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Researching COVID to enhance recovery (RECOVER) tissue pathology study protocol: Rationale, objectives, and design
Troxel, Andrea B; Bind, Marie-Abele C; Flotte, Thomas J; Cordon-Cardo, Carlos; Decker, Lauren A; Finn, Aloke V; Padera, Robert F; Reichard, R Ross; Stone, James R; Adolphi, Natalie L; Casimero, Faye Victoria C; Crary, John F; Elifritz, Jamie; Faustin, Arline; Ghosh, Saikat Kumar B; Krausert, Amanda; Martinez-Lage, Maria; Melamed, Jonathan; Mitchell, Roger A; Sampson, Barbara A; Seifert, Alan C; Simsir, Aylin; Adams, Cheryle; Haasnoot, Stephanie; Hafner, Stephanie; Siciliano, Michelle A; Vallejos, Brittany B; Del Boccio, Phoebe; Lamendola-Essel, Michelle F; Young, Chloe E; Kewlani, Deepshikha; Akinbo, Precious A; Parent, Brendan; Chung, Alicia; Cato, Teresa C; Mudumbi, Praveen C; Esquenazi-Karonika, Shari; Wood, Marion J; Chan, James; Monteiro, Jonathan; Shinnick, Daniel J; Thaweethai, Tanayott; Nguyen, Amber N; Fitzgerald, Megan L; Perlowski, Alice A; Stiles, Lauren E; Paskett, Moira L; Katz, Stuart D; Foulkes, Andrea S; ,
IMPORTANCE/OBJECTIVE:SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or organ dysfunction after the acute phase of infection, termed Post-Acute Sequelae of SARS-CoV-2 (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are poorly understood. The objectives of the Researching COVID to Enhance Recovery (RECOVER) tissue pathology study (RECOVER-Pathology) are to: (1) characterize prevalence and types of organ injury/disease and pathology occurring with PASC; (2) characterize the association of pathologic findings with clinical and other characteristics; (3) define the pathophysiology and mechanisms of PASC, and possible mediation via viral persistence; and (4) establish a post-mortem tissue biobank and post-mortem brain imaging biorepository. METHODS:RECOVER-Pathology is a cross-sectional study of decedents dying at least 15 days following initial SARS-CoV-2 infection. Eligible decedents must meet WHO criteria for suspected, probable, or confirmed infection and must be aged 18 years or more at the time of death. Enrollment occurs at 7 sites in four U.S. states and Washington, DC. Comprehensive autopsies are conducted according to a standardized protocol within 24 hours of death; tissue samples are sent to the PASC Biorepository for later analyses. Data on clinical history are collected from the medical records and/or next of kin. The primary study outcomes include an array of pathologic features organized by organ system. Causal inference methods will be employed to investigate associations between risk factors and pathologic outcomes. DISCUSSION/CONCLUSIONS:RECOVER-Pathology is the largest autopsy study addressing PASC among US adults. Results of this study are intended to elucidate mechanisms of organ injury and disease and enhance our understanding of the pathophysiology of PASC.
PMCID:10781091
PMID: 38198481
ISSN: 1932-6203
CID: 5628642
Researching COVID to enhance recovery (RECOVER) pediatric study protocol: Rationale, objectives and design
Gross, Rachel S; Thaweethai, Tanayott; Rosenzweig, Erika B; Chan, James; Chibnik, Lori B; Cicek, Mine S; Elliott, Amy J; Flaherman, Valerie J; Foulkes, Andrea S; Gage Witvliet, Margot; Gallagher, Richard; Gennaro, Maria Laura; Jernigan, Terry L; Karlson, Elizabeth W; Katz, Stuart D; Kinser, Patricia A; Kleinman, Lawrence C; Lamendola-Essel, Michelle F; Milner, Joshua D; Mohandas, Sindhu; Mudumbi, Praveen C; Newburger, Jane W; Rhee, Kyung E; Salisbury, Amy L; Snowden, Jessica N; Stein, Cheryl R; Stockwell, Melissa S; Tantisira, Kelan G; Thomason, Moriah E; Truong, Dongngan T; Warburton, David; Wood, John C; Ahmed, Shifa; Akerlundh, Almary; Alshawabkeh, Akram N; Anderson, Brett R; Aschner, Judy L; Atz, Andrew M; Aupperle, Robin L; Baker, Fiona C; Balaraman, Venkataraman; Banerjee, Dithi; Barch, Deanna M; Baskin-Sommers, Arielle; Bhuiyan, Sultana; Bind, Marie-Abele C; Bogie, Amanda L; Bradford, Tamara; Buchbinder, Natalie C; Bueler, Elliott; Bükülmez, Hülya; Casey, B J; Chang, Linda; Chrisant, Maryanne; Clark, Duncan B; Clifton, Rebecca G; Clouser, Katharine N; Cottrell, Lesley; Cowan, Kelly; D'Sa, Viren; Dapretto, Mirella; Dasgupta, Soham; Dehority, Walter; Dionne, Audrey; Dummer, Kirsten B; Elias, Matthew D; Esquenazi-Karonika, Shari; Evans, Danielle N; Faustino, E Vincent S; Fiks, Alexander G; Forsha, Daniel; Foxe, John J; Friedman, Naomi P; Fry, Greta; Gaur, Sunanda; Gee, Dylan G; Gray, Kevin M; Handler, Stephanie; Harahsheh, Ashraf S; Hasbani, Keren; Heath, Andrew C; Hebson, Camden; Heitzeg, Mary M; Hester, Christina M; Hill, Sophia; Hobart-Porter, Laura; Hong, Travis K F; Horowitz, Carol R; Hsia, Daniel S; Huentelman, Matthew; Hummel, Kathy D; Irby, Katherine; Jacobus, Joanna; Jacoby, Vanessa L; Jone, Pei-Ni; Kaelber, David C; Kasmarcak, Tyler J; Kluko, Matthew J; Kosut, Jessica S; Laird, Angela R; Landeo-Gutierrez, Jeremy; Lang, Sean M; Larson, Christine L; Lim, Peter Paul C; Lisdahl, Krista M; McCrindle, Brian W; McCulloh, Russell J; McHugh, Kimberly; Mendelsohn, Alan L; Metz, Torri D; Miller, Julie; Mitchell, Elizabeth C; Morgan, Lerraughn M; Müller-Oehring, Eva M; Nahin, Erica R; Neale, Michael C; Ness-Cochinwala, Manette; Nolan, Sheila M; Oliveira, Carlos R; Osakwe, Onyekachukwu; Oster, Matthew E; Payne, R Mark; Portman, Michael A; Raissy, Hengameh; Randall, Isabelle G; Rao, Suchitra; Reeder, Harrison T; Rosas, Johana M; Russell, Mark W; Sabati, Arash A; Sanil, Yamuna; Sato, Alice I; Schechter, Michael S; Selvarangan, Rangaraj; Sexson Tejtel, S Kristen; Shakti, Divya; Sharma, Kavita; Squeglia, Lindsay M; Srivastava, Shubika; Stevenson, Michelle D; Szmuszkovicz, Jacqueline; Talavera-Barber, Maria M; Teufel, Ronald J; Thacker, Deepika; Trachtenberg, Felicia; Udosen, Mmekom M; Warner, Megan R; Watson, Sara E; Werzberger, Alan; Weyer, Jordan C; Wood, Marion J; Yin, H Shonna; Zempsky, William T; Zimmerman, Emily; Dreyer, Benard P; ,
IMPORTANCE/OBJECTIVE:The prevalence, pathophysiology, and long-term outcomes of COVID-19 (post-acute sequelae of SARS-CoV-2 [PASC] or "Long COVID") in children and young adults remain unknown. Studies must address the urgent need to define PASC, its mechanisms, and potential treatment targets in children and young adults. OBSERVATIONS/METHODS:We describe the protocol for the Pediatric Observational Cohort Study of the NIH's REsearching COVID to Enhance Recovery (RECOVER) Initiative. RECOVER-Pediatrics is an observational meta-cohort study of caregiver-child pairs (birth through 17 years) and young adults (18 through 25 years), recruited from more than 100 sites across the US. This report focuses on two of four cohorts that comprise RECOVER-Pediatrics: 1) a de novo RECOVER prospective cohort of children and young adults with and without previous or current infection; and 2) an extant cohort derived from the Adolescent Brain Cognitive Development (ABCD) study (n = 10,000). The de novo cohort incorporates three tiers of data collection: 1) remote baseline assessments (Tier 1, n = 6000); 2) longitudinal follow-up for up to 4 years (Tier 2, n = 6000); and 3) a subset of participants, primarily the most severely affected by PASC, who will undergo deep phenotyping to explore PASC pathophysiology (Tier 3, n = 600). Youth enrolled in the ABCD study participate in Tier 1. The pediatric protocol was developed as a collaborative partnership of investigators, patients, researchers, clinicians, community partners, and federal partners, intentionally promoting inclusivity and diversity. The protocol is adaptive to facilitate responses to emerging science. CONCLUSIONS AND RELEVANCE/CONCLUSIONS:RECOVER-Pediatrics seeks to characterize the clinical course, underlying mechanisms, and long-term effects of PASC from birth through 25 years old. RECOVER-Pediatrics is designed to elucidate the epidemiology, four-year clinical course, and sociodemographic correlates of pediatric PASC. The data and biosamples will allow examination of mechanistic hypotheses and biomarkers, thus providing insights into potential therapeutic interventions. CLINICAL TRIALS.GOV IDENTIFIER/BACKGROUND:Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT05172011.
PMCID:11075869
PMID: 38713673
ISSN: 1932-6203
CID: 5658342
DIAPH1-MFN2 interaction regulates mitochondria-SR/ER contact and modulates ischemic/hypoxic stress
Yepuri, Gautham; Ramirez, Lisa M; Theophall, Gregory G; Reverdatto, Sergei V; Quadri, Nosirudeen; Hasan, Syed Nurul; Bu, Lei; Thiagarajan, Devi; Wilson, Robin; DÃez, Raquel López; Gugger, Paul F; Mangar, Kaamashri; Narula, Navneet; Katz, Stuart D; Zhou, Boyan; Li, Huilin; Stotland, Aleksandr B; Gottlieb, Roberta A; Schmidt, Ann Marie; Shekhtman, Alexander; Ramasamy, Ravichandran
Inter-organelle contact and communication between mitochondria and sarco/endoplasmic reticulum (SR/ER) maintain cellular homeostasis and are profoundly disturbed during tissue ischemia. We tested the hypothesis that the formin Diaphanous-1 (DIAPH1), which regulates actin dynamics, signal transduction and metabolic functions, contributes to these processes. We demonstrate that DIAPH1 interacts directly with Mitofusin-2 (MFN2) to shorten mitochondria-SR/ER distance, thereby enhancing mitochondria-ER contact in cells including cardiomyocytes, endothelial cells and macrophages. Solution structure studies affirm the interaction between the Diaphanous Inhibitory Domain and the cytosolic GTPase domain of MFN2. In male rodent and human cardiomyocytes, DIAPH1-MFN2 interaction regulates mitochondrial turnover, mitophagy, and oxidative stress. Introduction of synthetic linker construct, which shorten the mitochondria-SR/ER distance, mitigated the molecular and functional benefits of DIAPH1 silencing in ischemia. This work establishes fundamental roles for DIAPH1-MFN2 interaction in the regulation of mitochondria-SR/ER contact networks. We propose that targeting pathways that regulate DIAPH1-MFN2 interactions may facilitate recovery from tissue ischemia.
PMCID:10616211
PMID: 37903764
ISSN: 2041-1723
CID: 5610492
Major Adverse Cardiovascular Events After Colchicine Administration Before Percutaneous Coronary Intervention: Follow-Up of the Colchicine-PCI Trial
Shah, Binita; Smilowitz, Nathaniel R; Xia, Yuhe; Feit, Frederick; Katz, Stuart D; Zhong, Judy; Cronstein, Bruce; Lorin, Jeffrey D; Pillinger, Michael H
Periprocedural inflammation is associated with major adverse cardiovascular events in patients who undergo percutaneous coronary intervention (PCI). In the contemporary era, 5% to 10% of patients develop restenosis, and in the acute coronary syndrome cohort, there remains a 20% major adverse cardiovascular events rate at 3 years, half of which are culprit-lesion related. In patients at risk of restenosis, colchicine has been shown to reduce restenosis when started within 24 hours of PCI and continued for 6 months thereafter, compared with placebo. The Colchicine-PCI trial, which randomized patients to a 1-time loading dose of colchicine or placebo 1 to 2 hours before PCI, showed a dampening of the inflammatory response to PCI but no difference in postprocedural myocardial injury. On mean follow-up of 3.3 years, the incidence of major adverse cardiovascular events did not differ between colchicine and placebo groups (32.5% vs 34.9%; hazard ratio 0.95 [0.68 to 1.34]).
PMCID:10947505
PMID: 37536200
ISSN: 1879-1913
CID: 5728292
Rare Variant Genetics and Dilated Cardiomyopathy Severity: The DCM Precision Medicine Study
Hofmeyer, Mark; Haas, Garrie J; Jordan, Elizabeth; Cao, Jinwen; Kransdorf, Evan; Ewald, Gregory A; Morris, Alanna A; Owens, Anjali; Lowes, Brian; Stoller, Douglas; Wilson Tang, W H; Garg, Sonia; Trachtenberg, Barry H; Shah, Palak; Pamboukian, Salpy V; Sweitzer, Nancy K; Wheeler, Matthew T; Wilcox, Jane E; Katz, Stuart; Pan, Stephen; Jimenez, Javier; Smart, Frank; Wang, Jessica; Gottlieb, Stephen S; Judge, Daniel P; Moore, Charles K; Huggins, Gordon S; Kinnamon, Daniel D; Ni, Hanyu; Hershberger, Ray E; ,
BACKGROUND:Dilated cardiomyopathy (DCM) can lead to advanced disease, defined herein as necessitating a durable left ventricular assist device or a heart transplant (LVAD/HT). DCM is known to have a genetic basis, but the association of rare variant genetics with advanced DCM has not been studied. METHODS:We analyzed clinical and genetic sequence data from patients enrolled between 2016 and 2021 in the US multisite DCM Precision Medicine Study, which was a geographically diverse, multiracial, multiethnic cohort. Clinical evaluation included standardized patient interview and medical record query forms. DCM severity was classified into 3 groups: patients with advanced disease with LVAD/HT; patients with an implantable cardioverter defibrillator (ICD) only; or patients with no ICD or LVAD/HT. Rare variants in 36 DCM genes were classified as pathogenic or likely pathogenic or variants of uncertain significance. Confounding factors we considered included demographic characteristics, lifestyle factors, access to care, DCM duration, and comorbidities. Crude and adjusted associations between DCM severity and rare variant genetic findings were assessed using multinomial models with generalized logit link. RESULTS:Patients' mean (SD) age was 51.9 (13.6) years; 42% were of African ancestry, 56% were of European ancestry, and 44% were female. Of 1198 patients, 347 had LVAD/HT, 511 had an ICD, and 340 had no LVAD/HT or ICD. The percentage of patients with pathogenic or likely pathogenic variants was 26.2%, 15.9%, and 15.0% for those with LVAD/HT, ICD only, or neither, respectively. After controlling for sociodemographic characteristics and comorbidities, patients with DCM with LVAD/HT were more likely than those without LVAD/HT or ICD to have DCM-related pathogenic or likely pathogenic rare variants (odds ratio, 2.3 [95% CI, 1.5-3.6]). The association did not differ by ancestry. Rare variant genetic findings were similar between patients with DCM with an ICD and those without LVAD/HT or ICD. CONCLUSIONS:Advanced DCM was associated with higher odds of rare variants in DCM genes adjudicated as pathogenic or likely pathogenic, compared with individuals with less severe DCM. This finding may help assess the risk of outcomes in management of patients with DCM and their at-risk family members. REGISTRATION:URL: https://www. CLINICALTRIALS:gov; Unique identifier: NCT03037632.
PMCID:10530109
PMID: 37641966
ISSN: 1524-4539
CID: 5598752
Risk of post-acute sequelae of SARS-CoV-2 infection associated with pre-coronavirus disease obstructive sleep apnea diagnoses: an electronic health record-based analysis from the RECOVER initiative
Mandel, Hannah L; Colleen, Gunnar; Abedian, Sajjad; Ammar, Nariman; Bailey, L Charles; Bennett, Tellen D; Brannock, M Daniel; Brosnahan, Shari B; Chen, Yu; Chute, Christopher G; Divers, Jasmin; Evans, Michael D; Haendel, Melissa; Hall, Margaret A; Hirabayashi, Kathryn; Hornig, Mady; Katz, Stuart D; Krieger, Ana C; Loomba, Johanna; Lorman, Vitaly; Mazzotti, Diego R; McMurry, Julie; Moffitt, Richard A; Pajor, Nathan M; Pfaff, Emily; Radwell, Jeff; Razzaghi, Hanieh; Redline, Susan; Seibert, Elle; Sekar, Anisha; Sharma, Suchetha; Thaweethai, Tanayott; Weiner, Mark G; Yoo, Yun Jae; Zhou, Andrea; Thorpe, Lorna E
STUDY OBJECTIVES/OBJECTIVE:Obstructive sleep apnea (OSA) has been associated with more severe acute coronavirus disease-2019 (COVID-19) outcomes. We assessed OSA as a potential risk factor for Post-Acute Sequelae of SARS-CoV-2 (PASC). METHODS:We assessed the impact of preexisting OSA on the risk for probable PASC in adults and children using electronic health record data from multiple research networks. Three research networks within the REsearching COVID to Enhance Recovery initiative (PCORnet Adult, PCORnet Pediatric, and the National COVID Cohort Collaborative [N3C]) employed a harmonized analytic approach to examine the risk of probable PASC in COVID-19-positive patients with and without a diagnosis of OSA prior to pandemic onset. Unadjusted odds ratios (ORs) were calculated as well as ORs adjusted for age group, sex, race/ethnicity, hospitalization status, obesity, and preexisting comorbidities. RESULTS:Across networks, the unadjusted OR for probable PASC associated with a preexisting OSA diagnosis in adults and children ranged from 1.41 to 3.93. Adjusted analyses found an attenuated association that remained significant among adults only. Multiple sensitivity analyses with expanded inclusion criteria and covariates yielded results consistent with the primary analysis. CONCLUSIONS:Adults with preexisting OSA were found to have significantly elevated odds of probable PASC. This finding was consistent across data sources, approaches for identifying COVID-19-positive patients, and definitions of PASC. Patients with OSA may be at elevated risk for PASC after SARS-CoV-2 infection and should be monitored for post-acute sequelae.
PMID: 37166330
ISSN: 1550-9109
CID: 5509392
Genetic Architecture of Dilated Cardiomyopathy in Individuals of African and European Ancestry
Jordan, Elizabeth; Kinnamon, Daniel D; Haas, Garrie J; Hofmeyer, Mark; Kransdorf, Evan; Ewald, Gregory A; Morris, Alanna A; Owens, Anjali; Lowes, Brian; Stoller, Douglas; Tang, W H Wilson; Garg, Sonia; Trachtenberg, Barry H; Shah, Palak; Pamboukian, Salpy V; Sweitzer, Nancy K; Wheeler, Matthew T; Wilcox, Jane E; Katz, Stuart; Pan, Stephen; Jimenez, Javier; Fishbein, Daniel P; Smart, Frank; Wang, Jessica; Gottlieb, Stephen S; Judge, Daniel P; Moore, Charles K; Mead, Jonathan O; Hurst, Natalie; Cao, Jinwen; Huggins, Gordon S; Cowan, Jason; Ni, Hanyu; Rehm, Heidi L; Jarvik, Gail P; Vatta, Matteo; Burke, Wylie; Hershberger, Ray E; ,
IMPORTANCE:Black patients with dilated cardiomyopathy (DCM) have increased familial risk and worse outcomes than White patients, but most DCM genetic data are from White patients. OBJECTIVE:To compare the rare variant genetic architecture of DCM by genomic ancestry within a diverse population of patients with DCM. DESIGN:Cross-sectional study enrolling patients with DCM who self-identified as non-Hispanic Black, Hispanic, or non-Hispanic White from June 7, 2016, to March 15, 2020, at 25 US advanced heart failure programs. Variants in 36 DCM genes were adjudicated as pathogenic, likely pathogenic, or of uncertain significance. EXPOSURE:Presence of DCM. MAIN OUTCOMES AND MEASURES:Variants in DCM genes classified as pathogenic/likely pathogenic/uncertain significance and clinically actionable (pathogenic/likely pathogenic). RESULTS:A total of 505, 667, and 26 patients with DCM of predominantly African, European, or Native American genomic ancestry, respectively, were included. Compared with patients of European ancestry, a lower percentage of patients of African ancestry had clinically actionable variants (8.2% [95% CI, 5.2%-11.1%] vs 25.5% [95% CI, 21.3%-29.6%]), reflecting the lower odds of a clinically actionable variant for those with any pathogenic variant/likely pathogenic variant/variant of uncertain significance (odds ratio, 0.25 [95% CI, 0.17-0.37]). On average, patients of African ancestry had fewer clinically actionable variants in TTN (difference, -0.09 [95% CI, -0.14 to -0.05]) and other genes with predicted loss of function as a disease-causing mechanism (difference, -0.06 [95% CI, -0.11 to -0.02]). However, the number of pathogenic variants/likely pathogenic variants/variants of uncertain significance was more comparable between ancestry groups (difference, -0.07 [95% CI, -0.22 to 0.09]) due to a larger number of non-TTN non-predicted loss of function variants of uncertain significance, mostly missense, in patients of African ancestry (difference, 0.15 [95% CI, 0.00-0.30]). Published clinical case-based evidence supporting pathogenicity was less available for variants found only in patients of African ancestry (P < .001). CONCLUSION AND RELEVANCE:Patients of African ancestry with DCM were less likely to have clinically actionable variants in DCM genes than those of European ancestry due to differences in genetic architecture and a lack of representation of African ancestry in clinical data sets.
PMID: 37526719
ISSN: 1538-3598
CID: 5594452
Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection
Thaweethai, Tanayott; Jolley, Sarah E; Karlson, Elizabeth W; Levitan, Emily B; Levy, Bruce; McComsey, Grace A; McCorkell, Lisa; Nadkarni, Girish N; Parthasarathy, Sairam; Singh, Upinder; Walker, Tiffany A; Selvaggi, Caitlin A; Shinnick, Daniel J; Schulte, Carolin C M; Atchley-Challenner, Rachel; Alba, George A; Alicic, Radica; Altman, Natasha; Anglin, Khamal; Argueta, Urania; Ashktorab, Hassan; Baslet, Gaston; Bassett, Ingrid V; Bateman, Lucinda; Bedi, Brahmchetna; Bhattacharyya, Shamik; Bind, Marie-Abele; Blomkalns, Andra L; Bonilla, Hector; Bush, Patricia A; Castro, Mario; Chan, James; Charney, Alexander W; Chen, Peter; Chibnik, Lori B; Chu, Helen Y; Clifton, Rebecca G; Costantine, Maged M; Cribbs, Sushma K; Davila Nieves, Sylvia I; Deeks, Steven G; Duven, Alexandria; Emery, Ivette F; Erdmann, Nathan; Erlandson, Kristine M; Ernst, Kacey C; Farah-Abraham, Rachael; Farner, Cheryl E; Feuerriegel, Elen M; Fleurimont, Judes; Fonseca, Vivian; Franko, Nicholas; Gainer, Vivian; Gander, Jennifer C; Gardner, Edward M; Geng, Linda N; Gibson, Kelly S; Go, Minjoung; Goldman, Jason D; Grebe, Halle; Greenway, Frank L; Habli, Mounira; Hafner, John; Han, Jenny E; Hanson, Keith A; Heath, James; Hernandez, Carla; Hess, Rachel; Hodder, Sally L; Hoffman, Matthew K; Hoover, Susan E; Huang, Beatrice; Hughes, Brenna L; Jagannathan, Prasanna; John, Janice; Jordan, Michael R; Katz, Stuart D; Kaufman, Elizabeth S; Kelly, John D; Kelly, Sara W; Kemp, Megan M; Kirwan, John P; Klein, Jonathan D; Knox, Kenneth S; Krishnan, Jerry A; Kumar, Andre; Laiyemo, Adeyinka O; Lambert, Allison A; Lanca, Margaret; Lee-Iannotti, Joyce K; Logarbo, Brian P; Longo, Michele T; Luciano, Carlos A; Lutrick, Karen; Maley, Jason H; Marathe, Jai G; Marconi, Vincent; Marshall, Gailen D; Martin, Christopher F; Matusov, Yuri; Mehari, Alem; Mendez-Figueroa, Hector; Mermelstein, Robin; Metz, Torri D; Morse, Richard; Mosier, Jarrod; Mouchati, Christian; Mullington, Janet; Murphy, Shawn N; Neuman, Robert B; Nikolich, Janko Z; Ofotokun, Ighovwerha; Ojemakinde, Elizabeth; Palatnik, Anna; Palomares, Kristy; Parimon, Tanyalak; Parry, Samuel; Patterson, Jan E; Patterson, Thomas F; Patzer, Rachel E; Peluso, Michael J; Pemu, Priscilla; Pettker, Christian M; Plunkett, Beth A; Pogreba-Brown, Kristen; Poppas, Athena; Quigley, John G; Reddy, Uma; Reece, Rebecca; Reeder, Harrison; Reeves, W B; Reiman, Eric M; Rischard, Franz; Rosand, Jonathan; Rouse, Dwight J; Ruff, Adam; Saade, George; Sandoval, Grecio J; Schlater, Shannon M; Shepherd, Fitzgerald; Sherif, Zaki A; Simhan, Hyagriv; Singer, Nora G; Skupski, Daniel W; Sowles, Amber; Sparks, Jeffrey A; Sukhera, Fatima I; Taylor, Barbara S; Teunis, Larissa; Thomas, Robert J; Thorp, John M; Thuluvath, Paul; Ticotsky, Amberly; Tita, Alan T; Tuttle, Katherine R; Urdaneta, Alfredo E; Valdivieso, Daisy; VanWagoner, Timothy M; Vasey, Andrew; Verduzco-Gutierrez, Monica; Wallace, Zachary S; Ward, Honorine D; Warren, David E; Weiner, Steven J; Welch, Shelley; Whiteheart, Sidney W; Wiley, Zanthia; Wisnivesky, Juan P; Yee, Lynn M; Zisis, Sokratis; Horwitz, Leora I; Foulkes, Andrea S
IMPORTANCE:SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals. OBJECTIVE:To develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections. DESIGN, SETTING, AND PARTICIPANTS:Prospective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, and Puerto Rico. Participants who were enrolled in the RECOVER adult cohort before April 10, 2023, completed a symptom survey 6 months or more after acute symptom onset or test date. Selection included population-based, volunteer, and convenience sampling. EXPOSURE:SARS-CoV-2 infection. MAIN OUTCOMES AND MEASURES:PASC and 44 participant-reported symptoms (with severity thresholds). RESULTS:A total of 9764 participants (89% SARS-CoV-2 infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria. Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months. CONCLUSIONS AND RELEVANCE:A definition of PASC was developed based on symptoms in a prospective cohort study. As a first step to providing a framework for other investigations, iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC.
PMID: 37278994
ISSN: 1538-3598
CID: 5536662
Screening for Dilated Cardiomyopathy in At-Risk First-Degree Relatives
Ni, Hanyu; Jordan, Elizabeth; Kinnamon, Daniel D; Cao, Jinwen; Haas, Garrie J; Hofmeyer, Mark; Kransdorf, Evan; Ewald, Gregory A; Morris, Alanna A; Owens, Anjali; Lowes, Brian; Stoller, Douglas; Tang, W H Wilson; Garg, Sonia; Trachtenberg, Barry H; Shah, Palak; Pamboukian, Salpy V; Sweitzer, Nancy K; Wheeler, Matthew T; Wilcox, Jane E; Katz, Stuart; Pan, Stephen; Jimenez, Javier; Fishbein, Daniel P; Smart, Frank; Wang, Jessica; Gottlieb, Stephen S; Judge, Daniel P; Moore, Charles K; Huggins, Gordon S; Hershberger, Ray E
BACKGROUND:Cardiovascular screening is recommended for first-degree relatives (FDRs) of patients with dilated cardiomyopathy (DCM), but the yield of FDR screening is uncertain for DCM patients without known familial DCM, for non-White FDRs, or for DCM partial phenotypes of left ventricular enlargement (LVE) or left ventricular systolic dysfunction (LVSD). OBJECTIVES:This study examined the yield of clinical screening among reportedly unaffected FDRs of DCM patients. METHODS:Adult FDRs of DCM patients at 25 sites completed screening echocardiograms and ECGs. Mixed models accounting for site heterogeneity and intrafamilial correlation were used to compare screen-based percentages of DCM, LVSD, or LVE by FDR demographics, cardiovascular risk factors, and proband genetics results. RESULTS:A total of 1,365 FDRs were included, with a mean age of 44.8 ± 16.9 years, 27.5% non-Hispanic Black, 9.8% Hispanic, and 61.7% women. Among screened FDRs, 14.1% had new diagnoses of DCM (2.1%), LVSD (3.6%), or LVE (8.4%). The percentage of FDRs with new diagnoses was higher for those aged 45 to 64 years than 18 to 44 years. The age-adjusted percentage of any finding was higher among FDRs with hypertension and obesity but did not differ statistically by race and ethnicity (16.2% for Hispanic, 15.2% for non-Hispanic Black, and 13.1% for non-Hispanic White) or sex (14.6% for women and 12.8% for men). FDRs whose probands carried clinically reportable variants were more likely to be identified with DCM. CONCLUSIONS:Cardiovascular screening identified new DCM-related findings among 1 in 7 reportedly unaffected FDRs regardless of race and ethnicity, underscoring the value of clinical screening in all FDRs.
PMID: 37225358
ISSN: 1558-3597
CID: 5503782
Effectiveness of the Family Heart Talk Communication Tool in Improving Family Member Screening for Dilated Cardiomyopathy: Results of a Randomized Trial
Kinnamon, Daniel D; Jordan, Elizabeth; Haas, Garrie J; Hofmeyer, Mark; Kransdorf, Evan; Ewald, Gregory A; Morris, Alanna A; Owens, Anjali; Lowes, Brian; Stoller, Douglas; Tang, W H Wilson; Garg, Sonia; Trachtenberg, Barry H; Shah, Palak; Pamboukian, Salpy V; Sweitzer, Nancy K; Wheeler, Matthew T; Wilcox, Jane E; Katz, Stuart; Pan, Stephen; Jimenez, Javier; Aaronson, Keith D; Fishbein, Daniel P; Smart, Frank; Wang, Jessica; Gottlieb, Stephen S; Judge, Daniel P; Moore, Charles K; Mead, Jonathan O; Huggins, Gordon S; Ni, Hanyu; Burke, Wylie; Hershberger, Ray E
BACKGROUND:Managing disease risk among first-degree relatives of probands diagnosed with a heritable disease is central to precision medicine. A critical component is often clinical screening, which is particularly important for conditions like dilated cardiomyopathy (DCM) that remain asymptomatic until severe disease develops. Nonetheless, probands are frequently ill-equipped to disseminate genetic risk information that motivates at-risk relatives to complete recommended clinical screening. An easily implemented remedy for this key issue has been elusive. METHODS:booklet in increasing cardiovascular clinical screening uptake among first-degree relatives was assessed in a multicenter, open-label, cluster-randomized, controlled trial. The primary outcome measured in eligible first-degree relatives was completion of screening initiated within 12 months after proband enrollment. Because probands randomized to the intervention received the booklet at the enrollment visit, eligible first-degree relatives were limited to those who were alive the day after proband enrollment and not enrolled on the same day as the proband. RESULTS:=0.90). CONCLUSIONS: REGISTRATION/BACKGROUND:URL: https://www. CLINICALTRIALS/RESULTS:gov; Unique identifier: NCT03037632.
PMCID:10133091
PMID: 36938756
ISSN: 1524-4539
CID: 5464792