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Abstract
SARS-CoV-2 vaccine-associated myocarditis/myocardial injury should be evaluated in the contexts of COVID-19 infection, other types of viral myocarditis, and other vaccine-associated cardiac disorders. COVID-19 vaccine-associated myocardial injury can be caused by an inflammatory immune cell infiltrate, but other etiologies such as microvascular thrombosis are also possible. The clinical diagnosis is typically based on symptoms and cardiac magnetic resonance imaging. Endomyocardial biopsy is confirmatory for myocarditis, but may not show an inflammatory infiltrate because of rapid resolution or a non-inflammatory etiology. Myocarditis associated with SARS-COVID-19 vaccines occurs primarily with mRNA platform vaccines, which are also the most effective. In persons aged >16 or >12 years the myocarditis estimated crude incidences after the first 2 doses of BNT162b2 and mRNA-1273 are approximately 1.9 and 3.5 per 100 000 individuals, respectively. These rates equate to excess incidences above control populations of approximately 1.2 (BNT162b2) and 1.9 (mRNA-1273) per 100 000 persons, which are lower than the myocarditis rate for smallpox but higher than that for influenza vaccines. In the studies that have included mRNA vaccine and SARS-COVID-19 myocarditis measured by the same methodology, the incidence rate was increased by 3.5-fold over control in COVID-19 compared with 1.5-fold for BNT162b2 and 6.2-fold for mRNA-1273. However, mortality and major morbidity are less and recovery is faster with mRNA vaccine-associated myocarditis compared to COVID-19 infection. The reasons for this include vaccine-associated myocarditis having a higher incidence in young adults and adolescents, typically no involvement of other organs in vaccine-associated myocarditis, and based on comparisons to non-COVID viral myocarditis an inherently more benign clinical course.
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Affiliation(s)
- Natasha L. Altman
- Division of Cardiology, Department of Medicine (N.L.A., R.A.Q., E.A.G., M.R.B.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Amber A. Berning
- Department of Pathology (A.A.B.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Sarah C. Mann
- Division of Infectious Diseases, Department of Medicine (S.C.M., T.B.C.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Robert A. Quaife
- Division of Cardiology, Department of Medicine (N.L.A., R.A.Q., E.A.G., M.R.B.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Edward A. Gill
- Division of Cardiology, Department of Medicine (N.L.A., R.A.Q., E.A.G., M.R.B.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Scott R. Auerbach
- Division of Cardiology, Department of Pediatrics (S.R.A.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Thomas B. Campbell
- Division of Infectious Diseases, Department of Medicine (S.C.M., T.B.C.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Michael R. Bristow
- Division of Cardiology, Department of Medicine (N.L.A., R.A.Q., E.A.G., M.R.B.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
- Research and Development Department, ARCA Biopharma, CO (M.R.B.)
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2
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Shakowski C, Pham VA, Raines J, Quaife RA, Page RL. Safety and efficacy of IV theophylline for regadenoson-associated side effect reversal. J Nucl Cardiol 2023; 30:585-589. [PMID: 35799037 DOI: 10.1007/s12350-022-03031-3] [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: 05/23/2022] [Accepted: 05/31/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Aminophylline injection has been on an intermittent nation-wide shortage due to manufacturing delays leaving a need for an alternative reversal agent for regadenoson-associated side effects. Intravenous theophylline should be a logical acceptable pharmacological alternative; however, data regarding its safety and efficacy as a reversal agent are lacking. METHODS Utilizing electronic medical records at the University of Colorado hospital, we identified patients ≥ 18 years of age who had a pharmacologic stress test using regadenoson during periods of aminophylline shortage (3/1/2013 to 5/31/2013 and 4/1/2018 to 8/30/2018) in which theophylline was used as an alternative antidote for side effect reversal. Intravenous theophylline was prepared by the inpatient pharmacy to a concentration of 0.8 mg/mL in a total volume of 100 mL D5W. Specific side effects and side effect resolution were evaluated. RESULTS Of the 122 patients evaluated, theophylline was administered in doses ranging from 40 to 75 mg with the majority receiving 40 mg. Complete resolution of regadenoson side effects occurred in 98 patients with 12 experiencing partial resolution and 1 without resolution. No adverse effects or events were reported. CONCLUSION Due to limited availability of aminophylline, theophylline may be a safe and effective alternative to reverse regadenoson-associated side effects.
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Affiliation(s)
- Courtney Shakowski
- Department of Pharmacy, University of Colorado Health, University of Colorado Hospital, Aurora, CO, USA
| | - Vy A Pham
- Division of Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO, USA
| | - Joshua Raines
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO, USA
| | - Robert A Quaife
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO, USA
- Division of Nuclear Medicine, Department of Radiology, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO, USA
| | - Robert L Page
- Department of Pharmacy, University of Colorado Health, University of Colorado Hospital, Aurora, CO, USA.
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
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3
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Castrichini M, De Luca A, Paldino A, Quaife RA, Eldemire R, Graw SL, De Angelis G, Barbati G, Medo K, Taylor MR, Groves DW, Dal Ferro M, Gigli M, Merlo M, Mestroni L, Sinagra G. CARDIAC MAGNETIC RESONANCE PHENOTYPE AND GENOTYPE IN LEFT-SIDED CARDIOMYOPATHIES: CHARACTERIZATION AND CLINICAL OUTCOMES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00906-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Altman NL, Berning AA, Saxon CE, Adamek KE, Wagner JA, Slavov D, Quaife RA, Gill EA, Minobe WA, Jonas ER, Carroll IA, Huebler SP, Raines J, Messenger JC, Ambardekar AV, Mestroni L, Rosenberg RM, Rove J, Campbell TB, Bristow MR. Myocardial Injury and Altered Gene Expression Associated With SARS-CoV-2 Infection or mRNA Vaccination. JACC Basic Transl Sci 2023; 8:124-137. [PMID: 36281440 PMCID: PMC9581498 DOI: 10.1016/j.jacbts.2022.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/17/2022] [Accepted: 08/17/2022] [Indexed: 11/07/2022]
Abstract
SARS CoV-2 enters host cells via its Spike protein moiety binding to the essential cardiac enzyme angiotensin-converting enzyme (ACE) 2, followed by internalization. COVID-19 mRNA vaccines are RNA sequences that are translated into Spike protein, which follows the same ACE2-binding route as the intact virion. In model systems, isolated Spike protein can produce cell damage and altered gene expression, and myocardial injury or myocarditis can occur during COVID-19 or after mRNA vaccination. We investigated 7 COVID-19 and 6 post-mRNA vaccination patients with myocardial injury and found nearly identical alterations in gene expression that would predispose to inflammation, coagulopathy, and myocardial dysfunction.
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Key Words
- ACE, angiotensin I–converting enzyme gene
- ACE2, angiotensin-converting enzyme 2 gene
- AGT, angiotensinogen gene
- AGTR1, angiotensin II receptor type 1 gene
- ANG II, angiotensin II
- BNP, B-type natriuretic peptide
- CMR, cardiac magnetic resonance
- COVID-19
- EM, electron microscopy
- F3, coagulation factor III (tissue factor) gene
- ITGA5, integrin subunit alpha 5 gene
- IVS, interventricular septum
- LGE, late gadolinium enhancement
- LM, light microscopy
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- NDC, nonischemic dilated cardiomyopathy
- NPPB, natriuretic peptide B gene
- RV, right ventricular
- S, SARS-CoV-2 Spike
- TnI, troponin I
- gene expression
- mRNA vaccines
- myocardial injury
- myocarditis
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Affiliation(s)
- Natasha L. Altman
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amber A. Berning
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cara E. Saxon
- Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kylie E. Adamek
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jessica A. Wagner
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Dobromir Slavov
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Robert A. Quaife
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Edward A. Gill
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Wayne A. Minobe
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Eric R. Jonas
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | | | - Joshua Raines
- Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - John C. Messenger
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amrut V. Ambardekar
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Luisa Mestroni
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rachel M. Rosenberg
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jessica Rove
- Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Thomas B. Campbell
- Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael R. Bristow
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- ARCA Biopharma, Westminster, Colorado, USA
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5
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Edward JA, Cerbin LP, Groves DW, Quaife RA, Hunter KS, Levine BD, Cornwell WK. Right Ventricular Dysfunction During Endurance Exercise as Determined by Pressure-Volume Analysis. JACC Case Rep 2022; 4:1435-1438. [PMID: 36388707 PMCID: PMC9664012 DOI: 10.1016/j.jaccas.2022.08.006] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/12/2022] [Accepted: 08/04/2022] [Indexed: 06/16/2023]
Abstract
A 37-year-old athlete completed invasive endurance (90 km) bicycle exercise testing for right ventricular pressure-volume analysis. Increased right ventricular afterload caused declines in ventricular-arterial coupling and cardiac output, causing increased arteriovenous oxygen difference to maintain oxygen uptake. These findings demonstrate effects of changes in right ventricular performance on exercise capacity. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Justin A. Edward
- Department of Medicine–Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lukasz P. Cerbin
- Department of Medicine–Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Daniel W. Groves
- Department of Medicine–Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Radiology–Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Robert A. Quaife
- Department of Medicine–Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Radiology–Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kendall S. Hunter
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Benjamin D. Levine
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Campus, Dallas, Texas, USA
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas, USA
| | - William K. Cornwell
- Department of Medicine–Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Clinical Translational Research Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Saxon CE, Genders TS, Quaife RA, Chen SJ, Burke JM, McGuinn EM. Aortic valve chordae tendineae: A rare cause of aortic stenosis. Radiol Case Rep 2022; 18:1-3. [PMID: 36312300 PMCID: PMC9614645 DOI: 10.1016/j.radcr.2022.09.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 11/25/2022] Open
Abstract
We describe a rare case of severe low-flow, low-gradient aortic stenosis due to a calcified aortic valve chordae tendineae. The chordae was captured on cardiac computed tomography (CT) using advanced 3-dimensional image reconstruction to reveal the fibrous strand tethering the non-coronary cusp to the left ventricular outflow tract, rendering it functionally immobile. This is one of the first reported cases of severe aortic stenosis from an aortic valve chordae tendineae which highlights the utility of advanced image processing techniques in cardiac CT.
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Affiliation(s)
- Cara E. Saxon
- Department of Medicine, University of Colorado Anschutz Medical Campus, Academic Office One, 12361 E. 17th Ave, B177, Aurora, CO 80045, USA,Corresponding author.
| | - Tessa S.S. Genders
- Division of Cardiology, University of Colorado Anschutz Medical Campus, 12631 East 17th Ave, B130, Aurora, CO 80045, USA
| | - Robert A. Quaife
- Division of Cardiology, University of Colorado Anschutz Medical Campus, 12631 East 17th Ave, B130, Aurora, CO 80045, USA,Advanced Cardiac Imaging & Image Guidance Center, University of Colorado Anschutz Medical Campus, 12605 East 16th Ave, 3rd Floor, Aurora, CO 80045, USA
| | - S. James Chen
- Advanced Cardiac Imaging & Image Guidance Center, University of Colorado Anschutz Medical Campus, 12605 East 16th Ave, 3rd Floor, Aurora, CO 80045, USA
| | - Joseph M. Burke
- Division of Cardiology, Denver Health Medical Center, 660 Bannock St Suite 5635, Denver, CO 80204, USA
| | - Erin M. McGuinn
- Division of Cardiology, Denver Health Medical Center, 660 Bannock St Suite 5635, Denver, CO 80204, USA
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7
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Bricker RS, Quaife RA, Chen SYJ, Messenger JC, Hammers J, Carroll JD. Transcatheter Closure of Left Ventricle to Coronary Sinus Fistula Post-MVR and Septal Myectomy. JACC Case Rep 2021; 3:1258-1263. [PMID: 34471874 PMCID: PMC8387808 DOI: 10.1016/j.jaccas.2021.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/29/2021] [Accepted: 05/06/2021] [Indexed: 11/26/2022]
Abstract
This paper describes the case of a patient who developed refractory heart failure due to a fistula from the left ventricle to the coronary sinus that was unintentionally created after a surgical myectomy and mitral valve replacement. Advanced image guidance with a pre-procedure 3-dimensional physical model and intraprocedure echocardiography fusion facilitated transcatheter plugging of the shunt with symptom resolution. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Rory S Bricker
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Robert A Quaife
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Shiuh-Yung J Chen
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John C Messenger
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - John D Carroll
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
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8
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Jone P, Sandoval JP, Haak A, Hammers J, Rodriguez‐Zanella H, Quaife RA, Salcedo EE, Carroll JD, Gill E. Echocardiography–fluoroscopy fusion imaging: The essential features used in congenital and structural heart disease interventional guidance. Echocardiography 2020; 37:769-780. [DOI: 10.1111/echo.14670] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Pei‐Ni Jone
- Pediatric Cardiology Children’s Hospital Colorado University of Colorado School of Medicine Aurora Colorado
| | - Juan Pablo Sandoval
- Intervención en Cardiopatía Congénita y Estructural Instituto Nacional de Cardiología Ignacio Chávez Mexico City Mexico
| | | | | | - Hugo Rodriguez‐Zanella
- Intervención en Cardiopatía Congénita y Estructural Instituto Nacional de Cardiología Ignacio Chávez Mexico City Mexico
| | - Robert A. Quaife
- Division of Cardiology University of Colorado School of Medicine Aurora Colorado
| | - Ernesto E. Salcedo
- Division of Cardiology University of Colorado School of Medicine Aurora Colorado
| | - John D. Carroll
- Division of Cardiology University of Colorado School of Medicine Aurora Colorado
| | - Edward Gill
- Division of Cardiology University of Colorado School of Medicine Aurora Colorado
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9
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Petri N, Haak A, Quaife RA, Gill E, Salcedo E, Chen J, Carroll J. PSEUDO-ILLUMINATION IN 3D TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR STRUCTURAL HEART DISEASE INTERVENTIONS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31829-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Jone PN, Haak A, Ross M, Wiktor DM, Gill E, Quaife RA, Messenger JC, Salcedo EE, Carroll JD. Congenital and Structural Heart Disease Interventions Using Echocardiography-Fluoroscopy Fusion Imaging. J Am Soc Echocardiogr 2019; 32:1495-1504. [DOI: 10.1016/j.echo.2019.07.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/23/2019] [Accepted: 07/28/2019] [Indexed: 11/16/2022]
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11
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Donmez E, Salcedo EE, Quaife RA, Burke JM, Gill EA, Carroll JD. The acute effects of edge‐to‐edge percutaneous mitral valve repair on the shape and size of the mitral annulus and its relation to mitral regurgitation. Echocardiography 2019; 36:732-741. [DOI: 10.1111/echo.14284] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 12/28/2018] [Accepted: 01/24/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Esra Donmez
- Division of CardiologyUniversity of Colorado HospitalAnschutz Medical CenterUniversity of Colorado School of Medicine Aurora Colorado
- Department of CardiologyTurkish Ministry of Health Bakirkoy Dr. Sadi Konuk Training and Research Hospital Bakirkoy, Istanbul Turkey
| | - Ernesto E. Salcedo
- Division of CardiologyUniversity of Colorado HospitalAnschutz Medical CenterUniversity of Colorado School of Medicine Aurora Colorado
| | - Robert A. Quaife
- Division of CardiologyUniversity of Colorado HospitalAnschutz Medical CenterUniversity of Colorado School of Medicine Aurora Colorado
| | - Joseph M. Burke
- Division of CardiologyUniversity of Colorado HospitalAnschutz Medical CenterUniversity of Colorado School of Medicine Aurora Colorado
| | - Edward A. Gill
- Division of CardiologyUniversity of Colorado HospitalAnschutz Medical CenterUniversity of Colorado School of Medicine Aurora Colorado
| | - John D. Carroll
- Division of CardiologyUniversity of Colorado HospitalAnschutz Medical CenterUniversity of Colorado School of Medicine Aurora Colorado
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12
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Jone PN, Haak A, Petri N, Ross M, Morgan G, Wiktor DM, Gill E, Quaife RA, Messenger JC, Salcedo EE, Carroll JD. Echocardiography-Fluoroscopy Fusion Imaging for Guidance of Congenital and Structural Heart Disease Interventions. JACC Cardiovasc Imaging 2019; 12:1279-1282. [PMID: 30660524 DOI: 10.1016/j.jcmg.2018.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/10/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Pei-Ni Jone
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
| | | | - Nils Petri
- Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany; Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Michael Ross
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Gareth Morgan
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Dominik M Wiktor
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Edward Gill
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Robert A Quaife
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - John C Messenger
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Ernesto E Salcedo
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - John D Carroll
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
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13
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Bristow MR, Kao DP, Breathett KK, Altman NL, Gorcsan J, Gill EA, Lowes BD, Gilbert EM, Quaife RA, Mann DL. Structural and Functional Phenotyping of the Failing Heart: Is the Left Ventricular Ejection Fraction Obsolete? JACC Heart Fail 2018; 5:772-781. [PMID: 29096787 DOI: 10.1016/j.jchf.2017.09.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/04/2017] [Accepted: 09/10/2017] [Indexed: 12/20/2022]
Abstract
Diagnosis, prognosis, treatment, and development of new therapies for diseases or syndromes depend on a reliable means of identifying phenotypes associated with distinct predictive probabilities for these various objectives. Left ventricular ejection fraction (LVEF) provides the current basis for combined functional and structural phenotyping in heart failure by classifying patients as those with heart failure with reduced ejection fraction (HFrEF) and those with heart failure with preserved ejection fraction (HFpEF). Recently the utility of LVEF as the major phenotypic determinant of heart failure has been challenged based on its load dependency and measurement variability. We review the history of the development and adoption of LVEF as a critical measurement of LV function and structure and demonstrate that, in chronic heart failure, load dependency is not an important practical issue, and we provide hemodynamic and molecular biomarker evidence that LVEF is superior or equal to more unwieldy methods of identifying phenotypes of ventricular remodeling. We conclude that, because it reliably measures both left ventricular function and structure, LVEF remains the best current method of assessing pathologic remodeling in heart failure in both individual clinical and multicenter group settings. Because of the present and future importance of left ventricular phenotyping in heart failure, LVEF should be measured by using the most accurate technology and methodologic refinements available, and improved characterization methods should continue to be sought.
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Affiliation(s)
- Michael R Bristow
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado.
| | - David P Kao
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado
| | - Khadijah K Breathett
- Division of Cardiology, Department of Medicine, University of Arizona, Tucson, Arizona
| | - Natasha L Altman
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado
| | - John Gorcsan
- Division of Cardiology, Department of Medicine, Washington University Medical School, St. Louis, Missouri
| | - Edward A Gill
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado
| | - Brian D Lowes
- Division of Cardiology, Department of Medicine, School of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Edward M Gilbert
- Division of Cardiology, Department of Medicine, School of Medicine, University of Utah Medical Center, Salt Lake City, Utah
| | - Robert A Quaife
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado
| | - Douglas L Mann
- Division of Cardiology, Department of Medicine, Washington University Medical School, St. Louis, Missouri
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14
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Sucharov CC, Kao DP, Port JD, Karimpour-Fard A, Quaife RA, Minobe W, Nunley K, Lowes BD, Gilbert EM, Bristow MR. Myocardial microRNAs associated with reverse remodeling in human heart failure. JCI Insight 2017; 2:e89169. [PMID: 28138556 DOI: 10.1172/jci.insight.89169] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In dilated cardiomyopathies (DCMs) changes in expression of protein-coding genes are associated with reverse remodeling, and these changes can be regulated by microRNAs (miRs). We tested the general hypothesis that dynamic changes in myocardial miR expression are predictive of β-blocker-associated reverse remodeling. METHODS Forty-three idiopathic DCM patients (mean left ventricular ejection fraction 0.24 ± 0.09) were treated with β-blockers. Serial ventriculography and endomyocardial biopsies were performed at baseline, and after 3 and 12 months of treatment. Changes in RT-PCR (candidate miRs) or array-measured miRs were compared based on the presence (R) or absence (NR) of a reverse-remodeling response, and a miR-mRNA-function pathway analysis (PA) was performed. RESULTS At 3 months, 2 candidate miRs were selectively changed in Rs, decreases in miR-208a-3p and miR-591. PA revealed changes in miR-mRNA interactions predictive of decreased apoptosis and myocardial cell death. At 12 months, 5 miRs exhibited selective changes in Rs (decreases in miR-208a-3p, -208b-3p, 21-5p, and 199a-5p; increase in miR-1-3p). PA predicted decreases in apoptosis, cardiac myocyte cell death, hypertrophy, and heart failure, with increases in contractile and overall cardiac functions. CONCLUSIONS In DCMs, myocardial miRs predict the time-dependent reverse-remodeling response to β-blocker treatment, and likely regulate the expression of remodeling-associated miRs. TRIAL REGISTRATION ClinicalTrials.gov NCT01798992. FUNDING NIH 2R01 HL48013, 1R01 HL71118 (Bristow, PI); sponsored research agreements from Glaxo-SmithKline and AstraZeneca (Bristow, PI); NIH P20 HL101435 (Lowes, Port multi-PD/PI); sponsored research agreement from Miragen Therapeutics (Port, PI).
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Affiliation(s)
| | - David P Kao
- Division of Cardiology, Department of Medicine
| | | | - Anis Karimpour-Fard
- Department of Pharmacology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | | | | | - Brian D Lowes
- Division of Cardiology, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Edward M Gilbert
- Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City, Utah, USA
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Nguyen DT, Tzou WS, Zheng L, Barham W, Schuller JL, Shillinglaw B, Quaife RA, Sauer WH. Enhanced Radiofrequency Ablation With Magnetically Directed Metallic Nanoparticles. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.115.003820. [DOI: 10.1161/circep.115.003820] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 08/21/2015] [Accepted: 02/25/2016] [Indexed: 11/16/2022]
Abstract
Background—
Remote heating of metal located near a radiofrequency ablation source has been previously demonstrated. Therefore, ablation of cardiac tissue treated with metallic nanoparticles may improve local radiofrequency heating and lead to larger ablation lesions. We sought to evaluate the effect of magnetic nanoparticles on tissue sensitivity to radiofrequency energy.
Methods and Results—
Ablation was performed using an ablation catheter positioned with 10 g of force over prepared ex vivo specimens. Tissue temperatures were measured and lesion volumes were acquired. An in vivo porcine thigh model was used to study systemically delivered magnetically guided iron oxide (FeO) nanoparticles during radiofrequency application. Magnetic resonance imaging and histological staining of ablated tissue were subsequently performed as a part of ablation lesion analysis. Ablation of ex vivo myocardial tissue treated with metallic nanoparticles resulted in significantly larger lesions with greater impedance changes and evidence of increased thermal conductivity within the tissue. Magnet-guided localization of FeO nanoparticles within porcine thigh preps was demonstrated by magnetic resonance imaging and iron staining. Irrigated ablation in the regions with greater FeO, after FeO infusion and magnetic guidance, created larger lesions without a greater incidence of steam pops.
Conclusions—
Metal nanoparticle infiltration resulted in significantly larger ablation lesions with altered electric and thermal conductivity. In vivo magnetic guidance of FeO nanoparticles allowed for facilitated radiofrequency ablation without direct infiltration into the targeted tissue. Further research is needed to assess the clinical applicability of this ablation strategy using metallic nanoparticles for the treatment of cardiac arrhythmias.
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Affiliation(s)
- Duy T. Nguyen
- From the Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Colorado, Aurora
| | - Wendy S. Tzou
- From the Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Colorado, Aurora
| | - Lijun Zheng
- From the Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Colorado, Aurora
| | - Waseem Barham
- From the Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Colorado, Aurora
| | - Joseph L. Schuller
- From the Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Colorado, Aurora
| | - Benjamin Shillinglaw
- From the Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Colorado, Aurora
| | - Robert A. Quaife
- From the Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Colorado, Aurora
| | - William H. Sauer
- From the Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Colorado, Aurora
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16
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Clegg SD, Chen SJ, Nijhof N, Kim MS, Salcedo EE, Quaife RA, Messenger JC, Bracken J, Carroll JD. Integrated 3D echo-x ray to optimize image guidance for structural heart intervention. JACC Cardiovasc Imaging 2015; 8:371-374. [PMID: 25772840 DOI: 10.1016/j.jcmg.2014.06.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 06/11/2014] [Accepted: 06/12/2014] [Indexed: 10/23/2022]
Affiliation(s)
- Stacey D Clegg
- University of New Mexico Health Science Center, Albuquerque, New Mexico
| | - S James Chen
- University of Colorado Hospital, University of Colorado, Denver, Aurora, Colorado
| | | | - Michael S Kim
- University of Colorado Hospital, University of Colorado, Denver, Aurora, Colorado
| | - Ernesto E Salcedo
- University of Colorado Hospital, University of Colorado, Denver, Aurora, Colorado
| | - Robert A Quaife
- University of Colorado Hospital, University of Colorado, Denver, Aurora, Colorado
| | - John C Messenger
- University of Colorado Hospital, University of Colorado, Denver, Aurora, Colorado
| | | | - John D Carroll
- University of Colorado Hospital, University of Colorado, Denver, Aurora, Colorado.
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Abstract
BACKGROUND Whipple endocarditis is caused by Tropheryma whipplei and is a well-described complication of Whipple's disease. Limited and small case series have been published regarding the presentation, diagnosis, and clinical course of this disease. METHODS/RESULTS We describe 2 cases of patients with T. whipplei endocarditis, one of which underwent a successful heart transplant. CONCLUSION In both cases of Whipple's endocarditis, there was a subacute prodromal phase followed by an acute rapid decompensation with severe destruction of the aortic valve, heart failure, and embolism. Because the diagnosis of T. whipplei endocarditis is typically not made until pathological examination of tissue, clinicians must have a high suspicion for it in the absence of other offending organisms, especially among middle-aged white males with sub-acute symptoms and embolic complications.
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Affiliation(s)
- Ryan T Borne
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Ashok Babu
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora
| | - Marilyn Levi
- Division of Infectious Disease, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Andreas Brieke
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Robert A Quaife
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora.
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Bristow MR, Quaife RA. The adrenergic system in pulmonary arterial hypertension: bench to bedside (2013 Grover Conference series). Pulm Circ 2015; 5:415-23. [PMID: 26401244 PMCID: PMC4556494 DOI: 10.1086/682223] [Citation(s) in RCA: 15] [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: 08/01/2014] [Accepted: 01/21/2015] [Indexed: 12/20/2022] Open
Abstract
In heart failure with reduced left ventricular ejection fraction (HFrEF), adrenergic activation is a key compensatory mechanism that is a major contributor to progressive ventricular remodeling and worsening of heart failure. Targeting the increased adrenergic activation with β-adrenergic receptor blocking agents has led to the development of arguably the single most effective drug therapy for HFrEF. The pressure-overloaded and ultimately remodeled/failing right ventricle (RV) in pulmonary arterial hypertension (PAH) is also adrenergically activated, which raises the issue of whether an antiadrenergic strategy could be effectively employed in this setting. Anecdotal experience suggests that it will be challenging to administer an antiadrenergic treatment such as a β-blocking agent to patients with established moderate-severe PAH. However, the same types of data and commentary were prevalent early in the development of β-blockade for HFrEF treatment. In addition, in HFrEF approaches have been developed for delivering β-blocker therapy to patients who have extremely advanced heart failure, and these general principles could be applied to RV failure in PAH. This review examines the role played by adrenergic activation in the RV faced with PAH, contrasts PAH-RV remodeling with left ventricle remodeling in settings of sustained increases in afterload, and suggests a possible approach for safely delivering an antiadrenergic treatment to patients with RV dysfunction due to moderate-severe PAH.
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Affiliation(s)
- Michael R. Bristow
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Robert A. Quaife
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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19
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Kao DP, Lowes BD, Gilbert EM, Minobe W, Epperson LE, Meyer LK, Ferguson DA, Volkman AK, Zolty R, Borg CD, Quaife RA, Bristow MR. Therapeutic Molecular Phenotype of β-Blocker-Associated Reverse-Remodeling in Nonischemic Dilated Cardiomyopathy. ACTA ACUST UNITED AC 2015; 8:270-83. [PMID: 25637602 DOI: 10.1161/circgenetics.114.000767] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 06/25/2014] [Accepted: 01/14/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND When β-blockers produce reverse-remodeling in idiopathic dilated cardiomyopathy, they partially reverse changes in fetal-adult/contractile protein, natriuretic peptide, SR-Ca(2+)-ATPase gene program constituents. The objective of the current study was to further test the hypothesis that reverse-remodeling is associated with favorable changes in myocardial gene expression by measuring additional contractile, signaling, and metabolic genes that exhibit a fetal/adult expression predominance, are thyroid hormone-responsive, and are regulated by β1-adrenergic receptor signaling. A secondary objective was to identify which of these putative regulatory networks is most closely associated with observed changes. METHODS AND RESULTS Forty-seven patients with idiopathic dilated cardiomyopathy (left ventricular ejection fraction, 0.24±0.09) were randomized to the adrenergic-receptor blockers metoprolol (β1-selective), metoprolol+doxazosin (β1/α1), or carvedilol (β1/β2/α1). Serial radionuclide ventriculography and endomyocardial biopsies were performed at baseline, 3, and 12 months. Expression of 50 mRNA gene products was measured by quantitative polymerase chain reaction. Thirty-one patients achieved left ventricular ejection fraction reverse-remodeling response defined as improvement by ≥0.08 at 12 months or by ≥0.05 at 3 months (Δ left ventricular ejection fraction, 0.21±0.10). Changes in gene expression in responders versus nonresponders were decreases in NPPA and NPPB and increases in MYH6, ATP2A2, PLN, RYR2, ADRA1A, ADRB1, MYL3, PDFKM, PDHX, and CPT1B. All except PDHX involved increase in adult or decrease in fetal cardiac genes, but 100% were concordant with changes predicted by inhibition of β1-adrenergic signaling. CONCLUSIONS In addition to known gene expression changes, additional calcium-handling, sarcomeric, adrenergic signaling, and metabolic genes were associated with reverse-remodeling. The pattern suggests a fetal-adult paradigm but may be because of reversal of gene expression controlled by a β1-adrenergic receptor gene network. CLINICAL TRIAL REGISTRATION URL: www.clinicaltrials.gov. Unique Identifier: NCT01798992.
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Affiliation(s)
- David P Kao
- From the Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (D.P.K., W.M., L.E.E., L.K.M., D.A.F., R.A.Q., M.R.B.); Division of Cardiology, Department of Medicine, University of Nebraska Medical Center, Omaha (B.D.L.); Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City (E.M.G., A.K.V.); Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (R.Z.); and Heart Clinic of Arkansas, Little Rock (C.D.B.)
| | - Brian D Lowes
- From the Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (D.P.K., W.M., L.E.E., L.K.M., D.A.F., R.A.Q., M.R.B.); Division of Cardiology, Department of Medicine, University of Nebraska Medical Center, Omaha (B.D.L.); Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City (E.M.G., A.K.V.); Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (R.Z.); and Heart Clinic of Arkansas, Little Rock (C.D.B.)
| | - Edward M Gilbert
- From the Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (D.P.K., W.M., L.E.E., L.K.M., D.A.F., R.A.Q., M.R.B.); Division of Cardiology, Department of Medicine, University of Nebraska Medical Center, Omaha (B.D.L.); Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City (E.M.G., A.K.V.); Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (R.Z.); and Heart Clinic of Arkansas, Little Rock (C.D.B.)
| | - Wayne Minobe
- From the Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (D.P.K., W.M., L.E.E., L.K.M., D.A.F., R.A.Q., M.R.B.); Division of Cardiology, Department of Medicine, University of Nebraska Medical Center, Omaha (B.D.L.); Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City (E.M.G., A.K.V.); Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (R.Z.); and Heart Clinic of Arkansas, Little Rock (C.D.B.)
| | - L Elaine Epperson
- From the Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (D.P.K., W.M., L.E.E., L.K.M., D.A.F., R.A.Q., M.R.B.); Division of Cardiology, Department of Medicine, University of Nebraska Medical Center, Omaha (B.D.L.); Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City (E.M.G., A.K.V.); Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (R.Z.); and Heart Clinic of Arkansas, Little Rock (C.D.B.)
| | - Leslie K Meyer
- From the Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (D.P.K., W.M., L.E.E., L.K.M., D.A.F., R.A.Q., M.R.B.); Division of Cardiology, Department of Medicine, University of Nebraska Medical Center, Omaha (B.D.L.); Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City (E.M.G., A.K.V.); Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (R.Z.); and Heart Clinic of Arkansas, Little Rock (C.D.B.)
| | - Debra A Ferguson
- From the Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (D.P.K., W.M., L.E.E., L.K.M., D.A.F., R.A.Q., M.R.B.); Division of Cardiology, Department of Medicine, University of Nebraska Medical Center, Omaha (B.D.L.); Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City (E.M.G., A.K.V.); Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (R.Z.); and Heart Clinic of Arkansas, Little Rock (C.D.B.)
| | - Ann Kirkpatrick Volkman
- From the Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (D.P.K., W.M., L.E.E., L.K.M., D.A.F., R.A.Q., M.R.B.); Division of Cardiology, Department of Medicine, University of Nebraska Medical Center, Omaha (B.D.L.); Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City (E.M.G., A.K.V.); Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (R.Z.); and Heart Clinic of Arkansas, Little Rock (C.D.B.)
| | - Ronald Zolty
- From the Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (D.P.K., W.M., L.E.E., L.K.M., D.A.F., R.A.Q., M.R.B.); Division of Cardiology, Department of Medicine, University of Nebraska Medical Center, Omaha (B.D.L.); Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City (E.M.G., A.K.V.); Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (R.Z.); and Heart Clinic of Arkansas, Little Rock (C.D.B.)
| | - C Douglas Borg
- From the Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (D.P.K., W.M., L.E.E., L.K.M., D.A.F., R.A.Q., M.R.B.); Division of Cardiology, Department of Medicine, University of Nebraska Medical Center, Omaha (B.D.L.); Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City (E.M.G., A.K.V.); Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (R.Z.); and Heart Clinic of Arkansas, Little Rock (C.D.B.)
| | - Robert A Quaife
- From the Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (D.P.K., W.M., L.E.E., L.K.M., D.A.F., R.A.Q., M.R.B.); Division of Cardiology, Department of Medicine, University of Nebraska Medical Center, Omaha (B.D.L.); Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City (E.M.G., A.K.V.); Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (R.Z.); and Heart Clinic of Arkansas, Little Rock (C.D.B.)
| | - Michael R Bristow
- From the Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (D.P.K., W.M., L.E.E., L.K.M., D.A.F., R.A.Q., M.R.B.); Division of Cardiology, Department of Medicine, University of Nebraska Medical Center, Omaha (B.D.L.); Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City (E.M.G., A.K.V.); Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (R.Z.); and Heart Clinic of Arkansas, Little Rock (C.D.B.).
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20
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Moss TJ, Krantz MJ, Zipse MM, Quaife RA, Sauer WH, Messenger JC, Groves BM, Salcedo EE, Schuller JL. Left ventricular systolic function following alcohol septal ablation for symptomatic hypertrophic cardiomyopathy. Am J Cardiol 2014; 113:1401-4. [PMID: 24576545 DOI: 10.1016/j.amjcard.2014.01.417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/08/2014] [Accepted: 01/08/2014] [Indexed: 11/25/2022]
Abstract
Because alcohol septal ablation (ASA) for the treatment of symptomatic hypertrophic cardiomyopathy (HC) with left ventricular (LV) outflow tract (LVOT) obstruction results in a myocardial infarct of up to 10% of ventricular mass, LV systolic function could decline over time. We evaluated LV function during longitudinal follow-up in a cohort of patients who underwent ASA. We studied 145 consecutive patients with HC that underwent 167 ASA procedures from 2002 to 2011. Echocardiographic follow-up was available in 139 patients (96%). Echocardiographic indexes included LV ejection fraction (LVEF), mitral regurgitation severity, systolic anterior motion of the anterior mitral leaflet, and resting and provoked LVOT gradients. All patients had a baseline LVEF of >55%. LVEF was preserved in 97.1% of patients over a mean follow-up time of 3.1±2.3 years (maximum 9.7). Mild LV systolic dysfunction was observed (LVEF range 44% to 54%) in only 4 patients. Mitral regurgitation severity improved in 67% (n=112 of 138 with complete data). Resting LVOT gradient declined from a mean of 75 to 19 mm Hg (p<0.001), and provoked gradient declined from a mean of 101 to 33 mm Hg (p<0.001). New York Heart Association class improved from a mean of 2.9±0.4 to 1.3±0.5 (p<0.001). In conclusion, LV systolic function is only mildly reduced in a minority of patients after ASA for symptomatic HC; other echocardiographic and functional measures were significantly improved.
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Groves DW, Snell-Bergeon JK, Likhite D, DiBella EV, Rewers MJ, Quaife RA. Regadenoson blood flow in type 1 diabetes (RABIT1D Study). J Cardiovasc Magn Reson 2014. [PMCID: PMC4044762 DOI: 10.1186/1532-429x-16-s1-o59] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Eng MH, Salcedo EE, Kim M, Quaife RA, Carroll JD. Implementation of real-time three-dimensional transesophageal echocardiography for mitral balloon valvuloplasty. Catheter Cardiovasc Interv 2013; 82:994-8. [DOI: 10.1002/ccd.25052] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 03/01/2013] [Revised: 05/23/2013] [Accepted: 06/01/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Marvin H. Eng
- Department of Medicine, Division of Cardiology, University of Texas Health Sciences Center; San Antonio Texas
| | - Ernesto E. Salcedo
- Department of Medicine, Division of Cardiology, University of Colorado Denver; Aurora Colorado
| | - Michael Kim
- Department of Medicine, Division of Cardiology, University of Colorado Denver; Aurora Colorado
| | - Robert A. Quaife
- Department of Medicine, Division of Cardiology, University of Colorado Denver; Aurora Colorado
| | - John D. Carroll
- Department of Medicine, Division of Cardiology, University of Colorado Denver; Aurora Colorado
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23
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Dorosz JL, Fonseca BM, Kay JD, Graham BB, Salcedo EE, Quaife RA. A Sinus Venosus Atrial Septal Defect Is Diagnosed by Echocardiography with an Unusual Bubble Study. Echocardiography 2013; 30:E182-3. [DOI: 10.1111/echo.12191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Jennifer L. Dorosz
- Division of Cardiology; School of Medicine; University of Colorado Denver; Aurora; Colorado
| | - Brian M. Fonseca
- Division of Pediatric Cardiology; School of Medicine; University of Colorado Denver; Aurora; Colorado
| | | | - Brian B. Graham
- Division of Pulmonary - Critical Care Medicine; School of Medicine; University of Colorado Denver; Aurora; Colorado
| | - Ernesto E. Salcedo
- Division of Cardiology; School of Medicine; University of Colorado Denver; Aurora; Colorado
| | - Robert A. Quaife
- Division of Cardiology; School of Medicine; University of Colorado Denver; Aurora; Colorado
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Affiliation(s)
- Robert Lee Page
- Department of Clinical Pharmacy, School of Pharmacy, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA.
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25
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Quaife RA, Chen MY, Kim M, Klein AJP, Jehle A, Kay J, Groves BM, Carroll JD. Pre-procedural planning for percutaneous atrial septal defect closure: transesophageal echocardiography compared with cardiac computed tomographic angiography. J Cardiovasc Comput Tomogr 2010; 4:330-8. [PMID: 20947043 DOI: 10.1016/j.jcct.2010.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [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: 02/27/2010] [Revised: 07/14/2010] [Accepted: 08/09/2010] [Indexed: 11/15/2022]
Abstract
BACKGROUND The safety and efficacy of percutaneous closure of atrial septal defects (ASDs) is determined by several variables, including defect size, presence of adequate rim tissue, relationship to other cardiac structures, and associated congenital anomalies. OBJECTIVE We sought to determine the accuracy of computed tomographic angiography (CTA) in predicting a defect's size compared with pre-procedural transesophageal echocardiography (TEE) and to the current "gold standard" balloon sizing by intracardiac echocardiography (ICE). METHODS Thirty-five consecutive patients referred for possible percutaneous closure of suspected secundum ASD were evaluated with gated multislice CTA after initial TEE screening. Axial and sagittal image planes of the ASD from the CTA multiplanar reformation (MPR) images were used to measure the defect size and surface area. RESULTS Of the 35 patients with secundum-type ASDs, 5 subjects had disqualifying anatomy by CTA and 2 had an unsuccessful closure, resulting in a procedural success rate of 93%. Measurement of defect area by gated MPR images provided the strongest correlate to ICE balloon size. In large ASDs, TEE was less well correlated to the maximum defect size and identification of the inferior/inferoposterior rims than CTA. CONCLUSIONS Cardiac CTA is an accurate and useful technique for pre-procedural assessment of ASDs and may be superior to conventional TEE in large defects that have deficient inferior rims.
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Affiliation(s)
- Robert A Quaife
- Advanced Cardiac Imaging, Department of Medicine and Radiology, University of Colorado Health Sciences Center, PO Box 6511 Leprino Building 532, Cardiac and Vascular Center, 12401 E 17th Avenue, Aurora, CO 80045, USA.
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Salcedo EE, Quaife RA, Seres T, Carroll JD. A Framework for Systematic Characterization of the Mitral Valve by Real-Time Three-Dimensional Transesophageal Echocardiography. J Am Soc Echocardiogr 2009; 22:1087-99. [PMID: 19801300 DOI: 10.1016/j.echo.2009.07.007] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [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: 01/28/2009] [Indexed: 11/28/2022]
Affiliation(s)
- Ernesto E Salcedo
- University of Colorado Denver, Denver, Colorado, Aurora, CO 80045, USA.
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Regensteiner JG, Bauer TA, Reusch JEB, Quaife RA, Chen MY, Smith SC, Miller TM, Groves BM, Wolfel EE. Cardiac dysfunction during exercise in uncomplicated type 2 diabetes. Med Sci Sports Exerc 2009; 41:977-84. [PMID: 19346991 DOI: 10.1249/mss.0b013e3181942051] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Type 2 diabetes mellitus (T2DM) has been associated with reduced peak exercise capacity (VO(2peak)). The causes of this impairment are not clearly established, but evidence suggests that abnormalities in cardiac function play a significant role. We hypothesized that exercise would be associated with impaired cardiac function and hemodynamics in recently diagnosed T2DM, even in the absence of clinically evident cardiovascular complications. METHODS After baseline normal echocardiography screening, 10 premenopausal women with uncomplicated T2DM (average duration of diagnosed T2DM, 3.6 yr) and 10 healthy nondiabetic women of similar age, weight, and activity levels performed a peak cardiopulmonary exercise test while instrumented with an indwelling pulmonary artery catheter for assessing cardiac function. On separate days, technetium-99m sestamibi (cardolite) imaging was performed to assess myocardial perfusion at rest and peak exercise in seven T2DM and seven control patients. RESULTS Resting measures of cardiac hemodynamics were similar in T2DM and control subjects. Absolute VO(2peak) (mL x min(-1)) and peak cardiac output (L x min(-1)) tended to be lower in T2DM than in control subjects but did not reach statistical significance. However, pulmonary capillary wedge pressure (PCWP) rose significantly more during exercise in T2DM than in controls (148% vs 109% increase at peak exercise, P < 0.01). Normalized myocardial perfusion index was lower in persons with diabetes than in controls (11.0 +/- 3.5 x e(-9) vs 17.5 +/- 8.1 x e(-9), respectively, P < 0.05) and inversely related to peak exercise PCWP (R = -0.56, P < 0.05). CONCLUSIONS Cardiac hemodynamics during graded exercise are altered in women with recently diagnosed T2DM as demonstrated by the disproportionate increase in PCWP at peak exercise compared with controls subjects. Cardiac abnormalities observed are potentially early signs of subclinical cardiac dysfunction associated with T2DM, which may precede the more greatly impaired cardiac function at rest and with exercise observed in longer established T2DM.
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Affiliation(s)
- Judith G Regensteiner
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado Denver, Aurora, CO 80045, USA.
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Eng MH, Salcedo EE, Quaife RA, Carroll JD. Implementation of Real Time Three-Dimensional Transesophageal Echocardiography in Percutaneous Mitral Balloon Valvuloplasty and Structural Heart Disease Interventions. Echocardiography 2009; 26:958-66. [DOI: 10.1111/j.1540-8175.2009.00928.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Klein AJ, Kim MS, Quaife RA, Kay JD. Anomalous Left Anterior Descending Coronary Artery from the Pulmonary Artery, Unroofed Coronary Sinus, Patent Foramen Ovale, and a Persistent Left-sided SVC in a Single Patient: A Harmonious Quartet of Defects. CONGENIT HEART DIS 2009. [DOI: 10.1111/j.1747-0803.2009.00268.x] [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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Hudson PA, Eng MH, Kim MS, Quaife RA, Salcedo EE, Carroll JD. A comparison of echocardiographic modalities to guide structural heart disease interventions. J Interv Cardiol 2008; 21:535-46. [PMID: 18973503 DOI: 10.1111/j.1540-8183.2008.00410.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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
Percutaneous techniques to treat structural heart disease are rapidly evolving based on innovative interventions and the considerable advancement in image guidance technology. While two-dimensional transthoracic and transesophageal echocardiography have been integral to procedural planning and execution, intracardiac and three-dimensional echocardiography supply unique visualization of target structures with a potential improvement in patient safety and procedural efficacy. The choice of image guidance modality is based on specific differences between imaging systems, as well as other variables including cost, patient safety, operator expertise, and complexity of procedure. We will compare the adjunctive imaging tools for structural heart disease interventions, with a focus on intracardiac echocardiography and real-time three-dimensional transesophageal echocardiography.
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Affiliation(s)
- Paul A Hudson
- Division of Cardiology, University of Colorado Denver, Aurora, Colorado 80045, USA
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Abstract
As the appreciation of structural heart disease in children and adults has increased and as catheter-based closure procedures are now being performed in clinical practice, cardiovascular physicians have multiple compelling new reasons to better understand cardiac anatomic and spatial relationships. Current 2-dimensional imaging techniques remain limited both in their ability to represent the complex 3-dimensional relationships present in structural heart disease and in their capacity to adequately facilitate often complex corrective procedures. This review discusses the cardiovascular applications of rapid prototyping, a new technology that may not only play a significant role in the planning of catheter-based interventions but also may serve as a valuable educational tool to enhance the medical community’s understanding of the many forms of structural heart disease.
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Affiliation(s)
- Michael S. Kim
- From the University of Colorado at Denver, Aurora, Colo (M.S.K., A.R.H., R.A.Q., J.D.C.); and Philips Healthcare, Bothell, Wash (O.W.)
| | - Adam R. Hansgen
- From the University of Colorado at Denver, Aurora, Colo (M.S.K., A.R.H., R.A.Q., J.D.C.); and Philips Healthcare, Bothell, Wash (O.W.)
| | - Onno Wink
- From the University of Colorado at Denver, Aurora, Colo (M.S.K., A.R.H., R.A.Q., J.D.C.); and Philips Healthcare, Bothell, Wash (O.W.)
| | - Robert A. Quaife
- From the University of Colorado at Denver, Aurora, Colo (M.S.K., A.R.H., R.A.Q., J.D.C.); and Philips Healthcare, Bothell, Wash (O.W.)
| | - John D. Carroll
- From the University of Colorado at Denver, Aurora, Colo (M.S.K., A.R.H., R.A.Q., J.D.C.); and Philips Healthcare, Bothell, Wash (O.W.)
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Kim MS, Klein AJ, Groves BM, Quaife RA, Salcedo EE. Left ventricular outflow tract obstruction in the presence of asymmetric septal hypertrophy and accessory mitral valve tissue treated with alcohol septal ablation. ACTA ACUST UNITED AC 2008; 9:720-4. [DOI: 10.1093/ejechocard/jen152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Voelkel NF, Quaife RA, Leinwand LA, Barst RJ, McGoon MD, Meldrum DR, Dupuis J, Long CS, Rubin LJ, Smart FW, Suzuki YJ, Gladwin M, Denholm EM, Gail DB. Right Ventricular Function and Failure. Circulation 2006; 114:1883-91. [PMID: 17060398 DOI: 10.1161/circulationaha.106.632208] [Citation(s) in RCA: 864] [Impact Index Per Article: 48.0] [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] [Indexed: 01/23/2023]
MESH Headings
- Basic Helix-Loop-Helix Transcription Factors/genetics
- Basic Helix-Loop-Helix Transcription Factors/physiology
- Eisenmenger Complex/etiology
- Eisenmenger Complex/physiopathology
- Epoprostenol/therapeutic use
- Forecasting
- Genetic Predisposition to Disease
- Humans
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/physiopathology
- Myocardial Infarction/complications
- Peptidyl-Dipeptidase A/genetics
- Polymorphism, Genetic
- Pressure
- Pulmonary Heart Disease/etiology
- Pulmonary Heart Disease/physiopathology
- Transcription, Genetic
- Tricuspid Valve Insufficiency/complications
- Tricuspid Valve Insufficiency/physiopathology
- Vasodilator Agents/therapeutic use
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Right/drug therapy
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/genetics
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function
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Affiliation(s)
- Norbert F Voelkel
- Pulmonary Hypertension Center, University of Colorado at Denver and Health Sciences Center, 4200 E Ninth Ave, MC: C272, Denver, CO 80262, USA.
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Quaife RA, Chen MY, Lynch D, Badesch DB, Groves BM, Wolfel E, Robertson AD, Bristow MR, Voelkel NF. Importance of right ventricular end-systolic regional wall stress in idiopathic pulmonary arterial hypertension: a new method for estimation of right ventricular wall stress. Eur J Med Res 2006; 11:214-20. [PMID: 16723296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
RV dysfunction in idiopathic (primary) pulmonary hypertension (IPAH) is often characterized by chamber dilation, ventricular hypertrophy, and impaired systolic function. In this study we characterize right ventricular (RV) chamber size, end-diastolic thickness, myocardial mass, and ejection fraction in patients with right ventricular heart failure from IPAH, n = 16 and compare these characteristics to a control population of cardiac transplant patients (TX, n = 4) and a group of normal subjects (N, n = 5). Subjects underwent both gated cardiac magnetic resonance imaging (MRI) of the right ventricle and right heart catheterization (RHC). Using parameters from both the MRI and RHC, an estimate of RV end-systolic relative wall stress (RWS) was calculated. RV RWS was 34.7 +/- 8.4 and 17.3 +/- 3.8 Kdynes/cm2 in the cardiac transplant and control subjects respectively and was significantly elevated 104.1 Kdynes/cm2 in IPAH patients (IPAH vs N and TX; p = 0.004 and 0.008 ). RV ejection fraction RVEF was lower in IPAH patients 0.36 +/- .10 than in N and TX 0.57 +/- .04 and 0.55 +/- .08 respectively, (p = 0.0006 N and 0.0007 TX). An inverse linear correlation was demonstrated between RWS and RVEF (y = 215- 332x; R = .80, p < or = .0001). Right ventricular RWS is significantly elevated in IPAH and may provide a useful quantitative monitoring tool in patients with IPAH to assess the benefit of different therapeutic interventions and provide prognostic information.
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Affiliation(s)
- Robert A Quaife
- Cardiac Imaging, Division of Cardiology, University of Colorado Health Sciences Center, B-120, 4200 East Ninth Avenue, Denver, Colorado 80262, USA.
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Abstract
PFO is diagnosed by echocardiography using the combination of transthoracic two-dimensional imaging of the interatrial septum, followed by color and spectral Doppler (and if necessary saline contrast) imaging. Transesophageal imaging is an important adjunct when transthoracic imaging is not conclusive or yields suboptimal images.Three-dimensional echocardiography is useful for defining fenestrations within a PFO.
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Affiliation(s)
- Edward A Gill
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, 1959 Pacific Avenue NE, Seattle, WA 98195, USA.
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Abstract
The use of TEE and ICE techniques have been extremely important in the development of closure of PFOs and ASDs using interventional techniques. These two imaging techniques have revolutionized the diagnosis and treatment of these problems and have gone far beyond TTE and its known problems for diagnosing septal defects (Fig. 21).
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Affiliation(s)
- Edward A Gill
- Department of Medicine, Division of Cardiology, University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104-9747, USA.
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Lindenfeld J, Keller K, Campbell DN, Wolfe RR, Quaife RA. Improved systemic ventricular function after carvedilol administration in a patient with congenitally corrected transposition of the great arteries. J Heart Lung Transplant 2003; 22:198-201. [PMID: 12581770 DOI: 10.1016/s1053-2498(02)00656-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Congenitally corrected transposition of the great arteries (CCTGA) is associated with shortened survival due, at least in part, to progressive systolic dysfunction of the systemic ventricle. We report a substantial improvement in systemic ventricular function with carvedilol in a 63-year-old man with CCTGA.
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Affiliation(s)
- JoAnn Lindenfeld
- Division of Cardiology, University of Colorado Hospital and Children's Hospital, University of Colorado Health Sciences Center, Denver, Colorado, USA.
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Abraham WT, Gilbert EM, Lowes BD, Minobe WA, Larrabee P, Roden RL, Dutcher D, Sederberg J, Lindenfeld JA, Wolfel EE, Shakar SF, Ferguson D, Volkman K, Linseman JV, Quaife RA, Robertson AD, Bristow MR. Coordinate changes in Myosin heavy chain isoform gene expression are selectively associated with alterations in dilated cardiomyopathy phenotype. Mol Med 2002; 8:750-60. [PMID: 12520092 PMCID: PMC2039952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
BACKGROUND The most common cause of chronic heart failure in the US is secondary or primary dilated cardiomyopathy (DCM). The DCM phenotype exhibits changes in the expression of genes that regulate contractile function and pathologic hypertrophy. However, it is unclear if any of these alterations in gene expression are disease producing or modifying. MATERIALS AND METHODS One approach to providing evidence for cause-effect of a disease-influencing gene is to quantitatively compare changes in phenotype to changes in gene expression by employing serial measurements in a longitudinal experimental design. We investigated the quantitative relationships between changes in gene expression and phenotype n 47 patients with idiopathic DCM. In endomyocardial biopsies at baseline and 6 months later, we measured mRNA expression of genes regulating contractile function (beta-adrenergic receptors, sarcoplasmic reticulum Ca(2) + ATPase, and alpha- and beta-myosin heavy chain isoforms) or associated with pathologic hypertrophy (beta-myosin heavy chain and atrial natriuretic peptide), plus beta-adrenergic receptor protein expression. Left ventricular phenotype was assessed by radionuclide ejection fraction. RESULTS Improvement in DCM phenotype was directly related to a coordinate increase in alpha- and a decrease in beta-myosin heavy chain mRNA expression. In contrast, modification of phenotype was unrelated to changes in the expression of beta(1)- or beta(2)-adrenergic receptor mRNA or protein, or to the mRNA expression of sarcoplasmic reticulum Ca(2) + ATPase and atrial natriuretic peptide. CONCLUSION We conclude that in human DCM, phenotypic modification is selectively associated with myosin heavy chain isoform changes. These data support the hypothesis that myosin heavy chain isoform changes contribute to disease progression in human DCM.
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Affiliation(s)
- W T Abraham
- Division of Cardiology, University of Colorado Health Sciences Center, Denver 80262, USA
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Lowes BD, Gilbert EM, Abraham WT, Minobe WA, Larrabee P, Ferguson D, Wolfel EE, Lindenfeld J, Tsvetkova T, Robertson AD, Quaife RA, Bristow MR. Myocardial gene expression in dilated cardiomyopathy treated with beta-blocking agents. N Engl J Med 2002; 346:1357-65. [PMID: 11986409 DOI: 10.1056/nejmoa012630] [Citation(s) in RCA: 401] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Beta-blocker therapy may improve cardiac function in patients with idiopathic dilated cardiomyopathy. We tested the hypothesis that beta-blocker therapy produces favorable functional effects in dilated cardiomyopathy by altering the expression of myocardial genes that regulate contractility and pathologic hypertrophy. METHODS We randomly assigned 53 patients with idiopathic dilated cardiomyopathy to treatment with a beta-adrenergic-receptor blocking agent (metoprolol or carvedilol) or placebo. The amount of messenger RNA (mRNA) for contractility-regulating genes (those encoding beta1- and beta2-adrenergic receptors, calcium ATPase in the sarcoplasmic reticulum, and alpha- and beta-myosin heavy-chain isoforms) and of genes associated with pathologic hypertrophy (beta-myosin heavy chain and atrial natriuretic peptide) was measured with a quantitative reverse-transcription polymerase chain reaction in total RNA extracted from biopsy specimens of the right ventricular septal endomyocardium. Myocardial levels of beta-adrenergic receptors were also measured. Measurements were conducted at base line and after six months of treatment, and changes in gene expression were compared with changes in the left ventricular ejection fraction as measured by radionuclide ventriculography. RESULTS Twenty-six of 32 beta-blocker-treated patients (those with complete mRNA measurements) had an improvement in left ventricular ejection fraction of at least 5 ejection-fraction (EF) units (mean [+/-SE] increase, 18.8+/-1.8). As compared with the six beta-blocker-treated patients who did not have a response (mean change, a decrease of 2.5+/-1.8 EF units), those who did have a response had an increase in sarcoplasmic-reticulum calcium ATPase mRNA and alpha-myosin heavy chain mRNA and a decrease in beta-myosin heavy chain mRNA. The change in sarcoplasmic-reticulum calcium ATPase was not present in the patients in the placebo group who had a spontaneous response. There were no differences between those who had a response and those who did not in terms of the change in mRNA or protein expression of beta-adrenergic receptors. CONCLUSIONS In idiopathic dilated cardiomyopathy, functional improvement related to treatment with beta-blockers is associated with changes in myocardial gene expression.
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Affiliation(s)
- Brian D Lowes
- Division of Cardiology and the Cardiovascular Institute, University of Colorado Health Sciences Center, Denver 80262, USA
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Jones PP, Shapiro LF, Keisling GA, Quaife RA, Seals DR. Is autonomic support of arterial blood pressure related to habitual exercise status in healthy men? J Physiol 2002; 540:701-6. [PMID: 11956356 PMCID: PMC2290253 DOI: 10.1113/jphysiol.2001.013664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We determined if the tonic autonomic nervous system (ANS) contribution to arterial blood pressure (BP) maintenance in humans is related to habitual endurance exercise status. Twenty-three healthy young (age 18-31 years) males, 11 endurance exercise-trained and 12 untrained, were studied. Maximal oxygen consumption was higher (P < 0.001) and resting heart rate and body fatness were lower (P < 0.05) in the exercise-trained men. Plasma noradrenaline concentrations and BP decreased from baseline levels in response to ganglionic blockade (intravenous trimethaphan) in both groups (all P < 0.001). The absolute (Delta mmHg: systolic = -35 +/- 2 vs. -32 +/- 4; diastolic = -13 +/- 2 vs. -10 +/- 2; mean = -21 +/- 2 vs. -17 +/- 3) and relative (Delta%: systolic = -35 +/- 2 vs. -31 +/- 3; diastolic = -26 +/- 3 vs. -20 +/- 3; mean = -31 +/- 2 vs. -26 +/- 3) decreases in BP were not significantly different between the endurance-trained and untrained men. There were no significant group differences in the heart rate, stroke volume, cardiac output or systemic vascular resistance (conductance) responses to trimethaphan. Systemic vascular alpha-adrenergic sensitivity (slope of the increase in mean BP with incremental phenylephrine infusion during ganglionic blockade) also did not differ in the two groups (endurance-trained: 3.2 +/- 0.5; untrained: 3.2 +/- 0.7 mmHg (ng phenylephrine)(-1) (ml plasma)(-1)). In the pooled sample, the decrease in mean BP during trimethaphan was related to baseline and changes in plasma noradrenaline concentrations (r = 0.58-0.65, P < 0.001) and alpha-adrenergic sensitivity (r = 0.49, P < 0.02). Our results suggest that the endurance exercise-trained state is not obviously associated with altered ANS support of BP in healthy young men. Basal sympathetic nervous system (SNS) activity and alpha-adrenergic vascular sensitivity are significant physiological correlates of ANS support of BP in this population.
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Affiliation(s)
- Pamela Parker Jones
- Department of Kinesiology and Applied Physiology, University of Colorado at Boulder, Boulder, CO 80309, USA.
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Abstract
BACKGROUND This study reports summary biokinetics for 17 patients treated with huBrE-3 antibody labeled with indium-111 ((111)In) and yttrium-90 ((90)Y) in a Phase I dose escalation trial. METHODS Patients were infused with huBrE-3 antibody conjugated to 1-p-isothiocyanatobenzyl 3-methyl- and 1-p-isothiocyanatobenzyl 4-methyl-diethylenetriamine pentaacetic acid (MX-DTPA). The huBrE-3 was labeled with increasing amounts of (90)Y radioactivity according to the following activity regimen: 10 mCi/m(2), 20 mCi/m(2), 33 mCi/m(2), 50 mCi/m(2), and 70 mCi/m(2). In addition to the (90)Y activity, 3--5 mCi of (111)In was labeled to huBrE-3 to serve as an imaging agent. In characterizing the biokinetics of huBrE-3, serial urine and blood samples were acquired. Additionally, whole-body imaging using a scintillation camera was performed at four time points postinfusion. RESULTS Cumulative urine data yielded a plot of total-body biologic excretion that was relatively flat. Total body regions of interest derived from nuclear medicine scintigrams decreased according to a monoexponential function with a slope slightly greater than the rate of physical decay. When physical decay was combined with the urine biologic excretion rate, the calculated rate of activity decrease was indistinguishable from the scintigraphic rate of decrease in total-body activity. CONCLUSIONS The authors concluded from these observations that the radioactivity remains essentially inside the patient, that biologic excretion of activity from the total body is not appreciable, and that the path for biologic excretion of activity that does occur is via the urine. The half-time associated with the beta (slow) phase for extraction from the blood averages 40.5 hours. Since large amounts of radioactivity do not appear in the urine, and total-body activity is decreased approximately according to physical decay (64.1 hours), activity must pool elsewhere after leaving the blood. The logical place is the skeleton, with possible selective binding to the bone marrow. Bone marrow biopsies from 4 of 7 patients who consented to serial biopsies were supportive of this conclusion.
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Affiliation(s)
- Timothy K Johnson
- Department of Radiation Oncology, University of Colorado Health Sciences Center, Denver, Colorado 80010-0510, USA
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Abstract
BACKGROUND Primary aging is associated with changes in the autonomic nervous system (ANS), but the functional significance of these changes for systemic circulatory control of arterial blood pressure (BP) is unknown. We tested the hypothesis that ANS support of BP is altered in healthy older humans. METHODS AND RESULTS A total of 23 young (aged 24+/-1 years; systolic/diastolic BP, 126+/-2/66+/-1 mm Hg) and 16 older (aged 65+/-1 years; systolic/diastolic BP, 125+/-3/62+/-2 mm Hg) healthy men were studied before and during ganglionic blockade (intravenous trimethaphan). The reduction in mean BP (radial artery catheter) with trimethaphan was almost twice as great in the older men (-33+/-2 versus -19+/-2 mm Hg; -40% versus -22% of baseline; P<0.01) due to a lack of increase in heart rate (3+/-2 versus 25+/-2 bpm; P<0.001) and cardiac output (-0.42+/-0.19 versus 1.01+/-0.26 L/min; P<0.001); the decreases in systemic vascular resistance were not different. The absence of tachycardia in the older men was associated with reduced baseline heart rate variability (HRV, P<0.05); the change in heart rate with trimethaphan correlated with the standard deviation of the R-R intervals (HRV(SD R-R interval); r=0.57, P<0.001). Among individual subjects (pooled groups), the reductions in mean BP with trimethaphan were most strongly related to measures of sympathetic activity (r=0.58 to 0.67, P<0.005), change in mean BP with intravenous phenylephrine (r=0.57, P<0.001), and HRV(SD R-R interval) (r=-0.40, P<0.01). CONCLUSIONS ANS support of BP is altered with age in healthy men due to less cardiac vagal inhibition of heart rate and cardiac output. Basal sympathetic activity and alpha-adrenergic vascular sensitivity are also key physiological correlates of ANS support of BP in healthy men.
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Affiliation(s)
- P P Jones
- Department of Kinesiology and Applied Physiology, University of Colorado at Boulder, USA.
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Affiliation(s)
- E C Lin
- Division of Nuclear Medicine, University of Colorado Health Sciences Center, Denver, USA.
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Affiliation(s)
- E C Lin
- Division of Nuclear Medicine, University of Colorado Health Sciences Center, Denver, USA.
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MaWhinney S, Brown ER, Malcolm J, VillaNueva C, Groves BM, Quaife RA, Lindenfeld J, Warner BA, Hammermeister KE, Grover FL, Shroyer AL. Identification of risk factors for increased cost, charges, and length of stay for cardiac patients. Ann Thorac Surg 2000; 70:702-10. [PMID: 11016297 DOI: 10.1016/s0003-4975(00)01510-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND In this study we explored different risk model options to provide clinicians with predictions for resource utilization. The hypotheses were that predictors of mortality are not predictive of resource consumption, and that there is a correlation between cost estimates derived using a cost-to-charge ratio or a product-line costing approach. METHODS From March 1992 to June 1995, 2,481 University of Colorado Hospital patients admitted for ischemic heart disease were classified by diagnosis-related group code as having undergone or experienced coronary bypass procedures (CBP), percutaneous cardiovascular procedures (PCVP), acute myocardial infarction (AMI), and other cardiac-related discharges (Other). For each diagnosis-related group, Cox proportional hazards models were developed to determine predictors of cost, charges, and length of stay. RESULTS The diagnosis groups differed in the clinical factors that predicted resource use. As the two costing methods were highly correlated, either approach may be used to assess relative resource consumption provided costs are reconciled to audited financial statements. CONCLUSIONS To develop valid prediction models for costs of care, the clinical risk factors that are traditionally used to predict risk-adjusted mortality may need to be expanded.
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Affiliation(s)
- S MaWhinney
- Department of Preventive Medicine, University of Colorado Health Sciences Center, Denver, USA
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Quaife RA, Lynch D, Badesch DB, Voelkel NF, Lowes BD, Robertson AD, Bristow MR. Right ventricular phenotypic characteristics in subjects with primary pulmonary hypertension or idiopathic dilated cardiomyopathy. J Card Fail 1999; 5:46-54. [PMID: 10194660 DOI: 10.1016/s1071-9164(99)90024-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Studies of animal models and human subjects with cardiomyopathies suggest that cardiac myocyte and ventricular chamber remodeling show distinct phenotypic characteristics that may be dependent on specific signaling pathways. METHODS AND RESULTS In this study, we characterize right ventricular (RV) chamber size, end-diastolic thickness, myocardial mass, and ejection fraction (EF) in human subjects with chronic heart failure from primary pulmonary hypertension (PPH; n = 10) and idiopathic dilated cardiomyopathy (IDC; n = 10). Subjects underwent gated cardiac magnetic resonance imaging (MRI), and the RVs were phenotypically classified based on the presence or absence of hypertrophy (increased mass), systolic dysfunction (reduced EF), and degree of wall thickness (concentric v eccentric pattern of hypertrophy). Within this schema, five abnormal phenotypes could be identified. In PPH subjects, in whom the RV is subjected to the uniform insult of chronic pressure overload, four different abnormal phenotypes were identified. CONCLUSIONS These data indicate that distinct structural/functional ventricular chamber phenotypes may be classified by MRI, and that a uniform insult can result in multiple RV phenotypes.
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Affiliation(s)
- R A Quaife
- Department of Medicine, University of Colorado Health Sciences Center, Denver 80262, USA
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Bristow MR, Zisman LS, Lowes BD, Abraham WT, Badesch DB, Groves BM, Voelkel NF, Lynch DM, Quaife RA. The pressure-overloaded right ventricle in pulmonary hypertension. Chest 1998; 114:101S-106S. [PMID: 9676654 DOI: 10.1378/chest.114.1_supplement.101s] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- M R Bristow
- Division of Cardiology, University of Colorado Health Science Center, Denver, USA
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Abstract
This study investigated the effects of carvedilol on right ventricular (RV) volume and systolic function in chronic heart failure patients. Carvedilol treatment resulted in a significant improvement of RV ejection fraction and systolic performance, which paralleled the improvement of systolic function demonstrated in the left ventricle.
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Affiliation(s)
- R A Quaife
- Department of Medicine, University of Colorado Health Sciences Center, Denver 80262, USA
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Lowes BD, Minobe W, Abraham WT, Rizeq MN, Bohlmeyer TJ, Quaife RA, Roden RL, Dutcher DL, Robertson AD, Voelkel NF, Badesch DB, Groves BM, Gilbert EM, Bristow MR. Changes in gene expression in the intact human heart. Downregulation of alpha-myosin heavy chain in hypertrophied, failing ventricular myocardium. J Clin Invest 1997; 100:2315-24. [PMID: 9410910 PMCID: PMC508428 DOI: 10.1172/jci119770] [Citation(s) in RCA: 348] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Using quantitative RT-PCR in RNA from right ventricular (RV) endomyocardial biopsies from intact nonfailing hearts, and subjects with moderate RV failure from primary pulmonary hypertension (PPH) or idiopathic dilated cardiomyopathy (IDC), we measured expression of genes involved in regulation of contractility or hypertrophy. Gene expression was also assessed in LV (left ventricular) and RV free wall and RV endomyocardium of hearts from end-stage IDC subjects undergoing heart transplantation or from nonfailing donors. In intact failing hearts, downregulation of beta1-receptor mRNA and protein, upregulation of atrial natriuretic peptide mRNA expression, and increased myocyte diameter indicated similar degrees of failure and hypertrophy in the IDC and PPH phenotypes. The only molecular phenotypic difference between PPH and IDC RVs was upregulation of beta2-receptor gene expression in PPH but not IDC. The major new findings were that (a) both nonfailing intact and explanted human ventricular myocardium expressed substantial amounts of alpha-myosin heavy chain mRNA (alpha-MHC, 23-34% of total), and (b) in heart failure alpha-MHC was downregulated (by 67-84%) and beta-MHC gene expression was upregulated. We conclude that at the mRNA level nonfailing human heart expresses substantial alpha-MHC. In myocardial failure this alteration in gene expression of MHC isoforms, if translated into protein expression, would decrease myosin ATPase enzyme velocity and slow speed of contraction.
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Affiliation(s)
- B D Lowes
- Division of Cardiology, University of Colorado Health Sciences Center, Denver 80262, USA
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Trujillo NP, Pratt JP, Talusani S, Quaife RA, Kumpe D, Lear JL. DTPA aerosol in ventilation/perfusion scintigraphy for diagnosing pulmonary embolism. J Nucl Med 1997; 38:1781-3. [PMID: 9374354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
UNLABELLED The use of lung scintigraphy in evaluating suspected pulmonary embolism (PE) is controversial. Several diagnostic methods have been described for lung scans, of which the most widely applied uses 99mTc-MAA for perfusion, 133Xe for ventilation and PIOPED diagnostic criteria. This study evaluates the accuracy of lung scintigraphy using an alternative ventilation agent, 99mTc-diethylenetriamine pentacetic acid (DTPA) aerosol, and specific criteria. METHODS Diagnostic criteria for DTPA aerosol ventilation were prospectively applied to 5017 patients over a 9-yr period. Lung scan interpretations were analyzed for frequency of occurrence, and results were compared to those of angiography in 455 patients. RESULTS Scans were interpreted as normal, low or high probability in 79% of patients and as either indeterminate or medium probability in 21% of patients. Three patients had normal scans and negative angiography. In patients with low-probability scans, 111 angiograms were performed: 103 (93%) were negative, and 8 (7%) were positive. In patients with indeterminate scans, 114 angiograms were performed: 85 (75%) were negative, and 29 (25%) were positive. In patients with medium-probability scans, 149 angiograms were performed: 86 (58%) were negative, and 63 (42%) were positive. In patients with high-probability scans, 78 angiograms were performed: 6 (8%) were negative, and 72 (92%) were positive. CONCLUSION These results indicate that lung scintigraphy using DTPA aerosol and our criteria is accurate in diagnosing and stratifying risk of pulmonary embolic disease. Compared with 133Xe and PIOPED criteria, DTPA ventilation and our criteria reduced the false-negative rate in low-probability scans (7% versus 16%, p < 0.005) and decreased the fraction of intermediate-probability scans (21 % versus 39%, p < 0.01).
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Affiliation(s)
- N P Trujillo
- Division of Nuclear Medicine, University of Colorado Health Sciences Center, Denver 80226, USA
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