Impact of Race on Clinical Outcomes After Implantation With a Fully Magnetically Levitated Left Ventricular Assist Device: An Analysis From the MOMENTUM 3 Trial.

Background: Heart failure disproportionately affects Black patients. Whether differences among race influence outcomes in advanced heart failure with use of a fully magnetically levitated continuous-flow left ventricular assist device remains uncertain.

Methods: We included 515 IDE (Investigational Device Exemption) clinical trial patients and 500 Continued Access Protocol patients implanted with the HeartMate 3 left ventricular assist device in the MOMENTUM 3 study (Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3).

A Fully Magnetically Levitated Left Ventricular Assist Device - Final Report.

Background: In two interim analyses of this trial, patients with advanced heart failure who were treated with a fully magnetically levitated centrifugal-flow left ventricular assist device were less likely to have pump thrombosis or nondisabling stroke than were patients treated with a mechanical-bearing axial-flow left ventricular assist device.

Methods: We randomly assigned patients with advanced heart failure to receive either the centrifugal-flow pump or the axial-flow pump irrespective of the intended goal of use (bridge to transplantation or destination therapy). The composite primary end point was survival at 2 years free of disabling stroke or reoperation to replace or remove a malfunctioning device.

Aquapheresis Versus Intravenous Diuretics and Hospitalizations for Heart Failure.

Objectives: The AVOID-HF (Aquapheresis versus Intravenous Diuretics and Hospitalization for Heart Failure) trial tested the hypothesis that patients hospitalized for HF treated with adjustable ultrafiltration (AUF) would have a longer time to first HF event within 90 days after hospital discharge than those receiving adjustable intravenous loop diuretics (ALD).

Background: Congestion in hospitalized heart failure (HF) patients portends unfavorable outcomes.

Methods: The AVOID-HF trial, designed as a multicenter, 1-to-1 randomized study of 810 hospitalized HF patients, was terminated unilaterally and prematurely by the sponsor (Baxter Healthcare, Deerfield, Illinois) after enrollment of 224 patients (27.

The editor, the publisher, and his mother: the representation of lesbians and gays in the New York Times.

The attention and prominence given to issues in media outlets may affect the importance citizens attribute to them, so the actors who influence mass media coverage decisions may have political power in society generally. This article seeks to measure the relative influence of journalists, social trends, events, government officials, editors, and owners on the New York Times coverage of lesbians and gays from 1960 to 1995. Although many factors affected the nature and frequency of such coverage, the findings of this article show that the owners of the Times exerted decisive influence.

Pre-transplant reversible pulmonary hypertension predicts higher risk for mortality after cardiac transplantation.

Background: Pre-transplant fixed pulmonary hypertension is associated with higher post-transplant mortality. In this study, we assessed the significance of pre-transplant reversible pulmonary hypertension in patients undergoing cardiac transplantation.

Methods: Overall, we studied 182 patients with baseline normal pulmonary pressures or reversible pulmonary hypertension, defined as a decrease in pulmonary vascular resistance (PVR) to < or =2.

Selection of patients for heart transplantation in the current era of heart failure therapy.

Objectives: We sought to assess the relationship between survival, peak exercise oxygen consumption (VO(2)), and heart failure survival score (HFSS) in the current era of heart failure (HF) therapy.

Background: Based on predicted survival, HF patients with peak VO(2) <14 ml/min/kg or medium- to high-risk HFSS are currently considered eligible for heart transplantation. However, these criteria were developed before the widespread use of beta-blockers, spironolactone, and defibrillators-interventions known to improve the survival of HF patients.

Modeling the effects of functional performance and post-transplant comorbidities on health-related quality of life after heart transplantation.

Background: Health-related quality of life and functional performance are important outcome measures following heart transplantation. This study investigates the impact of pre-transplant functional performance and post-transplant rejection episodes, obesity and osteopenia on post-transplant health-related quality of life and functional performance.

Methods: Functional performance and health-related quality of life were measured in 70 adult heart transplant recipients.

Tolerability to beta-blocker therapy among heart failure patients in clinical practice.

Background: Although beta-blockers were well-tolerated by heart failure (HF) patients in clinical trials, tolerability of these drugs in a general population of HF patients is not well-described.

Methods: We studied a total of 308 encounters with beta-blockers therapy in 268 ambulatory HF patients. Side effects and frequency and predictors of discontinuation of therapy were studied.

Emergence of electronic home monitoring in chronic heart failure: rationale, feasibility, and early results with the HomMed Sentry-Observer system.

Electronic home monitoring for chronic heart failure is emerging as an available option to add to our armamentarium as a vital part of the multidisciplinary care process. This investigation describes the early clinical results of a multicenter study that suggests that important trends in medical resource utilization may be attained by the use of this modality. (c)2000 by CHF, Inc.

Left ventricular assist device implantation via left thoracotomy: alternative to repeat sternotomy.

Repeat sternotomy for left ventricular assist device insertion may result in injury to the right heart or patent coronary grafts, complicating intraoperative and postoperative management. In 4 critically ill patients, left thoracotomy was used as an alternative to repeat sternotomy. Anastomosis of the outflow conduit to the descending thoracic aorta provided satisfactory hemodynamic support.

Longitudinal analysis of fibroblast growth factor expression after transplantation and association with severity of cardiac allograft vasculopathy.

Background: Vascular smooth muscle cell growth factors are postulated to contribute to cardiac allograft vasculopathy (CAV). Few data quantitatively address the timing, location, or stimuli for growth factor expression and relationship to CAV.

Methods And Results: Acidic fibroblast growth factor (aFGF) mRNA expression was determined in serial endomyocardial biopsies during the first year after transplantation.

Pulmonary hypertension and exercise intolerance in patients with heart failure.

Objectives: This study was undertaken to investigate the relationship between pulmonary hypertension and exercise performance in patients with heart failure.

Background: The exercise capacity of patients with heart failure is frequently reduced. Pulmonary hypertension may contribute to this exercise intolerance by impairing blood flow through the pulmonary circulation.

Relationship between exertional symptoms and functional capacity in patients with heart failure.

Objectives: The present study was undertaken to investigate the relationship over time between exertional symptoms in heart failure and functional capacity.

Background: Most clinicians rely on exertional symptoms rather than on exercise testing to assess functional capacity in heart failure. However, it remains uncertain whether the subjective symptoms reported by patients provide a reliable index of functional capacity.

The utility of exercise testing after cardiac transplantation in older patients.

Background: The criteria for cardiac transplantation recipient selection, including the appropriate recipient upper age limit, continue to expand with an increasing number of recipients greater than 60 years of age. While others have reported their transplant experience in older recipients in terms of quality of life assessment, we have examined the role of exercise cardiopulmonary testing post-transplantation in older cardiac transplant recipients.

Methods: We reviewed inpatient and outpatient charts of 28 patients 60 years of age or older who underwent orthotopic heart transplantation at Vanderbilt University Medical Center.

Frequency of low-risk hospital admissions for heart failure.

Heart failure is one of the most common reasons for admission to acute care hospitals. A proportion of these admissions are probably low risk and could be managed in subacute care facilities, resulting in substantial cost savings. To investigate the proportion of low-risk hospital admissions for heart failure, all admissions for heart failure to Vanderbilt University Medical Center between July 1993 and June 1995 were identified (n = 743).

Prostaglandin production contributes to exercise-induced vasodilation in heart failure.

Endothelial release of prostaglandins may contribute to exercise-induced skeletal muscle arteriolar vasodilation in patients with heart failure. To test this hypothesis, we examined the effect of indomethacin on leg circulation and metabolism in eight chronic heart failure patients, aged 55 +/- 4 yr. Central hemodynamics and leg blood flow, determined by thermodilution, and leg metabolic parameters were measured during maximum treadmill exercise before and 2 h after oral administration of indomethacin (75 mg).

Effect of a heart failure program on hospitalization frequency and exercise tolerance.

Background: Most patients with heart failure are currently managed by physicians with little specific expertise in heart failure. This management system has been associated with evidence of suboptimal care, such as high rates of hospital readmission and underuse of ACE inhibitors. The current study was undertaken to determine whether hospitalization rates and functional outcomes are improved when patients are managed by physicians with special expertise in heart failure working in a dedicated heart failure program.

Normalization of acquired QT prolongation in humans by intravenous potassium.

Background: QT interval prolongation and dispersion have been implicated in serious arrhythmias in congestive heart failure (CHF) and the congenital and drug-induced long-QT syndromes (LQTS). In a subset of the congenital LQTS, infusion of potassium can correct QT abnormalities, consistent with in vitro increases in outward currents such as I(Kr) or I(Kl) when extracellular potassium concentration ([K+]o) is increased. Furthermore, increasing [K+]o decreases the potency of I(Kr)-blocking drugs in vitro.

Treatment of subclinical fluid retention in patients with symptomatic heart failure: effect on exercise performance.

Background: Patients with heart failure frequently have elevated intracardiac diastolic pressures but no clinical evidence of excess fluid retention. We speculated that such pressure elevations may indicate subclinical fluid retention and that removal of this fluid could improve exercise intolerance.

Methods: To test this hypothesis, we studied 10 patients with right atrial pressure > or = 8 mm Hg but without rales, edema, or apparent jugular venous distension.

Effect of sympathoinhibition on exercise performance in patients with heart failure.

Background: In patients with heart failure, excessive sympathetic activation during exercise could interfere with exercise performance by impairing arteriolar dilation in working muscle and by adversely altering skeletal muscle metabolic behavior. To test this hypothesis, we examined the effect of sympathoinhibition with clonidine, a central sympatholytic agent, on skeletal muscle blood flow and metabolism in patients with heart failure.

Methods And Results: Swan-Ganz and femoral venous catheters were inserted in 20 patients with chronic heart failure and exercise intolerance (peak exercise VO2 = 9.

Skeletal muscle mass and exercise performance in stable ambulatory patients with heart failure.

The purpose of this study was to determine whether skeletal muscle atrophy limits the maximal exercise capacity of stable ambulatory patients with heart failure. Body composition and maximal exercise capacity were measured in 100 stable ambulatory patients with heart failure. Body composition was assessed by using dual-energy X-ray absorption.

Hemodynamic exercise testing. A valuable tool in the selection of cardiac transplantation candidates.

Background: Peak exercise oxygen consumption (Vo2), a noninvasive index of peak exercise cardiac output (CO), is widely used to select candidates for heart transplantation. However, peak exercise Vo2 can be influenced by noncardiac factors such as deconditioning, motivation, or body composition and may yield misleading prognostic information. Direct measurement of the CO response to exercise may avoid this problem and more accurately predict prognosis.

Laser frequency bandwidth narrowing by photorefractive two-beam coupling.

We present a theoretical analysis and experimental demonstration of a new method for spectral narrowing of laser radiation. The bandwidth narrowing is experienced by a laser beam subjected to a photorefractive two-beam coupling process. Contrary to the conventional method of frequency filtering by a Fabry-Perot étalon, this technique has no intrinsic finesse limitation on its resolution.