Publications by authors named "Samer S Najjar"
Background: Proteomic phenotyping can provide insights into rejection pathophysiology, novel biomarkers, and therapeutic targets.
Methods: Within the prospective, multicenter Genomic Research Alliance for Transplantation study, 181 proteins were evaluated from blood drawn at the time of endomyocardial biopsy; protein fold change, logistic regression, and pathway analyses were conducted, with protein discovery adjusted for a 5% false discovery rate.
Results: Among 104 adult heart transplant patients (31% female sex, 53% Black race, median age 52 y), 74 had no rejection, 18 developed acute cellular rejection (ACR), and 12 developed antibody-mediated rejection (AMR).
Article Synopsis
- Heart transplant patients with donor-specific antibodies (DSAs) face a higher risk of rejection, but some do not show antibody-mediated rejection despite having graft dysfunction.
- A study involved 216 participants undergoing serial evaluations like endomyocardial biopsy (EMB) and echocardiograms to understand the relationship between DSAs, rejection types, and long-term outcomes.
- Results indicated that both antibody-mediated rejection (pAMR+) and DSA-related left ventricle dysfunction significantly correlated with increased mortality and prolonged heart dysfunction, particularly if they occurred within the first six months after transplant.
Background: There is significant variability among pathologists in the histopathological interpretation of the endomyocardial biopsy (EMB) for acute cellular rejection (ACR), and assessment of variability in the interpretation of antibody-mediated rejection (AMR) has not been reported. In contemporary practice, the strategy of allograft surveillance with donor-derived cell-free DNA (dd-cfDNA) compared to EMB has not been compared with a focus on long-term clinical outcomes beyond acute rejection (AR).
Methods: The Genomic Research Alliance for Transplantation is a multicenter, prospective cohort study that enrolled patients from 2015 to 2020.
The impact of cardiac resynchronization therapy (CRT) in patients receiving durable left ventricular assist device (LVAD) implantation remains unclear and there is no consensus regarding postoperative management. We sought to determine the impact of postoperative management of CRT on clinical outcomes following LVAD implantation. A total of 789 patients underwent LVAD implantation at our institution from 2007 to 2022 including 195 patients (24.
View Article and Find Full Text PDFAging is associated with a significant decline in aerobic capacity assessed by maximal exercise oxygen consumption (V̇o). The relative contributions of the specific V̇o components driving this decline, namely cardiac output (CO) and arteriovenous oxygen difference (A - V)O, remain unclear. We examined this issue by analyzing data from 99 community-dwelling participants (baseline age: 21-96 yr old; average follow-up: 12.
View Article and Find Full Text PDFBackground: Invasive hemodynamics are fundamental in assessing patients with advanced heart failure (HF). Several novel hemodynamic parameters have been studied; however, the relative prognostic potential remains ill-defined.
Hypothesis: Advanced hemodynamic parameters provide additional prognostication beyond the standard hemodynamic assessment.
Article Synopsis
- Many people with serious heart problems are using a treatment called CIIS to feel better, even though it doesn’t make them live longer.
- A study asked patients about their thoughts on CIIS, and most believed it would help them feel better and live longer, but only a few thought it would cure their heart issues.
- Overall, most patients felt their quality of life improved with CIIS, but more research is needed to help patients understand what this treatment really does.
Background: Black heart transplant patients are at higher risk of acute rejection (AR) and death than White patients. We hypothesized that this risk may be associated with higher levels of donor-derived cell-free DNA (dd-cfDNA) and cell-free mitochondrial DNA.
Methods: The Genomic Research Alliance for Transplantation is a multicenter, prospective, longitudinal cohort study.
Article Synopsis
- Invasive hemodynamic measurement using right heart catheterization shows inconsistent results in treating heart failure (HF) and cardiogenic shock, potentially due to differences in data collection and interpretation methods.
- A survey conducted among international HF and interventional cardiology professionals revealed substantial variations in how clinicians measure and interpret hemodynamic data, regardless of their subspecialty or experience level.
- Findings indicate that HF specialists are more likely than interventional cardiologists to measure specific hemodynamic parameters, highlighting a need for standardization in clinical practices.
Purpose Of Review: Cardiogenic shock (CS) is a complex clinical entity that continues to carry a high risk of mortality. The landscape of CS management has changed with the advent of several temporary mechanical circulatory support (MCS) devices designed to provide hemodynamic support. It remains challenging to understand the role of different temporary MCS devices in patients with CS, as many of these patients are critically ill, requiring complex care with multiple MCS device options.
View Article and Find Full Text PDFUse of continuous intravenous inotropic support (CIIS) strictly as palliative therapy for patients with ACC/AHA Stage D (end-stage) Heart Failure (HF) has increased significantly. The harms of CIIS therapy may detract from its benefits. To describe benefits (improvement in NYHA functional class) and harms (infection, hospitalization, days-spent-in-hospital) of CIIS as palliative therapy.
View Article and Find Full Text PDFDurable implantable left ventricular assist devices (LVADs) have been shown to improve survival and quality of life for patients with stage D heart failure. Even though LVADs remain underused overall, the number of patients with heart failure supported with LVADs is steadily increasing. Therefore, general cardiologists will increasingly encounter these patients.
View Article and Find Full Text PDFBackground: Many patients with advanced heart failure (HF) are administered chronic intravenous inotropic support (CIIS) as bridge to surgical therapy; some ultimately never receive surgery. We aimed to describe reasons patients "crossover" from CIIS as bridge therapy to palliative therapy, and compare end-of-life outcomes to patients initiated on CIIS as palliative therapy.
Methods: Single-institution, retrospective cohort study of patients on CIIS as bridge or palliative therapy between 2010 and 2016; data obtained through review of health records and multi-disciplinary selection meeting minutes, was analyzed using descriptive and inferential statistics.
Background: Noninvasive monitoring of heart allograft health is important to improve clinical outcomes. MicroRNAs (miRs) are promising biomarkers of cardiovascular disease and limited studies suggest they can be used to noninvasively diagnose acute heart transplant rejection.
Methods: The Genomic Research Alliance for Transplantation (GRAfT) is a multicenter prospective cohort study that phenotyped heart transplant patients from 5 mid-Atlantic centers.
Percutaneous mechanical circulatory support (pMCS) devices are increasingly used in patients with cardiogenic shock as a bridge to recovery or bridge to decision to advanced heart failure therapies. Gastrointestinal bleeding (GIB) is a common complication that can be catastrophic. Because of the paucity of data describing the association of GIB with pMCS, we analyzed this population using the United States National Inpatient Sample database.
View Article and Find Full Text PDFBackground: Continuous infusion of ambulatory inotropic therapy (AIT) is increasingly used in patients with end-stage heart failure (HF). There is a paucity of data concerning the concomitant use of beta-blockers (BB) in these patients.
Methods: We retrospectively reviewed all patients discharged from our institution on AIT.
Black patients suffer higher rates of antibody-mediated rejection and have worse long-term graft survival after heart transplantation. Donor-derived cell free DNA (ddcfDNA) is released into the blood following allograft injury. This study analyzed %ddcfDNA in 63 heart transplant recipients categorized by Black and non-Black race, during the first 200 days after transplant.
View Article and Find Full Text PDFInfiltrative cardiomyopathies are an increasingly recognized cause of heart failure warranting systematic evaluation. Given overlap of clinical and imaging findings among etiologies of infiltrative cardiomyopathies, comprehensive evaluation, including a history and physical examination, advanced cardiac imaging, and sometimes endomyocardial biopsy, is required for diagnosis. We report a case of infiltrative cardiomyopathy in which endomyocardial biopsy confirmed diagnosis of cobalt-induced cardiomyopathy.
View Article and Find Full Text PDFArticle Synopsis
- Previous LVAD models often excluded patients with small body sizes due to anatomical concerns, but outcomes for smaller patients using the HeartMate 3 (HM3) LVAD are not well understood.
- A study analyzed 220 patients, dividing them into small body surface area (BSA ≤1.8 m) and large BSA groups, focusing on characteristics and clinical outcomes such as survival and complications.
- Results showed that while small BSA patients had different baseline traits and some lower pump metrics, their survival rates and adverse event incidences were similar to larger patients, suggesting small BSA shouldn't exclude candidates for HM3 LVAD.
Background: Durable mechanical circulatory support (MCS) therapy improves survival in patients with advanced heart failure. Knowledge regarding the outcomes experienced by patients with inflammatory cardiomyopathy (CM) who receive durable MCS therapy is limited.
Methods And Results: We compared patients with inflammatory CM with patients with idiopathic dilated CM enrolled in the STS-INTERMACS registry.
Article Synopsis
- - The study examined the relationship between heart failure (HF) and breast cancer in postmenopausal women, focusing on whether having one condition affects the likelihood of developing the other.
- - Over a median follow-up period, there was no significant association found between prevalent HF and the incidence of invasive breast cancer, nor vice versa, indicating that having one does not increase the risk of the other in this population.
- - However, the research found that both conditions are linked to higher mortality rates when they occur; women with breast cancer and concurrent HF had worse survival outcomes, and vice versa.