The Experts below are selected from a list of 4075938 Experts worldwide ranked by ideXlab platform
Ravi R Thiagarajan - One of the best experts on this subject based on the ideXlab platform.
-
phosphodiesterase inhibitor based vasodilation improves oxygen delivery and clinical outcomes following Stage 1 palliation
Journal of the American Heart Association, 2016Co-Authors: Kimberly I Mills, Aditya K Kaza, Brian K Walsh, Hilary Bond, Mackenzie Ford, David Wypij, Ravi R ThiagarajanAbstract:BackgroundSystemic vasodilation using α‐receptor blockade has been shown to decrease the incidence of postoperative cardiac arrest following Stage 1 palliation (S1P), primarily when utilizing the m...
-
heart block following Stage 1 palliation of hypoplastic left heart syndrome
The Journal of Thoracic and Cardiovascular Surgery, 2016Co-Authors: Douglas Y Mah, Ravi R Thiagarajan, Henry Cheng, Mark E Alexander, Lynn A Sleeper, Jane W Newburger, Pedro J Del Nido, Satish RajagopalAbstract:Abstract Objectives Publicly available data from the Pediatric Heart Network's Single Ventricle Reconstruction Trial was analyzed to determine the prevalence, timing, risk factors for, and impact of second- and third-degree heart block (HB) on outcomes in patients who underwent Stage 1 palliation (S1P) for hypoplastic left heart syndrome (HLHS). Methods The presence and date of onset of post-S1P HB occurring within the first year of life, potential risk factors for HB, and factors known to predict poor outcomes after S1P were extracted. Multivariable logistic and Cox regression analyses were performed to identify risk factors for HB and to determine the effect of HB on 3-year transplantation-free survival. Results Among the 549 patients in the cohort, 33 (6%) developed HB after S1P. The median interval between S1P and HB was 8 days (interquartile range, 0-133 days). Regression analysis showed that tricuspid valve repair during S1P and obstruction of pulmonary venous drainage requiring pre-S1P intervention were independently associated with HB (adjusted odds ratio [aOR], 11.6, 95% confidence interval [CI] 3.3-40; P P = .02, respectively). Transplantation-free survival at 3 years was lower for those with HB (39% vs 65%; P = .004). HB remained associated with transplantation-free survival after controlling for known risk factors (adjusted hazard ratio, 3.1; 95% CI, 1.9-5.0; P Conclusions HB after S1P is rare but heralds a poor outcome. Careful monitoring of these patients is recommended given their significantly increased risks of death and heart transplantation.
-
pulmonary deadspace and postoperative outcomes in neonates undergoing Stage 1 palliation operation for single ventricle heart disease
Pediatric Critical Care Medicine, 2014Co-Authors: Divya Shakti, Kimberlee Gauvreau, Doff B Mcelhinney, Vamsi V Yarlagadda, Peter C Laussen, Peter Betit, Mary L Myrer, Ravi R ThiagarajanAbstract:OBJECTIVES: Increased pulmonary dead space fraction (VD/VT) has been associated with prolonged mechanical ventilation after surgery for congenital heart disease. The association of VD/VT with clinical outcomes in neonates undergoing Stage 1 palliation for single ventricle congenital heart disease has not been reported. We describe changes in VD/VT, differences in VD/VT based on shunt type (right ventricle to pulmonary artery conduit vs modified Blalock-Taussing shunt) and association of VD/VT with postoperative outcomes in patients undergoing Stage 1 palliation. DESIGN: Retrospective chart review for demographic, hemodynamics, outcome information, and VD/VT values were collected at 6-hour intervals during the first 48 postoperative hours in neonates undergoing Stage 1 palliation. VD/VT was calculated using mixed expired CO2 (PeCO2) obtained from capnography and paired arterial blood gas CO2 values. SETTING: Cardiac ICU in a tertiary care pediatric hospital. PATIENTS: Newborns with single ventricle congenital heart disease undergoing Stage 1 palliation during 2003-2004. MEASUREMENTS AND MAIN RESULTS: Of the 51 patients, 31 had right ventricle to pulmonary artery and 20 had Blalock-Taussing shunt. Although VD/VT was lower in the Blalock-Taussing shunt group over all time points (p = 0.02), maximal VD/VT on day 1 (0.49 ± 0.07) and on day 2 (0.46 ± 0.08) were not different between the shunt groups. VD/VT decreased significantly over time in both shunt groups (p = 0.001 for right ventricle to pulmonary artery; p < 0.001 for Blalock-Taussing shunt). Higher maximal VD/VT during first 48 postoperative hours was independently associated with fewer ventilator (β = -26.6; p = 0.035) and hospital-free days in the first month after Stage 1 palliation (β = -40.4; p = 0.002) after adjusting for potential confounders in a multivariable linear regression model. CONCLUSIONS: Increased pulmonary dead space exists early after Stage 1 palliation operation for single ventricle congenital heart disease. Higher VD/VT during the first 48 postoperative hours was associated with longer duration of ventilation and hospital LOS and may be a useful marker of postoperative outcomes in this population.
Vincent Dequattro - One of the best experts on this subject based on the ideXlab platform.
-
one year study of felodipine or placebo for Stage 1 isolated systolic hypertension
Hypertension, 2001Co-Authors: Henry R Black, William J Elliott, Michael A Weber, William H Frishman, Joel A Strom, Philip R Liebson, Clara Hwang, Dennis A Ruff, Rafael Montoro, Vincent DequattroAbstract:Asubstantial number of older hypertensive patients have Stage 1 isolated systolic hypertension (systolic blood pressure between 140 and 159 mm Hg and diastolic blood pressure <90 mm Hg), but there are currently no data showing that drug treatment is effective, safe, and/or beneficial. To compare the effects of active treatment compared with placebo on blood pressure, left ventricular hypertrophy, and quality of life among older Stage 1 isolated systolic hypertensive patients, a randomized, double-blind, parallel-group, multicenter clinical trial comparing felodipine (2.5, 5, or 10 mg once daily) and matching placebo was performed in 171 patients (49% male, average age 66+/-7 years, with 49% white and 30% Hispanic) with a baseline blood pressure of 149+/-7/83+/-6 mm Hg. During 52 weeks of treatment, patients randomized to active treatment achieved significantly lower blood pressures (137.0+/-11.7/80.2+/-7.6 mm Hg for extended-release felodipine versus 147.5+/-16.0/83.5+/-9.7 mm Hg for placebo, P<0.01 for each), a reduced incidence of left ventricular hypertrophy (7% for extended release felodipine versus 24% for placebo, P<0.04), and improved quality of life (change in Psychological General Well-Being index, 3.0+/-6.8 for extended-release felodipine versus -0.8+/-10.3 for placebo, P<0.01) versus baseline. There were no clinically significant differences between treatments in tolerability or adverse effects. Stage 1 isolated systolic hypertension can be effectively and safely treated pharmacologically. Treatment reduced progression to the higher Stages of hypertension, reduced the incidence of left ventricular hypertrophy, and improved an overall measure of the quality of life. Larger and longer studies will be needed to document any long-term reduction in cardiovascular event rates associated with treating Stage 1 systolic hypertension.
Aaron G Dewitt - One of the best experts on this subject based on the ideXlab platform.
-
severe acute kidney injury following Stage 1 norwood palliation effect on outcomes and risk of severe acute kidney injury at subsequent surgical Stages
Pediatric Critical Care Medicine, 2016Co-Authors: Joshua H Wong, David T Selewski, Sunkyung Yu, Kay E Leopold, Katelyn H Roberts, Janet E Donohue, Richard G Ohye, John R Charpie, Caren S Goldberg, Aaron G DewittAbstract:Objectives:To identify associations of severe acute kidney injury early after Stage 1 (Norwood) operation with risk of severe acute kidney injury and comorbidities at subsequent palliative Stages in patients with hypoplastic left heart syndrome and other single ventricle lesions with left-sided obst
Wendy S Post - One of the best experts on this subject based on the ideXlab platform.
-
role of coronary artery and thoracic aortic calcium as risk modifiers to guide antihypertensive therapy in Stage 1 hypertension from the multiethnic study of atherosclerosis
American Journal of Cardiology, 2020Co-Authors: Mohamed B Elshazly, Amal Abdellatif, Soha R Dargham, Mahmoud Al Rifai, Renato Quispe, Miguel Cainzosachirica, Seth S Martin, Joseph Yeboah, Bruce M Psaty, Wendy S PostAbstract:The 2017 American blood pressure (BP) guidelines recommended a personalized risk-based approach to treatment in Stage 1 hypertension. We sought to establish the utility of coronary artery or thoracic aortic calcium (CAC or TAC) as additional risk modifiers in this setting. We included 1859 Multiethnic Study of Atherosclerosis participants with Stage 1 hypertension. We compared adjusted HR for the composite outcome of incident atherosclerotic cardiovascular disease or heart failure across predefined categories of either CAC or TAC (0, 1 to 100, or >100) in: (1) the full sample; (2) 4 high-risk subgroups recommended for pharmacotherapy to a BP goal 100. CAC >100 was independently associated with a higher relative risk of events compared with CAC = 0 (e.g., adjusted HR [9.5 (1.8 to 18.7)] in the low-risk subgroup). NNT10 for CAC = 0 were 3 to 5 times higher than those for CAC >100 in all analyses. TAC was not a reliable risk modifier in our study. In conclusion, CAC, but not TAC, can further guide risk-based allocation of treatment in Stage 1 hypertension and should be considered as a risk modifier in future guidelines.
-
role of coronary artery and thoracic aortic calcium as risk modifiers to guide antihypertensive therapy in Stage 1 hypertension from the multi ethnic study of atherosclerosis
American Journal of Cardiology, 2020Co-Authors: Mohamed B Elshazly, Amal Abdellatif, Soha R Dargham, Mahmoud Al Rifai, Renato Quispe, Miguel Cainzosachirica, Seth S Martin, Joseph Yeboah, Bruce M Psaty, Wendy S PostAbstract:Abstract The 2017 American blood pressure (BP) guidelines recommended a personalized risk-based approach to treatment in Stage 1 hypertension. We sought to establish the utility of coronary artery or thoracic aortic calcium (CAC or TAC) as additional risk modifiers in this setting. We included 1859 MESA participants with Stage 1 hypertension. We compared adjusted HR for the composite outcome of incident atherosclerotic cardiovascular disease or heart failure across predefined categories of either CAC or TAC (0, 1-100, or >100) in: (1) the full sample; (2) four high-risk subgroups recommended for pharmacotherapy to a BP goal 100. CAC >100 was independently associated with a higher relative risk of events compared to CAC=0 (e.g., adjusted HR [9.5 (1.8-18.7)] in the low-risk subgroup). NNT10 for CAC = 0 were 3 to 5 times higher than those for CAC > 100 in all analyses. TAC was not a reliable risk modifier in our study. In conclusion, CAC, but not TAC, can further guide risk-based allocation of treatment in Stage 1 hypertension and should be considered as a risk modifier in future guidelines.
-
abstract 11878 the role of coronary artery calcium as a risk enhancer to personalize treatment in Stage 1 hypertension the multi ethnic study of atherosclerosis
Circulation, 2019Co-Authors: Amal Abdellatif, Mohamed B Elshazly, Soha R Dargham, Renato Quispe, Miguel Cainzosachirica, Seth S Martin, Joseph Yeboah, Bruce M Psaty, Wendy S Post, Khurram NasirAbstract:Background: The 2017 ACC/AHA multi-society High Blood Pressure (BP) guidelines recommend risk-based BP treatment goals in Stage 1 hypertension. We sought to establish whether coronary artery calciu...
Laura P Svetkey - One of the best experts on this subject based on the ideXlab platform.
-
dash dietary approaches to stop hypertension diet is effective treatment for Stage 1 isolated systolic hypertension
Hypertension, 2001Co-Authors: Thomas J Moore, Paul R Conlin, Jamy D Ard, Laura P SvetkeyAbstract:Use of the DASH (Dietary Approaches to Stop Hypertension) diet, which is rich in fruits, vegetables, and low-fat dairy foods, significantly lowers blood pressure. Among the 459 participants in the DASH Trial, 72 had Stage 1 isolated systolic hypertension (ISH) (systolic blood pressure, 140 to 159 mm Hg; diastolic blood pressure, P P
