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Tran P, Lau C, Joshi M, Kuehl M, Maddock H, Banerjee P. Exploring Changes in Myocyte Structure, Contractility, and Energetics From Mechanical Unloading in Patients With Heart Failure Undergoing Ventricular Assist Device Implantation: A Systematic Review and Meta-Analysis. Heart Lung Circ 2024:S1443-9506(24)00082-9. [PMID: 38704332 DOI: 10.1016/j.hlc.2024.01.039] [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: 09/17/2023] [Revised: 01/27/2024] [Accepted: 01/31/2024] [Indexed: 05/06/2024]
Abstract
AIMS Recent reports of myocardial recovery after mechanical unloading with left ventricular assist devices (LVADs) have challenged the prevailing notion that end-stage heart failure (HF) is irreversible. To improve our understanding of this phenomenon, we comprehensively analysed the structural, functional, and energetic changes in failing human cardiomyocytes after LVAD implantation. METHODS Based on a prospectively registered protocol (PROSPERO-CRD42022380214), 30 eligible studies were identified from 940 records with a pooled population of 648 patients predominantly with non-ischaemic cardiomyopathy. RESULTS LVAD led to a substantial regression in myocyte size similar to that of donor hearts (standardised mean difference, -1.29; p<0.001). The meta-regression analysis revealed that HF duration was a significant modifier on the changes in myocyte size. There were some suggestions of fibrosis reversal (-5.17%; p=0.009); however, this was insignificant after sensitivity analysis. Developed force did not improve in cardiac trabeculae (n=5 studies); however, non-physiological isometric contractions were tested. At the myocyte level (n=4 studies), contractile kinetics improved where the time-to-peak force reduced by 41.7%-50.7% and time to 50% relaxation fell by 47.4%-62.1% (p<0.05). Qualitatively, LVAD enhanced substrate utilisation and mitochondrial function (n=6 studies). Most studies were at a high risk of bias. CONCLUSION The regression of maladaptive hypertrophy, partial fibrosis reversal, and normalisation in metabolic pathways after LVAD may be a testament to the heart's remarkable plasticity, even in the advanced stages of HF. However, inconsistencies exist in force-generating capabilities. Using more physiological force-length work-loop assays, addressing the high risks of bias and clinical heterogeneity are crucial to better understand the phenomenon of reverse remodelling.
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Affiliation(s)
- Patrick Tran
- Centre for Health & Life Sciences, Coventry University, Coventry, UK; Cardiology Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
| | - Clement Lau
- Cardiology Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Mithilesh Joshi
- Cardiology Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - Michael Kuehl
- Cardiology Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - Helen Maddock
- Centre for Health & Life Sciences, Coventry University, Coventry, UK
| | - Prithwish Banerjee
- Centre for Health & Life Sciences, Coventry University, Coventry, UK; Cardiology Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
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Shergill S, Kuehl M, Banerjee P, Marshall L, Khan JN. Ending the legacy of an incorrect diagnosis: cardiovascular MRI scanning of legacy cardiac implantable electronic devices. Eur Heart J Cardiovasc Imaging 2024; 25:e110-e111. [PMID: 37878743 DOI: 10.1093/ehjci/jead284] [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] [Received: 06/05/2023] [Revised: 08/23/2023] [Accepted: 10/24/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- Simran Shergill
- University Hospitals Coventry & Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Michael Kuehl
- University Hospitals Coventry & Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
- Faculty of Science, Engineering and Medicine, University of Warwick, Coventry CV4 7AL, UK
| | - Prithwish Banerjee
- University Hospitals Coventry & Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
- Faculty of Science, Engineering and Medicine, University of Warwick, Coventry CV4 7AL, UK
- Faculty of Health & Life Sciences, Coventry University, Coventry CV1 5FB, UK
| | - Leeann Marshall
- University Hospitals Coventry & Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Jamal Nasir Khan
- University Hospitals Coventry & Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
- Faculty of Science, Engineering and Medicine, University of Warwick, Coventry CV4 7AL, UK
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Joshi M, Tran P, Barber TM, Ayub W, Kuehl M, Banerjee P. The Role of the Vasculature in Heart Failure. Curr Heart Fail Rep 2023:10.1007/s11897-023-00602-4. [PMID: 37160641 DOI: 10.1007/s11897-023-00602-4] [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] [Accepted: 04/21/2023] [Indexed: 05/11/2023]
Abstract
The contribution of the vasculature in the development and progression of heart failure (HF) syndromes is poorly understood and often neglected. Incorporating both arterial and venous systems, the vasculature plays a significant role in the regulation of blood flow throughout the body in meeting its metabolic requirements. A deterioration or imbalance between the cardiac and vascular interaction can precipitate acute decompensated HF in both preserved and reduced ejection fraction phenotypes. This is characterised by the increasingly recognised concept of ventricular-arterial coupling: a well-balanced relationship between ventricular and vascular stiffness, which has major implications in HF. Often, the cause of decompensation is unknown, with international guidelines mainly centred on arrhythmia, infection, acute coronary syndrome and its mechanical complications as common causes of decompensation; the vascular component is often underrecognised. A better understanding of the vascular contribution in cardiovascular failure can improve risk stratification, earlier diagnosis and facilitate earlier optimal treatment. This review focuses on the role of the vasculature by integrating the concepts of ventricular-arterial coupling, arterial stiffness and venous return in a failing heart.
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Affiliation(s)
- Mithilesh Joshi
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK.
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - Patrick Tran
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Centre for Sport, Exercise, Life Sciences, Faculty of Health and Life Sciences, Alison Gingell Building, Coventry University, Coventry, CV1 2DS, UK
| | - Thomas M Barber
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Waqar Ayub
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Michael Kuehl
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Prithwish Banerjee
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
- Centre for Sport, Exercise, Life Sciences, Faculty of Health and Life Sciences, Alison Gingell Building, Coventry University, Coventry, CV1 2DS, UK
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Pichiorri F, Suh SS, Rocci A, De Luca L, Taccioli C, Santhanam R, Zhou W, Benson DM, Hofmainster C, Alder H, Garofalo M, Di Leva G, Volinia S, Lin HJ, Perrotti D, Kuehl M, Aqeilan RI, Palumbo A, Croce CM. Retraction Notice to: Downregulation of p53-inducible microRNAs 192, 194, and 215 Impairs the p53/MDM2 Autoregulatory Loop in Multiple Myeloma Development. Cancer Cell 2022; 40:1442. [PMID: 36306791 DOI: 10.1016/j.ccell.2022.10.007] [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: 11/29/2022]
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5
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Pichiorri F, Suh SS, Rocci A, De Luca L, Taccioli C, Santhanam R, Zhou W, Benson DM, Hofmainster C, Alder H, Garofalo M, Di Leva G, Volinia S, Lin HJ, Perrotti D, Kuehl M, Aqeilan RI, Palumbo A, Croce CM. Retraction Notice to: Downregulation of p53-inducible microRNAs 192, 194, and 215 Impairs the p53/MDM2 Autoregulatory Loop in Multiple Myeloma Development. Cancer Cell 2022; 40:1441. [PMID: 36306793 PMCID: PMC9743993 DOI: 10.1016/j.ccell.2022.10.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Tran P, Long T, Smith J, Kuehl M, Mahdy T, Banerjee P. Developing a contemporary community clinic for patients with heart failure with preserved ejection fraction within the current National Health Service model. Open Heart 2022; 9:openhrt-2022-002101. [PMID: 36332941 PMCID: PMC9639156 DOI: 10.1136/openhrt-2022-002101] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction The diagnostic and therapeutic arsenal for heart failure with preserved ejection (HFpEF) has expanded. With novel therapies (eg, sodium-glucose co-transporter 2 inhibitors) and firmer recommendations to optimise non-cardiac comorbidities, it is unclear if outpatient HFpEF models can adequately deliver this. We; therefore, evaluated the efficacy of an existing dedicated HFpEF clinic to find innovative ways to design a more comprehensive model tailored to the modern era of HFpEF. Methods A single-centre retrospective analysis of 202 HFpEF outpatients was performed over 12 months before the COVID-19 pandemic. Baseline characteristics, clinic activities (eg, medication changes, lifestyle modifications, management of comorbidities) and follow-up arrangements were compared between a HFpEF and general cardiology clinic to assess their impact on mortality and morbidity at 6 and 12 months. Results Between the two clinic groups, the sample population was evenly matched with a typical HFpEF profile (mean age 79±9.6 years, 55% female and a high prevalence of cardiometabolic comorbidities). While follow-up practices were similar, the HFpEF clinic delivered significantly more interventions on lifestyle changes, blood pressure and heart rate control (p<0.0001) compared with the general clinic. Despite this, no significant differences in all-cause hospitalisation and mortality were observed. This may be attributed to the fact that clinic activities were primarily cardiology-focused. Importantly, non-cardiovascular admissions accounted for >60% of hospitalisation, including causes of recurrent admissions. Conclusion This study suggests that existing general and emerging dedicated HFpEF clinics may not be adequate in addressing the multifaceted aspects of HFpEF as clinic activities concentrated primarily on cardiological measures. Although the small cohort and short follow-up period are important limitations, this study reminds clinicians that HFpEF patients are more at risk of non-cardiac than HF-related events. We have therefore proposed a pragmatic framework that can comprehensively deliver the modern guideline-directed recommendations and management of non-cardiac comorbidities through a multidisciplinary approach.
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Affiliation(s)
- Patrick Tran
- Cardiology Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Centre for Sport, Exercise & Life Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Thomas Long
- Cardiology Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jessica Smith
- Cardiology Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Michael Kuehl
- Cardiology Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Tarek Mahdy
- Cardiology Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Prithwish Banerjee
- Centre for Sport, Exercise & Life Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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7
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Dinov B, Latuschynski C, Ebbinghaus H, Arya A, Kuehl M, Ueberham L, Hindricks G. Effects of positive endomyocardial biopsy on the survival and the outcomes of catheter ablation of ventricular tachycardia in patients with cardiac sarcoidosis. Europace 2022. [DOI: 10.1093/europace/euac053.114] [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
Funding Acknowledgements
Type of funding sources: Private hospital(s). Main funding source(s): Heart center of Leipzig
Background
Cardiac sarcoidosis (CS) is frequently unrecognized cause of non-ischemic cardiomyopathy associated ventricular tachycardia (VT), who eventually require VT ablations because of refractory VTs; however, the reported long-term outcomes after VT ablation are conflicting. Because of the low diagnostic yield of the endomyocardial biopsy (EMB), diagnosis of CS is often based on clinical and imaging criteria, which can lead to misdiagnosing.
Purpose and objectives
The purpose of this study was to identity whether patients with histologically-proven CS (EMB+) have different patient, procedural characteristics and outcomes after VT ablation as compared to those in whom the diagnosis was based on clinical criteria only (EMB-).
Methods
Between 2015-2021, 153 patients with suspected CS were evaluated according to a specified protocol including CMR, 18FDG-PET, EMB, bronchoscopy and EBUS biopsy, and serum markers. Those who fulfilled the latest criteria for CS of the Japanese Circulation Society (JCS) were divided into 2 groups: EMB (+) CS proven by myocardial biopsy, and EMB (-) CS fulfilling the clinical criteria for CS. The following endpoints were defined: 1) VT recurrence after ablation; and 2) the composite endpoint of death, heart transplantation or LVAD implantation.
Results
We identified 76 patients fulfilling the JCS criteria for CS (mean age 50 ± 10.6 years, 38% female, EMB (+) 35.5%). The leading symptoms were as follows: sustained VT in 23 (30%), high-grade AV block in 23 (30%), heart failure in 18 (24%), and other in 12 pts (16%). EMB (+) and the EMB (-) patients had similar clinical characteristics except for the imaging findings. EMB (+) patients exhibit LGE in CMR in 96% vs. 73% in EMB (-); P=0.024, whereas 18FDG-PET showed abnormal myocardial activity in 91% in the EMB (+) vs. 65% in the EMB (-); P=0.028. The primary composite endpoint was reached in 7.4% in EMB (+) group and in 12.2 % in EMB (-) group; P = 0.7. VT ablation was performed in 15 cases: 9 ablations (33%) in EMB (+) vs. 6 ablations (12%) in EMB (-); P=0.037. At the end of the procedure, all inducible VTs were successfully ablated in 100% of the EMB (-) patients vs. 56% in EMB (+) patients; P=0.1. VT recurrence was 78% in EMB (+) group vs. 67% in EMB (-); P = 0.6. The only procedural difference between the groups was the presence of vast RV low-voltage areas in 67% of the EMB (+) vs. 0% in EMB (-); P = 0.028.
Conclusions
Patients with CS and positive EMB exhibit more often LGE in CMR, abnormal 18FDG-PET activity and required more frequently VT ablation. The procedural characteristics between both groups were similar, except for the frequently observed RV low-voltage areas in most EMB (+) patients, whereas the RV was not affected in any of the EMB (-) patients. In spite of these differences, the VT recurrence rates and the survival seemed not to be affected by the histological evidence of CS in EMB.
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Affiliation(s)
- B Dinov
- University of Leipzig, Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - C Latuschynski
- University of Leipzig, Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - H Ebbinghaus
- University of Leipzig, Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - A Arya
- University of Leipzig, Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - M Kuehl
- University Hospital of Coventry and Warwickshire, Coventry, United Kingdom of Great Britain & Northern Ireland
| | - L Ueberham
- University of Leipzig, Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - G Hindricks
- University of Leipzig, Heart Center, Department of Electrophysiology, Leipzig, Germany
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Al-Sheikhli J, Patchett I, Lim VG, Marshall L, Foster W, Kuehl M, Yusuf S, Panikker S, Patel K, Osman F, Banerjee P, Lellouche N, Dhanjal T. Initial experience of temperature-controlled irrigated radiofrequency ablation for ischaemic cardiomyopathy ventricular tachycardia ablation. J Interv Card Electrophysiol 2022; 66:551-559. [PMID: 35192098 PMCID: PMC10066113 DOI: 10.1007/s10840-022-01158-4] [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: 12/31/2021] [Accepted: 02/10/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The DiamondTemp ablation (DTA) catheter system delivers high power, open-irrigated, temperature-controlled radiofrequency (RF) ablation. This novel ablation system has not been previously used for ventricular tachycardia (VT) ablation. OBJECTIVE Feasibility of using the DTA catheter system for VT ablation in ischaemic cardiomyopathy (ICM) patients. METHOD Ten ICM patients with optimal anti-arrhythmic drug therapy and implantable cardiac defibrillators (ICD) were recruited. VT inducibility testing was performed at the end of the procedure. ICD data for device detected VT episodes and device treated VT episodes were collected for 6-months pre- and post-ablation. RESULTS Substrate analysis demonstrated reductions in the borderzone area of 4.4 cm2 (p = 0.026) and late potential area of 3.5 cm2 (p = 0.0449) post-ablation, with reductions in the mean bipolar and unipolar voltages of the ablation target areas (0.14 mV (p = 0.0007); 0.59 mV (p = 0.0072) respectively). Complete procedural success was achieved in 9 procedures. Post-ablation VT inducibility testing was not performed in 1 procedure due to a steam pop complication resulting in pericardial tamponade requiring drainage. Mean follow-up of 214 ± 33 days revealed an 88% reduction in total VT episodes (n = 266 median 16 [IQR 3-57] to n = 33 median 0; p = 0.0164) and 77% reduction in ICD therapies (n = 128 median 5 [IQR 2-15] to n = 30 median 0; p = 0.0181). CONCLUSION The DTA system resulted in adequate lesion characteristics with effective substrate modification, acute procedural success and improved outcomes at intermediate-term follow-up. Randomised controlled trials are required to compare the performance of the DTA system against conventional ablation catheters.
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Affiliation(s)
- Jaffar Al-Sheikhli
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Ian Patchett
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Ven Gee Lim
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Leeann Marshall
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Will Foster
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Michael Kuehl
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Coventry, UK.,University of Warwick, Coventry, UK
| | - Shamil Yusuf
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Sandeep Panikker
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Kiran Patel
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Coventry, UK.,University of Warwick, Coventry, UK
| | - Faizel Osman
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Coventry, UK.,University of Warwick, Coventry, UK
| | - Prithwish Banerjee
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Coventry, UK.,University of Warwick, Coventry, UK
| | - Nicolas Lellouche
- Avenue du Marechal de Lattre de Tassigny, Hopital Henri Mondor Albert Chenevier, Creteil, Inserm U955, 94000, Paris, France
| | - Tarvinder Dhanjal
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Coventry, UK. .,University of Warwick, Coventry, UK.
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Lachlan T, He H, Aggour H, Sahota P, Harvey S, Patel K, Foster W, Yusuf S, Panikker S, Dhanjal T, Dandekar U, Barker T, Parmar J, Kuehl M, Osman F. Safety and feasibility of trans-venous cardiac device extraction using conscious sedation alone-Implications for the post-COVID-19 era. J Arrhythm 2021; 37:1522-1531. [PMID: 34887957 PMCID: PMC8637087 DOI: 10.1002/joa3.12637] [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] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/26/2021] [Accepted: 09/13/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Transvenous lead extraction (TLE) for implantable cardiac-devices is traditionally performed under general anesthesia (GA). This can lead to greater risk of exposure to COVID-19, longer recovery-times and increased procedural-costs. We report the feasibility/safety of TLE using conscious-sedation alone with immediate GA/cardiac-surgery back-up if needed. METHODS Retrospective case-series of consecutive TLEs performed using conscious-sedation alone between March 2016 and December 2019. All were performed in the electrophysiology-laboratory using intravenous Fentanyl, Midazolam/Diazepam with a stepwise approach using locking-stylets/cutting-sheaths, including mechanical-sheaths. Baseline patient-characteristics, procedural-details and TLE outcomes (including procedure-related complications/death) were recorded. RESULTS A total of 130 leads were targeted in 54 patients, mean age ± SD 74.6 ± 11.8years, 47(87%) males; dual-chamber pacemakers (n = 26; 48%), cardiac resynchronization therapy-defibrillators (n = 17; 31%) and defibrillators (n = 8; 15%) were commonest extracted devices. Mean ± SD/median (range) lead-dwell times were 11.0 ± 8.8/8.3 (0.3-37) years, respectively. Extraction indications included systemic infection (n = 23; 43%) and lead/pulse-generator erosion (n = 27; 50%); mean 2.1 ± 2.0 leads were removed per procedure/mean procedure-time was 100 ± 54 min. Local anesthetic (LA) was used for all (mean-dose: 33 ± 8 ml 1% lidocaine), IV drug-doses used (mean ± SD) were: midazolam: 3.95 ± 2.44 mg, diazepam: 4.69 ± 0.89 mg and fentanyl: 57 ± 40 µg. Complete lead-extraction was achieved in 110 (85%) leads, partial lead-extraction (<4 cm-fragment remaining) in 5 (4%) leads. Sedation-related hypotension requiring IV fluids occurred in 2 (managed without adverse-consequences) and hypoxia requiring additional airway-management in none. No procedural deaths occurred, one patient required emergency cardiac surgery for localized ventricular perforation, nine had minor complications (transient hypotension/bradycardia/pericardial effusion not requiring intervention). CONCLUSION TLE undertaken using LA/conscious-sedation was safe/feasible in our series and associated with good clinical outcome/low procedural complications. Reduced risk of aerosolization of COVID-19 and quicker patient recovery/reduced anesthetic risk are potential benefits that warrant further study.
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Affiliation(s)
- Thomas Lachlan
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
- University of Warwick (Medical School)CoventryUK
| | - Hejie He
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
- University of Warwick (Medical School)CoventryUK
| | - Hesham Aggour
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Preet Sahota
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Samuel Harvey
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Kiran Patel
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
- University of Warwick (Medical School)CoventryUK
| | - Will Foster
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
- Worcester Royal HospitalWorcesterUK
| | - Shamil Yusuf
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Sandeep Panikker
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Tarv Dhanjal
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
- University of Warwick (Medical School)CoventryUK
| | - Uday Dandekar
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Thomas Barker
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Jitendra Parmar
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Michael Kuehl
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Faizel Osman
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
- University of Warwick (Medical School)CoventryUK
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10
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Tran P, Marshall L, Patchett I, Salim H, Yusuf S, Panikker S, Kuehl M, Osman F, Banerjee P, Randeva H, Dhanjal T. Real-world evaluation of followup strategies after ICD therapies in patients with VT (REFINE-VT). Br J Cardiol 2021; 28:48. [PMID: 35747065 PMCID: PMC9063697 DOI: 10.5837/bjc.2021.048] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Implantable cardiac defibrillators (ICDs) can prevent sudden cardiac death, but the risk of recurrent ventricular arrhythmia (VA) and ICD shocks persist. Strategies to minimise such risks include medication optimisation, device programming and ventricular tachycardia (VT) ablation. Whether the choice of these interventions at follow-up are influenced by factors such as the type of arrhythmia or ICD therapy remains unclear. To investigate this, we evaluated ICD follow-up strategies in a real-world population with primary and secondary prevention ICDs. REFINE-VT (Real-world Evaluation of Follow-up strategies after Implantable cardiac-defibrillator therapies in patients with Ventricular Tachycardia) is an observational study of 514 ICD recipients recruited between 2018 and 2019. We found that 77 patients (15%) suffered significant VA and/or ICD therapies, of whom 26% experienced a second event; 31% received no intervention. We observed an inconsistent approach to the choice of strategies across different types of arrhythmias and ICD therapies. Odds of intervening were significantly higher if ICD shock was detected compared with anti-tachycardia pacing (odds ratio [OR] 8.4, 95% confidence interval [CI] 1.7 to 39.6, p=0.007). Even in patients with two events, the rate of escalation of antiarrhythmics or referral for VT ablation were as low as patients with single events. This is the first contemporary study evaluating how strategies that reduce the risk of recurrent ICD events are executed in a real-world population. Significant inconsistencies in the choice of interventions exist, supporting the need for a multi-disciplinary approach to provide evidence-based care to this population.
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Affiliation(s)
- Patrick Tran
- Cardiology Registrar University Hospitals Coventry & Warwickshire, Clifford Bridge Road, CV2 2DX
| | - Leeann Marshall
- Senior Cardiac Physiologist University Hospitals Coventry & Warwickshire, Clifford Bridge Road, CV2 2DX
| | - Ian Patchett
- Senior Cardiac Physiologist University Hospitals Coventry & Warwickshire, Clifford Bridge Road, CV2 2DX
| | - Handi Salim
- Cardiology Registrar University Hospitals Coventry & Warwickshire, Clifford Bridge Road, CV2 2DX
| | - Shamil Yusuf
- Consultant Electrophysiologist University Hospitals Coventry & Warwickshire, Clifford Bridge Road, CV2 2DX
| | - Sandeep Panikker
- Consultant Electrophysiologist University Hospitals Coventry & Warwickshire, Clifford Bridge Road, CV2 2DX
| | - Michael Kuehl
- Consultant Cardiologist University Hospitals Coventry & Warwickshire, Clifford Bridge Road, CV2 2DX
| | - Faizel Osman
- Consultant Electrophysiologist University Hospitals Coventry & Warwickshire, Clifford Bridge Road, CV2 2DX
| | - Prithwish Banerjee
- Consultant Cardiologist University Hospitals Coventry & Warwickshire, Clifford Bridge Road, CV2 2DX
| | - Harpal Randeva
- Director of Research & Development University Hospitals Coventry & Warwickshire, Clifford Bridge Road, CV2 2DX
| | - Tarvinder Dhanjal
- Consultant Electrophysiologist University Hospitals Coventry & Warwickshire, Clifford Bridge Road, CV2 2DX
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11
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Eftekhari H, He H, Lee JD, Paul G, Zhupaj A, Lachlan T, Kuehl M, Dhanjal T, Panikker S, Yusuf S, Hayat S, Osman F. Safety and outcome of nurse-led syncope clinics and implantable loop recorder implants. Heart Rhythm 2021; 19:443-447. [PMID: 34767989 DOI: 10.1016/j.hrthm.2021.11.006] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/26/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Implantable loop recorders (ILRs) are effective in achieving symptom-rhythm correlation. Data on the diagnostic yield of ILRs, on nurse-led syncope clinics, and on nurse-led ILR implants are limited. OBJECTIVE We evaluated the safety and efficacy of our nurse-led syncope clinic and nurse-led ILR implants. METHODS A retrospective study of all consecutive patients undergoing nurse-led ILR implantations was performed between April 2016 and April 2018. Patients were referred from both nurse-led and physician-led clinics. Data were collected on baseline demographic characteristics, referral source, symptom-rhythm correlation, ILR findings, and subsequent changes to management. All ILRs were enrolled into remote monitoring with automatic arrhythmia detection, and all immediate (≤24 hours) ILR implant complications were recorded. Comparisons were made between nurse-led and physician-led clinics and subsequent outcomes. RESULTS A total of 432 patients with an ILR were identified: 164 (38%) from nurse-led and 268 (62%) from physician-led clinics; 200 (46%) were women (mean age 66.5 ± 18.2 years; mean follow-up duration 28.9 ± 9.5 months). Primary ILR indications were syncope (n = 251 [58%]), presyncope (n = 33 [7%]), palpitation (n = 39 [9%]), cryptogenic stroke (n = 78 [18%]), and other reasons (n = 31 [7%]). No immediate ILR implant complications occurred. Overall, 156 patients (36%) had a change in management as a direct result of ILR findings, with no overall differences between nurse-led and physician-led clinics (35% vs 36%; P = .7). More patients had newly diagnosed atrial fibrillation in physician-led clinics (15% vs 7%; P = .01), and more patients had pacemaker implants for bradycardia in nurse-led clinics (23% vs 13%; P < .01). CONCLUSION Nurse-led ILR implantation was safe and effective. Nurse-led syncope clinics achieved good symptom-rhythm correlation with resultant significant changes to management in comparison to physician-led clinics. Larger prospective studies are needed to evaluate their longer-term impact.
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Affiliation(s)
- Helen Eftekhari
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Hejie He
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - James Doug Lee
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Geeta Paul
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Albiona Zhupaj
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Thomas Lachlan
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Michael Kuehl
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Tarv Dhanjal
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Sandeep Panikker
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Shamil Yusuf
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Sajad Hayat
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Faizel Osman
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom.
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12
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Senior J, Kuehl M. Cardiac implantable electronic device malfunction due to twiddler's syndrome in a patient with bipolar affective disorder. BMJ Case Rep 2021; 14:e245978. [PMID: 34667046 PMCID: PMC8527125 DOI: 10.1136/bcr-2021-245978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Michael Kuehl
- Cardiology, University Hospital Coventry, Coventry, UK
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13
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Tran P, Marshall L, Patchett I, Yusuf S, Panikker S, Banerjee P, Osman F, Kuehl M, Dhanjal T. Real-world evaluation of follow up strategies after implantable cardiac-defibrillator therapies in patients with ventricular tachycardia (REFINE-VT). Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0652] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Implantable cardiac-defibrillators (ICD) can prevent sudden cardiac death but the risk of recurrent ventricular arrhythmia (VA) and ICD therapies persists. Established strategies to minimize such risks include medication optimization, device reprogramming or ventricular tachycardia (VT) catheter ablation (CA). However, the timing and choice of these strategies at ICD follow-up may not be as consistent in the real-world as the regulated conditions of clinical trials. Furthermore, whether these decisions at follow-up are influenced by the type of arrhythmia, ICD therapy or patient characteristics remain unclear.
Purpose
We evaluated ICD follow-up strategies in patients with ischaemic (ICM) and non-ischaemic cardiomyopathy (NICM) to refine the outpatient management of these complex patients and ultimately improve overall patient outcome.
Methods
REFINE-VT is a retrospective study of 514 patients with ICD/CRT-D who attended ICD follow-up between June 2018 to September 2019 at the University Hospital Coventry & Warwickshire (UHCW) tertiary cardiology department. All follow-ups were face-to-face. Patients were divided into 2 groups according to the absence or presence of sustained VA (e.g. >30 seconds of VT and/or appropriate ICD therapy), described as “negative event” and “positive event” groups respectively. The type of strategy employed in response to a positive event were categorized into 4 groups: (1) Medication change only (2) Device programming +/− medication (3) Referral for VT CA (4) No intervention
Results
514 consecutive patients with ICD (52%) or CRT-D (48%) were analysed. Overall mean age was 67±14 years with 79% male patients. ICM was diagnosed in 329 (64%) patient and NICM in 185 (36%). 437 (85%) patients had no significant VA and/or ICD therapy referred to as the negative group. A total of 77 patients (15%) suffered VA and/or ICD therapies, of whom 22 patients (26%) experienced a second event. 31% (n=24) of this positive event group received no preventative strategy (Table 1). We observed an inconsistent approach to the choice of strategies across different types of arrhythmias and ICD therapies. E.g. the odds of intervening were significantly higher if ICD shock was detected compared to anti-tachycardia pacing (OR 8.4, 95% CI 1.7–39.6, p=0.007). Even in patients with two events, the rate of referral for VT ablation and escalation of antiarrhythmics were similarly as low as patients with a single event (Table 2).
Conclusion
This is the first contemporary study that has evaluated how strategies that reduce the risk of recurrent ICD events are executed in a real-world population. We have demonstrated that the decision to intervene and choices of strategy remain inconsistent and partially biased by the type of arrhythmia and ICD therapy at follow-up. This supports the need for an evidence-driven multi-disciplinary VT clinic to refine and standardize our approach to this heterogeneous population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Tran
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - L Marshall
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - I Patchett
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - S Yusuf
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - S Panikker
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - P Banerjee
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - F Osman
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - M Kuehl
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - T Dhanjal
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
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14
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Ueberham L, Jahnke C, Paetsch I, Klingel K, Kuehl M, Hindricks G, Dinov B. Current Diagnostic Criteria Show a Substantial Disagreement in Classification of Patients With Suspected Cardiac Sarcoidosis. JACC Clin Electrophysiol 2021; 7:538-539. [PMID: 33888272 DOI: 10.1016/j.jacep.2020.12.011] [Citation(s) in RCA: 4] [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: 10/28/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/25/2022]
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15
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Abdelsalam HA, Rai K, Kuehl M, Khan JN. Three-dimensional transoesophageal echocardiography allows unique assessment of pacemaker lead-related tricuspid valve dysfunction. Eur Heart J Case Rep 2021; 5:ytaa486. [PMID: 33554023 PMCID: PMC7850619 DOI: 10.1093/ehjcr/ytaa486] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/01/2020] [Accepted: 11/12/2020] [Indexed: 11/25/2022]
Affiliation(s)
| | - Kam Rai
- University Hospital Coventry & Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Michael Kuehl
- University Hospital Coventry & Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Jamal Nasir Khan
- University Hospital Coventry & Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
- University of Warwick, Coventry CV4 7AL, UK
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16
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Proietti R, Dowd R, Gee LV, Yusuf S, Panikker S, Hayat S, Osman F, Patel K, Salim H, Aldhoon B, Foster W, Merghani A, Kuehl M, Banerjee P, Lellouche N, Dhanjal T. Impact of a high-density grid catheter on long-term outcomes for structural heart disease ventricular tachycardia ablation. J Interv Card Electrophysiol 2021; 62:519-529. [PMID: 33392856 PMCID: PMC8645535 DOI: 10.1007/s10840-020-00918-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/31/2020] [Indexed: 01/04/2023]
Abstract
Background Substrate mapping has highlighted the importance of targeting diastolic conduction channels and late potentials during ventricular tachycardia (VT) ablation. State-of-the-art multipolar mapping catheters have enhanced mapping capabilities. The purpose of this study was to investigate whether long-term outcomes were improved with the use of a HD Grid mapping catheter combining complementary mapping strategies in patients with structural heart disease VT. Methods Consecutive patients underwent VT ablation assigned to either HD Grid, Pentaray, Duodeca, or point-by-point (PbyP) RF mapping catheters. Clinical endpoints included recurrent anti-tachycardia pacing (ATP), appropriate shock, asymptomatic non-sustained VT, or all-cause death. Results Seventy-three procedures were performed (33 HD Grid, 22 Pentaray, 12 Duodeca, and 6 PbyP) with no significant difference in baseline characteristics. Substrate mapping was performed in 97% of cases. Activation maps were generated in 82% of HD Grid cases (Pentaray 64%; Duodeca 92%; PbyP 33% (p = 0.025)) with similar trends in entrainment and pace mapping. Elimination of all VTs occurred in 79% of HD Grid cases (Pentaray 55%; Duodeca 83%; PbyP 33% (p = 0.04)). With a mean follow-up of 372 ± 234 days, freedom from recurrent ATP and shock was 97% and 100% respectively in the HD Grid group (Pentaray 64%, 82%; Duodeca 58%, 83%; PbyP 33%, 33% (log rank p = 0.0042, p = 0.0002)). Conclusions This study highlights a step-wise improvement in survival free from ICD therapies as the density of mapping capability increases. By using a high-density mapping catheter and combining complementary mapping strategies in a strict procedural workflow, long-term clinical outcomes are improved.
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Affiliation(s)
- Riccardo Proietti
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK.,Department of Cardiac, Thoracic, Vascular Sciences, and University of Padua, Padua, Italy
| | - Rory Dowd
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Lim Ven Gee
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Shamil Yusuf
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Sandeep Panikker
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Sajad Hayat
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Faizel Osman
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK.,University of Warwick (Medical School), Gibbet Hill, Coventry, CV4 7AJ, UK
| | - Kiran Patel
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK.,University of Warwick (Medical School), Gibbet Hill, Coventry, CV4 7AJ, UK
| | - Handi Salim
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Bashar Aldhoon
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Will Foster
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Ahmed Merghani
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Michael Kuehl
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Prithwish Banerjee
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Nicolas Lellouche
- Hopital Henri Mondor Albert Chenevier, University Paris Est Creteil Paris XII, Avenue du Marechal de Lattre de Tassigny, 94000, Creteil, Inserm U955, Paris, France
| | - Tarvinder Dhanjal
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK. .,University of Warwick (Medical School), Gibbet Hill, Coventry, CV4 7AJ, UK.
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17
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Hobart CG, Mazumdar A, Spencer SJ, Quigley M, Smith JP, Bertrand S, Pratt J, Kuehl M, Buerger SP. Achieving Versatile Energy Efficiency With the WANDERER Biped Robot. IEEE T ROBOT 2020. [DOI: 10.1109/tro.2020.2969017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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18
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Dobrovie M, Spampinato RA, Efimova E, da Rocha E Silva JG, Fischer J, Kuehl M, Voigt JU, Belmans A, Ciarka A, Bonamigo Thome F, Schloma V, Dmitrieva Y, Lehmann S, Hahn J, Strotdrees E, Mohr FW, Garbade J, Meyer AL. Reversibility of severe mitral valve regurgitation after left ventricular assist device implantation: single-centre observations from a real-life population of patients. Eur J Cardiothorac Surg 2019; 53:1144-1150. [PMID: 29351635 DOI: 10.1093/ejcts/ezx476] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 06/07/2017] [Accepted: 12/06/2017] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study evaluates the impact of untreated preoperative severe mitral valve regurgitation (MR) on outcomes after left ventricular assist device (LVAD) implantation. METHODS Of the 234 patients who received LVAD therapy in our centre during a 6-year period, we selected those who had echocardiographic images of good quality and excluded those who underwent mitral valve replacement prior to or mitral valve repair during LVAD placement. The 128 patients selected were divided into 2 groups: Group A with severe MR (n = 65) and Group B with none to moderate MR (n = 63, 28 with moderate MR). We evaluated transthoracic echocardiography preoperatively [15 (7-28) days before LVAD implantation; median (interquartile range)] and postoperatively up to the last available follow-up [501 (283-848) days after LVAD]. We collected mortality, complications and clinical status indicators of the patient cohort. RESULTS We observed a significant decrease in the severity of MR after LVAD implantation (severe MR 51% pre- vs 6% post-LVAD implantation, P < 0.001). There was no difference between groups in terms of right heart failure, rate of urgent heart transplantation, pump thrombosis or ventricular arrhythmias. There was no difference in 1-year survival and 3-year survival (87.7% vs 88.4% and 71.8% vs 66.6% for Groups A and B, respectively, P = 0.97). CONCLUSIONS Preoperative severe MR resolves in the majority of patients early on after LVAD implantation and is not associated with worse clinical outcomes or intermediate-term survival.
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Affiliation(s)
- Monica Dobrovie
- Department of Cardiac Surgery, University of Leipzig, Leipzig Heart Center, Leipzig, Germany
| | - Ricardo A Spampinato
- Department of Cardiac Surgery, University of Leipzig, Leipzig Heart Center, Leipzig, Germany
| | - Elena Efimova
- Department of Rhythmology, University of Leipzig, Leipzig Heart Center, Leipzig, Germany
| | | | - Julia Fischer
- Department of Cardiac Surgery, University of Leipzig, Leipzig Heart Center, Leipzig, Germany
| | - Michael Kuehl
- Department of Cardiac Surgery, University of Leipzig, Leipzig Heart Center, Leipzig, Germany.,Department of Rhythmology, University of Leipzig, Leipzig Heart Center, Leipzig, Germany
| | - Jens-Uwe Voigt
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Ann Belmans
- Leuven Biostatistics and Statistical Bioinformatics Centre, Leuven, Belgium
| | - Agnieszka Ciarka
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Fernanda Bonamigo Thome
- Department of Cardiac Surgery, University of Leipzig, Leipzig Heart Center, Leipzig, Germany
| | - Valerie Schloma
- Department of Cardiac Surgery, University of Leipzig, Leipzig Heart Center, Leipzig, Germany
| | - Yaroslava Dmitrieva
- Department of Cardiac Surgery, University of Leipzig, Leipzig Heart Center, Leipzig, Germany
| | - Sven Lehmann
- Department of Cardiac Surgery, University of Leipzig, Leipzig Heart Center, Leipzig, Germany
| | - Jochen Hahn
- Department of Cardiac Surgery, University of Leipzig, Leipzig Heart Center, Leipzig, Germany
| | - Elfriede Strotdrees
- Department of Cardiac Surgery, University of Leipzig, Leipzig Heart Center, Leipzig, Germany
| | - Friedrich-Wilhelm Mohr
- Department of Cardiac Surgery, University of Leipzig, Leipzig Heart Center, Leipzig, Germany
| | - Jens Garbade
- Department of Cardiac Surgery, University of Leipzig, Leipzig Heart Center, Leipzig, Germany
| | - Anna L Meyer
- Department of Cardiac Surgery, University of Leipzig, Leipzig Heart Center, Leipzig, Germany
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19
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Doring M, Knopp H, Bode K, Kuehl M, Muessigbrodt A, Hindricks G, Richter S. 539Transvenous revision of leads with cardiac perforation after implantation of cardiac electronic devices: complications and outcome. Europace 2018. [DOI: 10.1093/europace/euy015.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Doring
- Heart Centre, Department of Electrophysiology, Leipzig, Germany
| | - H Knopp
- Heart Centre, Department of Electrophysiology, Leipzig, Germany
| | - K Bode
- Heart Centre, Department of Electrophysiology, Leipzig, Germany
| | - M Kuehl
- Heart Centre, Department of Electrophysiology, Leipzig, Germany
| | - A Muessigbrodt
- Heart Centre, Department of Electrophysiology, Leipzig, Germany
| | - G Hindricks
- Heart Centre, Department of Electrophysiology, Leipzig, Germany
| | - S Richter
- Heart Centre, Department of Electrophysiology, Leipzig, Germany
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20
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Abstract
BACKGROUND Management of hypertrophic obstructive cardiomyopathy (HOCM) has evolved considerably over the last fifty years, and includes medical treatment as well as septal myectomy (SM) to relief symptoms caused by left ventricular outflow tract obstruction (LVOTO). We report the Leipzig Heart Center experience in the surgical management of patients with HOCM. METHODS We collected data from all patient treated surgically with a myectomy for LVOTO in patients with HOCM between 1997 and 2016. Patients with absent data were excluded from our analysis. All data were obtained from our surgical database and analyzed retrospectively. RESULTS We identified 115 patients who underwent surgical treatment for HOCM, where a male:female ratio of 1.1:1, a mean age of 60.8±14.6 years and a body mass index of 27.7±4.5 were observed. The most common symptom was dyspnea (n=102). Of all patients, 50% had New York Heart Association (NYHA) III class symptoms. Arterial hypertension was the most common comorbidity (n=80). Preoperative transthoracic echocardiography showed a mean ejection fraction (EF) of 65.9%±9.7%, median septal thickness of 21.1±5.3 mm, systolic anterior motion of the mitral valve (MV) in 61.7% of patients, and mean LVOT gradient of 70.1±45.2 mmHg. Surgery resulted in a mean decrease of the septal thickness by 15±3.7 mm and LVOT gradient by 9.7±8.5 mmHg. Isolated SM was carried out on 20 patients. Postoperatively, we were able to notice a significant improvement in NYHA classification, in which patients with NYHA III benefitted most from SM. Long-term follow-up data up to 11.3±0.7 years were available for 114 patients. During follow-up, 16 patients died, and one patient was lost to follow up. CONCLUSIONS Surgical treatment of LVOT in patients with HOCM is an effective intervention that improves cardiac function and quality of life (QoL) and is associated with a low operative risk.
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Affiliation(s)
- Jawad Khalil
- Department of Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Michael Kuehl
- Department of Electrophysiology, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Pirose Davierwala
- Department of Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
| | | | - Martin Misfeld
- Department of Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
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21
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Affiliation(s)
- Michael Kuehl
- Division of Electrophysiology, Leipzig Heart Centre, Leipzig, Germany.,Division of Cardiothoracic Surgery, Leipzig Heart Centre, Leipzig, Germany
| | - Jens Garbade
- Division of Cardiothoracic Surgery, Leipzig Heart Centre, Leipzig, Germany
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22
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Mazumdar A, Spencer SJ, Hobart C, Dabling J, Blada T, Dullea K, Kuehl M, Buerger SP. Synthetic Fiber Capstan Drives for Highly Efficient, Torque Controlled, Robotic Applications. IEEE Robot Autom Lett 2017. [DOI: 10.1109/lra.2016.2646259] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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23
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Pichiorri F, Suh SS, Rocci A, De Luca L, Taccioli C, Santhanam R, Zhou W, Benson DM, Hofmainster C, Alder H, Garofalo M, Di Leva G, Volinia S, Lin HJ, Perrotti D, Kuehl M, Aqeilan RI, Palumbo A, Croce CM. RETRACTED: Downregulation of p53-inducible microRNAs 192, 194, and 215 Impairs the p53/MDM2 Autoregulatory Loop in Multiple Myeloma Development. Cancer Cell 2016; 30:349-351. [PMID: 27505674 DOI: 10.1016/j.ccell.2016.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the editors. This correction has been retracted because the article that it relates to has now been retracted at the request of the editors.
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24
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Gu S, Kuehl M, Watkin R. 96 The Impact of “Consultant of The Week (Cow)” Inpatient Medical Care on Patient Outcomes: Abstract 96 Table 1. Heart 2016. [DOI: 10.1136/heartjnl-2016-309890.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Beadle RM, Williams LK, Kuehl M, Bowater S, Abozguia K, Leyva F, Yousef Z, Wagenmakers AJM, Thies F, Horowitz J, Frenneaux MP. Improvement in cardiac energetics by perhexiline in heart failure due to dilated cardiomyopathy. JACC Heart Fail 2015; 3:202-11. [PMID: 25650370 DOI: 10.1016/j.jchf.2014.09.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/05/2014] [Accepted: 09/19/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether short-term treatment with perhexiline improves cardiac energetics, left ventricular function, and symptoms of heart failure by altering cardiac substrate utilization. BACKGROUND Perhexiline improves exercise capacity and left ventricular ejection fraction (LVEF) in patients with heart failure (HF). (31)P cardiac magnetic resonance spectroscopy can be used to quantify the myocardial phosphocreatine/adenosine triphosphate ratio. Because improvement of HF syndrome can improve cardiac energetics secondarily, we investigated the effects of short-term perhexiline therapy. METHODS Patients with systolic HF of nonischemic etiology (n = 50, 62 ± 1.8 years of age, New York Heart Association functional class II to IV, LVEF: 27.0 ± 1.44%) were randomized to receive perhexiline 200 mg or placebo for 1 month in a double-blind fashion. Clinical assessment, echocardiography, and (31)P cardiac magnetic resonance spectroscopy were performed at baseline and after 1 month. A substudy of 22 patients also underwent cross-heart blood sampling at completion of the study to quantify metabolite utilization. RESULTS Perhexiline therapy was associated with a 30% increase in the phosphocreatine/adenosine triphosphate ratio (from 1.16 ± 0.39 to 1.51 ± 0.51; p < 0.001) versus a 3% decrease with placebo (from 1.36 ± 0.31 to 1.34 ± 0.31; p = 0.37). Perhexiline therapy also led to an improvement in New York Heart Association functional class compared with placebo (p = 0.036). Short-term perhexiline therapy did not change LVEF. Cross-heart measures of cardiac substrate uptake and respiratory exchange ratio (which reflects the ratio of substrates used) did not differ between patients who received perhexiline versus placebo. CONCLUSIONS Perhexiline improves cardiac energetics and symptom status with no evidence of altered cardiac substrate utilization. No change in LVEF is seen at this early stage. (Metabolic Manipulation in Chronic Heart Failure; NCT00841139).
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Affiliation(s)
- Roger M Beadle
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland
| | - Lynne K Williams
- Department of Cardiology, Toronto General Hospital, Toronto, Ontario, Canada
| | - Michael Kuehl
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, England
| | - Sarah Bowater
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, England
| | - Khalid Abozguia
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, England
| | - Francisco Leyva
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, England
| | - Zaheer Yousef
- Department of Cardiology, University Hospital of Wales, Cardiff, Wales
| | - Anton J M Wagenmakers
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, England
| | - Frank Thies
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland
| | - John Horowitz
- Department of Cardiology and Pharmacology, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - Michael P Frenneaux
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland.
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Fisher M, De Renteria J, Kuehl M, Suponcic S, Dharamshi K. Burden of Disease in Stage IV Non-Small Cell Lung Cancer: Comparing ALK Positive and ALK Negative Mutation Status in Egypt, Russia and the United Arab Emirates. Value Health 2014; 17:A618. [PMID: 27202172 DOI: 10.1016/j.jval.2014.08.2183] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Gamache BJ, Simmons JK, Michalowski A, Patel J, Zhang K, Zhang S, DuBois W, Zingone A, Kuehl M, Huang J, Landgren O, Mock B. Abstract 5472: Systems pharmacogenomics approach identifies synergistic molecular action of combined MTOR/HDAC inhibition on MYC. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-5472] [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: 11/16/2022]
Abstract
Abstract
Multiple myeloma (MM) and murine plasmacytoma (PCT) are rare mature B-lymphoid malignancies. Allelic variants of Mtor and Cdkn2a affect susceptibility to PCT, and functional alterations in the PI3K/MTOR and CYCLIN/CDK/CDKI/RB (RB) pathways are common to both malignancies. We found that combining sirolimus (rapamycin), an inhibitor of mechanistic target of rapamycin (MTOR), with entinostat (MS-275), a selective class I histone deacytlase (HDAC) inhibitor, was synergistic in controlling 90% of tested cell lines derived from B cell malignancies in vitro, effective in limiting xenograft growth in vivo, and diminished cellular viability in ex vivo patient samples. Similarly, the combination reduced tumor burden and volume and increased survival in a long-term, in-vivo study in C.B6-Bcl2l1 mice. To examine the core synergistic consequence of combining entinostat with sirolimus, an integrated, systems-level approach was used. Weighted gene co-expression analysis (WGCNA) of GEP data from MM cells treated individually and in combination was used to identify a distinct module of 126 genes cooperatively affected by both drugs. Of the cooperatively affected genes, 37 were found to be differentially expressed in MM and predictive of survival (p<0.01). Ingenuity upstream analysis identified MYC as a potential core regulator of the synergistic transcriptional response. MYC protein, but not mRNA, decreased in response to the drug combination when examined by Western blot and NanoString analyses, respectively. Using tet-off, MYC-inducible transformed P493 cells, the necessity of MYC for the drop in cellular viability and response of the gene signature to the combination was evident. Using the translational and proteasomal inhibitors, cycloheximide and MG132, respectively, it was determined that MYC protein half-life decreased with the combination, largely due to proteasomal degradation. Utilizing a systems-level approach and biological filters, an alternative route to MYC inhibition was determined. Biologically relevant, this methodology can be used to define the molecular underpinnings of drug combinations, applicable to many diseases.
Citation Format: Benjamin J. Gamache, John K. Simmons, Aleksandra Michalowski, Jyoti Patel, Ke Zhang, Shuling Zhang, Wendy DuBois, Adriana Zingone, Michael Kuehl, Jing Huang, Ola Landgren, Beverly Mock. Systems pharmacogenomics approach identifies synergistic molecular action of combined MTOR/HDAC inhibition on MYC. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5472. doi:10.1158/1538-7445.AM2014-5472
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Affiliation(s)
| | | | | | | | - Ke Zhang
- National Cancer Institute, Bethesda, MD
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Fateh-Moghadam S, Jorbenadze R, Kilias A, Kuehl M, Htun P, Sutaj B, Gawaz M, Bocksch W. Vascular and access site complication after transfemoral aortic valve implantation. A serial ultra-sound study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5396] [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: 11/15/2022] Open
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Simmons JK, Michalowski AM, Gamache B, Patel J, Zingone A, Zhang K, Kuehl M, Huang J, Landgren O, Mock BA. Abstract 2217: A systems pharmacogenomic approach to identify synergistic molecular mechanisms of combined mTOR/HDAC inhibition. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-2217] [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: 11/16/2022]
Abstract
Abstract
The necessity of combining targeted therapeutics to achieve optimal, lasting clinical benefit is clear, but standardized approaches for identifying the interactive effects of these combinations are not yet established. Discerning drug synergy at the molecular level has proven particularly challenging, yet identification of cooperatively responding, biologically-relevant targets could be useful for defining patient subsets for which the combination would be active. Here we used a transcriptional co-expression systems-level analysis to define the cooperative molecular response to the synergistic combination of mTOR/HDAC inhibitors in multiple myeloma (MM), and in other tumor types including triple negative breast cancer. Co-expression analysis of cells treated individually and in combination defined the contribution of each drug to the combination, and identified a distinct network of 126 genes cooperatively targeted by both drugs. We interrogated the cooperative network genes for differential expression between normal and malignant cells, as well as for correlation with survival in a large patient dataset. 37 of the cooperatively affected genes were both differentially expressed in MM and predictive of survival (p<0.01). Analysis of additional tumor types showed similar results. The pharmacodynamic response of the survival-linked signature to the drug combination was evaluated using the NanoString gene expression platform in a large number of cell lines from multiple tumor types and in ex vivo-treated primary patient samples before and after treatment. We found the expression change of signature genes to be highly specific for biological response to the drug combination across tumor types. Additionally, to link the response signature to a central molecular effect of combination treatment, Ingenuity transcription factor enrichment testing was performed. Based on these predictions, subsequent analysis of CHIP-Seq datasets was performed, and two oncogenic transcription factors (TFs) were found to bind nearly all genes of this signature. We then experimentally linked drug combination response to diminished expression of these TFs at the protein level ahead of cell cycle and apoptotic changes. Further experiments have been performed to establish a direct link between these TFs, our gene signature, and drug response. Thus, a systems-level genomic approach has identified a gene signature indicative of drug combination activity, mechanism, disease specificity, and clinical potential.
Citation Format: John K. Simmons, Aleksandra M. Michalowski, Ben Gamache, Jyoti Patel, Adriana Zingone, Ke Zhang, Michael Kuehl, Jing Huang, Ola Landgren, Beverly A. Mock. A systems pharmacogenomic approach to identify synergistic molecular mechanisms of combined mTOR/HDAC inhibition. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2217. doi:10.1158/1538-7445.AM2013-2217
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Abstract
Diabetic autonomic neuropathies are a heterogeneous and progressive disease entity and commonly complicate both type 1 and type 2 diabetes mellitus. Although the aetiology is not entirely understood, hyperglycaemia, insulin deficiency, metabolic derangements and potentially autoimmune mechanisms are thought to play an important role. A subgroup of diabetic autonomic neuropathy, cardiovascular autonomic neuropathy (CAN), is one of the most common diabetes-associated complications and is ultimately clinically important because of its correlation with increased mortality. The natural history of CAN is unclear, but is thought to progress from a subclinical stage characterized by impaired baroreflex sensitivity and abnormalities of spectral analysis of heart rate variability to a clinically apparent stage with diverse and disabling symptoms. Early diagnosis of CAN, using spectral analysis of heart rate variability or scintigraphic imaging techniques, might enable identification of patients at highest risk for the development of clinical CAN and, thereby, enable the targeting of intensive therapeutic approaches. This Review discusses methods for diagnosis, epidemiology, natural history and potential causes and consequences of CAN.
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Affiliation(s)
- Michael Kuehl
- Cardiovascular Research Department, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Beadle RM, Williams LK, Kuehl M, Bowater S, Abozguia K, Leon FL, Frenneaux MP. 95 Impaired cardiac energetics in dilated cardiomyopathy: magnetic resonance spectroscopy at 3T. Heart 2011. [DOI: 10.1136/heartjnl-2011-300198.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Weiss BM, Minter A, Abadie J, Howard R, Ascencao J, Schechter GP, Kuehl M, Landgren O. Patterns of monoclonal immunoglobulins and serum free light chains are significantly different in black compared to white monoclonal gammopathy of undetermined significance (MGUS) patients. Am J Hematol 2011; 86:475-8. [PMID: 21544856 DOI: 10.1002/ajh.22025] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 02/26/2011] [Accepted: 02/28/2011] [Indexed: 01/26/2023]
Abstract
Monoclonal gammopathy of undetermined significance (MGUS), the precursor to multiple myeloma, is more common in blacks than whites. The serum free light chain (sFLC) assay is an important prognostic test in MGUS, but no study has evaluated sFLC levels and ratios in black MGUS patients. One-hundred and twenty-five black MGUS patients at two urban centers were compared to the white population of the Mayo Clinic. The median age for blacks was 73 years [41-94] and 75% were male. The M-protein isotype in blacks was 81% IgG, 13% IgA, 2% IgM, and 4% biclonal compared to 70%, 12%, 16%, and 2%, respectively, in whites, (P < 0.0005). The median M-protein concentration for blacks was 0.44 gm/dL (trace-2.33) compared to 1.2 gm/dl in whites. An abnormal sFLC ratio was present in 45% of black compared to 33% of white (P = 0.01) patients. Using the Mayo Clinic risk model, black patients had a significantly lower proportion of higher risk MGUS compared to whites: low 43%, low-intermediate 45%, high-intermediate 10%, and high 2% (P = 0.014). Black patients with MGUS have significantly different laboratory findings compared to whites. The biologic basis for these disparities and their effect on prognostic assessment is unknown. Prognostic models based on these biomarkers should be used cautiously in nonwhite populations.
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Affiliation(s)
- Brendan M Weiss
- Hematology-Oncology, Brooke Army Medical Center, San Antonio, Texas, USA.
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Waxman AJ, Kuehl M, Balakumaran A, Weiss B, Landgren O. Smoldering (asymptomatic) multiple myeloma: revisiting the clinical dilemma and looking into the future. Clin Lymphoma Myeloma Leuk 2011; 10:248-57. [PMID: 20709660 DOI: 10.3816/clml.2010.n.053] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Recent studies show that multiple myeloma (MM) is consistently preceded by an asymptomatic precursor state. Smoldering MM (SMM) is a MM precursor defined by an M-protein concentration >or= 3 g/dL and/or >or= 10% bone marrow plasma cells, in the absence of end-organ damage. Compared with individuals diagnosed with monoclonal gammopathy of undetermined significance (MGUS), patients with SMM have a much higher annual risk of developing MM. However, based on clinical observations, the natural history of SMM varies greatly, from stable MGUS-like disease to highly progressive disease. Using conventional clinical markers, SMM patients can be stratified into 3 risk groups. Importantly, because of considerable molecular heterogeneity, we currently lack reliable markers to predict prognosis for individual SMM patients. Furthermore, until recently, potent drugs with reasonable toxicity profiles have not been available for the development of early MM treatment strategies. Consequently, current clinical guidelines emphasize the application of close clinical monitoring followed by treatment when the patient develops symptomatic MM. This review focuses on novel biomarkers, molecular profiles, and microenvironmental interactions of interest in myelomagenesis. We also discuss how the integration of novel biologic markers and clinical monitoring of SMM could facilitate the development of early treatment strategies for high-risk SMM patients in the future.
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Affiliation(s)
- Adam J Waxman
- Medical Oncology Branch, National Cancer Institute, Bethesda, MD, USA
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35
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Pichiorri F, Suh SS, Rocci A, De Luca L, Taccioli C, Santhanam R, Wenchao Z, Benson DM, Hofmainster C, Alder H, Garofalo M, Di Leva G, Volinia S, Lin HJ, Perrotti D, Kuehl M, Aqeilan RI, Palumbo A, Croce CM. RETRACTED: Downregulation of p53-inducible microRNAs 192, 194, and 215 impairs the p53/MDM2 autoregulatory loop in multiple myeloma development. Cancer Cell 2010; 18:367-81. [PMID: 20951946 PMCID: PMC3561766 DOI: 10.1016/j.ccr.2010.09.005] [Citation(s) in RCA: 346] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 06/16/2010] [Accepted: 08/09/2010] [Indexed: 01/24/2023]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the editors. This article was published on October 19, 2010, and Figures 4A and 7A were later corrected on August 8, 2016. In January 2021, The Ohio State University notified the Cancer Cell editors that an internal investigation concluded that Figures 1E, 4A, 4D, 5A, and 7A were falsified and that part of Figure 1E of the article is the same as part of Figure 1F in the correction of another article (Pichiorri et al., 2017, J. Exp. Med., 214, 1557, https://doi.org/10.1084/jem.2012095001172017c) and recommended retraction of the article. The editors no longer have confidence in the validity of the data and are retracting the article. S.-S. S. agrees with the retraction, and F.P., C.H., A.P., and C.M.C. disagree with the retraction; all other authors couldn't be reached or didn't respond.
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Affiliation(s)
- Flavia Pichiorri
- Departments of Molecular Virology, Immunology and Human Genetics, Comprehensive Cancer Center, The Ohio State; University, Columbus, OH 43210
- IMRIC-The Lautenberg Center for Immunology and Cancer Research, Hebrew University-Hadassah Medical School, Jerusalem, Israel 91120
| | - Sung-Suk Suh
- Departments of Molecular Virology, Immunology and Human Genetics, Comprehensive Cancer Center, The Ohio State; University, Columbus, OH 43210
- IMRIC-The Lautenberg Center for Immunology and Cancer Research, Hebrew University-Hadassah Medical School, Jerusalem, Israel 91120
| | - Alberto Rocci
- Division of Hematology, University of Turin, Turin, Italy, 10149
| | - Luciana De Luca
- Departments of Molecular Virology, Immunology and Human Genetics, Comprehensive Cancer Center, The Ohio State; University, Columbus, OH 43210
- Molecular Oncology Unit, IRCCS, Referral Cancer Center of Basilicata –Crob, Rionero in Vulture (PZ), Italy, 85028
| | - Cristian Taccioli
- Departments of Molecular Virology, Immunology and Human Genetics, Comprehensive Cancer Center, The Ohio State; University, Columbus, OH 43210
- Cancer Institute - University College London, London WC1E
| | - Ramasamy Santhanam
- Departments of Molecular Virology, Immunology and Human Genetics, Comprehensive Cancer Center, The Ohio State; University, Columbus, OH 43210
| | - Zhou Wenchao
- Medical Technology Division, School of Allied Medical Professions, The Ohio state University, Columbus, OH 43210
| | - Don M. Benson
- Division of Hematology and Oncology, Department of Medicine, Comprehensive Cancer Center, The Ohio state University, Columbus, OH 43210
| | - Craig Hofmainster
- Division of Hematology and Oncology, Department of Medicine, Comprehensive Cancer Center, The Ohio state University, Columbus, OH 43210
| | - Hansjuerg Alder
- Departments of Molecular Virology, Immunology and Human Genetics, Comprehensive Cancer Center, The Ohio State; University, Columbus, OH 43210
| | - Michela Garofalo
- Departments of Molecular Virology, Immunology and Human Genetics, Comprehensive Cancer Center, The Ohio State; University, Columbus, OH 43210
| | - Gianpiero Di Leva
- Departments of Molecular Virology, Immunology and Human Genetics, Comprehensive Cancer Center, The Ohio State; University, Columbus, OH 43210
| | - Stefano Volinia
- Departments of Molecular Virology, Immunology and Human Genetics, Comprehensive Cancer Center, The Ohio State; University, Columbus, OH 43210
- Telethon Facility-Data Mining for Analysis of DNA Microarrays, Department of Morphology and Embryology, University of Ferrara, Ferrara, Italy
| | - Huey-Jen Lin
- Medical Technology Division, School of Allied Medical Professions, The Ohio state University, Columbus, OH 43210
| | - Danilo Perrotti
- Departments of Molecular Virology, Immunology and Human Genetics, Comprehensive Cancer Center, The Ohio State; University, Columbus, OH 43210
| | - Michael Kuehl
- Genetics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20889-5105
| | - Rami I. Aqeilan
- Departments of Molecular Virology, Immunology and Human Genetics, Comprehensive Cancer Center, The Ohio State; University, Columbus, OH 43210
- IMRIC-The Lautenberg Center for Immunology and Cancer Research, Hebrew University-Hadassah Medical School, Jerusalem, Israel 91120
| | - Antonio Palumbo
- Division of Hematology, University of Turin, Turin, Italy, 10149
| | - Carlo M. Croce
- Departments of Molecular Virology, Immunology and Human Genetics, Comprehensive Cancer Center, The Ohio State; University, Columbus, OH 43210
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Rasmussen T, Haaber J, Dahl IM, Knudsen LM, Kerndrup GB, Lodahl M, Johnsen HE, Kuehl M. Identification of translocation products but not K-RAS mutations in memory B cells from patients with multiple myeloma. Haematologica 2010; 95:1730-7. [PMID: 20511669 DOI: 10.3324/haematol.2010.024778] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Several laboratories have shown that cells with a memory B-cell phenotype can have the same clonotype as multiple myeloma tumor cells. DESIGN AND METHODS The aim of this study was to determine whether some memory B cells have the same genetic alterations as their corresponding multiple myeloma malignant plasma cells. The methodology included sorting multiple myeloma or memory B cells into RNA stabilizing medium for generation of subset-specific polymerase chain reaction complementary DNA libraries from one or 100 cells. RESULTS Cells with the phenotype of tumor plasma cells (CD38(++)CD19(-)CD45(-/+)CD56(-/+/++)) or memory B cells (CD38(-)/CD19(+)/CD27(+)) were isolated by flow activated cell sorting. In samples from all four patients with multiple myeloma and from two of the three with monoclonal gammopathy of undetermined significance, we identified memory B cells expressing multiple myeloma-specific oncogenes (FGFR3; IGH-MMSET; CCND1 high) dysregulated by an IGH translocation in the respective tumor plasma cells. By contrast, in seven patients with multiple myeloma, each of whom had tumor plasma cells with a K-RAS61 mutation, a total of 32,400 memory B cells were analyzed using a sensitive allele-specific, competitive blocker polymerase chain reaction assay, but no K-RAS mutations were identified. CONCLUSIONS The increased expression of a specific "early" oncogene of multiple myeloma (monoclonal gammopathy of undetermined significance) in some memory B cells suggests that dysregulation of the oncogene occurs in a precursor B-cell that can generate memory B cells and transformed plasma cells. However, if memory B cells lack "late" oncogene (K-RAS) mutations but express the "early" oncogene, they cannot be involved in maintaining the multiple myeloma tumor, but presumably represent a clonotypic remnant that is only partially transformed.
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Affiliation(s)
- Thomas Rasmussen
- 1Department of Hematology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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Schlemmer M, Kuehl M, Schalhorn A, Rauch J, Jauch KW, Hentrich M. Tissue Levels of Reduced Folates in Patients with Colorectal Carcinoma After Infusion of Folinic Acid at Various Dose Levels. Clin Cancer Res 2008; 14:7930-4. [DOI: 10.1158/1078-0432.ccr-08-0258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kuehl M, Lewis M, Watson R. Bleeding complications as predictor for mortality. Am J Gastroenterol 2008; 103:2948-9. [PMID: 19032481 DOI: 10.1111/j.1572-0241.2008.02094_12.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Rasmussen T, Kuehl M, Lodahl M, Johnsen HE, Dahl IMS. Possible roles for activating RAS mutations in the MGUS to MM transition and in the intramedullary to extramedullary transition in some plasma cell tumors. Blood 2004; 105:317-23. [PMID: 15339850 DOI: 10.1182/blood-2004-03-0833] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To assess a possible role in tumor progression, the occurrence and type of K- and N-RAS mutations were determined in purified tumor cells, including samples from patients with premalignant monoclonal gammopathy of undetermined significance (MGUS), multiple myeloma (MM), and extramedullary plasma cell (PC) tumors (ExPCTs). Immunophenotypic aberrant PCs were flow sorted from 20 MGUS, 58 MM, and 13 ExPCT patients. One RAS mutation was identified in 20 MGUS tumors (5%), in contrast to a much higher prevalence of RAS mutations in all stages of MM (about 31%). Further, oncogene analyses showed that RAS mutations are not evenly distributed among different molecular subclasses of MM, with the prevalence being increased in MM-expressing cyclin D1 (P = .015) and decreased in MM with t(4;14) (P = .055). We conclude that RAS mutations often provide a genetic marker if not a causal event in the evolution of MGUS to MM. Surprisingly, RAS mutations were absent in bone marrow tumor cells from all patients with ExPCT, a result significantly different from intramedullary MM (P = .001). From 3 of 6 patients with paired intramedullary and extramedullary PCs and identical immunoglobulin heavy chain gene (IgH) sequences, RAS mutations were identified only in extramedullary PCs, suggesting a role for RAS mutations in the transition from intramedullary to extramedullary tumor.
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Affiliation(s)
- Thomas Rasmussen
- Department of Hematology L 54P4, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
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Abstract
We report a case of a 35-year-old male patient who presented with chronic atrial fibrillation secondary to a massive congenital left atrial appendage aneurysm. Minimal invasive endoscopic resection of the left atrial aneurysm with cryoablation was performed. The patient was discharged home in sinus rhythm.
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Affiliation(s)
- Bob Kiaii
- Clinic for Heart Surgery, Heart Center, University of Leipzig, Leipzig, Germany
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Shaughnessy J, Gabrea A, Qi Y, Brents L, Zhan F, Tian E, Sawyer J, Barlogie B, Bergsagel PL, Kuehl M. Cyclin D3 at 6p21 is dysregulated by recurrent chromosomal translocations to immunoglobulin loci in multiple myeloma. Blood 2001; 98:217-23. [PMID: 11418483 DOI: 10.1182/blood.v98.1.217] [Citation(s) in RCA: 143] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Reciprocal chromosomal translocations, which are mediated by errors in immunoglobulin heavy chain (IgH) switch recombination or somatic hypermutation as plasma cells are generated in germinal centers, are present in most multiple myeloma (MM) tumors. These translocations dysregulate an oncogene that is repositioned in proximity to a strong IgH enhancer. There is a promiscuous array of nonrandom chromosomal partners (and oncogenes), with the 3 most frequent partners (11q13 [cyclin D1]; 4p16 [FGFR3 and MMSET]; 16q23 [c-maf]) involved in nearly half of MM tumors. It is now shown that a novel t(6;14)(p21;q32) translocation is present in 1 of 30 MM cell lines and that this cell line uniquely overexpresses cyclin D3. The cloned breakpoint juxtaposes gamma 4 switch sequences with 6p21 sequences that are located about 65 kb centromeric to the cyclin D3 gene. By metaphase chromosome analysis, the t(6;14) (p21;q32) translocation was identified in 6 of 150 (4%) primary MM tumors. Overexpression of cyclin D3 messenger RNA (mRNA) was identified by microarray RNA expression analysis in 3 of 53 additional primary MM tumors, each of which was found to have a t(6;14) translocation breakpoint by interphase fluorescence in situ hybridization analysis. One tumor has a t(6;22)(p21;q11) translocation, so that cyclin D3 is bracketed by the IgL and IgH breakpoints. These results provide the first clear evidence for primary dysregulation of cyclin D3 during tumorigenesis. It is suggested that the initial oncogenic event for most MM tumors is a primary immunoglobulin translocation that dysregulates cyclin D1, cyclin D3, and other oncogenes to provide a proliferative stimulus to postgerminal center plasma cells.
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Affiliation(s)
- J Shaughnessy
- Donna D. and Donald M. Lambert Laboratory of Myeloma Genetics and Myeloma and the Transplantation Research Center, Arkansas Cancer Research Center, University of Arkansas for Medical Sciences, Little Rock, USA
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Capucci A, Villani GQ, Groppi F, Aschieri D, Hull M, Kuehl M. Comparison of therapy detection times between implantable cardioverter defibrillators with standard dual- and single-chamber pacing. J Interv Card Electrophysiol 1999; 3:329-33. [PMID: 10525248 DOI: 10.1023/a:1009883819803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Previous implantable cardioverter defibrillators (ICDs) required patients in need of dual-chamber (DDD) pacing for improved hemodynamic status to undergo implantation of separate devices to treat bradycardia and/or ventricular arrhythmias. An investigation was conducted to verify the performance of a new ICD that combines both therapies.Sixty-nine patients at 17 European and Canadian centers were implanted with VENTAK AV models 1810/1815, ICD's that includes DDD pacing and algorithms designed to differentiate between atrial and ventricular arrhythmias. 36 of the cohort were compared to 32 patients tested at six centers with an external test device (VENTAK MINI). In both cohorts detection times were calculated for ventricular fibrillation (VF) induced at implant. The mean detection times (DT) from the VENTAK AV device were compared to the DT from the VENTAK MINI device. Patient characteristics of the VENTAK AV and the VENTAK MINI control groups were similar. Mean VF detection time (+/-SD) with the VENTAK AV device was 2.21 +/- 0.54 seconds, as compared with 1.87 +/- 0.62 seconds with the VENTAK MINI (p < 0.01), indicating that the difference in means did not exceed one second. The VENTAK AV system function did not demonstrate interaction with the pacemaker function, as indicated by the clinical significance with the detection times of the study device. The difference in detection times between cohorts did not statistically exceed one second. Appropriate detection of the new ICD was not compromised by the addition of the dual-chamber pacing therapy.
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Gimble JM, Dorheim MA, Youkhana K, Hudson J, Nead M, Gilly M, Wood WJ, Hermanson GG, Kuehl M, Wall R. Alternatively spliced pp52 mRNA in nonlymphoid stromal cells. The Journal of Immunology 1993. [DOI: 10.4049/jimmunol.150.1.115] [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] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
The 52-kDa phosphoprotein, also reported as lymphocyte-specific gene 1 and WP34, is transcribed as a 1.6-kb mRNA in B lymphocytes, B cell lines, and untransformed T cells. This gene encodes a cytoplasmic and plasma membrane-associated protein that is phosphorylated at a casein kinase II site and reportedly binds calcium. Based on these properties, it has been hypothesized that lymphoid form of the 52-kDa phosphoprotein protein may play a role in lymphocyte signal transduction. We show that alternatively spliced mRNA are expressed from this gene in nonlymphoid cell lines (myocytes, stromal cells, fibroblasts). These cell lines do not express the 1.6-kb lymphoid cell-specific transcript. Instead, mRNA of 2.0 and 2.8 kb are detected in varying abundance. A full-length 2.0-kb cDNA has been cloned and sequenced from the BMS2 stromal cell line by conventional screening and polymerase chain reaction-based methods. This cDNA clone, designated S37, has a single open reading frame encoding a 328 amino acid peptide. The nucleotide sequence of the S37 stromal cell cDNA is identical to that of the lymphocyte derived pp52 cDNA from the 3' poly(A) tail to the codon encoding the amino acid at residue 24. This region of the S37 cDNA clone encodes a protein that is identical to that encoded by the lymphoid pp52 cDNA and includes a casein kinase II phosphorylation site. However, the two clones differ in their 5' nucleotide sequence and their NH3 terminal amino acid sequence. This organization is consistent with alternative exon utilization. These results suggest that tissue-specific control mechanisms are used to generate different forms of lymphoid form of the 52-kDa phosphoprotein mRNA in lymphoid cells versus mesoderm-derived, nonlymphoid cell lineages.
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Affiliation(s)
- J M Gimble
- Immunobiology and Cancer Program, Oklahoma Medical Research Foundation, Oklahoma City 73104
| | - M A Dorheim
- Immunobiology and Cancer Program, Oklahoma Medical Research Foundation, Oklahoma City 73104
| | - K Youkhana
- Immunobiology and Cancer Program, Oklahoma Medical Research Foundation, Oklahoma City 73104
| | - J Hudson
- Immunobiology and Cancer Program, Oklahoma Medical Research Foundation, Oklahoma City 73104
| | - M Nead
- Immunobiology and Cancer Program, Oklahoma Medical Research Foundation, Oklahoma City 73104
| | - M Gilly
- Immunobiology and Cancer Program, Oklahoma Medical Research Foundation, Oklahoma City 73104
| | - W J Wood
- Immunobiology and Cancer Program, Oklahoma Medical Research Foundation, Oklahoma City 73104
| | - G G Hermanson
- Immunobiology and Cancer Program, Oklahoma Medical Research Foundation, Oklahoma City 73104
| | - M Kuehl
- Immunobiology and Cancer Program, Oklahoma Medical Research Foundation, Oklahoma City 73104
| | - R Wall
- Immunobiology and Cancer Program, Oklahoma Medical Research Foundation, Oklahoma City 73104
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Gimble JM, Dorheim MA, Youkhana K, Hudson J, Nead M, Gilly M, Wood WJ, Hermanson GG, Kuehl M, Wall R. Alternatively spliced pp52 mRNA in nonlymphoid stromal cells. J Immunol 1993; 150:115-21. [PMID: 8417117] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The 52-kDa phosphoprotein, also reported as lymphocyte-specific gene 1 and WP34, is transcribed as a 1.6-kb mRNA in B lymphocytes, B cell lines, and untransformed T cells. This gene encodes a cytoplasmic and plasma membrane-associated protein that is phosphorylated at a casein kinase II site and reportedly binds calcium. Based on these properties, it has been hypothesized that lymphoid form of the 52-kDa phosphoprotein protein may play a role in lymphocyte signal transduction. We show that alternatively spliced mRNA are expressed from this gene in nonlymphoid cell lines (myocytes, stromal cells, fibroblasts). These cell lines do not express the 1.6-kb lymphoid cell-specific transcript. Instead, mRNA of 2.0 and 2.8 kb are detected in varying abundance. A full-length 2.0-kb cDNA has been cloned and sequenced from the BMS2 stromal cell line by conventional screening and polymerase chain reaction-based methods. This cDNA clone, designated S37, has a single open reading frame encoding a 328 amino acid peptide. The nucleotide sequence of the S37 stromal cell cDNA is identical to that of the lymphocyte derived pp52 cDNA from the 3' poly(A) tail to the codon encoding the amino acid at residue 24. This region of the S37 cDNA clone encodes a protein that is identical to that encoded by the lymphoid pp52 cDNA and includes a casein kinase II phosphorylation site. However, the two clones differ in their 5' nucleotide sequence and their NH3 terminal amino acid sequence. This organization is consistent with alternative exon utilization. These results suggest that tissue-specific control mechanisms are used to generate different forms of lymphoid form of the 52-kDa phosphoprotein mRNA in lymphoid cells versus mesoderm-derived, nonlymphoid cell lineages.
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Affiliation(s)
- J M Gimble
- Immunobiology and Cancer Program, Oklahoma Medical Research Foundation, Oklahoma City 73104
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Briskin M, Damore M, Law R, Lee G, Kincade PW, Sibley CH, Kuehl M, Wall R. Lipopolysaccharide-unresponsive mutant pre-B-cell lines blocked in NF-kappa B activation. Mol Cell Biol 1990; 10:422-5. [PMID: 2104663 PMCID: PMC360774 DOI: 10.1128/mcb.10.1.422-425.1990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
NF-kappa B activation is a crucial late step in the induction of immunoglobulin kappa light-chain gene expression in pre-B cells by lipopolysaccharide (LPS). We have analyzed NF-kappa B activation in three independent mutant lines of 70Z/3 pre-B cells which are unresponsive to LPS. All three variant cell lines failed to activate NF-kappa B when induced with LPS or the phorbol ester 12-O-tetradecanoylphorbol 13-acetate. However, all three cell lines contained functional NF-kappa B, as revealed by detergent treatment of cytoplasmic extracts. Moreover, cycloheximide induced limited activation of NF-kappa B comparable to that in wild-type 70Z/3 pre-B cells in two of the three variant lines. These results indicate that the mutations blocking kappa gene induction in these variant 70Z/3 pre-B-cell lines affect NF-kappa B activation.
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Affiliation(s)
- M Briskin
- Molecular Biology Institute, University of California School of Medicine, Los Angeles 90024
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Lawler AM, Kearney JF, Kuehl M, Gearhart PJ. Early rearrangements of genes encoding murine immunoglobulin kappa chains, unlike genes encoding heavy chains, use variable gene segments dispersed throughout the locus. Proc Natl Acad Sci U S A 1989; 86:6744-7. [PMID: 2505260 PMCID: PMC297922 DOI: 10.1073/pnas.86.17.6744] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Immunoglobulin heavy-chain variable region (TH) gene segments located closest to the joining (JH) gene segments are preferentially rearranged during ontogeny, indicating that chromosomal position influences the frequency of rearrangement. In addition, certain VH gene segments are repeatedly rearranged, suggesting that the DNA sequence or structure surrounding these segments may increase the probability of rearrangement. To determine whether there is similar based rearrangement of kappa variable (V kappa) gene segments, 25 rearrangements were sequenced from murine fetal and neonatal B-cell hybridomas and from subclones of a pre-B cell line that rearranged V kappa genes during in vitro culture. Four gene segments were isolated twice and one gene segment was isolated three times, suggesting that the process that targets individual variable gene segments for repeated rearrangement operates on both the VH and V kappa loci. Based on a current map of the V kappa locus, the rearranged gene segments belong to nine families that are dispersed throughout the locus. Thus, in these cell types, V kappa rearrangements use germ-line gene segments located across the entire locus, whereas the corresponding VH rearrangements use gene segments proximal to the JH gene segments. Heterogeneity of V kappa rearrangements would add diversity to the biased pool of VH rearrangements, producing a broad repertoire of antibodies early in development.
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Affiliation(s)
- A M Lawler
- Department of Biochemistry, Johns Hopkins University School of Hygiene, Baltimore, MD 21205
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Kuehl M, Brixner DI, Broom AD, Avery TL, Blakley RL. Cytotoxicity, uptake, polyglutamate formation, and antileukemic effects of 8-deaza analogues of methotrexate and aminopterin in mice. Cancer Res 1988; 48:1481-8. [PMID: 2449950] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In contrast to methotrexate (MTX) and aminopterin (AMT), the 8-deaza analogues of these antifolates are not substrates for rabbit liver aldehyde oxidase. Since they are not converted to 7-hydroxy derivatives, they have been investigated with regard to their cytotoxicity for CCRF-CEM cells, transport into these cells, and conversion to polyglutamate forms. For this purpose 3H-labeled analogues were synthesized. The drug concentrations of the analogues required to inhibit cell growth by 50% are significantly lower than for the parent compounds particularly for a short exposure of cells to the drug. Vmax and Km for unidirectional influx do not differ greatly among the four drugs, but amounts of uptake over 1 h are markedly different and increase in the order MTX less than 8-deazaMTX less than AMT less than 8-deazaAMT. During 1 h of uptake a much greater proportion of the 8-deaza analogues is converted to polyglutamate forms than in the case of parent drugs. Only 52% of MTX is converted to polyglutamates, whereas in the case of the other three compounds the conversion is greater than or equal to 90%. However, MTX is relatively efficient in adding two glutamate residues, whereas the other drugs predominantly accumulate as forms with only one additional glutamate (+Glu1). During 1 h of efflux the drugs without additional glutamates decrease to low concentrations and there is also a major loss of +Glu1 form, but there is also an increase in longer chain forms, especially in the case of MTX. The net result is a still greater disparity in total intracellular levels of the four drugs after the period of efflux. MTX has much lower toxicity in mice in vivo than the other three compounds, 8-deazaAMT being the most toxic. At the maximum tolerated dose MTX produced a considerably greater increase in life span for mice bearing P388 than any of the other drugs, and a somewhat greater increase for mice bearing L1210. Thus the 8-deaza analogues do not offer a therapeutic advantage over MTX against leukemias in the mouse, primarily due to their much greater toxicity.
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Affiliation(s)
- M Kuehl
- Department of Biochemical and Clinical Pharmacology, St. Jude Children's Research Hospital, Memphis, Tennessee 38101
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Huang MC, Ashmun RA, Avery TL, Kuehl M, Blakley RL. Effects of cytotoxicity of 2-chloro-2'-deoxyadenosine and 2-bromo-2'-deoxyadenosine on cell growth, clonogenicity, DNA synthesis, and cell cycle kinetics. Cancer Res 1986; 46:2362-8. [PMID: 2421877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The cytotoxic effects of the adenosine deaminase resistant analogues 2-bromo-2'-deoxyadenosine (2-BrdAdo) and 2-chloro-2'-deoxyadenosine (2-CldAdo) have been compared with those of deoxyadenosine (dAdo). Like 2-CldAdo, 2-BrdAdo is highly effective in inhibiting the growth of many T-lymphoblastoid, B-lymphoblastoid, and myeloid cell lines in culture. Concentrations required to inhibit growth of CCRF-CEM human T-lymphoblastoid cells by 50% (IC50) are: 2-CldAdo, 0.045 microM; 2-BrdAdo, 0.068 microM; dAdo, 0.9 microM in the presence of 5 microM erythro-9-(2-hydroxy-3-nonyl)adenine. Like dAdo, 2-BrdAdo causes a much greater decrease in DNA synthesis than in RNA and protein synthesis. For each of the nucleosides the concentration required to cause 50% inhibition of DNA synthesis (as measured by thymidine incorporation) in an 18-h exposure is very similar to the IC50 for growth and to the concentration required to decrease viability (clonogenicity) over 18 h by 50% (EC50). A fraction of CCRF-CEM cells (approximately equal to 30%) is resistant to killing by exposure to 2-BrdAdo or 2-CldAdo for 4 h at concentrations 100 times the EC50, but 3% of cells are resistant to exposure for 4 h to a concentration of dAdo 3 times the EC50. Each of the three nucleosides causes accumulation of cells in S phase, the accumulation becoming more marked with longer periods of exposure and with higher concentrations of nucleoside. During exposures for 18-24 h at a concentration of nucleoside near the EC50 most cells accumulate in S, with most in early S, whereas exposure to concentrations greater than EC95 accumulates cells at the G1/S border. This suggests that loss of viability is associated with a blockade of some process specifically occurring at the initiation of S phase. At an optimum dosage schedule, 2-BrdAdo and 2-CldAdo have similar therapeutic effects against L1210 in vivo, both producing over 99% cell kill, but the optimum dosage of 2-CldAdo is lower.
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Abstract
Cycle periods and electromyographic (EMG) burst durations of selected extensors and flexors are shorter during swimming than during running at 27 m/min, while the relative ON-OFF timing of these interrelationships are similar. The mean EMG activities of the tibialis anterior and adductor longus were higher and the soleus and medial gastrocnemius were lower during swimming than during running. Both fast and slow extensors are activated during both forms of locomotion, thus demonstrating that there is not a selective recruitment of fast or selective inhibition of slow ankle extensors during swimming as measures of muscle blood flow have suggested.
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Roy RR, Hirota WK, Kuehl M, Edgerton VR. MUSCLE RECRUITMENT PATTERNS IN THE RAT HINDLINB DURING SWIMMING. Med Sci Sports Exerc 1985. [DOI: 10.1249/00005768-198504000-00361] [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: 11/21/2022]
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