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7. Predicting post-operative right ventricular failure using video-based deep learning

Author

Shad, Rohan, Quach, Nicolas, Fong, Robyn, Kasinpila, Patpilai, Bowles, Cayley, Castro, Miguel, Guha, Ashrith, Suarez, Eddie, Jovinge, Stefan, Lee, Sangjin, Boeve, Theodore, Amsallem, Myriam, Tang, Xiu, Haddad, Francois, Shudo, Yasuhiro, Woo, Y. Joseph, Teuteberg, Jeffrey, Cunningham, John P., Langlotz, Curt P., and Hiesinger, William

Subjects
Computer Science - Computer Vision and Pattern Recognition, Computer Science - Artificial Intelligence
Abstract

Non-invasive and cost effective in nature, the echocardiogram allows for a comprehensive assessment of the cardiac musculature and valves. Despite progressive improvements over the decades, the rich temporally resolved data in echocardiography videos remain underutilized. Human reads of echocardiograms reduce the complex patterns of cardiac wall motion, to a small list of measurements of heart function. Furthermore, all modern echocardiography artificial intelligence (AI) systems are similarly limited by design - automating measurements of the same reductionist metrics rather than utilizing the wealth of data embedded within each echo study. This underutilization is most evident in situations where clinical decision making is guided by subjective assessments of disease acuity, and tools that predict disease onset within clinically actionable timeframes are unavailable. Predicting the likelihood of developing post-operative right ventricular failure (RV failure) in the setting of mechanical circulatory support is one such clinical example. To address this, we developed a novel video AI system trained to predict post-operative right ventricular failure (RV failure), using the full spatiotemporal density of information from pre-operative echocardiography scans. We achieve an AUC of 0.729, specificity of 52% at 80% sensitivity and 46% sensitivity at 80% specificity. Furthermore, we show that our ML system significantly outperforms a team of human experts tasked with predicting RV failure on independent clinical evaluation. Finally, the methods we describe are generalizable to any cardiac clinical decision support application where treatment or patient selection is guided by qualitative echocardiography assessments., Comment: 12 pages, 3 figures

Published
2021
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8. Misclassification of Pulmonary Hypertension With Current Hemodynamic Criteria.

Author

Guglin, Maya, Munshi, Kartik, Volz, Elizabeth, Bennett, Mosi, Benjamin, Terrie Ann, Bhatt, Kunjan, Bhimaraj, Arvind, Fendler, Timothy, Fudim, Marat, Guha, Ashrith, Heywood, James Thomas, Jonsson, Orvar, Klein, Liviu, McCann, Patrick, Muse, Evan, Robinson, Monique, Sauer, Andrew J., Shah, Hirak, and Abraham, Jacob

Subjects
PULMONARY hypertension, HEMODYNAMICS
Published
2025
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9. Association of secondary mitral regurgitation and right ventricular dysfunction among patients with non-ischaemic cardiomyopathy.

Author

Tayal, Bhupendar, Faza, Nadeen N, Nguyen, Duc T, Malahfji, Maan, Little, Stephen, Saeed, Mujtaba, Goel, Sachin S, Guha, Ashrith, El-Tallawi, Kinan Carlos, Graviss, Edward A, and Shah, Dipan J

Subjects
RISK assessment, MATHEMATICAL variables, CARDIOMYOPATHIES, RESEARCH funding, SCIENTIFIC observation, MAGNETIC resonance imaging, HEART physiology, HEART failure, SEVERITY of illness index, MITRAL valve insufficiency, LONGITUDINAL method, RESEARCH, RIGHT ventricular dysfunction, RIGHT heart ventricle, EVALUATION, DISEASE risk factors, DISEASE complications
Abstract

Aims The association between secondary mitral regurgitation (MR) and right ventricular (RV) dysfunction in heart failure patients with non-ischaemic cardiomyopathy (NICM) is unclear. Hence, our objective was to study the association between secondary MR and the occurrence of RV dysfunction among patients with NICM using cardiac magnetic resonance (CMR). Methods and results Patients with NICM were enrolled in a prospective observational registry between 2008 and 2019. CMR was used to quantify MR severity along with RV function. The RV dysfunction was defined as RV ejection fraction <45%. The outcome of the study was a composite event of all-cause death, heart transplantation, or left ventricular assist device implantation at follow-up. In the study cohort of 241 patients, RV dysfunction (RVEF < 45%) was present in 148 (61%). In comparison with patients without RV dysfunction, those with RV dysfunction had higher median MR volume {23 mL [interquartile range (IQR) 16–31 mL] vs. 18 mL (IQR 12–25 mL), P = 0.002} and MR fraction [33% (IQR 25–43%) vs. 22% (IQR 15–29%), P < 0.001]. Furthermore, secondary MR was independently associated with RV dysfunction: MR volume ≥ 24 mL (OR 3.21, 95% CI 1.26–8.15, P = 0.01) and MR fraction ≥ 30% (OR 5.46, 95% CI 2.23–13.35, P = 0.002). Increasing RVEF (every 1% increase) was independently associated with lower risk of adverse events (HR 0.98; 95% CI 0.95, 1.00; P = 0.047). Conclusion In patients with NICM, the severity of secondary MR is associated with an increased prevalence of RV dysfunction. The RV dysfunction is not only associated with the severity of LV dysfunction but also with the severity of secondary MR. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT04281823. [ABSTRACT FROM AUTHOR]

Published
2024
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11. A multi-institutional retrospective analysis on impact of RV acute mechanical support timing after LVAD implantation on 1-year mortality and predictors of RV acute mechanical support weaning

Author

Kumar, Salil, Derbala, Mohamed H., Nguyen, Duc T., Ferrall, Joel, Cefalu, Matthew, Rivas-Lasarte, Mercedes, Rashid, Syed Muhammad Ibrahim, Joseph, Denny T., Graviss, Edward A., Goldstein, Daniel, Jorde, Ulrich P., Bhimaraj, Arvind, Suarez, Erik E., Smith, Sakima A., Sims, Daniel B., and Guha, Ashrith

Published
2022
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17. Terbutaline for Management of Relative Bradycardia Post‐Orthotopic Heart Transplant: A Single Center Experience.

Author

Tu, Zoe H., Yun, Allison N., Gorthi, Janardhana, Guha, Ashrith, Krisl, Jill C., and Bhimaraj, Arvind

Subjects
HEART transplant recipients, SINOATRIAL node, TERBUTALINE, ACADEMIC medical centers, HEART transplantation
Abstract

Background: Vagal nerve denervation during the heart transplant procedure results in higher resting heart rates in these recipients compared to the general population. Relative bradycardia (RB) is a common and often temporary post‐operative complication that can be managed with agents like terbutaline; however, little data exist on the efficacy, safety, and necessity of long‐term terbutaline use post‐heart transplant. Methods: This was a single‐center, retrospective, descriptive study conducted at a large academic medical center investigating oral terbutaline use for RB management in heart transplant recipients. Outcomes included time to and reason for terbutaline discontinuation post‐transplant, adverse event rates, and permanent pacemaker (PPM) placement rates. Results: In the 229 patients included, the median (IQR) time to terbutaline initiation was 8 (5, 12) days post‐heart transplant, with a median (IQR) time to discontinuation of 56 (20, 96) days from the first dose. In most cases, terbutaline was successfully tapered off outpatient due to the resolution of RB. Tachyarrhythmias occurred in 29 (12.7%) patients without long‐term sequelae. At 3 months post‐transplant, PPM had been placed for chronotropic support in 15 patients (6.6%) with a median time (IQR) to PPM placement of 24 (19, 77) days from transplant. Conclusion: This study's overall low PPM placement rate suggests that early sinus node dysfunction can be treated with pharmacotherapy without committing to a permanent device, and that terbutaline can be used safely in early post‐heart transplant recipients. If patients require long‐term chronotropic support, the risk‐benefit of PPM placement versus continued terbutaline should be considered. [ABSTRACT FROM AUTHOR]

Published
2024
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20. Prognostic Value of Right Ventricular Afterload in Patients Undergoing Mitral Transcatheter Edge‐to‐Edge Repair

Author

Bou Chaaya, Rody G., primary, Hatab, Taha, additional, Samimi, Sahar, additional, Qamar, Fatima, additional, Kharsa, Chloe, additional, Aoun, Joe, additional, Faza, Nadeen, additional, Little, Stephen H., additional, Atkins, Marvin D., additional, Reardon, Michael J., additional, Kleiman, Neal S., additional, Nagueh, Sherif F., additional, Zoghbi, William A., additional, Guha, Ashrith, additional, Zaid, Syed, additional, and Goel, Sachin S., additional

Published
2024
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23. Effectiveness of combined plasma cell therapy and costimulation blockade based desensitization regimen in heart transplant candidates

Author

Fida, Nadia, primary, Eagar, Todd N., additional, Yun, Allison N., additional, Rogers, Alex W., additional, Nguyen, Duc T., additional, Graviss, Edward A., additional, Ishaq, Farhan, additional, DiPaola, Nicholas R., additional, Kim, Ju, additional, Janardhana, Gorthi, additional, Kassi, Mahwash, additional, Yousefzai, Rayan, additional, Suarez, Eric E., additional, Bhimaraj, Arvind, additional, Krisl, Jill C., additional, and Guha, Ashrith, additional

Published
2024
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25. Differences In Wait-list Mortality In Patients Bridged With Temporary Or Durable Mechanical Circulatory Support Devices; A Propensity Score Matched Analysis Of The Current Unos Listing System

Author

Kassi, Mahwash, primary, Zook, Salma, additional, Bhimaraj, Arvind, additional, Fida, Nadia, additional, Ahsan, Syed, additional, Gorthi, Janardhana, additional, Hussain, Imad, additional, Kim, Ju, additional, Legha, Sapna, additional, Martin, Cindy, additional, Kumar, Salil, additional, Nguyen, Duc, additional, Graviss, Edward, additional, and Guha, Ashrith, additional

Published
2024
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26. Early detection of pulmonary arterial hypertension through [18F] positron emission tomography imaging with a vascular endothelial receptor small molecule.

Author

Yang, Zhen, Li, Feng, Thandavarayan, Rajarajan A., Natarajan, Kartiga, Martin, Diego R., Li, Zheng, and Guha, Ashrith

Subjects
VASCULAR endothelial growth factor receptors, POSITRON emission tomography, PULMONARY arterial hypertension, LABORATORY rats, PULMONARY artery
Abstract

The objective of this study is to provide a positron emission tomography (PET) imaging modality targeting vascular endothelial growth factor receptors (VEGFR) for the early noninvasive detection and assessment of pulmonary arterial hypertension (PAH) severity. To validate the effectiveness of the [18F]VEGFR PET tracer, we utilized a monocrotaline (MCT)‐induced PAH rat model. Molecular optical imaging, using a Cy5.5‐conjugated VEGFR targeting agent, was employed to demonstrate the uptake of the agent at pulmonary arterioles, correlating with the onset and progression of PAH. Histological examinations of the MCT‐PAH rat lung revealed a significant correlation between VEGFR2 expression and the pathogenesis of PAH. Molecular optical imaging demonstrated heightened uptake of the Cy5.5‐conjugated VEGFR targeting agent at pulmonary arterioles, corresponding with the onset and progression of PAH. [18F]VEGFR PET showed increased lung uptake detectable in early‐stage PAH before increase in pulmonary artery pressures, and this uptake correlated with increased PAH severity. Moreover, when compared to [18F]FDG PET, [18F]VEGFR PET exhibited markedly lower background cardiac signal, enhancing imaging sensitivity for lung abnormalities. Our study provides a compelling evidence for the potential utility of the innovative [18F]VEGFR PET tracer, in non‐invasively detecting early signs of PAH, and monitoring its progression. The observed correlations between VEGFR2 expression, molecular optical imaging results, and [18F]VEGFR PET findings support the use of this tracer for early detection, and assessment of PAH severity. The lower background cardiac signal observed with [18F]VEGFR PET further enhances its imaging sensitivity, emphasizing its potential clinical significance. [ABSTRACT FROM AUTHOR]

Published
2024
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30. Multicenter registry and test bed for extended outpatient hemodynamic monitoring: the hemodynamic frontiers in heart failure (HF2) initiative

Author

Heywood, J. Thomas, primary, Munshi, Kartik, additional, Jordan, Timothy, additional, Muse, Evan, additional, Fudim, Marat, additional, Sauer, Andrew J., additional, McDermott, Margaret, additional, Shah, Hirak, additional, Bhimaraj, Arvind, additional, Khedraki, Rola, additional, Robinson, Monique R., additional, McCann, Patrick, additional, Volz, Elizabeth, additional, Guha, Ashrith, additional, Jonsson, Orvar, additional, Bhatt, Kunjan A., additional, Bennett, Mosi K., additional, Benjamin, Terrie Ann, additional, Guglin, Maya, additional, and Abraham, Jacob, additional

Published
2023
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32. Ventricular arrhythmias prior to continuous flow left ventricular assist device implantation were not associated with reduced 1-year mortality: a single-center experience

Author

Pandat, Summit, primary, Rothstein, Peter, additional, Laird, Rachel, additional, Islam, Momin, additional, Zaid, Syed, additional, Truman, Amy, additional, Bhimaraj, Arvind, additional, Yousefzai, Rayan, additional, Guha, Ashrith, additional, Schurmann, Paul, additional, Dave, Amish, additional, Valderrábano, Miguel, additional, and Mathuria, Nilesh, additional

Published
2023
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33. Bloodstream infections in prolonged use of axillary-placed, intra-aortic balloon-pump support: A single-center study

Author

Dreucean, Diane, primary, Donahue, Kevin R., additional, Morton, Celia, additional, Succar, Luma, additional, Krisl, Jill, additional, Agrawal, Tanushree, additional, Perez, Katherine, additional, Jaramillo, Taylor, additional, Kim, Ju, additional, Fida, Nadia, additional, Guha, Ashrith, additional, Kassi, Mahwash, additional, Yousefzai, Rayan, additional, Hussain, Imad, additional, Grimes, Kevin, additional, and Bhimaraj, Arvind, additional

Published
2023
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34. Translating Pressure Into Practice: Operational Characteristics of Ambulatory Hemodynamic Monitoring Program in the United States

Author

BHIMARAJ, ARVIND, primary, BENJAMIN, TERRIE-ANN, additional, GUGLIN, MAYA, additional, VOLZ, ELIZABETH, additional, SHAH, HIRAK, additional, GUHA, ASHRITH, additional, BHATT, KUNJAN, additional, BENNETT, MOSI, additional, SAUER, ANDREW, additional, FUDIM, MARAT, additional, ROBINSON, MONIQUE, additional, MUSE, EVAN D., additional, HEYWOOD, THOMAS J., additional, JONSSON, ORVAR, additional, and ABRAHAM, JACOB, additional

Published
2023
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35. TCT-599 The Prognostic Value of Right Ventricular Afterload in Patients Undergoing Mitral Transcatheter Edge-to-Edge Repair

Author

Chaaya, Rody Bou, primary, Hatab, Taha, additional, Samimi, Sahar, additional, Qamar, Fatima, additional, Aoun, Joe, additional, Little, Stephen, additional, Faza, Nadeen, additional, Atkins, Marvin, additional, Reardon, Michael, additional, Kleiman, Neal, additional, Zoghbi, William, additional, Guha, Ashrith, additional, Zaid, Syed, additional, and Goel, Sachin, additional

Published
2023
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39. Abstract 15341: Multi-center Validation of a Novel Echocardiography Artificial Intelligence System to Predict Post-operative Right Ventricular Failure in LVAD Patients

Author

Arora, Rohan Shad, Quach, Nicolas, Fong, Robyn, Kong, Sandra, Kasinpila, Patpilai, Castro, Miguel, Guha, Ashrith, Suarez, Erik E, Jovinge, Stefan, Lee, Sangjin, boeve, theodore, Langlotz, Curtis P, Amsallem, Myriam, Haddad, Francois, Shudo, Yasuhiro, Woo, Y Joseph Y, Teuteberg, Jeffrey, and Hiesinger, William

Published
2020
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42. Von Willebrand Factor Activation Assays Predict Bleeding And Other Hemocompatibility-Related Adverse Events In Patients With CF-LVAD.

Author

Vekaria, Bansi, primary, Avenatti, Eleonora, additional, Shah, Aayush, additional, Kim, Ju, additional, Yousefzai, Rayan, additional, Hussain, Imad, additional, Guha, Ashrith, additional, Bhimaraj, Arvind, additional, Gorthi, Janardhana, additional, Chen, Jian, additional, Graviss, Edward A, additional, Nguyen, Duc T, additional, De Oliveira, Marcos, additional, Chou, Lin-Chiang Philip, additional, Suarez, Erik, additional, MacGillivray, Thomas E., additional, and Kassi, Mahwash, additional

Published
2023
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44. Outflow cannula alignment in continuous flow left ventricular devices is associated with stroke

Author

Kassi, Mahwash, primary, Agrawal, Tanushree, additional, Xu, Jiaqiong, additional, Marcos-Abdala, Hernan Gerardo, additional, Araujo-Gutierrez, Raquel, additional, Macgillivray, Thomas, additional, Suarez, Erik E, additional, Yousefzai, Rayan, additional, Fida, Nadia, additional, Kim, Ju H, additional, Hussain, Imad, additional, Guha, Ashrith, additional, Trachtenberg, Barry, additional, Bhimaraj, Arvind, additional, Chang, Su Min, additional, and Estep, Jerry, additional

Published
2023
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45. Impact of exercise on pulmonary artery pressure in patients with heart failure using an ambulatory pulmonary artery pressure monitor

Author

Khedraki, Rola, primary, Abraham, Jacob, additional, Jonsson, Orvar, additional, Bhatt, Kunjan, additional, Omar, Hesham R., additional, Bennett, Mosi, additional, Bhimaraj, Arvind, additional, Guha, Ashrith, additional, McCann, Patrick, additional, Muse, Evan D., additional, Robinson, Monique, additional, Sauer, Andrew J., additional, Cheng, Andrew, additional, Bagsic, Samantha, additional, Fudim, Marat, additional, Heywood, J. Thomas, additional, and Guglin, Maya, additional

Published
2023
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48. Outcomes Of Patients With Advanced Chronic Kidney Disease And A Pulmonary Artery Pressure Sensor: Insights From The HF2 Registry

Author

Sanders, Mason, Volz, Elizabeth, Munshi, Kartik, Benjamin, Terrie Ann, Bennett, Mosi, Pilla, Pranathi, Bhatt, Kunjan, Bhimaraj, Arvind, Fendler, Timothy, Fudim, Marat, Guglin, Maya, Guha, Ashrith, Heywood, J. Thomas, Jonsson, Orvar, Klein, Liviu, McCann, Patrick, Robinson, Monique, Sauer, Andrew, Li, Hsin-Fang, Shah, Hirak, and Abraham, Jacob

Published
2025
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49. The Role Of Angiogenesis In Gastrointestinal Bleeding In Left Ventricular Assisted Device Patients: Highlighting Platelet-derived Growth Factor As A Predictive Marker

Author

Zook, Salma, Youker, Keith, Ingram, Katelyn, Saeed, Mujtaba, Ojukwu, Otito, Avenatti, Eleonora, Legha, Sapna, Yousefzai, Rayan, Kim, Ju, Hussain, Imad, Martin, Cindy, Gorthi, Janardhana, Ahsan, Syed, Fida, Nadia, Bhimaraj, Arvind, Guha, Ashrith, Shannon, Wilson, Moreno, Michael, and Kassi, Mahwash

Published
2025
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