Publications by authors named "Sperry B"
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.
Objectives: To evaluate the effectiveness of cervical transforaminal epidural steroid injection (CTFESI) for the treatment of unilateral cervical radicular pain.
Design: Single-group prospective cohort study.
Methods: Outcomes included ≥50% reductions in Numeric Rating Scale (NRS) for arm pain, ≥30% Neck Disability Index (NDI-5) improvement, health-related quality of life (EQ-5D), global improvement (PGIC), personal goal achievement (COMBI), Chronic Pain Sleep Index (CPSI), and healthcare utilization at one, three, six, and 12 months.
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.
Background: Lumbar medial branch radiofrequency ablation (LRFA) and intraarticular facet steroid injections (FJI) are commonly performed for recalcitrant facet joint-mediated pain. However, no study has compared clinical outcomes of the two treatments in patients selected using dual medial branch blocks (MBBs) with an 80% relief threshold.
Objective: Compare the effectiveness of cooled LRFA (C-LRFA) to FIJ as assessed by pain and functional improvements.
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.
Aliphatic amine and carboxylic acid ligands are widely used as organic solvents during the bottom-up synthesis of inorganic nanoparticles (NPs). Although the ligands' ability to alter final NP properties has been widely studied, side reactivity of these ligands is emerging as an important mechanism to consider. In this work, we study the thermal decomposition of common ligands with varying functional groups (amines and carboxylic acids) and bond saturations (from saturated to polyunsaturated).
View Article and Find Full Text PDFObjective(s): To evaluate the impact of consistent surgical teams on procedure duration in head and neck free tissue transfer, and to evaluate the length of stay and readmission rates with consistent teams.
Methods: A retrospective chart review of head and neck microvascular reconstruction by a single surgeon between August 2017 and November 2021 was performed. Procedure duration, wound complications, length of stay, and 30-day readmissions were analyzed.