Santhosh Mannem

Blood Pressure and Adverse Events During Continuous Flow Left Ventricular Assist Device Support

Background—Adverse events (AEs), such as intracranial hemorrhage, thromboembolic event, and progressive aortic insufficiency, create substantial morbidity and mortality during continuous flow left ventricular assist device support yet their relation to blood pressure control is underexplored. Methods and Results—A multicenter retrospective review of patients supported for at least 30 days and ⩽18 months by a continuous flow left ventricular assist device from June 2006 to December 2013 was conducted. All outpatient Doppler blood pressure (DOPBP) recordings were averaged up to the time of intracranial hemorrhage, thromboembolic event, or progressive aortic insufficiency. DOPBP was analyzed as a categorical variable grouped as high (>90 mm Hg; n=40), intermediate (80–90 mm Hg; n=52), and controlled (<80 mm Hg; n=31). Cumulative survival free from an AE was calculated using Kaplan–Meier curves and Cox hazard ratios were derived. Patients in the high DOPBP group had worse baseline renal function, lower angiotensin-converting enzyme inhibitor or angiotensin receptor blocker usage during continuous flow left ventricular assist device support, and a more prevalent history of hypertension. Twelve (30%) patients in the high DOPBP group had an AE, in comparison with 7 (13%) patients in the intermediate DOPBP group and only 1 (3%) in the controlled DOPBP group. The likelihood of an AE increased in patients with a high DOPBP (adjusted hazard ratios [95% confidence interval], 16.4 [1.8–147.3]; P=0.012 versus controlled and 2.6 [0.93–7.4]; P=0.068 versus intermediate). Overall, a similar association was noted for the risk of intracranial hemorrhage (P=0.015) and progressive aortic insufficiency (P=0.078) but not for thromboembolic event (P=0.638). Patients with an AE had a higher DOPBP (90±10 mm Hg) in comparison with those without an AE (85±10 mm Hg; P=0.05). Conclusions—In a population at risk, higher DOPBP during continuous flow left ventricular assist device support was significantly associated with a composite of AEs.

THE RED CELL DISTRIBUTION WIDTH AND THE CBC RISK SCORE MEASURED PRIOR TO LEFT VENTRICULAR ASSIST DEVICE IMPLANTATION PREDICT POST-IMPLANT SURVIVAL

The red cell distribution width (RDW) predicts mortality in many cardiovascular (CV) diseases. The sex-specific complete blood count (CBC) risk score uses the RDW and other CBC components to predict mortality. Very few risk models are known for predicting survival in patients undergoing left

Incremental Cost of Cardiovascular Disease, Hypertension and Pain for patients with Diabetes Mellitus

Chronic condition flags for coronary heart disease (CHD), stroke, acute myocardial infarction(AMI), and hypertension were provided in the data set. in is identified through: 1) condition flags (angina, non-specific chest pain, abdominal pain); 2) self report (Does pain interfere with your normal work? “moderately,” “a lot,” or “extremely”). Result Approximately 29.5% of patients with diabetes experienced pain. Pain differed significantly by age, gender, education, and race/ethnicity.

CLINICAL IMPROVEMENT IN PATIENTS WITH EXERCISE INDUCED PULMONARY ARTERY HYPERTENSION AFTER 6 MONTHS OF PHOSPHODIESTERASE-5 INHIBITORS OR ENDOTHELIAL RECEPTOR ANTAGONISTS OR BOTH

Pulmonary arterial hypertension (PAH) is a rapidly progressive disorder with high mortality rates despite traditional medical treatment. With the availability of PA targeted therapy, early PAH detection improves treatment outcomes. Exercise- induced Pulmonary Artery Hypertension (EiPAH) represents

CLINICAL IMPROVEMENT IN PATIENTS WITH EXERCISE INDUCED PULMONARY ARTERY HYPERTENSION IS SIMILAR TO PULMONARY ARTERIAL HYPERTENSION

Exercise-induced Pulmonary Artery Hypertension (EiPAH) represents an early phase of Pulmonary Arterial Hypertension (PAH) in which screening and early detection might facilitate treatment aimed at preventing progression of EiPAH to resting PAH. In this study we sought to compare change in 6MWD after

ATRIAL FIBRILLATION RESULTS IN HIGHER MORTALITY IN PATIENTS WITH PULMONARY HYPERTENSION

Established prognostic factors for pulmonary hypertension (PH) include brain natriuretic peptide and hemodynamic measures such as central venous pressure and cardiac output. The prognostic role of atrial fibrillation (AF) is yet to be determined in patients with PH. The aim of this study was to

CLINICAL OUTCOMES OF PATIENTS WITH SYSTOLIC HEART FAILURE AND ANEMIA OF CHRONIC DISEASE: MORTALITY AND READMISSION

Anemia of chronic disease (AOCD) is the most common anemia in systolic heart failure (SHF). While generalized anemia in SHF has been linked to a poor prognosis and greater risk of hospitalization, the effect of AOCD on outcomes in SHF is unknown. The aim of this study was to determine the effect of

Quite a backup: pericardial varices in a patient with hereditary antithrombin deficiency.

A 39 year-old female with known hypertension, gastro-esophageal reflux disease, and hereditary anti-thrombin deficiency (hATD) on life-long anti-coagulation presented to our emergency room with acute atypical chest and epigastric pain. Her hATD was diagnosed five years prior when repeated deep vein thromboses were discovered. At that time, the patient was started on life-long anticoagulation with warfarin and was able to consistently achieve therapeutic levels.