Role of ventricular assist therapy for patients with heart failure and restrictive physiology: Improving outcomes for a lethal disease

Grupper, Avishay; Park, Soon J.; Pereira, Naveen L.; Schettle, Sarah; Gerber, Yariv; Topilsky, Yan; Edwards, Brooks S.; Daly, Richard C.; Stulak, John M.; Joyce, Lyle D.; Kushwaha, Sudhir S.

doi:10.1016/j.healun.2015.03.012

Cited by 91 publications

(58 citation statements)

References 18 publications

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“…145 Survival with a VAD is strongly associated with left ventricular end diastolic diameter 146 . Other forms of circulatory support including intra-aortic balloon pump, BiVAD or total artificial heart (the latter employed given the need for biventricular support) have been employed though survival at one year is reduced if circulatory support is required 147 .…”

Section: Cardiac Replacement Therapy – Transplant and Vadmentioning

confidence: 99%

Addressing Common Questions Encountered in the Diagnosis and Management of Cardiac Amyloidosis

et al. 2017

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Advances in cardiac imaging have resulted in greater recognition of cardiac amyloidosis (CA) in everyday clinical practice, but the diagnosis continues to be made in patients with late stage disease, suggesting that more needs to be done to improve awareness of its clinical manifestations and the potential of therapeutic intervention to improve prognosis. Light chain CA (AL-CA) in particular, if recognized early and treated with targeted plasma cell therapy, can be managed very effectively. For patients with transthyretin amyloidosis, there are numerous therapies that are currently in late phase clinical trials. In this review we address common questions encountered in clinical practice regarding etiology, clinical presentation, diagnosis and management of cardiac amyloidosis, focusing on recent important developments in cardiac imaging and biochemical diagnosis. The aim is to show how a systematic approach to the evaluation of suspected CA can impact the prognosis of patients in the modern era.

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Section: Cardiac Replacement Therapy – Transplant and Vadmentioning

confidence: 99%

Addressing Common Questions Encountered in the Diagnosis and Management of Cardiac Amyloidosis

et al. 2017

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“…Left ventricular assist device has emerged as a new treatment modality for refractory heart failure. However, its use in cardiac amyloidosis has been primarily reserved for non-AL amyloidosis [149], reflecting strict patient selection as a result of serious AEs associated with the device [150]. Its use should be restricted to patients with isolated cardiac amyloidosis.…”

Section: Treatmentmentioning

confidence: 99%

Immunoglobulin Light-Chain Amyloidosis: From Basics to New Developments in Diagnosis, Prognosis and Therapy

et al. 2016

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Immunoglobulin amyloid light-chain (AL) amyloidosis is the most common form of systemic amyloidosis, where the culprit amyloidogenic protein is immunoglobulin light chains produced by marrow clonal plasma cells. AL amyloidosis is an infrequent disease, and since presentation is variable and often nonspecific, diagnosis is often delayed. This results in cumulative organ damage and has a negative prognostic effect. AL amyloidosis can also be challenging on the diagnostic level, especially when demonstration of Congo red-positive tissue is not readily obtained. Since as many as 31 known amyloidogenic proteins have been identified to date, determination of the amyloid type is required. While several typing methods are available, mass spectrometry has become the gold standard for amyloid typing. Upon confirming the diagnosis of amyloidosis, a pursuit for organ involvement is essential, with a focus on heart involvement, even in the absence of suggestive symptoms for involvement, as this has both prognostic and treatment implications. Details regarding initial treatment options, including stem cell transplantation, are provided in this review. AL amyloidosis management requires a multidisciplinary approach with careful patient monitoring, as organ impairment has a major effect on morbidity and treatment tolerability until a response to treatment is achieved and recovery emerges.

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“…Limited data on left ventricular assist devices have shown higher rates of complications compared to those with a dilated cardiomyopathy [43] and increased mortality in subjects with ventricular chamber size less than 46 mm. [44]…”

Section: Managementmentioning

confidence: 99%

Transthyretin Cardiac Amyloidosis in Older Americans

Brunjes

Castaño

Clemons

et al. 2016

Journal of Cardiac Failure

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Wild type transthyretin cardiac amyloidosis (ATTRwt), formerly called senile cardiac amyloidosis (SCA), is almost exclusively a disorder of older adults. As the population ages, the diagnosis of ATTRwt will increase making it the most common form of cardiac amyloidosis. An important precondition to reduce under-diagnosis and misdiagnosis is to maintain a high index of suspicion for cardiac amyloidosis. Several clues can be gleaned from the clinical history, physical exam, electrocardiogram and non-invasive imaging techniques. Nuclear scintigraphy agents using 99mTc-phosphate derivatives combined with assessment for monoclonal proteins are eliminating the need for tissue confirmation in ATTR cardiac amyloid. Morbidity and mortality from ATTRwt cardiac amyloid is high and the emergence of numerous therapies based on a biologic understanding of the pathophysiology of this condition including drugs to inhibit the synthesis of TTR, stabilize TTR, and degrade or extract amyloid provides new hope for those afflicted. This review will briefly cover the epidemiology, pathophysiology and clinical manifestations, as well as diagnostic strategies and treatment of older adults with ATTR cardiac amyloid.

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Role of ventricular assist therapy for patients with heart failure and restrictive physiology: Improving outcomes for a lethal disease

Cited by 91 publications

References 18 publications

Addressing Common Questions Encountered in the Diagnosis and Management of Cardiac Amyloidosis

Addressing Common Questions Encountered in the Diagnosis and Management of Cardiac Amyloidosis

Immunoglobulin Light-Chain Amyloidosis: From Basics to New Developments in Diagnosis, Prognosis and Therapy

Transthyretin Cardiac Amyloidosis in Older Americans

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