Publications by authors named "Michael Brener"
Background: There is a large variability in the management of conduction disturbances (CDs) after transcatheter aortic valve replacement (TAVR).
Objective: This study aimed to validate a prespecified algorithm for managing CDs in patients undergoing TAVR.
Methods: This was a prospective multicenter study including consecutive patients without prior pacemaker undergoing TAVR.
Article Synopsis
- Chronic heart failure (HF) is a condition where the heart cannot pump blood effectively, leading to either low cardiac output or a struggle to maintain normal output under stress.
- In HF with reduced left ventricular function, the heart undergoes changes, like dilation and a spherical shape, which increases stress on the heart walls.
- The review discusses ways to reverse these changes through both biological methods (adjusting stress on heart muscles) and physical methods (changing heart size or shape) using emerging device-based technologies.
Article Synopsis
- Left ventricular (LV) function is linked to the elasticity of the ascending aorta (AA), with stiffness in the AA potentially leading to reduced LV performance in patients with heart failure with preserved ejection fraction (HFpEF).
- A study using the Living Left Heart Human Model simulated different scenarios, including models with elastic and stiff AAs, as well as a stiff AA with a free LV apex.
- Results indicate that allowing the LV apex to move freely could counteract the negative effects of a stiff AA, suggesting a potential therapeutic approach to improve LV function in HFpEF patients.
Article Synopsis
- Despite advancements in treatment, ST-elevation myocardial infarction (STEMI) still results in high mortality rates, leading to a greater focus on comfort-oriented care for those with poor prognoses.
- In a study of 536 STEMI patients, 11.4% died during hospitalization, with a significant number transitioning to comfort-focused care, especially those on mechanical circulatory support.
- Palliative care consultations were infrequent, occurring in only about 10% of cases, typically late in hospitalization, suggesting a need for earlier integration of comfort care strategies.
Article Synopsis
- During systole, the left ventricle shortens, moving the aortic root and stretching the ascending aorta, which impacts heart function.
- A study revealed that stiffening of the ascending aorta increases stress in the left ventricle and leads to decreased muscle strain, particularly in the septal area.
- Overall, aortic stiffening negatively affects left ventricular function, but increasing myofiber contractility could help recover some lost stroke volume despite persistent reductions in specific muscle strains.
Article Synopsis
- This study examined how interactions between the ventricles affect right ventricular (RV) size and function in patients with left ventricular assist devices (LVADs) during hemodynamic tests by varying the device speed.
- Researchers found that faster LVAD speeds led to an increase in RV end-diastolic volume and stroke volume, while RV end-systolic volumes remained stable.
- The results suggest that these interventricular interactions actually improve RV compliance and decrease afterload without impairing RV contractility, challenging the common belief that these interactions negatively affect RV function.
There is growing evidence that severe tricuspid regurgitation (TR) impacts clinical outcomes in a variety of cardiovascular disease states. The late presentation of patients with advanced TR highlights the underappreciation of the disease, as well as the pitfalls of current guideline-directed medical management. Given the high in-hospital mortality associated with isolated tricuspid valve surgery, transcatheter options continue to be explored with the hope of improved survival and reduced heart failure hospitalizations.
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- Patients with heart failure and secondary mitral regurgitation (SMR) experience worse health outcomes and quality of life compared to those without SMR.
- Guideline-directed medical therapy remains the primary treatment for SMR, and recent trials on mitral transcatheter edge-to-edge repair have improved insights on which patients might benefit from these procedures with a focus on multidisciplinary care.
- The success of these repairs has led to investigations into their use in populations like end-stage heart failure and cardiogenic shock, alongside ongoing development of new transcatheter devices to enhance treatment options for patients with symptomatic SMR.
Article Synopsis
- Tricuspid transcatheter edge-to-edge repair (TEER) can help patients with tricuspid regurgitation (TR), but many still face risks post-procedure, especially related to stressed blood volume (eSBV).
- A study of 279 patients found that eSBV is linked to factors like obesity and organ dysfunction, critically impacting heart failure and blood flow dynamics.
- Higher eSBV was associated with worse outcomes, such as persistent venous congestion after TEER and increased rates of death and hospitalizations for heart failure, suggesting the need for better patient screening for additional treatments.
Article Synopsis
- - The study investigates the effectiveness of percutaneous left atrial appendage closure (LAAC) versus oral anticoagulation (OAC) for stroke prevention in patients with nonvalvular atrial fibrillation, aiming to provide updated insights based on recent randomized clinical trials (RCTs).
- - A systematic review included three RCTs with 1516 patients, finding LAAC reduced the risk of all-cause mortality, hemorrhagic stroke, and major nonprocedural bleeding compared to OAC, with a follow-up average of 54.7 months.
- - The results indicate that while LAAC may lower long-term death risk, it does not significantly change the overall stroke risk compared to OAC, highlighting the need for
Article Synopsis
- * Out of 408 patients, a significant portion presented with severe to torrential TR, with a median age of 79, and factors like symptoms and right atrial pressure linked to poorer outcomes.
- * Only a third of patients received surgical intervention, with transcatheter procedures associated with higher preoperative risks compared to traditional surgery, emphasizing varied treatment approaches based on individual risk profiles.
Clinical Applications of Pressure-Volume Assessment in Congenital Heart Disease.
J Soc Cardiovasc Angiogr Interv
February 2023
Article Synopsis
- - Ventricular pressure-volume (PV) loops provide valuable information about how the heart functions and how it can be affected by various conditions.
- - These loops are particularly useful for understanding congenital heart diseases, like single ventricular physiology, heart failure, and pulmonary hypertension.
- - The review emphasizes both the theory and practice of obtaining and interpreting PV loops, highlighting their significance in clinical settings and guiding treatment decisions.
Article Synopsis
- The study examines the outcomes of a specific technique called transatrial valve-in-mitral annular calcification (ViMAC) as an alternative to traditional mitral valve surgery, focusing on a large patient registry from multiple centers.
- A total of 126 patients were analyzed, revealing that the majority had successful procedures, although some experienced post-procedure complications and one-year mortality rates were observed.
- The findings suggest that while transatrial ViMAC is generally safe, patients with moderate or severe mitral regurgitation may have a higher risk of complications and may not benefit as much from this procedure.
Right-Sided Mechanical Circulatory Support - A Hemodynamic Perspective.
Curr Heart Fail Rep
October 2022
Article Synopsis
- Right ventricular (RV) failure is a significant health issue that leads to high rates of complications and death, and when medication fails, mechanical circulatory support (MCS) options should be explored.
- Recent advancements in temporary right-sided MCS are emerging, with new devices being designed that effectively unload the RV and improve blood flow by directly aspirating blood.
- Innovative single-access MCS devices are in development, allowing for less patient mobility restriction, and a notable new device called the PERKAT RV is being tested in human trials.
Epidemiology and management of right ventricular-predominant heart failure and shock in the cardiac intensive care unit.
Eur Heart J Acute Cardiovasc Care
July 2022
Article Synopsis
- Cardiogenic shock due to left ventricular failure is common in ICUs, while right ventricular (RV)-predominant heart failure causing shock is less understood.
- The article examines the frequency and causes of RV-predominant heart failure.
- It also explores treatment options, including medications and devices, for managing this complex clinical issue.
Article Synopsis
- Heart failure (HF) leads to increased cardiac filling pressures due to issues like myocardial dysfunction and volume overload.
- The review focuses on the venous system's role and explains the concepts of stressed and unstressed blood volumes in relation to blood distribution.
- It also discusses new methods for estimating stressed blood volume and their application in clinical studies, which enhance the understanding of hemodynamics and treatment options for HF.
Article Synopsis
- The study examined the relationship between right ventricular (RV) and pulmonary arterial (PA) function, focusing on how effectively the RV works against the pressure in the PA in patients with tricuspid regurgitation (TR) undergoing valve repair or replacement.
- Researchers measured the RV-PA coupling ratio by using echocardiograms before and after the procedure, with a key focus on the impact of this ratio on 1-year mortality.
- Findings showed that a higher RV-PA coupling ratio was linked to lower mortality rates, indicating that improved RV function is crucial for better outcomes post-surgery in patients with TR.
Article Synopsis
- The study aimed to assess how often cardiogenic shock (CS) occurs after surgery compared to a less invasive procedure called transcatheter tricuspid valve intervention (TTVI) for tricuspid regurgitation (TR).
- It analyzed data from 122 patients and found that surgery significantly increases the risk of developing advanced CS and that patients with higher central venous pressure (CVP) are at even greater risk.
- The results indicate that those who experience severe CS after either procedure face a higher likelihood of in-hospital death, highlighting the dangers associated with surgical interventions for TR.
Importance: Heart failure (HF) is often characterized by an insidious disease course leading to frequent rehospitalizations and a high use of ambulatory care. Remote cardiac monitoring is a promising approach to detect worsening HF early and intervene prior to an overt decompensation.
Observations: Recently, a multitude of novel technologies for remote cardiac monitoring (RCM) in patients with HF have been developed and are undergoing clinical trials.
Article Synopsis
- Right ventricular pressure-volume (PV) analysis assesses the heart's pumping abilities regardless of external factors like blood volume and pressure.
- It has historically been a complex technique used mainly in research, but advancements in technology have made it more accessible for clinical use.
- The review highlights foundational techniques for measuring and interpreting PV loops, explores its clinical applications, and emphasizes its significance in understanding right ventricular function in various health contexts.