Publications by authors named "Kelly C Epps"
Article Synopsis
- The study investigates the use of guideline-directed medical therapy (GDMT) in patients who survive cardiogenic shock (CS) with heart failure and reduced left ventricular ejection fraction (HFrEF) based on data from a single-center shock registry.
- Among 520 patients treated for CS, 185 (35.6%) had HFrEF upon discharge, with a median age of 64 years; 41% experienced shock due to acute myocardial infarction, while the rest had heart failure-related shock.
- At discharge, a substantial portion of patients were prescribed GDMT, including beta-blockers (78%), ACE inhibitors/ARBs (58%), and mineralocorticoid receptor antagonists (55%), yet 10
Patent Foramen Ovale (PFO) is a common congenital atrial septal defect present in 20%-35% of the general population. Although generally considered a benign anatomic variant, a PFO may facilitate passage of a thrombus from the venous to arterial circulation, thereby resulting in cryptogenic stroke or systemic embolization. A PFO is detected in nearly one half of patients presenting with cryptogenic stroke and often considered the most likely etiology when other causes have been excluded.
View Article and Find Full Text PDFAim: The "2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy" provides recommendations to guide clinicians in the management of patients with hypertrophic cardiomyopathy.
Methods: A comprehensive literature search was conducted from September 14, 2022, to November 22, 2022, encompassing studies, reviews, and other evidence on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through May 23, 2023, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate.
Aim: The "2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy" provides recommendations to guide clinicians in the management of patients with hypertrophic cardiomyopathy.
Methods: A comprehensive literature search was conducted from September 14, 2022, to November 22, 2022, encompassing studies, reviews, and other evidence on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through May 23, 2023, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate.
Article Synopsis
- The study examined sex-related differences in outcomes for patients with cardiogenic shock (CS) using a standardized team-based approach (STBA), focusing on 520 patients over three years.
- Women with acute myocardial infarction (AMI) showed greater baseline severity, while those with heart failure (HF) more frequently faced cardiac arrest and required more aggressive treatments compared to men.
- Despite these findings, there were no significant differences in in-hospital mortality or major adverse events between sexes, suggesting the STBA may help reduce historical disparities in outcomes.
Article Synopsis
- A study compared distal transradial access (dTRA) and forearm transradial access (fTRA) for coronary angiography, focusing on how each affects the healing of the radial artery after the procedure.
- 64 patients were randomly assigned to either dTRA or fTRA and were monitored using high-resolution vascular ultrasound for changes in forearm radial artery thickness and other outcomes after 90 days.
- Results showed no significant differences in radial artery healing, hand pain, or function between the two access methods, suggesting both are equally effective, but further research is needed for better understanding.
Background: Distal transradial access (dTRA) is an alternative to conventional forearm transradial access (fTRA) for coronary angiography (CAG). Differences in healing of the radial artery in the forearm (FRA) have not been evaluated between these 2 access strategies. We sought to compare FRA intimal-medial thickening (IMT) in patients randomized to dTRA vs.
View Article and Find Full Text PDFBackground: The benefits of standardized care for cardiogenic shock (CS) across regional care networks are poorly understood.
Objectives: The authors compared the management and outcomes of CS patients initially presenting to hub versus spoke hospitals within a regional care network.
Methods: The authors stratified consecutive patients enrolled in their CS registry (January 2017 to December 2019) by presentation to a spoke versus the hub hospital.
Article Synopsis
- Little is known about the differences in clinical characteristics and outcomes between patients experiencing cardiogenic shock due to heart failure (HF-CS) versus those due to acute myocardial infarction (AMI; AMI-CS).
- A study analyzed 520 patients with CS over three years, revealing that HF-CS patients tended to be younger, had fewer cardiac arrests, and utilized less aggressive treatments compared to AMI-CS patients.
- Despite HF-CS patients having lower cardiac power output and higher pulmonary wedge pressure, they experienced lower rates of in-hospital and 1-year mortality compared to their AMI-CS counterparts.
Socioeconomic disparities in cardiovascular risk factors and outcomes exist among women, particularly those of minority racial or ethnic backgrounds. Barriers to optimal cardiovascular health begin early in life-with inadequate access to effective contraception, postpartum follow-up, and maternity leave-and result in excess rates of myocardial infarction, stroke, and cardiovascular death in at-risk populations. Contributing factors include reduced access to care, low levels of income and social support, and lack of diversity among cardiology clinicians and within clinical trials.
View Article and Find Full Text PDFBackground: Minorities and women are underrepresented in cardiovascular research. Whether their higher enrollment can be predicted or influences research site performance is unclear.
Methods: We evaluated 104 sites that enrolled 4,184 patients in the U.
Background: Transradial access (TRA) is associated with improved survival and reduced vascular complications in acute myocardial infarction (AMI). Limited data exist regarding TRA utilization and outcomes for AMI complicated by cardiogenic shock (CS). We sought to assess the safety, feasibility, and clinical outcomes of TRA in AMI-CS.
View Article and Find Full Text PDFThis paper reports 2 cases of female carriers of the FMR1 premutation for developing spontaneous coronary artery dissection (SCAD). These women had classical presentations of premutation symptoms, including anxiety, depression, and connective tissue problems, all of which can contribute to SCAD. These cases suggest a possible connection between the fragile X premutation and a predisposition to SCAD.
View Article and Find Full Text PDFBackground: Cardiogenic shock (CS) is a multifactorial, hemodynamically complex syndrome associated with high mortality. Despite advances in reperfusion and mechanical circulatory support, management remains highly variable and outcomes poor.
Objectives: This study investigated whether a standardized team-based approach can improve outcomes in CS and whether a risk score can guide clinical decision making.
Sex Differences in Outcomes Following Percutaneous Coronary Intervention According to Age.
Circ Cardiovasc Qual Outcomes
February 2016
Background: Women <50 years of age with coronary artery disease may represent a group at higher risk for recurrent ischemic events after percutaneous coronary intervention (PCI); however, no long-term, multicenter outcomes assessment exists in this population.
Methods And Results: Using the National Heart, Lung, and Blood Institute Dynamic Registry, we evaluated the association of sex and age on cardiovascular-related outcomes in 10,963 patients (3797 women, 394 <50 years) undergoing PCI and followed for 5 years. Death, myocardial infarction, coronary artery bypass graft surgery, and repeat PCI were primary outcomes comprising major adverse cardiovascular events.
Background: Evaluation for coronary artery disease (CAD) is recommended prior to surgery for ascending aortic aneurysms. Concerns regarding the use of coronary angiography in this population include safety and the ability to successfully selectively engage the coronary arteries. Additionally, the prevalence of CAD is not well described.
View Article and Find Full Text PDFManagement of coronary artery disease (CAD) has evolved over the past decade, but there are few prospective studies evaluating long-term outcomes in a real-world setting of evolving technical approaches and secondary prevention. The aim of this study was to determine how the mortality and morbidity of CAD has changed in patients who have undergone percutaneous coronary intervention (PCI), in the setting of co-morbidities and evolving management. The National Heart, Lung, and Blood Institute Dynamic Registry was a cohort study of patients undergoing PCI at various time points.
View Article and Find Full Text PDFObjectives: To correlate estimated pulmonary artery pressures (PAP) by echocardiography with right heart catheterization (RHC) measurements and to correlate estimated left ventricular ejection fraction (EF) by echocardiography with cardiac output (CO) measurements by RHC.
Study Design: All women who had echocardiography at a single institution during a 6-year period and underwent RHC during pregnancy were included. Echocardiography estimates of right ventricular systolic pressure (RVSP) and EF were correlated with measured RHC PAP and CO, respectively.