18 results on '"Faris G. Araj"'
Search Results
2. Identifying Discordance of Right- and Left-Ventricular Filling Pressures in Patients With Heart Failure by the Clinical Examination
- Author
-
Robert M. Morlend, Alpesh Amin, Colby Ayers, Faris G. Araj, Mark H. Drazner, Sonia Garg, Elizabeth A. Hardin, Jennifer T. Thibodeau, David Pham, Justin L. Grodin, and Pradeep P.A. Mammen
- Subjects
Male ,medicine.medical_specialty ,Atrial Pressure ,Renal function ,Physical examination ,Article ,Ventricular Function, Left ,Ventricular Dysfunction, Left ,Internal medicine ,Ventricular Pressure ,medicine ,Humans ,In patient ,Pulmonary Wedge Pressure ,Physical Examination ,Heart Failure ,Ejection fraction ,medicine.diagnostic_test ,Venous pressure ,business.industry ,Hemodynamics ,Stroke Volume ,Middle Aged ,medicine.disease ,Heart failure ,Cardiology ,Cardiology and Cardiovascular Medicine ,Ventricular filling ,business - Abstract
Background: In ≈25% of patients with heart failure and reduced left-ventricular ejection fraction, right-ventricular (RV), and left-ventricular (LV) filling pressures are discordant (ie, one is elevated while the other is not). Whether clinical assessment allows detection of this discordance is unknown. We sought to determine the agreement of clinically versus invasively determined patterns of ventricular congestion. Methods: In 156 heart failure and reduced LV ejection fraction subjects undergoing invasive hemodynamic assessment, we categorized patterns of ventricular congestion (no congestion, RV only, LV only, or both) based on clinical findings of RV (jugular venous distention) or LV (hepatojugular reflux, orthopnea, or bendopnea) congestion. Agreement between clinically and invasively determined (RV congestion if right atrial pressure [RAP] ≥10 mm Hg and LV congestion if pulmonary capillary wedge pressure [PCWP] ≥22 mm Hg) categorizations was the primary end point. Results: The frequency of clinical patterns of congestion was: 51% no congestion, 24% both RV and LV, 21% LV only, and 4% RV only. Jugular venous distention had excellent discrimination for elevated RAP (C=0.88). However, agreement between clinical and invasive congestion patterns was poor, к=0.44 (95% CI, 0.34–0.55). While those with no clinical congestion usually had low RAP and PCWP (67/79, 85%), over one-half (24/38, 64%) with isolated LV clinical congestion had PCWP Conclusions: While clinical examination allows accurate detection of elevated RAP, it does not allow accurate detection of discordant RV and LV filling pressures.
- Published
- 2021
3. Ascites and Edema After Bicaval Orthotopic Heart Transplant
- Author
-
Faris G, Araj, Jyoti P, Balani, Alpesh A, Amin, Pradeep P A, Mammen, Sonia, Garg, and Michael, Luna
- Subjects
Anastomosis, Surgical ,Angioplasty ,Ascites ,Edema ,Heart Transplantation ,Humans ,Vena Cava, Inferior - Abstract
IVC stenosis is a rare complication of bicaval orthotopic heart transplant. IVC stenosis can occur at either the cavo-atrial anastomosis, or the caval cannulation site, with presentations ranging from acute shock early post transplant to a more indolent course. Causes include extensive hemostatic suturing, fibrous contraction, and donor-recipient size mismatch. Treatment strategies include percutaneous balloon angioplasty, stenting, and surgical revision. Evaluating for IVC stenosis is recommended for unexplained lower-extremity edema, new-onset ascites, or liver abnormalities after bicaval heart transplant.
- Published
- 2021
4. Letter by Hardin and Araj Regarding Article, 'Role of Pulmonary Artery Wedge Pressure Saturation During Right Heart Catheterization: A Prospective Study'
- Author
-
E. Ashley Hardin and Faris G. Araj
- Subjects
Right heart catheterization ,Heart Failure ,medicine.medical_specialty ,Cardiac Catheterization ,business.industry ,Hypertension, Pulmonary ,Internal medicine ,Cardiology ,medicine ,Humans ,Prospective Studies ,Pulmonary Wedge Pressure ,Cardiology and Cardiovascular Medicine ,Prospective cohort study ,Pulmonary wedge pressure ,Saturation (chemistry) ,business - Published
- 2021
5. Invasive Hemodynamic Red Flags to Left Ventricular Assist Device Implantation
- Author
-
Faris G, Araj, Alpesh A, Amin, Sonia, Garg, and E Ashley, Hardin
- Subjects
Heart Failure ,Hemodynamics ,Ventricular Function, Right ,Humans ,Heart-Assist Devices ,Emblems and Insignia ,Retrospective Studies - Abstract
Reliable identification of patients at high risk for right ventricular failure is very important. We identify 4 parameters as hemodynamic red flags to left ventricular assist device implantation.
- Published
- 2020
6. Heterozygous Cystic Fibrosis Transmembrane Regulator Gene Missense Variants Are Associated With Worse Cardiac Function in Patients With Duchenne Muscular Dystrophy
- Author
-
Chao Xing, Mark H. Drazner, Faris G. Araj, Pradeep P.A. Mammen, Xuan Jiang, Alpesh Amin, Yanqiu Shao, and Benjamin Greenberg
- Subjects
musculoskeletal diseases ,Adult ,Male ,Cardiac function curve ,congenital, hereditary, and neonatal diseases and abnormalities ,Pathology ,medicine.medical_specialty ,Cystic Fibrosis ,Duchene muscular dystrophy–associated cardiomyopathy ,Translational Studies ,Cardiomyopathy ,Duchenne muscular dystrophy ,Mutation, Missense ,Cystic Fibrosis Transmembrane Conductance Regulator ,Magnetic Resonance Imaging, Cine ,Brief Communication ,Cystic fibrosis ,whole exome sequencing ,Dystrophin ,Ventricular Dysfunction, Left ,03 medical and health sciences ,0302 clinical medicine ,Atrophy ,Cardiac magnetic resonance imaging ,Natriuretic Peptide, Brain ,Exome Sequencing ,medicine ,Humans ,Genetic Predisposition to Disease ,Exome sequencing ,030304 developmental biology ,Heart Failure ,genetic modifier ,0303 health sciences ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,Stroke Volume ,medicine.disease ,Peptide Fragments ,Remodeling ,Muscular Dystrophy, Duchenne ,Heart Function Tests ,Female ,Cardiomyopathies ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
Background Duchenne muscular dystrophy (DMD) is a neuromuscular disorder caused by mutations within the dystrophin gene. DMD is characterized by progressive skeletal muscle degeneration and atrophy and progressive cardiomyopathy. It has been observed the severity of cardiomyopathy varies in patients with DMD. Methods and Results A cohort of male patients with DMD and female DMD carriers underwent whole exome sequencing. Potential risk factor variants were identified according to their functional annotations and frequencies. Cardiac function of 15 male patients with DMD was assessed by cardiac magnetic resonance imaging, and various cardiac magnetic resonance imaging parameters and circulating biomarkers were compared between genotype groups. Five subjects carrying potential risk factor variants in the cystic fibrosis transmembrane regulator gene demonstrated lower left ventricular ejection fraction, larger left ventricular end‐diastolic volume, and higher NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) levels compared with 10 subjects who did not carry the potential risk factor variants ( P =0.023, 0.019 and 0.028, respectively). Conclusions This study revealed heterozygous cystic fibrosis transmembrane regulator gene missense variants were associated with worse cardiac function in patients with DMD. The cystic fibrosis transmembrane regulator gene may serve as a genetic modifier that accounts for more severe cardiomyopathy in patients with DMD, who would require more aggressive management of the cardiomyopathy.
- Published
- 2020
7. When a tree falls in a forest and no one is around to hear it, does it make a sound? Yes, it does
- Author
-
Faris G. Araj
- Subjects
Heart Failure ,geography ,geography.geographical_feature_category ,business.industry ,Acoustics ,Forests ,computer.software_genre ,Tree (data structure) ,Medicine ,Humans ,Accidental Falls ,Artificial intelligence ,Cardiology and Cardiovascular Medicine ,business ,computer ,Sound (geography) ,Natural language processing - Published
- 2020
8. Acute Isolated Coronary Artery Dissection Causing Massive Acute Myocardial Infarction and Leading to Unsuccessful Coronary Bypass, Extracorporeal Life Support, and Successful Cardiac Transplantation
- Author
-
Charles S. Roberts, Dan M. Meyer, Jamie Jarzembowski, Cesar Guerrero-Miranda, Andrea Cooley, Julie Cox, William C. Roberts, and Faris G. Araj
- Subjects
Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Coronary Vessel Anomalies ,Myocardial Infarction ,030204 cardiovascular system & hematology ,Extracorporeal ,03 medical and health sciences ,0302 clinical medicine ,Extracorporeal Membrane Oxygenation ,Internal medicine ,Extracorporeal membrane oxygenation ,Medicine ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Vascular Diseases ,Coronary Artery Bypass ,Heart transplantation ,Arterial dissection ,business.industry ,medicine.disease ,Transplantation ,medicine.anatomical_structure ,Treatment Outcome ,Shock (circulatory) ,Acute Disease ,Cardiology ,Heart Transplantation ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Described herein is a 42-year-old woman who suddenly developed a spontaneous isolated coronary arterial dissection which led to massive acute myocardial infarction with shock, unsuccessful coronary artery bypass grafting, transiently successful extracorporeal life support, and finally successful heart transplant. Such a sequence of events is exceedingly rare for patients with coronary dissection and prompted this report.
- Published
- 2019
9. Bendopnea and risk of adverse clinical outcomes in ambulatory patients with systolic heart failure
- Author
-
Jennifer T. Thibodeau, Pradeep P.A. Mammen, Robert M. Morlend, Colby Ayers, Alpesh Amin, Punag Divanji, Jeomi Maduka, Faris G. Araj, Mark H. Drazner, and Benjamin E. Jenny
- Subjects
Male ,Risk ,Inotrope ,medicine.medical_specialty ,medicine.medical_treatment ,Posture ,Cardiac index ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,Prospective Studies ,030212 general & internal medicine ,Aged ,Proportional Hazards Models ,business.industry ,Proportional hazards model ,Hazard ratio ,Middle Aged ,medicine.disease ,Hospitalization ,Transplantation ,Dyspnea ,Ventricular assist device ,Heart failure ,Ambulatory ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Heart Failure, Systolic - Abstract
Recently, the symptom of bendopnea, that is, shortness of breath when bending forwards such as when putting on shoes, has been described in heart failure patients and found to be associated with higher ventricular filling pressures, particularly in the setting of low cardiac index. However, it is not known whether bendopnea is associated with clinical outcomes.In a prospective convenience sample of 179 patients followed in our heart failure disease management clinic, we determined the presence of bendopnea at the time of enrollment and ascertained clinical outcomes through 1 year of follow-up. We performed univariate and stepwise multivariable modeling to test the association of bendopnea with clinical outcomes.Bendopnea was present in 32 of 179 (18%) subjects. At 1 year, those with versus without bendopnea were at increased risk of the composite endpoint of death, heart failure admission, inotrope initiation, left ventricular assist device implantation, or cardiac transplantation in univariate (hazard ratio [HR] 1.9, P.05) but not multivariable (HR 1.9, P = .11) analysis. Bendopnea was more strongly associated with short-term outcomes including heart failure admission at 3 months in both univariate (HR 3.1, P.004) and multivariable (HR 2.5, P = .04) analysis.Bendopnea was associated with an increased risk of adverse outcomes in ambulatory patients with heart failure, particularly heart failure admission at 3 months.
- Published
- 2017
10. Impact of induction immunosuppression on patient survival in heart transplant recipients treated with tacrolimus and mycophenolic acid in the current allocation era
- Author
-
Faris G. Araj, Alpesh Amin, Mark H. Drazner, Venkatesh Kumar Ariyamuthu, Pradeep P.A. Mammen, Mutlu Mete, Mehmet U. S. Ayvaci, Bekir Tanriover, and Marcus A. Urey
- Subjects
Graft Rejection ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Tacrolimus ,Mycophenolic acid ,Resource Allocation ,Postoperative Complications ,Risk Factors ,Internal medicine ,medicine ,Humans ,Retrospective Studies ,Immunosuppression Therapy ,Transplantation ,business.industry ,Graft Survival ,Retrospective cohort study ,Immunosuppression ,Patient survival ,Middle Aged ,Mycophenolic Acid ,Prognosis ,Survival Rate ,Cohort ,Propensity score matching ,Heart Transplantation ,Female ,Observational study ,business ,Immunosuppressive Agents ,Follow-Up Studies ,medicine.drug - Abstract
Background The practice of induction therapy with either rabbit anti-thymocyte globulin (r-ATG) or interleukin-2 receptor antagonists (IL-2RA) is common among heart transplant recipients. However, its benefits in the setting of contemporary maintenance immunosuppression with tacrolimus/mycophenolic acid (TAC/MPA) are unknown. Methods We compared post-transplant mortality among three induction therapy strategies (r-ATG vs IL2-RA vs no induction) in a retrospective cohort analysis of heart transplant recipients maintained on TAC/MPA in the Organ Procurement Transplant Network (OPTN) database between the years 2006 and 2015. We used a multivariable model adjusting for clinically important co-morbidities, and a propensity score analysis using the inverse probability weighted (IPW) method in the final analysis. Results In multivariable IPW analysis, r-ATG (HR = 1.23; 95% CI = 1.05-1.46, P = 0.01) remained significantly associated with a higher mortality. There was a trend toward having a higher mortality in the IL2-RA (HR = 1.11; 95% CI = 1.00-1.24, P = 0.06) group. Subgroup analyses failed to show a patient survival benefit in using either r-ATG or IL2-RA among any of the subgroups analyzed. Conclusion In this contemporary cohort of heart transplant recipients receiving TAC/MPA, neither r-ATG nor IL2-RA were associated with a survival benefit. On the contrary, adjusted analyses showed a significantly higher mortality in the r-ATG group and a trend toward higher mortality in the IL2-RA group. While caution is needed in interpreting treatment effects in an observational cohort, these data call into question the benefit of induction therapy as a common practice and highlight the need for more studies.
- Published
- 2019
11. Aim For the Bubbles: Agitated Saline Injection as an Adjunct Technique to Ultrasound-Guided Subclavian Vein Cannulation
- Author
-
Faris G, Araj, Jose, Pena, and Julie, Cox
- Subjects
Catheterization, Central Venous ,Air ,Injections, Intravenous ,Humans ,Saline Solution ,Subclavian Vein ,Ultrasonography, Interventional - Abstract
Agitated saline during central line placement is described for the purpose of identifying the subclavian vein during ultrasound-guided procedures.
- Published
- 2019
12. Leadless Pacemaker Implant After Heart Transplant
- Author
-
Faris G. Araj, Robert M. Morlend, and James D. Daniels
- Subjects
Male ,medicine.medical_specialty ,Pacemaker, Artificial ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Heart transplant recipient ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Heart transplantation ,Conduction abnormalities ,business.industry ,Pacemaker implant ,Equipment Design ,Transvenous pacemakers ,Heart Block ,Echocardiography ,Cardiology ,Heart Transplantation ,Permanent pacemaker ,Cardiology and Cardiovascular Medicine ,business - Abstract
Conduction abnormalities are known to occur after heart transplantation. In some cases, a permanent pacemaker is required. Conventional transvenous pacemakers can result in several complications, mainly related to the leads and device pocket. Leadless pacemaker technology was developed to overcome these issues. We report what we believe is the first US case of a leadless pacemaker implant (specifically in a heart transplant recipient) with the longest reported duration of follow-up.
- Published
- 2019
13. Infective endocarditis: Don’t forget the ICE
- Author
-
Faris G. Araj and Michael Luna
- Subjects
medicine.medical_specialty ,Endocarditis ,business.industry ,General surgery ,ComputingMethodologies_IMAGEPROCESSINGANDCOMPUTERVISION ,MEDLINE ,Endocarditis, Bacterial ,General Medicine ,medicine.disease ,Imaging modalities ,03 medical and health sciences ,0302 clinical medicine ,Infective endocarditis ,Humans ,Medicine ,030212 general & internal medicine ,business - Abstract
To the Editor : We read with great interest the article by Mgbokikwe et al about newer and more sophisticated imaging modalities for the evaluation of infective endocarditis.[1][1] As outlined in Table 1 of the article, each imaging method has its advantages and limitations. One further imaging
- Published
- 2020
14. Delayed febrile response with bloodstream infections in patients with continuous-flow left ventricular assist devices
- Author
-
Christopher A. Wrobel, William K. Cornwell, Alpesh Amin, Jennifer T. Thibodeau, Robert M. Morlend, Colby Ayers, Justin L. Grodin, Sonia Garg, Faris G. Araj, Mark H. Drazner, David Pham, Pradeep P.A. Mammen, and Ricardo M. La Hoz
- Subjects
Inotrope ,Adult ,Male ,medicine.medical_specialty ,Time Factors ,Fever ,Heart Ventricles ,030204 cardiovascular system & hematology ,030230 surgery ,General Biochemistry, Genetics and Molecular Biology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Sepsis ,Medicine ,Humans ,In patient ,Aged ,Retrospective Studies ,Heart Failure ,business.industry ,Continuous flow ,General Medicine ,Middle Aged ,medicine.disease ,equipment and supplies ,Disease control ,Pathophysiology ,Lower temperature ,Catheter ,Heart failure ,Cardiology ,Female ,Heart-Assist Devices ,business - Abstract
Bloodstream infections (BSIs) are common in patients with continuous-flow left ventricular assist devices (CF-LVADs). Whether CF-LVADs modulate the febrile response to BSIs is unknown. We retrospectively compared the febrile response to BSIs in patients with heart failure (HF) with CF-LVADs versus a control population of patients with HF receiving inotropic infusions. BSIs were adjudicated using the Centers for Disease Control and Prevention and the National Healthcare Safety Network criteria. Febrile status (temperature ≥38°C, 100.4 °F), temperature at presentation with BSI, and the highest temperature within 72 hours (Tmax) were collected. We observed 59 BSIs in LVAD patients and 45 BSIs in controls. LVAD patients were more likely to be afebrile and to have a lower temperature at presentation than control (88% vs 58%, p=0.002, and 37°C ±0.7 vs 37.7°C ±1.0, p=0.0009, respectively). By 72 hours, the difference in afebrile status diminished (53% vs 44%, p=0.42), and the Tmax was similar between the LVAD and control groups (37.9°C±0.9 vs 38.2°C±0.8, respectively, p=0.10). In conclusion, at presentation with a BSI, the vast majority of CF-LVAD patients were afebrile, an event which occurred at a higher frequency when compared with patients with advanced HF on chronic inotropes via an indwelling venous catheter. These data alert clinicians to have a very low threshold to obtain blood cultures in CF-LVAD patients even in the absence of fever. Further study is needed to determine whether a delayed or diminished febrile response represents another pathophysiological consequence of CF-LVADs.
- Published
- 2018
15. In-Hospital Cardiopulmonary Arrests in Patients With Left Ventricular Assist Devices
- Author
-
Dan M. Meyer, Mark H. Drazner, Brian Bethea, Jennifer T. Thibodeau, Matthias Peltz, Faris G. Araj, Catherine Fitzsimmons, Colby Ayers, Sonia Garg, and William K. Cornwell
- Subjects
Adult ,Male ,medicine.medical_specialty ,Resuscitation ,medicine.medical_treatment ,Population ,Risk Assessment ,Cause of Death ,Internal medicine ,medicine ,Humans ,Hospital Mortality ,Cardiopulmonary resuscitation ,education ,Aged ,Retrospective Studies ,Cause of death ,Heart Failure ,Inpatients ,education.field_of_study ,business.industry ,Advanced cardiac life support ,Retrospective cohort study ,Middle Aged ,equipment and supplies ,Survival Analysis ,Cardiopulmonary Resuscitation ,Heart Arrest ,Blood pressure ,Case-Control Studies ,Cardiology ,Arterial line ,Female ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,Hospital Rapid Response Team - Abstract
Background: Basic and advanced cardiac life support guidelines do not address resuscitation of patients with continuous-flow (CF) left ventricular assist devices (LVADs). As the population of LVAD patients increases, it becomes important to understand how to provide emergency care to such patients.We retrospectively reviewed a consecutive series of patients with an implanted CF-LVAD who had an in-hospital cardiopulmonary arrest at our medical center from January 2011 to October 2013. We compared them with a matched cohort of patients without LVADs who had an inhospital cardiopulmonary arrest during the same time period. Code documentation was used to determine arrest characteristics, perfusion assessment techniques, and time to cardiopulmonary resuscitation (CPR) initiation. There were 415 in-hospital arrests during the study period, and 4% (n 5 16) occurred in patients with CF-LVADs. Response teams used various approaches to assess arterial perfusion, including palpation or Doppler of the arterial pulse and measurement of blood pressure by Doppler or arterial line. Nine of the 16 patients required CPR, but only 5 (56%) received CPR in !2 minutes. In the control group (n 5 32) of patients without an LVAD, 22 received CPR, which was initiated within 2 minutes in all (100%) of the patients.Cardiopulmonary arrests in LVAD patients accounted for 4% of all arrests in our center. We identified important time delays in CPR initiation, highlighting the need to develop resuscitation guidelines for this patient population.
- Published
- 2014
16. Predictors of Death in Adults With Duchenne Muscular Dystrophy–Associated Cardiomyopathy
- Author
-
Rohan Khera, Jennifer T. Thibodeau, Justin L. Grodin, Pradeep P.A. Mammen, Faris G. Araj, Sonia Garg, Mark H. Drazner, Daniel Cheeran, Robert M. Morlend, Sandeep R Das, Shaida Khan, Anish B. Bhatt, and Alpesh Amin
- Subjects
Male ,Maximal Respiratory Pressures ,Time Factors ,Duchenne muscular dystrophy ,Cardiomyopathy ,Comorbidity ,030204 cardiovascular system & hematology ,0302 clinical medicine ,Risk Factors ,cardiac biomarkers ,Cause of Death ,Natriuretic Peptide, Brain ,Medicine ,Young adult ,Lung ,Original Research ,Cause of death ,2. Zero hunger ,education.field_of_study ,Prognosis ,Texas ,3. Good health ,Inhalation ,Cohort ,Female ,Cardiomyopathies ,Cardiology and Cardiovascular Medicine ,Adult ,medicine.medical_specialty ,Population ,Young Adult ,03 medical and health sciences ,Thinness ,Internal medicine ,Humans ,education ,Retrospective Studies ,Heart Failure ,heart failure therapy ,business.industry ,prognostic factors ,Retrospective cohort study ,medicine.disease ,Peptide Fragments ,Surgery ,Muscular Dystrophy, Duchenne ,Heart failure ,business ,cardiomyopathy ,Biomarkers ,030217 neurology & neurosurgery - Abstract
Background Duchenne muscular dystrophy ( DMD ) is frequently complicated by development of a cardiomyopathy. Despite significant medical advances provided to DMD patients over the past 2 decades, there remains a group of DMD patients who die prematurely. The current study sought to identify a set of prognostic factors that portend a worse outcome among adult DMD patients. Methods and Results A retrospective cohort of 43 consecutive patients was followed in the adult UT Southwestern Neuromuscular Cardiomyopathy Clinic. Clinical data were abstracted from the electronic medical record to generate baseline characteristics. The population was stratified by survival to time of analysis and compared with characteristics associated with death. The DMD population was in the early 20s, with median follow‐up times over 2 years. All the patients had developed a cardiomyopathy, with the majority of the patients on angiotensin‐converting enzyme inhibitors (86%) and steroids (56%), but few other guideline‐directed heart failure medications. Comparison between the nonsurviving and surviving cohorts found several poor prognostic factors, including lower body mass index (17.3 [14.8–19.3] versus 25.8 [20.8–29.1] kg/m 2 , P P =0.001), maximum inspiratory pressures (13 [0–30] versus 33 [25–40] cmH 2 O, P =0.03), and elevated cardiac biomarkers (N‐terminal pro‐brain natriuretic peptide: 288 [72–1632] versus 35 [21–135] pg/mL, P =0.03]. Conclusions The findings demonstrate a DMD population with a high burden of cardiomyopathy. The nonsurviving cohort was comparatively underweight, and had worse respiratory profiles and elevated cardiac biomarkers. Collectively, these factors highlight a high‐risk cardiovascular population with a worse prognosis.
- Published
- 2017
17. Induction regimen and survival in simultaneous heart-kidney transplant recipients
- Author
-
Fatih Ozay, Mark H. Drazner, Mythili Ghanta, Venkatesh Kumar Ariyamuthu, Faris G. Araj, Alpesh Amin, Bekir Tanriover, Prince Mohan, Sumit Mohan, Pradeep P.A. Mammen, Mutlu Mete, and Mehmet U. S. Ayvaci
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Urology ,030204 cardiovascular system & hematology ,Tacrolimus ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,030212 general & internal medicine ,Survival analysis ,Aged ,Retrospective Studies ,Immunosuppression Therapy ,Transplantation ,Proportional hazards model ,business.industry ,Hazard ratio ,Panel reactive antibody ,Immunosuppression ,Induction Chemotherapy ,Middle Aged ,Mycophenolic Acid ,Kidney Transplantation ,Confidence interval ,Survival Rate ,Cohort ,Heart Transplantation ,Prednisone ,Surgery ,Female ,Cardiology and Cardiovascular Medicine ,business ,Immunosuppressive Agents - Abstract
Background Induction therapy in simultaneous heart-kidney transplantation (SHKT) is not well studied in the setting of contemporary maintenance immunosuppression consisting of tacrolimus (TAC), mycophenolic acid (MPA), and prednisone (PRED). Methods We analyzed the Organ Procurement and Transplant Network registry from January 1, 2000, to March 3, 2015, for recipients of SHKT ( N = 623) maintained on TAC/MPA/PRED at hospital discharge. The study cohort was further stratified into 3 groups by induction choice: induction ( n = 232), rabbit anti-thymoglobulin (r-ATG; n = 204), and interleukin-2 receptor-α ( n = 187) antagonists. Survival rates were estimated using the Kaplan-Meier estimator . Multivariable inverse probability weighted Cox proportional hazard regression models were used to assess hazard ratios associated with post-transplant mortality as the primary outcome. The study cohort was censored on March 4, 2016, to allow at least 1-year of follow-up. Results During the study period, the number of SHKTs increased nearly 5-fold. The Kaplan-Meier survival curve showed superior outcomes with r-ATG compared with no induction or interleukin-2 receptor-α induction. Compared with the no-induction group, an inverse probability weighted Cox proportional hazard model showed no independent association of induction therapy with the primary outcome. In sub-group analysis, r-ATG appeared to lower mortality in sensitized patients with panel reactive antibody of 10% or higher (hazard ratio, 0.19; 95% confidence interval, 0.05–0.71). Conclusion r-ATG may provide a survival benefit in SHKT, especially in sensitized patients maintained on TAC/MPA/PRED at hospital discharge.
- Published
- 2017
18. Concentric left ventricular hypertrophy as assessed by cardiac magnetic resonance imaging and risk of death in cardiac transplant recipients
- Author
-
Sharon C. Reimold, Clyde W. Yancy, Mark H. Drazner, Pradeep P.A. Mammen, W. Steves Ring, Ronald M Peshock, David W. Markham, Joseph D. Mishkin, Faris G. Araj, Patricia A. Kaiser, Colby Ayers, Sachin Gupta, and Parag C. Patel
- Subjects
Pulmonary and Respiratory Medicine ,Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Diastole ,Left ventricular hypertrophy ,Young Adult ,Sex Factors ,Cardiac magnetic resonance imaging ,Risk Factors ,Internal medicine ,Cause of Death ,Medicine ,Humans ,Risk factor ,Cause of death ,Retrospective Studies ,Heart transplantation ,Transplantation ,medicine.diagnostic_test ,business.industry ,Odds ratio ,medicine.disease ,Magnetic Resonance Imaging ,Treatment Outcome ,Cardiology ,Heart Transplantation ,Surgery ,Female ,Hypertrophy, Left Ventricular ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine - Abstract
Although risk factors for left ventricular (LV) hypertrophy in the native heart are well known, as is its association with increased risk of adverse outcomes, such information is poorly defined in heart transplant (HTx) recipients. We determined whether increased LV mass and concentricity (mass/volume) were associated with death in patients after HTx.Between May 2003 and May 2006, 140 HTx recipients underwent cardiac magnetic resonance imaging (MRI). Clinical characteristics associated with increased LV mass were determined. Cox proportional hazard models were constructed to assess the relationship of LV mass and concentricity with death.MRIs were acquired a median of 6.0 years after transplant. The top quartile of indexed LV mass and concentricity were 35.8 g/m(2.7) or higher and 1.5 g/ml or higher, respectively. History of rejection (odds ratio [OR], 5.9; 95% confidence interval [CI], 2.1-16.4; p0.01), diabetes (OR, 3.3; 95% CI, 1.3-8.2; p = 0.01), and post-transplant year of MRI acquisition (OR, 1.2; 95% CI, 1.1-1.4; p0.01) were associated with the top quartile of LV mass in multivariable models. LV mass and concentricity were independently associated with cardiovascular death (hazard risk [HR], 1.11 per g/m;(2.7) HR, 10.1 per g/ml, p ≤ 0.01, respectively). LV concentricity was independently associated with all-cause mortality (HR, 4.4 per g/ml, p0.01).A history of rejection and diabetes are associated with increased LV mass. Increased LV mass, particularly of a concentric phenotype, is an independent risk factor for cardiovascular and all-cause mortality after HTx.
- Published
- 2010
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.