bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bleeding and Thromboembolic Events in Patients with Heartmate II Mechanical Circulatory Support
Authors: Allana Salman S. , Chapman Carrie B. , Sweitzer Nancy K. , Johnson Maryl R. , Kohmoto Takushi , Murray Margaret , Murray David , Li Zhanhai , Rahko Peter S. 
Published: October 2019

Background
Bleeding and thromboembolic events (TE) are common complications following HeartMate II (HMII) implantation. The aim of the study was to review our experience related to bleeding and TE events in patients with a HMII and identify factors associated with increased risk of these events.

Methods
We retrospectively reviewed 70 consecutive patients who received a HMII between May 2006 and December 2011. The patients were followed for 12 months or until cardiac transplantation, device explantation or death. Major bleeding was defined by INTERMACS criteria with intracranial bleeding events added.

Results
There were 48 bleeding events in 28 (40%) patients with gastrointestinal bleeding (54.2%) being most common. Patients with bleeding events had significantly higher average INR (p=0.04) and more chronic kidney disease (p=0.03), although 43.8% of bleeding events occurred at an INR <2. Twelve TE events occurred in 9 patients (12.9%), with ischemic stroke the most common (75%). TE events were associated with young age (p=0.04) and non-diabetes status (p=0.03) and were not associated with average INR. There was no association of bleeding or thromboembolism with gender, BMI, HMII speed, pulsatility index, hypothyroidism, smoking history or INTERMACS profile at the time of HMII implantation.
Conclusion
Different factors are associated with bleeding and TE events. The appropriate target INR range for HMII patients should be chosen to balance the risk between bleeding and TE events based largely on patient factors.
Outcomes of external repair of HeartMate IITM LVAD percutaneous leads
Authors: Pal Jay D. , Mahr Claudius , Smith Jason W. , Dardas Todd F. , Pinette Jay , Farrar David J. , Mokadam Nahush A. 
Published: October 2019

Background
The HeartMate II Left Ventricular Assist Device (LVAD) receives power via a percutaneous lead connected to an external controller and batteries. At times, this lead can be damaged during normal wear, as well as by traumatic fracture, which may jeopardize the functionality of the LVAD. If there is significant internal damage, surgical replacement of the LVAD is required. However it is possible to repair externally damaged leads by replacing the distal portion of the lead to avoid pump replacement. We report the overall experience and outcomes in patients with external lead repairs.
Methods
A procedure for full external lead replacement has been developed and is approved for implementation by the FDA. Pre-procedural steps include examination of high resolution x-rays of the driveline and analysis of pump log files. Efficacy and outcomes of all attempted external lead repairs were evaluated between initiation of repairs in 2008 through 2014.
Results
A total of 321 repairs were attempted in 297 patients with suspected isolated external lead damage after a median of 2.0 yr [range: 7d to 8.7 yr] of support. Of 297 patients, 37 (12.5%) had attempts at external repair that were unsuccessful

due to concomitant internal lead damage. 31 patients (10.4%) had additional serious malfunctions after lead repair resulting in 17 with repeat repairs and 14 who continued on ungrounded cables, and ultimately 14 of these 31 patients required pump exchanges. 27 of the 297 patients (9.1%) with lead repairs had only minor additional problems, including cuts or abrasion in the insulation which was fixed with tape or external reinforcement. There was one catastrophic failure during attempted lead repair requiring emergent pump exchange, and there were three deaths within 14 days of attempted repair related to continued percutaneous lead damage. One of these patients refused pump exchange, and two were not candidates for other clinical reasons. 202 of the 297 patients (68%) have had no recurrence of lead problems after a median follow-up of 189 days [n=11 over 2 years, longest 5.8 yr].

Conclusions

HeartMate II dysfunction due to percutaneous lead damage is uncommon but is of serious concern due to potential abrupt pump stoppage. Lead repair by replacement of the external distal percutaneous lead can be performed by trained personnel in a standardized fashion and may provide a durable solution in select patients with isolated external lead damage, thus avoiding the need for surgical pump exchange. We provide an algorithm for evaluating potential lead damage.
Adverse Events in Continuous-Flow LVAD Recipients: Gastrointestinal Bleeding is Still Notable?
Authors: Petrovic Marija , Nathan Sriram , Radovancevic Rajko , Rajapreyar Indranee , Dasher Kevin J. , Akay Mehmet H. , Akkanti Bindu , Loyalka Pranav , Kar Biswajit , Gregoric Igor D. 
Published: October 2019

Background
The etiology and risk factors associated with gastrointestinal bleeding (GIB) in patients with continuous-flow left ventricular assist devices (CF-LVADs) are currently unknown. Therefore, we sought to assess the risk factors for GIB in these patients.
Design and Methods
This was a retrospective, non-randomized, non-controlled study at a single center. Between 2012 and 2014, 65 men and 6 women (mean age = 55 ± 12 years) underwent CF-LVAD implantation at our institution. Overall, 23.9% of patients (17/71) had at least one GIB episode. Endoscopy confirmed GIB in 13/17. Arteriovenous malformation was the major GIB source in 8/13 (61%). There was no significant difference in incidence of GIB with regard to INTERMACS profile, blood type, or device type—HeartWare vs. HeartMateII. All our patients with GIB were men, most had hyperlipidemia, and most likely had ischemic cardiomyopathy (65%) and peripheral vascular disease (24%). The only significant risk factor for GIB was chronic kidney disease (odds ratio= 3.95; 95% confidence interval of 1.21 to 12.84; p=0.02). At the time of the first GIB, mean hemoglobin was 7.38 ± 1.06 g/dl, international normalized ratio was 2.08 ± 0.69 IU, and mean arterial pressure was 75 ± 12 mmHg. Ten patients (59%) required hospital admission for treatment.

Conclusion
In our patients GIB was often a single event and often occurred within first month after implantation. Prevention strategies should be focused on this vulnerable period, especially in patients with chronic kidney disease
Total Artificial Heart Imaging and Complications: a Pictorial Review
Authors: Gomez Carrie K. , Hobbs Susan 
Published: October 2019

Heart failure is a serious cause of morbidity and mortality with many patients ultimately requiring heart transplantation. As the rate of heart failure continues to increase and surpass the number of available donor hearts, the need for cardiac assist devices is rapidly rising. The total artificial heart has emerged as an effective therapeutic option in patients with end-stage biventricular heart failure who are awaiting orthotopic heart transplantation. The TAH replaces the patient’s native ventricle and valves and has one of the highest bridge to transplant rates. Many complications have been associated with the TAH including infections, bleeding, thrombosis, device malfunction, neurological complications among others. CT is the imaging modality of choice that aids in early recognition of TAH complications.
The aim of this review is to illustrate the TAH components and CT based imaging of TAH complications. Recognition of TAH complications can help to plan for early intervention and therefore improve patient’s survival.
Fever of Unknown Origin in Patient after Left Ventricular Assist Device Implantation
Authors: Raichlin Eugenia , Varnado Sara , Um John Y. , Moulton Michael J. , Zolty Ronald 
Published: October 2019

Mechanical circulatory support (MCS) is a lifesaving procedure in patients with refractory cardiogenic shock. Despite improvement in surgical techniques, ICU care and restored hemodynamics, some patients on MCS remain severely debilitated due to multiple medical problems, including infections, respiratory failure, de-conditioning and nutritional deficits. Here we present a case of a patient with persistent high degree fever, devastating muscle weakness, and elevated lactate dehydrogenase (LDH) level, who dramatically responded to treatment with vitamin B 12.
Common clinical dilemmas in left ventricular assist device therapy: A glimpse into current trends
Authors: Kilic Ahmet , Kiernan Michael S. , Brisco-Bacik Meredith A. , Lee Sangjin , Soleimani Behzad , Bansal Aditya , Gosev Igor , Eckman Peter , Lima Brian , Bethea Brian , Patel Chetan B. , Katz Jason N. , Rich Jonathan D. , Joseph Susan M. 
Published: October 2019

Background
Left ventricular assist device (LVAD) therapy has been thrust into the forefront of surgical treatment for advanced heart failure (HF). Despite advancements in survival and quality of life with these devices, the multi-disciplinary care for these patients remains far from standardized across institutions.
Methods
A survey of current practices in LVAD was carried out at the St. Jude Medical User’s meeting representing a variety of caregivers including cardiac surgeons, HF cardiologists, non-HF cardiologists, advanced practice providers and ventricular assist device coordinators, with representation from several continents. Utilizing an audience response system, eleven questions were asked related to the demographics of the audience, left ventricular assist device patient selection and patient management.
Results
A total of 120 audience members representing both transplant and LVAD centers, destination therapy only LVAD centers and non-implanting, shared care centers across a multitude of disciplines responded to the survey. Questions comprised of patient selection (body mass index, pre-existing renal failure, care giver presence and abstinence from substance abuse) and patient management (anticoagulation regimens, first line therapy for hemolysis, implantable cardioverter-defibrillator usage and route of preferred dialysis) issues.
Conclusions
LVAD technology will continue to change and improve with the next generation of pumps on the horizon. Progress cannot be made without pausing to understand the current state of technology, practice patterns and patient determinants of success. This survey underscores the lack of consensus regarding best practice principles and the need for an increased focus on care management for LVAD patients with collaborative, multi-institutional studies.
Left Ventricular Assist Device is a Viable Therapy in End Stage Hypertrophic Cardiomyopathy
Authors: Byku Mirnela , Nassif Michael , Novak Eric , Itoh Aki , Ewald Gregory , Larue Shane 
Published: October 2019

Left Ventricular Assist Device (LVAD) therapy use is increasing rapidly in advanced heart failure (HF). Little data exists on the application of this therapy in patients with advanced HF due to hypertrophic cardiomyopathy (HCM). Altered ventricular geometry, thickened septum and reduced LV end-diastolic diameter (LVEDD) in HCM may lead to increased suction events, arrhythmias and inflow cannula malfunction. We hypothesized that patients with end stage HCM benefit from LVAD therapy and have a similar rate of complications to those with ischemic or dilated CM. Between 2009 and 2014, 5 patients with end stage HCM (HCM and EF <50%), were implanted with either a HeartMate II ® (80%) or HVAD® (20%) device, as a bridge-to-transplant (BTT) (80%) or destination therapy (DT) (20%). We compared baseline characteristics, surgical, and long-term clinical outcomes between these patients and those receiving an LVAD for end stage dilated and ischemic CM (n=214) during that time frame. The HCM cohort had a smaller LVEDD (5.2 versus 6.9 cm, p=0.001) and a higher LVEF (28% v 18%, p=0.002). Cardiopulmonary bypass time was similar between the groups (72min vs 69min). Post-operative length of stay was also similar at 21 days. Operative mortality for HCM patients was 0. All 4 BTT patients survived to transplant. LVAD therapy resulted in improved LVEDD (5.2 cm to 3.9 cm), PASP (58.8 mmHg to 30.8 mmHg), and cardiac index (1.5 to 2.82L/min/m2) in patients with HCM, without an increased incidence of postoperative complications. Median duration of LVAD support in the HCM group was 14 months and 10 months for the control.

We conclude that select patients with end stage HCM may benefit from LVAD therapy with a similar rate of complications compared to traditional candidates. Additional study is warranted to further evaluate durable mechanical support in this population.
Capsule Endoscopy in Left Ventricular Assist Device Patients: Retrospective Review of Efficacy and Necessity
Authors: Vaidya Gaurang Nandkishor , Dahhan Ali , Krease Michael , Vijayakrishnan Rajakrishnan , Abbel Thomas , Birks Emma , Abramov Dmitry 
Published: October 2019

Background
Capsule endoscopy (CE) is mainstream in the evaluation of obscure gastrointestinal bleeding (GIB) in the general population. However, the diagnostic and therapeutic impact of CE in LVAD patients susceptible to transient bleeding remains largely unexplored. This study aimed to assess the benefits of CE in the evaluation of LVAD associated GIB.
Methods
Retrospective review of patients implanted with a continuous flow LVAD who underwent inpatient capsule endoscopy (CE) between January 2014 and May 2017 at our center. Identification of lesions with high bleeding potential or presence of frank blood were considered abnormal findings on CE study.
Results
Twenty-five inpatients who underwent 41 CE were identified. All patients presented with GIB and had preceding negative upper endoscopy and colonoscopy in the past 4 weeks. On the first capsule in each patient, 19 had interpretable images, abnormal findings were detected in 5 patients (high risk lesion in 3, frank blood in 2), four of these underwent an enteroscopy and only 2 (8%) patients had confirmation of the capsule findings with APC treatment (true positive). Excluding patients with malfunction, LVAD interference and poor bowel prep, 14 patients had negative/equivocal CE, of which 4 underwent enteroscopy due to continued bleeding and 2 of these patients had treatable culprit lesions (false negative). A total of 17 (68%) patients were discharged without any therapeutic intervention irrespective of the success or findings on CE due to clinical stabilization. Twenty patients (80%) had recurrence in a mean 154 days. As expected, repeat capsules in the same admission increased the diagnostic yield (p=0.031). Only nine patients (36%) had capsule-image evidence of reaching the cecum while 4 patients (16%) had retention which had to be retrieved without further complication.
Conclusions
This study demonstrated that evaluation of GIB with CE is feasible and safe but was associated with a low diagnostic yield and low conversion to therapeutic intervention. With a true positive yield of 4% in our cohort, the efficacy and cost-effectiveness of CE in the LVAD population is debatable. The role of CE in LVAD patients may need to be reevaluated. An identification of patients who would benefit from a capsule-first approach would allow optimum utilization of resources and reduce healthcare expenditure.
Electrocardiographic characteristics, antiarrhythmic utilization, and outcomes in patients with left ventricular assist devices
Authors: Lundgren Scott , Lyden Elizabeth , Stoller Douglas , Hyden Marshall , Burdorf Adam , Zolty Ronald , Um John , Lowes Brian 
Published: October 2019

Background
Left ventricular assist devices (LVAD) are an increasingly used therapy for patients with advanced heart failure. Arrhythmias are common complications following LVAD implantation requiring admission, initiation, and escalation of medical therapy. Despite their frequent use in the treatment of arrhythmias, little has been reported regarding electrocardiographic changes, antiarrhythmic utilization, and outcomes post-LVAD.
Methods
A total of 309 patients who received a LVAD underwent retrospective chart review pre- and post-LVAD. Kaplan-Meier curves were calculated and compared using the log-rank test. Cox regression model was used for univariate analysis and those with a p
Results
There was a significant reduction in both the QRS interval (p=0.0001) and QTc interval (p=0.0074) following LVAD implantation. Ventricular tachycardia is common following LVAD implant at 31.1%. Amiodarone use was frequent prior to LVAD (52.1%) and on discharge (68.6%). Amiodarone use (p=0.019, HR 1.7, 95% CI 1.1-2.6), age at implant (p
Conclusion
Amiodarone is a commonly used antiarrhythmic in advanced heart failure and its use prior to LVAD implantation may increase the risk of long-term mortality. Amiodarone's efficacy needs to be weighed against its long-term side effects and implant on clinical outcomes
Hemodynamic, Therapeutic, and Clinical Outcomes of Ambulatory Pressure-Guided Heart Failure Management
Authors: Abraham Jacob , Wang Lian , Lewis Rebecca , Callis Katherine , Remick Joshua , Spinelli Kateri J. 
Published: October 2019

Background
Heart failure (HF) management guided by CardioMEMS™ pulmonary artery pressure (PAP) monitoring reduces PAP and HF hospitalizations. The objective of this project was to characterize the relationship between medication adjustments, PAP change, and outcomes for all patients at an advanced HF center.
Methods
We retrospectively analyzed medication changes and hospitalizations for 32 consecutive patients implanted with the CardioMEMS™ sensor at a single HF center and related these outcomes to PAP data from the Merlin.net (Abbott) database. Absolute change in PAP from baseline was estimated using area under the curve normalized to days monitored.
Results
Patients had an average change in mean PAP of -3.9±1.3 mmHg at 6 months and -5.7±2.1 mmHg at 12 months. Compared to the pre-implant time period, hospital days for HF-related hospitalizations decreased by 6.9 (95% CI = 3.3-10.5) days per patient at 6 months (p<0.001) and 7.9 (95% CI = 4.3-11.5) days per patient at 12 months (p<0.001). Over 12 months, patients with baseline PAP 25-35mmHg and >35mmHg experienced a drop in PAP while their number of medication adjustments decreased, and patients with baseline PAP <25mmHg experienced a rise in PAP and an increase in medication adjustments
Conclusions
PAP-guided HF management involved time-varying intensity of medication changes, which correlated with sustained reductions in hospital stay.
Whole genome sequencing of apparently mutation-negative MEN1 patients
Authors: Backman Samuel , Bajic Duska , Crona Joakim , Hellman Per , Skogseid Britt , Stålberg Peter 
Published: October 2019

Objective
Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant syndrome usually caused by loss-of-function mutations in the MEN1 gene. However, a minority of patients who fulfill the criteria for MEN1 are not found to harbor MEN1 mutations. Besides, some of these individuals, present with a subtly different phenotype suggestive of sporadic disease. The aim of the present study was to investigate the genetic architecture of mutation-negative MEN1.

Design
Fourteen patients with a clinical diagnosis (n = 13) or suspicion (n = 1) of MEN1 who had negative genetic screening of the MEN1 gene were included.

Methods
Constitutional DNA from the included patients, as well as tumor DNA from six of the patients, was subjected to whole genome sequencing. Constitutional variants were filtered against population databases and somatic variants were studied under a tumor-suppressor model.

Results
Three patients carried pathogenic variants (two splice-site variants, one missense variant) in MEN1 that had not been detected during routine clinical sequencing, one patient carried a pathogenic variant in CASR and one patient carried a gross deletion on chromosome 1q which included the CDC73 gene. Analysis of matched tumor DNA from six patients without mutations did not detect any recurrent genes fulfilling Knudson’s two-hit model.

Conclusion
These results highlight the possibility of germline mutations being missed in routine screening, the importance of considering phenocopies in atypical or mutation-negative cases. The absence of apparent disease-causing mutations suggests that a fraction of MEN1 mutation-negative MEN1 cases may be due to the chance occurrence of several endocrine tumors in one patient.
Associations of plasma IGF1, IGFBP3 and estradiol with leucocyte telomere length, a marker of biological age, in men
Authors: Yeap Bu B , Hui Jennie , Knuiman Matthew W , S A Paul Chubb , Ken K Y Ho , Flicker Leon , Divitini Mark L , Arscott Gillian M , Twigg Stephen M , Almeida Osvaldo P , Hankey Graeme J , Golledge Jonathan , Beilby John P 
Published: October 2019

Objective
Effects of insulin-like growth factor 1 (IGF1) and its binding proteins (IGFBPs) on ageing, and their interaction with sex hormones, remain uncertain. We examined associations of plasma IGF1, IGFBP1, IGFBP3, estradiol and testosterone, with leucocyte telomere length (LTL), a marker of biological age, in 2999 community-dwelling men aged 70–84 years.

Methods
Plasma IGF1, IGFBP1 and IGFBP3 measured using immunoassay, sex hormones using mass spectrometry. LTL measured by PCR, expressed as ratio of telomeric to single-copy control gene DNA (T/S ratio). Linear regression models adjusted for age and cardio-metabolic risk factors, median splits defined low/high groups.

Results
Mean age was 76.7 ± 3.2 years. IGF1 and IGFBP3 showed age-adjusted correlations with LTL (coefficient 0.59, P = 0.001 and 0.45, P = 0.013 respectively), IGFBP1 did not. In multivariable-adjusted models IGF1 and IGFBP3 (but not IGFBP1) were associated with LTL (T/S ratio 0.015 higher per 1 s.d. increase in IGF1, P = 0.007, and 0.011 per 1 s.d. IGFBP3, P = 0.049). IGF1 and estradiol were independently associated with longer telomeres (T/S ratio 0.012 higher per 1 s.d. increase in estradiol, P = 0.027, when included in model with IGF1). Testosterone was not associated with LTL. Men with both high IGF1 (>133 µg/L) and high estradiol (>70 pmol/L) had longer LTL compared to men with lower values (multivariable-adjusted T/S ratio 1.20 vs 1.16, P = 0.018).

Conclusions
Higher IGF1 and IGFBP3 are independently associated with longer telomeres in older men. Additive associations of higher IGF1 and higher estradiol with telomere length are present. Further studies are needed to determine whether these hormonal exposures cooperate to slow biological aging.