G. Ashrith

Cardiovascular magnetic resonance characterization of left ventricular non-compaction provides independent prognostic information in patients with incident heart failure or suspected cardiomyopathy

BackgroundWith recent advances in imaging methods, detection of LVNC is increasingly common. Concomitantly, the prognostic importance of LVNC is less clear.MethodsWe followed 42 patients (63% male, age 44 ± 15 years) with incident heart failure or suspected cardiomyopathy, in whom cardiovascular magnetic resonance (CMR) yielded a diagnosis of LVNC, for 27 ± 16 months.ResultsLVNC was preferentially distributed among posterolateral segments, with apical predominance. Patients with maximum non-compacted-to-compacted thickness ratio (NC:C) < 3 improved by 0.9 ± 0.7 NYHA Class, compared to 0.3 ± 0.8 for patients with NC:C > 3 (p = 0.001). In 29 patients with baseline LVEF < 0.40, there was an inverse correlation between NC:C ratio, and the change in LVEF during follow-up. Tachyarrhythmias were observed in 42% of patients with LGE, and in 0% of patients without LGE (p = 0.02). In multivariate analysis, arrhythmia incidence was significantly higher in patients with LGE, even when adjusted for LVEF and RVEF.ConclusionsCMR assessments of myocardial morphology provide important prognostic information for patients with LVNC who present with incident heart failure or suspected cardiomyopathy.

Acquired and Hereditary Hypercoagulable States in Patients with Continuous Flow Left Ventricular Assist Devices: Prevalence and Thrombotic Complications

BACKGROUND Thrombotic events in patients with continuous flow left ventricular assist devices (CF-LVADs) are associated with significant morbidity and mortality. The objective of this study was to delineate the frequency, clinical characteristics, and outcomes of patients with hypercoagulable states who undergo CF-LVAD implantation. METHODS We performed a retrospective review of 168 consecutive patients who underwent CF-LVAD implantation between 2010 and 2013. Chart and laboratory data were reviewed for the presence of a hereditary and/or acquired hypercoagulable state. Adverse outcomes were defined as death, confirmed pump thrombosis, aortic root clot, stroke, deep vein thrombosis, and pulmonary embolism. Fishers exact test and Kaplan-Meier estimate were used to analyze frequency of adverse outcomes and event free survival, respectively. RESULTS A hypercoagulable state was identified in 20 patients (11.9%). There were 18 patients with acquired, 1 with a congenital, and 1 with both congenital and acquired hypercoagulable states. The median follow-up was 429 days and 475 days in patients with and without hypercoagulable states, respectively. During the study period, 15% (3/20) of the patients with a hypercoagulable state had a diagnosis of deep vein thrombosis vs 3% (4/148) of the patients without a hypercoagulable state (P = .030). Only patients with a hypercoagulable state had a subarachnoid hemorrhage (3/20 vs 0/148; P < .01). The event-free survival was lower in the patients with hypercoagulable states (P = .005). CONCLUSION Hypercoagulable states are not uncommon in patients with CF-LVADs and may be associated with increased morbidity. Prospective studies are needed to more accurately identify the incidence, prevalence, and significance of hypercoagulable states in patients being considered for CF-LVAD.

COST-EFFECTIVENESS COMPARISON OF INTRA AORTIC BALLOON PUMP VERSUS LEFT VENTRICULAR ASSIST DEVICES AS BRIDGE TO HEART TRANSPLANT STRATEGIES

There is a paucity of data comparing the cost-effectiveness use of mechanical support (LVAD vs IABP) as a bridge to heart transplant. Our aim was to compare the cost-effectiveness of patients BTT at our institution. We performed a retrospective study of patients that received a heart transplant

RAPAMYCIN POLYMER NANOTHERAPEUTICS FOR PULMONARY HYPERTENSION TREATMENT

Pulmonary hypertension (PH) ultimately leads to right side heart failure. Targeting dysregulated pathways, such as the PI3K/Akt/mTOR cascade, proves attractive but requires suitable drug carriers. Nanoparticles (NPs) increase drug circulation lifetimes and accumulation in areas of increased vascular

DISCHARGE ST2 PREDICTS HEART FAILURE READMISSIONS IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE

Heart failure readmissions portend worst outcomes in patients with heart failure and impose a heavy burden on the healthcare system. We investigated ST2 (soluble IL33 receptor) as a predictor of heart failure readmissions. We prospectively identified patients that were admitted to our hospital with

ECHOCARDIOGRAPHIC PREDICTORS OF COMBINED PRE AND POST CAPILLARY PULMONARY HYPERTENSION (PH) IN A POPULATION OF SYSTOLIC HEART FAILURE WITH WHO GROUP II PULMONARY HYPERTENSION

Diastolic pressure difference of 7 mm Hg has been shown to be very good discriminator of the presence of pre-capillary component in patients with WHO group II PH. Presence of combined pre and post capillary pulmonary hypertension (CPC-PH) portends highest risk of mortality in patients with WHO group