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Fairbank T, DeBauge A, Harvey CJ, Jiwani S, Ranka S, Beaver TA, Sheldon SH, Reddy M, Noheria A. Electrocardiographic Z-axis QRS-T voltage-time-integral in patients with typical right bundle branch block - Correlation with echocardiographic right ventricular size and function. J Electrocardiol 2024; 82:73-79. [PMID: 38043477 DOI: 10.1016/j.jelectrocard.2023.11.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/30/2023] [Accepted: 11/05/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Right bundle branch block (RBBB) can be benign or associated with right ventricular (RV) functional and structural abnormalities. Our aim was to evaluate QRS-T voltage-time-integral (VTI) compared to QRS duration and lead V1 R' as markers for RV abnormalities. METHODS We included adults with an ECG demonstrating RBBB and echocardiogram obtained within 3 months of each other, between 2010 and 2020. VTIQRS and VTIQRST were obtained for 12 standard ECG leads, reconstructed vectorcardiographic X, Y, Z leads and root-mean-squared (3D) ECG. Age, sex and BSA-adjusted linear regressions were used to assess associations of QRS duration, amplitudes, VTIs and lead V1 R' duration/VTI with echocardiographic tricuspid annular plane systolic excursion (TAPSE), RV tissue Doppler imaging S', basal and mid diameter, and systolic pressure (RVSP). RESULTS Among 782 patients (33% women, age 71 ± 14 years) with RBBB, R' duration in lead V1 was modestly associated with RV S', RV diameters and RVSP (all p ≤ 0.03). QRS duration was more strongly associated with RV diameters (both p < 0.0001). AmplitudeQRS-Z was modestly correlated with all 5 RV echocardiographic variables (all p ≤ 0.02). VTIR'-V1 was more strongly associated with TAPSE, RV S' and RVSP (all p ≤ 0.0003). VTIQRS-Z and VTIQRST-Z were among the strongest correlates of the 5 RV variables (all p < 0.0001). VTIQRST-Z.√BSA cutoff of ≥62 μVsm had sensitivity 62.7% and specificity 65.7% for predicting ≥3 of 5 abnormal RV variables (AUC 0.66; men 0.71, women 0.60). CONCLUSION In patients with RBBB, VTIQRST-Z is a stronger predictor of RV dysfunction and adverse remodeling than QRS duration and lead V1 R'.
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Affiliation(s)
- Tyan Fairbank
- The University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Ashley DeBauge
- The University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Christopher J Harvey
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Sania Jiwani
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Sagar Ranka
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Timothy A Beaver
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Seth H Sheldon
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Madhu Reddy
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Amit Noheria
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America.
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Sethi P, Acharya P, Lancaster P, Stack B, Munshi K, Ranka S, Shah Z, Sauer AJ, Gupta K. Orthostatic variation of pulmonary artery pressure in ambulatory heart failure patients. BMC Cardiovasc Disord 2023; 23:503. [PMID: 37817090 PMCID: PMC10566019 DOI: 10.1186/s12872-023-03534-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/26/2023] [Indexed: 10/12/2023] Open
Abstract
AIM To study effect of change in position (supine and standing) on pulmonary artery pressure (PAP) in ambulatory heart failure (HF) patients. METHODS Seventeen patients with CardioMEMS® sensor and stable heart failure were consented and included in this single center study. Supine and standing measurements were obtained with at least 5 min interval between the two positions. These measurements included PAP readings utilizing the manufacturer handheld interrogator obtaining 10 s data in addition to the systemic blood pressure and heart rate recordings. RESULTS Mean supine and standing readings and their difference (Δ) were as follows respectively: Systolic PAP were 33.4 (± 11.19), 23.6 (± 10) and Δ was 9.9 mmHg (p = 0.0001), diastolic PAP were 14.2 (± 5.6), 7.9 (± 5.7) and Δ was 6.3 mmHg (p = 0.0001) and mean PAP were 21.8 (± 7.8), 14 (± 7.2) and Δ was 7.4 mmHg (p = 0.0001) while the systemic blood pressure did not vary significantly. CONCLUSION There is orthostatic variation of PAP in ambulatory HF patients demonstrating a mean decline with standing in diastolic PAP by 6.3 mmHg, systolic PAP by 9.9 mmHg and mean PAP by 7.4 mmHg in absence of significant orthostatic variation in systemic blood pressure or heart rate. These findings have significant clinical implications and inform that PAP in each patient should always be measured in the same position. Since initial readings at the time of implant were taken in supine position, it may be best to use supine position or to obtain a baseline standing PAP reading if standing PAP is planned on being used.
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Affiliation(s)
- Prince Sethi
- Department of Cardiovascular Disease, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Prakash Acharya
- Department of Cardiovascular Disease, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Payton Lancaster
- Department of Cardiovascular Disease, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Brianna Stack
- Department of Cardiovascular Disease, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Kartik Munshi
- Department of Cardiovascular Disease, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Sagar Ranka
- Department of Cardiovascular Disease, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Zubair Shah
- Department of Cardiovascular Disease, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Andrew J Sauer
- Department of Cardiovascular Disease, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Kamal Gupta
- Department of Cardiovascular Disease, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.
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DeBauge A, Fairbank T, Harvey CJ, Ranka S, Jiwani S, Sheldon SH, Reddy M, Beaver TA, Noheria A. Electrocardiographic prediction of left ventricular hypertrophy in women and men with left bundle branch block - Comparison of QRS duration, amplitude and voltage-time-integral. J Electrocardiol 2023; 80:34-39. [PMID: 37178633 PMCID: PMC10846562 DOI: 10.1016/j.jelectrocard.2023.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Standard ECG criteria for left ventricular (LV) hypertrophy rely on QRS amplitudes. However, in the setting of left bundle branch block (LBBB), ECG correlates of LV hypertrophy are not well established. We sought to evaluate quantitative ECG predictors of LV hypertrophy in the presence of LBBB. METHODS We included adult patients with typical LBBB having ECG and transthoracic echocardiogram performed within 3 months of each other in 2010-2020. Orthogonal X, Y, Z leads were reconstructed from digital 12‑lead ECGs using Kors's matrix. In addition to QRS duration, we evaluated QRS amplitudes and voltage-time-integrals (VTIs) from all 12 leads, X, Y, Z leads and 3D (root-mean-squared) ECG. We used age, sex and BSA-adjusted linear regressions to predict echocardiographic LV calculations (mass, end-diastolic and end-systolic volumes, ejection fraction) from ECG, and separately generated ROC curves for predicting echocardiographic abnormalities. RESULTS We included 413 patients (53% women, age 73 ± 12 years). All 4 echocardiographic LV calculations were most strongly correlated with QRS duration (all p < 0.00001). In women, QRS duration ≥ 150 ms had sensitivity/specificity 56.3%/64.4% for increased LV mass and 62.7%/67.8% for increased LV end-diastolic volume. In men, QRS duration ≥ 160 ms had a sensitivity/specificity 63.1%/72.1% for increased LV mass and 58.3%/74.5% for increased LV end-diastolic volume. QRS duration was best able to discriminate eccentric hypertrophy (area under ROC curve 0.701) and increased LV end-diastolic volume (0.681). CONCLUSIONS In patients with LBBB, QRS duration (≥ 150 in women and ≥ 160 in men) is a superior predictor of LV remodeling esp. eccentric hypertrophy and dilation.
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Affiliation(s)
- Ashley DeBauge
- The University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Tyan Fairbank
- The University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Christopher J Harvey
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Sagar Ranka
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Sania Jiwani
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Seth H Sheldon
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Madhu Reddy
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Timothy A Beaver
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Amit Noheria
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America.
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Pothuru S, Chan WC, Mehta H, Vindhyal MR, Ranka S, Hu J, Yarlagadda SG, Wiley MA, Hockstad E, Tadros PN, Gupta K. Burden of Hypertensive Crisis in Patients With End-Stage Kidney Disease on Maintenance Dialysis: Insights From United States Renal Data System Database. Hypertension 2023; 80:e59-e67. [PMID: 36752114 DOI: 10.1161/hypertensionaha.122.20546] [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] [Indexed: 02/09/2023]
Abstract
BACKGROUND There is paucity of information on the incidence, clinical characteristics, admission trends, and outcomes of hypertensive crisis (HTN-C) in patients with end-stage kidney disease (ESKD) who are on maintenance dialysis. METHODS We conducted a retrospective observational study of HTN-C admissions in patients with end-stage kidney disease using the United States Renal Data System. We identified patients with end-stage kidney disease aged ≥18 years on dialysis and were hospitalized for HTN-C from January 2006 to August 2015. RESULTS A total of 54 483 patients with end-stage kidney disease were hospitalized for HTN-C during the study period. After study exclusions, 37 214 patients were included in the analysis. A majority of patients were Black, there were more women than men and the South region of the country accounted for a great majority of patients. During the study period, hospitalization rates increased from 1060 per 100 000 beneficiary years to 1821 (Ptrend<0.0001). Overall, in-hospital mortality, 30-day, and 1-year mortality were 0.6%, 2.3%, and 21.8%, respectively, and 30-day readmission rate was 31.1%. During the study period, most study outcomes showed a significant decreasing trend (in-hospital mortality 0.6%-0.5%, 30-day mortality 2.4%-1.9%, 1-year mortality 23.9%-19.7%, Ptrend<0.0001 for all). CONCLUSIONS Hospitalizations for HTN-C have increased consistently during the decade studied. Although temporal trends showed improving mortality and readmission rates, the absolute rates were still high with 1 in 3 patients readmitted within 30 days and 1 in 5 patients dying within 1 year of index hospitalization.
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Affiliation(s)
- Suveenkrishna Pothuru
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City.,Department of Internal Medicine, Ascension Via Christi Hospital, Manhattan, KS (S.P.)
| | - Wan-Chi Chan
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City
| | - Harsh Mehta
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City
| | - Mohinder R Vindhyal
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City
| | - Sagar Ranka
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City
| | - Jinxiang Hu
- Department of Biostatistics and Data Science, University of Kansas School of Medicine (J.H.)
| | - Sri G Yarlagadda
- Division of Nephrology and Hypertension, Department of Internal Medicine (S.G.Y.), University of Kansas School of Medicine, Kansas City
| | - Mark A Wiley
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City
| | - Eric Hockstad
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City
| | - Peter N Tadros
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City
| | - Kamal Gupta
- Department of Cardiovascular Medicine (S.P., W.-C.C., H.M., M.R.V., S.R., M.A.W., E.H., P.N.T., K.G.), University of Kansas School of Medicine, Kansas City
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Goyal A, Dalia T, Ranka S, Sauer AJ, Hu J, Cernik C, Nuqali A, Chandler J, Parimi N, Dennis K, Majmundar M, Tayeb T, Haglund J, Shah Z, Vidic A, Gupta B, Haglund NA. Impact of Biopsy Proven Liver Fibrosis on Patients Undergoing Evaluation and Treatment for Advanced Heart Failure Surgical Therapies. Am J Cardiol 2023; 194:46-55. [PMID: 36947946 DOI: 10.1016/j.amjcard.2023.02.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/28/2023] [Accepted: 02/06/2023] [Indexed: 03/24/2023]
Abstract
There is a paucity of data regarding the impact of liver fibrosis on patients with stage D heart failure (HF). We conducted a retrospective study (January 1, 2017 to December 12, 2020) in patients with stage D HF who underwent liver biopsy as part of their advanced HF therapy evaluation. Baseline characteristics and 1-year outcomes were compared between no- or mild-to-moderate-fibrosis (grade 0 to 2) and advanced-fibrosis (grade 3 to 4) groups. Of 519 patients with stage D HF, 136 who underwent liver biopsy (113 [83%] no or mild-to-moderate fibrosis and 23 [17%] advanced fibrosis) were included. A total of 71 patients (52%) received advanced HF therapies (23 heart transplantation, 48 left ventricular assist devices). One-year mortality was higher among patients with advanced fibrosis (52% vs 18%, p <0.001). Further subgroup analysis suggested a trend toward increased 1-year mortality among patients with advanced fibrosis who underwent advanced therapies (37% vs 13%, p = 0.09). There was a trend of lower likelihood of receiving advanced HF therapies in the advanced-fibrosis group, only 1 heart transplantation and 7 left ventricular assist devices, but it did not reach statistical significance (35% vs 56%, p = 0.06). After adjustment for confounders, degree of liver fibrosis was an independent predictor of mortality (odds ratio 6.2; 95% 1.27 to 30.29, p = 0.02). We conclude that advanced liver fibrosis is common among patients with stage D HF who undergo evaluation for advanced HF surgical therapies and significantly increases 1-year mortality. Further larger studies are needed to support our findings.
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Affiliation(s)
- Amandeep Goyal
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Tarun Dalia
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Sagar Ranka
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Andrew J Sauer
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Jinxiang Hu
- Departments of Biostatistics and Data Science, The University of Kansas Health System, Kansas City, Kansas
| | - Colin Cernik
- Departments of Biostatistics and Data Science, The University of Kansas Health System, Kansas City, Kansas
| | - Abdulelah Nuqali
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Jonathan Chandler
- Departments of Internal Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Nikhil Parimi
- Departments of Internal Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Katie Dennis
- Departments of Pathology, The University of Kansas Health System, Kansas City, Kansas
| | - Monil Majmundar
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Taher Tayeb
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Jennifer Haglund
- Departments of Gastroenterology and Hepatology, The University of Kansas Health System, Kansas City, Kansas
| | - Zubair Shah
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Andrija Vidic
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Bhanu Gupta
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Nicholas A Haglund
- Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas.
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Ranka S, Arora S, Dalia T, Villablanca PA. ADVERSE EVENTS WITH SHOCKWAVE INTRAVASCULAR LITHOTRIPSY 1 YEAR AFTER APPROVAL FOR CORONARY USE: A REPORT FROM MAUDE DATABASE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01425-0] [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: 03/06/2023]
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Rali AS, Taduru SS, Tran LE, Ranka S, Schlendorf KH, Barker CM, Shah AS, Lindenfeld J, Zalawadiya SK. Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement Outcomes in Left Ventricular Assist Device Patients with Aortic Insufficiency. Card Fail Rev 2022; 8:e30. [PMID: 36644645 PMCID: PMC9819997 DOI: 10.15420/cfr.2022.21] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/15/2022] [Indexed: 01/17/2023] Open
Abstract
Background: Worsening aortic insufficiency (AI) is a known sequela of prolonged continuous-flow left ventricular assist device (LVAD) support with a significant impact on patient outcomes. While medical treatment may relieve symptoms, it is unlikely to halt progression. Surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) are among non-medical interventions available to address post-LVAD AI. Limited data are available on outcomes with either SAVR or TAVR for the management of post-LVAD AI. Methods: The National Inpatient Sample data collected for hospital admissions between the years 2015 and 2018 for patients with pre-existing continuous-flow LVAD undergoing TAVR or SAVR for AI were queried. The primary outcome of interest was a composite of in-hospital mortality, stroke, transient ischaemic attack, MI, pacemaker implantation, need for open aortic valve surgery, vascular complications and cardiac tamponade. Results: Patients undergoing TAVR were more likely to receive their procedure during an elective admission (57.1 versus 30%, p=0.002), and a significantly higher prevalence of comorbidities, as assessed by the Elixhauser Comorbidity Index, was observed in the SAVR group (29 versus 18; p=0.0001). We observed a significantly higher prevalence of the primary composite outcome in patients undergoing SAVR (30%) compared with TAVR (14.3%; p=0.001). Upon multivariable analysis adjusting for the type of admission and Elixhauser Comorbidity Index, TAVR was associated with significantly lower odds of the composite outcome (odds ratio 0.243; 95% CI [0.06-0.97]; p=0.045). Conclusion: In this nationally representative cohort of LVAD patients with post-implant AI, it was observed that TAVR was associated with a lower risk of adverse short-term outcomes compared with SAVR.
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Affiliation(s)
- Aniket S Rali
- Division of Cardiovascular Diseases, Vanderbilt University Medical CenterNashville, Tennessee, US
| | - Siva S Taduru
- Department of Cardiovascular Diseases, University of Kansas Medical CenterKansas City, Kansas, US
| | - Lena E Tran
- Department of Internal Medicine, Vanderbilt University Medical CenterNashville, Tennessee, US
| | - Sagar Ranka
- Department of Cardiovascular Diseases, University of Kansas Medical CenterKansas City, Kansas, US
| | - Kelly H Schlendorf
- Division of Cardiovascular Diseases, Vanderbilt University Medical CenterNashville, Tennessee, US
| | - Colin M Barker
- Division of Cardiovascular Diseases, Vanderbilt University Medical CenterNashville, Tennessee, US
| | - Ashish S Shah
- Department of Cardiac Surgery, Vanderbilt University Medical CenterNashville, Tennessee, US
| | - JoAnn Lindenfeld
- Division of Cardiovascular Diseases, Vanderbilt University Medical CenterNashville, Tennessee, US
| | - Sandip K Zalawadiya
- Division of Cardiovascular Diseases, Vanderbilt University Medical CenterNashville, Tennessee, US
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Acharya P, Safarova MS, Dalia T, Bharati R, Ranka S, Vindhyal M, Jiwani S, Barua RS. Effects of Vitamin D Supplementation and 25-Hydroxyvitamin D Levels on the Risk of Atrial Fibrillation. Am J Cardiol 2022; 173:56-63. [PMID: 35369930 DOI: 10.1016/j.amjcard.2022.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/21/2022] [Accepted: 02/28/2022] [Indexed: 11/27/2022]
Abstract
The effects of vitamin D (Vit-D) deficiency and Vit-D treatment (VDT) on atrial fibrillation (AF) remain inconclusive. This study sought to determine the effects of VDT and nontreatment on AF risk in Vit-D-deficient patients without a previous history of AF. In this nested case-control study, 39,845 individuals with low 25-hydroxy-Vit-D ([25-OH]D) levels (<20 ng/ml) were divided into group-A (untreated, levels ≤20 ng/ml), group-B (treated, levels 21 to 29 ng/ml), and group-C (treated, levels ≥30 ng/ml). The risk of AF was compared utilizing propensity score-weighted Cox proportional hazard models. Among the individuals receiving VDT for ≥6 months, the risk of AF was significantly lower in group-B (hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.80 to 0.98, p = 0.03] and group-C (HR 0.84, 95% CI 0.73 to 0.0.95, p = 0.007] than in group-A. A subgroup analysis of men >65 years showed individuals with hypertension had a significantly lower risk of AF in group-C than in group-B (HR 0.79, CI 0.65 to 0.94, p = 0.02) and group-A (HR 0.78, CI 0.64 to 0.96, p = 0.012). A similar result was found in men >65 years with diabetes mellitus in group-C compared with group-B (HR 0.69, CI 0.51 to 0.93, p = 0.012) and group-A (HR 0.63, CI 0.47 to 0.84, p = 0.002). In what is, to best of our knowledge, the largest observational study to date of patients with Vit-D deficiency and no previous history of AF, (25-OH)D level of >20 ng/ml with VDT for ≥6 months was associated with a significantly lower risk of AF. Additionally, men >65 years with hypertension or diabetes mellitus had a further decrease in AF risk when the (25-OH)D levels were ≥30 ng/ml.
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Rali AS, Ranka S, Butcher A, Shah Z, Tonna JE, Anders MM, Brinkley MD, Siddiqi H, Punnoose L, Wigger M, Sacks SB, Pedrotty D, Ooi H, Bacchetta MD, Hoffman J, McMaster W, Balsara K, Shah AS, Menachem JN, Schlendorf KH, Lindenfeld J, Zalawadiya SK. Early Blood Pressure Variables Associated With Improved Outcomes in VA-ECLS: The ELSO Registry Analysis. JACC Heart Fail 2022; 10:397-403. [PMID: 35654524 PMCID: PMC9214574 DOI: 10.1016/j.jchf.2022.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/14/2022] [Accepted: 04/01/2022] [Indexed: 06/03/2023]
Abstract
BACKGROUND As utilization of veno-arterial extracorporeal life support (VA-ECLS) in treatment of cardiogenic shock (CS) continues to expand, clinical variables that guide clinicians in early recognition of myocardial recovery and therefore, improved survival, after VA-ECLS are critical. There remains a paucity of literature on early postinitiation blood pressure measurements that predict improved outcomes. OBJECTIVES The objective of this study is to help identify early blood pressure variables associated with improved outcomes in VA-ECLS. METHODS The authors queried the ELSO (Extracorporeal Life Support Organization) registry for cardiogenic shock patients treated with VA-ECLS or venovenous arterial ECLS between 2009 and 2020. Their inclusion criteria included treatment with VA-ECLS or venovenous arterial ECLS; absence of pre-existing durable right, left, or biventricular assist devices; no pre-ECLS cardiac arrest; and no surgical or percutaneously placed left ventricular venting devices during their ECLS runs. Their primary outcome of interest was the survival to discharge during index hospitalization. RESULTS A total of 2,400 CS patients met the authors' inclusion criteria and had complete documentation of blood pressures. Actual mortality during index hospitalization in their cohort was 49.5% and survivors were younger and more likely to be Caucasian, intubated for >30 hours pre-ECLS initiation, and had a favorable baseline SAVE (Survival After Veno-arterial ECMO) score (P < 0.05 for all). Multivariable regression analyses adjusting for SAVE score, age, ECLS flow at 4 hours, and race showed that every 10-mm Hg increase in baseline systolic blood pressure (HR: 0.92 [95% CI: 0.89-0.95]; P < 0.001), and baseline pulse pressure (HR: 0.88 [95% CI: 0.84-0.91]; P < 0.001) at 24 hours was associated with a statistically significant reduction in mortality. CONCLUSIONS Early (within 24 hours) improvements in pulse pressure and systolic blood pressure from baseline are associated with improved survival to discharge among CS patients treated with VA-ECLS.
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Affiliation(s)
- Aniket S Rali
- Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - Sagar Ranka
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Amy Butcher
- Department of Cardiovascular Anesthesia and Critical Care, Baylor College of Medicine, Houston, Texas, USA
| | - Zubair Shah
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Joseph E Tonna
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Marc M Anders
- Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Marshal D Brinkley
- Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hasan Siddiqi
- Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lynn Punnoose
- Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mark Wigger
- Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Suzanne B Sacks
- Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dawn Pedrotty
- Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Henry Ooi
- Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew D Bacchetta
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jordan Hoffman
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William McMaster
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Keki Balsara
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ashish S Shah
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan N Menachem
- Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelly H Schlendorf
- Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - JoAnn Lindenfeld
- Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sandip K Zalawadiya
- Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Sreenivasan J, Ranka S, Lahan S, Abu-Haniyeh A, Li H, Kaul R, Malik A, Aronow WS, Frishman WH, Lansman S. Extracorporeal Membrane Oxygenation in Patients With COVID-19. Cardiol Rev 2022; 30:129-133. [PMID: 34292184 PMCID: PMC8983617 DOI: 10.1097/crd.0000000000000410] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is characterized by a clinical spectrum of diseases ranging from asymptomatic or mild cases to severe pneumonia with acute respiratory distress syndrome (ARDS) requiring mechanical ventilation. Extracorporeal membrane oxygenation (ECMO) has been used as rescue therapy in appropriate patients with COVID-19 complicated by ARDS refractory to mechanical ventilation. In this study, we review the indications, challenges, complications, and clinical outcomes of ECMO utilization in critically ill patients with COVID-19-related ARDS. Most of these patients required venovenous ECMO. Although the risk of mortality and complications is very high among patients with COVID-19 requiring ECMO, it is similar to that of non-COVID-19 patients with ARDS requiring ECMO. ECMO is a resource-intensive therapy, with an inherent risk of complications, which makes its availability limited and its use challenging in the midst of a pandemic. Well-maintained data registries, with timely reporting of outcomes and evidence-based clinical guidelines, are necessary for the careful allocation of resources and for the development of standardized utilization protocols.
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Affiliation(s)
- Jayakumar Sreenivasan
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Sagar Ranka
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Shubham Lahan
- University College of Medical Sciences, New Delhi, India
| | - Ahmed Abu-Haniyeh
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Heyi Li
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Risheek Kaul
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Aaqib Malik
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Wilbert S. Aronow
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - William H. Frishman
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Steven Lansman
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
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11
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Goyal A, Chandler J, Dalia T, Ranka S, Fritzlen J, Sami F, Mastoris I, Titterington J, Khashab ME, Haglund N, Gupta B, Vidic A, Danter M, Sauer A, Shah Z, Abicht T. Outcomes In Heartmate 3 (HM3) Vs Heartware (HVAD) Patients: A Single Center Experience. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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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12
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Dalia T, Goyal A, Chan WC, Ranka S, Sami F, Weidling R, Pothuru S, Sauer A, Haglund N, Gupta K, Shah Z. Left Ventricular Assist Device Outcomes In Patients With Chronic Kidney Disease And End-stage Renal Disease. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.142] [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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13
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Kircher CF, Apte NM, Ranka S, Ramirez R, Pimentel RC. PRE AND POST TAVR PR AND QRS PARAMETERS HELP PREDICT NEED FOR A PERMANENT PACEMAKER FOLLOWING HOSPITAL DISCHARGE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01747-8] [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: 11/28/2022]
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14
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Patel N, Amgai B, Hajra A, Chakraborty S, Chowdary S, Bandyopadhyay D, Patel Z, Ranka S, Cordeiro N, Khalid M. IS LEFT VENTRICULAR ASSIST DEVICE ASSOCIATED WITH ADVERSE PERIPROCEDURAL OUTCOMES IN PATIENTS UNDERGOING CARDIAC TRANSPLANTATION? J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01511-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: 10/18/2022]
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15
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Patel N, Ranka S, Hajra A, Bandyopadhyay D, Amgai B, Chakraborty S, Khalid M, Goyal A, Dalia T, Reddy YM, Shani J. Gender-Specific Outcomes after Percutaneous Left Atrial Appendage Closure - A Nationwide Readmission Database Analysis. J Cardiovasc Electrophysiol 2022; 33:430-436. [PMID: 35023251 DOI: 10.1111/jce.15359] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/15/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Thromboembolism-associated stroke is the most feared complication of Atrial fibrillation (AF). Percutaneous left atrial appendage closure (pLAAC) is indicated for stroke prevention in patients with AF who can't tolerate long-term anticoagulation. We aim to study gender differences in peri-procedural and readmissions outcomes in pLAAC patients. METHODS Using the national readmission database from January 2016 to December 2018, AF patients undergoing the pLAAC procedure were identified. We used multivariate logistic regression analyses and time-to-event Cox regression analyses to conduct the study. Propensity matching with the Greedy method was done for the accuracy of results. RESULT 28,819 patients were included in our study. Among them 11,946 (41.5%) were women and 16,873 (58.6%) were men. The mean age of overall population was 76.1 ± 8.5 years, with women ~ 1 year older than men. The overall rate of complications was higher in women (8.6% vs 6.6%, P<0.001), primarily driven by bleeding-related complications i.e., Major bleed (OR: 1.32 95% CI: 1.03-1.69, p=0.029), blood transfusion (OR: 1.45, 95% CI: 1.06-1.97, p=0.019) and cardiac tamponade (OR: 1.80, 95% CI: 1.13-2.89, p=0.014). Women had two times higher peri-procedural ischemic stroke. There was no difference in peri-procedural mortality. Women remained at 20% and 13% higher risk for readmission at 30 days and 6 months of discharge. CONCLUSION Women had higher peri-procedural complications and were at higher risk of readmissions at 30 days and six months. However, there was no difference in mortality during the index hospitalization. Further studies are necessary to determine causality. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Neel Patel
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Sagar Ranka
- University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | | | | | | | - Amandeep Goyal
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Tarun Dalia
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Y Madhu Reddy
- University of Kansas Medical Center, Kansas City, KS, USA
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16
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Rali AS, Hall EJ, Dieter R, Ranka S, Civitello A, Bacchetta MD, Shah AS, Schlendorf K, Lindenfeld J, Chatterjee S. Left Ventricular Unloading during Extracorporeal Life Support: Current Practice. J Card Fail 2021; 28:1326-1336. [PMID: 34936896 DOI: 10.1016/j.cardfail.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/15/2021] [Revised: 11/24/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
Veno-arterial extracorporeal life support (VA-ECLS) is a powerful tool that can provide complete cardiopulmonary support for patients with refractory cardiogenic shock. However, VA-ECLS increases left ventricular afterload resulting in greater myocardial oxygen demand, which can impair myocardial recovery and worsen pulmonary edema. These complications can be ameliorated by various LV venting strategies to unload the LV. Evidence suggests that LV venting improves outcomes in VA-ECLS, but there is a paucity of randomized trials to help guide optimal strategy and the timing of venting. In this review, we discuss the available evidence regarding LV venting in VA-ECLS, explain important hemodynamic principles involved, and propose a practical approach to LV venting in VA-ECLS.
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Key Words
- Atrial septal defect, BNP
- Brain natriuretic peptide, CS
- Cardiogenic shock, IABP
- Extracorporeal life support, left ventricular unloading, left ventricular venting, cardiogenic shock, Abbreviations, ASD
- Intra-aortic balloon pump, LA
- Left atrium, LV
- Left ventricle, LVAD
- Left ventricular assist device, MCS
- Mechanical circulatory support, PAC
- Percutaneous ventricular assist device, RV
- Pulmonary artery catheter, PCWP
- Pulmonary capillary wedge pressure, P-VAD
- Right ventricle, VA-ECLS
- Veno-arterial extracorporeal life support
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Affiliation(s)
- Aniket S Rali
- Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Eric J Hall
- Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Raymond Dieter
- Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sagar Ranka
- Department of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas
| | - Andrew Civitello
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Department of Cardiology, Texas Heart Institute, Houston, Texas
| | - Matthew D Bacchetta
- Division of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ashish S Shah
- Division of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelly Schlendorf
- Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - JoAnn Lindenfeld
- Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Subhasis Chatterjee
- Divisions of General and Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas
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17
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Ranka S, Lahan S, Chhatriwalla AK, Allen KB, Chiang M, O'Neill B, Verma S, Wang DD, Lee J, Frisoli T, Eng M, Bagur R, O'Neill W, Villablanca P. Network meta-analysis comparing the short and long-term outcomes of alternative access for transcatheter aortic valve replacement. Cardiovasc Revasc Med 2021; 40:1-10. [PMID: 34972667 DOI: 10.1016/j.carrev.2021.11.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 10/13/2021] [Revised: 11/15/2021] [Accepted: 11/29/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Several studies have pair-wise compared access sites for transcatheter aortic valve replacement (TAVR) but pooled estimate of overall comparative efficacy and safety outcomes are not well known. We sought to compare short- and long-term outcomes following various alternative access routes for TAVR. METHODS Thirty-four studies with a pooled sample size of 32,756 patients were selected by searching PubMed and Cochrane library databases from inception through 11th June 2021 for patients undergoing TAVR via 1 of 6 different access sites: Transfemoral (TF), Transaortic (TAO), Transapical (TA), Transcarotid (TC), Transaxillary/Subclavian (TSA), and Transcaval (TCV). Data were extracted to conduct a frequentist network meta-analysis with a random-effects model using TF access as a reference group. RESULTS Compared with TF, both TAO [RR 1.91, 95% CI (1.46-2.50)] and TA access [RR 2.12, 95% CI (1.84-2.46)] were associated with an increased risk of 30-day mortality. No significant difference was observed for stroke, myocardial infarction, major bleeding, conversion to open surgery, and major adverse cardiovascular or cerebrovascular events at 30 days between different accesses. Major vascular complications were lower in TA [RR 0.43, (95% CI, 0.28-0.67)] and TC [RR 0.51, 95% CI (0.35-0.73)] access compared to TF. The 1-year mortality was higher in TAO [RR of 1.35, (95% CI, 1.01-1.81)] and TA [RR 1.44, (95% CI, 1.14-1.81)] groups. CONCLUSION Non-thoracic alternative access site utilization for TAVR implantation (TC, TSA and TCV) is associated with outcomes similar to conventional TF access. Thoracic TAVR access (TAO and TA) translates into increased short and long-term mortality.
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Affiliation(s)
- Sagar Ranka
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Shubham Lahan
- Division of Cardiovascular Prevention & Wellness, Department of Cardiology, Houston Methodist, Houston, TX, United States
| | - Adnan K Chhatriwalla
- Department of Cardiothoracic Surgery, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, United States
| | - Keith B Allen
- Department of Cardiothoracic Surgery, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, United States
| | - Michael Chiang
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Brian O'Neill
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Sadhika Verma
- Department of Family Medicine, Henry Ford Allegiance Health, Jackson, MI, United States
| | - Dee Dee Wang
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - James Lee
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Tiberio Frisoli
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Marvin Eng
- Department of Cardiology, Banner University Medical Center, Phoenix, AZ, United States
| | - Rodrigo Bagur
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - William O'Neill
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Pedro Villablanca
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States.
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18
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Bansal P, Goyal A, Cusick A, Lahan S, Dhaliwal HS, Bhyan P, Bhattad PB, Aslam F, Ranka S, Dalia T, Chhabra L, Sanghavi D, Sonani B, Davis JM. Hydroxychloroquine: a comprehensive review and its controversial role in coronavirus disease 2019. Ann Med 2021; 53:117-134. [PMID: 33095083 PMCID: PMC7880079 DOI: 10.1080/07853890.2020.1839959] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/19/2020] [Indexed: 12/11/2022] Open
Abstract
Hydroxychloroquine, initially used as an antimalarial, is used as an immunomodulatory and anti-inflammatory agent for the management of autoimmune and rheumatic diseases such as systemic lupus erythematosus. Lately, there has been interest in its potential efficacy against severe acute respiratory syndrome coronavirus 2, with several speculated mechanisms. The purpose of this review is to elaborate on the mechanisms surrounding hydroxychloroquine. The review is an in-depth analysis of the antimalarial, immunomodulatory, and antiviral mechanisms of hydroxychloroquine, with detailed and novel pictorial explanations. The mechanisms of hydroxychloroquine are related to potential cardiotoxic manifestations and demonstrate potential adverse effects when used for coronavirus disease 2019 (COVID-19). Finally, current literature associated with hydroxychloroquine and COVID-19 has been analyzed to interrelate the mechanisms, adverse effects, and use of hydroxychloroquine in the current pandemic. Currently, there is insufficient evidence about the efficacy and safety of hydroxychloroquine in COVID-19. KEY MESSAGES HCQ, initially an antimalarial agent, is used as an immunomodulatory agent for managing several autoimmune diseases, for which its efficacy is linked to inhibiting lysosomal antigen processing, MHC-II antigen presentation, and TLR functions. HCQ is generally well-tolerated although severe life-threatening adverse effects including cardiomyopathy and conduction defects have been reported. HCQ use in COVID-19 should be discouraged outside clinical trials under strict medical supervision.
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Affiliation(s)
| | - Amandeep Goyal
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Austin Cusick
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Shubham Lahan
- University College of Medical Sciences, New Delhi, India
| | | | - Poonam Bhyan
- Cape Fear Valley Hospital, Fayetteville, NC, USA
| | | | | | - Sagar Ranka
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Tarun Dalia
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Lovely Chhabra
- Heartland Regional Medical Center, Southern IL University, Carbondale, IL, USA
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19
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Vindhyal MR, Lu LK, Ranka S, Acharya P, Shah Z, Gupta K. Impact of Underlying Congestive Heart Failure on In-Hospital Outcomes in Patients with Septic Shock. J Intensive Care Med 2021; 37:965-969. [PMID: 34812081 DOI: 10.1177/08850666211061472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Purpose: Septic shock (SS) manifests with profound circulatory and cellular metabolism abnormalities and has a high in-hospital mortality (25%-50%). Congestive heart failure (CHF) patients have underlying circulatory dysfunction and compromised cardiac reserve that may place them at increased risk if they develop sepsis. Outcomes in patients with CHF who are admitted with SS have not been well studied. Materials and Method: Retrospective cross sectional secondary analysis of the Nationwide Readmission Database (NRD) for 2016 and 2017. ICD-10 codes were used to identify patients with SS during hospitalization, and then the cohort was dichotomized into those with and without an underlying diagnosis of CHF. Results: Propensity match analyses were performed to evaluate in-hospital mortality and clinical cardiovascular outcomes in the 2 groups. Cardiogenic shock patients were excluded from the study. A total of 578,629 patients with hospitalization for SS were identified, of whom 19.1% had a coexisting diagnosis of CHF. After propensity matching, 81,699 individuals were included in the comparative groups of SS with CHF and SS with no CHF. In-hospital mortality (35.28% vs 32.50%, P < .001), incidence of ischemic stroke (2.71% vs 2.53%, P = .0032), and acute kidney injury (69.9% vs 63.9%, P = .001) were significantly higher in patients with SS and CHF when compared to those with SS and no CHF. Conclusions: This study identified CHF as a strong adverse prognosticator for inpatient mortality and several major adverse clinical outcomes. Study findings suggest the need for further investigation into these findings' mechanisms to improve outcomes in patients with SS and underlying CHF.
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Affiliation(s)
- Mohinder R Vindhyal
- 8586The University of Kansas School of Medicine Wichita, Wichita, KS, USA.,The University of Kansas Medical Center, Kansas City, KS, USA
| | - Liuqiang Kelsey Lu
- 8586The University of Kansas School of Medicine Wichita, Wichita, KS, USA
| | - Sagar Ranka
- The University of Kansas Medical Center, Kansas City, KS, USA
| | - Prakash Acharya
- The University of Kansas Medical Center, Kansas City, KS, USA
| | - Zubair Shah
- The University of Kansas Medical Center, Kansas City, KS, USA
| | - Kamal Gupta
- The University of Kansas Medical Center, Kansas City, KS, USA
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20
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Ranka S, Lahan S. TCT-188 Short- and Long-Term Mortality Risk for Alternative Transcatheter Aortic Valve Replacement Access Routes: A Frequentist Network Meta-Analysis. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1041] [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: 10/19/2022]
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21
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Patel N, Amgai B, Hajra A, Ranka S, Chakraborty S, Bandyopadhyay D, Patel Z, Koirala S, Reddy M, Aronow W, Pancholy S. TCT-257 In-Patient Outcome Comparison of Patients With Acute Coronary Syndrome Undergoing PCI or CABG and Heparin-Induced Thrombocytopenia: A Nationwide Inpatient Sample Database Analysis. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1110] [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: 10/19/2022]
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22
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Ranka S, Mastoris I, Kapur NK, Tedford RJ, Rali A, Acharya P, Weidling R, Goyal A, Sauer AJ, Gupta B, Haglund N, Gupta K, Fang JC, Lindenfeld J, Shah Z. Right Heart Catheterization in Cardiogenic Shock Is Associated With Improved Outcomes: Insights From the Nationwide Readmissions Database. J Am Heart Assoc 2021; 10:e019843. [PMID: 34423652 PMCID: PMC8649238 DOI: 10.1161/jaha.120.019843] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background The usefulness of right heart catherization (RHC) has long been debated, and thus, we aimed to study the real‐world impact of the use of RHC in cardiogenic shock. Methods and Results In the Nationwide Readmissions Database using International Classification of Diseases, Tenth Revision (ICD‐10), we identified 236 156 patient hospitalizations with cardiogenic shock between 2016 and 2017. We sought to evaluate the impact of RHC during index hospitalization on management strategies, complications, and outcomes as well as on 30‐day readmission rate. A total 25 840 patients (9.6%) received RHC on index admission. The RHC group had significantly more comorbidities compared with the non‐RHC group. During the index admission, the RHC group had lower death (25.8% versus 39.5%, P<0.001) and stroke rates (3.1% versus 3.4%, P<0.001). Thirty‐day readmission rates (18.7% versus 19.7%, P=0.04) and death on readmission (7.9% versus 9.3%, P=0.03) were also lower in the RHC group. After adjustment, RHC was associated with lower index admission mortality (odds ratio, 0.69; 95% CI, 0.66–0.72), lower stroke rate (odds ratio, 0.81; 95% CI, 0.72–0.90), lower 30‐day readmission (odds ratio, 0.83; 95% CI, 0.78–0.88), and higher left ventricular assist device implantations/orthotopic heart transplants (odds ratio, 6.05; 95% CI, 4.43–8.28) during rehospitalization. Results were not meaningfully different after excluding patients with cardiac arrest. Conclusions RHC use in cardiogenic shock is associated with improved outcomes and increased use of downstream advanced heart failure therapies. Further blinded randomized studies are required to confirm our findings.
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Affiliation(s)
- Sagar Ranka
- Department of Cardiovascular Medicine The University of Kansas Health SystemUniversity of Kansas School of Medicine Kansas City KS
| | - Ioannis Mastoris
- Department of Cardiovascular Medicine The University of Kansas Health SystemUniversity of Kansas School of Medicine Kansas City KS
| | - Navin K Kapur
- The Cardiovascular Center Tufts Medical Center Tufts University School of Medicine Boston MA
| | - Ryan J Tedford
- Division of Cardiology Department of Medicine Medical University of South Carolina Charleston SC
| | - Aniket Rali
- Division of Pulmonary Critical Care and Sleep Medicine Department of Internal Medicine Baylor College of Medicine Houston TX
| | - Prakash Acharya
- Department of Cardiovascular Medicine The University of Kansas Health SystemUniversity of Kansas School of Medicine Kansas City KS
| | - Robert Weidling
- Department of Internal Medicine The University of Kansas Health SystemUniversity of Kansas School of Medicine Kansas City KS
| | - Amandeep Goyal
- Department of Cardiovascular Medicine The University of Kansas Health SystemUniversity of Kansas School of Medicine Kansas City KS
| | - Andrew J Sauer
- Department of Cardiovascular Medicine The University of Kansas Health SystemUniversity of Kansas School of Medicine Kansas City KS
| | - Bhanu Gupta
- Department of Cardiovascular Medicine The University of Kansas Health SystemUniversity of Kansas School of Medicine Kansas City KS
| | - Nicholas Haglund
- Department of Cardiovascular Medicine The University of Kansas Health SystemUniversity of Kansas School of Medicine Kansas City KS
| | - Kamal Gupta
- Department of Cardiovascular Medicine The University of Kansas Health SystemUniversity of Kansas School of Medicine Kansas City KS
| | - James C Fang
- Division of Cardiovascular Medicine University of Utah Salt Lake City UT
| | - JoAnn Lindenfeld
- Division of Cardiovascular Medicine Vanderbilt University Medical Center Nashville TN
| | - Zubair Shah
- Department of Cardiovascular Medicine The University of Kansas Health SystemUniversity of Kansas School of Medicine Kansas City KS
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23
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Ranka S, Sheldon SH, Downey PS, Noheria A. A Case of Leadless Pacemaker in the Left Ventricle With Cardioembolic Stroke. JACC Clin Electrophysiol 2021; 7:563-564. [PMID: 33888277 DOI: 10.1016/j.jacep.2021.01.002] [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] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Sagar Ranka
- Department of Cardiovascular Medicine, University of Kansas, Kansas City, Kansas, USA
| | - Seth H Sheldon
- Department of Cardiovascular Medicine, University of Kansas, Kansas City, Kansas, USA
| | - Peter S Downey
- Department of Cardiothoracic Surgery, University of Kansas, Kansas City, Kansas, USA
| | - Amit Noheria
- Department of Cardiovascular Medicine, University of Kansas, Kansas City, Kansas, USA.
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Acharya P, Ranka S, Sethi P, Bharati R, Hu J, Noheria A, Nallamothu BK, Hayek SS, Gupta K. Incidence, Predictors, and Outcomes of In-Hospital Cardiac Arrest in COVID-19 Patients Admitted to Intensive and Non-Intensive Care Units: Insights From the AHA COVID-19 CVD Registry. J Am Heart Assoc 2021; 10:e021204. [PMID: 34376062 PMCID: PMC8475028 DOI: 10.1161/jaha.120.021204] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Limited information is available regarding in‐hospital cardiac arrest (IHCA) in patients with COVID‐19. Methods and Results We leveraged the American Heart Association COVID‐19 Cardiovascular Disease (AHA COVID‐19 CVD) Registry to conduct a cohort study of adults hospitalized for COVID‐19. IHCA was defined as those with documentation of cardiac arrest requiring medication or electrical shock for resuscitation. Mixed effects models with random intercepts were used to identify independent predictors of IHCA and mortality while accounting for clustering at the hospital level. The study cohort included 8518 patients (6080 not in the intensive care unit [ICU]) with mean age of 61.5 years (SD 17.5). IHCA occurred in 509 (5.9%) patients overall with 375 (73.7%) in the ICU and 134 (26.3%) patients not in the ICU. The majority of patients at the time of ICHA were not in a shockable rhythm (76.5%). Independent predictors of IHCA included older age, Hispanic ethnicity (odds ratio [OR], 1.9; CI, 1.4–2.4; P<0.001), and non‐Hispanic Black race (OR, 1.5; CI, 1.1–1.9; P=0.004). Other predictors included oxygen use on admission, quick Sequential Organ Failure Assessment score on admission, and hypertension. Overall, 35 (6.9%) patients with IHCA survived to discharge, with 9.1% for ICU and 0.7% for non‐ICU patients. Conclusions Older age, Black race, and Hispanic ethnicity are independent predictors of IHCA in patients with COVID‐19. Although the incidence is much lower than in ICU patients, approximately one‐quarter of IHCA events in patients with COVID‐19 occur in non‐ICU settings, with the latter having a substantially lower survival to discharge rate.
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Affiliation(s)
- Prakash Acharya
- Department of Cardiovascular Medicine University of Kansas School of Medicine Kansas City KS
| | - Sagar Ranka
- Department of Cardiovascular Medicine University of Kansas School of Medicine Kansas City KS
| | - Prince Sethi
- Department of Cardiovascular Medicine University of Kansas School of Medicine Kansas City KS
| | - Rajani Bharati
- CUNY Graduate School of Public Health and Health Policy New York NY
| | - Jinxiang Hu
- Department of Cardiovascular Medicine University of Kansas School of Medicine Kansas City KS
| | - Amit Noheria
- Department of Cardiovascular Medicine University of Kansas School of Medicine Kansas City KS
| | - Brahmajee K Nallamothu
- Division of Cardiology Department of Medicine University of MichiganFrankel Cardiovascular Center Ann Arbor MI
| | - Salim S Hayek
- Division of Cardiology Department of Medicine University of MichiganFrankel Cardiovascular Center Ann Arbor MI
| | - Kamal Gupta
- Department of Cardiovascular Medicine University of Kansas School of Medicine Kansas City KS
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Pahuja M, Ranka S, Chauhan K, Patel A, Chehab O, Elmoghrabi A, Mony S, Ando T, Mishra T, Singh M, Abubaker H, Yassin A, Glazier JJ, Afonso L, Kapur NK, Burkhoff D. Rupture of Papillary Muscle and Chordae Tendinae Complicating STEMI: A Call for Action. ASAIO J 2021; 67:907-916. [PMID: 33093383 DOI: 10.1097/mat.0000000000001299] [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] [Indexed: 10/23/2022] Open
Abstract
Papillary muscle rupture (PMR) or chordae tendinae rupture (CTR) is a rare but lethal complication after ST elevation myocardial infarction (STEMI). Due to the rarity of this condition, there are limited studies defining its epidemiology and outcomes. This is a retrospective study from Nationwide Inpatient Sample database from 2002 to 2014 of patients with STEMI and PMR/CTR. Outcomes of interest were incidence of in-hospital mortality, cardiogenic shock (CS), utilization of mechanical circulatory support (MCS) devices and mitral valve procedures (MVPs) among patients with and without rupture. We also performed simulation using the cardiovascular model to better understand the hemodynamics of severe mitral regurgitation and effects of different medications and device therapy. We identified 1,888 patients with STEMI complicated with PMR/CTR. Most of the patients were >65 years of age (65.3%), male (63.6%), and white (82.3%). They had significantly higher incidence of CS, cardiac arrest, and utilization of MCS devices. In-hospital mortality was higher in patients with rupture (41% vs. 7.40%, p < 0.001) which remained unchanged over the study period. Hospitalization cost and length of stay was also higher in them. MVP and revascularization led to better survival rates (27.9% vs. 60.6%, adjusted OR: 0.14; 95% CI: 0.10-0.19; p < 0.001). Despite significant advancement in the revascularization strategy, PMR/CTR after STEMI continues to portend poor prognosis with high inpatient mortality. Cardiogenic shock is a common presentation and is associated with significantly inpatient mortality. Future studies are needed determine the best strategies to improve outcomes in patients with STEMI with PMR/CTR and CS.
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Affiliation(s)
- Mohit Pahuja
- From the Department of Cardiology, Medstar Georgetown University/Washington Hospital Center, Washington, DC
| | - Sagar Ranka
- Division of Cardiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Kinsuk Chauhan
- Internal Medicine Department, Wayne State University, Detroit, Michigan
| | - Achint Patel
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Omar Chehab
- Department of Internal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Adel Elmoghrabi
- Department of Internal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Shruti Mony
- Department of Gastroenterology, Johns Hopkins University school of Medicine, Baltimore, Maryland
| | - Tomo Ando
- Division of Cardiology, Department of Internal Medicine, Columbia University Medical Center, New York
| | - Tushar Mishra
- Department of Internal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Manmohan Singh
- Department of Internal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Hossam Abubaker
- Division of Cardiology, Department of Internal Medicine, Loma Linda University Medical Center, Los Angeles, California
| | - Ahmed Yassin
- Internal Medicine Department, Wayne State University, Detroit, Michigan
| | - James J Glazier
- From the Department of Cardiology, Medstar Georgetown University/Washington Hospital Center, Washington, DC
| | - Luis Afonso
- From the Department of Cardiology, Medstar Georgetown University/Washington Hospital Center, Washington, DC
| | - Navin K Kapur
- Division of Cardiology, Department of Internal Medicine, Tufts University Medical Center, Boston, Massachusetts
| | - Daniel Burkhoff
- Division of Cardiology, Department of Internal Medicine, Columbia University Medical Center, New York
- Cardiovascular Research Foundation, New York
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26
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Acharya P, Dalia T, Ranka S, Sethi P, Oni OA, Safarova MS, Parashara D, Gupta K, Barua RS. The Effects of Vitamin D Supplementation and 25-Hydroxyvitamin D Levels on the Risk of Myocardial Infarction and Mortality. J Endocr Soc 2021; 5:bvab124. [PMID: 34396023 PMCID: PMC8358990 DOI: 10.1210/jendso/bvab124] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Indexed: 12/14/2022] Open
Abstract
Objective The aim of the study was to examine the effects of the vitamin D (Vit-D) treatment and nontreatment on Vit-D–deficient patients without a prior history of myocardial infarction (MI). Materials and Methods This was a retrospective, observational, nested case–control study of patients (N = 20 025) with low 25-hydroxyvitamin D ([25-OH]D) levels (<20 ng/mL) who received care at the Veterans Health Administration from 1999 to 2018. Patients were divided into 3 groups: Group A (untreated, levels ≤20 ng/mL), Group B (treated, levels 21-29 ng/mL), and Group C (treated, levels ≥30 ng/mL). The risk of MI and all-cause mortality were compared utilizing propensity score–weighted Cox proportional hazard models. Results Among the cohort of 20 025 patients, the risk of MI was significantly lower in Group C than in Group B (hazard ratio [HR] 0.65, 95% CI 0.49-0.85, P = .002) and Group A (HR 0.73, 95% CI 0.55-0.96), P = .02). There was no difference in the risk of MI between Group B and Group A (HR 1.14, 95% CI 0.91-1.42, P = 0.24). Compared with Group A, both Group B (HR 0.59, 95% CI 0.54-0.63, P < .001) and Group C (HR 0.61, 95% CI 0.56-0.67, P < .001) had significantly lower all-cause mortality. There was no difference in all-cause mortality between Group B and Group C (HR 0.99, 95% CI 0.89-1.09, P = .78). Conclusions In patients with Vit-D deficiency and no prior history of MI, treatment to the (25-OH)D level of >20 ng/mL and >30 ng/mL was associated with a significantly lower risk of all-cause mortality. The lower risk of MI was observed only in individuals maintaining (25-OH)D levels ≥30 ng/mL.
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Affiliation(s)
- Prakash Acharya
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Tarun Dalia
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Sagar Ranka
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Prince Sethi
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Olurinde A Oni
- Division of Cardiovascular Research, Kansas City VA Medical Center, Kansas City, MO 4128, USA
| | - Maya S Safarova
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Deepak Parashara
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA.,Division of Cardiovascular Research, Kansas City VA Medical Center, Kansas City, MO 4128, USA.,Division of Cardiovascular Medicine, Kansas City VA Medical Center, Kansas City, MO 4128, USA
| | - Kamal Gupta
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Rajat S Barua
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA.,Division of Cardiovascular Research, Kansas City VA Medical Center, Kansas City, MO 4128, USA.,Division of Cardiovascular Medicine, Kansas City VA Medical Center, Kansas City, MO 4128, USA
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27
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Rao A, Ranka S, Ayers C, Hendren N, Rosenblatt A, Alger HM, Rutan C, Omar W, Khera R, Gupta K, Mody P, DeFilippi C, Das SR, Hedayati SS, de Lemos JA. Association of Kidney Disease With Outcomes in COVID-19: Results From the American Heart Association COVID-19 Cardiovascular Disease Registry. J Am Heart Assoc 2021; 10:e020910. [PMID: 34107743 PMCID: PMC8477855 DOI: 10.1161/jaha.121.020910] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Emerging evidence links acute kidney injury (AKI) in patients with COVID‐19 with higher mortality and respiratory morbidity, but the relationship of AKI with cardiovascular disease outcomes has not been reported in this population. We sought to evaluate associations between chronic kidney disease (CKD), AKI, and mortality and cardiovascular outcomes in patients hospitalized with COVID‐19. Methods and Results In a large multicenter registry including 8574 patients with COVID‐19 from 88 US hospitals, data were collected on baseline characteristics and serial laboratory data during index hospitalization. Primary exposure variables were CKD (categorized as no CKD, CKD, and end‐stage kidney disease) and AKI (classified into no AKI or stages 1, 2, or 3 using a modification of the Kidney Disease Improving Global Outcomes guideline definition). The primary outcome was all‐cause mortality. The key secondary outcome was major adverse cardiac events, defined as cardiovascular death, nonfatal stroke, nonfatal myocardial infarction, new‐onset nonfatal heart failure, and nonfatal cardiogenic shock. CKD and end‐stage kidney disease were not associated with mortality or major adverse cardiac events after multivariate adjustment. In contrast, AKI was significantly associated with mortality (stage 1 hazard ratio [HR], 1.72 [95% CI, 1.46–2.03]; stage 2 HR, 1.83 [95% CI, 1.52–2.20]; stage 3 HR, 1.69 [95% CI, 1.44–1.98]; versus no AKI) and major adverse cardiac events (stage 1 HR, 2.17 [95% CI, 1.74–2.71]; stage 2 HR, 2.70 [95% CI, 2.07–3.51]; stage 3 HR, 3.06 [95% CI, 2.52–3.72]; versus no AKI). Conclusions This large study demonstrates a significant association between AKI and all‐cause mortality and, for the first time, major adverse cardiovascular events in patients hospitalized with COVID‐19.
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Affiliation(s)
- Anjali Rao
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
| | - Sagar Ranka
- Department of Cardiovascular Medicine University of Kansas Kansas City KS
| | - Colby Ayers
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Nicholas Hendren
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
| | - Anna Rosenblatt
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
| | | | | | - Wally Omar
- Department of Internal Medicine Beth Israel Deaconess Medical Center Boston MA
| | - Rohan Khera
- Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Kamal Gupta
- Department of Cardiovascular Medicine University of Kansas Kansas City KS
| | - Purav Mody
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | | | - Sandeep R Das
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
| | - S Susan Hedayati
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - James A de Lemos
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
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28
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Sreenivasan J, Kaul R, Khan MS, Ranka S, Demmer RT, Yuzefpolskaya M, Aronow WS, Warraich HJ, Pan S, Panza JA, Cooper HA, Naidu SS, Colombo PC. Left Ventricular Assist Device Implantation in Hypertrophic and Restrictive Cardiomyopathy: A Systematic Review. ASAIO J 2021; 67:239-244. [PMID: 33627595 DOI: 10.1097/mat.0000000000001238] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Left ventricular assist device (LVAD) implantation in patients with advanced heart failure due to hypertrophic or restrictive cardiomyopathy (HCM/RCM) presents technical and physiologic challenges. We conducted a systematic review of observational studies to evaluate the utilization and clinical outcomes associated with LVAD implantation in patients with HCM/RCM and compared these to patients with dilated or ischemic cardiomyopathy (DCM/ICM). We searched MEDLINE, EMBASE, and Scopus from inception through May 2019 and included appropriate studies describing the use of an LVAD in patients with HCM/RCM. We identified six studies with a total of 2,766 patients with HCM/RCM and advanced heart failure, among whom 338 patients (12.2%) underwent LVAD implantation. In patients listed for transplant, the rate of LVAD implantation was significantly lower in patients with HCM/RCM compared to that in patients with DCM/ICM (4.4% vs. 18.2%, p < 0.001). Adverse clinical outcomes were significantly higher in HCM/RCM than in DCM/ICM, including operative/short-term mortality (14.0% vs. 9.0%), right ventricular failure (50.0% vs. 21.0%), infection (15.5% vs. 11.2%), bleeding (40.2% vs. 12.5%), renal failure (15.0% vs. 5.1%), stroke (5.0% vs. 2.4%), and arrhythmias (18.0% vs. 7.7%) (all p values <0.001).
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Affiliation(s)
- Jayakumar Sreenivasan
- From the Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Risheek Kaul
- From the Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Muhammad Shahzeb Khan
- Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Sagar Ranka
- Division of Cardiovascular Medicine, Kansas University Medical Center, Kansas City, KS
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Wilbert S Aronow
- From the Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Haider J Warraich
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Medicine, Cardiology Section, VA Boston Healthcare System, Boston, MA
| | - Stephen Pan
- From the Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Julio A Panza
- From the Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Howard A Cooper
- From the Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Srihari S Naidu
- From the Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Paolo C Colombo
- From the Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
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29
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Dalia T, Acharya P, Ranka S, Safarova M, Parashara D, Barua R. IMPACT OF VITAMIN D ON ATRIAL FIBRILLATION IN 25 HYDROXYVITAMIN D DEFICIENT ELDERLY PATIENTS: A STUDY FROM NATIONAL VA DATABASE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02882-5] [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: 11/29/2022]
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30
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Lahan S, Ranka S, Dalia T, Goyal A, Moriarty P. THE ASSOCIATION BETWEEN RED CELL DISTRIBUTION WIDTH AND CARDIOVASCULAR OUTCOMES - A METANALYSIS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02985-5] [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: 10/21/2022]
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31
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Acharya P, Dalia T, Safarova M, Ranka S, Parashara D, Barua R. ASSOCIATION OF VITAMIN D SUPPLEMENTATION AND RISK OF ATRIAL FIBRILLATION IN PATIENTS WITH 25-HYDROXYVITAMIN D DEFICIENCY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02890-4] [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: 10/21/2022]
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32
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Goyal A, Dalia T, Chandler J, Ranka S, Sethi P, Acharya P, Rosamond T, Shah Z. CRYPTOGENIC STROKE SECONDARY TO BIG CHIARI NETWORK IN A PATIENT WITH PATENT FORAMEN OVALE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03956-5] [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: 10/21/2022]
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33
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Goyal A, Safarova M, Dalia T, Bhattad VB, Ranka S, Garg N, Shah Z. RIGHT VENTRICULAR HEART FAILURE SECONDARY TO SEVERE PULMONARY HYPERTENSION AFTER RUPTURED BREAST IMPLANTS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03500-2] [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: 11/25/2022]
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34
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Acharya P, Sethi P, Ranka S, Alli A, Hance K, Prasad A, Shah Z, Gupta K. Nationwide study of six-month readmissions in critical limb ischemia: Predictors and impact of revascularization strategies. Vascular 2021; 30:255-266. [PMID: 33906558 DOI: 10.1177/17085381211011357] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is a paucity of data regarding six-month readmissions in critical limb ischemia patients and the influence of management strategy during index-admission [endovascular, surgical, hybrid procedure, medical therapy, and amputation]. We aimed to investigate the incidence, predictors, and impact of management strategies on six-month readmission in patients with critical limb ischemia. METHODS A secondary analysis of the Nationwide Readmissions Database (2016-2017) was conducted. Propensity score matching was performed for subgroup analysis. RESULTS We identified 50,058 patients with primary diagnosis of critical limb ischemia. Six-month all-cause and critical limb ischemia-related readmission rate was 52.36% and 10.86%, respectively. The risk of all-cause readmission was lower with amputation but was similar among other subgroups. Patients receiving surgical [HR 0.62, CI(0.48-0.79), p < 0.001] and hybrid procedure [HR 0.65 (0.46-0.93), p = 0.02] had lower risk of unplanned critical limb ischemia-related readmission compared to endovascular, though the risk of unplanned revascularization/amputation during readmission was similar between the three strategies. The risk of non-critical limb ischemia-related readmission was higher with surgical [HR 1.13, CI(1.04-1.23), p = 0.003] and hybrid procedure [HR 1.17, CI(1.08-1.28), p < 0.001], driven by increased procedure-related/wound complications. Eventhough endovascular patients were older with more severe critical limb ischemia presentation, a lower proportion received home-health or placement upon discharge from index-admission. This could account for higher readmission without higher repeat revascularization in endovascular group. CONCLUSION The risk of critical limb ischemia and non-critical limb ischemia-related readmission differ according to the management strategy. Significant differences in discharge disposition exist depending on revascularization strategy. Study findings identify opportunities for reducing readmissions by focusing on nonprocedural aspects like wound-care, discharge planning and placement.
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Affiliation(s)
- Prakash Acharya
- Department of Cardiovascular Disease, University of Kansas, Medical Center, Kansas City, KS, USA
| | - Prince Sethi
- Department of Cardiovascular Disease, University of Kansas, Medical Center, Kansas City, KS, USA
| | - Sagar Ranka
- Department of Cardiovascular Disease, University of Kansas, Medical Center, Kansas City, KS, USA
| | - Adam Alli
- Department of Radiology, University of Kansas, Medical Center, Kansas City, KS, USA
| | - Kirk Hance
- Division of Vascular Surgery, Department of Surgery, University of Kansas, Medical Center, Kansas City, KS, USA
| | - Anand Prasad
- Department of Cardiology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Zubair Shah
- Department of Cardiovascular Disease, University of Kansas, Medical Center, Kansas City, KS, USA
| | - Kamal Gupta
- Department of Cardiovascular Disease, University of Kansas, Medical Center, Kansas City, KS, USA
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35
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Ranka S, Dalia T, Acharya P, Taduru SS, Pothuru S, Mahmood U, Stack B, Shah Z, Gupta K. Comparison of Hospitalization Trends and Outcomes in Acute Myocardial Infarction Patients With Versus Without Opioid Use Disorder. Am J Cardiol 2021; 145:18-24. [PMID: 33454349 DOI: 10.1016/j.amjcard.2020.12.077] [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] [Received: 10/26/2020] [Revised: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 11/18/2022]
Abstract
Discrepancies in medical care are well known to adversely affect patients with opioid abuse disorders (OUD), including management and outcomes of acute myocardial infarction (AMI) in patients with OUD. We used the National Inpatient Sample was queried from January 2006 to September 2015 to identify all patients ≥18 years admitted with a primary diagnosis of AMI (weighted N = 13,030; unweighted N = 2,670) and concomitant OUD. Patients using other nonopiate illicit drugs were excluded. Propensity matching (1:1) yielded 2,253 well-matched pairs in which intergroup comparison of invasive revascularization strategies and cardiac outcomes were performed. The prevalence of OUD patients with AMI over the last decade has doubled, from 163 (2006) to 326 cases (2015) per 100,000 admissions for AMI. The OUD group underwent less cardiac catheterization (63.2% vs 72.2%; p <0.001), percutaneous coronary intervention (37.0% vs 48.5%; p <0.001) and drug-eluting stent placement (32.3% vs 19.5%; p <0.001) compared with non-OUD. No differences in in-hospital mortality/cardiogenic shock were noted. Among subgroup of ST-elevation myocardial infarction patients (26.2% of overall cohort), the OUD patients were less likely to receive percutaneous coronary intervention (67.9% vs 75.5%; p = 0.002), drug-eluting stent (31.4% vs 47.9%; p <0.001) with a significantly higher mortality (7.4% vs 4.3%), and cardiogenic shock (11.7% vs 7.9%). No differences in the frequency of coronary bypass grafting were noted in AMI or its subgroups. In conclusion, OUD patients presenting with AMI receive less invasive treatment compared with those without OUD. OUD patients presenting with ST-elevation myocardial infarction have worse in-hospital outcomes with increased mortality and cardiogenic shock.
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Affiliation(s)
- Sagar Ranka
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, Kansas
| | - Tarun Dalia
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, Kansas
| | - Prakash Acharya
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, Kansas
| | - Siva Sagar Taduru
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, Kansas
| | | | - Uzair Mahmood
- Department of Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Brianna Stack
- Kansas University School of Medicine, Kansas City, Kansas
| | - Zubair Shah
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, Kansas
| | - Kamal Gupta
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, Kansas.
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Shah Z, Mastoris I, Acharya P, Rali AS, Mohammed M, Sami F, Ranka S, Wagner S, Zanotti G, Salerno CT, Haglund NA, Sauer AJ, Ravichandran AK, Abicht T. Correction to: The use of enoxaparin as bridge to therapeutic INR after LVAD implantation. J Cardiothorac Surg 2021; 16:81. [PMID: 33853654 PMCID: PMC8045341 DOI: 10.1186/s13019-021-01451-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Zubair Shah
- Department of Cardiovascular Medicine, University of Kansas Health System, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Ioannis Mastoris
- Department of Cardiovascular Medicine, University of Kansas Health System, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Prakash Acharya
- Department of Cardiovascular Medicine, University of Kansas Health System, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Aniket S Rali
- Department of Cardiovascular Medicine, University of Kansas Health System, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Moghni Mohammed
- Department of Cardiovascular Medicine, University of Kansas Health System, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Farhad Sami
- Department of Cardiovascular Medicine, University of Kansas Health System, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Sagar Ranka
- Department of Cardiovascular Medicine, University of Kansas Health System, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Savahanna Wagner
- Cardiovascular Service Line, Ascension, St. Vincent Hospital, Indianapolis, Indiana, USA
| | - Giorgio Zanotti
- Cardiovascular Service Line, Ascension, St. Vincent Hospital, Indianapolis, Indiana, USA
| | - Christopher T Salerno
- Cardiovascular Service Line, Ascension, St. Vincent Hospital, Indianapolis, Indiana, USA
| | - Nicholas A Haglund
- Department of Cardiovascular Medicine, University of Kansas Health System, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Andrew J Sauer
- Department of Cardiovascular Medicine, University of Kansas Health System, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Ashwin K Ravichandran
- Cardiovascular Service Line, Ascension, St. Vincent Hospital, Indianapolis, Indiana, USA
| | - Travis Abicht
- Department of Cardiovascular and Thoracic Surgery, University of Kansas Health System, University of Kansas School of Medicine, Kansas City, Kansas, USA.
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Goyal A, Lahan S, Dalia T, Ranka S, Bhattad VB, Patel RR, Shah Z. Clinical comparison of V122I genotypic variant of transthyretin amyloid cardiomyopathy with wild-type and other hereditary variants: a systematic review. Heart Fail Rev 2021; 27:849-856. [PMID: 33768376 DOI: 10.1007/s10741-021-10098-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Accepted: 03/17/2021] [Indexed: 12/31/2022]
Abstract
V122I genotype variant (pV142I) is the most common hereditary transthyretin amyloidosis (hATTR) in the USA, with 3-3.5% of African-Americans being the carriers of this mutation. We aimed to compare baseline clinical features, cardiac parameters, and mortality in V122I-ATTR with the wild-type ATTR and other hATTR subtypes. We systematically searched PubMed/Medline and Google Scholar databases to identify relevant studies from inception to 10th September, 2020 reporting phenotypic, echocardiographic, and/or laboratory parameters in patients with hereditary and wild types of cardiac amyloidoses. A total of 2843 patients from 7 individual studies with 67-100% males and an overall follow-up duration of 51.6 ± 30.4 months were identified. The mean age of diagnosis among wild-type ATTR patients was 77 years, followed by 71.2 and 65 years in V122I and T60A group patients, respectively. V122I patients were mostly black, had a poor quality of life, and highest mortality risk compared with other subtypes. Merely, the presence of V122I mutation was identified as an independent predictor of mortality. V30M subtype correlated with the least severe cardiac disease and a median survival duration comparable with T60A subtype. V122I ATTR is an aggressive disease, prevalent in African-Americans, and is associated with a greater morbidity and mortality, which is partly attributed to its misdiagnosis and/or late diagnosis. Current advances in non-invasive studies to diagnose hATTR coupled with concurrent drug therapies have improved quality of life and provide a survival benefit to these patients.
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Affiliation(s)
- Amandeep Goyal
- Department of Cardiovascular Medicine, Medical Center, The University of Kansas, Kansas City, KS, USA
| | - Shubham Lahan
- University College of Medical Sciences, New Delhi, India
| | - Tarun Dalia
- Department of Cardiovascular Medicine, Medical Center, The University of Kansas, Kansas City, KS, USA
| | - Sagar Ranka
- Department of Cardiovascular Medicine, Medical Center, The University of Kansas, Kansas City, KS, USA
| | | | - Ronak R Patel
- Michigan State University School of Osteopathic Medicine, Canton, MI, USA
| | - Zubair Shah
- Department of Cardiovascular Medicine, Medical Center, The University of Kansas, Kansas City, KS, USA.
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Dalia T, Lahan S, Ranka S, Goyal A, Zoubek S, Gupta K, Shah Z. Warfarin versus direct oral anticoagulants for treating left ventricular thrombus: a systematic review and meta-analysis. Thromb J 2021; 19:7. [PMID: 33517885 PMCID: PMC7849079 DOI: 10.1186/s12959-021-00259-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/17/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Left ventricular thrombus (LVT) is not uncommon and pose a risk of systemic embolism, which can be mitigated by adequate anticoagulation. Direct oral anticoagulants (DOACs) are increasingly being used as alternatives to warfarin for anticoagulation, but their efficacy and safety profile has been debated. We aim to compare the therapeutic efficacy and safety of DOACs versus warfarin for the treatment of LVT. METHODOLOGY We systematically searched PubMed/Medline, Google Scholar, Cochrane library, and LILCAS databases from inception to 14th August 2020 to identify relevant studies comparing warfarin and DOACs for LVT treatment and used the pooled data extracted from retrieved studies to perform a meta-analysis. RESULTS We report pooled data on 1955 patients from 8 studies, with a mean age of 61 years and 59.7 years in warfarin and DOACs group, respectively. The pooled odds ratio for thrombus resolution was 1.11 (95% CI 0.51-2.39) on comparing warfarin to DOAC, but it did not reach a statistical significance (p = 0.76). The pooled risk ratio (RR) of stroke or systemic embolization and bleeding in patients treated with warfarin vs DOACs was 1.04 (95% CI 0.64-1.68; p = 0.85), and 1.15 (95% CI 0.62-2.13; p = 0.57), respectively; with an overall RR of 1.09 (95% CI 0.70-1.70; p = 0.48) for mortality. CONCLUSIONS DOACs appears to be non-inferior or at least as effective as warfarin in the treatment of left ventricular thrombus without any statistical difference in stroke or bleeding complications.
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Affiliation(s)
- Tarun Dalia
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Shubham Lahan
- University College of Medical Sciences, New Delhi, India
| | - Sagar Ranka
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Amandeep Goyal
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Sara Zoubek
- Department of Pharmacology, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kamal Gupta
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Zubair Shah
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
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Chandler JK, Apte N, Ranka S, Mohammed M, Noheria A, Emert M, Pimentel R, Dendi R, Reddy M, Sheldon SH. Ultrasound guided axillary vein access: An alternative approach to venous access for cardiac device implantation. J Cardiovasc Electrophysiol 2021; 32:458-465. [PMID: 33337570 DOI: 10.1111/jce.14846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/03/2020] [Revised: 10/21/2020] [Accepted: 11/05/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Ultrasound guided axillary vein access (UGAVA) is an emerging approach for cardiac implantable electronic device (CIED) implantation not widely utilized. METHODS AND RESULTS This is a retrospective, age and sex-matched cohort study of CIED implantation from January 2017 to July 2019 comparing UGAVA before incision to venous access obtained after incision without ultrasound (conventional). The study population included 561 patients (187 with attempted UGAVA, 68 ± 13 years old, 43% women, body mass index (BMI) 30 ± 8 kg/m2 , 15% right-sided, 43% implantable cardioverter-defibrillator, 15% upgrades). UGAVA was successful in 178/187 patients (95%). In nine patients where UGAVA was abandoned, the vein was too deep for access before incision. BMI was higher in abandoned patients than successful UGAVA (38 ± 6 vs. 28 ± 6 kg/m2 , p < .0001). Median time from local anesthetic to completion of UGAVA was 7 min (interquartile range [IQR]: 4-10) and median procedure time 61 min (IQR: 50-92). UGAVA changed implant laterality in two patients (avoiding an extra incision in both) and could have prevented unnecessary incision in four conventional patients. Excluding device upgrades, there was reduced fluoroscopy time in UGAVA versus conventional (4 vs. 6 min; IQR: 2-5 vs. 4-9; p < .001). Thirty-day complications were similar in UGAVA versus conventional (n = 7 vs. 26, 4 vs. 7%; p = .13, p = .41 adjusting for upgrades), partly driven by a trend towards reduced pneumothorax (n = 0 vs. 3, 0 vs. 1%; p = .22). CONCLUSIONS UGAVA is a safe approach for CIED implantation and helps prevent an extra incision if a barrier is identified changing laterality preincision.
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Affiliation(s)
- Jonathan K Chandler
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Nachiket Apte
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Sagar Ranka
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Moghniuddin Mohammed
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Amit Noheria
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Martin Emert
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Rhea Pimentel
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Raghuveer Dendi
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Madhu Reddy
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Seth H Sheldon
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
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Abstract
PURPOSE OF REVIEW Artificial intelligence is a broad set of sophisticated computer-based statistical tools that have become widely available. Cardiovascular medicine with its large data repositories, need for operational efficiency and growing focus on precision care is set to be transformed by artificial intelligence. Applications range from new pathophysiologic discoveries to decision support for individual patient care to optimization of system-wide logistical processes. RECENT FINDINGS Machine learning is the dominant form of artificial intelligence wherein complex statistical algorithms 'learn' by deducing patterns in datasets. Supervised machine learning uses classified large data to train an algorithm to accurately predict the outcome, whereas in unsupervised machine learning, the algorithm uncovers mathematical relationships within unclassified data. Artificial multilayered neural networks or deep learning is one of the most successful tools. Artificial intelligence has demonstrated superior efficacy in disease phenomapping, early warning systems, risk prediction, automated processing and interpretation of imaging, and increasing operational efficiency. SUMMARY Artificial intelligence demonstrates the ability to learn through assimilation of large datasets to unravel complex relationships, discover prior unfound pathophysiological states and develop predictive models. Artificial intelligence needs widespread exploration and adoption for large-scale implementation in cardiovascular practice.
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Affiliation(s)
- Sagar Ranka
- Department of Cardiovascular Medicine, The University of Kansas, Health System, Kansas City, Kansas, USA
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Abstract
PURPOSE OF REVIEW To review recent evidence evaluating the long-term safety and efficacy outcomes of left atrial appendage occlusion (LAAO), current guideline recommendations for LAAO use, performance of LAAO in comparison with direct oral anticoagulants (DOAC) and recently approved LAAO device. RECENT FINDINGS The last 18 months have been marked with increasing evidence of the utility of LAAO in patients who are not candidates for long-term oral anticoagulation (OAC). Long-term data from two continued access registries to PROTECT-AF and PREVAIL support LAAO as a safe and effective long-term anticoagulation therapy. This new evidence led to class IIb recommendation for LAAO in nonvalvular atrial fibrillation (NVAF) patients not eligible for long-term OAC. PRAGUE-17 randomized controlled trial showed LAAO is noninferior to DOAC lending support to use of this modality in current era. PINNACLE FLX trial showed improved implant success and adequate closure rate which led to the device's Food and Drug Administration approval. SUMMARY In conclusion, percutaneous LAAO appears to be a promising option for NVAF patients who are not candidates for long-term OAC in the current era. Further evidence guiding optimal patient selection and periprocedural antithrombotic regimen will help identify the patients who would benefit the most from this procedure.
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Affiliation(s)
- Moghniuddin Mohammed
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas
- Department of Biomedical and Health Informatics, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Sagar Ranka
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas
| | - Madhu Reddy
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas
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Hernandez-Suarez DF, Ranka S, Kim Y, Latib A, Wiley J, Lopez-Candales A, Pinto DS, Gonzalez MC, Ramakrishna H, Sanina C, Nieves-Rodriguez BG, Rodriguez-Maldonado J, Feliu Maldonado R, Rodriguez-Ruiz IJ, da Luz Sant'Ana I, Wiley KA, Cox-Alomar P, Villablanca PA, Roche-Lima A. Machine-Learning-Based In-Hospital Mortality Prediction for Transcatheter Mitral Valve Repair in the United States. Cardiovasc Revasc Med 2021; 22:22-28. [PMID: 32591310 PMCID: PMC7736498 DOI: 10.1016/j.carrev.2020.06.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/02/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Transcatheter mitral valve repair (TMVR) utilization has increased significantly in the United States over the last years. Yet, a risk-prediction tool for adverse events has not been developed. We aimed to generate a machine-learning-based algorithm to predict in-hospital mortality after TMVR. METHODS Patients who underwent TMVR from 2012 through 2015 were identified using the National Inpatient Sample database. The study population was randomly divided into a training set (n = 636) and a testing set (n = 213). Prediction models for in-hospital mortality were obtained using five supervised machine-learning classifiers. RESULTS A total of 849 TMVRs were analyzed in our study. The overall in-hospital mortality was 3.1%. A naïve Bayes (NB) model had the best discrimination for fifteen variables, with an area under the receiver-operating curve (AUC) of 0.83 (95% CI, 0.80-0.87), compared to 0.77 for logistic regression (95% CI, 0.58-0.95), 0.73 for an artificial neural network (95% CI, 0.55-0.91), and 0.67 for both a random forest and a support-vector machine (95% CI, 0.47-0.87). History of coronary artery disease, of chronic kidney disease, and smoking were the three most significant predictors of in-hospital mortality. CONCLUSIONS We developed a robust machine-learning-derived model to predict in-hospital mortality in patients undergoing TMVR. This model is promising for decision-making and deserves further clinical validation.
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Affiliation(s)
- Dagmar F Hernandez-Suarez
- Division of Cardiovascular Medicine, Department of Medicine, University of Puerto Rico School of Medicine, San Juan, PR, USA.
| | - Sagar Ranka
- Division of Cardiovascular Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Yeunjung Kim
- Division of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Azeem Latib
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Jose Wiley
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Angel Lopez-Candales
- Division of Cardiology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Duane S Pinto
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Maday C Gonzalez
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - Cristina Sanina
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Brenda G Nieves-Rodriguez
- Center for Collaborative Research in Health Disparities, University of Puerto Rico School of Medicine, San Juan, PR, USA
| | - Jovaniel Rodriguez-Maldonado
- Center for Collaborative Research in Health Disparities, University of Puerto Rico School of Medicine, San Juan, PR, USA
| | - Roberto Feliu Maldonado
- Center for Collaborative Research in Health Disparities, University of Puerto Rico School of Medicine, San Juan, PR, USA
| | - Israel J Rodriguez-Ruiz
- Center for Collaborative Research in Health Disparities, University of Puerto Rico School of Medicine, San Juan, PR, USA
| | - Istoni da Luz Sant'Ana
- Center for Collaborative Research in Health Disparities, University of Puerto Rico School of Medicine, San Juan, PR, USA
| | - Karlo A Wiley
- College of Agriculture and Life Sciences, Cornell University, Ithaca, NY, USA
| | - Pedro Cox-Alomar
- Division of Cardiology, Department of Medicine, Louisiana State University, New Orleans, LA, USA
| | - Pedro A Villablanca
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Abiel Roche-Lima
- Center for Collaborative Research in Health Disparities, University of Puerto Rico School of Medicine, San Juan, PR, USA
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Dalia T, Lahan S, Ranka S, Acharya P, Gautam A, Goyal A, Mastoris I, Sauer A, Shah Z. Impact of congestive heart failure and role of cardiac biomarkers in COVID-19 patients: A systematic review and meta-analysis. Indian Heart J 2020; 73:91-98. [PMID: 33714416 PMCID: PMC7719198 DOI: 10.1016/j.ihj.2020.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/02/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has been reported to cause worse outcomes in patients with underlying cardiovascular disease, especially in patients with acute cardiac injury, which is determined by elevated levels of high-sensitivity troponin. There is a paucity of data on the impact of congestive heart failure (CHF) on outcomes in COVID-19 patients. METHODS We conducted a literature search of PubMed/Medline, EMBASE, and Google Scholar databases from 11/1/2019 till 06/07/2020, and identified all relevant studies reporting cardiovascular comorbidities, cardiac biomarkers, disease severity, and survival. Pooled data from the selected studies was used for metanalysis to identify the impact of risk factors and cardiac biomarker elevation on disease severity and/or mortality. RESULTS We collected pooled data on 5967 COVID-19 patients from 20 individual studies. We found that both non-survivors and those with severe disease had an increased risk of acute cardiac injury and cardiac arrhythmias, our pooled relative risk (RR) was - 8.52 (95% CI 3.63-19.98) (p < 0.001); and 3.61 (95% CI 2.03-6.43) (p = 0.001), respectively. Mean difference in the levels of Troponin-I, CK-MB, and NT-proBNP was higher in deceased and severely infected patients. The RR of in-hospital mortality was 2.35 (95% CI 1.18-4.70) (p = 0.022) and 1.52 (95% CI 1.12-2.05) (p = 0.008) among patients who had pre-existing CHF and hypertension, respectively. CONCLUSION Cardiac involvement in COVID-19 infection appears to significantly adversely impact patient prognosis and survival. Pre-existence of CHF, and high cardiac biomarkers like NT-pro BNP and CK-MB levels in COVID-19 patients correlates with worse outcomes.
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Affiliation(s)
- Tarun Dalia
- Department of Cardiovascular Medicine, The University of Kansas Health System, KS, USA
| | - Shubham Lahan
- University College of Medical Sciences, New Delhi, India
| | - Sagar Ranka
- Department of Cardiovascular Medicine, The University of Kansas Health System, KS, USA
| | - Prakash Acharya
- Department of Cardiovascular Medicine, The University of Kansas Health System, KS, USA
| | - Archana Gautam
- Department of Nephrology, The University of Kansas Health System, KS, USA
| | - Amandeep Goyal
- Research and Clinical Fellow, Advanced heart failure and transplant division, University of Kansas Medical Center, Kansas City, Kansas, USA.
| | - Ioannis Mastoris
- Department of Cardiovascular Medicine, The University of Kansas Health System, KS, USA
| | - Andrew Sauer
- Department of Cardiovascular Medicine, The University of Kansas Health System, KS, USA
| | - Zubair Shah
- Department of Cardiovascular Medicine, The University of Kansas Health System, KS, USA.
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Shah Z, Mastoris I, Acharya P, Rali AS, Mohammed M, Sami F, Ranka S, Wagner S, Zanotti G, Salerno CT, Haglund NA, Sauer AJ, Ravichandran AK, Abicht T. The use of enoxaparin as bridge to therapeutic INR after LVAD implantation. J Cardiothorac Surg 2020; 15:329. [PMID: 33189134 PMCID: PMC7666514 DOI: 10.1186/s13019-020-01373-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/04/2020] [Indexed: 12/28/2022] Open
Abstract
Background Left ventricular assist devices (LVAD) have been increasingly used in the treatment of end-stage heart failure. While warfarin has been uniformly recommended in the long-term as anticoagulation strategy, no clear recommendation exists for the post-operative period. We sought to evaluate the feasibility of enoxaparin in the immediate and early postoperative period after LVAD implantation. Methods This is a two-center, retrospective analysis of 250 consecutive patients undergoing LVAD implantation between January 2017 and December 2018. Patients were bridged postoperatively to therapeutic INR by either receiving unfractionated heparin (UFH) or low molecular weight heparin (LMWH). Patients were followed while inpatient and for 3 months after LVAD implantation. The efficacy outcome was occurrence of first and subsequent cerebrovascular accident while safety outcome was the occurrence of bleeding events. Length of stay (LOS) was also assessed. Results Two hundred fifty and 246 patients were analyzed for index admission and 3-month follow up respectively. No statistically significant differences were found between the two groups in CVA (OR = 0.67; CI = 0.07–6.39, P = 0.73) or bleeding events (OR = 0.91; CI = 0.27–3.04, P = 0.88) during index admission. Similarly, there were no differences at 3 months in either CVAs or bleeding events (OR = 0.85; 0.31–2.34; p = 0.76). No fatal events occurred during the study follow-up period. Median LOS was significantly lower (4 days; p = 0.03) in the LMWH group. Conclusions LMWH in the immediate and early postoperative period after LVAD implantation appears to be a concurrently safe and efficacious option allowing earlier postoperative discharge and avoidance of recurrent hospitalizations due to sub-therapeutic INR.
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Affiliation(s)
- Zubair Shah
- University of Kansas Health System, University of Kansas School of Medicine, Department of Cardiovascular Medicine, Kansas City, Kansas, USA
| | - Ioannis Mastoris
- University of Kansas Health System, University of Kansas School of Medicine, Department of Cardiovascular Medicine, Kansas City, Kansas, USA
| | - Prakash Acharya
- University of Kansas Health System, University of Kansas School of Medicine, Department of Cardiovascular Medicine, Kansas City, Kansas, USA
| | - Aniket S Rali
- University of Kansas Health System, University of Kansas School of Medicine, Department of Cardiovascular Medicine, Kansas City, Kansas, USA
| | - Moghni Mohammed
- University of Kansas Health System, University of Kansas School of Medicine, Department of Cardiovascular Medicine, Kansas City, Kansas, USA
| | - Farhad Sami
- University of Kansas Health System, University of Kansas School of Medicine, Department of Cardiovascular Medicine, Kansas City, Kansas, USA
| | - Sagar Ranka
- University of Kansas Health System, University of Kansas School of Medicine, Department of Cardiovascular Medicine, Kansas City, Kansas, USA
| | - Savahanna Wagner
- Cardiovascular Service Line, Ascension, St. Vincent Hospital, Indianapolis, Indiana, USA
| | - Giorgio Zanotti
- Cardiovascular Service Line, Ascension, St. Vincent Hospital, Indianapolis, Indiana, USA
| | - Christopher T Salerno
- Cardiovascular Service Line, Ascension, St. Vincent Hospital, Indianapolis, Indiana, USA
| | - Nicholas A Haglund
- University of Kansas Health System, University of Kansas School of Medicine, Department of Cardiovascular Medicine, Kansas City, Kansas, USA
| | - Andrew J Sauer
- University of Kansas Health System, University of Kansas School of Medicine, Department of Cardiovascular Medicine, Kansas City, Kansas, USA
| | - Ashwin K Ravichandran
- Cardiovascular Service Line, Ascension, St. Vincent Hospital, Indianapolis, Indiana, USA
| | - Travis Abicht
- University of Kansas Health System, University of Kansas School of Medicine, Department of Cardiovascular and Thoracic Surgery, Kansas City, Kansas, USA.
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Ranka S, Parimi N, Dalia T, Acharya P, Taduru S, Gupta K, Shah Z. Comparison of Clinical Outcomes of Intraortic Balloon Pump Versus Impella in Patients with Cardiogenic Shock: A Real-World Analysis. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.400] [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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Ansari M, Mohammed M, Ranka S, Noheria A, Sheldon S, Reddy M. Abstract P123: Accuracy Of Hypertensive Emergency Diagnosis Code In Administrative Database: Insights From National Inpatient Sample 2017. Hypertension 2020. [DOI: 10.1161/hyp.76.suppl_1.p123] [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] [Indexed: 11/16/2022]
Abstract
Background:
Hypertensive emergency (HTNE) diagnostic code was introduced, in the US, in October 2016 to improve identification of patients with end-organ damage due to high blood pressure but its impact is unclear.
Objective:
To assess the accuracy of HTNE code using administrative data.
Methods:
We used National Inpatient Sample 2017 to identify adult patients, age ≥18 years, with International Classification of Disease-10th Clinical modification (ICD-10-CM) code of I16.1. We used the presence of end-organ damage diagnostic codes to identify true HTNE.
Results:
A total of 194,495 patients had a diagnosis of HTNE. Of these only 144,070 (74.1%) had a concomitant diagnosis of end-organ damage. Baseline characteristics of entire cohort stratified by presence of target organ damage (Table 1A) and frequency of end-organ damage in true HTNE patients (Table 1B) are shown. Patients with true HTNE were likely to be older and male with higher co-morbidity burden. There was also significant difference in outcomes between two groups with a higher proportion of true HTNE patients experiencing longer length of stay and increased mortality which is in-line with previous studies.
Conclusions:
The accuracy of hypertensive emergency diagnosis code is low with positive predictive value of 74.1% and caution is advised when using with administrative data. Further studies, using individual patient discharge records, are required to validate HTNE code.
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Affiliation(s)
| | | | | | | | | | - Madhu Reddy
- Univ of Kansas Health System, Kansas City, KS
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Rali AS, Ranka S, Acharya P, Buechler T, Weidling R, Mastoris I, Taduru S, Abicht T, Haglund N, Sauer AJ, Shah Z. Comparison of Trends, Mortality, and Readmissions After Insertion of Left Ventricular Assist Devices in Patients <65 Years Vs ≥65 Years. Am J Cardiol 2020; 128:16-27. [PMID: 32650911 DOI: 10.1016/j.amjcard.2020.04.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/10/2020] [Accepted: 04/20/2020] [Indexed: 01/14/2023]
Abstract
Left ventricular assist devices (LVADs) use in treatment of stage D heart failure (HF) has evolved and expanded in the past decade. There is paucity of data on LVAD utilization in patients with age ≥65 years with multiple co-morbidities. We aimed to investigate utilization trends, outcomes, and rates and predictors of readmissions in patients receiving LVADs with age ≥65 years (AO) and comparing them with patient age <65 years (AY). We analyzed hospitalization data from the Nationwide Inpatient Sample from 2007 to 2015 to evaluate LVAD utilization trends and outcomes between the 2 patient cohorts. We also queried the Nationwide Readmission Database from 2014 to third quarter of 2015 to identify trends and compare etiologies of readmissions. Implants in AO patients increased from 20% (154) of the total LVADs implanted in 2007 to 33.2% (1,215) in 2014 and 31.8% (910) through September 2015 (p < 0.01). Over the study period there was a steady and significant increase in the mean Elixhauser scores in elderly patients who underwent LVAD implantation from 15.4 in 2007 to 24.54 in 2015 (p < 0.01). Despite this finding, the mean LOS in the AO cohort decreased from 56.0 days in 2007 to 33.8 days in 2015 (p < 0.001). Furthermore, the in-hospital mortality associated with LVAD implantation among the AO group gradually decreased over the study time period (39% in 2007 to 12.2% in 2015, p < 0.001). The overall readmission rate was not significantly different between AO versus AY group (28% vs 33%, p = 0.2). The most common cause in both groups was gastrointestinal bleed but it was significantly higher in AO group (24.3% vs 11.3%, p = 0.01). In conclusion, patients age ≥65 years with multiple co-morbidities are receiving increasing number of LVADs with improved survival outcomes. Their 30-day readmissions are comparable to the younger patients.
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Ambrose JA, Najafi A, Jain V, Muller JE, Ranka S, Barua RS. Reducing Tobacco-Related Disability in Chronic Smokers. Am J Med 2020; 133:908-915. [PMID: 32325048 DOI: 10.1016/j.amjmed.2020.03.025] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 02/02/2023]
Abstract
Tobacco consumption (predominantly cigarettes) is the leading preventable cause of mortality worldwide. Although the major focus of strategies to reduce mortality from tobacco must include prevention of future generations from initially gaining access, some smokers are unwilling or unable to quit. Can the higher risk chronic smoker be identified and can their risk be reduced? The risk of adverse events in cigarette smokers is influenced by the intensity and duration of cigarette smoking or secondhand exposure, associated conventional risk factors, environmental stressors, and certain genetic variants and epigenetic modifiers. Recent data suggest that inflammatory markers such as high-sensitivity C-reactive protein (hs CRP) and targeted imaging can identify some smokers at higher risk. As smoking is prothrombotic, aspirin initiation and expanded statin use might reduce cardiovascular risk in those who do not presently meet criteria for these therapies, but further study is required. Thus, although advocacy for smoking cessation should always be the primary approach, increased efforts are needed to identify and potentially treat those who are unable or unwilling to quit.
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Affiliation(s)
- John A Ambrose
- University of California, San Francisco, Fresno Medical Education Program, Fresno, Calif.
| | - Amir Najafi
- University of California, San Francisco, Fresno Medical Education Program, Fresno, Calif
| | - Vipul Jain
- University of California, San Francisco, Fresno Medical Education Program, Fresno, Calif
| | | | - Sagar Ranka
- University of Kansas Medical Center, Kansas City Veterans' Administration, Kansas City, Mo
| | - Rajat S Barua
- University of Kansas Medical Center, Kansas City Veterans' Administration, Kansas City, Mo
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49
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Sami F, Ranka S, Lippmann M, Weiford B, Hance K, Whitman B, Wright L, Donaldson S, Boyer B, Gupta K. Cardiac rehabilitation in patients with peripheral arterial disease after revascularization. Vascular 2020; 29:350-354. [PMID: 32731806 DOI: 10.1177/1708538120945530] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate safety, feasibility, and benefit of cardiac rehabilitation (CR) in patients with peripheral arterial disease (PAD) who undergo revascularization. METHODS We conducted a prospective, non-randomized, pilot study to assess the feasibility, safety, and benefit of CR in PAD patients after revascularization compared to standard of care (controls). CR feasibility was assessed by the ability to complete 36 sessions. Safety was defined as the absence of adverse cardiovascular events during CR. Quality of life (QoL) assessment was performed using SF-36 form (Medical Outcomes Study 36-Item Short-Form Health Survey) and PAD-specific quality of life questionnaire (VascuQOL6). Other endpoints included incidence of claudication during 6-minute walk test (6MWT), mean distance, and number of laps walked. All outcome data were collected before and after CR completion. Standard statistical tests were used for comparisons. RESULTS This study enrolled 20 subjects (CR group = 10). Mean age was 60.70 (±7.13) and 63.1 (±9.17) years in CR and controls, respectively (p-value > 0.05). Fifty percent and 60% were female in CR and control group, respectively. All subjects completed 36 CR sessions without adverse events. The increase in mean distance walked during 6MWT was higher in the CR group compared to control group (63.7 m vs. 10.5 m, p = 0.043). Change in mean number of laps walked was higher in the CR group (3.5 vs. -1.1; p < 0.01). Scores on 6 of 8 scales of SF-36 and VascuQOL6 were higher in the CR group, though not statistically significant. CONCLUSION CR is safe, feasible, and improves walking ability in ambulatory patients with PAD after arterial revascularization.
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Affiliation(s)
- Farhad Sami
- Department of Internal Medicine, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Sagar Ranka
- Department of Cardiovascular Medicine, The University of Kansas, Kansas City, KS, USA
| | - Matthew Lippmann
- Department of Cardiovascular Medicine, The University of Kansas, Kansas City, KS, USA
| | - Brian Weiford
- Department of Cardiovascular Medicine, The University of Kansas, Kansas City, KS, USA
| | - Kirk Hance
- Department of Cardiovascular Surgery, The University of Kansas, Kansas City, KS, USA
| | - Bob Whitman
- Department of Pulmonary Function, The University of Kansas Health System, Kansas City, KS, USA
| | - Lanecia Wright
- Department of Cardiovascular Medicine, The University of Kansas, Kansas City, KS, USA
| | - Seth Donaldson
- Department of Cardiopulmonary Rehab, The University of Kansas Health System, Kansas City, KS, USA
| | - Blake Boyer
- Department of Cardiopulmonary Rehab, The University of Kansas Health System, Kansas City, KS, USA
| | - Kamal Gupta
- Department of Cardiovascular Medicine, The University of Kansas, Kansas City, KS, USA
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50
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Abstract
BACKGROUND Disasters, crises and pandemics are emergencies which impact on businesses severely. The COVID-19 pandemic reached its peak in mid-April 2020 in the UK. During this period, NHS Occupational Health Services (OHS) were stretched to their limit along with other health services. OHS may have had to change their pattern of operation, operating times, services offered, etc. to cope with the pandemic. Data about business model modifications, services offered by the OHS businesses during the pandemic could help in better utilization of OHS resources in the future. AIMS To understand the behaviour of OHS in different parts of the country during the COVID-19 pandemic. METHODS An online survey link was sent to both accredited and unaccredited UK Occupational Health Physicians (OHPs). RESULTS Sixty-two OHPs responded to the survey. In the current pandemic, 51% of the OHS (95% CI 0.38-0.62) offered weekend or out-of-hours (OOH) services, 21% had to employ extra staff (95% CI 0.13-0.33) and 54% had to change their working hours (95% CI 0.41-0.65). Ninety per cent of the OHS (95% CI 0.78-0.94) continued to offer routine services; however, there was a decline in offering vaccination services. Fifty-six per cent of the OHS (95% CI 0.42-0.67) offered a dedicated telephone line and 46% of the OHS (95% CI 0.32-0.56) started a dedicated COVID-19 queries inbox. CONCLUSIONS There was a change in the behaviour of the OHS to cope with the pandemic. Having a dedicated helpline to manage the crisis situation seemed a logical step whilst offering routine services.
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Affiliation(s)
- S Ranka
- Occupational Health, Healthwork Limited, Manchester, UK
| | - J Quigley
- Occupational Health, Healthwork Limited, Manchester, UK
| | - T Hussain
- Occupational Health, Healthwork Limited, Manchester, UK
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