Publications by authors named "Brett Sperry"
Importance: Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive cardiomyopathy that commonly presents with concomitant chronic kidney disease. Chronic kidney dysfunction is associated with worse outcomes, but the prognostic value of changes in kidney function over time has yet to be defined.
Objective: To assess the prognostic importance of a decline in estimated glomerular filtration rate (eGFR) in a large cohort of patients with ATTR-CM.
Article Synopsis
- The HELIOS-B trial is the first randomized study testing a gene silencing treatment, vutrisiran, for transthyretin cardiac amyloidosis (ATTR-CM) against a placebo.
- Vutrisiran showed a 28% reduction in all-cause mortality and recurrent cardiovascular events, along with significant improvements in patient-reported outcomes like the 6-minute walk test and quality of life metrics.
- Both treatment and control groups had similar rates of discontinuation and adverse events, indicating vutrisiran is well tolerated among patients.
Purpose Of Review: This article summarizes findings seen in various cardiomyopathies on myocardial perfusion imaging (MPI) with positron emission tomography (PET).
Recent Findings: MPI is the cornerstone for evaluation of coronary ischemia, and technological advancements have yielded improved imaging quality and reduction in radiation exposure, particularly with PET. Multi-specialty guidelines and appropriate use criteria provide guidance on utilization of PET MPI in various scenarios related to evaluation of chest pain, new onset cardiomyopathy, and other scenarios where coronary ischemia should be assessed.
Background: Quantitative myocardial blood flow (MBF) on positron-emission tomography myocardial perfusion imaging is a measure of the overall health of the coronary circulation. The ability to adequately augment blood flow, measured by myocardial blood flow reserve (MBFR), is associated with lower major adverse cardiovascular events and all-cause mortality. The age-specific ranges of MBFR in patients without demonstrable coronary artery disease have not been well established.
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- Chronic kidney disease is prevalent in patients with amyloid cardiomyopathy, prompting a study on tafamidis, which was previously approved for treating transthyretin amyloid cardiomyopathy (ATTR-CM) based on the ATTR-ACT trial.
- A post hoc analysis of the ATTR-ACT trial assessed renal function changes over 30 months among patients taking tafamidis versus a placebo, measuring estimated glomerular filtration rate (eGFR) and a composite endpoint of renal decline events.
- Results indicated that those treated with tafamidis experienced less decline in eGFR, improved CKD staging, and a lower rate of reaching critical renal failure events compared to the placebo
Article Synopsis
- This study focused on how Body Mass Index (BMI) influences radiation exposure in patients with chest pain undergoing different imaging techniques, highlighting the importance of optimizing doses for patient safety.
- A total of 9,046 patients were analyzed, and results showed PET/CT had the lowest radiation exposure, particularly for patients with higher BMI, while CCTA had significantly higher doses in heavier patients.
- The findings emphasize that while radiation doses for these imaging methods are generally modest, understanding BMI's impact is crucial for improving imaging practices and reducing unnecessary radiation exposure.
Article Synopsis
- Gastrointestinal bleeding (GIB) is frequent in patients with left ventricular assist devices (LVADs), but the best screening method before implantation is not well defined.
- A study at Saint Luke's Hospital analyzed data from 167 LVAD patients, revealing that pre-implantation endoscopic evaluations showed a high occurrence of angiodysplasia but did not reduce overall GIB rates.
- The findings support avoiding routine pre-LVAD endoscopic screening, advocating for individualized assessments based on each patient’s circumstances instead.
Background: Inhibition of the mammalian target of rapamycin (mTor) pathway after heart transplantation has been associated with reduced progression of coronary allograft vasculopathy (CAV). The application of low-dose mTOR inhibition in the setting of modern immunosuppression, including tacrolimus, remains an area of limited exploration.
Methods: This retrospective study included patients who received heart transplantation between January 2009 and January 2019 and had baseline, 1-year and 2-3-year coronary angiography with intravascular ultrasound (IVUS).
Article Synopsis
- - CARS (Cardiac Amyloidosis Registry Study) is a multicenter project launched in 2019 to study the natural history and treatment of cardiac amyloidosis, involving patients across the U.S. from 1997 to 2025.
- - As of February 2023, 1415 patients have been enrolled, with 82% diagnosed with transthyretin (ATTR) and 18% with light chain (AL) amyloidosis, highlighting a diverse cohort that includes a significant portion of Black participants.
- - The study aims to address important clinical questions about cardiac amyloidosis and improve comparisons of treatment options, with plans for future international collaboration to enhance its findings.
Background: Ischemia and reduced global myocardial blood flow reserve (MBFR) are associated with high cardiovascular risk among symptomatic patients with diabetes mellitus (DM).
Objectives: This study aimed to assess the prevalence and prognostic importance of silent ischemia and reduced MBFR among asymptomatic patients with DM.
Methods: This study included 2,730 consecutive patients with DM, without known coronary artery disease (CAD) or cardiomyopathy, who underwent rubidium-82 rest/stress positron emission tomography (PET) myocardial perfusion imaging (MPI) from 2010 to 2016.
Article Synopsis
- PET myocardial perfusion imaging (MPI) quantifies left ventricular ejection fraction (LVEF) during stress and rest, with LVEF reserve (LVEF-R) offering insights into patient prognosis post-revascularization.
- The study involved 14,649 patients undergoing PET MPI to assess the relationship between LVEF-R, known coronary artery disease (CAD), and survival benefits after revascularization.
- Results showed that patients without prior CAD and an LVEF-R ≤0 experienced better survival with revascularization, while LVEF-R was not predictive of outcomes in those with known CAD.
Introduction: Myocardial perfusion imaging (MPI) protocols have not changed significantly despite advances in instrumentation and software. We compared an early post-injection, stress-first SPECT protocol to standard delayed imaging.
Methods: 95 patients referred for SPECT MPI were imaged upright and supine on a Spectrum Dynamics D-SPECT CZT system with CT attenuation correction.
Immunoglobulin light chain (AL) amyloidosis may lead to amyloid fibril deposition into peripheral and autonomic nerves, resulting in resting and orthostatic hypotension. While most patients die from progressive heart failure, the most commonly proposed cardiac rhythm associated with sudden death is pulseless electrical activity (PEA). Herein, we describe four patients with severe AL cardiac amyloidosis who had witnessed cardiac arrest with pulseless electrical activity as a result of vasovagal syncope.
View Article and Find Full Text PDFImportance: Tafamidis reduced all-cause mortality and cardiovascular-related hospitalizations and minimized patient-reported health status deterioration at 30 months in patients with transthyretin (ATTR) amyloidosis. However, the clinical significance of health status changes remains unclear, particularly in patients with New York Heart Association (NYHA) class III symptoms who experienced more cardiovascular-related hospitalizations than those with NYHA class I-II symptoms.
Objective: To evaluate the health status of patients taking tafamidis with baseline NYHA class III symptoms.
Primer on the Differential Diagnosis and Workup for Transthyretin Cardiac Amyloidosis.
Am J Cardiol
December 2022
Amyloidosis has often been referred to as a "great masquerader," mimicking other systemic and cardiac diseases. As diagnostic techniques such as echocardiography with longitudinal strain, cardiac magnetic resonance imaging, and nuclear scintigraphy have advanced, identification of cardiac amyloidosis has become less daunting. This review covers the differential diagnosis and workup of patients with transthyretin cardiac amyloidosis, with a specific focus on developing a clinical suspicion through demographic, clinical, and echocardiographic features of the disease.
View Article and Find Full Text PDFBackground: Coronary vasomotor dysfunction (defined by reduced myocardial blood flow reserve [MBFR]) is associated with high cardiac risk in both men and women in absence of significant coexisting epicardial disease. Whether there is a sex-specific difference in prognostic value of reduced MBFR in patients with a greater burden of coexisting epicardial atherosclerotic disease is not well understood.
Objectives: The purpose of this study was to examine the association of sex, MBFR, and mortality in consecutive patients with suspected or known coronary artery disease undergoing positron emission tomography myocardial perfusion imaging.
Background: Post-systolic shortening index (PSI) is defined as myocardial shortening that occurs after aortic valve closure, and is an emerging measure of regional LV contractile dysfunction. PSI measurement variability amongst software vendor and its relationship with mechanical dyssynchrony and mechanical dispersion index (MDI) remains unknown. We evaluated PSI by speckle-tracking echocardiography from several vendors in patients with increased left ventricular wall thickness, and associations with MDI.
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