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Article ; Online: Determination of Left Main Coronary Artery Stenosis Through Noninvasive Testing to Guide Revascularization in Ischemic Heart Disease.

Wool, Thomas H / Ashley, Sarah C / Gupta, Vedant A

2023 Volume 204, Page(s) 345–351

Abstract: Anatomically severe left main coronary artery (LMCA) stenosis (>50%) remains one of the few groups to benefit from early revascularization in stable ischemic heart disease (SIHD). Identification of these patients through widely available noninvasive ... ...

Abstract	Anatomically severe left main coronary artery (LMCA) stenosis (>50%) remains one of the few groups to benefit from early revascularization in stable ischemic heart disease (SIHD). Identification of these patients through widely available noninvasive testing would decrease the need for additional upfront anatomic testing, lowering the overall cost of healthcare. Patients with SIHD who underwent either percutaneous or surgical revascularization over a 7-year period at our institution were retrospectively analyzed and categorized as having LMCA stenosis versus non-LM stenosis. All preceding noninvasive testing, including resting electrocardiogram, echocardiogram, and functional testing was evaluated and compared between groups using chi-square and t test. In total, 806 patients were evaluated. Of those, 121 were identified as having significant LMCA stenosis with 685 patients in the non-LM cohort. Between LMCA versus non-LM cohorts, there were similar rates of electrocardiogram abnormalities (68.9% vs 70.8%, p >0.05), abnormal echocardiograms (72.7% vs 69.7%, p >0.05), abnormal functional testing (83.3% vs 77.4%, p >0.05), and high-risk imaging findings (5.6% vs 4.8%, p >0.05). More importantly, of those with a complete workup, there were similar rates of normal results between the LMCA (3 of 18, 16.7%) and non-LM stenosis (9 of 189, 4.8%) groups. A comprehensive noninvasive profile of patients with IHD failed to identify or exclude patients with anatomically severe LMCA stenosis, necessitating anatomic assessment.
MeSH term(s)	Humans ; Constriction, Pathologic ; Retrospective Studies ; Coronary Stenosis/diagnosis ; Coronary Stenosis/surgery ; Coronary Artery Bypass ; Coronary Vessels/diagnostic imaging ; Coronary Vessels/surgery ; Coronary Artery Disease/surgery ; Treatment Outcome
Language	English
Publishing date	2023-08-11
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.2023.07.055
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Article ; Online: Prognostic Implication of Pre-Cannulation Cardiac Arrest in Patients Undergoing Extracorporeal Membrane Oxygenation for the Management of Cardiogenic Shock.

Whiteside, Hoyle L / Hillerson, Dustin / Abdel-Latif, Ahmed / Gupta, Vedant A

Journal of intensive care medicine

2022 Volume 38, Issue 2, Page(s) 202–207

Abstract: Background: The application of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in contemporary management of cardiogenic shock (CS) has dramatically increased. Despite increased utilization, few predictive models exist to estimate patient ... ...

Abstract	Background: The application of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in contemporary management of cardiogenic shock (CS) has dramatically increased. Despite increased utilization, few predictive models exist to estimate patient survival based on pre-ECMO characteristics. Furthermore, the prognostic implications of pre-ECMO cardiac arrest are not well defined. Methods: Utilizing an institutional VA-ECMO database, all consecutive patients undergoing VA-ECMO for the management of CS from January 1, 2014, to July 1, 2019, were identified. Survival to hospital discharge was analyzed based on cannulation indication in patients with and without pre-ECMO cardiac arrest. Patients who received extracorporeal cardiopulmonary resuscitation (eCPR) were analyzed separately. Results: Of the 214 patients identified, 110 did not suffer a cardiac arrest prior to cannulation (cohort 1), 57 patients had a cardiac arrest with sustained ROSC (cohort 2), and 47 were cannulated as a component of eCPR (cohort 3). Despite sustained ROSC (cohort 2), the presence of pre-ECMO cardiac arrest was associated with a significant reduction in survival to hospital discharge (22.8% vs. 55.5% in cohort 1; p < 0.001). Comparatively, survival to discharge was similar in patients undergoing eCPR (22.8% vs. 17.0%; p = 0.464). Finally, patients with a cardiac arrest were significantly more likely to have a neurological etiology death with VA-ECMO than patients supported prior to hemodynamic collapse (18.3% vs. 2.7%; p < 0.001). This result is seen in those with sustained ROSC (21.1% vs. 2.7%; p < 0.001) and those with eCPR (14.9% vs. 2.7%; p = 0.004). Conclusion: In our cohort, pre-ECMO cardiac arrest carries a negative prognostic value across all indications and is associated with an increased prevalence of neurological-etiology death. This finding is true in patients with sustained ROSC as well as those resuscitated with eCPR. Cardiac arrest can inform survival probability with VA-ECMO as early implementation of VA-ECMO may mitigate adverse outcomes in patients at the highest risk of hemodynamic collapse.
MeSH term(s)	Humans ; Shock, Cardiogenic/etiology ; Shock, Cardiogenic/therapy ; Extracorporeal Membrane Oxygenation ; Prognosis ; Heart Arrest/therapy
Language	English
Publishing date	2022-07-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	632828-3
ISSN	1525-1489 ; 0885-0666
ISSN (online)	1525-1489
ISSN	0885-0666
DOI	10.1177/08850666221115606
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Article: The burden of malnutrition & frailty in patients with coronary artery disease: An under-recognized problem.

Arshad, Samiullah / Khan, Samina / Karim, Adham / Gupta, Vedant A

JRSM cardiovascular disease

2022 Volume 11, Page(s) 20480040221102741

Abstract: Elderly patients with coronary artery disease have a high prevalence of frailty and malnutrition. Frailty syndrome is associated with poor outcomes in patients with myocardial infarction. There is a known overlap between frailty and malnutrition, yet ... ...

Abstract	Elderly patients with coronary artery disease have a high prevalence of frailty and malnutrition. Frailty syndrome is associated with poor outcomes in patients with myocardial infarction. There is a known overlap between frailty and malnutrition, yet these are two different entities. Fried Frailty Phenotype, Frail Scale, timed up and go test, and gait speed are rapid screening tests that may identify patients with frailty in everyday clinical setting. Short Form MNA is a sensitive tool to screen for malnutrition. Despite the availability of several tools for screening for both these conditions, the screening rates remain low. We aim to create awareness about the impacts of frailty and malnutrition, provide a brief overview of tools available and highlight the importance of screening in this high-risk population.
Language	English
Publishing date	2022-05-26
Publishing country	England
Document type	Journal Article
ZDB-ID	2663207-X
ISSN	2048-0040
ISSN	2048-0040
DOI	10.1177/20480040221102741
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Article ; Online: Continuity of Critical Care: Establishing a Cardiac Intensive Care Unit Recovery Clinic.

Hillerson, Dustin / Whiteside, Hoyle L / Gupta, Vedant A

JACC. Case reports

2021 Volume 3, Issue 18, Page(s) 1932–1935

Language	English
Publishing date	2021-12-15
Publishing country	Netherlands
Document type	Editorial
ISSN	2666-0849
ISSN (online)	2666-0849
DOI	10.1016/j.jaccas.2021.09.009
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Article ; Online: Multimodal Imaging and Management of a Metastatic Cardiac Intimal Sarcoma.

Ballout, Jad A / Arshia, Asma / Palm, Denada S / Reda, Hassan K / London, Tessa E / O'Connor, William / Gupta, Vedant A

CASE (Philadelphia, Pa.)

2023 Volume 7, Issue 5, Page(s) 163–167

Language	English
Publishing date	2023-03-31
Publishing country	United States
Document type	Case Reports
ISSN	2468-6441
ISSN (online)	2468-6441
DOI	10.1016/j.case.2023.01.008
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Article ; Online: A Meta-Analysis of the Sodium-Glucose Cotransporter 2 Inhibitors in Patients With Heart Failure and Preserved Ejection Fraction.

Al-Abdouh, Ahmad / Mhanna, Mohammed / Barbarawi, Mahmoud / Abusnina, Waiel / Gupta, Vedant A

The American journal of cardiology

2021 Volume 164, Page(s) 138–141

MeSH term(s)	Humans ; Cardiovascular Diseases/mortality ; Heart Failure/complications ; Heart Failure/drug therapy ; Heart Failure/physiopathology ; Hospitalization/statistics & numerical data ; Mortality ; Proportional Hazards Models ; Sodium-Glucose Transporter 2 Inhibitors/therapeutic use ; Stroke Volume/physiology
Chemical Substances	Sodium-Glucose Transporter 2 Inhibitors
Language	English
Publishing date	2021-11-17
Publishing country	United States
Document type	Letter ; Meta-Analysis
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2021.10.017
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Article: Trends and Outcomes of Oral Anticoagulation With Direct Current Cardioversion for Atrial Fibrillation/Flutter at an Academic Medical Center.

Arshad, Samiullah / Davis, George A / Amir, Muhammad / Goldberg, Ythan H / Gupta, Vedant A / Abdel-Latif, Ahmed K / Smyth, Susan

Cardiology research

2022 Volume 13, Issue 2, Page(s) 88–96

Abstract: Background: Increasing reports suggest the safe use of direct oral anticoagulants (DOACs) in electrical cardioversion. The aim of this study was to assess the trends and 30-day outcomes associated with anticoagulation for cardioversion.: Methods: ... ...

Abstract	Background: Increasing reports suggest the safe use of direct oral anticoagulants (DOACs) in electrical cardioversion. The aim of this study was to assess the trends and 30-day outcomes associated with anticoagulation for cardioversion. Methods: Patients who underwent electrical cardioversion from January 2015 to October 2020 with a 30-day follow-up were included; and outcomes including stroke, transient ischemic attack, intracranial hemorrhage (ICH), and major gastrointestinal bleeding were recorded. Results: Of the 515 patients, 351 (68%) were men and 164 (32%) were women, with a mean CHA Conclusions: Our study shows the increasing and safe use of DOACs for the purpose of cardioversion. The rates of 30-day ischemic stroke post cardioversion were low and only occurred in patients admitted in the intensive care unit.
Language	English
Publishing date	2022-03-12
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2598593-0
ISSN	1923-2837 ; 1923-2829
ISSN (online)	1923-2837
ISSN	1923-2829
DOI	10.14740/cr1352
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Article ; Online: Establishing a Cardiac ICU Recovery Clinic: Characterizing a Model for Continuity of Cardiac Critical Care.

Whiteside, Hoyle L / Hillerson, Dustin / Buescher, Victoria / Kreft, Kayla / Mayer, Kirby P / Montgomery-Yates, Ashley / Gupta, Vedant A

Critical pathways in cardiology

2022 Volume 21, Issue 3, Page(s) 135–140

Abstract: Background: Care in the cardiovascular intensive care unit (CICU) has become increasingly intricate due to a temporal rise in noncardiac diagnoses and overall clinical complexity with high risk for short-term rehospitalization and mortality. Survivors ... ...

Abstract	Background: Care in the cardiovascular intensive care unit (CICU) has become increasingly intricate due to a temporal rise in noncardiac diagnoses and overall clinical complexity with high risk for short-term rehospitalization and mortality. Survivors of critical illness are often faced with debility and limitations extending beyond the index hospitalization. Comprehensive ICU recovery programs have demonstrated some efficacy but have primarily targeted survivors of acute respiratory distress syndrome or sepsis. The efficacy of dedicated ICU recovery programs on the CICU population is not defined. Methods: We aim to describe the design and initial experience of a novel CICU-recovery clinic (CICURC). The primary outcome was death or rehospitalization in the first 30 days following hospital discharge. Self-reported outcome measures were performed to assess symptom burden and independence in activities of daily living. Results: Using standardized criteria, 41 patients were referred to CICURC of which 78.1% established care and were followed for a median of 88 (56-122) days. On intake, patients reported a high burden of heart failure symptoms (KCCQ overall summary score 29.8 [18.0-47.5]), and nearly half (46.4%) were dependent on caretakers for activities of daily living. Thirty days postdischarge, no deaths were observed and the rate of rehospitalization for any cause was 12.2%. Conclusions: CICU survivors are faced with significant residual symptom burden, dependence upon caretakers, and impairments in mental health. Dedicated CICURCs may help prioritize treatment of ICU related illness, reduce symptom burden, and improve outcomes. Interventions delivered in ICU recovery clinic for patients surviving the CICU warrant further investigation.
MeSH term(s)	Activities of Daily Living ; Aftercare ; Critical Care ; Heart Diseases/therapy ; Hospital Mortality ; Humans ; Intensive Care Units ; Patient Discharge
Language	English
Publishing date	2022-08-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2079676-6
ISSN	1535-2811 ; 1535-282X
ISSN (online)	1535-2811
ISSN	1535-282X
DOI	10.1097/HPC.0000000000000294
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Article: Role of Echocardiography in the Diagnostic Assessment and Etiology of Heart Failure in Older Adults: Opacify, Quantify, and Rectify.

Gupta, Vedant A / Nanda, Navin C / Sorrell, Vincent L

Heart failure clinics

2017 Volume 13, Issue 3, Page(s) 445–466

Abstract: Echocardiography allows the assessment of systolic and diastolic function and identifies many of the common causes of heart failure (HF). Patients with minimally symptomatic or unsuspected left ventricular systolic dysfunction may be identified and ... ...

Abstract	Echocardiography allows the assessment of systolic and diastolic function and identifies many of the common causes of heart failure (HF). Patients with minimally symptomatic or unsuspected left ventricular systolic dysfunction may be identified and receive the benefits of angiotensin-converting enzyme inhibitor therapy. Echocardiography is also for assessing prognosis and can be used serially to evaluate treatment. Ventricular filling pressures, pulmonary artery pressures, and cardiac output can be sequentially determined. The authors believe that all patients with HF should receive careful assessment echocardiography. The authors believe using echocardiography is especially valuable in the elderly.
MeSH term(s)	Age Factors ; Aged ; Aged, 80 and over ; Echocardiography/methods ; Female ; Heart Failure/diagnostic imaging ; Heart Failure/etiology ; Heart Failure/pathology ; Humans ; Male ; Middle Aged
Language	English
Publishing date	2017-07
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2212019-1
ISSN	1551-7136
ISSN	1551-7136
DOI	10.1016/j.hfc.2017.02.003
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Article ; Online: Cardiovascular Risk After Sepsis: Understanding the Role of Statin Indications and the Impact of Clinical Inertia on Prescribing Patterns.

Gupta, Vedant A / Alnabelsi, Talal S / Shringi, Sandipan / Leung, Steve W / Sorrell, Vincent L

Journal of cardiovascular pharmacology and therapeutics

2020 Volume 25, Issue 6, Page(s) 541–547

Abstract: Introduction: Patients with sepsis have high rates of major adverse cardiovascular events (MACE) in the literature, but the stratification of those at risk has been limited. Statin indicated groups provides clear criteria for therapy, but the risk of ... ...

Abstract	Introduction: Patients with sepsis have high rates of major adverse cardiovascular events (MACE) in the literature, but the stratification of those at risk has been limited. Statin indicated groups provides clear criteria for therapy, but the risk of MACE after sepsis based on these groups has never been assessed. Materials and methods: This was a retrospective cohort analysis conducted on adult patients admitted from January 1, 2013, to December 31, 2013, with suspected or confirmed sepsis and data available on statin use. Patients' past medical history; statin use prior, during, or at time of discharge; and occurrence of MACE were recorded from electronic health records. Result: A total of 321 patients were screened and 265 were found to have data available on statin use. The mean age of the patients was 59 ± 15 years and 47% were female. Overall, 9% were observed to have a MACE at 1 year, with significantly higher rates in those in a statin indicated group (12.2%). On admission, 174 patients were not taking a statin out of whom 52% were in a statin indicated group. Among those in a statin indicated group who survived to hospital discharge, only 10% not on a statin on admission received a statin on discharge, whereas 89% on a statin on admission received a statin on discharge. Conclusion: There is a high risk of MACE after sepsis especially among those in statin indicated groups with significant clinical inertia in prescribing practices.
MeSH term(s)	Adult ; Aged ; Cardiovascular Diseases/diagnosis ; Cardiovascular Diseases/mortality ; Cardiovascular Diseases/prevention & control ; Drug Utilization/trends ; Electronic Health Records ; Female ; Hospitalization ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Male ; Middle Aged ; Practice Patterns, Physicians'/trends ; Protective Factors ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Sepsis/diagnosis ; Sepsis/drug therapy ; Sepsis/mortality ; Treatment Outcome
Chemical Substances	Hydroxymethylglutaryl-CoA Reductase Inhibitors
Language	English
Publishing date	2020-06-19
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1329372-2
ISSN	1940-4034 ; 1074-2484
ISSN (online)	1940-4034
ISSN	1074-2484
DOI	10.1177/1074248420933395
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