JOHNS HOPKINS RESEARCHERS REPORT FROM THIS MONTH'S AMERICAN HEART ASSOCIATION MEETING
The following news tips are based on abstracts or posters to be presented at the American Heart Association's 73rd Scientific Sessions, held Nov. 12-15 in New Orleans.
To pursue any of these stories, please contact Beth Simpkins at 410-955-4288 or, starting Nov. 13, Karen Infeld at 410-955-1534 or [email protected]. Please observe the embargoes.
BLOOD COMPONENTS INDICATE RISK OF REJECTING A TRANSPLANTED HEART(Embargoed for Wednesday, Nov. 15, at 9:30 a.m. EST)
Two tiny substances in the blood might alert physicians to which heart transplant patients are likely to experience some form of organ rejection, a Johns Hopkins study indicates.
For the study, researchers collected 132 blood specimens and heart tissue samples from 35 patients between February 1997 and May 1998. The higher the level of the substances prothrombin fragment (PF) 1.2 and p-selectin -- substances circulating in the blood that are involved in clotting -- the higher the rate of rejection, researchers found. Low levels of both substances predicted that the specimen would be free of rejection 88 percent of the time. In addition, patients with a p-selectin level of at least 65 nanograms per milliliter were 21.4 times more likely to have rejection diagnosed in the biopsy specimens from their new hearts compared to those with lower amounts of the substance.
Chronic organ rejection is the Number 1 reason patients need a second transplant. Biopsies, which are done multiple times in the first few weeks and months following the transplant, are currently the only way to accurately detect organ rejection. Even after two years, many patients still must undergo biopsies two or three times a year.
In this study, the PF 1.2 and p-selectin levels accurately predicted what the biopsy would look like, says Jodi B. Segal, M.D., M.P.H., lead author of the study and an assistant professor of medicine at Hopkins.
"Perhaps these blood measures could reduce the number of biopsies needed by transplant patients, and allow us to monitor them noninvasively," she says. "Mechanistically, they also tell us something about how patients' platelets -- blood components involved with clotting -- are functioning, and suggest that anti-platelet agents should be further studied for prevention of organ rejection."
WOMEN LESS LIKELY TO GET "AGGRESSIVE" TREATMENT FOR VESSEL DISEASE(Embargoed for Wednesday, Nov. 15, at 10 a.m. EST)
Looking for a clue to the continuing cycle of hospitalizations among men and women with congestive heart failure (CHF) cased by coronary artery disease (CAD), Johns Hopkins researchers have observed that women with ischemic CHF (caused by lack of oxygen to the heart muscle) have a four-fold increased risk of being readmitted to the hospital due to factors such as repeated angioplasties, rhythm disturbances and ischemic events.
Zaruhi Babayan, M.D., Ph.D., lead author of the study, says that CAD is regarded as less prevalent in women: "Women's blood vessels are smaller, and it's harder to assess the extent of disease and provide definitive treatment, so disease is often diagnosed late or is mistreated. Moreover, as the rate of artery re-narrowing is high after angioplasty, the women who are preferentially treated with angioplasty rather than bypass surgery predictably have recurrent hospital readmissions for additional treatment."
Babayan and colleagues studied records from 493 heart failure patients who presented to the Hopkins Emergency Department, and followed them for hospital readmission within an average of 16 months to determine the cause(s) of relapse.
Researchers found that men (7.2 percent) and women (7 percent) hospitalized for heart failure were equally likely to have been treated before with angioplasty, but women (8.2 percent) were significantly less likely to have received bypass surgery than men (18.2 percent).
"Women are more likely to receive angioplasty than bypass surgery," says the study's senior author, Joao A.C. Lima, M.D., director of echocardiograhy. "But in 10 to 20 percent of angioplasty patients, the arteries re-narrow within six months, and those patients wind up back in the hospital. Our study shows that a history of angioplasty was the main predictor for hospital readmission for women."
Says Babayan, "These observational data serve as an alert that women with ischemic heart failure represent the group of patients at high risk for readmissions due to coronary artery disease and require definitive revascularization procedures early in the course of disease."
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Related links:
American Heart Association 73rd Scientific Sessions http://www.scientificsessions.org/index.oft
Information on Heart Disease Treatments at Johns Hopkinshttp://www.hopkinsmedicine.org/heartdisease.html
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