepted: 04/11/2021] [Indexed: 01/25/2023]
Abstract
Under the new US heart allocation policy, transplant centers listed significantly more candidates at high priority statuses (Status 1 and 2) with mechanical circulatory support devices than expected. We determined whether the practice change was widespread or concentrated among certain transplant centers. Using data from the Scientific Registry of Transplant Recipients, we used mixed-effect logistic regression to compare the observed listings of adult, heart-alone transplant candidates post-policy (December 2018 to February 2020) to seasonally matched pre-policy cohort (December 2016 to February 2018). US transplant centers (N = 96) listed similar number of candidates in each policy period (4472 vs. 4498) but listed significantly more at high priority status (25.5% vs. 7.0%, p < .001) than expected. Adjusted for candidate characteristics, 91 of 96 (94.8%) centers listed significantly more candidates at high-priority status than expected, with the unexpected increase varying from 4.8% to 50.4% (interquartile range [IQR]: 14.0%-23.3%). Centers in OPOs with highest Status 1A transplant rate pre-policy were significantly more likely to utilize high-priority status under the new policy (OR: 9.73, p = .01). The new heart allocation policy was associated with widespread and significantly variable changes in transplant center practice that may undermine the effectiveness of the new system.
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Affiliation(s)
- Gege Ran
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Kevin Chung
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | | | - Robert D. Gibbons
- Department of Medicine, University of Chicago, Chicago, Illinois,Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Nikhil Narang
- Department of Medicine, University of Illinois-Chicago, Chicago, Illinois, USA,Advocate Heart Institute, Advocate Christ Medical Center, Oak Lawn, Illinois
| | | | - William F. Parker
- Department of Medicine, University of Chicago, Chicago, Illinois,Department of Public Health Sciences, University of Chicago, Chicago, Illinois,MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
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8
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Jackson KC, Youmans QR, Wu T, Harap R, Anderson AS, Chicos A, Ezema A, Mandieka E, Ohiomoba R, Pawale A, Pham DT, Russell S, Sporn PHS, Yancy CW, Okwuosa IS. Heart transplantation outcomes in cardiac sarcoidosis. J Heart Lung Transplant 2021; 41:113-122. [PMID: 34756511 DOI: 10.1016/j.healun.2021.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 08/06/2021] [Accepted: 08/18/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cardiac sarcoidosis (CS) is a progressive inflammatory cardiomyopathy that can lead to heart failure, arrhythmia, and death. There is limited data on Orthotopic Heart Transplantation (OHT) outcomes in patients with CS. Here we examine outcomes in patients with CS who have undergone OHT at centers throughout the United States from 1987 to 2019. METHODS This was an analysis of 63,947 adult patients undergoing OHT captured in the United Network for Organ Sharing (UNOS) registry. Patients were characterized as cardiac sarcoidosis (CS) or Non-CS. Baseline characteristics were compared using chi-square and Kruskal-Wallis Tests. Outcomes of interest included primary graft failure, patient survival, treated graft rejection, hospitalization for infection, and post-transplant malignancy. RESULTS During the study period 227 patients with CS underwent OHT. Patients with CS were younger, had higher proportion of non-white patients, and received transplants at more urgent statuses. After multivariable modeling there was no difference in survival (HR 0.86, CI 0.59-1.3, p = 0.446) or graft failure (HR 0.849, CI 0.58-1.23, p = 0.394) between patients with CS and Non-CS. Patients with CS had lower odds of rejection (OR 0.558, CI 0.315- 0.985, p = 0.0444). Patients with CS had similar odds of hospitalization for infection and post-transplant malignancy, as Non-CS patients. CONCLUSIONS Patients with CS and Non-CS had similar post OHT survival, odds of graft failure, hospitalizations for infection, and post-transplant malignancy. Results of this study confirm the role of heart transplantation as a viable option for patients with CS.
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Affiliation(s)
- K C Jackson
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Q R Youmans
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - T Wu
- Department of Cardiac Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - R Harap
- Department of Cardiac Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - A S Anderson
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - A Chicos
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - A Ezema
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - E Mandieka
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - R Ohiomoba
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - A Pawale
- Department of Cardiac Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - D T Pham
- Department of Cardiac Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - S Russell
- Division of Pulmonary and Critical Care Medicine, Northwestern University, Feinberg School of Medicine
| | - P H S Sporn
- Division of Pulmonary and Critical Care Medicine, Northwestern University, Feinberg School of Medicine
| | - C W Yancy
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Ike S Okwuosa
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
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Haloot J, Elbey M, Cheema MS, Anderson AS, Badin A, Panday MM, Lakkireddy DR, Pillarisetti J. B-AB07-04 A SIMPLE AND EASY GUIDE TO PREDICT THE RISK OF ATRIAL FIBRILLATION RECURRENCE POST ABLATION: CHECK OUT THE SIZE OF THE FIBRILLATORY WAVES. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Ohiomoba RO, Youmans QR, Ezema A, Akanyirige P, Anderson AS, Bryant A, Jackson K, Mandieka E, Pham DT, Rich JD, Yancy CW, Okwuosa IS. Cardiac transplantation outcomes in patients with amyloid cardiomyopathy. Am Heart J 2021; 236:13-21. [PMID: 33621542 DOI: 10.1016/j.ahj.2021.02.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/16/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Amyloid cardiomyopathy (ACM) is a progressive and life-threatening disease caused by abnormal protein deposits within cardiac tissue. The most common forms of ACM are caused by immunoglobulin derived light chains (AL) and transthyretin (TTR). Orthotopic heart transplantation (OHT) remains the definitive treatment for patients with end stage heart failure. In this study, we perform a contemporary multicenter analysis evaluating post OHT survival in patients with ACM. METHODS We conducted a multicenter analysis of 40,044 adult OHT recipients captured in the United Network for Organ Sharing (UNOS) registry from 1987-2018. Patients were characterized as ACM or non-ACM. Baseline characteristics were obtained, and summary characteristics were calculated. Outcomes of interest included post-transplant survival, infection, treated rejection, and the ability to return to work. Racial differences in OHT survival were also analyzed. Unadjusted associations between ACM and non-ACM survival were determined using the Kaplan-Meier estimations and confounding was addressed using multivariable Cox proportional hazards models. RESULTS Three hundred ninety-eight patients with a diagnosis of ACM were identified of which 313 underwent heart only OHT. ACM patients were older (61 vs 53; P < .0001) and had a higher proportion of African Americans (30.7% vs 17.6%; P < .0001). Median survival for ACM was 10.2 years vs 12.5 years in non-ACM (P = .01). After adjusting for confounding, ACM patients had a higher likelihood of death post-OHT (HR 1.39 CI: 1.14, 1.70; P = .001). African American ACM patients had a higher likelihood of survival compared to White ACM patients (HR 0.51 CI 0.31-0.85; P = .01). No difference was observed in episodes of treated rejection (OR 0.63 CI 0.23, 1.78; P = .39), hospitalizations for infections (OR 1.24 CI: 0.85, 1.81; P = .26), or likelihood of returning to work for income (OR 1.23 CI: 0.84, 1.80; P = .30). CONCLUSIONS In this analysis of OHT in ACM, ACM was associated with a higher likelihood of post-OHT mortality. Racial differences in post-OHT were observed with African American patients with ACM having higher likelihood of survival compared to White patients with ACM. No differences were observed in episodes of treated rejection, hospitalization for infection, or likelihood to return to work for income.
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Affiliation(s)
| | | | - Ashley Ezema
- Northwestern University, Feinberg School of Medicine
| | - P Akanyirige
- Northwestern University, Feinberg School of Medicine
| | | | | | | | | | - Duc T Pham
- Northwestern University, Department of Cardiac Surgery
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11
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Puckelwartz MJ, Pesce LL, Dellefave‐Castillo LM, Wheeler MT, Pottinger TD, Robinson AC, Kearns SD, Gacita AM, Schoppen ZJ, Pan W, Kim G, Wilcox JE, Anderson AS, Ashley EA, Day SM, Cappola T, Dorn GW, McNally EM. Genomic Context Differs Between Human Dilated Cardiomyopathy and Hypertrophic Cardiomyopathy. J Am Heart Assoc 2021; 10:e019944. [PMID: 33764162 PMCID: PMC8174318 DOI: 10.1161/jaha.120.019944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/17/2021] [Indexed: 12/20/2022]
Abstract
Background Inherited cardiomyopathies display variable penetrance and expression, and a component of phenotypic variation is genetically determined. To evaluate the genetic contribution to this variable expression, we compared protein coding variation in the genomes of those with hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM). Methods and Results Nonsynonymous single-nucleotide variants (nsSNVs) were ascertained using whole genome sequencing from familial cases of HCM (n=56) or DCM (n=70) and correlated with echocardiographic information. Focusing on nsSNVs in 102 genes linked to inherited cardiomyopathies, we correlated the number of nsSNVs per person with left ventricular measurements. Principal component analysis and generalized linear models were applied to identify the probability of cardiomyopathy type as it related to the number of nsSNVs in cardiomyopathy genes. The probability of having DCM significantly increased as the number of cardiomyopathy gene nsSNVs per person increased. The increase in nsSNVs in cardiomyopathy genes significantly associated with reduced left ventricular ejection fraction and increased left ventricular diameter for individuals carrying a DCM diagnosis, but not for those with HCM. Resampling was used to identify genes with aberrant cumulative allele frequencies, identifying potential modifier genes for cardiomyopathy. Conclusions Participants with DCM had more nsSNVs per person in cardiomyopathy genes than participants with HCM. The nsSNV burden in cardiomyopathy genes did not correlate with the probability or manifestation of left ventricular measures in HCM. These findings support the concept that increased variation in cardiomyopathy genes creates a genetic background that predisposes to DCM and increased disease severity.
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Affiliation(s)
- Megan J. Puckelwartz
- Center for Genetic MedicineNorthwestern University Feinberg School of MedicineChicagoIL
- Department of PharmacologyNorthwestern University Feinberg School of MedicineChicagoIL
- Department of Medicine/Cardiovascular MedicineStanford UniversityStanfordCA
| | - Lorenzo L. Pesce
- Center for Genetic MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | | | - Matthew T. Wheeler
- Department of Medicine/Cardiovascular MedicineStanford UniversityStanfordCA
| | - Tess D. Pottinger
- Center for Genetic MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Avery C. Robinson
- Center for Genetic MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Samuel D. Kearns
- Center for Genetic MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Anthony M. Gacita
- Center for Genetic MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Zachary J. Schoppen
- Center for Genetic MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Wenyu Pan
- Center for Genetic MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Gene Kim
- Department of MedicineUniversity of ChicagoChicagoIL
| | - Jane E. Wilcox
- Department of MedicineBluhm Cardiovascular InstituteNorthwestern UniversityChicagoIL
| | - Allen S. Anderson
- Department of MedicineBluhm Cardiovascular InstituteNorthwestern UniversityChicagoIL
| | - Euan A. Ashley
- Department of MedicineBluhm Cardiovascular InstituteNorthwestern UniversityChicagoIL
| | - Sharlene M. Day
- Department of Internal MedicineThe University of MichiganAnn ArborMI
- Perelman School of MedicineDivision of Cardiovascular Medicine and Penn CardiovascularInstitute and Department of MedicineUniversity of PennsylvaniaPhiladelphiaPA
| | - Thomas Cappola
- Perelman School of MedicineDivision of Cardiovascular Medicine and Penn CardiovascularInstitute and Department of MedicineUniversity of PennsylvaniaPhiladelphiaPA
| | | | - Elizabeth M. McNally
- Center for Genetic MedicineNorthwestern University Feinberg School of MedicineChicagoIL
- Department of Internal MedicineThe University of MichiganAnn ArborMI
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Parker WF, Chung K, Anderson AS, Siegler M, Huang ES, Churpek MM. Practice Changes at U.S. Transplant Centers After the New Adult Heart Allocation Policy. J Am Coll Cardiol 2021; 75:2906-2916. [PMID: 32527399 DOI: 10.1016/j.jacc.2020.01.066] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND In October 2018, the U.S. heart allocation system expanded the number of priority "status" tiers from 3 to 6 and added cardiogenic shock requirements for some heart transplant candidates listed with specific types of treatments. OBJECTIVES This study sought to determine the impact of the new policy on the treatment practices of transplant centers. METHODS Initial listing data on all adult heart candidates listed from December 1, 2017 to April 30, 2019 were collected from the Scientific Registry of Transplant Recipients. The status-qualifying treatments (or exception requests) and hemodynamic values at listing of a post-policy cohort (December 2018 to April 2019) were compared with a seasonally matched pre-policy cohort (December 2017 to April 2018). Candidates in the pre-policy cohort were reclassified into the new priority system statuses by using treatment, diagnosis, and hemodynamics. RESULTS Comparing the post-policy cohort (N = 1,567) with the pre-policy cohort (N = 1,606), there were significant increases in listings with extracorporeal membrane oxygenation (+1.2%), intra-aortic balloon pumps (+ 4 %), and exceptions (+ 12%). Listings with low-dose inotropes (-18%) and high-dose inotropes (-3%) significantly decreased. The new priority status distribution had more status 2 (+14%) candidates than expected and fewer status 3 (-5%), status 4 (- 4%) and status 6 (-8%) candidates than expected (p values <0.01 for all comparisons). CONCLUSIONS After implementation of the new heart allocation policy, transplant centers listed more candidates with extracorporeal membrane oxygenation, intra-aortic balloon pumps, and exception requests and fewer candidates with inotrope therapy than expected, thus leading to significantly more high-priority status listings than anticipated. If these early trends persist, the new allocation system may not function as intended.
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Affiliation(s)
- William F Parker
- Department of Medicine, University of Chicago, Chicago, Illinois; MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois.
| | - Kevin Chung
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Allen S Anderson
- Department of Medicine, Northwestern University, Chicago Illinois
| | - Mark Siegler
- MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
| | - Elbert S Huang
- Department of Medicine, University of Chicago, Chicago, Illinois; MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
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13
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Simkowski JM, Wehbe RM, Goergen J, Anderson AS, Ghafourian K, Okwuosa I, Vorovich EE, Ahmad FS, Tibrewala A, Pham DT, Wilcox JE, Rich JD. Unsupervised Machine Learning of LGE Patterns on Cardiac MRI Identifies Patients at Risk for Right Ventricular Failure After LVAD. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
PURPOSE OF REVIEW We aim to review the mechanism of action and safety profile of mineralocorticoid receptor antagonists (MRAs) and discuss the differences between selective and non-selective MRAs. More specifically, finerenone is a new medication that is currently under investigation for its promising cardiovascular and nephrological effects. RECENT FINDINGS MRAs are well known for their utility in treating heart failure, refractory hypertension, and diverse nephropathies, namely, diabetic nephropathy. As their name denotes, MRAs inhibit the action of aldosterone at the mineralocorticoid receptor, preventing receptor activation. This prevents remodeling, decreases inflammation, and improves proteinuria. There are not significant differences in outcomes between selective and non-selective MRAs. A new selective MRA named finerenone (originally BAY 94-8862) has shown promising results in several trials (ARTS-HF and ARTS-DN) and smaller studies. Finerenone may have a dose-dependent benefit over older MRAs, decreasing rates of albuminuria and levels of BNP and NT-ProBNP without causing a significant increase in serum potassium levels. This medication is not yet approved as it is still in phase 3 clinical trials (FIGARO-DKD and FIDELIO-DKD trials). MRAs are beneficial in several disease states. Newer medications, such as finerenone, should be considered in patients with heart failure and diabetic nephropathy who may benefit from a reduction in albuminuria and BNP/NT-ProBNP. Data surrounding finerenone are limited to date. However, results from ongoing clinical trials, as well as new trials to evaluate use in other pathologies, could validate the implementation of this medication in daily practice.
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Affiliation(s)
- Juan Simon Rico-Mesa
- Department of Medicine, Division of Internal Medicine, University of Texas Health San Antonio, San Antonio, TX, 78229, USA
| | - Averi White
- Department of Medicine, Division of Internal Medicine, University of Texas Health San Antonio, San Antonio, TX, 78229, USA
| | - Ashkan Ahmadian-Tehrani
- Department of Medicine, Division of Internal Medicine, University of Texas Health San Antonio, San Antonio, TX, 78229, USA
| | - Allen S Anderson
- Department of Medicine, Division of Cardiovascular Diseases, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7872, San Antonio, TX, 78229, USA.
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Youmans QR, Zhou A, Harap R, Eskender MH, Anderson AS, Ezema AU, Ghafourian K, Ohiomoba R, Pham DT, Rich JD, Vorovich EE, Wilcox JE, Yancy CW, Okwuosa IS. Association of cigarette smoking and adverse events in left ventricular assist device patients. Int J Artif Organs 2020; 44:181-187. [PMID: 32794429 DOI: 10.1177/0391398820948874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Adverse events (AEs) associated with left ventricular assist devices (LVADs) cause significant morbidity and mortality. Little is known about patient-specific factors that contribute to rates of AEs. The purpose of this study was to assess the association of cigarette smoking history and AEs following LVAD implantation. METHODS This study was a single-center, observational examination of 355 consecutive patients who underwent continuous-flow LVAD implantation from May 1, 2008 to July 1, 2018. Based on self-report, 348 patients with available data were categorized as never, former, or current smokers. Pre-LVAD implantation baseline characteristics were obtained, and summary characteristics were calculated. Hospitalizations for gastrointestinal bleeds, driveline infections, strokes, pump thromboses, and acute heart failure were evaluated. The Cox proportional hazard model was used to estimate the association of smoking and AE-related hospital admissions. The cumulative incidence competing risk method was used for survival analysis. RESULTS Current (8.22%, p 0.006) and former (4.75%, p 0.026) smokers had a greater proportion of admissions for pump thrombosis compared to never smokers (2.22%). Former smoking was associated with admission for driveline infection (HR 2.43, CI 1.08-5.46, p 0.03) on multivariate analysis. There were no significant associations between smoking and the other AEs of interest. There was no difference in survival among the three groups. CONCLUSIONS Smokers had a higher proportion of admissions for pump thrombosis compared to never smokers, and former smoking was associated with admission for driveline infections in patients with LVADs.
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Affiliation(s)
- Quentin R Youmans
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amy Zhou
- Bluhm Cardiovascular Institute of Northwestern Medicine, Chicago, IL, USA
| | - Rebecca Harap
- Bluhm Cardiovascular Institute of Northwestern Medicine, Chicago, IL, USA
| | | | - Allen S Anderson
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ashley U Ezema
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kambiz Ghafourian
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ramael Ohiomoba
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Duc T Pham
- Department of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
| | - Jonathan D Rich
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Esther E Vorovich
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jane E Wilcox
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Clyde W Yancy
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ike S Okwuosa
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Ohiomoba RO, Youmans QR, Akanyirige PW, Ezema AU, Anderson AS, Bryant A, Jackson K, Mandieka E, Pham DT, Raza Y, Rich JD, Yancy CW, Okwuosa IS. History of cigarette smoking and heart transplant outcomes. Int J Cardiol Heart Vasc 2020; 30:100599. [PMID: 32775604 PMCID: PMC7398935 DOI: 10.1016/j.ijcha.2020.100599] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 11/17/2022]
Abstract
Background: Active cigarette smoking (CS) is a contraindication for Orthotopic Heart Transplantation (OHT) with a recommendation that HT candidates be free from CS for at minimum 6 months prior to HT. Animal studies have shown that a history of CS is associated with increased risk of allograft rejection, but few studies have examined the association of past CS and HT outcomes. Methods: Data were analyzed from HT recipients captured in the United Network for Organ Sharing (UNOS) transplant registry. Adults aged 18–79 who underwent HT from 1987 to 2018 and with data for all covariates (N = 32,260) were included in this study. The cohort was categorized by past smoking history (CS vs non-CS). Post-transplant outcomes of interest included survival, graft failure, treated rejection, malignancy and hospitalization for infection. Baseline characteristics were compared between the two groups using the chi-squared analysis. Unadjusted associations between CS and patient survival were determined using the Kaplan-Meier estimations and confounding was addressed using multivariable Cox proportional hazards models. Results: HT recipients with a history of CS were older (55 vs 50, p = <0.0001), more likely to be Caucasian (75.7 vs 62.3, p = <0.0001), male (81.7 vs 68.2, p =< 0.0001), and diabetic (27.4 vs 24.4, p =< 0.0001). CS was associated with significantly worse survival (HR: 1.23, p < 0.0001). A history of CS was also associated with increased risk of acute rejection (OR: 1.20, p < 0.0001), hospitalization for infection (OR:1.24, p < 0.0001), graft failure (OR:1.23, p < 0.0001) and post-transplant malignancy (OR:1.43, p < 0.0001). Conclusion: A history of CS is associated with increased risk of adverse events post OHT.
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Affiliation(s)
- R O Ohiomoba
- Northwestern University, Feinberg School of Medicine, United States
| | - Q R Youmans
- Northwestern University, Division of Cardiology, United States
| | - P W Akanyirige
- Northwestern University, Feinberg School of Medicine, United States
| | - A U Ezema
- Northwestern University, Feinberg School of Medicine, United States
| | - A S Anderson
- University of Texas San Antonio, Division of Cardiology, United States
| | - A Bryant
- Mehary Medical College, United States
| | - K Jackson
- Northwestern University, Department of Medicine, United States
| | - E Mandieka
- Northwestern University, Department of Medicine, United States
| | - D T Pham
- Northwestern University, Department of Cardiac Surgery, United States
| | - Y Raza
- Northwestern University, Division of Cardiology, United States
| | - J D Rich
- Northwestern University, Division of Cardiology, United States
| | - C W Yancy
- Northwestern University, Division of Cardiology, United States
| | - I S Okwuosa
- Northwestern University, Division of Cardiology, United States
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17
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Chaikriangkrai K, Abbasi MA, Sarnari R, Dolan R, Lee D, Anderson AS, Ghafourian K, Khan SS, Vorovich EE, Rich JD, Wilcox JE, Blaisdell JA, Yancy CW, Carr J, Markl M. Prognostic Value of Myocardial Extracellular Volume Fraction and T2-mapping in Heart Transplant Patients. JACC Cardiovasc Imaging 2020; 13:1521-1530. [PMID: 32199848 PMCID: PMC8809107 DOI: 10.1016/j.jcmg.2020.01.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 01/22/2020] [Accepted: 01/30/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The purpose of this study was to examine prognostic value of T1- and T2-mapping techniques in heart transplant patients. BACKGROUND Myocardial characterization using T2 mapping (evaluation of edema/inflammation) and pre- and post-gadolinium contrast T1 mapping (calculation of extracellular volume fraction [ECV] for assessment of interstitial expansion/fibrosis) are emerging modalities that have been investigated in various cardiomyopathies. METHODS A total of 99 heart transplant patients underwent the magnetic resonance imaging (MRI) scans including T1- (n = 90) and T2-mapping (n = 79) techniques. Relevant clinical characteristics, MRI parameters including late gadolinium enhancement (LGE), and invasive hemodynamics were collected. Median clinical follow-up duration after the baseline scan was 2.4 to 3.5 years. Clinical outcomes include cardiac events (cardiac death, myocardial infarction, coronary revascularization, and heart failure hospitalization), noncardiac death and noncardiac hospitalization. RESULTS Overall, the global native T1, postcontrast T1, ECV, and T2 were 1,030 ± 56 ms, 458 ± 84 ms, 27 ± 4% and 50 ± 4 ms, respectively. Top-tercile-range ECV (ECV >29%) independently predicted adverse clinical outcomes compared with bottom-tercile-range ECV (ECV <25%) (hazard ratio [HR]: 2.87; 95% confidence interval [CI]: 1.07 to 7.68; p = 0.04) in a multivariable model with left ventricular end-systolic volume and LGE. Higher T2 (T2 ≥50.2 ms) independently predicted adverse clinical outcomes (HR: 3.01; 95% CI: 1.39 to 6.54; p = 0.005) after adjustment for left ventricular ejection fraction, left ventricular end-systolic volume, and LGE. Additionally, higher T2 (T2 ≥50.2 ms) also independently predicted cardiac events (HR: 4.92; CI: 1.60 to 15.14; p = 0.005) in a multivariable model with left ventricular ejection fraction. CONCLUSIONS MRI-derived myocardial ECV and T2 mapping in heart transplant patients were independently associated with cardiac and noncardiac outcomes. Our findings highlight the need for larger prospective studies.
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Affiliation(s)
- Kongkiat Chaikriangkrai
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Muhannad Aboud Abbasi
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Roberto Sarnari
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ryan Dolan
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Daniel Lee
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Allen S Anderson
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Kambiz Ghafourian
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Sadiya S Khan
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Esther E Vorovich
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Jonathan D Rich
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Jane E Wilcox
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Julie A Blaisdell
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Clyde W Yancy
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - James Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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18
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Abstract
PURPOSE OF REVIEW We aim to provide a comprehensive analysis of hypercoagulability in individuals affected by COVID-19. Our goal is to describe the hypercoagulable state related to the infection and provide guidance regarding the possible benefits of anti-coagulation with the support of evidence from current literature. RECENT FINDINGS The incidence of thrombotic disease in individuals affected by COVID-19 is reported as high as 31%. A significant mortality benefit has been observed with the use of therapeutic anticoagulation in high-risk individuals. Literature supports the use of scoring systems, such as the sepsis-induced coagulopathy score, to risk-stratify individuals who might benefit from anticoagulation. COVID-19-induced hypercoagulability has been demonstrated to play a significant role in overall COVID-19 outcomes. Current literature shows promising evidence with the use of therapeutic anticoagulation in high-risk individuals. Further studies are needed to better analyze the risks and benefits of anticoagulation in this specific patient population.
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Affiliation(s)
- Juan Simon Rico-Mesa
- Department of Medicine, Division of Internal Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA
| | - Daniel Rosas
- Department of Medicine, Division of Internal Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA
| | - Ashkan Ahmadian-Tehrani
- Department of Medicine, Division of Internal Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA
| | - Averi White
- Department of Medicine, Division of Internal Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA
| | - Allen S. Anderson
- Department of Medicine, Division of Cardiovascular Diseases, University of Texas Health San Antonio, San Antonio, TX 78229 USA
| | - Robert Chilton
- Department of Medicine, Division of Cardiovascular Diseases, University of Texas Health San Antonio, San Antonio, TX 78229 USA
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Sarnari R, Pathrose A, Blake A, Abbasi M, Blaisdell J, Ghafourian K, Wilcox J, Khan S, Vorovich E, Rich J, Anderson AS, Yancy C, Carr JC, Markl M. MYOCARDIAL DYNAMICS AND RIGHT HEART PRESSURES CORRELATION AFTER HEART TRANSPLANTATION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32360-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Affiliation(s)
- Allen S. Anderson
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
- Now with Division of Cardiology, Department of Medicine, Long School of Medicine, University of Texas, San Antonio
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Abbasi M, Sarnari R, Chaikriangkrai K, Jivan A, Blaisdell J, Ghafourian K, Khan S, Wilcox J, Vorovich EE, Lee DC, Anderson AS, Rich J, Yancy CW, Carr JC, Markl M. MYOCARDIAL T2-MAPPING PREDICTS ADVERSE CARDIAC EVENTS IN HEART TRANSPLANTATION PATIENTS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32200-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Simkowski J, Wehbe R, Goergen J, Anderson AS, Ghafourian K, Okwuosa IS, Vorovich EE, Ahmad F, Tibrewala A, Pham D, Wilcox J, Rich J. RIGHT VENTRICULAR FUNCTIONAL PARAMETERS BY CARDIAC MRI ARE ASSOCIATED WITH RIGHT VENTRICULAR FAILURE AFTER LVAD. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31711-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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23
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Sarnari R, Blake AM, Ruh A, Abbasi MA, Pathrose A, Blaisdell J, Dolan RS, Ghafourian K, Wilcox JE, Khan SS, Vorovich EE, Rich JD, Anderson AS, Yancy CW, Carr JC, Markl M. Evaluating Biventricular Myocardial Velocity and Interventricular Dyssynchrony in Adult Patients During the First Year After Heart Transplantation. J Magn Reson Imaging 2020; 52:920-929. [PMID: 32061045 DOI: 10.1002/jmri.27091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Magnetic resonance tissue phase mapping (TPM) measures three-directional myocardial velocities of the left and right ventricle (LV, RV). This noninvasive technique may supplement endomyocardial biopsy (EMB) in monitoring grafts post-heart transplantation (HTx). PURPOSE To assess biventricular myocardial velocity alterations in grafts and investigate the relationship between velocities and acute cellular rejection (ACR) episodes. STUDY TYPE Prospective. SUBJECTS Twenty-seven patients within 1 year post-HTx (49 ± 13 years, 19 M) and 18 age-matched controls (49 ± 15 years, 12 M). FIELD STRENGTH/SEQUENCE 1.5T, 2D balanced steady-state free precession, and TPM. ASSESSMENT Ventricular function: end-diastolic and end-systolic volumes, stroke volumes, ejection fraction (EF), and myocardial mass. TPM velocities: peak-systolic and peak-diastolic velocities, cardiac twist, and interventricular dyssynchrony. ACR rejection episodes: International Society for Heart and Lung Transplantation grading of EMB specimens. STATISTICAL TESTS The Lilliefors test for normality, unpaired t-tests, and Wilcoxon rank-sum tests for normally and nonnormally distributed data, respectively, were used, as well as multivariate regression for confounding variables and Pearson's correlation for associations between TPM velocities and global function. RESULTS Compared to controls, HTx patients demonstrated reduced biventricular systolic longitudinal velocities (LV: 5.2 ± 2.1 vs. 4.0 ± 1.5 cm/s, P < 0.05; RV: 4.2 ± 1.3 vs. 3.1 ± 1.2 cm/s, P < 0.01). Correlation analysis revealed significant positive relationships for biventricular EF with radial peak velocities of the same ventricle in both systole and diastole (LV systole: r = 0.48, P < 0.01; LV diastole: r = 0.28, P < 0.05; RV systole: r = 0.35, P < 0.01; RV diastole: r = 0.36, P < 0.01). Segmentally, longitudinal velocities were impaired in 7/16 LV segments and 5/10 RV segments in systole and 7/10 RV segments in diastole. TPM analysis in studies with >4 preceding ACR episodes showed globally reduced RV and LV systolic radial velocity, and segmentally reduced radial and longitudinal systolic velocities. DATA CONCLUSION Biventricular global and segmental velocities were reduced in HTx patients. Patients with >4 rejection episodes showed reduced myocardial velocities. The TPM sequence may add functional information for monitoring graft dysfunction. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 2 J. Magn. Reson. Imaging 2020;52:920-929.
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Affiliation(s)
- Roberto Sarnari
- Department of Radiology, Cardiovascular Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Allison M Blake
- Department of Radiology, Cardiovascular Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alexander Ruh
- Department of Radiology, Cardiovascular Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Muhannad A Abbasi
- Department of Radiology, Cardiovascular Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashitha Pathrose
- Department of Radiology, Cardiovascular Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Julie Blaisdell
- Department of Radiology, Cardiovascular Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ryan S Dolan
- Department of Radiology, Cardiovascular Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kambiz Ghafourian
- Department of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jane E Wilcox
- Department of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sadiya S Khan
- Department of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Esther E Vorovich
- Department of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jonathan D Rich
- Department of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Allen S Anderson
- Department of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Clyde W Yancy
- Department of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - James C Carr
- Department of Radiology, Cardiovascular Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Cardiovascular Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, Illinois, USA
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Khan MS, Khan MS, Moustafa A, Anderson AS, Mehta R, Khan SS. Efficacy and Safety of Mineralocorticoid Receptor Antagonists in Patients With Heart Failure and Chronic Kidney Disease. Am J Cardiol 2020; 125:643-650. [PMID: 31843235 DOI: 10.1016/j.amjcard.2019.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/09/2019] [Accepted: 11/13/2019] [Indexed: 12/21/2022]
Abstract
Mineralocorticoid receptor antagonists (MRA) improve clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF) and reduce risk of heart failure (HF) hospitalization in patients with heart failure with preserved ejection fraction (HFpEF). However, the benefit and risks of MRA use are not clear in HF patients and chronic kidney disease (CKD) with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. We conducted a systematic review evaluating the efficacy and safety of MRA in patients with HF and CKD. PubMed, Embase, and Cochrane Central databases were searched for relevant studies on patients with HF and reduced renal function (defined as eGFR <60 mL/min/1.73 m2). Seven studies with 5,522 patients were included. We found 3 studies in patients with HFrEF, 1 study with HFpEF, and 2 in acute HF and 1 with mixed patient population of HF. Post hoc analyses from randomized controlled trials demonstrated reduction of risk in the primary end point (adverse cardiovascular outcomes and/or all-cause mortality and/or HF hospitalization) with MRA use in the CKD subgroup (eGFR 30 to 60 mL/min/1.73 m2) despite a greater risk of hyperkalemia and higher rates of drug discontinuation. In 3 observational studies, propensity score matching was performed to compare patients treated with and without MRA and did not identify benefits, but conclusions from these studies were limited due to residual confounding and concern for bias. In conclusion, benefits of MRA use in HF appear to be consistent in patients with reduced renal function (eGFR 30 to 60 mL/min/1.73 m).
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Parker WF, Churpek MM, Anderson AS. Is it too early to investigate survival outcomes of the new US heart allocation system? J Heart Lung Transplant 2020; 39:726. [PMID: 32037250 DOI: 10.1016/j.healun.2020.01.1343] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/06/2020] [Accepted: 01/24/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- William F Parker
- Department of Medicine and the; MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois.
| | | | - Allen S Anderson
- Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas
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Dolan RS, Rahsepar AA, Blaisdell J, Sarnari R, Ghafourian K, Wilcox JE, Khan SS, Vorovich EE, Rich JD, Yancy CW, Anderson AS, Carr JC, Markl M. Donor and Recipient Characteristics in Heart Transplantation Are Associated with Altered Myocardial Tissue Structure and Cardiac Function. Radiol Cardiothorac Imaging 2019; 1:e190009. [PMID: 32076670 PMCID: PMC6939741 DOI: 10.1148/ryct.2019190009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 08/06/2019] [Accepted: 09/09/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE To use structure-function cardiac MRI in the evaluation of relationships between donor and heart transplantation (HTx) recipient characteristics and changes in cardiac tissue structure and function. HTx candidates and donor hearts are evaluated for donor-recipient matches to improve survival, but the impact of donor and recipient characteristics on changes in myocardial tissue and function in the transplanted heart is not fully understood. MATERIALS AND METHODS Cardiac MRI at 1.5 T was performed from August 2014 to June 2017 in 58 HTx recipients (mean age, 51.1 years ± 12.6 [standard deviation], 26 female patients) and included T2 mapping (to evaluate edematous and/or inflammatory changes), precontrast and postcontrast T1 mapping (allowing the calculation of extracellular volume fraction [ECV] to estimate interstitial expansion), and tissue phase mapping (allowing the calculation of myocardial velocities and twist). Donor and recipient demographics (age, sex, height, weight, and body mass index [BMI]) and comorbidities (hypertension, diabetes, and smoking history) were evaluated for relationships with cardiac MRI measures. RESULTS Sex-influenced cardiac MRI measures of myocardial tissue and function are as follows: Female HTx recipients demonstrated increased precontrast T1 (P = .002) and reduced systolic peak long-axis velocities (P = .015). Increased age of the donor heart was associated with elevated T2 (r = 0.32; P < .05) and ECV (r = 0.47; P < .01), indicating increased edema and interstitial expansion, as well as impaired diastolic peak long-axis velocities (r = 0.41; P < .01). Recipient-donor differences in age, weight, and BMI were significantly associated with elevated ECV (r = 0.36-0.48; P < .05). Hypertension in donors resulted in increased ECV (31.0% ± 4.2 vs 26.0% ± 3.3; P = .001). CONCLUSION Donor and HTx recipient characteristics were significantly associated with cardiac MRI-derived measures of myocardial tissue structure and function.© RSNA, 2019.
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Affiliation(s)
- Ryan S. Dolan
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Amir A. Rahsepar
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Julie Blaisdell
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Roberto Sarnari
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Kambiz Ghafourian
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Jane E. Wilcox
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Sadiya S. Khan
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Esther E. Vorovich
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Jonathan D. Rich
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Clyde W. Yancy
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Allen S. Anderson
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - James C. Carr
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Michael Markl
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
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Parker WF, Anderson AS, Gibbons RD, Garrity ER, Ross LF, Huang ES, Churpek MM. Association of Transplant Center With Survival Benefit Among Adults Undergoing Heart Transplant in the United States. JAMA 2019; 322:1789-1798. [PMID: 31714985 PMCID: PMC6865773 DOI: 10.1001/jama.2019.15686] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE In the United States, the number of deceased donor hearts available for transplant is limited. As a proxy for medical urgency, the US heart allocation system ranks heart transplant candidates largely according to the supportive therapy prescribed by transplant centers. OBJECTIVE To determine if there is a significant association between transplant center and survival benefit in the US heart allocation system. DESIGN, SETTING, AND PARTICIPANTS Observational study of 29 199 adult candidates for heart transplant listed on the national transplant registry from January 2006 through December 2015 with follow-up complete through August 2018. EXPOSURES Transplant center. MAIN OUTCOMES AND MEASURES The survival benefit associated with heart transplant as defined by the difference between survival after heart transplant and waiting list survival without transplant at 5 years. Each transplant center's mean survival benefit was estimated using a mixed-effects proportional hazards model with transplant as a time-dependent covariate, adjusted for year of transplant, donor quality, ischemic time, and candidate status. RESULTS Of 29 199 candidates (mean age, 52 years; 26% women) on the transplant waiting list at 113 centers, 19 815 (68%) underwent heart transplant. Among heart transplant recipients, 5389 (27%) died or underwent another transplant operation during the study period. Of the 9384 candidates who did not undergo heart transplant, 5669 (60%) died (2644 while on the waiting list and 3025 after being delisted). Estimated 5-year survival was 77% (interquartile range [IQR], 74% to 80%) among transplant recipients and 33% (IQR, 17% to 51%) among those who did not undergo heart transplant, which is a survival benefit of 44% (IQR, 27% to 59%). Survival benefit ranged from 30% to 55% across centers and 31 centers (27%) had significantly higher survival benefit than the mean and 30 centers (27%) had significantly lower survival benefit than the mean. Compared with low survival benefit centers, high survival benefit centers performed heart transplant for patients with lower estimated expected waiting list survival without transplant (29% at high survival benefit centers vs 39% at low survival benefit centers; survival difference, -10% [95% CI, -12% to -8.1%]), although the adjusted 5-year survival after transplant was not significantly different between high and low survival benefit centers (77.6% vs 77.1%, respectively; survival difference, 0.5% [95% CI, -1.3% to 2.3%]). Overall, for every 10% decrease in estimated transplant candidate waiting list survival at a given center, there was an increase of 6.2% (95% CI, 5.2% to 7.3%) in the 5-year survival benefit associated with heart transplant. CONCLUSIONS AND RELEVANCE In this registry-based study of US heart transplant candidates, transplant center was associated with the survival benefit of transplant. Although the adjusted 5-year survival after transplant was not significantly different between high and low survival benefit centers, compared with centers with survival benefit significantly below the mean, centers with survival benefit significantly above the mean performed heart transplant for recipients who had significantly lower estimated expected 5-year waiting list survival without transplant.
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Affiliation(s)
- William F. Parker
- Department of Medicine, University of Chicago, Chicago, Illinois
- MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | | | - Robert D. Gibbons
- Department of Medicine, University of Chicago, Chicago, Illinois
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Edward R. Garrity
- Department of Medicine, University of Chicago, Chicago, Illinois
- MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
| | - Lainie F. Ross
- MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
- Department of Pediatrics, University of Chicago, Chicago, Illinois
| | - Elbert S. Huang
- Department of Medicine, University of Chicago, Chicago, Illinois
- MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
| | - Matthew M. Churpek
- Department of Medicine, University of Chicago, Chicago, Illinois
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
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Abstract
Importance Cardiac dysfunction is a leading cause of morbidity and mortality in Duchenne muscular dystrophy (DMD). This case highlights the importance of steroids in treating cardiac complications of DMD and the dangers of discontinuing or switching between steroid classes. Objective To recognize the presentation of acute myocardial inflammation, or dystrophinitis, in DMD, which presents as myocarditis and to treat the myocardial inflammation and dilated cardiomyopathy associated with DMD through guideline-directed medical therapy, steroids, and serial surveillance for cardiac dysfunction. Design, Setting, and Participant A case report of an 18-year-old patient with DMD and with steroid withdrawal-induced myocarditis followed up for 3 years to observe for cardiac function recovery and the natural history of cardiomyopathy in DMD, who was hospitalized in the cardiac care unit and followed up between November 3, 2016, and March 27, 2017. Exposures Switching from deflazacort to underdosed prednisone for 7 days. Main Outcomes and Measures Increased myocardial inflammation, edema, and fibrosis after stopping deflazacort abruptly. Results An 18-year-old male patient with DMD presented to the emergency department with acute-onset chest pain. Ischemic changes were present on electrocardiogram, and elevated cardiac enzymes were detected. Depressed cardiac function and potential evidence of inflammation were seen on cardiac magnetic resonance (CMR) imaging, characterized by elevated T2 values and late gadolinium enhancement. These findings were all consistent with acute myocarditis but without a viral prodrome. Several days prior to presentation, the patient's deflazacort was abruptly discontinued and converted to an equivalent dose of prednisone. After restarting deflazacort, his symptoms improved, and subsequent CMR showed resolution of myocardial edema and improved left ventricular function. Conclusions and Relevance This case highlights adverse effects associated with changing between corticosteroid classes in DMD cardiomyopathy and also demonstrates the utility of CMR in detecting myocardial inflammation and monitoring response to treatment.
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Affiliation(s)
- Abdul Rahman A Abutaleb
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth M McNally
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Associate Editor
| | - Sadiya S Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Allen S Anderson
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - James C Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Jane E Wilcox
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Wehbe RM, Anderson AS. Sex Differences in Outcomes of LVAD Patients Bridged to Transplant: The Problem of Selection Bias. JACC Heart Fail 2019; 7:731. [PMID: 31370968 DOI: 10.1016/j.jchf.2019.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/14/2019] [Indexed: 10/26/2022]
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Puckelwartz MJ, Pesce LL, Dellefave-Castillo LM, Wheeler MT, Pottinger TD, Robinson AC, Gacita AM, Schoppen ZJ, Pan W, Kim G, Wilcox JE, Anderson AS, Ashley EA, Day SM, Cappola T, Dorn GW, McNally EM. Abstract 469: Genomic Context Predicts Dilated but Not Hypertrophic Cardiomyopathy. Circ Res 2019. [DOI: 10.1161/res.125.suppl_1.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rationale:
Cardiomyopathies are a major cause of heart failure and have a strong heritable component.
Objective:
Determine the role of both common and rare nonsynonymous genetic variation in hypertrophic (HCM) and dilated familial cardiomyopathy (DCM).
Methods and Results:
Whole genome sequencing was used to determine common and rare nonsynonymous genetic variation in familial cases of HCM (n=56) or DCM (n=71). Variation was evaluated in 102 cardiomyopathy genes routinely assayed in clinical and commercial gene testing panels. We used cardiac gene expression data from GTEx (Genotype-Tissue Expression database) to define additional genes expressed in the heart. The number of nonsynonymous single nucleotide variants (nsSNVs), the majority of which were missense variants, was correlated with echocardiographic measurements. Principal component analysis (PCA) of left ventricular measures separated HCM and DCM. Regression of the first principal component using all nonsynonymous single nucleotide variants (nsSNVs) in cardiomyopathy genes showed the number of nsSNVs predicted DCM but not HCM. DCM probability in the cohort significantly increased as the number of cardiomyopathy gene nsSNVs increased (p<0.02). The increase in nsSNVs in cardiomyopathy genes significantly associated with reduced left ventricular ejection fraction and increased left ventricular diameter in DCM. Resampling methods identified genes with deviant cumulative allele frequencies, identifying potential modifier genes for cardiomyopathy.
Conclusions:
DCM subjects carry a greater burden of nsSNVs in cardiomyopathy genes. This genomic burden translates to impaired systolic cardiac function in DCM. In contrast, nsSNV burden in cardiomyopathy genes did not correlate with the probability or manifestation of left ventricular measures in HCM. These findings support a complex inheritance for DCM where increased variation in cardiomyopathy genes creates a genetic background that predisposes to DCM and increased disease severity. The distinct genetic landscapes of HCM and DCM suggest that greater genetic variation in cardiac genes provokes unfavorable ventricular remodeling with reduced systolic function.
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Dolan RS, Rahsepar AA, Blaisdell J, Suwa K, Ghafourian K, Wilcox JE, Khan SS, Vorovich EE, Rich JD, Anderson AS, Yancy CW, Collins JD, Carr JC, Markl M. Multiparametric Cardiac Magnetic Resonance Imaging Can Detect Acute Cardiac Allograft Rejection After Heart Transplantation. JACC Cardiovasc Imaging 2019; 12:1632-1641. [PMID: 30878427 PMCID: PMC6995349 DOI: 10.1016/j.jcmg.2019.01.026] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/14/2018] [Accepted: 01/04/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the sensitivity of multiparametric cardiac magnetic resonance imaging (CMR) for the detection of acute cardiac allograft rejection (ACAR). BACKGROUND ACAR is currently diagnosed by endomyocardial biopsy, but CMR may be a noninvasive alternative because of its capacity for regional myocardial structure and function characterization. METHODS Fifty-eight transplant recipients (mean age 47.0 ± 14.7 years) and 14 control subjects (mean age 47.7 ± 16.7 years) were prospectively recruited from August 2014 to May 2017 and underwent 97 CMR studies (83 transplant recipients, 14 control subjects) for assessment of global left ventricular function and myocardial T2, T1, and extracellular volume fraction (ECV). CMR studies were divided into 4 groups on the basis of biopsy grade: control subjects (n = 14), patients with no ACAR (no history of ACAR; n = 36), patients with past ACAR (history of ACAR; n = 24), and ACAR+ patients (active grade ≥1R ACAR; n = 23). RESULTS Myocardial T2 was significantly higher in patients with past ACAR compared with those with no ACAR (51.0 ± 3.8 ms vs. 49.2 ± 4.0 ms; p = 0.02) and in patients with no ACAR compared with control subjects (49.2 ± 4.0 ms vs. 45.2 ± 2.3 ms; p < 0.01). ACAR+ patients demonstrated increased T2 compared with the no ACAR group (52.4 ± 4.7 ms vs. 49.2 ± 4.0 ms, p < 0.01) but not compared with the past ACAR group. In contrast, ECV was significantly elevated in ACAR+ patients compared with transplant recipients without ACAR regardless of history of ACAR (no ACAR: 31.5 ± 3.9% vs. 26.8 ± 3.3% [p < 0.01]; past ACAR: 31.5 ± 3.9% vs. 26.8 ± 4.0% [p < 0.01]). Receiver operating characteristic curve analysis revealed that a combined model of age at CMR, global T2, and global ECV was predictive of ACAR (area under the curve = 0.84). CONCLUSIONS The combination of CMR-derived myocardial T2 and ECV has potential as a noninvasive tissue biomarker for ACAR. Larger studies during acute ACAR are needed for continued development of multiparametric CMR for transplant recipient surveillance.
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Affiliation(s)
- Ryan S Dolan
- Department of Radiology, Northwestern University, Chicago, Illinois.
| | - Amir A Rahsepar
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Julie Blaisdell
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Kenichiro Suwa
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Kambiz Ghafourian
- Department of Cardiology, Northwestern University, Chicago, Illinois
| | - Jane E Wilcox
- Department of Cardiology, Northwestern University, Chicago, Illinois
| | - Sadiya S Khan
- Department of Cardiology, Northwestern University, Chicago, Illinois
| | - Esther E Vorovich
- Department of Cardiology, Northwestern University, Chicago, Illinois
| | - Jonathan D Rich
- Department of Cardiology, Northwestern University, Chicago, Illinois
| | - Allen S Anderson
- Department of Cardiology, Northwestern University, Chicago, Illinois
| | - Clyde W Yancy
- Department of Cardiology, Northwestern University, Chicago, Illinois
| | - Jeremy D Collins
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - James C Carr
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, Illinois; Department of Biomedical Engineering, Northwestern University, Chicago, Illinois
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Quaggin-Smith J, Wehbe RM, Anderson AS, Ghafourian K, Okwuosa I, Vorovich E, Wilcox J, Ahmad F, Pham DT, Rich JD. Women Experience More Late Readmissions Than Men after Left Ventricular Assist Device Implantation. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ohiomoba R, Ezema A, Youmans QR, Anderson AS, Jackson K, Mandieka E, Pham DT, Rich JD, Yancy CW, Okwuosa IS. Cardiac Transplantation Outcomes in Patients with Amyloid Cardiomyopathy. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mandieka E, Zhou A, Harap R, Anderson AS, Ezema A, Jackson K, Ohiomoba R, Pham DT, Rich JD, Yancy CW, Youmans QR, Okwuosa IS. Bridging Strategies and their Association with Post Heart Transplant Outcomes. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.515] [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: 10/26/2022]
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Ohiomoba R, Youmans QR, Ezema A, Anderson AS, Jackson K, Mandieka E, Pham DT, Rich JD, Yancy CW, Okwuosa IS. History of Cigarette Smoking and Heart Transplant Outcomes. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Chaikriangkrai K, Abbasi MA, Sarnari R, Lee D, Anderson AS, Ghafourian K, Khan SS, Vorovich EE, Rich JD, Wilcox JE, Blaisdell JA, Yancy CW, Carr J, Markl M. Natural History of Myocardial Late Gadolinium Enhancement Predicts Adverse Clinical Events in Heart Transplant Recipients. JACC Cardiovasc Imaging 2019; 12:2092-2094. [PMID: 31326473 DOI: 10.1016/j.jcmg.2019.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/13/2019] [Accepted: 05/15/2019] [Indexed: 11/26/2022]
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Ahmad FS, Wehbe RM, Kansal P, Jackson HA, Anderson AS, Yancy CW, Mutharasan RK. Targeting the Correct Population When Designing Transitional Care Programs for Medicare Patients Hospitalized With Heart Failure. JAMA Cardiol 2019; 2:1274-1275. [PMID: 28975198 DOI: 10.1001/jamacardio.2017.3089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 11/14/2022]
Affiliation(s)
- Faraz S Ahmad
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of Epidemiology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ramsey M Wehbe
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Preeti Kansal
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Hannah A Jackson
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Value-Based Delivery, Northwestern Memorial HealthCare, Chicago, Illinois
| | - Allen S Anderson
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Clyde W Yancy
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Deputy Editor
| | - R Kannan Mutharasan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Moug SJ, Mutrie N, Barry SJE, Mackay G, Steele RJC, Boachie C, Buchan C, Anderson AS. Prehabilitation is feasible in patients with rectal cancer undergoing neoadjuvant chemoradiotherapy and may minimize physical deterioration: results from the REx trial. Colorectal Dis 2019; 21:548-562. [PMID: 30657249 DOI: 10.1111/codi.14560] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 11/07/2018] [Indexed: 12/11/2022]
Abstract
AIM Rectal cancer patients undergoing neoadjuvant chemoradiotherapy (NACRT) experience physical deterioration and reductions in their quality of life. This feasibility study assessed prehabilitation (a walking intervention) before, during and after NACRT to inform a definitive multi-centred randomized clinical trial (REx trial). METHODS Patients planned for NACRT followed by potentially curative surgery were approached (August 2014-March 2016) (www.isrctn.com; 62859294). Prior to NACRT, baseline physical and psycho-social data were recorded using validated tools. Participants were randomized to either the intervention group (exercise counselling session followed by a 13-17 week telephone-guided walking programme) or a control group (standard care). Follow-up testing was undertaken 1-2 weeks before surgery. RESULTS Of the 296 screened patients, 78 (26%) were eligible and 48 (61%) were recruited. N = 31 (65%) were men with a mean age of 65.9 years (range 33.7-82.6). Mean intervention duration was 14 weeks with 75% adherence. n = 40 (83%) completed follow-up testing. Both groups recorded reductions in daily walking but the reduction was less in the intervention group although not statistically significant. Participants reported high satisfaction and fidelity to trial procedures. CONCLUSION This study demonstrates that prehabilitation is feasible in rectal cancer patients undergoing NACRT. Good recruitment, adherence, retention and patient satisfaction rates support the development of a fully powered trial. The effects of the intervention on physical outcomes were promising.
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Affiliation(s)
- S J Moug
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - N Mutrie
- Institute of Sport, Physical Education and Health Sciences, Moray House School of Education, Edinburgh, UK
| | - S J E Barry
- Department of Mathematics and Statistics, Strathclyde University, Glasgow, UK
| | - G Mackay
- Department of Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - R J C Steele
- Head of Cancer Research Division, Ninewells Hospital and Medical School, Dundee, UK
| | - C Boachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - C Buchan
- Department of Surgery (Patient Representative), Royal Alexandra Hospital, Paisley, UK
| | - A S Anderson
- Public Health Nutrition, Division of Cancer Research, Ninewells Medical School, Dundee, UK
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Gurtman A, Begier E, Mohamed N, Baber J, Sabharwal C, Haupt RM, Edwards H, Cooper D, Jansen KU, Anderson AS. The development of a staphylococcus aureus four antigen vaccine for use prior to elective orthopedic surgery. Hum Vaccin Immunother 2018; 15:358-370. [PMID: 30215582 DOI: 10.1080/21645515.2018.1523093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Staphylococcus aureus (S. aureus) is a challenging bacterial pathogen which can cause a range of diseases, from mild skin infections, to more serious and invasive disease including deep or organ space surgical site infections, life-threatening bacteremia, and sepsis. S. aureus rapidly develops resistance to antibiotic treatments. Despite current infection control measures, the burden of disease remains high. The most advanced vaccine in clinical development is a 4 antigen S. aureus vaccine (SA4Ag) candidate that is being evaluated in a phase 2b/3 efficacy study in patients undergoing elective spinal fusion surgery (STaphylococcus aureus suRgical Inpatient Vaccine Efficacy [STRIVE]). SA4Ag has been shown in early phase clinical trials to be generally safe and well tolerated, and to induce high levels of bactericidal antibodies in healthy adults. In this review we discuss the design of SA4Ag, as well as the proposed clinical development plan supporting licensure of SA4Ag for the prevention of invasive disease caused by S. aureus in elective orthopedic surgical populations. We also explore the rationale for the generalizability of the results of the STRIVE efficacy study (patients undergoing elective open posterior multilevel instrumented spinal fusion surgery) to a broad elective orthopedic surgery population due to the common pathophysiology of invasive S. aureus disease and commonalties of patient and procedural risk factors for developing postoperative S. aureus surgical site infections.
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Affiliation(s)
- A Gurtman
- a Pfizer Vaccine Research and Development , Pfizer, Inc ., Pearl River , NY , USA
| | - E Begier
- a Pfizer Vaccine Research and Development , Pfizer, Inc ., Pearl River , NY , USA
| | - N Mohamed
- a Pfizer Vaccine Research and Development , Pfizer, Inc ., Pearl River , NY , USA
| | - J Baber
- b Pfizer Vaccine Research and Development , Sydney , NSW , Australia
| | - C Sabharwal
- a Pfizer Vaccine Research and Development , Pfizer, Inc ., Pearl River , NY , USA
| | - R M Haupt
- c Medical Development, Scientific and Clinical Affairs , Pfizer, Inc ., Collegeville , PA , USA
| | - H Edwards
- d World Wide Regulatory Affairs , Pfizer Inc ., Walton Oaks , UK
| | - D Cooper
- a Pfizer Vaccine Research and Development , Pfizer, Inc ., Pearl River , NY , USA
| | - K U Jansen
- a Pfizer Vaccine Research and Development , Pfizer, Inc ., Pearl River , NY , USA
| | - A S Anderson
- a Pfizer Vaccine Research and Development , Pfizer, Inc ., Pearl River , NY , USA
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Dolan RS, Rahsepar AA, Blaisdell J, Lin K, Suwa K, Ghafourian K, Wilcox JE, Khan SS, Vorovich EE, Rich JD, Anderson AS, Yancy CW, Collins JD, Markl M, Carr JC. Cardiac Structure-Function MRI in Patients After Heart Transplantation. J Magn Reson Imaging 2018; 49:678-687. [PMID: 30142237 DOI: 10.1002/jmri.26275] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 05/17/2018] [Revised: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Following heart transplantation (Tx), recipients are closely monitored using endomyocardial biopsy, which is limited by cost and invasiveness, and echocardiography, which is limited regarding detailed structural and functional evaluation. PURPOSE To test the feasibility of comprehensive structure-function cardiac MRI as a noninvasive modality to assess changes in myocardial structure and function. STUDY TYPE Prospective. SUBJECTS MR was performed in 61 heart transplant recipients (age 47.9 ± 16.3 years, 39% female) and 14 age-matched healthy controls (age 47.7 ± 16.7 years, 36% female). FIELD STRENGTH/SEQUENCE 1.5T; 2D CINE steady state free precession (SSF)P imaging, T2 -mapping, pre- and postgadolinium contrast T1 -mapping, and tissue-phase mapping (TPM). ASSESSMENT Quantification of myocardial T2 (as a measure of edema), pre- and post-Gd T1 (allowing calculation of extracellular volume (ECV) to estimate interstitial expansion), and TPM-based assessment of peak regional left ventricular (LV) velocities, dyssynchrony, and twist. STATISTICAL TESTS Comparisons between transplant recipients and controls were performed using independent samples t-tests. Relationships between structural (T2 , T1 , ECV) and functional measures (myocardial velocities, dyssynchrony, twist) were assessed using Pearson correlation analysis. RESULTS T2 and T1 were significantly elevated in transplant recipients compared to controls (global T2 : 50.5 ± 3.4 msec vs. 45.2 ± 2.3 msec, P < 0.01; global T1 : 1037.8 ± 48.0 msec vs. 993.8 ± 34.1 msec, P < 0.01). Systolic longitudinal function was impaired in transplant recipients compared to controls (reduced peak systolic longitudinal velocities, 2.9 ± 1.1 cm/s vs. 5.1 ± 1.2 cm/s, P < 0.01; elevated systolic longitudinal dyssynchrony, 60.2 ± 30.2 msec vs. 32.1 ± 25.1 msec, P < 0.01). Correlation analysis revealed a significant positive relationship between T2 and ECV (r = 0.45,P < 0.01). In addition, peak systolic longitudinal velocities demonstrated a significant inverse relationship with T2 (global r = -0.29, P = 0.02), and systolic radial dyssynchrony was positively associated with peak T2 and peak T1 (r = 0.26,P = 0.04; r = 0.27,P = 0.03). DATA CONCLUSION MR techniques are sensitive to structural and functional differences in transplant recipients compared to controls. Structural (T2 , T1 ) and functional (peak myocardial velocities, dyssynchrony) measures were significantly associated, suggesting a structure-function relationship of cardiac abnormalities following heart transplant. LEVEL OF EVIDENCE 2 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;49:678-687.
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Affiliation(s)
- Ryan S Dolan
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amir A Rahsepar
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Julie Blaisdell
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kai Lin
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kenichiro Suwa
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kambiz Ghafourian
- Department of Cardiology, Northwestern University, Chicago, Illinois, USA
| | - Jane E Wilcox
- Department of Cardiology, Northwestern University, Chicago, Illinois, USA
| | - Sadiya S Khan
- Department of Cardiology, Northwestern University, Chicago, Illinois, USA
| | - Esther E Vorovich
- Department of Cardiology, Northwestern University, Chicago, Illinois, USA
| | - Jonathan D Rich
- Department of Cardiology, Northwestern University, Chicago, Illinois, USA
| | - Allen S Anderson
- Department of Cardiology, Northwestern University, Chicago, Illinois, USA
| | - Clyde W Yancy
- Department of Cardiology, Northwestern University, Chicago, Illinois, USA
| | - Jeremy D Collins
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - James C Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Parker WF, Anderson AS, Huang ES, Garrity ER, Churpek MM. Reply: Does Overtreatment of Heart Transplantation Candidates Exist? J Am Coll Cardiol 2018; 72:703-704. [PMID: 30072009 DOI: 10.1016/j.jacc.2018.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/02/2018] [Indexed: 11/26/2022]
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Kislitsina ON, Anderson AS, Rich JD, Vorovich EE, Pham DT, Cox JL, McCarthy PM, Yancy CW. Strokes associated with left ventricular assist devices. J Card Surg 2018; 33:578-583. [DOI: 10.1111/jocs.13778] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Olga N. Kislitsina
- Department of Cardiology; Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University Medical Center; Chicago Illinois
- Department of Cardiac Surgery; Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University Medical Center; Chicago Illinois
| | - Allen S. Anderson
- Department of Cardiology; Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University Medical Center; Chicago Illinois
| | - Jonathan D. Rich
- Department of Cardiology; Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University Medical Center; Chicago Illinois
| | - Esther E. Vorovich
- Department of Cardiology; Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University Medical Center; Chicago Illinois
| | - Duc T. Pham
- Department of Cardiac Surgery; Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University Medical Center; Chicago Illinois
| | - James L. Cox
- Department of Cardiac Surgery; Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University Medical Center; Chicago Illinois
| | - Patrick M. McCarthy
- Department of Cardiac Surgery; Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University Medical Center; Chicago Illinois
| | - Clyde W. Yancy
- Department of Cardiology; Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University Medical Center; Chicago Illinois
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Akhabue E, Pierce JB, Davidson LJ, Prenner SB, Mutharasan RK, Puthumana JJ, Shah SJ, Anderson AS, Thomas JD. A Prospective Pilot Study of Pocket-Carried Ultrasound Pre- and Postdischarge Inferior Vena Cava Assessment for Prediction of Heart Failure Rehospitalization. J Card Fail 2018; 24:614-617. [PMID: 30081076 DOI: 10.1016/j.cardfail.2018.07.461] [Citation(s) in RCA: 6] [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: 03/29/2018] [Revised: 06/26/2018] [Accepted: 07/19/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Rehospitalization for heart failure (HF) is common, and subclinical congestion may be present at discharge. Larger inferior vena cava (IVC) size and lower collapsibility at discharge assessed via bedside ultrasound are predictive of rehospitalization; however, the utility of IVC assessment with the use of pocket-carried ultrasound (PCUS) during the transition from discharge to the posthospitalization follow-up visit (FU) has not been investigated. METHODS AND RESULTS IVCmax and IVCmin were measured with the use of PCUS, and the collapsibility index (IVCCI = [IVCmax - IVCmin]/IVCmax) was determined. The primary outcome was 90-day rehospitalization or death. We prospectively enrolled 49 adults (71 ± 13 years of age, 51% male, 47% black, 43% preserved ejection fraction) hospitalized for HF. Nineteen patients (39%) experienced the outcome. Within the rehospitalized group, discharge and FU mean IVCmax were both >2.1 cm (2.2 ± 0.5 and 2.2 ± 0.7) and IVCCIs <50% (44 ± 20% and 45 ± 24%). Within those not rehospitalized, FU IVCmax was ≤2.1 cm (2.1 ± 0.6 and 1.9 ± 0.6; P = .038) and IVCCI >50% at both time points (55 ± 25% and 62 ± 19%; P = NS). FU IVCCI below an optimal cutoff of 42% had modest discrimination alone (c-statistic = 0.73). FU IVCCI <42% was associated with a greater hazard of the outcome independent of admission log B-type natriuretic peptide (adjusted hazard ratio = 6.8; 95% confidence interval 2.4-19.0; P < .001). CONCLUSIONS Posthospitalization IVCCI assessment with PCUS predicts HF rehospitalization and may identify patients in need of intervention.
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Affiliation(s)
- Ehimare Akhabue
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Jacob B Pierce
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Laura J Davidson
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stuart B Prenner
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Raja K Mutharasan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jyothy J Puthumana
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Allen S Anderson
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - James D Thomas
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Echenique IA, Angarone MP, Rich JD, Anderson AS, Stosor V. Cytomegalovirus infection in heart transplantation: A single center experience. Transpl Infect Dis 2018; 20:e12896. [PMID: 29602266 DOI: 10.1111/tid.12896] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 05/19/2017] [Revised: 01/08/2018] [Accepted: 01/14/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) infection remains a major complication after heart transplantation with varying prophylaxis strategies employed. We sought to determine the impact of valganciclovir (VGC) duration on the epidemiology of CMV infections after heart transplantation. METHODS We performed a prospective cohort study of CMV donor (D) or recipient (R) seropositive heart transplant recipients from 2005 to 2012 who completed VGC prophylaxis, ranging from 3 to 12 months according to serostatus and induction immunosuppression. Univariate and multivariate logistic regression was performed. RESULTS Among 159 heart transplant recipients during the study period, 130 (82%) were eligible for VGC prophylaxis. CMV D/R serostatus was as follows: 24% D+/R-, 30% D+/R+, and 29% D-/R+. 65% and 21% received basiliximab and thymoglobulin induction, respectively, followed by maintenance tacrolimus, mycophenolate mofetil, and prednisone. Twenty-one (16%) recipients suffered CMV infection. There was no association with comorbidities including diabetes mellitus, chronic kidney disease, or mechanical assist devices, nor were there associations with rejection, treatments of rejection, or mortality. When VGC prophylaxis duration was stratified by ≤6 vs ≥12 months, time from heart transplantation to CMV infection was delayed (median 247 vs 452 days, P = .002) but there was no difference in days from VGC discontinuation to onset of CMV infection (median 72 vs 83 days, P = .31). CMV infection occurred most frequently within 6-16 weeks of VGC cessation, and 95% of infections occurred during the 6 months post-prophylaxis period. CONCLUSIONS Relative to ≤6 months, ≥12 months of VGC did not reduce incidence of CMV infection and only delayed time to onset. 95% of CMV infection occurs within 6 months after cessation of VGC.
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Affiliation(s)
| | - Michael P Angarone
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jonathan D Rich
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Allen S Anderson
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Valentina Stosor
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Organ Transplantation, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Quyn AJ, Fraser CG, Rodger J, Digan A, Anderson AS, Steele RJC. Participation in bowel screening among men attending abdominal aortic aneurysm screening. Br J Surg 2018; 105:529-534. [PMID: 29465743 DOI: 10.1002/bjs.10758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/31/2017] [Accepted: 10/17/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Uptake of population-based screening for colorectal cancer in Scotland is around 55 per cent. Abdominal aortic aneurysm (AAA) screening has recently been introduced for men aged 65 years and the reported uptake is 78 per cent. The aim was to determine the impact of a brief intervention on bowel screening in men who attended AAA screening, but previously failed to complete bowel screening. METHODS Men invited for AAA screening between September 2015 and March 2016 within NHS Tayside were included. Attendees who had not responded to their latest bowel screening invitation were seen by a colorectal cancer clinical nurse specialist. Reasons for not completing the faecal occult blood test (FOBT) were recorded; brief information on colorectal cancer screening was communicated, and participants were offered a further invitation to complete a FOBT. Those who responded positively were sent a further FOBT from the Scottish Bowel Screening Centre. Subsequent return of a completed FOBT within 6 months was recorded. RESULTS A total of 556 men were invited for AAA screening, of whom 38·1 per cent had not completed a recent FOBT. The primary reason stated for not participating was the time taken to complete the test or forgetting it (35·1 per cent). Other reasons included: lack of motivation (23·4 per cent), confusion regarding the aim of screening (16·2 per cent), disgust (19·8 per cent), fear (6·3 per cent) and other health problems (9·9 per cent). Following discussion, 81·1 per cent agreed to complete the FOBT and 49 per cent subsequently returned the test. CONCLUSION A substantial proportion of previous bowel screening non-responders subsequently returned a completed FOBT following a brief intervention with a nurse specialist. Attendance at non-bowel screening appointments may provide a valuable opportunity to improve bowel screening uptake.
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Affiliation(s)
- A J Quyn
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - C G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - J Rodger
- Department of Colorectal Surgery, Ninewells Hospital and Medical School, Dundee, UK
| | - A Digan
- Scottish Bowel Screening Centre, Dundee, UK
| | - A S Anderson
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - R J C Steele
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
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Fisher A, Craigie AM, Macleod M, Steele RJC, Anderson AS. The impact of social deprivation on the response to a randomised controlled trial of a weight management intervention (BeWEL) for people at increased risk of colorectal cancer. J Hum Nutr Diet 2017; 31:306-313. [PMID: 29171112 PMCID: PMC6001549 DOI: 10.1111/jhn.12524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although 45% of colorectal cancer (CRC) cases may be avoidable through appropriate lifestyle and weight management, health promotion interventions run the risk of widening health inequalities. The BeWEL randomised controlled trial assessed the impact of a diet and activity programme in overweight adults who were diagnosed with a colorectal adenoma, demonstrating a significantly greater weight loss at 12 months in intervention participants than in controls. The present study aimed to compare BeWEL intervention outcomes by participant deprivation status. METHODS The intervention group of the BeWEL trial (n = 163) was classified by the Scottish Index of Multiple Deprivation (SIMD) quintiles into 'more deprived' (SIMD 1-2, n = 58) and 'less deprived' (SIMD 3-5, n = 105). Socio-economic and lifestyle variables were compared at baseline to identify potential challenges to intervention adherence in the more deprived. Between group differences at 12 months in primary outcome (change in body weight) and secondary outcomes (cardiovascular risk factors, diet, physical activity, knowledge of CRC risk and psychosocial variables) were assessed by deprivation status. RESULTS At baseline, education (P = 0.001), income (P < 0.001), spending on physical activity (P = 0.003) and success at previous weight loss attempts (P = 0.007) were significantly lower in the most deprived. At 12 months, no between group differences by deprivation status were detected for changes in primary and main secondary outcomes. CONCLUSIONS Despite potential barriers faced by the more deprived participants, primary and most secondary outcomes were comparable between groups, indicating that this intervention is unlikely to worsen health inequalities and is equally effective across socio-economic groups.
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Affiliation(s)
- A Fisher
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, Ninewells Hospital & Medical School, Dundee, UK
| | - A M Craigie
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, Ninewells Hospital & Medical School, Dundee, UK
| | - M Macleod
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, Ninewells Hospital & Medical School, Dundee, UK
| | - R J C Steele
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, Ninewells Hospital & Medical School, Dundee, UK
| | - A S Anderson
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, Ninewells Hospital & Medical School, Dundee, UK
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Jancey J, Holt AM, Lee A, Kerr D, Robinson S, Tang L, Anderson AS, Hills AP, Howat P. Erratum to: Effects of a physical activity and nutrition program in retirement villages: a cluster randomised controlled trial. Int J Behav Nutr Phys Act 2017; 14:129. [PMID: 28934969 PMCID: PMC5607841 DOI: 10.1186/s12966-017-0568-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 08/11/2017] [Indexed: 02/05/2023] Open
Affiliation(s)
- Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Heath, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Anne-Marie Holt
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Heath, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Andy Lee
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Heath, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Deborah Kerr
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Heath, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Suzanne Robinson
- School of Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Li Tang
- School of Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.,Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan Province, 610041, China
| | - A S Anderson
- Centre for Public Health Nutrition Research, Division of Cancer Research, Ninewells Medical School, Dundee University, Level 7, Mailbox 7, Dundee, DD1 9SY, UK
| | - Andrew P Hills
- University of Tasmania, 41 Charles St, Launceston TAS, Launceston, TAS, 7250, Australia
| | - Peter Howat
- School of Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
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Ahmad FS, Wehbe RM, Kansal P, Jackson HA, Anderson AS, Yancy CW, Mutharasan. RK. Medicare Programs Underestimate Burden of Hospitalized Heart Failure. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Jancey J, Holt AM, Lee A, Kerr D, Robinson S, Tang L, Anderson AS, Hills AP, Howat P. Effects of a physical activity and nutrition program in retirement villages: a cluster randomised controlled trial. Int J Behav Nutr Phys Act 2017; 14:92. [PMID: 28697803 PMCID: PMC5504569 DOI: 10.1186/s12966-017-0543-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/29/2017] [Indexed: 02/05/2023] Open
Abstract
Background This cluster randomised controlled trial aimed to determine if a 6- month home-based intervention could improve the physical activity and dietary behaviours of adults aged 60 to 80 years living in retirement villages located in Perth, Western Australia. Methods Participants (n = 363) from 38 retirement villages were recruited into the trial and allocated to the intervention (n = 197: 17 sites) or control (n = 166: 21 sites) group and were blinded. Previously validated instruments-Fat and Fibre Barometer and International Physical Activity Questionnaire, along with anthropometric measures (weight, height, waist and hip circumferences) and blood pressure were collected at baseline and 6 -month time period. Comparisons between intervention and control groups were undertaken pre- and post- intervention using univariate chi-square and t-tests. Multi-level mixed regression analyses were then conducted to ascertain the effects of the intervention on changes in the outcome variables over time and between groups. Results A total of 139 (70.5%) intervention and 141 (84.9%) control group participants completed the program and post-test assessments. The intervention group demonstrated significant increases in time (80 min more per week on average) devoted to moderate-intensity physical activity, engagement in strength exercises (from 23.7% to 48.2%), frequency of fruit consumed as well as fat avoidance and fibre intake scores, in addition to a 0.5 kg mean reduction in weight post program, whereas no apparent changes were observed in the control group. Mixed regression results further confirmed statistically significant improvements in weight loss (p < 0.05), engagement in strength exercises (p < 0.001) and fruit intake (p = 0.012) by the intervention participants at post-test relative to their controls. Conclusions Retirement offers a time to reassess lifestyle, and adopt positive health enhancing physical activity and dietary behaviours. This intervention was successful in improving weight, engagement in strength exercises, increasing levels of moderate-intensity physical activity and consumption of fruit among retirement village residents. Further investigation is needed on how to better engage retirement village managers in such programs. Trial registration Australia and New Zealand Clinical Trial Registry (ACTRN12612001168842) registered November 2, 2012. Electronic supplementary material The online version of this article (doi:10.1186/s12966-017-0543-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Heath, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Anne-Marie Holt
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Heath, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Andy Lee
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Heath, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Deborah Kerr
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Heath, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Suzanne Robinson
- School of Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Li Tang
- School of Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.,Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan Province, 610041, China
| | - A S Anderson
- Centre for Public Health Nutrition Research, Division of Cancer Research, Ninewells Medical School, Dundee University, Level 7, Mailbox 7, Dundee, DD1 9SY, UK
| | - Andrew P Hills
- University of Tasmania, 41 Charles St, Launceston TAS, Launceston, TAS, 7250, Australia
| | - Peter Howat
- School of Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
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Luckman S, Xiao C, McLennan E, Anderson AS, Mutrie N, Moug SJ. An investigation into UK medical students’ knowledge of lifestyle factors on cancer. Scott Med J 2017; 62:110-114. [DOI: 10.1177/0036933017706896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background and aim Lifestyle factor modification (alcohol, smoking, obesity, diet, physical activity) has the potential to reduce cancer incidence and cancer survival. This study assessed the knowledge of lifestyle factors and cancer in undergraduate medical students. Methods and results A total of 218 students (7 UK universities) completed an online survey of nine questions in three areas: knowledge (lifestyle factors and cancer); information sources; clinical practice (witnessed clinical counselling). Diet, alcohol, smoking and physical activity were recognised as lifestyle factors by 98% of responders, while only 69% reported weight. The links of lung cancer/smoking and alcohol/liver cancer were recognised by >90%, while only 10% reported weight or physical activity being linked to any cancer. University teaching on lifestyle factors and cancer was reported by 78%: 34% rating it good/very good. GPs were witnessed giving lifestyle advice by 85% of responders. Conclusions Most respondents were aware of a relationship between lifestyle factors and cancer, mainly as a result of undergraduate teaching. Further work may widen the breadth of knowledge, and potentially improve primary and secondary cancer prevention.
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Affiliation(s)
- S Luckman
- Undergraduate Medical School, University of Birmingham, UK
| | - C Xiao
- Undergraduate Medical School, University of Glasgow, UK
| | - E McLennan
- Undergraduate Medical School, University of Glasgow, UK
| | - AS Anderson
- Professor of Public Health Nutrition, Ninewells Medical School, Centre for Research into Cancer Prevention and Screening, Centre for Public Health Nutrition Research, Dundee, UK
| | - N Mutrie
- Professor of Physical Activity for Health, Sport, Physical Education and Health Sciences, Moray House School of Education, University of Edinburgh, UK
| | - SJ Moug
- Consultant Surgeon and Honorary Clinical Senior Lecturer, Department of Surgery, University of Glasgow, UK
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