Publications (116) View all
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Article: Risk Stratification in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy Associated Desmosomal Mutation Carriers.
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ABSTRACT: BACKGROUND: -We investigated the role of phenotypic characteristics in stratifying the risk of sustained ventricular arrhythmias in patients harboring Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) associated mutations. METHODS AND RESULTS: -Clinical, electrocardiographic and arrhythmic outcome (composite measure of first occurrence of sustained ventricular tachycardia/resuscitated sudden cardiac death/sudden cardiac death/appropriate implantable cardioverter-defibrillator therapy) data was obtained for 215 patients (104 families; 85% PKP-2). Over a mean follow up of 7 years, eighty-six (40%) patients experienced the arrhythmic outcome). Event free survival was significantly lower among probands (p<0.001) and symptomatic (p<0.001) patients. Integration of electrocardiographic (ECG) repolarization and depolarization abnormalities allowed for differential risk categorization. Event free survival at 5 years for the low risk ECG group (0-1 T inversions or minor depolarization changes) was 97% vs.81% for the intermediate risk ECG group (2 T inversions + minor depolarization changes) vs. 33% for the high risk ECG group (≥3 T inversions ± major or minor depolarization changes)(p <0.001). Incremental arrhythmic risk was seen in patients with increasing premature ventricular complex count on a Holter (p <0.001). Proband status {HR 7.7; 95%CI 2.8-22.5; P<0.001}, ≥ 3 Twave inversions {HR 4.2; 95% CI 1.2-14.5; P=0.035} and male gender {HR 1.8; 95%CI 1.2-2.8; P=0.004} were independent predictors of the first arrhythmic event on multivariable analysis. CONCLUSIONS: -Pedigree evaluation, an electrocardiogram and a Holter examination provides for comprehensive arrhythmic risk stratification in patients with ARVD/C associated mutations. We propose an approach to risk stratification based on these variables.Circulation Arrhythmia and Electrophysiology 05/2013; · 6.46 Impact Factor -
Article: Outcomes of Cholecystectomy in US Heart Transplant Recipients.
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ABSTRACT: OBJECTIVE:: The aim of this study was to evaluate outcomes and predictors of in-hospital mortality after cholecystectomy in heart transplant (HTx) recipients. BACKGROUND:: There is a paucity of data on outcomes after cholecystectomy in HTx recipients. METHODS:: The Nationwide Inpatient Sample (NIS) database was used to identify HTx recipients who underwent cholecystectomy between 1998 and 2008. Multivariate logistic regression analysis was constructed using clinically relevant covariates (age, gender, Charlson comorbidity index, race, admission acuity, complicated gallstone disease, hospital teaching status, and open versus laparoscopic approach) to identify predictors of in-hospital mortality. RESULTS:: A total of 1687 HTx recipients underwent cholecystectomy (open n = 420; laparoscopic n = 1267) during the study period. Mean age was 57.1 ± 12.5 years, and there were 1230 (72.9%) males. The majority of patients had acute cholecystitis (n = 1218; 72.2%) and were admitted urgently/emergently (n = 1028; 60.9%). Overall inpatient mortality occurred in 37 (2.2%) patients, with a higher mortality rate in open cholecystectomy compared with laparoscopic (6.2% vs. 0.9%; P = 0.009), and in urgent/emergent versus elective cases (3.6% vs. 0%; P = 0.04). Open or urgent/emergent cholecystectomies also had higher overall complication and respiratory failure rates as compared with laparoscopic or elective cases. Predictors of inpatient mortality in multivariable analysis included urgent/emergent admission, open cholecystectomy, and complicated gallstone disease (each P < 0.05). CONCLUSIONS:: This is the largest reported study to date of cholecystectomy in HTx recipients. HTx patients appear to be at increased risk of inpatient mortality and morbidity after cholecystectomy as compared with the general population, and this rate is particularly high in those with a nonelective admission who undergo open cholecystectomy for complicated gallstone disease. Therefore, strong consideration should be given to prophylactic cholecystectomy in HTx recipients with asymptomatic and uncomplicated gallstone disease.Annals of surgery 03/2013; · 7.90 Impact Factor -
Article: The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: Executive summary.
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ABSTRACT: CO-CHAIRS: Feldman D: Minneapolis Heart Institute, Minneapolis, Minnesota, Georgia Institute of Technology and Morehouse School of Medicine; Pamboukian SV: University of Alabama at Birmingham, Birmingham, Alabama; Teuteberg JJ: University of Pittsburgh, Pittsburgh, Pennsylvania TASK FORCE CHAIRS: Birks E: University of Louisville, Louisville, Kentucky; Lietz K: Loyola University, Chicago, Maywood, Illinois; Moore SA: Massachusetts General Hospital, Boston, Massachusetts; Morgan JA: Henry Ford Hospital, Detroit, Michigan CONTRIBUTING WRITERS: Arabia F: Mayo Clinic Arizona, Phoenix, Arizona; Bauman ME: University of Alberta, Alberta, Canada; Buchholz HW: University of Alberta, Stollery Children's Hospital and Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada; Deng M: University of California at Los Angeles, Los Angeles, California; Dickstein ML: Columbia University, New York, New York; El-Banayosy A: Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Elliot T: Inova Fairfax, Falls Church, Virginia; Goldstein DJ: Montefiore Medical Center, New York, New York; Grady KL: Northwestern University, Chicago, Illinois; Jones K: Alfred Hospital, Melbourne, Australia; Hryniewicz K: Minneapolis Heart Institute, Minneapolis, Minnesota; John R: University of Minnesota, Minneapolis, Minnesota; Kaan A: St. Paul's Hospital, Vancouver, British Columbia, Canada; Kusne S: Mayo Clinic Arizona, Phoenix, Arizona; Loebe M: Methodist Hospital, Houston, Texas; Massicotte P: University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada; Moazami N: Minneapolis Heart Institute, Minneapolis, Minnesota; Mohacsi P: University Hospital, Bern, Switzerland; Mooney M: Sentara Norfolk, Virginia Beach, Virginia; Nelson T: Mayo Clinic Arizona, Phoenix, Arizona; Pagani F: University of Michigan, Ann Arbor, Michigan; Perry W: Integris Baptist Health Care, Oklahoma City, Oklahoma; Potapov EV: Deutsches Herzzentrum Berlin, Berlin, Germany; Rame JE: University of Pennsylvania, Philadelphia, Pennsylvania; Russell SD: Johns Hopkins, Baltimore, Maryland; Sorensen EN: University of Maryland, Baltimore, Maryland; Sun B: Minneapolis Heart Institute, Minneapolis, Minnesota; Strueber M: Hannover Medical School, Hanover, Germany INDEPENDENT REVIEWERS: Mangi AA: Yale University School of Medicine, New Haven, Connecticut; Petty MG: University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota; Rogers J: Duke University Medical Center, Durham, North Carolina.The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 02/2013; 32(2):157-87. · 3.54 Impact Factor -
Article: Cerebral blood flow autoregulation is preserved after continuous-flow left ventricular assist device implantation.
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ABSTRACT: To compare cerebral blood flow (CBF) autoregulation in patients undergoing continuous-flow left ventricular assist device (LVAD) implantation with that in patients undergoing coronary artery bypass grafting (CABG). Prospective, observational, controlled study. Academic medical center. Fifteen patients undergoing LVAD insertion and 10 patients undergoing CABG. Cerebral autoregulation was monitored with transcranial Doppler and near-infrared spectroscopy. A continuous Pearson correlation coefficient was calculated between mean arterial pressure (MAP) and CBF velocity and between MAP and near-infrared spectroscopic data, rendering the variables mean velocity index (Mx) and cerebral oximetry index (COx), respectively. Mx and COx approach 0 when autoregulation is intact (no correlation between CBF and MAP), but approach 1 when autoregulation is impaired. Mx was lower during and immediately after cardiopulmonary bypass in the LVAD group than in the CABG group, indicating better-preserved autoregulation. Based on COx monitoring, autoregulation tended to be better preserved in the LVAD group than in the CABG group immediately after surgery (p = 0.0906). On postoperative day 1, COx was lower in the LVAD group than in the CABG group, indicating preserved CBF autoregulation (p = 0.0410). Based on COx monitoring, 3 patients (30%) in the CABG group had abnormal autoregulation (COx ≥0.3) on the first postoperative day but no patient in the LVAD group had this abnormality (p = 0.037). These data suggest that CBF autoregulation is preserved during and immediately after surgery in patients undergoing LVAD insertion.Journal of cardiothoracic and vascular anesthesia 12/2012; 26(6):1022-8. · 1.06 Impact Factor -
Article: The variable natural history of idiopathic dilated cardiomyopathy.
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ABSTRACT: Determining the prognosis of patients with heart failure is essential for patient management and clinical trial conduct. The relative value of traditional prognostic criteria remains unclear and the assessment of long-term prognosis for individual patients is problematic. To determine the ability of clinical, hemodynamic and echocardiographic parameters to predict the long-term prognosis of patients with idiopathic dilated cardiomyopathy. We investigated the ability of clinical, hemodynamic and echocardiographic parameters to predict the long-term prognosis of individual patients in a large, representative, contemporary cohort of idiopathic dilated cardiomyopathy (IDCM) patients referred to Johns Hopkins from 1997 to 2004 for evaluation of cardiomyopathy. In all patients a baseline history was taken, and physical examination, laboratory studies, echocardiogram, right heart catheterization and endomyocardial biopsy were performed. In 171 IDCM patients followed for a median 3.5 years, there were 50 long-term event-free survivors (LTS) (median survival 6.4 years) and 34 patients died or underwent ventricular assist device placement or transplantation within 5 years (NLTS; non-long-term survivors) (median time to event 1.83 years. Established risk factors (gender, race, presence of diabetes, serum creatinine, sodium) and the use of accepted heart failure medications (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta blockers) were similar between the two groups. Although LTS had younger age, higher ejection fraction (EF) and lower New York Heart Association (NYHA) class at presentation, the positive predictive value of an EF < 25% was 64% (95% CI 41%-79%) and that of NYHA class > 2 was 53% (95% CI 36-69%). A logistic model incorporating these three variables incorrectly classified 29% of patients. IDCM exhibits a highly variable natural history and standard clinical predictors have limited ability to classify IDCM patients into broad prognostic categories. These findings suggest that there are important host-environmental factors still unappreciated in the biology of IDCM.The Israel Medical Association journal: IMAJ 11/2012; 14(11):666-71. · 1.02 Impact Factor
