Randall C . Starling

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Heart failure (HF) is a syndrome characterized by high mortality, frequent hospitalization, reduced quality of life, and a complex therapeutic regimen. Knowledge about HF is accumulating so rapidly that individual clinicians may be unable to readily and adequately synthesize new information into effective strategies of care for patients with this syndrome.(More)
The role of endomyocardial biopsy (EMB) in the diagnosis and treatment of adult and pediatric cardiovascular disease remains controversial, and the practice varies widely even among cardiovascular centers of excellence. A need for EMB exists because specific myocardial disorders that have unique prognoses and treatment are seldom diagnosed by noninvasive(More)
BACKGROUND Everolimus, a novel proliferation inhibitor and immunosuppressive agent, may suppress cardiac-allograft vasculopathy. We conducted a randomized, double-blind, clinical trial comparing everolimus with azathioprine in recipients of a first heart transplant. METHODS A total of 634 patients were randomly assigned to receive 1.5 mg of everolimus per(More)
Introduction This section deals with surgical issues that may potentially complicate the immediate post-transplant period. Many of these issues, particularly ones that arise in patient selection can have a very important impact on the immediate post-operative course of the patient and some can have far reaching consequences for long-term graft and patient(More)
Rejection diagnosis by endomyocardial biopsy (EMB) is invasive, expensive and variable. We investigated gene expression profiling of peripheral blood mononuclear cells (PBMC) to discriminate ISHLT grade 0 rejection (quiescence) from moderate/severe rejection (ISHLT > or = 3A). Patients were followed prospectively with blood sampling at post-transplant(More)
BACKGROUND Nesiritide is approved in the United States for early relief of dyspnea in patients with acute heart failure. Previous meta-analyses have raised questions regarding renal toxicity and the mortality associated with this agent. METHODS We randomly assigned 7141 patients who were hospitalized with acute heart failure to receive either nesiritide(More)
wo of the previous International Society for Heart and ung Transplantation (ISHLT) consensus conferences ave addressed listing criteria for patients awaiting eart transplantation. Guidelines from these two onferences were completed before the acceptance of -blocker and device therapies in the clinical treatment f late-stage heart failure. Guidelines(More)
OBJECTIVES To determine whether venous congestion, rather than impairment of cardiac output, is primarily associated with the development of worsening renal function (WRF) in patients with advanced decompensated heart failure (ADHF). BACKGROUND Reduced cardiac output is traditionally believed to be the main determinant of WRF in patients with ADHF. (More)
BACKGROUND This prospective placebo-controlled trial was designed to determine whether intravenous immune globulin (IVIG) improves left ventricular ejection fraction (LVEF) in adults with recent onset of idiopathic dilated cardiomyopathy or myocarditis. METHODS AND RESULTS Sixty-two patients (37 men, 25 women; mean age +/-SD 43.0+/-12.3 years) with recent(More)