Heart and Vascular Publications Highlights
At the UPMC Heart and Vascular Institute, our faculty, fellows, and clinical staff members engage in research to find new and better treatments for cardiovascular disease. By publishing their findings, our experts share important insights that can help improve treatments and patient care.
Wang Y, Sharbaugh MS, Munir MB, Adelstein EC, Wang NC, Althouse AD, Saba S. Gender Differences in CRT Device Choice and Outcomes in Older Heart Failure Patients. Am J Cardiol 2017 (epub ahead of print) PMID: 29050686
Lead Authors: Yanting Wang, MD; Samir Saba, MD
A team of researchers from the Division of Cardiology’s Cardiac Electrophysiology Program looked at how gender may influence the treatment decision for patients receiving a device for cardiac resynchronization therapy. The study, published in the American Journal of Cardiology, found that women had slightly better survival than men after receiving CRT devices, especially among patients that received a pacemaker as their CRT device in contrast to patients that received a defibrillator for CRT. Further research is needed to determine whether patient gender should be a consideration in the choice of pacemaker versus defibrillator therapy for patients requiring a cardiac resynchronization device.
Masri A, Abdelkarim I, Sharbaugh MS, Althouse AD, Xu J, Han W, Chan SY, Katz WE, Crock FW, Harinstein ME, Kliner DE, Navid F, Lee JS, Gleason TG, Schindler JT, Cavalcante JL. Outcomes of persistent pulmonary hypertension following Transcatheter Aortic Valve Replacement. Heart 2017 (epub ahead of print) PMID: 28970276
Lead Authors: Ahmad Masri, MD; Joao Cavalcante, MD
In a study published in the journal Heart, a team of UPMC researchers looked at the effects of elevated pulmonary arterial pressure (a condition known as pulmonary hypertension) on patients with severe aortic stenosis that were undergoing a procedure known as transcatheter aortic valve replacement (TAVR). The team performed serial echocardiograms in a cohort of 407 patients that underwent TAVR at UPMC between July 2011 and January 2016. The research team measured pulmonary arterial pressure before the procedure and again 1 month after the procedure, and determined that it was common for the pulmonary pressure to remain high in this population. Ahmad Masri, MD noted that "Persistent moderate-severe pulmonary hypertension is not only common after TAVR, but strongly associated with increased risk of all-cause mortality."
Senior author Joao Cavalcante, MD says, "In contrast, patients whose pulmonary pressures came down after TAVR had survival similar to patients with no evidence of pulmonary hypertension. Therefore, further investigation is required to determine whether persistent PH beyond TAVR is a modifiable target for future therapies. As aortic valve procedures account for an increasingly large share of clinical volume, it will be crucial to identify meaningful therapeutic targets in this population.”
Durrani AF, Soma S, Althouse AD, Leef G, Qin D, Saba S. Impact of Race on Outcome of Patients Undergoing Rhythm Control of Atrial Fibrillation. Journal of Immigrant and Minority Health 2017 (epub ahead of print) PMID: 28066862
Lead Author: Samir Saba, MD
In the first 2017 bimonthly issue of the Journal of Immigration and Minority Health, a group of UPMC researchers examined the impact of race on the outcomes of patients with atrial fibrillation (AF) showing that African American patients had a higher risk of death and stroke but a lower risk of AF recurrence compared to white patients.
“Understanding the racial and ethnic differences in outcomes of AF patients is essential for a better and more individualized management of these patients” said Samir Saba, MD, senior author on this study.
In the July 2017 issue of the American Journal of Cardiology, a group of researchers from UPMC reported on the causes and predictors of 30-day readmissions in patients with AF. Using data from the Nationwide Readmissions Database, they demonstrated in 388,340 AF patients that the rate of readmissions was 15.1 percent and that advanced age, female gender, and multiple co-morbidities were independent predictors of readmissions. Dr. Saba said that “understanding the predictors of readmissions in AF patients is a first step in identifying admissions that can be avoided, thus saving patients the risks and morbidity of unnecessary hospital stays while reducing the soaring cost of healthcare.”
Khandhar SJ, Althouse AD, Mulukutla S, Kormos R, Toma C, Marroquin O, Volz E, Tefera L, Bermudez C. Post-operative Outcomes and Management Strategies for Coronary Artery Disease in Patients in need of a Lung Transplantation. Clinical Transplantation 2017 (epub ahead of print) PMID: 28658533
Lead Author: Suresh Mulukutla, MD
A team of UPMC researchers found that patients with coronary disease can safely undergo lung transplant, according to a peer-reviewed article published this month, currently available on the Clinical Transplantation website. Of the 656 lung transplant recipients in the study period, 324 had at least some degree of coronary disease, including 106 with obstructive coronary disease; however, outcomes in the patients with coronary disease were not significantly different than outcomes in patients with no trace of coronary disease.
“There is a perception that patients with coronary artery disease are poor candidates for a lung transplant,” said co-author Suresh Mulukutla, MD. “Our data suggest that these patients are able to safely undergo lung transplant with reasonably good outcomes, even if they have advanced coronary disease that requires coronary intervention.”
Masri A, Althouse AD, McKibben J, Lee JS, Mulukutla SR. Limitations of Administrative Data for Studying Patients Hospitalized with Heart Failure. Annals of Internal Medicine 2017; 166(12): 916-917. PMID: 28462427
Lead Authors: Ahmad Masri, MD; Suresh Mulukutla, MD
In an analysis led by Ahmad Masri, MD, and colleagues at UPMC, investigators used diagnosis codes from administrative data to help determine whether codes that hospitals assign to patients with heart failure change over time. In this study, each heart failure encounter between 2008 and 2015 was assigned an ICD-9 heart failure code. These were classified into heart failure with reduced ejection fraction, heart failure with preserved ejection fraction, and heart failure of unspecified type.
"Using over 20,000 unique encounters of heart failure patients, we found that heart failure coding shifted over time from heart failure of unspecified type toward heart failure with reduced and preserved ejection fraction,” noted Dr. Masri. “While this suggests that coding became more precise and accurate, it also reveals the limitations in using administrative data alone to evaluate our patients."
Heart failure is a diverse condition and there are numerous codes to define the type of heart failure a patient may have, and these have different implications in terms of treatment and outcomes.
"There's a natural excitement to use administrative coding data to examine trends or to explore new hypotheses, but we must recognize that coding data may substantively change over time and so it must be used cautiously,” said Suresh Mulukutla, MD, lead author. “However, we work closely with the UPMC Clinical Analytics program, led by Dr. Oscar Marroquin, to combine administrative data with clinical and outcome data, and this has incredible potential to better define our patient populations so that we can draw the proper conclusions and develop the most effective pathways we need to deliver the highest level of patient-centric care."
Nayak A, Neill C, Kormos RL, Lagazzi L, Halder I, McTiernan C, Larsen J, Inashvili A, Teuteberg J, Bachman TN, Hanley-Yanez K, McNamara DM, Simon MA. Chemokine patterns and right heart failure in mechanical circulatory support. J Heart Lung Transplant 2017;36: 657–665. DOI: doi:10.1016/j.healun.2016.12.007. PMID: 28209402. PMCID: PMC5446283.
Lead Author: Marc Simon, MD
Left ventricular assist devices support the failing left ventricle with great success. However, patients may also suffer from right ventricular failure which may worsen outcomes after Left ventricular assist device implantation. Predicting right ventricular failure after surgery has been difficult.
We found that a family of recently discovered proteins on the heart, chemokine receptors, are decreased in the blood of patients just prior to undergoing Left ventricular assist device implantation and further decreased if those patients then developed right ventricular failure after surgery. This may be a new marker, measurable by blood test, that predicts right ventricular failure after Left ventricular assist device implantation.
Sridharan ND, Chaer RA, Wu BB, Eslami MH, Makaroun MS, Avgerinos ED.
Ann Vasc Surg. 2017 Jul 6. pii: S0890-5096(17)30863-4. doi: 10.1016/j.avsg.2017.06.150. [Epub ahead of print]
Lead Author: Natalie Sridharan, MD
Accumulated deficits, or decreased reserve in multiple organ systems that occurs with aging, has been shown to predict adverse events and mortality after vascular surgery including carotid endarterectomy. However, the impact of accumulated deficits on long-term survival after carotid surgery has not previously been demonstrated. We looked at seven deficits (coronary disease, renal insufficiency, pulmonary disease, peripheral vascular disease, heart failure, hypertension, and diabetes) and found significantly decreased survival over time with accumulating deficits.
We also found that the number of accumulated deficits that a patient had in their history predicted their risk of adverse events within 30-days of surgery (stroke, heart attack, or death) better than simply their age or whether they had stroke or stroke-like symptoms prior to the operation. This is an important finding because carotid disease is a unique pathology with multiple treatment modalities (open surgical, endovascular, and medical) where screening for accumulated deficits may actually shape management particularly in asymptomatic patients, who must have excellent outcomes and a reasonable life expectancy to justify a prophylactic operation.
Sommerfeld A, Althouse AD, Prince J, Atwood CW, Mulukutla SR, Hickey GW. Obstructive Sleep Apnea is Associated with Increased Readmission in Heart Failure Patients. Clin Cardiol 2017 (epub ahead of print) PMID: 28586100
Lead Authors: Alex J. Sommerfeld, MD;Gavin Hickey, MD
In a recent issue of Clinical Cardiology, a team of University of Pittsburgh School of Medicine researchers led by graduate internal medicine resident Alex J. Sommerfeld, MD, showed that obstructive sleep apnea (OSA) is highly prevalent in the heart failure (HF) population, and that HF patients with OSA have more than twice the risk of readmission compared to HF patients without OSA.
“Sleep apnea is an underdiagnosed and undertreated condition in the HF population,” said senior author Gavin Hickey, MD. “We hope that our findings will encourage the heart failure community to be highly vigilant in diagnosing and treating this important comorbidity.”
Helfield B, Chen X, Watkins S, Villanueva FS. Biophysical insight into mechanisms of sonoporation. Proc Natl Acad Sci USA 2016; 113(36):9983-9988. EPub 2016 August 22. doi: 10.1073/pnas.1606915113. PMID: 27551081.
Lead Author: Flordeliza Villanueva, MD
Blowing bubbles may be a child’s play but researchers have been using micron-sized bubbles to poke holes in biological cells for the delivery of drugs and genes to treat cardiovascular disease and cancer. A team of UPMC researchers recently reported their findings on the biophysical mechanisms of such a treatment platform in Proc Natl Acad Sci USA. With the use of an ultrafast camera system developed here at UPMC, they were able to microscopically observe ultrasound-stimulate microbubbles vibrating at a million times per second. They discovered that these oscillating bubbles need to generate a threshold amount of localized shear stress, beyond which cell membranes perforate (sonoporation) and allow entry of a targeted therapeutics. They observed the nature of this perforation to be small resealing pores within the cell membrane, accompanied by transient gaps between neighboring cells – allowing the delivery of therapeutics to the target tissue.
“We’re peering more closely into exactly how this technology works,” says Flordeliza Villanueva, MD, senior author of the study. “We are excited about its potential for affecting patient care, and we want to understand it in greater detail.”