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154. Impact of Age on Outcomes in Patients With Cardiogenic Shock

Author

Kanwar, Manreet, primary, Thayer, Katherine L., additional, Garan, Arthur Reshad, additional, Hernandez-Montfort, Jaime, additional, Whitehead, Evan, additional, Mahr, Claudius, additional, Sinha, Shashank S., additional, Vorovich, Esther, additional, Harwani, Neil M., additional, Zweck, Elric, additional, Abraham, Jacob, additional, Burkhoff, Daniel, additional, and Kapur, Navin K., additional

Published
2021
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155. Phenotyping Cardiogenic Shock

Author

Zweck, Elric, primary, Thayer, Katherine L., additional, Helgestad, Ole K. L., additional, Kanwar, Manreet, additional, Ayouty, Mohyee, additional, Garan, A. Reshad, additional, Hernandez‐Montfort, Jaime, additional, Mahr, Claudius, additional, Wencker, Detlef, additional, Sinha, Shashank S., additional, Vorovich, Esther, additional, Abraham, Jacob, additional, O’Neill, William, additional, Li, Song, additional, Hickey, Gavin W., additional, Josiassen, Jakob, additional, Hassager, Christian, additional, Jensen, Lisette O., additional, Holmvang, Lene, additional, Schmidt, Henrik, additional, Ravn, Hanne B., additional, Møller, Jacob E., additional, Burkhoff, Daniel, additional, and Kapur, Navin K., additional

Published
2021
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157. ISHLT consensus document on lung transplantation in patients with connective tissue disease: Part II: Cardiac, surgical, perioperative, operative, and post-operative challenges and management statements

Author

Bermudez, Christian C.A., Crespo, Maria M.M., Shlobin, Oksana Anatolia, Cantu, Edward, Mazurek, Jeremy J.A., Levine, Deborah, Gutsche, Jacob, Kanwar, Manreet M.K., Dellgren, Göran, Bush, Errol E.L., Heresi, Gustavo G.A., Cypel, Marcello, Hadler, Rachel, Kolatis, Nicholas, Franco, Veronica, Benvenuto, Luke, Mooney, Joshua, Pipeling, Matthew, King, Christopher, Mannem, Hannah, Raman, Sanjeev, Knoop, Christiane, Douglas, Aaron, Mercier, Olaf, Bermudez, Christian C.A., Crespo, Maria M.M., Shlobin, Oksana Anatolia, Cantu, Edward, Mazurek, Jeremy J.A., Levine, Deborah, Gutsche, Jacob, Kanwar, Manreet M.K., Dellgren, Göran, Bush, Errol E.L., Heresi, Gustavo G.A., Cypel, Marcello, Hadler, Rachel, Kolatis, Nicholas, Franco, Veronica, Benvenuto, Luke, Mooney, Joshua, Pipeling, Matthew, King, Christopher, Mannem, Hannah, Raman, Sanjeev, Knoop, Christiane, Douglas, Aaron, and Mercier, Olaf

Abstract

Patients with connective tissue disease (CTD) present unique surgical, perioperative, operative, and postoperative challenges related to the often underlying severe pulmonary hypertension and right ventricular dysfunction. The International Society for Heart and Lung Transplantation-supported consensus document on lung transplantation in patients with CTD standardization addresses the surgical challenges and relevant cardiac involvement in the perioperative, operative, and postoperative management in patients with CTD., SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2021

158. Phenotyping cardiogenic shock

Author

Zweck, Elric, Thayer, Katherine L., Helgestad, Ole K.L., Kanwar, Manreet, Ayouty, Mohyee, Garan, A. Reshad, Hernandez-Montfort, Jaime, Mahr, Claudius, Wencker, Detlef, Sinha, Shashank S., Vorovich, Esther, Abraham, Jacob, O’neill, William, Li, Song, Hickey, Gavin W., Josiassen, Jakob, Hassager, Christian, Jensen, Lisette O., Holmvang, Lene, Schmidt, Henrik, Ravn, Hanne B., Møller, Jacob E., Burkhoff, Daniel, Kapur, Navin K., Zweck, Elric, Thayer, Katherine L., Helgestad, Ole K.L., Kanwar, Manreet, Ayouty, Mohyee, Garan, A. Reshad, Hernandez-Montfort, Jaime, Mahr, Claudius, Wencker, Detlef, Sinha, Shashank S., Vorovich, Esther, Abraham, Jacob, O’neill, William, Li, Song, Hickey, Gavin W., Josiassen, Jakob, Hassager, Christian, Jensen, Lisette O., Holmvang, Lene, Schmidt, Henrik, Ravn, Hanne B., Møller, Jacob E., Burkhoff, Daniel, and Kapur, Navin K.

Abstract

BACKGROUND: Cardiogenic shock (CS) is a heterogeneous syndrome with varied presentations and outcomes. We used a machine learning approach to test the hypothesis that patients with CS have distinct phenotypes at presentation, which are associated with unique clinical profiles and in-hospital mortality. METHODS AND RESULTS: We analyzed data from 1959 patients with CS from 2 international cohorts: CSWG (Cardiogenic Shock Working Group Registry) (myocardial infarction [CSWG-MI; n=410] and acute-on-chronic heart failure [CSWG-HF; n=480]) and the DRR (Danish Retroshock MI Registry) (n=1069). Clusters of patients with CS were identified in CSWG-MI using the consensus k means algorithm and subsequently validated in CSWG-HF and DRR. Patients in each phenotype were further categorized by their Society of Cardiovascular Angiography and Interventions staging. The machine learning algorithms revealed 3 distinct clusters in CS: "non-congested (I)", "cardiorenal (II)," and "cardiometabolic (III)" shock. Among the 3 cohorts (CSWG-MI versus DDR versus CSWG-HF), in-hospital mortality was 21% versus 28% versus 10%, 45% versus 40% versus 32%, and 55% versus 56% versus 52% for clusters I, II, and III, respectively. The "cardiometabolic shock" cluster had the highest risk of developing stage D or E shock as well as in-hospital mortality among the phenotypes, regardless of cause. Despite baseline differences, each cluster showed reproducible demographic, metabolic, and hemodynamic profiles across the 3 cohorts. CONCLUSIONS: Using machine learning, we identified and validated 3 distinct CS phenotypes, with specific and reproducible associations with mortality. These phenotypes may allow for targeted patient enrollment in clinical trials and foster development of tailored treatment strategies in subsets of patients with CS.

Published
2021

161. Clinical Outcomes Associated With Acute Mechanical Circulatory Support Utilization in Heart Failure Related Cardiogenic Shock

Author

Hernandez-Montfort, Jaime, primary, Sinha, Shashank S., additional, Thayer, Katherine L., additional, Whitehead, Evan H., additional, Pahuja, Mohit, additional, Garan, Arthur Reshad, additional, Mahr, Claudius, additional, Haywood, Jillian L., additional, Harwani, Neil M., additional, Schaeffer, August, additional, Wencker, Detlef, additional, Kanwar, Manreet, additional, Vorovich, Esther, additional, Abraham, Jacob, additional, Burkhoff, Daniel, additional, and Kapur, Navin K., additional

Published
2021
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164. Reply

Author

Garan, A. Reshad, primary, Kanwar, Manreet, additional, Hernandez-Montfort, Jaime, additional, Mahr, Claudius, additional, Sinha, Shashank S., additional, Burkhoff, Daniel, additional, and Kapur, Navin K., additional

Published
2021
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179. Risk stratification in pulmonary arterial hypertension using Bayesian analysis

Author

Kanwar, Manreet K., primary, Gomberg-Maitland, Mardi, additional, Hoeper, Marius, additional, Pausch, Christine, additional, Pittrow, David, additional, Strange, Geoff, additional, Anderson, James J., additional, Zhao, Carol, additional, Scott, Jacqueline V., additional, Druzdzel, Marek J., additional, Kraisangka, Jidapa, additional, Lohmueller, Lisa, additional, Antaki, James, additional, and Benza, Raymond L., additional

Published
2020
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185. PREDICTING CARDIAC STRUCTURAL AND FUNCTIONAL IMPROVEMENT INDUCED BY MECHANICAL UNLOADING IN CHRONIC HEART FAILURE: A DERIVATION-VALIDATION MULTICENTER STUDY

Author

Taleb, Iosif, primary, Wever-Pinzon, Omar, additional, Kfoury, Abdallah, additional, Caine, William, additional, Stehlik, Josef, additional, McKellar, Stephen, additional, Alharethi, Rami, additional, Koliopoulou, Antigoni, additional, Fang, James C., additional, Selzman, Craig, additional, Shah, Palak, additional, Singh, Ramesh, additional, Psotka, Mitchell, additional, Zhu, Wei, additional, Slaughter, Mark S., additional, Birks, Emma, additional, Koenig, Stephen, additional, Kanwar, Manreet, additional, Guglin, Maya, additional, Kotter, John, additional, Campbell, Kenneth, additional, Vidic, Andrija, additional, Raval, Nirav, additional, Silvestry, Scott, additional, and Drakos, Stavros, additional

Published
2020
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190. Response

Author

Fakih, Mohamad G., Khatib, Riad, Kanwar, Manreet, and Brar, Navkiranjot

Published
2007
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191. Right Ventricular Dysfunction Is Common and Identifies Patients at Risk of Dying in Cardiogenic Shock.

Author

Jain, Pankaj, THAYER, Katherine L., ABRAHAM, Jacob, EVERETT, Kay D., PAHUJA, Mohit, WHITEHEAD, Evan H., SCHWARTZ, Benjamin P., LALA, Anuradha, SINHA, Shashank S., KANWAR, Manreet K., GARAN, A Reshad, HERNANDEZ-MONFORT, Jaime A, MAHR, Claudius, VOROVICH, Esther, WENCKER, Detlef, MCCABE, James M., JONES, Tara, GOUD, Maithri, BACA, Paulina, and HARWANI, Neil

Abstract

Background: Understanding the prognostic impact of right ventricular dysfunction (RVD) in cardiogenic shock (CS) is a key step toward rational diagnostic and treatment algorithms and improved outcomes. Using a large multicenter registry, we assessed (1) the association between hemodynamic markers of RVD and in-hospital mortality, (2) the predictive value of invasive hemodynamic assessment incorporating RV evaluation, and (3) the impact of RVD severity on survival in CS.Methods and Results: Inpatients with CS owing to acute myocardial infarction (AMI) or heart failure (HF) between 2016 and 2019 were included. RV parameters (right atrial pressure, right atrial/pulmonary capillary wedge pressure [RA/PCWP], pulmonary artery pulsatility index [PAPI], and right ventricular stroke work index [RVSWI]) were assessed between survivors and nonsurvivors, and between etiology and SCAI stage subcohorts. Multivariable logistic regression analysis determined hemodynamic predictors of in-hospital mortality; the resulting models were compared with SCAI staging alone. Nonsurvivors had a significantly higher right atrial pressure and RA/PCWP and lower PAPI and RVSWI than survivors, consistent with more severe RVD. Compared with AMI, patients with HF had a significantly lower RA/PCWP (0.58 vs 0.66, P = .001) and a higher PAPI (2.71 vs 1.78, P < .001) and RVSWI (5.70 g-m/m2 vs 4.66 g-m/m2, P < .001), reflecting relatively preserved RV function. Paradoxically, multiple RVD parameters (PAPI, RVSWI) were associated with mortality in the HF but not the AMI cohort. RVD was more severe with advanced SCAI stage, although its prognostic value was progressively diluted in stages D and E. Multivariable modelling incorporating the RA/PCWP improved the predictive value of SCAI staging (area under the curve [AUC] 0.78 vs 0.73, P < .001), largely driven by patients with HF (AUC 0.82 vs 0.71, P < .001).Conclusions: RVD is associated with poor outcomes in CS, with key differences across etiology and shock severity. Further studies are needed to assess the usefulness of RVD assessment in guiding therapy. [ABSTRACT FROM AUTHOR]

Published
2021
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193. Right Ventricular Pressure-Volume Analysis During Left Ventricular Assist Device Speed Optimization Studies: Insights Into Interventricular Interactions and Right Ventricular Failure.

Author

Brener, Michael I., Hamid, Nadira B., Fried, Justin A., Masoumi, Amirali, raikhelkar, Jayant, Kanwar, Manreet K., Pahuja, Mohit, Mondellini, Giulio M., Braghieri, Lorenzo, Majure, David T., Colombo, Paolo C., Yuzefpolskaya, Melana, Sayer, Gabriel T., Uriel, Nir, and Burkhoff, Daniel

Abstract

Background: Interventricular interaction, which refers to the impact of left ventricular (LV) function on right ventricular (RV) function and vice versa, has been implicated in the pathogenesis of RV failure in LV assist device (LVAD) recipients. We sought to understand more about interventricular interaction by quantifying changes in the RV systolic and diastolic function with varying LVAD speeds.Methods and Results: Four patients (ages 22-69 years, 75% male, and 25% with ischemic cardiomyopathy) underwent a protocolized hemodynamic ramp test within 12 months of LVAD implantation where RV pressure-volume loops were recorded with a conductance catheter. The end-systolic PV relationship and end-diastolic PV relationship were compared using the V20 and V10 indices (volumes at which end-systolic PV relationship and end-diastolic PV relationship reach a pressure of 20 and 10 mm Hg, respectively). The ∆V20 and ∆V10 refer to the change in V20 and V10 from the minimum to maximum LVAD speeds. RV PV loops demonstrated variable changes in systolic and diastolic function with increasing LVAD speed. The end-systolic PV relationship changed in 1 patient (patient 2, ∆V20 = 23.5 mL), reflecting a decrease in systolic function with increased speed, and was unchanged in 3 patients (average ∆V20 = 7.4 mL). The end-diastolic PV relationship changed with increasing speed in 3 of 4 patients (average ∆V10 = 12.5 mL), indicating an increase in ventricular compliance, and remained unchanged in one participant (patient 1; ∆V10 = 4.0 mL).Conclusions: Interventricular interaction can improve RV compliance and impair systolic function, but the overall effect on RV performance in this pilot investigation is heterogeneous. Further research is required to understand which patient characteristics and hemodynamic parameters influence the net impact of interventricular interaction. [ABSTRACT FROM AUTHOR]

Published
2021
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194. Monitoring Pulmonary Arterial Hypertension Using an Implantable Hemodynamic Sensor

Author

Benza, Raymond L., primary, Doyle, Mark, additional, Lasorda, David, additional, Parikh, Kishan S., additional, Correa-Jaque, Priscilla, additional, Badie, Nima, additional, Ginn, Greg, additional, Airhart, Sophia, additional, Franco, Veronica, additional, Kanwar, Manreet K., additional, Murali, Srinivas, additional, Raina, Amresh, additional, Agarwal, Rahul, additional, Rajagopal, Sudarshan, additional, White, Jason, additional, and Biederman, Robert, additional

Published
2019
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196. Noninvasive detection of graft injury after heart transplant using donor-derived cell-free DNA: A prospective multicenter study

Author

Khush, Kiran K., primary, Patel, Jignesh, additional, Pinney, Sean, additional, Kao, Andrew, additional, Alharethi, Rami, additional, DePasquale, Eugene, additional, Ewald, Gregory, additional, Berman, Peter, additional, Kanwar, Manreet, additional, Hiller, David, additional, Yee, James P., additional, Woodward, Robert N., additional, Hall, Shelley, additional, and Kobashigawa, Jon, additional

Published
2019
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