The Wilson N. Jones Regional Medical Center (WNJ), formerly Texas Health Presbyterian Hospital–WNJ, is a hospital in Sherman, Texas. It has 237 beds, and employs 1000 staff. It was established in 1914.In 2014, Alecto Healthcare Services acquired the hospital from Texas Health Resources..
Importance:Myeloperoxidase is one of the most abundant peroxidase enzymes in activated myeloid cells. Myeloperoxidase inhibitors may have a clinical benefit in amyotrophic lateral sclerosis (ALS) by slowing neurodegeneration via reduced neuroinflammation and oxidative stress. Objective:To determine the safety, tolerability, and efficacy of verdiperstat, a selective myeloperoxidase inhibitor, in ALS. Design Settings and Participants:Verdiperstat was tested as a regimen of the HEALEY ALS Platform Trial, a multicenter, double-blind, perpetual platform design, randomized clinical trial, with sharing of trial infrastructure and placebo data across multiple regimens. The study was conducted at 54 ALS referral centers across the US from July 2020 to April 2022. Adult participants with a diagnosis of clinically possible, probable, laboratory-supported probable, or definite ALS defined by the revised El Escorial criteria were randomized to verdiperstat or regimen-specific placebo. An additional group of participants concurrently randomized to placebo from other regimens was included in the analyses. Interventions:Eligible participants were randomized in a 3:1 ratio to receive oral verdiperstat, 600 mg, twice daily or matching placebo for a planned placebo-controlled duration of 24 weeks. Main Outcomes and Measures:The primary efficacy outcome was change from baseline through week 24 in disease severity, as measured by a joint model of ALS Functional Rating Scale-Revised and survival, with the treatment effect quantified by the disease rate ratio (DRR), with DRR less than 1 indicating a slowing in disease progression of verdiperstat relative to placebo. Results:A total of 167 participants (mean [SD] age, 58.5 [11.4] years; 59 [35.3%] female; 108 [64.6%] male) were randomized to either verdiperstat (126 [75.4%]) or to placebo (41 [25.6%]). Among the participants randomized to the verdiperstat regimen, 130 (78%) completed the trial. The estimated DRR was 0.98 (95% credible interval, 0.77-1.24; posterior probability = 0.57 for slowing of disease progression [DRR <1]). Verdiperstat was estimated to slow progression by 2% vs placebo (95% credible interval, -23% to 24%; posterior probability 0.57). Verdiperstat was overall safe and well tolerated. Common adverse events in the verdiperstat group were nausea, insomnia, and elevated thyrotropin levels. Conclusions and Relevance:Results demonstrate that treatment with verdiperstat was unlikely to alter disease progression in ALS. Trial Registration:Clinical Trial Identifiers: NCT04297683 and NCT04436510.
There are limited comparative data on the use of plaque modification devices during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We compared intravascular lithotripsy (IVL) with rotational atherectomy (RA) for lesion preparation in patients who underwent CTO PCI across 50 US and non-US centers from 2019 to 2024. Of 15,690 patients who underwent CTO PCI during the study period, 436 (2.78%) underwent IVL and 381 (2.45%) RA. Patients treated with IVL had more co-morbidities and more complex CTO lesions. Antegrade wiring was the most used initial and successful crossing strategy for lesions treated with both IVL and RA, although the retrograde approach was more frequently used in IVL cases. Procedure and fluoroscopy times, and air kerma radiation doses and contrast volumes, were greater in patients treated with RA than those treated with IVL. There were no significant differences between the groups in technical success (97.2% vs 95.3%, p = 0.20), procedural success (94.7% vs 91.8%, p = 0.14), and in-hospital major adverse cardiac events (MACEs) (3.0% vs 4.2%, p = 0.47). However, coronary artery perforations were more frequent in patients who underwent RA (9.5% vs 3.2%, p <0.001). Multivariable logistic regression analysis revealed that IVL compared with RA was not independently associated with technical success, procedural success, or in-hospital MACE. In patients who undergo CTO PCI, IVL is associated with similar in-hospital MACE, technical success, and procedural success but lower incidence of coronary artery perforation compared with RA.
BACKGROUND:Prescription of obesity medications is increasing, but our understanding of their effects in patients with cardiovascular disorders, such as postural orthostatic tachycardia syndrome (POTS), is limited. CASE SUMMARY:POTS was exacerbated in a 28-year-old woman with obesity after using tirzepatide for weight reduction. Her condition was effectively treated with progressive exercise training and counseling, which reduced supine and standing heart rates to normal values, before starting tirzepatide. However, while using tirzepatide, the patient's supine and standing heart rates were markedly elevated, and she experienced recurrence of orthostatic intolerance symptoms. DISCUSSION:Although small increases in resting heart rate with glucagon-like peptide-1 receptor agonist use have been reported in adults (approximately 3 beats/min), such a large increase in both supine and standing heart rate (20-30 beats/min) with tirzepatide has not been reported to our knowledge. TAKE-HOME MESSAGE:Prescription of tirzepatide may exacerbate symptoms of orthostatic intolerance and cause marked tachycardia in patients with POTS.
During standard cardiovascular magnetic resonance (CMR) the horizontal long-axis cine image (i.e., 4-chamber) is captured which includes a cross-section of the descending aorta. The aortic cross-section can be used to assess aortic stiffness (distensibility; ∆area/pressure) or circumferential strain (percentage vascular deformation). We examined whether descending aortic strain from traditional CMR is sensitive to age- and disease-related (heart failure with preserved ejection fraction; HFpEF) arteriosclerosis. We recruited 83 participants into three groups: (1) 34 young individuals (age: 22 ± 3 years; body mass index (BMI): 24.3 ± 2.8 kg/m2); (2) 19 older individuals (age: 69 ± 5 years; BMI: 26.9 ± 4.7 kg/m2) and (3) 26 patients with HFpEF (age: 69 ± 6 years; BMI: 35.8 ± 6.1 kg/m2). All participants were studied in the same 3 T scanner (Phillips, Achieva). Descending aortic cross-sectional area and circumferential strain were measured using cvi42 software. Blood pressure was measured via a brachial oscillometric cuff. Data were compared via ANOVA. All data are reported as means ± standard deviation. Compared to the young group (71 ± 5 mmHg), mean arterial pressure was higher in the older (83 ± 9 mmHg, P < 0.001) and HFpEF groups (86 ± 10 mmHg, P < 0.001). Minimum and maximum aortic areas were greater in the older and HFpEF groups (both, P < 0.01). Peak descending aortic strain (young: 11.4% ± 2.2%; older: 4.8% ± 1.6%; HFpEF 3.8% ± 1.6%) and absolute distension were lower (all, P < 0.02) in the older and HFpEF groups compared to the young. Peak descending aortic strain and strain rates are sensitive to age and may provide a novel assessment of arterial stiffness for longitudinal studies that utilize or have utilized CMR.
BACKGROUND:Infants discharged from a neonatal intensive care unit (NICU) to unprepared caregivers are at risk for adverse events and hospital readmission. We developed strategies to improve caregivers' ability to provide infant care after NICU discharge (DC). METHODS:Our interdisciplinary team developed a 7-year, single-center quality initiative to enhance caregivers' abilities to care for infants after NICU DC. We tracked DC care-related failures (DCRFs), hospital readmissions, and caregiver training efficacy before and after implementing care training improvements. Key interventions included implementing standardized DC education with targeted feedback, establishing a DC navigator role, and performing post-DC phone calls to mitigate and quantify errors. Outcomes measured were DCRF rates, all-cause and preventable readmissions within 30 days of DC, caregiver/staff DC readiness, and satisfaction scores. RESULTS:Between 2013 and 2019, 3305 NICU DCs occurred and 44% (1,453) of caregivers were successfully contacted after DC. DCRFs were common, decreasing from 23% (79/342) at baseline to 11% (46/424) and 17% (114/687) in contacted caregivers during intervention and maintenance phases, respectively. Improvements were seen in feeding, oxygen, and primary care physician (PCP) follow-up-related DCRFs. Readmissions were infrequent with no differences between phases. Despite high DCRF incidence, caregivers consistently reported high DC readiness (≥90%). Nurse satisfaction with the DC process increased markedly from 2% (1/43) at baseline to 67% (40/60) in 2020. CONCLUSION:Following DC from the NICU, errors in medication and feeding administration, oxygen delivery, and PCP follow-up were not uncommon. However, study interventions enhanced caregivers' ability to provide post-DC care, leading to a reduction in errors and potential infant harm.
