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Your search keyword '"Bhandari, Sanjay S."' showing total 24 results
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24 results on '"Bhandari, Sanjay S."'

18. Trimethylamine N-oxide and prognosis in acute heart failure.

Author

Toru Suzuki, Heaney, Liam M., Bhandari, Sanjay S., Jones, Donald J. L., Ng, Leong L., and Suzuki, Toru

Subjects
HEART failure, HEART diseases, THERAPEUTICS, TRIMETHYLAMINE oxide, CARDIAC arrest, BIOMARKERS, CARDIOVASCULAR diseases risk factors, PROGNOSIS, HEART failure treatment, AMINES, BIOCHEMISTRY, CHI-squared test, LIQUID chromatography, MASS spectrometry, PHENOMENOLOGY, MULTIVARIATE analysis, PEPTIDE hormones, PEPTIDES, RESEARCH funding, RISK assessment, TIME, LOGISTIC regression analysis, PREDICTIVE tests, PROPORTIONAL hazards models, ACUTE diseases, PATIENT readmissions, HOSPITAL mortality, ODDS ratio, DIAGNOSIS
Abstract

Objective: Acute heart failure (AHF) is associated with high mortality and morbidity. Trimethylamine N-oxide (TMAO), a gut-derived metabolite, has reported association with mortality risk in chronic HF but this association in AHF is still unknown. The present study investigated TMAO in patients admitted to hospital with AHF, and association of circulating levels with prognosis.Methods: In total, 972 plasma samples were analysed for TMAO concentration by liquid chromatography-mass spectrometry. Associations with in-hospital mortality (72 events), all-cause mortality (death, 268 events) and a composite of death or rehospitalisation due to HF (death/HF, 384 events) at 1 year were examined.Results: TMAO improved risk stratification for in-hospital mortality in combination with current clinical scorings (OR≥1.13, p≤0.014). TMAO tertile analyses reported a graded risk in adverse outcome within 1 year (OR≥1.61, p≤0.004) and improved outcome prediction when stratified as none, one or both biomarker(s) elevated in combination with N-terminal pro B-type natriuretic peptide (NT-proBNP) (OR≥2.15, p≤0.007). TMAO was independently predictive for death and death/HF when corrected for cardiac risk factors (HR≥1.16, p≤0.037); however, this ability was weakened when indices of renal function were included, possibly due to multicollinearity.Conclusions: TMAO contributed additional information on patient stratification for in-hospital mortality of AHF admissions using available clinical scores that include renal indices. Furthermore, elevated levels were associated with poor prognosis at 1 year and combination of TMAO and NT-proBNP provided additional prognostic information. TMAO was a univariate predictor of death and death/HF, and remained an independent predictor until adjusted for renal confounders. [ABSTRACT FROM AUTHOR]

Published
2016
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23. Improving quality and reducing inequality in heart failure.

Author

Bhandari SS and Chan DC

Abstract

The popular annual autumn meeting of the British Society for Heart Failure (BSH) boasted a line-up of internationally recognised authorities in heart failure. Held in London on 28 th -29 th November 2019, the meeting's focus was on improving quality and reducing inequality. Drs Sanjay S Bhandari and Daniel CS Chan report its highlights., (Copyright © 2020 Medinews (Cardiology) Limited.)

Published
2020

24. Recurrent valve obstruction in a patient with a pure carbon bileaflet metallic mitral valve: a case report.

Author

Bhandari SS and Nicolson WB

Abstract

Background: Despite overcoming the morbidity from severe native valve disease, prosthetic metallic valve replacement is not without its inherent morbidity, in particular from prosthetic valve thrombosis (PVT). The contemporary pure carbon bileaflet metallic valve confers reduced thrombogenicity., Case Summary: We describe the case of a 45-year-old woman with a pure carbon bileaflet metallic mitral valve replacement (27/29 mm On-X) 6 months previously for severe rheumatic mitral stenosis, who presented with a rapid onset of dyspnoea, paroxysmal nocturnal dyspnoea, and haemoptysis. This was preceded by an interruption in therapeutic anticoagulation. On admission the patient was in cardiogenic shock. Transthoracic and transoesophageal (TOE) echocardiograms revealed increased transmitral gradients with disc hypomobility, suggestive of PVT, unexpected given the favourable safety profile of the On-X valve. Fluoroscopy confirmed the findings. The patient was thrombolysed successfully with alteplase, with restoration of normal transmitral gradients. A target international normalized ratio of 3.5-4.5 was chosen, in addition to aspirin 75 mg, to minimize thrombotic sequalae. Repeat TOE 6 weeks later revealed disc hypomobilty with a large adherent clot. Due to the high risks from thrombolysis, emergency redo-mitral bioprosthetic valve surgery was performed, to negate the need for long-term anticoagulation., Discussion: Subtherapeutic anticoagulation and the rapid development of dyspnoea, should prompt the clinician to suspect PVT. Thorough clinical examination and immediate bedside echocardiography are critical for assessing prosthetic valve patients in cardiogenic shock. The treatment of PVT is complex, with considerable risks to the patient, irrespective of the strategy (thrombolysis/emergency valve replacement), necessitating the expertise of cardiologists and cardiac surgeons.

Published
2018
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