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daSilva-deAbreu A, Faaborg-Andersen C, Joury A, Tutor A, Desai S, Eiswirth C, Krim SR, Wever-Pinzon J, Lavie CJ, Ventura HO. Outcomes of Patients With Left Ventricular Assist Devices Requiring Intermittent Hemodialysis: Single-Center Cohort, Systematic Review, and Individual-Participant Data Meta-Analysis. Curr Probl Cardiol 2024; 49:102090. [PMID: 37734691 DOI: 10.1016/j.cpcardiol.2023.102090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/18/2023] [Indexed: 09/23/2023]
Abstract
Patients with left ventricular assist devices (LVADs) who require intermittent hemodialysis (iHD) are considered to have a poor prognosis despite a paucity of supportive evidence, mostly from small single-center cohorts and extrapolations from studies of patients who received continuous renal replacement therapy but no iHD. We conducted a systematic review and individual-participant-data meta-analysis of the literature including our single-center cohort to examine the outcomes of patients initiated on iHD following LVAD implantation. Sixty-four patients from 5 cohorts met selection criteria (age 57.5 [46-64.5] years, 87% HeartMate II, mostly bridge to transplantation). Follow-up after iHD initiation was 87.5 (38.5-269.5) days, although it was considerably longer in our center than in other cohorts (601.5 [93-1559] days vs 65 [26-180] days, P = 0.0007). The estimated median survival was 308 (76-912.5) days and varied significantly among cohorts, ranging from 60 (57-65) to 838 (103-1872) days (P = 0.0096). Twelve (18.8%) patients achieved either heart transplantation (HT) or remission during follow-up. Patients who received HT had an 8-fold longer estimated median survival (1972 [799-1972] days vs 244 [64-838] days, P = 0.0112). Being from a more recent cohort was associated with better 1-year survival. Renal recovery occurred in eight patients (13.1%) at 30 days and its cumulative incidence increased to 73% (27/37 patients with available data) at 1 year. Most patients initiated on iHD after LVAD experienced renal recovery within the first year after implantation. Improved survival was observed for patients who received HT and in those from more recent cohorts. Some patients were able to survive on LVAD and iHD support for several years.
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Affiliation(s)
| | | | - Abdulaziz Joury
- Division of Cardiology, McGill University Health Centre, McGill University, Montreal, QC, Canada; King Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Austin Tutor
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA
| | - Sapna Desai
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA; The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA
| | - Clement Eiswirth
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA; The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA
| | - Selim R Krim
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA; The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA
| | - James Wever-Pinzon
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA; The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA; The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA
| | - Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA; The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA
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Barillas-Lara MI, daSilva-deAbreu A, Ventura HO. Association of Glucosamine Supplementation and Incidence of Heart Failure. Mayo Clin Proc 2023; 98:1118-1120. [PMID: 37536800 DOI: 10.1016/j.mayocp.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 08/05/2023]
Affiliation(s)
| | | | - Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; The University of Queensland Ochsner Clinical School, The University of Queensland, New Orleans, LA.
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Tandan N, Lavie CJ, Stewart MH, Milani RV, Ventura HO. Secondary hypertension: evaluation and management. Curr Opin Cardiol 2023; 38:318-325. [PMID: 37115960 DOI: 10.1097/hco.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
PURPOSE OF REVIEW Hypertension (HTN) that can be attributed to a particular source is known as secondary HTN (SH). Often, SH is difficult to control and thus referred to as resistant HTN, although the two terms are not mutually exclusive. RECENT FINDINGS A common theme across several contributors to SH are coactivation of the sympathetic drive and hormonal changes, independent of hormonal axis activation. The key to effective management of SH is early recognition and treatment to avoid catastrophic cardiovascular disease effects and mortality. SUMMARY This review article provides a contemporary summary of the conditions associated with SH and briefly reviews diagnostics and management.
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Affiliation(s)
- Nitin Tandan
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana USA
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Ventura HO, Lavie CJ, Mehra MR. Angiotensin-Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction: You Win Some, You Lose Some. J Am Coll Cardiol 2023:S0735-1097(23)05526-2. [PMID: 37220861 DOI: 10.1016/j.jacc.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/25/2023]
Affiliation(s)
- Hector O Ventura
- John Ochsner Heart and Vascular Institute, Department of Cardiovascular Diseases, Ochsner Clinical School -the University of Queensland School of Medicine, New Orleans, Louisiana.
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Department of Cardiovascular Diseases, Ochsner Clinical School -the University of Queensland School of Medicine, New Orleans, Louisiana
| | - Mandeep R Mehra
- Center of Advanced Heart Disease, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Ventura HO, Elagizi A, Lavie CJ. Optimal Prevention of Cardiovascular Diseases: The Earlier the Better. J Am Coll Cardiol 2023; 81:1162-1164. [PMID: 36948732 DOI: 10.1016/j.jacc.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 03/24/2023]
Affiliation(s)
- Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana, USA.
| | - Andrew Elagizi
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana, USA
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Duran A, Ventura HO. The value of frequent objective risk assessments in heart failure management. Int J Cardiol 2023; 379:100-101. [PMID: 36889649 DOI: 10.1016/j.ijcard.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023]
Affiliation(s)
- Antonio Duran
- Division of Cardiology, University of California San Diego, La Jolla, CA, USA; The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA.
| | - Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA; The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
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Faaborg-Andersen CC, daSilva-deAbreu A, Ventura HO. Trends in Heart Failure Outcomes From a Large, Geographically Diverse Cohort During the COVID-19 Pandemic. Mayo Clin Proc 2023; 98:4-6. [PMID: 36603957 PMCID: PMC9676170 DOI: 10.1016/j.mayocp.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022]
Affiliation(s)
| | | | - Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA.
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Tutor AW, Lavie CJ, Kachur S, Milani RV, Ventura HO. Updates on obesity and the obesity paradox in cardiovascular diseases. Prog Cardiovasc Dis 2022:S0033-0620(22)00134-7. [PMID: 36481212 DOI: 10.1016/j.pcad.2022.11.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 11/26/2022] [Indexed: 12/10/2022]
Abstract
The prevalence of obesity has reached pandemic proportions worldwide and certainly in the United States. Obesity is a well-established independent risk factor for development of many cardiovascular diseases (CVD), including heart failure, coronary heart disease, atrial fibrillation, and hypertension. Therefore, it is logical to expect obesity would have a strong correlation with CVD mortality. However, a substantial body of literature demonstrates a paradox with improved prognosis of overweight and obese patients with established CVD compared to lean patients with the identical CVD. Surprisingly, similar data has also shown that cardiovascular fitness, rather than weight loss alone, influences the relationship between obesity and mortality in those with established CVD. The impact of fitness, exercise, physical activity (PA), and weight loss and their relationship to the obesity paradox are all reviewed here.
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Affiliation(s)
- Austin W Tutor
- John Ochsner Heart and Vascular Institute, Department of Cardiovascular Diseases, Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, LA, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Department of Cardiovascular Diseases, Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, LA, USA.
| | - Sergey Kachur
- John Ochsner Heart and Vascular Institute, Department of Cardiovascular Diseases, Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, LA, USA; Ascension Sacred Heart Regional Heart and Vascular Institute, Pensacola, FL, USA; Department of Medicine, University of Central Florida School of Medicine, Orlando, FL, USA
| | - Richard V Milani
- John Ochsner Heart and Vascular Institute, Department of Cardiovascular Diseases, Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, LA, USA
| | - Hector O Ventura
- John Ochsner Heart and Vascular Institute, Department of Cardiovascular Diseases, Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, LA, USA
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Lavie CJ, daSilva-deAbreu A, Ventura HO, Mehra MR. Is There an Obesity Paradox in Cardiogenic Shock? J Am Heart Assoc 2022; 11:e026088. [PMID: 35658482 PMCID: PMC9238744 DOI: 10.1161/jaha.122.026088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Carl J Lavie
- John Ochsner Heart and Vascular InstituteOchsner Clinical School - The University of Queensland School of Medicine New Orleans LA
| | - Adrian daSilva-deAbreu
- Section of Cardiovascular Medicine Yale School of MedicineHeart and Vascular CenterYale-New Haven Hospital New Haven CT
| | - Hector O Ventura
- John Ochsner Heart and Vascular InstituteOchsner Clinical School - The University of Queensland School of Medicine New Orleans LA
| | - Mandeep R Mehra
- Brigham and Women's Hospital and Harvard Medical School Boston MA
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Faaborg-Andersen C, daSilva-deAbreu A, Ventura HO. Erratum to 'Understanding Heart Failure Risk in a Diverse Cohort with Human Immunodeficiency Virus': [Mayo Clinic Proceedings 97 (2022) 433-435]. Mayo Clin Proc 2022; 97:1217. [PMID: 35489962 DOI: 10.1016/j.mayocp.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - Adrian daSilva-deAbreu
- Heart and Vascular Center Yalee New Haven Hospital Section of Cardiovascular Medicine Yale University School of Medicine New Haven, CT
| | - Hector O Ventura
- John Ochsner Heart and Vascular Institute Ochsner Medical Center New Orleans, LA
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11
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Bocchi EA, Ventura HO. Systemic Blood Pressure in Heart Failure: The Next Frontier in Prognosis and Chronic HF Treatment? JACC Heart Fail 2022; 10:393-396. [PMID: 35654523 DOI: 10.1016/j.jchf.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Edimar Alcides Bocchi
- Unidade de Insuficiência Cardíaca, Instituto do Coracao, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, and the University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, Louisiana, USA
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12
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Duran A, Tutor A, Shariati F, Sleem A, Wever-Pinzon J, Desai S, Eiswirth C, Ventura HO, Krim SR. Preimplant hyponatremia does not predict adverse outcomes in patient with left ventricular assist devices. Curr Probl Cardiol 2022:101239. [PMID: 35513184 DOI: 10.1016/j.cpcardiol.2022.101239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 04/29/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Hyponatremia is a well-established marker of adverse outcomes in chronic heart failure (HF) but not well studied in patients with left ventricular assist device (LVAD). METHODS This is a retrospective study, single center study of HM3 [Abbott, USA] LVAD implants. We divided our population based on their sodium prior to LVAD implantation - hyponatremia if <135 mEq/L and normal sodium if 135 - 145 mEq/L. We compared postoperative and long-term outcomes. RESULTS A total of 195 patients were included, preimplant hyponatremia was present in 40% with a sodium of 132.1±2.1 vs. 137.8±1.9 mEq/L in the normal sodium group. No differences were observed in the postoperative or long-term outcomes. CONCLUSION Preimplant hyponatremia was not associated with mortality or HF admissions, likely due to adequate left ventricular unloading and resolution of the mechanisms that lead to hyponatremia. These results suggest that optimization of mild hyponatremia may not be critical and should not delay LVAD placement.
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Affiliation(s)
- Antonio Duran
- Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
| | - Austin Tutor
- Department of Internal Medicine, Ochsner Medical Center, New Orleans, LA
| | - Farnoosh Shariati
- Department of Internal Medicine, Ochsner Medical Center, New Orleans, LA
| | - Amber Sleem
- Department of Internal Medicine, Ochsner Medical Center, New Orleans, LA
| | - James Wever-Pinzon
- Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA
| | - Sapna Desai
- Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA
| | - Clement Eiswirth
- Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA
| | - Hector O Ventura
- Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Selim R Krim
- Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
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13
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Cittadini A, Ventura HO. Emerging Comorbidities in Heart Failure. Cardiol Clin 2022. [DOI: 10.1016/s0733-8651(22)00008-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Overweight and obesity adversely impact cardiac structure and function, affecting systolic and diastolic ventricular function. Epidemiologic studies have documented an obesity paradox in large heart failure cohorts, where overweight and obese individuals with established heart failure have a better short- and medium-term prognosis compared with leaner patients; this relationship is strongly impacted by level of cardiorespiratory fitness. There are implications for therapies aimed at increasing lean mass as well as weight loss and improvements in quality of diet for the prevention and treatment of heart failure and concomitant obesity to improve cardiorespiratory fitness.
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Cittadini A, Bossone E, Ventura HO. Emerging Comorbidities in Heart Failure. Cardiol Clin 2022; 40:xi-xiv. [DOI: 10.1016/j.ccl.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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daSilva-deAbreu A, Tutor A, Desai S, Eiswirth C, Krim S, Wever-Pinzon J, Lavie CJ, Ventura HO. Outcomes Of Intermittent Hemodialysis During Support With Ventricular Assist Devices: A Potential Bridge To Heart/kidney Transplantation? J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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daSilva-deAbreu A, Tutor A, Desai S, Eiswirth C, Krim S, Wever-Pinzon J, Lavie CJ, Ventura HO. Short-term Outcomes Of Intermittent Hemodialysis In Patients With Ventricular Assist Devices. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Faaborg-Andersen C, daSilva-deAbreu A, Ventura HO. Understanding Heart Failure Risk in a Diverse Cohort With Human Immunodeficiency Virus Infection. Mayo Clin Proc 2022; 97:433-435. [PMID: 35246281 DOI: 10.1016/j.mayocp.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/20/2022] [Indexed: 11/26/2022]
Affiliation(s)
| | - Adrian daSilva-deAbreu
- Heart and Vascular Center, Yale-New Haven Hospital, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
| | - Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA.
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Piña IL, Jimenez S, Lewis EF, Morris AA, Onwuanyi A, Tam E, Ventura HO. Race and Ethnicity in Heart Failure: JACC Focus Seminar 8/9. J Am Coll Cardiol 2021; 78:2589-2598. [PMID: 34887145 DOI: 10.1016/j.jacc.2021.06.058] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 12/15/2022]
Abstract
Heart failure (HF) affects >6 million Americans, with variations in incidence, prevalence, and clinical outcomes by race/ethnicity. Black adults have the highest risk for HF, with earlier age of onset and the highest risk of death and hospitalizations. The risk of hospitalizations for Hispanic patients is higher than White patients. Data on HF in Asian individuals are more limited. However, the higher burden of traditional cardiovascular risk factors, particularly among South Asian adults, is associated with increased risk of HF. The role of environmental, socioeconomic, and other social determinants of health, more likely for Black and Hispanic patients, are increasingly recognized as independent risk factors for HF and worse outcomes. Structural racism and implicit bias are drivers of health care disparities in the United States. This paper will review the clinical, physiological, and social determinants of HF risk, unique for race/ethnic minorities, and offer solutions to address systems of inequality that need to be recognized and dismantled/eradicated.
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Affiliation(s)
| | | | | | - Alanna A Morris
- Emory University, Atlanta, Georgia, USA. https://twitter.com/morrismd
| | | | - Edlira Tam
- Montefiore Medical Center, Bronx, New York, USA
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Costanzo MR, O'Connor CM, Ventura HO. Advanced Heart Failure: Progress and Disappointments. JACC Heart Fail 2021; 9:938-940. [PMID: 34857178 DOI: 10.1016/j.jchf.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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21
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22
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Krim SR, Bennett A, Pfeffer M, Campbell PT, Thai S, Baetz B, Wever-Pinzon J, Eiswirth C, Desai S, Ventura HO. Triple Antithrombotic Therapy in Patients With Left Ventricular Assist Devices. Curr Probl Cardiol 2021; 47:100940. [PMID: 34384617 DOI: 10.1016/j.cpcardiol.2021.100940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/09/2021] [Indexed: 11/03/2022]
Abstract
Data on the efficacy and safety of the combination of warfarin and dual-antiplatelet therapy compared with warfarin and mono-antiplatelet therapy (MAPT) in patients with left ventricular assist devices (LVAD) remains scarce. Single-center study of 130 consecutive patients with durable LVAD. Baseline demographics, antithrombotic and antiplatelet regimen, and outcomes were compared between patients receiving warfarin plus dual-antiplatelet therapy (Group 1) and warfarin plus MAPT (Group 2). Antiplatelet therapy was assessed at hospital discharge post-LVAD implant and included aspirin, clopidogrel and dipyridamole. Outcomes at 1-year were assessed in each group. All patients were on aspirin and warfarin. No significant differences with regards to age, gender or ethnicity were noted at baseline between the two groups. Group 1 was more likely to have higher lactate dehydrogenase LDH levels at discharge and a history of stroke. No significant differences in international normalized ratio INR, hemoglobin or hematocrit were noted at discharge. During the study period, 48 patients had gastrointestinal bleeding events: 28 of 68 (41.2%) in Group 1 vs 20 of 62 (32.2%) in Group 2 (P = 0.293). At 1year, no statistically significant differences were noted in gastrointestinal bleeding (Group 1=27.90% vs Group 2 = 25.80, P = 0.784), ischemic stroke (Group 1 = 8.8% vs group 2 = 6.5%, P = 0.612), hemorrhagic stroke (Group 1 = 4.4% vs group 2 = 3.2%, P = 0.725) or mortality (Group 1 = 5.9% vs Group 2 = 1.6%, P = 0.206). Rates of pump thrombosis however were lower in Group 1 (Group 1 = 0% vs Group 2 = 6.5%, P = 0.033). Our study showed a high prevalence of triple-therapy antithrombotic use in LVAD patients with no significant differences in bleeding, stroke or survival. However, the risk for pump thrombosis was lower at 1-year when compared to patient receiving MAPT.
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Affiliation(s)
- Selim R Krim
- Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
| | - Amanda Bennett
- Heart & Vascular Center, University of Rochester Medical Center, Rochester, NY
| | - Michael Pfeffer
- Department of Medicine, Oregon Health & Science University, Portland, OR
| | | | - Steven Thai
- Department of Pharmacy, Ochsner Clinic Foundation, New Orleans, LA
| | - Brooke Baetz
- Department of Pharmacy, Ochsner Clinic Foundation, New Orleans, LA
| | - James Wever-Pinzon
- Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA
| | - Clement Eiswirth
- Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA
| | - Sapna Desai
- Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA
| | - Hector O Ventura
- Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
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Ventura HO, Lavie CJ. Editorial: The burden of hypertension and its management. Curr Opin Cardiol 2021; 36:397. [PMID: 33797419 DOI: 10.1097/hco.0000000000000863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Hector O Ventura
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana, USA
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Abstract
PURPOSE OF REVIEW Hypertension (HTN) is the most common chronic disease impacting over half the US adult population. Our current office-based model of care is failing in its ability to control blood pressure (BP) as only 44% of adult US hypertensives are achieving minimal levels of BP control (< 140/90 mmHg), leading to high rates of preventable cardiovascular events and death. RECENT FINDINGS Reengineering care delivery using a fully digital platform combined with a dedicated team-based approach to HTN management has demonstrated superior BP control rates, very high levels patient acceptance, and the ability to better diagnose and treat masked and white coat HTN. SUMMARY A digital medicine program in the clinical care setting can be an effective and convenient mechanism of delivering HTN management, outperforming traditional office-based care, and is well accepted by patients.
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Affiliation(s)
- Richard V Milani
- Center for Healthcare Innovation
- Department of Cardiology, Ochsner Health and Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Carl J Lavie
- Department of Cardiology, Ochsner Health and Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Hector O Ventura
- Department of Cardiology, Ochsner Health and Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, Louisiana, USA
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Abstract
PURPOSE OF REVIEW Hypertension (HTN) and obesity are major risk factors for cardiac remodeling and dysfunction, leading to left ventricular hypertrophy (LVH) and heart failure (HF). In this review, we discuss the complex mechanisms and effects of HTN and obesity, and their treatments in LVH, ventricular function, and HF. RECENT FINDINGS Obesity and HTN impact the heart through overlapping neurohormonal pathways. However, the relationship between obesity and cardiomyopathy is more complex, and additional metabolic and hemodynamic pathways seem to contribute to cardiac dysfunction in these patients. Weight loss and blood pressure (BP) control help to prevent and reverse at least some of the damage caused by obesity and HTN even beyond what would be expected from solely the hemodynamic changes. SUMMARY Obesity and HTN cause maladaptive changes in the heart that can lead to LVH and HF. Weight loss and BP control help to, at least partially, reverse some of these changes and improve clinical outcomes in patients with HF.
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Affiliation(s)
- Adrian daSilva-deAbreu
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation
- The University of Queensland Ochsner Clinical School, New Orleans, Louisiana
| | | | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation
- The University of Queensland Ochsner Clinical School, New Orleans, Louisiana
| | - Richard V Milani
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation
- The University of Queensland Ochsner Clinical School, New Orleans, Louisiana
| | - Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation
- The University of Queensland Ochsner Clinical School, New Orleans, Louisiana
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26
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Duran A, daSilva-deAbreu A, Joury A, Ventura HO. FGF23 predicts outcomes in heart failure but questions remain unanswered. Int J Cardiol 2021; 338:145-146. [PMID: 34157358 DOI: 10.1016/j.ijcard.2021.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Antonio Duran
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.; The University of Queensland, Ochsner Clinical School, Faculty of Medicine, New Orleans, LA, USA.
| | - Adrian daSilva-deAbreu
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.; The University of Queensland, Ochsner Clinical School, Faculty of Medicine, New Orleans, LA, USA
| | - Abdulaziz Joury
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.; The University of Queensland, Ochsner Clinical School, Faculty of Medicine, New Orleans, LA, USA
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27
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Lavie CJ, Josephson RA, Ventura HO. Physical Activity to Reduce Subclinical Myocardial Injury Associated Heart Failure in Blacks. JACC Heart Fail 2021; 9:494-496. [PMID: 34119467 DOI: 10.1016/j.jchf.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Carl J Lavie
- Department of Cardiovascular Diseases, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana, USA.
| | - Richard A Josephson
- Harrington Heart and Vascular Institute, Case Western Reserve University, Division of Cardiovascular Diseases, University Hospital Health Systems, Cleveland, Ohio, USA
| | - Hector O Ventura
- Department of Cardiovascular Diseases, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana, USA
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28
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daSilva-deAbreu A, Maitas O, Rodriguez-Escudero JP, Desai S, Eiswirth C, Krim S, Patel H, Ventura HO, Mandras SA. Ruptured hemorrhagic bulla in a patient with a HeartMate 3 treated with an Amplatzer device. Arch Cardiol Mex 2021; 91:371-372. [PMID: 33761522 PMCID: PMC8351646 DOI: 10.24875/acm.20000331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/20/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Adrian daSilva-deAbreu
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA, USA
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
| | - Oscar Maitas
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA, USA
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
| | - Juan P. Rodriguez-Escudero
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA, USA
| | - Sapna Desai
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA, USA
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
| | - Clement Eiswirth
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA, USA
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
| | - Selim Krim
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA, USA
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
| | - Hamang Patel
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA, USA
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
| | - Hector O. Ventura
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA, USA
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
| | - Stacy A. Mandras
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA, USA
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
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29
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Affiliation(s)
- Hector O Ventura
- John Ochsner Heart and Vascular Institute and The University of Queensland Ochsner Clinical School, New Orleans, LA
| | - Adrian daSilva-deAbreu
- John Ochsner Heart and Vascular Institute and The University of Queensland Ochsner Clinical School, New Orleans, LA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute and The University of Queensland Ochsner Clinical School, New Orleans, LA
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Cittadini A, Salzano A, Iacoviello M, Triggiani V, Rengo G, Cacciatore F, Maiello C, Limongelli G, Masarone D, Perticone F, Cimellaro A, Perrone Filardi P, Paolillo S, Mancini A, Volterrani M, Vriz O, Castello R, Passantino A, Campo M, Modesti PA, De Giorgi A, Monte IP, Puzzo A, Ballotta A, D'Assante R, Arcopinto M, Gargiulo P, Sciacqua A, Bruzzese D, Colao A, Napoli R, Suzuki T, Eagle KA, Ventura HO, Marra AM, Bossone E. Multiple hormonal and metabolic deficiency syndrome predicts outcome in heart failure: the T.O.S.CA. Registry. Eur J Prev Cardiol 2021; 28:1691-1700. [PMID: 33693736 DOI: 10.1093/eurjpc/zwab020] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/04/2021] [Accepted: 02/02/2021] [Indexed: 12/14/2022]
Abstract
AIMS Recent evidence supports the occurrence of multiple hormonal and metabolic deficiency syndrome (MHDS) in chronic heart failure (CHF). However, no large observational study has unequivocally demonstrated its impact on CHF progression and outcome. The T.O.S.CA. (Trattamento Ormonale nello Scompenso CArdiaco; Hormone Treatment in Heart Failure) Registry has been specifically designed to test the hypothesis that MHDS affects morbidity and mortality in CHF patients. METHODS AND RESULTS The T.O.S.CA. Registry is a prospective, multicentre, observational study involving 19 Italian centres. Thyroid hormones, insulin-like growth factor-1, total testosterone, dehydropianoandrosterone sulfate, insulin resistance, and the presence of diabetes were evaluated. A MHDS was defined as the presence of ≥2 hormone deficiencies (HDs). Primary endpoint was a composite of all-cause mortality and cardiovascular hospitalizations. Four hundred and eighty heart failure patients with ejection fraction ≤45% were enrolled. MHDS or diabetes was diagnosed in 372 patients (77.5%). A total of 271 events (97 deaths and 174 cardiovascular hospitalizations) were recorded, 41% in NO-MHDS and 62% in MHDS (P < 0.001). Median follow-up was of 36 months. MHDS was independently associated with the occurrence of the primary endpoint [hazard ratio 95% (confidence interval), 1.93 (1.37-2.73), P < 0.001] and identified a group of patients with a higher mortality [2.2 (1.28-3.83), P = 0.01], with a graded relation between HDs and cumulative events (P < 0.01). CONCLUSION MHDS is common in CHF and independently associated with increased all-cause mortality and cardiovascular hospitalization, representing a promising therapeutic target. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT023358017.
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Affiliation(s)
- Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy
| | - Andrea Salzano
- IRCCS SDN, Diagnostic and Nuclear Research Institute, Naples, Italy
| | - Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari 'A Moro', Bari, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy.,Istituti Clinici Scientifici Maugeri SpA Società Benefit (ICS Maugeri SpA SB), IRCCS, Scientific Institute of Telese Terme, Telese BN, Italy
| | - Francesco Cacciatore
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Ciro Maiello
- Heart Transplantation Unit, Monaldi Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Giuseppe Limongelli
- Division of Cardiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Daniele Masarone
- Division of Cardiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Antonio Cimellaro
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Antonio Mancini
- Operative Unit of Endocrinology, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Olga Vriz
- Heart Center Department, King Faisal Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Roberto Castello
- Division of General Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Michela Campo
- Department of Medical and Surgical Sciences, Unit of Endocrinology and Metabolic Diseases, University of Foggia, Foggia, Italy
| | - Pietro A Modesti
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Florence, Italy
| | - Alfredo De Giorgi
- Department of Medical Sciences, School of Medicine, Pharmacy and Prevention, University of Ferrara, Ferrara, Italy
| | - Ines P Monte
- Department of General Surgery and Medical-Surgery Specialties, University of Catania, Catania, Italy
| | | | - Andrea Ballotta
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Roberta D'Assante
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy
| | - Michele Arcopinto
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy
| | - Paola Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Dario Bruzzese
- Department of Public Health, Federico II University, Naples, Italy
| | - Annamaria Colao
- Clinical Medicine and Surgery Department, Federico II University, Naples, Italy
| | - Raffaele Napoli
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Toru Suzuki
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Kim A Eagle
- Michigan Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Alberto M Marra
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy.,Center for Pulmonary Hypertension, Thoraxclinic at Heidelberg University Hospital, Heidelberg, Germany
| | - Eduardo Bossone
- Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy.,Cardiology Division, A Cardarelli Hospital, Naples, Italy
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daSilva-deAbreu A, Alhafez BA, Curbelo-Pena Y, Lavie CJ, Ventura HO, Loro-Ferrer JF, Mandras SA. Bariatric Surgery in Patients with Obesity and Ventricular Assist Devices Considered for Heart Transplantation: Systematic Review and Individual Participant Data Meta-analysis. J Card Fail 2020; 27:338-348. [PMID: 33358959 DOI: 10.1016/j.cardfail.2020.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 12/10/2020] [Accepted: 12/17/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Class II obesity (body mass index BMI ≥35 kg/m2) is a contraindication to heart transplantation (HT). Although few single-center studies (case reports/series and small cohorts) have reported promising outcomes of bariatric surgery (BS) in patients with obesity and ventricular assist devices, low sample sizes have made their analysis and interpretation challenging. METHODS AND RESULTS We conducted a systematic search in ClinicalTrials.gov, Cochrane, Embase, PubMed, Google Scholar, and most relevant bariatric and heart failure journals. We extracted baseline and outcome individual participant data for every ventricular assist device patient undergoing BS with reported postoperative BMI and their respective timepoints when BMI data were measured. Fourteen references with 29 patients were included. The mean age was 41.9 ± 12.2 years, 82.8% underwent laparoscopic sleeve gastrectomy, and 39.3% had reported perioperative adverse events. The mean pre-BS BMI was 45.5 ± 6.6 kg/m2 and decreased significantly during follow-up (rho -0.671; P< .00001). Among 23 patients with documented listing status, 78.3% were listed for HT. Thirteen of 28 patients (46.4%) underwent HT at 14.4 ± 7.0 months. There were no reported deaths for the HT-free 1-year period. Median follow-up was 24 months (interquartile range, 12-30 months). Twenty-two of 28 patients (78.6%) achieved the composite outcome (BMI of<35 kg/m2/HT/listing for HT/myocardial recovery) at 11 months (interquartile range, 3-17 months). Patients with a BMI<45 kg/m2 had a higher chance of achieving the composite outcome (P< .003). CONCLUSIONS BS may help patients with obesity and ventricular assist devices to lose a significant amount of weight and improve their candidacy for HT or even achieve myocardial recovery.
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Affiliation(s)
- Adrian daSilva-deAbreu
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana; The University of Queensland Ochsner Clinical School, New Orleans, Louisiana; Doctoral School, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain.
| | | | - Yuhamy Curbelo-Pena
- Service of General Surgery, Consorci Sanitari de l'Alt Penedes i Garraf, Barcelona, Spain
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana; The University of Queensland Ochsner Clinical School, New Orleans, Louisiana
| | - Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana; The University of Queensland Ochsner Clinical School, New Orleans, Louisiana
| | | | - Stacy A Mandras
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana; The University of Queensland Ochsner Clinical School, New Orleans, Louisiana
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32
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Qamruddin S, Ventura HO. Serial echocardiographic parameters to evaluate prognosis in patients with HFrEF - is it worth the second test? Int J Cardiol 2020; 328:141-142. [PMID: 33358837 DOI: 10.1016/j.ijcard.2020.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Salima Qamruddin
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA, USA.
| | - Hector O Ventura
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA, USA
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Rodriguez-Escudero JP, Duran A, Eiswirth C, Mandras SA, Desai SV, Patel HM, Patel R, Ventura HO, Krim SR. Use of TandemHeart as Bridge to Recovery for Antibody-Mediated Rejection in a Heart Transplant Patient. JACC Case Rep 2020; 2:2358-2362. [PMID: 34317171 PMCID: PMC8305082 DOI: 10.1016/j.jaccas.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Juan P. Rodriguez-Escudero
- Section of Cardiomyopathy and Heart Transplantation, Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, The University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Antonio Duran
- Section of Cardiomyopathy and Heart Transplantation, Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, The University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Clement Eiswirth
- Section of Cardiomyopathy and Heart Transplantation, Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, The University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Stacy A. Mandras
- Section of Cardiomyopathy and Heart Transplantation, Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, The University of Queensland School of Medicine, New Orleans, Louisiana, USA
- Department of Medicine, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Sapna V. Desai
- Section of Cardiomyopathy and Heart Transplantation, Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, The University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Hamang M. Patel
- Section of Cardiomyopathy and Heart Transplantation, Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, The University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Rajan Patel
- Section of Cardiomyopathy and Heart Transplantation, Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, The University of Queensland School of Medicine, New Orleans, Louisiana, USA
- Department of Medicine, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Hector O. Ventura
- Section of Cardiomyopathy and Heart Transplantation, Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, The University of Queensland School of Medicine, New Orleans, Louisiana, USA
- Department of Medicine, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Selim R. Krim
- Section of Cardiomyopathy and Heart Transplantation, Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, The University of Queensland School of Medicine, New Orleans, Louisiana, USA
- Department of Medicine, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana, USA
- Address for correspondence: Dr. Selim R. Krim, Section of Cardiomyopathy and Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, Lousiana 70121, USA.
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34
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Affiliation(s)
- Hector O Ventura
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA, USA.
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35
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daSilva-deAbreu A, Alhafez BA, Curbelo-Pena Y, Lavie CJ, Ventura HO, Loro-Ferrer JF, Mandras SA. Outcomes After Bariatric Surgery In Patients With Ventricular Assist Devices: Systematic Review And Individual Participant Data Meta-analysis. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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36
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daSilva-deAbreu A, Alhafez BA, Curbelo-Pena Y, Lavie CJ, Ventura HO, Loro-Ferrer JF, Mandras SA. BMI Trends In Patients With Ventricular Assist Devices After Bariatric Surgery. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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37
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daSilva-deAbreu A, Garikapati K, Alhafez BA, Desai S, Eiswirth C, Krim S, Patel H, Lavie CJ, Ventura HO, Loro-Ferrer JF, Mandras SA. Laparoscopic sleeve gastrectomy in obese patients with ventricular assist devices: a data note. BMC Res Notes 2020; 13:439. [PMID: 32938487 PMCID: PMC7496210 DOI: 10.1186/s13104-020-05272-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 09/04/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Patients with end-stage heart failure (ESHF) treated with ventricular assist devices (VADs) tend to gain weight after implantation, which is associated with higher complication rates and is a contraindication for heart transplantation (HT). The objective was to analyze the outcomes of obese patients with ESHF and VADs who underwent laparoscopic sleeve gastrectomy (LSG) at Ochsner Medical Center in New Orleans, which is the only program performing VADs and HT in the State of Louisiana, and also one of the largest VAD centers in the USA. DATA DESCRIPTION This dataset contains detailed baseline, perioperative, and long-term data of patients with VADs undergoing LSG. These variables were collected retrospectively from electronic medical records. Patients who achieved ≥ 50% excess BMI loss, BMI ≤ 35 kg/m2, listing for HT, HT, or myocardial recovery were identified and the timing to each of these milestones was documented. These data can be used alone or in combination with other datasets to achieve a larger sample size with more power for further analysis of these variables, which include the most important, standard, and objective bariatric and ESHF outcomes of patients with VADs undergoing LSG. Elaboration of composite outcomes is feasible.
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Affiliation(s)
- Adrian daSilva-deAbreu
- The John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA USA
- Doctoral School, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Kiran Garikapati
- The John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
| | | | - Sapna Desai
- The John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA USA
| | - Clement Eiswirth
- The John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA USA
| | - Selim Krim
- The John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA USA
| | - Hamang Patel
- The John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA USA
| | - Carl J. Lavie
- The John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA USA
| | - Hector O. Ventura
- The John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA USA
| | | | - Stacy A. Mandras
- The John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA USA
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daSilva-deAbreu A, Garikapati K, Alhafez BA, Desai S, Eiswirth C, Krim S, Patel H, Ventura HO, Lavie CJ, Loro-Ferrer JF, Mandras SA. Laparoscopic Sleeve Gastrectomy in Patients with Obesity and Ventricular Assist Devices: a Comprehensive Outcome Analysis. Obes Surg 2020; 31:884-890. [PMID: 32840719 DOI: 10.1007/s11695-020-04948-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 02/07/2023]
Abstract
We analyzed in detail the outcomes of eight patients with ventricular assist devices (VADs) and obesity who underwent laparoscopic sleeve gastrectomy (LSG) at a single heart transplant (HT) center. This comprehensive analysis included body mass index (BMI) trends from VAD implantation to the time of LSG; BMI and percentage of excess BMI lost during follow-up; adverse outcomes; and changes in echocardiographic parameters, fasting lipids, unplanned hospitalizations, and functional status. We also identified the patients who achieved the following outcomes: listing for HT, HT, 50% excess BMI loss, and BMI < 35 kg/m2. Laparoscopic sleeve gastrectomy seems to be a reasonable and effective intervention to help patients with VADs and obesity to decrease excess BMI and become candidates for HT.
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Affiliation(s)
- Adrian daSilva-deAbreu
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA. .,The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA. .,Doctoral School, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain.
| | - Kiran Garikapati
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.,The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
| | | | - Sapna Desai
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.,The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
| | - Clement Eiswirth
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.,The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
| | - Selim Krim
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.,The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
| | - Hamang Patel
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.,The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
| | - Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.,The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.,The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
| | | | - Stacy A Mandras
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.,The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
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daSilva-deAbreu A, Alhafez BA, Curbelo-Pena Y, Lavie CJ, Ventura HO, Loro-Ferrer JF, Mandras SA. Bariatric surgery in obese patients with ventricular assist devices. BMC Res Notes 2020; 13:382. [PMID: 32795382 PMCID: PMC7427728 DOI: 10.1186/s13104-020-05221-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/04/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Patients with end-stage heart failure (ESHF) treated with ventricular assist devices (VADs) tend to gain weight, which may prevent them from receiving heart transplantation (HT) if their body mass index (BMI) reaches ≥ 35 kg/m2. The objective was to synthesize all cases available in the literature and describe the most important outcomes of bariatric surgery (BS) in VAD patients, including BMI trends, reaching a BMI < 35 kg/m2, listing for HT, achieving HT, myocardial recovery, and mortality. These data were obtained for an individual participant data (IPD) meta-analysis and include available IPD for every case in the scientific literature describing VAD patients undergoing BS during VAD support with documented postoperative BMI (and time of measurement) during follow-up. DATA DESCRIPTION These data include baseline, periprocedural, and long-term outcomes for the 29 patients meeting selection criteria. The composite outcome includes reaching a BMI < 35 kg/m2, listing for HT, receiving HT, and myocardial recovery, indicating significant BMI loss associated with major ESHF outcomes. As multiple centers are becoming more experienced in this field, the present data can be merged with their databases to form larger samples that will allow to perform further statistical analysis to identify outcome predictors and improve clinical protocols and outcomes.
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Affiliation(s)
- Adrian daSilva-deAbreu
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
- The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA USA
- Doctoral School, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
| | | | - Yuhamy Curbelo-Pena
- Service of General Surgery, Consorci Sanitari de L’Alt Penedes I Garraf, Barcelona, Spain
| | - Carl J. Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
- The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA USA
| | - Hector O. Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
- The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA USA
| | | | - Stacy A. Mandras
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
- The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA USA
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Ferrario CM, Varagic J, Navar LG, Re RN, Ventura HO. Edward D. Frohlich, MD: September 10, 1931-August 16, 2019. Hypertension 2019; 74:1229-1231. [PMID: 31680563 DOI: 10.1161/hypertensionaha.119.13883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Carlos M Ferrario
- Departments of Surgery and Physiology/Pharmacology, Wake Forest School of Medicine, Winston Salem, NC
| | - Jasmina Varagic
- Vascular Biology and Hypertension Branch, Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Luis Gabriel Navar
- Department of Physiology, Tulane University Health Science Center, New Orleans, LA
| | - Richard N Re
- Hypertension Section, Ochsner Clinic Foundation, New Orleans, LA
| | - Hector O Ventura
- The John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA
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Lavie CJ, Ventura HO. Obesity and Prognosis in Pediatric Dilated Cardiomyopathy: No Paradox or Adverse Effects. JACC Heart Fail 2019; 6:231-232. [PMID: 29428437 DOI: 10.1016/j.jchf.2017.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana.
| | - Hector O Ventura
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
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Abstract
This review discusses common mental health disorders and their associations with cardiovascular disease risks. Commonly found mental health disorders include depression, anxiety, and personality types. The link between depression and cardiovascular disease mortality has been established. Depression is also common in patients with heart failure. In addition to discussing psychological disorders, a review of psychotropic drugs is also included. Drugs are described for therapy for depression and anxiety, as well as associations with cardiovascular drug-drug interactions. Drug-drug interactions are more common and potentially dangerous in elderly patients, in whom the conditions often coexist. The most common drug-drug interactions involve the P450 system of enzymes.
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Affiliation(s)
- Ileana L Piña
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.
| | - Katherine E Di Palo
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, New Orleans, Louisiana; The University of Queensland School of Medicine, St. Lucia, Queensland, Australia
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Affiliation(s)
- Carl J Lavie
- Department of Cardiovascular Disease, John Ochsner Heart & Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana.
| | - Richard V Milani
- Department of Cardiovascular Disease, John Ochsner Heart & Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
| | - Hector O Ventura
- Department of Cardiovascular Disease, John Ochsner Heart & Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
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Ventura HO, Stewart MH, Lavie CJ. New Guidelines, Increasing Hypertension Numbers, Resistance and Resistance to Change? Mayo Clin Proc 2019; 94:745-747. [PMID: 31054600 DOI: 10.1016/j.mayocp.2019.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 03/19/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA.
| | - Merrill H Stewart
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA
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Abstract
PURPOSE OF THE REVIEW Pharmacology remains the mainstay of treatment for hypertension across the globe. In what may seem like a well-trodden field, there are actually an exciting array of new pathways for the treatment of hypertension on the horizon. This review seeks to discuss the most recent research in ongoing areas of drug development in the field of hypertension. RECENT FINDINGS Novel areas of research in the field of hypertension pharmacology include central nervous system regulators, peripheral noradrenergic inhibitors, gastrointestinal sodium modulators, and a counter-regulatory arm of the renin-angiotensin-aldosterone system. This review discusses these pathways in a look into the current status of emerging pharmacological therapies for hypertension.
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Affiliation(s)
- Merrill H Stewart
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, 70121, USA.
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
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Ventura HO, Piña IL. The Impact of Mediators of Health Literacy on Clinical Outcomes in Cardiovascular Diseases. Mayo Clin Proc 2018; 93:1700-1702. [PMID: 30522589 DOI: 10.1016/j.mayocp.2018.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 10/22/2018] [Indexed: 11/23/2022]
Affiliation(s)
- Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA.
| | - Ileana L Piña
- Albert Einstein College of Medicine and Montefiore Heart and Vascular Center, Bronx, NY
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