Results of a Preliminary Study at NewYork-Presbyterian Hospital/Columbia University Medical Center Presented Today at 2010 AHA Meeting
Nov 15, 2010
A novel genomic blood test can be developed to detect or predict multi-organ dysfunction after mechanical circulatory-support-device implantation in heart failure patients, a new study has found. The preliminary feasibility study was conducted at NewYork-Presbyterian Hospital/Columbia University Medical Center. Results were presented today at the 2010 American Heart Association Scientific Sessions in Chicago.
Study results were presented at 5 p.m. CT in Room N230b, McCormick Place.
Researchers looked at the gene expression profiling of circulating white blood cells in heart failure patients undergoing implantation of a mechanical circulatory support device or ventricular assist device such as an LVAD. Multi-organ dysfunction was defined by a clinical scoring system called the Sequential Organ Failure Assessment (SOFA) score. They found that the gene expression patterns successfully differentiated the patients with higher degree of multi-organ dysfunction from those with normal functions.
"This simple blood test will potentially act as an early warning system to help physicians predict whether mechanical support can help a patient with advanced heart failure, or if the risk for complications is too great," says Dr. Mario Deng, the study's principal investigator; director of cardiac transplantation research at Columbia University Medical Center; associate professor of medicine at Columbia University College of Physicians and Surgeons; and a cardiologist at NewYork-Presbyterian Hospital/Columbia University Medical Center. Dr. Deng was co-principal investigator in the Cardiac Allograft Rejection Gene Expression Observation (CARGO) and Invasive Monitoring Attenuation through Gene Expression (IMAGE) studies, which led to the development of a genomic test called AlloMap available across heart transplant centers in the United States to rule out rejection.
"In theory, the test can also be used to guide clinical decisions following heart surgery, or even help with end-of-life decisions," adds Dr. Deng.
Approximately 5 million Americans suffer from heart failure, and the burden of this disease is expected to grow dramatically over the next 50 years. Heart failure currently results in 3.5 million hospitalizations and 20 percent of all hospital admissions among individuals aged 65 years and older. Surgical interventions for heart failure include cardiac repair (coronary artery bypass grafting, valve repair or replacement), cardiac support (mechanical circulatory-support devices) and cardiac replacement (heart transplantation). These modern interventions of cardiac surgery, although on one hand have dramatically improved outcomes, are associated with complications such as multi-organ dysfunction.
The multi-organ dysfunction syndrome after injury, trauma and sepsis is the major cause of morbidity and mortality in the critical care units. According to a multiyear survey conducted in surgical intensive care unit (ICU) patients, more than 50 percent of patients develop some degree of multi-organ dysfunction during their ICU stay. In adult ICUs 47 percent of trauma patients develop multi-organ dysfunction defined by the SOFA score of ≥3 in ≥2 organ systems. The data show that the severity of multi-organ dysfunction correlates significantly with mortality.
"These results are a breakthrough for us and will help to better understand the mechanisms of multi-organ dysfunction, especially how circulating white blood cell biology in response to injury plays a key role in the development of multi-organ dysfunction. These groundbreaking results could have huge implications on outcomes of our heart failure patients undergoing surgical interventions," says Dr. Khurram Shahzad, a postdoctoral scientist in Dr Deng's lab, who presented the data at the annual meeting of the American Heart Association.
NewYork-Presbyterian Hospital, based in New York City, is the nation's largest not-for-profit, non-sectarian hospital, with 2,353 beds. The Hospital has nearly 2 million inpatient and outpatient visits in a year, including more than 220,000 visits to its emergency departments -- more than any other area hospital. NewYork-Presbyterian provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine at five major centers: NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian Hospital/Columbia University Medical Center, NewYork-Presbyterian/Morgan Stanley Children's Hospital, NewYork-Presbyterian/The Allen Hospital and NewYork-Presbyterian Hospital/Westchester Division. One of the most comprehensive health care institutions in the world, the Hospital is committed to excellence in patient care, research, education and community service. NewYork-Presbyterian is the #1 hospital in the New York metropolitan area and is consistently ranked among the best academic medical institutions in the nation, according to U.S.News & World Report. The Hospital has academic affiliations with two of the nation's leading medical colleges: Weill Cornell Medical College and Columbia University College of Physicians and Surgeons. For more information, visit www.nyp.org.
Columbia University Medical Center
Columbia University Medical Center provides international leadership in basic, pre-clinical and clinical research, in medical and health sciences education, and in patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Established in 1767, Columbia's College of Physicians and Surgeons was the first institution in the country to grant the M.D. degree and is now among the most selective medical schools in the country. Columbia University Medical Center is home to the most comprehensive medical research enterprise in New York City and State and one of the largest in the United States. Columbia University Medical Center is affiliated with NewYork-Presbyterian Hospital, the nation's largest not-for-profit, non-sectarian hospital provider. For more information, please visit www.cumc.columbia.edu.