1
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Gould KL, Johnson NP, Roby AE, Bui L, Kitkungvan D, Patel MB, Nguyen T, Kirkeeide R, Haynie M, Arain SA, Charitakis K, Dhoble A, Smalling R, Nascimbene A, Jumean M, Kumar S, Kar B, Sdringola S, Estrera A, Gregoric I, Lai D, Li R, McPherson D, Narula J. Coronary flow capacity and survival prediction after revascularization: physiological basis and clinical implications. Eur Heart J 2024; 45:181-194. [PMID: 37634192 PMCID: PMC10787661 DOI: 10.1093/eurheartj/ehad579] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND AND AIMS Coronary flow capacity (CFC) is associated with an observed 10-year survival probability for individual patients before and after actual revascularization for comparison to virtual hypothetical ideal complete revascularization. METHODS Stress myocardial perfusion (mL/min/g) and coronary flow reserve (CFR) per pixel were quantified in 6979 coronary artery disease (CAD) subjects using Rb-82 positron emission tomography (PET) for CFC maps of artery-specific size-severity abnormalities expressed as percent left ventricle with prospective follow-up to define survival probability per-decade as fraction of 1.0. RESULTS Severely reduced CFC in 6979 subjects predicted low survival probability that improved by 42% after revascularization compared with no revascularization for comparable severity (P = .0015). For 283 pre-and-post-procedure PET pairs, severely reduced regional CFC-associated survival probability improved heterogeneously after revascularization (P < .001), more so after bypass surgery than percutaneous coronary interventions (P < .001) but normalized in only 5.7%; non-severe baseline CFC or survival probability did not improve compared with severe CFC (P = .00001). Observed CFC-associated survival probability after actual revascularization was lower than virtual ideal hypothetical complete post-revascularization survival probability due to residual CAD or failed revascularization (P < .001) unrelated to gender or microvascular dysfunction. Severely reduced CFC in 2552 post-revascularization subjects associated with low survival probability also improved after repeat revascularization compared with no repeat procedures (P = .025). CONCLUSIONS Severely reduced CFC and associated observed survival probability improved after first and repeat revascularization compared with no revascularization for comparable CFC severity. Non-severe CFC showed no benefit. Discordance between observed actual and virtual hypothetical post-revascularization survival probability revealed residual CAD or failed revascularization.
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Affiliation(s)
- K Lance Gould
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Nils P Johnson
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Amanda E Roby
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Linh Bui
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Danai Kitkungvan
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Monica B Patel
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Tung Nguyen
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Richard Kirkeeide
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Mary Haynie
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Salman A Arain
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Konstantinos Charitakis
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Abhijeet Dhoble
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Richard Smalling
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Angelo Nascimbene
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, TX, USA
| | - Marwan Jumean
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, TX, USA
| | - Sachin Kumar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, TX, USA
| | - Biswajit Kar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, TX, USA
| | - Stefano Sdringola
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Anthony Estrera
- Department of Cardiothoracic Vascular Surgery, McGovern Medical School, University of Texas Health Science Center, Memorial Hermann Hospital, Houston, TX, USA
| | - Igor Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, TX, USA
| | - Dejian Lai
- Department of Biostatistics and Data Science, University of Texas School of Public Health-Houston, Houston, TX, USA
| | - Ruosha Li
- Department of Biostatistics and Data Science, University of Texas School of Public Health-Houston, Houston, TX, USA
| | - David McPherson
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Jagat Narula
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
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Weeks P, Dunton K, Gulbis B, Jumean M, Janowiak L, Banjac I, Radovancevic R, Gregoric I, Kar B. Comparison of survival by vasoactive-inotropic score in patients receiving veno-arterial extracorporeal life support. Int J Artif Organs 2023; 46:592-596. [PMID: 37622440 DOI: 10.1177/03913988231193443] [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] [Indexed: 08/26/2023]
Abstract
After the initiation of veno-arterial extracorporeal membrane oxygenation (V-A ECMO) for hemodynamic support, patients often require vasopressor and inotropic medications to support their blood pressure and cardiac contractility. The vasoactive-inotropic score (VIS) is a standardized calculation of vasopressor and inotrope equivalence, which uses coefficients for each medication to calculate a total value. This study evaluated the association between the 30-day survival of patients receiving V-A ECMO support and the VIS calculated 24 h after ECMO cannulation (VIS24). This was a single-center, retrospective, observational cohort study. The median VIS24 of the entire cohort was 6.0, and was determined as a cutoff for comparison. Patients with a VIS24 < 6.0 were assigned to a group, and those with a VIS24 ≥ 6.0 were assigned to a second group. Patients with a VIS24 < 6.0 had higher 30-day survival than those with a VIS24 ≥ 6.0 (54.5% vs 41.4%; p = 0.03). The group with a VIS24 < 6.0 also had significantly improved survival to decannulation of ECMO support; however, there was no difference in the survival to hospital discharge. We conducted a secondary analysis of quartiles and determined that individuals with a VIS24 > 11.4 had the lowest survival in the cohort. This finding may help identify patients with the lowest probability of 30-day survival in those receiving V-A ECMO for hemodynamic support.
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Affiliation(s)
| | | | - Brian Gulbis
- Memorial Hermann Health System, Houston, TX, USA
| | - Marwan Jumean
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Lisa Janowiak
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Igor Banjac
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rajko Radovancevic
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Igor Gregoric
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Biswajit Kar
- The University of Texas Health Science Center at Houston, Houston, TX, USA
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Dunton K, Weeks PA, Gulbis B, Jumean M, Kumar S, Janowiak L, Banjac I, Radovancevic R, Gregoric I, Kar B. Evaluation of Vasoactive-Inotropic Score and Survival to Decannulation in Adult Patients on Venoarterial Extracorporeal Life Support: An Observational Cohort Study. ASAIO J 2023; 69:873-878. [PMID: 37155964 DOI: 10.1097/mat.0000000000001982] [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] [Indexed: 05/10/2023] Open
Abstract
Extracorporeal life support with venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used to assist circulation in patients with severe cardiogenic shock or cardiac arrest. The vasoactive-inotropic score (VIS) is a standardized calculation of vasoactive medication support which uses coefficients for each medication that converts them to an equivalent value. The purpose of this study was to assess the VIS as an early prognostication tool for survival to decannulation patients on adult VA-ECMO support. This was a single-center, observational cohort study of adult patients who received VA-ECMO support compared based on their survival to decannulation. The primary endpoint was the VIS at hour 24 postcannulation. Among the 265 patients included in this study, 140 patients (52.8%) survived to decannulation of VA-ECMO. At 24 hours postcannulation, a lower VIS was observed in the group that survived decannulation (6.5 ± 7.5 vs. 12.3 ± 16.9; p < 0.001). Multivariate analysis performed also demonstrates an association between 24-hour VIS and survival to decannulation (odds ratio 0.95; 95% confidence interval, 0.91-0.95). This study suggests that the 24-hour VIS may be an early prognostic indicator in patients on VA-ECMO patients. http://links.lww.com/ASAIO/B39.
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Affiliation(s)
- Kelly Dunton
- From the Department of Pharmacy, Memorial Hermann-Texas Medical Center, Houston, Texas
- Department of Pharmacy, AdventHealth, Orlando, Florida
| | - Phillip A Weeks
- From the Department of Pharmacy, Memorial Hermann-Texas Medical Center, Houston, Texas
| | - Brian Gulbis
- From the Department of Pharmacy, Memorial Hermann-Texas Medical Center, Houston, Texas
| | - Marwan Jumean
- Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, University of Texas Health Science Center at Houston, Houston, Texas
| | - Sachin Kumar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, University of Texas Health Science Center at Houston, Houston, Texas
| | - Lisa Janowiak
- Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, University of Texas Health Science Center at Houston, Houston, Texas
| | - Igor Banjac
- Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, University of Texas Health Science Center at Houston, Houston, Texas
| | - Rajko Radovancevic
- Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, University of Texas Health Science Center at Houston, Houston, Texas
| | - Igor Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, University of Texas Health Science Center at Houston, Houston, Texas
| | - Biswajit Kar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, University of Texas Health Science Center at Houston, Houston, Texas
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Salas-De-Armas I, Bhardwaj A, Bergeron A, Gilley C, Reeves K, Kumar S, Aponte MP, Patel M, Patel J, Marcano J, Seal Z, Nathan S, Gregoric I, Kar B. Prehabilitation Maximizing Functional Mobility in Patient with Cardiogenic Shock Supported on Axillary Impella. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.046] [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: 04/05/2023] Open
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Monlezun DJ, Badalamenti A, Javaid A, Marmagkiolis K, Honan K, Kim JW, Patel R, Akhanti B, Halperin D, Dasari A, Koutroumpakis E, Kim P, Lopez-Mattei J, Yusuf SW, Cilingiroglu M, Mamas MA, Gregoric I, Yao J, Hassan S, Iliescu C. Artificial intelligence-augmented analysis of contemporary procedural, mortality, and cost trends in carcinoid heart disease in a large national cohort with a focus on the "forgotten pulmonic valve". Front Cardiovasc Med 2023; 9:1071138. [PMID: 36843627 PMCID: PMC9945326 DOI: 10.3389/fcvm.2022.1071138] [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: 10/15/2022] [Accepted: 12/30/2022] [Indexed: 02/11/2023] Open
Abstract
Background Carcinoid heart disease is increasingly recognized and challenging to manage due to limited outcomes data. This is the largest known cohort study of valvular pathology, treatment (including pulmonary and tricuspid valve replacements [PVR and TVR]), dispairties, mortality, and cost in patients with malignant carcinoid tumor (MCT). Methods Machine learning-augmented propensity score-adjusted multivariable regression was conducted for clincal outcomes in the 2016-2018 U.S. National Inpatient Sample (NIS). Regression models were weighted by the complex survey design and adjusted for known confounders and the likelihood of undergoing valvular procedures. Results Among 101,521,656 hospitalizations, 55,910 (0.06%) had MCT. Patients with MCT vs. those without had significantly higher inpatient mortality (2.93 vs. 2.04%, p = 0.002), longer mean length of stay (12.20 vs. 4.62, p < 0.001), and increased mean total cost of stay ($70,252.18 vs. 51,092.01, p < 0.001). There was a step-wise increased rate of TVR and PVR with each subsequent year, with significantly more TV (0.16% vs. 0.01, p < 0.001) and PV (0.03 vs. 0.00, p = 0.040) diagnosed with vs. without MCT for 2016, with comparable trends in 2017 and 2018. There were no significant procedural disparities among patients with MCT for sex, race, income, urban density, or geographic region, except in 2017, when the highest prevalence of PV procedures were performed in the Western North at 50.00% (p = 0.034). In machine learning and propensity score augmented multivariable regression, MCT did not significantly increase the likelihood of TVR or PVR. In sub-group analysis restricted to MCT, neither TVR nor PVR significantly increased mortality, though it did increase cost (respectively, $141,082.30, p = 0.015; $355,356.40, p = 0.012). Conclusion This analysis reflects a favorable trend in recognizing the need for TVR and PVR in patients with MCT, with associated increased cost but not mortality. Our study also suggests that pulmonic valve pathology is increasingly recognized in MCT as reflected by the upward trend in PVRs. Further research and updated societal guidelines may need to focus on the "forgotten pulmonic valve" to improve outcomes and disparities in this understudied patient population.
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Affiliation(s)
- Dominique J. Monlezun
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States,Center for Artificial Intelligence and Health Equities, Global System Analytics and Structures (GSAS), New Orleans, LA, United States,*Correspondence: Dominique J. Monlezun ✉
| | - Andrew Badalamenti
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Awad Javaid
- Division of Cardiovascular Medicine, Kirk Kerkorian School of Medicine at the University of Nevada-Las Vegas, Las Vegas, NV, United States
| | - Kostas Marmagkiolis
- Division of Cardiovascular Disease, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Kevin Honan
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Jin Wan Kim
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Rishi Patel
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Bindu Akhanti
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Dan Halperin
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Arvind Dasari
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Efstratios Koutroumpakis
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Peter Kim
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Syed Wamique Yusuf
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Mehmet Cilingiroglu
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom
| | - Igor Gregoric
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - James Yao
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Saamir Hassan
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Cezar Iliescu
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
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6
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Honan KA, Hassan S, Deswal A, Herrmann J, Song J, Monlezun D, Halperin D, Mahvash A, Dasari A, Koutroumpakis E, Akay M, Balanescu DV, de Armas IS, Patel M, Nathan S, Kar B, Marmagkiolis K, Lopez-Mattei J, Patel J, Gregoric I, Yao J, Iliescu CA. Bioprosthetic valve monitoring in patients with carcinoid heart disease. Front Cardiovasc Med 2023; 9:1072890. [PMID: 36712267 PMCID: PMC9878394 DOI: 10.3389/fcvm.2022.1072890] [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: 10/18/2022] [Accepted: 12/22/2022] [Indexed: 01/14/2023] Open
Abstract
Background Carcinoid heart disease (CnHD) is a frequent cause of morbidity and mortality in patients with neuroendocrine tumors and carcinoid syndrome. Although valve replacement surgery appears to decrease all-cause mortality in patients with advanced CnHD, few studies have investigated the outcomes of patients after valve replacement. Methods We conducted a multi-institution retrospective registry of patients who received both tricuspid and pulmonic bioprosthetic valve (TV/PV) replacements for advanced CnHD from November 2005 to March 2021. Patients were followed post-operatively with echocardiographic studies every 3 months. Carcinoid valvular heart disease scores were used to monitor valve degeneration. Neuroendocrine tumor treatment, their administration times, and associations with echocardiographic findings were recorded. Results Of 87 patients with CnHD, 22 patients underwent simultaneous surgical TV and PV replacement. In 6 patients (27.3%), increased PV Vmax was the first echocardiographic manifestation of valve degeneration in the setting of occult neurohormonal release. Post-operative telotristat ethyl and peptide receptor radionuclide therapy appeared to stabilize PV Vmax. The PV Vmax showed consistent elevation in the entire patient population when compared to baseline, while bioprosthetic TV echocardiographic parameters were relatively unchanged throughout. Post-operative warfarin therapy did not affect the rate of PV degeneration, and no major bleeding was recorded during or after post-operative anticoagulation therapy. Conclusion Bioprosthetic valve degeneration is common in CnHD. Monitoring with echocardiographic studies every 3 months, focusing on PV velocities, could identify patients with occult disease that very likely promotes valve degeneration. Novel neuroendocrine tumor therapies may have a beneficial impact on valve degeneration.
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Affiliation(s)
- Kevin A. Honan
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Saamir Hassan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Anita Deswal
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Joerg Herrmann
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Juhee Song
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Dominique Monlezun
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Daniel Halperin
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Armeen Mahvash
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Arvind Dasari
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Efstratios Koutroumpakis
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mehmet Akay
- Department of Cardiothoracic Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Dinu-Valentin Balanescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ismael Salas de Armas
- Department of Cardiothoracic Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Manish Patel
- Department of Cardiothoracic Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Sriram Nathan
- Center for Advanced Heart Failure, Memorial Hermann Hospital, Heart and Vascular Institute, Texas Medical Center, Houston, TX, United States
| | - Biswajit Kar
- Center for Advanced Heart Failure, Memorial Hermann Hospital, Heart and Vascular Institute, Texas Medical Center, Houston, TX, United States
| | - Konstantinos Marmagkiolis
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jay Patel
- Department of Cardiothoracic Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Igor Gregoric
- Department of Cardiothoracic Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - James Yao
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Cezar A. Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States,*Correspondence: Cezar A. Iliescu,
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Liang Y, Gregoric I, Kar B, Eltzschig HK. Current Concepts of Mechanical Circulatory Support. J Am Coll Cardiol 2022; 80:e155. [DOI: 10.1016/j.jacc.2022.04.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022]
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Liang Y, Dhoble A, Pakanati A, Zhao Y, Kork F, Ruan W, Markham T, Smalling R, Balan P, Estrera A, Nguyen TC, Gregoric I, Kar B, Eltzschig H. Catastrophic Cardiac Events during Transcatheter Aortic Valve Replacement. Can J Cardiol 2021; 37:1522-1529. [PMID: 33992736 DOI: 10.1016/j.cjca.2021.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Perioperative complications of transcatheter aortic valve replacement (TAVR) are decreasing but can be catastrophic when they occur. Systematic reports of the nature of these events are lacking in the contemporary era. Our study aimed to report the incidence, outcomes, and perioperative management of catastrophic cardiac events in patients undergoing TAVR and to propose a working strategy to address these complications. METHODS This is a retrospective cohort study of patients who developed catastrophic cardiac events during or immediately after TAVR between 2015 and 2019 at a single academic center. RESULTS Of 2102 patients who underwent TAVR, 51 (2.5%) developed catastrophic cardiac events. The causes included cardiac perforation and tamponade (n=19, 37.3%), acute left ventricular failure (n=10, 19.6%), coronary artery obstruction (n=10, 19.6%), aortic root disruption (7, 13.7%), and device embolization (n=5, 9.8%). Twenty-four patients (47.0%) with catastrophic cardiac events required stabilization by either intra-aortic balloon counter-pulsation or extracorporeal membrane oxygenation. The in-hospital mortality rate increased by 11.7-fold for patients with catastrophic cardiac events compared to those without (25.5% vs 2.0%, p<0.001). Patients who developed aortic root disruption had the highest mortality rate (42.8%) compared with the others. The incidence of catastrophic cardiac events remained stable over a 5-year period, but the associated mortality decreased from 38.5% in 2015 to 9.1% in 2019. CONCLUSIONS Catastrophic cardiac events during TAVR are rare, but they account for a dramatic increase in perioperative mortality. Early recognition and development of a standardized perioperative team approach can help manage patients experiencing these complications.
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Affiliation(s)
| | | | | | | | - Felix Kork
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | | | | | | | | | - Anthony Estrera
- Department of Cardiac Surgery, The University of Texas Health Science Center at Houston, McGovern Medical School/Memorial Hermann Heart and Vascular Institute, Houston, TX, USA
| | - Tom C Nguyen
- Department of Cardiac Surgery, The University of Texas Health Science Center at Houston, McGovern Medical School/Memorial Hermann Heart and Vascular Institute, Houston, TX, USA
| | - Igor Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation
| | - Biswajit Kar
- Department of Advanced Cardiopulmonary Therapies and Transplantation
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9
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Agrawal N, Hameed F, Battel L, Arora A, Kumar S, Akkanti B, Bhardwaj A, Hussain R, Jumean M, Nathan S, Gregoric I, Kar B. CLINICAL OUTCOMES IN ACUTE RIGHT VENTRICULAR FAILURE WITH PERCUTANEOUS RIGHT VENTRICULAR ASSIST DEVICES: IMPELLA RP AND PROTEK DUO. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01993-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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Gok E, Patel M, Stojkovic B, Patel J, Dinh K, Hussein R, Akkanti B, Gregoric I, Jyothula S. Lung Transplantation in COVID 19 ARDS - Short Term Outcomes. J Heart Lung Transplant 2021. [PMCID: PMC7979378 DOI: 10.1016/j.healun.2021.01.2035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction COVID-19 associated severe acute respiratory syndrome rapidly progress to irreversible lung injury, multiple organ failure and death. Lung transplantation is considered as the rescue therapy for these patients. Herein, we reported a case series of two successful life-saving bilateral lung transplantations for COVID-19-associated respiratory failure. Case Report Case 1: A 69-year-old male was admitted for hypoxia and altered mental status. He was diagnosed with COVID-19 pneumonia by abnormal CT findings and positive PCR result. After receiving a course of dexamethasone, convalescent plasma, remdesivir and broad-spectrum antibiotics, he remained to be profoundly hypoxic, requiring non-invasive ventilation. Following two negative PCR results, he underwent bilateral lung transplantation on day 57. He was discharged to rehab unit on postoperative day 26. No desaturation was observed with the 6-min walk test on 30-day follow-up. Case 2: A 63-year-old male was presented with cough, and dyspnea. He was hemodynamically stable, SpO2 was 94%, chest x-ray was normal and tested positive for COVID-19. He was discharged home with dexamethasone and bronchodilators. However, he presented back on day 6 with worsening dyspnea. He was admitted and received a course of dexamethasone, remdesivir, convalescent plasma and broad-spectrum antibiotics. Due to persistent hypoxic respiratory failure, the patient underwent bilateral orthotopic lung transplantation on day 68. His postoperative course was complicated by primary graft dysfunction stage 3 and required open tracheostomy. His condition gradually improved and decannulated. He is currently on room air and able to walk 30 ft using a roller walker. Summary SARS-CoV-2 recovery is characterized by post inflammatory fibrosis and multi organ dysfunction. Lung transplantation can be successfully performed in patients with final stage respiratory failure of COVID-19 related pulmonary fibrosis.
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Abstract
Endothelial dysfunction (ED) plays a substantial role in the pathogenesis of atherosclerosis and some other vascular diseases. ED has been demonstrated in patients with hypercholesterolemia, diabetes, smoking, hypertension, and in patients with atherosclerotic disease. Besides classical risk factors, ED is affected by chronic inflammatory diseases and acute infections, particularly viral diseases. Causes of ED include oxidative stress, inflammation, and shear stress, which decrease the bioavailability of nitric oxide. Markers of ED have been sought, particularly circulating markers. Using these tests, it is possible to evaluate the response to harmful effects of risk factors and the effects of treatment on vessel wall function. Endothelial dysfunction is significantly and directly correlated with the occurrence of cardiac events and the risk of cardiac events increase as ED worsens. Because endothelial function plays a central role in atherogenesis it became a therapeutic target. Endothelial dysfunction is reversible and its improvement may be achieved by elimination of risk factors, inhibitors of endothelium-derived contracting factors (angiotensin-converting enzyme), smoking cessation, lipid-lowering drugs, diet, and physical exercise. By reversing ED, it is possible to restore vascular function.
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Affiliation(s)
- Pavel Poredos
- Department of Vascular Disease, 37663University Medical Centre Ljubljana, Slovenia.,Department of Advanced Cardiopulmonary Therapies and Transplantation, 7067The University of Texas Health Science Centre at Houston, TX, USA
| | | | - Igor Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, 7067The University of Texas Health Science Centre at Houston, TX, USA
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12
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Gill C, Lee M, Balanescu DV, Donisan T, Serauto Canache AJ, Palaskas N, Lopez-Mattei J, Kim PY, Song J, Yang EH, Cilingiroglu M, Kar B, Gregoric I, Marmagkiolis K, Iakobishvili Z, Iliescu C. Transcatheter and surgical aortic valve replacement impact on outcomes and cancer treatment schedule. Int J Cardiol 2020; 326:62-70. [PMID: 32858137 DOI: 10.1016/j.ijcard.2020.08.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/10/2020] [Revised: 06/01/2020] [Accepted: 08/19/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent data suggest that transcatheter aortic valve replacement (TAVR) for the treatment of severe aortic stenosis (AS) is viable in cancer patients. TAVR may be preferred in cancer patients due to its minimally invasive nature and smaller impact on oncologic therapies compared to SAVR. Objectives We sought to determine if TAVR is an acceptable alternative to SAVR in cancer patients and whether TAVR allows for earlier initiation or resumption of anti-cancer therapies. METHODS Cancer patients in a tertiary cancer center diagnosed with severe AS were retrospectively included. Patients accepted by the heart team underwent either TAVR or SAVR, while remaining patients received medical therapy alone. Time intervals to initiation of cancer treatment and the impact of cancer treatment on the replaced valves were recorded. Logistic regression was performed to determine the impact of treatment strategy on overall survival (OS) in all 3 subgroups. RESULTS One hundred and eighty-seven cancer patients diagnosed with severe AS were identified. AVR was associated with better OS compared to medical therapy alone (p < 0.0001). TAVR was associated with better OS at 72 months (HR = 0.468, p < 0.001) compared to medical therapy alone, with no difference in OS observed between SAVR and TAVR. Time intervals to initiation of cancer treatments were shorter in the TAVR group, with no valve deterioration or infection observed in all groups. CONCLUSION Cancer patients with severe AS benefit from AVR. TAVR is a viable alternative to SAVR in high-risk cancer patients to prolong survival and allow for earlier administration or resumption of anti-neoplastic therapies.
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Affiliation(s)
- Clarence Gill
- Division of Cardiology, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA; Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michelle Lee
- Division of Cardiology, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Dinu Valentin Balanescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Teodora Donisan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Astrid Josefina Serauto Canache
- Division of Cardiology, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nicolas Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Y Kim
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Juhee Song
- Division of Biostatistics, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eric H Yang
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Biswajit Kar
- Division of Cardiology, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Igor Gregoric
- Division of Cardiology, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Zaza Iakobishvili
- Department of Cardiology, Tel Aviv Jaffa District, Clalit Health Fund, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Cezar Iliescu
- Division of Cardiology, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA.
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Mubashir T, Balogh J, Chaudhry R, Quiroz C, Kar B, De Armas IAS, Liang Y, Markham T, Kumar R, Choi W, Akkanti B, Gregoric I, Williams G, Zaki J. Transcatheter and Surgical Aortic Valve Replacement Outcomes for Patients with Chronic Heart Failure. J Cardiothorac Vasc Anesth 2020; 35:888-895. [PMID: 32718887 DOI: 10.1053/j.jvca.2020.06.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To determine in-hospital outcomes and assess high-risk groups among chronic heart failure (CHF) patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). DESIGN A retrospective analysis of the Nationwide Inpatient Sample database from January 2012 to September 2015 was performed. SETTING Hospitals across the United States that offer TAVRs or SAVRs. PARTICIPANTS Adults with a diagnosis of CHF and AS. INTERVENTIONS The patients underwent either TAVR or SAVR. MEASUREMENTS AND MAIN RESULTS Totals of 5,871 and 4,008 CHF patients underwent TAVR and SAVR, respectively. TAVR patients were significantly older, more were female, and had a higher comorbidity burden. No significant differences in in-hospital mortality were noted between TAVR and SAVR. However, mean length of stay was significantly longer by 3.5 days in the SAVR group, as was the mean total cost. With the exception of complete heart block, permanent pacemaker implantation, and vascular complications, the majority of postoperative events were higher among the SAVR group. Multivariate regression analysis identified postoperative cardiac, respiratory and renal complications as significant predictors of in-hospital mortality for both groups. Additionally, age ≥75 years and vascular complications were significant predictors of mortality for patients undergoing TAVR. CONCLUSIONS Among CHF patients with symptomatic AS, TAVR had similar in-hospital mortality rate compared with SAVR despite higher comorbidity burden. TAVR patients are at a lower risk of cardiovascular, respiratory, and renal complications and might lead to reduced length of hospital stay and cost. Hence, TAVR may be a safer option in this population.
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Affiliation(s)
- Talha Mubashir
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX
| | - Julius Balogh
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX
| | - Rabail Chaudhry
- Department of Anesthesiology, University of Toronto, University Health Network, Toronto, Canada
| | - Cooper Quiroz
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX
| | - Biswajit Kar
- Department of Cardiology, Center for Advanced Heart Failure, Memorial Hermann Heart & Vascular Institute, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX
| | - Ismael A Salas De Armas
- Department of Cardiothoracic Surgery, Center for Advanced Heart Failure, Memorial Hermann Heart & Vascular Institute, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX
| | - Yafen Liang
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX
| | - Travis Markham
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX
| | - Rishi Kumar
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX
| | - Warren Choi
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX
| | - Bindu Akkanti
- Department of Pulmonary, Critical Care and Sleep Medicine, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX
| | - Igor Gregoric
- Department of Cardiothoracic Surgery, Center for Advanced Heart Failure, Memorial Hermann Heart & Vascular Institute, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX
| | - George Williams
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX
| | - John Zaki
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX.
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Paniagua LM, Sudhakar D, Perez LE, Miranda D, Urena P, Gregoric I, Kar B, Jneid H, Ramirez J, Paniagua D. Prosthetic Valve Endocarditis From Trichosporon asahii in an Immunocompetent Patient. JACC Case Rep 2020; 2:693-696. [PMID: 34317326 PMCID: PMC8301711 DOI: 10.1016/j.jaccas.2020.03.017] [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: 11/21/2019] [Revised: 02/26/2020] [Accepted: 03/05/2020] [Indexed: 11/29/2022]
Abstract
Fungal endocarditis is a rare clinical entity. This report describes an unusual case of fungal endocarditis caused by infection with Trichosporon asahii in a 20-year-old immunocompetent man who received the diagnosis 1 year following biological aortic valve replacement. (Level of Difficulty: Beginner.)
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Affiliation(s)
| | - Deepthi Sudhakar
- Baylor College of Medicine, Houston, Texas
- Address for correspondence: Dr. Deepthi Sudhakar, Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030.
| | - Lara Erika Perez
- Medicina Cardiovascular Asociada, Santo Domingo, Dominican Republic
| | - David Miranda
- Hennepin County Medical Center, Minneapolis, Minnesota
- Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Pedro Urena
- Medicina Cardiovascular Asociada, Santo Domingo, Dominican Republic
| | | | - Biswajit Kar
- University of Texas, Houston, Texas
- Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Hani Jneid
- Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Jonalis Ramirez
- Lincoln Medical and Mental Health Center, Weil Cornell Medical College, New York, New York
| | - David Paniagua
- Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey VA Medical Center, Houston, Texas
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15
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Bowman S, Weeks P, Chow E, Huang A, Nathan S, Radovancevic R, Kar B, Gregoric I. Implementation of pharmacist‐managed anticoagulation in patients with continuous flow left ventricular assist devices. J Am Coll Clin Pharm 2019. [DOI: 10.1002/jac5.1081] [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] [Indexed: 11/06/2022]
Affiliation(s)
- Stephanie Bowman
- Department of Pharmacy Memorial Hermann – Texas Medical Center Houston Texas
- Department of Pharmacy Nebraska Medicine Omaha Nebraska
| | - Phillip Weeks
- Department of Pharmacy Memorial Hermann – Texas Medical Center Houston Texas
| | - Elaine Chow
- Department of Pharmacy Memorial Hermann – Texas Medical Center Houston Texas
| | - Athena Huang
- Department of Pharmacy Memorial Hermann – Texas Medical Center Houston Texas
| | - Sriram Nathan
- Center for Advanced Heart Failure University of Texas Health Science Center‐Houston Houston Texas
| | - Rajko Radovancevic
- Center for Advanced Heart Failure University of Texas Health Science Center‐Houston Houston Texas
| | - Biswajit Kar
- Center for Advanced Heart Failure University of Texas Health Science Center‐Houston Houston Texas
| | - Igor Gregoric
- Center for Advanced Heart Failure University of Texas Health Science Center‐Houston Houston Texas
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16
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Donisan T, Balanescu DV, Lopez-Mattei JC, Kim P, Leja MJ, Banchs J, Marmagkiolis K, Herrmann J, Gregoric I, Durand JB, Iliescu CA. In Search of a Less Invasive Approach to Cardiac Tumor Diagnosis: Multimodality Imaging Assessment and Biopsy. JACC Cardiovasc Imaging 2019; 11:1191-1195. [PMID: 30092973 DOI: 10.1016/j.jcmg.2018.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 04/26/2018] [Accepted: 05/03/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Teodora Donisan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Peter Kim
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Monika Jacquelina Leja
- Department of Internal Medicine and Cardiology, University of Michigan, Northville, Michigan
| | - Jose Banchs
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Joerg Herrmann
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Igor Gregoric
- Department of Cardiothoracic and Vascular Surgery, Center for Advanced Heart Failure, The University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Houston, Texas
| | - Jean-Bernard Durand
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cezar Angi Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Sobanian M, Saltarrelli J, Weeks P, Nathan S, Radovancevic R, Kar B, Gregoric I. P075 Comparative efficacy of bortezomib and carfilzomib desensitization protocols in highly sensitized cardiac transplant candidates. Hum Immunol 2019. [DOI: 10.1016/j.humimm.2019.07.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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18
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Iliescu C, Balanescu DV, Hassan S, Lopez-Mattei J, Palaskas N, Dasari A, Halperin DM, Yao JC, Kar B, Gregoric I, Nathan S, Durand JB, Karimzad K, Kim PY, Iliescu G, Balanescu SM, Marmagkiolis K, Donisan T. Predictors of mortality following cardiac surgery for carcinoid heart disease. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e15692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15692 Background: Carcinoid Heart Disease (CHD) complicates 50% of carcinoid syndrome cases and represents a major cause of mortality in these patients. Surgery continues to be the only strategy to improve survival in CHD. We aimed to evaluate predictors of mortality following surgery for CHD. Methods: We retrospectively analyzed patients with CHD and a history of valve surgery presenting at a tertiary cancer center between November 2005 and March 2018. Data regarding symptoms, clinical findings, and CHD treatment were collected. Overall survival (OS, time interval from heart surgery to death) was calculated. Univariate Cox proportional hazards regression analyses were conducted to identify variables that were associated with OS. Results: We identified 25 patients with CHD who underwent surgical replacement with bioprosthetic valves: 10 (40%) the tricuspid valve (TV), 11 (44%) TV and pulmonary valve (PV), 3 (12%) TV, PV, and aortic valve, and 1 (4%) all 4 valves. Among them, 19 (76%) survived at least 12 months after the surgery. Clinical factors associated with decreased OS are presented in Table 1. Conclusions: OS following surgery is dictated by the severity of CHD at the time of surgery. Worse outcomes are predicted by a history of congestive heart failure, the number of symptoms, and ascites. Better selection criteria are needed in order to choose the candidates for surgery who will benefit the most. [Table: see text]
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Affiliation(s)
- Cezar Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Saamir Hassan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nicolas Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Arvind Dasari
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Daniel M. Halperin
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James C. Yao
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Biswajit Kar
- Center for Advanced Heart Failure, The University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Houston, TX
| | - Igor Gregoric
- Department of Cardiothoracic and Vascular Surgery, Center for Advanced Heart Failure, The University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Houston, TX
| | - Sriram Nathan
- Center for Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Houston, TX
| | - Jean-Bernard Durand
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kaveh Karimzad
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Peter Y. Kim
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gloria Iliescu
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Serban Mihai Balanescu
- Department of Cardiology, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Teodora Donisan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Balanescu DV, Donisan T, Lopez-Mattei J, Hassan S, Kim P, Dasari A, Halperin D, Yao J, Kar B, Gregoric I, Balanescu SM, Iliescu C. The 1, 2, 3, 4 of carcinoid heart disease: Comprehensive cardiovascular imaging is the mainstay of complex surgical treatment. Oncol Lett 2019; 17:4126-4132. [PMID: 30944605 PMCID: PMC6444330 DOI: 10.3892/ol.2018.9732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/10/2018] [Indexed: 12/29/2022] Open
Abstract
Carcinoid heart disease (CHD) is a rare complication of neuroendocrine tumors, most commonly involving the tricuspid and pulmonary valves. The mitral and aortic valves can also be affected, albeit rarely, in certain circumstances such as the presence of a patent foramen ovale. Transthoracic echocardiogram is generally considered the key imaging modality, but cardiac magnetic resonance can add valuable information, particularly in the assessment of pulmonary valve function or multivalvular disease. Previously, surgical management of CHD carried high mortality, as a result of less advanced surgical techniques and of late intervention, reserved for cases of severely symptomatic heart failure. Modern approaches are associated with significantly improved survival rates, even in multivalvular, complex cases. Valve replacement can provide survival benefits in patients with CHD, but the optimal timing for the intervention is uncertain, with data suggesting a trend of improved survival with earlier intervention. A comprehensive imaging assessment may contribute to establishing optimal surgical timing. This approach may shift the main driver of mortality from the cardiac involvement to the primary malignancy and lead to improved outcomes. We present a series of imaging findings in CHD patients who have successfully undergone simultaneous surgical replacement with bioprosthetic valves of 1 to 4 heart valves. The surgical decision in these patients was based on a multimodality cardiovascular approach, including transthoracic and transesophageal echocardiography and cardiac magnetic resonance. The patients had uncomplicated postoperative courses, significant symptomatic relief from heart failure symptoms, and there was no cardiovascular mortality. Early recognition of CHD with a multimodality approach may improve outcome, even in complex cases. Bioprosthetic valves are generally preferred in CHD due to decreased need for anticoagulation, despite concern for premature degeneration. A collaboration between the Oncology and Cardiology teams is essential for the long-term management of CHD patients.
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Affiliation(s)
- Dinu Valentin Balanescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Teodora Donisan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Saamir Hassan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Peter Kim
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Arvind Dasari
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Daniel Halperin
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - James Yao
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Biswajit Kar
- Center for Advanced Heart Failure, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Igor Gregoric
- Center for Advanced Heart Failure, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Serban Mihai Balanescu
- Department of Cardiology, Elias Emergency University Hospital, 'Carol Davila' University of Medicine and Pharmacy, Bucharest 011134, Romania
| | - Cezar Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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20
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Sobhanian M, Saltarrelli J, Weeks P, Nathan S, Radovancevic R, Kar B, Gregoric I. Comparative Efficacy of Bortezomib and Carfilzomib Desensitization Protocols in Highly Sensitized Cardiac Transplant Candidates. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.070] [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: 10/27/2022] Open
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21
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Schechter M, Balanescu DV, Donisan T, Dayah TJ, Kar B, Gregoric I, Giza DE, Song J, Lopez‐Mattei J, Kim P, Balanescu SM, Cilingiroglu M, Toutouzas K, Smalling RW, Marmagkiolis K, Iliescu C. An update on the management and outcomes of cancer patients with severe aortic stenosis. Catheter Cardiovasc Interv 2018; 94:438-445. [DOI: 10.1002/ccd.28052] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 09/19/2018] [Revised: 11/25/2018] [Accepted: 12/04/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Michael Schechter
- Department of Internal MedicineMcGovern Medical School at The University of Texas Health Science Center at Houston Houston Texas
| | | | - Teodora Donisan
- Department of CardiologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Tariq J. Dayah
- Department of Internal MedicineMcGovern Medical School at The University of Texas Health Science Center at Houston Houston Texas
| | - Biswajit Kar
- Department of Internal MedicineMcGovern Medical School at The University of Texas Health Science Center at Houston Houston Texas
| | - Igor Gregoric
- Department of Internal MedicineMcGovern Medical School at The University of Texas Health Science Center at Houston Houston Texas
| | - Dana E. Giza
- Department of Family and Community MedicineMcGovern Medical School at The University of Texas Health Science Center at Houston Houston Texas
| | - Juhee Song
- Department of BiostatisticsThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Juan Lopez‐Mattei
- Department of CardiologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Peter Kim
- Department of CardiologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Serban Mihai Balanescu
- Department of CardiologyElias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy Bucharest Romania
| | - Mehmet Cilingiroglu
- Department of CardiologyArkansas Heart Hospital Little Rock Arkansas
- Florida Hospital Pepin Heart Institute Tampa Florida
| | - Konstantinos Toutouzas
- First Department of CardiologyHippokration Hospital, National and Kapodistrian University Medical School Athens Greece
| | - Richard W. Smalling
- Department of Internal MedicineMcGovern Medical School at The University of Texas Health Science Center at Houston Houston Texas
| | | | - Cezar Iliescu
- Department of CardiologyThe University of Texas MD Anderson Cancer Center Houston Texas
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22
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Abstract
Pump thrombosis remains a serious complication of implantable ventricular assist device therapy and is associated with increased risk of morbidity and mortality. Optimal management strategies remain controversial and are guided largely by limited literature and expert opinion. Medical management of pump thrombosis, including the use of direct thrombin inhibitors, has been associated with mixed results. The purpose of this study is to report the outcomes associated with bivalirudin therapy in LVAD patients with suspected pump thrombosis. A single-center, retrospective observational study of 15 patients with suspected pump thrombosis that were all treated with bivalirudin therapy was conducted. The majority of subjects' initial treatment courses were unsuccessful [9/15 (60%)]; however, 6/15 (40%) achieved an initial improvement in serum lactate dehydrogenase (LDH) levels and were stabilized to be successfully discharged from the hospital. Of the subjects discharged, there was a high rate of recurrence of pump thrombosis within 6 months [5/6 (83.3%)]. Bivalirudin therapy was not associated with a consistent reduction in LDH among all subjects studied, and clinical responses to therapy appear to be associated with high rates of thrombosis recurrence. This study analyzes the largest cohort to date of LVAD patients with pump thrombosis treated with bivalirudin therapy, and suggests that alternative therapies should be considered in management.
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Affiliation(s)
- Phillip Weeks
- Department of Pharmacy, Memorial Hermann - Texas Medical Center, Houston, TX, USA.
| | - Adam Sieg
- University of Kentucky Healthcare, Lexington, KY, USA
| | | | - Sriram Nathan
- Center for Advanced Heart Failure, University of Texas Health Science Center, Houston, TX, USA
| | - Marwan Jumean
- Center for Advanced Heart Failure, University of Texas Health Science Center, Houston, TX, USA
| | - Manish Patel
- Center for Advanced Heart Failure, University of Texas Health Science Center, Houston, TX, USA
| | - Rajko Radovancevic
- Center for Advanced Heart Failure, University of Texas Health Science Center, Houston, TX, USA
| | - Biswajit Kar
- Center for Advanced Heart Failure, University of Texas Health Science Center, Houston, TX, USA
| | - Igor Gregoric
- Center for Advanced Heart Failure, University of Texas Health Science Center, Houston, TX, USA
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23
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Balanescu D, Donisan T, Schechter M, Dayah T, Sudasena D, Kar B, Gregoric I, Giza D, Stone J, Stone D, Boone D, Lopez-Mattei J, Kim P, Yusuf S, Cilingiroglu M, Toutouzas K, Boccalandro F, Smalling R, Marmagkiolis K, Iliescu C. TCT-609 Choosing Between Transcatheter, Surgical, and Medical Management in Cancer Patients With Severe Aortic Stenosis. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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24
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Gould KL, Johnson NP, Roby AE, Nguyen T, Kirkeeide R, Haynie M, Lai D, Zhu H, Patel MB, Smalling R, Arain S, Balan P, Nguyen T, Estrera A, Sdringola S, Madjid M, Nascimbene A, Loyalka P, Kar B, Gregoric I, Safi H, McPherson D. Regional, Artery-Specific Thresholds of Quantitative Myocardial Perfusion by PET Associated with Reduced Myocardial Infarction and Death After Revascularization in Stable Coronary Artery Disease. J Nucl Med 2018; 60:410-417. [PMID: 30115688 PMCID: PMC6424226 DOI: 10.2967/jnumed.118.211953] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/29/2018] [Indexed: 12/26/2022] Open
Abstract
Because randomized coronary revascularization trials in stable coronary artery disease (CAD) have shown no reduced myocardial infarction (MI) or mortality, the threshold of quantitative myocardial perfusion severity was analyzed for association with reduced death, MI, or stroke after revascularization within 90 d after PET. Methods: In a prospective long-term cohort of stable CAD, regional, artery-specific, quantitative myocardial perfusion by PET, coronary revascularization within 90 d after PET, and all-cause death, MI, and stroke (DMS) at 9-y follow-up (mean ± SD, 3.0 ± 2.3 y) were analyzed by multivariate Cox regression models and propensity analysis. Results: For 3,774 sequential rest–stress PET scans, regional, artery-specific, severely reduced coronary flow capacity (CFC) (coronary flow reserve ≤ 1.27 and stress perfusion ≤ 0.83 cc/min/g) associated with 60% increased hazard ratio for major adverse cardiovascular events and 30% increased hazard of DMS that was significantly reduced by 54% associated with revascularization within 90 d after PET (P = 0.0369), compared with moderate or mild CFC, coronary flow reserve, other PET metrics or medical treatment alone. Depending on severity threshold for statistical certainty, up to 19% of this clinical cohort had CFC severity associated with reduced DMS after revascularization. Conclusion: CFC by PET provides objective, regional, artery-specific, size–severity physiologic quantification of CAD severity associated with high risk of DMS that is significantly reduced after revascularization within 90 d after PET, an association not seen for moderate to mild perfusion abnormalities or medical treatment alone.
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Affiliation(s)
- K Lance Gould
- Division of Cardiology, Department of Medicine, McGovern Medical School, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Nils P Johnson
- Division of Cardiology, Department of Medicine, McGovern Medical School, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Amanda E Roby
- Division of Cardiology, Department of Medicine, McGovern Medical School, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Tung Nguyen
- Division of Cardiology, Department of Medicine, McGovern Medical School, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Richard Kirkeeide
- Division of Cardiology, Department of Medicine, McGovern Medical School, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Mary Haynie
- Division of Cardiology, Department of Medicine, McGovern Medical School, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Dejian Lai
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center, Houston Texas
| | - Hongjian Zhu
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center, Houston Texas
| | - Monica B Patel
- Division of Cardiology, Department of Medicine, McGovern Medical School, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Richard Smalling
- Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Sal Arain
- Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Prakash Balan
- Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Tom Nguyen
- Department of Cardiothoracic Vascular Surgery, McGovern Medial School, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas; and
| | - Anthony Estrera
- Department of Cardiothoracic Vascular Surgery, McGovern Medial School, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas; and
| | - Stefano Sdringola
- Division of Cardiology, Department of Medicine, McGovern Medical School, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Mohammad Madjid
- Division of Cardiology, Department of Medicine, McGovern Medical School, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Angelo Nascimbene
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Texas
| | - Pranav Loyalka
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Texas
| | - Biswajit Kar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Texas
| | - Igor Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Texas
| | - Hazem Safi
- Department of Cardiothoracic Vascular Surgery, McGovern Medial School, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas; and
| | - David McPherson
- Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
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25
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Shobayo F, Upadhyay A, Arain S, Gregoric I, Kar B, De Armas IAS. MANAGEMENT OF SUBMASSIVE PULMONARY EMBOLISM COMPLICATED BY PARADOXICAL THROMBUS-IN-TRANSIT. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32989-9] [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: 11/28/2022]
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26
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Compton F, Wahed MA, Gregoric I, Dasgupta A, Tint H. 28 Intraoperative Administration of Antifibrinolytic Drug Tranexamic Acid Is Not Associated with Decreased Intraoperative Blood Loss During Major Cardiac Surgery. Am J Clin Pathol 2018. [DOI: 10.1093/ajcp/aqx149.397] [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: 11/13/2022] Open
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27
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Thenappan T, Stulak JM, Agarwal R, Maltais S, Shah P, Eckman P, Emani S, Katz JN, Gregoric I, Keebler ME, Uriel N, Adler E, Chuang J, Farrar DJ, Sundareswaran KS, John R. Early intervention for lactate dehydrogenase elevation improves clinical outcomes in patients with the HeartMate II left ventricular assist device: Insights from the PREVENT study. J Heart Lung Transplant 2018; 37:25-32. [DOI: 10.1016/j.healun.2017.10.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 10/18/2017] [Indexed: 01/15/2023] Open
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28
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Compton F, Wahed A, Gregoric I, Kar B, Dasgupta A, Tint H. Can Tranexamic Acid Reduce Blood Loss during Major Cardiac Surgery? A Pilot Study. Ann Clin Lab Sci 2017; 47:600-603. [PMID: 29066488] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We examined the effectiveness of tranexamic acid in preventing intraoperative blood loss during major cardiac surgery. Out of initial 81 patients undergoing major cardiac surgery (both coronary artery bypass and valve repair procedures) at our teaching hospital, sixty-seven patients were selected for this study. We compared estimated blood loss, decrease in percent hemoglobin and hematocrit following surgery between two groups of patients (none of them received any blood product during surgery), one group receiving no tranexamic acid (n=17) and another group receiving tranexamic acid (n=25). In the second study, we combined these patients with patients receiving modest amounts of blood products (1-2 unit) and compared these parameters between two groups of patients (25 patients received no tranexamic acid, 42 patients received tranexamic acid). In patients who received no blood product during surgery, those who received no tranexamic acid showed statistically significant (independent t-test two tailed at p<0.05) reduced estimated blood loss (mean: 713.5 mL, SD: 351.6, n=17) compared to those who received tranexamic acid (mean: 987.2 mL, SD: 459.9, n=25). We observed similar results when the patients receiving no blood products and patients receiving modest amount of blood products were combined based on the use of tranexamic acid or not. No statistically significant difference was observed in percent reduced hemoglobin or hematocrit following surgery in any group of patients. We conclude that intraoperative antifibrinolytic therapy with tranexamic acid does not reduce intraoperative blood loss during major cardiac surgery which contradicts popular belief.
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Affiliation(s)
- Frances Compton
- Department of Pathology and Laboratory Medicine, The University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - Amer Wahed
- Department of Pathology and Laboratory Medicine, The University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - Igor Gregoric
- Department of Surgery, The University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - Biswajit Kar
- Department of Medicine, The University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - Amitava Dasgupta
- Department of Pathology and Laboratory Medicine, The University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - Hlaing Tint
- Department of Pathology and Laboratory Medicine, The University of Texas McGovern Medical School at Houston, Houston, TX, USA
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29
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Quintana-Quezada RA, Rajapreyar I, Postalian-Yrausquin A, Yeh YC, Choi S, Akkanti B, Sieg A, Weeks P, Patel M, Patel J, Nathan S, Kar B, Loyalka P, Gregoric I. Clinical Factors Implicated in Primary Graft Dysfunction After Heart Transplantation: A Single-center Experience. Transplant Proc 2017; 48:2168-71. [PMID: 27569965 DOI: 10.1016/j.transproceed.2016.02.073] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/16/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Primary graft dysfunction (PGD) is a frequent complication after cardiac transplantation and remains one of the leading causes of mortality in these patients. The objective of this case-control study is to identify donor and surgical procedure's factors associated with PGD, and further guide possible strategies to prevent PGD. METHODS Retrospective analysis of the medical records of patients who underwent cardiac transplantation at Memorial Hermann Hospital at Texas Medical Center between October 2012 and February 2015. RESULTS The study population included 99 patients, of which 18 developed PGD. Univariate analysis of donor characteristics revealed opioid use (P = .049) and death owing to anoxia (P = .021) were associated with PGD. The recipient/donor blood type match AB/A was significantly associated with PGD (P = .031). Time from brain death to aortic cross clamp (TBDACC) of ≥3 and ≥5 days were also found to be associated with PGD (P = .0011 and .0003, respectively). Multivariate analysis confirmed that patients with a time from brain death to aortic cross clamp ≥3 and ≥5 days had lesser odds of developing PGD (odds ratio, 0.098 [P = .0026] and OR, 0.092 [P = .0017], respectively]. CONCLUSIONS Our study showed that a longer time from brain death to aortic cross clamp was associated with lower odds of developing PGD. Therefore, postponing heart procurement for a few days after brain death seems to be beneficial in preventing PGD.
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Affiliation(s)
- R A Quintana-Quezada
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas.
| | - I Rajapreyar
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - A Postalian-Yrausquin
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - Y C Yeh
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - S Choi
- Division of Clinical and Translational Sciences, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, Texas
| | - B Akkanti
- Division of Critical Care, Pulmonary and Sleep, University of Texas Medical School at Houston, Houston, Texas
| | - A Sieg
- Department of Pharmacy, Memorial Hermann - Texas Medical Center, Houston, Texas
| | - P Weeks
- Department of Pharmacy, Memorial Hermann - Texas Medical Center, Houston, Texas
| | - M Patel
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - J Patel
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - S Nathan
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - B Kar
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - P Loyalka
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - I Gregoric
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
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30
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Thenappan T, Stulak J, Agarwal R, Maltais S, Shah P, Eckman P, Emani S, Katz J, Gregoric I, Keebler M, Uriel N, Adler E, Chuang J, Farrar D, Sundareswaran K, John R. Trends in Serum Lactate Dehydrogenase During HeartMate II Left Ventricular Assist Device Support and Its Relation to Clinical Outcomes: Insights from the PREVENT Study. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.285] [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: 11/16/2022] Open
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31
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Rajapreyar I, Nathan S, Ghotra A, Nolan M, Weeks P, Sieg A, Kar B, Loyalka P, Paruthi C, Gregoric I. Early Antibody Mediated Rejection Post Orthotopic Heart Transplantation: A Single Center Experience. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1449] [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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32
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Katz J, Emani S, Egnaczyk G, Adler E, Chin J, Shah P, Brieke A, Keebler M, Nathan S, Gregoric I, Crandall D, Farrar D, Sundareswaran K, Maltais S. Impact of Adherence to Standard Practice Guidelines for Patients Receiving a Left Ventricular Assist Device - Insights from the PREVENT Study. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.165] [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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33
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Gacad V, Bellera R, De Cicco I, Zhao Y, Llanos-Chea F, McBride C, Kar B, Balan P, Smalling R, Gregoric I, Loyalka P, Nguyen T, Dhoble A. GENDER-BASED OUTCOMES IN DIABETICS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35386-x] [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: 11/27/2022]
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34
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Maltais S, Kilic A, Nathan S, Keebler M, Emani S, Ransom J, Katz JN, Sheridan B, Brieke A, Egnaczyk G, Entwistle JW, Adamson R, Stulak J, Uriel N, O’Connell JB, Farrar DJ, Sundareswaran KS, Gregoric I. PREVENtion of HeartMate II Pump Thrombosis Through Clinical Management: The PREVENT multi-center study. J Heart Lung Transplant 2017; 36:1-12. [DOI: 10.1016/j.healun.2016.10.001] [Citation(s) in RCA: 202] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 09/30/2016] [Accepted: 10/05/2016] [Indexed: 01/23/2023] Open
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35
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Sieg A, Gass J, Weeks P, Brown A, Rajapreyar I, Gregoric I. Anticoagulation Monitoring in Left Ventricular Assist Device (LVAD) Patients. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.1212] [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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36
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Balan P, Nguyen T, Estrera A, Loyalka P, Kar B, Gregoric I, Smalling R. STS RISK SCORE AS PREDICTOR OF 30-DAY MORTALITY IN TRANSCATHETER VERSUS SURGICAL AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30249-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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37
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Maltais S, Kilic A, Nathan S, Keebler M, Emani S, Ransom J, Katz J, Sheridan B, Brieke A, Egnaczyk G, Entwistle J, Adamson R, Stulak J, Uriel N, O’Connell J, Farrar D, Sundareswaran K, Gregoric I. PREVENtion of HeartMate II Pump Thrombosis Through Clinical Management (PREVENT). J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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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38
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Raman AS, Metz B, Kar B, Nascimbene A, Gregoric I, Loyalka P. Role of Mechanical Support in Post Myocardial Infarction Septal Defects Percutaneous Repair. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.935] [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: 11/24/2022] Open
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39
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Ottaviani G, Segura AM, Rajapreyar IN, Zhao B, Radovancevic R, Loyalka P, Kar B, Gregoric I, Buja LM. Left ventricular noncompaction cardiomyopathy in end-stage heart failure patients undergoing orthotopic heart transplantation. Cardiovasc Pathol 2016; 25:293-299. [PMID: 27135206 DOI: 10.1016/j.carpath.2016.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 03/06/2016] [Accepted: 03/24/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Previous studies reported that left ventricular noncompaction (LVNC) is a cardiomyopathy, familial or sporadic, arising from arrest of the normal process of trabecular remodeling during embryonic development. The diagnosis is usually made by echocardiography, but to date, there has been little research on the occurrence and clinicopathological features of LVNC in the explanted hearts of orthotopic heart transplant (OHT) recipients. DESIGN The clinical, echocardiographic, and pathologic findings were reviewed for evidence of LVNC, diagnosed by echocardiographic criteria, in 105 patients with end-stage heart failure (HF) undergoing OHT. Analyses of multiple sections of the explanted hearts were carried out. The hearts were evaluated for grades (0, negative; 1, mild/occasional foci; 2, moderate/multiple foci; 3, severe/extensive, diffuse) of fibrosis, reactive and replacement, hypertrophy, myocytolysis in left ventricle, right ventricle, interventricular septum, and atria. Absolute measurements of noncompacted and compacted portions of the left ventricle wall and noncompacted/compacted ratios were calculated. RESULTS Isolated LVNC was observed in 0 of 54 ischemic cardiomyopathy and in 4 of 51 (7.8%) nonischemic cardiomyopathy patients - 2 men and 2 women, with a mean age±SEM of 34.2±6.9years. The echocardiogram disclosed marked left ventricular dilatation, prominent trabeculations, and left ventricle ejection fraction <20%. Mural thrombi were seen in 3 of 4 (75%) patients. The heart weight mean±SEM was 468±55.3 g (range, 340-600g); noncompacted myocardium was 22±5.8mm, compacted myocardium was 13.2±3.5mm, and noncompacted/compacted ratio was 1.7/1±0.2. The total scores of hypetrophy, myocytolysis, and fibrosis were as follows: left ventricle, 7.7±0.2; right ventricle, 6.2±0.5; interventricular septum, 6.7±0.2; and atria, 7.5±0.3. CONCLUSIONS LVNC is an unusual form of nonischemic cardiomyopathy in patients suffering from end-stage HF undergoing OHT. The variability in the noncompacted/compacted ratio and discordance between the echocardiographic and pathological findings points to the need for further clarification of diagnostic imaging and diagnostic criteria for LVNC. Further studies in larger series, correlating the anatomoclinical and genetic variables, also would improve our understanding of LVNC as a cause of advanced HF leading to OHT.
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Affiliation(s)
- Giulia Ottaviani
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA; "Lino Rossi" Research Center for the study and prevention of unexpected perinatal death and sudden infant death syndrome (SIDS)-Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
| | - Ana Maria Segura
- Cardiovascular Pathology Research Laboratory, Texas Heart Institute, CHI St. Luke's Hospital, Houston, TX, USA
| | - Indranee N Rajapreyar
- Center for Advanced Heart Failure, Memorial Hermann-Texas Medical Center, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Bihong Zhao
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rajko Radovancevic
- Center for Advanced Heart Failure, Memorial Hermann-Texas Medical Center, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Pranav Loyalka
- Center for Advanced Heart Failure, Memorial Hermann-Texas Medical Center, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Biswajit Kar
- Center for Advanced Heart Failure, Memorial Hermann-Texas Medical Center, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Igor Gregoric
- Center for Advanced Heart Failure, Memorial Hermann-Texas Medical Center, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - L Maximilian Buja
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA; Cardiovascular Pathology Research Laboratory, Texas Heart Institute, CHI St. Luke's Hospital, Houston, TX, USA
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Kennedy E, Vanichanan J, Rajapreyar I, Gonzalez B, Nathan S, Gregoric I, Kar B, Loyalka P, Weeks P, Chavez V, Wanger A, Ostrosky Zeichner L. A pseudo-outbreak of disseminated cryptococcal disease after orthotopic heart transplantation. Mycoses 2015; 59:75-9. [PMID: 26627342 DOI: 10.1111/myc.12433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 10/13/2015] [Accepted: 10/18/2015] [Indexed: 12/23/2022]
Abstract
Cryptococcal infection is the third most common invasive fungal infection (IFI) among solid-organ transplant (SOT) recipients and is considered an important opportunistic infection due to its significant morbidity and mortality. To determine whether a cluster of cryptococcosis in heart transplant patients was of nosocomial nature, three cases of orthotopic heart transplant recipients with postoperative disseminated cryptococcal infection were investigated and paired with an environmental survey in a tertiary care hospital. The infection prevention department conducted a multidisciplinary investigation, which did not demonstrate any evidence of health care-associated environmental exposure. Moreover, multilocus sequence typing showed that one isolate was unique and the two others, although identical, were not temporally related and belong to the most common type seen in the Southern US. Additionally, all three patients had preexisting abnormalities of the CT chest scan and various degrees of acute and chronic rejection. Reactivation was suggested in all three patients. Screening methods may be useful to identify at risk patients and trigger a prophylactic or preemptive approach. However, more data is needed.
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Affiliation(s)
- E Kennedy
- Infection Prevention Department, Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - J Vanichanan
- Division of Infectious Diseases, UT Health Medical School at Houston, Houston, TX, USA
| | - I Rajapreyar
- Program of Advanced Heart Failure, UT Health Medical School at Houston, Houston, TX, USA.,Program of Advanced Heart Failure, Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - B Gonzalez
- Program of Advanced Heart Failure, Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - S Nathan
- Program of Advanced Heart Failure, UT Health Medical School at Houston, Houston, TX, USA.,Program of Advanced Heart Failure, Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - I Gregoric
- Program of Advanced Heart Failure, UT Health Medical School at Houston, Houston, TX, USA.,Program of Advanced Heart Failure, Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - B Kar
- Program of Advanced Heart Failure, UT Health Medical School at Houston, Houston, TX, USA.,Program of Advanced Heart Failure, Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - P Loyalka
- Program of Advanced Heart Failure, UT Health Medical School at Houston, Houston, TX, USA.,Program of Advanced Heart Failure, Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - P Weeks
- Program of Advanced Heart Failure, Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - V Chavez
- Department of Pathology, UT Health Medical School at Houston, Houston, TX, USA
| | - A Wanger
- Department of Pathology, UT Health Medical School at Houston, Houston, TX, USA
| | - L Ostrosky Zeichner
- Infection Prevention Department, Memorial Hermann Texas Medical Center, Houston, TX, USA.,Division of Infectious Diseases, UT Health Medical School at Houston, Houston, TX, USA
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Negi SI, Malahfji M, Sokolovic M, Torguson R, Didier R, Gregoric I, Loyalka P, Pichard A, Satler LF, Kar BO, Waksman R. TCT-199 A Comparative Analysis Of Use Of Extracorporeal Membrane Oxygenation And Peripheral Ventricular Assist Device TandemHeart In Acute Myocardial Infarction. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.213] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Nascimbene A, Banjac I, Janowiak L, Akkanti B, Shabari FR, Rajapreyar I, Hussain R, Nathan S, Loyalka P, Gregoric I, Kar BO. TCT-200 ECMO for hemodynamic support in patients with profound cardiogenic shock: experience and outcomes from a large single center. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.214] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Malahfji M, Centeno EN, Negi SI, Mahfouz M, Nassir B, Gregoric I, Kar BO, Loyalka P. TCT-203 Use of Percutaneous Assist Device Therapy in Ventricular Septal Defects in Postinfraction Cardiogenic Shock. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.217] [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: 11/25/2022]
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Ottaviani G, Radovancevic R, Kar B, Gregoric I, Buja LM. Pathological assessment of end-stage heart failure in explanted hearts in correlation with hemodynamics in patients undergoing orthotopic heart transplantation. Cardiovasc Pathol 2015; 24:283-9. [DOI: 10.1016/j.carpath.2015.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 05/20/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022] Open
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Lopa R, Bai Y, Wu C, Hobbs R, Rossman S, Hartwell B, Adams C, Legal-Stockwell L, Tu T, Nathan S, Loyalka P, Gregoric I, Kar B, Bynon J, Ling M. LBP08. Hum Immunol 2015. [DOI: 10.1016/j.humimm.2015.01.040] [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: 11/28/2022]
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Huang RSP, Nedelcu E, Bai Y, Wahed A, Klein K, Tint H, Gregoric I, Patel M, Kar B, Loyalka P, Nathan S, Radovancevic R, Nguyen AND. Post-operative bleeding risk stratification in cardiac pulmonary bypass patients using artificial neural network. Ann Clin Lab Sci 2015; 45:181-186. [PMID: 25887872] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The prediction of bleeding risk in cardiopulmonary bypass (CPB) patients plays a vital role in their postoperative management. Therefore, an artificial neural network (ANN) to analyze intra-operative laboratory data to predict postoperative bleeding was set up. The JustNN software (Neural Planner Software, Cheshire, England) was used. This ANN was trained using 15 intra-operative laboratory parameters paired with one output category - risk of bleeding, defined as units of blood components transfused in 48 hours. The ANN was trained with the first 39 CPB cases. The set of input parameters for this ANN was also determined, and the ANN was validated with the next 13 cases. The set of input parameters include five components: pro-thrombin time, platelet count, thromboelastograph-reaction time, D-Dimer, and thromboelastograph-coagulation index. The validation results show 9 cases (69.2%) with exact match, 3 cases (23.1%) with one-grading difference, and 1 case (7.7%) with two-grading difference between actual blood usage versus predicted blood usage. To the best of our knowledge, ours is the first ANN developed for post-operative bleeding risk stratification of CPB patients. With promising results, we have started using this ANN to risk-stratify our CPB patients, and it has assisted us in predicting post-operative bleeding risk.
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Affiliation(s)
- Richard S P Huang
- The University of Texas Health Science Center at Houston-Department of Pathology and Laboratory Medicine, Houston, TX, USA
| | - Elena Nedelcu
- The University of Texas Health Science Center at Houston-Department of Pathology and Laboratory Medicine, Houston, TX, USA
| | - Yu Bai
- The University of Texas Health Science Center at Houston-Department of Pathology and Laboratory Medicine, Houston, TX, USA
| | - Amer Wahed
- The University of Texas Health Science Center at Houston-Department of Pathology and Laboratory Medicine, Houston, TX, USA
| | - Kimberly Klein
- The University of Texas Health Science Center at Houston-Department of Pathology and Laboratory Medicine, Houston, TX, USA
| | - Hlaing Tint
- The University of Texas Health Science Center at Houston-Department of Pathology and Laboratory Medicine, Houston, TX, USA
| | - Igor Gregoric
- The University of Texas Health Science Center at Houston-Center for Advanced Heart Failure, Houston, TX, USA
| | - Manish Patel
- The University of Texas Health Science Center at Houston-Center for Advanced Heart Failure, Houston, TX, USA
| | - Biswajit Kar
- The University of Texas Health Science Center at Houston-Center for Advanced Heart Failure, Houston, TX, USA
| | - Pranav Loyalka
- The University of Texas Health Science Center at Houston-Center for Advanced Heart Failure, Houston, TX, USA
| | - Sriram Nathan
- The University of Texas Health Science Center at Houston-Center for Advanced Heart Failure, Houston, TX, USA
| | - Rajko Radovancevic
- The University of Texas Health Science Center at Houston-Center for Advanced Heart Failure, Houston, TX, USA
| | - Andy N D Nguyen
- The University of Texas Health Science Center at Houston-Department of Pathology and Laboratory Medicine, Houston, TX, USA
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Welsh KJ, Nedelcu E, Bai Y, Wahed A, Klein K, Tint H, Gregoric I, Patel M, Kar B, Loyalka P, Nathan S, Loubser P, Weeks PA, Radovancevic R, Nguyen AND. How do we manage cardiopulmonary bypass coagulopathy? Transfusion 2014; 54:2158-66. [PMID: 24942083 DOI: 10.1111/trf.12751] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 04/24/2014] [Accepted: 04/25/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Patients who undergo cardiopulmonary bypass (CPB) are at risk for coagulopathy. Suboptimal turnaround time (TAT) of laboratory coagulation testing results in empiric administration of blood products to treat massive bleeding. We describe our initiative in establishing the coagulation-based hemotherapy (CBH) service, a clinical pathology consultation service that uses rapid TAT coagulation testing and provides comprehensive assessment of bleeding in patients undergoing CPB. A transfusion algorithm that treats the underlying cause of coagulopathy was developed. STUDY DESIGN AND METHODS The coagulation testing menu includes all aspects of coagulopathy with close proximity of the laboratory to the operating room to allow for rapid test results. The hemotherapy pathologist monitors laboratory results at several stages in surgery and uses a comprehensive algorithm to monitor a patient's hemostasis. The optimal number and type of blood products are selected when the patient is taken off CPB. RESULTS The CBH service was consulted for 44 ventricular assist device implants, 30 heart transplants, and 31 other cardiovascular surgeries from May 2012 through November 2013. The TAT for laboratory tests was 15 minutes for complete blood count, antithrombin, and coagulation panel and 30 minutes for VerifyNow and thromboelastography, in comparison to 45 to 60 minutes in normal settings. The transfusion algorithms were used with optimal administration of blood components with preliminary data suggestive of reduced blood product usage and better patient outcomes. CONCLUSION We described the successful introduction of a novel pathology consultation service that uses a rapid TAT coagulation testing menu with transfusion algorithms for improved management of CPB patients.
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Huang RSP, Nedelcu E, Bai Y, Wahed A, Klein K, Gregoric I, Patel M, Kar B, Loyalka P, Nathan S, Loubser P, Weeks PA, Radovancevic R, Nguyen AND. Mobile computing platform with decision support modules for hemotherapy. Am J Clin Pathol 2014; 141:834-40. [PMID: 24838328 DOI: 10.1309/ajcprg5lywl6dxmx] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES We describe the development of a mobile computing platform (MCP) with a decision support module (DSM) for patients in our coagulation-based hemotherapy service. METHODS The core of our MCP consists of a Microsoft Excel spreadsheet template used to gather and compute data on cardiopulmonary bypass (CPB) patients intraoperatively. The DSM is embedded into the Excel file, where the user would enter in laboratory results, and through our 45 embedded algorithms, recommendations for transfusion products would be displayed in the Excel file. RESULTS The DSM has helped decrease the time it takes to come to a transfusion recommendation, helps double-check recommendations, and is an excellent tool for teaching. Furthermore, the problems that occur with a paper system have been eliminated, and we are now able to access this information easily and reliably. CONCLUSIONS The development and implementation of our MCP system has greatly increased the productivity and efficiency of our hemotherapy service.
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Affiliation(s)
- Richard S. P. Huang
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston
| | - Elena Nedelcu
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston
| | - Yu Bai
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston
| | - Amer Wahed
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston
| | - Kimberly Klein
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston
| | - Igor Gregoric
- Center for Advanced Heart Failure, The University of Texas Health Science Center at Houston, Houston
| | - Manish Patel
- Center for Advanced Heart Failure, The University of Texas Health Science Center at Houston, Houston
| | - Biswajit Kar
- Center for Advanced Heart Failure, The University of Texas Health Science Center at Houston, Houston
| | - Pranav Loyalka
- Center for Advanced Heart Failure, The University of Texas Health Science Center at Houston, Houston
| | - Sriram Nathan
- Center for Advanced Heart Failure, The University of Texas Health Science Center at Houston, Houston
| | - Paul Loubser
- Cardiovascular Anesthesia, The University of Texas Health Science Center at Houston, Houston
| | | | - Rajko Radovancevic
- Center for Advanced Heart Failure, The University of Texas Health Science Center at Houston, Houston
| | - Andy N. D. Nguyen
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston
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Negi SI, Balan P, Lee R, Denktas A, Anand A, Loyalka P, Kar B, Estrera A, Gregoric I, Smalling R. CHANGES IN LEFT VENTRICULAR DIASTOLIC FUNCTION AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61746-0] [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: 11/30/2022]
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Negi SI, Loyalka P, Gregoric I, Kar B. Retrieval of Ruptured Valves and Their Accessories During Transcatheter Aortic Valve Replacement. J Card Surg 2014; 29:209-212. [DOI: 10.1111/jocs.12285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Smita I. Negi
- Division of Cardiology; Department of Medicine; University of Texas at Houston; Houston Texas
| | - Pranav Loyalka
- Center for Advanced Heart Failure; University of Texas at Houston; Houston Texas
| | - Igor Gregoric
- Center for Advanced Heart Failure; University of Texas at Houston; Houston Texas
| | - Biswajit Kar
- Center for Advanced Heart Failure; University of Texas at Houston; Houston Texas
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