Bruce Reid | University of Utah (original) (raw)

Papers by Bruce Reid

Research paper thumbnail of Transient Aortic Obstruction with the Use of an Intraaortic Balloon Pump During Cardiopulmonary Support

Asaio J, 2006

Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for AS... more Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for ASAIO Journal. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed ...

Research paper thumbnail of The Red Cell Distribution Width and the CBC Risk Score Measured Prior to Left Ventricular Assist Device Implantation Predict Post-Implant Survival

Research paper thumbnail of Comparison of standard Maze III and radiofrequency Maze operations for treatment of atrial fibrillation

The Journal of Thoracic and Cardiovascular Surgery, 2007

This study compares clinical results of the standard Maze III operation, a highly effective treat... more This study compares clinical results of the standard Maze III operation, a highly effective treatment for atrial fibrillation, to less complex variations of the Maze III operation utilizing unipolar and bipolar radiofrequency ablation and pulmonary vein isolation. Records were reviewed of 377 patients who had operations for treatment of atrial fibrillation at a single institution over a 10-year period. Standard Maze III was performed in 220 patients, unipolar radiofrequency Maze III in 60, bipolar radiofrequency Maze III in 65, and radiofrequency pulmonary vein isolation in 32. Electrocardiograms were obtained at discharge and 3-, 6-, and 12-month intervals. Chi-square test, logistic regression, and Bayesian theory analyses were performed to determine significant associations between operative procedures and outcomes. Mean age was 65.1 years (range 22-87). There were 13 hospital deaths (3.4%) and 16 deaths during follow-up. Most patients (90.2%, 340/377) had concomitant operations. Electrocardiogram analysis was available in 344 patients at 3 months and 313 patients at 6 months. Freedom from atrial fibrillation at 6 months was superior after standard Maze III compared with radiofrequency modifications. Subanalysis according to surgeon experience demonstrated good results regardless of operative experience. This single-institution experience suggests that the standard Maze III operation is superior to radiofrequency operations for treatment of atrial fibrillation. Radiofrequency modifications of the Maze III operation are also effective treatments for atrial fibrillation and can achieve good results regardless of surgeon experience.

Research paper thumbnail of Early Screening for Antibody-mediated Rejection in Heart Transplant Recipients

The Journal of Heart and Lung Transplantation, 2007

The International Society for Heart and Lung Transplantation (ISHLT) recently established a diagn... more The International Society for Heart and Lung Transplantation (ISHLT) recently established a diagnostic scheme for antibody-mediated rejection (AMR). Currently, however, confirmatory immunohistochemistry studies are recommended only if AMR is clinically or histologically suspected. In this study, we examine whether a pattern of repetitive AMR occurred early enough after transplantation to warrant prospective immunohistochemistry screening in all recently transplanted recipients.

Research paper thumbnail of Abstract 19188: Effects of Continuous-Flow Left Ventricular Assist Device Unloading on the Diastolic Function of the Failing Human Heart

Circulation, Nov 20, 2012

Research paper thumbnail of 560: Insight into Causes for the Time-Dependent Improvement in Heart Transplantation Survival: 20-Year Analysis of United Network for Organ Sharing (UNOS) Data

J Heart Lung Transplant, 2009

that rejection rates are lower for recipients over the age of 70. However, complications of immun... more that rejection rates are lower for recipients over the age of 70. However, complications of immunosuppression such as renal dysfunction and hospitalizations for infections were more prevalent in the older population. These findings suggest a potential need for reducing the intensity of immunosuppression in older heart transplant recipients.

Research paper thumbnail of Effect of Blood Product Transfusion�Induced Tolerance on Incidence of Cardiac Allograft Rejection

Transplantation Proceedings, Sep 30, 2010

Blood product transfusion has been successfully used in solid-organ transplantation to induce tol... more Blood product transfusion has been successfully used in solid-organ transplantation to induce tolerance. Whether a similar protective effect of blood product transfusion exists in heart transplantation is controversial. To investigate the effect of cellular blood product transfusion within 2 weeks posttransplantation on the incidence of cellular and antibody-mediated rejection. Patients were grouped on the basis of number of blood transfusions; group 1 received no transfusions, and groups 2, 3, and 4 each received an incremental number of transfusion units. All endomyocardial biopsy samples were routinely studied using immunofluorescence in the first 12 weeks posttransplantation. Baseline characteristics including age, sex, body mass index, history of diabetes, donor characteristics, and pretransplantation laboratory values were similar except that group 4 had a higher rate of previous sternotomy and longer ischemic time during transplantation. Approximately 9200 endomyocardial biopsy samples composed the data. Short- and long-term freedom from the International Society for Heart & Lung Transplantation grade 3A or higher cellular rejection and from antibody-mediated rejection were comparable between groups. Blood transfusions within the first 2 weeks post-transplantation do not seem to confer any protective effect against posttransplantation cellular rejection or antibody- mediated rejection. Whether other unmeasured confounding factors mask their effect requires further prospective studies.

Research paper thumbnail of Coronary vascular function is improved in ischemic patients after continuous-flow left ventricular assist device implantation (1071.8)

The Faseb Journal, Apr 1, 2014

Research paper thumbnail of Immunological effects of continuous flow left ventricular assist devices before and after heart transplant

The Journal of Heart and Lung Transplantation, 2016

Immune allosensitization can be triggered by continuous-flow left ventricular assist devices (CF ... more Immune allosensitization can be triggered by continuous-flow left ventricular assist devices (CF LVAD). However, the effect of this type of allosensitization on post-transplant outcomes remains controversial. This study examined the post-transplant course in a contemporary cohort of patients undergoing transplantation with and without LVAD bridging. We included consecutive patients who were considered for cardiac transplant from 2006 to 2015. Serum alloantibodies were detected with single-antigen beads on the Luminex platform (One Lambda Inc., Canoga Park, CA). Allosensitization was defined as calculated panel reactive antibody (cPRA) > 10%. cPRA was determined at multiple times. LVAD-associated allosensitization was defined as development of cPRA > 10% in patients with cPRA ≤ 10% before LVAD implantation. Post-transplant outcomes of interest were acute cellular rejection (ACR), antibody-mediated rejection (AMR), and survival. Allosensitization status was evaluated in 268 patients (20% female). Mean age was 52 ± 12 years, and 132 (49.3%) received CF LVADs. After LVAD implant, 30 patients (23%) became newly sensitized, and the level of sensitization appeared to diminish in many of these patients while awaiting transplant. During the study period, 225 of 268 patients underwent transplant, and 43 did not. A CF LVAD was used to bridge 50% of the transplant recipients. Compared with patients without new sensitization or those already sensitized at baseline, the patients with LVAD-associated sensitization had a higher risk of ACR (p = 0.049) and higher risk of AMR (p = 0.018) but a similar intermediate-term post-transplant survival. The patients who did not receive a transplant had higher level of allosensitization, with a baseline cPRA of 20% vs 6% in those who received an allograft and a high risk (40%) of death during follow-up. New allosensitization takes place in > 20% of patents supported with CF LVADs. Among patients who undergo transplant, this results in a higher risk of ACR and AMR, but survival remains favorable, likely due to the efficacy of current management after transplant. However, mortality in sensitized patients who do not reach transplant remains high, and new approaches are necessary to meet the needs of this group of patients.

Research paper thumbnail of Myocardial and End-Organ Response after Long-Term Mechanical Unloading with Continuous-Flow Left Ventricular Assist Device: Axial- Versus Centrifugal-Flow

The Journal of Heart and Lung Transplantation, 2016

Research paper thumbnail of Antibody testing for cardiac antibody-mediated rejection: Which panel correlates best with cardiovascular death?

The Journal of Heart and Lung Transplantation the Official Publication of the International Society For Heart Transplantation, Feb 1, 2011

BACKGROUND: Recent efforts are being undertaken to update and refine current diagnostic criteria ... more BACKGROUND: Recent efforts are being undertaken to update and refine current diagnostic criteria for antibody-mediated rejection (AMR) in heart transplantation. We believe that the appropriate reactants are those that best predict the adverse consequences of AMR and therefore tested various models using different reactants to find the best predictors of cardiovascular mortality in pathologically defined AMR.

Research paper thumbnail of Reasons for, and Outcomes of Patients who were Referred for a Ventricular Assist Device but were Declined: The Recent Era Forgotten Ones

Clinical transplantation, Jan 21, 2015

Ventricular assist devices (VADs) have a proven survival benefit in select patients with advanced... more Ventricular assist devices (VADs) have a proven survival benefit in select patients with advanced heart failure, yet many patients considered for implantation are declined for various reasons. The outcome of these patients is obscure owing to their exclusion from recent VAD studies. We aim to compare the outcomes of patients who received a VAD to those who did not. For this study, the Artificial Heart Program's database at Intermountain Medical Center was queried from 2006-2012 for patients referred for a VAD. Kaplan-Meier survival analysis was performed with Log-Rank test determining significance. Of 232 patients included, 118 patients received a VAD and 114 patients did not. The prevailing reason for VAD decline in eligible and willing patients was due to preexisting illness (39%). Mortality was higher in non-VAD versus VAD patients (58.8% vs. 35.6%, p < 0.001) with a median time-to-death of 67 (IQR:12-314) and 301 (IQR:136-694) days respectively (p = 0.007). In the current...

Research paper thumbnail of ISHLT Pathology Antibody Mediated Rejection Score (pAMR) Correlates with Increased Risk of Cardiovascular Mortality: A Retrospective Validation Analysis

The Journal of Heart and Lung Transplantation, 2015

Antibody-mediated rejection (AMR) in cardiac transplant recipients is a serious form of rejection... more Antibody-mediated rejection (AMR) in cardiac transplant recipients is a serious form of rejection with adverse patient outcomes. The International Society of Heart and Lung Transplantation (ISHLT) has published a consensus schema for the pathologic diagnosis of various grades of antibody-mediated rejection (pathology antibody-mediated rejection [pAMR]). We sought to determine whether the ISHLT pAMR grading schema correlates with patient outcomes. Using our database, which contains a semi-quantitative scoring of all pathologic descriptors of pAMR, we retrospectively used these descriptors to convert the previous AMR categories to the current ISHLT pAMR categories. Cox proportional hazard models were fit with cardiovascular (CV) death or retransplant as the outcome. The pAMR value was included as a categorical variable, and cellular rejection (CR) values were included in a separate model. There were 13,812 biopsies from 1,014 patients analyzed. The pAMR grades of pAMR1h, pAMR1i, and pAMR2 conferred comparable increased risk for CV mortality. Significantly increased risk of CV mortality was conferred by biopsies graded as severe AMR (pAMR3). The new ISHLT pAMR grading schema identifies patients at increased risk of CV mortality, consistent with risks published from several programs before 2011. The current schema is validated by this analysis in a large biopsy database. Because pAMR1h, pAMR1i, and pAMR2 have similar CV risks associated with them, the threshold for a positive diagnosis of pAMR should be re-evaluated in future iterations of the ISHLT schema.

Research paper thumbnail of DTI and Quantitative Histological Correlation of Diffuse Fibrosis in Failing Hearts

Introduction. Diffuse fibrosis of the failing heart impacts the mechanical (1) and electrical (2)... more Introduction. Diffuse fibrosis of the failing heart impacts the mechanical (1) and electrical (2) behaviors of the myocardium, and has been linked to increased risk of ventricular and atrial tachyarrhythmia and sudden cardiac death (3). T1-mapping before and after gadolinium (Gd) administration is currently used to quantify extracellular space volume fraction as a surrogate for diffuse myocardial fibrosis (4). However, in light of recent concerns on Gd-based contrast agent use (5), alternative techniques for quantifying diffuse myocardial fibrosis can be desirable. Diffusion tensor imaging (DTI) has been used to characterize tissue microstructure including mapping the fiber structure of the myocardium (6,7). Although the technique is increasingly employed clinically to evaluate myocardial remodeling associated with cardiac diseases (8,9), quantitative correlation between DTI-derived scalar metrics and diffuse fibrosis remains lacking. The present study aims to investigate the relati...

Research paper thumbnail of Cardiac Rotational Mechanics as a Predictor of Favorable Functional and Structural Response After Mechanical Unloading With Cardiac Assist Devices in Advanced Heart Failure Patients

Journal of Cardiac Failure, 2015

Research paper thumbnail of Elevated resting heart rate in heart transplant recipients: innocent bystander or adverse prognostic indicator?

Clinical Transplantation, 2015

The elevated baseline heart rate (HR) of a heart transplant recipient has previously been conside... more The elevated baseline heart rate (HR) of a heart transplant recipient has previously been considered inconsequential. However, we hypothesized that a resting HR above 100 beats per minute (bpm) may be associated with morbidity and mortality. The U.T.A.H. Cardiac Transplant Program studied patients who received a heart transplant between 2000 and 2011. Outpatient HR values for each patient were averaged during the first year post-transplant. The study cohort was divided into two groups: the tachycardic (TC) (HR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;100 bpm) and the non-TC group (HR ≤100 bpm) in which mortality, incidence of rejection, and cardiac allograft vasculopathy were compared. Three hundred and ten patients were included as follows: 73 in the TC and 237 in the non-TC group. The TC group had a higher risk of a 10-yr all-cause mortality (p = 0.004) and cardiovascular mortality (p = 0.044). After adjustment for donor and recipient characteristics in multivariable logistic regression analysis, the hazard ratio was 3.9, (p = 0.03, CI: 1.2-13.2) and 2.6 (p = 0.02, CI: 1.2-5.5) for cardiovascular mortality and all-cause mortality, respectively. Heart transplant recipients with elevated resting HR appear to have higher mortality than those with lower resting HR. Whether pharmacologically lowering the HR would result in better outcomes warrants further investigation.

Research paper thumbnail of 610: Impact of Illness Acuity on Blood Products Usage in Patients Implanted with Left Ventricular Assist Devices (LVAD)

Journal of Heart and Lung Transplantation, 2009

risk. Eighty-eight percent of the high risk LVAD patients developed significant complications tha... more risk. Eighty-eight percent of the high risk LVAD patients developed significant complications that included CVA (12.5%), right heart failure (25%), acute renal failure (12.5%) and infection (37.5%) and 1 of the high risk TAH-t patients experienced multi-organ system failure (16%). Prior to transplantation 38% of high risk LVAD patients died but only 1 (16%) of the high risk TAH-t patients died. Conclusions: In pre-operative patients with high risk scores TAH-t may offer a potential survival advantage over LVAD as a bridge to transplantation.

Research paper thumbnail of Pulsatility and the risk of nonsurgical bleeding in patients supported with the continuous-flow left ventricular assist device HeartMate II

Circulation. Heart failure, 2013

Bleeding is an important cause of morbidity and mortality in patients with continuous-flow left v... more Bleeding is an important cause of morbidity and mortality in patients with continuous-flow left ventricular assist devices (LVADs). Reduced pulsatility has been implicated as a contributing cause. The aim of this study was to assess the effects of different degrees of pulsatility on the incidence of nonsurgical bleeding. The Utah Transplantation Affiliated Hospitals (U.T.A.H.) heart failure and transplant program databases were queried for patients with end-stage heart failure who required support with the continuous-flow LVAD HeartMate II (Thoratec Corp, Pleasanton, CA) between 2004 and 2012. Pulsatility was evaluated by means of the LVAD parameter pulsatility index (PI) and by the echocardiographic assessment of aortic valve opening during the first 3 months of LVAD support. PI was analyzed as a continuous variable and also stratified according to tertiles of all the PI measurements during the study period (low PI: <4.6, intermediate PI: 4.6-5.2, and high PI: >5.2). Major no...

Research paper thumbnail of Characterization of diffuse fibrosis in the failing human heart via diffusion tensor imaging and quantitative histological validation

Research paper thumbnail of Late Antibody-Mediated Rejection (AMR) in Heart Transplantation: How “Late” Is It?

Journal of Cardiac Failure, 2014

Research paper thumbnail of Transient Aortic Obstruction with the Use of an Intraaortic Balloon Pump During Cardiopulmonary Support

Asaio J, 2006

Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for AS... more Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for ASAIO Journal. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed ...

Research paper thumbnail of The Red Cell Distribution Width and the CBC Risk Score Measured Prior to Left Ventricular Assist Device Implantation Predict Post-Implant Survival

Research paper thumbnail of Comparison of standard Maze III and radiofrequency Maze operations for treatment of atrial fibrillation

The Journal of Thoracic and Cardiovascular Surgery, 2007

This study compares clinical results of the standard Maze III operation, a highly effective treat... more This study compares clinical results of the standard Maze III operation, a highly effective treatment for atrial fibrillation, to less complex variations of the Maze III operation utilizing unipolar and bipolar radiofrequency ablation and pulmonary vein isolation. Records were reviewed of 377 patients who had operations for treatment of atrial fibrillation at a single institution over a 10-year period. Standard Maze III was performed in 220 patients, unipolar radiofrequency Maze III in 60, bipolar radiofrequency Maze III in 65, and radiofrequency pulmonary vein isolation in 32. Electrocardiograms were obtained at discharge and 3-, 6-, and 12-month intervals. Chi-square test, logistic regression, and Bayesian theory analyses were performed to determine significant associations between operative procedures and outcomes. Mean age was 65.1 years (range 22-87). There were 13 hospital deaths (3.4%) and 16 deaths during follow-up. Most patients (90.2%, 340/377) had concomitant operations. Electrocardiogram analysis was available in 344 patients at 3 months and 313 patients at 6 months. Freedom from atrial fibrillation at 6 months was superior after standard Maze III compared with radiofrequency modifications. Subanalysis according to surgeon experience demonstrated good results regardless of operative experience. This single-institution experience suggests that the standard Maze III operation is superior to radiofrequency operations for treatment of atrial fibrillation. Radiofrequency modifications of the Maze III operation are also effective treatments for atrial fibrillation and can achieve good results regardless of surgeon experience.

Research paper thumbnail of Early Screening for Antibody-mediated Rejection in Heart Transplant Recipients

The Journal of Heart and Lung Transplantation, 2007

The International Society for Heart and Lung Transplantation (ISHLT) recently established a diagn... more The International Society for Heart and Lung Transplantation (ISHLT) recently established a diagnostic scheme for antibody-mediated rejection (AMR). Currently, however, confirmatory immunohistochemistry studies are recommended only if AMR is clinically or histologically suspected. In this study, we examine whether a pattern of repetitive AMR occurred early enough after transplantation to warrant prospective immunohistochemistry screening in all recently transplanted recipients.

Research paper thumbnail of Abstract 19188: Effects of Continuous-Flow Left Ventricular Assist Device Unloading on the Diastolic Function of the Failing Human Heart

Circulation, Nov 20, 2012

Research paper thumbnail of 560: Insight into Causes for the Time-Dependent Improvement in Heart Transplantation Survival: 20-Year Analysis of United Network for Organ Sharing (UNOS) Data

J Heart Lung Transplant, 2009

that rejection rates are lower for recipients over the age of 70. However, complications of immun... more that rejection rates are lower for recipients over the age of 70. However, complications of immunosuppression such as renal dysfunction and hospitalizations for infections were more prevalent in the older population. These findings suggest a potential need for reducing the intensity of immunosuppression in older heart transplant recipients.

Research paper thumbnail of Effect of Blood Product Transfusion�Induced Tolerance on Incidence of Cardiac Allograft Rejection

Transplantation Proceedings, Sep 30, 2010

Blood product transfusion has been successfully used in solid-organ transplantation to induce tol... more Blood product transfusion has been successfully used in solid-organ transplantation to induce tolerance. Whether a similar protective effect of blood product transfusion exists in heart transplantation is controversial. To investigate the effect of cellular blood product transfusion within 2 weeks posttransplantation on the incidence of cellular and antibody-mediated rejection. Patients were grouped on the basis of number of blood transfusions; group 1 received no transfusions, and groups 2, 3, and 4 each received an incremental number of transfusion units. All endomyocardial biopsy samples were routinely studied using immunofluorescence in the first 12 weeks posttransplantation. Baseline characteristics including age, sex, body mass index, history of diabetes, donor characteristics, and pretransplantation laboratory values were similar except that group 4 had a higher rate of previous sternotomy and longer ischemic time during transplantation. Approximately 9200 endomyocardial biopsy samples composed the data. Short- and long-term freedom from the International Society for Heart &amp;amp;amp;amp;amp; Lung Transplantation grade 3A or higher cellular rejection and from antibody-mediated rejection were comparable between groups. Blood transfusions within the first 2 weeks post-transplantation do not seem to confer any protective effect against posttransplantation cellular rejection or antibody- mediated rejection. Whether other unmeasured confounding factors mask their effect requires further prospective studies.

Research paper thumbnail of Coronary vascular function is improved in ischemic patients after continuous-flow left ventricular assist device implantation (1071.8)

The Faseb Journal, Apr 1, 2014

Research paper thumbnail of Immunological effects of continuous flow left ventricular assist devices before and after heart transplant

The Journal of Heart and Lung Transplantation, 2016

Immune allosensitization can be triggered by continuous-flow left ventricular assist devices (CF ... more Immune allosensitization can be triggered by continuous-flow left ventricular assist devices (CF LVAD). However, the effect of this type of allosensitization on post-transplant outcomes remains controversial. This study examined the post-transplant course in a contemporary cohort of patients undergoing transplantation with and without LVAD bridging. We included consecutive patients who were considered for cardiac transplant from 2006 to 2015. Serum alloantibodies were detected with single-antigen beads on the Luminex platform (One Lambda Inc., Canoga Park, CA). Allosensitization was defined as calculated panel reactive antibody (cPRA) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 10%. cPRA was determined at multiple times. LVAD-associated allosensitization was defined as development of cPRA &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 10% in patients with cPRA ≤ 10% before LVAD implantation. Post-transplant outcomes of interest were acute cellular rejection (ACR), antibody-mediated rejection (AMR), and survival. Allosensitization status was evaluated in 268 patients (20% female). Mean age was 52 ± 12 years, and 132 (49.3%) received CF LVADs. After LVAD implant, 30 patients (23%) became newly sensitized, and the level of sensitization appeared to diminish in many of these patients while awaiting transplant. During the study period, 225 of 268 patients underwent transplant, and 43 did not. A CF LVAD was used to bridge 50% of the transplant recipients. Compared with patients without new sensitization or those already sensitized at baseline, the patients with LVAD-associated sensitization had a higher risk of ACR (p = 0.049) and higher risk of AMR (p = 0.018) but a similar intermediate-term post-transplant survival. The patients who did not receive a transplant had higher level of allosensitization, with a baseline cPRA of 20% vs 6% in those who received an allograft and a high risk (40%) of death during follow-up. New allosensitization takes place in &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 20% of patents supported with CF LVADs. Among patients who undergo transplant, this results in a higher risk of ACR and AMR, but survival remains favorable, likely due to the efficacy of current management after transplant. However, mortality in sensitized patients who do not reach transplant remains high, and new approaches are necessary to meet the needs of this group of patients.

Research paper thumbnail of Myocardial and End-Organ Response after Long-Term Mechanical Unloading with Continuous-Flow Left Ventricular Assist Device: Axial- Versus Centrifugal-Flow

The Journal of Heart and Lung Transplantation, 2016

Research paper thumbnail of Antibody testing for cardiac antibody-mediated rejection: Which panel correlates best with cardiovascular death?

The Journal of Heart and Lung Transplantation the Official Publication of the International Society For Heart Transplantation, Feb 1, 2011

BACKGROUND: Recent efforts are being undertaken to update and refine current diagnostic criteria ... more BACKGROUND: Recent efforts are being undertaken to update and refine current diagnostic criteria for antibody-mediated rejection (AMR) in heart transplantation. We believe that the appropriate reactants are those that best predict the adverse consequences of AMR and therefore tested various models using different reactants to find the best predictors of cardiovascular mortality in pathologically defined AMR.

Research paper thumbnail of Reasons for, and Outcomes of Patients who were Referred for a Ventricular Assist Device but were Declined: The Recent Era Forgotten Ones

Clinical transplantation, Jan 21, 2015

Ventricular assist devices (VADs) have a proven survival benefit in select patients with advanced... more Ventricular assist devices (VADs) have a proven survival benefit in select patients with advanced heart failure, yet many patients considered for implantation are declined for various reasons. The outcome of these patients is obscure owing to their exclusion from recent VAD studies. We aim to compare the outcomes of patients who received a VAD to those who did not. For this study, the Artificial Heart Program's database at Intermountain Medical Center was queried from 2006-2012 for patients referred for a VAD. Kaplan-Meier survival analysis was performed with Log-Rank test determining significance. Of 232 patients included, 118 patients received a VAD and 114 patients did not. The prevailing reason for VAD decline in eligible and willing patients was due to preexisting illness (39%). Mortality was higher in non-VAD versus VAD patients (58.8% vs. 35.6%, p < 0.001) with a median time-to-death of 67 (IQR:12-314) and 301 (IQR:136-694) days respectively (p = 0.007). In the current...

Research paper thumbnail of ISHLT Pathology Antibody Mediated Rejection Score (pAMR) Correlates with Increased Risk of Cardiovascular Mortality: A Retrospective Validation Analysis

The Journal of Heart and Lung Transplantation, 2015

Antibody-mediated rejection (AMR) in cardiac transplant recipients is a serious form of rejection... more Antibody-mediated rejection (AMR) in cardiac transplant recipients is a serious form of rejection with adverse patient outcomes. The International Society of Heart and Lung Transplantation (ISHLT) has published a consensus schema for the pathologic diagnosis of various grades of antibody-mediated rejection (pathology antibody-mediated rejection [pAMR]). We sought to determine whether the ISHLT pAMR grading schema correlates with patient outcomes. Using our database, which contains a semi-quantitative scoring of all pathologic descriptors of pAMR, we retrospectively used these descriptors to convert the previous AMR categories to the current ISHLT pAMR categories. Cox proportional hazard models were fit with cardiovascular (CV) death or retransplant as the outcome. The pAMR value was included as a categorical variable, and cellular rejection (CR) values were included in a separate model. There were 13,812 biopsies from 1,014 patients analyzed. The pAMR grades of pAMR1h, pAMR1i, and pAMR2 conferred comparable increased risk for CV mortality. Significantly increased risk of CV mortality was conferred by biopsies graded as severe AMR (pAMR3). The new ISHLT pAMR grading schema identifies patients at increased risk of CV mortality, consistent with risks published from several programs before 2011. The current schema is validated by this analysis in a large biopsy database. Because pAMR1h, pAMR1i, and pAMR2 have similar CV risks associated with them, the threshold for a positive diagnosis of pAMR should be re-evaluated in future iterations of the ISHLT schema.

Research paper thumbnail of DTI and Quantitative Histological Correlation of Diffuse Fibrosis in Failing Hearts

Introduction. Diffuse fibrosis of the failing heart impacts the mechanical (1) and electrical (2)... more Introduction. Diffuse fibrosis of the failing heart impacts the mechanical (1) and electrical (2) behaviors of the myocardium, and has been linked to increased risk of ventricular and atrial tachyarrhythmia and sudden cardiac death (3). T1-mapping before and after gadolinium (Gd) administration is currently used to quantify extracellular space volume fraction as a surrogate for diffuse myocardial fibrosis (4). However, in light of recent concerns on Gd-based contrast agent use (5), alternative techniques for quantifying diffuse myocardial fibrosis can be desirable. Diffusion tensor imaging (DTI) has been used to characterize tissue microstructure including mapping the fiber structure of the myocardium (6,7). Although the technique is increasingly employed clinically to evaluate myocardial remodeling associated with cardiac diseases (8,9), quantitative correlation between DTI-derived scalar metrics and diffuse fibrosis remains lacking. The present study aims to investigate the relati...

Research paper thumbnail of Cardiac Rotational Mechanics as a Predictor of Favorable Functional and Structural Response After Mechanical Unloading With Cardiac Assist Devices in Advanced Heart Failure Patients

Journal of Cardiac Failure, 2015

Research paper thumbnail of Elevated resting heart rate in heart transplant recipients: innocent bystander or adverse prognostic indicator?

Clinical Transplantation, 2015

The elevated baseline heart rate (HR) of a heart transplant recipient has previously been conside... more The elevated baseline heart rate (HR) of a heart transplant recipient has previously been considered inconsequential. However, we hypothesized that a resting HR above 100 beats per minute (bpm) may be associated with morbidity and mortality. The U.T.A.H. Cardiac Transplant Program studied patients who received a heart transplant between 2000 and 2011. Outpatient HR values for each patient were averaged during the first year post-transplant. The study cohort was divided into two groups: the tachycardic (TC) (HR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;100 bpm) and the non-TC group (HR ≤100 bpm) in which mortality, incidence of rejection, and cardiac allograft vasculopathy were compared. Three hundred and ten patients were included as follows: 73 in the TC and 237 in the non-TC group. The TC group had a higher risk of a 10-yr all-cause mortality (p = 0.004) and cardiovascular mortality (p = 0.044). After adjustment for donor and recipient characteristics in multivariable logistic regression analysis, the hazard ratio was 3.9, (p = 0.03, CI: 1.2-13.2) and 2.6 (p = 0.02, CI: 1.2-5.5) for cardiovascular mortality and all-cause mortality, respectively. Heart transplant recipients with elevated resting HR appear to have higher mortality than those with lower resting HR. Whether pharmacologically lowering the HR would result in better outcomes warrants further investigation.

Research paper thumbnail of 610: Impact of Illness Acuity on Blood Products Usage in Patients Implanted with Left Ventricular Assist Devices (LVAD)

Journal of Heart and Lung Transplantation, 2009

risk. Eighty-eight percent of the high risk LVAD patients developed significant complications tha... more risk. Eighty-eight percent of the high risk LVAD patients developed significant complications that included CVA (12.5%), right heart failure (25%), acute renal failure (12.5%) and infection (37.5%) and 1 of the high risk TAH-t patients experienced multi-organ system failure (16%). Prior to transplantation 38% of high risk LVAD patients died but only 1 (16%) of the high risk TAH-t patients died. Conclusions: In pre-operative patients with high risk scores TAH-t may offer a potential survival advantage over LVAD as a bridge to transplantation.

Research paper thumbnail of Pulsatility and the risk of nonsurgical bleeding in patients supported with the continuous-flow left ventricular assist device HeartMate II

Circulation. Heart failure, 2013

Bleeding is an important cause of morbidity and mortality in patients with continuous-flow left v... more Bleeding is an important cause of morbidity and mortality in patients with continuous-flow left ventricular assist devices (LVADs). Reduced pulsatility has been implicated as a contributing cause. The aim of this study was to assess the effects of different degrees of pulsatility on the incidence of nonsurgical bleeding. The Utah Transplantation Affiliated Hospitals (U.T.A.H.) heart failure and transplant program databases were queried for patients with end-stage heart failure who required support with the continuous-flow LVAD HeartMate II (Thoratec Corp, Pleasanton, CA) between 2004 and 2012. Pulsatility was evaluated by means of the LVAD parameter pulsatility index (PI) and by the echocardiographic assessment of aortic valve opening during the first 3 months of LVAD support. PI was analyzed as a continuous variable and also stratified according to tertiles of all the PI measurements during the study period (low PI: <4.6, intermediate PI: 4.6-5.2, and high PI: >5.2). Major no...

Research paper thumbnail of Characterization of diffuse fibrosis in the failing human heart via diffusion tensor imaging and quantitative histological validation

Research paper thumbnail of Late Antibody-Mediated Rejection (AMR) in Heart Transplantation: How “Late” Is It?

Journal of Cardiac Failure, 2014