Publications by authors named "Trevor Jenkins"

12 Publications

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Endothelin-1 and peak oxygen consumption in patients with heart failure with preserved ejection fraction.

Heart Lung 2021 May-Jun;50(3):442-446. Epub 2021 Feb 23.

Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, Cleveland, OH, USA. Electronic address:

Background: Mechanisms of exercise intolerance in patients with heart failure with preserved ejection fraction (HFpEF) are not well understood. Pulmonary hypertension, a common accompaniment in patients with HFpEF, is associated with poor outcomes. While Endothelin -1 (ET-1) plays a mechanistic role in pulmonary hypertension, its role in exercise intolerance in HFpEF is not well established.

Objective: To explore the association between plasma ET-1 levels and maximal oxygen consumption (pVO2), and their changes over 24 weeks in HFpEF.

Methods: This is a post-hoc analysis of the Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Heart Failure with Preserved Ejection Fraction (RELAX) trial. We performed linear regressions to assess the relationship between plasma ET-1 and pVO2. We also used linear regressions to determine whether ET-1 was associated with change in peak VO2 (ΔpVO).

Results: A total of 210 patients were included. Baseline plasma ET-1 levels were associated with older age, higher NT-proBNP levels, higher serum creatinine levels, and higher prevalence of atrial fibrillation. Patients with higher ET1 levels also had higher plasma galectin-3 and CITP levels. After multiple adjustments, baseline ET1 levels were associated with lower pVO (β -0.927, SE 0.196, p < 0.001). Over 24 weeks, the change in ET1 levels was associated with the change in pVO2 (multivariable adjusted β -0.415, SE 0.115, p = 0.018). Baseline ET1 levels did not modify the effect of sildenafil on change in peak VO.

Conclusions: Plasma ET1 levels are significantly associated with lower exercise oxygen consumption both at baseline and longitudinally over 24 weeks. Future studies should explore Endothelin-1 antagonism to improve exercise tolerance in HFpEF.
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http://dx.doi.org/10.1016/j.hrtlng.2021.02.004DOI Listing
April 2021

Evaluation of dyspnea of unknown etiology in HIV patients with cardiopulmonary exercise testing and cardiovascular magnetic resonance imaging.

J Cardiovasc Magn Reson 2020 10 12;22(1):74. Epub 2020 Oct 12.

Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA.

Aim: Human Immunodeficiency Virus (HIV) patients commonly experience dyspnea for which an immediate cause may not be always apparent. In this prospective cohort study of HIV patients with exercise limitation, we use cardiopulmonary exercise testing (CPET) coupled with exercise cardiovascular magnetic resonance (CMR) to elucidate etiologies of dyspnea.

Methods And Results: Thirty-four HIV patients on antiretroviral therapy with dyspnea and exercise limitation (49.7 years, 65% male, mean absolute CD4 count 700) underwent comprehensive evaluation with combined rest and maximal exercise treadmill CMR and CPET. The overall mean oxygen consumption (VO) peak was reduced at 23.2 ± 6.9 ml/kg/min with 20 patients (58.8% of overall cohort) achieving a respiratory exchange ratio > 1. The ventilatory efficiency (VE)/VCO slope was elevated at 36 ± 7.92, while ventilatory reserve (VE: maximal voluntary ventilation (MVV)) was within normal limits. The mean absolute right ventricular (RV) and left ventricular (LV) contractile reserves were preserved at 9.0% ± 11.2 and 9.4% ± 9.4, respectively. The average resting and post-exercise mean average pulmonary artery velocities were 12.2 ± 3.9 cm/s and 18.9 ± 8.3 respectively, which suggested lack of exercise induced pulmonary artery hypertension (PAH). LV but not RV delayed enhancement were identified in five patients. Correlation analysis found no relationship between peak VO measures of contractile RV or LV reserve, but LV and RV stroke volume correlated with PET CO (p = 0.02, p = 0.03).

Conclusion: Well treated patients with HIV appear to have conserved RV and LV function, contractile reserve and no evidence of exercise induced PAH. However, we found evidence of impaired ventilation suggesting a non-cardiopulmonary etiology for dyspnea.
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http://dx.doi.org/10.1186/s12968-020-00664-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549205PMC
October 2020

Relationship of HIV Status and Fatigue, Cardiorespiratory Fitness, Myokines, and Physical Activity.

J Assoc Nurses AIDS Care 2019 Jul-Aug;30(4):392-404

People living with HIV (PLWH) experience high rates of fatigue, which can be improved with physical activity. We examined relationships between HIV infection, fatigue, cardiorespiratory fitness, physical activity, and myokines. Twenty PLWH and 20 HIV-uninfected adults completed a fatigue assessment, a maximal cardiometabolic exercise test, serum measures of myokines, and wore an accelerometer for 7 days. Measures were completed at baseline, 3 months, and 6 months. At baseline, PLWH had more fatigue (4.7 ± 2.6 vs. 2.8 ± 2.5, p = .01) and higher peak ventilatory efficiency (VE/VCO2; 33 ± 5.5 vs. 30.2 ± 2.5; p = .06). Half of PLWH engaged in at least one 10-minute bout of physical activity in the previous week, compared with control subjects (65%). Over time, HIV infection and fibroblast growth factor 21 were associated with fatigue (p < .05). People living with HIV have more fatigue and a higher ventilatory efficiency; expression of fibroblast growth factor 21 may underpin this relationship.
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http://dx.doi.org/10.1097/JNC.0000000000000022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7179736PMC
April 2020

Cardiorespiratory fitness is associated with inflammation and physical activity in HIV+ adults.

AIDS 2019 05;33(6):1023-1030

Division of Cardiovascular Medicine, Case Western Reserve University School of Medicine.

Objective: Our objective was to examine the effect of a lifestyle diet and exercise intervention on cardiorespiratory fitness (CRF) and to examine predictors of change in CRF.

Design: People living with HIV (PLHIV) are at increased risk for cardiovascular disease. CRF is a better predictor of cardiovascular disease-related mortality than established risk factors yet very little is known about CRF in PLHIV.

Methods: One-hundred and seven virally suppressed PLHIV were randomized to a group-based intervention to improve lifestyle behaviors or a control condition. All PLHIV maximal cardiorespiratory stress test to determine VO2 peak, VO2 at anaerobic threshold, and ventilatory efficiency/VCO2, at baseline and 6 months later. Participants wore an accelerometer to measure physical activity, completed waist-hip circumference measures, and had a fasting lipid profile, IL-6, and high sensitivity C-reactive protein analyzed. Generalized estimating equations were used to examine the effect of the intervention on CRF and predictors of change in CRF.

Results: Participants were approximately 53 years old, 65% male (n = 70), and 86% African-American (n = 93). There was no effect of the intervention on markers of CRF over time (P > 0.05). After controlling for age, sex, waist-hip-ratio, the inflammatory biomarker IL-6 was inversely associated with a decline in both VO2 peak (P = 0.03) and VO2 at anaerobic threshold (P = 0.03). In addition, participants who walked an additional 10 000 steps per day had a 2.69 ml/kg per min higher VO2 peak (P = 0.02).

Conclusion: Despite HIV viral suppression, PLHIV had remarkably poor CRF and inflammation was associated with a clinically adverse CRF profile. However, increased physical activity was associated with improved CRF.
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http://dx.doi.org/10.1097/QAD.0000000000002154DOI Listing
May 2019

Pharmacologic Targeting of Red Blood Cells to Improve Tissue Oxygenation.

Clin Pharmacol Ther 2018 09 17;104(3):553-563. Epub 2018 Jan 17.

Institute for Transformative Molecular Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.

Disruption of microvascular blood flow is a common cause of tissue hypoxia in disease, yet no therapies are available that directly target the microvasculature to improve tissue oxygenation. Red blood cells (RBCs) autoregulate blood flow through S-nitroso-hemoglobin (SNO-Hb)-mediated export of nitric oxide (NO) bioactivity. We therefore tested the idea that pharmacological enhancement of RBCs using the S-nitrosylating agent ethyl nitrite (ENO) may provide a novel approach to improve tissue oxygenation. Serial ENO dosing was carried out in sheep (1-400 ppm) and humans (1-100 ppm) at normoxia and at reduced fraction of inspired oxygen (FiO ). ENO increased RBC SNO-Hb levels, corrected hypoxia-induced deficits in tissue oxygenation, and improved measures of oxygen utilization in both species. No adverse effects or safety concerns were identified. Inasmuch as impaired oxygenation is a major cause of morbidity and mortality, ENO may have widespread therapeutic utility, providing a first-in-class agent targeting the microvasculature.
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http://dx.doi.org/10.1002/cpt.979DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6590078PMC
September 2018

The Influence of Exercise on Cardiovascular Health in Sedentary Adults With Human Immunodeficiency Virus.

J Cardiovasc Nurs 2018 May/Jun;33(3):239-247

Allison R. Webel, PhD, RN Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Joseph Perazzo, PhD, RN Postdoctoral Fellow, fellow Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Christopher T. Longenecker, MD Assistant Professor, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Ohio. Trevor Jenkins, MD Assistant Professor, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Ohio. Abdus Sattar, PhD Assoicate Professor, School of Medicine, Case Western Reserve University, Cleveland, Ohio. Margaret Rodriguez Student Research Assistant, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Nate Schreiner, PhD, RN Graduate Research Assistant, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Richard A. Josephson, MD, MS Professor, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Ohio.

Background: Lifestyle physical activity (ie, moderate physical activity during routine daily activities most days of the week) may benefit human immunodeficiency virus (HIV)-positive adults who are at high risk for cardiovascular disease.

Objective: The aims of this study were to describe lifestyle physical activity patterns in HIV-positive adults and to examine the influence of lifestyle physical activity on markers of cardiovascular health. Our secondary objective was to compare these relationships between HIV-positive adults and well-matched HIV-uninfected adults.

Methods: A total of 109 HIV-positive adults and 20 control participants wore an ActiGraph accelerometer, completed a maximal graded cardiopulmonary exercise test, completed a coronary computed tomography, completed anthropomorphic measures, and had lipids and measures of insulin resistance measured from peripheral blood.

Results: Participants (N = 129) had a mean age of 52 ± 7.3 years, 64% were male (n = 82), and 88% were African American (n = 112). On average, HIV-positive participants engaged in 33 minutes of moderate-to-vigorous physical activity per day (interquartile range, 17-55 minutes) compared with 48 minutes in controls (interquartile range, 30-62 minutes, P = .05). Human immunodeficiency virus-positive adults had poor fitness (peak oxygen uptake [VO2], 16.8 ± 5.2 mL/min per kg; and a ventilatory efficiency, 33.1 [4.6]). A marker of HIV disease (current CD4+ T cell) was associated with reduced peak VO2 (r = -0.20, P < .05) and increased insulin resistance (r = 0.25, P < .01) but not with physical activity or other markers of cardiovascular health (P ≥ 0.05). After controlling for age, gender, body mass index, and HIV status, physical activity was not significantly associated with peak VO2 or ventilatory efficiency.

Conclusion: Human immunodeficiency virus-positive adults have poor physical activity patterns and diminished cardiovascular health. Future longitudinal studies should examine whether HIV infection blunts the beneficial effects of physical activity on cardiovascular health.
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http://dx.doi.org/10.1097/JCN.0000000000000450DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5893400PMC
November 2019

Design of the exercise MRI evaluation of HIV-pulmonary arterial hypertension longitudinal determinants (EXALTED) trial.

J Cardiovasc Med (Hagerstown) 2017 Nov;18(11):888-896

aDivision of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio bDivision of Cardiovascular Medicine, University of Maryland Baltimore, Maryland cDivision of Infectious Diseases and Institute of Human Virology dHouston Methodist DeBakey Heart & Vascular Center, Houston, Texas eDivision of Infectious Disease, Cleveland Medical Center, Cleveland, Ohio fThe Ohio State University, Columbus, Ohio, USA.

Background: Pulmonary arterial hypertension (PAH) is a potentially serious cause of dyspnea and exercise limitation in patients with HIV infection. In this trial, we propose using exercise MRI in conjunction with cardiopulmonary testing to delineate PAH from other causes of cardiovascular dysfunction, identify individuals with exercise-induced PAH who are at high risk of developing resting PAH, and provide longitudinal estimates of progression of PAH and right ventricular function.

Methods: In this prospective observational study, HIV patients with dyspnea and exercise limitation in the absence of identifiable causes and those who meet the inclusion criteria will be enrolled based on resting pulmonary artery pressure (≤ or >40 mmHg) on a screening echocardiogram and exercise limitation on the Modified Medical Research Council dyspnea scale. Patients without evidence of resting PAH will be enrolled into both rest and exercise MRI and cardiopulmonary testing protocol, whereas patients with evidence of PAH on resting echocardiograms will undergo only resting cardiac MRI studies to evaluate right ventricular function and fibrosis. Both patient subgroups will be followed for 24 months to obtain longitudinal progression of the disease. In a sub-study, we will further analyze inflammatory variables that may predict these changes, thus allowing early identification of these patients.

Implications And Conclusions: This trial will be the first study to provide an understanding of the mechanisms underpinning the functional deterioration of the right ventricle in patients with HIV and will impart insight into the immune mediators of PAH progression and right ventricular functional deterioration in patients with HIV-PAH.
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http://dx.doi.org/10.2459/JCM.0000000000000575DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5985161PMC
November 2017

Multimodal imaging of the tricuspid valve: normal appearance and pathological entities.

Insights Imaging 2016 Oct 9;7(5):649-67. Epub 2016 Jun 9.

Cardiothoracic Imaging, Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH, USA.

The tricuspid valve, which is the atrioventricular valve attached to the morphological right ventricle, is affected by a wide range of pathological processes. Tricuspid valve diseases are now increasingly recognized as a significant cause of morbidity and mortality. Echocardiography is the most widely available and, hence, the first-line imaging modality used in the evaluation of tricuspid valve disorders; however, CT and MRI are also increasingly used for further evaluation and characterization of these entities. In this article, we first review the normal anatomy and embryology of the tricuspid valve, followed by a discussion of the role of multiple imaging modalities in the evaluation of tricuspid valve abnormalities. We then review and illustrate the imaging appearance of several congenital and acquired tricuspid valve abnormalities. Main Messages • Tricuspid valve diseases have a significant impact on morbidity and mortality. • CT and MRI are increasingly used in the evaluation of tricuspid disorders. • CT and MRI help in diagnosis, functional evaluation, pre-surgical planning and post-surgical follow-up. • The most common cause of tricuspid regurgitation is functional.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028338PMC
http://dx.doi.org/10.1007/s13244-016-0504-7DOI Listing
October 2016

Evaluation of left ventricular ejection fraction using through-time radial GRAPPA.

J Cardiovasc Magn Reson 2014 Oct 1;16:79. Epub 2014 Oct 1.

Biomedical Engineering, Case Western Reserve University, Room 309 Wickenden Building 2071 Martin Luther King Jr. Drive, Cleveland, OH, 44106-7207, USA.

Background: The determination of left ventricular ejection fraction using cardiovascular magnetic resonance (CMR) requires a steady cardiac rhythm for electrocardiogram (ECG) gating and multiple breathholds to minimize respiratory motion artifacts, which often leads to scan times of several minutes. The need for gating and breathholding can be eliminated by employing real-time CMR methods such as through-time radial GRAPPA. The aim of this study is to compare left ventricular cardiac functional parameters obtained using current gold-standard breathhold ECG-gated functional scans with non-gated free-breathing real-time imaging using radial GRAPPA, and to determine whether scan time or the occurrence of artifacts are reduced when using this real-time approach.

Methods: 63 patients were scanned on a 1.5T CMR scanner using both the standard cardiac functional examination with gating and breathholding and the real-time method. Total scan durations were noted. Through-time radial GRAPPA was employed to reconstruct images from the highly accelerated real-time data. The blood volume in the left ventricle was assessed to determine the end systolic volume (ESV), end diastolic volume (EDV), and ejection fraction (EF) for both methods, and images were rated for the presence of artifacts and quality of specific image features by two cardiac readers. Linear regression analysis, Bland-Altman plots and two-sided t-tests were performed to compare the quantitative parameters. A two-sample t-test was performed to compare the scan durations, and a two-sample test of proportion was used to analyze the presence of artifacts. For the reviewers´ ratings the Wilcoxon test for the equality of the scores' distributions was employed.

Results: The differences in EF, EDV, and ESV between the gold-standard and real-time methods were not statistically significant (p-values of 0.77, 0.82, and 0.97, respectively). Additionally, the scan time was significantly shorter for the real-time data collection (p<0.001) and fewer artifacts were reported in the real-time images (p<0.01). In the qualitative image analysis, reviewers marginally preferred the standard images although some features including cardiac motion were equivalently rated.

Conclusion: Real-time functional CMR with through-time radial GRAPPA performed without ECG-gating under free-breathing can be considered as an alternative to gold-standard breathhold cine imaging for the evaluation of ejection fraction in patients.
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http://dx.doi.org/10.1186/s12968-014-0079-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4180954PMC
October 2014

Direct procurement of wound management products.

Authors:
Trevor Jenkins

Br J Community Nurs 2014 Mar;Suppl:S21-2, S24-7

Community Health Services Pharmacy Lead for Bedfordshire, South Essex Partnership Trust (SEPT).

This article describes a collaborative project between Bedfordshire Community Health Services and Primary Care Trusts/Clinical Commissioning Groups to improve provision of dressings to nurses for the patients they treat. Commissioners have facilitated a transformational approach and encouraged development of efficient systems of increased cost-effectiveness rather than a transactional approach based on opportunistic cost improvement plans. Reconfiguration to direct procurement from GP prescribing has reduced wastage, released nurse time from processes to spend on clinical contact time with patients, increased efficiency, and reduced prescription workload for GPs, all without adverse effects on expenditure. Establishing a wound care products formulary placed control under the nurses treating patients and facilitated decision-making based on cost-effectiveness in clinical use. Nurses now manage 60% of expenditure in the local community health economy, and this is increasing. Relationships with the dressings manufacturing industry have also changed in a positive, constructive direction.
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http://dx.doi.org/10.12968/bjcn.2014.19.sup3.s21DOI Listing
March 2014

Multimodality imaging of an unusual case of an obstructive intracaval mass by an aberrant liver.

Circulation 2014 Feb;129(5):e310-2

Department of Radiology (K.A.-G., L.L., P.R.), Department of Cardiology (T.J.), and Department of Pathology (W.X.), University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.

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http://dx.doi.org/10.1161/CIRCULATIONAHA.113.004621DOI Listing
February 2014

Arthur G. Steinberg, 1912-2006.

Authors:
Trevor Jenkins

Am J Hum Genet 2007 Jun;80(6):100913

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June 2007
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