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4,333 results on '"O'Neill, William"'

3. Characteristics and outcomes of patients presenting with acute myocardial infarction and cardiogenic shock during COVID‐19

Author

Ahlers, Michael J, Srivastava, Pratyaksh K, Basir, Mir B, O'Neill, William W, Hacala, Michael, Ammar, Kareem, Khalil, Suzan, Hollowed, John, and Nsair, Ali

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Cardiovascular, Prevention, Heart Disease, Heart Disease - Coronary Heart Disease, Clinical Research, Good Health and Well Being, COVID-19, Female, Heart-Assist Devices, Humans, Middle Aged, Myocardial Infarction, Pandemics, Percutaneous Coronary Intervention, ST Elevation Myocardial Infarction, Shock, Cardiogenic, Treatment Outcome, United States, acute myocardial infarction/STEMI, coronary artery disease, intervention, mechanical circulatory support, ECMO/IABP/tandem/Impella, shock, cardiogenic, coronary artery disease, intervention, mechanical circulatory support, ECMO/IABP/tandem/Impella, shock, cardiogenic, Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology, Cardiovascular medicine and haematology
Abstract

ObjectivesTo evaluate characteristics and outcomes of patients presenting with acute myocardial infarction and cardiogenic shock (AMICS) during the coronavirus disease 2019 (COVID-19) pandemic.BackgroundThe COVID-19 pandemic has created challenges in delivering acute cardiovascular care. Quality measures and outcomes of patients presenting with AMICS during COVID-19 in the United States have not been well described.MethodsWe identified 406 patients from the National Cardiogenic Shock Initiative (NCSI) with AMICS and divided them into those presenting before (N = 346, 5/9/2016-2/29/2020) and those presenting during the COVID-19 pandemic (N = 60, 3/1/2020-11/10/2020). We compared baseline clinical data, admission characteristics, and outcomes.ResultsThe median age of the cohort was 64 years, and 23.7% of the group was female. There were no significant differences in age, sex, and medical comorbidities between the two groups. Patients presenting during the pandemic were less likely to be Black compared to those presenting prior. Median door to balloon (90 vs. 88 min, p = 0.38), door to support (88 vs. 78 min, p = 0.13), and the onset of shock to support (74 vs. 62 min, p = 0.15) times were not significantly different between the two groups. Patients presented with ST-elevation myocardial infarction more often during the COVID-19 period (95.0% vs. 80.0%, p = 0.005). In adjusted logistic regression models, COVID-19 period did not significantly associate with survival to discharge (odds ratio [OR] 1.09, 95% confidence interval [CI] 0.54-2.19, p = 0.81) or with 1-month survival (OR 0.82, 95% CI 0.42-1.61, p = 0.56).ConclusionsCare of patients presenting with AMICS has remained robust among hospitals participating in the NCSI during the COVID-19 pandemic.

Published
2022

5. Temporary mechanical circulatory support in infarct-related cardiogenic shock: an individual patient data meta-analysis of randomised trials with 6-month follow-up

Author

Burkhoff, Daniel, Cohen, Howard, Brunckhorst, Corinna, O'Neill, William W., Thiele, Holger Thiele, Sick, Peter, Boudriot, Enno, Diederich, Klaus-Werner, Hambrecht, Rainer, Niebauer, Josef, Schuler, Gerhard, Seyfarth, Melchior, Sibbing, Dirk, Bauer, Iris, Fröhlich, Georg, Bott-Flügel, Lorenz, Byrne, Robert, Dirschinger, Josef, Kastrati, Adnan, Schömig, Albert, Ouweneel, Dagmar M., Eriksen, Erlend, Sjauw, Krischan D., van Dongen, Ivo M., Hirsch, Alexander, Packer, Erik J.S, Vis, M. Marie, Wykrzykowska, Joanna J., Koch, Karel T., Baan, Jan, De Winter, Robbert J, Piek, Jan J., Lagrand, Wim K, de Mol, Bas A.J.M, Tijssen, Jan G.P., Henriques, José P.S., Møller, Jacob E., Engstrøm, Thomas, Jensen, Lisette Okkels, Eiskjær, Hans, Mangner, Norman, Polzin, Amin, Schulze, P. Christian, Skurk, Carsten, Nordbeck, Peter, Clemmensen, Peter, Panoulas, Vasileios, Zimmer, Sebastian, Schäfer, Andreas, Werner, Nikos, Frydland, Martin, Holmvang, Lene, Kjærgaard, Jesper, Sørensen, Rikke, Lønborg, Jacob, Greve, Matias, Christiansen, Evald H., Linke, Axel, Woitek, Felix J., Westenfeld, Ralf, Moebius-Winkler, Sven, Wachtell, Kristian, Ravn, Hanne Berg, Lassen, Jens Flensted, Boesgaard, Søren, Gerke, Oke, Hassager, Christian, Lackermair, Korbinian, Brunner, Stefan, Orban, Mathias, Peterss, Sven, Orban, Martin, Theiss, Hans D., Huber, Bruno C., Juchem, Gerd, Born, Frank, Boulesteix, Anne-Laure, Bauer, Axel, Pichlmaier, Maximilian, Hausleiter, Jörg, Massberg, Steffen, Hagl, Christian, Guenther, Sabina P.W., Ostadal, Petr, Rokyta, Richard, Karasek, Jiri, Kruger, Andreas, Vondrakova, Dagmar, Janotka, Marek, Naar, Jan, Smalcova, Jana, Hubatova, Marketa, Hromadk, Milan, Volovar, Stefan, Seyfrydova, Miroslava, Jarkovsky, Jiri, Svoboda, Michal, Linhart, Ales, Belohlavek, Jan, Banning, Amerjeet S., Sabaté, Manel, Gracey, Jay, López-Sobrino, Teresa, Bogaerts, Kris, Adriaenssens, Tom, Berry, Colin, Erglis, Andrejs, Haine, Steven, Myrmel, Truls, Patel, Sameer, Buera, Irene, Sionis, Alessandro, Vilalta, Victoria, Yusuff, Hakeem, Vrints, Christiaan, Adlam, David, Flather, Marcus, Gershlick, Anthony H., Thiele, Holger, Zeymer, Uwe, Akin, Ibrahim, Behnes, Michael, Rassaf, Tienush, Mahabadi, Amir-Abbas, Lehmann, Ralf, Eitel, Ingo, Graf, Tobias, Seidler, Tim, Schuster, Andreas, Duerschmied, Daniel, Hennersdorf, Marcus, Fichtlscherer, Stephan, Voigt, Ingo, John, Stefan, Ewen, Sebastian, Tigges, Eike, Nordbeck, Peter Steffen, Bruch, Leonhard, Jung, Christian, Franz, Jutta, Lauten, Philipp, Goslar, Tomaz, Feistritzer, Hans-Josef, Pöss, Janine, Kirchhof, Eva, Ouarrak, Taoufik, Schneider, Steffen, Desch, Steffen, Freund, Anne, Møller, Jacob E, Henriques, Jose P S, Bogerd, Margriet, Hochadel, Matthias, and Schulze, P Christian

Published
2024
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7. The Transcatheter Aortic Valve Replacement-Conduction Study: The Value of the His-Ventricular Interval in Risk Stratification for Post-TAVR Atrioventricular-Block

Author

Raad, Mohamad, Greenberg, Joshua, Altawil, Mahmoud, Lee, James, Wang, Dee Dee, Oudeif, Ahmed, Birchak, John, Abdelrahim, Elsheikh, Makki, Tarek, Mohammed, Mustafa, Chehab, Omar, Ignatius, Abel, Singh, Gurjit, Maskoun, Waddah, O'Neill, Brian, Lahiri, Marc, Eng, Marvin, Villablanca, Pedro, Wyman, Janet F., Khan, Arfaat, Epstein, Andrew E., O'Neill, William, Schuger, Claudio, and Frisoli, Tiberio M.

Published
2024
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12. Clinical outcomes among patients with mitral valve regurgitation undergoing Impella-supported high-risk PCI

Author

Abu-Much, Arsalan, Grines, Cindy L., Chen, Shmuel, Batchelor, Wayne B., Zhao, Duzhi, Falah, Batla, Maini, Aneel S., Redfors, Björn, Bellumkonda, Lavanya, Bharadwaj, Aditya S., Moses, Jeffrey W., Truesdell, Alexander G., Zhang, Yiran, Zhou, Zhipeng, Baron, Suzanne J., Lansky, Alexandra J., Basir, Mir B., O'Neill, William W., and Cohen, David J.

Published
2024
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13. Feasibility and Outcomes of a Cardiovascular Medicine Inclusive Extracorporeal Membrane Oxygenation (ECMO) Service

Author

Fadel, Raef A., Almajed, Mohamed Ramzi, Parsons, Austin, Kalsi, Jasmeet, Shadid, Muthanna, Maki, Mohamed, Alqarqaz, Mohammad, Aronow, Herb, Cowger, Jennifer, Fuller, Brittany, Frisoli, Tiberio, Grafton, Gillian, Kim, Henry, Jones, Crystal, Koenig, Gerald, Khandelwal, Akshay, Nemeh, Hassan, O’Neill, Brian, Tanaka, Daizo, Williams, Celeste, Villablanca, Pedro, O’Neill, William, Alaswad, Khaldoon, and Basir, Mir Babar

Published
2024
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19. William A. O'Neill records

Author

O'Neill, William A. and O'Neill, William A.

Subjects
Governors Archives. Connecticut, Administrative agencies Connecticut., Campaign literature Connecticut., Older people Government policy Connecticut., People with mental disabilities Government policy Connecticut., Transportation and state Connecticut., Gouverneurs Archives. Connecticut, Administration publique Connecticut., Campagnes électorales Documentation Connecticut., Personnes âgées Politique gouvernementale Connecticut., Personnes ayant une déficience intellectuelle Politique gouvernementale Connecticut., Transport Politique gouvernementale Connecticut., Administrative agencies., Campaign literature., Governors., Older people Government policy., People with mental disabilities Government policy., Politics and government., Transportation and state., Connecticut Sources. History, Connecticut Sources. Politics and government 1951, Connecticut Sources. Histoire, Connecticut Sources. Politique et gouvernement 1951, Connecticut.
Abstract

Constituent correspondence, reports from state agencies, records of the Governor's legal counsel (Jay Jackson and Howard Rifkin), records of special assistant David McQuade, correspondence and reports from the Governor's Washington office, and press releases, photographs, and campaign materials including film and videotapes.

Published
2024

20. Outcomes following TAVR in patients with cardiogenic shock: A systematic review and meta-analysis

Author

Jabri, Ahmad, Ayyad, Mohammed, Albandak, Maram, Al-Abdouh, Ahmad, Madanat, Luai, Khalefa, Basma Badrawy, Alhuneafat, Laith, Ayyad, Asem, Lemor, Alejandro, Mhanna, Mohammed, Al Jebaje, Zaid, Fadel, Raef, Gonzalez, Pedro Engel, O'Neill, Brian, Bagur, Rodrigo, Hanson, Ivan D., Abbas, Amr E., Frisoli, Tiberio, Lee, James, Wang, Dee Dee, Aggarwal, Vikas, Alaswad, Khaldoon, O'Neill, William W., Aronow, Herbert D., AlQarqaz, Mohammad, and Villablanca, Pedro

Published
2024
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22. Automated laser induced damage threshold testing applied to a ferroelectric spatial light modulator

Author

Christopher, Peter J., Gabbani, Nadeem, O'Neill, William, and Wilkinson, Timothy D.

Subjects
Physics - Instrumentation and Detectors
Abstract

Laser Induced Damage Thresholds (LIDTs) are a measure of the level of fluence an optical component may be expected to handle without observable damage. In this work we present an automated system for measurement of LIDTs for a wide range of components and include details of the data handling, image processing and code required. We then apply this system to LIDT measurements of a commercial HDP-1280-2 'BlueJay' ferroelectric display finding a LIDT of 9.2 W/cm2 {\O}27{\mu}m, 5.5 W/cm2 {\O}150{\mu}m and 3.2 W/cm2 {\O}3.1mm with wavelength 1090+-5nm. Finally, the quality of the results obtained are discussed and conclusions drawn.

Published
2020

23. 1-Year Outcomes From the CLASP IID Randomized Trial for Degenerative Mitral Regurgitation

Author

Zahr, Firas, Smith, Robert L., Gillam, Linda D., Chadderdon, Scott, Makkar, Raj, von Bardeleben, Ralph Stephan, Ruf, Tobias Friedrich, Kipperman, Robert M., Rassi, Andrew N., Szerlip, Molly, Goldman, Scott, Inglessis-Azuaje, Ignacio, Yadav, Pradeep, Lurz, Philipp, Davidson, Charles J., Mumtaz, Mubashir, Gada, Hemal, Kar, Saibal, Kodali, Susheel K., Laham, Roger, Hiesinger, William, Fam, Neil P., Keßler, Mirjam, O’Neill, William W., Whisenant, Brian, Kliger, Chad, Kapadia, Samir, Rudolph, Volker, Choo, Joseph, Hermiller, James, Morse, Michael A., Schofer, Niklas, Gafoor, Sameer, Latib, Azeem, Mahoney, Paul, Kaneko, Tsuyoshi, Shah, Pinak B., Riddick, John A., Muhammad, Kamran I., Boekstegers, Peter, Price, Matthew J., Praz, Fabien, Koulogiannis, Konstantinos, Marcoff, Leo, Hausleiter, Jörg, and Lim, D. Scott

Published
2023
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24. 1-Year Outcomes of Transcatheter Edge-to-Edge Repair in Anatomically Complex Degenerative Mitral Regurgitation Patients

Author

Smith, Robert L., Lim, D. Scott, Gillam, Linda D., Zahr, Firas, Chadderdon, Scott, Rassi, Andrew N., Makkar, Raj, Goldman, Scott, Rudolph, Volker, Hermiller, James, Kipperman, Robert M., Dhoble, Abhijeet, Smalling, Richard, Latib, Azeem, Kodali, Susheel K., Lazkani, Mohamad, Choo, Joseph, Lurz, Philipp, O’Neill, William W., Laham, Roger, Rodés-Cabau, Josep, Kar, Saibal, Schofer, Niklas, Whisenant, Brian, Inglessis-Azuaje, Ignacio, Baldus, Stephan, Kapadia, Samir, Szerlip, Molly, Kliger, Chad, Boone, Robert, Webb, John G., Williams, Mathew R., von Bardeleben, Ralph Stephan, Ruf, Tobias Friedrich, Guerrero, Mayra, Eleid, Mackram, McCabe, James M., Davidson, Charles, Hiesinger, William, Kaneko, Tsuyoshi, Shah, Pinak B., Yadav, Pradeep, Koulogiannis, Konstantinos, Marcoff, Leo, and Hausleiter, Jörg

Published
2023
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25. 5-Year Prospective Evaluation of Mitral Valve-in-Valve, Valve-in-Ring, and Valve-in-MAC Outcomes: MITRAL Trial Final Results

Author

Guerrero, Mayra E., Eleid, Mackram F., Wang, Dee Dee, Pursnani, Amit, Kodali, Susheel K., George, Isaac, Palacios, Igor, Russell, Hyde, Makkar, Raj R., Kar, Saibal, Satler, Lowell F., Rajagopal, Vivek, Dangas, George, Tang, Gilbert H.L., McCabe, James M., Whisenant, Brian K., Fang, Kenith, Balan, Prakash, Smalling, Richard, Kaptzan, Tatiana, Lewis, Bradley, Douglas, Pamela S., Hahn, Rebecca T., Thaden, Jeremy, Oh, Jae K., Leon, Martin, O’Neill, William, and Rihal, Charanjit

Published
2023
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27. 3D Printing, Computational Modeling, and Artificial Intelligence for Structural Heart Disease

Author

Wang, Dee Dee, Qian, Zhen, Vukicevic, Marija, Engelhardt, Sandy, Kheradvar, Arash, Zhang, Chuck, Little, Stephen H, Verjans, Johan, Comaniciu, Dorin, O'Neill, William W, and Vannan, Mani A

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Research, Bioengineering, Heart Disease, Cardiovascular, Good Health and Well Being, Artificial Intelligence, Cardiac Catheterization, Cardiac Surgical Procedures, Heart Diseases, Humans, Predictive Value of Tests, Printing, Three-Dimensional, 3D printing, artificial intelligence, computational modeling, computed tomography, left atrial appendage, structural heart disease, transcatheter aortic valve replacement, transcatheter mitral valve replacement, transesophageal echocardiogram, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Cardiovascular System & Hematology, Cardiovascular medicine and haematology, Clinical sciences
Abstract

Structural heart disease (SHD) is a new field within cardiovascular medicine. Traditional imaging modalities fall short in supporting the needs of SHD interventions, as they have been constructed around the concept of disease diagnosis. SHD interventions disrupt traditional concepts of imaging in requiring imaging to plan, simulate, and predict intraprocedural outcomes. In transcatheter SHD interventions, the absence of a gold-standard open cavity surgical field deprives physicians of the opportunity for tactile feedback and visual confirmation of cardiac anatomy. Hence, dependency on imaging in periprocedural guidance has led to evolution of a new generation of procedural skillsets, concept of a visual field, and technologies in the periprocedural planning period to accelerate preclinical device development, physician, and patient education. Adaptation of 3-dimensional (3D) printing in clinical care and procedural planning has demonstrated a reduction in early-operator learning curve for transcatheter interventions. Integration of computation modeling to 3D printing has accelerated research and development understanding of fluid mechanics within device testing. Application of 3D printing, computational modeling, and ultimately incorporation of artificial intelligence is changing the landscape of physician training and delivery of patient-centric care. Transcatheter structural heart interventions are requiring in-depth periprocedural understanding of cardiac pathophysiology and device interactions not afforded by traditional imaging metrics.

Published
2021

33. Randomized Comparison of Transcatheter Edge-to-Edge Repair for Degenerative Mitral Regurgitation in Prohibitive Surgical Risk Patients

Author

Lim, D. Scott, Smith, Robert L., Gillam, Linda D., Zahr, Firas, Chadderdon, Scott, Makkar, Raj, von Bardeleben, Ralph Stephan, Kipperman, Robert M., Rassi, Andrew N., Szerlip, Molly, Goldman, Scott, Inglessis-Azuaje, Ignacio, Yadav, Pradeep, Lurz, Philipp, Davidson, Charles J., Mumtaz, Mubashir, Gada, Hemal, Kar, Saibal, Kodali, Susheel K., Laham, Roger, Hiesinger, William, Fam, Neil P., Keßler, Mirjam, O’Neill, William W., Whisenant, Brian, Kliger, Chad, Kapadia, Samir, Rudolph, Volker, Choo, Joseph, Hermiller, James, Morse, Michael A., Schofer, Niklas, Gafoor, Sameer, Latib, Azeem, Koulogiannis, Konstantinos, Marcoff, Leo, and Hausleiter, Jörg

Published
2022
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34. 2-Year Outcomes of Transcatheter Mitral Valve Replacement in Patients With Annular Calcification, Rings, and Bioprostheses

Author

Eleid, Mackram F., Wang, Dee Dee, Pursnani, Amit, Kodali, Susheel K., George, Issac, Palacios, Igor, Russell, Hyde, Makkar, Raj R., Kar, Saibal, Satler, Lowell F., Rajagopal, Vivek, Dangas, George, Tang, Gilbert H.L., McCabe, James M., Whisenant, Brian K., Fang, Kenith, Kaptzan, Tatiana, Lewis, Bradley, Douglas, Pamela, Hahn, Rebecca, Thaden, Jeremy, Oh, Jae K., Leon, Martin, O'Neill, William, Rihal, Charanjit S., and Guerrero, Mayra E.

Published
2022
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38. Multivessel Versus Culprit-Vessel Percutaneous Coronary Intervention in Cardiogenic Shock

Author

Lemor, Alejandro, Basir, Mir B., O'Neill, William W., Patel, Kirit, Kolski, Brian, Schreiber, Theodore, Kaki, Amir, Tehrani, Behnam, Truesdell, Alexander G., Lasorda, David, Bharadwaj, Aditya, Hanson, Ivan, Almany, Steve, Timmis, Steven, Dixon, Simon, Lalonde, Thomas, Attallah, Antonious, Todd, Josh, Marso, Steve, Wilkins, Charles, Patel, Nainesh, Senter, Shaun, McRae, Thomas, Rahman, Ayaz, Gelormini, Joseph, Kapur, Navin, Singh, Inder M., Riley, Robert, O'Neill, Brian, Overly, Tijuan, Sharma, Rahul, Dupont, Allison, Green, Michael, Lim, Michael, Khuddus, Matheen, Caputo, Christopher, Larkin, Timothy, Askari, Raza, Nsair, Ali, Akhtar, Yasir, Lin, Lang, McAllister, David, Finley, John, Goldsweig, Andrew, Park, James, Gorwara, Simon, Nazir, Raja, Martin, Scott, Foster, Malcolm, Smith, Craig, Rangaswamy, Chandhiran, Zuberi, Omer, Federici, Robert, Baker, John, Cawich, Ian, Korpas, Denes, Srivastava, Nalin, Aronow, Herbert D., Schaeffer, Michael, Wohns, David, Belford, P. Matthew, Mehra, Aditya, Blank, Nimrod, Alraies, M. Chadi, Ashbrook, Michael, Abdel-Hafez, Osama, Khandelwal, Akshay, Alaswad, Khaldoon, Gorgis, Sarah, Johnson, Tyrell, Hacala, Michael, Kapur, Navin K., LaLonde, Thomas, and O'Neill, William

Published
2020
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40. Improved outcomes in patients with severely depressed LVEF undergoing percutaneous coronary intervention with contemporary practices

Author

O'Neill, William W., Anderson, Mark, Burkhoff, Daniel, Grines, Cindy L., Kapur, Navin K., Lansky, Alexandra J., Mannino, Salvatore, McCabe, James M., Alaswad, Khaldoon, Daggubati, Ramesh, Wohns, David, Meraj, Perwaiz M., Pinto, Duane S., Popma, Jeffrey J., Moses, Jeffrey W., Schreiber, Theodore L., and Magnus Ohman, E.

Published
2022
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43. Clinical Outcomes of Patients Experiencing Transient Loss of Pulse Pressure During High-Risk PCI with Impella.

Author

BASIR, MIR B., BENTLEY, DANA, TRUESDELL, ALEXANDER G., KUNKEL, KATHERINE, LEMOR, ALEJANDRO, MEGALY, MICHAEL, ALQARQAZ, MOHAMMAD, ALASWAD, KHALDOON, KHANDEWAL, AKSHAY, JORTBERG, ELISE, KALRA, SANJOG, KAKI, AMIR, BURKHOFF, DANIEL, MOSES, JEFFREY W., PINTO, DUANE S., STONE, GREGG W., and O'NEILL, WILLIAM W.

Abstract

• Patients experiencing loss of pulse pressure (LOPP) during high-risk percutaneous coronary intervention (HR-PCI) are transiently dependent on mechanical circulatory support (MCS) devices. • LOPP during HR-PCI with Impella was common and occurred more frequently in patients with cardiomyopathy and low systolic blood pressure. LOPP was strongly associated with higher 90-day major adverse cardiac and cerebrovascular events, acute kidney injury, and mortality. • The ongoing randomized PROTECT-IV trial will determine whether Impella CP support during HR-PCI improves early and late clinical outcomes compared with the standard of care. The trial includes a right heart catheterization substudy that should help to define the role of invasive hemodynamics in stratifying and managing patients undergoing HR-PCI. Patients experiencing loss of pulse pressure (LOPP) during high-risk percutaneous coronary intervention (HR-PCI) are transiently dependent on mechanical circulatory support devices. We sought to define the frequency and clinic outcomes of patients who experience LOPP during HR-PCI. Patients enrolled in the PROTECT III study and had automated Impella controller logs capturing real-time hemodynamics were included in this analysis. A LOPP event was defined as a mean pulse pressure on Impella of <20 mm Hg for ≥5 seconds during PCI. Clinical characteristics and outcomes were then compared between those with and without LOPP. Logistic regression identified clinical and hemodynamic predictors of LOPP. We included 302 patients, of whom 148 patients (49%) experienced LOPP. Age, sex, and comorbidities were similar in patients with and without LOPP. Mean baseline systolic blood pressure (118.6 mm Hg vs 129.8 mm Hg; P <.001) and mean arterial pressure (86.9 mm Hg vs 91.6 mm Hg; P =.011) were lower in patients with LOPP, whereas heart rate (78 bpm vs 73 bpm; P =.012) was higher. Anatomical complexity was similar between groups. Patients with LOPP were more likely to experience major adverse cardiac and cerebrovascular events (23.5% vs 8.8%; P =.002), acute kidney injury (10.1% vs 2.6%; P =.030), and death (20.2% vs 7.9%; P =.008) within 90 days. A low baseline systolic blood pressure and cardiomyopathy were the strongest predictors of LOPP (P =.003 and P =.001, respectively). LOPP on Impella during HR-PCI was common and occurred more frequently in patients with cardiomyopathy and a low systolic blood pressure. LOPP was strongly associated with higher 90-day major adverse cardiac and cerebrovascular events, acute kidney injury, and mortality. Condensed Abstract We sought to define the frequency and clinic outcomes of patients who experience LOPP during high-risk percutaneous coronary intervention (HR-PCI). We included 302 patients, of whom 148 (49%) experienced LOPP. Patients with LOPP were more likely to experience major adverse cardiac and cerebrovascular events (23.5% vs 8.8%; P =.002), acute kidney injury (10.1% vs 2.6%; P =.030), and death (20.2% vs 7.9%; P =.008) within 90 days. A low baseline systolic blood pressure and cardiomyopathy were the strongest predictors of LOPP (P =.003 and P =.001, respectively). [ABSTRACT FROM AUTHOR]

Published
2024
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44. Impact of Right Ventricular Dysfunction on Outcomes in Acute Myocardial Infarction and Cardiogenic Shock: Insights from the National Cardiogenic Shock Initiative.

Author

GORGIS, SARAH, GUPTA, KARTIK, LEMOR, ALEJANDRO, BENTLEY, DANA, MOYER, CHRISTIAN, McRAE, THOMAS, KHUDDUS, MATHEEN, SHARMA, RAHUL, LIM, MICHAEL, NSAIR, ALI, WOHNS, DAVID, MEHRA, ADITYA, LIN, LANG, BHARADWAJ, ADITYA, TEDFORD, RYAN, KAPUR, NAVIN, COWGER, JENNIFER, O'NEILL, WILLIAM, and BASIR, MIR B.

Abstract

Right ventricular dysfunction (RVD) complicates 30%–40% of cases in acute myocardial infarction (AMI) and cardiogenic shock (CS). There are sparse data on the effects of RVD on outcomes and the impact of providing early left ventricular (LV) mechanical circulatory support (MCS) on RV function and hemodynamics. Between July 2016 and December 2020, 80 sites participated in the study. All centers agreed to treat patients with AMI-CS using a standard protocol emphasizing invasive hemodynamic monitoring and rapid initiation of LV-MCS. RVD was defined as a right atrial (RA) pressure of >12 mm Hg and a pulmonary artery pulsatility index (PAPI) of <1 within 24 hours of the index procedure. The primary outcome was survival to discharge. In a subgroup analysis, data available from the Automated Impella Controller console was used to analyze diastolic suction alarms from LV placement signal and its relation to RVD. A total of 361 patients were included in the analysis, of whom 28% had RVD. The median age was 64 years (interquartile range 55–72 years), 22.7% were female and 75.7% were White. There was no difference in age, sex, or comorbidities between those with or without RVD. Patients with RVD had a higher probability of active CPR during LV-MCS implant (14.7% vs 6.3%), Society for Cardiovascular Angiography and Interventions stage E shock (39.2% vs 23.2%), and higher admission lactate levels (5.1 mg/dL vs 3.0 mg/dL). Survival to discharge was significantly lower among those with RVD (61.8% vs 73.4%, odds ratio 0.89, 95% confidence interval 0.36–0.95, P =.031). This association remained significant in the multivariate analysis. There was no significant difference in hemodynamic variables within 24 hours of LV-MCS support among those with or without RVD. At 24 hours, patients with a CPO of >0.6 W and a PAPi of >1 had a trend toward better survival to discharge compared with those with a CPO of ≤0.6 W and a PAPi of ≤1 (77.1% vs 54.6%, P =.092). Patients with RVD were significantly more likely to have diastolic suction alarms within 24 hours of LV-MCS initiation. RVD in AMI-CS is common and associated with worse survival to discharge. Early LV-MCS decreases filling pressures rapidly within the first 24 hours and decreases the rate of RVD. Achieving a CPO of >0.6 W and a PAPi of >1 within 24 hours is associated with high survival. Diastolic suction alarms may have usefulness as an early marker of RVD. [ABSTRACT FROM AUTHOR]

Published
2024
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45. Right Ventricular Dysfunction in Patients Undergoing High-Risk PCI with Impella.

Author

ROMMEL, KARL-PHILIPP, BONNET, GUILLAUME, BELLUMKONDA, LAVANYA, LANSKY, ALEXANDRA J., ZHAO, DUZHI, THOMPSON, JULIA B., ZHANG, YIRAN, REDFORS, BJÖRN, LURZ, PHILIPP C., GRANADA, JUAN F., BHARADWAJ, ADITYA S., BASIR, M. BABAR, O'NEILL, WILLIAM W., and BURKHOFF, DANIEL

Abstract

Right ventricular dysfunction (RVD) is an important prognostic factor in several cardiac conditions, including acute and chronic heart failure. The impact of baseline RVD on clinical outcomes of patients undergoing high-risk percutaneous coronary intervention (HRPCI) supported by Impella is unknown. Patients from the single-arm, multicenter PROTECT III study of Impella-supported HRPCI were stratified based on the presence or absence of RVD. RVD was quantitatively assessed by an echocardiography core laboratory and was defined as fractional area change < 35%, tricuspid annular plane systolic excursion < 17 mm or pulsed-wave Doppler S-wave of the lateral tricuspid annulus < 9.5 cm/s. Procedural outcomes, 90-day major adverse cardiac and cerebrovascular events (MACCE: the composite of all-cause mortality, myocardial infarction, stroke/TIA, and repeat revascularization), and 1-year mortality were assessed. Of the 239 patients who underwent RV function assessment, 124 were found to have RVD. Lower left ventricular ejection fraction, higher blood urea nitrogen levels, and more severe RV dilation were independently associated with RVD. The incidence of hypotensive episodes during PCI, the proportion of patients requiring prolonged Impella support, the completeness of revascularization, and the rate of in-hospital mortality did not differ significantly between patients with vs without RVD. However, 90-day MACCE rates were higher in those with RVD, and RVD was a robust predictor of 1-year mortality in multivariable Cox-regression analyses. In patients undergoing HRPCI with Impella, RVD was associated with more advanced biventricular failure. The use of Impella support during HRPCI facilitated effective revascularization, even in those with concomitant RVD. Nevertheless, RVD was associated with unfavorable long-term prognoses. In the PROTECT III study, among the 239 patients undergoing high-risk percutaneous coronary intervention (HRPCI) with Impella, 48% demonstrated normal right ventricular (RV) function, while 52% exhibited RV dysfunction, based on quantitative imaging. Both groups displayed a comparable extent of revascularization, as evaluated by the SYNTAX Score pre- and post-procedure, and similar in-hospital mortality rates. However, patients with RV dysfunction experienced higher rates of 90-day major adverse cardiac and cerebrovascular events (MACCE) as well as higher 1-year mortality rates. [Display omitted] [ABSTRACT FROM AUTHOR]

Published
2024
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48. Impact of Tricuspid Regurgitation on Outcomes of Transcatheter Aortic Valve Replacement With Balloon-Expandable Valves.

Author

Zahr, Firas, Elmariah, Sammy, Vemulapalli, Sreekanth, Kodali, Susheel K., Hahn, Rebecca T., Anderson, Allen S., Eleid, Mackram F., Davidson, Charles J., Sharma, Rahul P., O'Neill, William W., Bethea, Brian, Thourani, Vinod H., Chakravarty, Tarun, Gupta, Aakriti, and Makkar, Raj R.

Abstract

Tricuspid regurgitation (TR) is highly prevalent in the transcatheter aortic valve replacement (TAVR) population, but clear management guidelines are lacking. The aims of this study were to elucidate the prevalence and consequences of severe TR in patients with aortic stenosis undergoing TAVR and to examine the change in TR post-TAVR, including predictors of improvement and its impact on longer term mortality. Using Centers for Medicare and Medicaid Services–linked TVT (Transcatheter Valve Therapy) Registry data, a propensity-matched analysis was performed among patients undergoing TAVR with baseline mild, moderate, or severe TR. Kaplan-Meier estimates were used to assess the impact of TR on 3-year mortality. Multivariable analysis identified predictors of 30-day TR improvement. Of the 312,320 included patients, 84% had mild, 13% moderate, and 3% severe TR. In a propensity-matched cohort, severe baseline TR was associated with higher in-hospital mortality (2.5% vs 2.1% for moderate TR and 1.8% for mild TR; P = 0.009), higher 1-year mortality (24% vs 19.6% for moderate TR and 16.6% for mild TR; P < 0.0001), and 3-year mortality (54.2% vs 48.5% for moderate TR and 43.3% for mild TR; P < 0.0001). Among the patients with severe TR at baseline, 76.4% improved to moderate or less TR 30 days after TAVR. Baseline mitral regurgitation moderate or greater, preserved ejection fraction, higher aortic valve gradient, and better kidney function predicted TR improvement after TAVR. However, severe 30-day residual TR was associated with higher 1-year mortality (27.4% vs 18.7% for moderate TR and 16.8% for mild TR; P < 0.0001). Severe baseline and 30-day residual TR after TAVR are associated with increased mortality up to 3 years. This analysis identifies a higher risk group that could be evaluated for the recently approved tricuspid interventions. [Display omitted] [ABSTRACT FROM AUTHOR]

Published
2024
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