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Rapid assessment of quality of life in patients with advanced heart failure
S132
Abstracts
in depression, anxiety, and hostility, respectively. Those with ischemia prior to HT tended to be more hostile (⫽ -.243, p⫽.07). Number of rejections contributed to anxiety (⫽.389, p⫽.02) and depression (⫽.292, p⫽.03). Those receiving cyclosporine had more anxiety (⫽ -.301, p⫽.02), depression (⫽ -.338, p⫽.01), and hostility (⫽ -.392, p⫽.004) than those receiving tacrolimus. Conclusion: Many women are likely to experience emotional distress at levels above normative values after HT. Cyclosporine’s cosmetic side effects (hirsutism and gingival hyperplasia) may contribute to higher levels of emotional distress. Annual psychological assessment should be part of post transplant evaluation. 179 RAPID ASSESSMENT OF QUALITY OF LIFE IN PATIENTS WITH ADVANCED HEART FAILURE B.L. Baird,1 A.W. Velleca,1 V.S. Erickson,1 M.A. Woo,1 J.K. Patel,1 M.A. Hamilton,1 J.A. Kobashigawa,1 K.A. Dracup,2 1Cardiology, The David Geffen School of Medicine at UCLA, Los Angeles, CA; 2UCSF School of Nursing, San Francisco, CA Background: Evaluation of quality of life (QOL) in patients with heart failure is an important part of patient assessment, but most QOL instruments are not clinically practical. A single QOL question that does not require high literacy or time to answer could be extremely useful. The purpose of this study was to determine the relationship between a single item health-related QOL question and the Minnesota Living with Heart Failure (MLHF). Methods: 364 heart failure (HF) patients (age 55 ⫾ 12 years, male 79%, Caucasian 68%, ejection fraction 26 ⫾ 7%, VO2 max 15 ⫾ 5cc/kg/min) from a university affiliated HF clinic completed the MLHF and a QOL question. The MLHF measures extent of impairment from a score of 0 for no impairment to 105 for maximum impairment. Patients rated their QOL as excellent, very good, good, fair or poor, considering the general state of their health. Demographic and clinical variables were obtained by chart review. Data were analyzed using non-parametric correlations, ANOVA and receiver operating characteristic curves. Results: The single QOL question was significantly correlated with the total MLHF score (r⫽.667, p⬍ .001). Analysis of variance showed significant differences in total MLHF (LHFT) score by categories of QOL. Those reporting excellent QOL had a mean LHFT score of 17 ⫾ 18, while those reporting poor QOL had a mean LHFT 71⫾ 18. The areas under receiver operating characteristic curve with best and worst quartile LHFT scores were .806-.821. Conclusions: A single question can provide clinicians with important information about patient QOL and will allow for a simple measure of QOL at each clinic visit. Further research is needed to determine whether a single QOL question is responsive to changes in treatment and patient condition and can accurately track changes in QOL over time. 180 NEUTROPHIL DEFENSIN CONCENTRATIONS IN PEDIATRIC LUNG TRANSPLANT RECIPIENTS A. Faro,1 L.T. Spencer,1 G.A. Visner,1 M. Brantley,2 1Pediatrics, University of Florida, Gainesville, FL; 2Medicine, University of Florida, Gainesville, FL Neutrophil concentrations are elevated in adult lung transplant recipients with bronchiolitis obliterans (OB). We are studying pediatric lung transplant recipients to determine if increased concentrations of neutrophil elastase (NE) and neutrophil defensins correlate with the development of rejection or infection. Sixty one bronchoalveolar lavage (BAL) samples were obtained in 15 pediatric lung transplant recipients during surveillance
The Journal of Heart and Lung Transplantation January 2003 or clinically indicated bronchoscopies. At these visits clinical data such as history, physical exam, pulmonary function testing, BAL cultures and cytology, and histologic grading of biopsy specimens were recorded. A standardized protocol was used in the collection of the BAL fluid. Total cell counts were determined manually. To determine NE, ␣-1 antitrypsin levels, and neutrophil defensin concentrations an indirect sandwich immunoassay was employed. Epithelial lining fluid dilution was standardized using the urea method. NE and defensin concentrations were significantly elevated in culture positive patients as compared to culture negative patients (p⫽0.001 and p⫽0.003 respectively). The table below demonstrates median values with interquartile ranges (differences of 25th and 75th percentile) in parentheses. This elevation was similar whether the patient had a positive bacterial culture or positive fungal culture. There was no statistical difference in concentrations of ␣-1 antitrypsin. There was no difference between any of these markers in patients with acute rejection or those without rejection. These findings suggest that elevated concentrations of neutrophil defensins and NE correlate with the presence of bacterial or fungal organisms in BAL fluid. Elevated concentrations of defensins or NE do not correlate with the presence of acute rejection. Culture (ⴙ)
Culture (ⴚ)
ACR (ⴙ)
ACR (ⴚ)
NE (M) 1155 (234–6780) 51 (18–128) 365 (67–1349) 301 (34–4284) AAT (M) 2805 (1875–4250) 2173 (1437–2476) 2345 (1945–3597) 2243 (1294–4080) Defensins (M) 1376 (163–5590) 25 (25–219) 584 (25–1741) 173 (25–3501)
181 HYPOGAMMAGLOBULINEMIA IN PEDIATRIC LUNG TRANSPLANT RECIPIENTS IS ASSOCIATED WITH INCREASE MORTALITY M.T. De la Morena,1 S. Pradhan,1 S.C. Sweet,1 P.M. Schuler,1 E.N. Mendeloff,2 C.B. Huddleston,2 1Pediatrics, Washington University School of Medicine, St. Louis, MO, British Virgin Islands; 2 Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO Purpose: Immunosuppression is an important contributor to morbidity and mortality after transplantation. We report the relationship between hypogammaglobulinemia and bacterial lower respiratory tract infections (LRTI), bronchiolitis obliterans (BO), acute rejection (AR), diagnosis of post-transplant lymphoproliferative disease (PTLD) and mortality in a cohort of pediatric lung transplant recipients. Procedures: Between September of 1999 and September of 2001, IgG levels were preformed by standard nephelometry on pediatric patients (pts) at time of evaluation for lung transplantation and as part of routine follow up at 3, 6, 12 months, and yearly after transplantation. Gender, primary diagnosis, type of transplant, age at transplant, occurrence of more than three bacterial LRTI (defined as 3100,000 colony forming units (CFU)/ml of bacteria from bronchoalveolar lavage), occurrence of more than 1 episode of AR (grade 3A2), development of BO (defined histologically from open lung biopsies) and development of PTLD were compared between patients with low IgG levels (L) and patients with normal IgG levels (N) for age by Chi-square analysis. Kaplan Meier analysis assessed survival. Results: A total of 108 were included in this study. 25/108 (23%) had low total IgG levels. Mortality was higher in those patients with low IgG levels (P⫽0.0018). However, we found no differences in the number of LRTI [L⫽6/25 pts (24%) vs. N⫽22/83 pts (26%)]; episodes of acute rejection [L⫽14/25 pts (56%) vs. N⫽48/83 pts (57%)]; diagnosis of BO [L⫽8/25 pts (32%) vs. N⫽23/83 pts (27%)];or PTLD [L⫽ 4/25 pts (16%) vs. N⫽8/83 pts (9.6%)]. Gender, primary diagnosis, type of transplant or age at transplant had no effect on IgG levels after transplantation.
Abstracts
in depression, anxiety, and hostility, respectively. Those with ischemia prior to HT tended to be more hostile (⫽ -.243, p⫽.07). Number of rejections contributed to anxiety (⫽.389, p⫽.02) and depression (⫽.292, p⫽.03). Those receiving cyclosporine had more anxiety (⫽ -.301, p⫽.02), depression (⫽ -.338, p⫽.01), and hostility (⫽ -.392, p⫽.004) than those receiving tacrolimus. Conclusion: Many women are likely to experience emotional distress at levels above normative values after HT. Cyclosporine’s cosmetic side effects (hirsutism and gingival hyperplasia) may contribute to higher levels of emotional distress. Annual psychological assessment should be part of post transplant evaluation. 179 RAPID ASSESSMENT OF QUALITY OF LIFE IN PATIENTS WITH ADVANCED HEART FAILURE B.L. Baird,1 A.W. Velleca,1 V.S. Erickson,1 M.A. Woo,1 J.K. Patel,1 M.A. Hamilton,1 J.A. Kobashigawa,1 K.A. Dracup,2 1Cardiology, The David Geffen School of Medicine at UCLA, Los Angeles, CA; 2UCSF School of Nursing, San Francisco, CA Background: Evaluation of quality of life (QOL) in patients with heart failure is an important part of patient assessment, but most QOL instruments are not clinically practical. A single QOL question that does not require high literacy or time to answer could be extremely useful. The purpose of this study was to determine the relationship between a single item health-related QOL question and the Minnesota Living with Heart Failure (MLHF). Methods: 364 heart failure (HF) patients (age 55 ⫾ 12 years, male 79%, Caucasian 68%, ejection fraction 26 ⫾ 7%, VO2 max 15 ⫾ 5cc/kg/min) from a university affiliated HF clinic completed the MLHF and a QOL question. The MLHF measures extent of impairment from a score of 0 for no impairment to 105 for maximum impairment. Patients rated their QOL as excellent, very good, good, fair or poor, considering the general state of their health. Demographic and clinical variables were obtained by chart review. Data were analyzed using non-parametric correlations, ANOVA and receiver operating characteristic curves. Results: The single QOL question was significantly correlated with the total MLHF score (r⫽.667, p⬍ .001). Analysis of variance showed significant differences in total MLHF (LHFT) score by categories of QOL. Those reporting excellent QOL had a mean LHFT score of 17 ⫾ 18, while those reporting poor QOL had a mean LHFT 71⫾ 18. The areas under receiver operating characteristic curve with best and worst quartile LHFT scores were .806-.821. Conclusions: A single question can provide clinicians with important information about patient QOL and will allow for a simple measure of QOL at each clinic visit. Further research is needed to determine whether a single QOL question is responsive to changes in treatment and patient condition and can accurately track changes in QOL over time. 180 NEUTROPHIL DEFENSIN CONCENTRATIONS IN PEDIATRIC LUNG TRANSPLANT RECIPIENTS A. Faro,1 L.T. Spencer,1 G.A. Visner,1 M. Brantley,2 1Pediatrics, University of Florida, Gainesville, FL; 2Medicine, University of Florida, Gainesville, FL Neutrophil concentrations are elevated in adult lung transplant recipients with bronchiolitis obliterans (OB). We are studying pediatric lung transplant recipients to determine if increased concentrations of neutrophil elastase (NE) and neutrophil defensins correlate with the development of rejection or infection. Sixty one bronchoalveolar lavage (BAL) samples were obtained in 15 pediatric lung transplant recipients during surveillance
The Journal of Heart and Lung Transplantation January 2003 or clinically indicated bronchoscopies. At these visits clinical data such as history, physical exam, pulmonary function testing, BAL cultures and cytology, and histologic grading of biopsy specimens were recorded. A standardized protocol was used in the collection of the BAL fluid. Total cell counts were determined manually. To determine NE, ␣-1 antitrypsin levels, and neutrophil defensin concentrations an indirect sandwich immunoassay was employed. Epithelial lining fluid dilution was standardized using the urea method. NE and defensin concentrations were significantly elevated in culture positive patients as compared to culture negative patients (p⫽0.001 and p⫽0.003 respectively). The table below demonstrates median values with interquartile ranges (differences of 25th and 75th percentile) in parentheses. This elevation was similar whether the patient had a positive bacterial culture or positive fungal culture. There was no statistical difference in concentrations of ␣-1 antitrypsin. There was no difference between any of these markers in patients with acute rejection or those without rejection. These findings suggest that elevated concentrations of neutrophil defensins and NE correlate with the presence of bacterial or fungal organisms in BAL fluid. Elevated concentrations of defensins or NE do not correlate with the presence of acute rejection. Culture (ⴙ)
Culture (ⴚ)
ACR (ⴙ)
ACR (ⴚ)
NE (M) 1155 (234–6780) 51 (18–128) 365 (67–1349) 301 (34–4284) AAT (M) 2805 (1875–4250) 2173 (1437–2476) 2345 (1945–3597) 2243 (1294–4080) Defensins (M) 1376 (163–5590) 25 (25–219) 584 (25–1741) 173 (25–3501)
181 HYPOGAMMAGLOBULINEMIA IN PEDIATRIC LUNG TRANSPLANT RECIPIENTS IS ASSOCIATED WITH INCREASE MORTALITY M.T. De la Morena,1 S. Pradhan,1 S.C. Sweet,1 P.M. Schuler,1 E.N. Mendeloff,2 C.B. Huddleston,2 1Pediatrics, Washington University School of Medicine, St. Louis, MO, British Virgin Islands; 2 Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO Purpose: Immunosuppression is an important contributor to morbidity and mortality after transplantation. We report the relationship between hypogammaglobulinemia and bacterial lower respiratory tract infections (LRTI), bronchiolitis obliterans (BO), acute rejection (AR), diagnosis of post-transplant lymphoproliferative disease (PTLD) and mortality in a cohort of pediatric lung transplant recipients. Procedures: Between September of 1999 and September of 2001, IgG levels were preformed by standard nephelometry on pediatric patients (pts) at time of evaluation for lung transplantation and as part of routine follow up at 3, 6, 12 months, and yearly after transplantation. Gender, primary diagnosis, type of transplant, age at transplant, occurrence of more than three bacterial LRTI (defined as 3100,000 colony forming units (CFU)/ml of bacteria from bronchoalveolar lavage), occurrence of more than 1 episode of AR (grade 3A2), development of BO (defined histologically from open lung biopsies) and development of PTLD were compared between patients with low IgG levels (L) and patients with normal IgG levels (N) for age by Chi-square analysis. Kaplan Meier analysis assessed survival. Results: A total of 108 were included in this study. 25/108 (23%) had low total IgG levels. Mortality was higher in those patients with low IgG levels (P⫽0.0018). However, we found no differences in the number of LRTI [L⫽6/25 pts (24%) vs. N⫽22/83 pts (26%)]; episodes of acute rejection [L⫽14/25 pts (56%) vs. N⫽48/83 pts (57%)]; diagnosis of BO [L⫽8/25 pts (32%) vs. N⫽23/83 pts (27%)];or PTLD [L⫽ 4/25 pts (16%) vs. N⫽8/83 pts (9.6%)]. Gender, primary diagnosis, type of transplant or age at transplant had no effect on IgG levels after transplantation.