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Merdler I, Case BC, Pahuja M, Hayat F, Isaac I, Gadodia R, Chitturi KR, Reddy PK, Cellamare M, Ben-Dor I, Waksman R. Is there additional value in adding Impella to veno-arterial extracorporeal membrane oxygenation in patients with cardiogenic shock? Cardiovasc Revasc Med 2024:S1553-8389(24)00485-8. [PMID: 38782613 DOI: 10.1016/j.carrev.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Ilan Merdler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Mohit Pahuja
- Section of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Fatima Hayat
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Imad Isaac
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ritika Gadodia
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Kalyan R Chitturi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Pavan K Reddy
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Matteo Cellamare
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
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Kapur NK, Pahuja M, Kochar A, Karas RH, Udelson JE, Moses JW, Stone GW, Aghili N, Faraz H, O'Neill WW. Delaying reperfusion plus left ventricular unloading reduces infarct size: Sub-analysis of DTU-STEMI pilot study. Cardiovasc Revasc Med 2024; 60:11-17. [PMID: 37891053 DOI: 10.1016/j.carrev.2023.09.009] [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: 07/24/2023] [Revised: 09/11/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023]
Abstract
INTRODUCTION The STEMI-DTU pilot study tested the early safety and practical feasibility of left ventricular (LV) unloading with a trans-valvular pump before reperfusion. In the intent-to-treat cohort, no difference was observed for microvascular obstruction (MVO) or infarct size (IS) normalized to either the area at risk (AAR) at 3-5 days or total LV mass (TLVM) at 3-5 days We now report a per protocol analysis of the STEMI-DTU pilot study. METHODS In STEMI-DTU STUDY 50 adult patients (25 in each arm) with anterior STEMI [sum of precordial ST-segment elevation (ΣSTE) ≥4 mm] requiring primary percutaneous coronary intervention (PCI) were enrolled. Only patients who met all inclusion and exclusion criteria were included in this analysis. Cardiac magnetic resonance (CMR) imaging 3-5 days after PCI quantified IS/AAR and IS/TLVM and MVO. Group differences were assessed using Student's t-tests and linear regression (SAS Version-9.4). RESULTS Of the 50 patients enrolled, 2 died before CMR imaging. Of the remaining 48 patients those without CMR at 3-5 days (n = 8), without PCI of a culprit left anterior descending artery lesion (n = 2), with OHCA (n = 1) and with ΣSTE < 4 mm (n = 5) were removed from this analysis leaving 32/50 (64 %) patients meeting all inclusion and exclusion criteria (U-IR, n = 15; U-DR, n = 17) as per protocol. Despite longer symptom-to-balloon times in the U-DR arm (228 ± 80 vs 174 ± 59 min, p < 0.01), IS/AAR was significantly lower with 30 min of delay to reperfusion in the presence of active LV unloading (47 ± 16 % vs 60 ± 15 %, p = 0.02) and remained lower irrespective of the magnitude of precordial ΣSTE. MVO was not significantly different between groups (1.5 ± 2.8 % vs 3.5 ± 4.8 %, p = 0.15). Among patients who received LV unloading within 180 min of symptom onset, IS/AAR was significantly lower in the U-DR group. CONCLUSION In this per-protocol analysis of the STEMI-DTU pilot study we observed that LV unloading for 30 min before reperfusion significantly reduced IS/AAR compared to LV unloading and immediate reperfusion, whereas in the ITT cohort no difference was observed between groups. This observation supports the design of the STEMI-DTU pivotal trial and suggests that strict adherence to the study protocol can significantly influence the outcome.
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Affiliation(s)
- Navin K Kapur
- Tuft University Medical Center, Boston, MA, United States of America.
| | - Mohit Pahuja
- University of Oklahoma Medical Science, Oklahoma city, OK, United States of America
| | - Ajar Kochar
- Brigham and Women's Hospital, Boston, MA, United States of America
| | - Richard H Karas
- Tuft University Medical Center, Boston, MA, United States of America
| | - James E Udelson
- Tuft University Medical Center, Boston, MA, United States of America
| | - Jeffrey W Moses
- Columbia University Medical Center, New York, United States of America
| | - Gregg W Stone
- Hackensack Medical Center, Hoboken, NJ, United States of America
| | - Nima Aghili
- St. Anthony's Hospital, Denver, Colorado, USA
| | - Haroon Faraz
- Hackensack Medical Center, Hoboken, NJ, United States of America
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Akhtar KH, Pahuja M, Baber U. Self-expanding or balloon-expandable valve for TAVR in low risk patients: The jury is still out! Int J Cardiol 2024; 397:131619. [PMID: 38036268 DOI: 10.1016/j.ijcard.2023.131619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/26/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Khawaja Hassan Akhtar
- Department of Medicine, Section of Cardiovascular Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
| | - Mohit Pahuja
- Department of Medicine, Section of Cardiovascular Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Usman Baber
- Department of Medicine, Section of Cardiovascular Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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Ton VK, Kanwar MK, Li B, Blumer V, Li S, Zweck E, Sinha SS, Farr M, Hall S, Kataria R, Guglin M, Vorovich E, Hernandez-Montfort J, Garan AR, Pahuja M, Vallabhajosyula S, Nathan S, Abraham J, Harwani NM, Hickey GW, Wencker D, Schwartzman AD, Khalife W, Mahr C, Kim JH, Bhimaraj A, Sangal P, Zhang Y, Walec KD, Zazzali P, Burkhoff D, Kapur NK. Impact of Female Sex on Cardiogenic Shock Outcomes: A Cardiogenic Shock Working Group Report. JACC Heart Fail 2023; 11:1742-1753. [PMID: 37930289 DOI: 10.1016/j.jchf.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/30/2023] [Accepted: 09/13/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Studies reporting cardiogenic shock (CS) outcomes in women are scarce. OBJECTIVES The authors compared survival at discharge among women vs men with CS complicating acute myocardial infarction (AMI-CS) and heart failure (HF-CS). METHODS The authors analyzed 5,083 CS patients in the Cardiogenic Shock Working Group. Propensity score matching (PSM) was performed with the use of baseline characteristics. Logistic regression was performed for log odds of survival. RESULTS Among 5,083 patients, 1,522 were women (30%), whose mean age was 61.8 ± 15.8 years. There were 30% women and 29.1% men with AMI-CS (P = 0.03). More women presented with de novo HF-CS compared with men (26.2% vs 19.3%; P < 0.001). Before PSM, differences in baseline characteristics and sex-specific outcomes were seen in the HF-CS cohort, with worse survival at discharge (69.9% vs 74.4%; P = 0.009) and a higher rate of maximum Society for Cardiac Angiography and Interventions stage E (26% vs 21%; P = 0.04) in women than in men. Women were less likely to receive pulmonary artery catheterization (52.9% vs 54.6%; P < 0.001), heart transplantation (6.5% vs 10.3%; P < 0.001), or left ventricular assist device implantation (7.8% vs 10%; P = 0.01). Regardless of CS etiology, women had more vascular complications (8.8% vs 5.7%; P < 0.001), bleeding (7.1% vs 5.2%; P = 0.01), and limb ischemia (6.8% vs 4.5%; P = 0.001). More vascular complications persisted in women after PSM (10.4% women vs 7.4% men; P = 0.06). CONCLUSIONS Women with HF-CS had worse outcomes and more vascular complications than men with HF-CS. More studies are needed to identify barriers to advanced therapies, decrease complications, and improve outcomes of women with CS.
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Affiliation(s)
- Van-Khue Ton
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Manreet K Kanwar
- Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Borui Li
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Song Li
- University of Washington Medical Center, Seattle, Washington, USA
| | - Elric Zweck
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Shashank S Sinha
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Maryjane Farr
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shelley Hall
- Baylor University Medical Center, Dallas, Texas, USA
| | - Rachna Kataria
- Lifespan Cardiovascular Center, Brown University, Providence, Rhode Island, USA
| | - Maya Guglin
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Esther Vorovich
- Bluhm Cardiovascular Institute of Northwestern University, Chicago, Illinois, USA
| | | | - A Reshad Garan
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mohit Pahuja
- University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | | | | | | | - Neil M Harwani
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Gavin W Hickey
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | | | - Wissam Khalife
- University of Texas Medical Branch, Galveston, Texas, USA
| | - Claudius Mahr
- University of Washington Medical Center, Seattle, Washington, USA
| | - Ju H Kim
- Houston Methodist Research Institute, Houston, Texas, USA
| | | | - Paavni Sangal
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Yijing Zhang
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Karol D Walec
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Peter Zazzali
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Navin K Kapur
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA.
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Waksman R, Pahuja M, van Diepen S, Proudfoot AG, Morrow D, Spitzer E, Nichol G, Weisfeldt ML, Moscucci M, Lawler PR, Mebazaa A, Fan E, Dickert NW, Samsky M, Kormos R, Piña IL, Zuckerman B, Farb A, Sapirstein JS, Simonton C, West NEJ, Damluji AA, Gilchrist IC, Zeymer U, Thiele H, Cutlip DE, Krucoff M, Abraham WT. Standardized Definitions for Cardiogenic Shock Research and Mechanical Circulatory Support Devices: Scientific Expert Panel From the Shock Academic Research Consortium (SHARC). Circulation 2023; 148:1113-1126. [PMID: 37782695 PMCID: PMC11025346 DOI: 10.1161/circulationaha.123.064527] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/31/2023] [Indexed: 10/04/2023]
Abstract
The Shock Academic Research Consortium is a multi-stakeholder group, including representatives from the US Food and Drug Administration and other government agencies, industry, and payers, convened to develop pragmatic consensus definitions useful for the evaluation of clinical trials enrolling patients with cardiogenic shock, including trials evaluating mechanical circulatory support devices. Several in-person and virtual meetings were convened between 2020 and 2022 to discuss the need for developing the standardized definitions required for evaluation of mechanical circulatory support devices in clinical trials for cardiogenic shock patients. The expert panel identified key concepts and topics by performing literature reviews, including previous clinical trials, while recognizing current challenges and the need to advance evidence-based practice and statistical analysis to support future clinical trials. For each category, a lead (primary) author was assigned to perform a literature search and draft a proposed definition, which was presented to the subgroup. These definitions were further modified after feedback from the expert panel meetings until a consensus was reached. This manuscript summarizes the expert panel recommendations focused on outcome definitions, including efficacy and safety.
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Affiliation(s)
- Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC (R.W.)
| | - Mohit Pahuja
- Division of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City (M.P.)
| | - Sean van Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (S.v.D.)
| | - Alastair G Proudfoot
- Department of Perioperative Medicine, Barts Heart Centre, London, UK (A.G.P.)
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Germany (A.G.P.)
| | - David Morrow
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (D.M.)
| | - Ernest Spitzer
- Cardialysis, Rotterdam, The Netherlands (E.S.)
- Cardiology Department, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands (E.S.)
| | - Graham Nichol
- University of Washington-Harborview Center for Prehospital Emergency Care, University of Washington Harborview Center, Seattle (G.N.)
| | - Myron L Weisfeldt
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.L.W.)
| | - Mauro Moscucci
- Office of Cardiovascular Devices, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (M.M., B.Z., A.F., J.S.S.)
| | - Patrick R Lawler
- Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, Canada (P.R.L.)
- McGill University Health Centre, Montreal, Canada (P.R.L.)
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada (P.R.L.)
| | - Alexandre Mebazaa
- Université Paris Cité, Department of Anesthesiology and Critical Care Medicine, Hôpital Lariboisière, France (A.M.)
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada (E.F.)
| | - Neal W Dickert
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.W.D.)
| | - Marc Samsky
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (M.S.)
| | - Robert Kormos
- Global Medical Affairs Heart Failure, Abbott Laboratories, Austin, TX (R.K.)
| | - Ileana L Piña
- Division of Cardiology, Thomas Jefferson University, Philadelphia, PA (I.L.P.)
| | - Bram Zuckerman
- Office of Cardiovascular Devices, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (M.M., B.Z., A.F., J.S.S.)
| | - Andrew Farb
- Office of Cardiovascular Devices, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (M.M., B.Z., A.F., J.S.S.)
| | - John S Sapirstein
- Office of Cardiovascular Devices, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (M.M., B.Z., A.F., J.S.S.)
| | | | | | - Abdulla A Damluji
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA (A.A.D.)
| | - Ian C Gilchrist
- Department of Interventional Cardiology/Heart and Vascular Institute, Penn State Health/Hershey Medical Center (I.C.G.)
| | - Uwe Zeymer
- Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z.)
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Germany (H.T.)
- Leipzig Heart Science, Germany (H.T.)
| | - Donald E Cutlip
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston MA (D.E.C.)
| | - Mitchell Krucoff
- Department of Medicine, Duke University School of Medicine, Durham, NC (M.K.)
| | - William T Abraham
- Division of Cardiovascular Medicine and the Davis Heart and Lung Research Institute, The Ohio State University College of Medicine/Ohio State University Wexner Medical Center, Columbus (W.T.A.)
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Cheema HA, Shafiee A, Jafarabady K, Seighali N, Shahid A, Ahmad A, Ahmad I, Ahmad S, Pahuja M, Dani SS. Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A meta-analysis of randomized controlled trials. Pacing Clin Electrophysiol 2023; 46:1246-1250. [PMID: 37697953 DOI: 10.1111/pace.14820] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/15/2023] [Accepted: 09/04/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Extracorporeal cardiopulmonary resuscitation (ECPR) is a resuscitation method for patients with refractory out-of-hospital cardiac arrest (OHCA). However, evidence from randomized controlled trials (RCTs) is lacking. METHODS We searched several electronic databases until March 2023 for RCTs comparing ECPR with conventional CPR in OHCA patients. RevMan 5.4 was used to pool risk ratios (RR) with 95% confidence intervals (CIs). RESULTS A total of four RCTs were included. The results of our meta-analysis showed no statistically significant benefit of ECPR regarding mid-term survival (RR 1.21; 95% CI 0.64 to 2.28; I2 = 48%; p = .55). We found a significant improvement with ECPR in mid-term favorable neurological outcome (RR 1.59; 95% CI 1.09 to 2.33; I2 = 0%; p = .02). There was no significant difference between ECPR and conventional CPR in long-term survival (RR 1.32; 95% CI 0.18 to 9.50; I2 = 64%; p = .79), and long-term favorable neurological outcome (RR 1.47; 95% CI 0.89 to 2.43; I2 = 25%; p = .13). There was an increased incidence of adverse events in the ECPR group (RR 3.22; 95% CI 1.18 to 8.80; I2 = 63%; p = .02). CONCLUSION ECPR in OHCA patients was not associated with improved survival or long-term favorable neurological outcome but did improve favorable neurological outcome in the mid-term. However, these results are likely underpowered due to the small number of available RCTs. Large-scale confirmatory RCTs are needed to provide definitive conclusions.
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Affiliation(s)
| | - Arman Shafiee
- Clinical Research Development Unit, Alborz University of Medical Sciences, Karaj, Iran
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Kyana Jafarabady
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Niloofar Seighali
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Abia Shahid
- Department of Cardiology, King Edward Medical University, Lahore, Pakistan
| | - Adeel Ahmad
- Department of Internal Medicine, Mass General Brigham - Salem Hospital, Salem, Massachusetts, USA
| | - Imama Ahmad
- Division of Pulmonary and Critical Care, Cleveland Clinic, Cleveland, Ohio, USA
| | - Soban Ahmad
- Department of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Mohit Pahuja
- Department of Cardiology, University of Oklahoma College of Medicine, Oklahoma, Oklahoma, USA
| | - Sourbha S Dani
- Division of Cardiovascular Medicine, Beth Israel Lahey Health, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
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Kanwar MK, Blumer V, Zhang Y, Sinha SS, Garan AR, Hernandez-Montfort J, Khalif A, Hickey GW, Abraham J, Mahr C, Li B, Sangal P, Walec KD, Zazzali P, Kataria R, Pahuja M, Ton VANK, Harwani NM, Wencker D, Nathan S, Vorovich E, Hall S, Khalife W, Li S, Schwartzman A, Kim JU, Vishnevsky OA, Trinquart L, Burkhoff D, Kapur NK. Pulmonary Artery Catheter Use and Risk of In-hospital Death in Heart Failure Cardiogenic Shock. J Card Fail 2023; 29:1234-1244. [PMID: 37187230 DOI: 10.1016/j.cardfail.2023.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 03/16/2023] [Revised: 04/29/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Pulmonary artery catheters (PACs) are increasingly used to guide management decisions in cardiogenic shock (CS). The goal of this study was to determine if PAC use was associated with a lower risk of in-hospital mortality in CS owing to acute heart failure (HF-CS). METHODS AND RESULTS This multicenter, retrospective, observational study included patients with CS hospitalized between 2019 and 2021 at 15 US hospitals participating in the Cardiogenic Shock Working Group registry. The primary end point was in-hospital mortality. Inverse probability of treatment-weighted logistic regression models were used to estimate odds ratios (ORs) and corresponding 95% confidence intervals (CI), accounting for multiple variables at admission. The association between the timing of PAC placement and in-hospital death was also analyzed. A total of 1055 patients with HF-CS were included, of whom 834 (79%) received a PAC during their hospitalization. In-hospital mortality risk for the cohort was 24.7% (n = 261). PAC use was associated with lower adjusted in-hospital mortality risk (22.2% vs 29.8%, OR 0.68, 95% CI 0.50-0.94). Similar associations were found across SCAI stages of shock, both at admission and at maximum SCAI stage during hospitalization. Early PAC use (≤6 hours of admission) was observed in 220 PAC recipients (26%) and associated with a lower adjusted risk of in-hospital mortality compared with delayed (≥48 hours) or no PAC use (17.3% vs 27.7%, OR 0.54, 95% CI 0.37-0.81). CONCLUSIONS This observational study supports PAC use, because it was associated with decreased in-hospital mortality in HF-CS, especially if performed within 6 hours of hospital admission. CONDENSED ABSTRACT An observational study from the Cardiogenic Shock Working Group registry of 1055 patients with HF-CS showed that pulmonary artery catheter (PAC) use was associated with a lower adjusted in-hospital mortality risk (22.2% vs 29.8%, odds ratio 0.68, 95% confidence interval 0.50-0.94) compared with outcomes in patients managed without PAC. Early PAC use (≤6 hours of admission) was associated with a lower adjusted risk of in-hospital mortality compared with delayed (≥48 hours) or no PAC use (17.3% vs 27.7%, odds ratio 0.54, 95% confidence interval 0.37-0.81).
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Affiliation(s)
- Manreet K Kanwar
- Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Vanessa Blumer
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio
| | - Yijing Zhang
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Shashank S Sinha
- Inova Heart and Vascular Institute, Inova Fairfax Campus, Falls Church, Virginia
| | - Arthur R Garan
- Beth Israel Deaconess Medical Center, Boston, Massachusetts'
| | | | - Adnan Khalif
- Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Gavin W Hickey
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jacob Abraham
- Center for Cardiovascular Analytics, Research and Data Science, Providence Heart Institute, Portland, OR
| | - Claudius Mahr
- University of Washington Medical Center, Seattle, Washington
| | - Borui Li
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Paavni Sangal
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Karol D Walec
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Peter Zazzali
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Rachna Kataria
- Lifespan Cardiovascular Institute, Brown University, Providence, Rhode Island
| | - Mohit Pahuja
- University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - VAN-Khue Ton
- Massachusetts General Hospital, Boston, Massachusetts
| | - Neil M Harwani
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Detlef Wencker
- Baylor Scott & White Advanced Heart Failure Clinic, Dallas, Texas
| | | | | | - Shelley Hall
- Baylor Scott & White Advanced Heart Failure Clinic, Dallas, Texas
| | | | - Song Li
- University of Washington Medical Center, Seattle, Washington
| | | | - J U Kim
- Houston Methodist Research Institute, Houston, Texas
| | | | - Ludovic Trinquart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston and Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA
| | | | - Navin K Kapur
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts.
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Kshirsagar N, Pahuja M, Chatterjee NS, Kamboj VP. Gaps in translating basic science research from bench to bedside. Indian J Med Res 2023; 158:228-232. [PMID: 37815067 PMCID: PMC10720959 DOI: 10.4103/ijmr.ijmr_1665_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Indexed: 10/11/2023] Open
Affiliation(s)
- N. Kshirsagar
- ICMR-National Institute of Research in Reproductive & Child Health, Mumbai 400 012, Maharashtra, India
| | - M. Pahuja
- Division of Basic Medical Sciences, Indian Council of Medical Research, New Delhi 110 029, India
| | - N. S. Chatterjee
- Division of Basic Medical Sciences, Indian Council of Medical Research, New Delhi 110 029, India
| | - V. P. Kamboj
- Department of Reproductive Biology, Central Drug Research Institute, Lucknow 226 031, Uttar Pradesh, India
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Pahuja M, Kabir R, Johnson A, Ben-Dor I, Hashim HD, Satler LF, Sheikh FH, Bernardo NL, Waksman R. GENDER VARIATION IN CLINICAL OUTCOMES IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AND CARDIOGENIC SHOCK: ANALYSIS FROM LARGE US HEALTHCARE SYSTEM. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01571-1] [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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Hernandez-Montfort J, Kanwar M, Sinha SS, Garan AR, Blumer V, Kataria R, Whitehead EH, Yin M, Li B, Zhang Y, Thayer KL, Baca P, Dieng F, Harwani NM, Guglin M, Abraham J, Hickey G, Nathan S, Wencker D, Hall S, Schwartzman A, Khalife W, Li S, Mahr C, Kim J, Vorovich E, Pahuja M, Burkhoff D, Kapur NK. Clinical Presentation and In-Hospital Trajectory of Heart Failure and Cardiogenic Shock. JACC Heart Fail 2023; 11:176-187. [PMID: 36342421 DOI: 10.1016/j.jchf.2022.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Heart failure-related cardiogenic shock (HF-CS) remains an understudied distinct clinical entity. OBJECTIVES The authors sought to profile a large cohort of patients with HF-CS focused on practical application of the SCAI (Society for Cardiovascular Angiography and Interventions) staging system to define baseline and maximal shock severity, in-hospital management with acute mechanical circulatory support (AMCS), and clinical outcomes. METHODS The Cardiogenic Shock Working Group registry includes patients with CS, regardless of etiology, from 17 clinical sites enrolled between 2016 and 2020. Patients with HF-CS (non-acute myocardial infarction) were analyzed and classified based on clinical presentation, outcomes at discharge, and shock severity defined by SCAI stages. RESULTS A total of 1,767 patients with HF-CS were included, of whom 349 (19.8%) had de novo HF-CS (DNHF-CS). Patients were more likely to present in SCAI stage C or D and achieve maximum SCAI stage D. Patients with DNHF-CS were more likely to experience in-hospital death and in- and out-of-hospital cardiac arrest, and they escalated more rapidly to a maximum achieved SCAI stage, compared to patients with acute-on-chronic HF-CS. In-hospital cardiac arrest was associated with greater in-hospital death regardless of clinical presentation (de novo: 63% vs 21%; acute-on-chronic HF-CS: 65% vs 17%; both P < 0.001). Forty-five percent of HF-CS patients were exposed to at least 1 AMCS device throughout hospitalization. CONCLUSIONS In a large contemporary HF-CS cohort, we identified a greater incidence of in-hospital death and cardiac arrest as well as a more rapid escalation to maximum SCAI stage severity among DNHF-CS. AMCS use in HF-CS was common, with significant heterogeneity among device types. (Cardiogenic Shock Working Group Registry [CSWG]; NCT04682483).
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Affiliation(s)
| | - Manreet Kanwar
- Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Shashank S Sinha
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - A Reshad Garan
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Vanessa Blumer
- Duke University Medical Center, Durham, North Carolina, USA
| | - Rachna Kataria
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Michael Yin
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Borui Li
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Yijing Zhang
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Katherine L Thayer
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Paulina Baca
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Fatou Dieng
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Neil M Harwani
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Maya Guglin
- Indiana University Health Advanced Heart and Lung Care, Indianapolis, Indiana, USA
| | | | - Gavin Hickey
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Detlef Wencker
- Baylor Scott and White Health, Advanced Heart Disease Program, Temple, Texas, USA
| | - Shelley Hall
- Baylor Scott and White Advanced Heart Failure Clinic, Dallas, Texas, USA
| | | | - Wissam Khalife
- University of Texas Medical Branch, Galveston, Texas, USA
| | - Song Li
- University of Washington Medical Center, Seattle, Washington, USA
| | - Claudius Mahr
- University of Washington Medical Center, Seattle, Washington, USA
| | - Ju Kim
- Houston Methodist Research Institute, Houston, Texas, USA
| | | | - Mohit Pahuja
- Medstar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
| | | | - Navin K Kapur
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA.
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11
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Chehab O, Kanj A, Zeitoun R, Mir T, Shafi I, Pahuja M, Briasoulis A, Doria de Vasconcellos H, Minhas A, Varadarajan V, Wu C, Arbab-Zadeh A, Post WS, Wu KC, Lima JA. Association of HIV infection with clinical features and outcomes of patients with aortic aneurysms. Vasc Med 2022; 27:557-564. [PMID: 36190774 DOI: 10.1177/1358863x221122577] [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: 01/24/2023]
Abstract
Data on the characteristics and outcomes of hospitalized patients with aortic aneurysms (AA) and HIV remain scarce. This is a cohort study of hospitalized adult patients with a diagnosis of AA from 2013 to 2019 using the US National Inpatient Readmission Database. Patients with a diagnosis of HIV were identified. Our outcomes included trends in hospitalizations and comparison of clinical characteristics, complications, and mortality in patients with AA and HIV compared to those without HIV. Among 1,905,837 hospitalized patients with AA, 4416 (0.23%) were living with HIV. There was an overall age-adjusted increase in the rate of HIV among patients hospitalized with AA over the years (14-29 per 10,000 person-years; age-adjusted p-trend < 0.001). Patients with AA and HIV were younger than those without HIV (median age: 60 vs 76 years, p < 0.001) and were less likely to have a history of smoking, hypertension, dyslipidemia, diabetes mellitus, and obesity. Thoracic aortic aneurysms were more prevalent in those with HIV (37.5% vs 26.7%, p < 0.001). On multivariable logistic regression, HIV was not associated with increased risk of aortic rupture (OR: 0.79; 95% CI: 0.61-1.01, p = 0.06), acute aortic dissection (OR: 0.73; 95% CI: 0.51-1.06, p = 0.3), readmissions (OR: 1.04; 95% CI: 0.95-1.13, p = 0.4), or aortic repair (OR: 0.89; 95% CI: 0.79-1.00, p = 0.05). Hospitalized patients with AA and HIV had a lower crude mortality rate compared to those without HIV (OR: 0.75 (0.63-0.91), p = 0.003). Hospitalized patients with AA and HIV likely constitute a distinct group of patients with AA; they are younger, have fewer traditional cardiovascular risk factors, and a higher rate of thoracic aorta involvement. Differences in clinical features may account for the lower mortality rate observed in patients with AA and HIV compared to those without HIV.
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Affiliation(s)
- Omar Chehab
- Department of Medicine, Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amjad Kanj
- Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, MN, USA
| | - Ralph Zeitoun
- Department of Medicine, Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tanveer Mir
- Department of Internal Medicine, Wayne State University / Detroit Medical Center, Detroit, MI, USA
| | - Irfan Shafi
- Department of Internal Medicine, Wayne State University / Detroit Medical Center, Detroit, MI, USA.,Department of Internal Medicine, Division of Cardiology, Wayne State University / Detroit Medical Center, Detroit, MI, USA
| | - Mohit Pahuja
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Alexandros Briasoulis
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | - Anum Minhas
- Department of Medicine, Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vinithra Varadarajan
- Department of Medicine, Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Colin Wu
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Armin Arbab-Zadeh
- Department of Medicine, Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wendy S Post
- Department of Medicine, Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katherine C Wu
- Department of Medicine, Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - João Ac Lima
- Department of Medicine, Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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12
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Pahuja M, Tuli A, Kallur A, Saxena A, Johnson A, Zhang C, Rappaport S, Hashim H, Satler L, Ben-Dor I, Waksman R. TCT-95 Role of Pulmonary Artery Catheter Utilization in Different SCAI Classifications in Patients With Acute Myocardial Infarction and Cardiogenic Shock: Analysis From a Large US Healthcare System. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.115] [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: 10/14/2022]
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13
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Pahuja M, Case BC, Molina EJ, Waksman R. Overview of the FDA's Circulatory System Devices Panel virtual meeting on the TransMedics Organ Care System (OCS) Heart - portable extracorporeal heart perfusion and monitoring system. Am Heart J 2022; 247:90-99. [PMID: 35150637 DOI: 10.1016/j.ahj.2022.02.003] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/11/2022] [Accepted: 02/03/2022] [Indexed: 11/18/2022]
Abstract
There are a limited number of donor hearts available for transplantation every year, and an even lower number of these hearts actually undergo transplantation. One of the barriers to utilizing donor hearts is the inferior outcomes associated with prolonged ischemic times. There have been increasing attempts to develop alternative techniques for prolonged storage to raise the number of heart transplants while maintaining acceptable outcomes. One such new technology utilizes continuous ex vivo perfusion of the donor heart with oxygenated blood and allows for prolonged storage and preservation times. The TransMedics Organ Care System (OCS) Heart (TransMedics; Andover, MA) claims to optimize the condition of the donor organs by preserving them in a warm, functioning environment. On April 6, 2021, the United States Food and Drug Administration convened a virtual meeting of the Circulatory System Devices Panel of the Medical Devices Advisory Committee to provide guidance on the TransMedics OCS Heart System's application for premarket approval. This application was subsequently approved on September 7, 2021. We provide an overview of the meeting, including the results of the clinical trials that were presented.
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Affiliation(s)
- Mohit Pahuja
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Ezequiel J Molina
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
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14
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Yerasi C, Case BC, Pahuja M, Ben-Dor I, Waksman R. The Need for Additional Phenotyping When Defining Cardiogenic Shock. JACC Cardiovasc Interv 2022; 15:890-895. [PMID: 35450689 DOI: 10.1016/j.jcin.2021.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/12/2021] [Accepted: 12/21/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Charan Yerasi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Mohit Pahuja
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
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15
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Pahuja M, Leifer E, Clarke JR, Pina IL. The Impact Of Race And Ethnicity On Clinical Outcomes In Patients With Heart Failure(On Behalf Of The Guide-IT Steering Committee). J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.007] [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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16
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Pahuja M, Hernandez-Montfort J, Whitehead EH, Kawabori M, Kapur NK. Device profile of the Impella 5.0 and 5.5 system for mechanical circulatory support for patients with cardiogenic shock: overview of its safety and efficacy. Expert Rev Med Devices 2021; 19:1-10. [PMID: 34894975 DOI: 10.1080/17434440.2022.2015323] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Trans-valvular micro-axial flow pumps such as Impella are increasingly utilized in patients with cardiogenic shock [CS]. A number of different Impella devices are now available providing a wide range of cardiac output. Among these, the Impella 5.0 and recently introduced Impella 5.5 pumps can provides 5.55 L/min of flow, enabling complete left ventricular support with more favorable hemodynamic effects on myocardial oxygen consumption and left ventricular unloading. These devices require placement of a surgical conduit graft for endovascular delivery, but are increasingly being used in patients with CS due to acutely decompensated heart failure [ADHF], acute myocardial infarction [AMI] and after cardiac surgery as a bridge to transplant or durable ventricular assist device surgery or myocardial recovery. AREAS COVERED This review focuses on the device profile and use of the Impella 5.0 and 5.5 systems in patients with CS. Specifically; we reviewed the published literature for Impella 5.0 device to summarize data regarding safety and efficacy. EXPERT OPINION The Impella 5.0 and 5.5 are trans-valvular micro-axial flow pumps for which the current data suggest excellent safety and efficacy profiles as approaches to provide circulatory support, myocardial unloading, and axillary placement enabling patient mobilization and rehabilitation. ABBREVIATIONS pMCS, Percutaneous mechanical circulatory support devices; CS, Cardiogenic shock; ADHF, Acute decompensated heart failure; AMI, Acute myocardial infarction; LVAD, Left ventricular assist deviceI; ABP, Intra-aortic balloon pump; VA-ECLS, Veno-arterial extracorporeal life support.
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Affiliation(s)
- Mohit Pahuja
- Division of Cardiology, Medstar Heart and Vascular Institute, Georgetown University/Washington Hospital Center, Washington, USA
| | | | | | - Masashi Kawabori
- Division of Cardiothoracic Surgery, The Cardiovascular Center, Tufts Medical Center, Boston, USA
| | - Navin K Kapur
- Division of Cardiology, The Cardiovascular Center, Tufts Medical Center, Boston, USA
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17
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Pahuja M, Mony S, Adegbala O, Ben-Dor I, Waksman R. TCT-344 Incidence and Trend of Gastrointestinal Bleeding in Patients With Percutaneous Mechanical Circulatory Support Devices. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1197] [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: 11/27/2022]
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18
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Marbach JA, Stone S, Schwartz B, Pahuja M, Thayer KL, Faugno AJ, Chweich H, Rabinowitz JB, Kapur NK. Lactate Clearance Is Associated With Improved Survival in Cardiogenic Shock: A Systematic Review and Meta-Analysis of Prognostic Factor Studies. J Card Fail 2021; 27:1082-1089. [PMID: 34625128 DOI: 10.1016/j.cardfail.2021.08.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Elevated blood lactate levels are strongly associated with mortality in patients with cardiogenic shock. Recent evidence suggests that the degree and rate at which blood lactate levels decrease after the initiation of treatment may be equally important in patient prognosis. We performed a systematic review and meta-analysis to evaluate the usefulness of lactate clearance as a prognostic factor in cardiogenic shock. METHODS AND RESULTS We performed searches of Ovid MEDLINE, Elsevier EMBASE, EBM Reviews-Cochrane Central Register of Controlled Trials, and Web of Science to identify studies comparing lactate clearance between survivors and nonsurvivors at one or more timepoints. Both prospective and retrospective studies were eligible for inclusion. Two study investigators independently screened, extracted data, and assessed the quality of all included studies. Twelve studies were included in the meta-analysis. The median lactate clearance at 6-8 hours was 21.9% (interquartile range [IQR] 14.6%-42.1%) in survivors and 0.6% (IQR -3.7% to 14.6%) in nonsurvivors. At 24 hours, the median lactate clearance was 60.7% (IQR 58.1%-76.3%) and 40.3% (IQR 30.2%-55.8%) in survivors and nonsurvivors, respectively. Accordingly, the pooled mean difference in lactate clearance between survivors and nonsurvivors at 6-8 hours was 17.3% (95% CI 11.6%-23.1%, P < .001) at 6-8 hours and 27.9% (95% CI 14.1%-41.7%, P < .001) at 24 hours. CONCLUSIONS Survivors had significantly greater lactate clearance at 6-8 hours and at 24 hours compared with nonsurvivors, suggesting that lactate clearance is an important prognostic marker in cardiogenic shock.
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Affiliation(s)
- Jeffrey A Marbach
- The Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts; Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - Samuel Stone
- Department of Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - Benjamin Schwartz
- Department of Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - Mohit Pahuja
- Division of Cardiology, Medstar Georgetown University / Washington Hospital Center, Washington, DC
| | - Katherine L Thayer
- Department of Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - Anthony J Faugno
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - Haval Chweich
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - Judy B Rabinowitz
- Hirsh Health Sciences Library, Tufts University, Boston, Massachusetts
| | - Navin K Kapur
- The Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts; Department of Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts.
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19
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Abraham J, Blumer V, Burkhoff D, Pahuja M, Sinha SS, Rosner C, Vorovich E, Grafton G, Bagnola A, Hernandez-Montfort JA, Kapur NK. Heart Failure-Related Cardiogenic Shock: Pathophysiology, Evaluation and Management Considerations: Review of Heart Failure-Related Cardiogenic Shock. J Card Fail 2021; 27:1126-1140. [PMID: 34625131 DOI: 10.1016/j.cardfail.2021.08.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 06/06/2021] [Revised: 07/27/2021] [Accepted: 08/09/2021] [Indexed: 12/23/2022]
Abstract
Despite increasing prevalence in critical care units, cardiogenic shock related to HF (HF-CS) is incompletely understood and distinct from acute myocardial infarction related CS. This review highlights the pathophysiology, evaluation, and contemporary management of HF-CS.
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Affiliation(s)
- Jacob Abraham
- Providence Heart Institute, Center for Cardiovascular Analytics, Research, and Data Science (CARDS), Providence St. Joseph Health, Portland, Oregon
| | - Vanessa Blumer
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Dan Burkhoff
- Cardiovascular Research Foundation, New York, New York
| | - Mohit Pahuja
- Medstar Georgetown University Hospital, Washington, D.C
| | - Shashank S Sinha
- Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, Virginia
| | | | | | - Gillian Grafton
- The Ohio State University Wexner Medical Center, Department of Pharmacy, Columbus, Ohio
| | - Aaron Bagnola
- Heart and Vascular Institute, Cleveland Clinic Florida, Weston, Florida
| | | | - Navin K Kapur
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts.
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20
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Jain P, Thayer KL, Abraham J, Everett KD, Pahuja M, Whitehead EH, Schwartz BP, Lala A, Sinha SS, Kanwar MK, Garan AR, Hernandez-Monfort JA, Mahr C, Vorovich E, Wencker D, McCabe JM, Jones T, Goud M, Baca P, Harwani N, Burkhoff D, Kapur NK. Right Ventricular Dysfunction Is Common and Identifies Patients at Risk of Dying in Cardiogenic Shock. J Card Fail 2021; 27:1061-1072. [PMID: 34625126 DOI: 10.1016/j.cardfail.2021.07.013] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Understanding the prognostic impact of right ventricular dysfunction (RVD) in cardiogenic shock (CS) is a key step toward rational diagnostic and treatment algorithms and improved outcomes. Using a large multicenter registry, we assessed (1) the association between hemodynamic markers of RVD and in-hospital mortality, (2) the predictive value of invasive hemodynamic assessment incorporating RV evaluation, and (3) the impact of RVD severity on survival in CS. METHODS AND RESULTS Inpatients with CS owing to acute myocardial infarction (AMI) or heart failure (HF) between 2016 and 2019 were included. RV parameters (right atrial pressure, right atrial/pulmonary capillary wedge pressure [RA/PCWP], pulmonary artery pulsatility index [PAPI], and right ventricular stroke work index [RVSWI]) were assessed between survivors and nonsurvivors, and between etiology and SCAI stage subcohorts. Multivariable logistic regression analysis determined hemodynamic predictors of in-hospital mortality; the resulting models were compared with SCAI staging alone. Nonsurvivors had a significantly higher right atrial pressure and RA/PCWP and lower PAPI and RVSWI than survivors, consistent with more severe RVD. Compared with AMI, patients with HF had a significantly lower RA/PCWP (0.58 vs 0.66, P = .001) and a higher PAPI (2.71 vs 1.78, P < .001) and RVSWI (5.70 g-m/m2 vs 4.66 g-m/m2, P < .001), reflecting relatively preserved RV function. Paradoxically, multiple RVD parameters (PAPI, RVSWI) were associated with mortality in the HF but not the AMI cohort. RVD was more severe with advanced SCAI stage, although its prognostic value was progressively diluted in stages D and E. Multivariable modelling incorporating the RA/PCWP improved the predictive value of SCAI staging (area under the curve [AUC] 0.78 vs 0.73, P < .001), largely driven by patients with HF (AUC 0.82 vs 0.71, P < .001). CONCLUSIONS RVD is associated with poor outcomes in CS, with key differences across etiology and shock severity. Further studies are needed to assess the usefulness of RVD assessment in guiding therapy.
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Affiliation(s)
- Pankaj Jain
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts
| | | | - Jacob Abraham
- Center for Cardiovascular Analytics, Research, and Data Science (CARDS), Portland, OR
| | - Kay D Everett
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Mohit Pahuja
- Division of Cardiology, Medstar Washington Hospital Center, Washington, DC
| | - Evan H Whitehead
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Anuradha Lala
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York
| | - Shashank S Sinha
- Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, Virginia
| | - Manreet K Kanwar
- Cardiovascular Institute at Allegheny Health Network, Pittsburgh, PA
| | - A Reshad Garan
- Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | | | - Claudius Mahr
- Department of Medicine, University of Washington, Seattle, Washington
| | - Esther Vorovich
- Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Detlef Wencker
- Department of Medicine, Division of Cardiology, Baylor Scott & White Advanced Heart Failure Clinic, Dallas, Texas
| | - James M McCabe
- Department of Medicine, University of Washington, Seattle, Washington
| | - Tara Jones
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah
| | - Maithri Goud
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Paulina Baca
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Neil Harwani
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts
| | | | - Navin K Kapur
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts.
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21
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Stone S, Schwartz B, Marbach J, Faugno A, Chweich H, Thayer K, Pahuja M, Kapur N. LACTATE CLEARANCE PREDICTS MORTALITY IN CARDIOGENIC SHOCK: A SYSTEMATIC REVIEW AND META-ANALYSIS. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.050] [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] Open
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22
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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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23
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Brener MI, Hamid NB, Fried JA, Masoumi A, Raikhelkar J, Kanwar MK, Pahuja M, Mondellini GM, Braghieri L, Majure DT, Colombo PC, Yuzefpolskaya M, Sayer GT, Uriel N, Burkhoff D. Right Ventricular Pressure-Volume Analysis During Left Ventricular Assist Device Speed Optimization Studies: Insights Into Interventricular Interactions and Right Ventricular Failure. J Card Fail 2021; 27:991-1001. [PMID: 33989781 DOI: 10.1016/j.cardfail.2021.04.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 02/05/2021] [Revised: 03/30/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Interventricular interaction, which refers to the impact of left ventricular (LV) function on right ventricular (RV) function and vice versa, has been implicated in the pathogenesis of RV failure in LV assist device (LVAD) recipients. We sought to understand more about interventricular interaction by quantifying changes in the RV systolic and diastolic function with varying LVAD speeds. METHODS AND RESULTS Four patients (ages 22-69 years, 75% male, and 25% with ischemic cardiomyopathy) underwent a protocolized hemodynamic ramp test within 12 months of LVAD implantation where RV pressure-volume loops were recorded with a conductance catheter. The end-systolic PV relationship and end-diastolic PV relationship were compared using the V20 and V10 indices (volumes at which end-systolic PV relationship and end-diastolic PV relationship reach a pressure of 20 and 10 mm Hg, respectively). The ∆V20 and ∆V10 refer to the change in V20 and V10 from the minimum to maximum LVAD speeds. RV PV loops demonstrated variable changes in systolic and diastolic function with increasing LVAD speed. The end-systolic PV relationship changed in 1 patient (patient 2, ∆V20 = 23.5 mL), reflecting a decrease in systolic function with increased speed, and was unchanged in 3 patients (average ∆V20 = 7.4 mL). The end-diastolic PV relationship changed with increasing speed in 3 of 4 patients (average ∆V10 = 12.5 mL), indicating an increase in ventricular compliance, and remained unchanged in one participant (patient 1; ∆V10 = 4.0 mL). CONCLUSIONS Interventricular interaction can improve RV compliance and impair systolic function, but the overall effect on RV performance in this pilot investigation is heterogeneous. Further research is required to understand which patient characteristics and hemodynamic parameters influence the net impact of interventricular interaction.
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Affiliation(s)
- Michael I Brener
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital in New York, New York, New York.
| | - Nadira B Hamid
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital in New York, New York, New York
| | - Justin A Fried
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital in New York, New York, New York
| | - Amirali Masoumi
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital in New York, New York, New York
| | - Jayant Raikhelkar
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital in New York, New York, New York
| | - Manreet K Kanwar
- Cardiovascular Institute at Alleghany Health Network in Pittsburgh, Pennsylvania
| | - Mohit Pahuja
- Division of Cardiology, MedStar Georgetown University/Washington Hospital Center in Washington, DC
| | - Giulio M Mondellini
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital in New York, New York, New York
| | - Lorenzo Braghieri
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital in New York, New York, New York
| | - David T Majure
- Division of Cardiology, Weill Cornell University-New York Presbyterian Hospital in New York, New York
| | - Paolo C Colombo
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital in New York, New York, New York
| | - Melana Yuzefpolskaya
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital in New York, New York, New York
| | - Gabriel T Sayer
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital in New York, New York, New York
| | - Nir Uriel
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital in New York, New York, New York
| | - Daniel Burkhoff
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital in New York, New York, New York; Cardiovascular Research Foundation in New York, New York
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24
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Hernandez-Montfort J, Sinha SS, Thayer KL, Whitehead EH, Pahuja M, Garan AR, Mahr C, Haywood JL, Harwani NM, Schaeffer A, Wencker D, Kanwar M, Vorovich E, Abraham J, Burkhoff D, Kapur NK. Clinical Outcomes Associated With Acute Mechanical Circulatory Support Utilization in Heart Failure Related Cardiogenic Shock. Circ Heart Fail 2021; 14:e007924. [PMID: 33905259 DOI: 10.1161/circheartfailure.120.007924] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [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
BACKGROUND Cardiogenic shock occurring in the setting of advanced heart failure (HF-CS) is increasingly common. However, recent studies have focused almost exclusively on acute myocardial infarction-related CS. We sought to define clinical, hemodynamic, metabolic, and treatment parameters associated with clinical outcomes among patients with HF-CS, using data from the Cardiogenic Shock Working Group registry. METHODS Patients with HF-CS were identified from the multicenter Cardiogenic Shock Working Group registry and divided into 3 outcome categories assessed at hospital discharge: mortality, heart replacement therapy (HRT: durable ventricular assist device or orthotopic heart transplant), or native heart survival. Clinical characteristics, hemodynamic, laboratory parameters, drug therapies, acute mechanical circulatory support device (AMCS) utilization, and Society of Cardiovascular Angiography and Intervention stages were compared across the 3 outcome cohorts. RESULTS Of the 712 patients with HF-CS identified, 180 (25.3%) died during their index admission, 277 (38.9%) underwent HRT (durable ventricular assist device or orthotopic heart transplant), and 255 (35.8%) experienced native heart survival without HRT. Patients who died had the highest right atrial pressure and heart rate and the lowest mean arterial pressure of the 3 outcome groups (P<0.01 for all). Biventricular and isolated left ventricular congestion were common among patients who died or underwent HRT, respectively. Lactate, blood urea nitrogen, serum creatinine, and aspartate aminotransferase were highest in patients with HF-CS experiencing in-hospital death. Intraaortic balloon pump was the most commonly used AMCS device in the overall cohort and among patients receiving HRT. Patients receiving >1 AMCS device had the highest in-hospital mortality rate irrespective of the number of vasoactive drugs used. Mortality increased with deteriorating Society of Cardiovascular Angiography and Intervention stages (stage B: 0%, stage C: 10.7%, stage D: 29.4%, stage E: 54.5%, 1-way ANOVA=<0.001). CONCLUSIONS Patients with HF-CS experiencing in-hospital mortality had a high prevalence of biventricular congestion and markers of end-organ hypoperfusion. Substantial heterogeneity exists with use of AMCS in HF-CS with intraaortic balloon pump being the most common device used and high rates of in-hospital mortality after exposure to >1 AMCS device.
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Affiliation(s)
| | - Shashank S Sinha
- Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, VA (S.S.S.)
| | - Katherine L Thayer
- The Cardiovascular Center, Tufts Medical Center, Boston, MA (K.L.T., J.L.H., N.M.H., N.K.K.)
| | | | - Mohit Pahuja
- Medstar Georgetown University Hospital, Washington, D.C. (M.P.)
| | | | - Claudius Mahr
- University of Washington Medical Center, Seattle (C.M.)
| | - Jillian L Haywood
- The Cardiovascular Center, Tufts Medical Center, Boston, MA (K.L.T., J.L.H., N.M.H., N.K.K.)
| | - Neil M Harwani
- The Cardiovascular Center, Tufts Medical Center, Boston, MA (K.L.T., J.L.H., N.M.H., N.K.K.)
| | | | - Detlef Wencker
- Baylor Scott & White Advanced Heart Failure Clinic, Dallas, TX (D.W.)
| | | | | | | | | | - Navin K Kapur
- The Cardiovascular Center, Tufts Medical Center, Boston, MA (K.L.T., J.L.H., N.M.H., N.K.K.)
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25
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Hernandez-Montfort J, Sinha S, Thayer K, Whitehead E, Pahuja M, Garan A, Mahr C, Haywood J, Harwani N, Schaeffer A, Kanwar M, Burkhoff D, Kapur N. Clinical Outcomes Associated with Acute Mechanical Circulatory Support Utilization in Heart Failure Related Cardiogenic Shock. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.406] [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: 10/21/2022] Open
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26
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Jain P, Thayer K, Whitehead E, Everett K, Schwartz B, Pahuja M, Kanwar M, Sinha S, Garan A, Hernandez-Montfort J, Mahr C, Burkhoff D, Kapur N. Identifying Right Ventricular Dysfunction Increases the Predictive Value of SCAI Staging: A Case for an ‘R’ Modifier. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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27
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Shereef H, Subahi A, Pahuja M, Afonso L. Unusual transmitral Doppler filling profile induced by right ventricular pacing. BMJ Case Rep 2021; 14:e242539. [PMID: 33766979 PMCID: PMC8006843 DOI: 10.1136/bcr-2021-242539] [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] [Accepted: 03/13/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Hammam Shereef
- Internal Medicine, Beaumont Hospital Dearborn, Dearborn, Michigan, USA
| | - Ahmed Subahi
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan, USA
| | - Mohit Pahuja
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan, USA
| | - Luis Afonso
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan, USA
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28
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Mir T, Prakash P, Sattar Y, Ahmad U, Pervez E, Javed A, Khan MS, Ullah W, Pacha HM, Pahuja M, Lohia P, Alraies MC. Takotsubo syndrome vs anterior STEMI electrocardiography; a meta-analysis and systematic review. Expert Rev Cardiovasc Ther 2020; 18:819-825. [PMID: 32880506 DOI: 10.1080/14779072.2020.1813027] [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: 10/23/2022]
Abstract
BACKGROUND Takotsubo syndrome (TTS) and its differentiation from anterior wall ST-elevation myocardial infarction on electrocardiography (ECG) has been a debate. METHODS Six studies comparing ECG changes in TTS and AW-STEMI were identified. The primary endpoint was reciprocal changes, presence of Q-waves, and QT-interval. An unadjusted odds ratio (OR) with a 95% confidence interval (CI) was calculated using Review Manager (RevMan) 5.3. RESULTS Six studies consisting of 1090 patients (TTS = 220, AW-STEMI = 870) were included. Reciprocal changes on ECG were less commonly associated with TTS than AW STEMI with OR of 0.05 and 95%CI- 0.02-0.11 (P-<0.00001). Q-wave presence on ECG was comparable between the groups with OR-0.68, 95%CI-0.08-5.63 (p-0.72). QT interval on ECG was comparable between the two groups with OR-1.09, 95%CI-0.63-1.54 (p-<0.00001). There was minimal publication bias among the studies. CONCLUSION AW STEMI is associated with reciprocal changes. Q-waves and QT interval has no differentiating significance between AW STEMI and TTS.
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Affiliation(s)
- Tanveer Mir
- Internal Medicine Department, Detroit Medical Center, Wayne State University , Detroit, USA
| | - Preeya Prakash
- Internal Medicine Department, Detroit Medical Center, Wayne State University , Detroit, USA
| | - Yasar Sattar
- Icahn School of Medicine at Mount Sinai Elmhurst Hospital , New York, USA
| | - Usman Ahmad
- Internal Medicine Department, Detroit Medical Center, Wayne State University , Detroit, USA
| | - Eskara Pervez
- Internal Medicine Department, Detroit Medical Center, Wayne State University , Detroit, USA
| | - Aamer Javed
- Internal Medicine Department, Detroit Medical Center, Wayne State University , Detroit, USA
| | - Muhammad Shayan Khan
- Internal Medicine Residency, Mercy St Vincent Medical Centre , Toledo, Ohio, USA
| | - Waqas Ullah
- Internal medicine, Abington Jefferson Health , Abington, PA, USA
| | - Homam Mossa Pacha
- Macgoven Medical School, University of Texas Health Science Center , Texas, USA
| | - Mohit Pahuja
- Cardiovascular Medicine, Detroit Medical Center, Wayne State University , Detroit, USA
| | - Prateek Lohia
- Internal Medicine Department, Detroit Medical Center, Wayne State University , Detroit, USA
| | - M Chadi Alraies
- Cardiovascular Medicine, Detroit Medical Center, Wayne State University , Detroit, USA
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29
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Chehab O, Morsi RZ, Kanj A, Rachwan RJ, Pahuja M, Mansour S, Tabaja H, Ahmad U, Zein SE, Raad M, Saker A, Alvarez P, Briasoulis A. Incidence and clinical outcomes of nosocomial infections in patients presenting with STEMI complicated by cardiogenic shock in the United States. Heart Lung 2020; 49:716-723. [PMID: 32866743 DOI: 10.1016/j.hrtlng.2020.08.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/31/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study addresses the incidence, trends, and impact of nosocomial infections (NI) on the outcomes of patients admitted with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock (STEMI-CS) using the United States National Inpatient Sample (NIS) database. METHODS We analyzed data from 105,184 STEMI-CS patients using the NIS database from the years 2005-2014. NI was defined as infections of more than or equal to three days, comprising of central line-associated bloodstream infection (CLABSI), urinary tract infection (UTI), hospital-acquired pneumonia (HAP), Clostridium difficile infection (CDI), bacteremia, and skin related infections. Outcomes of the impact of NI on STEMI-CS included in-hospital mortality, length of hospital stay (LOS) and costs. Significant associations of NI in patients admitted with STEMI-CS were also identified. RESULTS Overall, 19.1% (20,137) of patients admitted with STEMI-CS developed NI. Trends of NI have decreased from 2005-2014. The most common NI were UTI (9.2%), followed by HAP (6.8%), CLABSI (1.5%), bacteremia (1.5%), skin related infections (1.5%), and CDI (1.3%). The strongest association of developing a NI was increasing LOS (7-9 days; OR: 1.99; 95% CI: 1.75-2.26; >9 days; OR: 4.51; 95% CI: 4.04-5.04 compared to 4-6 days as reference). Increased mortality risk among patients with NI was significant, especially those with sepsis-associated NI compared to those without sepsis (OR: 2.95; 95% CI: 2.72-3.20). Patients with NI were found to be associated with significantly longer LOS and higher costs, irrespective of percutaneous mechanical circulatory support placement. CONCLUSIONS NI were common among patients with STEMI-CS. Those who developed NI were at a greater risk of in-hospital mortality, increased LOS and costs.
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Affiliation(s)
- Omar Chehab
- Department of Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan, USA.
| | - Rami Z Morsi
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Amjad Kanj
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rayan Jo Rachwan
- Department of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Mohit Pahuja
- Department of Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Shareef Mansour
- Division of Cardiovascular Medicine, Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Hussam Tabaja
- Department of Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Usman Ahmad
- Department of Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Said El Zein
- Department of Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Mohammad Raad
- Division of Cardiology, Department of Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ali Saker
- Department of Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Paulino Alvarez
- Division of Cardiovascular Medicine, Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Alexandros Briasoulis
- Division of Cardiovascular Medicine, Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
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30
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Sattar Y, Ullah W, Rauf H, Virk HUH, Yadav S, Chowdhury M, Connerney M, Mamtani S, Pahuja M, Patel RD, Mir T, Almas T, Moussa Pacha H, Chadi Alraies M. COVID-19 cardiovascular epidemiology, cellular pathogenesis, clinical manifestations and management. Int J Cardiol Heart Vasc 2020; 29:100589. [PMID: 32724831 PMCID: PMC7359794 DOI: 10.1016/j.ijcha.2020.100589] [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: 05/29/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 02/08/2023]
Abstract
Coronavirus Disease 2019 (COVID-19) is a rapidly progressing global pandemic that may present with a variety of cardiac manifestations including, but not limited to, myocardial injury, myocardial infarction, arrhythmias, heart failure, cardiomyopathy, shock, thromboembolism, and cardiac arrest. These cardiovascular effects are worse in patients who have pre-existing cardiac conditions such as coronary artery disease, hypertension, diabetes mellitus, and coagulation abnormalities. Other predisposing risk factors include advanced age, immunocompromised state, and underlying systemic inflammatory conditions. Here we review the cellular pathophysiology, clinical manifestations and treatment modalities of the cardiac manifestations seen in patients with COVID-19.
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Affiliation(s)
- Yasar Sattar
- Internal Medicine, Icahn School of Medicine at Mount Sinai – Elmhurst Hospital, NY, USA
| | - Waqas Ullah
- Internal Medicine, Abington Jefferson Health, PA, USA
| | - Hiba Rauf
- Internal Medicine, American Society of Clinical Oncology, VA, USA
| | - Hafeez ul Hassan Virk
- Interventional Cardiology, Case Western Reserve University/University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
| | - Sunita Yadav
- Internal Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY, USA
| | - Medhat Chowdhury
- Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Michael Connerney
- Internal Medicine, Icahn School of Medicine at Mount Sinai – Elmhurst Hospital, NY, USA
| | - Sahil Mamtani
- Internal Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY, USA
| | - Mohit Pahuja
- Internal Medicine, Rochester General Hospital, Rochester, NY, USA
- Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Raj D. Patel
- Detroit Medical Center, Wayne State University, Detroit, MI, USA
- University of Illinois College of Medicine Peoria, Chicago, IL, USA
| | - Tanveer Mir
- Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Talal Almas
- Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Homam Moussa Pacha
- Cardiology Department, University of Texas, Memorial Hermann Heart and Vascular Institute, Houston, TX, USA
| | - M. Chadi Alraies
- Detroit Medical Center, Wayne State University, Detroit, MI, USA
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31
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Kapur NK, Whitehead EH, Thayer KL, Pahuja M. The science of safety: complications associated with the use of mechanical circulatory support in cardiogenic shock and best practices to maximize safety. F1000Res 2020; 9. [PMID: 32765837 PMCID: PMC7391013 DOI: 10.12688/f1000research.25518.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 12/16/2022] Open
Abstract
Acute mechanical circulatory support (MCS) devices are widely used in cardiogenic shock (CS) despite a lack of high-quality clinical evidence to guide their use. Multiple devices exist across a spectrum from modest to complete support, and each is associated with unique risks. In this review, we summarize existing data on complications associated with the three most widely used acute MCS platforms: the intra-aortic balloon pump (IABP), Impella systems, and veno-arterial extracorporeal membrane oxygenation (VA-ECMO). We review evidence from available randomized trials and highlight challenges comparing complication rates from case series and comparative observational studies where a lack of granular data precludes appropriate matching of patients by CS severity. We further offer a series of best practices to help shock practitioners minimize the risk of MCS-associated complications and ensure the best possible outcomes for patients.
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Affiliation(s)
- Navin K Kapur
- The Cardiovascular Center for Research and Innovation, Tufts Medical Center, Boston, MA, USA
| | - Evan H Whitehead
- The Cardiovascular Center for Research and Innovation, Tufts Medical Center, Boston, MA, USA
| | - Katherine L Thayer
- The Cardiovascular Center for Research and Innovation, Tufts Medical Center, Boston, MA, USA
| | - Mohit Pahuja
- Division of Cardiology, Detroit Medical Center/Wayne State University School of Medicine, Detroit, MI, USA
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32
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Pahuja M, Ranka S, Chehab O, Mishra T, Akintoye E, Adegbala O, Yassin AS, Ando T, Thayer KL, Shah P, Kimmelstiel CD, Salehi P, Kapur NK. Incidence and clinical outcomes of bleeding complications and acute limb ischemia in STEMI and cardiogenic shock. Catheter Cardiovasc Interv 2020; 97:1129-1138. [PMID: 32473083 DOI: 10.1002/ccd.29003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Received: 02/05/2020] [Revised: 04/22/2020] [Accepted: 05/12/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Bleeding complications and acute limb ischemia (ALI) are devastating vascular complications in patients with ST-segment elevation myocardial infarction (STEMI). Cardiogenic shock (CS) can further increase this risk due to multiorgan failure. In the contemporary era, percutaneous mechanical circulatory support is commonly used for management of CS. We hypothesized that vascular complications may be an important determinant of clinical outcomes for CS due to STEMI (CS-STEMI). OBJECTIVE We evaluated 10-year national trends, resource utilization and outcomes of bleeding complications, and ALI in CS-STEMI. METHODS We performed a retrospective cohort study of CS-STEMI patients from a large U.S. national database (National Inpatient Sample) between 2005 and 2014. Events were then divided into four different groups: no MCS, with intra-aortic balloon pump, percutaneous ventricular assist device includes Impella or Tandem Heart or extracorporeal membrane oxygenation. RESULTS Bleeding complications and ALI were observed in 31,389 (18.2%) and 1,628 (0.9%) out of 172,491 admissions with CS-STEMI, respectively. Between 2005 and 2014, overall trends increased for ALI; however, the number of bleeding events decreased. ALI was associated with increased in-hospital mortality in comparison to those without any ALI. However, bleeding complications were not associated with increased in-hospital mortality. Compared to patients without complications, both bleeding and ALI were associated with increased length of stay (LOS) and hospitalization costs. CONCLUSIONS Bleeding and ALI are common complications associated with CS-STEMI in the contemporary era. Both complications are associated with increased hospital costs and LOS. These findings highlight the need to develop algorithms focused on vascular safety in CS-STEMI.
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Affiliation(s)
- Mohit Pahuja
- Division of Cardiology, Department of Internal Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Sagar Ranka
- Division of Cardiology, Department of Internal Medicine, Kansas University Medical Center, Kansas, Kansas, USA
| | - Omar Chehab
- Department of Internal Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Tushar Mishra
- Department of Internal Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Emmanuel Akintoye
- Division of Cardiology, Department of Internal Medicine, University of Iowa Medical Center, Iowa, Iowa, USA
| | - Oluwole Adegbala
- Division of Cardiology, Department of Internal Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Ahmed S Yassin
- Department of Internal Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Tomo Ando
- Division of Cardiology, Department of Internal Medicine, Columbia University Medical Center, New York, New York, USA
| | - Katherine L Thayer
- Division of Cardiology, Department of Internal Medicine, Tuft University Medical Center, Boston, Massachusetts, USA
| | - Palak Shah
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, Virginia, USA
| | - Carey D Kimmelstiel
- Division of Cardiology, Department of Internal Medicine, Tuft University Medical Center, Boston, Massachusetts, USA
| | - Payam Salehi
- Division of Cardiology, Department of Internal Medicine, Tuft University Medical Center, Boston, Massachusetts, USA
| | - Navin K Kapur
- Division of Cardiology, Department of Internal Medicine, Tuft University Medical Center, Boston, Massachusetts, USA
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Pahuja M, Chehab O, Ranka S, Mishra T, Ando T, Yassin AS, Thayer KL, Shah P, Kimmelstiel CD, Salehi P, Kapur NK. Incidence and clinical outcomes of stroke in
ST
‐elevation myocardial infarction and cardiogenic shock. Catheter Cardiovasc Interv 2020; 97:217-225. [DOI: 10.1002/ccd.28919] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Mohit Pahuja
- Division of Cardiology, Department of Internal Medicine Detroit Medical Center/Wayne State University School of Medicine Detroit Michigan USA
| | - Omar Chehab
- Department of Internal Medicine Detroit Medical Center/Wayne State University School of Medicine Detroit Michigan USA
| | - Sagar Ranka
- Division of Cardiology, Department of Internal Medicine Kansas University Medical Center Kansas City Kansas USA
| | - Tushar Mishra
- Department of Internal Medicine Detroit Medical Center/Wayne State University School of Medicine Detroit Michigan USA
| | - Tomo Ando
- Division of Cardiology, Department of Internal Medicine Columbia University Medical Center New York New York USA
| | - Ahmed S. Yassin
- Department of Internal Medicine Detroit Medical Center/Wayne State University School of Medicine Detroit Michigan USA
| | - Katherine L. Thayer
- Division of Cardiology, Department of Internal Medicine Tuft University Medical Center Boston Massachusetts USA
| | - Palak Shah
- Division of Cardiology Inova Heart and Vascular Institute Fairfax Virginia USA
| | - Carey D. Kimmelstiel
- Division of Cardiology, Department of Internal Medicine Tuft University Medical Center Boston Massachusetts USA
| | - Payam Salehi
- Division of Cardiology, Department of Internal Medicine Tuft University Medical Center Boston Massachusetts USA
| | - Navin K. Kapur
- Division of Cardiology, Department of Internal Medicine Tuft University Medical Center Boston Massachusetts USA
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Ando T, Adegbala O, Uemura T, Ashraf S, Akintoye E, Pahuja M, Afonso L, Briasoulis A, Takagi H. Palliative Care in Ruptured Aortic Aneurysm in the United States: A Retrospective Analysis of Nationwide Inpatient Sample Database. Angiology 2020; 71:633-640. [DOI: 10.1177/0003319720917239] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We assessed the trend of palliative care (PC) referrals and its effect on hospitalization cost and length of stay (LOS) in ruptured aortic aneurysm (rAA). The Nationwide Inpatient Sample from 2005 to 2014 was used to identify admissions with age ≥50 and rAA. A total of 54 134 rAA admissions were identified and 5019 (9.3%) had PC referrals. During the study period, PC referral rate increased from 0.97% to 15.3% ( P trend < .0001). Length of stay (1.7 vs 2.8 days, adjusted mean ratio [aMR] = 0.62, 95% confidence interval [CI]: 0.58-0.66), and cost (US$7778 vs US$13 575, aMR = 0.57, 95% CI: 0.52-0.63) were significantly lower in rAA admissions that did not undergo interventions. In the percutaneous repair group, LOS was similar but the cost was higher (US$61 759 vs US$52 260, aMR = 1.18, 95% CI: 1.05-1.30), whereas in surgical repair group, LOS was shorter (4.6 vs 5.9 days, aMR = 0.77, 95% CI: 0.73-0.82) but the cost was higher (US$59 755 vs US$52 523, aMR = 1.14, 95% CI: 1.02-1.28). Palliative care could shorten LOS and save hospitalization cost in rAA admissions not a candidate for repair. Further studies are required to investigate the variable effects of PC on rAA.
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Affiliation(s)
- Tomo Ando
- Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Oluwole Adegbala
- Englewood Hospital and Medical Center, Seton Hall University-Hackensack Meridian School of Medicine, Englewood, NJ, USA
| | - Takeshi Uemura
- University Health Partners of Hawaii, John A Burns School of Medicine, Honolulu, HI, USA
| | - Said Ashraf
- Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | | | - Mohit Pahuja
- Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Luis Afonso
- Wayne State University/Detroit Medical Center, Detroit, MI, USA
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Chehab O, Pahuja M, Mansour S, Kanj A, Alvarez P, Briasoulis A. In-Hospital Mortality, Acute Kidney Injury, Length of Stay and Cost among Patients with Acute Myocardial Infarction Related Cardiogenic Shock Complicated with Nosocomial Infections: Analysis of National Inpatient Sample Data. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.808] [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: 10/24/2022] Open
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Chehab O, Pahuja M, Morsi RZ, Tabja H, Weinberger J, Levine D, Afonso LC, Abidov A. GENDER AND RACE RELATED CARDIOVASCULAR MORBIDITY AND MORTALITY OF PATIENTS HOSPITALIZED WITH HIV. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32571-7] [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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Shokr M, Adegbala O, Elmoghrabi A, Saleh M, Ajam M, Ali A, Yassin AS, Ando T, Eperjesiova B, Aly A, Pahuja M, Ashraf S, Abubakar H, Ahmed A, Subahi A, Lieberman R, Afonso L. Impact of Chronic Thrombocytopenia on Outcomes After Transcatheter Valvular Intervention and Cardiac Devices Implantation (From a National Inpatient Sample). Am J Cardiol 2019; 124:1601-1607. [PMID: 31522774 DOI: 10.1016/j.amjcard.2019.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/30/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
Abstract
To evaluate the impact of chronic thrombocytopenia (cTCP) on outcomes of transcatheter valvular procedures such as aortic valve implantation (TAVI), MitraClip, permanent pacemaker (PPM), implantable-cardioverter defibrillator (ICD), cardiac resynchronization therapy (CRT), left atrial appendage closure, and pericardiocentesis. Impact of cTCP on clinical outcomes following TAVI, Mitraclip, PPM, ICD, CRT, left atrial appendage closure, and pericardiocentesis procedures is not well described. Utilizing the National Inpatient Sample and (ICD-9-CM) procedural codes, we evaluated patients (age ≥18 years) who underwent these procedures, from January 1, 2009 to December 31, 2014, with or without cTCP as a chronic condition variable indicator. Propensity score matching model implemented to derive 2 matched groups. Propensity score matching created 47,292 and 47,351 hospitalizations matched pairs with and without cTCP, respectively. Patients with cTCP were older (mean age, 74.27 vs 72.26 years; absolute standardized differences [ASD] = 15.6) and less likely to be female (36.76% vs 43.74%, ASD = -14.31). They experienced higher in-hospital mortality (3.0% vs 2.0%; odds ratio [OR], 1.53; 95% confidence interval [CI], 1.27 to 1.83) and higher odds of vascular injury requiring surgery (2.63% vs 1.10%; OR, 2.43; 95% CI, 1.93 to 3.05). Postoperative hematoma and bleeding were 2-fold higher (4.57% vs 2.24%; OR, 2.08; 95% CI, 1.77 to 2.45) and 3-fold higher (6.34% vs 2.45%; OR, 2.69; 95% CI, 2.31 to 3.13) respectively among cTCP patients. They had greater health-care cost ($47,163 vs $35,763, p <0.0001) and longer hospital stay (mean 9.26 days vs 6.84 days, p <0.0001). In conclusion, cTCP patients had higher risk of complications after TAVI, MitraClip, PPM, ICD, CRT, left atrial appendage closure, and pericardiocentesis, including a 1.5-fold increased risk of in-hospital mortality.
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Chehab O, Abdallah N, Kanj A, Pahuja M, Adegbala O, Morsi RZ, Mishra T, Afonso L, Abidov A. Impact of immune thrombocytopenic purpura on clinical outcomes in patients with acute myocardial infarction. Clin Cardiol 2019; 43:50-59. [PMID: 31710764 PMCID: PMC6954382 DOI: 10.1002/clc.23287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Received: 08/06/2019] [Revised: 10/14/2019] [Accepted: 10/21/2019] [Indexed: 11/29/2022] Open
Abstract
Background Patients with immune thrombocytopenic purpura (ITP) admitted with acute myocardial infarction (AMI) may be challenging to manage given their increased risk of bleeding complications. There is limited evidence in the literature guiding appropriate interventions in this population. The objective of this study is to determine the difference in clinical outcomes in AMI patients with and without ITP. Methods Using the United States national inpatient sample database, adults aged ≥18 years, who were hospitalized between 2007 and 2014 for AMI, were identified. Among those, patients with ITP were selected. A propensity‐matched cohort analysis was performed. The primary outcome was in‐hospital mortality. Secondary outcomes were coronary revascularization procedures, bleeding and cardiovascular complications, and length of stay (LOS). Results The propensity‐matched cohort included 851 ITP and 851 non‐ITP hospitalizations for AMI. There was no difference in mortality between ITP and non‐ITP patients with AMI (6% vs7.3%, OR:0.81; 95% CI:0.55‐1.19; P = .3). When compared to non‐ITP patients, ITP patients with AMI underwent fewer revascularization procedures (40.9% vs 45.9%, OR:0.81; 95% CI:0.67‐0.98; P = .03), but had a higher use of bare metal stents (15.4% vs 11.3%, OR:1.43; 95% CI:1.08‐1.90; P = .01), increased risk of bleeding complications (OR:1.80; CI:1.36‐2.38; P < .0001) and increased length of hospital stay (6.14 vs 5.4 days; mean ratio: 1.14; CI:1.05‐1.23; P = .002). More cardiovascular complications were observed in patients requiring transfusions. Conclusions Patients with ITP admitted for AMI had a similar in‐hospital mortality risk, but a significantly higher risk of bleeding complications and a longer LOS compared to those without ITP. Further studies are needed to assess optimal management strategies of AMI that minimize complications while improving outcomes in this population.
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Affiliation(s)
- Omar Chehab
- Department of Internal Medicine, Wayne State University, Detroit, Michigan
| | - Nadine Abdallah
- Department of Internal Medicine, Wayne State University, Detroit, Michigan
| | - Amjad Kanj
- Department of Internal Medicine, Wayne State University, Detroit, Michigan
| | - Mohit Pahuja
- Department of Internal Medicine, Wayne State University, Detroit, Michigan
| | - Oluwole Adegbala
- Department of Internal Medicine, Wayne State University, Detroit, Michigan
| | - Rami Z Morsi
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tushar Mishra
- Department of Internal Medicine, Wayne State University, Detroit, Michigan
| | - Luis Afonso
- Department of Internal Medicine, Wayne State University, Detroit, Michigan
| | - Aiden Abidov
- Department of Internal Medicine, Wayne State University, Detroit, Michigan.,Cardiology Section, Department of Internal Medicine, John D. Dingell VA Medical Center, Detroit, Michigan
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Pahuja M, Shehab O, Ando T, Kapur N. TCT-21 Incidence and Clinical Outcomes of Stroke in Patients With Percutaneous Mechanical Circulatory Support Devices: Insights From a Large National Database. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.047] [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: 11/24/2022]
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Chehab O, Pahuja M, Adegbala O, Akintoye E, Ramia P, Morsi R, Alrojolah L, Mishra T, Shokr M, Kanj A, Abdallah N, Tabaja H, Afonso L, Abidov A. P3603Impact of idiopathic thrombocytopenic purpura on clinical outcomes in patients with acute myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0462] [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: 11/13/2022] Open
Abstract
Abstract
Background
There is scarce evidence reflecting the clinical outcomes in patients with Idiopathic Thrombocytopenic Purpura (ITP) and Acute Myocardial Infarction (AMI). The ITP patient population is at higher risk of bleeding complications due to low platelet counts and difficulty in managing their antiplatelet and anticoagulation therapy. In our study, we sought to assess clinical outcomes of ITP patients admitted with AMI using the US national inpatient sample (NIS) database.
Purpose
To determine difference in in-hospital mortality, clinical complications, and length of stay (LOS) in AMI patients with and without ITP.
Methods
We identified adults aged ≥18 years hospitalized from 2005 to 2014 with AMI as their primary diagnosis utilizing ICD-9 codes 410.0 to 410.92. Patients with ITP were identified using ICD-9 code 287.31. The primary outcome was in-hospital mortality. Secondary outcomes included coronary revascularization procedures (PCI and CABG), and in-hospital complications including bleeding (intracranial, epistaxis, GI, and GU bleeding, hematoma, and bleeding requiring transfusion), cardiac complications, transfusions, acute ischemic stroke (AIS), and LOS. A propensity-matched cohort accounting for demographic characteristics, comorbidities, and cardiovascular risk factors, was created to compare these outcomes. Patients with secondary causes of ITP such as HIV, pregnancy, sepsis, SLE, malignancy were excluded.
Results
A total of 1108034 AMI admissions, of which 1002 with ITP, were identified. In the unmatched group, patients with ITP were older, and had more comorbidities (diabetes mellitus; hypothyroidism; atrial fibrillation; previous history of cardiovascular, peripheral, and end stage renal disease; all p<0.05). In the AMI population, 851 ITP and 851 non-ITP admissions were propensity-matched. Figure 1 illustrates the primary and secondary outcomes of the study among the propensity-matched study groups. Although there was no difference in short-term mortality between the ITP and non-ITP patients with AMI, patients with ITP were less likely to undergo coronary revascularization possibly because of thrombocytopenia. Patients with ITP had significantly more bleeding complications and transfusions. We observed in our study that patients with ITP had a significantly longer LOS compared to non-ITP patients (6.1 vs 5.4 days, with a mean ratio of 1.14 (95% CI: 1.05,1.23)).
Conclusion
In the large population of patients included in the NIS database, patients with ITP admitted with AMI, have a significantly higher rate of bleeding complications, undergo less PCI and have a longer LOS compared to AMI patients without ITP. There are no current guidelines by ACC/AHA/ESC regarding management of patients with AMI and thrombocytopenia. These results warrant further investigation through randomized controlled trials including patients with thrombocytopenia to assess long term outcomes and to define optimal management in this population.
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Affiliation(s)
- O Chehab
- Wayne State University, Detroit, United States of America
| | - M Pahuja
- Wayne State University, Detroit, United States of America
| | - O Adegbala
- Wayne State University, Detroit, United States of America
| | - E Akintoye
- Wayne State University, Detroit, United States of America
| | - P Ramia
- American University of Beirut AUB, Beirut, Lebanon
| | - R Morsi
- Harvard Medical School, Boston, United States of America
| | - L Alrojolah
- American University of Beirut AUB, Beirut, Lebanon
| | - T Mishra
- Wayne State University, Detroit, United States of America
| | - M Shokr
- Wayne State University, Detroit, United States of America
| | - A Kanj
- Wayne State University, Detroit, United States of America
| | - N Abdallah
- Wayne State University, Detroit, United States of America
| | - H Tabaja
- Wayne State University, Detroit, United States of America
| | - L Afonso
- Wayne State University, Detroit, United States of America
| | - A Abidov
- Wayne State University, Detroit, United States of America
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Affiliation(s)
- Mohit Pahuja
- Division of Cardiology, Department of Internal Medicine, Detroit Medical Center/Wayne State University School of Medicine, MI (M.P.)
| | - Daniel Burkhoff
- Cardiovascular Research Foundation and Division of Cardiology, Columbia University, New York, NY (D.B.)
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Ando T, Ashraf S, Villablanca P, Kuno T, Pahuja M, Shokr M, Afonso L, Grines C, Briasoulis A, Takagi H. Meta-Analysis of Effectiveness and Safety of Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Low-to-Intermediate Surgical Risk Cohort. Am J Cardiol 2019; 124:580-585. [PMID: 31200922 DOI: 10.1016/j.amjcard.2019.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/08/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has been used to treat high surgical risk cohorts but has been expanded to treat low-to-intermediate risk cohort as well. We performed a systematic review and meta-analysis to compare the outcomes between TAVI and surgical aortic valve replacement (SAVR) in low-to-intermediate risk cohort. We queried PUBMED, EMBASE, and ClinicalTrial.gov for relevant articles. Randomized controlled trials that compared at least one of the outcomes of interest between TAVI and SAVR were included. Risk ratio (RR) and 95% confidence interval (CI) were pooled with a random-effects model to compare the risk of the primary outcome between the 2 procedures. The primary outcome was a composite of all-cause mortality or disabling/major stroke at 1 year. Seven studies with a total of 7,143 patients (3,665 TAVI) were included. All-cause mortality or disabling/major stroke at 30 days (6 studies, RR 0.71, 95% CI 0.49 to 1.03) was similar between TAVI and SAVR but was significantly lower in TAVI at 1 year (5 studies, RR 0.81, 95% CI 0.67 to 0.98). All-cause mortality was similar at both 30 days (7 studies, RR 0.90, 95% CI 0.67 to 1.21) and 1 year (6 studies, RR 0.89, 95% CI 0.76 to 1.04). Disabling/major stroke was similar between the 2 procedures (6 studies, RR 0.69, 95% CI 0.42 to 1.12) at 30 days but was significantly lower in TAVI at 1 year (5 studies RR 0.71, 95% CI 0.51 to 0.98). Age, gender, diabetes, and surgical risk score did not modulate the primary outcome. TAVI had a significantly lower composite of all-cause mortality or disabling/major stroke at 1 year compared with SAVR in low-to-intermediate surgical risk cohort.
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Mehta H, Shah I, Pahuja M, Amin S, Bhurwal A, Moni S, Hawthorne K. Outcomes of Acute Pancreatitis in Patients with Heart Failure: Insights from the Nationwide Inpatient Sample. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Background:
Ventricular septal defect (VSD) is a lethal complication of acute myocardial infarction (AMI) and is often associated with cardiogenic shock. The optimal form of percutaneous mechanical circulatory support (MCS) for AMI-VSD is unknown.
Methods and Results:
We used a previously validated cardiovascular model to simulate AMI-VSD with parameters adjusted to replicate average hemodynamics reported in the literature, including a pulmonary-to-systemic blood flow ratio of 3.0. We then predicted effects of different types of percutaneous MCS (including intra-aortic balloon pumping, Impella, TandemHeart, and extracorporeal membrane oxygenation) on pressures and flows throughout the cardiovascular system. The simulation replicated all major hemodynamic parameters reported in the literature with AMI-VSD. Inotropes and vasopressors worsened left-to-right shunting, whereas vasodilators decreased shunting at the expense of worsening hypotension. All MCS devices increased forward blood flow and arterial pressure but other effects varied among devices. Impella 5.0 provided the greatest degree of pulmonary capillary wedge pressure reductions and decreased left-to-right shunting. Extracorporeal membrane oxygenation worsened pulmonary capillary wedge pressure and shunting, which could be improved by adding Impella or passive left ventricular vent. Pulmonary-to-systemic blood flow ratio could not be reduced below 2.0, and pulmonary flows remained high with all forms of MCS.
Conclusions:
Although no form of percutaneous MCS normalized hemodynamics in AMI-VSD, pulmonary capillary wedge pressure and shunting were worsened by extracorporeal membrane oxygenation and improved by Impella. Accordingly, based on hemodynamics alone, Impella provides the optimal form of support in AMI-VSD. However, other factors, including team experience, device availability, potential for tissue ingestion, and clinical characteristics, need to be considered when choosing a percutaneous MCS device for AMI-VSD.
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Affiliation(s)
- Mohit Pahuja
- Division of Cardiology, Department of Internal Medicine, Detroit Medical Center/Wayne State University Medical School of Medicine, Detroit, MI (M.P.)
| | - Benedikt Schrage
- Department of Cardiology, University Heart Centre Hamburg Eppendorf, Hamburg, Germany (B.S., D.W.)
| | - Dirk Westermann
- Department of Cardiology, University Heart Centre Hamburg Eppendorf, Hamburg, Germany (B.S., D.W.)
| | - Mir B. Basir
- Division of Cardiology, Department of Medicine, Henry Ford Health System, Detroit, MI (M.B.B.)
| | - Arthur Reshad Garan
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (A.R.G., D.B.)
| | - Daniel Burkhoff
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (A.R.G., D.B.)
- Cardiovascular Research Foundation, New York, NY (D.B.)
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Pahuja M, Adegbala O, Mishra T, Akintoye E, Chehab O, Mony S, Singh M, Ando T, Abubaker H, Yassin A, Subahi A, Shokr M, Ranka S, Briasoulis A, Kapur NK, Burkhoff D, Afonso L. Trends in the Incidence of In-Hospital Mortality, Cardiogenic Shock, and Utilization of Mechanical Circulatory Support Devices in Myocarditis (Analysis of National Inpatient Sample Data, 2005-2014). J Card Fail 2019; 25:457-467. [PMID: 31035007 DOI: 10.1016/j.cardfail.2019.04.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 01/14/2019] [Revised: 04/09/2019] [Accepted: 04/20/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Myocarditis may be associated with hemodynamic instability and portends a poor prognosis when associated with cardiogenic shock (CS). There are limited data available on the incidence of in-hospital mortality, CS, and utilization of mechanical circulatory support (MCS) devices in these patients. METHODS We queried the 2005-2014 National Inpatient Sample databases to identify all patients aged >18 years with myocarditis in the United States. RESULTS The number of reported cases of myocarditis per 1 million gradually increased from 95 in 2005 to 144 in 2014 (Pfor trend <.01). The trend and incidence of endomyocardial biopsy remained the same despite the increase in clinical diagnosis. Overall, in-hospital mortality was 4.43% of total admissions without a change in overall trend over the study period. We also observed a significant increase in the incidence of CS from 6.94% in 2005 to 11.99% in 2014 (Pfor trend <.01). There was a parallel increase in the utilization of advanced MCS devices during the same time period such as extracorporeal membrane oxygenation or percutaneous cardiopulmonary support (0.32% in 2005 to 2.1% in 2014; P< .01) and percutaneous ventricular assist devices such as Impella/tandem heart (0.176% in 2005 to 1.75% in 2014; P< .01). CONCLUSION Although the incidence of myocarditis has increased in the last decade, the in-hospital mortality has remained the same despite increases in the incidence of CS, possibly reflecting the benefits of increased usage of advanced MCS devices. We noted that increasing age, presence of multiple comorbidities and CS were associated with an increase in in-patient mortality.
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Affiliation(s)
- Mohit Pahuja
- Division of Cardiology, Department of Inernal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Oluwole Adegbala
- Department of Internal Medicine, Engelwood Hospital and Medical Center, Seton Hall University-Hackensack Meridian School of Medicine, Engelwood, New Jersey
| | - Tushar Mishra
- Department of Inernal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Emmanuel Akintoye
- Division of Cardiology, Departement of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa
| | - Omar Chehab
- Department of Inernal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Shruti Mony
- Division of Gastroenterology, University of South Florida, Tampa, Florida
| | - Manmohan Singh
- Division of Cardiology, Department of Inernal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Tomo Ando
- Division of Cardiology, Department of Inernal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Hossam Abubaker
- Department of Inernal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Ahmed Yassin
- Department of Inernal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Ahmed Subahi
- Department of Inernal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Mohamed Shokr
- Division of Cardiology, Department of Inernal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Sagar Ranka
- Department of Internal Medicine, Cook County Hospital, Chicago, Illinios
| | - Alexandros Briasoulis
- Division of Cardiology, Departement of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa
| | - Navin K Kapur
- Division of Cardiology, Department of Internal Medicine, Tufts Medical Center
| | - Daniel Burkhoff
- Cardiovascular Research Foundation; Division of Cardiology, Department of Internal Medicine, Columbia University Medical Center, New York, New York
| | - Luis Afonso
- Division of Cardiology, Department of Inernal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan.
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Pahuja M, Ranka S, Mony S, Chahab O, Ando T, Abubakar H, Yassen A, Alvarez P, Afonso L, Brisoulis A. Utilization of Combined Mechanical Circulatory Support Devices in Cardiogenic Shock: Insights from the National Inpatient Sample. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.566] [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: 10/27/2022] Open
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47
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Shokr M, Adegbala O, Saleh M, Yassin AS, Abubakar H, Subahi A, Ajam M, Chehab O, Ahmed A, Pahuja M, Ashraf S, Ando T, Lieberman R, Afonso L. IMPACT OF CHRONIC THROMBOCYTOPENIA ON CLINICAL OUTCOMES AFTER TRANSCATHETER VALVULAR INTERVENTIONS AND CARDIAC DEVICES IMPLANTATIONS (PROPENSITY MATCHED ANALYSIS OF THE NATIONAL INPATIENT SAMPLE). J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31756-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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48
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Pahuja M, Ranka S, Chehab O, Shokr M, Mony S, Ando T, Abubakar H, Yassin A, Briasoulis A, Afonso L. INPATIENT OUTCOMES OF SINGLE VERSUS COMBINED MECHANICAL CIRCULATORY SUPPORT DEVICES IN PATIENTS WITH CARDIOGENIC SHOCK OF ISCHEMIC ETIOLOGY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)30795-8] [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: 10/27/2022]
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49
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Pahuja M, Ranka S, Chehab O, Mony S, Abubakar H, Mishra T, Ando T, Shokr M, Yassin A, Briasoulis A, Afonso L. INPATIENT OUTCOMES OF SINGLE VERSUS COMBINED MECHANICAL CIRCULATORY SUPPORT DEVICES IN PATIENTS WITH NON-ISCHEMIC CARDIOGENIC SHOCK. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31510-4] [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: 11/25/2022]
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50
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Mishra T, Pahuja M, Abidov A. Increasingly Recognized Role of Right Ventricle Assessment in Cardiac Amyloidosis. JACC Heart Fail 2019; 7:277-278. [PMID: 30819388 DOI: 10.1016/j.jchf.2018.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 11/24/2018] [Indexed: 05/25/2023]
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