Research Spotlight

Ferreira, J. P., Packer, M., Butler, J. and Zannad, F. (2022). “Reconsidering the ejection fraction centric view of pharmacologic treatment for heart failure.” Eur J Heart Fail.

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In the 1980s randomized, controlled, and double-blind trials in HF started to be conducted.14 The first large randomized controlled trial (RCT) with a survival endpoint, the Veterans Administration Cooperative Study (V-HeFT-I),15 selected patients taking digoxin and a diuretic to receive additional double-blind treatment with placebo, prazosin, or the combination of hydralazine and isosorbide dinitrate based on evidence of cardiac dilatation (cardiothoracic ratio >0.55 on chest X-ray or a left ventricular internal diameter in diastole >2.7 cm/m2 on echocardiography) or a radionuclide ejection fraction <45% in association with reduced exercise tolerance. The Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS) trial randomized patients to enalapril or placebo based on the presence of severe symptoms and a radiologically-determined heart size >600 ml/m2 in men and >550 ml/m2 in women, without the characterization of ejection fraction.

Dellon, E. S., Gonsalves, N., Abonia, J. P., Alexander, J. A., Arva, N. C., Atkins, D., Attwood, S. E., Auth, M. K., Bailey, D. D., Biederman, L., Blanchard, C., Bonis, P. A., Bose, P., Bredenoord, A. J., Chang, J. W., Chehade, M., Collins, M. H., Di Lorenzo, C., Dias, J. A., Dohil, R., Dupont, C., Falk, G. W., Ferreira, C. T., Fox, A. T., Genta, R. M., Greuter, T., Gupta, S. K., Hirano, I., Hiremath, G. S., Horsley-Silva, J. L., Ishihara, S., Ishimura, N., Jensen, E. T., Gutiérrez-Junquera, C., Katzka, D. A., Khoury, P., Kinoshita, Y., Kliewer, K. L., Koletzko, S., Leung, J., Liacouras, C. A., Lucendo, A. J., Martin, L. J., McGowan, E. C., Menard-Katcher, C., Metz, D. C., Miller, T. L., Moawad, F. J., Muir, A. B., Mukkada, V. A., Murch, S., Nhu, Q. M., Nomura, I., Nurko, S., Ohtsuka, Y., Oliva, S., Orel, R., Papadopoulou, A., Patel, D. A., Pesek, R. D., Peterson, K. A., Philpott, H., Putnam, P. E., Richter, J. E., Rosen, R., Ruffner, M. A., Safroneeva, E., Schreiner, P., Schoepfer, A., Schroeder, S. R., Shah, N., Souza, R. F., Spechler, S. J., Spergel, J. M., Straumann, A., Talley, N. J., Thapar, N., Vandenplas, Y., Venkatesh, R. D., Vieira, M. C., von Arnim, U., Walker, M. M., Wechsler, J. B., Wershil, B. K., Wright, B. L., Yamada, Y., Yang, G. Y., Zevit, N., Rothenberg, M. E., Furuta, G. T. and Aceves, S. S. (2022). “International consensus recommendations for eosinophilic gastrointestinal disease nomenclature.” Clin Gastroenterol Hepatol.

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BACKGROUND & AIMS: Substantial heterogeneity in terminology used for eosinophilic gastrointestinal diseases (EGID), particularly the catchall term “eosinophilic gastroenteritis”, limits clinical and research advances. We aimed to achieve an international consensus for standardized EGID nomenclature. METHODS: This consensus process utilized Delphi methodology. An initial naming framework was proposed and refined in iterative fashion, then assessed in a first round of Delphi voting. Results were discussed in two consensus meetings, the framework was updated, and re-assessed in a second Delphi vote, with a 70% threshold set for agreement. RESULTS: Of 91 experts participating, 85 (93%) completed the first and 82 (90%) completed the second Delphi surveys. Consensus was reached on all but two statements. “EGID” was the preferred umbrella term for disorders of GI tract eosinophilic inflammation in the absence of secondary causes (100% agreement). Involved GI tract segments will be named specifically and use an “Eo” abbreviation convention: eosinophilic gastritis (now abbreviated EoG), eosinophilic enteritis (EoN), and eosinophilic colitis (EoC). The term “eosinophilic gastroenteritis” is no longer preferred as the overall name (96% agreement). When >2 GI tract areas are involved, the name should reflect all of the involved areas. CONCLUSIONS: This international process resulted in consensus for updated EGID nomenclature for both clinical and research use. EGID will be the umbrella term rather than “eosinophilic gastroenteritis”, and specific naming conventions by location of GI tract involvement are recommended. As more data are developed, this framework can be updated to reflect best practices and the underlying science.

da Graca, B., Johannesson, L., Testa, G. and Wall, A. E. (2022). “The Ethical Evolution of Uterus Transplantation From Concept to Clinical Procedure.” Clin Obstet Gynecol 65(1): 24-36.

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Uterus transplantation (UTx) offers women with absolute uterine factor infertility a path to motherhood that enables them to carry their own pregnancy. Debates about the ethics of UTx have evolved in tandem with its clinical evolution: clinical trials have provided evidence regarding risks and benefits to donors and recipients that were initially uncertain; technical advances have altered the balance between risks and benefits; and the experiences of donors and recipients has revealed questions that were not anticipated. As UTx transitions to a clinical procedure, questions remain about long-term risks and benefits, applications beyond carrying a pregnancy, and cost and access.

Cowger, J. A., Estep, J. D., Rinde-Hoffman, D. A., Givertz, M. M., Anderson, A. S., Jacoby, D., Chen, L., Brieke, A., Mahr, C., Hall, S., Ewald, G. A., Dirckx, N., Baker, A. T. and Pinney, S. P. (2022). “Variability in Blood Pressure Assessment in Patients Supported with the HeartMate 3TM.” Asaio j 68(3): 374-383.

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Targeted blood pressure (BP) control is a goal of left ventricular assist device medical management, but the interpretation of values obtained from noninvasive instruments is challenging. In the MOMENTUM 3 Continued Access Protocol, paired BP values in HeartMate 3 (HM3) patients were compared from arterial (A)-line and Doppler opening pressure (DOP) (319 readings in 261 patients) and A-line and automated cuff (281 readings in 247 patients). Pearson (R) correlations between A-line mean arterial (MAP) and systolic blood pressures (SBP) were compared with DOP and cuff measures according to the presence (>1 pulse in 5 seconds) or absence of a palpable radial pulse. There were only moderate correlations between A-line and noninvasive measurements of SBP (DOP R = 0.58; cuff R = 0.47) and MAP (DOP R = 0.48; cuff R = 0.37). DOP accuracy for MAP estimation, defined as the % of readings within ± 10 mmHg of A-line MAP, decreased from 80% to 33% for DOP ≤ 90 vs. >90 mmHg, and precision also diminished (mean absolute difference [MAD] increased from 6.3 ± 5.6 to 16.1 ± 11.4 mmHg). Across pulse pressures, cuff MAPs were within ±10 mmHg of A-line 62.9%-68.8% of measures and MADs were negligible. The presence of a palpable pulse reduced the accuracy and precision of the DOP-MAP estimation but did not impact cuff-MAP accuracy or precision. In summary, DOP may overestimate MAP in some patients on HM3 support. Simultaneous use of DOP and automated cuff and radial pulse may be needed to guide antihypertensive medication titration in outpatients on HM3 support.

Colόn, N. S., Pantho, A. F., Afroze, S. H., Ashraf, A., Akter, R., Kuehl, T. J. and Uddin, M. N. (2022). “Reduced urinary angiotensinogen excretion in preeclampsia.” Pregnancy Hypertens 27: 1-5.

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OBJECTIVE: This study evaluated urinary angiotensinogen in preeclampsia. METHODS: Normal pregnant (n = 57) and preeclamptic patients (n = 31); Normal pregnant (n = 10) and preeclamptic rats (n = 10) were studied. Urinary angiotensinogen and plasma angiotensin II were assayed by enzyme-linked immunosorbent assay (ELISA). RESULTS: Urinary angiotensinogen in preeclampsia patients (2.0 ± 1.1 ng/mg creatinine) was suppressed (*p < 0.05) compared to normal pregnant (2.7 ± 1.5 ng/mg creatinine). Plasma angiotensin II in preeclampsia patients (preeclampsia: 36.2 ± 7; normal pregnant: 48.1 ± 5 fmol/mL) was lower. The similar result was observed in preeclampsia rat model. CONCLUSIONS: The reduced urinary excretion of angiotensinogen was both in human preeclampsia patients and rat model of preeclampsia.