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Gokhale T, Harinstein ME. Challenging the Paradigm of Post-Capillary Pulmonary Hypertension. Am J Cardiol 2024; 215:74-75. [PMID: 38163578 DOI: 10.1016/j.amjcard.2023.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/24/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Tanmay Gokhale
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center,Pittsburgh, Pennsylvania
| | - Matthew E Harinstein
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center,Pittsburgh, Pennsylvania.
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Singh S, Chaudhary R, Bliden KP, Tantry US, Gurbel PA, Visweswaran S, Harinstein ME. Meta-Analysis of the Performance of AI-Driven ECG Interpretation in the Diagnosis of Valvular Heart Diseases. Am J Cardiol 2024; 213:126-131. [PMID: 38103769 PMCID: PMC10842912 DOI: 10.1016/j.amjcard.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/17/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023]
Abstract
Valvular heart diseases (VHDs) significantly impact morbidity and mortality rates worldwide. Early diagnosis improves patient outcomes. Artificial intelligence (AI) applied to electrocardiogram (ECG) interpretation presents a promising approach for early VHD detection. We conducted a meta-analysis on the efficacy of AI models in this context. We reviewed databases including PubMed, MEDLINE, Embase, Scopus, and Cochrane until August 20, 2023, focusing on AI for ECG-based VHD detection. The outcomes included pooled accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value. The pooled proportions were derived using a random-effects model with 95% confidence intervals (CIs). Study heterogeneity was evaluated with the I-squared statistic. Our analysis included 10 studies, involving ECG data from 713,537 patients. The AI algorithms mainly screened for aortic stenosis (n = 6), mitral regurgitation (n = 4), aortic regurgitation (n = 3), mitral stenosis (n = 1), mitral valve prolapse (n = 2), and tricuspid regurgitation (n = 1). A total of 9 studies used convolution neural network models, whereas 1 study combined the strengths of support vector machine logistic regression and multilayer perceptron for ECG interpretation. The collective AI models demonstrated a pooled accuracy of 81% (95% CI 73 to 89, I² = 92%), sensitivity was 83% (95% CI 77 to 88, I² = 86%), specificity was 72% (95% CI 68 to 75, I² = 52%), PPV was 13% (95% CI 7 to 19, I² = 90%), and negative predictive value was 99% (95% CI 97 to 99, I² = 50%). The subgroup analyses for aortic stenosis and mitral regurgitation detection yielded analogous outcomes. In conclusion, AI-driven ECG offers high accuracy in VHD screening. However, its low PPV indicates the need for a combined approach with clinical judgment, especially in primary care settings.
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Affiliation(s)
- Sahib Singh
- Department of Medicine, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Rahul Chaudhary
- Artificial Intelligence for Holistic Evaluation and Advancement of Cardiovascular Thrombosis (AI-HEART) Lab, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Intelligent Systems Program, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Kevin P Bliden
- Department of Cardiology, Sinai Center of Thrombosis Research and Drug Development, Baltimore, Maryland
| | - Udaya S Tantry
- Department of Cardiology, Sinai Center of Thrombosis Research and Drug Development, Baltimore, Maryland
| | - Paul A Gurbel
- Department of Medicine, Sinai Hospital of Baltimore, Baltimore, Maryland; Department of Cardiology, Sinai Center of Thrombosis Research and Drug Development, Baltimore, Maryland
| | - Shyam Visweswaran
- Intelligent Systems Program, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Matthew E Harinstein
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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3
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Fatima S, Jang S, Harinstein ME. Importance Of Assessing Right Ventricular Systolic Function in Patients Presenting With ST-Elevation Myocardial Infarction. Am J Cardiol 2024; 211:367-368. [PMID: 37980998 DOI: 10.1016/j.amjcard.2023.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/21/2023]
Affiliation(s)
- Shumail Fatima
- Division of Hospital Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sae Jang
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Matthew E Harinstein
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Chaudhary R, Rajaratnam A, Harinstein ME. Hemodynamic Forces in Cardiac Resynchronization Therapy: Implications and Future Directions. Am J Cardiol 2024; 210:295-296. [PMID: 37866450 PMCID: PMC10807484 DOI: 10.1016/j.amjcard.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 10/17/2023] [Indexed: 10/24/2023]
Affiliation(s)
- Rahul Chaudhary
- University of Pittsburgh, School of Computing and Information, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Artificial Intelligence for Holistic Evaluation and Advancement of Cardiovascular Thrombosis (AI-HEART) Lab, Pittsburgh, Pennsylvania
| | - Arun Rajaratnam
- Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Matthew E Harinstein
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Skowronski J, Keen S, Harinstein ME. Advancing the Understanding of the Utility of Inhaled Nitric Oxide to Guide Treatment in Patients With Combined Precapillary and Postcapillary Pulmonary Hypertension. Am J Cardiol 2023; 209:250-251. [PMID: 37898161 DOI: 10.1016/j.amjcard.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/30/2023]
Affiliation(s)
- Jenna Skowronski
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Susan Keen
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Matthew E Harinstein
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Chaudhary R, Harinstein ME. Leveraging Artificial Intelligence in Cardiology: Interaction Between Atrial Fibrillation and Cardiopulmonary Dynamics. Am J Cardiol 2023; 205:497-498. [PMID: 37679192 PMCID: PMC10809774 DOI: 10.1016/j.amjcard.2023.08.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Rahul Chaudhary
- School of Computing and Information, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Artificial Intelligence for Holistic Evaluation and Advancement of Cardiovascular Thrombosis (AI-HEART) Lab, Pittsburgh, Pennsylvania
| | - Matthew E Harinstein
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Chaudhary R, Rajaratnam A, Harinstein ME. Tumor Necrosis Factor-α Inhibitors in Cardiac Sarcoidosis Management: Evaluating Therapeutic Efficacy and Future Directions. Am J Cardiol 2023; 205:493-494. [PMID: 37679194 PMCID: PMC10807249 DOI: 10.1016/j.amjcard.2023.08.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Rahul Chaudhary
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; School of Computing and Information, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Arun Rajaratnam
- Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Matthew E Harinstein
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Harinstein ME, Rajaratnam A. Enhancing Detection of Pulmonary Hypertension: A Screening Tool to Quickly Identify and Refer Patients. Am J Cardiol 2023; 203:511-512. [PMID: 37500320 DOI: 10.1016/j.amjcard.2023.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/08/2023] [Indexed: 07/29/2023]
Affiliation(s)
- Matthew E Harinstein
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennslyvania.
| | - Arun Rajaratnam
- Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennslyvania
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9
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Izzy M, Fortune BE, Serper M, Bhave N, deLemos A, Gallegos-Orozco JF, Guerrero-Miranda C, Hall S, Harinstein ME, Karas MG, Kriss M, Lim N, Palardy M, Sawinski D, Schonfeld E, Seetharam A, Sharma P, Tallaj J, Dadhania DM, VanWagner LB. Management of cardiac diseases in liver transplant recipients: Comprehensive review and multidisciplinary practice-based recommendations. Am J Transplant 2022; 22:2740-2758. [PMID: 35359027 PMCID: PMC9522925 DOI: 10.1111/ajt.17049] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/10/2022] [Accepted: 03/27/2022] [Indexed: 01/25/2023]
Abstract
Cardiac diseases are one of the most common causes of morbidity and mortality following liver transplantation (LT). Prior studies have shown that cardiac diseases affect close to one-third of liver transplant recipients (LTRs) long term and that their incidence has been on the rise. This rise is expected to continue as more patients with advanced age and/or non-alcoholic steatohepatitis undergo LT. In view of the increasing disease burden, a multidisciplinary initiative was developed to critically review the existing literature (between January 1, 1990 and March 17, 2021) surrounding epidemiology, risk assessment, and risk mitigation of coronary heart disease, arrhythmia, heart failure, and valvular heart disease and formulate practice-based recommendations accordingly. In this review, the expert panel emphasizes the importance of optimizing management of metabolic syndrome and its components in LTRs and highlights the cardioprotective potential for the newer diabetes medications (e.g., sodium glucose transporter-2 inhibitors) in this high-risk population. Tailoring the multidisciplinary management of cardiac diseases in LTRs to the cardiometabolic risk profile of the individual patient is critical. The review also outlines numerous knowledge gaps to pave the road for future research in this sphere with the ultimate goal of improving clinical outcomes.
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Affiliation(s)
- Manhal Izzy
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University, Nashville, TN, USA
| | - Brett E Fortune
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, USA
| | - Marina Serper
- Department of Medicine, Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nicole Bhave
- Department of Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Andrew deLemos
- Department of Medicine, Division of Hepatology, Atrium Health, Charlotte, NC, USA
| | - Juan F. Gallegos-Orozco
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Utah School, Salt Lake City, UT, USA
| | - Cesar Guerrero-Miranda
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX, USA
| | - Shelley Hall
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX, USA
| | - Matthew E Harinstein
- Department of Medicine, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Maria G. Karas
- Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York, NY, USA
| | - Michael Kriss
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado, Aurora, CO, USA
| | - Nicholas Lim
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Maryse Palardy
- Department of Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Deirdre Sawinski
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medical College, New York, NY, USA
| | - Emily Schonfeld
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, USA
| | - Anil Seetharam
- Department of Medicine, Division of Gastroenterology and Hepatology, Banner - University Medical Center Phoenix, Phoenix, AZ, USA
| | - Pratima Sharma
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | - Jose Tallaj
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama, Birmingham, AL, USA
| | - Darshana M Dadhania
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medical College, New York, NY, USA
| | - Lisa B. VanWagner
- Department of Medicine, Division of Gastroenterology & Hepatology, and Department of Preventive Medicine, Division of Epidemiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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10
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Kavalieratos D, Harinstein ME, Rose B, Lowers J, Hoydich ZP, Bekelman DB, Allen LA, Rollman BL, Ernecoff NC, Moreines LT, Bakitas MA, Arnold RM. Primary palliative care for heart failure provided within ambulatory cardiology: A randomized pilot trial. Heart Lung 2022; 56:125-132. [PMID: 35863099 PMCID: PMC9941979 DOI: 10.1016/j.hrtlng.2022.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 04/25/2022] [Revised: 06/13/2022] [Accepted: 07/06/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Heart failure is characterized by physical and emotional symptoms and decreased quality of life (QoL). Palliative care can reduce burdens of serious illness but often is limited to inpatient or academic settings. OBJECTIVES To develop and test the Primary Education for Nurses in Palliative care-HF (PENPal-HF) intervention, training outpatient cardiology nurses to address symptom burden, patient priorities for care and QoL, and advance care planning as part of quarterly HF visits. METHODS We conducted a pilot randomized clinical trial for adults with NYHA Stage III or IV HF and ≥ 2 hospitalizations in the past 12 months, recruited from a community-based cardiology clinic. Participants were randomized 2:1, PENPal-HF plus usual care versus usual care alone. Primary outcomes were feasibility and acceptability. RESULTS We randomized 30 adults with Stage III HF - 20 to PENPal-HF and 10 to usual care. Most in the intervention group (71%) and in the control group (62%) completed the study through the final outcome assessment in week 56; 5 participants died. Of 20 participants in the intervention, 14 (70%) remained in the study through the end of intervention visits; 11 (55%) completed all visits. Most intervention participants (93.75%) agreed or strongly agreed that they were satisfied with their care, and 87.5% agreed or strongly agreed that all people with HF should receive the intervention. Most intervention group participants (93.75%) reported a perceived improvement in physical symptoms, mood, and/or QoL. CONCLUSIONS This pilot study suggests that nurse-led primary palliative care in outpatient cardiology settings is promising. Research is warranted to determine efficacy and effectiveness.
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Affiliation(s)
| | | | - Beth Rose
- University of Pittsburgh Medical Center.
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11
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Curtis BR, Rollman BL, Belnap BH, Jeong K, Yu L, Harinstein ME, Kavalieratos D. Perceptions of Need for Palliative Care in Recently Hospitalized Patients With Systolic Heart Failure. J Pain Symptom Manage 2021; 62:1252-1261. [PMID: 34119619 PMCID: PMC8908441 DOI: 10.1016/j.jpainsymman.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 11/20/2022]
Abstract
CONTEXT The symptom burden associated with heart failure (HF) remains high despite improvements in therapy and calls for the integration of palliative care into traditional HF care. Little is also known about how patients with HF perceive palliative care and patient-level characteristics associated with the need for palliative care, which could influence the utilization of palliative care in HF management. OBJECTIVES To identify characteristics of HF patients associated with perceived need for palliative care. METHODS We analyzed data from the Hopeful Heart Trial, which studied the efficacy of a collaborative care intervention for treating both systolic HF and depression. Palliative care preferences were collected during routine study follow-up. We assessed the association of perceived need for palliative care during study follow-up and baseline data on sociodemographics, clinical measures, and patient-centered outcomes. We then used descriptive statistics and logistic regression to analyze our data. RESULTS Participants were on average 64 years old, male, and reported severe HF symptoms and poor to below average quality of life (. Most had unfavorable impressions of palliative care, but many still perceived a need for palliative care. Factors associated with perceived need for palliative care included depression, non-white race, more severe HF symptoms, and lower mental & physical health-related quality of life. CONCLUSION HF patients' beliefs about palliative care may affect utilization of palliative care. Specific characteristics can help identify patients with HF who may benefit from palliative care involvement. Education targeted towards patients with selected attributes may help incorporate palliative care into HF management.
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Affiliation(s)
- Brett R Curtis
- School of Medicine, University of Pittsburgh (B.R.C., B.L.R.), Pittsburgh, Pennsylvania
| | - Bruce L Rollman
- School of Medicine, University of Pittsburgh (B.R.C., B.L.R.), Pittsburgh, Pennsylvania; Division of General Medicine, University of Pittsburgh School of Medicine (B.L.R., B.H.B., L.Y.), Pittsburgh, Pennsylvania; University of Pittsburgh Center for Behavioral Health, Media and Technology (B.L.R., B.H.B.), Pittsburgh, Pennsylvania
| | - Bea Herbeck Belnap
- Division of General Medicine, University of Pittsburgh School of Medicine (B.L.R., B.H.B., L.Y.), Pittsburgh, Pennsylvania; University of Pittsburgh Center for Behavioral Health, Media and Technology (B.L.R., B.H.B.), Pittsburgh, Pennsylvania
| | - Kwonho Jeong
- Center for Research on Health Care Data Center, University of Pittsburgh (K.J.), Pittsburgh, Pennsylvania
| | - Lan Yu
- Division of General Medicine, University of Pittsburgh School of Medicine (B.L.R., B.H.B., L.Y.), Pittsburgh, Pennsylvania
| | - Matthew E Harinstein
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center (M.E.H.), Pittsburgh, Pennsylvania
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University (D.K.), Atlanta, Georgia; Department of Epidemiology, Rollins School of Public Health, Emory University (D.K.), Atlanta, Georgia.
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12
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Shpilsky D, Harinstein ME. Evaluation of the impact of laboratory accreditation on downstream outcomes. J Nucl Cardiol 2021; 28:2962-2964. [PMID: 32715417 DOI: 10.1007/s12350-020-02292-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Daniel Shpilsky
- Heart and Vascular Institute, University of Pittsburgh Medical Center, South Tower 3F, E352.2, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Matthew E Harinstein
- Heart and Vascular Institute, University of Pittsburgh Medical Center, South Tower 3F, E352.2, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
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13
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Nieves RA, Bukhari S, Harinstein ME. Adding value to myocardial perfusion scintigraphy: A prediction tool to predict adverse cardiac outcomes and risk stratify. J Nucl Cardiol 2021; 28:2283-2285. [PMID: 34169472 DOI: 10.1007/s12350-021-02670-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Ricardo A Nieves
- Heart and Vascular Institute, University of Pittsburgh Medical Center, South Tower 3F, 3E52.2, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Syed Bukhari
- Heart and Vascular Institute, University of Pittsburgh Medical Center, South Tower 3F, 3E52.2, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Matthew E Harinstein
- Heart and Vascular Institute, University of Pittsburgh Medical Center, South Tower 3F, 3E52.2, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
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Altieri Dunn SC, Bellon JE, Bilderback A, Borrebach JD, Hodges JC, Wisniewski MK, Harinstein ME, Minnier TE, Nelson JB, Hall DE. SafeNET: Initial development and validation of a real-time tool for predicting mortality risk at the time of hospital transfer to a higher level of care. PLoS One 2021; 16:e0246669. [PMID: 33556123 PMCID: PMC7870086 DOI: 10.1371/journal.pone.0246669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/24/2021] [Indexed: 01/31/2023] Open
Abstract
Background Processes for transferring patients to higher acuity facilities lack a standardized approach to prognostication, increasing the risk for low value care that imposes significant burdens on patients and their families with unclear benefits. We sought to develop a rapid and feasible tool for predicting mortality using variables readily available at the time of hospital transfer. Methods and findings All work was carried out at a single, large, multi-hospital integrated healthcare system. We used a retrospective cohort for model development consisting of patients aged 18 years or older transferred into the healthcare system from another hospital, hospice, skilled nursing or other healthcare facility with an admission priority of direct emergency admit. The cohort was randomly divided into training and test sets to develop first a 54-variable, and then a 14-variable gradient boosting model to predict the primary outcome of all cause in-hospital mortality. Secondary outcomes included 30-day and 90-day mortality and transition to comfort measures only or hospice care. For model validation, we used a prospective cohort consisting of all patients transferred to a single, tertiary care hospital from one of the 3 referring hospitals, excluding patients transferred for myocardial infarction or maternal labor and delivery. Prospective validation was performed by using a web-based tool to calculate the risk of mortality at the time of transfer. Observed outcomes were compared to predicted outcomes to assess model performance. The development cohort included 20,985 patients with 1,937 (9.2%) in-hospital mortalities, 2,884 (13.7%) 30-day mortalities, and 3,899 (18.6%) 90-day mortalities. The 14-variable gradient boosting model effectively predicted in-hospital, 30-day and 90-day mortality (c = 0.903 [95% CI:0.891–0.916]), c = 0.877 [95% CI:0.864–0.890]), and c = 0.869 [95% CI:0.857–0.881], respectively). The tool was proven feasible and valid for bedside implementation in a prospective cohort of 679 sequentially transferred patients for whom the bedside nurse calculated a SafeNET score at the time of transfer, taking only 4–5 minutes per patient with discrimination consistent with the development sample for in-hospital, 30-day and 90-day mortality (c = 0.836 [95%CI: 0.751–0.921], 0.815 [95% CI: 0.730–0.900], and 0.794 [95% CI: 0.725–0.864], respectively). Conclusions The SafeNET algorithm is feasible and valid for real-time, bedside mortality risk prediction at the time of hospital transfer. Work is ongoing to build pathways triggered by this score that direct needed resources to the patients at greatest risk of poor outcomes.
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Affiliation(s)
| | - Johanna E. Bellon
- The Wolff Center at UPMC, Pittsburgh, Pennsylvania, United States of America
| | - Andrew Bilderback
- The Wolff Center at UPMC, Pittsburgh, Pennsylvania, United States of America
| | | | - Jacob C. Hodges
- The Wolff Center at UPMC, Pittsburgh, Pennsylvania, United States of America
| | - Mary Kay Wisniewski
- The Wolff Center at UPMC, Pittsburgh, Pennsylvania, United States of America
| | - Matthew E. Harinstein
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Tamra E. Minnier
- The Wolff Center at UPMC, Pittsburgh, Pennsylvania, United States of America
| | - Joel B. Nelson
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Daniel E. Hall
- The Wolff Center at UPMC, Pittsburgh, Pennsylvania, United States of America
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
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15
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Jahangir E, Harinstein ME, Murthy VL, Moslehi J. The forgotten right ventricle in cardio-oncology. J Nucl Cardiol 2020; 27:2164-2166. [PMID: 30771160 PMCID: PMC6697233 DOI: 10.1007/s12350-019-01602-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Eiman Jahangir
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Cardio-Oncology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew E Harinstein
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Javid Moslehi
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Division of Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Cardio-Oncology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
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Harinstein ME. Avaliação da Gravidade da Doença Arterial Coronariana em Pacientes Tratados com Quimioterapia: A Necessidade Adicional da Cardio-Oncologia. Arq Bras Cardiol 2020; 114:1013-1014. [PMID: 32638898 PMCID: PMC8416125 DOI: 10.36660/abc.20200408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Bianco V, Kilic A, Gleason TG, Aranda-Michel E, Harinstein ME, Thoma F, Navid F, Sultan I. Outcomes in patients with solid organ transplants undergoing cardiac surgery. J Thorac Cardiovasc Surg 2019; 160:701-707. [PMID: 31564544 DOI: 10.1016/j.jtcvs.2019.07.102] [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: 12/17/2018] [Revised: 07/08/2019] [Accepted: 07/25/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Long-term outcomes after cardiac surgery in solid organ transplant recipients are limited in the contemporary literature. The objective of this study is to evaluate postoperative outcomes in these patients, including variables associated with mortality and readmissions. METHODS All adults undergoing isolated coronary artery bypass grafting, isolated valve, or coronary artery bypass grafting + valve cardiac surgical procedures from 2011 to 2018 were included in this study. Patients with solid organ transplants undergoing cardiac surgery were studied. Primary outcomes included operative (30-day) and 5-year mortality. RESULTS A total of 11,190 patients underwent isolated coronary artery bypass grafting, isolated valve, or coronary artery bypass grafting + valve operations at our institution from 2011 to 2018. Of these, 129 patients (1%) had solid organ transplants and underwent isolated coronary artery bypass grafting (n = 84), isolated valve (n = 30), or coronary artery bypass grafting + valve (n = 15). Type of organ transplant included 84 patients (65%) with kidney, 27 patients (21%) with liver, 9 patients (7%) with heart, and 9 patients (7%) with lung transplants. The median Society of Thoracic Surgeons Predicted Risk Of Mortality for the cohort was 2.73 (Q1-Q3: 1.67-6.33). Three patients (2%) had an operative (30-day) mortality. Significant variables associated with 5-year mortality on multivariable Cox regression analysis included chronic obstructive pulmonary disease (hazard ratio, 2.44; 1.01-5.90; P = .048) and congestive heart failure (hazard ratio, 4.45; 1.81-10.9; P = .001). Significant variables associated with 5-year readmissions included chronic obstructive pulmonary disease, dialysis dependence, and concomittant valve surgery with coronary artery bypass grafting. Five-year readmission rate was 88%, and patients with valve operations (± coronary artery bypass grafting) had significantly lower (P = .009) freedom from readmission (6%). CONCLUSIONS Cardiac surgery can be performed with low operative mortality and good long-term survival in patients with solid organ transplants. Five-year hospital readmissions are common, with significantly more readmissions in patients who had valve procedures.
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Affiliation(s)
- Valentino Bianco
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Arman Kilic
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Thomas G Gleason
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Edgar Aranda-Michel
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Matthew E Harinstein
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Floyd Thoma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Forozan Navid
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
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Baman JR, Knapper J, Raval Z, Harinstein ME, Friedewald JJ, Maganti K, Cuttica MJ, Abecassis MI, Ali ZA, Gheorghiade M, Flaherty JD. Preoperative Noncoronary Cardiovascular Assessment and Management of Kidney Transplant Candidates. Clin J Am Soc Nephrol 2019; 14:1670-1676. [PMID: 31554619 PMCID: PMC6832054 DOI: 10.2215/cjn.03640319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The pretransplant risk assessment for patients with ESKD who are undergoing evaluation for kidney transplant is complex and multifaceted. When considering cardiovascular disease in particular, many factors should be considered. Given the increasing incidence of kidney transplantation and the growing body of evidence addressing ESKD-specific cardiovascular risk profiles, there is an important need for a consolidated, evidence-based model that considers the unique cardiovascular challenges that these patients face. Cardiovascular physiology is altered in these patients by abrupt shifts in volume status, altered calcium-phosphate metabolism, high-output states (in the setting of arteriovenous fistulization), and adverse geometric and electrical remodeling, to name a few. Here, we present a contemporary review by addressing cardiomyopathy/heart failure, pulmonary hypertension, valvular dysfunction, and arrhythmia/sudden cardiac death within the ESKD population.
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Affiliation(s)
| | | | - Zankhana Raval
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York; and
| | - Matthew E Harinstein
- Division of Cardiology, Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John J Friedewald
- Division of Nephrology, Department of Medicine.,Division of Transplantation, Department of Surgery, and
| | | | - Michael J Cuttica
- Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Ziad A Ali
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York; and
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Soman P, Harinstein ME. Testing our tests: Do clinical studies of diagnostic performance truly inform patient management? J Nucl Cardiol 2019; 26:1284-1285. [PMID: 29417416 DOI: 10.1007/s12350-018-1210-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Prem Soman
- Division of Cardiology and The Heart and Vascular Institute, University of Pittsburgh Medical Center, A-429 Scaife Hall, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
| | - Matthew E Harinstein
- Division of Cardiology and The Heart and Vascular Institute, University of Pittsburgh Medical Center, A-429 Scaife Hall, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
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20
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Knapper JT, Raval Z, Harinstein ME, Friedewald JJ, Skaro AI, Abecassis MI, Ali ZA, Gheorghiade M, Flaherty JD. Assessment and management of coronary artery disease in kidney and pancreas transplant candidates. J Cardiovasc Med (Hagerstown) 2019; 20:51-58. [DOI: 10.2459/jcm.0000000000000742] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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21
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VanWagner LB, Harinstein ME, Runo JR, Darling C, Serper M, Hall S, Kobashigawa JA, Hammel LL. Multidisciplinary approach to cardiac and pulmonary vascular disease risk assessment in liver transplantation: An evaluation of the evidence and consensus recommendations. Am J Transplant 2018; 18:30-42. [PMID: 28985025 PMCID: PMC5840800 DOI: 10.1111/ajt.14531] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 09/12/2017] [Accepted: 09/28/2017] [Indexed: 01/25/2023]
Abstract
Liver transplant (LT) candidates today are older, have greater medical severity of illness, and have more cardiovascular comorbidities than ever before. In addition, there are specific cardiovascular responses in cirrhosis that can be detrimental to the LT candidate. Cirrhotic cardiomyopathy, a condition characterized by increased cardiac output and a reduced ventricular response to stress, is present in up to 30% of patients with cirrhosis, thus challenging perioperative management. Current noninvasive tests that assess for subclinical coronary and myocardial disease have low sensitivity, and altered hemodynamics during the LT surgery can unmask latent cardiovascular disease either intraoperatively or in the immediate postoperative period. Therefore, this review, assembled by a group of multidisciplinary experts in the field and endorsed by the American Society of Transplantation Liver and Intestine and Thoracic and Critical Care Communities of Practice, provides a critical assessment of the diagnosis of cardiac and pulmonary vascular disease and interventions aimed at managing these conditions in LT candidates. Key points and practice-based recommendations for the diagnosis and management of cardiac and pulmonary vascular disease in this population are provided to offer guidance for clinicians and identify gaps in knowledge for future investigations.
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Affiliation(s)
- Lisa B. VanWagner
- Division of Gastroenterology and Hepatology, Department of Medicine and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Matthew E. Harinstein
- Heart and Vascular Institute, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - James R. Runo
- Division of Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - Christopher Darling
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - Marina Serper
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Shelley Hall
- Division of Transplant Cardiology, Baylor University Medical Center, Dallas, TX USA
| | - Jon A. Kobashigawa
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Laura L. Hammel
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
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22
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Masri A, Abdelkarim I, Sharbaugh MS, Althouse AD, Xu J, Han W, Chan SY, Katz WE, Crock FW, Harinstein ME, Kliner DE, Navid F, Lee JS, Gleason TG, Schindler JT, Cavalcante JL. Outcomes of persistent pulmonary hypertension following transcatheter aortic valve replacement. Heart 2017; 104:821-827. [PMID: 28970276 DOI: 10.1136/heartjnl-2017-311978] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To determine the prevalence and factors associated with persistent pulmonary hypertension (PH) following transcatheter aortic valve replacement (TAVR) and its relationship with long-term mortality. METHODS Consecutive patients who underwent TAVR from July 2011 through January 2016 were studied. The prevalence of baseline PH (mean pulmonary artery pressure ≥25 mm Hg on right heart catheterisation) and the prevalence and the predictors of persistent≥moderate PH (pulmonary artery systolic pressure (PASP)>45 mm Hg on 1 month post-TAVR transthoracic Doppler echocardiography) were collected. Cox models quantified the effect of persistent PH on subsequent mortality while adjusting for confounders. RESULTS Of the 407 TAVR patients, 273 (67%) had PH at baseline. Of these, 102 (25%) had persistent≥moderate PH. Mortality at 2 years in patients with no baseline PH versus those with PH improvement (follow-up PASP≤45 mm Hg) versus those with persistent≥moderate PH was 15.4%, 16.6% and 31.3%, respectively (p=0.049). After adjusting for Society of Thoracic Surgeons Predicted Risk of Mortality and baseline right ventricular function (using tricuspid annular plane systolic excursion), persistent≥moderate PH remained associated with all-cause mortality (HR=1.82, 95% CI 1.06 to 3.12, p=0.03). Baseline characteristics associated with increased likelihood of persistent≥moderate PH were ≥moderate tricuspid regurgitation, ≥moderate mitral regurgitation, atrial fibrillation/flutter, early (E) to late (A) ventricular filling velocities (E/A ratio) and left atrial volume index. CONCLUSIONS Persistency of even moderate or greater PH at 1 month post-TAVR is common and associated with higher all-cause mortality.
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Affiliation(s)
- Ahmad Masri
- Department of Medicine, Division of Cardiovascular Diseases, University of Pittsburgh, UPMC-Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - Islam Abdelkarim
- Department of Medicine, Division of Cardiovascular Diseases, University of Pittsburgh, UPMC-Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - Michael S Sharbaugh
- Department of Medicine, Division of Cardiovascular Diseases, University of Pittsburgh, UPMC-Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - Andrew D Althouse
- Department of Medicine, Division of Cardiovascular Diseases, University of Pittsburgh, UPMC-Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - Jeffrey Xu
- Department of Medicine, Division of Cardiovascular Diseases, University of Pittsburgh, UPMC-Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - Wei Han
- Department of Medicine, Division of Cardiovascular Diseases, University of Pittsburgh, UPMC-Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - Stephen Y Chan
- Department of Medicine, Division of Cardiovascular Diseases, University of Pittsburgh, UPMC-Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - William E Katz
- Department of Medicine, Division of Cardiovascular Diseases, University of Pittsburgh, UPMC-Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - Frederick W Crock
- Department of Medicine, Division of Cardiovascular Diseases, University of Pittsburgh, UPMC-Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - Matthew E Harinstein
- Department of Medicine, Division of Cardiovascular Diseases, University of Pittsburgh, UPMC-Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - Dustin E Kliner
- Department of Medicine, Division of Cardiovascular Diseases, University of Pittsburgh, UPMC-Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - Forozan Navid
- Department of Medicine, Division of Cardiovascular Diseases, University of Pittsburgh, UPMC-Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - Joon S Lee
- Department of Medicine, Division of Cardiovascular Diseases, University of Pittsburgh, UPMC-Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - Thomas G Gleason
- Department of Medicine, Division of Cardiovascular Diseases, University of Pittsburgh, UPMC-Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - John T Schindler
- Department of Medicine, Division of Cardiovascular Diseases, University of Pittsburgh, UPMC-Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - João L Cavalcante
- Department of Medicine, Division of Cardiovascular Diseases, University of Pittsburgh, UPMC-Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
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Schindler J, Cavalcante J, Althouse A, Sharbaugh MS, Kliner D, Katz W, Harinstein ME, Crock FW, Navid F, Lee J, Gleason T. TCT-676 Prevalence of Residual Mitral and Tricuspid Regurgitation (MR/TR) following Transcatheter Aortic Valve Replacement (TAVR): Residual Mod/Severe MR and TR is Associated with Higher Mortality post TAVR. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Multiple epidemiological factors including population aging and improved survival after acute coronary syndromes have contributed to a heart failure (HF) prevalence in the USA in epidemic proportions. In the absence of transplantation, HF remains a progressive disease with poor prognosis. The structural and functional abnormalities of the myocardium in HF can be assessed by various radionuclide imaging techniques. Radionuclide imaging may be uniquely suited to address several important clinical questions in HF such as identifying etiology and guiding the selection of patients for coronary revascularization. Newer approaches such as autonomic innervation imaging, phase analysis for synchrony assessment, and other molecular imaging techniques continue to expand the applications of radionuclide imaging in HF. In this manuscript, we review established and evolving applications of radionuclide imaging for the diagnosis, risk stratification, and management of HF.
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Affiliation(s)
- Matthew E Harinstein
- Heart and Vascular Institute, University of Pittsburgh Medical Center, A-429 Scaife Hall, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Prem Soman
- Heart and Vascular Institute, University of Pittsburgh Medical Center, A-429 Scaife Hall, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
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25
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Cavalcante JL, Rijal S, Althouse AD, Delgado-Montero A, Katz WE, Schindler JT, Crock F, Harinstein ME, Navid F, Gleason TG, Lee JS. Right Ventricular Function and Prognosis in Patients with Low-Flow, Low-Gradient Severe Aortic Stenosis. J Am Soc Echocardiogr 2016; 29:325-33. [DOI: 10.1016/j.echo.2015.12.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Indexed: 11/28/2022]
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26
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Cavalcante JL, Althouse A, Massa R, Maddula M, Katz W, Crock F, Harinstein ME, Navid F, Kliner D, Schindler JT, Gleason T, Lee JS. TCT-662 Prognostic Importance Of Pulmonary Hypertension Etiology By Invasive Hemodynamics In Patients With Severe Aortic Stenosis. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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27
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Raval Z, Harinstein ME, Flaherty JD. Role of cardiovascular intervention as a bridge to liver transplantation. World J Gastroenterol 2014; 20:10651-10657. [PMID: 25152569 PMCID: PMC4138446 DOI: 10.3748/wjg.v20.i31.10651] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 01/11/2014] [Accepted: 04/03/2014] [Indexed: 02/06/2023] Open
Abstract
End stage liver disease (ESLD) is associated with many specific derangements in cardiovascular physiology, which influence perioperative outcomes and may profoundly influence diagnostic and management strategies in the preoperative period. This review focuses on evidence-based diagnosis and management of coronary, hemodynamic and pulmonary vascular disease in this population with an emphasis on specific strategies that may provide a bridge to transplantation. Specifically, we address the underlying prevalence of cardiovascular disease states in the ESLD population, and relevant diagnostic criteria thereof. We highlight traditional and non-traditional predictors of cardiovascular outcomes following liver transplant, as well as data to guide risk-factor based diagnostic strategies. We go on to discuss the alterations in cardiovascular physiology which influence positive- and negative-predictive values of standard noninvasive testing modalities in the ESLD population, and review the data regarding the safety and efficacy of invasive testing in the face of ESLD and its co-morbidities. Finally, based upon the totality of available data, we outline an evidence-based approach for the management of ischemia, heart failure and pulmonary vascular disease in this population. It is our hope that such evidence-driven strategies can be employed to more safely bridge appropriate candidates to liver transplant, and to improve their cardiovascular health and outcomes in the peri-operative period.
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28
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Harinstein ME, Sharma R, Khanna M, Naraki SB, Mathier M, Fontes P, Planinsic R, Edelman K, Katz W, Lopez-Candales N. RIGHT VENTRICULAR LONGITUDINAL MYOCARDIAL STRAIN INCREASES IN RESPONSE TO INCREASED HEMODYNAMIC STRESS IN PATIENTS WITH END-STAGE LIVER DISEASE REFERRED FOR LIVER TRANSPLANTATION. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60905-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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29
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Greene SJ, Vaduganathan M, Wilcox JE, Harinstein ME, Maggioni AP, Subacius H, Zannad F, Konstam MA, Chioncel O, Yancy CW, Swedberg K, Butler J, Bonow RO, Gheorghiade M. The prognostic significance of heart rate in patients hospitalized for heart failure with reduced ejection fraction in sinus rhythm: insights from the EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study With Tolvaptan) trial. JACC Heart Fail 2013; 1:488-96. [PMID: 24622000 DOI: 10.1016/j.jchf.2013.08.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 08/01/2013] [Accepted: 08/09/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The purpose of this study was to characterize the relationship between heart rate and post-discharge outcomes in patients with hospitalization for heart failure (HHF) with reduced ejection fraction (EF) in sinus rhythm. BACKGROUND A reduction in heart rate improves clinical outcomes in patients with chronic heart failure and in sinus rhythm, but the association between heart rate and post-discharge outcomes in patients with HHF is presently unclear. METHODS This post-hoc analysis of the EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study With Tolvaptan) trial examined 1,947 patients with HHF and EF ≤40% not in atrial fibrillation/flutter or pacemaker dependent. RESULTS The median follow-up period was 9.9 months. At baseline, patients with a higher heart rate tended to be younger with lower EF and were more likely to have worse New York Heart Association functional class and higher natriuretic peptide levels. After adjustment for clinical risk factors, baseline heart rate was not predictive of all-cause mortality (p ≥ 0.066). However, at ≥70 beats/min, every 5-beat increase in 1-week post-discharge heart rate was independently associated with increased all-cause mortality (hazard ratio: 1.13 [95% confidence interval: 1.05 to 1.22]; p = 0.002). Similarly, every 5-beat increase ≥70 beats/min in 4-week post-discharge heart rate was predictive of all-cause mortality (hazard ratio: 1.12 [95% confidence interval: 1.05 to 1.19]; p = 0.001). CONCLUSIONS In this large cohort of patients with HHF with reduced EF and in sinus rhythm, baseline heart rate did not correlate with all-cause mortality. In contrast, at ≥70 beats/min, higher heart rate in the early post-discharge period was independently predictive of death during subsequent follow-up. Further study of post-discharge heart rate as a potential therapeutic target in this high-risk population is encouraged.
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Affiliation(s)
- Stephen J Greene
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Muthiah Vaduganathan
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jane E Wilcox
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew E Harinstein
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Haris Subacius
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Faiez Zannad
- INSERM CIC 9501 and U961, Université de Lorraine, CHU Cardiology, Nancy, France
| | - Marvin A Konstam
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Ovidiu Chioncel
- Cardiology 1, Institut de Boli Cardiovasculare C.C. Iliescu, Bucharest, Romania
| | - Clyde W Yancy
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Javed Butler
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Robert O Bonow
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mihai Gheorghiade
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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30
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Affiliation(s)
- Matthew E. Harinstein
- Heart and Vascular Institute; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Oscar C. Marroquin
- Heart and Vascular Institute; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
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31
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Wang NC, Piccini JP, Fonarow GC, Knight BP, Harinstein ME, Butler J, Lahiri MK, Metra M, Vaduganathan M, Gheorghiade M. The potential role of nonpharmacologic electrophysiology-based interventions in improving outcomes in patients hospitalized for heart failure. Heart Fail Clin 2013; 9:331-43, vi-vii. [PMID: 23809419 DOI: 10.1016/j.hfc.2013.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hospitalization for heart failure (HHF) is commonly associated with symptomatic improvement in response to standard medical therapy, yet there remains a substantial risk of rehospitalization and death. Clinically stable outpatients and decompensated inpatients represent two types of patients with chronic heart failure. In the former, treatment of common heart rhythm disorders with nonpharmacologic electrophysiology-based interventions is of substantial benefit in select patients. The potential benefits of these interventions in the hospitalized setting are not well studied. In this review, current knowledge is discussed and future research directions are suggested with nonpharmacologic electrophysiology-based interventions to reduce the morbidity and mortality associated with patients with HHF.
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Affiliation(s)
- Norman C Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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Harinstein ME, Flaherty JD, Mathier MA, Katz WE, Lopez-Candales A. Reply: To PMID 23021513. Am J Cardiol 2013; 111:1231. [PMID: 23557999 DOI: 10.1016/j.amjcard.2012.11.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 11/16/2012] [Indexed: 11/17/2022]
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33
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Harinstein ME, Iyer S, Mathier MA, Flaherty JD, Fontes P, Planinsic RM, Edelman K, Katz WE, Lopez-Candales A. Role of baseline echocardiography in the preoperative management of liver transplant candidates. Am J Cardiol 2012; 110:1852-5. [PMID: 23021513 DOI: 10.1016/j.amjcard.2012.08.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 08/01/2012] [Accepted: 08/01/2012] [Indexed: 12/22/2022]
Abstract
Liver transplantation (LT) has not traditionally been offered to patients with intracardiac shunts (ICSs) or pulmonary hypertension (PH). There is a paucity of data regarding cardiac structural characteristics in LT candidates. We examined echocardiographic characteristics and their role in managing LT candidates diagnosed with ICS and PH. We identified 502 consecutive patients (318 men, mean age 55 ± 11 years) who underwent LT and had preoperative echocardiogram. Demographics, cardiovascular risk factors, and echocardiographic variables were recorded and data were analyzed for end-stage liver disease diagnosis. ICSs were diagnosed with contrast echocardiography and PH was defined as estimated pulmonary artery systolic pressure >40 mm Hg. Primary end points included short-term (30-day) and long-term (mean 41-month) mortalities and the correlation between pre- and perioperative stroke. In our studied population >50% had >2 cardiovascular risk factors and with increasing frequency ICSs were diagnosed in 16%, PH in 25%, and intrapulmonary shunts in 41% of LT candidates. There was no correlation between short- and long-term mortality and ICS (p = 0.71 and 0.76, respectively) or PH (p = 0.79 and 0.71). Importantly, in those with ICS, no strokes occurred. In conclusion, structural differences exist between various end-stage liver disease diagnoses. ICSs diagnosed by echocardiography are not associated with an increased risk of perioperative stroke or increased mortality. A diagnosis of mild or moderate PH on baseline echocardiogram is not associated with worse outcomes and requires further assessment. Based on these findings, patients should not be excluded from consideration for LT based solely on the presence of an ICS or PH.
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Harinstein ME, Flaherty JD, Ambrosy AP, Fonarow GC, Bonow RO, Gheorghiade M. The Authors' reply: Figure 1. Heart 2012. [DOI: 10.1136/heartjnl-2011-301231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Harinstein ME, Raval Z, Gheorghiade M, Flaherty JD. Reply. J Am Coll Cardiol 2011. [DOI: 10.1016/j.jacc.2011.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Keeling AN, Flaherty JD, Davarpanah AH, Ambrosy A, Farrelly CT, Harinstein ME, Flamm SL, Abecassis MI, Skaro AI, Carr JC, Gheorghiade M. Coronary multidetector computed tomographic angiography to evaluate coronary artery disease in liver transplant candidates: methods, feasibility and initial experience. J Cardiovasc Med (Hagerstown) 2011; 12:460-8. [PMID: 21610507 DOI: 10.2459/jcm.0b013e3283483916] [Citation(s) in RCA: 38] [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: 12/13/2022]
Abstract
AIMS In patients undergoing orthotopic liver transplantation (OLT), coronary artery disease (CAD), obstructive and nonobstructive, is associated with high morbidity and mortality. In OLT candidates, stress testing for detecting ischemia is often inaccurate, and this patient population often has relative contraindications for cardiac catheterization. The objective of this study was to describe the methods, assess the feasibility and determine the extent and severity of CAD in OLT candidates without a prior history of CAD using coronary multidetector computer tomographic angiography (MDCTA). METHODS Sixty-five OLT candidates without known CAD underwent coronary MDCTA with dual source cardiac computed tomography (Siemens Definition). Coronary arteries were divided into 17 segments based on American Heart Association guidelines and evaluated independently by two blinded reviewers. Image quality of coronary MDCTA was assessed on a four-point Likert scale (0 = poor, 1 = fair, 2 = good, and 3 = excellent). Atherosclerotic lesions were evaluated for severity [mild (0-50%), moderate (51-70%), and severe (71-100%)], morphology, extent, location and consistency. RESULTS Image quality was graded as good or excellent in 73.8%. In this cohort of OLT candidates without known CAD, 9% had normal coronary arteries, 58% had mild CAD and 34% had moderate to severe CAD. Plaque severity and burden scores were high. CONCLUSION The prevalence of asymptomatic CAD is high in OLT candidates. Coronary MDCTA is feasible in OLT candidates and appears to be a useful technique to diagnose occult CAD in this patient population.
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Affiliation(s)
- Aoife N Keeling
- Division of Cardiovascular Imaging, Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA
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Raval Z, Harinstein ME, Skaro AI, Erdogan A, DeWolf AM, Shah SJ, Fix OK, Kay N, Abecassis MI, Gheorghiade M, Flaherty JD. Cardiovascular risk assessment of the liver transplant candidate. J Am Coll Cardiol 2011; 58:223-31. [PMID: 21737011 DOI: 10.1016/j.jacc.2011.03.026] [Citation(s) in RCA: 166] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 03/08/2011] [Accepted: 03/21/2011] [Indexed: 12/18/2022]
Abstract
Liver transplantation (LT) candidates today are increasingly older, have greater medical acuity, and have more cardiovascular comorbidities than ever before. Steadily rising model for end-stage liver disease (MELD) scores at the time of transplant, resulting from high organ demand, reflect the escalating risk profiles of LT candidates. In addition to advanced age and the presence of comorbidities, there are specific cardiovascular responses in cirrhosis that can be detrimental to the LT candidate. Patients with cirrhosis requiring LT usually demonstrate increased cardiac output and a compromised ventricular response to stress, a condition termed cirrhotic cardiomyopathy. These cardiac disturbances are likely mediated by decreased beta-agonist transduction, increased circulating inflammatory mediators with cardiodepressant properties, and repolarization changes. Low systemic vascular resistance and bradycardia are also commonly seen in cirrhosis and can be aggravated by beta-blocker use. These physiologic changes all contribute to the potential for cardiovascular complications, particularly with the altered hemodynamic stresses that LT patients face in the immediate post-operative period. Post-transplant reperfusion may result in cardiac death due to a multitude of causes, including arrhythmia, acute heart failure, and myocardial infarction. Recognizing the hemodynamic challenges encountered by LT patients in the perioperative period and how these responses can be exacerbated by underlying cardiac pathology is critical in developing recommendations for the pre-operative risk assessment and management of these patients. The following provides a review of the cardiovascular challenges in LT candidates, as well as evidence-based recommendations for their evaluation and management.
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Affiliation(s)
- Zankhana Raval
- Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
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Beohar N, Meyers SN, Erdogan A, Harinstein ME, Pieper K, Gagnon S, Davidson CJ. Off-label use of drug-eluting versus bare metal stents: a lesion-specific systematic review of long-term outcomes. J Interv Cardiol 2010; 23:528-45. [PMID: 20735712 DOI: 10.1111/j.1540-8183.2010.00588.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The purpose of this systematic review was to evaluate differences in lesion-specific outcomes with the "off-label" use of drug-eluting stents (DES) versus bare metal stents (BMS). METHODS MEDLINE, PubMed, the Cochrane databases, and other Web were searched for studies evaluating off-label use of DES and BMS with the same characteristics. Of 1,258 abstracts or manuscripts reviewed, 112 studies were included (total N = 23,438). Studies were excluded if patients received both types of stent or no stent; lesion type was unknown; lesion-specific outcomes for ≥6 months were unavailable; or <25 patients were enrolled. RESULTS Overall mortality at 6-12 months was approximately 3% for BMS and DES for off-label use. Increase in mortality was greater from 6-12 months to 2 years with BMS than with DES (3.3%-9.1%; 2.8%-4.1%); however, rates were similar at 3 years (BMS: 18.8%; DES:15.3%). Myocardial Infarction rates were similar for both types at 6-12 months (BMS: 6.5%; DES: 6.0%). Overall rates of stent thrombosis were 1.8% and 1.7% for BMS and DES, respectively. Similar or slightly lower rates of stent thrombosis were seen for most lesion types, except higher rates for small vessels for BMS (5.2%) and true bifurcation for DES (3.3%). Rates of target lesion revascularization (TLR) were 7.5% for BMS and 19.6% for DES at 6-12 months. At 2-years TLR remained lower than DES. When the combined group was compared to registry data alone, similar values were seen. CONCLUSIONS Rates of mortality, myocardial infarction (MI), and stent thrombosis were similar in patients receiving BMS or DES, while TLR rates were lower in DES patients.
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Affiliation(s)
- Nirat Beohar
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
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Gheorghiade M, Khan S, Blair JEA, Harinstein ME, Krum H, Mukherjee R, Pitt B. The effects of eplerenone on length of stay and total days of heart failure hospitalization after myocardial infarction in patients with left ventricular systolic dysfunction. Am Heart J 2009; 158:437-43. [PMID: 19699868 DOI: 10.1016/j.ahj.2009.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Accepted: 07/02/2009] [Indexed: 02/03/2023]
Abstract
BACKGROUND Heart failure (HF) with reduced left ventricular ejection fraction (LVEF) after acute myocardial infarction (AMI) is associated with increased readmission rates. This study evaluated the effects of eplerenone, a selective aldosterone blocking agent, on the duration of subsequent hospitalizations for HF in the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS). METHODS The EPHESUS study included 6,632 patients post-AMI with LVEF < or =40% and clinical HF or diabetes, receiving standard therapy, randomized to either eplerenone 25 mg, titrated to 50 mg daily, or placebo, with a mean follow-up of 16 months. Analyses of the length of stay and total number of days of HF hospitalizations per patient were conducted on a subgroup of 828 patients with subsequent HF hospitalizations, overall and across 5 distinct geographic regions. RESULTS Eplerenone was associated with a 1.6-day reduction in the mean length of HF hospitalization (9.2 vs 10.8 days with placebo; P = .019) and 3.6-day reduction in the total days spent in the hospital for HF (13.3 vs 16.9 days with placebo; P = .0006). These benefits were observed in all geographic regions. CONCLUSIONS In patients post-AMI with reduced LVEF and HF or diabetes, eplerenone added to standard therapy reduced the mean length and total days of HF hospitalizations compared to placebo in all regions. Given the high cost of hospital care for HF, these findings may translate into an economic benefit to health care worldwide.
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Affiliation(s)
- Mihai Gheorghiade
- Department of Medicine, Center for Cardiovascular Quality and Outcomes, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA.
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Harinstein ME, Gheorghiade M. Acute Heart Failure Syndromes: Highlights from the ESC Working Group on Acute Cardiac Care Meeting Prague, Czech Republic 2006. ACTA ACUST UNITED AC 2009; 8:179-80. [PMID: 17162543 DOI: 10.1080/17482940601100827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Harinstein ME, Filippatos GS, Gheorghiade M. Acute heart failure syndromes: the role of vasopressin antagonists. Acute Card Care 2009; 11:61-65. [PMID: 19526382 DOI: 10.1080/17482940902923356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Hospitalizations for acute heart failure syndromes (AHFS) are associated with high post-discharge morbidity and mortality. The potential role of vasopressin antagonists (VA) in AHFS was presented at the 2008 European Society of Cardiology Working Group on Acute Cardiac Care Meeting held in Versailles, France from 25-28 October 2008. This report represents a summary of the presentation at this meeting.
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Harinstein ME, Flaherty JD, Ansari AH, Robin J, Davidson CJ, Rossi JS, Flamm SL, Blei AT, Bonow RO, Abecassis M, Gheorghiade M. Predictive value of dobutamine stress echocardiography for coronary artery disease detection in liver transplant candidates. Am J Transplant 2008; 8:1523-8. [PMID: 18510630 DOI: 10.1111/j.1600-6143.2008.02276.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Patients with obstructive coronary artery disease (CAD) undergoing orthotopic liver transplantation (OLT) are at increased risk of poor outcomes. The accuracy of dobutamine stress echocardiography (DSE) to detect obstructive CAD is not well established in this population. We retrospectively identified patients with end-stage liver disease who underwent both DSE and coronary angiography as part of risk stratification prior to OLT. One hundred and five patients had both DSE and angiography, of whom 14 had known CAD and 27 failed to reach target heart rate during DSE. Among the remaining 64 patients (45 men; average age 61 +/- 8 years) DSE had a low sensitivity (13%), high specificity (85%), low positive predictive value (PPV) (22%) and intermediate negative predictive value (NPV) (75%) for obstructive CAD. DSE as a screening test for obstructive CAD in OLT candidates has a poor sensitivity. The frequent chronotropic incompetence and low sensitivity in patients who achieve target heart rate, even in those with multiple cardiovascular disease risk factors, suggest that alternative or additional methods of risk stratification are necessary.
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Affiliation(s)
- M E Harinstein
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Abstract
Few cardiologists have considered that constituents of the heart muscle cells are in a continuous state of flux. The proteins of sarcomeres, mitochondria, membranes, the cytosol, and even ribosomes and the cell nucleus, are continuously degraded and remade. Schoenheimer's concept of the "dynamic state of body constituents," has received relatively little attention in the world of cardiovascular research, at least not until recently. We propose that the term nutrition of the heart extends well beyond the supply of energy-providing substrates and includes the supply of amino acids, micronutrients, and regulators of protein synthesis and degradation. This short article is written to make the reader think in broad concepts.
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Affiliation(s)
- Heinrich Taegtmeyer
- Division of Cardiology, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, Texas 77030, USA.
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Abstract
Cardiac lympangiectasia is a rare pathological dilation of the lymphatic channels of the heart. Diagnosis is made by pathology; however, there remains no definitive diagnostic study. There are reports of cardiac cystic lymphangiectasias in children. A case of right atrial lymphangiectasia, initially identified by echocardiography, is presented here. This is the first report of such a mass.
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Affiliation(s)
- Azmey Matarieh
- Department of Medicine, Division of Cardiology, Northwestern University, Feinberg, School of Medicine, Chicago, Illinois 60611, USA
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