Publications by authors named "Ruth Tamrat"

5 Publications

  • Page 1 of 1

Incremental prognostic value of visually estimated coronary artery calcium in patients undergoing positron emission tomography imaging.

Open Heart 2021 May;8(1)

Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA

Objective: Visually estimated coronary artery calcium (VECAC) from chest CT or attenuation correction (AC)/CT obtained during positron emission tomography (PET)-myocardial perfusion imaging (MPI) is feasible. Our aim was to determine the prognostic value of VECAC beyond conventional risk factors and PET imaging parameters, including coronary flow reserve (CFR).

Methods: We analysed 608 patients without known coronary artery disease who underwent PET-MPI between 2012 and 2016 and had AC/CT and/or chest CT images. We used Cox regression to estimate the association of VECAC categories (≤10, 11-400, >400 Agatston units (AU)) with the primary outcome of all-cause death, acute coronary syndrome or stroke (mean follow-up 4.3±1.8 years). C-statistics assessed the relationship between PET parameters and VECAC with the primary outcome.

Results: Mean age was 58±11 years, 65% were women and 67% were black. VECAC ≤10, 11-400 and >400 AU was observed in 68%, 12% and 20% of subjects, respectively. Compared with VECAC ≤10, VECAC categories 11-400 (HR 2.25, 95% CI 1.24 to 4.08) and >400 AU (HR 3.05, 95% CI 1.87 to 4.98) were associated with the primary outcome after adjusting for traditional risk factors, MPI findings and CFR. Adding VECAC to a model that included PET-MPI, CFR and clinical risk factors improved the prognostic value for the primary outcomes (c-statistic 0.71 to 0.75 with VECAC, p=0.01).

Conclusions: VECAC is a potent predictor of events beyond traditional risk factors and PET imaging markers, including CFR. These data further support the importance for routine VECAC implementation.
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May 2021

Women with peripartum cardiomyopathy have normal ejection fraction, but abnormal systolic strain, during pregnancy.

ESC Heart Fail 2021 May 4. Epub 2021 May 4.

Division of Cardiology, Perelman Center for Advanced Medicine, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, 2-East Pavilion, Philadelphia, PA, 19104, USA.

We report a case series of six women with peripartum cardiomyopathy (PPCM) who incidentally underwent echocardiography prior to the clinical presentation of PPCM. For comparison, we identified controls, matched 2:1 on age, race, body mass index, gestational age, and hypertensive disorder. Among the six cases, all were diagnosed with PPCM during the post-partum period. Pre-PPCM echocardiograms were performed between 17.7 weeks of gestation and 13 days post-partum. Baseline left ventricular ejection fraction and size were normal and similar to the 12 matched controls (60% ± 6.6% vs. 61.4% ± 6.3%, P = 0.63) or left ventricular end-diastolic dimension (4.6 cm ± 0.2 cm vs. 4.5 cm ± 0.4 cm, P = 0.689). There was a trend towards a less negative (more abnormal) mean global longitudinal strain in cases compared with controls (-14% ± 4% vs. -18.3% ± 4.5%, P = 0.0658). Mean global circumferential strain was significantly less negative (more abnormal) in cases compared with controls (-21.5% ± 5% vs. -29.3% ± 7.6%, P = 0.0329). We conclude that women who develop PPCM have normal left ventricular ejection fraction during gestation preceding PPCM, indicating that the disease develops acutely in the peripartum period. Abnormal strain can be detected, however, suggesting that strain imaging could represent a screening method in populations at high risk for PPCM if confirmed in future studies.
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May 2021

Patients Commonly Believe Their Heart Failure Hospitalizations Are Preventable and Identify Worsening Heart Failure, Nonadherence, and a Knowledge Gap as Reasons for Admission.

J Card Fail 2017 Mar 11;23(3):252-256. Epub 2016 Oct 11.

Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland.

Background: There are few data describing patient-identified precipitants of heart failure (HF) hospitalization. We hypothesized a patient's perception of reason for or preventability of an admission may be related to 30-day readmission rates.

Methods And Results: Ninety-four patients admitted with decompensated HF from July 2014 to March 2015 completed a brief questionnaire regarding circumstances leading to admission. Thirty-day outcomes were assessed via telephone call and chart review. Mean age was 58 ± 14 years, with 60% blacks (n = 56) and 41% females (n = 39). Median left ventricular ejection fraction was 30%; 27 had preserved ejection fraction. Seventy-two patients identified their hospitalization to be due to HF (± another condition). Most common patient-identified precipitants of admission were worsening HF (n = 37) and dietary nonadherence (n = 11). Readmitted patients tended to have longer time until first follow-up appointment (21 vs 8 days). Seven of the 42 patients who identified their hospitalization as preventable were readmitted compared with 21/49 who believed their hospitalization was unpreventable (P = .012). On multivariate regression analysis, patients who thought their hospitalization was preventable were less likely to be readmitted (odds ratio 0.31; 95% confidence interval 0.10-0.91; P = .04).

Conclusion: Almost 50% of patients believe their HF hospitalization is preventable, and these patients appear to be less likely to be readmitted within 30 days. Notably, patients cite nonadherence and lack of knowledge as reasons hospitalizations are preventable. These results lend insight into possible interventions to reduce HF readmissions.
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March 2017

Apolipoprotein L1, income and early kidney damage.

BMC Nephrol 2015 Feb 10;16:14. Epub 2015 Feb 10.

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Background: The degree to which genetic or environmental factors are associated with early kidney damage among African Americans (AAs) is unknown.

Methods: Among 462 AAs in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study, we examined the cross-sectional association between apolipoprotein L1 (APOL1) risk variants and income with: 1) mildly reduced eGFR (<75 mL/min/1.73 m(2), creatinine-cystatin C equation) and 2) elevated urine albumin-to-creatinine ratio (ACR) (≥17 in men and ≥25 mg/g in women). High risk APOL1 status was defined by 2 copies of high-risk variants; low risk if 0 or 1 copy. Income groups were dichotomized as < $14,000/year (lowest income group) or ≥ $14,000/year. Logistic regression models were adjusted for age, sex, and % European ancestry.

Results: Overall, participants' mean age was 47 years and 16% (n = 73) had high risk APOL1 status. Mean eGFR was 99 mL/min/1.73 m(2). Mildly reduced eGFR was prevalent among 11% (n = 51). The lowest income group had higher adjusted odds (aOR) of mildly reduced eGFR than the higher income group (aOR 1.8, 95% CI 1.2-2.7). High-risk APOL1 was not significantly associated with reduced eGFR (aOR 1.5, 95% CI 0.9-2.5). Among 301 participants with ACR data, 7% (n = 21) had elevated ACR. Compared to low-risk, persons with high-risk APOL1 had higher odds of elevated ACR (aOR 3.8, 95% CI 2.0-7.3). Income was not significantly associated with elevated ACR (aOR 1.8, 95% CI 0.7-4.5). There were no significant interactions between APOL1 and income.

Conclusions: Both genetic and socioeconomic factors may be important determinants of early kidney damage among AAs.
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February 2015

Non-pharmacologic interventions to improve the sleep of hospitalized patients: a systematic review.

J Gen Intern Med 2014 May 10;29(5):788-95. Epub 2013 Oct 10.

Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E. Monument St, Suite 1-500W, Baltimore, MD, 21287, USA,

Objectives: Despite the known adverse effects of sleep deprivation on recovery from illness, studies have shown that sleep deprivation remains an incompletely addressed problem among acutely ill inpatients. Behavioral interventions are recommended as first-line therapy prior to using pharmacologic therapy due to the side effects of sedative hypnotics. The objective of this systematic review was to identify non-pharmacologic interventions that have been used to improve sleep quality and quantity of non-intensive care unit (ICU) inpatients.

Data Sources: PubMed, Embase, Web of Science, CINAHL, and Cochrane Library through January 2013; manual searches of reference lists.

Study Eligibility Criteria, Participants, Interventions: Any study in which a non-pharmacologic intervention was conducted in a general inpatient setting, and nighttime sleep quantity or quality was assessed.

Study Appraisal And Synthesis Methods: Information on study design, populations, interventions, comparators, outcomes, time frame, and risk of bias were independently abstracted by two investigators.

Results: 13 intervention studies with 1,154 participants were included. Four studies were randomized controlled trials. Seven studies had a low to medium risk of bias, and there was significant heterogeneity in the interventions. Relaxation techniques improved sleep quality 0-38%, interventions to improve sleep hygiene or reduce sleep interruptions improved sleep quantity 5%, and daytime bright light exposure improved sleep quantity 7-18%.

Limitations: The heterogeneity in the types and dose of interventions, outcome measures, length of follow-up, differences in patient populations, and dearth of randomized trials may dilute effects seen or make it more difficult to draw conclusions.

Conclusions And Implications Of Key Findings: There is insufficient to low strength of evidence that any non-pharmacologic intervention improves sleep quality or quantity of general inpatients. Further studies are needed in this area to guide clinicians.
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May 2014