Natraj Katta

Does Long-Term Furosemide Therapy Cause Thiamine Deficiency in Patients with Heart Failure? A Focused Review

Diuretic therapy is a cornerstone in the management of heart failure. Most studies assessing body thiamine status have reported variable degrees of thiamine deficiency in patients with heart failure, particularly those treated chronically with high doses of furosemide. Thiamine deficiency in patients with heart failure seems predominantly to be due to increased urine volume and urinary flow rate. There is also evidence that furosemide may directly inhibit thiamine uptake at the cellular level. Limited data suggest that thiamine supplementation is capable of increasing left ventricular ejection fraction and improving functional capacity in patients with heart failure and a reduced left ventricular ejection fraction who were treated with diuretics (predominantly furosemide). Therefore, it may be reasonable to provide such patients with thiamine supplementation during heart failure exacerbations.

Anti‐thrombotic therapy for atrial fibrillation in patients with chronic kidney disease: Current views

Chronic kidney disease (CKD) occurs in approximately one‐third of patients with non‐valvular atrial fibrillation (AF). The presence of CKD, particularly advanced CKD, confers increased risk of both thromboembolism and major bleeding in this group of patients who are already at risk for ischemic stroke and systemic embolism and at risk of bleeding due to anticoagulation. Studies assessing the effect of warfarin on risk of ischemic stroke, systemic embolism, and major bleeding have produced disparate results, particularly in patients with advanced CKD including those treated with hemodialysis. The direct oral anticoagulants (DOACs) have been studied in patients with stage III (moderate) CKD and appear to be as effective or more effective (dabigatran 150 mg twice daily) than warfarin in preventing ischemic stroke or embolism in this group. Two of the DOACs, apixaban and edoxaban, confer lower risk of major bleeding than warfarin with appropriate dose adjustments. Substantial gaps exist in our knowledge of anti‐thrombotic therapy in patients with AF and CKD, primarily due to exclusion of patients with advanced CKD from randomized controlled trials comparing DOACs with warfarin.

Successful Percutaneous Retrieval of Embolized Septal Occluder Device from Aortic Arch and Placement of a Newer Septal Occluder Device in Combined Procedure

Embolization of the Amplatzer Septal Occluder (ASO) device (St. Jude Medical, Minnesota) after percutaneous closure of atrial septal defect (ASD) is a rare and potentially catastrophic complication. Percutaneous retrieval of the embolized device is gaining ground as an acceptable method, although these patients are usually subsequently referred for open surgical closure of the ASD. We present a unique case of percutaneous retrieval embolized ASO device and placement of newer larger ASO device in a single procedure.

Clozapine-induced hypersensitivity myocarditis presenting as sudden cardiac death

Hypersensitivity myocarditis is a rare but serious adverse effect of clozapine, a commonly used psychiatric drug. We report the case of sudden cardiac death from clozapine-induced hypersensitivity myocarditis diagnosed at autopsy. A 54-year-old Caucasian male on clozapine therapy for bipolar disorder presented with a sudden onset of shortness of breath. Laboratory studies were significant for elevated N-terminal prohormone of brain natriuretic peptide. During his hospital stay, the patient died of sudden cardiac arrest from ventricular tachycardia. The autopsy revealed hypersensitivity myocarditis, which usually occurs in the first 4 weeks after the initiation of clozapine. A 4-week monitoring protocol, including laboratory assessment of troponin and C-reactive protein, may assist in the early diagnosis of this potentially fatal condition.

TCT-248 Pacemaker Implantation in Transcatheter Aortic Valve Replacement vs. Sutureless Surgical Aortic Valve Replacement: A Meta-analysis

TCT-247 Discharge Status Following Coronary Artery Bypass or Percutaneous Coronary Intervention from the National Inpatient Sample Joseph Rossi, Sally Stearns, John Vavalle, Thomas Caranasos, James Flaherty University of North Carolina, Greensboro, North Carolina, United States; Hospital Universitario de Cabueñes, Gijón., Chapel Hill, North Carolina, United States; Duke University, Chapel Hill, North Carolina, United States; Chapel Hill, North Carolina, United States; Unknown, Chicago, Illinois, United States

TCT-154 Multivessel Revascularization versus Culprit Vessel Only Revascularization in Patients with ST-Elevation Myocardial Infarction and multivessel disease: An Updated Meta-analaysis

Several observational studies and randomized clinical trials (RCTs) have demonstrated conflicting results on the benefit of multivessel percutaneous coronary intervention (MV-PCI) vs. culprit only vessel percutaneous coronary intervention (CV-PCI) in ST-elevation myocardial infarction (STEMI) and

TCT-216 Bivalrudin vs. Argatroban for treatment of Heparin-induced Thrombocytopenia: A Meta-analysis.

RESULTS A total of 8,044 patients from 5 trials were included. The incidence of major bleeding was 1.8% in the bivalirudin group versus 2.2% in the unfractionated heparin group (RR 0.72, 95% CI 0.44-1.17, p1⁄40.18). Subgroup analysis showed benefit with bivalirudin when compared with unfractionated heparin plus planned or provisional glycoprotein IIb/IIIa inhibitors, but not when compared with unfractionated heparin plus provisional glycoprotein IIb/IIIa inhibitors (Pinteraction1⁄40.03). Meta-regression analysis demonstrated that the risk of major bleeding was lower with bivalirudin when higher doses of unfractionated heparin were used in the control arm (p1⁄40.02). There were no significant differences in the incidence of major adverse cardiac events, all-cause mortality, and net adverse clinical events between both groups (RR 1.15, 95% CI 0.81-1.64, p1⁄40.44; RR 0.98, 95% CI 0.70-1.36, p1⁄40.89; and RR 0.79, 95% CI 0.62-1.03, p1⁄40.08; respectively).

Role of isolated ultrafiltration in the management of chronic refractory and acute decompensated heart failure

Chronic congestive heart failure (CHF) and acute decompensated heart failure (ADHF) refractory to medical therapy represent therapeutic challenges. In such patients, attempts to reduce pulmonary and systemic congestion frequently produce deterioration of renal function. In studies of patients with chronic severe CHF refractory to medical therapy (including loop diuretics), isolated ultrafiltration was frequently able to relieve congestive symptoms by precise removal of extracellular water and sodium, and in some cases was able to restore responsiveness to loop diuretics. Randomized controlled trials comparing isolated ultrafiltration and medical therapy (mainly loop diuretics) in patients with ADHF failed to demonstrate the superiority of isolated ultrafiltration over diuretic therapy with respect to renal function and mortality. Isolated ultrafiltration reduced length of hospital stay in several studies. At this time, there is insufficient evidence to support the use of isolated ultrafiltration as initial therapy of ADHF.