Garmany, Armin

Introduction: Left ventricular assist devices (LVAD) with magnetically levitated impellers have become standard due to hemocompatibility and survival profile. To optimize LVAD speeds, we previously introduced simultaneous right and left heart (RH/LH) catheterization during ramp studies. Here, we report pairing of this approach with pressure-volume (PV) assessment in a patient with a HeartMate 3 LVAD with mitral regurgitation (MR). The combined approach evaluated left ventricular (LV) hemodynamics and right ventricular (RV) PV-relationships during ramp testing. Methods: A 68-year-old male with ischemic cardiomyopathy, two years following HeartMate3 implantation, presented with NYHA class III symptoms. To evaluate for dyspnea, he underwent a RH/LH catheterization ramp study. RV PV-loops were created by use of a conductance catheter system, allowing creation of PV loops. Results: At the baseline LVAD speed of 5300 rotations per minute (RPM), right atrial pressure was elevated at 16 mmHg and pulmonary artery (PA) pressure of 26 mmHg. Left-end diastolic pressure (LVEDP) was elevated (16mmHg). Baseline cardiac index (CI) was 2.01 L/min/m 2 . Ramp testing was performed, increasing speeds from 5300 to 5800 RPM. Progressive LV unloading was observed with a 5 mmHg drop in LVEDP and a 3 mmHg drop in PA pressure. However, RV PV loop monitoring revealed a negative impact on RV contractility with the maximal elastance (Emax) slope demonstrating a 22% reduction. Furthermore, a 17% reduction in RV stroke volume was documented, while diastolic function remained unchanged. Thus, despite excellent LV offloading and diminishment of RV afterload, the significant negative impact on Emax resulted in no net increase in CI (+0.04 L/min/m 2 ) during the ramp evaluation. Inotrope therapy was initiated for RV function with increased LVAD RPM to outcompete MR. Conclusions: While RH/LH catheterization provides a real-time perspective of the interventricular relationship during ramp, the impact of increasing LVAD speeds on RV function has yet to be directly measured. Here, the RV PV loop relationship during LVAD ramp showed that although LVAD speed increases in the setting of MR may facilitate LV unloading, a drop in RV afterload did not compensate for reduction in RV contractility.

Background Despite, the potential clinical utility of 60–4 visual fields, they are not frequently used in clinical practice partly, due to the purported impact of facial contour on field defects. The purpose of this study was to design and test an artificial intelligence-driven platform to predict facial structure-dependent visual field defects on 60–4 visual field tests. Methods Subjects with no ocular pathology were included. Participants were subject to optical coherence tomography, 60–4 Swedish interactive thresholding algorithm visual field tests and photography. The predicted visual field was compared with observed 60–4 visual field results in subjects. Average and point-specific sensitivity, specificity, precision, negative predictive value, accuracy, and F1-scores were primary outcome measures. Results 30 healthy were enrolled. Three-dimensional facial reconstruction using a convolution neural network (CNN) was able to predict facial contour-dependent 60–4 visual field defects in 30 subjects without ocular pathology. Overall model accuracy was 97%±3% and 96%±3% and the F1-score, dependent on precision and sensitivity, was 58%±19% and 55%±15% for the right eye and left eye, respectively. Spatial-dependent model performance was observed with increased sensitivity and precision within the far inferior nasal field reflected by an average F1-score of 76%±20% and 70%±29% for the right eye and left eye, respectively. Conclusions This pilot study reports the development of a CNN-enhanced platform capable of predicting 60–4 visual field defects in healthy controls based on facial contour. Further study with this platform may enhance understanding of the influence of facial contour on 60–4 visual field testing.

Abstract Stem cell paracrine activity is implicated in cardiac repair. Linkage between secretome functionality and therapeutic outcome was here interrogated by systems analytics of biobanked human cardiopoietic cells, a regenerative biologic in advanced clinical trials. Protein chip array identified 155 proteins differentially secreted by cardiopoietic cells with clinical benefit, expanded into a 520 node network, collectively revealing inherent vasculogenic properties along with cardiac and smooth muscle differentiation and development. Next generation RNA sequencing, refined by pathway analysis, pinpointed miR-146 dependent regulation upstream of the decoded secretome. Intracellular and extracellular integration unmasked commonality across cardio-vasculogenic processes. Mirroring the secretome pattern, infarcted hearts benefiting from cardiopoietic cell therapy restored the disease proteome engaging cardiovascular system functions. The cardiopoietic cell secretome thus confers a therapeutic molecular imprint on recipient hearts, with response informed by predictive systems profiling.

Précis: In this longitudinal study of patients with open-angle (OAG), pseudoexfoliative (PXE), or neovascular glaucoma (NVG) receiving glaucoma drainage devices (GDD), posttube cumulative rates of reoperation, corneal graft, and visually threatening complications (VT-complications) increased beyond 5 years and were not significantly affected by glaucoma type. Purpose: To study the need for additional glaucoma surgery and development of complications after first GDD surgery in eyes with primary OAG, PXE, or NVG glaucoma. Patients and Methods: There were 306 eyes with OAG (n=185), PXE (n=60), or NVG (n=61) glaucoma who received a first GDD between 1996 and 2017. Outcomes including glaucoma reoperation, corneal graft procedure, and VT-complications after GDD were measured. Kaplan-Meier analysis was used to compare cumulative rate of reaching outcomes over time after GDD placement among the 3 glaucoma groups. Results: When comparing the OAG, PXE, and NVG groups, there were no significant differences in post-GDD cumulative rates of reoperation (P=0.33), corneal graft (P=0.26), or VT-complications (P=0.65) over time. For all eyes, the overall cumulative rates for each outcome measure increased beyond 5 years, and specific Kaplan-Meier rates (5-y, 10-y) included: reoperation (16%, 25%), corneal graft (6%, 12%), VT-complications (9%, 14%). When comparing specific GDDs, the Ahmed FP7 had a higher cumulative reoperation rate over time compared with the Baerveldt 350 (P=0.019). Conclusion: Glaucoma type did not significantly affect post-GDD cumulative rates of reoperation, corneal graft, and VT-complication among the OAG, PXE, and NVG groups. For all eyes, cumulative rates of reoperation, corneal graft, and VT-complications increased beyond 5 years. The Ahmed FP7 had a significantly higher cumulative reoperation rate compared with the Baerveldt 350 over time.

Précis: Kaplan-Meier analysis was used to compare the rate of corneal grafting after glaucoma drainage device (GDD) placement in pediatric and adult patients. Adults were at an increased risk of receiving a corneal graft after device placement. Purpose: The goal of this study was to compare the rate of corneal graft implantation after GDD placement in pediatric and adult patients. Patients: Patients receiving a GDD between January 1, 1985 and December 31, 2017 were selected from the medical records. Patients receiving their first device while <18 years of age were considered children for the extent of the study. Methods: We compared the rate of receiving a corneal graft after GDD implantation using Kaplan-Meier analysis. Baseline patient characteristics and surgical characteristics were compared using a generalized estimating equation. Results: Corneal grafting occurred in 8.6% of adults and 4.7% of children from the original cohort. The rate of receiving a corneal graft at 5, 10, and 15 years was 9.4%, 16.8%, 39.4% and 1.6%, 1.6%, 12.5% for adults and children, respectively. However, certain characteristics were different between the 2 groups. Conclusion: Adult patients were more likely to receive a corneal graft after GDD placement. However, pediatric and adult patients differed in the prevalence of preexisting corneal disease, glaucoma type, GDD type used, and types of previous surgeries. Elucidation of the impact of these factors on corneal graft rate requires a larger cohort size.