Sentara Heart Hospital

In the PROACTIVE-HF trial, remote heart failure (HF) management using comprehensive vital signs and seated mean pulmonary artery pressure (mPAP) was safe and resulted in a low reported rate of HF hospitalization (HFH) and all-cause mortality (HFH/D) through 12 months. In this report, we extend the results from the PROACTIVE-HF study through 2 years, stratified by ejection fraction (EF). PROACTIVE-HF was a prospective, multicenter, open-label, single-arm trial evaluating the safety and efficacy of patient management using the Cordella PA pressure sensor system in patients with New York Heart Association class III symptoms, regardless of EF. In the first 24 months, the incidence of HF events (HFE)/D was 0.89 (95% CI 0.81-0.99) events per patient, driven by HFH. Patients with HF with reduced EF had greater HFE/D rates than those with HF with preserved EF (1.0 vs 0.8 events per patient, P = .048). For patients with HF experiencing moderate-to-severe symptoms, management using the Cordella PA sensor system was associated with low event rates and improved health status at 2 years, regardless of EF. Comprehensive remote monitoring of vital signs, seated PAP, and patient-reported symptoms via a digital platform supports sustained benefit for high-risk patients with HF.

Radial and carotid arterial pulse signals for assessing cardiovascular function at rest and during post-exercise recovery in a heart transplant patient: a case study, Rahman, Md Mahfuzur, Hasan, Mamun, May, Jennifer, Herre, John, Reynolds, Leryn, Hao, Zhili (Julie)

BACKGROUNDDonor-derived cell-free DNA (dd-cfDNA) has emerged as a biomarker for antibody-mediated rejection (AMR), but its performance characteristics have not been evaluated in a large contemporary heart transplant population.OBJECTIVESThe study aimed to characterize the incidence and timing of biopsy-proven AMR and evaluate the performance characteristics of dd-cfDNA for AMR.METHODSThe authors included 2,240 subjects from the SHORE (Surveillance HeartCare Outcomes Registry) registry transplanted between 2017 and 2022 with verified biopsy, dd-cfDNA, echocardiographic, and donor-specific antibody (DSA) data. They evaluated the performance characteristics of dd-cfDNA for AMR and the incidence of AMR in different clinical contexts.RESULTSAMR was present in 2.6% of biopsies with significant variability depending on the clinical context: AMR occurred in 1.1% of biopsies with normal graft function and no DSAs vs 20.4% of biopsies with known DSA and graft dysfunction. In patients with neither DSA nor graft dysfunction, the incidence of AMR was 0.7% for dd-cfDNA levels <0.20%, 1.2% for levels between 0.20% and 0.49%, and 6.7% for dd-cfDNA levels ≥0.50%. In patients with known DSA but no graft dysfunction, the incidence of AMR was 1.4% for dd-cfDNA levels <0.20%, 4.8% for levels between 0.20% and 0.49%, and 15.5% for dd-cfDNA levels ≥0.50%.CONCLUSIONSThe authors document significant context dependent variability of AMR incidence and the utility of dd-cfDNA in predicting biopsy yield. These data complement prior studies on the interpretation of peripheral gene expression profiling and dd-cfDNA for rejection monitoring and should further obviate the need for surveillance biopsies. (Surveillance HeartCare Outcomes Registry [SHORE]; NCT03695601).

Heart failure (HF) is a clinical syndrome characterized by signs and symptoms resulting from any structural or functional deficiency of ventricular filling or blood ejection. The mainstay of initial treatment remains lifestyle modifications, guideline-directed medical therapy, and addressing contributing factors. However, the past two decades have come with significant advances in device therapies to improve morbidity and mortality in HF despite evidence-based management as above. Given the rapidly evolving area of HF research and therapeutic development, it is important for clinicians to be familiar with novel therapies and how they can complement medical management. In this review we discuss the current landscape of novel non-surgical device therapies in HF, their respective trials, major outcomes, and their mechanisms of action and target pathways.

Abstract Introduction: Triple-negative breast cancer (TNBC) is an aggressive breast cancer subtype that disproportionately affects BRCA1 mutation carriers and young Black/white women. Black/AA patients have the highest mortality and the shortest survival of any racial/ethnic group in the US. Pembrolizumab and neoadjuvant chemotherapy (NACT) has become the standard of care (SOC) for high-risk early-stage TNBC. Pathologic complete response (pCR) predicts good outcome, whereas pathologic incomplete response (pIR) with high residual cancer burden (RCB) is correlated with early tumor relapse, treatment resistance, and poor survival. Many similarly treated patients with identical TNM and RCB classifications experience treatment disparity, distinct relapse rates, and disparate survival. Current methods fall short in predicting early tumor relapse/chemo-resistance/patient survival with high accuracy in the clinic. Methods: We have conducted IHC staining of EGFR, Ki67, SIAH and PD-L1 expression in a large cohort of TNBC patients (&amp;gt; 1,000 patients), of which 48% patients are Black/AA and 48% patients are white patients, from the Sentara Cancer Network and VCU Massey Comprehensive Cancer Center, both of which serve socio-economically-disadvantaged, medically underserved, and underinsured racial/ethnic minorities in low-income communities in Virginia. Results: We found that high SIAH expression in residual tumors reflects ineffective therapy and persistent EGFR/K-RAS/SIAH pathway activation (ON) and predicts early relapse, chemo-resistance, and poor survival. Conversely, low SIAH expression in residual tumors reflects effective therapy and EGFR/K-RAS/SIAH pathway inactivation (OFF) and predicts tumor remission and good survival. We detected a major racial disparity in the large TNBC cohort. Black/AA breast cancer patients suffer a higher MBC mortality and reduced survival compared to their white counterparts in our clinical studies similar to the SEER/CDC databases. Conclusions: We found that persistent EGFR/RAS/SIAH pathway activation is a major driving force in TNBC malignancy. As an evolutionarily conserved RING-domain E3 ligase, SIAH is a new prognostic biomarker for patient risk stratification, tumor relapse prediction, and racial disparity detection in TNBC. We aim to validate the prognostic power of SIAH and develop a SIAH-centered biomarker panel for patient risk stratification and relapse/resistance/survival prediction in TNBC. Citation Format: Amy H. Tang, Richard A. Hoefer, Mary L. Guye, Billur Samli, Janet S. Winston, Jennifer Koblinski, Valentina Robila, Michael O. Idowu, Rick J. Jansen, Harry D. Bear. Early detection of tumor relapse, racial disparity, and treatment resistance in triple negative breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 3336.

Diverticulitis is an acute inflammatory condition that typically affects the colon. Diverticulitis of the ileum is rare, with most cases reported in the terminal ileum, and is often triggered by an underlying infection, obstruction, or ischemia. Clinically, ileal diverticulitis presents with symptoms similar to colonic diverticulitis, such as abdominal pain, fever, and constipation. Symptoms can also mimic other conditions, including Crohn's disease and appendicitis. Thus, diagnosis is difficult and often delayed, leading to abscess, fistula formation, and acute abdomen. Diagnosing ileal diverticulitis requires a high clinical suspicion, which is depicted in this case of terminal ileal diverticulitis complicated by sepsis and the patient's underlying medical comorbidities.