Publications by authors named "Kevin Shah"

Background: The epidemiology and prognostic significance of acute non-cardiac organ dysfunction across cardiogenic shock (CS) subtypes are not well-defined.

Methods: CS admissions from 2017-2022 in the Critical Care Cardiology Trials Network Registry were classified as acute myocardial infarction-related CS (AMI-CS), acute-on-chronic heart failure-related CS (AoC HF-CS), or de novo HF-CS, and categorized as having at least moderate respiratory, kidney, liver, and/or neurologic dysfunction using established criteria. Burden of organ dysfunction was defined as no organ dysfunction (NOD), single organ dysfunction (SOD), or multi (≥2) organ dysfunction (MOD).

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  • Fewer than 20% of heart failure patients with reduced ejection fraction receive all recommended treatments, highlighting the need to investigate disparities based on race, sex, and social factors for effective care.
  • A study analyzed data from the American Heart Association's registry to evaluate how these disparities affect the optimization of quadruple therapy in heart failure patients between July 2021 and September 2023.
  • Results showed that while Black and Hispanic patients had slightly higher therapy scores compared to non-Hispanic Whites, females performed better than males, and those without private insurance faced significantly lower optimization scores.
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: The endovascular treatment of complex intracranial aneurysms, such as wide-neck aneurysms (WNAs), remains a challenge. More established endovascular techniques, which include balloon-assisted coiling, stent-assisted coiling, and flow diversion, all have their drawbacks. Intrasaccular flow disruptor devices have emerged as a useful tool for the neurointerventionalist.

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Background: Multidisciplinary Shock Teams have improved clinical outcomes for cardiogenic shock, but their implementation costs have not been studied. This study's objective was to compare costs between patients treated with and without a Shock Team and determine if the team's implementation is cost-effective compared with standard of care.

Methods: We examined patients with refractory cardiogenic shock treated with or without a Shock Team at a tertiary academic hospital from 2009 to 2018.

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  • * A study reviewed the use of a balloon guide catheter (BGC) in 22 patients undergoing VSS, effectively aiding in stent delivery without complications.
  • * The findings suggest that BGCs enhance safety and efficiency in VSS, particularly in navigating complex venous structures.
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  • An interatrial shunt is being studied as a potential treatment for heart failure, aimed at lowering left atrial pressure and improving symptoms and outcomes for patients.
  • In a clinical trial involving 508 patients, participants were randomly assigned to receive either the shunt or a placebo, with their progress tracked over a maximum of two years.
  • Results showed that while the shunt had no major safety issues, it did not significantly improve overall effectiveness compared to the placebo, although it appeared to reduce adverse cardiovascular events in patients with reduced left ventricular ejection fraction.
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Purpose Of Review: The purpose of this review is to describe the evidence behind various blood and imaging-based biomarkers that can improve the identification of congestion when not clearly evident on routine examination.

Recent Findings: The natriuretic peptides (NPs) BNP and NT-proBNP have been shown to closely correlate with intra-cardiac filling pressures, both at baseline and when trended following improvement in congestion. Additionally, NPs rise well before clinical congestion is apparent so can be used as a tool to help identify subclinical HF decompensation.

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  • The study explores how incorporating patient-reported outcomes (PROs) can enhance the prediction of hospitalization and mortality risks in patients with heart failure (HF).
  • The research involved 1165 patients with heart failure with reduced ejection fraction (HFrEF) and 456 with preserved ejection fraction (HFpEF), utilizing advanced statistical methods to analyze risk over time.
  • Findings indicated that models including PROs significantly improved risk prediction, demonstrating their value alongside traditional clinical assessments in managing outpatient heart failure.
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Background: Nearly one-half of patients admitted with acute decompensated heart failure (ADHF) are discharged with unresolved congestion, elevating rehospitalization risk. This may be due to suboptimal intravenous (IV) loop diuretic dosing, which may be influenced by home oral diuretic dose.

Objectives: The objective of this study was to determine the association between: 1) home oral loop diuretic dose and optimal initial IV loop diuretic dosing in ADHF; and 2)receiving optimal initial IV loop diuretic dosing and length of stay and 30-day readmission.

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Background: Cardiogenic shock (CS) can stem from multiple causes and portends poor prognosis. Prior studies have focused on acute myocardial infarction-CS; however, acute decompensated heart failure (ADHF)-CS accounts for most cases. We studied patients suffering ADHF-CS to identify clinical factors, early in their trajectory, associated with a higher probability of successful outcomes.

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We describe a novel use of evolocumab for successful postoperative lipid control in a patient with familial hyperlipidemia who underwent isolated heart transplantation. We believe that this case carries valuable lessons regarding post-transplant proprotein convertase subtilisin kexin 9 inhibitor use with implications for the future of combined organ allocation and transplantation waitlist times.

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The following case details a 67-year-old male with a history of heart failure with reduced ejection fraction secondary to cardiac amyloidosis who underwent orthotopic heart transplantation and was later found to have an anomalous left circumflex arising from the right coronary artery in the donor heart.

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Heart failure (HF) remains a progressive syndrome with high morbidity and mortality, and accounts for many hospitalisations globally with a downstream impact of increasing healthcare costs. South Asian individuals account for most of the global burden of non-communicable diseases. In this systematic review, a literature search was performed for all studies focusing on South Asians and HF using PubMed as the primary research tool and citations were included from relevant MEDLINE-indexed journals.

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  • The study examines the characteristics and outcomes of adult congenital heart disease (ACHD) patients admitted to cardiac intensive care units (CICUs) in North America from 2017 to 2022, revealing limited previous knowledge in this area.
  • Out of 23,299 CICU admissions, only 441 (1.9%) were for ACHD, which tended to be younger patients who had more admissions related to heart failure and medical issues compared to non-ACHD patients.
  • Despite longer hospital stays for ACHD patients, their in-hospital mortality rates were similar to those of non-ACHD patients, indicating the need for more focused research on managing specific complexities related to ACHD in the CICU.*
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Venous sinus stenting for dural venous sinus outflow obstruction due to an intrinsic filling obstruction or extrinsic stenosis is an increasingly popular treatment strategy for idiopathic intracranial hypertension (IIH) and isolated pulsatile tinnitus (PT). The most common site of stenosis is the lateral venous sinus at the transverse-sigmoid junction. Approximately 10% of the population has a persistent occipital venous sinus (OVS), a variant that may be the dominant venous drainage pathway in the setting of a hypoplastic or aplastic transverse sinus.

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Background: Pial arteriovenous fistulas (pAVFs) are rare vascular malformations characterized by high-flow arteriovenous shunting involving a cortical arterial supply directly connecting to venous drainage without an intermediate nidus. Dural arteriovenous fistulas (dAVFs) can infrequently involve additional pial feeders which can introduce higher flow shunting and increase the associated treatment risk. In the posterior fossa, arteriovenous fistula (AVF) angioarchitecture tends to be particularly complex, involving either multiple arterial feeders-sometimes from both dural and pial origins-or small caliber vessels that are difficult to catheterize and tend to be intimately involved with functionally critical brainstem or upper cervical cord structures.

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Background: Associations of early changes in vasoactive support with cardiogenic shock (CS) mortality remain incompletely defined.

Methods: The Critical Care Cardiology Trials Network is a multicenter registry of cardiac intensive care units. Patients admitted with CS (2018-2023) had vasoactive dosing assessed at 4 and 24 hours from cardiac intensive care unit admission and quantified by the vasoactive-inotropic score (VIS).

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Background And Objectives: Moyamoya disease (MMD) is a chronic steno-occlusive disease of the intracranial circulation that depends on neoangiogenesis of collateral vessels to maintain cerebral perfusion and is primarily managed with cerebral revascularization surgery. A quantitative assessment of preoperative and postoperative collateral flow using quantitative magnetic resonance angiography with noninvasive optimal vessel analysis (NOVA) was used to illustrate the impact of revascularization on cerebral flow distribution.

Methods: A retrospective review of patients with unilateral MMD who underwent direct, indirect, or combined direct/indirect cerebral revascularization surgery was conducted between 2011 and 2020.

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Robotic pancreaticoduodenectomy (RPD) has a learning curve of approximately 30-250 cases to reach proficiency. The learning curve for laparoscopic pancreaticoduodenectomy (LPD) at Duke University was previously defined as 50 cases. This study describes the RPD learning curve for a single surgeon following experience with LPD.

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Cerebral venous sinus thrombosis comprises 0.5% of all strokes and usually affects young adults. Straight sinus involvement is relatively rare, and it is associated with poor prognosis.

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Purpose: Surgical subinternships are important rotations for students preparing for a career in general surgery; however, these rotations often vary by institution and service. This modified Delphi study was conducted to reach a consensus set of roles, responsibilities, and expectations of fourth-year medical students on their surgical subinternships.

Method: Candidate statements on roles, responsibilities, and expectations of subinterns were categorized into 7 domains: rotation structure, rounding and patient care, operating room conduct, technical skills, knowledge base, clinic, and professionalism.

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  • Limited research exists on the causes of death in patients with cardiogenic shock (CS), prompting a study by the Critical Care Cardiology Trials Network from October 2021 to September 2022.
  • Among 1068 cases studied, 337 patients (31.6%) died, and 82.2% of these deaths were attributed to cardiovascular issues, primarily persistent cardiogenic shock.
  • Key findings showed that patients with prior cardiac arrest had higher risks of dying from anoxic brain injury or arrhythmia, and those receiving temporary mechanical circulatory support (tMCS) often succumbed to persistent shock.
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