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3. Added prognostic value of visually estimated coronary artery calcium among heart transplant recipients

Author

Clerkin, Kevin J., Sewanan, Lorenzo, Griffin, Jan M., DeFilippis, Ersilia M., Peng, Boyu, Chernovolenko, Margarita, Harris, Erin, Prasad, Nikil, Colombo, Paolo C., Yuzefpolskaya, Melana, Fried, Justin, Raikhelkar, Jayant, Topkara, Veli K., Castillo, Michelle, Lam, Elaine Y., Latif, Farhana, Takeda, Koji, Uriel, Nir, Sayer, Gabriel, and Einstein, Andrew J.

Published
2024
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7. Pulsatility and flow patterns across macro- and microcirculatory arteries of continuous-flow left ventricular assist device patients

Author

Stöhr, Eric J., Ji, Ruiping, Mondellini, Giulio, Braghieri, Lorenzo, Akiyama, Koichi, Castagna, Francesco, Pinsino, Alberto, Cockcroft, John R., Silverman, Ronald H., Trocio, Samuel, Zatvarska, Oksana, Konofagou, Elisa, Apostolakis, Iason, Topkara, Veli K., Takayama, Hiroo, Takeda, Koji, Naka, Yoshifumi, Uriel, Nir, Yuzefpolskaya, Melana, Willey, Joshua Z., McDonnell, Barry J., and Colombo, Paolo C.

Published
2023
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18. Long-term outcomes of patients bridged to recovery with venoarterial extracorporeal life support.

Author

Dardik, Gabriel, Ning, Yuming, Kurlansky, Paul, Almodovar Cruz, Guillermo, Vinogradsky, Alice, Fried, Justin, Topkara, Veli K, and Takeda, Koji

Subjects
CARDIOGENIC shock, PEARSON correlation (Statistics), EXTRACORPOREAL membrane oxygenation, RESEARCH funding, ACADEMIC medical centers, T-test (Statistics), SURVIVAL rate, VENTRICULAR ejection fraction, PROBABILITY theory, MULTIPLE regression analysis, DISCHARGE planning, TREATMENT effectiveness, RETROSPECTIVE studies, DESCRIPTIVE statistics, MANN Whitney U Test, CHI-squared test, HEART failure, LONGITUDINAL method, KAPLAN-Meier estimator, LOG-rank test, CONVALESCENCE, MEDICAL records, ACQUISITION of data, ADRENERGIC beta blockers, CONFIDENCE intervals, DATA analysis software, PROPORTIONAL hazards models, REGRESSION analysis, PATIENT aftercare
Abstract

Objective: Our study examines the long-term outcomes of patients discharged from the hospital without heart replacement therapy (HRT) after recovery from cardiogenic shock using venoarterial extracorporeal life support (VA-ECLS). Methods: We retrospectively reviewed 615 cardiogenic shock patients who recovered from VA-ECLS at our institution between January 2015 and July 2021. Of those, 166 patients (27.0%) who recovered from VA-ECLS without HRT were included in this study. Baseline characteristics, discharge labs, vitals, electrocardiograms and echocardiograms were assessed. Patients were contacted to determine vital status. The primary outcome was post-discharge mortality. Results: Of 166 patients, 158 patients (95.2%) had post-discharge follow-up, with a median time of follow-up of 2 years (IQR: [1 year, 4 years]). At discharge, the median ejection fraction (EF) was 52.5% (IQR: [32.5, 57.5]). At discharge, 92 patients (56%) were prescribed β-blockers, 28 (17%) were prescribed an ACE inhibitor, ARB or ARNI, and 50 (30%) were prescribed loop diuretics. Kaplan-Meier analysis showed a 1-year survival rate of 85.6% (95% CI: [80.1%, 91.2%]) and a 5-year survival rate of 60.6% (95% CI: [49.9%, 71.3%]). A Cox regression model demonstrated that a history of congestive heart failure (CHF) was strongly predictive of increased mortality hazard (HR = 1.929; p = 0.036), while neither discharge EF nor etiology of VA-ECLS were associated with increased post-discharge mortality. Conclusions: Patients discharged from the hospital after full myocardial recovery from VA-ECLS support without HRT should have close outpatient follow-up due to the risk of recurrent heart failure and increased mortality in these patients. [ABSTRACT FROM AUTHOR]

Published
2024
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20. Presence of Intracardiac Thrombus at the Time of Left Ventricular Assist Device Implantation Is Associated With an Increased Risk of Stroke and Death

Author

Bravo, Claudio A., Fried, Justin A., Willey, Joshua Z., Javaid, Azka, Mondellini, Giulio M., Braghieri, Lorenzo, Lumish, Heidi, Topkara, Veli K., Kaku, Yuji, Witer, Lucas, Takayama, Hiroo, Takeda, Koji, Sayer, Gabriel, Uriel, Nir, Demmer, Ryan T., Naka, Yoshifumi, Yuzefpolskaya, Melana, and Colombo, Paolo C.

Published
2021
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24. Role of Artificial Intelligence and Machine Learning to Create Predictors, Enhance Molecular Understanding, and Implement Purposeful Programs for Myocardial Recovery.

Author

LANG, FREDERICK M., LEE, BENJAMIN C., LOTAN, DOR, SABUNCU, MERT R., and TOPKARA, VELI K.

Subjects
ARTIFICIAL intelligence, MACHINE learning, ARTIFICIAL hearts, HEART failure, INDIVIDUALIZED medicine
Abstract

Heart failure (HF) affects millions of individuals and causes hundreds of thousands of deaths each year in the United States. Despite the public health burden, medical and device therapies for HF significantly improve clinical outcomes and, in a subset of patients, can cause reversal of abnormalities in cardiac structure and function, termed "myocardial recovery." By identifying novel patterns in high-dimensional data, artificial intelligence (AI) and machine learning (ML) algorithms can enhance the identification of key predictors and molecular drivers of myocardial recovery. Emerging research in the area has begun to demonstrate exciting results that could advance the standard of care. Although major obstacles remain to translate this technology to clinical practice, AI and ML hold the potential to usher in a new era of purposeful myocardial recovery programs based on precision medicine. In this review, we discuss applications of ML to the prediction of myocardial recovery, potential roles of ML in elucidating the mechanistic basis underlying recovery, barriers to the implementation of ML in clinical practice, and areas for future research. [ABSTRACT FROM AUTHOR]

Published
2024
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25. Hemodynamic Optimization by Invasive Ramp Test in Patients Supported With HeartMate 3 Left Ventricular Assist Device.

Author

RUBINSTEIN, GAL, MOELLER, CATHRINE M., LOTAN, DOR, SLOMOVICH, SHARON, FERNANDEZ-VALLEDOR, ANDREA, OREN, DANIEL, OH, KYUNG T., FRIED, JUSTIN A., CLERKIN, KEVIN J., RAIKHELKAR, JAYANT K., TOPKARA, VELI K., YUJI KAKU, KOJI TAKEDA, YOSHIFUMI NAKA, BURKHOFF, DANIEL, LATIF, FARHANA, MAJURE, DAVID, COLOMBO, PAOLO C., YUZEFPOLSKAYA, MELANA, and SAYER, GABRIEL T.

Published
2024
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28. Gut microbiota, endotoxemia, inflammation, and oxidative stress in patients with heart failure, left ventricular assist device, and transplant

Author

Yuzefpolskaya, Melana, Bohn, Bruno, Nasiri, Mojdeh, Zuver, Amelia M., Onat, Drew D., Royzman, Eugene A., Nwokocha, Joseph, Mabasa, Melissa, Pinsino, Alberto, Brunjes, Danielle, Gaudig, Antonia, Clemons, Autumn, Trinh, Pauline, Stump, Stephania, Giddins, Marla J., Topkara, Veli K., Garan, A. Reshad, Takeda, Koji, Takayama, Hiroo, Naka, Yoshifumi, Farr, Maryjane A., Nandakumar, Renu, Uhlemann, Anne-Catrin, Colombo, Paolo C., and Demmer, Ryan T.

Published
2020
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31. Endoscopic Algorithm for Management of Gastrointestinal Bleeding in Patients With Continuous Flow LVADs: A Prospective Validation Study

Author

Axelrad, Jordan E., Faye, Adam S., Pinsino, Alberto, Thanataveerat, Anusorn, Cagliostro, Barbara, Pineda, Marie Finelle T., Ross, Katherine, Te-Frey, Rosie T., Effner, Lisa, Garan, Arthur R., Topkara, Veli K., Takayama, Hiroo, Takeda, Koji, Naka, Yoshifumi, Ramirez, Ivonne, Garcia-Carrasquillo, Reuben, Colombo, Paolo C., Gonda, Tamas, and Yuzefpolskaya, Melana

Published
2020
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38. Prognostic implications of serial outpatient blood pressure measurements in patients with an axial continuous-flow left ventricular assist device

Author

Pinsino, Alberto, Castagna, Francesco, Zuver, Amelia M., Royzman, Eugene A., Nasiri, Mojdeh, Stöhr, Eric J., Cagliostro, Barbara, McDonnell, Barry, Cockcroft, John R., Garan, A. Reshad, Topkara, Veli K., Schulze, P. Christian, Takeda, Koji, Takayama, Hiroo, Naka, Yoshifumi, Demmer, Ryan T., Willey, Joshua Z., Yuzefpolskaya, Melana, and Colombo, Paolo C.

Published
2019
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43. Utility of a fusion protein T‐cell co‐stimulation blocker Belatacept in heart transplant recipients: Real world experience from a high volume center.

Author

Oren, Daniel, Uriel, Matan, Moeller, Cathrine M., Valledor, Andrea Fernandez, DeFilippis, Ersilia M., Lotan, Dor, Colombo, Paolo C., Yuzefpolskaya, Melana, Topkara, Veli K., Clerkin, Kevin J., Raikhelkar, Jayant K., Fried, Justin A., Oh, David, Bae, David, Lin, Eddie, Theodoropoulos, Kleanthis, Naka, Yoshifumi, Takeda, Koji, Choe, Jason, and Jennings, Douglas L.

Subjects
HEART transplant recipients, KIDNEY transplantation, CHIMERIC proteins, BELATACEPT, T cells, CELL receptors
Abstract

Background: Belatacept (BTC), a fusion protein, selectively inhibits T‐cell co‐stimulation by binding to the CD80 and CD86 receptors on antigen‐presenting cells (APCs) and has been used as immunosuppression in adult renal transplant recipients. However, data regarding its use in heart transplant (HT) recipients are limited. This retrospective cohort study aimed to delineate BTC's application in HT, focusing on efficacy, safety, and associated complications at a high‐volume HT center. Methods: A retrospective cohort study was conducted of patients who underwent HT between January 2017 and December 2021 and subsequently received BTC as part of their immunosuppressive regimen. Twenty‐one HT recipients were identified. Baseline characteristics, history of rejection, and indication for BTC use were collected. Outcomes included renal function, graft function, allograft rejection and mortality. Follow‐up data were collected through December 2023. Results: Among 776 patients monitored from January 2017 to December 2021 21 (2.7%) received BTC treatment. Average age at transplantation was 53 years (± 12 years), and 38% were women. BTC administration began, on average, 689 [483, 1830] days post‐HT. The primary indications for BTC were elevated pre‐formed donor‐specific antibodies in highly sensitized patients (66.6%) and renal sparing (23.8%), in conjunction with reduced calcineurin inhibitor dosage. Only one (4.8%) patient encountered rejection within a year of starting BTC. Graft function by echocardiography remained stable at 6 and 12 months posttreatment. An improvement was observed in serum creatinine levels (76.2% of patients), decreasing from a median of 1.58 to 1.45 (IQR [1.0–2.1] to [1.1–1.9]) over 12 months (p =.054). eGFR improved at 3 and 6 months compared with 3 months pre‐ BTC levels; however, this was not statistically significant (p =.24). Treatment discontinuation occurred in seven patients (33.3%) of whom four (19%) were switched back to full dose CNI. Infections occurred in 11 patients (52.4%), leading to BTC discontinuation in 4 patients (19%). Conclusion: In this cohort, BTC therapy was used as alternative immunosuppression for management of highly sensitized patients or for renal sparing. BTC therapy when combined with CNI dose reduction resulted in stabilization in renal function as measured through renal surrogate markers, which did not, however, reach statistical significance. Patients on BTC maintained a low rejection rate and preserved graft function. Infections were common during BTC therapy and were associated with medication pause/discontinuation in 19% of patients. Further randomized studies are needed to assess the efficacy and safety of BTC in HT recipients. [ABSTRACT FROM AUTHOR]

Published
2024
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44. Right heart failure after durable left ventricular assist device implantation.

Author

Miller, Tamari, Lang, Frederick M., Rahbari, Ashkon, Theodoropoulos, Kleanthis, and Topkara, Veli K.

Subjects
HEART assist devices, ARTIFICIAL blood circulation, HEART failure, HEART failure patients, MEDICAL equipment
Abstract

Right heart failure (RHF) is a well-known complication after left ventricular assist device (LVAD) implantation and portends increased morbidity and mortality. Understanding the mechanisms and predictors of RHF in this clinical setting may offer ideas for early identification and aggressive management to minimize poor outcomes. A variety of medical therapies and mechanical circulatory support options are currently available for the management of post-LVAD RHF. We reviewed the existing definitions of RHF including its potential mechanisms in the context of durable LVAD implantation and currently available medical and device therapies. We performed a literature search using PubMed (from 2010 to 2023). RHF remains a common complication after LVAD implantation. However, existing knowledge gaps limit clinicians' ability to adequately address its consequences. Early identification and management are crucial to reducing the risk of poor outcomes, but existing risk stratification tools perform poorly and have limited clinical applicability. This is an area ripe for investigation with the potential for major improvements in identification and targeted therapy in an effort to improve outcomes. [ABSTRACT FROM AUTHOR]

Published
2024
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