Browsing by Author "Mehta, Nishaki"

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    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.
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    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.
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    Right Atrial Volume Index to Left Atrial Volume Index Ratio is Associated with Adverse Clinical Outcomes in Cardiogenic Shock
    (Springer, 2022) Patel, Paras R.; Stafford, Patrick L.; Bilchick, Kenneth C.; Walker, McCall R.; Ibrahim, Sami; Martin, David; Betz, Yaqub; Patel, Toral R.; Kwon, Younghoon; Mehta, Nishaki; Sodhi, Nishtha; Mwansa, Hunter; Breathett, Khadijah; Mazimba, Sula; Medicine, School of Medicine
    Background: Structural remodeling in chronic systolic heart failure (HF) is associated with neurohormonal and hemodynamic perturbations among HF patients presenting with cardiogenic shock (CS) and HF. Our objective was to test the hypothesis was that atrial remodeling marked by an increased right atrial volume index (RAVI) to left atrial volume index (LAVI) ratio is associated with adverse clinical outcomes in CS. Methods: Patients in this cohort were admitted to the intensive care unit with evidence of congestion (pulmonary capillary wedge pressure > 15) and cardiogenic shock (cardiac index < 2.2, systolic blood pressure < 90 mmHg, and clinical evidence supporting CS) and had an echocardiogram at the time of admission. RAVI was measured using Simpson's method in the apical four-chamber view, while LAVI was measured using the biplane disc summation method in the four and two-chamber views by two independent observers. Cox proportional hazards regression analysis was used to assess the association of RAVI-LAVI with the combined outcome of death or left ventricular assist device (LVAD). Results: Among 113 patients (mean age 59 ± 14.9 years, 29.2% female), median RAVI/LAVI was 0.84. During a median follow-up of 12 months, 43 patients died, and 65 patients had the combined outcomes of death or LVAD. Patients with RAVI/LAVI ratio above the median had a greater incidence of death or LVAD (Log-rank p ≤ 0.001), and increasing RAVI/LAVI was significantly associated with the outcomes of death or LVAD (HR 1.71 95% CI 1.11-2.64, chi square 5.91, p = 0.010) even after adjustment for patient characteristics, echocardiographic and hemodynamic variables. Conclusion: RAVI/LAVI is an easily assessed novel echocardiographic parameter strongly associated with the survival and or the need for mechanical circulatory support in patients with CS.