1
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Rozenbaum Z, Granot Y, Sadeh B, Havakuk O, Arnold JH, Shimiaie J, Ghermezi M, Barak O, Ben Gal Y, Shacham Y, Keren G, Topilsky Y, Laufer-Perl M. Sex differences in heart failure patients assessed by combined echocardiographic and cardiopulmonary exercise testing. Front Cardiovasc Med 2023; 10:1098395. [PMID: 36815019 PMCID: PMC9939638 DOI: 10.3389/fcvm.2023.1098395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/16/2023] [Indexed: 02/08/2023] Open
Abstract
Background We aimed to test the differences in peak VO2 between males and females in patients diagnosed with heart failure (HF), using combined stress echocardiography (SE) and cardiopulmonary exercise testing (CPET). Methods Patients who underwent CPET and SE for evaluation of dyspnea or exertional intolerance at our institution, between January 2013 and December 2017, were included and retrospectively assessed. Patients were divided into three groups: HF with preserved ejection fraction (HFpEF), HF with mildly reduced or reduced ejection fraction (HFmrEF/HFrEF), and patients without HF (control). These groups were further stratified by sex. Results One hundred seventy-eight patients underwent CPET-SE testing, of which 40% were females. Females diagnosed with HFpEF showed attenuated increases in end diastolic volume index (P = 0.040 for sex × time interaction), significantly elevated E/e' (P < 0.001), significantly decreased left ventricle (LV) end diastolic volume:E/e ratio (P = 0.040 for sex × time interaction), and lesser increases in A-VO2 difference (P = 0.003 for sex × time interaction), comparing to males with HFpEF. Females diagnosed with HFmrEF/HFrEF showed diminished increases in end diastolic volume index (P = 0.050 for sex × time interaction), mostly after anaerobic threshold was met, comparing to males with HFmrEF/HFrEF. This resulted in reduced increases in peak stroke volume index (P = 0.010 for sex × time interaction) and cardiac output (P = 0.050 for sex × time interaction). Conclusions Combined CPET-SE testing allows for individualized non-invasive evaluation of exercise physiology stratified by sex. Female patients with HF have lower exercise capacity compared to men with HF. For females diagnosed with HFpEF, this was due to poorer LV compliance and attenuated peripheral oxygen extraction, while for females diagnosed with HFmrEF/HFrEF, this was due to attenuated increase in peak stroke volume and cardiac output. As past studies have shown differences in clinical outcomes between females and males, this study provides an essential understanding of the differences in exercise physiology in HF patients, which may improve patient selection for targeted therapeutics.
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Affiliation(s)
- Zach Rozenbaum
- Cardiology Division, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv-Yafo, Israel,Section of Cardiology, Tulane University School of Medicine, New Orleans, LA, United States
| | - Yoav Granot
- Cardiology Division, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv-Yafo, Israel
| | - Ben Sadeh
- Cardiology Division, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv-Yafo, Israel
| | - Ofer Havakuk
- Cardiology Division, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv-Yafo, Israel
| | - Joshua H. Arnold
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Jason Shimiaie
- Cardiology Division, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv-Yafo, Israel
| | - Michael Ghermezi
- Cardiology Division, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv-Yafo, Israel
| | - Orly Barak
- Cardiology Division, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv-Yafo, Israel
| | - Yanai Ben Gal
- Cardiac Surgery Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv-Yafo, Israel
| | - Yacov Shacham
- Cardiology Division, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv-Yafo, Israel
| | - Gad Keren
- Cardiology Division, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv-Yafo, Israel
| | - Yan Topilsky
- Cardiology Division, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv-Yafo, Israel
| | - Michal Laufer-Perl
- Cardiology Division, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv-Yafo, Israel,*Correspondence: Michal Laufer-Perl ✉
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2
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Gross Z, Rahbari A, Wirtschafter E, Spektor TM, Udd KA, Bujarski S, Ghermezi M, Nosrati JD, Vidisheva A, Eades B, Cecchi G, Maluso T, Swift R, Berenson JR. Elotuzumab and dexamethasone for relapsed or refractory multiple myeloma patients: A retrospective study. Eur J Haematol 2018. [PMID: 29524348 DOI: 10.1111/ejh.13058] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of elotuzumab and dexamethasone (Ed) for relapsed or refractory multiple myeloma (RRMM) patients. METHOD This retrospective study evaluated the efficacy and safety of Ed treatment for 21 RRMM patients, 11 of whom were considered lenalidomide-refractory, and all of whom had progressed on at least 1 prior steroid-containing regimen. We also evaluated the efficacy of adding lenalidomide to a subset of patients following progression from Ed. RESULTS The overall response rate (ORR) and clinical benefit rate (CBR) of Ed were 10% and 19%, respectively. An additional 52% of patients demonstrated stable disease as their best response. The median PFS was 1.8 months on Ed for all patients. Fifteen patients received ERd following progression on Ed, and 60% of these patients were lenalidomide-refractory. The ORR and CBR were 20% and 33%, respectively, and the median PFS was 3.4 months. CONCLUSION Our results suggest that some patients can benefit from Ed without an accompanying immunomodulatory agent and that efficacy can be achieved with the addition of lenalidomide at the time of progression. No new safety signals were detected, except for thrombocytopenia in 1 patient on Ed.
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Affiliation(s)
- Zachary Gross
- Institute for Myeloma and Bone Cancer Research, West Hollywood, CA, USA
| | - Ashkon Rahbari
- Institute for Myeloma and Bone Cancer Research, West Hollywood, CA, USA.,James R Berenson, MD Inc, West Hollywood, CA, USA
| | - Eric Wirtschafter
- Institute for Myeloma and Bone Cancer Research, West Hollywood, CA, USA.,Olive View-UCLA Medical Center, Sylmar, CA, USA
| | | | - Kyle A Udd
- Institute for Myeloma and Bone Cancer Research, West Hollywood, CA, USA
| | - Sean Bujarski
- Institute for Myeloma and Bone Cancer Research, West Hollywood, CA, USA
| | - Michael Ghermezi
- Institute for Myeloma and Bone Cancer Research, West Hollywood, CA, USA
| | - Jason D Nosrati
- Institute for Myeloma and Bone Cancer Research, West Hollywood, CA, USA.,Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Aleksandra Vidisheva
- Oncotherapeutics, West Hollywood, CA, USA.,University of Arizona College of Medicine, Tucson, AZ, USA
| | | | - Gary Cecchi
- Northern California Hematology, Berkeley, CA, USA
| | - Tina Maluso
- James R Berenson, MD Inc, West Hollywood, CA, USA
| | - Regina Swift
- James R Berenson, MD Inc, West Hollywood, CA, USA
| | - James R Berenson
- Institute for Myeloma and Bone Cancer Research, West Hollywood, CA, USA.,James R Berenson, MD Inc, West Hollywood, CA, USA.,Oncotherapeutics, West Hollywood, CA, USA
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3
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Kramer J, Biner S, Ghermezi M, Pressman GS, Shmueli H, Shimiaie J, Finkelstein A, Banai S, Steinvil A, Buffle E, Aviram G, Ingbir M, Nesher N, Keren G, Topilsky Y. Impact of left ventricular filling parameters on outcome of patients undergoing trans-catheter aortic valve replacement. Eur Heart J Cardiovasc Imaging 2018; 18:304-314. [PMID: 27166025 DOI: 10.1093/ehjci/jew097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 01/12/2016] [Accepted: 04/14/2016] [Indexed: 11/14/2022] Open
Abstract
Aim To assess the impact of left ventricular (LV) filling parameters on outcomes following trans-catheter aortic valve replacement (TAVR). Methods and results A total of 526 TAVR patients were compared with 300 patients with severe aortic stenosis (AS) treated conservatively. Clinical variables were collected along with echocardiographic data at baseline, 1 month, and 6 months after study entry. End points included all-cause mortality and the combination of death and heart failure admission. LV filling parameters associated with mortality included reduced A wave velocity (P = 0.005) and shorter deceleration time (DT) (P = 0.0005). DT was superior to all other parameters (P = 0.05) apart from patients with atrial fibrillation in whom E/e' was better. Short DT (<160 ms) was associated with lower survival than long DT (≥220 ms; P = 0.002) or intermediate DT (P = 0.05), even after adjustment for age, gender, stroke volume index (SVI), and co-morbidities. However, patients with short baseline DT exhibited greater improvement in DT, E/A, and systolic pulmonary pressure at follow-up than patients with baseline DT ≥160 ms (P < 0.05 for all time x group interactions). Most importantly, among patients with short DT, TAVR was associated with better survival than conservative treatment (46 ± 7 vs. 28 ± 12% at 3 years, P = 0.05), even after adjustment for age, gender, and SVI (P = 0.05). Conclusion Short DT is an independent predictor of adverse outcome following TAVR. Nevertheless, LV filling parameters improve in most patients post TAVR, and TAVR is associated with improved survival compared with conservative therapy, even in patients with evidence of elevated LV filling. Thus, evidence of elevated LV filling should not be viewed as a contraindication for TAVR.
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Affiliation(s)
- Judith Kramer
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Simon Biner
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Michael Ghermezi
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Gregg S Pressman
- Heart and Vascular Institute Philadelphia, Einstein Medical Center, PA, USA
| | - Hezzi Shmueli
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Jason Shimiaie
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Arie Finkelstein
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Arie Steinvil
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Eric Buffle
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Galit Aviram
- Division of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Meirav Ingbir
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Nahum Nesher
- Division of Cardiovascular Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Gad Keren
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.,Division of Cardiovascular Diseases and Internal Medicine, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, Israel
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4
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Ghermezi M, Li M, Vardanyan S, Harutyunyan NM, Gottlieb J, Berenson A, Spektor TM, Andreu-Vieyra C, Petraki S, Sanchez E, Udd K, Wang CS, Swift RA, Chen H, Berenson JR. Serum B-cell maturation antigen: a novel biomarker to predict outcomes for multiple myeloma patients. Haematologica 2017; 102:785-795. [PMID: 28034989 PMCID: PMC5395119 DOI: 10.3324/haematol.2016.150896] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 12/22/2016] [Indexed: 11/26/2022] Open
Abstract
B-cell maturation antigen is expressed on plasma cells. In this study, we have identified serum B-cell maturation antigen as a novel biomarker that can monitor and predict outcomes for multiple myeloma patients. Compared to healthy donors, patients with multiple myeloma showed elevated serum B-cell maturation antigen levels (P<0.0001). Serum B-cell maturation antigen levels correlated with the proportion of plasma cells in bone marrow biopsies (Spearman's rho = 0.710; P<0.001), clinical status (complete response vs partial response, P=0.0374; complete response vs progressive disease, P<0.0001), and tracked with changes in M-protein levels. Among patients with non-secretory disease, serum B-cell maturation antigen levels correlated with bone marrow plasma cell levels and findings from positron emission tomography scans. Kaplan-Meier analysis demonstrated that serum B-cell maturation antigen levels above the median levels were predictive of a shorter progression-free survival (P=0.0006) and overall survival (P=0.0108) among multiple myeloma patients (n=243). Specifically, patients with serum B-cell maturation antigen levels above the median level at the time of starting front-line (P=0.0043) or a new salvage therapy (P=0.0044) were found to have shorter progression-free survival. Importantly, serum B-cell maturation antigen levels did not show any dependence on renal function and maintained independent significance when tested against other known prognostic markers for multiple myeloma such as age, serum β2 microglobulin, hemoglobin, and bone disease. These data identify serum B-cell maturation antigen as a new biomarker to manage multiple myeloma patients.
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Affiliation(s)
- Michael Ghermezi
- Institute for Myeloma & Bone Cancer Research, West Hollywood, CA, USA
| | - Mingjie Li
- Institute for Myeloma & Bone Cancer Research, West Hollywood, CA, USA
| | - Suzie Vardanyan
- Institute for Myeloma & Bone Cancer Research, West Hollywood, CA, USA
| | | | - Jillian Gottlieb
- Institute for Myeloma & Bone Cancer Research, West Hollywood, CA, USA
| | - Ariana Berenson
- Institute for Myeloma & Bone Cancer Research, West Hollywood, CA, USA
| | | | | | | | - Eric Sanchez
- Institute for Myeloma & Bone Cancer Research, West Hollywood, CA, USA
| | - Kyle Udd
- Institute for Myeloma & Bone Cancer Research, West Hollywood, CA, USA
| | - Cathy S Wang
- Institute for Myeloma & Bone Cancer Research, West Hollywood, CA, USA
| | | | - Haiming Chen
- Institute for Myeloma & Bone Cancer Research, West Hollywood, CA, USA
| | - James R Berenson
- Institute for Myeloma & Bone Cancer Research, West Hollywood, CA, USA
- Oncotherapeutics, West Hollywood, CA, USA
- James R. Berenson, MD, Inc., West Hollywood, CA, USA
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5
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Schwartz LA, Rozenbaum Z, Ghantous E, Kramarz J, Biner S, Ghermezi M, Shimiaie J, Finkelstein A, Banai S, Aviram G, Ingbir M, Keren G, Topilsky Y. Impact of Right Ventricular Dysfunction and Tricuspid Regurgitation on Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement. J Am Soc Echocardiogr 2016; 30:36-46. [PMID: 27742242 DOI: 10.1016/j.echo.2016.08.016] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Right ventricular (RV) dysfunction and tricuspid regurgitation (TR) may coexist with aortic stenosis. The aim of this study was to assess the association between RV dysfunction, TR, associated comorbidities, and outcomes following transcatheter aortic valve replacement (TAVR). METHODS A retrospective analysis was conducted of baseline and 6-month clinical and echocardiographic parameters, including TR grade, RV size (grade, end-diastolic and end-systolic areas, annular diameter), and function (grade, tricuspid annular plane systolic excursion [TAPSE], fractional area change, Tei index), in 519 consecutive TAVR patients. RESULTS The prevalence of moderate or greater TR was 11% (n = 59). Although TR was associated with increased mortality (P = .02) in unadjusted analysis, it did not demonstrate an independent association with outcome when adjusted for RV dysfunction (TAPSE; P = .30) or multiple clinical parameters (P ≥ .20). RV parameters associated with poor outcomes included TAPSE (P = .006) and Tei index (P = .005). TAPSE was associated with lower survival even when adjusted for TR (P = .009) and all clinical parameters (P = .01). Persistence of moderate or greater TR 6 months after TAVR seemed to be associated with lower survival (P = .02), even when adjusted for clinical and RV parameters (P = .07). CONCLUSIONS TR in association with aortic stenosis is frequently progressive despite TAVR but is not independently associated with outcomes. RV function is a stronger driver of adverse outcomes compared with TR itself, and RV quantitative rather than qualitative evaluation is the key to stratify these patients.
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Affiliation(s)
| | - Zach Rozenbaum
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ehab Ghantous
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Judith Kramarz
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Simon Biner
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Michael Ghermezi
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Jason Shimiaie
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | | | - Shmuel Banai
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Galit Aviram
- Division of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Meirav Ingbir
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Gad Keren
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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6
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Harutyunyan NM, Vardanyan S, Ghermezi M, Gottlieb J, Berenson A, Andreu-Vieyra C, Berenson JR. Levels of uninvolved immunoglobulins predict clinical status and progression-free survival for multiple myeloma patients. Br J Haematol 2016; 174:81-7. [PMID: 27017948 DOI: 10.1111/bjh.14026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 01/12/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | - Suzie Vardanyan
- Institute for Myeloma & Bone Cancer Research; West Hollywood CA USA
| | - Michael Ghermezi
- Institute for Myeloma & Bone Cancer Research; West Hollywood CA USA
| | - Jillian Gottlieb
- Institute for Myeloma & Bone Cancer Research; West Hollywood CA USA
| | - Ariana Berenson
- Institute for Myeloma & Bone Cancer Research; West Hollywood CA USA
| | | | - James R. Berenson
- Institute for Myeloma & Bone Cancer Research; West Hollywood CA USA
- Oncotherapeutics; West Hollywood CA USA
- James R. Berenson, MD, Inc.; West Hollywood CA USA
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