Impact of exercise on pulmonary artery pressure in patients with heart failure using an ambulatory pulmonary artery pressure monitor.

Background: In this multicenter prospective study, we explored the relationship between pulmonary artery pressure (PAP) at rest and in response to a 6-min walk test (6MWT) in ambulatory patients with heart failure (HF) with an implantable PAP sensor (CardioMEMS, Abbott).

Methods: Between 5/2019 and 2/2021, HF patients with a CardioMEMS sensor were recruited from seven sites. PAP was recorded in the supine and seated position at rest and in the seated position immediately post-exercise.

Ventricular Assist Devices and Chronic Kidney Replacement Therapy: Technology and Outcomes.

Heart failure and kidney failure are very common conditions, precipitating and exacerbating each other. Left ventricular assist devices (LVADs) represent a relatively new technology for treatment of advanced heart failure. Kidney dysfunction, if present, makes candidate selection for LVADs challenging and contributes to multiple complications while the patients are on an LVAD support.

Survival on Venoarterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock: Which Lactate Is Most Useful?

Prognostic significance of elevated serum lactate in patients on venoarterial extracorporeal membrane oxygenation (ECMO) is widely known. Our objective was to study the utility of lactate measured at different points of time and lactate clearance in predicting the two study endpoints: successful ECMO weaning and hospital survival. Among 238 consecutive patients treated with ECMO, lactic acid was collected before initiating ECMO and then on days 1, 3, 5, and 10 while on ECMO.

Discharge pulmonary artery pulsatility index predicts morbidity and mortality after acute heart failure: From the ESCAPE trial.

Introduction: The pulmonary artery pulsatility index (PAPI) is a newer hemodynamic index used for assessment of right ventricular performance. We hypothesized that PAPI predicts morbidity and mortality in acute systolic heart failure (HF).

Methods: The ESCAPE trial was utilized to identify the prognostic value of PAPI at different time points in patients hospitalized with acute systolic HF who received care assisted with central hemodynamic monitoring.

Right Atrial Pressure Predicts Mortality Among LVAD Recipients: Analysis of the INTERMACS Database.

Introduction: Risk stratifying candidates for left ventricular assist device (LVAD) is challenging. While INTERMACS profiles provide some prognostic insights, there is an ongoing search for better tools. We studied pre-LVAD haemodynamic parameters in predicting post-LVAD mortality.

Association of Serum Albumin and Severity of Pulmonary Embolism.

Inflammation is considered a risk factor for venous thromboembolism. The association between inflammatory markers and the severity of acute pulmonary embolism (APE) has not been explored. We studied the association between two crude markers of inflammation, serum albumin, and red cell distribution width (RDW) and massive versus non-massive APE.

Serum Albumin as a Biomarker of Pulmonary Sarcoidosis Chronicity.

Objectives: The duration of sarcoidosis is associated with a higher risk of irreversible pulmonary fibrosis. Sarcoidosis shows diverse clinical presentations, which may lead to a delayed diagnosis due to lack of a specific diagnostic test. Biomarkers of sarcoidosis duration have not been previously explored.

Higher Diuretic Requirements in Acute Heart Failure With Admission Hyponatraemia Versus Normonatraemia.

Background: Diuretic requirements in patients with acute decompensated heart failure (ADHF) and hyponatraemia versus normonatraemia on admission has not been previously explored.

Methods: The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial dataset was utilised to examine the characteristics and diuretic requirements of patients with ADHF with hyponatraemia or normonatraemia on admission.

Results: Patients with ADHF and admission hyponatraemia (n = 103, average Na 130.

Response to cardiac resynchronization therapy in non-ischemic cardiomyopathy is unrelated to medical therapy.

Introduction: Current guidelines recommend at least 3 months of guideline-directed medical therapy (GDMT) for patients with a new onset of non-ischemic cardiomyopathy (NICM) and left bundle branch block (LBBB) prior to cardiac resynchronization therapy (CRT). For patients who do not receive optimal GDMT, response to CRT is unknown.

Methods: Patients with NICM and LBBB with QRS ≥ 120 ms were identified among all patients who underwent CRT.

Rise of first follow-up sodium in patients hospitalized with acute heart failure is associated with better outcomes.

Introduction: The prognostic effect of the direction of change in sodium (Na) level from admission to subsequent check in patients with acute heart failure (HF) has not been previously explored.

Methods: The ESCAPE trial data was utilized to study whether the rise of 1 follow-up Na (at day 3) relative to admission (among patients with admission hyponatremia) is associated with favorable outcomes. The study endpoints were all-cause rehospitalization and a composite of death, rehospitalization and cardiac transplant, both up to 6-month after discharge.

Internist, anesthesiologist and surgeon use of ketogenic diet.

Ketogenic diet is being increasingly utilized in recent decades because of its success as an effective tool for short and intermediate-term weight loss. Promoting physiological ketosis from a drastically low carbohydrate diet is the fundamental basis for this diet regime. Though debated, these diets have been demonstrated to be effective, at least in the short- to medium terms, to manage excess weight, hyperlipidemia, and other cardiovascular risk factors.

Circulatory TGF-beta1 is significantly higher in early stage of pulmonary sarcoidosis.

The pathogenesis of pulmonary fibrosis in sarcoidosis is not known. We hypothesized that higher levels of circulatory growth factors are present in early stages of pulmonary sarcoidosis and may be associated with pulmonary fibrosis. Age and sex-matched subjects with sarcoidosis stage 0-1 (n=18), stage 4-5 (n=13) and healthy controls (n=5) had their serum TGF-β1, FGF, and VEGF levels measured as well as their gene expressions determined in peripheral blood mononuclear cells.

Syncope on presentation is a surrogate for submassive and massive acute pulmonary embolism.

Introduction: There are conflicting data regarding the prognostic value of syncope in patients with acute pulmonary embolism (APE).

Methods: We retrospectively reviewed data of 552 consecutive adults with computed tomography pulmonary angiogram-confirmed APE to determine the correlates and outcome of the occurrence of syncope at the time of presentation.

Results: Among 552 subjects with APE (mean age 54years, 47% men), syncope occurred in 12.

A retrospective comparison of survivors and non-survivors of massive pulmonary embolism receiving veno-arterial extracorporeal membrane oxygenation support.

Introduction: While the optimal care of patients with massive pulmonary embolism (PE) is unclear, the general goal of therapy is to rapidly correct the physiologic derangements propagated by obstructive clot. Extracorporeal membrane oxygenation (ECMO) in this setting is promising, however the paucity of data limits its routine use. Our institution expanded the role of ECMO as an advanced therapy option in the initial management of massive PE.

Prognostic Significance of Discharge Hyponatremia in Heart Failure Patients With Normal Admission Sodium (from the ESCAPE Trial).

Hyponatremia in acute decompensated heart failure (HF) is indicative of a poor prognosis and predicts morbidity and mortality. We explored the predictive utility of hyponatremia at the time of hospital discharge among HF patients with normal admission sodium (Na). Characteristics and outcomes of HF patients enrolled in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial, who had normal Na on admission, were compared between those who were hyponatremic (Na <135 meq/L) or normonatremic on discharge.