Randall C. Starling

Increased Need for Right Ventricular Support in Patients With Chemotherapy-Induced Cardiomyopathy Undergoing Mechanical Circulatory Support: Outcomes From the INTERMACS Registry (Interagency Registry for Mechanically Assisted Circulatory Support)

OBJECTIVESnThe aim of this study was to investigate the use of durable mechanical circulatory support (MCS) in patients with chemotherapy-induced cardiomyopathy (CCMP) and determine their outcomes and survival in comparison to that of other patients with end-stage heart failure treated similarly.nnnBACKGROUNDnPatients with end-stage heart failure as a result of CCMP from anthracyclines are often precluded from heart transplantation because of a history of cancer. In such patients, durable MCS may offer an important chance for life prolongation. Yet, there are no data to support the use of MCS in this increasingly prevalent group of patients.nnnMETHODSnWe searched 3,812 MCS patients from June 2006 through March 2011 in the INTERMACS (Interagency Registry forxa0Mechanically Assisted Circulatory Support) database for the diagnosis of CCMP. We compared characteristics, outcomes, and survival between CCMP patients and patients with nonischemic cardiomyopathy and ischemic cardiomyopathy.nnnRESULTSnCompared with patients with nonischemic cardiomyopathy and ischemic cardiomyopathy, patients with CCMP were overwhelmingly female (72% vs. 24% vs. 13%, pxa0= 0.001), had MCS more often implanted as destination therapy (33%xa0vs. 14% vs. 22%, pxa0= 0.03), required more right ventricular assist device support (19% vs. 11% vs. 6%, pxa0= 0.006), and had a higher risk of bleeding (pxa0= 0001). Survival of CCMP patients was similar to that of other groups.nnnCONCLUSIONSnCCMP patients treated with MCS have survival similar to other MCS patients despite more frequent need for right ventricular assist device support and increased bleeding risk.

Importance of Treadmill Exercise Time as an Initial Prognostic Screening Tool in Patients With Systolic Left Ventricular Dysfunction

Background— We sought to determine whether treadmill exercise time may be of value as an initial prognostic screening tool in ambulatory patients with impaired systolic function who are referred for cardiopulmonary exercise testing. Methods and Results— We studied 2231 adult systolic heart failure patients (27% of whom were women) who underwent cardiopulmonary stress testing using a modified Naughton protocol. We assessed the value of treadmill exercise time for prediction of all-cause death and a composite of death or United Network for Organ Sharing status 1 heart transplantation. During a mean follow-up of 5 years, 742 patients (33%) died. There were 249 United Network for Organ Sharing status 1 heart transplants (11%). Treadmill exercise time was predictive of death and the composite outcome in both women and men, even after accounting for peak oxygen consumption and other clinical covariates (adjusted hazard ratio of lowest versus high sex-specific quartile for prediction of death 1.70, 95% confidence interval 1.05 to 2.75, P=0.03; for prediction of the composite outcome, 1.75, 95% confidence interval 1.15 to 2.66, P=0.009). For a 1-minute change in exercise time, there was a 7% increased hazard of death (eg, comparing 480 to 540 seconds, hazard ratio =1.07, 95% confidence interval 1.02 to 1.12, P=0.004). Conclusions— Because cardiopulmonary stress testing is not available in every hospital, treadmill exercise time with a modified Naughton protocol may be of value as an initial prognostic screening tool.

Spirituality and well being among elders: differences between elders with heart failure and those without heart failure

Heart failure is a chronic debilitating disease that affects all aspects of a person’s life, including physical, mental and spiritual dimensions. The associations among these dimensions, and the relationship to overall health status, have not been clearly identified. The purpose of this quantitative, descriptive study was to explore differences between spirituality, depressive symptoms, and quality of life among elders with and without heart failure. A total of 44 elders with heart failure and 40 non-heart failure elders completed several questionnaires including: The Daily Spiritual Experiences Scale (DSES), Spirituality Index of Well-Being (SIWB), Center for Epidemiologic Studies Depression Scale (CES-D), and SF-12™ Health Survey. There were significant differences in the groups on gender and ethnicity; thus these variables were controlled in the analyses related to the dependent variables. After controlling for gender and ethnicity, there were significant differences in the physical component of quality of life and spiritual well-being. The heart failure patients had significantly lower physical quality of life but more spiritual well-being than the non-heart failure patients. There were no significant differences in daily spiritual experiences, mental component of quality of life, and depressive symptoms between the two groups.