Publications by authors named "Justin Fried"
Elevated Donor-Derived Cell-Free DNA Levels Are Associated With Reduced Myocardial Blood Flow but Not Angiographic Cardiac Allograft Vasculopathy: The EVIDENT Study.
Circ Heart Fail
December 2024
Background: Cardiac allograft vasculopathy (CAV) leads to impaired myocardial blood flow (MBF), increasing the risk of cardiovascular death or retransplant among heart transplantation (HT) recipients. Data on elevation in donor-derived cell-free DNA (dd-cfDNA) and CAV in the absence of rejection are mixed. We sought to test the hypothesis that CAV with reduced MBF (RMBF) is associated with elevated dd-cfDNA.
View Article and Find Full Text PDFCardiac allograft vasculopathy (CAV) is a major cause of morbidity and mortality following heart transplantation (HT). Prior studies identified distinct CAV trajectories in the early post-HT period with unique predictors, but the evolution of CAV in later periods is not well-described. This study assessed the prevalence of late CAV progression and associated risk factors in HT recipients with ISHLT CAV 0/1 at 10 years post-HT.
View Article and Find Full Text PDFBackground: Donor-derived cell-free DNA (dd-cfDNA) has emerged as a reliable, noninvasive method for the surveillance of allograft rejection in heart transplantation (HT) patients, but its utility in multi-organ transplants (MOT) is unknown. We describe our experience using dd-cfDNA in simultaneous MOT recipients.
Methods: A single-center retrospective review of all HT recipients between 2018 and 2022 that had at least one measurement of dd-cfDNA collected.
Background: Cancer survivors (CS) comprise a particularly high-risk group for both de-novo and recurrent malignancies after solid organ transplantation.
Case Presentation: We report a case of relapsed melanoma, presented as metastatic disease seven months after heart transplantation in a patient who had an early-stage melanoma resected 25 years prior. Treatment with a combination of dabrafenib, a BRAF inhibitor, and trametinib, a mitogen-activated protein kinase (MEK) inhibitor resulted in a near-complete metabolic response, without major adverse effects.
Article Synopsis
- Cardiogenic shock (CS) is a serious condition that can lead to severe complications, and this study looked at how changes in hemodynamic (blood flow-related) measurements correlate with patient outcomes in those suffering from heart failure or heart attack.
- Researchers analyzed data from over 2,200 patients to compare the hemodynamic profiles at the start and end of hospitalization, finding that mortality rates were higher in patients with acute myocardial infarction compared to those with heart failure.
- The study revealed that improvements in various hemodynamic and metabolic factors during hospitalization, such as lower blood pressure and better cardiac output, were linked to increased survival rates in both groups of patients.
Article Synopsis
- Cardiomyopathies are a significant cause of cardiovascular issues in the peripartum period, and the study focuses on cases of cardiogenic shock (CS) requiring mechanical circulatory support (MCS).
- The retrospective analysis included 11 cases, with a majority of patients experiencing shock after delivery and many treated with various MCS devices like intra-aortic balloon pumps and ECMO.
- Outcomes showed a high recovery rate of 63.6% over a median follow-up of 4.5 years, suggesting that MCS could be a viable option before considering heart transplants.
Article Synopsis
- The CSWG-SCAI staging system helps assess the severity of cardiogenic shock (CS) in patients, but there’s limited data on how these stages change over time and affect outcomes.
- This study analyzed data from 3,268 patients with acute myocardial infarction-related CS and heart failure-related CS to see how their SCAI stages changed over 72 hours.
- Findings showed that most patients’ stages changed within the first 24 hours, particularly those in stage B who had a high risk of worsening, indicating that early detection and ongoing evaluation are crucial for improving patient outcomes.
Feasibility of veno-arterial extracorporeal life support in awake patients with cardiogenic shock.
Interdiscip Cardiovasc Thorac Surg
August 2024
Objectives: This study sought to demonstrate outcomes of veno-arterial extracorporeal life support (VA-ECLS) in non-intubated ('awake') patients with cardiogenic shock, as very few studies have investigated safety and feasibility in this population.
Methods: This was a retrospective review of 394 consecutive VA-ECLS patients at our institution from 2017 to 2021. We excluded patients cannulated for indications definitively associated with intubation.
Article Synopsis
- Cardiac hybrid PET/CT is used to assess cardiac allograft vasculopathy (CAV) in heart transplant patients and visually estimated coronary artery calcium (VECAC) from CT scans can help predict cardiovascular outcomes.
- A study of 430 heart transplant patients found that higher VECAC scores (specifically 10-99 and 100+) were linked to a significantly greater risk of death or retransplantation during a median follow-up of 4.2 years.
- The findings suggest that VECAC can be a valuable independent marker for predicting adverse outcomes post-heart transplant and should be considered in patient evaluations.
Objectives: Veno-arterial extracorporeal life support (V-A ECLS) is increasingly being utilized for postcardiotomy shock (PCS), though data describing the relationship between type of indexed operation and outcomes are limited. This study compared V-A ECLS outcomes across four major cardiovascular surgical procedures.
Methods: This was a single-center retrospective study of patients who required V-A ECLS for PCS between 2015 and 2022.
Article Synopsis
- The HeartMate 3 survival risk score was validated to predict survival chances for patients receiving a HeartMate 3 left ventricular assist device, categorizing them into different survival probability groups.
- A study involving 181 patients revealed that those in the high survival group had a significantly higher two-year survival rate compared to average and low survival groups, with rates of 93.5%, 81.6%, and 82.0%, respectively.
- Although the score's original stratification didn't clearly show survival differences, using a binary cutoff indicated better survival for patients in the high-risk category, demonstrating its potential utility in clinical settings.
Article Synopsis
- The study examined the effects of glucagon-like-peptide 1 receptor agonists (GLP1-RA) on heart transplant recipients dealing with diabetes and obesity, as there has been limited research in this area.
- A total of 74 patients were analyzed, with significant improvements in cardiometabolic parameters such as reduced BMI, lower blood sugar levels (HbA1C), and decreased LDL cholesterol after using GLP1-RA for around 383 days.
- Results indicated that GLP1-RA therapy was effective in managing diabetes and weight in these patients, with minimal impact on their immunosuppression medication adjustments.
Article Synopsis
- - The study investigated the effects of two heart preservation methods—ice-cold storage (ICS) and the Paragonix SherpaPak CTS—on ischemia reperfusion injury (IRI) following heart transplantation, as ischemic times have increased since the 2018 allocation system change.
- - Analysis of biopsies from 90 heart transplant recipients showed similar IRI rates between the two methods, but the CTS group had a significant reduction in coagulative myocyte necrosis (CMN) from weeks 1 to 4, and both methods showed reductions by week 8.
- - Despite longer ischemic times with CTS, the study found no significant differences in rejection rates or survival between the groups, suggesting that CTS is a viable option
Article Synopsis
- Despite advancements in treatment, ST-elevation myocardial infarction (STEMI) still results in high mortality rates, leading to a greater focus on comfort-oriented care for those with poor prognoses.
- In a study of 536 STEMI patients, 11.4% died during hospitalization, with a significant number transitioning to comfort-focused care, especially those on mechanical circulatory support.
- Palliative care consultations were infrequent, occurring in only about 10% of cases, typically late in hospitalization, suggesting a need for earlier integration of comfort care strategies.
Article Synopsis
- - *The study aimed to assess the effectiveness of molecular gene expression analysis (MMDx) in improving the diagnosis of heart transplant rejection, compared to traditional histopathological evaluation.* - *Out of 418 biopsies analyzed, MMDx detected rejection in 22.7% of cases, significantly higher than the 7.7% identified by histology, highlighting the potential of MMDx in finding "biopsy-negative" rejection.* - *MMDx influenced clinical management strategies in 20.4% of cases, particularly leading to changes in antirejection treatment protocols, indicating its significant role in improving patient outcomes post-transplant.*
Article Synopsis
- A study analyzed data from 7,070 patients with cardiogenic shock (CS), finding that 5.6% developed acute limb ischemia (ALI), particularly among women and those with peripheral arterial disease.* -
- ALI incidence increased with the severity of CS, with highest rates among patients using advanced support devices like VA-ECMO and balloon pumps, yet less than half used distal perfusion catheters.* -
- Mortality rates were significantly higher for patients with ALI (57.4%) compared to those without (38.0%), highlighting ALI's severe impact on survival in CS patients.*
Article Synopsis
- The Impella 5.0 and 5.5 pumps are mechanical assist devices used in patients with severe cardiogenic shock (CS), but there is limited real-world data on their usage and outcomes.* -
- A study analyzed data from 6,205 patients across 34 hospitals, focusing on 754 who received Impella pumps between 2020-2023, with findings indicating that 32% used the Impella as the only device while 68% combined it with others.* -
- The overall survival rate for patients using Impella was 67%, with 20.4% achieving native heart recovery and 45.5% requiring heart replacement therapy; those with acute myocardial infarction had different outcomes compared
Article Synopsis
- This study explores the challenges faced by pediatric heart transplant (HT) recipients when transitioning to adult care, focusing on identifying risk factors for poor health outcomes.
- Researchers analyzed data from 72 patients who made this transition between 2011 and 2021, noting key factors such as medication adherence, psychiatric history, and age at transition.
- The findings emphasize the need for structured transition plans tailored to high-risk individuals to improve adherence and outcomes in adult HT care.
Article Synopsis
- Belatacept (BTC) is a fusion protein that inhibits T-cell activation and has primarily been used for immunosuppression in kidney transplants, but its effectiveness for heart transplant patients remains less understood.
- A retrospective study analyzed 21 heart transplant recipients who received BTC between 2017 and 2021, focusing on their health outcomes, including rejection rates and kidney function over a follow-up period that extended to December 2023.
- Results indicated that BTC treatment had a low rejection rate (4.8%) and stable graft function, with a slight improvement in kidney health for the majority of the patients, though a significant portion of them discontinued the treatment within the study period.
Article Synopsis
- Patients with HeartMate 3 LVADs show improved hemodynamics through pump speed adjustments, particularly during hemodynamic ramp tests conducted from 2015 to 2022.
- Out of 60 studied patients, only 58% had optimized filling pressures at baseline, but after speed adjustments, 65% achieved optimized measurements.
- Those who attained optimized pressures experienced significantly lower readmission rates over 6 and 12 months, mainly due to reduced cardiac-related hospitalizations, compared to nonoptimized patients.
Article Synopsis
- This study examined how interactions between the ventricles affect right ventricular (RV) size and function in patients with left ventricular assist devices (LVADs) during hemodynamic tests by varying the device speed.
- Researchers found that faster LVAD speeds led to an increase in RV end-diastolic volume and stroke volume, while RV end-systolic volumes remained stable.
- The results suggest that these interventricular interactions actually improve RV compliance and decrease afterload without impairing RV contractility, challenging the common belief that these interactions negatively affect RV function.
Background: This study examines the role of extracorporeal life support flow in the development of acute kidney injury in cardiogenic shock.
Methods: We performed a retrospective analysis of 465 patients placed on extracorporeal life support at our institution between January 2015 and December 2020 for cardiogenic shock. Flow index was calculated by dividing mean flow by body surface.
Article Synopsis
- Endomyocardial biopsy (EMB) is important for diagnosing fulminant myocarditis in adults, but its timing and effects on patient outcomes are still being studied.
- In a study involving 419 patients across 36 centers, those who had an early EMB (within 2 days of ICU admission) showed significantly better survival rates (63%) without needing heart transplants or LVAD compared to those with delayed EMB (40%).
- The research suggests that early EMB is associated with lower mortality rates and better overall outcomes, supporting its prompt use in ICU patients suspected of having fulminant myocarditis.
Article Synopsis
- * Out of 10 documented pregnancies during LVAD support, 8 resulted in successful births, while 1 case involved maternal and fetal mortality and another was a spontaneous abortion.
- * The study emphasizes the importance of a collaborative care approach, proper medication management, and understanding the physiological changes during pregnancy to support maternal and fetal health while on LVAD.