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Biomedical subjects

Srinivas Murali

Publications and source records attributed to Srinivas Murali.

25 records · Page 2Linked to original sources
PubMed2003

Selected patients listed for cardiac transplantation may benefit from defibrillator implantation regardless of an established indication.

BACKGROUND: End-stage heart failure (HF) patients are at high risk of sudden cardiac death. This study evaluates the role of implantable cardiac defibrillators (ICDs) in HF patients awaiting cardiac transplantation. METHODS: We identified 194 consecutive patients (age 51 +/- 12 years) with New York Heart Association Class 3 or 4 HF (ejection fraction 22 +/- 9%) listed for cardiac transplantation, 35 of whom underwent ICD implantation. Of the implanted patients, 16 (Group A) had an established indication for ICD implantation (cardiac arrest, n = 10; sustained ventricular tachycardia [VT], n = 3; and positive electrophysiology study, n = 3). Nineteen patients (Group B) underwent ICD implantation for non-established indications (syncope with non-ischemic cardiomyopathy, n = 4; non-sustained VT, n = 15). There were no procedural complications from ICD implantation. RESULTS: During follow-up of 9.2 +/- 10.1 months, there were 3 deaths in the ICD groups (A and B), and 40 in the control group (8.6% vs 25.2%, p = 0.032). Five patients in Group A and 6 in Group B (31%) received appropriate ICD therapy. The number of therapies per patient and the time to the first shock were similar between Groups A and B. Four of 6 Group B patients on outpatient inotropic therapy (67%) received appropriate ICD therapy. CONCLUSIONS: Selected end-stage heart failure patients awaiting heart transplantation, including those without established ICD indications, are at high risk for malignant arrhythmias and may benefit from ICD implantation. Patients with ICD seem to have improved survival compared to those without ICD. Randomized prospective studies are needed to confirm these findings.

Adult↗
PubMed2003

Non-invasive assessment of myocardial recovery on chronic left ventricular assist device: results associated with successful device removal.

BACKGROUND: Myocardial recovery may occur in patients with heart failure who are receiving left ventricular assist-device support, but identification of candidates for device removal remains challenging. We hypothesized that on-line quantitative echocardiography during trials of decreased device support alone or in combination with exercise cardiopulmonary testing can assess cardiac recovery to predict successful device removal. METHODS: We studied 18 patients with severe heart failure, aged 45 +/- 19 years, who received 234 +/- 169 days of assist-device support as a bridge to transplantation. We used echocardiographic automated border detection from mid-ventricular short-axis images and non-invasive arterial pressure to measure beat-to-beat responses in 2 to 5 minute trials of decreased device flow. We also assessed maximal oxygen consumption in 14 patients who could exercise. RESULTS: Six patients experienced myocardial recovery and underwent successful device removal; 12 remained device dependent. With transient, low assist-device flow, patients with device removal had increased echocardiographic stroke area of 27% +/- 36% vs -24% +/- 12% (p < 0.05) and fractional area change of 51% +/- 13% vs 23% +/- 11% (p < 0.05) in the patients who were device dependent. Estimates of pre-load-adjusted maximal power, a relatively load-independent index, were 6.7 +/- 2.1 mW/cm(4) in patients with successful device removal vs 1.2 +/- 1.2 mW/cm(4) in patients who were device dependent (p < 0.005). Maximal oxygen consumption was 17.2 +/- 1.4 ml/kg/min in patients with myocardial recovery vs 13.1 +/- 1.9 ml/kg/min in patients who were device dependent (p < 0.005) and correlated with pre-load-adjusted maximal power (r = 0.89, p < 0.001). Maximal oxygen consumption >16 ml/kg/min, increased stroke area, >40% increase in fractional area change, or pre-load-adjusted maximal power >4.0 mW/cm(4) with low device flow were associated with successful device removal (p < 0.05). CONCLUSIONS: On-line quantitative echocardiography alone or combined with exercise cardiopulmonary testing can assess myocardial recovery of patients receiving left ventricular assist-device support and has the potential to identify patients who are clinical candidates for device removal.

Adult↗
PubMed2002

Outcome after cardiopulmonary resuscitation in patients with pulmonary arterial hypertension.

Patients with pulmonary arterial hypertension (PAH) often die from right heart failure or sudden cardiac death. Cardiopulmonary resuscitation (CPR) may be instituted in these patients but there are no data in the medical literature about the outcome of CPR in this group of patients. We conducted a retrospective multicenter international study on the frequency and results of CPR in patients with PAH. A total of 3,130 patients with PAH were treated between 1997 and 2000 in 17 referral centers in Europe and in the United States. During this period, 513 patients had circulatory arrest and CPR was attempted in 132 (26%) of these patients. Although 96% of the CPR attempts took place in hospitalized patients (74% in intensive care units or equally equipped facilities) and although there was only minimal delay between collapse and initiation of CPR, resuscitation efforts were primarily unsuccessful in 104 patients (79%). Only eight patients (6%) survived for more than 90 d; these patients had no residual neurologic deficit. Hemodynamics obtained within 3 mo before CPR did not show any significant differences between the survivors and nonsurvivors. Except for one patient, all long-term survivors had identifiable causes of circulatory arrest that were rapidly reversible. Our data indicate that CPR for circulatory arrest in patients with PAH is rarely successful unless the cause of the cardiopulmonary decompensation can be corrected.

Aged↗
PubMed2002

Propagation of activated T lymphocytes from endomyocardial biopsy samples of cardiac allografts: influence of the addition of recombinant interleukin-4 to the culture environment.

In vivo, activated T cells can be propagated from endomyocardial biopsy (EMB) samples of cardiac allografts in cultures containing recombinant interleukin-2 (rIL-2). However, T cells are sometimes not propagated in such cultures, even when rejection is present, and at other times the yield of lymphocytes is too small to allow further studies of these graft-infiltrating cells. The current study investigated the effects of the addition of recombinant interleukin-4 (rIL-4) to the culture environment. Cultures were performed on 532 consecutive EMB samples from 120 adult and pediatric heart transplant recipients. Each sample was divided into multiple fragments. Half of the fragments were cultured in media containing 30 U/mL of rIL-2 and the remaining half were cultured under identical conditions but with the addition of 200 U/mL of rIL-4. After 14 days, cell counts were performed, the cell phenotypes were assessed by flow cytometry, and donor specificity and cytotoxicity were assessed using the primed lymphocyte test (PLT) and cell-mediated lympholysis (CML) assay, respectively. Lymphocyte growth occurred in 18% of grade 0-1a EMB in the presence of rIL-2 and in 29% of grade 0-1a EMB in the presence of rIL-2/rIL-4 (p = 0.02). For higher-grade EMB (equivalent to grade >or=1b), the proportion of positive cultures (approximately 39%) was similar in both conditions. For positive cultures, there was a 5-fold increase in the number of cells in the rIL-2/4 cultures compared to rIL-2 alone (1.6 x 10(6) versus 3.4 x 10(5)). Flow cytometry revealed an increase in the proportion of CD8+ cells in the rIL-2/4 cultures (42% versus 23%, p = 0.004). Proliferative responses to donor antigens (as assessed by using the PLT) were comparable between the two groups, but donor-specific cell-mediated cytotoxicity was enhanced on addition of rIL-4. Hence, addition of rIL-4 enhances the propagation of donor-specific T cells from heart biopsy samples, especially in the presence of minimal rejection. This will provide a greater quantity of material for further studies of graft-infiltrating cells.

Adolescent↗
PubMed2002

Adherence to angiotensin-converting enzyme inhibitor therapy for heart failure.

This study examined adherence to angiotensin-converting enzyme inhibitor therapy among 171 heart failure clinic patients. Adherence was monitored over a 3-month period with an electronic event monitor housed in a medication bottle cap, which recorded the date and time the cap was opened and closed. The average percentage of days that the prescribed number of doses (regimen adherence) was taken over the observation period was 84%. Seventy-one percent of patients showed 85%-100% adherence with their daily regimen; 19% exhibited less than 70% adherence. The overall high rates of adherence to angiotensin-converting enzyme inhibitor therapy observed among heart failure clinic patients is consistent with research that shows improved outcomes for patients managed in heart failure clinics. Electronic medication monitoring can be useful in identifying a substantial fraction of patients who are poorly adherent so that interventions to improve adherence can be targeted toward them. Additional research is needed to develop and test adherence-enhancing interventions.

Aged↗
PubMed1999

Determining Quality of Life in Older and Younger Women With Congestive Heart Failure and Myocardial Infarction.

The purpose of this study was to compare quality of life (QOL) between older and younger women diagnosed with congestive heart failure (CHF) or myocardial infarction (MI) and to ascertain if QOL varied with age. Using the Medical Outcomes Survey (MOS-SF-36) we examined 131 women: 69 diagnosed with CHF and 62 with MI. Older women (age equals 65 years) with CHF had a higher mean for general health, whereas younger women (age equals 64 years) had higher mean scores for role physical, vitality, role emotion, and social functioning. Older women with MI had higher mean scores on role emotion, mental health, and social functioning. The younger MI women had higher mean scores on physical functioning, and role physical. Aspects of QOL may vary in subsets of women depending on age and cardiac diagnosis. This suggests the need for age appropriate intervention in women with MI and CHF.

Journal Article↗