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Yogeswaran A, Gall H, Fünderich M, Wilkins MR, Howard L, Kiely DG, Lawrie A, Hassoun PM, Sirenklo Y, Torbas O, Sweatt AJ, Zamanian RT, Williams PG, Frauendorf M, Arvanitaki A, Giannakoulas G, Saleh K, Sabbour H, Cajigas HR, Frantz R, Al Ghouleh I, Chan SY, Brittain E, Annis JS, Pepe A, Ghio S, Orfanos S, Anthi A, Majeed RW, Wilhelm J, Ghofrani HA, Richter MJ, Grimminger F, Sahay S, Tello K, Seeger W. Comparison of Contemporary Risk Scores in All Groups of Pulmonary Hypertension: A Pulmonary Vascular Research Institute GoDeep Meta-Registry Analysis. Chest 2024:S0012-3692(24)00309-X. [PMID: 38508334 DOI: 10.1016/j.chest.2024.03.018] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/22/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is a heterogeneous disease with a poor prognosis. Accurate risk stratification is essential for guiding treatment decisions in pulmonary arterial hypertension (PAH). Although various risk models have been developed for PAH, their comparative prognostic potential requires further exploration. Additionally, the applicability of risk scores in PH groups beyond group 1 remains to be investigated. RESEARCH QUESTION Are risk scores originally developed for PAH predictive in PH groups 1 through 4? STUDY DESIGN AND METHODS We conducted a comprehensive analysis of outcomes among patients with incident PH enrolled in the multicenter worldwide Pulmonary Vascular Research Institute GoDeep meta-registry. Analyses were performed across PH groups 1 through 4 and further subgroups to evaluate the predictive value of PAH risk scores, including REVEAL Lite 2, REVEAL 2.0, ESC/ERS 2022, COMPERA 3-strata, and COMPERA 4-strata. RESULTS Eight thousand five hundred sixty-five patients were included in the study, of whom 3,537 patients were assigned to group 1 PH, whereas 1,807 patients, 1,635 patients, and 1,586 patients were assigned to group 2 PH, group 3 PH, and group 4 PH, respectively. Pulmonary hemodynamics were impaired with median mean pulmonary arterial pressure of 42 mm Hg (33-52 mm Hg) and pulmonary vascular resistance of 7 WU (4-11 WU). All risk scores were prognostic in the entire PH population and in each of the PH groups 1 through 4. The REVEAL scores, when used as continuous prediction models, demonstrated the highest statistical prognostic power and granularity; the COMPERA 4-strata risk score provided subdifferentiation of the intermediate-risk group. Similar results were obtained when separately analyzing various subgroups (PH subgroups 1.1, 1.4.1, and 1.4.4; PH subgroups 3.1 and 3.2; group 2 with isolated postcapillary PH vs combined precapillary and postcapillary PH; patients of all groups with concomitant cardiac comorbidities; and severe [> 5 WU] vs nonsevere PH). INTERPRETATION This comprehensive study with real-world data from 15 PH centers showed that PAH-designed risk scores possess predictive power in a large PH cohort, whether considered as common to the group or calculated separately for each PH group (1-4) and various subgroups.
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Affiliation(s)
- Athiththan Yogeswaran
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | - Henning Gall
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | - Meike Fünderich
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany
| | - Martin R Wilkins
- National Heart and Lung Institute, Imperial College London, London
| | - Luke Howard
- National Heart and Lung Institute, Imperial College London, London
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, University of Sheffield and National Institute for Health and Care Research Sheffield Biomedical Research Centre, Sheffield, England
| | - Allan Lawrie
- National Heart and Lung Institute, Imperial College London, London; Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, University of Sheffield and National Institute for Health and Care Research Sheffield Biomedical Research Centre, Sheffield, England
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yuriy Sirenklo
- National Scientific Center M.D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine, The National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Olena Torbas
- National Scientific Center M.D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine, The National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Andrew J Sweatt
- Division of Pulmonary, Allergy, and Critical Care and the Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Palo Alto, CA
| | - Roham T Zamanian
- Division of Pulmonary, Allergy, and Critical Care and the Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Palo Alto, CA
| | | | | | - Alexandra Arvanitaki
- First Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Giannakoulas
- First Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Khaled Saleh
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Hani Sabbour
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Hector R Cajigas
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Robert Frantz
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | - Stefano Ghio
- Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | | | | | - Raphael W Majeed
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute of Medical Informatics, RWTH Aachen University, Aachen, Germany
| | - Jochen Wilhelm
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | - Hossein Ardeschir Ghofrani
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | - Manuel J Richter
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | - Friedrich Grimminger
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | | | - Khodr Tello
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany
| | - Werner Seeger
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Giessen, Germany; Institute for Lung Health, Cardio-Pulmonary Institute (CPI), Giessen, Germany.
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Cueto-Robledo G, González-Hermosillo LM, Porres-Aguilar M, Navarro-Vergara DI, Garcia-Cesar M, Torres-Rojas MB, Martinez-Carrillo AD, Cajigas HR. Complications of Right Heart Catheterization in Patients ≥70 Years of Age With Suspected Pulmonary Hypertension: Experience From a Tertiary Care Center. Curr Probl Cardiol 2024; 49:102136. [PMID: 37858849 DOI: 10.1016/j.cpcardiol.2023.102136] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/14/2023] [Indexed: 10/21/2023]
Abstract
Right heart catheterization (RHC) represents the gold standard diagnostic approach for pulmonary hypertension (PH). Historically, the complication rates of RHC are known to be low. The study aimed to evaluate the indications for performing RHC and the occurrence of adverse events related to the procedure in patients > over 70 years of age in a Mexican Tertiary Care Center. We conducted a retrospective single-center registry from July 2017 to July 2022. A total of 517 patients with suspected PH underwent RHC. The cohort included patients <70 (n = 427) and ≥70 years of age (n = 90). Adverse events were classified as major (eg, death, pneumothorax, and carotid artery puncture) and minor (eg, atrial arrhythmia, superior vena cava dissection, incidental arterial puncture, and local hematoma). Appropriate hemodynamic parameters were recorded. No report of major adverse events in the entire cohort. In the <70 years age group, 9 minor events, and 3 minor events were in the ≥70-year-old patients (P < 0.0001). There was a significant difference in the measurement of mean pulmonary artery pressure (mPAP) between the <70 years old vs ≥70 years old (P < 0.001); there was a significant difference in right atrial pressures: 4.71 ± 3.14 mmHg in the <70-year-old vs 4.07 ± 1.94 mmHg for the ≥ 70-year-old group (P = 0.014). Our findings suggest that RHC can be safely performed in patients aged ≥70 years using different vascular access routes without significant major complications.
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Affiliation(s)
- Guillermo Cueto-Robledo
- Cardiorespiratory Emergencies, Hospital General de México 'Dr Eduardo Liceaga', Mexico City, Mexico; Pulmonary Circulation Clinic, Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico; Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
| | - Leslie-Marisol González-Hermosillo
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico; Doctorate Program in Biomedical Sciences, Postgraduate Unit. National Autonomous University of Mexico, Mexico City, Mexico
| | - Mateo Porres-Aguilar
- Divisions of Hospital and Adult Thrombosis Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center and Paul L. Foster School of Medicine, El Paso, TX
| | - Dulce-Iliana Navarro-Vergara
- Cardiorespiratory Emergencies, Hospital General de México 'Dr Eduardo Liceaga', Mexico City, Mexico; Pulmonary Circulation Clinic, Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico
| | - Marisol Garcia-Cesar
- Cardiorespiratory Emergencies, Hospital General de México 'Dr Eduardo Liceaga', Mexico City, Mexico; Pulmonary Circulation Clinic, Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico
| | - Maria-Berenice Torres-Rojas
- Cardiorespiratory Emergencies, Hospital General de México 'Dr Eduardo Liceaga', Mexico City, Mexico; Pulmonary Circulation Clinic, Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico
| | | | - Hector R Cajigas
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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Cajigas HR, Lavon B, Harmsen W, Muchmore P, Costa J, Mussche C, Pulsipher S, De Backer J. Quantitative CT measures of pulmonary vascular volume distribution in pulmonary hypertension associated with COPD: Association with clinical characteristics and outcomes. Pulm Circ 2023; 13:e12321. [PMID: 38098498 PMCID: PMC10719487 DOI: 10.1002/pul2.12321] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/08/2023] [Accepted: 12/02/2023] [Indexed: 12/17/2023] Open
Abstract
To determine whether quantitative computed tomography (qCT)-derived metrics of pulmonary vascular volume distribution could distinguish chronic obstructive pulmonary disease (COPD) subjects with associated pulmonary hypertension (PH) from those without and to characterize associations of these measurements with clinical and physiological characteristics and outcomes. We collected retrospective CT, pulmonary hemodynamic, clinical, and outcomes data from subjects with COPD and right-heart catheterization-confirmed PH (PH-COPD) and control subjects with COPD but without PH. We measured the volumes of pulmonary vessels < 5 and >10 mm2 in cross-sectional area as a percentage of total pulmonary vascular volume (qCT-derived volume of pulmonary vessels < 5 mm2 in cross-sectional area as a volume fraction of total pulmonary blood volume [BV5%] and qCT-derived volume of pulmonary vessels > 10 mm2 in cross-sectional area [BV10] as a volume fraction of total pulmonary blood volume [BV10%], respectively) using Functional Respiratory Imaging (FRI), an automated qCT platform, and compared them between PH and control arms and between subjects with mild-moderate PH and those with severe disease. Correlations of hemodynamics with pulmonary function and associations with survival were tested. Forty-five PH-COPD and 42 control subjects were studied. BV5% was lower in PH subjects (32.2% vs. 37.7%, p = 0.003), and BV10% was higher (50.2% vs. 43.5, p = 0.001). Subjects with severe PH did not differ from those with mild-moderate PH in qCT. Pulmonary vascular volumes were not associated with pulmonary function. BV10 was associated with mean pulmonary artery pressure (r = 0.3, p = 0.05). Associations with survival were observed for BV5% (hazard ratio 0.63, p = 0.02) and BV10% (hazard ratio 1.43, p = 0.03) in the PH-COPD arm, but not for controls. qCT-derived measures of pulmonary vascular volume may have diagnostic and prognostic significance in PH-COPD and should be investigated further as screening and risk stratification tools.
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Affiliation(s)
- Hector R. Cajigas
- Department of Internal Medicine, Division of Pulmonary and Critical CareMayo ClinicRochesterMinnesotaUSA
| | | | - William Harmsen
- Department of Quantitative Health Sciences, Division of Clinical Trials and BiostatisticsMayo ClinicRochesterMinnesotaUSA
| | | | | | | | - Sydney Pulsipher
- Department of Quantitative Health Sciences, Division of Clinical Trials and BiostatisticsMayo ClinicRochesterMinnesotaUSA
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Cajigas HR, Burger CD, Cartin-Ceba R, DuBrock H, Swanson K, Vargas HE, Keaveny AP, Watt KD, Krowka M. Portopulmonary Hypertension in Nontransplanted Patients: Results of the Largest US Single-Institution Registry. Mayo Clin Proc 2022; 97:2236-2247. [PMID: 36336515 DOI: 10.1016/j.mayocp.2022.08.020] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/19/2022] [Accepted: 08/30/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To explore clinical characteristics, risk profiles, and outcomes of patients with portopulmonary hypertension (PoPH) who have contraindications to liver transplant (LT). METHODS From the largest US single-institution registry of patients with PoPH, we analyzed 160 patients who did not receive LT between 1988 to 2019. Pulmonary arterial hypertension (PAH)-pertinent characteristics, hemodynamic features, treatments, and risk stratification were compared at baseline, first follow-up visit, and censor/death time. RESULTS Median survival for the entire cohort was 27.5 months from the diagnosis of PoPH. Overall survival was 89%, 77%, 51%, and 38% at 6 months, 1 year, 3 years, and 5 years, respectively. Survival was significantly affected by the severity of liver disease (P<.001). Most patients received PAH-specific therapies (136 [85%]), predominantly monotherapy (123 [77%)]. With treatment, significant improvements were noted in World Health Organization functional class (P=.04), 6-minute walk distance (P<.001), right ventricular function (P<.001), pulmonary vascular resistance (P<.001), and Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management (REVEAL) Lite 2 score (P=.02) univariately. Per European Society of Cardiology risk stratification, no patient met full criteria for low risk at baseline or at follow-up. In a multivariate Cox risk model, 6-minute walk distance, right atrial pressure, pulmonary capillary wedge pressure, bilirubin level, and Model for End-Stage Liver Disease-sodium score of 15 or higher were associated with increased risk of death. CONCLUSION Patients with PoPH who did not undergo LT had a poor prognosis. This persisted despite use of PAH-specific therapies and significant improvements in hemodynamics, echocardiography parameters of right ventricle function, 6-minute walk distance, and World Health Organization functional class.
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Affiliation(s)
- Hector R Cajigas
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Charles D Burger
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Rodrigo Cartin-Ceba
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Hilary DuBrock
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Karen Swanson
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Hugo E Vargas
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Andrew P Keaveny
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Kymberly D Watt
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Michael Krowka
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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Agboola KM, Kowlgi GN, Csecs I, DuBrock HM, Cajigas HR, Allison TG. Bezold‐Jarisch Reflex Mediated Syncope in Pulmonary Arterial Hypertension: An Illustrative Case Series. Pulm Circ 2022; 12:e12147. [PMID: 36325510 PMCID: PMC9618286 DOI: 10.1002/pul2.12147] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/13/2022] [Accepted: 08/16/2022] [Indexed: 11/15/2022] Open
Abstract
We present a novel description of Bezold–Jarisch Reflex (BJR) during cardiopulmonary exercise testing (CPET) in three young female patients with Group 1 pulmonary arterial hypertension (PAH). These three cases presented within 26 months, representing only 0.8% of 11,387 tests on patients with PAH undergoing CPET during this time frame.
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Affiliation(s)
| | | | - Ibolya Csecs
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine New York NY
| | - Hilary M. DuBrock
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine Mayo Clinic Rochester MN
| | - Hector R. Cajigas
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine Mayo Clinic Rochester MN
| | - Thomas G. Allison
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology Mayo Clinic Rochester MN
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DuBrock HM, Reddy YN, Durst LA, Schroeder DR, Park G, Cajigas HR, Kane GC, Kushwaha SS, McCully RB, Murphy JG, Vidhu Anand, Krowka MJ, Frantz RP. The feasibility and value of assessing patient reported outcomes in pulmonary arterial hypertension. Pulm Circ 2022; 12:e12143. [PMID: 36262468 PMCID: PMC9575699 DOI: 10.1002/pul2.12143] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/02/2022] [Accepted: 09/19/2022] [Indexed: 11/21/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a progressive pulmonary vascular disease that negatively impacts health‐related quality of life (HRQOL). The PAH‐symptoms and impact (PAH‐SYMPACT) questionnaire is a validated disease‐specific patient‐reported outcome (PRO) instrument that assesses a patient's symptoms and the impact of PAH and its treatment on well‐being. We performed a single‐center prospective cohort study of patients with PAH to determine the feasibility of assessing PROs in clinical practice and to determine the association between PAH‐SYMPACT domains and clinical characteristics and outcomes. One hundred and ten patients completed the 1‐day version of the PAH‐SYMPACT questionnaire which consists of 22 Likert‐scale questions that assess HRQOL across four domains: cardiopulmonary (CP) symptoms, cardiovascular (CV) symptoms, physical impact (PI), and cognitive and emotional (CE) impact. Higher scores indicate worse HRQOL. Patients were predominantly female (n = 86, 78%) with a mean age of 57.8 ± 16.2 years. While several patient characteristics were associated with CP and PI domains, few were associated with CV and CE domains. PI and CE impact scores were associated with recent hospitalizations and mortality and CE impact score was independently associated with an increased risk of death after adjustment for disease severity (hazard ratio: 3.29, 95% confidence interval: 1.56–6.91, p = 0.002). In conclusion, the assessment of PROs in clinical practice using the PAH‐SYMPACT questionnaire is both feasible and valuable. PAH‐SYMPACT scores have independent prognostic value and are not adequately reflected by traditional measures of disease severity. These findings underscore the importance of assessing HRQOL in clinical practice.
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Affiliation(s)
| | - Yogesh N. Reddy
- Mayo Clinic Rochester, MN Department of Cardiovascular Medicine
| | - Louise A. Durst
- Mayo Clinic Rochester, MN Department of Cardiovascular Medicine
| | | | - Grace Park
- Mayo Clinic Rochester, MN Department of Cardiovascular Medicine
| | | | - Garvan C. Kane
- Mayo Clinic Rochester, MN Department of Cardiovascular Medicine
| | | | | | | | - Vidhu Anand
- Mayo Clinic Rochester, MN Department of Cardiovascular Medicine
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Majeed RW, Wilkins MR, Howard L, Hassoun PM, Anthi A, Cajigas HR, Cannon J, Chan SY, Damonte V, Elwing J, Förster K, Frantz R, Ghio S, Al Ghouleh I, Hilgendorff A, Jose A, Juaneda E, Kiely DG, Lawrie A, Orfanos SE, Pepe A, Pepke‐Zaba J, Sirenko Y, Swett AJ, Torbas O, Zamanian RT, Marquardt K, Michel‐Backofen A, Antoine T, Wilhelm J, Barwick S, Krieb P, Fuenderich M, Fischer P, Gall H, Ghofrani H, Grimminger F, Tello K, Richter MJ, Seeger W. Pulmonary Vascular Research Institute GoDeep: A meta-registry merging deep phenotyping datafrom international PH reference centers. Pulm Circ 2022; 12:e12123. [PMID: 36034404 PMCID: PMC9399782 DOI: 10.1002/pul2.12123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 11/08/2022] Open
Abstract
The Pulmonary Vascular Research Institute GoDeep meta-registry is a collaboration of pulmonary hypertension (PH) reference centers across the globe. Merging worldwide PH data in a central meta-registry to allow advanced analysis of the heterogeneity of PH and its groups/subgroups on a worldwide geographical, ethnical, and etiological landscape (ClinTrial. gov NCT05329714). Retrospective and prospective PH patient data (diagnosis based on catheterization; individuals with exclusion of PH are included as a comparator group) are mapped to a common clinical parameter set of more than 350 items, anonymized and electronically exported to a central server. Use and access is decided by the GoDeep steering board, where each center has one vote. As of April 2022, GoDeep comprised 15,742 individuals with 1.9 million data points from eight PH centers. Geographic distribution comprises 3990 enrollees (25%) from America and 11,752 (75%) from Europe. Eighty-nine perecent were diagnosed with PH and 11% were classified as not PH and provided a comparator group. The retrospective observation period is an average of 3.5 years (standard error of the mean 0.04), with 1159 PH patients followed for over 10 years. Pulmonary arterial hypertension represents the largest PH group (42.6%), followed by Group 2 (21.7%), Group 3 (17.3%), Group 4 (15.2%), and Group 5 (3.3%). The age distribution spans several decades, with patients 60 years or older comprising 60%. The majority of patients met an intermediate risk profile upon diagnosis. Data entry from a further six centers is ongoing, and negotiations with >10 centers worldwide have commenced. Using electronic interface-based automated retrospective and prospective data transfer, GoDeep aims to provide in-depth epidemiological and etiological understanding of PH and its various groups/subgroups on a global scale, offering insights for improved management.
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Affiliation(s)
- Raphael W. Majeed
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
- Institute of Medical InformaticsRWTH Aachen UniversityAachenGermany
| | - Martin R. Wilkins
- National Heart and Lung Institute and Imperial CollegeLondon NHS Healthcare TrustLondonUK
| | - Luke Howard
- National Heart and Lung Institute and Imperial CollegeLondon NHS Healthcare TrustLondonUK
| | - Paul M. Hassoun
- Department of MedicineDivision of Pulmonary and Critical Care Medicine, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Anastasia Anthi
- 1st Department of Critical CareNational & Kapodistrian University of Athens Medical School and Pulmonary Hypertension Clinic, Evangelismos General HospitalAthensGreece
| | - Hector R. Cajigas
- Division of Pulmonary and Critical Care MedicineMayo ClinicRochesterNew YorkUSA
| | - John Cannon
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge Biomedical CampusCambridgeUK
| | - Stephen Y. Chan
- Department of Medicine, Division of Cardiology, Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine InstituteUniversity of Pittsburgh School of Medicine and University of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Victoria Damonte
- Hospital de Niños, Hospital Privado Universitario, Clinica Universitaria Reina Fabiola and Instituto Oulton‐Catholic, University of CórdobaCórdobaArgentina
| | - Jean Elwing
- Division of Pulmonary, Critical Care and Sleep MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Kai Förster
- Ludwig‐Maximilians University of MunichMunchenGermany
| | - Robert Frantz
- Department of CardiologyMayo ClinicRochesterNew YorkUSA
| | | | - Imad Al Ghouleh
- Department of Medicine, Division of Cardiology, Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine InstituteUniversity of Pittsburgh School of Medicine and University of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | | | - Arun Jose
- Division of Pulmonary, Critical Care and Sleep MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Ernesto Juaneda
- Hospital de Niños, Hospital Privado Universitario, Clinica Universitaria Reina Fabiola and Instituto Oulton‐Catholic, University of CórdobaCórdobaArgentina
| | - David G. Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital and University of SheffieldSheffieldUK
| | - Allan Lawrie
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital and University of SheffieldSheffieldUK
| | - Stylianos E. Orfanos
- 1st Department of Critical CareNational & Kapodistrian University of Athens Medical School and Pulmonary Hypertension Clinic, Evangelismos General HospitalAthensGreece
| | | | - Joanna Pepke‐Zaba
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge Biomedical CampusCambridgeUK
| | - Yuriy Sirenko
- Department of Symptomatic Hypertension“National Scientific Center ‘The M.D. Strazhesko Institute of Cardiology’” of National Academy of Medical ScienceKyivUkraine
| | - Andrew J. Swett
- Division of Pulmonary, Allergy, and Critical Care, and Vera Moulton Wall Center for Pulmonary Vascular DiseaseStanford UniversityStanfordCaliforniaUSA
| | - Olena Torbas
- Department of Symptomatic Hypertension“National Scientific Center ‘The M.D. Strazhesko Institute of Cardiology’” of National Academy of Medical ScienceKyivUkraine
| | - Roham T. Zamanian
- Division of Pulmonary, Allergy, and Critical Care, and Vera Moulton Wall Center for Pulmonary Vascular DiseaseStanford UniversityStanfordCaliforniaUSA
| | - Kurt Marquardt
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
| | - Achim Michel‐Backofen
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
| | - Tobiah Antoine
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
| | - Jochen Wilhelm
- Institute for Lung Health (ILH), Cardio‐Pulmonary Institute (CPI)GiessenGermany
| | | | - Phillipp Krieb
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
| | - Meike Fuenderich
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
| | - Patrick Fischer
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
| | - Henning Gall
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
| | - Hossein‐Ardeschir Ghofrani
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
- Institute for Lung Health (ILH), Cardio‐Pulmonary Institute (CPI)GiessenGermany
| | - Friedrich Grimminger
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
- Institute for Lung Health (ILH), Cardio‐Pulmonary Institute (CPI)GiessenGermany
| | - Khodr Tello
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
- Institute for Lung Health (ILH), Cardio‐Pulmonary Institute (CPI)GiessenGermany
| | - Manuel J. Richter
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
- Institute for Lung Health (ILH), Cardio‐Pulmonary Institute (CPI)GiessenGermany
| | - Werner Seeger
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
- Institute for Lung Health (ILH), Cardio‐Pulmonary Institute (CPI)GiessenGermany
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8
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Cajigas HR, Kaptzan T, Lewis B, El-Sabbagh A, Al-Hijji M, Eleid M, Alkhouli M, Wang DD, Eng M, Kodali S, George I, Chakravarty T, Pershad A, O'Hair D, Jones N, Makkar R, Reisman M, Leon M, O'Neill W, Rihal C, Guerrero M. The impact of pulmonary hypertension on outcomes of transcatheter mitral valve replacement in mitral annular calcification. Catheter Cardiovasc Interv 2022; 99:1647-1658. [PMID: 35019204 DOI: 10.1002/ccd.30057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/12/2021] [Accepted: 12/14/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To assess the impact of pulmonary hypertension (PH) on outcomes of patients with severe mitral annular calcification (MAC) undergoing transcatheter mitral valve replacement (TMVR). BACKGROUND PH is associated with poor outcomes after mitral valve surgery. Whether the presence of PH in patients with MAC undergoing (TMVR) is associated with poor outcomes, is unknown. METHODS Retrospective evaluation of 116 patients from 51 centers in 11 countries who underwent TMVR with valve in mitral annular calcification (ViMAC) using balloon-expandable aortic transcatheter valves (THVs) from September 2012 to March 2017. Pulmonary artery systolic blood pressure (PASP) by echocardiogram was available in 90 patients. The subjects were stratified based on PASP: No PH = PASP ≤35 mmHg (n = 11); mild to moderate PH = PASP 36-49 mmHg (n = 21) and severe PH = PASP ≥50 mmHg (n = 58). Clinical, procedural, and echocardiographic outcomes were assessed. RESULTS Mean age was 72.7 (±12.8) years, 59 (65.6%) were female, Society of Thoracic Surgeons score was 15.8 + 11.8% and 90.0% where in New York Heart Association (NYHA) class III-IV. There was no significant difference in all-cause mortality at 30 days (no PH = 27.3%, mild-moderate PH = 19.0%, severe PH = 31.6%; p = 0.55) or at 1 year (no PH = 54.5%, mild-moderate PH = 38.1%, severe PH = 56.1%; p = 0.36). No difference in adverse events, NYHA class or amount of residual mitral regurgitation at 1 year were observed between the groups. CONCLUSION This study suggests that the presence of PH in patients with predominantly mitral stenosis with MAC undergoing TMVR does not impact mortality or adverse events. Further studies are needed to fully understand the effect of PH in this group of patients.
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Affiliation(s)
- Hector R Cajigas
- Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, Minnesota, USA
| | - Tatiana Kaptzan
- Cardiovascular Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Bradley Lewis
- Division of Biostatistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Abdallah El-Sabbagh
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | - Mohammed Al-Hijji
- Division of Cardiovascular Diseases, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mackram Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Dee Dee Wang
- Division of Cardiovascular Medicine, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan, USA
| | - Marvin Eng
- Division of Cardiovascular Medicine, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan, USA
| | - Susheel Kodali
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Isaac George
- Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Tarun Chakravarty
- Division of Cardiology, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Ashish Pershad
- Division of Cardiology, Chandler Regional and Mercy Gilbert Medical Center, Gilbert, Arizona, USA
| | - Daniel O'Hair
- Division of Cardiac Surgery, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, USA
| | - Noah Jones
- Division of Cardiology, Mount Carmel East Hospital, Columbus, Ohio, USA
| | - Raj Makkar
- Division of Cardiovascular Medicine, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mark Reisman
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Martin Leon
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - William O'Neill
- Division of Cardiovascular Diseases, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Charanjit Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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9
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Affiliation(s)
- Jason H Anderson
- Division of Pediatric Cardiology, Mayo Clinic, Rochester MN.(J.H.A., A.K.C., N.W.T.).,Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN. (J.H.A., A.K.C., R.P.F., N.W.T.)
| | - Allison K Cabalka
- Division of Pediatric Cardiology, Mayo Clinic, Rochester MN.(J.H.A., A.K.C., N.W.T.).,Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN. (J.H.A., A.K.C., R.P.F., N.W.T.)
| | - Robert P Frantz
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN. (J.H.A., A.K.C., R.P.F., N.W.T.)
| | - Hector R Cajigas
- Division of Pulmonary and Critical Care, Mayo Clinic, Rochester MN. (H.R.C.)
| | - Nathaniel W Taggart
- Division of Pediatric Cardiology, Mayo Clinic, Rochester MN.(J.H.A., A.K.C., N.W.T.).,Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN. (J.H.A., A.K.C., R.P.F., N.W.T.)
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10
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Vallabhajosyula S, Shankar A, Vojjini R, Cheungpasitporn W, Sundaragiri PR, DuBrock HM, Sekiguchi H, Frantz RP, Cajigas HR, Kane GC, Oh JK. Impact of Right Ventricular Dysfunction on Short-term and Long-term Mortality in Sepsis. Chest 2021; 159:2254-2263. [DOI: 10.1016/j.chest.2020.12.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 12/12/2022] Open
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11
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D'Netto ME, Archibald WJ, Cajigas HR. 44-Year-Old Woman With Altered Mental Status and Tachypnea. Mayo Clin Proc 2021; 96:776-781. [PMID: 33673925 DOI: 10.1016/j.mayocp.2020.07.042] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/24/2020] [Accepted: 07/02/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Michael E D'Netto
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - William J Archibald
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Hector R Cajigas
- Advisor to residents and Consultant in Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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12
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Anand V, Vallabhajosyula S, Cheungpasitporn W, Frantz RP, Cajigas HR, Strand JJ, DuBrock HM. Inpatient Palliative Care Use in Patients With Pulmonary Arterial Hypertension: Temporal Trends, Predictors, and Outcomes. Chest 2020; 158:2568-2578. [PMID: 32800817 DOI: 10.1016/j.chest.2020.07.079] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 04/10/2020] [Revised: 07/03/2020] [Accepted: 07/27/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a progressive disease associated with significant morbidity and mortality. Despite the negative impact of PAH on quality of life and survival, data on use of specialty palliative care services (PCS) is scarce. RESEARCH QUESTION We sought to evaluate the inpatient use of PCS in patients with PAH. STUDY DESIGN AND METHODS Using the National (Nationwide) Inpatient Sample, 30,495 admissions with a primary diagnosis of PAH were identified from 2001 through 2017. The primary outcome of interest was temporal trends and predictors of inpatient PCS use in patients with PAH. RESULTS The inpatient use of PCS was low (2.2%), but increased during the study period from 0.5% in 2001 to 7.6% in 2017, with a significant increase starting in 2009. White race, private insurance, higher socioeconomic status, hospital-specific factors, higher comorbidity burden (Charlson Comorbidity Index), cardiac and noncardiac organ failure, and use of extracorporeal membrane oxygenation and noninvasive mechanical ventilation were independent predictors of increased PCS use. PCS use was associated with a higher prevalence of do-not-resuscitate status, a longer length of stay, higher hospitalization costs, and increased in-hospital mortality with less frequent discharges to home, likely because these patients were also sicker (higher comorbidity index and illness acuity). INTERPRETATION The inpatient use of PCS in patients with PAH is low, but has been increasing over recent years. Despite increased PCS use over time, patient- and hospital-specific disparities in PCS use continue. Further studies evaluating these disparities and the role of PCS in the comprehensive care of PAH patients are warranted.
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Affiliation(s)
- Vidhu Anand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Saraschandra Vallabhajosyula
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Wisit Cheungpasitporn
- Division of Nephrology, Department of Medicine, University of Mississippi School of Medicine, Jackson, MS
| | - Robert P Frantz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Hector R Cajigas
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Jacob J Strand
- Center for Palliative Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Hilary M DuBrock
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
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13
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Albitar HAH, Almodallal Y, Gallo De Moraes A, O'Brien E, Choby GW, Pruthi RK, Stokken JK, Kamath PS, Cajigas HR, DuBrock HM, Krowka MJ, Iyer VN. Intravenous Bevacizumab in Hereditary Hemorrhagic Telangiectasia-Related Bleeding and High-Output Cardiac Failure: Significant Inter-Individual Variability in the Need for Maintenance Therapy. Mayo Clin Proc 2020; 95:1604-1612. [PMID: 32753135 DOI: 10.1016/j.mayocp.2020.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/03/2019] [Revised: 02/23/2020] [Accepted: 03/03/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To present our center's experience with a maintenance treatment algorithm for intravenous bevacizumab that allows for personalized therapy decisions. PATIENTS AND METHODS We reviewed all patients treated with intravenous bevacizumab for hereditary hemorrhagic telangiectasia-related bleeding and/or high-output cardiac failure (HOCF) from January 1, 2013, to July 1, 2019, at the Mayo Clinic, Rochester, Minnesota. Data regarding subsequent bevacizumab dosing were abstracted. RESULTS A total of 57 patients (n=40, 70.2% females) were identified with a median age of 65 (55 to 74; range, 37 to 89) years. High-cardiac output state was present in 21 patients (36.8%) and 10 (17.5%) were treated with intravenous bevacizumab primarily for HOCF. The median duration of follow-up after completion of the initial intravenous bevacizumab treatment was 25 (12.3 to 40.8; range, 0.1 to 65.4) months. A total of 20 (35.1%) patients with a median follow-up of 13.5 (range, 0 to 48.4) months required no maintenance dosing throughout the duration of follow-up. Among those who required subsequent maintenance doses, only a small fraction (8 patients; 14.0%) required regular maintenance doses every 4 to 8 weeks during follow-up whereas the majority of patients required intermittent "as-needed" doses at varying intervals. CONCLUSION There is significant inter-individual variability in the need for maintenance intravenous bevacizumab when patients are followed using a predefined bevacizumab maintenance dosing treatment algorithm. The use of "as-needed" maintenance bevacizumab appears to be an effective strategy for management of hereditary hemorrhagic telangiectasia-related bleeding and HOCF.
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Affiliation(s)
| | - Yahya Almodallal
- Division of Pediatric Allergy and Immunology, Mayo Clinic, Rochester, MN
| | | | - Erin O'Brien
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Hector R Cajigas
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Hilary M DuBrock
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Michael J Krowka
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Vivek N Iyer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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14
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Godfrey A, Cajigas HR. A 55-Year-Old Woman With Pulmonary Hypertension, Worsening Dyspnea, and Chest Pain. Chest 2018; 145:642-645. [PMID: 27845638 DOI: 10.1378/chest.13-1735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 08/08/2013] [Indexed: 11/01/2022] Open
Affiliation(s)
- Amanda Godfrey
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI
| | - Hector R Cajigas
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI.
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15
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Horng M, Mohammad I, Smith ZR, Awdish RL, Cajigas HR. Inhaled Iloprost for Chronic Thromboembolic Pulmonary Hypertension (CTEPH) During Pregnancy: A Case Report. Pharmacotherapy 2016; 36:e142-7. [DOI: 10.1002/phar.1793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Michelle Horng
- Department of Pharmacy; Henry Ford Hospital; Detroit Michigan
| | - Insaf Mohammad
- Department of Pharmacy; Henry Ford Hospital; Detroit Michigan
| | | | - Rana L. Awdish
- Department of Pulmonary Medicine; Henry Ford Hospital; Detroit Michigan
| | - Hector R. Cajigas
- Department of Pulmonary Medicine; Henry Ford Hospital; Detroit Michigan
- Department of Pulmonary Medicine; Northwestern University Feinberg School of Medicine; Chicago Illinois
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16
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