4 results on '"Kennedy, Jamie L. W."'
Search Results
2. Diastolic pulmonary gradient predicts outcomes in group 1 pulmonary hypertension (analysis of the NIH primary pulmonary hypertension registry).
- Author
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Mazimba S, Mejia-Lopez E, Black G, Kennedy JL, Bergin J, Tallaj JA, Abuannadi M, Mihalek AD, and Bilchick KC
- Subjects
- Adolescent, Adult, Cardiac Catheterization, Clinical Trials as Topic, Familial Primary Pulmonary Hypertension mortality, Female, Heart Failure complications, Humans, Hypertension, Pulmonary mortality, Lung physiopathology, Male, Middle Aged, Outcome Assessment, Health Care, Predictive Value of Tests, Prognosis, Pulmonary Wedge Pressure physiology, Registries, Vascular Resistance physiology, Young Adult, Diastole physiology, Familial Primary Pulmonary Hypertension physiopathology, Hypertension, Pulmonary physiopathology, Lung blood supply, Pulmonary Artery physiopathology
- Abstract
Background: Diastolic pulmonary gradient (DPG), calculated as the difference between pulmonary artery diastolic pressure and mean pulmonary capillary wedge pressure ≥ 7 mmHg is associated with pulmonary vascular disease and portends poor prognosis in heart failure (HF). The prognostic relevance of DPG in group 1 pulmonary hypertension (PH) is uncertain., Methods: Using the Pulmonary Hypertension Connection (PHC) risk equation for 225 patients in the NIH-PPH, the 5-year probability of death was calculated, which was then compared with DPG using a Cox proportional hazards model. Kaplan-Meier survival curves were determined for two cohorts using the median DPG of 30 mmHg as cutoff, and significance was tested using the log-rank test., Results: The mean age was 38.1 ± 16.0 years old, 63% female, and 72% were "white". The mean DPG was 31.6 mmHg ± 13.8 mm Hg and only 1.8% had a DPG <7 mm Hg. Increasing DPG was significantly associated with increased 5-year mortality even after adjustment for the PHC risk equation (HR 1.29 per 10 mm Hg increase). When DPG was dichotomized based on the median of 30 mm Hg, the HR for DPG >30 mm Hg with respect to 5-year mortality was 2.03. After adjustment for pulmonary artery systolic pressure (PASP), increasing DPG remained significantly associated with decreased 5 years survival (HR 1.99 for DPG > 30 mm Hg)., Conclusions: DPG is independently associated with survival in group 1 PH patients even after adjustment for the PHC risk equation or PASP. Patients with increased DPG had a 2-fold increased risk of mortality. The use of DPG for guiding treatment and prognosis in group 1 PH should be further investigated., (Copyright © 2016 Elsevier Ltd. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
3. Detection of elevated right ventricular extracellular volume in pulmonary hypertension using Accelerated and Navigator-Gated Look-Locker Imaging for Cardiac T1 Estimation (ANGIE) cardiovascular magnetic resonance.
- Author
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Mehta BB, Auger DA, Gonzalez JA, Workman V, Chen X, Chow K, Stump CJ, Mazimba S, Kennedy JL, Gay E, Salerno M, Kramer CM, Epstein FH, and Bilchick KC
- Subjects
- Adult, Aged, Case-Control Studies, Contrast Media, Feasibility Studies, Female, Fibrosis, Gadolinium DTPA, Heart Failure diagnosis, Heart Failure physiopathology, Heart Ventricles pathology, Humans, Hypertension, Pulmonary complications, Hypertension, Pulmonary physiopathology, Linear Models, Male, Middle Aged, Multivariate Analysis, Observer Variation, Predictive Value of Tests, Prognosis, Reproducibility of Results, Ventricular Function, Left, Heart Ventricles physiopathology, Hypertension, Pulmonary diagnosis, Image Interpretation, Computer-Assisted methods, Magnetic Resonance Imaging, Cine methods, Stroke Volume, Ventricular Function, Right
- Abstract
Background: Assessment of diffuse right ventricular (RV) fibrosis is of particular interest in pulmonary hypertension (PH) and heart failure (HF). Current cardiovascular magnetic resonance (CMR) T1 mapping techniques such as Modified Look-Locker inversion recovery (MOLLI) imaging have limited resolution, but accelerated and navigator-gated Look-Locker imaging for cardiac T1 estimation (ANGIE) is a novel CMR sequence with spatial resolution suitable for T1 mapping of the RV. We tested the hypothesis that patients with PH would have significantly more RV fibrosis detected with MRI ANGIE compared with normal volunteers and patients having HF with reduced (LV) ejection fraction (HFrEF) without co-existing PH, independent of RV dilitation and dysfunction., Methods: Patients with World Health Organization group 1 or group 4 PH, patients with HFrEF without PH, and normal volunteers were recruited to undergo contrast-enhanced CMR. RV and LV extracellular volume fractions (RV-ECV and LV-ECV) were determined using pre-contrast and post-contrast T1 mapping using ANGIE (RV and LV) and MOLLI (LV only)., Results: Thirty-two participants (53.1% female, median age 52 years, IQR 26-65 years) were enrolled, including n = 12 with PH, n = 10 having HFrEF without co-existing PH, and n = 10 normal volunteers. ANGIE ECV imaging was of high quality, and ANGIE measurements of LV-ECV were highly correlated with those of MOLLI (r = 0.91; p < 0.001). The RV-ECV in PH patients was 27.2% greater than the RV-ECV in normal volunteers (0.341 v. 0.268; p < 0.0001) and 18.9% greater than the RV-ECV in HFrEF patients without PH (0.341 v. 0.287; p < 0.0001). RV-ECV was greater than LV-ECV in PH (RV-LV difference = 0.04), but RV-ECV was nearly equivalent to LV-ECV in normal volunteers (RV-LV difference = 0.002) (p < 0.0001 for RV-LV difference in PH versus normal volunteers). RV-ECV was linearly associated with both increasing RVEDVI (p = 0.049) and decreasing RVEF (p = 0.04) in a multivariable linear model, but PH was still associated with greater RV-ECV even after adjustment for RVEDVI and RVEF., Conclusions: Pre- and post-contrast ANGIE imaging provides high-resolution ECV determination for the RV. PH is independently associated with increased RV-ECV even after adjustment for RV dilatation and dysfunction, consistent with an independent effect of PH on fibrosis. ANGIE RV imaging merits further clinical evaluation in PH.
- Published
- 2015
- Full Text
- View/download PDF
4. Mitral stenosis caused by an amplatzer occluder device used to treat a paravalvular leak.
- Author
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Kennedy JL, Mery CM, Kern JA, and Bergin JD
- Subjects
- Anastomotic Leak diagnosis, Aortic Valve pathology, Cardiac Catheterization, Coronary Angiography, Device Removal, Echocardiography, Doppler, Color, Female, Humans, Middle Aged, Mitral Valve pathology, Mitral Valve Stenosis diagnosis, Postoperative Complications diagnosis, Recurrence, Reoperation, Anastomotic Leak surgery, Aortic Valve surgery, Bioprosthesis, Endocarditis, Bacterial surgery, Heart Valve Prosthesis Implantation adverse effects, Mitral Valve surgery, Mitral Valve Stenosis etiology, Mitral Valve Stenosis surgery, Postoperative Complications etiology, Postoperative Complications surgery, Septal Occluder Device adverse effects
- Abstract
Paravalvular leaks following valve replacement can result in heart failure and hemolysis. Surgical intervention is the treatment of choice, but it carries substantial risk of morbidity and mortality. Percutaneous techniques using devices designed for congenital heart disease are increasingly applied to the treatment of paravalvular leaks. We present the case of a mitral paravalvular leak treated with an Amplatzer occluder device. Unfortunately, the device occluded flow through the mitral valve, resulting in symptomatic mitral stenosis requiring surgical intervention., (Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2012
- Full Text
- View/download PDF
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