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Okerberg C, Adie S, Konerman M, Zimmerman C. Understanding the paradigm. Am J Health Syst Pharm 2024:zxae071. [PMID: 38507225 DOI: 10.1093/ajhp/zxae071] [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: 03/13/2024] [Indexed: 03/22/2024] Open
Abstract
In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
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Affiliation(s)
- Carl Okerberg
- Department of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Sarah Adie
- Department of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Matthew Konerman
- Division of Cardiovascular Medicine, Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Chris Zimmerman
- Department of Health Information and Technology Services, Michigan Medicine, Ann Arbor, MI, USA
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2
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Jain N, Anwar T, Patel N, Albert-Stone EG, Dils A, Cascino T, Konerman M, Koelling TM, Stein A, Spranger E, Heidemann L. BRIDGING THE GAP: EARLY PRIMARY CARE FOLLOW-UP IS NOT ASSOCIATED WITH REDUCED 30-DAY READMISSION RATES FOR ACUTE DECOMPENSATED HEART FAILURE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00801-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Okerberg C, Adie S, Konerman M, Zimmerman C. Implementation of a clinical decision support alert to prevent use of intravenous -blockers and nondihydropyridine calcium channel blockers in hospitalized patients with acute decompensated heart failure. Am J Health Syst Pharm 2023; 80:e119-e125. [PMID: 36776139 DOI: 10.1093/ajhp/zxad036] [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: 02/02/2023] [Indexed: 02/14/2023] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE Intravenous (IV) β-blockers (BBs) and nondihydropyridine calcium channel blockers (NDCCBs) are harmful in patients with acute decompensated heart failure (ADHF), but they are commonly used for rate control in atrial fibrillation (AF). This study evaluated the implementation of a clinical decision support (CDS) alert in the electronic health record (EHR) to prevent the use of these agents for AF in patients with ADHF, as well as results from the alert's continuous quality improvement. METHODS This was a single-center, retrospective, quasi-experimental pre/post analysis of hospitalized adult patients with an ejection fraction of less than 40% documented during their encounter. Groups corresponding to encounters before and after introduction of the alert were compared, and the first version of the alert was compared to its second version that was refined by iterative design. RESULTS For all patient hospital encounters, the rate of IV BB and NDCCB orders decreased in the period after alert implementation from 16.2% to 12% (P < 0.001). The alert's override rate decreased from 83.8% for the first version to 70.1% after iterative design (P = 0.015). CONCLUSION This study demonstrates that a CDS alert can be used in the EHR to reduce the use of potentially harmful IV BBs and NDCCBs in patients with ADHF for rate control. User compliance with the alert was improved by applying human factors design principles and iterative design during continuous quality improvement.
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Affiliation(s)
- Carl Okerberg
- Department of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Sarah Adie
- Department of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Matthew Konerman
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Chris Zimmerman
- Department of Health Information and Technology Services, Michigan Medicine, Ann Arbor, MI, USA
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Schütz S, Nguyen-Phan A, Konerman M, Chervin R, Hummel S. 0716 Risk for Heart Failure with preserved Ejection Fraction in patients with or without Obstructive Sleep Apnea. Sleep 2022. [DOI: 10.1093/sleep/zsac079.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Approximately two out of three patients with Heart Failure with preserved Ejection Fraction (HFpEF) have co-morbid sleep apnea, but the risk of HFpEF in patients who test positive for obstructive sleep apnea (OSA) is unknown.
Methods
Referred subjects (n=228) over the age of 18 underwent a diagnostic in-lab polysomnogram at the University of Michigan Sleep Laboratories between 1/8/2019-3/11/2020 and an echocardiogram within 12 months of their sleep study. Individuals with a known history of HFpEF were excluded (n=44). OSA was defined as an apnea-hypopnea-index (AHI) ≥ 5/hour. Clinical and echocardiogram variables were abstracted from the electronic medical record and used to determine H2FPEF scores (ordinal scale, range 0-9). The H2FPEF score is a validated predictor of HFpEF risk in patients with dyspnea. In the presence of dyspnea, a H2FPEF score ≥ 3 indicates a >50% risk of HFpEF, though dyspnea was not assessed in this study. HFpEF probability (continuous variable) was determined using the corresponding online calculator. Linear regression was used to predict HFpEF probability based on AHI.
Results
The 184 subjects without a known diagnosis of HFpEF had a median age of 65 years (interquartile range (IQR) 51, 71). Seventy subjects (38%) were male, 150 (82%) had OSA, and the median AHI was 15 (7, 35). The median H2FPEF score was 3 (2, 5). Among 34 participants without OSA, 10 (29%) had an H2FPEF score ≥ 3, whereas among 150 participants with OSA, 59 (39%) had an H2FPEF score ≥ 3. Linear regression indicated that higher AHI is associated with a higher probability of HFpEF (β = 0.39, p=0.0001).
Conclusion
Many patients referred for polysomnography may be at high risk for HFpEF. Sleep-study-referred subjects without clinically-indicated echocardiograms were not assessed, but patients at sleep disorders centers who test positive for OSA may have a particularly high rate of undiagnosed HFpEF. Sleep physicians should consider a cardiology referral in appropriately screened patients.
Support (If Any)
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Biermann CR, Wu J, Hummel S, Scott R, Konerman M, Langen E, Davis MB. Peripartum Heart Failure With Preserved Ejection Fraction: A Distinct But Under-Recognized Clinical Syndrome. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ghannam M, Yun HJ, Ficaro EP, Ghanbari H, Lazarus JJ, Konerman M, Shah RV, Weinberg R, Corbett JR, Oral H, Murthy VL. Multiparametric assessment of left atrial remodeling using 18F-FDG PET/CT cardiac imaging: A pilot study. J Nucl Cardiol 2020; 27:1547-1562. [PMID: 30191438 PMCID: PMC6411463 DOI: 10.1007/s12350-018-1429-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 08/08/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Left atrial (LA) remodeling is associated with structural, electric, and metabolic LA changes. Integrated evaluation of these features in vivo is lacking. METHODS Patients undergoing 18F-fluorodeoxyglucose (FDG) PET-CT during a hyperinsulinemic-euglycemic clamp were classified into sinus rhythm (SR), paroxysmal AF (PAF), and persistent AF (PerAF). The LA was semiautomatically segmented, and global FDG uptake was quantified using standardized uptake values (SUVmax and SUVmean) in gated, attenuation-corrected images and normalized to LA blood pool activity. Regression was used to relate FDG data to AF burden and critical patient factors. Continuous variables were compared using t-tests or Mann-Whitney tests. RESULTS 117 patients were included (76% men, age 66.4 ± 11.0, ejection fraction (EF) 25[22-35]%) including those with SR (n = 48), PAF (n = 55), and PerAF (n = 14). Patients with any AF had increased SUVmean (2.3[1.5-2.4] vs 2.0[1.5-2.5], P = 0.006), SUVmax (4.4[2.8-6.7] vs 3.2[2.3-4.3], P < 0.001), uptake coefficient of variation (CoV) 0.28[0.22-0.40] vs 0.25[0.2-0.33], P < 0.001), and hypometabolic scar (32%[14%-53%] vs 16.5%[0%-38.5%], P = 0.01). AF burden correlated with increased SUVmean, SUVmax, CoV, and scar independent of age, gender, EF, or LA size (P < 0.03 for all). CONCLUSIONS LA structure and metabolism can be assessed using FDG PET/CT. Greater AF burden correlates with the increased LA metabolism and scar.
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Affiliation(s)
- Michael Ghannam
- Department of Medicine (Division of Cardiovascular Medicine), University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA
| | - Hong Jun Yun
- Department of Medicine (Division of Cardiovascular Medicine), University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA
| | - Edward P Ficaro
- INVIA Medical Imaging Solutions, Ann Arbor, MI, USA
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Hamid Ghanbari
- Department of Medicine (Division of Cardiovascular Medicine), University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA
| | - John J Lazarus
- Department of Medicine (Division of Cardiovascular Medicine), University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA
| | - Matthew Konerman
- Department of Medicine (Division of Cardiovascular Medicine), University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA
| | - Ravi V Shah
- Department of Medicine (Division of Cardiovascular Medicine), Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard Weinberg
- Department of Medicine (Division of Cardiovascular Medicine), University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA
| | - James R Corbett
- Department of Medicine (Division of Cardiovascular Medicine), University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA
- INVIA Medical Imaging Solutions, Ann Arbor, MI, USA
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Hakan Oral
- Department of Medicine (Division of Cardiovascular Medicine), University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA
| | - Venkatesh L Murthy
- Department of Medicine (Division of Cardiovascular Medicine), University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA.
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
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Schütz SG, Nguyen-Phan A, Konerman M, Hummel S, Chervin RD. 0602 Daytime Sleepiness in Heart Failure with Preserved Versus Reduced Ejection Fraction. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Sleep apnea is common in patients with heart failure, though often not associated with significant daytime sleepiness in heart failure with reduced ejection fraction (HFrEF). The clinical presentation of sleep apnea in patients who have heart failure with borderline or preserved ejections fraction (HFbEF and HFpEF, respectively) is not well characterized.
Methods
Eighty patients with heart failure were identified retrospectively in data from University of Michigan Sleep Disorders Laboratories. Heart failure was categorized as heart failure with reduced ejection fraction (HFrEF)/systolic heart failure, heart failure with borderline ejection fraction (HFbEF) or heart failure with preserved ejection fraction (HFpEF)/diastolic heart failure. Clinical information and Epworth Sleepiness Scale (ESS) scores were extracted from medical records. A subset of subjects underwent a diagnostic polysomnogram. ANOVA was used to compare clinical characteristics in subjects with different heart failure types.
Results
ESS scores trended higher in 49 subjects with HFpEF (ESS mean 10.9±4.7 [sd]) compared to 9 with HFbEF (ESS 8.0±3.4) and 22 with HFrEF (ESS 8.4±5.0) (p=0.058). Among the 40 subjects who underwent diagnostic polysomnography, no statistically significant difference emerged in apnea-hypopnea index between subjects with HFpEF, HFbEF, and HFrEF (p=0.43). No significant differences emerged for the central apnea index (p=0.16), despite magnitudes of discrepancy that suggested a larger sample size might show different
results
CAI in participants with HFrEF showed a mean of 9.0±14.6/h, compared to 0.1±0.1/h in HFbEF and 3.1±6.3/h in HFpEF.
Conclusion
Among these patients with HFpEF, HFbEF, and HFrEF, subjects with HFpEF showed a trend towards increased subjective daytime sleepiness, though overall apnea and central apnea severity did not differ between groups. Further examination of clinical phenotypes in larger cohorts may help guide care in heterogeneous heart failure populations.
Support
National Institutes of Health grant NS107158
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Affiliation(s)
| | | | | | - S Hummel
- University of Michigan, Ann Arbor, MI
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Tang PC, Sarsour N, Haft JW, Romano MA, Konerman M, Colvin M, Koelling T, Aaronson KD, Pagani FD. Aortic Valve Repair Versus Replacement Associated With Durable Left Ventricular Assist Devices. Ann Thorac Surg 2020; 110:1259-1264. [PMID: 32105716 DOI: 10.1016/j.athoracsur.2020.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/16/2019] [Accepted: 01/06/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Aortic valve (AV) repair (AVr) using a central coaptation stitch or bioprosthetic AV replacement (AVR) are most commonly performed at the time of durable left ventricular assist device implant to address AV insufficiency (AI). METHODS Prospective data collection on 46 patients undergoing left ventricular assist device implant from 2007 through 2018 who received concomitant AVr (n = 40) or AVR (n = 6) was retrospectively analyzed to assess freedom from recurrent aortic insufficiency. Paired Wilcoxon rank-sum test was used to compare echocardiographic findings. Mantel-Cox statistics were used to analyze survival. RESULTS For AVr, central coaptation led to a mean decrease in AI severity by 2.1 ± 1.0 grades (P < .001). Three patients (7.5%) had recurrence of at least moderate AI by 3 years. In comparison, all patients in the AVR group had mild or less AI on subsequent follow-up. Success of AVr in downgrading AI severity was associated with a smaller aortic root diameter (P = .011) and sinotubular junction diameter (P = .003). An aortic root diameter greater than 3.5 cm was predictive of less improvement in AI severity compared with 3.5 cm or less (1.83 ± 1.03 versus 2.47 ± 0.80 grades of improvement; P = .038). Duration of cardiopulmonary bypass was 32 minutes longer and duration of aortic cross-clamp was 38 minutes longer for AVR versus AVr cohorts. No difference in 30-day (P = .418) or overall survival (P = .572) between the AVr and AVR groups was seen. CONCLUSIONS Aortic valve repair for addressing AI has a recurrence rate of 7.5% at 3 years. Success in downgrading AI is more likely with a smaller aortic root. No difference in survival was observed between AVr and AVR.
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Affiliation(s)
- Paul C Tang
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan.
| | - Nadeen Sarsour
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan
| | - Jonathan W Haft
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan
| | - Matthew A Romano
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan
| | - Matthew Konerman
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan
| | - Monica Colvin
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan
| | - Todd Koelling
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan
| | - Keith D Aaronson
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan
| | - Francis D Pagani
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan
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Ghannam M, Mikhova K, Yun HJ, Lazarus JJ, Konerman M, Saleh A, Weinberg RL, Cunnane R, Shah RV, Hiller KM, Ficaro EP, Corbett JR, Murthy VL. Relationship of non-invasive quantification of myocardial blood flow to arrhythmic events in patients with implantable cardiac defibrillators. J Nucl Cardiol 2019; 26:417-427. [PMID: 28687967 DOI: 10.1007/s12350-017-0975-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 03/19/2017] [Accepted: 05/23/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Ischemia contributes to arrhythmogenesis though its role is incompletely understood. Abnormal myocardial perfusion measured by PET imaging may predict ventricular arrhythmias (VAs) in a high-risk population. METHODS Patients with implantable cardiac defibrillators who had undergone rubidium-82 cardiac PET imaging were identified. Patients were stratified by median MBF and MFR values for analysis. The Cox proportional hazards model was used to assess the impact of myocardial perfusion on survival free of VT independent of critical covariates. RESULTS A total of 159 patients (124 (78%) males, median age 65.9 years, IQR [56.76-72.63]) were followed for 1.43 years IQR [0.83-2.21]. VA occurred in 29 patients (23.7%). After adjustment for ejection fraction, age, and sex, impaired stress MBF was associated with an increased risk of VA (adjusted HR per ml/min/g 1.52, 95% CI (1.01-2.31), P = 0.04). Summed rest and stress scores were not predictive of VA. Among patients with severe LV dysfunction, stress MBF remained an independent predictor of VA (adjusted HR per 1 ml/min/g HR 1.69, 95% CI (1.03-11.36), P = 0.03), while residual EF, summed rest, and summed stress scores were not (P > 0.05). CONCLUSIONS Impaired stress myocardial blood flow was associated with less survival free of ventricular arrhythmias.
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Affiliation(s)
- Michael Ghannam
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA.
| | | | - Hong Jun Yun
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA
| | - John J Lazarus
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA
| | - Matthew Konerman
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA
| | - Ashraf Saleh
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Richard L Weinberg
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA
| | - Ryan Cunnane
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA
| | - Ravi V Shah
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Keri M Hiller
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Edward P Ficaro
- INVIA Medical Imaging Solutions, Ann Arbor, MI, USA
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - James R Corbett
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA
- INVIA Medical Imaging Solutions, Ann Arbor, MI, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
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Brinker L, McNamara JL, Konerman M, Hornsby WE, Willer CJ, Brenner M, Dorsch M, Hummel S, Goyal P. POLYPHARMACY AND POTENTIALLY INAPPROPRIATE MEDICATION USE ARE UNIVERSAL AMONG PATIENTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31459-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Golbus JR, Zapico A, Weinberg R, Murthy V, Konerman M. PREDICTORS OF CHANGE IN PET MYOCARDIAL FLOW RESERVE FOLLOWING HEART TRANSPLANTATION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32260-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hummel SL, Bassis C, Marolt C, Konerman M, Schmidt TM. GUT MICROBIOME DIFFERS BETWEEN HEART FAILURE WITH PRESERVED EJECTION FRACTION AND AGE-MATCHED CONTROLS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31358-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sola M, Thompson A, Coe AB, Marshall V, Thomas M, Iwashyna TJ, Prescott HC, Konerman M. VARIATION IN CARDIAC REHABILITATION REFERRALS FOLLOWING CARDIAC INTENSIVE CARE UNIT ADMISSIONS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32432-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Saxon D, Kennel P, Guyer H, Zahs D, Goyal P, Hummel SL, Konerman M. Practice Variability Across Disciplines Caring for Heart Failure with Preserved Ejection Fraction. J Card Fail 2018. [DOI: 10.1016/j.cardfail.2018.07.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Moles VM, Cascino T, Saleh A, Mikhova K, Lazarus JJ, Ghannam M, Yun HJ, Konerman M, Weinberg RL, Ficaro EP, Corbett JR, McLaughlin VV, Murthy VL. Safety of regadenoson stress testing in patients with pulmonary hypertension. J Nucl Cardiol 2018; 25:820-827. [PMID: 27896702 DOI: 10.1007/s12350-016-0734-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 10/30/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We sought to determine the safety of regadenoson stress testing in patients with PH. BACKGROUND PH is increasingly recognized at more advanced ages. As many as one-third of patients with PH have coronary artery disease. Because of their physical limitations, patients with PH are unable to adequately exercise. Regadenoson can potentially have an adverse impact due to their tenuous hemodynamics. Current guidelines suggest performing a coronary angiography in patients with PH who have angina or multiple coronary risk factors. METHODS We identified 67 consecutive patients with confirmed PH by catheterization (mean PA > 25 mmHg not due to left heart disease) who underwent MPI with regadenoson stress. Medical records were reviewed to determine hemodynamic and ECG response to regadenoson. RESULTS No serious events occurred. Common side effects related to regadenoson were observed, dyspnea being the most common (70.6%). No syncope occurred. Heart rate increased from 74.6 ± 14 to 96.3 ± 18.3 bpm, systolic blood pressure increased from 129.8 ± 20.9 to 131.8 ± 31 mmHg, and diastolic blood pressure decreased from 77.1 ± 11.4 to 72.9 ± 15.3 mmHg. There was no ventricular tachycardia, ventricular fibrillation, or second- or third-degree atrioventricular block. CONCLUSION Regadenoson stress MPI appears to be well tolerated and safe in patients with PH.
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Affiliation(s)
- Victor M Moles
- Division of Cardiovascular Medicine, Department of Internal Medicine and Frankel Cardiovascular Center, University of Michigan, 2nd Floor CVC / SPC 5853, 1500 E. Medical Center Dr.,, Ann Arbor, MI, 48109-5853, USA.
| | - Thomas Cascino
- Division of Cardiovascular Medicine, Department of Internal Medicine and Frankel Cardiovascular Center, University of Michigan, 2nd Floor CVC / SPC 5853, 1500 E. Medical Center Dr.,, Ann Arbor, MI, 48109-5853, USA
| | - Ashraf Saleh
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Krasimira Mikhova
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - John J Lazarus
- Division of Cardiovascular Medicine, Department of Internal Medicine and Frankel Cardiovascular Center, University of Michigan, 2nd Floor CVC / SPC 5853, 1500 E. Medical Center Dr.,, Ann Arbor, MI, 48109-5853, USA
| | - Michael Ghannam
- Division of Cardiovascular Medicine, Department of Internal Medicine and Frankel Cardiovascular Center, University of Michigan, 2nd Floor CVC / SPC 5853, 1500 E. Medical Center Dr.,, Ann Arbor, MI, 48109-5853, USA
| | - Hong J Yun
- Division of Cardiovascular Medicine, Department of Internal Medicine and Frankel Cardiovascular Center, University of Michigan, 2nd Floor CVC / SPC 5853, 1500 E. Medical Center Dr.,, Ann Arbor, MI, 48109-5853, USA
| | - Matthew Konerman
- Division of Cardiovascular Medicine, Department of Internal Medicine and Frankel Cardiovascular Center, University of Michigan, 2nd Floor CVC / SPC 5853, 1500 E. Medical Center Dr.,, Ann Arbor, MI, 48109-5853, USA
| | - Richard L Weinberg
- Division of Cardiovascular Medicine, Department of Internal Medicine and Frankel Cardiovascular Center, University of Michigan, 2nd Floor CVC / SPC 5853, 1500 E. Medical Center Dr.,, Ann Arbor, MI, 48109-5853, USA
| | - Edward P Ficaro
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - James R Corbett
- Division of Cardiovascular Medicine, Department of Internal Medicine and Frankel Cardiovascular Center, University of Michigan, 2nd Floor CVC / SPC 5853, 1500 E. Medical Center Dr.,, Ann Arbor, MI, 48109-5853, USA
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Vallerie V McLaughlin
- Division of Cardiovascular Medicine, Department of Internal Medicine and Frankel Cardiovascular Center, University of Michigan, 2nd Floor CVC / SPC 5853, 1500 E. Medical Center Dr.,, Ann Arbor, MI, 48109-5853, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine and Frankel Cardiovascular Center, University of Michigan, 2nd Floor CVC / SPC 5853, 1500 E. Medical Center Dr.,, Ann Arbor, MI, 48109-5853, USA
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
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Konerman M, Kulkarni K, Toth PP, Jones SR. Lipoprotein(a) particle concentration and lipoprotein(a) cholesterol assays yield discordant classification of patients into four physiologically discrete groups. J Clin Lipidol 2012; 6:368-73. [DOI: 10.1016/j.jacl.2012.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 12/09/2011] [Accepted: 01/18/2012] [Indexed: 11/25/2022]
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Konerman M, Kulkarni K, Toth PP, Jones SR. Evidence of dependence of lipoprotein(a) on triglyceride and high-density lipoprotein metabolism. J Clin Lipidol 2012; 6:27-32. [DOI: 10.1016/j.jacl.2011.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 07/22/2011] [Accepted: 08/26/2011] [Indexed: 10/17/2022]
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Konerman M, Weeks KR, Shands JR, Tilburt JC, Dy S, Bone LR, Levine DM, Young JH. Short Form (SF-36) Health Survey measures are associated with decreased adherence among urban African Americans with severe, poorly controlled hypertension. J Clin Hypertens (Greenwich) 2010; 13:385-90. [PMID: 21545400 DOI: 10.1111/j.1751-7176.2010.00402.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The objective of this study was to determine whether an association exists between Short Form (SF-36) Health Survey measures and nonadherence among urban African Americans with poorly controlled hypertension. A total of 158 African Americans were admitted to an urban academic hospital for severe, uncontrolled hypertension. The main outcome measure was self-reported nonadherence to antihypertensive medications using a validated instrument. For every 10-point increase in Physical Component Summary (PCS) score, an individual was almost two times more likely to report being nonadherent (odds ratio, 1.94; 95% confidence interval, 1.30-2.90; P<.01). A significant interaction (P=.05) was observed between the physical functioning and mental health subscales. Individuals with high physical functioning and low mental health scores displayed the lowest adherence rate. These results suggest that high physical functioning, especially if associated with poor mental health, increases the likelihood of nonadherence to antihypertensive regimens among urban African Americans. The SF-36 may serve as an effective clinical tool that identifies patients at risk for nonadherence and, more importantly, may improve clinicians' understanding of nonadherence, allowing for discussions about antihypertensive medications to be tailored to individual patients.
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Affiliation(s)
- Matthew Konerman
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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Hansen C, Atwood C, Konerman M, Fowler J, Kwok J, Koenig A, Goetzke J, Neuzner J. 523 Evaluation of Epworth sleepiness scale in a population of dual-chamber-pacemaker patients. Europace 2005. [DOI: 10.1016/eupace/7.supplement_1.153-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | - C. Atwood
- Pittsburgh VA Healthcare System, Pittsburgh, PA, United States of America
| | | | - J. Fowler
- Univ. of Utah, Salt Lake City, UT, United States of America
| | - J. Kwok
- Guidant CRM, Research, St. Paul, MN, United States of America
| | | | - J. Goetzke
- Guidant Europe, Clinical Research, Diegem, Belgium
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