Aditi Nayak

Chemokine receptor patterns and right heart failure in mechanical circulatory support

BACKGROUND Right ventricular failure (RVF) complicates 9% to 44% of left ventricular assist device (LVAD) implants post-operatively. Current prediction scores perform only modestly in validation studies, and do not include immune markers. Chemokines are inflammatory signaling molecules with a fundamental role in cardiac physiology and stress adaptation. In this study we investigated chemokine receptor regulation in LVAD recipients who develop RVF. METHODS Expression of chemokine receptor (CCR) genes 3 to 8 were examined in the peripheral blood of 111 LVAD patients, collected 24 hours before implant. RNA was isolated using a PAXgene protocol. Gene expression was assessed using a targeted microarray (RT2 Profiler PCR Array; Qiagen). Results were expressed as polymerase chain reaction (PCR) cycles to threshold and normalized to the average of 3 control genes, glyceraldehyde phosphate dehydrogenase (GAPDH), hypoxanthine phosphoribosyltransferase 1 (HPRT1) and β2-microglobulin (B2M). Secondary outcomes studied were 1-year mortality and long-term RV failure (RVF-LT). RESULTS CCR3, CCR4, CCR6, CCR7 and CCR8 were downregulated in LVAD recipients with RVF. Within this cohort of patients, CCR4, CCR7 and CCR8 were further downregulated in those who required RV mechanical support. In addition, under-expression of CCR3 to CCR8 was independently associated with an increased risk of mortality at 1 year, even after adjusting for RVF. CCR expression did not predict RVF-LT in our patient cohort. CONCLUSIONS Pre-LVAD CCR downregulation is associated with RVF and increased mortality after implant. Inflammatory signatures may play a major role in prognostication in this patient population.

Ceftriaxone-Induced Gallstones: Case Report and Literature Review

We report a case of gallbladder and common bile duct stones occurring in a 14-year-old male who was exposed to ceftriaxone for 6 weeks. Ceftriaxone-induced gallstones are under-reported and remain an important cause of gallstones in patients exposed to this antibiotic. Gallstone development should be considered in the appropriate clinical context.

REGIONAL RIGHT VENTRICULAR (RV) FUNCTION AS DETERMINED BY GATED BLOOD POOL SPECT (GBPS) PROVIDES ADDITIVE VALUE TO EVALUATION OF PATIENTS UNDERGOING LEFT VENTRICULAR ASSIST DEVICE (LVAD) IMPLANTATION

Background: Pre-LVAD analysis of RV function is critical for surgical planning and determines operative outcome. Current imaging techniques have yielded limited success at predicting RV failure (RVF). GBPS is count based without geometric assumption, and allows global and regional RV function