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Tibrewala A, Hu M, Petito L, Rich J, Pham D, De By T, Gustafsson F, Veen K, Vanderheyden M, Lloyd-Jones D, Shah S. Derivation and Validation of a Risk Prediction Model for Waitlist Mortality in Left Ventricular Assist Device Patients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.536] [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: 04/05/2023] Open
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2
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Farina LA, Tibrewala A, Meng Z, Baldridge AS, Voit JM, Raissi SR, Lu M, Khan SS, Freed BH, Akhter N. Echocardiographic correlates of major adverse cardiac events at 1 year in patients with apical ballooning takotsubo syndrome. Echocardiography 2023; 40:86-95. [PMID: 36632682 DOI: 10.1111/echo.15524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/15/2022] [Accepted: 12/03/2022] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Takotsubo syndrome (TTS) is characterized by transient left ventricular dysfunction and associated with considerable morbidity and mortality. We sought to evaluate the association between change in cardiac mechanics after diagnosis of TTS with 1-year incidence of major adverse cardiovascular events (MACE). METHODS We retrospectively identified 85 patients with apical TTS based on ICD 9/10 codes and chart adjudication, who had a follow-up echocardiogram within 6 months of diagnosis. Echocardiograms were analyzed for left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), GLS ratio, global circumferential strain (GCS), and global radial strain (GRS). Multivariable logistic regression was performed to identify parameters associated with MACE (all-cause mortality, heart failure, stroke, and coronary artery disease [CAD] requiring percutaneous coronary intervention [PCI]) at 1 year. Event-free survival was assessed in patients with GLS (≤-18% vs. >18%) and LVEF (≥53% vs. <53%). RESULTS Within 1 year of diagnosis, MACE occurred in 15 (18%) patients. Between baseline and follow-up echocardiogram (median 15 [range 1-151] days), there were significant differences in change in LVEF and GLS in patients with versus without incident MACE. In multivariate analysis, change in LVEF (odds ratio [OR] = .93 [.87, .98], p = .013) and change in GLS (OR = 1.32 [1.04, 1.67], p = .022) were independently associated with MACE; however, the association with change in GLS was attenuated (odds ratio [OR] = 1.13 [.94, 1.36], p = .21) after adjustment for baseline and change in LVEF. Among patients with normalized LVEF at follow-up, there were five (14.7%) MACE; whereas, there were no events among patients with normalized GLS. CONCLUSIONS In patients with apical TTS, recovery in GLS and LVEF at follow-up was associated with significantly lower MACE at 1 year. Normalization of GLS at follow-up was better able to discriminate event-free survival than normalization of LVEF.
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Affiliation(s)
- Lauren A Farina
- Department of Medicine, Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anjan Tibrewala
- Department of Medicine, Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Zhiying Meng
- Department of Medicine, Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Abigail S Baldridge
- Department of Medicine, Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jay M Voit
- Department of Medicine, Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sasan R Raissi
- Department of Medicine, Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michelle Lu
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sadiya S Khan
- Department of Medicine, Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Benjamin H Freed
- Department of Medicine, Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nausheen Akhter
- Department of Medicine, Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
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3
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Tibrewala A, Wehbe RM, Wu T, Harap R, Ghafourian K, Wilcox JE, Okwuosa IS, Vorovich EE, Ahmad FS, Yancy C, Pawale A, Anderson AS, Pham DT, Rich JD. Hyponatremia Is a Powerful Predictor of Poor Prognosis in Left Ventricular Assist Device Patients. ASAIO J 2022; 68:1475-1482. [PMID: 35696712 PMCID: PMC9908070 DOI: 10.1097/mat.0000000000001691] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Serum sodium is an established prognostic marker in heart failure (HF) patients and is associated with an increased risk of morbidity and mortality. We sought to study the prognostic value of serum sodium in left ventricular assist device (LVAD) patients and whether hyponatremia reflects worsening HF or an alternative mechanism. We identified HF patients that underwent LVAD implantation between 2008 and 2019. Hyponatremia was defined as Na ≤134 mEq/L at 3 months after implantation. We assessed for differences in hyponatremia before and after LVAD implantation. We also evaluated the association of hyponatremia with all-cause mortality and recurrent HF hospitalizations. There were 342 eligible LVAD patients with a sodium value at 3 months. Among them, there was a significant improvement in serum sodium after LVAD implantation compared to preoperatively (137.2 vs. 134.7 mEq/L, P < 0.0001). Patients with and without hyponatremia had no significant differences in echocardiographic and hemodynamic measurements. In a multivariate analysis, hyponatremia was associated with a markedly increased risk of all-cause mortality (HR 3.69, 95% CI, 1.93-7.05, P < 0.001) when accounting for age, gender, co-morbidities, use of loop diuretics, and B-type natriuretic peptide levels. Hyponatremia was also significantly associated with recurrent HF hospitalizations (HR 2.11, 95% CI, 1.02-4.37, P = 0.04). Hyponatremia in LVAD patients is associated with significantly higher risk of all-cause mortality and recurrent HF hospitalizations. Hyponatremia may be a marker of ongoing neurohormonal activation that is more sensitive than other lab values, echocardiography parameters, and hemodynamic measurements.
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Affiliation(s)
- Anjan Tibrewala
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Ramsey M. Wehbe
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Tingqing Wu
- Clinical Trials Unit, Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Rebecca Harap
- Department of Surgery, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois
| | - Kambiz Ghafourian
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Jane E. Wilcox
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Ike S. Okwuosa
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Esther E. Vorovich
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Faraz S. Ahmad
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Clyde Yancy
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Amit Pawale
- Department of Surgery, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois
| | - Allen S. Anderson
- Department of Medicine, Division of Cardiology, University of Texas at San Antonio, San Antonio, Texas
| | - Duc T. Pham
- Department of Surgery, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois
| | - Jonathan D. Rich
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
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Cheema B, Mutharasan RK, Sharma A, Jacobs M, Powers K, Lehrer S, Wehbe FH, Ronald J, Pifer L, Rich JD, Ghafourian K, Tibrewala A, McCarthy P, Luo Y, Pham DT, Wilcox JE, Ahmad FS. Augmented Intelligence to Identify Patients With Advanced Heart Failure in an Integrated Health System. JACC Adv 2022; 1:100123. [PMID: 36643021 PMCID: PMC9838119 DOI: 10.1016/j.jacadv.2022.100123] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Timely referral for specialist evaluation in patients with advanced heart failure (HF) is a Class 1 recommendation. However, the transition from stage C HF to advanced or stage D HF often goes undetected in routine care, resulting in delayed referral and higher mortality rates. OBJECTIVES The authors sought to develop an augmented intelligence-enabled workflow using machine learning to identify patients with stage D HF and streamline referral. METHODS We extracted data on HF patients with encounters from January 1, 2007, to November 30, 2020, from a HF registry within a regional, integrated health system. We created an ensemble machine learning model to predict stage C or stage D HF and integrated the results within the electronic health record. RESULTS In a retrospective data set of 14,846 patients, the model had a good positive predictive value (60%) and low sensitivity (25%) for identifying stage D HF in a 100-person, physician-reviewed, holdout test set. During prospective implementation of the workflow from April 1, 2021, to February 15, 2022, 416 patients were reviewed by a clinical coordinator, with agreement between the model and the coordinator in 50.3% of stage D predictions. Twenty-four patients have been scheduled for evaluation in a HF clinic, 4 patients started an evaluation for advanced therapies, and 1 patient received a left ventricular assist device. CONCLUSIONS An augmented intelligence-enabled workflow was integrated into clinical operations to identify patients with advanced HF. Endeavors such as this require a multidisciplinary team with experience in design thinking, informatics, quality improvement, operations, and health information technology, as well as dedicated resources to monitor and improve performance over time.
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Affiliation(s)
- Baljash Cheema
- Bluhm Cardiovascular Institute Center for Artificial Intelligence, Northwestern Medicine, Chicago, Illinois, USA,Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - R. Kannan Mutharasan
- Bluhm Cardiovascular Institute Center for Artificial Intelligence, Northwestern Medicine, Chicago, Illinois, USA,Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Aditya Sharma
- Bluhm Cardiovascular Institute Center for Artificial Intelligence, Northwestern Medicine, Chicago, Illinois, USA,Northwestern Medicine, Chicago, Illinois, USA
| | - Maia Jacobs
- Department of Computer Science, Northwestern University McCormick School of Engineering, Evanston, Illinois, USA
| | | | | | - Firas H. Wehbe
- Bluhm Cardiovascular Institute Center for Artificial Intelligence, Northwestern Medicine, Chicago, Illinois, USA,Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | - Jonathan D. Rich
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kambiz Ghafourian
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anjan Tibrewala
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Patrick McCarthy
- Bluhm Cardiovascular Institute Center for Artificial Intelligence, Northwestern Medicine, Chicago, Illinois, USA,Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Yuan Luo
- Division of Health and Biomedical Informatics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Duc T. Pham
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jane E. Wilcox
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Faraz S. Ahmad
- Bluhm Cardiovascular Institute Center for Artificial Intelligence, Northwestern Medicine, Chicago, Illinois, USA,Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA,Division of Health and Biomedical Informatics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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5
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Tibrewala A, Khush KK, Cherikh WS, Foutz J, Stehlik J, Rich JD. Risk of Renal Dysfunction Following Heart Transplantation in Patients Bridged with a Left Ventricular Assist Device. ASAIO J 2022; 68:646-653. [PMID: 34419984 DOI: 10.1097/mat.0000000000001558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/26/2022] Open
Abstract
Acute renal failure (ARF) and chronic kidney disease (CKD) are associated with short- and long-term morbidity and mortality following heart transplantation (HT). We investigated the incidence and risk factors for developing ARF requiring hemodialysis (HD) and CKD following HT specifically in patients with a left ventricular assist device (LVAD). We examined the International Society for Heart and Lung Transplantation (ISHLT) Thoracic Transplant Registry for heart transplant patients between January 2000 and June 2015. We compared patients bridged with durable continuous-flow LVAD to those without LVAD support. Primary outcomes were ARF requiring HD before discharge following HT and CKD (defined as creatinine >2.5 mg/dl, permanent dialysis, or renal transplant) within 3 years. There were 18,738 patients, with 4,535 (24%) bridged with LVAD support. Left ventricular assist device patients had higher incidence of ARF requiring HD and CKD at 1 year, but no significant difference in CKD at 3 years compared to non-LVAD patients. Among LVAD patients, body mass index (BMI) (odds ratio [OR] = 1.79, p < 0.001), baseline estimated glomerular filtration rate (eGFR) (OR = 0.43, p < 0.001), and ischemic time (OR = 1.28, p = 0.014) were significantly associated with ARF requiring HD. Similarly, BMI (hazard ratio [HR] = 1.49, p < 0.001), baseline eGFR (HR = 0.41, p < 0.001), pre-HT diabetes mellitus (DM) (HR = 1.37, p = 0.011), and post-HT dialysis before discharge (HR = 3.93, p < 0.001) were significantly associated with CKD. Left ventricular assist device patients have a higher incidence of ARF requiring HD and CKD at 1 year after HT compared with non-LVAD patients, but incidence of CKD is similar by 3 years. Baseline renal function, BMI, ischemic time, and DM can help identify LVAD patients at risk of ARF requiring HD or CKD following HT.
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Affiliation(s)
- Anjan Tibrewala
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California
| | - Wida S Cherikh
- Research Department, United Network for Organ Sharing, Richmond, Virginia
| | - Julia Foutz
- Research Department, United Network for Organ Sharing, Richmond, Virginia
| | - Josef Stehlik
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah
| | - Jonathan D Rich
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
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6
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Chuzi S, Wu T, Argaw S, Harap R, Ahmad F, Grady K, Pham D, Khan S, Wilcox J, Tibrewala A. Time Spent Engaging In Healthcare In Patients With Left Ventricular Assist Devices. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.107] [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: 11/30/2022]
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7
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Hasty GT, Argaw S, Wu T, Harap R, Ohiomoba R, Youmans Q, Ezema A, Akanyirige P, Jackson K, Mandieka E, Pawale A, Pham DT, Tibrewala A, Bryant A, Wilcox J, Okwuosa I. Long-term Survival And Factors Associated With Chronic Kidney Disease Requiring Dialysis Post Orthotopic Heart Transplantation. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.195] [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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8
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Farina LA, Tibrewala A, Voit JM, Raissi SR, Chen L, Welty LJ, Khan SS, Freed BH, Akhter N. Echocardiographic parameters associated with in-hospital adverse outcomes in patients with Takotsubo syndrome. Echocardiography 2021; 38:878-884. [PMID: 33983652 DOI: 10.1111/echo.15069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/05/2021] [Accepted: 04/24/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Takotsubo syndrome (TTS) is an acute heart failure syndrome that leads to significant morbidity and mortality. We sought to evaluate the association of cardiac mechanics on presentation with in-hospital adverse outcomes in patients with apical TTS. METHODS We retrospectively identified 468 patients with TTS based on ICD-9/10 codes between 2006 and 2017. The association of echocardiographic parameters with a composite outcome of heart failure and all-cause mortality during the index hospitalization was analyzed. RESULTS One hundred and forty one patients with the apical subtype and adequate imaging were included. 113 (80.1%) were female, left ventricular ejection fraction (LVEF) was 41.7% ± 12.4%, and global longitudinal strain was -10.1% ± 3.2%. The composite outcome occurred in 58 patients (41%), with heart failure occurring in 55 patients and death occurring in nine patients. Global longitudinal strain, global circumferential strain, global radial strain, right ventricular fractional area change, tricuspid annular plane systolic excursion, and right ventricular free wall strain were significantly worse in patients who experienced the composite outcome in univariate analyses. However, only LVEF was independently associated with the composite outcome in multivariable-adjusted analysis. CONCLUSIONS In patients with apical TTS, the strain has limited prognostic utility in the acute setting compared to LVEF, which was the only echocardiographic parameter associated with in-hospital heart failure and all-cause mortality.
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Affiliation(s)
- Lauren A Farina
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anjan Tibrewala
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jay M Voit
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Sasan R Raissi
- Cardiovascular Medicine, Saint Thomas West Hospital, Nashville, TN, USA
| | - Liqi Chen
- Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Leah J Welty
- Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sadiya S Khan
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Benjamin H Freed
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nausheen Akhter
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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9
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Hughes Z, Youmans Q, Wu T, Harap R, Pawale A, Pham D, Rich J, Ghafourian K, Vorovich E, Wilcox J, Ahmad F, Tibrewala A, Raza Y, Okwuosa I. Risk Factors for Malignancy after Orthotopic Heart Transplant: An Analysis of the UNOS Registry. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.735] [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: 11/29/2022] Open
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10
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Kong NW, Bavishi A, Amaral AP, Tibrewala A, Jivan A, Silberman P, Stone NJ. Risk Differences in Secondary Prevention Patients Who Present With Acute Coronary Syndrome and Implications of Guideline-Directed Cholesterol Management. Am J Cardiol 2020; 133:1-6. [PMID: 32807385 DOI: 10.1016/j.amjcard.2020.07.039] [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: 05/18/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 11/24/2022]
Abstract
The 2018 American College of Cardiology/American Heart Association cholesterol guidelines for secondary prevention identified a group of "very high risk" (VHR) patients, those with multiple major atherosclerotic cardiovascular disease (ASCVD) events or 1 major ASCVD event with multiple high-risk features. A second group, "high risk" (HR), was defined as patients without any of the risk features in the VHR group. The incidence and relative risk differences of these 2 groups in a nontrial population has not been well characterized. Using the Northwestern Medicine Enterprise Data Warehouse, we compared the incidence of VHR and HR patients as well as their relative risk for cardiovascular morbidity and mortality in a single-center, large, academic, retrospective cohort study. Total 1,483 patients with acute coronary events from January 2014 to December 2016 were risk stratified into VHR and HR groups. International Classification of Diseases versions 9 and 10 were used to assess for composite events of unstable angina pectoris, non-ST elevation myocardial infarction, or ST-elevation myocardial infarction, ischemic stroke, or all-cause death with a median follow-up of 3.3 years. VHR patients were found to have 87 ± 5.4 composite events per 1,000 patient-years compared with HR patients who had 33 ± 5.1 events per 1,000 patient-years (p <0.001). VHR group had increased risk of future events as compared to the HR group (multivariable adjusted hazard ratio 1.66 [1.01 to 2.74], p = 0.047). In conclusion, these results support the stratification of patients into the VHR and HR risk groups for secondary prevention.
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Affiliation(s)
- Nathan W Kong
- Department of Internal Medicine, University of Chicago, Chicago, Illinois.
| | - Aakash Bavishi
- Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ansel Philip Amaral
- Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Anjan Tibrewala
- Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Arif Jivan
- Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Philip Silberman
- Clinical and Translational Sciences Institute, Northwestern University, Chicago, Illinois
| | - Neil J Stone
- Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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11
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Kirollos JA, Harap R, Wu T, Okwuosa IS, Wilcox JE, Vorovich EE, Ghafourian K, Tibrewala A, Ahmad F, Pawale A, Pham DT, Rich JD. Journey of the Right Heart Following Left Ventricular Assist Device Implantation. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.401] [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: 11/29/2022]
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12
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Simkowski JM, Wehbe RM, Goergen J, Anderson AS, Ghafourian K, Okwuosa I, Vorovich EE, Ahmad FS, Tibrewala A, Pham DT, Wilcox JE, Rich JD. Unsupervised Machine Learning of LGE Patterns on Cardiac MRI Identifies Patients at Risk for Right Ventricular Failure After LVAD. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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13
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Tibrewala A, Khush K, Cherikh W, Foutz J, Ghafourian K, Okwuosa I, Vorovich E, Wilcox J, Yancy C, Ahmad F, Pham D, Stehlik J, Rich J. Risk of Renal Dysfunction Following Heart Transplantation in Patients Bridged with Left Ventricular Assist Devices. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1137] [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: 11/16/2022] Open
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14
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Simkowski J, Wehbe R, Goergen J, Anderson AS, Ghafourian K, Okwuosa IS, Vorovich EE, Ahmad F, Tibrewala A, Pham D, Wilcox J, Rich J. RIGHT VENTRICULAR FUNCTIONAL PARAMETERS BY CARDIAC MRI ARE ASSOCIATED WITH RIGHT VENTRICULAR FAILURE AFTER LVAD. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31711-3] [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: 10/24/2022]
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15
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Tibrewala A, Jivan A, Oetgen WJ, Stone NJ. A Comparative Analysis of Current Lipid Treatment Guidelines: Nothing Stands Still. J Am Coll Cardiol 2019; 71:794-799. [PMID: 29447742 DOI: 10.1016/j.jacc.2017.12.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 11/05/2017] [Revised: 12/15/2017] [Accepted: 12/15/2017] [Indexed: 11/17/2022]
Abstract
Lipid treatment guidelines have continued to evolve as new evidence emerges. We sought to review similarities and differences of 5 lipid treatment guidelines from the American College of Cardiology/American Heart Association, Canadian Cardiovascular Society, European Society for Cardiology/European Atherosclerosis Society, U.S. Preventive Services Task Force, and U.S. Veterans Affairs/Department of Defense. All guidelines utilize rigorous evidentiary review, highlight statin therapy for primary and secondary prevention of atherosclerotic cardiovascular disease, and emphasize a clinician-patient risk discussion. However, there are differences in statin intensities, use of risk estimators, treatment of specific patient subgroups, and consideration of safety concerns. Clinicians should understand these similarities and differences in current and future guideline recommendations when considering if and how to treat their patients with statin therapy.
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Affiliation(s)
- Anjan Tibrewala
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Arif Jivan
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Neil J Stone
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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16
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Vullaganti S, Tibrewala A, Rich JD, Pham DT, Rich S. The use of a durable right ventricular assist device for isolated right ventricular failure due to combined pre- and postcapillary pulmonary hypertension. Pulm Circ 2019; 9:2045894019831222. [PMID: 30698486 PMCID: PMC6540493 DOI: 10.1177/2045894019831222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 11/16/2022] Open
Abstract
Patients with isolated right ventricular (RV) failure have poor outcomes and minimal treatment options. We report a case where a durable RV assist device (RVAD) was implanted for end-stage RV failure from combined pre- and postcapillary pulmonary hypertension (PH) due in part to chronic thromboembolic PH using a temporary percutaneous RVAD as a bridging strategy. While the patient ultimately died from non-cardiovascular causes, there was significant improvement in markers of cardiogenic shock and hemodynamic RV function parameters without adverse effects from increased pulmonary artery pressures. More research is needed to identify an appropriate long-term mechanical support strategy for this patient population.
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Affiliation(s)
- Sirish Vullaganti
- 1 Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anjan Tibrewala
- 1 Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jonathan D Rich
- 1 Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Duc T Pham
- 2 Department of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stuart Rich
- 1 Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Abstract
Heart failure with preserved ejection fraction (HFpEF) is an increasingly prevalent condition, particularly in women. Comorbidities, including older age, obesity, diabetes mellitus, hypertension, and hyperlipidemia, are risk factors and define phenotypic profiles of HFpEF in women. The condition has a relatively high burden of morbidity and mortality, with phenotypic profiles potentially characterizing risk of hospitalization and mortality. Based on limited data, nonpharmacologic and pharmacologic treatments may provide benefit; however, compelling evidence-based, disease-modifying treatments are needed. Many unanswered questions about HFpEF in women warrant further investigation to improve understanding of the disease and provide better patient care.
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Affiliation(s)
- Anjan Tibrewala
- Department of Internal Medicine, Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Clyde W Yancy
- Department of Internal Medicine, Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
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18
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Abstract
A 24-year-old man with acute myelogenous leukaemia and a history of anthracycline treatment is hospitalised for non-anthracycline chemotherapy. He develops new-onset heart failure requiring intesive care unit (ICU) admission during his stay. There is debate as to the aetiology of his heart failure, whether anthracycline cardiotoxicity or takotsubo syndrome. He is diuresed and discharged home with close follow-up. Ultimately, the retrospective use of two-dimensional speckle-tracking echocardiography derived strain helps diagnose reverse takotsubo syndrome.
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Affiliation(s)
- Jay Voit
- Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Anjan Tibrewala
- Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Nausheen Akhter
- Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Chicago, Illinois, USA
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19
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Tibrewala A, Voit JM, Farina LA, Ryan SR, Freed BH, Akhter N. Change in Strain Echocardiography Predicts Mortality in Takotsubo Cardiomyopathy. J Card Fail 2018. [DOI: 10.1016/j.cardfail.2018.07.112] [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: 10/28/2022]
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20
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Abstract
Strain imaging is a sensitive marker of myocardial dysfunction and may be underused in Takotsubo cardiomyopathy (TC). We present a case of biventricular TC in which early improvement in left ventricular longitudinal strain predated subsequent improvement in ejection fraction. Early temporal patterns of strain of the left and right ventricles have not previously been described in TC. Our case illustrates how strain can be a sensitive marker for myocardial dysfunction and recovery in TC. Increased use of strain in TC may have further implications on prognosis and management.
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Affiliation(s)
- Anjan Tibrewala
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Nausheen Akhter
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Tibrewala A, Nassif ME, Andruska A, Shuster JE, Novak E, Vader JM, Ewald GA, LaRue SJ, Silvestry S, Itoh A. Use of adenosine diphosphate receptor inhibitor prior to left ventricular assist device implantation is not associated with increased bleeding. J Artif Organs 2016; 20:42-49. [PMID: 27830349 DOI: 10.1007/s10047-016-0932-7] [Citation(s) in RCA: 2] [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: 06/28/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
Current guidelines recommend adenosine diphosphate receptor inhibitors (ADPRi) be discontinued 5-7 days prior to cardiac surgery due to increased bleeding events, rates of re-exploration, and transfusions. However, the risks of left ventricular assist device (LVAD) implantation in patients taking an ADPRi have not previously been studied. We retrospectively identified 134 eligible patients with ischemic cardiomyopathy that underwent LVAD implantation between July 2009 and August 2013. The cohorts received an ADPRi ≤5 days of surgery (n = 25) versus >5 days prior or not at all (n = 109). Subgroup analyses adjusted for differences in frequency of redo sternotomy between cohorts, excluded patients that received an ADPRi >1 year prior to surgery, and excluded patients with a redo sternotomy. The ADPRi and control groups did not have significant differences in the primary outcomes, intraoperative PRBC units transfused (3.0 vs. 4.0, p = 0.12) or chest tube output within 24 h of surgery (1.66 L vs. 1.80 L, p = 0.61). After adjusting for differences in frequency of redo sternotomy (ADPRi vs. control, 12 vs. 52%, p ≤ 0.001), no significant difference in PRBC units transfused (3.1 vs. 3.5, p = 0.59) or chest tube output (2.04 L vs. 2.04 L, p = 0.98) was seen. No significant difference in 30-day mortality (8.0 vs. 11.0%, p = 0.63), 90-day mortality (16.4 vs. 23.3%, p = 0.42), or length of stay (29.0 vs. 28.0, p = 0.61) was seen. In this single-center experience, use of an ADPRi ≤5 days prior to LVAD implantation was not associated with increased bleeding, length of stay, or mortality.
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Affiliation(s)
- Anjan Tibrewala
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael E Nassif
- Division of Cardiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Adam Andruska
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Jerrica E Shuster
- Division of Cardiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric Novak
- Division of Cardiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Justin M Vader
- Division of Cardiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Gregory A Ewald
- Division of Cardiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Shane J LaRue
- Division of Cardiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Scott Silvestry
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Campus Box 8234, 660 S Euclid Avenue, St. Louis, MO, 63110, USA
| | - Akinobu Itoh
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Campus Box 8234, 660 S Euclid Avenue, St. Louis, MO, 63110, USA.
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22
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Nassif ME, Raymer DS, Tibrewala A, Ewald GA, LaRue SJ, Vader JM, Gage BF. Anticoagulation Intensity and Thrombotic or Bleeding Outcomes in Outpatients with Continuous Flow Left Ventricular Assist Devices. J Card Fail 2015. [DOI: 10.1016/j.cardfail.2015.06.149] [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: 10/23/2022]
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23
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Tibrewala A, Nassif M, Raymer D, Vader J, LaRue S, Silvestry S, Ewald G. Early Elevated Pump Power and Associated Hemolysis Amongst HeartMate II Left Ventricular Assist Devices. J Card Fail 2015. [DOI: 10.1016/j.cardfail.2015.06.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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24
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Adamo L, Nassif M, Tibrewala A, Novak E, Vader J, Silvestry SC, Itoh A, Ewald GA, Mann DL, LaRue SJ. The Heartmate Risk Score predicts morbidity and mortality in unselected left ventricular assist device recipients and risk stratifies INTERMACS class 1 patients. JACC Heart Fail 2015; 3:283-90. [PMID: 25770410 DOI: 10.1016/j.jchf.2014.11.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 11/25/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study evaluated the Heartmate Risk Score (HMRS) and its potential benefits in clinical practice. BACKGROUND The HMRS has been shown to correlate with mortality in the cohort of patients enrolled in the Heartmate II trials, but its validity in unselected, "real world" populations remains unclear. METHODS This study identified a cohort of 269 consecutive patients who received a Heartmate II left ventricular assist device at our institution, the Barnes-Jewish Hospital in St. Louis, Missouri, between June 2005 and June 2013. Ninety-day and 2-year mortality rates, as well as frequency of several morbid events, were compared by retrospectively assigned HMRS category groups. The analysis was repeated within the subgroup of INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) class 1 patients. RESULTS Receiver operating curve analysis showed that the HMRS correlated with 90-day mortality with an area under the curve of 0.70. Stratification in low, mid, and high HMRS groups identified patients with increasing hazard of 90-day mortality, increasing long-term mortality, increasing rate of gastrointestinal bleeding events, and increasing median number of days spent in the hospital in the first year post implant. Within INTERMACS class 1 patients, those in the highest HMRS group were found to have a relative risk of 90-day mortality 5.7 times higher than those in the lowest HMRS group (39.1% vs. 6.9%, p = 0.029). CONCLUSIONS HMRS is a valid clinical tool to stratify risk of morbidity and mortality after implant of Heartmate II devices in unselected patients and can be used to predict short-term mortality risk in INTERMACS class 1 patients.
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Affiliation(s)
- Luigi Adamo
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Michael Nassif
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Anjan Tibrewala
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Eric Novak
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Justin Vader
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Scott C Silvestry
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Akinobu Itoh
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Gregory A Ewald
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Douglas L Mann
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Shane J LaRue
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri.
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25
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Lindman BR, Goldstein JS, Nassif ME, Zajarias A, Novak E, Tibrewala A, Vatterott AM, Lawler C, Damiano RJ, Moon MR, Lawton JS, Lasala JM, Maniar HS. Systemic inflammatory response syndrome after transcatheter or surgical aortic valve replacement. Heart 2015; 101:537-45. [PMID: 25605654 DOI: 10.1136/heartjnl-2014-307057] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE An inflammatory response after cardiac surgery is associated with worse clinical outcomes, but recent trials to attenuate it have been neutral. We evaluated the association between systemic inflammatory response syndrome (SIRS) and mortality after transcatheter (TAVR) and surgical aortic valve replacement (SAVR) for aortic stenosis (AS) and evaluated whether diabetes influenced this relationship. METHODS Patients (n=747) with severe AS treated with TAVR (n=264) or SAVR (n=483) between January 2008 and December 2013 were included and 37% had diabetes mellitus. SIRS was defined by four criteria 12-48 h after aortic valve replacement (AVR): (1) white blood cell count <4 or >12; (2) heart rate >90; (3) temperature <36 or >38°C; or (4) respiratory rate >20. Severe SIRS was defined as meeting all four criteria. The primary endpoint was 6-month all-cause mortality (60 deaths occurred by 6 months). Inverse probability weighting (IPW) was performed on 44 baseline and procedural variables to minimise confounding. RESULTS Severe SIRS developed in 6% of TAVR patients and 11% of SAVR patients (p=0.02). Six-month mortality tended to be higher in those with severe SIRS (15.5%) versus those without (7.4%) (p=0.07). After adjustment, severe SIRS was associated with higher 6-month mortality (IPW adjusted HR 2.77, 95% CI 2.04 to 3.76, p<0.001). Moreover, severe SIRS was more strongly associated with increased mortality in diabetic (IPW adjusted HR 4.12, 95% CI 2.69 to 6.31, p<0.001) than non-diabetic patients (IPW adjusted HR 1.74, 95% CI 1.10 to 2.73, p=0.02) (interaction p=0.007). The adverse effect of severe SIRS on mortality was similar after TAVR and SAVR. CONCLUSIONS Severe SIRS was associated with a higher mortality after SAVR or TAVR. It occurred more commonly after SAVR and had a greater effect on mortality in diabetic patients. These findings may have implications for treatment decisions in patients with AS, may help explain differences in outcomes between different AVR approaches and identify diabetic patients as a high-risk subgroup to target in clinical trials with therapies to attenuate SIRS.
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Affiliation(s)
- Brian R Lindman
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jacob S Goldstein
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael E Nassif
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Alan Zajarias
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Eric Novak
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anjan Tibrewala
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anna M Vatterott
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Cassandra Lawler
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jennifer S Lawton
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John M Lasala
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hersh S Maniar
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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26
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Tibrewala A, Nassif ME, Raymer DS, Itoh A, Silvestry S, Vader J, LaRue SJ, Ewald GA. Increased Heart Rate Predicts Early Mortality in LVAD Patients. J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.06.090] [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: 10/25/2022]
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27
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Carlisle AJ, Tibrewala A, Novak E, Singh J, Amin AP. Abstract 350: The ‘Frequent Flyer’ Hypothesis and Increased Risk of Thirty Day Readmission after Percutaneous Coronary Intervention. Circ Cardiovasc Qual Outcomes 2014. [DOI: 10.1161/circoutcomes.7.suppl_1.350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 11/16/2022]
Abstract
Background:
Thirty day readmission (30DR) post PCI is both prevalent and significant. These readmissions are associated with increased costs of care. Previous studies have shown comorbidities, socio-demographics, and angiographic characteristics as risk factors for readmission post PCI. However, unique factors such as prior frequent admissions and specifically its interaction with anxiety or depression as risk factors for readmission after PCI have not been studied.
Methods:
We retrospectively analyzed 1,343 consecutive PCIs representing 1,256 patients from a single institution from February 1, 2012 to August 13, 2013. The primary outcome was 30DR post PCI. Secondary outcomes included 30DR for PCI, CABG, and acute systolic or diastolic heart failure. The independent variables were ‘number of prior admissions in the 12 months before PCI’ and history of ‘anxiety or depression’ based on an ICD9 diagnosis in the preceding 10 years. Negative binominal and logistic regression models were built to examine the association between ‘anxiety or depression’ diagnosis, number of prior admissions, and 30DR after adjusting for known covariates including: age, gender, admission status, prior CABG, CHF, chronic lung disease, peripheral artery disease, cardiogenic shock, renal function, and insurance.
Results:
Of the 1,343 PCIs, 30.6% were readmitted within 30 days. We observed a large prevalence of ‘anxiety or depression’ in patients undergoing PCI (439, 33%). The mean number of 30DR post PCI was higher at 0.55 for patients with anxiety or depression and 0.43 for patients without anxiety or depression (P=0.006). Prior admissions were a strong and independent risk factor for 30DR with OR 1.258 (95% CI 1.164 to 1.360, P<0.001). ‘Anxiety or depression’ was also an independent risk factor for 30DR with OR 1.384 (95% CI 1.056 to 1.814, P=0.019). Interestingly, patients with anxiety or depression did not have significantly different 30DR for PCI, CABG, acute systolic or diastolic CHF 0.093 (95% CI 0.068 to 0.128) vs. 0.087 (95% CI 0.070, 0.109) among patients without anxiety or depression (p=0.74).
Conclusion:
A prior history of frequent admissions and anxiety or depression diagnoses contribute significantly and independently towards 30DR post PCI, even after adjusting for traditional risk factors of readmissions. As such, they should be considered as important risk factors for post PCI readmission. Patients with diagnoses of anxiety or depression were not at increased risk of 30DR for cardiovascular events such as PCI, CABG or acute CHF. Future studies are needed to evaluate the role of treating anxiety and depression in patients at risk for frequent readmissions.
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Nassif M, Tibrewala A, Raymer D, Andruska A, Vader J, Ewald G, LaRue S. Systolic Blood Pressure on Discharge from LVAD Insertion Is Associated with Future Stroke. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.357] [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: 11/27/2022] Open
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29
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Adamo L, Nassif M, Tibrewala A, Vader J, Ewald G, Mann D, LaRue S. The Heart Mate Risk Score Correlates with Mortality in an Unselected Mixed Cohort of Heart Mate II and Heart Ware LVAD from a Single Large Volume Center. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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30
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Tibrewala A, Nassif M, Andruska A, Vader J, Novak E, Shuster J, Jackups R, LaRue S, Ewald G, Itoh A. Use of ADP Receptor Inhibitor Prior to LVAD Implantation Does Not Increase Risk of Bleeding. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.637] [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: 10/25/2022] Open
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Staub D, Patel MB, Tibrewala A, Ludden D, Johnson M, Espinosa P, Coll B, Jaeger KA, Feinstein SB. Vasa Vasorum and Plaque Neovascularization on Contrast-Enhanced Carotid Ultrasound Imaging Correlates With Cardiovascular Disease and Past Cardiovascular Events. Stroke 2010; 41:41-7. [PMID: 19910551 DOI: 10.1161/strokeaha.109.560342] [Citation(s) in RCA: 191] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background and Purpose—
Histological data associate proliferation of adventitial vasa vasorum and intraplaque neovascularization with vulnerable plaques represented by symptomatic vascular disease. In this observational study, the presence of carotid intraplaque neovascularization and adventitial vasa vasorum were correlated with the presence and occurrence of cardiovascular disease (CVD) and events (CVE).
Methods—
The contrast-enhanced carotid ultrasound examinations of 147 subjects (mean age 64±11 years, 61% male) were analyzed for the presence of intraluminal plaque, plaque neovascularization (Grade 1=absent; Grade 2=present), and degree of adventitial vasa vasorum (Grade 1=absent, Grade 2=present). These observations were correlated with preexisting cardiovascular risk factors, presence of CVD, and history of CVE (myocardial infarction and transient ischemic attack/stroke).
Results—
The presence of intraluminal carotid plaque was directly correlated to cardiovascular risk factors, CVD, and CVE (
P
<0.05). Adventitial vasa vasorum Grade 2 was associated with significant more subjects with CVD than vasa vasorum Grade 1 (73 versus 54%,
P
=0.029). Subjects with intraplaque neovascularization Grade 2 had significantly more often a history of CVE than subjects with intraplaque neovascularization Grade 1 (38 versus 20%,
P
=0.031). Multivariate logistic regression analysis revealed that presence of plaque was significantly associated with CVD (odds ratio 4.7, 95% CI 1.6 to 13.8) and intraplaque neovascularization grade 2 with CVE (odds ratio 4.0, 95% CI 1.3 to 12.6).
Conclusion—
The presence and degree of adventitial vasa vasorum and plaque neovascularization were directly associated with CVD and CVE in a retrospective study of 147 patients undergoing contrast-enhanced carotid ultrasound.
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Affiliation(s)
- Daniel Staub
- From the Department of Internal Medicine, Section of Cardiology (D.S., M.B.P., A.T., D.L., M.J., P.E., S.B.F.), Rush University Medical Center, Chicago, Ill; Unitat de Diagnòstic i Tractament de Malalties Aterotrombòtiques (UDETMA) (B.C.), Hospital Arnau de Vilanova, Lleida, Spain; and the Department of Angiology (K.A.J.), University Hospital, Basel, Switzerland
| | - Mita B. Patel
- From the Department of Internal Medicine, Section of Cardiology (D.S., M.B.P., A.T., D.L., M.J., P.E., S.B.F.), Rush University Medical Center, Chicago, Ill; Unitat de Diagnòstic i Tractament de Malalties Aterotrombòtiques (UDETMA) (B.C.), Hospital Arnau de Vilanova, Lleida, Spain; and the Department of Angiology (K.A.J.), University Hospital, Basel, Switzerland
| | - Anjan Tibrewala
- From the Department of Internal Medicine, Section of Cardiology (D.S., M.B.P., A.T., D.L., M.J., P.E., S.B.F.), Rush University Medical Center, Chicago, Ill; Unitat de Diagnòstic i Tractament de Malalties Aterotrombòtiques (UDETMA) (B.C.), Hospital Arnau de Vilanova, Lleida, Spain; and the Department of Angiology (K.A.J.), University Hospital, Basel, Switzerland
| | - David Ludden
- From the Department of Internal Medicine, Section of Cardiology (D.S., M.B.P., A.T., D.L., M.J., P.E., S.B.F.), Rush University Medical Center, Chicago, Ill; Unitat de Diagnòstic i Tractament de Malalties Aterotrombòtiques (UDETMA) (B.C.), Hospital Arnau de Vilanova, Lleida, Spain; and the Department of Angiology (K.A.J.), University Hospital, Basel, Switzerland
| | - Mahala Johnson
- From the Department of Internal Medicine, Section of Cardiology (D.S., M.B.P., A.T., D.L., M.J., P.E., S.B.F.), Rush University Medical Center, Chicago, Ill; Unitat de Diagnòstic i Tractament de Malalties Aterotrombòtiques (UDETMA) (B.C.), Hospital Arnau de Vilanova, Lleida, Spain; and the Department of Angiology (K.A.J.), University Hospital, Basel, Switzerland
| | - Paul Espinosa
- From the Department of Internal Medicine, Section of Cardiology (D.S., M.B.P., A.T., D.L., M.J., P.E., S.B.F.), Rush University Medical Center, Chicago, Ill; Unitat de Diagnòstic i Tractament de Malalties Aterotrombòtiques (UDETMA) (B.C.), Hospital Arnau de Vilanova, Lleida, Spain; and the Department of Angiology (K.A.J.), University Hospital, Basel, Switzerland
| | - Blai Coll
- From the Department of Internal Medicine, Section of Cardiology (D.S., M.B.P., A.T., D.L., M.J., P.E., S.B.F.), Rush University Medical Center, Chicago, Ill; Unitat de Diagnòstic i Tractament de Malalties Aterotrombòtiques (UDETMA) (B.C.), Hospital Arnau de Vilanova, Lleida, Spain; and the Department of Angiology (K.A.J.), University Hospital, Basel, Switzerland
| | - Kurt A. Jaeger
- From the Department of Internal Medicine, Section of Cardiology (D.S., M.B.P., A.T., D.L., M.J., P.E., S.B.F.), Rush University Medical Center, Chicago, Ill; Unitat de Diagnòstic i Tractament de Malalties Aterotrombòtiques (UDETMA) (B.C.), Hospital Arnau de Vilanova, Lleida, Spain; and the Department of Angiology (K.A.J.), University Hospital, Basel, Switzerland
| | - Steven B. Feinstein
- From the Department of Internal Medicine, Section of Cardiology (D.S., M.B.P., A.T., D.L., M.J., P.E., S.B.F.), Rush University Medical Center, Chicago, Ill; Unitat de Diagnòstic i Tractament de Malalties Aterotrombòtiques (UDETMA) (B.C.), Hospital Arnau de Vilanova, Lleida, Spain; and the Department of Angiology (K.A.J.), University Hospital, Basel, Switzerland
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