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Fedrigo M, Berry GJ, Coutance G, Reed EF, Lin CY, Giarraputo A, Kransdorf E, Thaunat O, Goddard M, Angelini A, Neil DAH, Bruneval P, Duong Van Huyen JP, Loupy A, Miller DV. Report of the 2022 Banff Heart Concurrent: Focus on non-human leukocyte antigen antibodies in rejection and the pathology of "mixed" rejection. Am J Transplant 2024; 24:533-541. [PMID: 37838218 DOI: 10.1016/j.ajt.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 10/16/2023]
Abstract
The Banff Heart Concurrent Session, held as part of the 16th Banff Foundation for Allograft Pathology Conference at Banff, Alberta, Canada, on September 21, 2022, focused on 2 major topics: non-human leukocyte antigen (HLA) antibodies and mixed rejection. Each topic was addressed in a multidisciplinary fashion with clinical, immunological, and pathology perspectives and future developments and prospectives. Following the Banff organization model and principles, the collective aim of the speakers on each topic was to • Determine current knowledge gaps in heart transplant pathology • Identify limitations of current pathology classification systems • Discuss next steps in addressing gaps and refining classification system.
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Affiliation(s)
- Marny Fedrigo
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padova, Padua Italy
| | - Gerald J Berry
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Guillaume Coutance
- Department of cardiac surgery, La Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris (APHP), Sorbonne University Medical School, Paris France
| | - Elaine F Reed
- UCLA Immunogenetics Center, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Chieh-Yu Lin
- Department of Pathology and Immunology, School of Medicine, Washington University St. Louis, Missouri, USA
| | - Alessia Giarraputo
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padova, Padua Italy
| | - Evan Kransdorf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Beverly Hills, California, USA
| | - Olivier Thaunat
- Department of Transplantation, Nephrology and Clinical Immunology, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon France
| | - Martin Goddard
- The Cardiothoracic Transplant Unit Papworth Hospital, Cambridge, United Kingdom
| | - Annalisa Angelini
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padova, Padua Italy
| | - Desley A H Neil
- University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Patrick Bruneval
- Université de Paris Cité, INSERM, PARCC, Paris Institute for Transplantation and Organ Regeneration, Paris, France
| | | | - Alexandre Loupy
- Université de Paris Cité, INSERM, PARCC, Paris Institute for Transplantation and Organ Regeneration, Paris, France
| | - Dylan V Miller
- Utah Transplant Affiliated Hospitals (UTAH) Heart Transplant Network, Intermountain Central Laboratory, Salt Lake City, Utah, USA.
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Miller DV. Response to Manion, et al. Cardiovasc Pathol 2023; 63:107487. [PMID: 36306969 DOI: 10.1016/j.carpath.2022.107487] [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] [Received: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Dylan V Miller
- University of Utah, Electron Microscopy and Immunostains Lab, Intermountain Central Laboratory, 5252 S Intermountain Drive, Salt Lake City, UT 84157, USA.
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Miller DV. Reply to Halloran and Madill-Thomsen letter to editor. Cardiovasc Pathol 2022; 61:107472. [PMID: 36067979 DOI: 10.1016/j.carpath.2022.107472] [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] [Received: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- Dylan V Miller
- Intermountain Central Laboratory, Intermountain Healthcare, Dr. Salt lake city, Utah, USA.
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Miller DV. Commentary on development of the "molecular microscope (MMDX)" assay for heart transplant biopsy rejection surveillance: SCVP journal club. Cardiovasc Pathol 2022; 60:107449. [PMID: 35781018 DOI: 10.1016/j.carpath.2022.107449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Dylan V Miller
- Intermountain Central Laboratory, Salt Lake City, UT 84157.
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Miller DV, Watson KE, Wang H, Fyfe-Kirschner B, Heide RSV. Racially Related Risk Factors for Cardiovascular Disease: Society for Cardiovascular Pathology Symposium 2022. Cardiovasc Pathol 2022; 61:107470. [PMID: 36029934 DOI: 10.1016/j.carpath.2022.107470] [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] [Received: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Dylan V Miller
- Department of Pathology, University of Utah and Intermountain Central Laboratory, Salt Lake City, UT, USA
| | - Karol E Watson
- Department of Medicine (Cardiology), UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - He Wang
- Department of Pathology, Yale University, New Haven, CT, USA
| | - Billie Fyfe-Kirschner
- Department of Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Richard S Vander Heide
- Department of Pathology and Laboratory Medicine, Marshfield Clinic Health System, Marshfield, WI, USA
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Duong Van Huyen JP, Fedrigo M, Fishbein GA, Leone O, Neil D, Marboe C, Peyster E, von der Thüsen J, Loupy A, Mengel M, Revelo MP, Adam B, Bruneval P, Angelini A, Miller DV, Berry GJ. The XVth Banff Conference on Allograft Pathology the Banff Workshop Heart Report: Improving the diagnostic yield from endomyocardial biopsies and Quilty effect revisited. Am J Transplant 2020; 20:3308-3318. [PMID: 32476272 DOI: 10.1111/ajt.16083] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 04/12/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 01/25/2023]
Abstract
The XVth Banff Conference on Allograft Pathology meeting was held on September 23-27, 2019, in Pittsburgh, Pennsylvania, USA. During this meeting, two main topics in cardiac transplant pathology were addressed: (a) Improvement of endomyocardial biopsy (EMB) accuracy for the diagnosis of rejection and other significant injury patterns, and (b) the orphaned lesion known as Quilty effect or nodular endocardial infiltrates. Molecular technologies have evolved in recent years, deciphering pathophysiology of cardiac rejection. Diagnostically, it is time to integrate the histopathology of EMBs and molecular data. The goal is to incorporate molecular pathology, performed on the same paraffin block as a companion test for histopathology, to yield more accurate and objective EMB interpretation. Application of digital image analysis from hematoxylin and eosin (H&E) stain to multiplex labeling is another means of extracting additional information from EMBs. New concepts have emerged exploring the multifaceted significance of myocardial injury, minimal rejection patterns supported by molecular profiles, and lesions of arteriolitis/vasculitis in the setting of T cell-mediated rejection (TCMR) and antibody-mediated rejection (AMR). The orphaned lesion known as Quilty effect or nodular endocardial infiltrates. A state-of-the-art session with historical aspects and current dilemmas was reviewed, and possible pathogenesis proposed, based on advances in immunology to explain conflicting data. The Quilty effect will be the subject of a multicenter project to explore whether it functions as a tertiary lymphoid organ.
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Affiliation(s)
- Jean-Paul Duong Van Huyen
- Paris Translational Research Center for Organ Transplantation, INSERM U970 and Université de Paris, Paris, France.,Department of Pathology, Necker Hospital, Paris, France
| | - Marny Fedrigo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Gregory A Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ornella Leone
- Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Desley Neil
- Department of Cellular Pathology, Queen Elizabeth Hospital Birmingham and Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Charles Marboe
- Department of Pathology and Cell Biology, Columbia University, New York, New York, USA
| | - Eliot Peyster
- Cardiovascular Research Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Alexandre Loupy
- Paris Translational Research Center for Organ Transplantation, INSERM U970 and Université de Paris, Paris, France.,Department of Nephrology and Transplantation, Necker-Enfants Hospital, Paris, France
| | - Michael Mengel
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Monica P Revelo
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Benjamin Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick Bruneval
- Paris Translational Research Center for Organ Transplantation, INSERM U970 and Université de Paris, Paris, France
| | - Annalisa Angelini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | | | - Gerald J Berry
- Department of Pathology, Stanford University, Stanford, California, USA
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Borowsky AD, Glassy EF, Wallace WD, Kallichanda NS, Behling CA, Miller DV, Oswal HN, Feddersen RM, Bakhtar OR, Mendoza AE, Molden DP, Saffer HL, Wixom CR, Albro JE, Cessna MH, Hall BJ, Lloyd IE, Bishop JW, Darrow MA, Gui D, Jen KY, Walby JAS, Bauer SM, Cortez DA, Gandhi P, Rodgers MM, Rodriguez RA, Martin DR, McConnell TG, Reynolds SJ, Spigel JH, Stepenaskie SA, Viktorova E, Magari R, Wharton KA, Qiu J, Bauer TW. Digital Whole Slide Imaging Compared With Light Microscopy for Primary Diagnosis in Surgical Pathology. Arch Pathol Lab Med 2020; 144:1245-1253. [DOI: 10.5858/arpa.2019-0569-oa] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2020] [Indexed: 12/28/2022]
Abstract
Context.—The adoption of digital capture of pathology slides as whole slide images (WSI) for educational and research applications has proven utility.Objective.—To compare pathologists' primary diagnoses derived from WSI versus the standard microscope. Because WSIs differ in format and method of observation compared with the current standard glass slide microscopy, this study is critical to potential clinical adoption of digital pathology.Design.—The study enrolled a total of 2045 cases enriched for more difficult diagnostic categories and represented as 5849 slides were curated and provided for diagnosis by a team of 19 reading pathologists separately as WSI or as glass slides viewed by light microscope. Cases were reviewed by each pathologist in both modalities in randomized order with a minimum 31-day washout between modality reads for each case. Each diagnosis was compared with the original clinical reference diagnosis by an independent central adjudication review.Results.—The overall major discrepancy rates were 3.64% for WSI review and 3.20% for manual slide review diagnosis methods, a difference of 0.44% (95% CI, −0.15 to 1.03). The time to review a case averaged 5.20 minutes for WSI and 4.95 minutes for glass slides. There was no specific subset of diagnostic category that showed higher rates of modality-specific discrepancy, though some categories showed greater discrepancy than others in both modalities.Conclusions.—WSIs are noninferior to traditional glass slides for primary diagnosis in anatomic pathology.
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Affiliation(s)
- Alexander D. Borowsky
- From the Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento (Borowsky, Bishop, Darrow, Gui, Jen, Walby)
| | - Eric F. Glassy
- The Affiliated Pathologists Medical Group, Rancho Dominguez, California (Glassy, Kallichanda)
| | | | - Nathash S. Kallichanda
- The Affiliated Pathologists Medical Group, Rancho Dominguez, California (Glassy, Kallichanda)
| | - Cynthia A. Behling
- The Pacific Rim Pathology Lab and Sharp Healthcare, San Diego, California (Behling, Mendoza, Molden, Saffer, Wixom)
| | - Dylan V. Miller
- Intermountain Central Laboratory, Salt Lake City, Utah (Miller, Albro, Cessna, Hall, Lloyd)
| | - Hemlata N. Oswal
- The Pathology Department, Lucent Pathology Partners Mercy San Juan Hospital, Carmichael, California (Oswal, SM Bauer, Cortez, Rodgers, Rodriguez)
| | - Richard M. Feddersen
- The Histology Lab, TriCore Reference Laboratories, Albuquerque, New Mexico (Feddersen, Martin, McConnell, Reynolds, Spigel, Stepenaskie)
| | - Omid R. Bakhtar
- Scripps Clinic Torrey Pines, La Jolla, California (Bakhtar, Ghandi)
| | - Arturo E. Mendoza
- The Pacific Rim Pathology Lab and Sharp Healthcare, San Diego, California (Behling, Mendoza, Molden, Saffer, Wixom)
| | - Daniel P. Molden
- The Pacific Rim Pathology Lab and Sharp Healthcare, San Diego, California (Behling, Mendoza, Molden, Saffer, Wixom)
| | - Helene L. Saffer
- The Pacific Rim Pathology Lab and Sharp Healthcare, San Diego, California (Behling, Mendoza, Molden, Saffer, Wixom)
| | - Christopher R. Wixom
- The Pacific Rim Pathology Lab and Sharp Healthcare, San Diego, California (Behling, Mendoza, Molden, Saffer, Wixom)
| | - James E. Albro
- Intermountain Central Laboratory, Salt Lake City, Utah (Miller, Albro, Cessna, Hall, Lloyd)
| | - Melissa H. Cessna
- Intermountain Central Laboratory, Salt Lake City, Utah (Miller, Albro, Cessna, Hall, Lloyd)
| | - Brian J. Hall
- Intermountain Central Laboratory, Salt Lake City, Utah (Miller, Albro, Cessna, Hall, Lloyd)
| | - Isaac E. Lloyd
- Intermountain Central Laboratory, Salt Lake City, Utah (Miller, Albro, Cessna, Hall, Lloyd)
| | - John W. Bishop
- From the Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento (Borowsky, Bishop, Darrow, Gui, Jen, Walby)
| | - Morgan A. Darrow
- From the Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento (Borowsky, Bishop, Darrow, Gui, Jen, Walby)
| | - Dorina Gui
- From the Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento (Borowsky, Bishop, Darrow, Gui, Jen, Walby)
| | - Kuang-Yu Jen
- From the Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento (Borowsky, Bishop, Darrow, Gui, Jen, Walby)
| | - Julie Ann S. Walby
- From the Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento (Borowsky, Bishop, Darrow, Gui, Jen, Walby)
| | - Stephen M. Bauer
- The Pathology Department, Lucent Pathology Partners Mercy San Juan Hospital, Carmichael, California (Oswal, SM Bauer, Cortez, Rodgers, Rodriguez)
| | - Daniel A. Cortez
- The Pathology Department, Lucent Pathology Partners Mercy San Juan Hospital, Carmichael, California (Oswal, SM Bauer, Cortez, Rodgers, Rodriguez)
| | - Pranav Gandhi
- Scripps Clinic Torrey Pines, La Jolla, California (Bakhtar, Ghandi)
| | - Melissa M. Rodgers
- The Pathology Department, Lucent Pathology Partners Mercy San Juan Hospital, Carmichael, California (Oswal, SM Bauer, Cortez, Rodgers, Rodriguez)
| | - Rafael A. Rodriguez
- The Pathology Department, Lucent Pathology Partners Mercy San Juan Hospital, Carmichael, California (Oswal, SM Bauer, Cortez, Rodgers, Rodriguez)
| | - David R. Martin
- The Histology Lab, TriCore Reference Laboratories, Albuquerque, New Mexico (Feddersen, Martin, McConnell, Reynolds, Spigel, Stepenaskie)
| | - Thomas G. McConnell
- The Histology Lab, TriCore Reference Laboratories, Albuquerque, New Mexico (Feddersen, Martin, McConnell, Reynolds, Spigel, Stepenaskie)
| | - Samuel J. Reynolds
- The Histology Lab, TriCore Reference Laboratories, Albuquerque, New Mexico (Feddersen, Martin, McConnell, Reynolds, Spigel, Stepenaskie)
| | - James H. Spigel
- The Histology Lab, TriCore Reference Laboratories, Albuquerque, New Mexico (Feddersen, Martin, McConnell, Reynolds, Spigel, Stepenaskie)
| | - Shelly A. Stepenaskie
- The Histology Lab, TriCore Reference Laboratories, Albuquerque, New Mexico (Feddersen, Martin, McConnell, Reynolds, Spigel, Stepenaskie)
| | | | - Robert Magari
- Beckman Coulter, Inc., Miami, Florida (Viktorova, Magari)
| | - Keith A. Wharton
- Leica Biosystems Imaging, Inc., Danvers, Massachusetts (Wharton)
| | | | - Thomas W. Bauer
- The Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York (TW Bauer)
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Bauer TW, Behling C, Miller DV, Chang BS, Viktorova E, Magari R, Jensen PE, Wharton KA, Qiu J. Precise Identification of Cell and Tissue Features Important for Histopathologic Diagnosis by a Whole Slide Imaging System. J Pathol Inform 2020; 11:3. [PMID: 32154040 PMCID: PMC7032023 DOI: 10.4103/jpi.jpi_47_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/09/2019] [Indexed: 11/17/2022] Open
Abstract
Background: Previous studies have demonstrated the noninferiority of pathologists’ interpretation of whole slide images (WSIs) compared to microscopic slides in diagnostic surgical pathology; however, to our knowledge, no published studies have tested analytical precision of an entire WSI system. Methods: In this study, five pathologists at three locations tested intra-system, inter-system/site, and intra- and inter-pathologist precision of the Aperio AT2 DX System (Leica Biosystems, Vista, CA, USA). Sixty-nine microscopic slides containing 23 different morphologic features suggested by the Digital Pathology Association as important to diagnostic pathology were identified and scanned. Each of 202 unique fields of view (FOVs) had 1–3 defined morphologic features, and each feature was represented in three different tissues. For intra-system precision, each site scanned 23 slides at three different times and one pathologist interpreted all FOVs. For inter-system/site precision, all 69 slides were scanned once at each of three sites, and FOVs from each site were read by one pathologist. To test intra- and inter-pathologist precision, all 69 slides were scanned at one site, FOVs were saved in three different orientations, and the FOVs were transferred to a different site. Three different pathologists then interpreted FOVs from all 69 slides. Wildcard (unscored) slides and washout intervals were included in each study. Agreement estimates with 95% confidence intervals were calculated. Results: Combined precision from all three studies, representing 606 FOVs in each of the three studies, showed overall intra-system agreement of 97.9%; inter-system/site agreement was 96%, intra-pathologist agreement was 95%, and inter-pathologist agreement was 94.2%. Conclusions: Pathologists using the Aperio AT2 DX System identified histopathological features with high precision, providing increased confidence in using WSI for primary diagnosis in surgical pathology.
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Affiliation(s)
- Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY, USA
| | | | - Dylan V Miller
- Intermountain Central Laboratory, Salt Lake City, UT, USA
| | | | | | | | | | | | - Jinsong Qiu
- Leica Biosystems Imaging, Inc., Vista, CA, USA
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Miller DV, Jensen TA, Bair TL, Jensen T. A novel, rapid, and low cost method for preparing tissues with metallic stents for routine histology. Cardiovasc Pathol 2019; 45:107177. [PMID: 31891881 DOI: 10.1016/j.carpath.2019.107177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/31/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Coronary artery stenting has become a common procedure and cardiovascular pathology specimens containing these metallic stents are accordingly becoming common. Histologic examination of stented vessels is imperative, but special techniques are needed due to the presence of metal within the tissue. We describe a rapid and inexpensive method for preparing stented vascular specimens for routine histology suitable for use in almost any histology laboratory. DESIGN After formalin fixation and decalcification, stented vascular segments were freeze-embedded and sectioned using a handheld power micro cutoff wheel tool into ~1 mm slices. Sections were allowed to thaw and the strut shards removed with fine forceps. No longer containing metal, the sections were processed for routine paraffin embedding, microtomy and staining. RESULTS Histologic sections showed only minor tissue disruption around the stent struts. In our experience with 25 stented arteries (mean interval from implantation 5.6 years), the mean subjective section quality score was 4.1 out of 5. The position of each strut could easily be determined, along with neointimal in-stent restenosis and thrombosis. Local reaction to each strut could be surmised even if minor tissue disruption occurred. The entire process was completed in 2-3 days. The incremental cost over that of routine histology is nominal. CONCLUSION This method for examining stented vascular segments histologically could readily be applied in most pathology laboratories and serves as a highly practical solution to dilemma of examining stents histologically.
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Affiliation(s)
- Dylan V Miller
- Department of Pathology, Intermountain Medical Center, Salt Lake City, UT, USA.
| | | | - Tami L Bair
- Department of Cardiology, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Thom Jensen
- Intermountain Biorepository, Salt Lake City, UT, USA
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Troxell ML, Fulton RS, Swanson PE, Bellizzi AM, Fitzgibbons PL, Ambaye AB, Haas TS, Goldsmith JD, Loykasek PA, Miller DV, O'Malley D, Qiu J, Salama ME, Schaberg KB, Schwartz RA, Shia J, Summers TA, Wu Y. Predictive Markers Require Thorough Analytic Validation. Arch Pathol Lab Med 2019; 143:907-909. [PMID: 31339757 DOI: 10.5858/arpa.2019-0112-le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Megan L Troxell
- 1 Department of Pathology, Stanford University Medical Center, Stanford, California
| | | | - Paul E Swanson
- 3 Department of Pathology, University of Washington, Seattle
| | | | | | - Abiy B Ambaye
- 6 Department of Pathology, University of Vermont, Burlington
| | - Thomas S Haas
- 7 Department of Pathology, St Francis Hospital, Milwaukee, Wisconsin
| | - Jeffrey D Goldsmith
- 8 Department of Pathology, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts
| | | | - Dylan V Miller
- 10 Intermountain Central Laboratory, University of Utah, Salt Lake City
| | | | - Jingxin Qiu
- 12 Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | - Kurt B Schaberg
- 14 Department of Pathology, University of Kentucky, Lexington
| | - Robert A Schwartz
- 15 Department of Pathology, Waterbury Hospital, Waterbury, Connecticut
| | - Jinru Shia
- 16 Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Thomas A Summers
- 17 Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Yaping Wu
- 18 Oregon Regional Pathology Services, Providence Health & Services, Portland
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Colvin MM, Cook JL, Chang PP, Hsu DT, Kiernan MS, Kobashigawa JA, Lindenfeld J, Masri SC, Miller DV, Rodriguez ER, Tyan DB, Zeevi A. Sensitization in Heart Transplantation: Emerging Knowledge: A Scientific Statement From the American Heart Association. Circulation 2019; 139:e553-e578. [DOI: 10.1161/cir.0000000000000598] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Sensitization, defined as the presence of circulating antibodies, presents challenges for heart transplant recipients and physicians. When present, sensitization can limit a transplantation candidate’s access to organs, prolong wait time, and, in some cases, exclude the candidate from heart transplantation altogether. The management of sensitization is not yet standardized, and current therapies have not yielded consistent results. Although current strategies involve antibody suppression and removal with intravenous immunoglobulin, plasmapheresis, and antibody therapy, newer strategies with more specific targets are being investigated.
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Daud A, Xu D, Revelo MP, Shah Z, Drakos SG, Dranow E, Stoddard G, Kfoury AG, Hammond MEH, Nativi-Nicolau J, Alharethi R, Miller DV, Gilbert EM, Wever-Pinzon O, McKellar SH, Afshar K, Khan F, Fang JC, Selzman CH, Stehlik J. Microvascular Loss and Diastolic Dysfunction in Severe Symptomatic Cardiac Allograft Vasculopathy. Circ Heart Fail 2018; 11:e004759. [DOI: 10.1161/circheartfailure.117.004759] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 01/06/2023]
Affiliation(s)
- Anees Daud
- Division of Cardiovascular Medicine (A.D., D.X., Z.S., S.G.D., E.D., G.S., J.N.-N., E.M.G., O.W.-P., J.C.F., J.S.)
| | - David Xu
- Division of Cardiovascular Medicine (A.D., D.X., Z.S., S.G.D., E.D., G.S., J.N.-N., E.M.G., O.W.-P., J.C.F., J.S.)
| | - Monica P. Revelo
- Department of Pathology (M.P.R., M.E.H.H.,D.V.M.)
- Utah Transplant Affiliated Hospitals Cardiac Transplant Program, Salt Lake City (M.P.R., S.G.D., A.G.K., M.E.H.H., J.N.-N., R.A., D.V.M.,E.M.G., O.W.-P., S.H.M., K.A., F.K., J.C.F., C.H.S., J.S.)
| | - Zubair Shah
- Division of Cardiovascular Medicine (A.D., D.X., Z.S., S.G.D., E.D., G.S., J.N.-N., E.M.G., O.W.-P., J.C.F., J.S.)
| | - Stavros G. Drakos
- Division of Cardiovascular Medicine (A.D., D.X., Z.S., S.G.D., E.D., G.S., J.N.-N., E.M.G., O.W.-P., J.C.F., J.S.)
- University of Utah School of Medicine, Salt Lake City. George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT (S.G.D., J.N.-N., E.M.G., O.W.-P., J.S.)
- Utah Transplant Affiliated Hospitals Cardiac Transplant Program, Salt Lake City (M.P.R., S.G.D., A.G.K., M.E.H.H., J.N.-N., R.A., D.V.M.,E.M.G., O.W.-P., S.H.M., K.A., F.K., J.C.F., C.H.S., J.S.)
| | - Elizabeth Dranow
- Division of Cardiovascular Medicine (A.D., D.X., Z.S., S.G.D., E.D., G.S., J.N.-N., E.M.G., O.W.-P., J.C.F., J.S.)
| | - Gregory Stoddard
- Division of Cardiovascular Medicine (A.D., D.X., Z.S., S.G.D., E.D., G.S., J.N.-N., E.M.G., O.W.-P., J.C.F., J.S.)
| | - Abdallah G. Kfoury
- Intermountain Medical Center Heart Institute, Salt Lake City, UT (M.E.H.H., R.A., D.V.M., K.A., A.G.K.)
| | - M. Elizabeth H. Hammond
- Department of Pathology (M.P.R., M.E.H.H.,D.V.M.)
- Intermountain Medical Center Heart Institute, Salt Lake City, UT (M.E.H.H., R.A., D.V.M., K.A., A.G.K.)
- Utah Transplant Affiliated Hospitals Cardiac Transplant Program, Salt Lake City (M.P.R., S.G.D., A.G.K., M.E.H.H., J.N.-N., R.A., D.V.M.,E.M.G., O.W.-P., S.H.M., K.A., F.K., J.C.F., C.H.S., J.S.)
| | - Jose Nativi-Nicolau
- Division of Cardiovascular Medicine (A.D., D.X., Z.S., S.G.D., E.D., G.S., J.N.-N., E.M.G., O.W.-P., J.C.F., J.S.)
- University of Utah School of Medicine, Salt Lake City. George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT (S.G.D., J.N.-N., E.M.G., O.W.-P., J.S.)
- Utah Transplant Affiliated Hospitals Cardiac Transplant Program, Salt Lake City (M.P.R., S.G.D., A.G.K., M.E.H.H., J.N.-N., R.A., D.V.M.,E.M.G., O.W.-P., S.H.M., K.A., F.K., J.C.F., C.H.S., J.S.)
| | - Rami Alharethi
- Intermountain Medical Center Heart Institute, Salt Lake City, UT (M.E.H.H., R.A., D.V.M., K.A., A.G.K.)
- Utah Transplant Affiliated Hospitals Cardiac Transplant Program, Salt Lake City (M.P.R., S.G.D., A.G.K., M.E.H.H., J.N.-N., R.A., D.V.M.,E.M.G., O.W.-P., S.H.M., K.A., F.K., J.C.F., C.H.S., J.S.)
| | - Dylan V. Miller
- Division of Cardiothoracic Surgery (S.H.M., C.H.S.)
- Intermountain Medical Center Heart Institute, Salt Lake City, UT (M.E.H.H., R.A., D.V.M., K.A., A.G.K.)
- Utah Transplant Affiliated Hospitals Cardiac Transplant Program, Salt Lake City (M.P.R., S.G.D., A.G.K., M.E.H.H., J.N.-N., R.A., D.V.M.,E.M.G., O.W.-P., S.H.M., K.A., F.K., J.C.F., C.H.S., J.S.)
| | - Edward M. Gilbert
- Division of Cardiovascular Medicine (A.D., D.X., Z.S., S.G.D., E.D., G.S., J.N.-N., E.M.G., O.W.-P., J.C.F., J.S.)
- University of Utah School of Medicine, Salt Lake City. George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT (S.G.D., J.N.-N., E.M.G., O.W.-P., J.S.)
- Utah Transplant Affiliated Hospitals Cardiac Transplant Program, Salt Lake City (M.P.R., S.G.D., A.G.K., M.E.H.H., J.N.-N., R.A., D.V.M.,E.M.G., O.W.-P., S.H.M., K.A., F.K., J.C.F., C.H.S., J.S.)
| | - Omar Wever-Pinzon
- Division of Cardiovascular Medicine (A.D., D.X., Z.S., S.G.D., E.D., G.S., J.N.-N., E.M.G., O.W.-P., J.C.F., J.S.)
- University of Utah School of Medicine, Salt Lake City. George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT (S.G.D., J.N.-N., E.M.G., O.W.-P., J.S.)
- Utah Transplant Affiliated Hospitals Cardiac Transplant Program, Salt Lake City (M.P.R., S.G.D., A.G.K., M.E.H.H., J.N.-N., R.A., D.V.M.,E.M.G., O.W.-P., S.H.M., K.A., F.K., J.C.F., C.H.S., J.S.)
| | - Stephen H. McKellar
- Division of Cardiothoracic Surgery (S.H.M., C.H.S.)
- Utah Transplant Affiliated Hospitals Cardiac Transplant Program, Salt Lake City (M.P.R., S.G.D., A.G.K., M.E.H.H., J.N.-N., R.A., D.V.M.,E.M.G., O.W.-P., S.H.M., K.A., F.K., J.C.F., C.H.S., J.S.)
| | - Kia Afshar
- Intermountain Medical Center Heart Institute, Salt Lake City, UT (M.E.H.H., R.A., D.V.M., K.A., A.G.K.)
- Utah Transplant Affiliated Hospitals Cardiac Transplant Program, Salt Lake City (M.P.R., S.G.D., A.G.K., M.E.H.H., J.N.-N., R.A., D.V.M.,E.M.G., O.W.-P., S.H.M., K.A., F.K., J.C.F., C.H.S., J.S.)
| | - Farman Khan
- Utah Transplant Affiliated Hospitals Cardiac Transplant Program, Salt Lake City (M.P.R., S.G.D., A.G.K., M.E.H.H., J.N.-N., R.A., D.V.M.,E.M.G., O.W.-P., S.H.M., K.A., F.K., J.C.F., C.H.S., J.S.)
| | - James C. Fang
- Division of Cardiovascular Medicine (A.D., D.X., Z.S., S.G.D., E.D., G.S., J.N.-N., E.M.G., O.W.-P., J.C.F., J.S.)
- Utah Transplant Affiliated Hospitals Cardiac Transplant Program, Salt Lake City (M.P.R., S.G.D., A.G.K., M.E.H.H., J.N.-N., R.A., D.V.M.,E.M.G., O.W.-P., S.H.M., K.A., F.K., J.C.F., C.H.S., J.S.)
| | - Craig H. Selzman
- Division of Cardiothoracic Surgery (S.H.M., C.H.S.)
- Utah Transplant Affiliated Hospitals Cardiac Transplant Program, Salt Lake City (M.P.R., S.G.D., A.G.K., M.E.H.H., J.N.-N., R.A., D.V.M.,E.M.G., O.W.-P., S.H.M., K.A., F.K., J.C.F., C.H.S., J.S.)
| | - Josef Stehlik
- Division of Cardiovascular Medicine (A.D., D.X., Z.S., S.G.D., E.D., G.S., J.N.-N., E.M.G., O.W.-P., J.C.F., J.S.)
- University of Utah School of Medicine, Salt Lake City. George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT (S.G.D., J.N.-N., E.M.G., O.W.-P., J.S.)
- Utah Transplant Affiliated Hospitals Cardiac Transplant Program, Salt Lake City (M.P.R., S.G.D., A.G.K., M.E.H.H., J.N.-N., R.A., D.V.M.,E.M.G., O.W.-P., S.H.M., K.A., F.K., J.C.F., C.H.S., J.S.)
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14
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Chanana N, Van Dorn CS, Everitt MD, Weng HY, Miller DV, Menon SC. Alteration of Cardiac Deformation in Acute Rejection in Pediatric Heart Transplant Recipients. Pediatr Cardiol 2017; 38:691-699. [PMID: 28161809 DOI: 10.1007/s00246-016-1567-4] [Citation(s) in RCA: 7] [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: 05/20/2016] [Accepted: 12/30/2016] [Indexed: 11/28/2022]
Abstract
The objective of this study is to assess changes in cardiac deformation during acute cellular- and antibody-mediated rejection in pediatric HT recipients. Pediatric HT recipients aged ≤18 years with at least one episode of biopsy-diagnosed rejection from 2006 to 2013 were included. Left ventricular systolic S (SS) and SR (SSr) data were acquired using 2D speckle tracking on echocardiograms obtained within 12 h of right ventricular endomyocardial biopsy. A mixed effect model was used to compare cardiac deformation during CR (Grade ≥ 1R), AMR (pAMR ≥ 2), and mixed rejection (CR and AMR positive) versus no rejection (Grade 0R and pAMR 0 or 1). A total of 20 subjects (10 males, 50%) with 71 rejection events (CR 35, 49%; AMR 21, 30% and mixed 15, 21%) met inclusion criteria. The median time from HT to first biopsy used for analysis was 5 months (IQR 0.25-192 months). Average LV longitudinal SS and SSr were reduced significantly during rejection (SS: -17.2 ± 3.4% vs. -10.7 ± 4.5%, p < 0.001 and SSr: -1.2 ± 0.2 s- 1 vs. -0.9 ± 0.3 s- 1; p < 0.001) and in all rejection types. Average LV short-axis radial SS was reduced only in CR compared to no rejection (p = 0.04), while average LV circumferential SS and SSr were reduced significantly in AMR compared to CR (SS: 18.9 ± 4.2% vs. 20.8 ± 8.8%, p = 0.03 and SSr: 1.35 ± 0.8 s- 1 vs. 1.54 ± 0.9 s- 1; p = 0.03). In pediatric HT recipients, LV longitudinal SS and SSr were reduced in all rejection types, while LV radial SS was reduced only in CR. LV circumferential SS and SSr further differentiated between CR and AMR with a significant reduction seen in AMR as compared to CR. This novel finding suggests mechanistic differences between AMR- and CR-induced myocardial injury which may be useful in non-invasively predicting the type of rejection in pediatric HT recipients.
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Affiliation(s)
- Nitin Chanana
- Pediatric Cardiology, Children's Heart Center of El Paso, El Paso, TX, USA
| | - Charlotte S Van Dorn
- Division of Critical Care and Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
| | - Melanie D Everitt
- Division of Cardiology, Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA
| | - Hsin Yi Weng
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, 81 N. Mario Capecchi Drive, Salt Lake City, UT, 84113, USA
| | - Dylan V Miller
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Shaji C Menon
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, 81 N. Mario Capecchi Drive, Salt Lake City, UT, 84113, USA.
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15
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Kim HS, Umbricht CB, Illei PB, Cimino-Mathews A, Cho S, Chowdhury N, Figueroa-Magalhaes MC, Pesce C, Jeter SC, Mylander C, Rosman M, Tafra L, Turner BM, Hicks DG, Jensen TA, Miller DV, Armstrong DK, Connolly RM, Fetting JH, Miller RS, Park BH, Stearns V, Visvanathan K, Wolff AC, Cope L. Optimizing the Use of Gene Expression Profiling in Early-Stage Breast Cancer. J Clin Oncol 2016; 34:4390-4397. [PMID: 27998227 DOI: 10.1200/jco.2016.67.7195] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose Gene expression profiling assays are frequently used to guide adjuvant chemotherapy decisions in hormone receptor-positive, lymph node-negative breast cancer. We hypothesized that the clinical value of these new tools would be more fully realized when appropriately integrated with high-quality clinicopathologic data. Hence, we developed a model that uses routine pathologic parameters to estimate Oncotype DX recurrence score (ODX RS) and independently tested its ability to predict ODX RS in clinical samples. Patients and Methods We retrospectively reviewed ordered ODX RS and pathology reports from five institutions (n = 1,113) between 2006 and 2013. We used locally performed histopathologic markers (estrogen receptor, progesterone receptor, Ki-67, human epidermal growth factor receptor 2, and Elston grade) to develop models that predict RS-based risk categories. Ordering patterns at one site were evaluated under an integrated decision-making model incorporating clinical treatment guidelines, immunohistochemistry markers, and ODX. Final locked models were independently tested (n = 472). Results Distribution of RS was similar across sites and to reported clinical practice experience and stable over time. Histopathologic markers alone determined risk category with > 95% confidence in > 55% (616 of 1,113) of cases. Application of the integrated decision model to one site indicated that the frequency of testing would not have changed overall, although ordering patterns would have changed substantially with less testing of estimated clinical risk-high or clinical risk-low cases and more testing of clinical risk-intermediate cases. In the validation set, the model correctly predicted risk category in 52.5% (248 of 472). Conclusion The proposed model accurately predicts high- and low-risk RS categories (> 25 or ≤ 25) in a majority of cases. Integrating histopathologic and molecular information into the decision-making process allows refocusing the use of new molecular tools to cases with uncertain risk.
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Affiliation(s)
- Hyun-Seok Kim
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
| | - Christopher B Umbricht
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
| | - Peter B Illei
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
| | - Ashley Cimino-Mathews
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
| | - Soonweng Cho
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
| | - Nivedita Chowdhury
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
| | - Maria Cristina Figueroa-Magalhaes
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
| | - Catherine Pesce
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
| | - Stacie C Jeter
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
| | - Charles Mylander
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
| | - Martin Rosman
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
| | - Lorraine Tafra
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
| | - Bradley M Turner
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
| | - David G Hicks
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
| | - Tyler A Jensen
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
| | - Dylan V Miller
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
| | - Deborah K Armstrong
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
| | - Roisin M Connolly
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
| | - John H Fetting
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
| | - Robert S Miller
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
| | - Ben Ho Park
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
| | - Vered Stearns
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
| | - Kala Visvanathan
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
| | - Antonio C Wolff
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
| | - Leslie Cope
- Hyun-seok Kim, Christopher B. Umbricht, Peter B. Illei, Ashley Cimino-Mathews, Soonweng Cho, Nivedita Chowdhury, Maria Cristina Figueroa-Magalhaes, Catherine Pesce, Stacie C. Jeter, Deborah K. Armstrong, Roisin M. Connolly, John H. Fetting, Ben Ho Park, Vered Stearns, Antonio C. Wolff, and Leslie Cope, The Johns Hopkins University School of Medicine; Kala Visvanathan, The Johns Hopkins University Bloomberg School of Public Health, Baltimore; Charles Mylander, Martin Rosman, and Lorraine Tafra, Anne Arundel Medical Center, Annapolis, MD; Bradley M. Turner, David G. Hicks, University of Rochester Medical Center, Rochester, NY; Robert S. Miller, American Society of Clinical Oncology, Alexandria, VA; and Tyler A. Jensen and Dylan V. Miller, Intermountain Healthcare, Salt Lake City, UT
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Diakos NA, Navankasattusas S, Abel ED, Rutter J, McCreath L, Ferrin P, McKellar SH, Miller DV, Park SY, Richardson RS, Deberardinis R, Cox JE, Kfoury AG, Selzman CH, Stehlik J, Fang JC, Li DY, Drakos SG. Evidence of Glycolysis Up-Regulation and Pyruvate Mitochondrial Oxidation Mismatch During Mechanical Unloading of the Failing Human Heart: Implications for Cardiac Reloading and Conditioning. JACC Basic Transl Sci 2016; 1:432-444. [PMID: 28497127 PMCID: PMC5422992 DOI: 10.1016/j.jacbts.2016.06.009] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
LVAD unloading reverses several but not all aspects of myocardial remodeling and usually leads to incomplete cardiac recovery in a subset of patients with advanced HF. We performed metabolomic analysis and mitochondrial structural and functional characterization in paired human myocardial tissue procured from 31 patients with advanced HF at LVAD implant and at heart transplant plus tissue from 11 normal donors. LVAD unloading induces glycolysis up-regulation without a corresponding increase in glucose oxidation. Lack of post-LVAD improvement in mitochondrial function and volume density could explain the glycolysis-glucose oxidation mismatch. Therapeutic interventions, such as myocardial conditioning, that are known to improve mitochondrial biogenesis, structure, and function might further improve cardiac metabolism and energy production and thereby enhance cardiac recovery with LVAD-induced unloading.
This study sought to investigate the effects of mechanical unloading on myocardial energetics and the metabolic perturbation of heart failure (HF) in an effort to identify potential new therapeutic targets that could enhance the unloading-induced cardiac recovery. The authors prospectively examined paired human myocardial tissue procured from 31 advanced HF patients at left ventricular assist device (LVAD) implant and at heart transplant plus tissue from 11 normal donors. They identified increased post-LVAD glycolytic metabolites without a coordinate increase in early, tricarboxylic acid (TCA) cycle intermediates. The increased pyruvate was not directed toward the mitochondria and the TCA cycle for complete oxidation, but instead, was mainly converted to cytosolic lactate. Increased nucleotide concentrations were present, potentially indicating increased flux through the pentose phosphate pathway. Evaluation of mitochondrial function and structure revealed a lack of post-LVAD improvement in mitochondrial oxidative functional capacity, mitochondrial volume density, and deoxyribonucleic acid content. Finally, post-LVAD unloading, amino acid levels were found to be increased and could represent a compensatory mechanism and an alternative energy source that could fuel the TCA cycle by anaplerosis. In summary, the authors report evidence that LVAD unloading induces glycolysis in concert with pyruvate mitochondrial oxidation mismatch, most likely as a result of persistent mitochondrial dysfunction. These findings suggest that interventions known to improve mitochondrial biogenesis, structure, and function, such as controlled cardiac reloading and conditioning, warrant further investigation to enhance unloading-induced reverse remodeling and cardiac recovery.
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Affiliation(s)
- Nikolaos A Diakos
- Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.,Molecular Medicine Program, University of Utah, Salt Lake City, Utah
| | | | - E Dale Abel
- Division of Endocrinology and Metabolism, Department of Medicine, University of Iowa, Iowa City, Iowa
| | - Jared Rutter
- Department of Biochemistry, University of Utah, Salt Lake City, Utah
| | - Lauren McCreath
- Molecular Medicine Program, University of Utah, Salt Lake City, Utah
| | - Peter Ferrin
- Molecular Medicine Program, University of Utah, Salt Lake City, Utah
| | - Stephen H McKellar
- Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Dylan V Miller
- Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Song Y Park
- Department of Exercise and Sport Science, University of Utah, Salt Lake City, Utah
| | - Russell S Richardson
- Department of Exercise and Sport Science, University of Utah, Salt Lake City, Utah
| | - Ralph Deberardinis
- Division of Pediatric Genetics and Metabolism, UT Southwestern, Dallas, Texas
| | - James E Cox
- Department of Biochemistry, University of Utah, Salt Lake City, Utah
| | - Abdallah G Kfoury
- Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Craig H Selzman
- Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Josef Stehlik
- Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - James C Fang
- Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Dean Y Li
- Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.,Molecular Medicine Program, University of Utah, Salt Lake City, Utah
| | - Stavros G Drakos
- Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.,Molecular Medicine Program, University of Utah, Salt Lake City, Utah
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Lloyd IE, Gallan A, Huston HK, Raphael KL, Miller DV, Revelo MP, Khalighi MA. C3 glomerulopathy in adults: a distinct patient subset showing frequent association with monoclonal gammopathy and poor renal outcome. Clin Kidney J 2016; 9:794-799. [PMID: 27994856 PMCID: PMC5162413 DOI: 10.1093/ckj/sfw090] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 06/09/2016] [Accepted: 08/04/2016] [Indexed: 01/28/2023] Open
Abstract
Background C3 glomerulopathy (C3G) includes both C3 glomerulonephritis (C3GN) and dense deposit disease (DDD) and is defined by C3-dominant deposits on immunofluorescence. Dysfunction of the alternative pathway (AP) of complement is central to the pathophysiology of C3G and young patients often harbor genetic alterations of AP mediators. Recently, a link between C3G and paraproteinemia has been established. We performed this study to better characterize older patients with C3G where this association is more frequently seen. Methods Fourteen biopsies from 12 patients meeting diagnostic criteria for C3G were identified in patients > 49 years of age from 2005 to 2015 after exclusion of cases containing masked monotypic immunoglobulin deposits. Pathologic and clinical features were reviewed. Results The median age was 63.5 years and 75% of patients were male. All had renal insufficiency at presentation. Kidney biopsy showed DDD in three patients and C3GN in the remainder. Serum protein electrophoresis revealed a paraprotein in 10 patients, 8 of which had a plasma cell dyscrasia on bone marrow biopsy. A membranoproliferative pattern of glomerular injury was seen in 64% of biopsies, while mesangial proliferative and endocapillary proliferative patterns were seen less frequently. Among patients with at least 1 year of follow-up (n = 9), five were on renal replacement therapy, three showed stable (but impaired) kidney function and one demonstrated improvement. Conclusions C3G is an uncommon but important cause of kidney injury in older adults and associates with a high prevalence of paraproteinemia. In adult patients with C3G, prognosis is guarded as most patients showed either progression to end-stage kidney disease or stable but impaired kidney function.
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Affiliation(s)
- Isaac E Lloyd
- Department of Pathology, University of Utah, 1950 Circle of Hope Drive, Room N3100, Salt Lake City, UT 84112, USA
| | - Alexander Gallan
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Hunter K Huston
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Kalani L Raphael
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Dylan V Miller
- Department of Pathology, University of Utah, 1950 Circle of Hope Drive, Room N3100, Salt Lake City, UT 84112, USA
| | - Monica P Revelo
- Department of Pathology, University of Utah, 1950 Circle of Hope Drive, Room N3100, Salt Lake City, UT 84112, USA
| | - Mazdak A Khalighi
- Department of Pathology, University of Utah, 1950 Circle of Hope Drive, Room N3100, Salt Lake City, UT 84112, USA
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Ware AL, Miller DV, Erickson LK, Menon SC. Marfan syndrome associated aortic disease in neonates and children: a clinical-morphologic review. Cardiovasc Pathol 2016; 25:418-22. [PMID: 27479044 DOI: 10.1016/j.carpath.2016.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/10/2016] [Accepted: 06/12/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Marfan syndrome (MFS) is a multisystem connective tissue disorder that can lead to aortic dilation requiring aortic root replacement. Neonatal MFS (nMFS) is a rare and severe form of MFS compared to classic MFS (cMFS). Aortic root histology in MFS is thought to demonstrate predominantly medial degeneration (MD) of a translamellar mucoid extracellular matrix accumulation (MEMA-T) vs. the intralamellar mucoid extracellular matrix accumulation (MEMA-I) seen in other aortopathies. The objective of this study was to describe the clinical and histopathologic features of nMFS and cMFS patients undergoing aortic root replacement. METHODS Children with MFS who underwent aortic root replacement between 2000 and 2012 at a single institution were included. Medical records including clinical details, aortic dimensions (Z scores), and histology including MD type were obtained. Statistics were descriptive with univariate analysis of age at surgery and type of MD. RESULTS Eleven patients, 3 (27%) with nMFS, were included. Root dilation at time of surgery was greater in nMFS compared to cMFS (Z=12.8 vs. 7.6, P=.005), and nMFS patients were younger at time of surgery (7.3 vs. 18.8 years, P=.002). Histology in the nMFS group demonstrated MEMA-I in one and no MD in two. In the cMFS group, there were three with MEMA-T, four with MEMA-I, and one with both types. CONCLUSION In summary, nMFS has earlier root dilation often in the absence of MD. Both forms of MD were present in our cohort, and there was no correlation between age at surgery and type of MD.
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Affiliation(s)
- Adam L Ware
- Division of Pediatric Cardiology, University of Utah Department of Pediatrics, Salt Lake City, UT 84113, USA
| | - Dylan V Miller
- Division of Anatomic Pathology, University of Utah Department of Pathology, Salt Lake City, UT 84113, USA
| | - Lance K Erickson
- Division of Anatomic Pathology, University of Utah Department of Pathology, Salt Lake City, UT 84113, USA
| | - Shaji C Menon
- Division of Pediatric Cardiology, University of Utah Department of Pediatrics, Salt Lake City, UT 84113, USA.
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Revelo M, Miller DV, Stehlik J, Hammond E, Kfoury B. Can Electron Microscopy of Endomyocardial Biopsies Define Chronic AMR? J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.139] [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: 11/27/2022]
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20
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Ko BS, Drakos S, Kfoury AG, Hurst D, Stoddard GJ, Willis CA, Delgado JC, Hammond EH, Gilbert EM, Alharethi R, Revelo MP, Nativi-Nicolau J, Reid BB, McKellar SH, Wever-Pinzon O, Miller DV, Eckels DD, Fang JC, Selzman CH, Stehlik J. Immunologic effects of continuous-flow left ventricular assist devices before and after heart transplant. J Heart Lung Transplant 2016; 35:1024-30. [DOI: 10.1016/j.healun.2016.05.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/09/2016] [Accepted: 05/01/2016] [Indexed: 10/21/2022] Open
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21
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Revelo MP, Hammond EB, Snow GL, Miller DV, Stehlik J, Drakos SG, Hammond EH, Kfoury AG. Cluster and Heatmap Analysis in Idiopathic Dilated Cardiomyopathy (IDC): Discriminatory Variables. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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McNally JS, Burton TM, Aldred BW, Kim SE, McLaughlin MS, Eisenmenger LB, Stoddard GJ, Majersik JJ, Miller DV, Treiman GS, Parker DL. Vitamin D and Vulnerable Carotid Plaque. AJNR Am J Neuroradiol 2016; 37:2092-2099. [PMID: 27313129 DOI: 10.3174/ajnr.a4849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 04/26/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging-detected carotid intraplaque hemorrhage indicates vulnerable plaque with high stroke risk. Angiotensin II stimulates intraplaque hemorrhage in animal models, and the angiotensin system is highly regulated by vitamin D. Our purpose was to determine whether low vitamin D levels predict carotid intraplaque hemorrhage in humans. MATERIALS AND METHODS In this cross-sectional study, 65 patients with carotid disease underwent carotid MR imaging and blood draw. Systemic clinical confounders and local lumen imaging markers were recorded. To determine the association of low vitamin D levels with MR imaging detected intraplaque hemorrhage, we performed multivariable Poisson regression by using generalized estimating equations to account for up to 2 carotid arteries per patient and backward elimination of confounders. MR imaging detected intraplaque hemorrhage volume was also correlated with vitamin D levels and maximum plaque thickness. Thirty-five patients underwent carotid endarterectomy, and histology-detected intraplaque hemorrhage was correlated with vitamin D levels and total plaque area. RESULTS Low vitamin D levels (<30 ng/mL, prevalence ratio = 2.05, P = .03) were a significant predictor of MR imaging detected intraplaque hemorrhage, along with plaque thickness (prevalence ratio = 1.40, P < .001). MR imaging detected intraplaque hemorrhage volume linearly correlated with plaque thickness (partial r = 0.45, P < .001) and low vitamin D levels (partial r = 0.26, P = .003). Additionally, histology-detected intraplaque hemorrhage area linearly correlated with plaque area (partial r = 0.46, P < .001) and low vitamin D levels (partial r = 0.22, P = .03). The association of intraplaque hemorrhage volume with low vitamin D levels was also higher with ischemic stroke. CONCLUSIONS Low vitamin D levels and plaque thickness predict carotid intraplaque hemorrhage and outperform lumen markers of vulnerable plaque. This research demonstrates a significant link between low vitamin D levels and carotid intraplaque hemorrhage.
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Affiliation(s)
- J S McNally
- From the Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research (J.S.M., B.W.A., S.-E.K., M.S.M., L.B.E., D.L.P.)
| | - T M Burton
- Department of Neurology (T.M.B., J.J.M.)
| | - B W Aldred
- From the Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research (J.S.M., B.W.A., S.-E.K., M.S.M., L.B.E., D.L.P.)
| | - S-E Kim
- From the Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research (J.S.M., B.W.A., S.-E.K., M.S.M., L.B.E., D.L.P.)
| | - M S McLaughlin
- From the Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research (J.S.M., B.W.A., S.-E.K., M.S.M., L.B.E., D.L.P.)
| | - L B Eisenmenger
- From the Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research (J.S.M., B.W.A., S.-E.K., M.S.M., L.B.E., D.L.P.)
| | - G J Stoddard
- Department of Orthopedics, Study Design and Biostatistics Center (G.J.S)
| | | | | | - G S Treiman
- Department of Surgery at the University of Utah and VA Salt Lake City Health Care System, Salt Lake City, Utah (G.S.T.)
| | - D L Parker
- From the Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research (J.S.M., B.W.A., S.-E.K., M.S.M., L.B.E., D.L.P.)
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Kfoury AG, Miller DV, Snow GL, Afshar K, Stehlik J, Drakos SG, Budge D, Fang JC, Revelo MP, Alharethi RA, Gilbert EM, Caine WT, McKellar S, Molina KM, Hammond MEH. Mixed cellular and antibody-mediated rejection in heart transplantation: In-depth pathologic and clinical observations. J Heart Lung Transplant 2016; 35:335-341. [DOI: 10.1016/j.healun.2015.10.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/01/2015] [Accepted: 10/14/2015] [Indexed: 11/25/2022] Open
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Ware AL, Malmberg E, Delgado JC, Hammond ME, Miller DV, Stehlik J, Kfoury A, Revelo MP, Eckhauser A, Everitt MD. The use of circulating donor specific antibody to predict biopsy diagnosis of antibody-mediated rejection and to provide prognostic value after heart transplantation in children. J Heart Lung Transplant 2015; 35:179-85. [PMID: 26520246 DOI: 10.1016/j.healun.2015.10.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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: 05/20/2015] [Revised: 08/31/2015] [Accepted: 10/01/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Antibody-mediated rejection (AMR) is a significant cause of mortality after heart transplantation (HT). Although the presence of donor specific antibody (DSA) is a risk factor for developing AMR, serial DSA testing is not widely performed. We aimed to investigate the predictive values and prognostic implications of circulating DSA using endomyocardial biopsy as the gold standard for AMR diagnosis in pediatric recipients of HT. METHODS We performed a retrospective study in pediatric recipients of HT followed during the period 2009-2013 with at least 1 biopsy paired with DSA testing. Positive DSA was defined at mean fluorescent intensity (MFI) ≥2,000 using single antigen bead testing. Statistical analyses included 2 × 2 contingency tables, receiver operating characteristic analysis for optimal MFI cutoffs, Spearman correlation of MFI strength to AMR grade, and Kaplan-Meier analysis of event-free survival. RESULTS Of 66 children included, 27 (41%) had ≥1 DSA positive test. DSA testing had a sensitivity of 92.6%, specificity of 62.2%, positive predictive value of 24.0%, and negative predictive value of 98.5% for biopsy diagnosis of AMR at our institution. There was a statistically significant correlation between higher MFI and higher AMR grade. Patients with positive DSA and AMR had similar survival early after DSA detection but trended toward lower cardiovascular event-free survival later compared with patients without DSA and a negative biopsy. CONCLUSIONS The results of DSA testing in this cohort showed excellent sensitivity and negative predictive value for biopsy-diagnosed AMR, suggesting that DSA testing may aid in the non-invasive prediction of AMR absence in HT. The correlation of DSA MFI strength with higher AMR biopsy grade and the trend toward differences in longer term cardiovascular outcomes provide evidence for routine DSA monitoring after pediatric HT.
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Affiliation(s)
- Adam L Ware
- University of Utah School of Graduate Medical Education, Salt Lake City, Utah
| | - Elisabeth Malmberg
- ARUP Institute for Clinical and Experimental Pathology, Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Julio C Delgado
- ARUP Institute for Clinical and Experimental Pathology, Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah
| | - M Elizabeth Hammond
- Intermountain Medical Center and Intermountain Healthcare, Salt Lake City, Utah; Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, Salt Lake City, Utah
| | - Dylan V Miller
- Intermountain Medical Center and Intermountain Healthcare, Salt Lake City, Utah; Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, Salt Lake City, Utah
| | - Josef Stehlik
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, Salt Lake City, Utah; University of Utah School of Medicine, Salt Lake City, Utah; George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Abdallah Kfoury
- Intermountain Medical Center and Intermountain Healthcare, Salt Lake City, Utah; Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, Salt Lake City, Utah
| | - Monica P Revelo
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, Salt Lake City, Utah; University of Utah School of Medicine, Salt Lake City, Utah
| | - Aaron Eckhauser
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, Salt Lake City, Utah; University of Utah School of Medicine, Salt Lake City, Utah; Primary Children's Hospital, Salt Lake City, Utah
| | - Melanie D Everitt
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, Salt Lake City, Utah; University of Utah School of Medicine, Salt Lake City, Utah; Primary Children's Hospital, Salt Lake City, Utah.
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Delgado JC, Ware AL, Malmberg E, Hammond E, Miller DV, Stehlik J, Kfoury A, Revelo P, Eckhauser A, Everitt MD. The utility of circulating donor specific antibody to predict biopsy-proven antibody-mediated rejection and to provide prognostic value after heart transplantation in children. Hum Immunol 2015. [DOI: 10.1016/j.humimm.2015.07.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Revelo MP, Hammond EB, Snow GL, Dakros SG, Molina KM, Miller DV, Gilbert EM, Hammond EH, Kfoury AG. Cluster Analysis in Idiopathic Dilated Cardiomyopathy (IDC): Opportunity to Define Pathogenesis? J Card Fail 2015. [DOI: 10.1016/j.cardfail.2015.06.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Salvarani C, Brown RD, Christianson TJH, Huston J, Giannini C, Miller DV, Hunder GG. Adult Primary Central Nervous System Vasculitis Treatment and Course: Analysis of One Hundred Sixty-Three Patients. Arthritis Rheumatol 2015; 67:1637-45. [DOI: 10.1002/art.39068] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 02/05/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Carlo Salvarani
- Mayo Clinic, Rochester, Minnesota, and Azienda Ospedaliera IRCCS di Reggio Emilia; Reggio Emilia, Italy
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Stone JR, Bruneval P, Angelini A, Bartoloni G, Basso C, Batoroeva L, Buja LM, Butany J, d'Amati G, Fallon JT, Gittenberger-de Groot AC, Gouveia RH, Halushka MK, Kelly KL, Kholova I, Leone O, Litovsky SH, Maleszewski JJ, Miller DV, Mitchell RN, Preston SD, Pucci A, Radio SJ, Rodriguez ER, Sheppard MN, Suvarna SK, Tan CD, Thiene G, van der Wal AC, Veinot JP. Consensus statement on surgical pathology of the aorta from the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology: I. Inflammatory diseases. Cardiovasc Pathol 2015; 24:267-78. [PMID: 26051917 DOI: 10.1016/j.carpath.2015.05.001] [Citation(s) in RCA: 192] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/11/2015] [Accepted: 05/11/2015] [Indexed: 10/23/2022] Open
Abstract
Inflammatory diseases of the aorta include routine atherosclerosis, aortitis, periaortitis, and atherosclerosis with excessive inflammatory responses, such as inflammatory atherosclerotic aneurysms. The nomenclature and histologic features of these disorders are reviewed and discussed. In addition, diagnostic criteria are provided to distinguish between these disorders in surgical pathology specimens. An initial classification scheme is provided for aortitis and periaortitis based on the pattern of the inflammatory infiltrate: granulomatous/giant cell pattern, lymphoplasmacytic pattern, mixed inflammatory pattern, and the suppurative pattern. These inflammatory patterns are discussed in relation to specific systemic diseases including giant cell arteritis, Takayasu arteritis, granulomatosis with polyangiitis (Wegener's), rheumatoid arthritis, sarcoidosis, ankylosing spondylitis, Cogan syndrome, Behçet's disease, relapsing polychondritis, syphilitic aortitis, and bacterial and fungal infections.
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Affiliation(s)
| | | | | | | | | | | | - L Maximilian Buja
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | | | | | | | | | | | | | | | - Ornella Leone
- Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Salvarani C, Brown RD, Christianson T, Miller DV, Giannini C, Huston J, Hunder GG. An update of the Mayo Clinic cohort of patients with adult primary central nervous system vasculitis: description of 163 patients. Medicine (Baltimore) 2015; 94:e738. [PMID: 26020379 PMCID: PMC4616419 DOI: 10.1097/md.0000000000000738] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [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] [Indexed: 11/26/2022] Open
Abstract
Primary central nervous system vasculitis (PCNSV) is an uncommon condition in which lesions are limited to vessels of the brain and spinal cord. Because the clinical manifestations are not specific, the diagnosis is often difficult, and permanent disability and death are frequent outcomes. This study is based on a cohort of 163 consecutive patients with PCNSV who were examined at the Mayo Clinic over a 29-year period from 1983 to 2011. The aim of the study was to define the characteristics of these patients, which represents the largest series in adults reported to date. A total of 105 patients were diagnosed by angiographic findings and 58 by biopsy results. The patients diagnosed by biopsy more frequently had at presentation cognitive dysfunction, greater cerebrospinal fluid total protein concentrations, less frequent cerebral infarcts, and more frequent leptomeningeal gadolinium-enhanced lesions on magnetic resonance imaging (MRI), along with less mortality and disability at last follow-up. The patients diagnosed by angiograms more frequently had at presentation hemiparesis or a persistent neurologic deficit or stroke, more frequent infarcts on MRI and an increased mortality. These differences were mainly related to the different size of the vessels involved in the 2 groups. Although most patients responded to therapy with glucocorticoids alone or in conjunction with cyclophosphamide and tended to improve during the follow-up period, an overall increased mortality rate was observed. Relapses occurred in one-quarter of the patients and were less frequent in patients treated with prednisone and cyclophosphamide compared with those treated with prednisone alone. The mortality rate and degree of disability at last follow-up were greater in those with increasing age, cerebral infarctions on MRI, angiographic large vessel involvement, and diagnosis made by angiography alone, but were lower in those with gadolinium-enhanced lesions on MRI and in those with cerebral amyloid angiopathy. The annual incidence rate of PCNSV was estimated at 2.4 cases per 1,000,000 person-years. PCNSV appears to consist of several subsets defined by the size of the vessels involved, the clinical characteristics at presentation, MRI findings, and histopathological patterns on biopsy. Early recognition and treatment may reduce poor outcomes.
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Affiliation(s)
- Carlo Salvarani
- From the Department of Neurology (RDB); Division of Biomedical Statistics and Informatics (TC); Department of Radiology (JH); Division of Anatomic Pathology (CG, DVM); and Division of Rheumatology (GGH), Mayo Clinic, Rochester, Minnesota
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McCandless SP, Ledford ID, Mason NO, Alharethi R, Rasmusson BY, Budge D, Stoker SL, Clayson SE, Doty JR, Thomsen GE, Caine WT, Kfoury AG, Reid BB, Miller DV. Comparing velour versus silicone interfaces at the driveline exit site of HeartMate II devices: infection rates, histopathology, and ultrastructural aspects. Cardiovasc Pathol 2014; 24:71-5. [PMID: 25483742 DOI: 10.1016/j.carpath.2014.07.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 04/04/2014] [Revised: 06/24/2014] [Accepted: 07/03/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Driveline exit site (DLES) infection is a major complication of ventricular assist devices (VADs). Differences in the sheath material interfacing with exit site tissue appear to affect healing time and infection risk more than site hygiene, but the mechanistic basis for this is not clear. METHODS Health record data from Utah Artificial Heart Program patients with HeartMate II (HMII) devices implanted from 2008 to 2012 were retrospectively reviewed, with particular attention to interface type, incorporation (healing) time, and infections. Tissue samples from the DLES were collected at the time of VAD removal in a small subset. These samples were examined by routine histology and environmental scanning electron microscopy (ESEM). RESULTS Among 57 patients with sufficient data, 15 had velour interfaces and 42 had silicone. Indications for and duration of support were similar between the groups. The silicone group had shorter incorporation time (45 ±22 vs. 56 ±34 days, P=.17) and fewer DLES infections (20% vs. 1.7%, P=.026, for patient infections and 0.0340 vs. 0.166, P=.16, for infections per patient-year). Tissues from five patients, three with velour, were examined. Velour interfaces demonstrated more hyperkeratosis, hypergranulosis, and dermal inflammation. By ESEM, the silicone driveline tracts appeared relatively smooth and flat, whereas the velour interface samples were irregular with deep fissures and globular material adhering to the surface. CONCLUSIONS Using the silicone portion of the HMII driveline at the DLES was associated with fewer infections and a trend toward faster healing in this small retrospective series. Whether the intriguing microscopic differences directly account for this needs further study on a larger scale.
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Affiliation(s)
- Sean P McCandless
- Utah Artificial Heart Program, Intermountain Medical Center and Intermountain Healthcare, Salt Lake City, Utah
| | - Ian D Ledford
- Utah Artificial Heart Program, Intermountain Medical Center and Intermountain Healthcare, Salt Lake City, Utah
| | - Nathan O Mason
- Utah Artificial Heart Program, Intermountain Medical Center and Intermountain Healthcare, Salt Lake City, Utah
| | - Rami Alharethi
- Department of Cardiology, Intermountain Medical Center and Intermountain Healthcare, Salt Lake City, Utah
| | - Brad Y Rasmusson
- Department of Critical Care Intensive Medicine, Intermountain Medical Center and Intermountain Healthcare, Salt Lake City, Utah
| | - Deborah Budge
- Department of Cardiology, Intermountain Medical Center and Intermountain Healthcare, Salt Lake City, Utah
| | - Sandi L Stoker
- Utah Artificial Heart Program, Intermountain Medical Center and Intermountain Healthcare, Salt Lake City, Utah
| | - Stephen E Clayson
- Department of Cardiothoracic Surgery, Intermountain Medical Center and Intermountain Healthcare, Salt Lake City, Utah
| | - John R Doty
- Department of Cardiothoracic Surgery, Intermountain Medical Center and Intermountain Healthcare, Salt Lake City, Utah
| | - George E Thomsen
- Department of Critical Care Intensive Medicine, Intermountain Medical Center and Intermountain Healthcare, Salt Lake City, Utah
| | - William T Caine
- Department of Cardiothoracic Surgery, Intermountain Medical Center and Intermountain Healthcare, Salt Lake City, Utah
| | - Abdallah G Kfoury
- Department of Cardiology, Intermountain Medical Center and Intermountain Healthcare, Salt Lake City, Utah
| | - Bruce B Reid
- Department of Cardiothoracic Surgery, Intermountain Medical Center and Intermountain Healthcare, Salt Lake City, Utah
| | - Dylan V Miller
- Department of Pathology, Intermountain Medical Center and Intermountain Healthcare, Salt Lake City, Utah.
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Miller DV, Stender H, Kristensen T, Min RK, Isaac J, Hansen J, Seaman J, Grunkin M, Vyberg M. Abstract P3-05-03: HER2-CONNECT® pathologist-assisted image analysis algorithm for HER2 IHC interpretation improves correlation with HER2 FISH results. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p3-05-03] [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
Background: HER2 testing by immunohistochemistry (IHC) is prone to inter-observer variability and subjective interpretation. Pathologist-assisted digital image analysis is recommended in the CAP/ASCO guidelines to improve interpretive consistency. As a quality benchmark, HER2 IHC results should correlate with HER2 fluorescence in-situ hybridization (FISH) in >95% of positive and negative cases. HER2-CONNECT® (Visiopharm, Hoersholm Denmark) is a digital analysis algorithm that scores stained membrane interconnectivity rather than relying solely on staining of individual cells. As such, it can be thought of as a surrogate for the so-called “chickenwire” pattern characteristic of true HER2 positive tumors. In this study we applied HER2-CONNECT® analysis with pathologist quantitative interpretation (HC+PQI) to a set of breast tumors with known HER2 FISH status to assess concordance.
Design: Breast carcinoma tissue sections previously stained with HER2 IHC (HercepTest) and interpreted manually were retrospectively re-submitted for HC+PQI. These included core and excisional biopsies from primary and metastatic sites. Fixation times were documented within recommended guidelines. HER2 FISH (PathVysion) was performed on all cases. Using connectivity scores on a scale of 0 - 1.0 from the analyzed regions, a pathologist determined the overall% of HER2 positive tumor cells in the sample (since HER2-CONNECT reports connectivity, but not tumor cell quantitation) and reported a final score per CAP/ASCO guidelines (<10% = 1+, 10-30% = 2+, >30% = 3+).
Results: 190 cases comprised the analysis set, including 77 3+, 73 2+, and 40 0/1+ as scored in the original reports. 66 cases were HER2 FISH amplified (64/77, 83% of the original 3+ cases and 2/73, 2.7% of 2+ cases) and 6 cases were FISH equivocal. None of the 0/1+ cases were HER2 FISH amplified. Using HC+PQI, the new scores were 67 3+, 68 2+, and 55 1+. Correlation between HC+PQI and HER2 FISH was 95.5% (64/67) for 3+/amplified and 100% (55/55) for <2+/nonamplified (overall concordance 97.5%). Using FISH as the gold standard, the HC+PQI interpretation reduced the false positive rate from 13% (15/108) to 3% (4/108). 17 of 63 HER2 nonamplified samples originally scored 2+ were changed to 1+ on HC+PQI (i.e. reduction of FISH testing by 27% (17/63)).
Conclusions: Relative to the original report scores, HC+PQI improved correlation with HER2 FISH and reduced the overall number of 2+ results (potentially reducing the number of FISH tests required). These data also objectively highlight the importance of the “chickenwire” pattern in positive result interpretation for HER2.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-05-03.
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Affiliation(s)
- DV Miller
- Intermountain Healthcare, Salt Lake City, UT; Visiopharm, Hoersholm, Denmark; Aalborg University Hospital, Aalborg, Denmark
| | - H Stender
- Intermountain Healthcare, Salt Lake City, UT; Visiopharm, Hoersholm, Denmark; Aalborg University Hospital, Aalborg, Denmark
| | - T Kristensen
- Intermountain Healthcare, Salt Lake City, UT; Visiopharm, Hoersholm, Denmark; Aalborg University Hospital, Aalborg, Denmark
| | - RK Min
- Intermountain Healthcare, Salt Lake City, UT; Visiopharm, Hoersholm, Denmark; Aalborg University Hospital, Aalborg, Denmark
| | - J Isaac
- Intermountain Healthcare, Salt Lake City, UT; Visiopharm, Hoersholm, Denmark; Aalborg University Hospital, Aalborg, Denmark
| | - J Hansen
- Intermountain Healthcare, Salt Lake City, UT; Visiopharm, Hoersholm, Denmark; Aalborg University Hospital, Aalborg, Denmark
| | - J Seaman
- Intermountain Healthcare, Salt Lake City, UT; Visiopharm, Hoersholm, Denmark; Aalborg University Hospital, Aalborg, Denmark
| | - M Grunkin
- Intermountain Healthcare, Salt Lake City, UT; Visiopharm, Hoersholm, Denmark; Aalborg University Hospital, Aalborg, Denmark
| | - M Vyberg
- Intermountain Healthcare, Salt Lake City, UT; Visiopharm, Hoersholm, Denmark; Aalborg University Hospital, Aalborg, Denmark
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Castonguay MC, Wang Y, Gerhart JL, Miller DV, Stulak JM, Edwards WD, Maleszewski JJ. Surgical pathology of atrial appendages removed during the cox-maze procedure: a review of 86 cases (2004 to 2005) with implications for prognosis. Am J Surg Pathol 2013; 37:890-7. [PMID: 23629441 DOI: 10.1097/pas.0b013e31827e180b] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Some patients are managed surgically (Cox-maze procedure) with removal of 1 or both atrial appendages. A retrospective review was performed on surgically excised atrial appendages from 86 consecutive patients with AF (2004 to 2005), at Mayo Clinic in Rochester, MN. These were compared with atrial appendages removed from 2 autopsy control groups without a history of AF (26 without heart disease, and 20 with heart disease). Compared with the 2 control groups, appendages from patients with AF contained more myocyte vacuolization, fatty infiltration, and myocardial inflammation. Among the AF patients, left atrial appendages (LAA) were larger and more likely to show fatty infiltration, endocardial fibroelastosis, and mural thrombus than were right atrial appendages (RAA); in contrast, RAA were more likely to show myocyte hypertrophy and interstitial fibrosis than were LAA. In the LAA, myocyte hypertrophy and interstitial fibrosis were more often seen in patients with long-term AF recurrence than were those who remained in normal sinus rhythm postoperatively (P=0.045 and 0.036, respectively). Given the potential clinical relevance of these findings, it is recommended that the presence or absence of hypertrophy and fibrosis, and their extent, be incorporated into the surgical pathology report of all patients undergoing resection of an atrial appendage.
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Affiliation(s)
- Mathieu C Castonguay
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
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Menon SC, Erickson LK, McFadden M, Miller DV. Effect of ventriculotomy on right-ventricular remodeling in hypoplastic left heart syndrome: a histopathological and echocardiography correlation study. Pediatr Cardiol 2013; 34:354-63. [PMID: 22875140 DOI: 10.1007/s00246-012-0462-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 07/16/2012] [Indexed: 11/28/2022]
Abstract
The objective of this study was to compare histopathological changes in hypoplastic left heart syndrome right ventricles (RV) of patients undergoing Sano and modified Blalock-Taussig (MBT) shunt and correlate them with echocardiographic findings. Myocardial tissue samples were obtained from hearts with Sano or MBT shunts after transplantation or at autopsy. Histologic sections were reviewed manually and by automated digital image analysis. Velocity vector imaging was performed on echocardiogram images obtained before transplant or death. All of these parameters were compared between the Sano and MBT shunt cohorts. A total of 14 specimens (7 Sano and 7 MBT shunt) were studied. Median age at transplant/death of Sano and MBT shunt cohorts was 11 (range 2-41) and 8 months (range 2-200), respectively. All Sano specimens had a scar at ventriculotomy site, and the mean scar area was 6.2 ± 3.3 cm(2). Compared with remote RV free wall, myocardium bordering the scar showed increased fibrosis (34 ± 16 % vs. 28 ± 14 %, p = 0.04) and thinning (0.8 ± 0.9 vs. 5.3 ± 0.8 mm; p < 0.001), which did not regress with time. The Sano ventriculotomy site showed significantly decreased velocity, strain, and strain rate compared with the corresponding contralateral segment. No focal scarring or regional hypokinesia was seen in the MBT shunt cohort. This is the first study to demonstrate histopathological features of ventriculotomy-associated RV myocardial scarring and myocardial thinning. The scarred ventriculotomy site showed decreased segmental myocardial deformation after Norwood with Sano shunt.
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Affiliation(s)
- Shaji C Menon
- Division of Pediatric Cardiology, University of Utah, Salt Lake, UT 84113, USA.
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Abstract
Melanoma is a common neoplasm with a propensity to metastasize to the heart. Although cardiac metastasis is rarely diagnosed ante mortem, using a multimodality approach, several imaging findings may be seen. Echocardiography is often the initial imaging method used to detect cardiac metastases and their complications. On computed tomography, intraluminal filling defects and myocardial/pericardial nodules may be seen. On magnetic resonance imaging, metastatic melanoma is classically hyperintense on T1 images and hypointense on T2 images, a result of the T1 shortening of melanin; however, this is seen in a minority of cases. As melanoma metastases are fluorine-18-fluorodeoxyglucose avid, fluorine-18-fluorodeoxyglucose positron emission tomography may also be used to detect cardiac metastases.
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Affiliation(s)
- Brian C Allen
- Department of Radiology, Wake Forest Baptist Medical Center, Winston Salem, NC 27157, USA.
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Revelo MP, Miller DV, Stehlik J, Brunisholz K, Drakos S, Gilbert EM, Everitt M, Budge D, Alharethi R, Snow G, Hammond EH, Kfoury AG. Longitudinal evaluation of microvessel density in survivors vs. nonsurvivors of cardiac pathologic antibody-mediated rejection. Cardiovasc Pathol 2012; 21:445-54. [DOI: 10.1016/j.carpath.2012.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 12/09/2011] [Accepted: 01/27/2012] [Indexed: 11/26/2022] Open
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Ware AL, Miller DV, Porter CBJ, Edwards WD. Characterization of atrial morphology and sinus node morphology in heterotaxy syndrome: an autopsy-based study of 41 cases (1950–2008). Cardiovasc Pathol 2012; 21:421-7. [DOI: 10.1016/j.carpath.2011.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 12/19/2011] [Accepted: 12/28/2011] [Indexed: 10/14/2022] Open
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Fealey ME, Edwards WD, Miller DV, Maleszewski JJ. Unicommissural aortic valves: gross, histological, and immunohistochemical analysis of 52 cases (1978-2008). Cardiovasc Pathol 2012; 21:324-33. [DOI: 10.1016/j.carpath.2011.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 10/10/2011] [Accepted: 11/02/2011] [Indexed: 11/15/2022] Open
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Everitt MD, Hammond MEH, Snow GL, Stehlik J, Revelo MP, Miller DV, Kaza AK, Budge D, Alharethi R, Molina KM, Kfoury AG. Biopsy-diagnosed antibody-mediated rejection based on the proposed International Society for Heart and Lung Transplantation working formulation is associated with adverse cardiovascular outcomes after pediatric heart transplant. J Heart Lung Transplant 2012; 31:686-93. [DOI: 10.1016/j.healun.2012.03.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 03/05/2012] [Accepted: 03/23/2012] [Indexed: 10/28/2022] Open
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Kfoury AG, Snow GL, Budge D, Alharethi RA, Stehlik J, Everitt MD, Miller DV, Drakos SG, Reid BB, Revelo MP, Gilbert EM, Selzman CH, Bader FM, Connelly JJ, Hammond MEH. A longitudinal study of the course of asymptomatic antibody-mediated rejection in heart transplantation. J Heart Lung Transplant 2012; 31:46-51. [PMID: 22153551 DOI: 10.1016/j.healun.2011.10.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 10/06/2011] [Accepted: 10/19/2011] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Growing evidence suggests worse cardiac allograft vasculopathy and mortality in patients with asymptomatic antibody-mediated rejection (AMR). Debate continues about whether therapeutic intervention is warranted to avoid adverse outcomes. In this study we examine the course of individual episodes of untreated asymptomatic AMR on follow-up endomyocardial biopsy (EMB). METHODS The U.T.A.H. Cardiac Transplant Program database was queried for transplant recipients between 1985 and 2009 who survived beyond 1 year and had at least 1 episode of lone AMR with a follow-up EMB. All EMBs were screened for AMR by immunofluorescence and graded for severity. Data were analyzed based on time from transplant (early, ≤12 months; late, >12 months). RESULTS Nine hundred fifty-eight patients with a total of 15,448 biopsies qualified for the study. Average age at transplant was 46.7 years; 13% of the patients were female. Within the first year post-transplant, asymptomatic AMR was diagnosed in 13.6% of biopsies compared with 5.2% beyond 1 year. AMR resolved in 65% (early) vs 75% (late) on follow-up EMB. More severe AMR was less likely to improve regardless of time from transplant. Furthermore, after an episode of AMR had resolved, the recurrence rate at 3, 6 and 12 months was 44%, 50.1% and 56.2%, respectively. CONCLUSIONS The incidence of AMR is higher in the first year post-transplant and the likelihood of resolution is less on follow-up EMB, especially when more severe. A small but significant number of cases became worse or did not change. These new findings may be helpful in planning future studies that test whether therapeutic interventions on asymptomatic AMR favorably impact outcomes.
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Affiliation(s)
- Abdallah G Kfoury
- Intermountain Medical Center and Intermountain Healthcare, Salt Lake City, Utah, USA.
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Abstract
Cardiac neoplasms and other mass-forming lesions are not commonly encountered in surgical pathology practice. Fortunately, for the most part, these fall into a small group of well characterized and readily-recognized entities, although they are not without diagnostic dilemmas. A brief and practical synopsis of cardiac tumors is presented in this section with attention to more frequently encountered and clinically significant diagnostic challenges as well as pertinent clinical associations and prognostic information.
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Affiliation(s)
- Dylan V Miller
- Intermountain Central Laboratory, Immunostains and Electron Microscopy, University of Utah, 5252 South Intermountain Drive, Salt Lake City, UT 84157, USA
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Salvarani C, Brown RD, Calamia KT, Christianson TJH, Huston J, Meschia JF, Giannini C, Miller DV, Hunder GG. Primary central nervous system vasculitis presenting with intracranial hemorrhage. ACTA ACUST UNITED AC 2011; 63:3598-606. [PMID: 22038406 DOI: 10.1002/art.30594] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Nixon JL, Kfoury AG, Brunisholz K, Horne BD, Myrick C, Miller DV, Budge D, Bader F, Everitt M, Saidi A, Stehlik J, Schmidt TC, Alharethi R. Impact of high-dose inotropic donor support on early myocardial necrosis and outcomes in cardiac transplantation. Clin Transplant 2011; 26:322-7. [DOI: 10.1111/j.1399-0012.2011.01504.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Brown SM, Miller DV, Vezina D, Dean NC, Grissom CK. Horses and Zebras: complex cardiac anatomy in a patient with out-of-hospital cardiac arrest. Crit Ultrasound J 2011; 3:29-31. [PMID: 22022658 DOI: 10.1007/s13089-011-0059-2] [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: 11/30/2022] Open
Abstract
This case report describes a woman presenting after out-of-hospital cardiac arrest with several cardiac anomalies, including a form fruste of Ebstein's anomaly complicated by a large tricuspid valve vegetation. On autopsy, she proved to have unstable plaques in epicardial vessels that likely caused arrhythmic sudden cardiac death, a reminder that even in the presence of rare anomalies, common things are common.
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Affiliation(s)
- Samuel M Brown
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Salt Lake City, UT, USA; Critical Care Echocardiography Service, Intermountain Medical Center, Salt Lake City, UT, USA; Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT, USA
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Miller DV, Maleszewski JJ. The pathology of large-vessel vasculitides. Clin Exp Rheumatol 2011; 29:S92-S98. [PMID: 21586202] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 03/15/2011] [Indexed: 05/30/2023]
Abstract
Vasculitis affecting large elastic arteries, including the aorta and major proximal branches, encompasses various diseases including Takayasu arteritis, giant cell (or temporal) arteritis, and tertiary syphilis, but also may occur as a rare complication of Behçet's disease, rheumatoid arthritis, sarcoidosis, Cogan syndrome, Kawasaki disease, ankylosing spondylitis, systemic lupus erythematosus and Wegener's granulomatosis. Recent reports have also established a link between inflammatory abdominal aortic aneurysm as well as lymphoplasmacytic thoracic aortitis with an overabundance of IgG4-producing plasma cells and the burgeoning constellation of 'Hyper-IgG4' syndromes. This review focuses on morphologic aspects of large-vessel vasculitis pathology associated with giant cell arteritis, Takayasu arteritis, idiopathic or isolated aortitis, lymphoplasmacytic thoracic and ascending aortitis, and the inflammatory aneurysm/retroperitoneal fibrosis syndrome.
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Affiliation(s)
- Dylan V Miller
- Intermountain Medical Center & University of Utah, Murray, USA.
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Abstract
The term "chronic periaortitis" (CP), proposed by Mitchinson in 1984, comprises 3 main entities: idiopathic retroperitoneal fibrosis (IRF), inflammatory abdominal aortic aneurysms (IAAAs), and perianeurysmal retroperitoneal fibrosis (PRF).The presence of constitutional symptoms, high acute-phase reactants, positive autoantibodies, and associated autoimmune diseases suggests a systemic inflammatory process. Histopathologic findings show vasculitis with fibrinoid necrosis involving the aortic vasa vasorum as well as the small and medium retroperitoneal vessels.We reviewed the medical records of 608 patients with a diagnosis of vasculitis involving the gastrointestinal (GI) tract at the Mayo Clinic between January 1996 and December 2007. Only patients with biopsy-proven or typical angiographic findings of vasculitis localized to the GI tract were included.Five patients were identified with evidence of CP (1 patient with PRF, 1 with IRF, and 3 with IAAAs). Three patients were men, and the median age at diagnosis was 49 years. The diagnosis of GI vasculitis and CP was made simultaneously in 4 patients. At the time of onset, all patients had abdominal pain and constitutional manifestations; the median erythrocyte sedimentation rate was 62.5 mm/1 h (range, 20-86 mm/1 h). All patients had evidence of mesenteric vasculitis at angiography. Three patients also had associated renal artery stenoses. Abdominal computed tomography showed spleen infarcts in 2 patients, bowel wall thickening in 1, and liver infarction in 1. Two patients underwent surgical intervention for acute abdomen; there was histologic evidence of small bowel infarcts and infarction of the spleen and liver in 1. Oral prednisone was administered to all 5 patients (median starting dose, 60 mg/d; range, 25-80 mg/d). Three patients also received immunosuppressive agents, 1 tamoxifen, and 1 anti-tumor necrosis factor therapy. All patients had at least 1 relapse or recurrence of vasculitis, but at last visit, GI vasculitis and CP were in remission in all 5 patients.This study provides evidence that GI manifestations due to mesenteric vasculitis may be associated with CP. Vasculitic involvement of the renal arteries is also frequently present in these patients. Aggressive immunosuppressive treatment should be promptly initiated to forestall abdominal complications. These findings reinforce the hypothesis that a vasculitic process plays an important role in the pathogenesis of CP.
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Affiliation(s)
- Carlo Salvarani
- From Unità di Reumatologia (CS, NP), Arcispedale S. Maria Nuova, Reggio Emilia, Italy; Division of Rheumatology (KTC), Mayo Clinic, Jacksonville, Florida; Division of Rheumatology (ELM, GGH, KJW), and Division of Anatomic Pathology (DVM), Mayo Clinic, Rochester, Minnesota
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Miller DV, Roden AC, Gamez JD, Tazelaar HD. Detection of C4d deposition in cardiac allografts: a comparative study of immunofluorescence and immunoperoxidase methods. Arch Pathol Lab Med 2010; 134:1679-84. [PMID: 21043822 DOI: 10.5858/2009-0511-oar1.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Complement activation, evidenced by deposition of C4d, is important in the diagnosis of antibody-mediated rejection of cardiac allografts. C4d deposition can be assessed by either immunofluorescence (IF)- or immunoperoxidase (IP)-based methods. The use of methods varies considerably among institutions, but there are few data addressing their diagnostic equivalence. OBJECTIVE To compare IF and IP C4d staining on paired endomyocardial biopsy samples from a large number of heart transplant patients. DESIGN Retrospectively selected paired frozen and paraffin-embedded samples from the same biopsy were stained for C4d by IF and IP methods. Capillary staining was scored by using a 0, 1+, 2+, 3+ scale. RESULTS A total of 296 biopsy pairs from 70 patients were studied. There were two hundred forty-three cases that were scored 0, twenty-four scored 1+, sixteen scored 2+, and thirteen scored 3+ by IF. Two hundred thirty-one cases scored 0, forty scored 1+, ten scored 2+, and fifteen scored 3+ by IP. Complete agreement was seen in 81% of cases. Among discrepant cases, 89% (n = 51) were minor (±1) and 11% (n = 6) were major (±2). Five of the 6 major discrepancy biopsies came from 2 patients, both of whom had concordant (IF and IP) 3+ results on prior biopsies. The weighted κ value for the entire sample set was 0.78 and for the first biopsy only set (to correct for bias introduced by multiple biopsies from the same patient) the weighted κ value was 0.88. CONCLUSIONS Immunofluorescence and IP C4d staining methods are highly comparable and are both viable options for antibody-mediated rejection surveillance in transplant heart biopsies.
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Salvarani C, Brown RD, Calamia KT, Christianson TJH, Huston J, Meschia JF, Giannini C, Miller DV, Hunder GG. Rapidly progressive primary central nervous system vasculitis. Rheumatology (Oxford) 2010; 50:349-58. [PMID: 20959356 DOI: 10.1093/rheumatology/keq303] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [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
OBJECTIVE To describe a subset of cases in a large cohort of patients with primary CNS vasculitis (PCNSV) who appear to have a rapidly progressive clinical course. METHOD In the present study, we use our updated cohort of 131 consecutive patients with PCNSV seen over the 25-year period of 1983-2007 at Mayo Clinic, Rochester, MN, USA. The diagnosis of PCNSV was based on brain/spinal cord biopsy or cerebral angiography. The modified Rankin scale was used to identify rapidly progressive disease and included patients with Rankin scores indicating severe disability or death at diagnosis or within 6 months after the diagnosis. We compared patients with rapidly progressive disease to those without. RESULTS Compared with the 120 patients without rapidly progressive vasculitis, the 11 patients with rapidly progressive vasculitis more frequently had paraparesis/quadriparesis at presentation, angiographic presence of bilateral, large-vessel vasculitis and MRI evidence of cerebral infarctions; those infarctions were more frequently multiple and bilateral, and more frequently involved both the cortex and subcortical regions on initial MRI. Granulomatous and/or necrotizing histopathological patterns of vasculitis were observed in patients with positive biopsies. CONCLUSION Rapidly progressive PCNSV appears to form a subset of PCNSV at the worst end of the clinical spectrum of this vasculitis, characterized by bilateral, multiple, large cerebral vessel lesions and multiple CNS infarctions.
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Affiliation(s)
- Carlo Salvarani
- Department of Neurology, Mayo Clinic, , Rochester, MN 55905, USA
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Sethi S, Sukov WR, Zhang Y, Fervenza FC, Lager DJ, Miller DV, Cornell LD, Krishnan SGS, Smith RJH. Dense deposit disease associated with monoclonal gammopathy of undetermined significance. Am J Kidney Dis 2010; 56:977-82. [PMID: 20832153 DOI: 10.1053/j.ajkd.2010.06.021] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 06/23/2010] [Indexed: 02/06/2023]
Abstract
Dense deposit disease (DDD) is a rare glomerular disease that typically affects children, young adults, and much less commonly, older patients. The pathophysiologic process underlying DDD is uncontrolled activation of the alternative pathway (AP) of complement cascade, most frequently secondary to an autoantibody to C3 convertase called C3 nephritic factor, although mutations in factor H and autoantibodies to this protein can impair its function and also cause DDD. Since 1995, we have diagnosed DDD in 14 patients aged 49 years or older; 10 of these patients (71.4%) carry a concomitant diagnosis of monoclonal gammopathy of undetermined significance (MGUS). In 1 of these 10 patients, the index case described here, we evaluated the AP and showed low serum AP protein levels consistent with complement activity, heterozygosity for the H402 allele of factor H, and low levels of factor H autoantibodies, which can affect the ability of factor H to regulate AP activity. In aggregate, these findings suggest that in some adults with MGUS, DDD may develop as a result of autoantibodies to factor H (or other complement proteins) that on a permissive genetic background (the H402 allele of factor H) lead to dysregulation of the AP with subsequent glomerular damage. Thus, DDD in some older patients may be a distinct clinicopathologic entity that represents an uncommon complication of MGUS.
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Affiliation(s)
- Sanjeev Sethi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.
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Boland JM, Chung HH, Robberts FJL, Wilson WR, Steckelberg JM, Baddour LM, Miller DV. Fungal prosthetic valve endocarditis: Mayo Clinic experience with a clinicopathological analysis. Mycoses 2010; 54:354-60. [DOI: 10.1111/j.1439-0507.2010.01884.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
CONTEXT Primary cardiac tumors are rare and the great majority are benign neoplasms. Mass-forming reactive and pseudoneoplastic growths are less common, but recognizing and distinguishing these lesions from the neoplasms they resemble is critical to appropriate patient care. OBJECTIVE The general clinical, imaging, gross pathologic, and histologic features of 5 important pseudoneoplasms (inflammatory myofibroblastic tumor, hamartoma of mature cardiac myocytes, mesothelial/monocytic cardiac excrescences, calcified amorphous tumor, and lipomatous hypertrophy of the atrial septum) are discussed, with an emphasis on features differentiating them from other benign and malignant tumors. DATA SOURCES Pertinent citations of the literature and observations from the authors' experience are drawn upon. CONCLUSIONS While lacking malignant potential, these lesions can be associated with considerable morbidity and occasional mortality. Their recognition is important in guiding patient management, providing both guidance for appropriate therapy and avoidance of inappropriately aggressive and toxic treatments.
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