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Siems CB, Ji Z, Jedeon Z, Schultz J, Teigen L, Allen T, John R, Estep JD, Masotti M, Alexy T, Kamdar F, Maharaj V, Pritzker M, Garry D, Shaffer A, Cogswell R. Validation of the Minnesota Pectoralis Risk Score to predict mortality in the HeartMate 3 population. J Heart Lung Transplant 2024; 43:539-546. [PMID: 37956881 DOI: 10.1016/j.healun.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/20/2023] [Accepted: 11/05/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The Minnesota Pectoralis Risk Score (MPRS) utilizes computed tomography-quantified thoracic muscle and clinical variables to predict survival after left ventricular assist device (LVAD) implantation. The model has not been prospectively tested in HeartMate 3 recipients. METHODS A single-center HeartMate 3 cohort from July 2016 to July 2021 (n = 108) was utilized for this analysis. Cohort subjects with complete covariates for MPRS calculation (pectoralis muscle measures, Black race, creatinine, total bilirubin, body mass index, bridge to transplant status, and presence/absence of contrast) implanted after MPRS development were included. MPRS were calculated on each subject. Receiver operating characteristic curves were generated to test model discrimination at 30-day, 90-day, and 1-year mortality post-LVAD. Next, the performance of the 1-year post-LVAD outcome was compared to the HeartMate 3 survival risk score (HM3RS). RESULTS The mean age was 58 (15 years), 80% (86/108) were male, and 26% (28/108) were destination therapy. The area under the curve (AUC) for the MPRS model to predict post-LVAD mortality was 0.73 at 30 days, 0.78 at 90 days, and 0.81 at 1 year. The AUC for the HM3RS for the 1-year outcome was 0.693. Each 1-unit point of the MPRS was associated with a significant increase in the hazard rate of death after LVAD (hazard ratio 2.1, 95% confidence interval 1.5-3.0, p < 0.0001). CONCLUSIONS The MPRS had high performance in this prospective validation, particularly with respect to 90-day and 1-year post-LVAD mortality. Such a tool can provide additional information regarding risk stratification to aid informed decision-making.
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Affiliation(s)
- Chesney B Siems
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
| | - Ziyu Ji
- Department of Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | - Zeina Jedeon
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Jessica Schultz
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Levi Teigen
- Department of Food Science and Nutrition, University of Minnesota, Minneapolis, Minnesota
| | - Tadashi Allen
- Department of Diagnostic Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Ranjit John
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Jerry D Estep
- Department of Cardiology, Cleveland Clinic Florida, Weston, Florida
| | - Maria Masotti
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Tamas Alexy
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Forum Kamdar
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Valmiki Maharaj
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Marc Pritzker
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Daniel Garry
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Andrew Shaffer
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Rebecca Cogswell
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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Kamdar F, Randhawa VK. Singling out the Heart: Revolutionizing Heart Failure by Harnessing Translational Technologies. J Card Fail 2023; 29:939-942. [PMID: 37321699 PMCID: PMC10275488 DOI: 10.1016/j.cardfail.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/20/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Forum Kamdar
- Cardiovascular Division, Lillehei Heart Institute, University of Minnesota, Minneapolis, MN, USA.
| | - Varinder Kaur Randhawa
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of Cardiology, St Michael's Hospital, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Ernst P, Bidwell PA, Dora M, Thomas DD, Kamdar F. Cardiac calcium regulation in human induced pluripotent stem cell cardiomyocytes: Implications for disease modeling and maturation. Front Cell Dev Biol 2023; 10:986107. [PMID: 36742199 PMCID: PMC9889838 DOI: 10.3389/fcell.2022.986107] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/23/2022] [Indexed: 01/19/2023] Open
Abstract
Human induced pluripotent stem cell cardiomyocytes (hiPSC-CMs) are based on ground-breaking technology that has significantly impacted cardiovascular research. They provide a renewable source of human cardiomyocytes for a variety of applications including in vitro disease modeling and drug toxicity testing. Cardiac calcium regulation plays a critical role in the cardiomyocyte and is often dysregulated in cardiovascular disease. Due to the limited availability of human cardiac tissue, calcium handling and its regulation have most commonly been studied in the context of animal models. hiPSC-CMs can provide unique insights into human physiology and pathophysiology, although a remaining limitation is the relative immaturity of these cells compared to adult cardiomyocytes Therefore, this field is rapidly developing techniques to improve the maturity of hiPSC-CMs, further establishing their place in cardiovascular research. This review briefly covers the basics of cardiomyocyte calcium cycling and hiPSC technology, and will provide a detailed description of our current understanding of calcium in hiPSC-CMs.
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Affiliation(s)
- Patrick Ernst
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States
| | - Philip A. Bidwell
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States
| | - Michaela Dora
- College of Biological Sciences, University of Minnesota, Minneapolis, MN, United States
| | - David D. Thomas
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, MN, United States
| | - Forum Kamdar
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States,*Correspondence: Forum Kamdar,
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Jedeon Z, Masotti M, Schultz J, Vest AR, Alexy T, Pritzker M, Maharaj V, Kamdar F, Knopper R, Shaffer A, John R, Cogswell R. Overestimation of Renal Function Using Serum Creatinine in the Advanced Heart Failure Population: A Call for Alternative Measures. J Card Fail 2023; 29:116-118. [PMID: 36336141 DOI: 10.1016/j.cardfail.2022.10.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/23/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Zeina Jedeon
- Division of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - Maria Masotti
- University of Minnesota School of Public Health, Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | - Jessica Schultz
- University of Minnesota School of Public Health, Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | - Amanda R Vest
- Division of Cardiology, Tufts Medical Center, Boston, Massachusetts
| | - Tamas Alexy
- Division of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - Marc Pritzker
- Division of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - Valmiki Maharaj
- Division of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - Forum Kamdar
- Division of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - Ryan Knopper
- Department of Surgery, Division of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - Andrew Shaffer
- Department of Surgery, Division of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - Ranjit John
- Department of Surgery, Division of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - Rebecca Cogswell
- Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
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Hsieh J, Becklin KL, Givens S, Komosa ER, Lloréns JEA, Kamdar F, Moriarity BS, Webber BR, Singh BN, Ogle BM. Myosin Heavy Chain Converter Domain Mutations Drive Early-Stage Changes in Extracellular Matrix Dynamics in Hypertrophic Cardiomyopathy. Front Cell Dev Biol 2022; 10:894635. [PMID: 35784482 PMCID: PMC9245526 DOI: 10.3389/fcell.2022.894635] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 05/24/2022] [Indexed: 11/24/2022] Open
Abstract
More than 60% of hypertrophic cardiomyopathy (HCM)-causing mutations are found in the gene loci encoding cardiac myosin-associated proteins including myosin heavy chain (MHC) and myosin binding protein C (MyBP-C). Moreover, patients with more than one independent HCM mutation may be at increased risk for more severe disease expression and adverse outcomes. However detailed mechanistic understanding, especially at early stages of disease progression, is limited. To identify early-stage HCM triggers, we generated single (MYH7 c.2167C > T [R723C] with a known pathogenic significance in the MHC converter domain) and double (MYH7 c.2167C > T [R723C]; MYH6 c.2173C > T [R725C] with unknown significance) myosin gene mutations in human induced pluripotent stem cells (hiPSCs) using a base-editing strategy. Cardiomyocytes (CMs) derived from hiPSCs with either single or double mutation exhibited phenotypic characteristics consistent with later-stage HCM including hypertrophy, multinucleation, altered calcium handling, metabolism, and arrhythmia. We then probed mutant CMs at time points prior to the detection of known HCM characteristics. We found MYH7/MYH6 dual mutation dysregulated extracellular matrix (ECM) remodeling, altered integrin expression, and interrupted cell-ECM adhesion by limiting the formation of focal adhesions. These results point to a new phenotypic feature of early-stage HCM and reveal novel therapeutic avenues aimed to delay or prohibit disease onset.
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Affiliation(s)
- Jeanne Hsieh
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Kelsie L. Becklin
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Sophie Givens
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Elizabeth R. Komosa
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Juan E. Abrahante Lloréns
- University of Minnesota Informatics Institute (UMII), University of Minnesota, Minneapolis, MN, United States
| | - Forum Kamdar
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Branden S. Moriarity
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Beau R. Webber
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Bhairab N. Singh
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
- Stem Cell Institute, University of Minnesota, Minneapolis, MN, United States
- *Correspondence: Bhairab N. Singh, ; Brenda M. Ogle,
| | - Brenda M. Ogle
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
- Stem Cell Institute, University of Minnesota, Minneapolis, MN, United States
- *Correspondence: Bhairab N. Singh, ; Brenda M. Ogle,
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Touma AM, Nijjar PS, Manousakis GE, Kamdar F. A rare case report of severe cardiomyopathy associated with myotonic dystrophy type 2. Eur Heart J Case Rep 2022; 6:ytac015. [PMID: 35350724 PMCID: PMC8942102 DOI: 10.1093/ehjcr/ytac015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/21/2021] [Accepted: 12/30/2021] [Indexed: 11/25/2022]
Abstract
Background Myotonic dystrophies (DM) are multi-systemic diseases characterized by muscle
weakness and myotonia. Despite a growing appreciation for the cardiovascular
manifestations in myotonic dystrophy type 1 (DM1), cardiac involvement in
myotonic dystrophy type 2 (DM2) has been less well characterized. In
patients with DM2, cardiomyopathy has rarely been described. Case summary This case report describes a rare case of DM2 associated cardiomyopathy. A
56-year-old male with DM2 who presented with palpitations and fatigue.
Cardiac magnetic resonance (CMR) imaging confirmed a severely enlarged left
ventricular cavity with a left ventricular ejection fraction of 28%
consistent with severely reduced global systolic function. The lateral wall
epicardium exhibited late gadolinium enhancement in a pattern seen in
myotonic dystrophy-related cardiomyopathy. Discussion This case highlights the potential for significant cardiovascular involvement
in DM2, as well as the importance of screening, including CMR imaging, and
therapy in the myotonic dystrophy patient population.
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Affiliation(s)
- Anja M Touma
- Medical School, Medical Scientist Training Program (MSTP), University of Minnesota Medical School, Twin Cities, Minneapolis, MN 55455, USA
| | - Prabhjot S Nijjar
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Twin Cities, Minneapolis, MN, 55455, USA
| | - Georgios E Manousakis
- Department of Neurology, University of Minnesota Medical School, Twin Cities, 420 Delaware St. SE, MMC 508 Cardiology, Minneapolis, MN USA
| | - Forum Kamdar
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Twin Cities, Minneapolis, MN, 55455, USA
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Maharaj V, Steiner M, Boyle B, Kazmirczak F, Markowitz J, Alexy T, Shaffer A, John R, Martin CM, Cogswell R, Kamdar F. Rapidly Progressive Left Ventricular Assist Device Outflow Graft Thrombosis Associated With COVID-19 Infection. Circ Heart Fail 2021; 14:e008334. [PMID: 34775782 DOI: 10.1161/circheartfailure.121.008334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Valmiki Maharaj
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis. (V.M., B.B., F. Kazmirczak, J.M., T.A., C.M.M., R.C., F. Kamdar)
| | - Marie Steiner
- Divisions of Hematology and Oncology and Critical Care, University of Minnesota, Minneapolis. (M.S.)
| | - Brenden Boyle
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis. (V.M., B.B., F. Kazmirczak, J.M., T.A., C.M.M., R.C., F. Kamdar)
| | - Felipe Kazmirczak
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis. (V.M., B.B., F. Kazmirczak, J.M., T.A., C.M.M., R.C., F. Kamdar)
| | - Jeremy Markowitz
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis. (V.M., B.B., F. Kazmirczak, J.M., T.A., C.M.M., R.C., F. Kamdar)
| | - Tamas Alexy
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis. (V.M., B.B., F. Kazmirczak, J.M., T.A., C.M.M., R.C., F. Kamdar)
| | - Andrew Shaffer
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis. (A.S., R.J.)
| | - Ranjit John
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis. (A.S., R.J.)
| | - Cindy M Martin
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis. (V.M., B.B., F. Kazmirczak, J.M., T.A., C.M.M., R.C., F. Kamdar)
| | - Rebecca Cogswell
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis. (V.M., B.B., F. Kazmirczak, J.M., T.A., C.M.M., R.C., F. Kamdar)
| | - Forum Kamdar
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis. (V.M., B.B., F. Kazmirczak, J.M., T.A., C.M.M., R.C., F. Kamdar)
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El Rafei A, Schultz J, Masotti M, Maharaj V, Fraser M, Mutschler M, Martin C, Alexy T, Kamdar F, Knoper R, Shaffer A, John R, Cogswell R. Risk Factors and Clinical Significance of Vasoplegia after LVAD Implantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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9
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Shaaban A, Schultz J, Leonard J, John R, Martin C, Alexy T, Pritzker M, Thenappan T, Kamdar F, Shaffer A, Cogswell R. Outcomes of Patients Referred for Cardiac Rehabilitation after Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.532] [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: 11/30/2022] Open
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Kamdar F, Das S, Gong W, Klaassen Kamdar A, Meyers TA, Shah P, Ervasti JM, Townsend D, Kamp TJ, Wu JC, Garry MG, Zhang J, Garry DJ. Stem Cell-Derived Cardiomyocytes and Beta-Adrenergic Receptor Blockade in Duchenne Muscular Dystrophy Cardiomyopathy. J Am Coll Cardiol 2020; 75:1159-1174. [PMID: 32164890 DOI: 10.1016/j.jacc.2019.12.066] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/12/2019] [Accepted: 12/22/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although cardiomyopathy has emerged as a leading cause of death in Duchenne muscular dystrophy (DMD), limited studies and therapies have emerged for dystrophic heart failure. OBJECTIVES The purpose of this study was to model DMD cardiomyopathy using DMD patient-specific human induced pluripotent stem cell (hiPSC)-derived cardiomyocytes and to identify physiological changes and future drug therapies. METHODS To explore and define therapies for DMD cardiomyopathy, the authors used DMD patient-specific hiPSC-derived cardiomyocytes to examine the physiological response to adrenergic agonists and β-blocker treatment. The authors further examined these agents in vivo using wild-type and mdx mouse models. RESULTS At baseline and following adrenergic stimulation, DMD hiPSC-derived cardiomyocytes had a significant increase in arrhythmic calcium traces compared to isogenic controls. Furthermore, these arrhythmias were significantly decreased with propranolol treatment. Using telemetry monitoring, the authors observed that mdx mice, which lack dystrophin, had an arrhythmic death when stimulated with isoproterenol; the lethal arrhythmias were rescued, in part, by propranolol pre-treatment. Using single-cell and bulk RNA sequencing (RNA-seq), the authors compared DMD and control hiPSC-derived cardiomyocytes, mdx mice, and control mice (in the presence or absence of propranolol and isoproterenol) and defined pathways that were perturbed under baseline conditions and pathways that were normalized after propranolol treatment in the mdx model. The authors also undertook transcriptome analysis of human DMD left ventricle samples and found that DMD hiPSC-derived cardiomyocytes have dysregulated pathways similar to the human DMD heart. The authors further determined that relatively few patients with DMD see a cardiovascular specialist or receive β-blocker therapy. CONCLUSIONS The results highlight mechanisms and therapeutic interventions from human to animal and back to human in the dystrophic heart. These results may serve as a prelude for an adequately powered clinical study that examines the impact of β-blocker therapy in patients with dystrophinopathies.
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Affiliation(s)
- Forum Kamdar
- Lillehei Heart Institute, Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota; Paul and Sheila Muscular Dystrophy Center, University of Minnesota, Minneapolis, Minnesota
| | - Satyabrata Das
- Lillehei Heart Institute, Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota
| | - Wuming Gong
- Lillehei Heart Institute, Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota
| | - André Klaassen Kamdar
- Lillehei Heart Institute, Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota
| | - Tatyana A Meyers
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, Minnesota
| | - Pruthvi Shah
- Lillehei Heart Institute, Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota
| | - James M Ervasti
- Paul and Sheila Muscular Dystrophy Center, University of Minnesota, Minneapolis, Minnesota; Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, Minnesota
| | - DeWayne Townsend
- Lillehei Heart Institute, Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota; Paul and Sheila Muscular Dystrophy Center, University of Minnesota, Minneapolis, Minnesota; Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, Minnesota
| | - Timothy J Kamp
- Cardiovascular Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford University, Palo Alto, California
| | - Mary G Garry
- Lillehei Heart Institute, Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota; Paul and Sheila Muscular Dystrophy Center, University of Minnesota, Minneapolis, Minnesota
| | - Jianyi Zhang
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama
| | - Daniel J Garry
- Lillehei Heart Institute, Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota; Paul and Sheila Muscular Dystrophy Center, University of Minnesota, Minneapolis, Minnesota; Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, Minnesota; Stem Cell Institute, University of Minnesota, Minneapolis, Minnesota.
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Bellam N, Denfeld QE, Kamdar F, Alexy T, Breathett K, Patel PA, Faulkenberg K, Moyer B, Psotka MA, Ginwalla M. Navigating Early Careers in Heart Failure in the Era of Novel Coronavirus Disease-2019. J Card Fail 2020; 27:97-99. [PMID: 33227417 PMCID: PMC7677680 DOI: 10.1016/j.cardfail.2020.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Naveen Bellam
- Advent Health Transplant Institute, Orlando, FL, USA
| | - Quin E Denfeld
- School of Nursing, Oregon Health & Science University, Portland, OR, USA.
| | - Forum Kamdar
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Tamas Alexy
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona, Tucson, AZ, USA
| | | | | | | | | | - Mahazarin Ginwalla
- Cardiovascular Division, Palo Alto Medical Foundation/Sutter Health, Burlingame, CA, USA
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Kamdar F, Tan CD, Rodriguez ER, Moazami N, Hanna M. Intramural coronary light-chain amyloidosis and left ventricular assist device implantation. J Heart Lung Transplant 2020; 39:1163-1164. [PMID: 32736937 DOI: 10.1016/j.healun.2020.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Forum Kamdar
- Advanced Heart Failure Section, Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota.
| | - Carmela D Tan
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | | | - Nader Moazami
- Cardiovascular Surgery, NYU Langone Health, New York, New York
| | - Mazen Hanna
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
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Schultz J, Trachtenberg B, Estep J, Goodwin K, Araujo R, Rafei A, Pritzker M, Kamdar F, John R, Cogswell R. Association of Use of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers on LVAD Support and Risk of Gastrointestinal Bleeding: A Multi-Center Analysis. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Stroik DR, Ceholski DK, Bidwell PA, Mleczko J, Thanel PF, Kamdar F, Autry JM, Cornea RL, Thomas DD. Viral expression of a SERCA2a-activating PLB mutant improves calcium cycling and synchronicity in dilated cardiomyopathic hiPSC-CMs. J Mol Cell Cardiol 2019; 138:59-65. [PMID: 31751570 DOI: 10.1016/j.yjmcc.2019.11.147] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 08/22/2019] [Revised: 11/04/2019] [Accepted: 11/10/2019] [Indexed: 12/19/2022]
Abstract
There is increasing momentum toward the development of gene therapy for heart failure (HF) that is defined by impaired calcium (Ca2+) transport and reduced contractility. We have used FRET (fluorescence resonance energy transfer) between fluorescently-tagged SERCA2a (the cardiac Ca2+ pump) and PLB (phospholamban, ventricular peptide inhibitor of SERCA) to test directly the effectiveness of loss-of-inhibition/gain-of-binding (LOI/GOB) PLB mutants (PLBM) that were engineered to compete with the binding of inhibitory wild-type PLB (PLBWT). Our therapeutic strategy is to relieve PLBWT inhibition of SERCA2a by using the reserve adrenergic capacity mediated by PLB to enhance cardiac contractility. Using a FRET assay, we determined that the combination of a LOI PLB mutation (L31A) and a GOB PLB mutation (I40A) results in a novel engineered LOI/GOB PLBM (L31A/I40A) that effectively competes with PLBWT binding to cardiac SERCA2a in HEK293-6E cells. We demonstrated that co-expression of PLBM enhances SERCA Ca-ATPase activity by increasing enzyme Ca2+ affinity (1/KCa) in PLBWT-inhibited HEK293 cell homogenates. For an initial assessment of PLBM physiological effectiveness, we used human induced pluripotent stem cell derived cardiomyocytes (hiPSC-CMs) from a healthy individual. In this system, we observed that adeno-associated virus 2 (rAAV2)-driven expression of PLBM enhances the amplitude of SR Ca2+ release and the rate of SR Ca2+ re-uptake. To assess therapeutic potential, we used a hiPSC-CM model of dilated cardiomyopathy (DCM) containing PLB mutation R14del, where we observed that rAAV2-driven expression of PLBM rescues arrhythmic Ca2+ transients and alleviates decreased Ca2+ transport. Thus, we propose that PLBM transgene expression is a promising gene therapy strategy that directly targets the underlying pathophysiology of abnormal Ca2+ transport and thus contractility in underlying systolic heart failure.
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Affiliation(s)
- Daniel R Stroik
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, MN 55455, United States of America
| | - Delaine K Ceholski
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York City, New York 10029, United States of America
| | - Philip A Bidwell
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, MN 55455, United States of America; Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, United States of America
| | - Justyna Mleczko
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York City, New York 10029, United States of America
| | - Paul F Thanel
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, MN 55455, United States of America
| | - Forum Kamdar
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, United States of America
| | - Joseph M Autry
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, MN 55455, United States of America
| | - Razvan L Cornea
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, MN 55455, United States of America
| | - David D Thomas
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, MN 55455, United States of America.
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Schultz J, Goodwin K, John R, Alexy T, Kamdar F, Martin C, Cogswell R. Association Between Angiotensin II Receptor Blockade and Recurrent Gastrointestinal Bleeding on Left Ventricular Assist Device Support. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.395] [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: 10/17/2022] Open
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16
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Cogswell R, John R, Shultz J, Martin C, Thenappan T, Kamdar F, Earthman C, Teigen L. Pre-Operative Pectoralis Muscle Quantity and Attenuation by Computed Tomography are Predictive of Recurrent Gastrointestinal Bleeding on Left Ventricular Assist Device Support. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.164] [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: 10/17/2022] Open
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17
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Abstract
Digoxin remains one of the oldest therapies for heart failure; however, its safety and efficacy have been controversial since its initial use. Questions that remain include the clinical efficacy of digoxin when added to contemporary medical therapy, when and if it should be added, and how to minimize adverse effects. In this review, we will summarize recent data on the use of digoxin in systolic heart failure and address some of the controversies regarding the role of digoxin in the modern era of heart failure treatment.
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Affiliation(s)
- Chonyang L Albert
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Forum Kamdar
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Mazen Hanna
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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Abstract
Dystrophinopathies are a group of distinct neuromuscular diseases that result from mutations in the structural cytoskeletal Dystrophin gene. Dystrophinopathies include Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD), X-linked dilated cardiomyopathy, as well as DMD and BMD female carriers. The primary presenting symptom in most dystrophinopathies is skeletal muscle weakness. However, cardiac muscle is also a subtype of striated muscle and is similarly affected in many of the muscular dystrophies. Cardiomyopathies associated with dystrophinopathies are an increasingly recognized manifestation of these neuromuscular disorders and contribute significantly to their morbidity and mortality. Recent studies suggest that these patient populations would benefit from cardiovascular therapies, annual cardiovascular imaging studies, and close follow-up with cardiovascular specialists. Moreover, patients with DMD and BMD who develop end-stage heart failure may benefit from the use of advanced therapies. This review focuses on the pathophysiology, cardiac involvement, and treatment of cardiomyopathy in the dystrophic patient.
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Affiliation(s)
- Forum Kamdar
- Cardiovascular Division, Lillehei Heart Institute, University of Minnesota, Minneapolis, Minnesota
| | - Daniel J Garry
- Cardiovascular Division, Lillehei Heart Institute, University of Minnesota, Minneapolis, Minnesota.
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Kamdar F, Urban M, Szczech D, John R, Starling R, Moazami N. The Impact of LVAD Pump Thrombosis (PT) on Renal Function in Patients Undergoing Continuous Flow (CF) Left Ventricular Device (LVAD) Exchange. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.672] [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] Open
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20
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Kamdar F, Das G. Treatment of focal transplant vasculopathy with a bioresorbable coronary artery stent. J Heart Lung Transplant 2016; 35:943-4. [PMID: 27095002 DOI: 10.1016/j.healun.2016.02.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/16/2016] [Accepted: 02/26/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Forum Kamdar
- Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota
| | - Gladwin Das
- Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota
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Kamdar F, Thenappan T, Missov E. Pulmonary arterial hypertension in von Recklinghausen's disease. Am J Med 2015; 128:e39-40. [PMID: 26144102 DOI: 10.1016/j.amjmed.2015.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 06/10/2015] [Accepted: 06/10/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Forum Kamdar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, Minneapolis
| | - Thenappan Thenappan
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, Minneapolis
| | - Emil Missov
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, Minneapolis.
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Kamdar F, Hertz M, Shumway S, Missov E. Late effusive-constrictive pericarditis after lung transplantation. Am J Med 2015; 128:e1-2. [PMID: 25555547 DOI: 10.1016/j.amjmed.2014.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 12/05/2014] [Accepted: 12/05/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Forum Kamdar
- Division of Cardiology, University of Minnesota Medical Center, Minneapolis
| | - Marshall Hertz
- Division of Pulmonary and Critical Care, University of Minnesota Medical Center, Minneapolis
| | - Sara Shumway
- Division of Cardiothoracic Surgery, University of Minnesota Medical Center, Minneapolis
| | - Emil Missov
- Division of Cardiology, University of Minnesota Medical Center, Minneapolis.
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Kamdar F, Pera V, Valeti U. Stenting a moving target. Neurological and hemodynamic recovery after 80 minutes of CPR using an automated chest compression device to facilitate percutaneous coronary intervention. Minn Med 2015; 98:34-36. [PMID: 26065187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Despite significant advances in the science of resuscitation, survival to discharge after an in-hospital cardiac arrest in the catheterization laboratory remains poor. Clinicians face the challenges of performing CPR during procedures to address the cause of the arrest and the limitations of prolonged manual CPR. In this article we describe the first case of a patient presenting in cardiogenic shock caused by acute coronary syndrome secondary to bypass graft failure who developed cardiac arrest and survived 80 minutes of resuscitation in the catheterization lab, allowing for revascularization of a vein graft. The patient experienced complete neurological and hemodynamic recovery. This case demonstrates the importance of prompt high-quality, uninterrupted CPR using an automated chest compression device to facilitate early emergent revascularization of a vein graft.
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Kamdar F, Klaassen Kamdar A, Koyano-Nakagawa N, Garry MG, Garry DJ. Cardiomyopathy in a dish: using human inducible pluripotent stem cells to model inherited cardiomyopathies. J Card Fail 2015; 21:761-70. [PMID: 25934595 DOI: 10.1016/j.cardfail.2015.04.010] [Citation(s) in RCA: 11] [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] [Received: 03/07/2015] [Revised: 04/11/2015] [Accepted: 04/17/2015] [Indexed: 12/15/2022]
Abstract
Inherited cardiomyopathies, including hypertrophic cardiomyopathy, dilated cardiomyopathies, arrythmogenic right ventricular cardiomyopathy, and other inherited forms of heart failure, represent a unique set of genetically defined cardiovascular disease processes. Unraveling the molecular mechanisms of these deadly forms of human heart disease has been challenging, but recent groundbreaking scientific advances in stem cell technology have allowed for the generation of patient-specific human inducible stem cell (hiPSC)-derived cardiomyocytes (CMs). hiPSC-derived CMs retain the genetic blueprint of the patient, they can be maintained in culture, and they recapitulate the phenotypic characteristics of the disease in vitro, thus serving as a disease in a dish. This review provides an overview of in vitro modeling of inherited cardiomyopathies with the use of patient-specific hiPSC-derived CMs.
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Affiliation(s)
- Forum Kamdar
- Cardiovascular Division and Lillehei Heart Institute, University of Minnesota, Minneapolis, Minnesota
| | - Andre Klaassen Kamdar
- Cardiovascular Division and Lillehei Heart Institute, University of Minnesota, Minneapolis, Minnesota
| | - Naoko Koyano-Nakagawa
- Cardiovascular Division and Lillehei Heart Institute, University of Minnesota, Minneapolis, Minnesota
| | - Mary G Garry
- Cardiovascular Division and Lillehei Heart Institute, University of Minnesota, Minneapolis, Minnesota
| | - Daniel J Garry
- Cardiovascular Division and Lillehei Heart Institute, University of Minnesota, Minneapolis, Minnesota.
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Kamdar F, Sathnur N, Klaassen Kamdar A, Eckman P, John R. Low Cardiac Power Index (CPI) Is Associated With Higher Mortality in Cardiogenic Shock: Stratifying INTERMACS 1 and 2 Patients Undergoing Continuous-Flow LVAD (CF-LVAD) Implantation. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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26
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Kamdar P, Kamdar F, Roettger M, Eckman P. Dental Care in Left Ventricular Assist Devices (LVAD) Patients: A Survey of Dentists. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Whitson BA, Eckman P, Kamdar F, Lacey A, Shumway SJ, Liao KK, John R. Hemolysis, pump thrombus, and neurologic events in continuous-flow left ventricular assist device recipients. Ann Thorac Surg 2014; 97:2097-103. [PMID: 24775803 DOI: 10.1016/j.athoracsur.2014.02.041] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 02/17/2014] [Accepted: 02/20/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND An ongoing challenge in the management of patients with heart failure who receive left ventricular assist devices (LVADs) is achieving optimal anticoagulation. Adverse prothrombotic events include hemolysis or pump thrombus (H/T) and neurologic events (NEs), and all limit the success of LVAD therapy. Our aim was to study the incidence and clinical outcomes associated with these events in a large single-center cohort. METHODS We retrospectively reviewed our prospectively collected database of all patients receiving a HeartMate II (Thoratec Corp, Pleasanton, CA) LVAD from 2005 to 2012. Demographic, clinical, and outcome data were analyzed using standard statistical methods. All adverse events were recorded. RESULTS Of 193 patients receiving LVADs, we identified 39 H/T events in 26 (13.4%) patients and 22 NEs in 19 (9.8%) patients. Seventy-four percent of events occurred in the last 3 years of the series, during which time 63% of implants were placed. Of patients with H/T, 8 (31% of those having H/T, 4.1% of total) had more than 1 event and 4 (15.4% of those having H/T, 2.1% of total) underwent pump exchanges. Five (23%) patients had NEs after H/T, and 6 (32%) died as a result of the NE. Of patients with H/T, 27% had preceding episodes of infection, 31% had an international normalized ratio (INR) of less than 1.5, 31% had an INR of 1.5 to 2, 15% had a history of clotting or were hypercoagulable, and 4% had anticoagulation intentionally withheld. Lactate dehydrogenase (LDH), plasma hemoglobin, INR, and platelet determinations were significantly different at the time of H/T compared with baseline values. The survival at 6 months (alive or having undergone transplantation) for those with a prothrombotic event compared with those without was 70% versus 75.2% (p = 0.5). CONCLUSIONS The incidence of H/T or NEs is significant and results in major morbidity after LVAD placement. Infection and suboptimal anticoagulation are associated with the majority of these events. Identification of patients at higher risk for hemolysis (ie, infection) may allow for modification of anticoagulation regimens to reduce these risks and improve clinical outcomes.
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Affiliation(s)
- Bryan A Whitson
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, University of Minnesota, Minneapolis, Minnesota; Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, Ohio State University, Columbus, Ohio
| | - Peter Eckman
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - Forum Kamdar
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - Alexandra Lacey
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Sara J Shumway
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Kenneth K Liao
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Ranjit John
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, University of Minnesota, Minneapolis, Minnesota.
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Kamdar F, Valeti U. CARDIAC ARREST SECONDARY TO EARLY BYPASS GRAFT FAILURE: PROLONGED CARDIOPULMONARY RESUSCITATION (CPR) WITH HEMODYNAMIC AND NEUROLOGICAL RECOVERY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60688-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Papillary fibroelastomas are benign cardiac tumors with high embolic potential typically found on the valvular surfaces of the heart. Nonvalvular papillary fibroelastomas are exceedingly rare. We report the case of a 66-year-old Caucasian male with acute bilateral basal ganglia infarctions found to have a mass adherent to the left ventricular septum by transesophageal echocardiography. The mass was identified as a rare nonvalvular cardiac papillary fibroelastoma based on echogenicity, pedunculated nature, and typical motion. Tissue characterization by cardiac magnetic resonance imaging demonstrated homogeneously hypo-intense signal on T2 weighted imaging and signal hyperintensity after administration of gadolinium contrast, confirming the fibroelastic nature of the mass. Surgical excision was performed via ventriculotomy and histopathologic examination was pathognomonic of a papillary fibroelastoma. We conclude that transesophageal echocardiography provides high diagnostic certainty in patients with cardiac papillary fibroelastomas and can reliably identify atypical locations of these tumors on nonvalvular surfaces. A multimodality imaging approach is not necessarily indicated in all patients with this condition. LEARNING OBJECTIVE Papillary fibroelastomas are benign cardiac tumors with high embolic potential typically found on the valvular surfaces of the heart. Nonvalvular papillary fibroelastomas are exceedingly rare. Transesophageal echocardiography readily identifies nonvalvular papillary fibroelastomas based on echogenicity, pedunculated nature, and characteristic motion, and reliably differentiates them from other cardiac masses. A multimodality imaging approach is not indicated in all patients with this condition.
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Affiliation(s)
- Forum Kamdar
- Division of Cardiology, University of Minnesota Medical Center, 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Sithu Win
- Division of Cardiology, University of Minnesota Medical Center, 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - J Carlos Manivel
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis, MN 55455, USA
| | - Sara Shumway
- Division of Cardiothoracic Surgery, University of Minnesota Medical Center, Minneapolis, MN 55455, USA
| | - Emil Missov
- Division of Cardiology, University of Minnesota Medical Center, 420 Delaware Street SE, Minneapolis, MN 55455, USA
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Kamdar F, Eckman P, John R. Safety of discontinuation of anti-coagulation in patients with continuous-flow left ventricular assist devices. J Heart Lung Transplant 2013; 33:316-8. [PMID: 24462558 DOI: 10.1016/j.healun.2013.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 10/17/2013] [Accepted: 12/11/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- Forum Kamdar
- Divisions of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - Peter Eckman
- Divisions of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - Ranjit John
- Cardiothoracic Surgery, University of Minnesota, Minneapolis, Minnesota
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Kamdar F, Doyle M, Chapman C, Lohr J, Koyano Nakagawa N, Garry D. In Vitro Modeling of Duchenne Muscular Dystrophy (DMD) Cardiomyopathy Using Human Induced Pluripotent Stem Cells (hiPSC). J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
Cellular transplantation for cardiac repair has emerged as an exciting treatment option for patients with myocardial infarction (MI) and heart failure. Animal models of post-infarction left ventricular remodeling have demonstrated an improvement in left ventricular (LV) function, decrease in scar size, and amelioration of adverse cardiac remodeling after stem cell transplantation. These beneficial effects occur despite minimal engraftment and negligible differentiation of transplanted cells. Evidence of the heart capability to self-renew continues to mount; however, the extent to which this occurs is still unclear. Although there is a specific population of cardiac stem cells capable of differentiating into cardiomyocytes, they alone are not capable of fully regenerating tissue damaged by MI. Therefore, paracrine mechanisms may be responsible for activating endogenous stem cells to promote regeneration and prevent apoptosis. These structural beneficial effects may reduce regional wall stresses, consequently leading to long-term host myocardium gene/protein expression changes, which may subsequently result in improvement in LV function.
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Affiliation(s)
- Forum Kamdar
- Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA
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Kamdar F, Liao K, Eckman P, Colvin-Adams M, Shumway S, John R. 583 Post-Cardiac Transplant Survival in the Current Era in Patients Receiving Continuous-Flow LVADs. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.596] [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: 10/28/2022] Open
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34
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Kamdar F, Eckman P, Liao K, Colvin-Adams M, John R. 554 Safety of Discontinuation of Anticoagulation in Patients with Continuous-Flow LVADs. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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35
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Kamdar F, Eckman P, Goldstein D, Sai-Sudhaker C, Aggarwal S, Pagani F, John R. 31 Pump-Related Infections (PRI) after Implantation of Continuous-Flow Left Ventricular Devices (CF LVADs): Analysis of 2900 Patients from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.034] [Citation(s) in RCA: 2] [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: 11/26/2022] Open
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36
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Kamdar F, Caccamo M, Martin C, Masri C, Eckman P, Colvin-Adams M. 675 CD19 Monitoring after Rituxamab in Patients with Cardiac Transplant Antibody Mediated Rejection (AMR). J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.690] [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: 11/30/2022] Open
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37
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Eckman P, Rosenbaum A, Vongooru H, Basraon J, Kamdar F, John R, Levy W. Survival of INTERMACS Profile 4-6 Patients after Left Ventricular Assist Device Implant Is Improved Compared to Seattle Heart Failure Model Estimated Survival. J Card Fail 2011. [DOI: 10.1016/j.cardfail.2011.06.129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lee J, Hu Q, Mansoor A, Kamdar F, Zhang J. Effect of acute xanthine oxidase inhibition on myocardial energetics during basal and very high cardiac workstates. J Cardiovasc Transl Res 2011; 4:504-13. [PMID: 21584861 DOI: 10.1007/s12265-011-9276-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 03/29/2011] [Indexed: 02/07/2023]
Abstract
Myocardial ischemia is associated with reduced myocardial adenosine triphosphate (ATP) and increased free adenosine diphosphate (ADP) similar to the normal heart at very high cardiac workstates (HCW). We examined whether acute xanthine oxidase inhibition (XOI) in vivo can decrease myocardial free ADP in normal hearts functioning at basal cardiac workstates (BCW) or very HCW (catecholamine-induced). Myocardial high-energy phosphate ((31)P magnetic resonance spectroscopy), blood flow (radioactive microspheres), and oxygen consumption (MVO(2)) were measured in an open-chest canine model before and after infusion of vehicle or an XO inhibitor (allopurinol or febuxostat; n = 10 in each group) during BCW and infusion of dobutamine + dopamine to induce a very HCW. During BCW, both allopurinol and febuxostat resulted in higher phosphocreatine (PCr)/ATP, corresponding to lower ADP levels. During vehicle infusion, HCW caused a decrease of PCr/ATP and an increase in myocardial free ADP. Although XOI did not prevent an increase in free ADP during catecholamine infusion, the values in the allopurinol or febuxostat groups (0.141 ± 0.012 and 0.136 ± 0.011 μmol/g dry wt, respectively) remained significantly less than in the vehicle group (0.180 ± 0.017; P < 0.05). Thus, at a given rate of ATP synthesis, XOI decreased the free ADP level needed to drive ATP synthesis, suggesting a more energy-efficient status. As contractile dysfunction in ischemia is characterized by increase of myocardial free ADP and energy deficiency, the data suggest that XOI might be a potential therapy for improving energy efficiency during myocardial ischemia.
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Affiliation(s)
- Joseph Lee
- Division of Cardiology, Department of Medicine, University of Minnesota Academic Health Center, Minneapolis, MN, USA
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Kamdar F, Nieto D, Eckman P, Colvin-Adams M, Liao K, John R. 640 Poor Pre-Operative Pulmonary Function Tests (PFT) Do Not Predict Worse Outcomes in Patients Undergoing LVAD Placement. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Garcia S, Akbar MS, Ali SS, Kamdar F, Tsai MY, Duprez DA. N-terminal pro B-type natriuretic peptide predicts mortality in patients with left ventricular hypertrophy. Int J Cardiol 2010; 143:349-52. [DOI: 10.1016/j.ijcard.2009.03.070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 11/25/2008] [Accepted: 03/12/2009] [Indexed: 10/20/2022]
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John R, Liao K, Kamdar F, Eckman P, Boyle A, Colvin-Adams M. Effects on pre- and posttransplant pulmonary hemodynamics in patients with continuous-flow left ventricular assist devices. J Thorac Cardiovasc Surg 2010; 140:447-52. [PMID: 20435321 DOI: 10.1016/j.jtcvs.2010.03.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 02/08/2010] [Accepted: 03/09/2010] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Pulsatile left ventricular assist devices have been shown to effectively reduce pulmonary hypertension in patients with end-stage heart failure. However, it remains to be seen whether newer continuous-flow left ventricular assist devices have a similar effect on pulmonary hypertension. The objective of this study was to determine whether the HeartMate II (Thoratec Corp, Pleasanton, Calif), a continuous-flow left ventricular assist device, is effective in improving pulmonary hemodynamics in the period after left ventricular assist device support and posttransplant. METHODS Fifty patients with end-stage heart failure underwent HeartMate II left ventricular assist device placement as a bridge to transplant. We evaluated their pulmonary hemodynamics with right-sided heart catheterization at baseline, after left ventricular assist device placement, and after heart transplant. RESULTS The mean age of patients was 53.7 +/- 13.5 years. Ischemic etiology was present in 60% of the patients. After left ventricular assist device placement (mean duration, 135 +/- 60 days), mean systolic and diastolic pulmonary artery pressures decreased significantly from a baseline of 55.2 +/- 13.4 mm Hg and 27.3 +/- 6.8 mm Hg, respectively, to 35.9 +/- 10.8 mm Hg and 15.8 +/- 6.5 mm Hg, respectively (P < .001). Similarly, mean pulmonary vascular resistance decreased significantly from a baseline of 3.6 +/- 1.9 Woods units to 2.1 +/- 0.8 Woods units (P < .001). Posttransplant pulmonary hemodynamics also remained within normal limits, even in patients with previously severe pulmonary hypertension. CONCLUSION Continuous-flow left ventricular assist devices effectively improve pulmonary hemodynamics associated with end-stage heart failure. Moreover, pulmonary hemodynamics remain within normal limits in the posttransplant period, even in patients with severe pulmonary hypertension. Therefore, adequate left ventricular decompression achieved with newer left ventricular assist devices can reverse significant pulmonary hypertension in patients with end-stage heart failure, making them eligible for cardiac transplantation.
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Affiliation(s)
- Ranjit John
- Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, Minn 55455, USA.
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Lee S, Kamdar F, John R. 65: Changing Patterns and Regional Differences in the Use of Ventricular Assist Devices as a Bridge-to-Transplant: An Analysis of UNOS Data. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Kamdar F, Boyle A, Colvin-Adams M, Liao K, Joyce L, John R. 690: Left Ventricular Unloading Is Comparable between Axial and Centrifugal Continuous-Flow LVADs. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Lee S, Kamdar F, Madlon-Kay R, John R. 608: Effects of the HeartMate II Continuous-Flow Left Ventricular Assist Device on RV Function. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.615] [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] Open
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Kamdar F, Liao K, Martinez F, Colvin-Adams M, Boyle A, Joyce L, John R. 49: Obesity – No Longer an Exclusion Criteria for LVAD Implantation. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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John R, Kamdar F, Liao K, Colvin-Adams M, Miller L, Joyce L, Boyle A. Low thromboembolic risk for patients with the Heartmate II left ventricular assist device. J Thorac Cardiovasc Surg 2008; 136:1318-23. [PMID: 19026822 DOI: 10.1016/j.jtcvs.2007.12.077] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 11/14/2007] [Accepted: 12/18/2007] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Thromboembolic events can occur in up to 20% of patients with a left ventricular assist device. The aggressive use of anticoagulation with newer continuous-flow devices has potentially increased the risk of postoperative bleeding. The predecessor of the HeartMate II left ventricular assist device, the HeartMate XVE (Thoratec Corp, Pleasanton, Calif), was associated with an extremely low thromboembolic risk, even without anticoagulation, because of its unique textured surfaces. Even though several areas of the HeartMate II are textured, a protocol was adopted for this new axial flow pump requiring long-term anticoagulation with warfarin. In our study, we investigated whether the HeartMate II left ventricular assist device is associated with a similarly low thromboembolic risk as the HeartMate XVE. METHODS At our institution, 45 patients (mean age, 57.24 +/- 14.2 years) underwent implantation of the HeartMate II; 30 underwent bridge-to-transplantation therapy, 7 underwent destination therapy, and 8 underwent left ventricular assist device exchange for a failed XVE left ventricular assist device. Total duration of HeartMate II support was 352.13 patient-months (mean duration, 7.2 +/- 5.2 months). All 45 patients were treated postoperatively with warfarin and aspirin. We recorded use of these 2 medications and monthly international normalized ratios. Prospectively, we also monitored patients for any clinical thromboembolic events and for pump thrombus. RESULTS Of our 45 study patients, 41 had a mean international normalized ratio of less than 2.0; of those 41 patients, 21 had a mean international normalized ratio of less than 1.6. Because of recurrent gastrointestinal bleeding episodes, 7 patients discontinued warfarin for a total duration of 39.1 patient-months. During the entire period of HeartMate II support, we noted 1 thromboembolic event. In addition, another patient had a suspected left ventricular assist device pump thrombus that resolved with a high-intensity heparin anticoagulation protocol (international normalized ratio, 1.3). CONCLUSIONS Our preliminary single-center analysis suggests that the HeartMate II is associated with an extremely low thromboembolic risk and with less stringent requirements for anticoagulation. Selected patients at high risk for bleeding can be safely followed with either no or extremely low anticoagulation requirements for prolonged periods.
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Affiliation(s)
- Ranjit John
- Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, Minn 55455, USA.
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Kamdar F, Boyle A, Colvin-Adams M, Pritzker M, Missov E, Liao K, Joyce L, John R. 286: The Effect of Centrifugal, Axial, and Pulsatile Left Ventricular Assist Device Support on End-Organ Function in Heart Failure Patients. J Heart Lung Transplant 2008. [DOI: 10.1016/j.healun.2007.11.295] [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: 10/22/2022] Open
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John R, Liao K, Lietz K, Kamdar F, Colvin-Adams M, Boyle A, Miller L, Joyce L. Experience with the Levitronix CentriMag circulatory support system as a bridge to decision in patients with refractory acute cardiogenic shock and multisystem organ failure. J Thorac Cardiovasc Surg 2007; 134:351-8. [PMID: 17662772 DOI: 10.1016/j.jtcvs.2007.01.085] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [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: 09/26/2006] [Revised: 01/22/2007] [Accepted: 01/29/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Patients with refractory acute cardiogenic shock and multisystem organ failure have a poor outcome with implantation of permanent ventricular assist devices. We review our experience with the use of the CentriMag (Levitronix LLC, Waltham, Mass) circulatory support system in such patients whose neurologic status was uncertain. METHODS From January 2004 to June 2006, 30 patients underwent CentriMag circulatory support system placement at the University of Minnesota. Of these patients, 12 were transferred from an outside hospital with refractory acute cardiogenic shock requiring biventricular support; they are the focus of this study. RESULTS Of our 12 study patients, 8 underwent successful bridging to the HeartMate XVE (Thoratec Corp, Pleasanton, Calif) ventricular assist device after biventricular support (mean support time of 9.4 days, range: 5-22 days). Another 2 patients underwent successful explantation (after 8 and 9 days); the remaining 2 patients died (after 4 days). Thus, the survival on CentriMag support, to either bridge or recovery, was 83% (10/12). Of the 8 patients who subsequently underwent HeartMate implantation, 5 also underwent a heart transplant within 6.9 months (range, 4.5-10 months), another 2 are still awaiting a transplant, and 1 died of sepsis and right ventricular failure 3 days after HeartMate implantation. Thus, for our 12 study patients, long-term survival was 75% at 1 month and 62.5% at 1 year. CONCLUSIONS Our aggressive strategy in this group of patients involved early operative intervention and implantation of biventricular support. By using this strategy, we avoided the urgent placement of expensive long-term ventricular assist devices in hemodynamically unstable patients with multisystem organ failure whose neurologic status was uncertain until end-organ recovery and excellent hemodynamic stability were achieved with the relatively inexpensive short-term CentriMag circulatory support system. The excellent midterm outcomes in this group of patients whose original prognosis was poor justify this therapeutic strategy.
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Affiliation(s)
- Ranjit John
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn, USA.
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John R, Kamdar F, Toninato C, Boyle A, Colvin-Adams M, Liao K, Miller L, Joyce L. 539: Low thromboembolic risk with the Heartmate II left ventricular assist device. J Heart Lung Transplant 2007. [DOI: 10.1016/j.healun.2006.11.563] [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] Open
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