Publications by authors named "Mark Belkin"
Background: Despite improvements in hemocompatibility-related adverse events (HRAEs) with the HeartMate 3 left ventricular assist device (LVAD), hemodynamic-related events (HDREs), such as right ventricular failure (RVF) and aortic insufficiency, still result in considerable morbidity and mortality. We investigated a comprehensive, upfront RV protection strategy combining hemodynamic, ventilatory and pharmaceutical optimization to mitigate the risk of RVF.
Methods/results: Participants were prospectively randomized in a 1:1 fashion to either the RV-protection strategy or usual care for post-operative LVAD management.
Article Synopsis
- The study examines how aortic pulsatility index (API) and cardiac power output (CPO) can help assess heart function in patients with cardiogenic shock (CS) after administering a milrinone bolus.
- In a group of 224 patients with severe CS, those with lower baseline API and CPO had a higher risk of needing advanced heart treatments or dying within a year.
- The findings suggest that using API and CPO measurements can effectively stratify risk and predict outcomes in these patients, enhancing clinical decision-making.
Article Synopsis
- Patients with transposition of the great arteries (TGA) and systemic right ventricle face serious heart-related risks, and researchers sought to determine if specific invasive hemodynamic measures can predict outcomes.
- The study included 242 adults who underwent cardiac catheterization from 1994 to 2020, analyzing various hemodynamic parameters over an average follow-up period of 11.4 years.
- Results indicated that a low aortic pulsatility index (<1.5) strongly predicts negative outcomes such as death or the need for heart transplantation, with the cold/wet hemodynamic profile presenting the highest associated risk.
Intracardiac thrombus is a rare but treatable complication following DeVega tricuspid annuloplasty in the setting of orthotopic heart transplantation. Consistent imaging in the post-transplantation period is therefore essential for early identification and management of thromboembolic complications.
View Article and Find Full Text PDFWe assessed the prognostic potential of Galectin-3 in a sample of 159 heart failure patients who received a left ventricular assist device (LVAD) implant from 2012 to 2020. Clinical outcomes included hemodynamic data, right heart failure (RHF), hemocompatibility-related adverse events (HRAEs), and mortality. Galectin-3 was compounded into Michigan-RVF and EUROMACS-RHF risk scores and compared to the noncompounded risk scores.
View Article and Find Full Text PDFBackground: Invasive hemodynamics are fundamental in assessing patients with advanced heart failure (HF). Several novel hemodynamic parameters have been studied; however, the relative prognostic potential remains ill-defined.
Hypothesis: Advanced hemodynamic parameters provide additional prognostication beyond the standard hemodynamic assessment.
A 63-year-old woman who underwent heart transplantation for cardiac sarcoidosis developed new headache and vision changes. Extensive workup resulted in a diagnosis of neurosarcoidosis treated with pulse dose steroids and infliximab. Recurrence of sarcoidosis after transplantation for isolated cardiac sarcoidosis occurs, but optimal surveillance methods remain unknown.
View Article and Find Full Text PDFArticle Synopsis
- The US heart allocation system prioritizes patients most at risk of death without a transplant, but its current method is flawed and can be manipulated.
- Researchers aimed to create a new risk score, the US Candidate Risk Score (US-CRS), using clinical data to enhance decision-making for heart transplant candidates.
- A study involving nearly 17,000 candidates validated the US-CRS, which proved more effective than existing models in predicting mortality rates before transplant.
The accurate assessment of hemodynamics is paramount to providing timely and efficacious care for patients presenting in cardiogenic shock. Recently, the regular use of the pulmonary artery catheter in cardiogenic shock has had a resurgence with emerging data indicating improved survival in the modern era. Optimal multidisciplinary management of advanced heart failure and cardiogenic shock relies on our ability to effectively communicate and understand the complete hemodynamic assessment.
View Article and Find Full Text PDFLeft ventricular assist devices (LVADs) provide lifesaving therapy for patients with advanced heart failure. The recognition of pump thrombosis, stroke, and nonsurgical bleeding as hemocompatibility-related adverse events (HRAEs) led to pump design improvements and reduced adverse event rates. However, continuous flow can predispose patients to right-sided heart failure (RHF) and aortic insufficiency (AI), especially as patients live longer with their device.
View Article and Find Full Text PDFPurpose: Tolvaptan, a selective vasopressin type-2 antagonist, has been shown to increase serum sodium (Na) and urine output in hyponatremic left ventricular assist device (LVAD) patients in retrospective studies. In this prospective randomized pilot study, we aimed to assess the efficacy of tolvaptan in this population.
Methods: We conducted a prospective, randomized, non-blinded pilot study of LVAD recipients with post-operative hyponatremia (Na < 135 mEq/L) (NCT05408104).
Background: Invasive hemodynamic variables obtained from right heart catheterization have been used for risk-stratifying patients with advanced heart failure (HF). However, there is a paucity of data on the prognostic value of invasive hemodynamic variables in patients with left ventricular assist devices (LVAD). We hypothesized that cardiac power output (CPO), cardiac power efficiency (CPE), and left ventricular stroke work index (LVSWI) can serve as prognostic markers in patients with LVADs.
View Article and Find Full Text PDFPurpose Of Review: Cardiogenic shock remains a complex and variable disease process requiring early recognition and prompt, multidisciplinary treatment. Available data link usage of high-dose and/or multiple vasopressors in cardiogenic shock to increased mortality. This review proposes a structured approach to escalation of percutaneous mechanical circulatory support (pMCS) in cardiogenic shock, based on the hemodynamic and metabolic parameters highlighted in the revised SCAI Shock Classification, and supported by the available clinical data.
View Article and Find Full Text PDFThe HeartMate 3 left ventricular assist device (LVAD) is now the only centrifugal pump intended for durable support being actively manufactured and implanted for adults in the United States. The changes in preload and afterload that accompany common clinical scenarios experienced by patients with an LVAD will cause specific changes to the LVAD pump parameters, namely, the pump power, pulsatility index, and flow. Appropriate care of this unique, and growing, population requires a full understanding of these variables as well as the underlying physiologic principles governing their derivation.
View Article and Find Full Text PDFBackground: The initial derivation of cardiac power output (CPO) included the difference between mean arterial pressure (MAP) and right atrial pressure (RAP) in the numerator, before multiplying by cardiac output (CO). We hypothesized that the inclusion of RAP (CPO-RAP) would enhance the prognostic performance of this parameter in those with an elevated RAP.
Methods And Results: We obtained patient-level data from the ESCAPE trial via the Biolincc database.