Baylor Research Institute

Blanke, P., J. K. Park, P. Grayburn, C. Naoum, K. Ong, K. Kohli, B. L. Norgaard, J. G. Webb, J. Popma, D. Boshell, P. Sorajja, D. Muller and J. Leipsic (2017). “Left ventricular access point determination for a coaxial approach to the mitral annular landing zone in transcatheter mitral valve replacement.” J Cardiovasc Comput Tomogr: Apr [Epub ahead of print].

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INTRODUCTION: To facilitate coaxial device deployment in transcatheter mitral valve replacement (TMVR), a coaxial approach to the mitral annular plane is needed. We sought to establish a method to determine an ‘orthogonal’ left ventricular (LV) access point for transapical TMVR and to quantitatively characterize its location in patients with severe mitral regurgitation using cardiac computed tomography. METHODS: Cardiac CT data sets of 54 patients with moderate-severe mitral regurgitation evaluated for potential TMVR were analyzed. The D-shaped mitral annular contour was segmented and a 2-dimensional annular plane was derived, allowing for subsequent definition of the perpendicularly oriented mitral annular trajectory. The ‘orthogonal’ LV access point was defined as the transection point of mitral trajectory with the LV epicardial surface. The location of the access point was quantified by its epicardial distance from the true apex and by the rotational offset from a 3-chamber view. RESULTS: LV access points orthogonal to the mitral annular plane were most frequently located in the anterolateral (n = 22, 40.7%) and anterior (n = 16, 29.6%), less frequently anteroseptal (n = 6, 11.1%) and inferolateral (n = 5, 9.3%) ventricular segment; none inferior or inferoseptal. The mean distance to the LV apex was 17.6 +/- 7.7 mm. The mean forward rotational offset from the 3-chamber view was 96.4 +/- 43.4 degrees , relating to a mean forward rotational offset of 6.4 +/- 43.4 degrees in regard to a hypothetical, secondary 90 degrees x-plane view. No significant difference between patients with degenerative mitral valve disease or functional mitral regurgitation was observed. CONCLUSION: The location of the LV access point that provides an orthogonal trajectory to the mitral annular plane exhibits relevant inter-individual variability. It is commonly not identical with the true apex, and frequently localized in the anterolateral or anterior ventricular segments.

Garofalo, R., E. Ceccarelli, A. Castagna, V. Calvisi, B. Flanagin, M. Conti and S. G. Krishnan (2017). “Open capsular and ligament reconstruction with semitendinosus hamstring autograft successfully controls superior and posterior translation for type v acromioclavicular joint dislocation.” Knee Surg Sports Traumatol Arthrosc: Apr [Epub ahead of print].

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PURPOSE: Appropriate surgical management for type V complete acromioclavicular (AC) joint dislocation remains controversial. The purpose of this paper is to retrospectively report the clinical and radiographic outcomes of an open surgical technique consisting for AC joint ligamentous and capsular reconstruction using autologous hamstring tendon grafts and semi-permanent sutures. METHODS: Between January 2005 and December 2011, 32 consecutive patients with symptomatic type V complete AC joint dislocation underwent surgical treatment using the same technique. The median time from injury to surgery was 45 days (range 24-90). The average median postoperative clinical and radiographic follow-up time was 30 months (range 24-33). Clinical outcomes measures included the ASES score, the visual analog score (VAS), and subjective patient satisfaction score. Minimum follow-up was 2 years. RESULTS: ASES score increased from a median of 38.2 +/- 6.2 preoperative to 92.1 +/- 4.7 postoperatively (p

Jacquart, J., S. Papini, M. L. Davis, D. Rosenfield, M. B. Powers, G. M. Frierson, L. B. Hopkins, S. O. Baird, B. H. Marcus, T. S. Church, M. W. Otto, M. J. Zvolensky and J. A. J. Smits (2017). “Identifying attendance patterns in a smoking cessation treatment and their relationships with quit success.” Drug Alcohol Depend 174: 65-69.

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BACKGROUND: While important for substance use outcomes, knowledge about treatment attendance patterns, and their relation with clinical outcomes is limited. We examined the association between attendance patterns and smoking outcomes in a randomized, controlled smoking cessation intervention trial. METHODS: In addition to standard smoking cessation treatment, participants were randomized to 15 weeks of an exercise intervention (n=72) or an education control condition (n=64). Latent class growth analysis (LCGA) tested whether intervention attendance would be better modeled as qualitatively distinct attendance patterns rather than as a single mean pattern. Multivariate generalized linear mixed modeling (GLMM) was used to evaluate associations between the attendance patterns and abstinence at the end of treatment and at 6-month follow-up. RESULTS: The LCGA solution with three patterns characterized by high probability of attendance throughout (Completers, 46.3%), gradual decreasing probability of attendance (Titrators, 23.5%), and high probability of dropout within the first few weeks (Droppers, 30.1%) provided the best fit. The GLMM analysis indicated an interaction of attendance pattern by treatment condition, such that titration was associated with lower probability of quit success for those in the control condition. Probability of quit success was not significantly different between Titrators and Completers in the exercise condition. CONCLUSIONS: These findings underscore the importance of examining how treatment efficacy may vary as a function of attendance patterns. Importantly, treatment discontinuation is not necessarily indicative of poorer abstinence outcome.

Howard, C. E. and P. A. McCullough (2017). “Decoding acute myocardial infarction among patients on dialysis.” J Am Soc Nephrol 28(5): 1337-1339.

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In this issue of the Journal of the American Society of Nephrology, Shroff et al. utilized hospital billing records from patients on HD in the United States.3 In brief, professional coding specialists determine the principal diagnosis as that condition, established after study, which resulted in the patient’s admission to the hospital. Secondary diagnoses include comorbidities, complications, and other diagnoses that are documented by the attending physician on the inpatient face sheet, discharge summary, history and physical, consultation reports, operative reports, and other ancillary reports. Age, sex, discharge destination, principal diagnosis, up to 24 secondary diagnoses, and up to 25 procedure codes are entered into a computerized algorithm to generate the Medicare diagnosis-related group that determines payment to the hospital.4 The authors demonstrated that although the overall AMI claims in patients on dialysis have increased, the proportion of those in the principal position decreased, whereas those in the secondary position increased.3 In particular, the overall and proportional increase of NSTEMI claims increased dramatically in both the principal and secondary coding positions. These data are consistent with the general population, where several studies have shown a sharp decline in ST-segment elevation myocardial infarction (STEMI) and a lesser decline or increase in NSTEMI.5,6 Interestingly, other data sources suggest that unstable angina is ever less frequent because more sensitive troponin assays clinch a diagnosis of NSTEMI over unstable angina in about 98% of cases.7

Havrdova, E., G. Giovannoni, R. Gold, R. J. Fox, L. Kappos, J. T. Phillips, M. Okwuokenye and J. L. Marantz (2017). “Effect of delayed-release dimethyl fumarate on no evidence of disease activity in relapsing-remitting multiple sclerosis: Integrated analysis of the phase iii define and confirm studies.” Eur J Neurol 24(5): 726-733.

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BACKGROUND AND PURPOSE: Significant effects on clinical/neuroradiological disease activity have been reported in patients with relapsing-remitting multiple sclerosis treated with delayed-release dimethyl fumarate (DMF) in phase III DEFINE/CONFIRM trials. We conducted a post hoc analysis of integrated data from DEFINE/CONFIRM to evaluate the effect of DMF on achieving no evidence of disease activity (NEDA) in patients with relapsing-remitting multiple sclerosis. METHODS: The analysis included patients randomized to DMF 240 mg twice daily, placebo or glatiramer acetate (CONFIRM only) for