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Wesley Milks M, Sahay S, Benza RL, Farber HW. Risk assessment in patients with pulmonary arterial hypertension in the era of COVID 19 pandemic and the telehealth revolution: State of the art review. J Heart Lung Transplant 2021; 40:172-182. [PMID: 33414063 PMCID: PMC7749286 DOI: 10.1016/j.healun.2020.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 11/25/2022] Open
Abstract
Patients affected by pulmonary arterial hypertension (PAH) benefit from intensive, continuous clinical monitoring to guide escalation of treatments that carry the potential to improve survival and quality of life. During the coronavirus disease 2019 pandemic, the need for physical distancing has fueled the expeditious expansion of various telehealth modalities, which may apply in a unique manner to individuals with PAH. Performance of objective risk assessments in patients with PAH remotely via telemedical visits and other telehealth mechanisms is unprecedented and not yet rigorously validated. The uniquely high risk for rapid deterioration in patients with PAH demands a high degree of sensitivity to detect changes in functional assessments. In this review, several telehealth modalities for potential utilization in risk assessment and treatment titration in patients with PAH are explored, yet additional study is needed for their validation with the pre-pandemic care paradigm.
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Affiliation(s)
- Michael Wesley Milks
- Division of Cardiovascular Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Sandeep Sahay
- Houston Methodist Lung Center, Division of Pulmonary, Critical care & Sleep Medicine, Houston Methodist Hospital, Houston, Texas; Weill Cornell Medicine College, Institute of Academic Medicine, Houston Methodist Hospital, Houston, Texas.
| | - Raymond L Benza
- Division of Cardiovascular Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Harrison W Farber
- Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, Massachusetts
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Milks MW, Chiang C, Xu W, Larry J, Mehta L, Li L, Retchin S. Real-world health care costs incurred by early adopters of PCSK9 inhibitor therapy*. J Clin Lipidol 2019. [DOI: 10.1016/j.jacl.2019.04.093] [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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Harfi TT, Milks MW, Orsinelli DA, Raman SV, Abraham WT, Kahwash R. Imaging Device Therapy: Essentials for the Imager. Heart Fail Clin 2019; 15:305-320. [PMID: 30832820 DOI: 10.1016/j.hfc.2018.12.011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Treatment of patients with heart failure with reduced ejection fraction has evolved. Recently, a fully implantable remote hemodynamic monitoring sensor in the pulmonary artery was approved in the treatment of patients at risk of heart failure readmissions. Several novel devices designed to offload the left atrium by creating a small interatrial shunt are being investigated. Cardiac imaging plays a vital role in the selection process, implantation, and monitoring of individuals with such devices. This article discusses in detail various imaging techniques and key clinical points relating to several cardiac devices used in the treatment of patients with heart failure.
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Affiliation(s)
- Thura T Harfi
- Division of Cardiology, Department of Medicine, The Ohio State University Wexner Medical Center, The Ohio State University, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA.
| | - Michael Wesley Milks
- Division of Cardiology, Department of Medicine, The Ohio State University Wexner Medical Center, The Ohio State University, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - David A Orsinelli
- Division of Cardiology, Department of Medicine, The Ohio State University Wexner Medical Center, The Ohio State University, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - Subha V Raman
- Division of Cardiology, Department of Medicine, The Ohio State University Wexner Medical Center, The Ohio State University, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - William T Abraham
- Division of Cardiology, Department of Medicine, The Ohio State University Wexner Medical Center, The Ohio State University, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - Rami Kahwash
- Division of Cardiology, Department of Medicine, The Ohio State University Wexner Medical Center, The Ohio State University, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
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Wilson MW, Milks MW. Acute renal vein thrombosis and nephrotic syndrome in the setting of retroperitoneal fibrosis. Oxf Med Case Reports 2015; 2015:309-10. [PMID: 26421156 PMCID: PMC4584503 DOI: 10.1093/omcr/omv043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 05/06/2015] [Accepted: 05/28/2015] [Indexed: 12/16/2022] Open
Abstract
Idiopathic retroperitoneal fibrosis (RPF) is a rare disease that involves non-specific inflammation and fibrosis surrounding the aorta. As a result, RPF is a challenging diagnosis to make; patients often seek medical attention after complications arise, such as nephrotic syndrome. The patient in our case report initially complained of flank pain. Laboratory evaluation revealed acute renal failure and nephrotic syndrome with substantial proteinuria. Multiple imaging modalities demonstrated a large, ill-defined, infiltrative retroperitoneal soft tissue mass that encased the great vessels. The patient was also noted to have acute left renal vein thrombosis. Although the patient was eventually diagnosed with RPF of unknown etiology, his clinical course is particularly unique given the rarity of the renal vein thrombosis. This case report adds a value to the medical community by helping to elucidate RPF and exposing its potentially life-threatening complications.
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Affiliation(s)
- Matthew Whitaker Wilson
- Department of Internal Medicine , Wake Forest Baptist Medical Center , Winston-Salem, NC , USA
| | - Michael Wesley Milks
- Department of Internal Medicine , Wake Forest Baptist Medical Center , Winston-Salem, NC , USA
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Lin T, Milks MW, Upadhya B, Hundley WG, Stacey RB. Improvement in systolic function in left ventricular non-compaction cardiomyopathy: A case report. J Cardiol Cases 2014; 10:231-234. [DOI: 10.1016/j.jccase.2014.08.004] [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] [Received: 05/02/2014] [Revised: 07/09/2014] [Accepted: 08/08/2014] [Indexed: 11/30/2022] Open
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