Arash Harzand

Uric Acid, Heart Failure Survival, and the Impact of Xanthine Oxidase Inhibition

Increasing evidence suggests that serum uric acid (UA), a product of xanthine oxidase (XO), may be a useful marker for metabolic, hemodynamic, and functional staging in heart failure (HF) and a valid predictor of survival in HF patients. Recent data support an expanded role for UA and the XO pathway in the pathogenesis of HF, as studies have shown that an elevation in the enzymatic activity of XO can lead to increases in oxidative stress, endothelial dysfunction, and reduced myocardial function. Numerous population studies have previously reported that elevated UA levels are an independent predictor of cardiovascular mortality, and recent evidence suggests that lowering serum levels of UA may lead to improved outcomes in HF patients. The question of whether UA is only a marker rather than a causal factor in the pathogenesis of HF remains. Regardless of whether UA levels are ready for routine clinical use, either as a prognostic factor or novel therapeutic target, further prospective studies are necessary to demonstrate that routine measurement or reduction of UA levels improves outcomes in HF patients.

Feasibility of a Smartphone-enabled Cardiac Rehabilitation Program in Male Veterans With Previous Clinical Evidence of Coronary Heart Disease

Cardiac rehabilitation (CR) is recommended for patients with coronary heart disease, however, participation among veterans remains poor. Smartphones may facilitate data transfer and communication between patients and providers, among other benefits. We evaluated the feasibility of a smartphone-enabled CR program in a population of veterans. Qualifying veterans were prospectively enrolled in a single-arm, nonrandomized feasibility study of a smartphone-enabled, home-based CR program, featuring an app with daily reminders to exercise, log vitals, and review educational materials. A coach remotely monitored patients through an online dashboard and scheduled telephone visits. Clinical end points were assessed as an exploratory aim. After 21 veterans provided informed consent, 18 were enrolled and successfully completed at least 30days of the program; 13 completed the entire 12-week intervention. Mean (standard deviation) age was 62 (7) years and 96% were male. Program completers logged a mean (standard deviation) of 3.5 (1.4) exercise sessions and 150 (86) exercise minutes per week. The majority (84%) of program completers reported being satisfied overall with the program. Mean functional capacity improved by 1.0 metabolic equivalents (5.3 to 6.3, 95% confidence interval 0.3 to 1.7; p = 0.008) and mean systolic blood pressure at rest improved by 9.6mm Hg (mean difference 9.6, 95% confidence interval -19.0 to -0.7; p = 0.049) among completers. Smartphone-enabled, home-based CR is feasible in veterans with heart disease and is associated with moderate to high levels of engagement and patient satisfaction.

DOBUTAMINE STRESS ECHOCARDIOGRAPHY RISK-STRATIFIES WOMEN WITH LOW-GRADIENT AORTIC STENOSIS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT

Patients with severe aortic stenosis and low mean transvalvular gradient have poor outcomes, with an estimated 30 day post-surgical Aortic Valve Replacement (AVR) mortality of 21%. Low Dose Dobutamine Stress Echocardiography (LD-DSE) is performed in these patients for further risk stratification by

Epicardial adipose tissue measured by magnetic resonance imaging predicts abnormal adenosine stress cardiovascular magnetic resonance imaging and future adverse cardiovascular events

Background A growing body of evidence demonstrates a quantitative association between Epicardial Adipose Tissue (EAT), cardiometabolic risk factors and measures of coronary artery disease (CAD). It is still unclear, however, if EAT is predictive of abnormal functional stress tests and clinical outcomes. The aim of this study is to elucidate the relationship between the total volume of EAT, the detection of ischemia and/or infarct with Adenosine Stress Cardiovascular Magnetic Resonance imaging (AS-CMR), and combined future adverse cardiovascular events. Methods