Publications by authors named "Lori B Daniels"
Association between Proenkephalin A and cardiovascular outcomes in ambulatory Veterans.
Int J Cardiol Heart Vasc
December 2024
Article Synopsis
- Proenkephalin (PENK) is a potential biomarker indicating kidney function and cardiovascular risk, particularly in patients with cardiovascular disease.
- An observational study of 199 ambulatory Veterans found that higher levels of PENK were linked to an increased risk of major adverse cardiac events (MACE), although this association was less significant after adjusting for other factors.
- PENK did not show a clear relationship with all-cause mortality, heart failure, or left ventricular measurements, but it did reveal an interesting non-linear connection with left ventricular ejection fraction (LVEF). Further research is needed to confirm these findings.
Background: Giant coronary artery aneurysms and myocardial fibrosis after Kawasaki disease may lead to devastating cardiovascular outcomes. We characterised the vascular and myocardial outcomes in five selected Kawasaki disease patients with a history of giant coronary artery aneurysms that completely regressed.
Methods: Five patients were selected who had giant coronary artery aneurysm in early childhood that regressed when studied 12-33 years after Kawasaki disease onset.
Background: We evaluated the Vitros® Immunodiagnostic Products N-terminal pro B-type natriuretic peptide (NT-proBNP) II assay for aiding in diagnosis of heart failure (HF) in patients with acute dyspnea.
Methods: Serum concentrations of NT-proBNP were measured in patient samples from 20 emergency departments across the United States. Study endpoints included sensitivity, specificity, likelihood ratios, and predictive values for diagnosis of acute HF according to age-stratified cutoffs (450, 900, and 1800 pg/mL), and a rule-out age-independent cutoff (300 pg/mL).
Study Objective: The association of prior to admission guideline-directed medical therapy (GDMT) use in patients hospitalized with Heart Failure with Reduced Ejection Fraction (HFrEF, ejection fraction ≤40 %) and Coronavirus Disease 2019 (COVID-19) with in-hospital outcomes has not been well studied.
Design/setting/participants/interventions/outcome Measures: Using the American Heart Association's Get With The Guidelines Heart Failure Registry, we identified HFrEF patients presenting with acute decompensated heart failure (ADHF) and compared rates of GDMT prescription between those presenting prior to and during the pandemic. In a subgroup of patients with a concomitant COVID-19 diagnosis, we evaluated the association of prior to admission GDMT use with in-hospital mortality and severe COVID-19.
Article Synopsis
- This study examines different patient phenotypes along the transition from preshock to cardiogenic shock (CS) to understand their prognostic implications and outcomes.* -
- It classifies nearly 2,500 admissions into four categories and finds that in-hospital mortality rates vary significantly, from 3.6% for isolated low cardiac output to 24.0% for SCAI stage C CS.* -
- Results indicate that patients in the earlier stages of shock can still experience a high risk of deteriorating, suggesting the need for improved definitions and severity assessments in CS.*
Article Synopsis
- The study investigates sex-related differences in characteristics and outcomes of patients with cardiogenic shock (CS), particularly focusing on heart failure-related CS (HF-CS) versus acute myocardial infarction-related CS.
- Among patients with HF-CS, women had shorter lengths of stay in the Cardiac Intensive Care Unit (CICU) but were less likely to receive critical interventions like pulmonary artery catheters and mechanical support.
- In-hospital mortality rates were higher for women with HF-CS compared to men, even after controlling for factors like age and overall health status, highlighting a disparity in treatment and outcomes based on sex.
Article Synopsis
- Previous studies show variability in cardiac intensive care unit (CICU) length of stay (LOS), but lacked detailed risk assessments upon admission, prompting a new evaluation of LOS and its link to in-hospital mortality across different hospitals.
- Analysis of 22,862 admissions from 35 CICUs over five years revealed a median CICU LOS of 2.2 days, with longer stays associated with younger patients having more comorbidities and higher mortality rates across tertiles of LOS.
- The study concluded that significant differences in CICU LOS exist and that longer LOS correlates with increased risk of in-hospital mortality, suggesting improvements in CICU planning and resource use are necessary.
Article Synopsis
- The study aimed to evaluate the effectiveness of the IABP-SHOCK II risk score in predicting in-hospital mortality in cardiogenic shock (CS) patients from a North American cohort, comparing its performance to its original European context.
- The analysis included 5,340 admissions for CS across 35 medical centers, revealing that the IABP-SHOCK II score effectively identified different risk levels of mortality in both AMI-related and non-AMI-related CS patients.
- Overall, while the risk score demonstrated some predictive capability for in-hospital mortality in various CS types, its correlation with other mortality assessment tools was only moderate, indicating room for improvement in risk stratification methods.
Interhospital Variation in Admissions Managed With Critical Care Therapies or Invasive Hemodynamic Monitoring in Tertiary Cardiac Intensive Care Units: An Analysis From the Critical Care Cardiology Trials Network Registry.
Circ Cardiovasc Qual Outcomes
January 2024
Article Synopsis
- * A study analyzed data from nearly 18,000 CICU admissions across 34 hospitals to assess the use of CCRx and its association with in-hospital survival, finding disparities in patient acuity and therapy utilization among hospitals.
- * The findings revealed that patients in hospitals with higher CCRx usage tended to have more severe conditions and higher comorbidity rates; however, adjusted mortality rates did not significantly differ based on CCRx levels, implying patient factors primarily influence therapy variations.
Prognostic significance of haemodynamic parameters in patients with cardiogenic shock.
Eur Heart J Acute Cardiovasc Care
October 2023
Article Synopsis
- Invasive haemodynamic assessment using a pulmonary artery catheter is important for managing patients with cardiogenic shock (CS) and understanding their prognosis.
- A study analyzed data from a multicenter registry involving patients with CS to find relationships between their haemodynamic parameters and outcomes like in-hospital mortality and end-organ dysfunction.
- Key findings indicated that lower mean arterial pressure, lower systolic blood pressure, and other specific haemodynamic metrics were linked to worse outcomes and higher serum lactate levels, suggesting severe circulatory issues.
Article Synopsis
- The study investigates the varying use of pulmonary artery catheters (PACs) in cardiac intensive care units (CICUs) and their impact on patient outcomes, particularly in terms of in-hospital mortality among critically ill cardiac patients.
- Data was collected from a multicenter network involving over 13,000 CICU admissions between 2017 and 2021, focusing on factors like patient diagnosis, demographic information, and PAC usage.
- The findings revealed significant variation in PAC usage between different centers, with its use linked to lower mortality rates in shock patients, highlighting the need for more randomized trials to establish best practices for PAC application in cardiac care.
Article Synopsis
- * In a study of 32,636 patients, 6,234 (19.4%) had elevated cTn levels, revealing low rates of invasive coronary angiography and variability in care across different medical sites, while showing an increase in procedures and a decrease in mortality over time.
- * The findings suggest that despite low initial use of invasive treatments in early COVID-19, there was improvement in mortality and procedural assessments, emphasizing the need for more research to understand how variations in care impact patient outcomes.
Article Synopsis
- The review focuses on the role of cardiac troponin (cTn) in assessing prognosis for both acute and chronic heart failure, and its potential use in predicting heart failure occurrence.
- Recent therapies like sacubitril/valsartan and sodium-glucose cotransporter-2 inhibitors have been effective in improving outcomes for heart failure patients, with greater benefits noticed in those with higher cTn levels.
- While troponin serves as a useful prognostic marker across heart failure cases, its effectiveness in preventing heart failure and customizing treatment plans is still uncertain.
Background: The pathobiology of inflammation, thrombosis, and myocardial injury associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) may be assessed by circulating biomarkers. However, their relative prognostic importance has been incompletely described.
Methods: We analyzed data from patients hospitalized with COVID-19 from January 2020, to April 2021, at 122 US hospitals in the American Heart Association (AHA) COVID-19 cardiovascular (CV) disease registry.
Clinician and Algorithmic Application of the 2019 and 2022 Society of Cardiovascular Angiography and Intervention Shock Stages in the Critical Care Cardiology Trials Network Registry.
Circ Heart Fail
January 2023
Article Synopsis
- The study examines how effectively the 2019 SCAI shock stages predict mortality risk in cardiogenic shock patients, noting differences between clinician assessments and algorithmic applications.
- Researchers analyzed data from 9612 cardiac ICU admissions, determining that both clinician and algorithm-based methods reveal a clear gradient in mortality risk, with clinicians identifying higher risk patients.
- An updated algorithm using the 2022 SCAI criteria and a vasoactive-inotropic score enhances risk prediction, aligning more closely with clinician assessments compared to previous methods.
Article Synopsis
- The study examined the adoption of high-sensitivity cardiac troponin (hs-cTn) assays in U.S. hospitals from January 2019 to September 2021, revealing a significant increase in use from 3.3% to 32.6%.
- There was a correlation between hs-cTn usage and increased echocardiography for patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) but a decrease in invasive procedures for low-risk patients.
- Despite the increased implementation of hs-cTn assays, there were no significant impacts on hospital mortality or revascularization rates; however, hs-cTn use was linked to shorter patient hospital stays.
Critical Care Cardiology Trials Network (CCCTN): a cohort profile.
Eur Heart J Qual Care Clin Outcomes
October 2022
Aims: The aims of the Critical Care Cardiology Trials Network (CCCTN) are to develop a registry to investigate the epidemiology of cardiac critical illness and to establish a multicentre research network to conduct randomised clinical trials (RCTs) in patients with cardiac critical illness.
Methods And Results: The CCCTN was founded in 2017 with 16 centres and has grown to a research network of over 40 academic and clinical centres in the United States and Canada. Each centre enters data for consecutive cardiac intensive care unit (CICU) admissions for at least 2 months of each calendar year.
Background: Cardiac troponin (cTn) can be elevated in many patients presenting to the emergency department (ED) with chest pain but without a diagnosis of acute coronary syndrome (ACS). We compared the prognostic significance of cTn in these different populations.
Methods: We retrospectively analyzed the CHOPIN study, which enrolled patients who presented to the ED with chest pain.
Article Synopsis
- The study analyzed admissions for acute coronary syndrome (ACS) in cardiac intensive care units (CICUs) to understand patient characteristics and outcomes.
- Out of over 10,000 CICU admissions, nearly 30% were for ACS, showing significant differences in admission reasons and mortality rates compared to non-ACS patients.
- Most ACS admissions were for monitoring only, with a very low mortality rate and short hospital stays, indicating that many ACS patients may not require intensive care after initial evaluation.
Objective: To determine the utility of a highly sensitive troponin assay when utilized in the emergency department.
Methods: The FAST-TRAC study prospectively enrolled >1,500 emergency department patients with suspected acute coronary syndrome within 6 hours of symptom onset and 2 hours of emergency department presentation. It has several unique features that are not found in the majority of studies evaluating troponin.
Article Synopsis
- Smoking increases the risk of severe complications in COVID-19 patients, including higher chances of death and the need for mechanical ventilation.
- A study analyzed data from over 31,000 hospitalized adults, comparing smokers and non-smokers to assess outcomes related to COVID-19 severity.
- Results showed that current smokers had significantly greater adjusted odds of death (41% increase) and major cardiovascular events, highlighting the negative impact of smoking on COVID-19 severity.
Article Synopsis
- The study investigates the relationship between sleep disordered breathing and myocardial injury in patients with acutely decompensated heart failure, indicating that sleep apnea may worsen heart condition due to intermittent hypoxemia.
- Researchers performed sleep apnea tests and measured cardiac troponin levels in hospitalized patients, finding that a significant majority had sleep disordered breathing and showed increased troponin levels.
- The results suggest that severe sleep apnea, particularly of the central type, is linked to myocardial injury, highlighting the potential benefits of monitoring sleep patterns and cardiac biomarkers to understand this relationship better.