Kristen M. Tecson Ph.D.

Tecson, K. M., D. Brown, J. W. Choi, G. Feghali, G. V. Gonzalez-Stawinski, B. L. Hamman, R. Hebeler, S. R. Lander, B. Lima, S. Potluri, J. M. Schussler, R. C. Stoler, C. Velasco and P. A. McCullough (2018). “Major Adverse Renal and Cardiac Events After Coronary Angiography and Cardiac Surgery.” Ann Thorac Surg 105(6): 1724-1730.

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BACKGROUND: Patients at high risk for having postprocedural complications may receive iodixanol, an iso-osmolar contrast, during coronary angiography to minimize the risk of renal toxicity. For those who also require cardiac surgery, the wait time between angiography and surgery may be a modifiable factor capable of mitigating poor surgical outcomes; however, there have been inconsistent reports regarding the optimal wait time. We sought to determine the effects of wait time between angiography and cardiac surgery, as well as contrast-induced acute kidney injury on the development of major adverse renal and cardiac events (MARCE). METHODS: We merged datasets to identify adults who underwent coronary angiography with iodixanol and subsequent cardiac surgery. RESULTS: Of 965 patients, 126 (13.1%) had contrast-induced acute kidney injury; 133 (13.8%) had MARCE within 30 days and 253 (26.2%) within 1 year of surgery. After adjusting for contrast-induced acute kidney injury, age, and Thakar acute renal failure score, the effect of wait time lost significance for the full cohort, but remained for the subgroup of 654 who had coronary artery bypass graft surgery. Patients undergoing coronary artery bypass graft surgery within 1 day of coronary angiography had an approximate twofold increase in risk of MARCE (30-day hazard ratio 2.13, 95% confidence interval: 1.16 to 3.88, p = 0.014; 1-year hazard ratio 2.07, 95% confidence interval: 1.32 to 3.23, p = 0.002) compared with patients who waited 5 or more days. CONCLUSIONS: Patients who had contrast-induced acute kidney injury and had cardiac surgery within 1 day of angiography had an increased risk of MARCE.

Carey, S. A., K. M. Tecson, K. Bass, J. Felius and S. A. Hall (2018). “Patient activation with respect to advanced heart failure therapy in patients over age 65 years.” Heart Lung. Apr 20. [Epub ahead of print].

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BACKGROUND: Clinical and ethical issues persist in determining candidacy for advanced heart failure (HF) therapies in elderly patients. Selection takes many factors into account, including “activation” (engagement and ability to self-manage). OBJECTIVE: To investigate effects of age, activation, and depression/anxiety on selection and 6-month survival of participants considered for therapy. METHODS: Consecutive people referred for advanced HF therapy completed the Patient Activation Measure and Hospital Anxiety and Depression Scale. We analyzed data from participants by age (>/=65 vs. <65 years), stratified by approval for therapy. RESULTS: Among 168 referred, 109 were approved, with no difference in activation between age groups (88% highly activated). Similarly, activation was not associated with age among those not approved. Activation was related to anxiety in older, approved participants, but not to depression. CONCLUSIONS: Concerns regarding reduced self-management in the elderly may not be valid. Age alone should not disqualify a candidate for advanced HF therapy.RE

Carey, S. A., K. M. Tecson, A. K. Jamil, J. Felius, T. K. Wolf-Doty and S. A. Hall (2018). “Gene expression profiling scores in dual organ transplant patients are similar to those in heart-only recipients.” Transpl Immunol. Mar 26. [Epub ahead of print].

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BACKGROUND: Serial gene expression profiling (GEP) may reduce the need for endomyocardial biopsies for detecting acute cellular rejection (ACR) after transplantation, but its performance in dual organ transplant recipients is currently unknown. METHODS: We analyzed 18months of follow-up in a national cohort of 27 dual organ recipients (18 heart-kidney, 8 heart-liver, 1 heart-lung) matched to 54 heart-only recipients for gender, age, and time to first GEP (AlloMap(R)) test. ACR, antibody-mediated rejection (AMR), cytomegalovirus infections, biopsies, and longitudinal GEP scores were evaluated. RESULTS: During the first 90days post-transplant, the mean GEP score for dual organ recipients was 25.2+/-9.1, vs. 23.5+/-7.7 for heart-only recipients (P=0.48), with final GEP scores being 29.1+/-6.1 and 32.3+/-3.4, respectively (P=0.34). GEP scores increased over time (P<0.001) at a similar rate (P=0.33) for both groups. One heart-only recipient had treated ACR (GEP score=17). Fourteen subjects had cytomegalovirus infection, 8 of whom were dual-organ. During follow-up, mean GEP score among patients with cytomegalovirus infection was 32.3, compared to 26.7 (p<0.001) in patients without cytomegalovirus. Only 4 (2%) of 233 biopsies were positive for mild AMR; all occurring in 2 heart-only recipients (GEP scores=18-33). CONCLUSIONS: This largest cohort to date suggests that dual organ transplantation alone should not be reason to omit GEP testing from post-transplant medical management, as the two groups' scores did not differ significantly. Confirming that GEP scores increase over time for heart-only and dual organ recipients and in the presence of cytomegalovirus infection, our work shows promise for the use of serial GEP testing in dual organ recipients.

Wesson, D., H. Kitzman, K. H. Halloran and K. Tecson (2018). “Innovative Population Health Model Associated With Reduced Emergency Department Use And Inpatient Hospitalizations.” Health Aff (Millwood) 37(4): 543-550.

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Population health strategies that improve access to health care and address social determinants of health may reduce the use of costly emergency services. Here we describe a strategy adopted by Baylor Scott & White Health to reduce rising rates of emergency department use and inpatient hospitalizations in an underserved Dallas community that is home to many people with low socioeconomic status. Baylor Scott & White partnered with the Dallas Park and Recreation Department to create a level-three primary care clinic integrating wellness and prevention programs in a city recreational center. The clinic, known as the Baylor Scott & White Health and Wellness Center, exemplifies the integration of social determinants of health within a population health strategy. Emergency department (ED) and inpatient care use was examined over twelve months after initiation of services at the center. People who used the center’s services showed a reduction in ED use of 21.4 percent and a reduction in inpatient care use of 36.7 percent, with an average cost decrease of 34.5 percent and 54.4 percent, respectively. These data support the use of population health strategies to reduce the use of emergency services.

Tecson, K. M., D. Brown, J. W. Choi, G. Feghali, G. V. Gonzalez-Stawinski, B. L. Hamman, R. Hebeler, S. R. Lander, B. Lima, S. Potluri, J. M. Schussler, R. C. Stoler, C. Velasco and P. A. McCullough (2018). “Major Adverse Renal and Cardiac Events Following Coronary Angiography and Cardiac Surgery.” Ann Thorac Surg. Feb 2. [Epub ahead of print].

Full text of this article.

BACKGROUND: Patients at high risk for developing post-procedural complications may receive iodixanol, an iso-osmolar contrast, during coronary angiography to minimize the risk of renal toxicity. For those who additionally require cardiac surgery, the wait-time between angiography and surgery may be a modifiable factor capable of mitigating poor surgical outcomes; however, there have been inconsistsent reports regarding the optimal wait-time. We sought to determine the effects of wait time between angiogram and cardiac surgery, as well as contrast induced acute injury (CI-AKI) on the development of major adverse renal and cardiac events (MARCE). METHODS: We merged datasets to identify adults who underwent coronary angiography with iodixanol and subsequent cardiac surgery. RESULTS: Of 965 patients, 126 (13.1%) developed CI-AKI; 133 (13.8%) experienced MARCE within 30 days and 253 (26.2%) within 1 year of surgery. After adjusting for CI-AKI, age, and Thakar acute renal failure score, the effect of wait-time lost significance for the full cohort, but remained for the 654 who had coronary artery bypass grafting. Those with coronary artery bypass grafting within 1 day of coronary angiography had an approximate 2-fold increase in risk of MARCE (30-day hazard ratio =2.13, 95% confidence interval 1.16-3.88, p=0.014; 1-year hazard ratio =2.07, 95% confidence interval 1.32, 3.23, p = 0.002) compared to those who waited 5 or more days. CONCLUSIONS: Patients who suffered CI-AKI and had cardiac surgery within 1 day of angiography had increased risk of MARCE.