2023
A randomized clinical trial assessing the effect of automated medication-targeted alerts on acute kidney injury outcomes
Wilson F, Yamamoto Y, Martin M, Coronel-Moreno C, Li F, Cheng C, Aklilu A, Ghazi L, Greenberg J, Latham S, Melchinger H, Mansour S, Moledina D, Parikh C, Partridge C, Testani J, Ugwuowo U. A randomized clinical trial assessing the effect of automated medication-targeted alerts on acute kidney injury outcomes. Nature Communications 2023, 14: 2826. PMID: 37198160, PMCID: PMC10192367, DOI: 10.1038/s41467-023-38532-3.Peer-Reviewed Original ResearchConceptsAcute kidney injuryUsual care groupKidney injuryCare groupAcute Kidney Injury OutcomesAlert groupNon-steroidal anti-inflammatory drugsComposite of progressionHours of randomizationMedications of interestAldosterone system inhibitorsClasses of medicationsProton pump inhibitorsRandomized clinical trialsAnti-inflammatory drugsClinical decision support systemNephrotoxic medicationsHospitalized adultsDiscontinuation ratesCertain medicationsPrimary outcomeSubstantial morbiditySystem inhibitorsPump inhibitorsParallel group
2022
The impact of induction therapy on mortality and treated rejection in cardiac transplantation: A retrospective study
Bellumkonda L, Oikonomou EK, Hsueh C, Maulion C, Testani J, Patel J. The impact of induction therapy on mortality and treated rejection in cardiac transplantation: A retrospective study. The Journal Of Heart And Lung Transplantation 2022, 41: 482-491. PMID: 35094919, DOI: 10.1016/j.healun.2022.01.008.Peer-Reviewed Original ResearchConceptsInduction therapyCause mortalityOutcome measuresLeft ventricular assist device therapyT-cell depleting agentsVentricular assist device therapyDual organ transplantsRoutine induction therapySecondary outcome measuresTime of transplantationPrimary outcome measureCox regression modelPropensity score adjustmentRisk of rejectionPrior transplantCardiac transplantationHeart transplantationUNOS databaseAdult patientsOverall survivalDevice therapyMedian ageRetrospective studyReceptor antagonistReduced odds
2021
Evidence for SARS-CoV-2 Spike Protein in the Urine of COVID-19 Patients
George S, Pal AC, Gagnon J, Timalsina S, Singh P, Vydyam P, Munshi M, Chiu JE, Renard I, Harden CA, Ott IM, Watkins AE, Vogels CBF, Lu P, Tokuyama M, Venkataraman A, Casanovas-Massana A, Wyllie AL, Rao V, Campbell M, Farhadian SF, Grubaugh ND, Dela Cruz CS, Ko AI, Perez A, Akaho EH, Moledina DG, Testani J, John AR, Ledizet M, Mamoun CB, Team A. Evidence for SARS-CoV-2 Spike Protein in the Urine of COVID-19 Patients. Kidney360 2021, 2: 924-936. PMID: 35373072, PMCID: PMC8791366, DOI: 10.34067/kid.0002172021.Peer-Reviewed Original ResearchConceptsSARS-CoV-2 spike proteinSARS-CoV-2Spike proteinUrine samplesSARS-CoV-2 infectionYale-New Haven HospitalCOVID-19 patientsAntigen capture assayDetectable viral RNANew Haven HospitalPositive PCR resultsPossible long-term consequencesSpike S1 proteinNP PCRChildren's HospitalNasopharyngeal swabsSARS-CoV-2 spike S1 proteinRenal abnormalitiesLong-term effectsCystatin CLong-term consequencesHospitalUrineViral RNAAlbuminuriaRisk stratification of patients listed for heart transplantation while supported with extracorporeal membrane oxygenation
Ivey-Miranda JB, Maulion C, Farrero-Torres M, Griffin M, Posada-Martinez EL, Testani JM, Bellumkonda L. Risk stratification of patients listed for heart transplantation while supported with extracorporeal membrane oxygenation. Journal Of Thoracic And Cardiovascular Surgery 2021, 165: 711-720. PMID: 34167814, DOI: 10.1016/j.jtcvs.2021.05.032.Peer-Reviewed Original ResearchConceptsHeart transplantMajor risk factorRisk factorsPosttransplantation mortalityHT recipientsMembrane oxygenationGood long-term prognosisSevere cardiogenic shockOrgan Sharing databaseLong-term prognosisExtracorporeal membrane oxygenationMinor risk factorsVentricular assist deviceCardiogenic shockHeart transplantationRecipient ageIndependent predictorsPrimary outcomeSharing databaseMechanical ventilationRisk stratificationUnited NetworkAdult candidatesECMOAbsence of recovery
2020
Differential Impact of Class I and Class II Panel Reactive Antibodies on Post-Heart Transplant Outcomes
Ivey-Miranda JB, Kunnirickal S, Bow L, Maulion C, Testani JM, Jacoby D, Kransdorf EP, Bellumkonda L. Differential Impact of Class I and Class II Panel Reactive Antibodies on Post-Heart Transplant Outcomes. Journal Of Cardiac Failure 2020, 27: 40-47. PMID: 32750489, DOI: 10.1016/j.cardfail.2020.07.012.Peer-Reviewed Original ResearchConceptsPanel reactive antibodyCause mortalityReactive antibodiesClass IClass II panel reactive antibodiesAdult heart transplant patientsPost-heart transplant outcomesClass IIRejection-related mortalityHeart transplant patientsOrgan Sharing dataHeart transplantationTransplant outcomesTransplant patientsSensitized patientsUnited NetworkIsolated elevationHigh riskGroup 2Group 1High mortalityCombined elevationGroup 4MortalityPatientsAccess and Outcomes Among Hypertrophic Cardiomyopathy Patients in a Large Integrated Health System
Thomas A, Papoutsidakis N, Spatz E, Testani J, Soucier R, Chou J, Ahmad T, Darr U, Hu X, Li F, Chen ME, Bellumkonda L, Sumathipala A, Jacoby D. Access and Outcomes Among Hypertrophic Cardiomyopathy Patients in a Large Integrated Health System. Journal Of The American Heart Association 2020, 9: e014095. PMID: 31973610, PMCID: PMC7033886, DOI: 10.1161/jaha.119.014095.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedCardiomyopathy, HypertrophicCause of DeathConnecticutDelivery of Health Care, IntegratedFemaleHealthcare DisparitiesHeart Disease Risk FactorsHospitalizationHumansMaleMiddle AgedOutcome and Process Assessment, Health CareReferral and ConsultationRetrospective StudiesRisk AssessmentSocial ClassSocial Determinants of HealthTreatment OutcomeConceptsSpecialty careHCM patientsCare cohortHypertrophic cardiomyopathyYale New Haven Health SystemLarge integrated health systemHealth systemBackground Hypertrophic cardiomyopathyRetrospective cohort studySocioeconomic statusPatients' socioeconomic statusHigher socioeconomic status groupsHypertrophic cardiomyopathy patientsIntegrated health systemSpecialty care accessSocioeconomic status groupsMedical insurance providersCardiomyopathy clinicCause deathLSES patientsCause hospitalizationCause mortalityNoncardiac causesCohort studySecondary outcomes
2019
Chronic Heart Failure Is Infrequently Associated With Renal Dysfunction in Hypertrophic Cardiomyopathy
Rowin EJ, Romashko M, Testani JM, Koethe BC, Saxena D, Udelson JE, Maron BJ, Maron MS. Chronic Heart Failure Is Infrequently Associated With Renal Dysfunction in Hypertrophic Cardiomyopathy. Journal Of Cardiac Failure 2019, 25: 690-692. PMID: 31158468, DOI: 10.1016/j.cardfail.2019.05.012.Peer-Reviewed Original ResearchLeft atrial fibrosis correlates with extent of left ventricular myocardial delayed enhancement and left ventricular strain in hypertrophic cardiomyopathy
Latif SR, Nguyen VQ, Peters DC, Soufer A, Henry ML, Grunseich K, Testani J, Hur DJ, Huber S, Mojibian H, Dicks D, Sinusas AJ, Meadows JL, Papoutsidakis N, Jacoby D, Baldassarre LA. Left atrial fibrosis correlates with extent of left ventricular myocardial delayed enhancement and left ventricular strain in hypertrophic cardiomyopathy. The International Journal Of Cardiovascular Imaging 2019, 35: 1309-1318. PMID: 30790116, DOI: 10.1007/s10554-019-01551-7.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAngiotensin Receptor AntagonistsAngiotensin-Converting Enzyme InhibitorsAtrial Function, LeftAtrial RemodelingCardiomyopathy, HypertrophicContrast MediaFemaleFibrosisHeart AtriaHeart VentriclesHumansHypertrophy, Left VentricularMagnetic Resonance Imaging, CineMaleMiddle AgedOrganometallic CompoundsPredictive Value of TestsRetrospective StudiesVentricular Dysfunction, LeftVentricular Function, LeftVentricular RemodelingConceptsLA fibrosisLV-LGEHypertrophic cardiomyopathyLA-LGELV fibrosisLV parametersLV end-diastolic volumeSetting of HCMAldosterone system inhibitionLate gadolinium enhancement (LGE) sequencesLV global strainLeft ventricular massEnd-diastolic volumeLeft atrial fibrosisMaximum wall thicknessFibrosis correlatesRenin-AngiotensinVentricular strainMedication usageAtrial fibrosisLV remodelingVentricular massLV massSystem inhibitionDiastolic volumeElevated renalase levels in patients with acute coronary microvascular dysfunction – A possible biomarker for ischemia
Safdar B, Guo X, Johnson C, D'Onofrio G, Dziura J, Sinusas AJ, Testani J, Rao V, Desir G. Elevated renalase levels in patients with acute coronary microvascular dysfunction – A possible biomarker for ischemia. International Journal Of Cardiology 2019, 279: 155-161. PMID: 30630613, PMCID: PMC6482834, DOI: 10.1016/j.ijcard.2018.12.061.Peer-Reviewed Original ResearchConceptsCoronary microvascular dysfunctionFramingham risk scorePET/CTChest painInflammatory markersMicrovascular dysfunctionEmergency departmentRisk scoreRb-82 PET/CTElevated renalase levelsAcute chest painCoronary artery diseaseC-reactive proteinVascular endothelial growth factorAnti-inflammatory proteinTumor necrosis factorEndothelial growth factorAngina historyCMD diagnosisRenalase levelsHypertensive crisisED presentationsHemodynamic instabilityArtery diseaseHeart failure
2016
Efficacy of Intravenous Chlorothiazide for Refractory Acute Decompensated Heart Failure Unresponsive to Adjunct Metolazone
Cardinale M, Altshuler J, Testani JM. Efficacy of Intravenous Chlorothiazide for Refractory Acute Decompensated Heart Failure Unresponsive to Adjunct Metolazone. Pharmacotherapy The Journal Of Human Pharmacology And Drug Therapy 2016, 36: 843-851. PMID: 27321568, DOI: 10.1002/phar.1787.Peer-Reviewed Original ResearchConceptsAcute decompensated heart failureIntravenous chlorothiazideUrine outputIndex doseOral metolazoneLoop diureticsHigh-dose loop diureticsAdministration of chlorothiazideDecompensated heart failurePrimary end pointRetrospective cohort studyTertiary care hospitalFurosemide equivalentsHospital mortalityImproved diuresisDiuretic dosesLast doseMedian doseCohort studyCare hospitalHeart failureMultiple dosesInstitutional protocolInadequate responseOwn control
2015
Familial dilated cardiomyopathy diagnosis is commonly overlooked at the time of transplant listing
Seidelmann SB, Laur O, Hwa J, Depasquale E, Bellumkonda L, Sugeng L, Pomianowski P, Testani J, Chen M, McKenna W, Jacoby D. Familial dilated cardiomyopathy diagnosis is commonly overlooked at the time of transplant listing. The Journal Of Heart And Lung Transplantation 2015, 35: 474-480. PMID: 26852066, PMCID: PMC5423783, DOI: 10.1016/j.healun.2015.12.002.Peer-Reviewed Original ResearchConceptsEnd-stage heart failureStage heart failureHeart failureUNOS registryEchocardiographic findingsUNOS databaseTeaching hospitalDetailed pedigree analysisVentricular end-diastolic dimensionPanel reactive antibody levelsTertiary care teaching hospitalLarge tertiary teaching hospitalCenter-specific dataAdvanced heart failureEnd-diastolic dimensionOrgan Sharing registryMajority of patientsNon-ischemic DCMTertiary teaching hospitalMitral valve annulusDetailed family historyTransplant listingAdult patientsClinical characteristicsUNOS dataThe Impact of Donor and Recipient Renal Dysfunction on Cardiac Allograft Survival: Insights Into Reno-Cardiac Interactions
Laur O, Brisco MA, Kula AJ, Cheng SJ, Mangi AA, Bellumkonda L, Jacoby DL, Coca S, Tang WH, Parikh CR, Testani JM. The Impact of Donor and Recipient Renal Dysfunction on Cardiac Allograft Survival: Insights Into Reno-Cardiac Interactions. Journal Of Cardiac Failure 2015, 22: 368-375. PMID: 26616578, PMCID: PMC4904299, DOI: 10.1016/j.cardfail.2015.11.009.Peer-Reviewed Original ResearchConceptsRenal dysfunctionCardiac transplantationAdverse recipient outcomesCardiac allograft survivalOrgan Sharing registryGlomerular filtration ratePotent risk factorImpact of donorAllograft survivalCardiac allograftsRecipient deathRecipient outcomesUnited NetworkAdverse outcomesFiltration rateMyocardial necrosisRisk factorsCardiovascular diseaseHigh riskDonor characteristicsOlder ageRetransplantationDeathTransplantationDysfunctionAutomated, electronic alerts for acute kidney injury: a single-blind, parallel-group, randomised controlled trial
Wilson FP, Shashaty M, Testani J, Aqeel I, Borovskiy Y, Ellenberg SS, Feldman HI, Fernandez H, Gitelman Y, Lin J, Negoianu D, Parikh CR, Reese PP, Urbani R, Fuchs B. Automated, electronic alerts for acute kidney injury: a single-blind, parallel-group, randomised controlled trial. The Lancet 2015, 385: 1966-1974. PMID: 25726515, PMCID: PMC4475457, DOI: 10.1016/s0140-6736(15)60266-5.Peer-Reviewed Original ResearchConceptsAcute kidney injuryUsual care groupKidney injuryCare groupAlert groupClinical outcomesElectronic alertsEligible participantsKidney Disease Improving Global OutcomesEnd-stage renal diseaseAcute kidney injury alertsEffective treatment optionIntensive care unitElectronic alert systemComputer-generated sequenceRandomisation strataSurgical admissionsUsual carePrimary outcomeRenal diseaseCare unitTreatment optionsCreatinine valuesCreatinine concentrationSuch injuriesIntravenous Fluids in Acute Decompensated Heart Failure
Bikdeli B, Strait KM, Dharmarajan K, Li SX, Mody P, Partovian C, Coca SG, Kim N, Horwitz LI, Testani JM, Krumholz HM. Intravenous Fluids in Acute Decompensated Heart Failure. JACC Heart Failure 2015, 3: 127-133. PMID: 25660836, PMCID: PMC4438991, DOI: 10.1016/j.jchf.2014.09.007.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overCohort StudiesDatabases, FactualFemaleFluid TherapyHeart FailureHospital MortalityHospitalizationHumansInfusions, IntravenousIntensive Care UnitsIntubation, IntratrachealIsotonic SolutionsMaleMiddle AgedRenal Replacement TherapyRetrospective StudiesRinger's SolutionSaline Solution, HypertonicSodium Potassium Chloride Symporter InhibitorsUnited StatesYoung AdultConceptsAcute decompensated heart failureDecompensated heart failureHeart failureIntravenous fluidsRetrospective cohort studyCritical care admissionRenal replacement therapyDays of hospitalizationProportion of hospitalizationsHalf-normal salineWarrants further investigationOnly diureticsCare admissionHospital deathHospital outcomesCohort studyLoop diureticsPatient groupReplacement therapyWorse outcomesNormal salineInpatient careMedian volumePatientsHospitalization
2014
A Combined-Biomarker Approach to Clinical Phenotyping Renal Dysfunction in Heart Failure
Testani JM, Damman K, Brisco MA, Chen S, Laur O, Kula AJ, Tang WH, Parikh C. A Combined-Biomarker Approach to Clinical Phenotyping Renal Dysfunction in Heart Failure. Journal Of Cardiac Failure 2014, 20: 912-919. PMID: 25152498, PMCID: PMC4292792, DOI: 10.1016/j.cardfail.2014.08.008.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedBiomarkersBlood Urea NitrogenCardio-Renal SyndromeCohort StudiesConfidence IntervalsCreatinineFemaleGlomerular Filtration RateHeart FailureHospitals, UniversityHumansMaleMiddle AgedPhenotypePrognosisRenal InsufficiencyRetrospective StudiesSensitivity and SpecificityStatistics, NonparametricSurvival RateConceptsB-type natriuretic peptideElevated B-type natriuretic peptideRenal dysfunctionHeart failureLower B-type natriuretic peptideUse of BNPCombined biomarker approachDecompensated heart failureIntrinsic kidney diseaseBlood urea nitrogenDifferent clinical phenotypesBUN/Diuretic resistanceInotrope useWorse survivalCreatinine ratioRisk stratificationDischarge diagnosisNatriuretic peptideVenous congestionKidney diseaseStratify patientsClinical phenotypingPatientsUrea nitrogenInsufficient Natriuretic Response to Continuous Intravenous Furosemide Is Associated With Poor Long-Term Outcomes in Acute Decompensated Heart Failure
Singh D, Shrestha K, Testani JM, Verbrugge FH, Dupont M, Mullens W, Tang WH. Insufficient Natriuretic Response to Continuous Intravenous Furosemide Is Associated With Poor Long-Term Outcomes in Acute Decompensated Heart Failure. Journal Of Cardiac Failure 2014, 20: 392-399. PMID: 24704538, PMCID: PMC4067259, DOI: 10.1016/j.cardfail.2014.03.006.Peer-Reviewed Original ResearchConceptsAcute decompensated heart failureContinuous intravenous furosemideDecompensated heart failureLong-term outcomesIntravenous furosemideNatriuretic responseRenal functionUrine sodiumHeart failureClinical outcomesUrine creatinineAdverse long-term clinical outcomesAdverse long-term outcomesLong-term clinical outcomesPoor long-term outcomesAdverse long-term eventsWeight lossContinuous furosemide infusionNet urine outputUrine sodium excretionAdverse clinical outcomesGlomerular filtration rateNet fluid outputGreater likelihoodLow urine sodium
2013
Influence of Age-Related Versus Non–Age-Related Renal Dysfunction on Survival in Patients With Left Ventricular Dysfunction
Testani JM, Brisco MA, Han G, Laur O, Kula AJ, Cheng SJ, Tang WH, Parikh CR. Influence of Age-Related Versus Non–Age-Related Renal Dysfunction on Survival in Patients With Left Ventricular Dysfunction. The American Journal Of Cardiology 2013, 113: 127-131. PMID: 24216124, PMCID: PMC3915785, DOI: 10.1016/j.amjcard.2013.09.029.Peer-Reviewed Original ResearchConceptsLow glomerular filtration rateGlomerular filtration rateVentricular dysfunctionRenal dysfunctionNormal agingLeft ventricular dysfunctionRisk of deathNormal aging resultsAge-related decreaseInfluence of ageBaseline eGFRMean eGFRLower eGFRWorsened survivalPrognostic importanceFiltration rateSurvival disadvantagePrimary analysisDysfunctionEGFRSignificant riskPatientsUnderlying mechanismRiskMortalityCardiac transplantation can be safely performed using selected diabetic donors
Taghavi S, Jayarajan SN, Wilson LM, Komaroff E, Testani JM, Mangi AA. Cardiac transplantation can be safely performed using selected diabetic donors. Journal Of Thoracic And Cardiovascular Surgery 2013, 146: 442-447. PMID: 23490247, PMCID: PMC4067258, DOI: 10.1016/j.jtcvs.2013.02.047.Peer-Reviewed Original ResearchMeSH KeywordsAdultChi-Square DistributionDiabetes MellitusDonor SelectionFemaleHeart TransplantationHumansHypoglycemic AgentsInsulinKaplan-Meier EstimateMaleMiddle AgedMultivariate AnalysisProportional Hazards ModelsRegistriesRetrospective StudiesRisk AssessmentRisk FactorsTime FactorsTissue and Organ ProcurementTissue DonorsTreatment OutcomeUnited StatesConceptsExtracorporeal membrane oxygenationBody mass indexDiabetic donorsCardiac transplantationIschemic timeMultivariate analysisHuman leukocyte antigen mismatchesDonor body mass indexHigher body mass indexRecipient black raceDuration of diabetesOrgan Sharing databaseInsulin-dependent diabetesAntigen mismatchesCardiac donorsRecipient creatinineRecipient diabetesMedian survivalMembrane oxygenationSharing databaseMass indexMechanical ventilationUnited NetworkRace mismatchBlack race
2011
Influence of renal dysfunction phenotype on mortality in the setting of cardiac dysfunction: analysis of three randomized controlled trials
Testani JM, Coca SG, Shannon RP, Kimmel SE, Cappola TP. Influence of renal dysfunction phenotype on mortality in the setting of cardiac dysfunction: analysis of three randomized controlled trials. European Journal Of Heart Failure 2011, 13: 1224-1230. PMID: 21926073, PMCID: PMC3200208, DOI: 10.1093/eurjhf/hfr123.Peer-Reviewed Original ResearchConceptsGlomerular filtration rateBUN/creatinineRenal insufficiencyNeurohormonal activationRisk of mortalityHeart failurePulmonary Artery Catheterization Effectiveness trialLeft Ventricular Dysfunction (SOLVD) trialBaseline renal insufficiencyBeta-Blocker EvaluationVentricular Dysfunction trialsHeart failure populationCongestive heart failureBlood urea nitrogenCreatinine ratioPrimary outcomeCardiac dysfunctionFailure populationFiltration rateEffectiveness trialPoor survivalStudy populationUrea nitrogenPatientsMortalityImpact of changes in blood pressure during the treatment of acute decompensated heart failure on renal and clinical outcomes†
Testani JM, Coca SG, McCauley BD, Shannon RP, Kimmel SE. Impact of changes in blood pressure during the treatment of acute decompensated heart failure on renal and clinical outcomes†. European Journal Of Heart Failure 2011, 13: 877-884. PMID: 21693504, PMCID: PMC3143830, DOI: 10.1093/eurjhf/hfr070.Peer-Reviewed Original ResearchConceptsDecompensated heart failureBlood pressure reductionSystolic blood pressureHeart failureBlood pressurePulmonary Artery Catheterization Effectiveness trialAcute decompensated heart failureSignificant blood pressure reductionSystolic blood pressure reductionPressure reductionThiazide diuretic useCongestive heart failureDifferent prognostic implicationsRegional vascular bedsFinal common pathwayGreater weight reductionOral vasodilatorsDiuretic useRenal functionWorsened survivalAdverse prognosisPerfusion pressurePrognostic implicationsPrognostic significanceEffectiveness trial