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Khanna S, Wen I, Thakur A, Bhat A, Chen H, Gan G, Tan T. Prognostic Implications of Traditional and Emerging Risk Factor Profiles in Patients With Systemic Sclerosis. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.369] [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: 10/16/2022]
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Khanna S, Wen I, Thakur A, Bhat A, Chen H, Gan G, Tan T. Prognostic Impact of Traditional and Emerging Risk Factor Profiles in Patients With Systemic Lupus Erythematosus. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.368] [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: 10/16/2022]
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Khanna S, Wen I, Gupta A, Thakur A, Bhat A, Chen HHL, Gan GCH, Tan TC. LV-GLS is a predictor of all-cause death and cardiovascular MACE events in patients with neuro-immunological disorders. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.025] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Neuro-immunological disorders encompass several disease states, including multiple sclerosis (MS), autoimmune encephalitis (AE) and myasthenia gravis (MG). These autoimmune conditions are mediated via pro-inflammatory cytokines, and there is growing evidence to suggest cardiovascular involvement within these inflammatory states. Left ventricular global longitudinal strain (LV-GLS) is proposed to be a more sensitive measure of LV systolic function when compared to standard two-dimensional measures such as LV ejection fraction (LVEF).
Purpose
The purpose of this study was to assess for subclinical cardiac dysfunction in a cohort of patients with neuro-immunological disorders and correlate this with the development of outcomes on follow-up.
Methods
Consecutive patients with MS, AE and MG admitted to our institution during 2013–2020 were assessed (n=102). Patients without pre-existing cardiovascular disease, LVEF <50% or lack of comprehensive transthoracic echocardiography during their index admission were included (n=55). This group was compared to age- and gender-matched controls (n=55) LV-GLS was measured offline using vendor-independent software (TomTec Arena, Germany v4.6) by two cardiologists blinded to the patient group or outcomes. These patients were followed for up for the composite outcome of all-cause death and major adverse cardiovascular events (MACE).
Results
A total of 55 patients (31 MS, 14 AE and 10 MG) were age- and gender- matched to 55 controls. There was no significant difference in baseline demographic characteristics or cardiovascular risk factors between groups. Patients with neuro-immunological disorders demonstrated impaired LV-GLS (−17.6±3.5 vs −20.8±1.9; p<0.01) when compared to healthy controls, despite an LVEF within the normal range (60.9±7.7 vs 64.1±5.7; p=0.02) in both groups. There were a total of 9 (16.4%) outcomes during a mean follow-up of 41.0±33.0 months. LV-GLS was the only significant echocardiographic predictor of all-cause death and MACE events (p=0.013) on multi-variate analysis.
Conclusions
Our results suggest that patients with neuro-immunological disorders have subclinical LV dysfunction as assessed by LV-GLS which has prognostic capacity in this population. Further larger studies are required to further characterize this phenomenon.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Khanna
- Blacktown Hospital, Sydney, Australia
| | - I Wen
- Blacktown Hospital, Sydney, Australia
| | - A Gupta
- Blacktown Hospital, Sydney, Australia
| | - A Thakur
- Blacktown Hospital, Sydney, Australia
| | - A Bhat
- Blacktown Hospital, Sydney, Australia
| | | | - G C H Gan
- Blacktown Hospital, Sydney, Australia
| | - T C Tan
- Blacktown Hospital, Sydney, Australia
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Khanna S, Wen I, Gupta A, Thakur A, Bhat A, Chen HHL, Gan GCH, Tan TC. Patients with rare autoimmune inflammatory disorders demonstrate sub-clinical left ventricular dysfunction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.027] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
ANCA-associated Vasculitis (AAV) and inflammatory myositis (IM) are rare inflammatory autoimmune disorders mediated via pro-inflammatory cytokines and result in a systemic inflammatory state with multi-organ involvement. There is growing evidence to suggest cardiovascular involvement within these inflammatory states. Left ventricular global longitudinal strain (LV-GLS) is proposed to be a more sensitive measure of LV systolic function when compared to standard two-dimensional measures such as LV ejection fraction (LVEF).
Purpose
The purpose of this study was to assess for subclinical cardiac dysfunction in these cohorts when compared to controls.
Methods
Consecutive patients with AAV (n=56) and IM (n=68) admitted to our institution during 2013–2021 were assessed. Patients with pre-existing cardiovascular disease, significant renal impairment (eGFR <30mL/min/1.73m2), LVEF <50% or lack of comprehensive transthoracic echocardiography during admission were excluded (n=72). LV-GLS was measured offline using vendor-independent software (TomTec Arena, Germany v4.6).
Results
A total of 52 patients (22 AAV and 30 IM) were age- and gender-matched to 52 controls. In comparison of the two study populations (AAV and IM), patients with AAV had higher rates of renal impairment (p=0.02) but lower rates of interstitial lung disease when compared to IM (p=0.02). There were no differences between the two groups in terms of cardiovascular risk factors, demographics or other laboratory investigations (p>0.05 for all). In comparison to the control population, patients with AAV and IM had higher indexed LV mass and a lower TAPSE, respectively, when compared to controls. These cohorts also demonstrated impaired LV-GLS (−17.7±2.6 vs −20.6±2.4; p<0.01) when compared to healthy controls, despite no differences in LVEF (62.6±7.8 vs 61.8±5.4; p=0.56) between both groups.
Conclusions
Our results suggest that patients with autoimmune inflammatory disorders demonstrate subclinical LV dysfunction which is likely secondary to a chronic inflammatory state.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Khanna
- Blacktown Hospital, Sydney, Australia
| | - I Wen
- Blacktown Hospital, Sydney, Australia
| | - A Gupta
- Blacktown Hospital, Sydney, Australia
| | - A Thakur
- Blacktown Hospital, Sydney, Australia
| | - A Bhat
- Blacktown Hospital, Sydney, Australia
| | | | - G C H Gan
- Blacktown Hospital, Sydney, Australia
| | - T C Tan
- Blacktown Hospital, Sydney, Australia
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Khanna S, Newman J, Gupta A, Wen I, Bhat A, Chen H, Gan G, Tan T. Left Ventricular Global Longitudinal Strain is a Predictor of Adverse Cardiovascular Outcomes in Patients With Rheumatoid Arthritis. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.226] [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]
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Wen I, Khanna S, Thakur A, Chen H, Bhat A, Gan G, Tan T. Patients With Neuro-Immunological Disorders With Normal Left Ventricular Ejection Fraction Demonstrate Impaired Left Ventricular Global Longitudinal Strain. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.235] [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: 10/20/2022]
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Wen I, Price LE, Spray AM, Marmar CR. Mending broken bonds in military couples using emotionally focused therapy for couples: Tips and discoveries. J Clin Psychol 2020; 76:865-870. [DOI: 10.1002/jclp.22921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Irina Wen
- Department of PsychiatryNew York University School of Medicine, Steven A. Cohen Military Family Center, NYU Langone HealthNew York City New York
| | - Laura E. Price
- Department of PsychiatryNew York University School of Medicine, Steven A. Cohen Military Family Center, NYU Langone HealthNew York City New York
| | - Amanda M. Spray
- Department of PsychiatryNew York University School of Medicine, Steven A. Cohen Military Family Center, NYU Langone HealthNew York City New York
| | - Charles R. Marmar
- Department of PsychiatryNew York University School of Medicine, Steven A. Cohen Military Family Center, NYU Langone HealthNew York City New York
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Spray AM, Wen I, Price LE, Marmar CR. Challenging the patient and therapist during evolving phases of a veteran's treatment within a strong public-private partnership. J Clin Psychol 2020; 76:871-877. [PMID: 31909832 DOI: 10.1002/jclp.22922] [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: 11/10/2022]
Abstract
Veterans Health Administration (VA) Medical Centers provide excellent care for many veterans. However, there are a number of veterans who are ineligible or choose not to access mental health treatment at the VA. To meet the needs of those veterans and of military family members, private centers have emerged to fill in gaps where care is unavailable or scarce. This paper describes how one such center, the Steven A. Cohen Military Family Center at NYU Langone Health, partnered with the local VA hospital to give one veteran ineligible for free mental health services the care he desperately needed. The case demonstrates the transformative work that can take place when public-private partnerships are forged and evidence-based treatments can be provided in a flexible way. It also illustrates the complexity of many veterans' presentations, which in this case required the therapist to continually challenge her conceptualization as she and the patient navigated different phases of his treatment.
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Affiliation(s)
- Amanda M Spray
- Department of Psychiatry, New York University School of Medicine, Steven A. Cohen Military Family Center, NYU Langone Health, New York City, New York
| | - Irina Wen
- Department of Psychiatry, New York University School of Medicine, Steven A. Cohen Military Family Center, NYU Langone Health, New York City, New York
| | - Laura E Price
- Department of Psychiatry, New York University School of Medicine, Steven A. Cohen Military Family Center, NYU Langone Health, New York City, New York
| | - Charles R Marmar
- Department of Psychiatry, New York University School of Medicine, Steven A. Cohen Military Family Center, NYU Langone Health, New York City, New York
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Jethwani U, Chandrakumar D, Wen I, Tan T. 185 Traditional and Non-Traditional Cardiovascular Risk Profiles of Patients With Solid Organ Malignancies Undergoing Chemotherapy and Their Incidence of Cardiovascular Events. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wen I, Gu K, Bhat A, Chen H, Kayes M, Gan G. Utility of Transthoracic Echocardiograms in Patients with Chronic Kidney Disease Living in Western Sydney. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.332] [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: 10/26/2022]
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Abstract
This paper explores the triumphs and challenges of providing free, integrative treatment to veterans and military families through secure video connections into their homes. Two case studies of telemental health treatment conducted through the Greater NYC Military Family Consortium in conjunction with the Steven A. Cohen Military Family Center at NYU Langone Health in New York City illustrate the complexities and opportunities that emerge in the course of treatment, most of which was conducted remotely. The access to people's lives through a portal adds new wrinkles to evidence-based practice in military settings while underscoring the overall need to broaden a network of care in partnership with Veterans Affairs hospital (VAs), Vet Centers, and community providers to reach those who might otherwise not seek help.
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Affiliation(s)
- Laura E Price
- Department of Psychiatry, New York University School of Medicine, New York, New York
| | - Paraskevi Noulas
- Department of Psychiatry, New York University School of Medicine, New York, New York
| | - Irina Wen
- Department of Psychiatry, New York University School of Medicine, New York, New York
| | - Amanda Spray
- Department of Psychiatry, New York University School of Medicine, New York, New York
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