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114. Pregnancy Outcomes in Women With Heart Disease: The CARPREG II Study

Author

Silversides, Candice K., Grewal, Jasmine, Mason, Jennifer, Sermer, Mathew, Kiess, Marla, Rychel, Valerie, Wald, Rachel M., Colman, Jack M., and Siu, Samuel C.

Subjects
cardiology, heart failure, pregnancy, risk score, arrhythmia, outcomes, cardiomyopathy, congenital heart disease, mortality, valve disease
Abstract

Background: Identifying women at high risk is an important aspect of care for women with heart disease. Objectives: This study sought to: 1) examine cardiac complications during pregnancy and their temporal trends; and 2) derive a risk stratification index. Methods: We prospectively enrolled consecutive pregnant women with heart disease and determined their cardiac outcomes during pregnancy. Temporal trends in complications were examined. A multivariate analysis was performed to identify predictors of cardiac complications and these were incorporated into a new risk index. Results: In total, 1,938 pregnancies were included. Cardiac complications occurred in 16% of pregnancies and were primarily related to arrhythmias and heart failure. Although the overall rates of cardiac complications during pregnancy did not change over the years, the frequency of pulmonary edema decreased (8% from 1994 to 2001 vs. 4% from 2001 to 2014; p value = 0.012). Ten predictors of maternal cardiac complications were identified: 5 general predictors (prior cardiac events or arrhythmias, poor functional class or cyanosis, high-risk valve disease/left ventricular outflow tract obstruction, systemic ventricular dysfunction, no prior cardiac interventions); 4 lesion-specific predictors (mechanical valves, high-risk aortopathies, pulmonary hypertension, coronary artery disease); and 1 delivery of care predictor (late pregnancy assessment). These 10 predictors were incorporated into a new risk index (CARPREG II [Cardiac Disease in Pregnancy Study]). Conclusions: Pregnancy in women with heart disease continues to be associated with significant morbidity, although mortality is rare. Prediction of maternal cardiac complications in women with heart disease is enhanced by integration of general, lesion-specific, and delivery of care variables.

Published
2018

118. Contributors

Author

Aaronson, Keith D., Ackerman, Michael J., Ades, Philip A., Albert, Christine M., Albert, Michelle A., Alberts, Mark J., Al-Kindi, Sadeer, Anavekar, Nandan S., Attia, Zachi, Babu-Narayan, Sonya V., Baddour, Larry M., Baggish, Aaron L., Bairey Merz, C. Noel, Bakris, George L., Balady, Gary J., Balzer, David T., Beckman, Joshua A., Bers, Donald M., Bhatnagar, Aruni, Bhatt, Deepak L., Biondi, Bernadette, Blankstein, Ron, Bohula, Erin A., Bonaca, Marc P., Bonow, Robert O., Borlaug, Barry A., Bradfield, Jason S., Braunwald, Eugene, Braverman, Alan C., Brush, John E., Jr., Calkins, Hugh, Canty, John M., Jr., Carney, Robert M., Chandrashekhar, Y.S., Chen, Peng-Shen, Chung, Mina K., Cooper, Leslie T., Jr., Creager, Mark A., Cremer, Paul C., Crestanello, Juan A., Curtis, Anne B., Dangas, George D., Daubert, James P., de Lemos, James A., Després, Jean-Pierre, Devries, Stephen, Di Carli, Marcelo F., Dorbala, Sharmila, Dorfman, Adam L., Duncker, Dirk J., Ellenbogen, Kenneth A., Everett, Thomas H., IV, Fang, James C., Felker, G. Michael, Fleg, Jerome L., Fleisher, Lee A., Forman, Daniel E., Freedland, Kenneth E., Friedman, Paul, Gaziano, J. Michael, Gaziano, Thomas A., Genest, Jacques, Gerszten, Robert, Gillam, Linda D., Giudicessi, John R., Giugliano, Robert P., Goldberger, Ary L., Goldberger, Jeffrey J., Goldhaber, Samuel Z., Groh, William J., Gulati, Martha, Hahn, Rebecca Tung, Hasenfuss, Gerd, Herrmann, Howard C., Herrmann, Joerg, Hershberger, Ray E., Ho, Carolyn Y., Hsue, Priscilla Y., Hundley, W. Gregory, Inzucchi, Silvio E., Jacobson, Francine L., Januzzi, James L., Jr., Joynt Maddox, Karen E., Kalman, Jonathan M., Kapa, Suraj, Kern, Morton J., Kinlay, Scott, Klein, Allan L., Kloner, Robert A., Knowlton, Kirk U., Krieger, Eric V., Krumholz, Harlan M., Kumbhani, Dharam J., Kwong, Raymond Y., Ky, Bonnie, Lam, Carolyn S.P., Larose, Eric, Lasala, John M., Lenihan, Daniel J., Lenze, Eric J., Leon, Martin B., LeWinter, Martin M., Libby, Peter, Lindenfeld, JoAnn, Lindman, Brian R., Mack, Michael J., Madjid, Mohammad, Mann, Douglas L., Maron, Bradley A., Marx, Nikolaus, Mason, Justin C., Maurer, Mathew S., McCullough, Peter A., McGuire, Darren K., McMurray, John, McNally, Elizabeth M., Mehran, Roxana, Miller, John M., Mirvis, David M., Mocumbi, Ana Olga, Mora, Samia, Morady, Fred, Morris, Alanna A., Morrow, David A., Mozaffarian, Dariush, Musunuru, Kiran, Myerburg, Robert J., Natarajan, Pradeep, Nattel, Stanley, Nishimura, Rick A., Nkomo, Vuyisile T., Noseworthy, Peter, O’Gara, Patrick T., Olgin, Jeffrey E., Ommen, Steve R., Otto, Catherine M., Pagani, Francis D., Patton, Kristen K., Pellikka, Patricia A., Piazza, Gregory, Pibarot, Philippe, Poirier, Paul, Prabhakaran, Dorairaj, Rajagopalan, Sanjay, Reardon, Michael J., Redline, Susan, Rezkalla, Shereif, Rich, Michael W., Ridker, Paul M, Roden, Dan M., Ruberg, Frederick L., Sabatine, Marc S., Sanders, Prashanthan, Schermerhorn, Marc, Scirica, Benjamin M., Seto, Arnold H., Shah, Sanjiv J., Shahanavaz, Shabana, Shivkumar, Kalyanam, Silversides, Candice K., Siu, Samuel C., Solomon, Scott D., Sorrentino, Matthew J., Starling, Randall C., Stevenson, William G., Teerlink, John R., Tester, David J., Thomas, Randal Jay, Thompson, Paul D., Tomaselli, Gordon F., Turakhia, Mintu P., Valente, Anne Marie, Vardeny, Orly, Waters, David D., Weitz, Jeffrey I., Wenger, Nanette Kass, Wilson, Walter R., Wu, Justina C., Zeppenfeld, Katja, and Zile, Michael R.

Published
2022
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119. Contributors

Author

Abbas, Amr E., Addetia, Karima, Afilalo, Jonathan, Ahmed, Hanna N., Ahmed, Mohamed, Alizadeh, Ahmadreza, Alnabelsi, Talal S., Alviar, Carlos L., Anderson, Bonita, Annabi, Mohamed-Salah, Arsanjani, Reza, Asch, Federico M., Aurigemma, Gerard P., Axsom, Kelly, Badano, Luigi P., Balakrishnan, Revathi, Bamira, Daniel, Bansal, Manish, Bax, Jeroen J., Beigel, Roy, Berkowitz, Eric, Bernard, Samuel, Bertrand, Philippe B., Blanchard, Daniel G., Bruce, Matthew, Buggey, Jonathan, Burstow, Darryl J., Byrd, Benjamin, III, Carerj, Ludovica, Carerj, Scipione, Carroll, John D., Chaliki, Hari P., Chamsi-Pasha, Mohammed A., Chan, Jonathan, Chan, Kwan-Leung, Chetrit, Michael, Chitroceanu, Alexandra Maria, Chidsey, Geoff, Ciampi, Quirino, Clavel, Marie-Annick, Conroy, Jennifer, Cui, Vivian W., Cusmà-Piccione, Maurizio, Daneshvar, Daniel A., Danik, Jacqueline S., Davidoff, Ravin, Davidson, Brian P., DeCara, Jeanne M., Delgado, Victoria, DeMaria, Anthony N., Desai, Ankit A., Dianati-Maleki, Neda, Dickey, John B., Doherty, Bryan, Donnino, Robert, Douglas, Pamela S., Dryden, Adam M., Dulgheru, Raluca Elena, Dumesnil, Jean G., Edwards, Natalie F.A., Eidem, Benjamin W., El Hangouche, Nadia, Elkayam, Uri, Erenberg, Francine, Evangelista, Arturo, Faza, Nadeen N., Fazlinezhad, Afsoon, Ferreira, Beatriz, Fine, Nowell M., Flink, Laura, Flint, Nir, Fordyce, Christopher B., Freed, Benjamin H., Galatas, Christos, Gardin, Julius M., Gill, Edward A., Gill, Kudrat, Gillam, Linda D., Giovannone, Steven, Girgis, Mina, Goldberger, Mark, Goldstein, Steven A., Gong, Fei Fei, Gorcsan, John, III, Grapsa, Julia, Grawe, Erin S., Gupta, Pooja, Gupta, Vedant A., Gurudevan, Swaminatha V., Guzzetti, Ezequiel, Hahn, Rebecca T., Hellawell, Jennifer, Hoit, Brian D., Hoss, Sara, Hsieh, Grace, Humes, Richard, Hung, Judy, Islam, Sabrina, Isselbacher, Eric M., Jackson, Kamari C., Jain, Renuka, Kadosh, Bernard, Kahn, Peter A., Katayama, Minako, Keane, Martin G., Kenigsberg, Benjamin B., Khandheria, Bijoy K., Khazan, Benjamin, Kimura, Bruce J., Kirkpatrick, James N., Klein, Allan L., Kodra, Arber, Kohli, Payal, Kort, Smadar, Kosmala, Wojciech, Kremkau, Frederick W., Krieger, Eric V., Kronzon, Itzhak, Kumar, Preetham, Kwon, Agatha, Lai, Wyman W., Lambert, A. Stephane, Lancellotti, Patrizio, Lang, Roberto M., Lau, Katherine, Le Ven, Florent, Lee, Hanna, Lehenbauer, Kyle R., Lester, Steven J., Leung, Steve W., Lin, Aaron C.W., Lindner, Jonathan R., Little, Stephen H., Liu, Shiying, Longobardo, Luca, Lopez, Leo, Sainz, Ángela López, Luis, Sushil Allen, Main, Michael L., Mangion, Judy R., Mankad, Sunil V., Maragiannis, Dimitrios, Marcus, Rachel, Marwick, Thomas H., Masri, S. Carolina, Mehla, Priti, Mehta, Sudhir Ken, Mendelson, Todd, Mir, Hassan, Mitchell, Carol, Mookadam, Farouk, Moran, Tyler B., Morcos, Michael, Muraru, Denisa, Nagueh, Sherif F., Namasivayam, Mayooran, Naqvi, Tasneem Z., Narang, Akhil, Negishi, Kazuaki, Niaz, Talha, Nishtala, Arvind, Nkomo, Vuyisile T., O’Connell, Thomas F., Oechslin, Erwin, Olson, Joan, Panza, Julio A., Papolos, Alexander I., Parikh, Roosha K., Parker, Matthew W., Patel, Amit R., Patel, Aneet, Patel, Hena N., Patel, Yash, Perk, Gila, Peters, Andrew C., Peters, Ferande, Pham, Duc Thinh, Pibarot, Philippe, Picano, Eugenio, Picard, Michael H., Plana, Juan Carlos, Popović, Zoran B., Porter, Thomas R., Postolache, Adriana, Pun, Shawn C., Quaife, Robert A., Rahko, Peter S., Rakowski, Harry, Ramchand, Jay, Rankin, Kate, Rao, Rajeev V., Rashedi, Nina, Rearick, Corey, Rigolin, Vera H., Roberson, David A., Rodríguez Palomares, José F., Roemer, Sarah M., Ross, Eleanor, Ruberg, Frederick L., Rudski, Lawrence G., Ruiz, Carlos E., Salaun, Erwan, Salcedo, Ernesto E., Yoerger Sanborn, Danita M., Sanil, Yamuna, Saric, Muhamed, Scalia, Gregory M., Schiller, Nelson B., Sengupta, Partho P., Shah, Atman P., Shanewise, Jack S., Shanks, Miriam, Shernan, Stanton K., Sicari, Rosa, Siddiqi, Omar K., Siegel, Robert J., Singh, Amita, Sinner, Gregory J., Siu, Samuel, Sorrell, Vincent L., Sperlongano, Simona, Stainback, Raymond F., Takeuchi, Masaaki, Tamarappoo, Balaji K., Tejpal, Astha, Thavendiranathan, Paaladinesh, Thomas, James D., Trost, Biana, Tsang, Michael Y.C., Tsang, Wendy, Umland, Matt M., Vainrib, Alan F., Venturini, Joseph M., Vignon, Philippe, Wald, Rachel, Watanabe, Nozomi, Wei, Kevin, Weissman, Neil J., Welch, Mariko, White, Brent, Williams, Lynne, Woo, Anna, Xie, Feng, Zito, Concetta, and Zoghbi, William A.

Published
2022
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120. Contributors

Author

Aboulhosn, Jamil A., Akoum, Nazem, Banchs, Jose, Bax, Jeroen J., Beladan, Carmen C., Bouleti, Claire, Brosnan, Maria, Buber, Jonathan, Burchill, Luke J., Carroll, John D., Celermajer, David S., Cheng, Andrew, Cheng, Richard K., Clavel, Marie-Annick, Cohen, Jennifer, Danik, Jacqueline, Deen, Jason F., Delgado, Victoria, Di Tullio, Marco R., Drake, Daniel H., Evangelista, Arturo, Edvardsen, Thor, Fender, Erin A., Freeman, Rosario V., Galian Gay, Laura, Gerber, Ivor L., Gonzales, Holly, Greaves, MMedSci, Sally Caroline, Gupta, Deepak K., Hall, Michael L., Heitner, Stephen B., Huang, Gary, Hung, Judy, Iung, Bernard, Jander, Nikolaus, Kim, Yuli Y., Kirkpatrick, James N., Krieger, Eric V., Lang, Roberto M., Lee, James, Lin, Jeannette, Lindner, Jonathan R., Linefsky, Jason P., Mackensen, G. Burkhard, Masri, Ahmad, Masri, Sofia Carolina, McConnaughey, Shannon, Minners, Jan, Miranda, William R., Nihoyannopoulos, Petros, Otto, Catherine M., Owens, David S., Oxorn, Donald C., Pibarot, Philippe, Playford, David, Popescu, Bogdan A., Prior, David, Prutkin, Jordan M., Quaife, Robert A., Rader, Florian, Raghav, Vrishank, Roldan, Carlos A., Salcedo, Ernesto E., Samad, Zainab, Sanders, Stephen P., Schlendorf, Kelly H., Sheu, Richard, Sidebotham, David A., Siegel, Robert J., Silversides, Candice K., Siu, Samuel C., Smiseth, Otto A., Stainback, Raymond F., Stern, Kenan W.D., Tanner, Felix C., Torp, Hans, Tsang, Wendy, Vahanian, Alec, Valente, Anne Marie, van der Bijl, Pieter, Wald, Rachel M., Wang, Andrew, Wang, Dee Dee, Welch, Terrence D., Yoganathan, Ajit P., Zaidi, Ali N., and Zimmerman, Karen G.

Published
2022
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125. Comparative efficacy of nifedipine gastrointestinal therapeutic system versus diltiazem when added to beta blockers in stable angina pectoris

Author

Siu, Samuel C., Jacoby, Richard M., Phillips, Roland T., and Nesto, Richard W.

Subjects
Nifedipine -- Evaluation, Diltiazem -- Evaluation, Adrenergic beta blockers -- Health aspects, Angina pectoris -- Drug therapy, Health
Abstract

To determine the relative efficacy of nifedipine gastrointestinal therapeutic system (GITS) and diltiazem, 20 patients with angina pectoris and coronary artery disease were studied in a double-blinded, placebo-controlled randomized crossover trial. All patients were taking concomitant [Beta] blockers. Efficacy was assessed by symptoms, exercise treadmill testing, and ambulatory ST monitoring at baseline and after 6 weeks on each medication. Mean daily dose was titrated to 119 [+ or -] 7 mg (nifedipine GITS) and 342 [+ or -] 59 mg (diltiazem). The addition of either nifedipine GITS or diltiazem resulted in a significant reduction in angina frequency, improvement in exercise treadmill duration (7 vs 7 and 8 minutes; baseline vs nifedipine GITS and diltiazem), time to angina onset 4 vs 7 and 7 minutes; baseline vs nifedipine GITS and diltiazem), and time to ST-segment depression 5 vs 6 and 7 minutes; baseline vs nifedipine GITS and diltiazem). There was no significant difference between nifedipine GITS and diltiazem with respect to the magnitude of improvement in anginal symptoms or exercise test parameters. Both nifedipine GITS and diltiazem reduced the overall frequency and duration of ischemic episodes on ambulstory monitoring, but this reduction was not statistically different. Thus, nifedipine GITS and diltiazem at maximally tolerated doses were equally effective at reducing angina and increasing exercise tolerance as [Beta] blockers alone. (Am J Cardiol 1993;71:887-892)

Published
1993

129. Coronary artery disease in the octogenarian: angiographic spectrum and suitability for revascularization

Author

Kowalchuk, Glen J., Siu, Samuel C., and Lewis, Stanley M.

Subjects
Transluminal angioplasty -- Usage, Aging -- Physiological aspects, Coronary artery bypass -- Usage, Coronary heart disease -- Care and treatment, Coronary heart disease -- Demographic aspects, Health
Abstract

The angiographic findings of 84 consecutive octogenarians presenting with symptoms of coronary artery disease (CAD) were examined to determine the extent of CAD as well as suitability for both coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA). The frequency of 0-, 1-, 2-, and 3-vessel and left main CAD was 7, 14, 21, 57 and 13%, respectively. Based on angiographic criteria, 69 of 78 patients (88%) with significant CAD had suitable coronary anatomy for CABG. Only 24 patients (31%) had coronary anatomy amenable to PTCA. CABG was performed in 19 patients with an operative mortality of 16% and major complication rate of 37%. PTCA was performed in 12 patients with a clinical success rate of 83%, mortality of 8% and major complication rate of 8%. It is concluded that in octogenarians with CAD, cardiac catheterization will often reveal coronary anatomy that is suitable for CABG but less suitable for PTCA. The morbidity and mortality associated with these interventions are high. (Am J Cardiol 1990;66:1319-1323), Coronary artery disease (CAD) is a progressive condition in which the blood vessels supplying the heart are partially or completely obstructed, resulting in diminished blood flow to the heart (myocardial ischemia). Age is an important determinant in the development of this condition, which can lead to heart attack and death. Treatment is generally carried out by either coronary artery bypass grafting (CABG) or mechanically expanding the blocked arteries with a balloon-tipped catheter (percutaneous transluminal coronary angioplasty, or PTCA). In elderly patients, particularly those over 80 years of age, CABG may be associated with a high degree of mortality. PTCA, a less invasive procedure with lower mortality, is not applicable to all cases of CAD. To assess these factors, researchers studied the angiographic findings of 84 patients (80 years of age or older) who were being treated for symptoms of CAD. The patients were diagnosed with one-vessel (14 percent), two-vessel (21 percent), three-vessel (57 percent), or left main artery (13 percent) CAD. Eighty-eight percent had CAD that was amenable to CABG; only 31 percent had CAD that was amenable to PTCA. Of the 19 patients who underwent CABG, 3 died; of the 12 patients who underwent PTCA, one died. Elderly patients with symptoms of CAD are more often treatable by CABG than by PTCA; in this age group mortality associated with both procedures is high. (Consumer Summary produced by Reliance Medical Information, Inc.)

Published
1990

131. Pregnancy Outcomes in Women With Heart Disease

Author

Silversides, Candice K., primary, Grewal, Jasmine, additional, Mason, Jennifer, additional, Sermer, Mathew, additional, Kiess, Marla, additional, Rychel, Valerie, additional, Wald, Rachel M., additional, Colman, Jack M., additional, and Siu, Samuel C., additional

Published
2018
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136. Contributors

Author

Afifi, Ahmed, Aiello, Vera D., Allen, Kiona, Alsaied, Tarek, Anderson, Jeffrey, Anderson, Robert H., Apitz, Christian, Asija, Ritu, Backer, Carl L., Baker, Annette, Bamforth, Simon D., de Faria, Guilherme Baptista, Barron, David J., Bates, Katherine E., Benson, Lee N., Berger, John Torrey, III, Berger, Stuart, Block, Joseph R., Brawn, William J., Brizard, Christian P., Bronicki, Ronald A., Brothers, Julie, Brown, David W., Brown, Nigel A., Bruneau, Benoit G., Bryant, Roosevelt, III, Bryant-Stephens, Tyra, Burn, John, Bryant, Roosevelt G., III, Calcagni, Giulio, Caldarone, Christopher, Camarda, Joseph A., Cameron, Duke E., Chaouki, Ahmad Sami, Cheung, Yiu-Fai, Christov, Georgi, Chung, Michael, Cohen, Mitchell I., Colman, Jack M., Crucean, Adrian, Daubeney, Piers E.F., Davis, Sarah Prochaska, Dayton, Jeffrey D., Dearani, Joseph, Dees, Lynn, Digilio, M. Cristina, Dionne, Audrey, Dipchand, Anne I., Dixon, Garth, d'Udekem, Yves, Ebels, Tjark, ElGuindy, Ahmed M., Elias, Barbara A., English, Robert, Etheridge, Susan P., Fisk, Anna, Flores, Saul, Fraser, Charles D., III, Freud, Lindsay R., Gentles, Thomas L., Jaeggi, Edgar, Gardiner, Helena M., Ghanayem, Nancy S., Giesinger, Regan E., Ginde, Salil, Goldberg, David J., Goldstein, Bryan H., Goldstein, Stuart L., Gowda, Srinath T., Green, Amanda S., Grogan, Kelly L., Grosse, Scott D., Gruber, Peter, Gupta, Saurabh K., Haller, Christoph, Hanley, Frank L., Harris, Matthew, Hayman, Laura, Hilton-Kamm, Debra, Hlavacek, Anthony M., Ho, Deborah Y., Hoffman, George M., Holzer, Ralf J., Hornberger, Lisa K., Hraska, Viktor, Hugo-Hamman, Christopher, Iyer, Krishna, Iyer, Parvathi, Jacobs, Marshall, James, Jeanne, Jefferies, John Lynn, Johnson, Joyce Tawfik, Jokhadar, Maan, Justino, Henri, Kasparian, Nadine A., Khoury, Michael, Kirk, Richard, Kirsch, Roxanne, Koffarnus, Mara, Kostolny, Martin, Kropf, Paulette Andrea, Kumar, Krishna, Kyle, William B., Lannon, Carole, Licht, Daniel J., Lihn, Stacey, Loepke, Andreas W., Loomba, Rohit S., Ma, Michael, Madrigal, Vanessa, Marcondes, Luciana, Marino, Bradley S., Marino, Bruno, Marshall, Audrey C., McBride, Michael G., McBrien, Angela, McCrindle, Brian W., McElhinney, Doff B., McNamara, Patrick J., Mertens, Luc L., Milano, Elena G., Miller, Kelley D., Mohun, Timothy J., Mokshagundam, Deepa, Moore, Ryan A., Morales, David L.S., Morgan, Conall T., Moon, Thomas, Moons, Philip, Mori, Shumpei, Mota, Cleonice, Muñiz, Juan-Carlos G., Mussatto, Kathleen, Naim, Maryam Y., Newburger, Jane W., Newkirk, Betsy, O'Leary, Patrick W., Olen, Melissa, Opotowsky, Alexander R., Oster, Matthew E., Paridon, Stephen M., Pasquali, Sara K., Penny, Daniel J., Perak, Amanda M., Perlow, Gabriel, Petit, Christopher J., Phillips, Alistair, Pinto, Nelangi M., Poh, Chin Leng, Presnell, Laura, Quail, Michael A., Qureshi, Athar M., Raczka, Lauren E., Reagor, James A., Rebolledo, Michael, Redington, Andrew N., Reid, Christopher, Remenyi, Bo, Rhodes, John F., Rice, Kathryn, Riggs, Kyle W., Riley, Christine M., Robbins, Jeffrey, Rossano, Joseph W., Rudd, Nancy A., Ryan, Thomas D., Rychik, Jack, Sable, Craig, Salvin, Joshua W., Satou, Gary, Savoca, Melanie Lyn, Saxena, Anita, Schmelzer, Anne C., Schmidt, Julie, Schumacher, Kurt R., Seed, Mike, Sermer, Mathew, Shaddy, Robert E., Shah, Sanket, Shekerdemian, Lara S., Shirali, Girish S., Siegel, Bryan, Silversides, Candice, Simpson, John, Sinha, Manish D., Siu, Samuel, Skinner, Jonathan, Smith, Liz, Soquet, Jerome, Spicer, Diane E., Srivastava, Deepak, Stephens, Paul, Jr, St. George-Hyslop, Cecilia, Stumper, Oliver, Szwast, Anita, Tanem, Jena, Taylor, Andrew M., Tretter, Justin T., Tweddell, James S., Tworetzky, Wayne, Unolt, Marta, Urbina, Elaine, Utens, Elisabeth M.W.J., Van, Glen S., Vanderlaan, Rachel D., Verghese, George, Versacci, Paolo, Villa, Chet Ridall, Vricella, Luca A., Wagner, Jonathan, Webster, Gregory, Wernovsky, Gil, Wilson, Nigel, Wise-Faberowski, Lisa, Yacub, Magdi, and Yoo, Shi-Joon

Published
2020
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138. Paediatric-onset coronary artery anomalies in pregnancy: a single-centre experience and systematic literature review

Author

Keir, Michelle, primary, Bhagra, Catriona, additional, Vatenmakher, Debra, additional, Arancibia-Galilea, Francisca, additional, Jansen, Katrijn, additional, Toh, Norihisa, additional, Silversides, Candice K., additional, Colman, Jack, additional, Siu, Samuel C., additional, Sermer, Mathew, additional, Crean, Andrew M., additional, and Wald, Rachel M., additional

Published
2017
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139. Development of a Core Outcome Set for Studies on Cardiac Disease in Pregnancy (COSCarP): a study protocol.

Author

D'Souza, Rohan, Hall, Chelsea, Sermer, Mathew, Siu, Samuel, and Silversides, Candice

Subjects
PREGNANCY complications, HEART diseases, PRENATAL care, PREGNANCY
Abstract

Background: Clinical studies looking at interventions to optimize pregnancy and long-term outcomes for women with cardiac disease and their babies are inconsistent in their reporting of clinical outcomes, making it difficult to compare results across studies and draw meaningful conclusions. The development of a core outcome set (COS)-a standardized, minimum set of outcomes that must be collected and reported in all studies-is a practical solution to this problem.Methods/design: We will follow a five-step process in developing a COS for studies on pregnant women with cardiac disease. First, a systematic literature review will identify all reported outcomes (including patient-reported outcomes) and definitions. Second, semi-structured interviews with stakeholders involved in the care of pregnant women with cardiac disease will determine their perspective and add new outcomes that they consider important. Third, an international electronic Delphi survey will narrow outcomes obtained through the first two steps, in an attempt to arrive at a consensus. Fourth, a face-to-face consensus meeting will deliberate to finalize the COS. Finally, measurement tools and definitions for included outcomes will be determined through a series of literature reviews and Delphi surveys.Discussion: This protocol provides an overview of the steps involved in the development of a COS that must be reported in studies involving pregnant women with cardiac disease, in an attempt to harmonize outcome reporting and ensure the validity of study results that will not only inform clinical practice and future research but also encourage the development of COS in other areas of medicine. COMET CORE OUTCOME SET REGISTRATION: http://www.comet initiative.org/studies/details/834. [ABSTRACT FROM AUTHOR]

Published
2020
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140. Ventricular arrhythmias and sudden death in adults after a Mustard operation for transposition of the great arteries

Author

Schwerzmann, Markus, Salehian, Omid, Harris, Louise, Siu, Samuel C., Williams, William G., Webb, Gary D., Colman, Jack M., Redington, Andrew, Silversides, Candice K., Schwerzmann, Markus, Salehian, Omid, Harris, Louise, Siu, Samuel C., Williams, William G., Webb, Gary D., Colman, Jack M., Redington, Andrew, and Silversides, Candice K.

Abstract

Aims To examine the prevalence of sustained ventricular tachycardia (VT) and sudden death (SD) in adults with atrial repair of transposition of the great arteries (TGA) and to determine associated risk factors. Methods and results In a single-centre review, we studied the outcome of 149 adults (mean age 28 ± 7 years) who had undergone a Mustard operation for TGA. During a mean follow-up of 9 ± 6 years, sustained VT and/or SD occurred in 9% (13/149) of the cohort. Sustained VT/SD was more likely to occur in patients with associated anatomic lesions [hazard ratio (HR) 4.9, 95% CI 1.5-16.0], with NYHA class ≥III (HR 9.8, 95% CI 3.0-31.6) and with an impaired subaortic right ventricular (RV) ejection fraction (EF) (HR 2.2, 95% CI 1.2-4.0 per 10% decrease in EF). There was an inverse correlation between the RV-EF and both age and QRS duration. Patients with a QRS duration ≥140 ms were at highest risk of sustained VT/SD (HR 13.6, 95% CI 2.9-63.4). Atrial tachyarrhythmia was detected in 66 (44%) patients, but was not a statistically significant predictor of sustained VT/SD in our adult population (HR 2.7, 95% CI 0.6-13.0). Conclusion Sustained VT/SD in adults after a Mustard operation for TGA are more common than previously described. Age, systemic ventricular function, and QRS duration are interrelated and are associated with VT/SD. A QRS duration ≥140 ms helps to identify the high risk patient

Published
2017

146. Prevalence and correlates of successful transfer from pediatric to adult health care among a cohort of young adults with complex congenital heart defects

Author

Reid, Graham J., Irvine, M. Jane, McCrindle, Brian W., Sananes, Renee, Ritvo, Paul G., Siu, Samuel C., and Webb, Gary D.

Abstract

Objectives. More than 85% of children born today with chronic medical conditions will live to adulthood, and many should transfer from pediatric to adult health care. The numbers of adults with congenital heart defects (CHDs) are increasing rapidly. Current guidelines recommend that just over half of adult CHD patients should be seen every 12 to 24 months by a cardiologist with specific CHD expertise at a regional CHD center, because they are at risk for serious complications (eg, reoperation and/or arrhythmias) and premature mortality. The present study aimed to determine the percent of young adults with CHDs who successfully transferred from pediatric to adult care and examine correlates of successful transfer. Design. Cross-sectional study with prevalence data from an entire cohort. Setting and Patients. All patients (n = 360) aged 19 to 21 years with complex CHDs who, according to current practice guidelines, should be seen annually at a specialized adult CHD center were identified from the database of the cardiology program at the Hospital for Sick Children in Toronto, Canada, a pediatric tertiary care center. Of these patients, 234 completed measures about health beliefs, health behaviors, and medical care since 18 years. Main Outcome Measure. All 15 specialized adult CHD centers in Canada formed the Canadian Adult Congenital Heart (CACH) Network. Attendance for at least 1 follow-up appointment at a CACH center before the age of 22 years was ascertained for all eligible patients. Attendance at a CACH center provides a clear criterion for successful transfer. Results. In the total cohort, 47% (95% confidence interval [CI]: 42-52) had transferred successfully to adult care. There was no difference in rates of successful transfer between patients consenting to complete questionnaires (48%) and those who declined (47%). More than one quarter (27%) of the patients reported having had no cardiac appointments since 18 years. In multivariate analyses of the entire cohort, successful transfer was significantly associated with more pediatric cardiovascular surgeries (odds ratio [OR]: 2.47; 95% CI: 1.40-4.37), older age at last visit to the Hospital for Sick Children (OR: 1.29; 95% CI: 1.10-1.51), and documented recommendations in the medical chart for follow-up at a CACH center. In multivariate analyses of the patients completing questionnaires, successful transfer was significantly related to documented recommendations and patient beliefs that adult CHD care should be at a CACH center (OR: 3.64; 95% CI: 1.34-9.90). Comorbid conditions (OR: 3.13; 95% CI: 1.13-8.67), not using substances (eg, binge drinking; OR: 0.18; 95% CI: 0.07-0.50), using dental antibiotic prophylaxis (OR: 4.23; 95% CI: 1.48-12.06), and attending cardiac appointments without parents or siblings (OR: 6.59; 95% CI: 1.61-27.00) also correlated with successful transfer. Conclusions. This is the first study to document the percent of young adults with a chronic illness who successfully transfer to adult care in a timely manner. Patients were from an entire birth cohort from the largest pediatric cardiac center in Canada, and outcome data were obtained on all eligible patients. Similar data should be obtained for other chronic illnesses. There is need for considerable improvement in the numbers of young adults with CHDs who successfully transfer to adult care. At-risk adolescents with CHDs should begin the transition process before their teens, should be educated in the importance of antibiotic prophylaxis, should be contacted if a follow-up appointment is missed, and should be directed to a specific CHD cardiologist or program, with the planned timing being stated explicitly. Adult care needs to be discussed in the pediatric setting, and patients must acquire appropriate beliefs about adult care well before transfer. Developmentally appropriate, staged discussions involving the patient, with and without parents, throughout adolescence may help patients acquire these beliefs and an understanding of the need for ongoing care. Improved continuity of pediatric care and provision of clear details for adult follow-up might be sufficient to cause substantive improvements in successful transfer. An understanding of why patients drop out of pediatric care may be needed to improve the continuity of care throughout adolescence. Almost one quarter of the patients believed adult care should be somewhere other than at a CACH center despite opposite recommendations. For these patients, a single discussion of adult care during the final pediatric visit may be too little, too late. In addition to earlier discussions, multiple mechanisms such as referral letters and transition clinics are needed. Similarly, patients engaging in multiple risky or poor health behaviors such as substance use may need more intensive programs to make substantial changes in these behaviors, which hopefully would lead to successful transfer. Overall, these data support the view that transition to adult care (a planned process of discussing and preparing for transfer to an adult health center) is important and should begin well before patients are transferred. The future health of adults with chronic conditions may depend on our ability to make these changes. Pediatrics 2004;113:e197-e205. URL: http://www.pediatrics.org/cgi/ content/full/113/3/e197; congenital heart defects, transition, transfer, continuity of care, adolescent, young adult.

Published
2004

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