Browsing by Author "Mehta, Nishaki"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Change in Systemic Arterial Pulsatility index (SAPi) during heart failure hospitalization is associated with improved outcomes
    (Elsevier, 2023-03) Lin, Emily; Boadu, Akua; Skeiky, Natalie; Mehta, Nishaki; Kwon, Younghoon; Breathett, Khadijah; Ilonze, Onyedika; Lamp, Josephine; Bilchick, Kenneth C.; Mazimba, Sula; Medicine, School of Medicine
    Study objective: To identify Change in Systemic Arterial Pulsatitlity index (∆SAPi) as a novel hemodynamic marker associated with outcomes in heart failure (HF). Design: The ESCAPE trial was a randomized controlled trial. Setting: The ESCAPE trial was conducted at 26 sites. Participants: 134 patients were analyzed (mean age 56.8 ± 13.4 years, 29 % female). Interventions: We evaluated the change in SAPi, (systemic pulse pressure/pulmonary artery wedge pressure) obtained at baseline and at the final hemodynamic measurement in the ESCAPE trial. Main outcome measures: Change in SAPi, (∆SAPi), was analyzed for the primary outcomes of death, heart transplant, left ventricular assist device (DTxLVAD) or hospitalization, (DTxLVADHF) and secondary outcome of DTxLVAD using Cox proportional hazards regression. Results: Median change in SAPi was 0.81 (IQR 0.20–1.68). ∆SAPi in uppermost quartile was associated with reductions in DTxLVADHF (HR 0.55 [95 % CI 0.32, 0.93]). ∆SAPi in the uppermost and lowermost quartiles combined was similarly associated with significant reductions in DTxLVADHF (HR 0.62 [95 % CI 0.41, 0.94]). ∆SAPi higher than 1.17 was associated with improved DTxLVADHF. ∆SAPi was also associated with troponin levels at discharge (regression coefficient p = 0.001) and trended with 6-minute walk at discharge (Spearman correlation r = 0.179, p = 0.058). Conclusion: ∆SAPi was strongly associated with improved HF clinical profile and adverse outcomes. These findings support further exploration of ∆ SAPi in the risk stratification of HF.
  • Thumbnail Image
    Item
    Relationship of Ejection Fraction and Natriuretic Peptide Trajectories in Heart Failure with Baseline Reduced and Mid- MidRange Ejection Fraction
    (Elsevier, 2022) Bilchick, Kenneth C.; Stafford, Patrick; Laja, Olusola; Elumogo, Comfort; Persey, Bediako; Tolbert, Nora; Sawch, Douglas; David, Sthuthi; Sodhi, Nishtha; Barber, Anita; Kwon, Younghoon; Mehta, Nishaki; Patterson, Brandy; Breathett, Khadijah; Mazimba, Sula; Medicine, School of Medicine
    Background: The prognostic importance of trajectories of neurohormones relative to left ventricular function over time in heart failure with reduced and mid-range EF (HFrEF and HFmrEF) is poorly defined. Objective: To evaluate left ventricular ejection fraction (LVEF) and B-type natriuretic peptide (BNP) trajectories in HFrEF and HFmrEF. Methods: Analyses of LVEF and BNP trajectories after incident HF admissions presenting with abnormal LV systolic function were performed using 3 methods: a Cox proportional hazards model with time-varying covariates, a dual longitudinal-survival model with shared random effects, and an unsupervised analysis to capture 3 discrete trajectories for each parameter. Results: Among 1,158 patients (68.9 ± 13.0 years, 53.3% female), both time-varying LVEF measurements (P=.001) and log-transformed BNP measurements (p-values=2 × 10-16) were independently associated with survival during 6 years after covariate adjustment. In the dual longitudinal/survival model, both LVEF and BNP trajectories again were independently associated with survival (P<.0001 in each model); however, LVEF was more dynamic than BNP (P <.0001 for time covariate in LVEF longitudinal model versus P=.88 for the time covariate in BNP longitudinal model). In the unsupervised analysis, 3 discrete LVEF trajectories (dividing the cohort into approximately thirds) and 3 discrete BNP trajectories were identified. Discrete LVEF and BNP trajectories had independent prognostic value in Kaplan-Meier analyses (P<.0001), and substantial membership variability across BNP and LVEF trajectories was noted. Conclusion: Although LVEF trajectories have greater temporal variation, BNP trajectories provide additive prognostication and an even stronger association with survival times in heart failure patients with abnormal LV systolic function.