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Bhagra CJ, Cherikh WS, Ross H, Kittleson MM, Stehlik J, Lewis A, DeFilippis EM, Macera F. Informing preconception counseling: Outcomes among female heart transplant recipients in the ISHLT registry. J Heart Lung Transplant 2024; 43:727-736. [PMID: 38101760 DOI: 10.1016/j.healun.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/02/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The numbers of women of child-bearing age undergoing heart transplantation (HT) and female pediatric HT recipients surviving to child-bearing age have increased, along with improvements in post-transplant survival. Data regarding life expectancy and comorbidities in reproductive-aged female HT recipients are needed to inform shared decision-making at the time of preconception counseling. METHODS The International Society for Heart and Lung Transplantation (ISHLT) Thoracic Organ Transplant Registry was investigated for HT recipients between January 1, 2000 and June 30, 2017. Women of childbearing age were defined as those aged 15-45 years, either at transplant, or at the respective post-transplant follow-up. Characteristics and outcomes of female recipients of childbearing age at transplant, 5-, 10-, and 15-year follow-up were compared to females > 45 years of age, males 15-45 years and males > 45 years of age at the corresponding time intervals. Outcomes included survival, development of diabetes (DM), severe renal dysfunction (CKD), and cardiac allograft vasculopathy (CAV). RESULTS During the study period, 71,585 HT recipients were included: 24% (n = 17,194) were female and 9.2% (n = 6602) were of childbearing age at HT. A pre-transplant diagnosis of peripartum cardiomyopathy was associated with significantly worse post-transplant survival, a finding that remained independent of panel reactive antibody levels. The presence of pre-transplant DM and/or severe CKD was significantly associated with lower survival as were the presence of CAV, DM, and CKD post-HT. CONCLUSION Knowledge of the impact of pre-existing comorbidities and complications post-HT on survival are important for risk stratification for preconception counseling post-HT.
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Affiliation(s)
- Catriona J Bhagra
- Department of Cardiology, Royal Papworth NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Heather Ross
- Division of Cardiology, Ted Rogers Centre for Heart Research, Toronto General Hospital, Toronto, Ontario, Canada
| | - Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Josef Stehlik
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
| | | | - Ersilia M DeFilippis
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia University Irving Medical Center, New York, New York.
| | - Francesca Macera
- Heart Failure and Heart Transplant Unit, Department of Cardiovascular Medicine, Great Metropolitan "Niguarda" Hospital, Milan, Italy; Division of Cardiology, Erasme Hospital, Cliniques Hospitalières Universitaires de Bruxelles, Brussels, Belgium
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2
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Grady KL, Kallen MA, Cella D, Allen LA, Lindenfeld J, McIlvennan CK, Beiser DG, Walsh MN, Denfeld QE, Lee CS, Ruo B, Murks C, Stehlik J, Kirklin JK, Teuteberg J, Adler E, Kiernan M, Rich J, Bedjeti K, Hahn EA. Efficient Measurement of Multiple Ventricular Assist Device Patient-reported Outcomes: Creation of a 20-item Profile from the MCS A-QOL Study. J Heart Lung Transplant 2024:S1053-2498(24)01635-8. [PMID: 38692444 DOI: 10.1016/j.healun.2024.04.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/15/2024] [Accepted: 04/23/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Patient-reported outcome (PRO) measures of distinct concepts are often put together into patient profile assessments. When brief, profile assessments can decrease respondent burden and increase measure completion rates. In this report, we describe creation of five self-reported 4-item short forms and the MCS A-QOL 20-item profile to assess PROs specific to adjustment and health-related quality of life (HRQOL) among patients who undergo left ventricular assist device (LVAD) implantation. METHODS Using a cross-sectional sample of patients (n=620) who underwent LVAD implantation at 12 U.S. sites or participated in the MyLVAD.com support group, we created five 4-item short forms: Satisfaction with Treatment, VAD Team Communication, Being Bothered by VAD Self-care and Limitations, Self-efficacy Regarding VAD self-care, and Stigma, which we combined into a 20-item Profile. Analyses included inter-correlations among measures, Cronbach's alpha (i.e., internal consistency reliability)/score-level-specific reliability, and construct validity. RESULTS The 620 patients were mean age=57 years, 78% male, 70% white, and 56% on destination therapy LVADs. Inter-correlations among the five 4-item measures were low to moderate (<0.50), indicating they are associated yet largely distinct, and correlations with calibrated measures and 6-item short forms were >0.76, indicating their ability to reflect full-item bank scores. Internal consistency reliability for the five 4-item short forms ranged from acceptable (≥0.70) to good (≥0.80). Construct validity was demonstrated for these measures. CONCLUSIONS Our five 4-item short forms are reliable and valid and may be used individually or together as a 20-item Profile to assess adjustment and HRQOL in patients who undergo LVAD implantation.
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Affiliation(s)
- Kathleen L Grady
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL.
| | - Michael A Kallen
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - David Cella
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Larry A Allen
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | | | | | - David G Beiser
- Section of Emergency Medicine, University of Chicago, Chicago, IL
| | | | - Quin E Denfeld
- School of Nursing, Oregon Health & Science University, Portland, OR
| | | | - Bernice Ruo
- Department of Medicine, University of California-San Diego, La Jolla, CA
| | | | - Josef Stehlik
- Department of Medicine, University of Utah, Salt Lake City, UT
| | | | | | - Eric Adler
- Department of Medicine, University of California-San Diego, La Jolla, CA
| | | | - Jonathan Rich
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Katy Bedjeti
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL
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Sideris K, Weir CR, Schmalfuss C, Hanson H, Pipke M, Tseng PH, Lewis N, Sallam K, Bozkurt B, Hanff T, Schofield R, Larimer K, Kyriakopoulos CP, Taleb I, Brinker L, Curry T, Knecht C, Butler JM, Stehlik J. Artificial intelligence predictive analytics in heart failure: results of the pilot phase of a pragmatic randomized clinical trial. J Am Med Inform Assoc 2024; 31:919-928. [PMID: 38341800 PMCID: PMC10990545 DOI: 10.1093/jamia/ocae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/20/2023] [Accepted: 01/17/2024] [Indexed: 02/13/2024] Open
Abstract
OBJECTIVES We conducted an implementation planning process during the pilot phase of a pragmatic trial, which tests an intervention guided by artificial intelligence (AI) analytics sourced from noninvasive monitoring data in heart failure patients (LINK-HF2). MATERIALS AND METHODS A mixed-method analysis was conducted at 2 pilot sites. Interviews were conducted with 12 of 27 enrolled patients and with 13 participating clinicians. iPARIHS constructs were used for interview construction to identify workflow, communication patterns, and clinician's beliefs. Interviews were transcribed and analyzed using inductive coding protocols to identify key themes. Behavioral response data from the AI-generated notifications were collected. RESULTS Clinicians responded to notifications within 24 hours in 95% of instances, with 26.7% resulting in clinical action. Four implementation themes emerged: (1) High anticipatory expectations for reliable patient communications, reduced patient burden, and less proactive provider monitoring. (2) The AI notifications required a differential and tailored balance of trust and action advice related to role. (3) Clinic experience with other home-based programs influenced utilization. (4) Responding to notifications involved significant effort, including electronic health record (EHR) review, patient contact, and consultation with other clinicians. DISCUSSION Clinician's use of AI data is a function of beliefs regarding the trustworthiness and usefulness of the data, the degree of autonomy in professional roles, and the cognitive effort involved. CONCLUSION The implementation planning analysis guided development of strategies that addressed communication technology, patient education, and EHR integration to reduce clinician and patient burden in the subsequent main randomized phase of the trial. Our results provide important insights into the unique implications of implementing AI analytics into clinical workflow.
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Affiliation(s)
- Konstantinos Sideris
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States
| | - Charlene R Weir
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84108, United States
| | - Carsten Schmalfuss
- Cardiology Section, Medical Service, Malcom Randall VA Medical Center, Gainesville, FL 32608, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL 32610, United States
| | - Heather Hanson
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States
| | - Matt Pipke
- PhysIQ, Inc., Chicago, IL 60563, United States
| | - Po-He Tseng
- PhysIQ, Inc., Chicago, IL 60563, United States
| | - Neil Lewis
- Cardiology Section, Medical Service, Hunter Holmes McGuire Veterans Medical Center, Richmond, VA 23249, United States
- Department of Internal Medicine, Division of Cardiovascular Disease, Virginia Commonwealth University, Richmond, VA 23249, United States
| | - Karim Sallam
- Cardiology Section, Medical Service, VA Palo Alto Health Care System, Palo Alto, CA 94304, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Biykem Bozkurt
- Cardiology Section, Medical Service, Michael E. DeBakey VA Medical Center, Houston, TX 77030, United States
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, United States
| | - Thomas Hanff
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States
| | - Richard Schofield
- Cardiology Section, Medical Service, Malcom Randall VA Medical Center, Gainesville, FL 32608, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL 32610, United States
| | | | - Christos P Kyriakopoulos
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States
| | - Iosif Taleb
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States
| | - Lina Brinker
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States
| | - Tempa Curry
- Cardiology Section, Medical Service, Malcom Randall VA Medical Center, Gainesville, FL 32608, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL 32610, United States
| | - Cheri Knecht
- Cardiology Section, Medical Service, Malcom Randall VA Medical Center, Gainesville, FL 32608, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL 32610, United States
| | - Jorie M Butler
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84108, United States
| | - Josef Stehlik
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States
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4
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Wert L, Stewart GC, Mehra MR, Milwidsky A, Jorde UP, Goldstein DJ, Selzman CH, Stehlik J, Alshamdin FD, Khaliel FH, Gustafsson F, Boschi S, Loforte A, Ajello S, Scandroglio AM, Tučanová Z, Netuka I, Schlöglhofer T, Zimpfer D, Zijderhand CF, Caliskan K, Dogan G, Schmitto JD, Maier S, Schibilsky D, Jawad K, Saeed D, Faerber G, Morshuis M, Hanuna M, Müller CS, Mulzer J, Kempfert J, Falk V, Potapov EV. A multicenter evaluation of external outflow graft obstruction with a fully magnetically levitated left ventricular assist device. J Thorac Cardiovasc Surg 2024; 167:1322-1330.e6. [PMID: 36562497 DOI: 10.1016/j.jtcvs.2022.09.051] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/18/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The HeartMate 3 (HM 3; Abbott) left ventricular assist device (LVAD) has improved hemocompatibility-related adverse outcomes. In sporadic cases, external compression of the outflow graft causing obstruction (eOGO) can result from substance accumulation between the outflow graft and its bend relief. We sought to evaluate the prevalence, course, and clinical implications of eOGO in an international study. METHODS A multicenter retrospective analysis of HM 3 LVADs implanted between November 2014 and April 2021 (n = 2108) was conducted across 17 cardiac centers in 8 countries. We defined eOGO as obstruction >25% in the cross-sectional area in imaging (percutaneous angiography, computed tomography, or intravascular ultrasound). The prevalence and annual incidence were calculated. Serious adverse events and outcomes (death, transplantation, or device exchange) were analyzed for eOGO cases. RESULTS Of 2108 patients, 62 were diagnosed with eOGO at a median LVAD support duration of 953 (interquartile range, 600-1267) days. The prevalence of eOGO was 3.0% and the incidence at 1, 2, 3, 4, and 5 years of support was 0.6%, 2.8%, 4.0%, 5.2%, and 9.1%, respectively. Of 62 patients, 9 were observed, 27 underwent surgical revision, 15 underwent percutaneous stent implantation, 8 received a heart transplant, and 2 died before intervention. One patient underwent surgical revision and later stent implantation. The mortality with therapeutic intervention was 9/53 (17.0%). CONCLUSIONS Although uncommon, HM 3 LVAD-supported patients might develop eOGO with an increasing incidence after 1 year of support. Although engineering efforts to reduce this complication are under way, clinicians must maintain a focus on early detection and remain vigilant.
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Affiliation(s)
- Leonhard Wert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.
| | - Garrick C Stewart
- Division of Cardiovascular Medicine, Center for Advanced Heart Disease, Brigham and Women's Hospital, Boston, Mass
| | - Mandeep R Mehra
- Division of Cardiovascular Medicine, Center for Advanced Heart Disease, Brigham and Women's Hospital, Boston, Mass
| | - Assi Milwidsky
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Ulrich P Jorde
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Daniel J Goldstein
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Craig H Selzman
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Josef Stehlik
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Faisal D Alshamdin
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Feras H Khaliel
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Silvia Boschi
- Department of Cardiac Surgery, IRCCS Bologna, S. Orsola University Hospital, Bologna, Italy
| | - Antonio Loforte
- Department of Cardiac Surgery, IRCCS Bologna, S. Orsola University Hospital, Bologna, Italy
| | - Silvia Ajello
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Anna M Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Zuzana Tučanová
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Ivan Netuka
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Thomas Schlöglhofer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Casper F Zijderhand
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Günes Dogan
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Sven Maier
- Department of Cardiovascular Surgery, Heart Center University Freiburg-Bad Krozingen, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David Schibilsky
- Department of Cardiovascular Surgery, Heart Center University Freiburg-Bad Krozingen, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Khalil Jawad
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Diyar Saeed
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Gloria Faerber
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Michiel Morshuis
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre NRW, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Maja Hanuna
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | - Christoph S Müller
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | - Johanna Mulzer
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany; Department of Cardiothoracic Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Evgenij V Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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Halloran PF, Reeve J, Mackova M, Madill-Thomsen KS, Demko Z, Olymbios M, Campbell P, Melenovsky V, Gong T, Hall S, Stehlik J. Comparing Plasma Donor-derived Cell-free DNA to Gene Expression in Endomyocardial Biopsies in the Trifecta-Heart Study. Transplantation 2024:00007890-990000000-00702. [PMID: 38538559 DOI: 10.1097/tp.0000000000004986] [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: 04/05/2024]
Abstract
BACKGROUND Plasma donor-derived cell-free DNA (dd-cfDNA) is used to screen for rejection in heart transplants. We launched the Trifecta-Heart study (ClinicalTrials.gov No. NCT04707872), an investigator-initiated, prospective trial, to examine the correlations between genome-wide molecular changes in endomyocardial biopsies (EMBs) and plasma dd-cfDNA. The present report analyzes the correlation of plasma dd-cfDNA with gene expression in EMBs from 4 vanguard centers and compared these correlations with those in 604 kidney transplant biopsies in the Trifecta-Kidney study (ClinicalTrials.gov No. NCT04239703). METHODS We analyzed 137 consecutive dd-cfDNA-EMB pairs from 70 patients. Plasma %dd-cfDNA was measured by the Prospera test (Natera Inc), and gene expression in EMBs was assessed by Molecular Microscope Diagnostic System using machine-learning algorithms to interpret rejection and injury states. RESULTS Top transcripts correlating with dd-cfDNA were related to genes increased in rejection such as interferon gamma-inducible genes (eg, HLA-DMA ) but also with genes induced by injury and expressed in macrophages (eg, SERPINA1 and HMOX1 ). In gene enrichment analysis, the top dd-cfDNA-correlated genes reflected inflammation and rejection pathways. Dd-cfDNA correlations with rejection genes in EMB were similar to those seen in kidney transplant biopsies, with somewhat stronger correlations for TCMR genes in hearts and ABMR genes in kidneys. However, the correlations with parenchymal injury-induced genes and macrophage genes were much stronger in hearts. CONCLUSIONS In this first analysis of Trifecta-Heart study, dd-cfDNA correlates significantly with molecular rejection but also with injury and macrophage infiltration, reflecting the proinflammatory properties of injured cardiomyocytes. The relationship supports the utility of dd-cfDNA in clinical management of heart transplant recipients.
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Affiliation(s)
- Philip F Halloran
- Alberta Transplant Applied Genomics Center, Edmonton, AB, Canada
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Transcriptome Sciences Inc, Edmonton, AB, Canada
| | - Jeff Reeve
- Alberta Transplant Applied Genomics Center, Edmonton, AB, Canada
- Transcriptome Sciences Inc, Edmonton, AB, Canada
| | - Martina Mackova
- Alberta Transplant Applied Genomics Center, Edmonton, AB, Canada
- Transcriptome Sciences Inc, Edmonton, AB, Canada
| | - Katelynn S Madill-Thomsen
- Alberta Transplant Applied Genomics Center, Edmonton, AB, Canada
- Transcriptome Sciences Inc, Edmonton, AB, Canada
| | | | | | | | | | | | | | - Josef Stehlik
- Department of Internal Medicine, University of Utah, Salt Lake City, UT
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6
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Halloran PF, Madill-Thomsen K, Aliabadi-Zuckermann AZ, Cadeiras M, Crespo-Leiro MG, Depasquale EC, Deng M, Gökler J, Hall S, Jamil A, Kim DH, Kobashigawa J, Macdonald P, Melenovsky V, Patel J, Potena L, Shah K, Stehlik J, Zuckermann A. Redefining the molecular rejection states in 3230 heart transplant biopsies: Relationships to parenchymal injury and graft survival. Am J Transplant 2024:S1600-6135(24)00241-7. [PMID: 38527588 DOI: 10.1016/j.ajt.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 03/27/2024]
Abstract
The first-generation Molecular Microscope (MMDx) system for heart transplant endomyocardial biopsies used expression of rejection-associated transcripts (RATs) to diagnose not only T cell-mediated rejection (TCMR) and antibody-mediated rejection (ABMR) but also acute injury. However, the ideal system should detect rejection without being influenced by injury, to permit analysis of the relationship between rejection and parenchymal injury. To achieve this, we developed a new rejection classification in an expanded cohort of 3230 biopsies: 1641 from INTERHEART (ClinicalTrials.gov NCT02670408), plus 1589 service biopsies added to improve the power of the machine learning algorithms. The new system used 6 rejection classifiers instead of RATs and generated 7 rejection archetypes: No rejection, 48%; Minor, 24%; TCMR1, 2.3%; TCMR2, 2.7%; TCMR/mixed, 2.7%; early-stage ABMR, 3.9%; and fully developed ABMR, 16%. Using rejection classifiers eliminated cross-reactions with acute injury, permitting separate assessment of rejection and injury. TCMR was associated with severe-recent injury and late atrophy-fibrosis and rarely had normal parenchyma. ABMR was better tolerated, seldom producing severe injury, but in later biopsies was often associated with atrophy-fibrosis, indicating long-term risk. Graft survival and left ventricular ejection fraction were reduced not only in hearts with TCMR but also in hearts with severe-recent injury and atrophy-fibrosis, even without rejection.
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Affiliation(s)
- Philip F Halloran
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | | | | | - Martin Cadeiras
- Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Marisa G Crespo-Leiro
- Advanced Heart Failure and Heart Transplant Unit, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | - Mario Deng
- Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Johannes Gökler
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Aayla Jamil
- Baylor Scott & White Health, Dallas, Texas, USA
| | - Daniel H Kim
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jon Kobashigawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Peter Macdonald
- The Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Vojtech Melenovsky
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Jignesh Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Luciano Potena
- Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Keyur Shah
- Department of Cardiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Josef Stehlik
- Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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7
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Hanff TC, Johnson MR, Stehlik J. Heart Transplant Performance Metrics: Separating Signal From Noise. JACC Heart Fail 2024:S2213-1779(24)00240-3. [PMID: 38613560 DOI: 10.1016/j.jchf.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 04/15/2024]
Affiliation(s)
- Thomas C Hanff
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
| | - Maryl R Johnson
- Division of Cardiovascular Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Josef Stehlik
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
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Wohlfahrt P, Jenča D, Melenovský V, Stehlik J, Mrázková J, Šramko M, Kotrč M, Želízko M, Adámková V, Piťha J, Kautzner J. Development and validation of a prognostic score integrating remote heart failure symptoms and clinical variables in mortality risk prediction after myocardial infarction. The PragueMi score. Eur J Prev Cardiol 2024:zwae114. [PMID: 38497201 DOI: 10.1093/eurjpc/zwae114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/17/2024] [Accepted: 03/15/2024] [Indexed: 03/19/2024]
Abstract
AIMS While heart failure (HF) symptoms are associated with adverse prognosis after myocardial infarction (MI), they are not routinely used for patients' stratification. The primary objective of this study was to develop and validate a score to predict mortality risk after MI, combining remotely recorded HF symptoms and clinical risk factors, and to compare it against the guideline-recommended GRACE score. METHODS A cohort study design using prospectively collected data from consecutive patients hospitalized for MI at a large tertiary heart centre between June 2017 and September 2022 was used. RESULTS Data from 1,135 patients (aged 64±12 years, 26.7% women), were split into derivation (70%) and validation cohort (30%). Components of the 23-item Kansas City Cardiomyopathy Questionnaire (KCCQ) questionnaire and clinical variables were used as possible predictors. The best model included the following variables - age, heart failure history, admission creatinine and heart rate, ejection fraction at hospital discharge, and HF symptoms 1 month after discharge including walking impairment, leg swelling, and change in HF symptoms. Based on these variables, the PragueMi score was developed. In the validation cohort, the PragueMi score showed superior discrimination to the GRACE score for 6 months (AUC 90.1, 95% CI 81.8-98.4 vs. 77.4, 95% CI 62.2-92.5, p=0.04) and 1-year risk prediction (AUC 89.7, 95% CI 83.5-96.0 vs. 76.2, 95% CI 64.7-87.7, p=0.004). CONCLUSION The PragueMi score combining heart failure symptoms and clinical variables performs better than the currently recommended GRACE score.
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Affiliation(s)
- Peter Wohlfahrt
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- First Medical School, Charles University, Prague, Czech Republic
| | - Dominik Jenča
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
- Third Medical School, Charles University, Prague, Czech Republic
| | - Vojtěch Melenovský
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Josef Stehlik
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jolana Mrázková
- Experimental Medicine Centre, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Marek Šramko
- First Medical School, Charles University, Prague, Czech Republic
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Martin Kotrč
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Michael Želízko
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Věra Adámková
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jan Piťha
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
- Medical and Dentistry School, Palacký University, Olomouc, Czech Republic
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Halloran PF, Madill-Thomsen K, Mackova M, Aliabadi-Zuckermann AZ, Cadeiras M, Crespo-Leiro MG, Depasquale EC, Deng M, Gökler J, Hall SA, Kim DH, Kobashigawa J, Macdonald P, Potena L, Shah K, Stehlik J, Zuckermann A, Reeve J. Molecular states associated with dysfunction and graft loss in heart transplants. J Heart Lung Transplant 2024; 43:508-518. [PMID: 38042442 DOI: 10.1016/j.healun.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/23/2023] [Accepted: 11/21/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND We explored the changes in gene expression correlating with dysfunction and graft failure in endomyocardial biopsies. METHODS Genome-wide microarrays (19,462 genes) were used to define mRNA changes correlating with dysfunction (left ventricular ejection fraction [LVEF] ≤ 55) and risk of graft loss within 3 years postbiopsy. LVEF data was available for 1,013 biopsies and survival data for 779 patients (74 losses). Molecular classifiers were built for predicting dysfunction (LVEF ≤ 55) and postbiopsy 3-year survival. RESULTS Dysfunction is correlated with dedifferentiation-decreased expression of normal heart transcripts, for example, solute carriers, along with increased expression of inflammation genes. Many genes with reduced expression in dysfunction were matrix genes such as fibulin 1 and decorin. Gene ontology (GO) categories suggested matrix remodeling and inflammation, not rejection. Genes associated with the risk of failure postbiopsy overlapped dysfunction genes but also included genes affecting microcirculation, for example, arginase 2, which reduces NO production, and endothelin 1. GO terms also reflected increased glycolysis and response to hypoxia, but decreased VEGF and angiogenesis pathways. T cell-mediated rejection was associated with reduced survival and antibody-mediated rejection with relatively good survival, but the main determinants of survival were features of parenchymal injury. Both dysfunction and graft loss were correlated with increased biopsy expression of BNP (gene NPPB). Survival probability classifiers divided hearts into risk quintiles, with actuarial 3-year postbiopsy survival >95% for the highest versus 50% for the lowest. CONCLUSIONS Dysfunction in transplanted hearts reflects dedifferentiation, decreased matrix genes, injury, and inflammation. The risk of short-term loss includes these changes but is also associated with microcirculation abnormalities, glycolysis, and response to hypoxia.
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Affiliation(s)
- Philip F Halloran
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | | | - Martina Mackova
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | - Mario Deng
- Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Johannes Gökler
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Daniel H Kim
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Peter Macdonald
- The Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Luciano Potena
- Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Keyur Shah
- Department of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Josef Stehlik
- Department of Medicine, University of Utah, Salt Lake City, Utah
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Jeff Reeve
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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10
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Noroozi Gilandehi S, Wong KH, Francis T, Wright MA, Lord J, Stehlik J, Kemeyou L, Smith T, Clardy SL. Cardiac Involvement in Neurosarcoidosis: A Single-Center Investigation. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200196. [PMID: 38181319 DOI: 10.1212/nxi.0000000000200196] [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] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/06/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND AND OBJECTIVES Sarcoidosis is a multisystem inflammatory granulomatous disease. Among systemic sarcoidosis manifestations, cardiac or nervous system involvement can result in significant morbidity and mortality. We describe the overlapping incidence of cardiac sarcoidosis (CS) within a neurosarcoidosis (NS) cohort and determine the frequency of other nonsarcoid cardiac diseases in these patients. METHODS We performed a retrospective chart review of patients evaluated at the University of Utah from 2010 to 2022. Patients were included if they had (1) at least one instance of a diagnostic code for sarcoidosis in their medical record-International Classification of Diseases (ICD) 9 code 135 or ICD 10 code D86; (2) at least one outpatient visit in the Neurology Department within the University of Utah electronic health record with a diagnosis of definite, probable, or possible NS based on 2018 consensus criteria; (3) at least one outpatient visit in the Cardiology Department within the University of Utah electronic health record; and (4) ECG available in their medical record for review. Of 64 definite, probable, or possible patients with NS in the University of Utah cohort, 52 met our inclusion criteria and were included in this study. RESULTS Of 52 patients with NS who met our inclusion criteria, 65.38% were female, with an average age of 60.9 years (range 38-84). More than half (58%) were obese (BMI ≥ 30). CS was diagnosed in 6 patients with NS (12%). Symptoms suggestive of possible cardiac dysfunction included lower extremity edema (50%), palpitations (46%), chest pain (44%), and shortness of breath (27%). ECG abnormalities included nonspecific T-wave change (40%) and right bundle branch block (17%). Three patients experienced ventricular tachycardia: sustained in one patient and nonsustained in 2 patients. Cardiac MRI was performed in 17 patients (32.7%) and in 3 patients (17.6%), which revealed diffuse myocardial enhancement suggesting CS. DISCUSSION In this cohort, 12% of patients with NS also had confirmed CS. In addition, these patients had a high burden of cardiovascular disease not directly attributed to sarcoidosis. Our data suggest that patients with NS require comprehensive cardiac evaluation. Future studies are needed to clarify the extent of the direct contribution of granulomatous inflammation on the cardiovascular system from the indirect contribution of treatments such as glucocorticoids that lead to increased risk of cardiovascular disease in sarcoidosis.
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Affiliation(s)
- Sama Noroozi Gilandehi
- From the Department of Neurology (S.N.G., K.-H.W., T.F., M.A.W., J.L., T.S., S.L.C.); Division of Cardiovascular Medicine (J.S., L.K.), Department of Internal Medicine, University of Utah; Department of Neurology (J.S., L.K., T.S., S.L.C.); Geriatric Research Education and Clinical Center (T.S.), George E. Whalen Department of Veterans Affairs Medical Center; and Department of Pathology (T.S.), University of Utah, Salt Lake City
| | - Ka-Ho Wong
- From the Department of Neurology (S.N.G., K.-H.W., T.F., M.A.W., J.L., T.S., S.L.C.); Division of Cardiovascular Medicine (J.S., L.K.), Department of Internal Medicine, University of Utah; Department of Neurology (J.S., L.K., T.S., S.L.C.); Geriatric Research Education and Clinical Center (T.S.), George E. Whalen Department of Veterans Affairs Medical Center; and Department of Pathology (T.S.), University of Utah, Salt Lake City
| | - Trieste Francis
- From the Department of Neurology (S.N.G., K.-H.W., T.F., M.A.W., J.L., T.S., S.L.C.); Division of Cardiovascular Medicine (J.S., L.K.), Department of Internal Medicine, University of Utah; Department of Neurology (J.S., L.K., T.S., S.L.C.); Geriatric Research Education and Clinical Center (T.S.), George E. Whalen Department of Veterans Affairs Medical Center; and Department of Pathology (T.S.), University of Utah, Salt Lake City
| | - Melissa A Wright
- From the Department of Neurology (S.N.G., K.-H.W., T.F., M.A.W., J.L., T.S., S.L.C.); Division of Cardiovascular Medicine (J.S., L.K.), Department of Internal Medicine, University of Utah; Department of Neurology (J.S., L.K., T.S., S.L.C.); Geriatric Research Education and Clinical Center (T.S.), George E. Whalen Department of Veterans Affairs Medical Center; and Department of Pathology (T.S.), University of Utah, Salt Lake City
| | - Jennifer Lord
- From the Department of Neurology (S.N.G., K.-H.W., T.F., M.A.W., J.L., T.S., S.L.C.); Division of Cardiovascular Medicine (J.S., L.K.), Department of Internal Medicine, University of Utah; Department of Neurology (J.S., L.K., T.S., S.L.C.); Geriatric Research Education and Clinical Center (T.S.), George E. Whalen Department of Veterans Affairs Medical Center; and Department of Pathology (T.S.), University of Utah, Salt Lake City
| | - Josef Stehlik
- From the Department of Neurology (S.N.G., K.-H.W., T.F., M.A.W., J.L., T.S., S.L.C.); Division of Cardiovascular Medicine (J.S., L.K.), Department of Internal Medicine, University of Utah; Department of Neurology (J.S., L.K., T.S., S.L.C.); Geriatric Research Education and Clinical Center (T.S.), George E. Whalen Department of Veterans Affairs Medical Center; and Department of Pathology (T.S.), University of Utah, Salt Lake City
| | - Line Kemeyou
- From the Department of Neurology (S.N.G., K.-H.W., T.F., M.A.W., J.L., T.S., S.L.C.); Division of Cardiovascular Medicine (J.S., L.K.), Department of Internal Medicine, University of Utah; Department of Neurology (J.S., L.K., T.S., S.L.C.); Geriatric Research Education and Clinical Center (T.S.), George E. Whalen Department of Veterans Affairs Medical Center; and Department of Pathology (T.S.), University of Utah, Salt Lake City
| | - Tammy Smith
- From the Department of Neurology (S.N.G., K.-H.W., T.F., M.A.W., J.L., T.S., S.L.C.); Division of Cardiovascular Medicine (J.S., L.K.), Department of Internal Medicine, University of Utah; Department of Neurology (J.S., L.K., T.S., S.L.C.); Geriatric Research Education and Clinical Center (T.S.), George E. Whalen Department of Veterans Affairs Medical Center; and Department of Pathology (T.S.), University of Utah, Salt Lake City
| | - Stacey L Clardy
- From the Department of Neurology (S.N.G., K.-H.W., T.F., M.A.W., J.L., T.S., S.L.C.); Division of Cardiovascular Medicine (J.S., L.K.), Department of Internal Medicine, University of Utah; Department of Neurology (J.S., L.K., T.S., S.L.C.); Geriatric Research Education and Clinical Center (T.S.), George E. Whalen Department of Veterans Affairs Medical Center; and Department of Pathology (T.S.), University of Utah, Salt Lake City
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11
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Taleb I, Kyriakopoulos CP, Fong R, Ijaz N, Demertzis Z, Sideris K, Wever-Pinzon O, Koliopoulou AG, Bonios MJ, Shad R, Peruri A, Hanff TC, Dranow E, Giannouchos TV, Krauspe E, Zakka C, Tang DG, Nemeh HW, Stehlik J, Fang JC, Selzman CH, Alharethi R, Caine WT, Cowger JA, Hiesinger W, Shah P, Drakos SG. Machine Learning Multicenter Risk Model to Predict Right Ventricular Failure After Mechanical Circulatory Support: The STOP-RVF Score. JAMA Cardiol 2024; 9:272-282. [PMID: 38294795 PMCID: PMC10831631 DOI: 10.1001/jamacardio.2023.5372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 11/28/2023] [Indexed: 02/01/2024]
Abstract
Importance The existing models predicting right ventricular failure (RVF) after durable left ventricular assist device (LVAD) support might be limited, partly due to lack of external validation, marginal predictive power, and absence of intraoperative characteristics. Objective To derive and validate a risk model to predict RVF after LVAD implantation. Design, Setting, and Participants This was a hybrid prospective-retrospective multicenter cohort study conducted from April 2008 to July 2019 of patients with advanced heart failure (HF) requiring continuous-flow LVAD. The derivation cohort included patients enrolled at 5 institutions. The external validation cohort included patients enrolled at a sixth institution within the same period. Study data were analyzed October 2022 to August 2023. Exposures Study participants underwent chronic continuous-flow LVAD support. Main Outcome and Measures The primary outcome was RVF incidence, defined as the need for RV assist device or intravenous inotropes for greater than 14 days. Bootstrap imputation and adaptive least absolute shrinkage and selection operator variable selection techniques were used to derive a predictive model. An RVF risk calculator (STOP-RVF) was then developed and subsequently externally validated, which can provide personalized quantification of the risk for LVAD candidates. Its predictive accuracy was compared with previously published RVF scores. Results The derivation cohort included 798 patients (mean [SE] age, 56.1 [13.2] years; 668 male [83.7%]). The external validation cohort included 327 patients. RVF developed in 193 of 798 patients (24.2%) in the derivation cohort and 107 of 327 patients (32.7%) in the validation cohort. Preimplant variables associated with postoperative RVF included nonischemic cardiomyopathy, intra-aortic balloon pump, microaxial percutaneous left ventricular assist device/venoarterial extracorporeal membrane oxygenation, LVAD configuration, Interagency Registry for Mechanically Assisted Circulatory Support profiles 1 to 2, right atrial/pulmonary capillary wedge pressure ratio, use of angiotensin-converting enzyme inhibitors, platelet count, and serum sodium, albumin, and creatinine levels. Inclusion of intraoperative characteristics did not improve model performance. The calculator achieved a C statistic of 0.75 (95% CI, 0.71-0.79) in the derivation cohort and 0.73 (95% CI, 0.67-0.80) in the validation cohort. Cumulative survival was higher in patients composing the low-risk group (estimated <20% RVF risk) compared with those in the higher-risk groups. The STOP-RVF risk calculator exhibited a significantly better performance than commonly used risk scores proposed by Kormos et al (C statistic, 0.58; 95% CI, 0.53-0.63) and Drakos et al (C statistic, 0.62; 95% CI, 0.57-0.67). Conclusions and Relevance Implementing routine clinical data, this multicenter cohort study derived and validated the STOP-RVF calculator as a personalized risk assessment tool for the prediction of RVF and RVF-associated all-cause mortality.
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Affiliation(s)
- Iosif Taleb
- U.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant Program: University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Christos P. Kyriakopoulos
- U.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant Program: University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Robyn Fong
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Naila Ijaz
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart & Vascular Institute, Falls Church, Virginia
| | | | - Konstantinos Sideris
- U.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant Program: University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Omar Wever-Pinzon
- U.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant Program: University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Antigone G. Koliopoulou
- U.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant Program: University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
- Onassis Cardiac Surgery Center, Athens, Greece
| | - Michael J. Bonios
- U.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant Program: University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
- Onassis Cardiac Surgery Center, Athens, Greece
| | - Rohan Shad
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia
| | | | - Thomas C. Hanff
- U.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant Program: University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Elizabeth Dranow
- U.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant Program: University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Theodoros V. Giannouchos
- U.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant Program: University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
- Department of Health Policy and Organization, School of Public Health, The University of Alabama at Birmingham, Birmingham
| | - Ethan Krauspe
- U.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant Program: University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Cyril Zakka
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Daniel G. Tang
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart & Vascular Institute, Falls Church, Virginia
| | | | - Josef Stehlik
- U.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant Program: University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - James C. Fang
- U.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant Program: University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Craig H. Selzman
- U.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant Program: University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Rami Alharethi
- U.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant Program: University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - William T. Caine
- U.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant Program: University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | | | - William Hiesinger
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Palak Shah
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart & Vascular Institute, Falls Church, Virginia
| | - Stavros G. Drakos
- U.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant Program: University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
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Foroutan F, Guyatt G, Stehlik J, Gustafsson F, Greig D, McDonald M, Bertolotti AM, Kugathasan L, Rayner DG, Cuello CA, Cook A, Zlatanoski D, Ram S, Demas-Clarke P, Kozuszko S, Alba AC. Use of induction therapy post-heart transplantation: Clinical practice recommendations based on systematic review and network meta-analysis of evidence. Clin Transplant 2024; 38:e15270. [PMID: 38445536 DOI: 10.1111/ctr.15270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/03/2024] [Accepted: 02/09/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND The use of induction therapy (IT) agents in the early post-heart transplant period remains controversial. The following recommendations aim to provide guidance on the use of IT agents, including Basiliximab and Thymoglobulin, as part of routine care in heart transplantation (HTx). METHODS We recruited an international, multidisciplinary panel of 15 stakeholders, including patient partners, transplant cardiologists and surgeons, nurse practitioners, pharmacists, and methodologists. We commissioned a systematic review on benefits and harms of IT on patient-important outcomes, and another on patients' values and preferences to inform our recommendations. We used the GRADE framework to summarize our findings, rate certainty in the evidence, and develop recommendations. The panel considered the balance between benefits and harms, certainty in the evidence, and patient's values and preferences, to make recommendations for or against the routine post-operative use of Thymoglobulin or Basiliximab. RESULTS The panel made recommendations on three major clinical problems in HTx: (1) We suggest against the routine post-operative use of Basiliximab compared to no IT, (2) we suggest against the routine use of Thymoglobulin compared to no IT, and (3) for those patients for whom IT is deemed desirable, we suggest for the use of Thymoglobulin as compared to Basiliximab. CONCLUSION This report highlights gaps in current knowledge and provides directions for clinical research in the future to better understand the clinical utility of IT agents in the early post heart transplant period, leading to improved management and care.
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Affiliation(s)
- Farid Foroutan
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster, Hamilton, Ontario, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster, Hamilton, Ontario, Canada
| | - Josef Stehlik
- Department of Medicine, Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Finn Gustafsson
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - Douglas Greig
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Michael McDonald
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | | | - Lakshmi Kugathasan
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | - Daniel G Rayner
- Department of Health Research Methods, Evidence, and Impact, McMaster, Hamilton, Ontario, Canada
| | - Carlos A Cuello
- Department of Health Research Methods, Evidence, and Impact, McMaster, Hamilton, Ontario, Canada
| | - Amanda Cook
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | - Darko Zlatanoski
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | - Sujivan Ram
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | | | - Stella Kozuszko
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | - Ana Carolina Alba
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
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13
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Kim IC, Kim SH, Youn JC, Kim D, Lee S, Kim H, Kim JJ, Jung MH, Rossano JW, Cherikh WS, Kobashigawa JA, Stehlik J. Temporal Trends, Risk Factors, and Clinical Outcomes of De Novo Lymphoproliferative Disorders After Heart Transplantation. JACC Heart Fail 2024; 12:395-405. [PMID: 38326002 DOI: 10.1016/j.jchf.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/02/2023] [Accepted: 10/17/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Post-transplant lymphoproliferative disorder (PTLD) is an important cause of morbidity and mortality in heart transplant (HTx) recipients. However, previous studies of PTLD after HTx are limited to single-center analyses or extrapolated from all solid organ transplantations. OBJECTIVES The authors analyzed the temporal trends, risk factors, and clinical outcome of de novo PTLD specifically after HTx. METHODS Using multi-institutional, multinational data from the International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, the authors evaluated the real-world data of PTLD after HTx, transplanted between January 2000 and June 2015. Multivariable analysis was done to identify risk factors for PTLD development after HTx. RESULTS Among 28,136 HTx recipients, 1,069 (3.8%) developed PTLD within 10 years of transplantation. PTLD showed a bimodal age pattern with peak incidence in patients of pediatric age and late adulthood at transplantation. The early transplant era (2000-2007 vs 2008-2015), male recipient, and EBV donor-positive-recipient-negative match were independent risk factors of PTLD development within 3 years of transplantation, whereas maintenance therapy with cyclosporine vs tacrolimus at initial discharge was associated with a lower incidence. PTLD development within 3 years of transplantation was significantly associated with mortality (HR: 2.42 [95% CI: 2.01-2.91]; P < 0.001). Survival after PTLD diagnosis was higher in the recent transplant era. CONCLUSIONS PTLD is relatively rare, but potentially fatal, post-transplant malignancy. PTLD incidence and mortality after HTx have decreased in the recent era. Strategies to minimize the risk of PTLD, and ensure early diagnosis and effective treatment are likely to improve outcomes in HTx.
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Affiliation(s)
- In-Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Sang Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seonhwa Lee
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Jin-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joseph W Rossano
- The Cardiac Center, The Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wida S Cherikh
- United Network for Organ Sharing, Richmond, Virginia, USA; ISHLT Transplant Registry, Dallas, Texas, USA
| | - Jon A Kobashigawa
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Josef Stehlik
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
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14
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Allen LA, Thompson JS, Stehlik J. STRONG-HF Evidence for Proactive, Patient-Centered Prescribing. JAMA Cardiol 2024; 9:103-104. [PMID: 38150243 DOI: 10.1001/jamacardio.2023.4565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Affiliation(s)
- Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora
| | - Jocelyn S Thompson
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora
| | - Josef Stehlik
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
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15
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Wohlfahrt P, Jenča D, Melenovský V, Stehlik J, Spertus JA, Mrázková J, Šramko M, Kotrč M, Želízko M, Adámková V, Piťha J, Kautzner J. Remote Heart Failure Symptoms Assessment After Myocardial Infarction Identifies Patients at Risk for Death. J Am Heart Assoc 2024; 13:e032505. [PMID: 38193321 PMCID: PMC10926820 DOI: 10.1161/jaha.123.032505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/03/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Heart failure is a common complication after myocardial infarction (MI) and is associated with increased mortality. Whether remote heart failure symptoms assessment after MI can improve risk stratification is unknown. The authors evaluated the association of the 23-item Kansas City Cardiomyopathy Questionnaire (KCCQ) with all-cause mortality after MI. METHODS AND RESULTS Prospectively collected data from consecutive patients hospitalized for MI at a large tertiary heart center between June 2017 and September 2022 were used. Patients remotely completed the KCCQ 1 month after discharge. A total of 1135 (aged 64±12 years, 26.7% women) of 1721 eligible patients completed the KCCQ. Ranges of KCCQ scores revealed that 30 (2.6%), 114 (10.0%), 274 (24.1%), and 717 (63.2%) had scores <25, 25 to 49, 50 to 74, and ≥75, respectively. During a mean follow-up of 46 months (interquartile range, 29-61), 146 (12.9%) died. In a fully adjusted analysis, KCCQ scores <50 were independently associated with mortality (hazard ratio [HR], 6.05 for KCCQ <25, HR, 2.66 for KCCQ 25-49 versus KCCQ ≥50; both P<0.001). Adding the 30-day KCCQ to clinical risk factors improved risk stratification: change in area under the curve of 2.6 (95% CI, 0.3-5.0), Brier score of -0.6 (95% CI, -1.0 to -0.2), and net reclassification improvement of 0.71 (95% CI, 0.45-1.04). KCCQ items most strongly associated with mortality were walking impairment, leg swelling, and change in symptoms. CONCLUSIONS Remote evaluation of heart failure symptoms using the KCCQ among patients recently discharged for MI identifies patients at risk for mortality. Whether closer follow-up and targeted therapy can reduce mortality in high-risk patients warrants further study.
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Affiliation(s)
- Peter Wohlfahrt
- Department of Preventive CardiologyInstitute for Clinical and Experimental MedicinePragueCzech Republic
- First Medical SchoolCharles UniversityPragueCzech Republic
| | - Dominik Jenča
- Department of CardiologyInstitute for Clinical and Experimental Medicine (IKEM)PragueCzech Republic
- Third Medical School, Charles UniversityPragueCzech Republic
| | - Vojtěch Melenovský
- Department of CardiologyInstitute for Clinical and Experimental Medicine (IKEM)PragueCzech Republic
| | - Josef Stehlik
- University of Utah School of MedicineSalt Lake CityUTUSA
| | - John A. Spertus
- University of Missouri Kansas City’s Healthcare Institute for Innovations in Quality and Saint Luke’s Mid America Heart InstituteKansas CityMOUSA
| | - Jolana Mrázková
- Experimental Medicine CentreInstitute for Clinical and Experimental Medicine (IKEM)PragueCzech Republic
| | - Marek Šramko
- First Medical SchoolCharles UniversityPragueCzech Republic
- Department of CardiologyInstitute for Clinical and Experimental Medicine (IKEM)PragueCzech Republic
| | - Martin Kotrč
- Department of CardiologyInstitute for Clinical and Experimental Medicine (IKEM)PragueCzech Republic
| | - Michael Želízko
- Department of CardiologyInstitute for Clinical and Experimental Medicine (IKEM)PragueCzech Republic
| | - Věra Adámková
- Department of Preventive CardiologyInstitute for Clinical and Experimental MedicinePragueCzech Republic
| | - Jan Piťha
- Department of CardiologyInstitute for Clinical and Experimental Medicine (IKEM)PragueCzech Republic
| | - Josef Kautzner
- Department of CardiologyInstitute for Clinical and Experimental Medicine (IKEM)PragueCzech Republic
- Medical and Dentistry SchoolPalacký UniversityOlomoucCzech Republic
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16
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Grady KL, Kallen MA, Beiser DG, Lindenfeld J, Teuteberg J, Allen LA, McIlvennan CK, Rich J, Yancy C, Lee CS, Denfeld QE, Kiernan M, Walsh MN, Adler E, Ruo B, Stehlik J, Kirklin JK, Bedjeti K, Cella D, Hahn EA. Novel measures to assess ventricular assist device patient-reported outcomes: Findings from the MCS A-QOL study. J Heart Lung Transplant 2024; 43:36-50. [PMID: 37591454 PMCID: PMC10867283 DOI: 10.1016/j.healun.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/24/2023] [Accepted: 08/09/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Generic and heart failure-specific measures do not capture unique aspects of living with a ventricular assist device (VAD). Using state-of-the-science psychometric measurement methods, we developed a measurement system to assess post-ventricular assist device adjustment and health-related quality of life (HRQOL). METHODS Patients were recruited from 10/26/16-2/29/20 from 12 U.S. VAD programs. We created a dataset of participants (n = 620) enrolled before left (L)VAD implantation, with data at 3- or 6- months post-implantation (group1 [n = 154]), and participants enrolled after LVAD implantation, with data at one timepoint (group 2 [n = 466]). We constructed 5 item banks: 3 modified from existing measures and 2 new measures. Analyses included item response theory (IRT) modeling, differential item functioning tests for systematic measurement bias, and indicators of reliability and validity. RESULTS Of 620 participants, 56% (n = 345) were implanted as destination therapy, 51% (n = 316) were <12 months post-implantation, mean age = 57.3 years, 78% (n = 485) male, 70% (n = 433) White, 58% (n = 353) married/partnered, and 58% (n = 357) with >high school education. We developed 5 new VAD item banks/measures: 6-item VAD Team Communication; 12-item Self-efficacy Regarding VAD Self-care; 11-item Being Bothered by VAD Self-care and Limitations; 7-item Satisfaction with Treatment; and 11-item Stigma. Cronbach's alpha reliability ranged from good (≥0.80) to excellent (≥0.90) for item banks/measures. All measures, except VAD Team Communication, demonstrated at least moderate correlations (≥0.30) with construct validity indicators. CONCLUSIONS These measures meet IRT modeling assumptions and requirements; scores demonstrate reliability and validity. Use of these measures may assist VAD clinicians to inform patients about VADs as a treatment option and guide post-VAD interventions.
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Affiliation(s)
- Kathleen L Grady
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
| | - Michael A Kallen
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - David G Beiser
- Section of Emergency Medicine, University of Chicago, Chicago, Illinois
| | - JoAnn Lindenfeld
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | | | - Larry A Allen
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Colleen K McIlvennan
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Jonathan Rich
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Clyde Yancy
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | | | - Quin E Denfeld
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Michael Kiernan
- Department of Medicine, Tufts University, Boston, Massachusetts
| | | | - Eric Adler
- Department of Medicine, University of California-San Diego, La Jolla, California
| | - Bernice Ruo
- Department of Medicine, University of California-San Diego, La Jolla, California
| | - Josef Stehlik
- Department of Medicine, University of Utah, Salt Lake City, Utah
| | | | - Katy Bedjeti
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Dave Cella
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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17
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Kang Y, Stoddard G, Stehlik J, Stephens C, Facelli J, Gouripeddi R, Horne BD. Developing 60-Day Readmission Risk Score among Home Healthcare Patients with Heart Failure. Home Healthc Now 2024; 42:42-51. [PMID: 38190163 DOI: 10.1097/nhh.0000000000001226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Heart failure (HF) readmissions are common, costly, and often preventable. Despite the implementation of HF programs across clinical settings, rehospitalization is still common. Efforts to identify risk factors for 60-day rehospitalization among HF patients exist, but risk scoring has not been utilized in home healthcare. The purpose of this study was to develop a 60-day rehospitalization risk score for home care patients with HF. This study is a secondary data analysis of a retrospective cross-sectional dataset that was composed of data using the Outcome Assessment Information Set (OASIS)-C version for patients with HF. We computed the Charlson Comorbidity Index (CCI) to use as a confounder. The risk score was computed from the final logistic regression model regression coefficients. The median age was 78 years old, 45.4% were male, and 81.0% were White. We identified 10 significant risk factors including CCI score. The risk score achieved a c-statistic of 0.70 in this patient sample. This risk score could prove useful in clinical practice for guiding attention and decision-making for personalized care of patients with unrecognized or under-treated health needs.
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18
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DiChiacchio L, Goodwin ML, Kagawa H, Griffiths E, Nickel IC, Stehlik J, Selzman CH. Heart Transplant and Donors After Circulatory Death: A Clinical-Preclinical Systematic Review. J Surg Res 2023; 292:222-233. [PMID: 37657140 DOI: 10.1016/j.jss.2023.07.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 07/04/2023] [Accepted: 07/12/2023] [Indexed: 09/03/2023]
Abstract
INTRODUCTION Heart transplantation is the treatment of choice for end-stage heart failure. There is a mismatch between the number of donor hearts available and the number of patients awaiting transplantation. Expanding the donor pool is critically important. The use of hearts donated following circulatory death is one approach to increasing the number of available donor hearts. MATERIALS AND METHODS A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines utilizing Pubmed/MEDLINE and Embase. Articles including adult human studies and preclinical animal studies of heart transplantation following donation after circulatory death were included. Studies of pediatric populations or including organs other than heart were excluded. RESULTS Clinical experience and preclinical studies are reviewed. Clinical experience with direct procurement, normothermic regional perfusion, and machine perfusion are included. Preclinical studies addressing organ function assessment and enhancement of performance of marginal organs through preischemic, procurement, preservation, and reperfusion maneuvers are included. Articles addressing the ethical considerations of thoracic transplantation following circulatory death are also reviewed. CONCLUSIONS Heart transplantation utilizing organs procured following circulatory death is a promising method to increase the donor pool and offer life-saving transplantation to patients on the waitlist living with end-stage heart failure. There is robust ongoing preclinical and clinical research to optimize this technique and improve organ yield. There are also ongoing ethical considerations that must be addressed by consensus before wide adoption of this approach.
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Affiliation(s)
- Laura DiChiacchio
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Matthew L Goodwin
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Hiroshi Kagawa
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Eric Griffiths
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Ian C Nickel
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Josef Stehlik
- Division of Cardiology, University of Utah, Salt Lake City, Utah
| | - Craig H Selzman
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah.
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19
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Alba AC, Kirklin JK, Cantor RS, Deng L, Ross HJ, Jacobs JP, Rao V, Hanff TC, Stehlik J. The impact of obesity and LVAD-bridging on heart transplant candidate outcomes: a linked STS INTERMACS - OPTN/UNOS data analysis. J Heart Lung Transplant 2023; 42:1587-1596. [PMID: 37385418 PMCID: PMC10640766 DOI: 10.1016/j.healun.2023.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/17/2023] [Accepted: 06/04/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Limited data integrating waitlist and postheart transplant (HT) mortality have evaluated outcomes of left ventricular assist device (LVAD)-bridged strategy vs no LVAD according to patient characteristics. We evaluated waitlist and post-HT mortality in LVAD-bridged vs nonbridged patients based on body mass index (BMI). METHODS We included linked adults listed for HT in Organ Procurement and Transplant Network/United Network for Organ Sharing and patients receiving durable LVAD as bridge to HT or candidacy in Society of Thoracic Surgeons/Interagency Mechanical Circulatory Support databases (2010-2019). Using BMI at listing or LVAD implant, we categorized patients as underweight (<18.5 kg/m2), normal weight (18.5-24.99 kg/m2), overweight (25-29.99 kg/m2), and obese (≥30 kg/m2). Kaplan-Meier analysis and multivariable Cox proportional hazards models informed the effect of LVAD-bridged and nonbridged strategy by BMI on waitlist, post-HT, and overall mortality (including waitlist and post-HT mortality). RESULTS Among 11,216 LVAD-bridged and 17,122 nonbridged candidates, bridged candidates were more frequently obese (37.3% vs 28.6%) (p < 0.001). Multivariable analysis indicated increased waitlist mortality in LVAD-bridged vs nonbridged with overweight (Hazard ratio (HR) 1.18, 95% confidence interval (CI) 1.02-1.36) or obesity (HR 1.35, 95%CI 1.17-1.56) in comparison to normal weight candidates (HR 1.02, 95%CI 0.88-1.19) (p-interaction < 0.001). Post-transplant mortality was not statistically different in LVAD-bridged vs nonbridged patients across BMI categories (p-interaction = 0.26). There was a nonsignificant graded increase in overall mortality in LVAD-bridged with overweight (HR 1.53, 95%CI 1.39-1.68) or obesity (HR 1.61, 95%CI 1.46-1.78) compared to nonbridged patients (p-interaction = 0.13). CONCLUSIONS LVAD-bridged candidates with obesity had higher waitlist mortality compared to nonbridged candidates with obesity. Post-transplant mortality was similar in LVAD-bridged and nonbridged patients, but obesity remained associated with increased mortality in both groups. This study may aid clinicians and advanced heart failure patients with obesity in decision-making.
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Affiliation(s)
- Ana C Alba
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.
| | | | - Ryan S Cantor
- University of Alabama at Birmingham, Birmingham, Washington
| | - Luqin Deng
- University of Alabama at Birmingham, Birmingham, Washington
| | - Heather J Ross
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada
| | | | - Vivek Rao
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada
| | - Thomas C Hanff
- University of Utah School of Medicine, Salt Lake City, Utah
| | - Josef Stehlik
- University of Utah School of Medicine, Salt Lake City, Utah
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20
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Kagawa H, Goodwin M, Stehlik J, Campsen J, Baker T, Selzman CH. A Case Report of Triple Organ Transplantation From a Donor After Circulatory Death Using Thoraco-Abdominal Normothermic Regional Perfusion. Transplant Proc 2023; 55:1883-1887. [PMID: 37612153 DOI: 10.1016/j.transproceed.2023.07.015] [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] [Received: 05/15/2023] [Accepted: 07/31/2023] [Indexed: 08/25/2023]
Abstract
Organ transplantation with donation after circulatory death can potentially increase the donor pool. Here, we report the rare case of triple-organ (heart/liver/kidney) transplantation from a donor after circulatory death using thoraco-abdominal normothermic regional perfusion. The recipient was a 61-year-old man with end-stage heart failure, liver failure, and kidney failure secondary to arrhythmogenic right ventricular dysplasia. He received a heart/liver/kidney transplantation from a donor after circulatory death. The course was complicated with primary graft dysfunction of the heart that resolved on postoperative day 3. The patient was discharged on postoperative day 39. He has no evidence for rejection on heart biopsy, and all 3 organs exhibit stable function. The use of donation after cardiac death donors greatly increases the donor pool and should be considered for patients requiring multiorgan transplantation. The use of thoraco-abdominal normothermic reperfusion is not only a feasible method for multiorgan procurement but also provides enhanced protection for all transplanted organs.
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Affiliation(s)
- Hiroshi Kagawa
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Matthew Goodwin
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Josef Stehlik
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jeffrey Campsen
- Division of Transplantation and Advanced Hepatobiliary Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Talia Baker
- Division of Transplantation and Advanced Hepatobiliary Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Craig H Selzman
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
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21
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Bozkurt B, Ahmad T, Alexander KM, Baker WL, Bosak K, Breathett K, Fonarow GC, Heidenreich P, Ho JE, Hsich E, Ibrahim NE, Jones LM, Khan SS, Khazanie P, Koelling T, Krumholz HM, Khush KK, Lee C, Morris AA, Page RL, Pandey A, Piano MR, Stehlik J, Stevenson LW, Teerlink JR, Vaduganathan M, Ziaeian B. Heart Failure Epidemiology and Outcomes Statistics: A Report of the Heart Failure Society of America. J Card Fail 2023; 29:1412-1451. [PMID: 37797885 PMCID: PMC10864030 DOI: 10.1016/j.cardfail.2023.07.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Affiliation(s)
- Biykem Bozkurt
- Winters Center for Heart Failure, Cardiology, Baylor College of Medicine, Houston, Texas.
| | - Tariq Ahmad
- Heart Failure Program Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Kevin M Alexander
- Cardiovascular Medicine, Stanford University, Stanford University School of Medicine, Stanford, California
| | | | - Kelly Bosak
- KU Medical Center, School Of Nursing, Kansas City, Kansas
| | - Khadijah Breathett
- Division of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Gregg C Fonarow
- Division of Cardiology, University of California Los Angeles, Los Angeles, California
| | - Paul Heidenreich
- Cardiovascular Medicine, Stanford University, Stanford University School of Medicine, Stanford, California
| | - Jennifer E Ho
- Advanced Heart Failure and Transplant Cardiology, Beth Israel Deaconess, Boston, Massachusetts
| | - Eileen Hsich
- Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Nasrien E Ibrahim
- Advanced Heart Failure and Transplant, Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Lenette M Jones
- Department of Health Behavior and Biological Sciences, University of Michigan, School of Nursing, Ann Arbor, Michigan
| | - Sadiya S Khan
- Northwestern University, Cardiology Feinberg School of Medicine, Chicago, Illinois
| | - Prateeti Khazanie
- Advanced Heart Failure and Transplant Cardiology, UC Health, Aurora, Colorado
| | - Todd Koelling
- Frankel Cardiovascular Center. University of Michigan, Ann Arbor, Michigan
| | - Harlan M Krumholz
- Heart Failure Program Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Kiran K Khush
- Cardiovascular Medicine, Stanford University, Stanford University School of Medicine, Stanford, California
| | - Christopher Lee
- Boston College William F. Connell School of Nursing, Boston, Massachusetts
| | - Alanna A Morris
- Division of Cardiology, Emory School of Medicine, Atlanta, Georgia
| | - Robert L Page
- Departments of Clinical Pharmacy and Physical Medicine, University of Colorado, Aurora, Colorado
| | - Ambarish Pandey
- Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas
| | | | - Josef Stehlik
- Advanced Heart Failure Section, Cardiology, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - John R Teerlink
- Cardiology University of California San Francisco (UCSF), San Francisco, California
| | - Muthiah Vaduganathan
- Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Boback Ziaeian
- Division of Cardiology, University of California Los Angeles, Los Angeles, California
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22
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Singh TP, Cherikh WS, Hsich E, Lewis A, Perch M, Kian S, Hayes D, Potena L, Stehlik J, Zuckermann A, Cogswell R. Graft survival in primary thoracic organ transplant recipients: A special report from the International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2023; 42:1321-1333. [PMID: 37549773 PMCID: PMC10901564 DOI: 10.1016/j.healun.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023] Open
Affiliation(s)
- Tajinder P Singh
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Wida S Cherikh
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Eileen Hsich
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Alexandra Lewis
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Michael Perch
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Shaina Kian
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Don Hayes
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Luciano Potena
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Josef Stehlik
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Andreas Zuckermann
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Rebecca Cogswell
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois..
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23
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Hahn EA, Allen LA, Lee CS, Denfeld QE, Stehlik J, Cella D, Lindenfeld J, Teuteberg JJ, McIlvennan CK, Kiernan MS, Beiser DG, Walsh MN, Adler ED, Ruo B, Kirklin JK, Klein L, Bedjeti K, Cummings PD, Burns JL, Vela AM, Grady KL. PROMIS: Physical, Mental and Social Health Outcomes Improve From Before to Early After LVAD Implant: Findings From the Mechanical Circulatory Support: Measures of Adjustment and Quality of Life (MCS A-QOL) Study. J Card Fail 2023; 29:1398-1411. [PMID: 37004864 PMCID: PMC10544687 DOI: 10.1016/j.cardfail.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/28/2023] [Accepted: 03/15/2023] [Indexed: 04/03/2023]
Abstract
Study participants (n = 272) completed 12 Patient-Reported Outcomes Measurement Information System (PROMIS) physical, mental and social health measures (questionnaires) prior to implantation of a left ventricular assist device (LVAD) and again at 3 and 6 months postimplant. All but 1 PROMIS measure demonstrated significant improvement from pre-implant to 3 months; there was little change between 3 and 6 months. Because PROMIS measures were developed in the general population, patients with an LVAD, their caregivers and their clinicians can interpret the meaning of PROMIS scores in relation to the general population, helping them to monitor a return to normalcy in everyday life.
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Affiliation(s)
- Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Larry A Allen
- Department of Cardiology, University of Colorado, Aurora, CO
| | - Christopher S Lee
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA
| | - Quin E Denfeld
- Oregon Health & Science University School of Nursing, Portland, OR
| | - Josef Stehlik
- Department of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | - David G Beiser
- Department of Medicine, University of Chicago, Chicago, IL
| | - Mary N Walsh
- Ascension St. Vincent Heart Center, Indianapolis, IN
| | - Eric D Adler
- Department of Medicine, University of California, San Diego, CA
| | - Bernice Ruo
- Department of Medicine, University of California, San Diego, CA
| | - James K Kirklin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Liviu Klein
- Department of Medicine, University of California, San Francisco, CA
| | - Katy Bedjeti
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Peter D Cummings
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - James L Burns
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alyssa M Vela
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kathleen L Grady
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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Kilic A, Kwon JH, Grady KL, Singletary BA, Kilic A, Everitt M, Cleveland J, Cantor RS, Blackmon S, Breathett K, McKellar S, Keebler M, Kirklin JK, Stehlik J. Impact of adverse events on health-related quality of life after left ventricular assist device implantation: An STS INTERMACS analysis. J Heart Lung Transplant 2023; 42:1214-1222. [PMID: 37040860 DOI: 10.1016/j.healun.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 03/09/2023] [Accepted: 04/03/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND We sought to quantify the impact of pre- and postoperative variables on health-related quality of life (HRQOL) after left ventricular assist device (LVAD) implantation. METHODS Primary durable LVAD implants between 2012 and 2019 in the Interagency Registry for Mechanically Assisted Circulatory Support were identified. Multivariable modeling using general linear models assessed the impact of baseline characteristics and postimplant adverse events (AEs) on HRQOL as assessed by the EQ-5D visual analog scale (VAS) and the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ) at 6 months and 3 years. RESULTS Of 22,230 patients, 9,888 had VAS and 10,552 had KCCQ reported at 6 months, and 2,170 patients had VAS and 2,355 had KCCQ reported at 3 years postimplant. VAS improved from a mean of 38.2 ± 28.3 to 70.7 ± 22.9 at 6 months and from 40.1 ± 27.8 to 70.3 ± 23.1 at 3 years. KCCQ improved from 28.2 ± 23.9 to 64.3 ± 23.2 at 6 months and from 29.8 ± 23.7 to 63.0 ± 23.7 at 3 years. Preimplant variables, including baseline VAS, had small effect sizes on HRQOL while postimplant AEs had large negative effect sizes. Recent stroke, respiratory failure, and renal dysfunction had the largest negative effect on HRQOL at 6 months, while recent renal dysfunction, respiratory failure, and infection had the largest negative effect at 3 years. CONCLUSIONS AEs following LVAD implantation have large negative effects on HRQOL in early and late follow-up. Understanding the impact of AEs on HRQOL may assist shared decision-making regarding LVAD eligibility. Continued efforts to reduce post-LVAD AEs are warranted to improve HRQOL in addition to survival.
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Affiliation(s)
- Arman Kilic
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina.
| | - Jennie H Kwon
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Kathleen L Grady
- Departments of Surgery and Medicine. Northwestern University, Chicago, Illinois
| | - Brandon A Singletary
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ahmet Kilic
- Division of Cardiac Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Melanie Everitt
- Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - Joseph Cleveland
- Division of Cardiothoracic Surgery, University of Colorado, Aurora, Colorado
| | - Ryan S Cantor
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Shanda Blackmon
- Division of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana
| | - Stephen McKellar
- Division of Cardiovascular and Thoracic Surgery, Intermountain Medical Center, Murray, Utah
| | - Mary Keebler
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James K Kirklin
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Josef Stehlik
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
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Ródenas-Alesina E, Foroutan F, Fan CP, Stehlik J, Bartlett I, Tremblay-Gravel M, Aleksova N, Rao V, Miller RJH, Khush KK, Ross HJ, Moayedi Y. Predicted Heart Mass: A Tale of 2 Ventricles. Circ Heart Fail 2023; 16:e008311. [PMID: 37602381 DOI: 10.1161/circheartfailure.120.008311] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/07/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Total predicted heart mass (PHM) is the recommended metric to assess donor-recipient size matching in patients undergoing heart transplantation. Separately measuring right ventricular (RV) and left ventricular (LV) PHM may improve risk prediction of 1-year graft failure. METHODS Adult heart transplant recipients from the UNOS database from 2000 to 2018 were included in the study. LV and RV PHM were modeled as restricted cubic splines. The association with 1-year graft failure was determined using adjusted Cox regression. The risk reclassification of using both LV and RV PHM versus total PHM was assessed using the net reclassification index. RESULTS A total of 34 976 recipients were included. We observed a U-shaped association between total PHM and 1-year graft failure, such that risk increased for hearts undersized by >15% and those oversized by more than 27%. Graft failure incrementally increased when LV PHM was undersized by more than 5% and when RV was oversized by >20%. There was 1.5-fold greater risk of graft failure for an LV undersized by >26% or an RV oversized by more than 40%. Using LV and RV PHM risk-assessment separately led to a net reclassification index=8.5% ([95% CI, 5.3%-11.7%], nonevent net reclassification index=9.1%, event net reclassification index=-0.6%). CONCLUSIONS The association between donor-recipient PHM match and the risk of graft failure after heart transplantation can be further understood as risk attributable to LV undersizing and RV oversizing. Assessing LV and RV PHM separately instead of total PHM could further refine the methods used to match donors and recipients for heart transplantation, minimize the risk of 1-year graft failure, and increase the use of donor organs.
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Affiliation(s)
- Eduard Ródenas-Alesina
- Ted Rogers Centre for Heart Research (E.R.-A., I.B., N.A., H.J.R., Y.M.), Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Farid Foroutan
- Ted Rogers Computational Program (F.F., C.-P.S.F.), Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Chun-Po Fan
- Ted Rogers Computational Program (F.F., C.-P.S.F.), Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Josef Stehlik
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City (J.S.)
| | - Ina Bartlett
- Ted Rogers Centre for Heart Research (E.R.-A., I.B., N.A., H.J.R., Y.M.), Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | | | - Natasha Aleksova
- Ted Rogers Centre for Heart Research (E.R.-A., I.B., N.A., H.J.R., Y.M.), Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Vivek Rao
- Department of Cardiovascular Surgery, Cardiac Transplant, and Mechanical Circulatory Support, University Health Network, Toronto, ON, Canada (V.R.)
| | - Robert J H Miller
- Division of Cardiology, University of Calgary, AB, Canada (R.J.H.M.)
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, CA (K.K.K.)
| | - Heather J Ross
- Ted Rogers Centre for Heart Research (E.R.-A., I.B., N.A., H.J.R., Y.M.), Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Yasbanoo Moayedi
- Ted Rogers Centre for Heart Research (E.R.-A., I.B., N.A., H.J.R., Y.M.), Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
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Kyriakopoulos CP, Horne BD, Sideris K, Taleb I, Griffin RJ, Sheffield E, Alharethi R, Hanff TC, Stehlik J, Selzman CH, Drakos SG. Left ventricular functional improvement appears to contribute to lower rates of device thrombosis in patients on durable mechanical circulatory support. J Heart Lung Transplant 2023; 42:853-858. [PMID: 37086251 PMCID: PMC10293076 DOI: 10.1016/j.healun.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/23/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023] Open
Abstract
By unloading the failing heart, left ventricular (LV) assist devices (LVADs) provide a favorable environment for reversing adverse structural and functional cardiac changes. Prior reports have suggested that an improved native LV function might contribute to the development of LVAD thrombosis. We used the Interagency Registry for Mechanically Assisted Circulatory Support and found that LV functional improvement is associated with a lower risk for device thrombosis. The risk for cerebrovascular accident and transient ischemic attack was comparable across post-LVAD LV function subgroups, while the risk of hemolysis was lower in subgroups of patients with better LV function on LVAD support.
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Affiliation(s)
- Christos P Kyriakopoulos
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program & Utah Cardiac Recovery (UCAR) Program (University of Utah Health & School of Medicine, George E. Wahlen Department of Veterans Affairs Medical Center, Intermountain Medical Center), Salt Lake City, Utah; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah
| | - Benjamin D Horne
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program & Utah Cardiac Recovery (UCAR) Program (University of Utah Health & School of Medicine, George E. Wahlen Department of Veterans Affairs Medical Center, Intermountain Medical Center), Salt Lake City, Utah; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California
| | - Konstantinos Sideris
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program & Utah Cardiac Recovery (UCAR) Program (University of Utah Health & School of Medicine, George E. Wahlen Department of Veterans Affairs Medical Center, Intermountain Medical Center), Salt Lake City, Utah
| | - Iosif Taleb
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program & Utah Cardiac Recovery (UCAR) Program (University of Utah Health & School of Medicine, George E. Wahlen Department of Veterans Affairs Medical Center, Intermountain Medical Center), Salt Lake City, Utah; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah
| | - Rachel J Griffin
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program & Utah Cardiac Recovery (UCAR) Program (University of Utah Health & School of Medicine, George E. Wahlen Department of Veterans Affairs Medical Center, Intermountain Medical Center), Salt Lake City, Utah; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah
| | - Eric Sheffield
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program & Utah Cardiac Recovery (UCAR) Program (University of Utah Health & School of Medicine, George E. Wahlen Department of Veterans Affairs Medical Center, Intermountain Medical Center), Salt Lake City, Utah
| | - Rami Alharethi
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program & Utah Cardiac Recovery (UCAR) Program (University of Utah Health & School of Medicine, George E. Wahlen Department of Veterans Affairs Medical Center, Intermountain Medical Center), Salt Lake City, Utah
| | - Thomas C Hanff
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program & Utah Cardiac Recovery (UCAR) Program (University of Utah Health & School of Medicine, George E. Wahlen Department of Veterans Affairs Medical Center, Intermountain Medical Center), Salt Lake City, Utah
| | - Josef Stehlik
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program & Utah Cardiac Recovery (UCAR) Program (University of Utah Health & School of Medicine, George E. Wahlen Department of Veterans Affairs Medical Center, Intermountain Medical Center), Salt Lake City, Utah
| | - Craig H Selzman
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program & Utah Cardiac Recovery (UCAR) Program (University of Utah Health & School of Medicine, George E. Wahlen Department of Veterans Affairs Medical Center, Intermountain Medical Center), Salt Lake City, Utah; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah
| | - Stavros G Drakos
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program & Utah Cardiac Recovery (UCAR) Program (University of Utah Health & School of Medicine, George E. Wahlen Department of Veterans Affairs Medical Center, Intermountain Medical Center), Salt Lake City, Utah; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah.
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Moayedi Y, Rodenas-Alesina E, Mueller B, Fan CPS, Cherikh WS, Stehlik J, Teuteberg JJ, Ross HJ, Khush KK. Rethinking Donor and Recipient Risk Matching in Europe and North America: Using Heart Transplant Predictors of Donor and Recipient Risk. Circ Heart Fail 2023; 16:e009994. [PMID: 37192289 DOI: 10.1161/circheartfailure.122.009994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/23/2022] [Indexed: 05/18/2023]
Abstract
BACKGROUND In Europe, there is greater acceptance of hearts from higher-risk donors for transplantation, whereas in North America, the donor heart discard rate is significantly higher. A Donor Utilization Score (DUS) was used to compare European and North American donor characteristics for recipients included in the International Society for Heart and Lung Transplantation registry from 2000 to 2018. DUS was further evaluated as an independent predictor for 1-year freedom from graft failure, after adjusting for recipient risk. Lastly, we assessed donor-recipient risk matching with the outcome of 1-year graft failure. METHODS DUS was applied to the International Society for Heart and Lung Transplantation cohort using meta-modeling. Posttransplant freedom from graft failure was summarized by Kaplan-Meier survival. Multivariable Cox proportional hazard regression was applied to quantify the effects of DUS and Index for Mortality Prediction After Cardiac Transplantation score on the 1-year risk of graft failure. We present 4 donor/recipient risk groups using the Kaplan-Meier method. RESULTS European centers accept significantly higher-risk donor hearts compared to North America. DUS 0.45 versus 0.54, P<0.005). DUS was an independent predictor for graft failure with an inverse linear relationship when adjusted for covariates (P<0.001). The Index for Mortality Prediction After Cardiac Transplantation score, a validated tool to assess recipient risk, was also independently associated with 1-year graft failure (P<0.001). In North America, 1-year graft failure was significantly associated with donor-recipient risk matching (log-rank P<0.001). One-year graft failure was highest with pairing of high-risk recipients and donors (13.1% [95% CI, 10.7%-13.9%]) and lowest among low-risk recipients and donors (7.4% [95% CI, 6.8%-8.0%]). Matching of low-risk recipients with high-risk donors was associated with significantly less graft failure (9.0% [95% CI, 8.3%-9.7%]) than high-risk recipients with low-risk donors (11.4% [95% CI, 10.7%-12.2%]) Conclusions: European heart transplantation centers are more likely to accept higher-risk donor hearts than North American centers. Acceptance of borderline-quality donor hearts for lower-risk recipients could improve donor heart utilization without compromising recipient survival.
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Affiliation(s)
- Yasbanoo Moayedi
- Ted Rogers Centre for Heart Research (Y.M., E.R.-A., H.J.R.)
- Ted Rogers Computational Program (B.M., C.-P.S.F.), Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | | | - Brigitte Mueller
- Ted Rogers Computational Program (B.M., C.-P.S.F.), Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Chun-Po S Fan
- Ted Rogers Computational Program (B.M., C.-P.S.F.), Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | | | - Josef Stehlik
- Department of Medicine, Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City (J.S.)
| | - Jeffrey J Teuteberg
- Section of Heart Failure, Cardiac Transplant, and Mechanical Circulatory Support, and Department of Medicine, Stanford University, CA (Y.M., J.J.T., K.K.K.)
| | - Heather J Ross
- Ted Rogers Centre for Heart Research (Y.M., E.R.-A., H.J.R.)
| | - Kiran K Khush
- Section of Heart Failure, Cardiac Transplant, and Mechanical Circulatory Support, and Department of Medicine, Stanford University, CA (Y.M., J.J.T., K.K.K.)
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Rodgers N, Gerding B, Cusi V, Vaida F, Tada Y, Morris GP, Adler ED, Stehlik J, Kim PJ. Comparison of two donor-derived cell-free DNA tests and a blood gene-expression profile test in heart transplantation. Clin Transplant 2023:e14984. [PMID: 37036133 DOI: 10.1111/ctr.14984] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/21/2023] [Accepted: 03/25/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Donor-derived cell-free DNA (dd-cfDNA) testing is an emerging screening modality for noninvasive detection of acute rejection (AR). This study compared the testing accuracy for AR of two commercially available dd-cfDNA and gene-expression profiling (GEP) testing in heart transplant (HTx) recipients. METHODS This is a retrospective, observational study of HTx only patients who underwent standard and expanded single nucleotide polymorphism (SNP) dd-cfDNA between October 2020 to January 2022. Comparison with GEP was also performed. Assays were compared for correlation, accurate classification, and prediction for AR. RESULTS A total of 428 samples from 112 unique HTx patients were used for the study. A positive standard SNP correlated with the expanded SNP assay (p < .001). Both standard and expanded SNP tests showed low sensitivity (39%, p = 1.0) but high specificity (82% and 84%, p = 1.0) for AR. GEP did not improve sensitivity and showed worse specificity (p < .001) compared to standard dd-cfDNA. CONCLUSION We found no significant difference between standard and expanded SNP assays in detecting AR. We show improved specificity without change in sensitivity using dd-cfDNA in place of GEP testing. Prospective controlled studies to address how to best implement dd-cfDNA testing into clinical practice are needed.
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Affiliation(s)
| | | | | | - Florin Vaida
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, USA
| | - Yuko Tada
- UC San Diego Health, San Diego, California, USA
| | | | | | - Josef Stehlik
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Paul J Kim
- UC San Diego Health, San Diego, California, USA
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Roest S, Gürgöze MT, Cherikh WS, Stehlik J, Boersma EH, Zijlstra F, Manintveld OC. Influence of chronic kidney disease and other risk factors pre-heart transplantation on malignancy incidence post-heart transplantation. Front Cardiovasc Med 2023; 10:1145996. [PMID: 37077737 PMCID: PMC10106779 DOI: 10.3389/fcvm.2023.1145996] [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] [Received: 01/16/2023] [Accepted: 03/06/2023] [Indexed: 04/05/2023] Open
Abstract
AimsChronic kidney disease (CKD) pre-heart transplantation (HTx) has been proposed as a risk factor for malignancy risk post-HTx. Using multicenter registry data, our aim was to calculate the death-adjusted annual incidence of malignancies post-HTx, corroborate the association between CKD pre-HTx and malignancy risk post-HTx, and determine other risk factors for post-HTx malignancies.Methods and materialsWe used data from patients transplanted in North American HTx centers between January 2000 and June 2017 and registered in the International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry. We excluded recipients with missing data on post-HTx malignancies, heterotopic heart transplant, retransplantation, multi-organ transplantation, and patients with a total artificial heart pre-HTx.ResultsOverall, 34,873 patients were included to determine the annual incidence of malignancies, 33,345 patients were included in the risk analyses. The incidence of any malignancy, solid-organ malignancy, post-transplant lymphoproliferative disease (PTLD), and skin cancer adjusted for death 15 years post-HTx, was 26.6%, 10.9%, 3.6%, and 15.8% respectively. Besides widely acknowledged risk factors, CKD stage ≥4 pre-HTx was associated with the development of all malignancies post-HTx (HR 1.17 compared to CKD stage 1, p = 0.023), as well as solid-organ malignancies (HR 1.35, p = 0.01), but not for PTLD (HR 0.73, p = 0.057), and skin cancer (HR 1.06, p = 0.59).ConclusionRisk of malignancy post-HTx remains high. CKD stages ≥4 pre-HTx was associated with an increased risk for any malignancy and solid-organ malignancy post-HTx. Strategies to mitigate the impact of pre-HTx patient factors on the risk of post-HTx malignancy are needed.
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Affiliation(s)
- Stefan Roest
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Erasmus MC Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Muhammed T. Gürgöze
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Wida S. Cherikh
- United Network for Organ Sharing, Richmond, VA, United States
| | - Josef Stehlik
- Divisionof Cardiovascular Medicine, U.T.A.H. Cardiac Transplant Program, University of Utah Health Salt Lake City, Utah, UT, United States
| | - Eric H. Boersma
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Olivier C. Manintveld
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Erasmus MC Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Correspondence: Olivier C. Manintveld
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Kyriakopoulos C, Horne B, Sideris K, Taleb I, Griffin R, Sheffield E, Alharethi R, Hanff T, Stehlik J, Selzman C, Drakos S. Left Ventricular Functional Improvement is Associated with Lower Rates of Device Thrombosis in Patients on Durable Mechanical Circulatory Support. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1636] [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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Anderson M, Chavez M, Dickey J, Selzman C, Fang J, Drakos S, Stehlik J, Hanff T. Pre-Transplant Waitlist Mortality Not Associated with Severity of Shock Hemodynamics. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1668] [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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Grady K, Burns J, Teuteberg J, Allen L, Beiser D, Lindenfeld J, Yancy C, Cella D, Kirklin J, Denfeld Q, Ruo B, McIlvennan C, Walsh M, Adler E, Klein L, Murks C, Pham D, Rich J, Stehlik J, Kiernan M, Hahn E. New Ventricular Assist Device-Specific Self-Report Measures are Important for Understanding Health-Related Quality of Life: Findings from the MCS A-QOL Study. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1635] [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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Kyriakopoulos C, Taleb I, Wever-Pinzon O, Selzman C, Bonios M, Dranow E, Wever-Pinzon J, Yin M, Tseliou E, Stehlik J, Alharethi R, Kfoury A, Hanff T, Fang J, Koliopoulou A, Sideris K, Krauspe E, Nelson M, Elmer A, Singh R, Psotka M, Birks E, Slaughter M, Koenig S, Kyvernitakis A, Hoffman K, Guglin M, Kotter J, Campbell K, Silvestry S, Vidic A, Raval N, Mehra M, Cowger J, Kanwar M, Shah P, Drakos S. Multicenter Development and Validation of a Machine Learning Model to Predict Myocardial Recovery During LVAD Support: The UCAR Score. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1519] [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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Kapelios C, Tseliou E, Alharethi R, Shah K, Hanff T, Kyriakopoulos C, Sideris K, Taleb I, Stehlik J, Carter S, Kfoury A, Caine W, Selzman C, Fang J, Wever-Pinzon O, Drakos S. Impaired Liver Function is Associated with Hypotension and Elevated Right Atrial Pressure but Not Depressed Cardiac Index in Chronic Heart Failure. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.503] [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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Patel S, Knierim J, Goldstein D, Lamba H, Sun B, Schmitto J, Lowes B, Shah P, Kanwar M, Wald J, Ravichandran A, MacGowan G, Ton V, Silvestry S, Sera F, Farooq M, Jorde U, Stehlik J, Selzman C, Potapov E, Drakos S. Long-Term Clinical Trajectory after Durable Lvad Weaning: An International Registry Report. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1518] [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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May L, Cabrera A, Wilkes J, Ou Z, Stehlik J, Keenan H. Regional Incidence of Pediatric Heart Failure, Cohort Characteristics, and Outcomes. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1325] [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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Foroutan F, Guyatt G, Stehlik J, Gustafsson F, Greig D, McDonald M, Bertolotti A, Kugathasan L, Rayner D, Cook A, Zlatanoski D, Ram S, Demas-Clarke P, Kozuszko S, Alba A. Use of Induction Therapy Post Heart Transplantation - Clinical Practice Recommendations Based on Systematic Review and Network Meta-Analysis of Evidence. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1267] [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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Stehlik J, Schroder J, Pinney S, Patel C, D'Alessandro D, Goldstein D, Jorde U, Patel S, Mani D, Esmailian F, Kobashigawa J, Takeda K, Uriel N, Pham S, Patel P, Kai M, Sun B, Shah A, Ono M, Couper G, DeNofrio D, Vest A, Joyce D, DeVore A, Mallidi H, Itoh A, Mehra M, Givertz M, Milano C, Farr M. First Report of the Transmedics Organ Care System Heart Perfusion Registry. A Multi-Institutional Outcomes Analysis. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.634] [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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Chavez M, Anderson M, Dickey J, Selzman C, Drakos S, Stehlik J, Hanff T. Impact of Blood Group on Status 2 vs Status 3 Heart Transplant Listing in the U.S. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.537] [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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Kyriakopoulos C, Giannouchos T, Mylavarapu R, Krauspe E, Sheffield E, Sideris K, Elmer A, Vance N, Carter S, Hanff T, Wever-Pinzon O, Stehlik J, Selzman C, Drakos S, Goodwin M. Hospital Readmissions in Patients Supported with Durable Centrifugal-Flow Left Ventricular Assist Devices. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.782] [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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41
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Dickey J, Anderson M, Chavez M, Selzman C, Tseliou E, Kapelios C, Fang J, Drakos S, Stehlik J, Hanff T. Impact of Intra-Aortic Balloon Pumps on Cardiogenic Shock Survival Pre-Transplant: A Propensity Score Stratified Analysis. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.439] [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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42
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Roest S, Gürgöze M, Cherikh W, Stehlik J, Boersma E, Zijlstra F, Manintveld O. Influence of Chronic Kidney Disease and Other Risk Factors Pre-Heart Transplantation on Malignancy Incidence Post-Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.575] [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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Milano C, Schroder J, Farr M, DeVore A, D'Alessandro D, Goldstein D, Jorde U, Patel S, Daneshmand M, Pinney S, Esmailian F, Kobashigawa J, Takeda K, Uriel N, Pham S, Patel P, Kai M, Sun B, Shah A, Ono M, Couper G, DeNofrio D, Vest A, Joyce D, Mallidi H, Itoh A, Mehra M, Givertz M, Patel C, Stehlik J. Demographics and Outcomes of Clinical Trial vs Initial Post-Approval Use of Transmedics Organ Care System Heart. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.135] [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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44
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Kapelios C, Tseliou E, Alharethi R, Shah K, Hanff T, Kyriakopoulos CP, Sideris K, Taleb I, Stehlik J, Carter S, Kfoury AG, Caine W, Selzman CH, Fang JC, Wever-Pinzon O, Drakos SG. IMPAIRED LIVER FUNCTION IS ASSOCIATED WITH HYPOTENSION AND ELEVATED RIGHT ATRIAL PRESSURE BUT NOT DEPRESSED CARDIAC INDEX IN CHRONIC HEART FAILURE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00919-1] [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: 03/06/2023]
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Hanff TC, Browne A, Dickey J, Gaines H, Harhay MO, Goodwin M, Selzman CH, Fang JC, Drakos SG, Stehlik J. Heart waitlist survival in adults with an intra-aortic balloon pump relative to other Status 2, Status 1, and inotrope Status 3 patients. J Heart Lung Transplant 2023; 42:368-376. [PMID: 36369224 PMCID: PMC9974555 DOI: 10.1016/j.healun.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/03/2022] [Accepted: 10/09/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Intra-aortic balloon pump (IABP) utilization has significantly outpaced other Status 2 eligibility criteria for heart transplant. The risk of waitlist mortality of IABP-supported patients relative to other Status 2 listed patients has not been described. METHODS We performed a retrospective analysis of all adult patients listed Status 2 for heart transplantation under the current U.S. allocation policy, using data from the United Network for Organ Sharing. Patients listed status 1 and status 3 for high-dose inotropes were included for reference. Mortality and waitlist decompensation were modeled as a function of time-varying status in cause-specific Cox survival models. RESULTS We identified 3638 Status 2 listings, of whom 1676 (46%) were Status 2 due to IABP. Relative to patients supported with IABP, status 2 patients with ventricular tachycardia/fibrillation [VT/VF] (HR 4.0, p < .001), right-or-biventricular assist device configurations (HR 2.3, p = .002), or temporary surgical left ventricular assist devices [LVAD] (HR 2.6, p = .003) had greater risk of waitlist mortality and decompensation. Other Status 2 subgroups had mortality comparable to IABP Status 2. Risk of waitlist mortality and decompensation for IABP Status 2 was similar to Status 3 patients listed for high-dose inotropes (HR 1.2, p = .27) and lower than Status 1 patients (HR 0.7, p = .002). CONCLUSIONS Waitlist mortality varies significantly by Status 2 eligibility criteria and is highest among patients listed for VT/VF, right-or-biVAD configurations, or temporary surgical LVADs. IABP-supported patients were among those with the lowest Status 2 waitlist mortality risk and comparable to Status 3 inotrope-supported patients.
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Affiliation(s)
- Thomas C Hanff
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
| | - Adeline Browne
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jacqueline Dickey
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Holly Gaines
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Michael O Harhay
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matt Goodwin
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Craig H Selzman
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - James C Fang
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Stavros G Drakos
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Josef Stehlik
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Sideris K, Zhang M, Siu AF, Wohlfahrt P, Shen J, Kyriakopoulos CP, Taleb I, Wever-Pinzon O, Shah K, Selzman CH, Correa CR, Kapelios C, Brinker LM, Alharethi R, Hess R, Drakos SG, Steinberg BA, Kfoury AG, Spertus JA, Fang JC, Stehlik J. HEALTH RELATED QUALITY OF LIFE AS PREDICTOR OF OUTCOMES IN HEART FAILURE WITH PRESERVED EJECTION FRACTION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01057-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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47
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Hamouche R, Tatum S, Dranow E, Kyriakopoulos CP, Shankar TS, Visker J, Ling J, Sideris K, Selzman CH, Kfoury AG, Stehlik J, Alharethi R, Fang JC, Navankasattusas S, Holland W, Summers S, Drakos SG, Tseliou E. SPHINGOLIPIDS AS POTENTIAL SURROGATES OF MYOCARDIAL RECOVERY IN LEFT VENTRICULAR ASSIST DEVICE PATIENTS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00741-6] [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: 03/06/2023]
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48
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Hahn EA, Walsh MN, Allen LA, Lee CS, Denfeld QE, Teuteberg JJ, Beiser DG, McIlvennan CK, Lindenfeld J, Klein L, Adler ED, Stehlik J, Ruo B, Bedjeti K, Cummings PD, Vela AM, Grady KL. Validity of Patient-Reported Outcomes Measurement Information System Physical, Mental, and Social Health Measures After Left Ventricular Assist Device Implantation and Implications for Patient Care. Circ Cardiovasc Qual Outcomes 2023; 16:e008690. [PMID: 36752104 PMCID: PMC9940833 DOI: 10.1161/circoutcomes.121.008690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND A better understanding is needed of the burdens and benefits of left ventricular assist device (LVAD) implantation on patients' physical, mental, and social well-being. The purpose of this report was to evaluate the validity of Patient-Reported Outcomes Measurement Information System (PROMIS) measures for LVAD patients and to estimate clinically important score differences likely to have implications for patient treatment or care. METHODS Adults from 12 sites across all US geographic regions completed PROMIS measures ≥3 months post-LVAD implantation. Other patient-reported outcomes (eg, Kansas City Cardiomyopathy Questionnaire-12 item), clinician ratings, performance tests, and clinical adverse events were used as validity indicators. Criterion and construct validity and clinically important differences were estimated with Pearson correlations, ANOVA methods, and Cohen d effect sizes. RESULTS Participants' (n=648) mean age was 58 years, and the majority were men (78%), non-Hispanic White people (68%), with dilated cardiomyopathy (55%), long-term implantation strategy (57%), and New York Heart Association classes I and II (54%). Most correlations between validity indicators and PROMIS measures were medium to large (≥0.3; p<0.01). Most validity analyses demonstrated medium-to-large effect sizes (≥0.5) and clinically important differences in mean PROMIS scores (up to 14.8 points). Ranges of minimally important differences for 4 PROMIS measures were as follows: fatigue (3-5 points), physical function (2-3), ability to participate in social roles and activities (3), and satisfaction with social roles and activities (3-5). CONCLUSIONS The findings provide convincing evidence for the relevance and validity of PROMIS physical, mental, and social health measures in patients from early-to-late post-LVAD implantation. Findings may inform shared decision-making when patients consider treatment options. Patients with an LVAD, their caregivers, and their clinicians should find it useful to interpret the meaning of their PROMIS scores in relation to the general population, that is, PROMIS may help to monitor a return to normalcy in everyday life.
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Affiliation(s)
- Elizabeth A. Hahn
- Medical Social Sciences (E.A.H., K.B., P.D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mary N. Walsh
- Ascension St. Vincent Heart Center, Indianapolis, IN (M.N.W.)
| | - Larry A. Allen
- Cardiology, University of Colorado, Aurora (L.A.A., C.K.M.)
| | - Christopher S. Lee
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA (C.S.L.)
| | - Quin E. Denfeld
- Oregon Health and Science University School of Nursing, Portland (Q.E.D.)
| | | | | | | | | | - Liviu Klein
- Medicine, University of California, San Francisco (L.K.)
| | - Eric D. Adler
- Medicine, University of California, San Diego (E.D.A., B.R.)
| | - Josef Stehlik
- Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City (J.S.)
| | - Bernice Ruo
- Medicine, University of California, San Diego (E.D.A., B.R.)
| | - Katy Bedjeti
- Medical Social Sciences (E.A.H., K.B., P.D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Peter D. Cummings
- Medical Social Sciences (E.A.H., K.B., P.D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alyssa M. Vela
- Surgery (A.M.V., K.L.G.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kathleen L. Grady
- Surgery (A.M.V., K.L.G.), Northwestern University Feinberg School of Medicine, Chicago, IL
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Browne A, Gaines H, Alharethi R, Goodwin M, Selzman CH, Fang JC, Drakos SG, Stehlik J, Hanff TC. Interrupted Time Series Analysis of Donor Heart Use Before and After the 2018 UNOS Heart Allocation Policy Change. J Card Fail 2023; 29:220-224. [PMID: 36195202 PMCID: PMC9957886 DOI: 10.1016/j.cardfail.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Donor heart scarcity remains the fundamental barrier to increased transplant access. We examined whether 2018 United Network for Organ Sharing (UNOS) policy changes have had an impact on donor heart acceptance rates. METHODS AND RESULTS We performed an interrupted time series analysis in UNOS to evaluate for abrupt changes in donor heart-acceptance rates associated with the new policy. All adult donor offers were evaluated between 2015 and 2021 (n = 66,654 donors). Donor volumes and transplants increased during this period, but the donor acceptance rate declined significantly from 31% in quarter 3 of 2018 to 26% acceptance in quarter 3 of 2021 (slope change -0.4% per quarter; P < 0.001). We identified 2 trends associated with this decline: (1) a growing number of donors with high-risk features, and (2) decreased acceptance of donors with certain high-risk features in the new allocation system. CONCLUSIONS Heart transplant volumes have increased in recent years as a result of increased donor volumes, but donor heart acceptance rates began decreasing under the current allocation system. Changes in the donor pool and acceptance patterns for certain donor-risk features may explain this shift and warrant further evaluation to maximize donor heart use.
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Affiliation(s)
- Adeline Browne
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Holly Gaines
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Rami Alharethi
- Utah Transplant Affiliated Hospitals Cardiac Transplant Program, University of Utah Healthcare and School of Medicine, Intermountain Medical Center, Salt Lake Veterans Affairs Health Care System, Salt Lake City, Utah
| | - Matt Goodwin
- Utah Transplant Affiliated Hospitals Cardiac Transplant Program, University of Utah Healthcare and School of Medicine, Intermountain Medical Center, Salt Lake Veterans Affairs Health Care System, Salt Lake City, Utah; Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Craig H Selzman
- Utah Transplant Affiliated Hospitals Cardiac Transplant Program, University of Utah Healthcare and School of Medicine, Intermountain Medical Center, Salt Lake Veterans Affairs Health Care System, Salt Lake City, Utah; Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - James C Fang
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah; Utah Transplant Affiliated Hospitals Cardiac Transplant Program, University of Utah Healthcare and School of Medicine, Intermountain Medical Center, Salt Lake Veterans Affairs Health Care System, Salt Lake City, Utah
| | - Stavros G Drakos
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah; Utah Transplant Affiliated Hospitals Cardiac Transplant Program, University of Utah Healthcare and School of Medicine, Intermountain Medical Center, Salt Lake Veterans Affairs Health Care System, Salt Lake City, Utah
| | - Josef Stehlik
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah; Utah Transplant Affiliated Hospitals Cardiac Transplant Program, University of Utah Healthcare and School of Medicine, Intermountain Medical Center, Salt Lake Veterans Affairs Health Care System, Salt Lake City, Utah
| | - Thomas C Hanff
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah; Utah Transplant Affiliated Hospitals Cardiac Transplant Program, University of Utah Healthcare and School of Medicine, Intermountain Medical Center, Salt Lake Veterans Affairs Health Care System, Salt Lake City, Utah.
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50
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Wohlfahrt P, Jenča D, Stehlik J, Melenovský V, Mrázková J, Staněk V, Kettner J, Šramko M, Želízko M, Adámková V, Piťha J, Kautzner J. Heart failure-related quality-of-life impairment after myocardial infarction. Clin Res Cardiol 2023; 112:39-48. [PMID: 35304902 DOI: 10.1007/s00392-022-02008-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 03/07/2022] [Indexed: 01/21/2023]
Abstract
AIMS Recent advances in therapy led to a significant decrease in mortality and morbidity after myocardial infarction (MI). However, little is known about quality of life (QoL) after MI. We examined heart failure (HF)-related quality-of-life (QoL) impairment, its trajectories, and determinants after MI. METHODS Data from a single-center prospectively designed registry of consecutive patients hospitalized for MI at a large tertiary cardiology center were utilized. At 1 month and 1 year after hospital discharge, patients completed the Kansas City Cardiomyopathy Questionnaire (KCCQ). RESULTS In total, 850 patients (aged 65 ± 12 years, 27% female) hospitalized between June 2017 and October 2020 completed KCCQ at 1 month after discharge. Of these, 38.7% showed HF-related QoL impairment (KCCQ ≤ 75). In addition to characteristics of MI (MI size, diuretics need, heart rate), comorbidities as renal dysfunction and anemia were associated with QoL impairment. Of the 673 eligible, 500 patients (74.3%) completed KCCQ at 1 year after MI. On average, QoL improved by 5.9 ± 16.8 points during the first year after MI (p < 0.001); but, in 18% of patients QoL worsened. Diabetes control and hemoglobin level at the time of hospitalization were associated with QoL worsening. CONCLUSION Two out of 5 patients after MI present with HF-related QoL impairment. In addition to guideline-directed MI management, careful attention to key non-cardiac comorbidities as chronic kidney disease, anemia and diabetes may lead to further augmentation of the benefit of modern therapies in terms of QoL.
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Affiliation(s)
- Peter Wohlfahrt
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. .,Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Videnska 800, 140 59, Prague, Czech Republic.
| | - Dominik Jenča
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Josef Stehlik
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Vojtěch Melenovský
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Jolana Mrázková
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Vladimír Staněk
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Jiří Kettner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Marek Šramko
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Michael Želízko
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Věra Adámková
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jan Piťha
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
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