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Article ; Online: Tricuspid Repair in Patients with Degenerative Mitral Regurgitation.

Bellumkonda, Lavanya

2022 Volume 386, Issue 19, Page(s) 1861

MeSH term(s)	Humans ; Mitral Valve/diagnostic imaging ; Mitral Valve/surgery ; Mitral Valve Insufficiency/surgery ; Tricuspid Valve Insufficiency/complications ; Tricuspid Valve Insufficiency/diagnostic imaging ; Tricuspid Valve Insufficiency/surgery
Language	English
Publishing date	2022-05-30
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	207154-x
ISSN	1533-4406 ; 0028-4793
ISSN (online)	1533-4406
ISSN	0028-4793
DOI	10.1056/NEJMc2202775
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Article ; Online: Omecamtiv Mecarbil in Systolic Heart Failure.

Bellumkonda, Lavanya

The New England journal of medicine

2021 Volume 384, Issue 20, Page(s) 1967

MeSH term(s)	Cardiac Myosins ; Heart Failure, Systolic/drug therapy ; Humans ; Stroke Volume ; Urea/analogs & derivatives
Chemical Substances	omecamtiv mecarbil (2M19539ERK) ; Urea (8W8T17847W) ; Cardiac Myosins (EC 3.6.1.-)
Language	English
Publishing date	2021-05-19
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	207154-x
ISSN	1533-4406 ; 0028-4793
ISSN (online)	1533-4406
ISSN	0028-4793
DOI	10.1056/NEJMc2102893
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Article ; Online: Dual organ transplantation: when heart alone is not enough.

Nuqali, Abdulelah / Bellumkonda, Lavanya

Current opinion in organ transplantation

2023 Volume 28, Issue 5, Page(s) 370–375

Abstract: Purpose of review: The number of dual organ transplantations (DOT) are steadily increasing over the past few years. This is both a reflection of increasing complexity and advanced disease process in the patients and greater transplant center experience ... ...

Abstract	Purpose of review: The number of dual organ transplantations (DOT) are steadily increasing over the past few years. This is both a reflection of increasing complexity and advanced disease process in the patients and greater transplant center experience with performing dual organ transplants. Due to lack of standardization of the process, there remains significant center-based variability in patient selection, perioperative and long-term management of these patients. Recent findings: Overall posttransplant outcomes for DOT have been acceptable with some immunological advantages because of partial tolerance offered by the second organ. These achievements should, however, be balanced with the ethical implications of bypassing the patients who are listed for single organ transplantation because of the preferential allocation of organs for DOT. Summary: The field of DOT is expanding rapidly, with good long-term outcomes. There is an urgent need for guidelines to standardize the process of patient selection and listing dual organ transplantation.
MeSH term(s)	Humans ; Organ Transplantation/adverse effects ; Heart Transplantation ; Tissue and Organ Procurement ; Waiting Lists
Language	English
Publishing date	2023-08-13
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	1390429-2
ISSN	1531-7013 ; 1087-2418
ISSN (online)	1531-7013
ISSN	1087-2418
DOI	10.1097/MOT.0000000000001093
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Zs.A 5609: Show issues

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Article ; Online: Role of ascorbic acid in cardiac allograft vasculopathy.

Chang, Alyssa / Martin, Kathleen A / Colvin, Monica / Bellumkonda, Lavanya

Clinical transplantation

2023 Volume 37, Issue 12, Page(s) e15153

Abstract: Purpose of the review: Cardiac allograft vasculopathy (CAV) is a progressive fibroproliferative disease which occurs after heart transplantation and is associated with significant long-term morbidity and mortality. Currently available strategies ... ...

Abstract	Purpose of the review: Cardiac allograft vasculopathy (CAV) is a progressive fibroproliferative disease which occurs after heart transplantation and is associated with significant long-term morbidity and mortality. Currently available strategies including statins, mammalian target of rapamycin (mTOR) inhibitors, and revascularization, have limited overall effectiveness in treating this pathology once the disease process is established. mTOR inhibitors, while effective when used early in the disease process, are not well tolerated, and hence not routinely used in post-transplant care. Recent data: Recent work on rodent models have given us a novel mechanistic understanding of effects of ascorbic acid in preventing CAV. TET methyl cytosine dioxygenase2 (TET2) reduces vascular smooth muscle cell (VSMC) apoptosis and intimal thickening. TET2 is repressed by interferon γ (IFNγ) in the setting of CAV. Ascorbic acid has been shown to promote TET2 activity and attenuate allograft vasculopathy in animal models and CAV progression in a small clinical trial. Summary: CAV remains a challenging disease process and needs better preventative strategies. Ascorbic acid improves endothelial dysfunction, reduces reactive oxygen species, and prevents development of intimal hyperplasia by preventing smooth muscle cell apoptosis and hyperproliferation. Further large-scale randomized control studies of ascorbic acid are needed to establish the role in routine post-transplant management.
MeSH term(s)	Animals ; Humans ; Ascorbic Acid/therapeutic use ; Heart Diseases/etiology ; Vascular Diseases/drug therapy ; Vascular Diseases/etiology ; Vascular Diseases/prevention & control ; Transplantation, Homologous ; Heart Transplantation/adverse effects ; Allografts ; Mammals
Chemical Substances	Ascorbic Acid (PQ6CK8PD0R)
Language	English
Publishing date	2023-10-04
Publishing country	Denmark
Document type	Journal Article ; Review
ZDB-ID	639001-8
ISSN	1399-0012 ; 0902-0063
ISSN (online)	1399-0012
ISSN	0902-0063
DOI	10.1111/ctr.15153
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Zs.A 2204: Show issues

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Article ; Online: Sarcoid Heart Disease: an Update on Diagnosis and Management.

Masri, Sofia Carolina / Bellumkonda, Lavanya

Current cardiology reports

2020 Volume 22, Issue 12, Page(s) 177

Abstract: Purpose of review: The purpose of this review is to provide an update on cardiac sarcoidosis (CS) and to discuss the current recommendations and progress in diagnosis and management of this disease. Sarcoidosis is a multisystem granulomatous disease of ... ...

Abstract	Purpose of review: The purpose of this review is to provide an update on cardiac sarcoidosis (CS) and to discuss the current recommendations and progress in diagnosis and management of this disease. Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Cardiac involvement is seen in at least 25% and is associated with poor prognosis. Manifestations of cardiac sarcoidosis (CS) can vary from presence of silent myocardial granulomas, which may lead to sudden death, to symptomatic conduction abnormalities, ventricular arrhythmias, and heart failure. Recent findings: We discuss newer imaging modalities such as cardiac magnetic resonance imaging and positron emission tomography in conjunction with clinical criteria increasingly used for diagnosing and prognosticating patients with CS. Immunosuppression (primarily corticosteroids) is recommended for treatment of CS; however, its efficacy has never been proven in prospective randomized studies. The role of imaging to guide the use of immunotherapy is unknown. Cardiac sarcoidosis continues to challenge clinicians due to its protean presentations, lack of diagnostic standards, and data for risk stratification and treatment. There is a need for prospective, randomized controlled trials to understand how best to diagnose and treat cardiac sarcoidosis.
MeSH term(s)	Cardiomyopathies/diagnostic imaging ; Heart Diseases/diagnostic imaging ; Heart Diseases/therapy ; Humans ; Positron-Emission Tomography ; Prospective Studies ; Sarcoidosis/diagnosis
Language	English
Publishing date	2020-10-29
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2055373-0
ISSN	1534-3170 ; 1523-3782
ISSN (online)	1534-3170
ISSN	1523-3782
DOI	10.1007/s11886-020-01429-4
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Zs.A 5524: Show issues

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Article ; Online: Intra-Aortic Balloon Pump: Uncovering Myths and Misconceptions.

Isath, Ameesh / Naami, Edmund / Fried, Justin A / Bellumkonda, Lavanya / Naidu, Srihari S / Tang, W H Wilson / Sharma, Samin / Jneid, Hani / Krittanawong, Chayakrit

Current problems in cardiology

2023 Volume 48, Issue 10, Page(s) 101806

Language	English
Publishing date	2023-05-18
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	441230-8
ISSN	1535-6280 ; 0146-2806
ISSN (online)	1535-6280
ISSN	0146-2806
DOI	10.1016/j.cpcardiol.2023.101806
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Article ; Online: Recent advances in the role of mammalian target of rapamycin inhibitors on cardiac allograft vasculopathy.

Bellumkonda, Lavanya / Patel, Jignesh

Clinical transplantation

2019 Volume 34, Issue 1, Page(s) e13769

Abstract: Cardiac allograft vasculopathy (CAV) is a progressive fibroproliferative disease, which contributes to significant morbidity and mortality during long-term follow-up after heart transplantation. Mammalian target of rapamycin (mTOR) inhibitors have ... ...

Abstract	Cardiac allograft vasculopathy (CAV) is a progressive fibroproliferative disease, which contributes to significant morbidity and mortality during long-term follow-up after heart transplantation. Mammalian target of rapamycin (mTOR) inhibitors have favorable effects on endothelial function and reduce intimal proliferation, and their early use after transplantation has been associated with a reduction in the risk of development and progression of CAV. However, there are conflicting reports on the efficacy of these agents in treating established CAV. Most of the data until recently have been based on short-term follow-up, and CAV was assessed by changes in intravascular ultrasound. In this study, we review the mechanism of action of mTOR inhibitors and their protective role in CAV and summarize some of the recent literature, which include long-term follow-up using this class of medications.
MeSH term(s)	Allografts ; Graft Rejection/drug therapy ; Graft Rejection/etiology ; Graft Rejection/prevention & control ; Heart Transplantation/adverse effects ; Humans ; Sirolimus ; TOR Serine-Threonine Kinases
Chemical Substances	TOR Serine-Threonine Kinases (EC 2.7.1.1) ; Sirolimus (W36ZG6FT64)
Language	English
Publishing date	2019-12-31
Publishing country	Denmark
Document type	Journal Article ; Review
ZDB-ID	639001-8
ISSN	1399-0012 ; 0902-0063
ISSN (online)	1399-0012
ISSN	0902-0063
DOI	10.1111/ctr.13769
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Article ; Online: Usefulness of Intra-aortic Balloon Pump in Patients With Cardiogenic Shock.

Gul, Burcu / Bellumkonda, Lavanya

The American journal of cardiology

2018 Volume 123, Issue 5, Page(s) 750–756

Abstract: Predictors of survival in cardiogenic shock (CS) treated with intra-aortic balloon pump (IABP) are not clearly understood. In this retrospective study, we sought to evaluate patient characteristics and impact of timing of IABP in treatment of CS. ... ...

Abstract	Predictors of survival in cardiogenic shock (CS) treated with intra-aortic balloon pump (IABP) are not clearly understood. In this retrospective study, we sought to evaluate patient characteristics and impact of timing of IABP in treatment of CS. Patients presenting to the Yale New Haven Hospital in CS who received IABP between February 2013 and April 2017 were included in the study. We assessed baseline characteristics and clinical predictors of 30-day mortality. Hundred ninety-three (n = 193) patients were included in this study. Mean age was 68.8 ± 14.5 years. Thirty percent (30%) were women, 38% had cardiac arrest, and left ventricular ejection fraction was 33.7 ± 14.9%. Overall 30-day mortality was 36%. Thirty-day mortality was 24% when IABP was placed within less than 1 hour of onset of CS versus 49% when implanted ≥1 hour after recognition of CS (p = 0.001). Mortality was 18%, 21%, 36%, and 74% for patient requiring 0, 1, 2, and 3 or more inotropes after IABP placement (p < 0.001). In multivariate analysis, advancing age, cardiac arrest on presentation, time to IABP implantation, and number of inotropes needed after IABP implantation predicted 30-day mortality. In the 193 patients, 134 (69.4%) presented with CS from ACS and 59 (30.6%) with CS from non-ACS-related causes. No difference in mortality was noted between the ACS and non-ACS groups 34.3% versus 40.7% (p = 0.39). In conclusion, early use of IABP in CS was associated with significant improvement in 30-day mortality regardless of the etiology of CS. Continued need for significant inotropic support after IABP is associated with worse prognosis and maybe used as an indicator for need to escalate to higher levels of support.
MeSH term(s)	Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Hospital Mortality/trends ; Humans ; Intra-Aortic Balloon Pumping/methods ; Male ; Middle Aged ; Retrospective Studies ; Shock, Cardiogenic/mortality ; Shock, Cardiogenic/physiopathology ; Shock, Cardiogenic/therapy ; Stroke Volume/physiology ; Survival Rate/trends ; Treatment Outcome ; United States/epidemiology ; Ventricular Function, Left/physiology
Language	English
Publishing date	2018-12-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2018.11.041
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Article: Sex and Heart Failure Treatment Prescription and Adherence.

Farrero, Marta / Bellumkonda, Lavanya / Gómez Otero, Inés / Díaz Molina, Beatriz

Frontiers in cardiovascular medicine

2021 Volume 8, Page(s) 630141

Abstract: Heart disease is the leading cause of death in both men and women in developed countries. Heart failure (HF) contributes to significant morbidity and mortality and continues to remain on the rise. While advances in pharmacological therapies have improved ...

Abstract	Heart disease is the leading cause of death in both men and women in developed countries. Heart failure (HF) contributes to significant morbidity and mortality and continues to remain on the rise. While advances in pharmacological therapies have improved its prognosis, there remain a number of unanswered questions regarding the impact of these therapies in women. Current HF guidelines recommend up-titration of neurohormonal blockade, to the same target doses in both men and women but several factors may impair achieving this goal in women: more adverse drug reactions, reduced adherence and even lack of evidence on the optimal drug dose. Systematic under-representation of women in cardiovascular drug trials hinders the identification of sex differences in the efficacy and safety of cardiovascular medications. Women are also under-represented in device therapy trials and are 30% less likely to receive a device in clinical practice. Despite presenting with fewer ventricular arrythmias and having an increased risk of implant complications, women show better response to resynchronization therapy, with lower mortality and HF hospitalizations. Fewer women receive advanced HF therapies. They have a better post-heart transplant survival compared to men, but an increased immunological risk needs to be acknowledged. Technological advances in mechanical circulatory support, with smaller and more hemocompatible devices, will likely increase their implantation in women. This review outlines current evidence regarding sex-related differences in prescription, adherence, adverse events, and prognostic impact of the main management strategies for HF.
Language	English
Publishing date	2021-05-07
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2781496-8
ISSN	2297-055X
ISSN	2297-055X
DOI	10.3389/fcvm.2021.630141
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Article ; Online: The impact of induction therapy on mortality and treated rejection in cardiac transplantation: A retrospective study.

Bellumkonda, Lavanya / Oikonomou, Evangelos K / Hsueh, Christine / Maulion, Christopher / Testani, Jeffrey / Patel, Jignesh

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

2022 Volume 41, Issue 4, Page(s) 482–491

Abstract: Background: Evidence regarding the utility of routine induction therapy on outcomes is not clear. This study aims to evaluate whether induction therapy is associated with a reduced risk of treated rejection and improved overall survival.: Methods: We ...

Abstract	Background: Evidence regarding the utility of routine induction therapy on outcomes is not clear. This study aims to evaluate whether induction therapy is associated with a reduced risk of treated rejection and improved overall survival. Methods: We retrospectively analyzed all adult patients (age ≥ 18 years) that are included in the UNOS database who underwent heart transplantation between 2000 and 2017. Patients with prior transplants and dual organ transplants were excluded. 34,361 patients were included in the final analysis. We assessed the impact of induction therapy with T cell depleting agents (TC-DA), IL2 receptor antagonists (IL2R antagonist) and compared that to no induction therapy using Cox regression models adjusted for propensity scores. The primary outcome measure was all-cause mortality, whereas treated rejection at one year was analyzed as a secondary outcome measure (available in 77% of patients). Results: A total of 52% of the cohort did not receive any induction therapy. A total of 27% received IL2R antagonist and the rest received TC-DA. Median age of the recipients was 55 (IQR: 46-62) years. A total of 25% of the population were women and 39% were supported on left ventricular assist device therapy at the time of transplantation. Median follow-up was 4.2 (IQR: 1.1-8.5) years with 32% reported mortality. Multivariate analysis with propensity score adjustment showed that TC-DA induction did not have any effect on mortality (HR = 0.98, 95% CI 0.93-1.03, p = 0.48). However, IL2R antagonist was associated with a modestly increased risk of all-cause mortality compared to no induction (HR = 1.06, 95% CI 1.01-1.11, p = 0.02, respectively). A total of 25% of patients were found to have treated rejection at one year, TC-DA induction was associated with reduced odds of rejection at one year (OR = 0.82, 95% CI 0.76-0.88, p < 0.001). However, induction with IL2R antagonist was not found to have a significant impact (OR = 1.03, 95% CI 0.96-1.11, p = 0.36). Conclusions: Compared to no induction therapy, induction with TC-DA was associated with reduction in risk of treated rejection at 1 year with no effect on mortality and IL2R antagonist was associated with a small but statistically significant increase in mortality without any impact on risk of rejection.
MeSH term(s)	Adolescent ; Adult ; Antilymphocyte Serum ; Female ; Graft Rejection/epidemiology ; Graft Rejection/prevention & control ; Graft Survival ; Heart Transplantation/adverse effects ; Humans ; Immunosuppressive Agents ; Induction Chemotherapy ; Middle Aged ; Retrospective Studies
Chemical Substances	Antilymphocyte Serum ; Immunosuppressive Agents
Language	English
Publishing date	2022-01-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	1062522-7
ISSN	1557-3117 ; 1053-2498
ISSN (online)	1557-3117
ISSN	1053-2498
DOI	10.1016/j.healun.2022.01.008
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