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Work 1-10 of 32

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Article

Emerging Research Directions in Adult Congenital Heart Disease A Report From an NHLBI/ACHA Working Group

by Michelle Gurvitz; Kristin M. Burns; Ralph Brindis; Craig S. Broberg; Curt J. Daniels; Stephanie M.P.N. Fuller; Margaret A. Honein; Paul Khairy; Karen S. Kuehl; Michael J. Landzberg; William Mahle; Douglas L. Mann; Ariane Marelli; Jane W. Newburger; Gail D. Pearson; Randall C. Starling; Glenn R. Tringali; Anne Marie Valente; Joseph C. Wu; Robert M. Califf

2016

Subjects
  • Health Sciences, General
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© 2016 American College of Cardiology Foundation.Congenital heart disease (CHD) is the most common birth defect, affecting about 0.8% of live births. Advances in recent decades have allowed >85% of children with CHD to survive to adulthood, creating a growing population of adults with CHD. Little information exists regarding survival, demographics, late outcomes, and comorbidities in this emerging group, and multiple barriers impede research in adult CHD. The National Heart, Lung, and Blood Institute and the Adult Congenital Heart Association convened a multidisciplinary working group to identify high-impact research questions in adult CHD. This report summarizes the meeting discussions in the broad areas of CHD-related heart failure, vascular disease, and multisystem complications. High-priority subtopics identified included heart failure in tetralogy of Fallot, mechanical circulatory support/transplantation, sudden cardiac death, vascular outcomes in coarctation of the aorta, late outcomes in single-ventricle disease, cognitive and psychiatric issues, and pregnancy.

Article

Clinical Events After Deferral of LAD Revascularization Following Physiological Coronary Assessment

by Sayan Sen; Yousif Ahmad; Hakim-Moulay Dehbi; James P. Howard; Juan F. Iglesias; Rasha Al-Lamee; Ricardo Petraco; Sukhjinder Nijjer; Ravinay Bhindi; Sam Lehman; Darren Walters; James Sapontis; Luc Janssens; Christiaan J. Vrints; Ahmed Khashaba; Mika Laine; Eric Van Belle; Florian Krackhardt; Waldemar Bojara; Olaf Going; Tobias Haerle; Ciro Indolfi; Giampaolo Niccoli; Flavio Ribichini; Nobuhiro Tanaka; Hiroyoshi Yokoi; Hiroaki Takashima; Yuetsu Kikuta; Andrejs Erglis; Hugo Vinhas; Pedro Canas Silva; Sergio B. Baptista; Ali Alghamdi; Farrel Hellig; Bon-Kwon Koo; Chang-Wook Nam; Eun-Seok Shin; Joon-Hyung Doh; Salvatore Brugaletta; Eduardo Alegria-Barrero; Martijin Meuwissen; Jan J. Piek; Niels van Royen; Murat Sezer; Carlo Di Mario; Robert T. Gerber; Iqbal S. Malik; Andrew S.P. Sharp; Suneel Talwar; Kare Tang; Habib Samady; John Altman; Arnold H. Seto; Jasvindar Singh; Allen Jeremias; Hitoshi Matsuo; Rajesh K. Kharbanda; Manesh R. Patel; Patrick Serruys; Javier Escaned; Justin E. Davies

2019

Subjects
  • Health Sciences, Medicine and Surgery
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Background: Physicians are not always comfortable deferring treatment of a stenosis in the left anterior descending (LAD) artery because of the perception that there is a high risk of major adverse cardiac events (MACE). The authors describe, using the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) trial, MACE rates when LAD lesions are deferred, guided by physiological assessment using fractional flow reserve (FFR) or the instantaneous wave-free ratio (iFR). Objectives: The purpose of this study was to establish the safety of deferring treatment in the LAD using FFR or iFR within the DEFINE-FLAIR trial. Methods: MACE rates at 1 year were compared between groups (iFR and FFR) in patients whose physiological assessment led to LAD lesions being deferred. MACE was defined as a composite of cardiovascular death, myocardial infarction (MI), and unplanned revascularization at 1 year. Patients, and staff performing follow-up, were blinded to whether the decision was made with FFR or iFR. Outcomes were adjusted for age and sex. Results: A total of 872 patients had lesions deferred in the LAD (421 guided by FFR, 451 guided by iFR). The event rate with iFR was significantly lower than with FFR (2.44% vs. 5.26%; adjusted HR: 0.46; 95% confidence interval [CI]: 0.22 to 0.95; p = 0.04). This was driven by significantly lower unplanned revascularization with iFR and numerically lower MI (unplanned revascularization: 2.22% iFR vs. 4.99% FFR; adjusted HR: 0.44; 95% CI: 0.21 to 0.93; p = 0.03; MI: 0.44% iFR vs. 2.14% FFR; adjusted HR: 0.23; 95% CI: 0.05 to 1.07; p = 0.06). Conclusions: iFR-guided deferral appears to be safe for patients with LAD lesions. Patients in whom iFR-guided deferral was performed had statistically significantly lower event rates than those with FFR-guided deferral.

Article

Clinical Outcomes for Peripartum Cardiomyopathy in North America Results of the IPAC Study (Investigations of Pregnancy-Associated Cardiomyopathy)

by Dennis M. McNamara; Uri Elkayam; Rami Alharethi; Julie Damp; Eileen Hsich; Gregory Ewald; Kalgi Modi; Jeffrey D. Alexis; Gautam V. Ramani; Marc J. Semigran; Jennifer Haythe; David Markham; Josef Marek; John Gorcsan; Wen-Chi Wu; Yan Lin; Indrani Halder; Jessica Pisarcik; Leslie T. Cooper; James D. Fett

2015

Subjects
  • Health Sciences, Public Health
  • Health Sciences, Epidemiology
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Background Peripartum cardiomyopathy (PPCM) remains a major cause of maternal morbidity and mortality. Objectives This study sought to prospectively evaluate recovery of the left ventricular ejection fraction (LVEF) and clinical outcomes in the multicenter IPAC (Investigations of Pregnancy Associated Cardiomyopathy) study. Methods We enrolled and followed 100 women with PPCM through 1 year post-partum. The LVEF was assessed by echocardiography at baseline and at 2, 6, and 12 months post-partum. Survival free from major cardiovascular events (death, transplantation, or left ventricular [LV] assist device) was determined. Predictors of outcome, particularly race, parameters of LV dysfunction (LVEF), and remodeling (left ventricular end-diastolic diameter [LVEDD] ) at presentation, were assessed by univariate and multivariate analyses. Results The cohort was 30% black, 65% white, 5% other; the mean patient age was 30 ± 6 years; and 88% were receiving beta-blockers and 81% angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. The LVEF at study entry was 0.35 ± 0.10, 0.51 ± 0.11 at 6 months, and 0.53 ± 0.10 at 12 months. By 1 year, 13% had experienced major events or had persistent severe cardiomyopathy with an LVEF < 0.35, and 72% achieved an LVEF ≥0.50. An initial LVEF < 0.30 (p = 0.001), an LVEDD ≥6.0 cm (p < 0.001), black race (p = 0.001), and presentation after 6 weeks post-partum (p = 0.02) were associated with a lower LVEF at 12 months. No subjects with both a baseline LVEF < 0.30 and an LVEDD ≥6.0 cm recovered by 1 year post-partum, whereas 91% with both a baseline LVEF ≥0.30 and an LVEDD < 6.0 cm recovered (p < 0.00001). Conclusions In a prospective cohort with PPCM, most women recovered; however, 13% had major events or persistent severe cardiomyopathy. Black women had more LV dysfunction at presentation and at 6 and 12 months post-partum. Severe LV dysfunction and greater remodeling at study entry were associated with less recovery. (Investigations of Pregnancy Associated Cardiomyopathy [IPAC]; NCT01085955).

Article

Cardiac Care for Older Adults Time for a New Paradigm

by Daniel E. Forman; Michael W. Rich; Karen P. Alexander; Susan Zieman; Mathew S. Maurer; Samer S. Najjar; Joseph C. Cleveland; Harlan M. Krumholz; Nanette Wenger

2011

Subjects
  • Health Sciences, Health Care Management
  • Health Sciences, General
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Article

10-Year Resource Utilization and Costs for Cardiovascular Care

by Leslee J Shaw; Abhinav Goyal; Christina Mehta; Joe Xie; Lawrence Phillips; Anita Kelkar; Joseph Knapper; Daniel S. Berman; Khurram Nasir; Emir Veledar; Michael J. Blaha; Roger Blumenthal; James K. Min; Reza Fazel; Peter Wilson; Matthew J. Budoff

2018

Subjects
  • Health Sciences, Health Care Management
  • Health Sciences, Medicine and Surgery
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Background: Cardiovascular disease (CVD) imparts a heavy economic burden on the U.S. health care system. Evidence regarding the long-term costs after comprehensive CVD screening is limited. Objectives: This study calculated 10-year health care costs for 6,814 asymptomatic participants enrolled in MESA (Multi-Ethnic Study of Atherosclerosis), a registry sponsored by the National Heart, Lung, and Blood Institute, National Institutes of Health. Methods: Cumulative 10-year costs for CVD medications, office visits, diagnostic procedures, coronary revascularization, and hospitalizations were calculated from detailed follow-up data. Costs were derived by using Medicare nationwide and zip code–specific costs, inflation corrected, discounted at 3% per year, and presented in 2014 U.S. dollars. Results: Risk factor prevalence increased dramatically and, by 10 years, diabetes, hypertension, and dyslipidemia was reported in 19%, 57%, and 53%, respectively. Self-reported symptoms (i.e., chest pain or shortness of breath) were common (approximately 40% of enrollees). At 10 years, approximately one-third of enrollees reported having an echocardiogram or exercise test, whereas 7% underwent invasive coronary angiography. These utilization patterns resulted in 10-year health care costs of $23,142. The largest proportion of costs was associated with CVD medication use (78%). Approximately $2 of every $10 were spent for outpatient visits and diagnostic testing among the elderly, obese, those with a high-sensitivity C-reactive protein level >3 mg/l, or coronary artery calcium score (CACS) ≥400. Costs varied widely from <$7,700 for low-risk (Framingham risk score <6%, 0 CACS, and normal glucose measurements at baseline) to >$35,800 for high-risk (persons with diabetes, Framingham risk score ≥20%, or CACS ≥400) subgroups. Among high-risk enrollees, CVD costs accounted for $74 million of the $155 million consumed by MESA participants. Conclusions: Longitudinal patterns of health care resource use after screening revealed new evidence on the economic burden of treatment and testing patterns not previously reported. Maintenance of a healthy population has the potential to markedly reduce the economic burden of CVD among asymptomatic individuals.

Article

Overcoming the Roadblocks to Cardiac Cell Therapy Using Tissue Engineering

by Mounica Yanamandala; Wuqiang Zhu; Daniel J. Garry; Timothy Kamp; Joshua M. Hare; Ho-wook Jun; Young-sup Yoon; Nenad Bursac; Sumanth D. Prabhu; Gerald W. Dorn, II; Roberto Bolli; Richard N. Kitsis; Jianyi Zhang

2017

Subjects
  • Health Sciences, Medicine and Surgery
  • Engineering, Biomedical
  • Health Sciences, Pharmacology
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Transplantations of various stem cells or their progeny have repeatedly improved cardiac performance in animal models of myocardial injury; however, the benefits observed in clinical trials have been generally less consistent. Some of the recognized challenges are poor engraftment of implanted cells and, in the case of human cardiomyocytes, functional immaturity and lack of electrical integration, leading to limited contribution to the heart's contractile activity and increased arrhythmogenic risks. Advances in tissue and genetic engineering techniques are expected to improve the survival and integration of transplanted cells, and to support structural, functional, and bioenergetic recovery of the recipient hearts. Specifically, application of a prefabricated cardiac tissue patch to prevent dilation and to improve pumping efficiency of the infarcted heart offers a promising strategy for making stem cell therapy a clinical reality.

Article

Hypoplastic Left Heart Syndrome Current Considerations and Expectations

by Jeffrey A. Feinstein; D. Woodrow Benson; Anne M. Dubin; Meryl S. Cohen; Dawn M. Maxey; William Mahle; Elfriede Pahl; Juan Villafane; Ami B. Bhatt; Lynn F. Peng; Beth Ann Johnson; Alison L. Marsden; Curt J. Daniels; Nanacy A. Rudd; Christopher A. Caldarone; Kathleen A. Mussatto; David L. Morales; D. Dunbar Ivy; J. William Gaynor; James S. Tweddell; Barbara J. Deal; Anke K. Furck; Geoffrey L. Rosenthal; Richard G. Ohye; Nancy S. Ghanayem; John P. Cheatham; Wayne Tworetzky; Gerard R. Martin

2012

Subjects
  • Health Sciences, Medicine and Surgery
  • Health Sciences, General
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In the recent era, no congenital heart defect has undergone a more dramatic change in diagnostic approach, management, and outcomes than hypoplastic left heart syndrome (HLHS). During this time, survival to the age of 5 years (including Fontan) has ranged from 50% to 69%, but current expectations are that 70% of newborns born today with HLHS may reach adulthood. Although the 3-stage treatment approach to HLHS is now well founded, there is significant variation among centers. In this white paper, we present the current state of the art in our understanding and treatment of HLHS during the stages of care: 1) pre-Stage I: fetal and neonatal assessment and management; 2) Stage I: perioperative care, interstage monitoring, and management strategies; 3) Stage II: surgeries; 4) Stage III: Fontan surgery; and 5) long-term follow-up. Issues surrounding the genetics of HLHS, developmental outcomes, and quality of life are addressed in addition to the many other considerations for caring for this group of complex patients.

Article

Hypertension Across a Woman's Life Cycle

by Nanette Wenger; Anita Arnold; C. Noel Bairey Merz; Rhonda M. Cooper-DeHoff; Keith C. Ferdinand; Jerome L. Fleg; Martha Gulati; Ijeoma Isiadinso; Dipti Itchhaporia; KellyAnn Light-McGroary; Kathryn J. Lindley; Jennifer H. Mieres; Mary L. Rosser; George R. Saade; Mary Norine Walsh; Carl J. Pepine

2018

Subjects
  • Health Sciences, Medicine and Surgery
  • Health Sciences, Obstetrics and Gynecology
  • Health Sciences, Pharmacology
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Hypertension accounts for 1 in 5 deaths among American women, posing a greater burden for women than men, and is among their most important risk factors for death and development of cardiovascular and other diseases. Hypertension affects women in all phases of life, with specific characteristics relating to risk factors and management for primary prevention of hypertension in teenage and young adult women; hypertension in pregnancy; hypertension during use of oral contraceptives and assisted reproductive technologies, lactation, menopause, or hormone replacement; hypertension in elderly women; and issues of race and ethnicity. All are detailed in this review, as is information relative to women in clinical trials of hypertension and medication issues. The overarching message is that effective treatment and control of hypertension improves cardiovascular outcomes. But many knowledge gaps persist, including the contribution of hypertensive disorders of pregnancy to cardiovascular disease risk, the role of hormone replacement, blood pressure targets for elderly women, and so on.

Article

Hybrid Coronary Revascularization for the Treatment of Multivessel Coronary Artery Disease: A Multicenter Observational Study

by John D. Puskas; Michael Halkos; Joseph J. DeRose; Emilia Bagiella; Marissa A. Miller; Jessica Overbey; Johannes Bonatti; V.S. Srinivas; Mark Vesely; Francis Sutter; Janine Lynch; Katherine Kirkwood; Timothy A. Shapiro; Konstantinos Boudoulas; Juan Crestanello; Thomas Gehrig; Peter Smith; Michael Ragosta; Steven J. Hoff; David Zhao; Annetine C. Gelijns; Wilson Y. Szeto; Giora Weisz; Michael Argenziano; Thomas Vassiliades; Henry Liberman; William Matthai; Deborah D. Ascheim

2016

Subjects
  • Health Sciences, Medicine and Surgery
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BACKGROUND: Hybrid coronary revascularization (HCR) combines minimally invasive surgical coronary artery bypass grafting of the left anterior descending artery with percutaneous coronary intervention (PCI) of non–left anterior descending vessels. HCR is increasingly used to treat multivessel coronary artery disease that includes stenoses in the proximal left anterior descending artery and at least 1 other vessel, but its effectiveness has not been rigorously evaluated. OBJECTIVES: This National Institutes of Health–funded, multicenter, observational study was conducted to explore the characteristics and outcomes of patients undergoing clinically indicated HCR and multivessel PCI for hybrid-eligible coronary artery disease, to inform the design of a confirmatory comparative effectiveness trial. METHODS: Over 18 months, 200 HCR and 98 multivessel PCI patients were enrolled at 11 sites. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE) (i.e., death, stroke, myocardial infarction, repeat revascularization) within 12 months post-intervention. Cox proportional hazards models were used to model time to first MACCE event. Propensity scores were used to balance the groups. RESULTS: Mean age was 64.2 ± 11.5 years, 25.5% of patients were female, 38.6% were diabetic, and 4.7% had previous stroke. Thirty-eight percent had 3-vessel coronary artery disease, and the mean SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score was 19.7 ± 9.6. Adjusted for baseline risk, MACCE rates were similar between groups within 12 months post-intervention (hazard ratio [HR]: 1.063; p = 0.80) and during a median 17.6 months of follow-up (HR: 0.868; p = 0.53). CONCLUSIONS: These observational data from this first multicenter study of HCR suggest that there is no significant difference in MACCE rates over 12 months between patients treated with multivessel PCI or HCR, an emerging modality. A randomized trial with long-term outcomes is needed to definitively compare the effectiveness of these 2 revascularization strategies. (Hybrid Revascularization Observational Study; NCT01121263)

Article

Trends in Long-Term Mortality After Congenital Heart Surgery

by Logan G. Spector; Jeremiah S. Menk; Jessica H. Knight; Courtney McCracken; Amanda S. Thomas; Jeffrey M. Vinocur; Matthew E. Oster; James D. St Louis; James H. Moller; Lazaros Kochilas

2018

Subjects
  • Health Sciences, Medicine and Surgery
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Background: Congenital heart surgery has improved the survival of patients with even the most complex defects, but the long-term survival after these procedures has not been fully described. Objectives: The purpose of this study was to evaluate the long-term survival of patients (age <21 years) who were operated on for congenital heart defects (CHDs). Methods: This study used the Pediatric Cardiac Care Consortium data, a U.S.-based, multicenter registry of pediatric cardiac surgery. Survival analysis included 35,998 patients who survived their first congenital heart surgery at <21 years of age and had adequate identifiers for linkage with the National Death Index through 2014. Survival was compared to that in the general population using standardized mortality ratios (SMRs). Results: After a median follow-up of 18 years (645,806 person-years), 3,191 deaths occurred with an overall SMR of 8.3 (95% confidence interval [CI]: 8.0 to 8.7). The 15-year SMR decreased from 12.7 (95% CI: 11.9 to 13.6) in the early era (1982 to 1992) to 10.0 (95% CI: 9.3 to 10.8) in the late era (1998 to 2003). The SMR remained elevated even for mild forms of CHD such as patent ductus arteriosus (SMR 4.5) and atrial septal defects (SMR 4.9). The largest decreases in SMR occurred for patients with transposition of great arteries (early: 11.0 vs. late: 3.8; p < 0.05), complete atrioventricular canal (31.3 vs. 15.3; p < 0.05), and single ventricle (53.7 vs. 31.3; p < 0.05). Conclusions: In this large U.S. cohort, long-term mortality after congenital heart surgery was elevated across all forms of CHD. Survival has improved over time, particularly for severe defects with significant changes in their management strategy, but still lags behind the general population.
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