William T Abraham

Columbus State University, Columbus, Georgia, United States

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Publications (547)4119.57 Total impact

  • Nishaki K Mehta, William T Abraham
    Europace 06/2015; DOI:10.1093/europace/euv136 · 3.05 Impact Factor
  • JACC Cardiovascular Interventions 05/2015; 8(6). DOI:10.1016/j.jcin.2015.02.009 · 7.44 Impact Factor
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    ABSTRACT: In EchoCRT, a randomized trial evaluating the effect of cardiac resynchronization therapy (CRT) in patients with a QRS duration of <130 ms and echocardiographic evidence of left ventricular dyssynchrony, the primary outcome occurred more frequently in the CRT when compared with the control group. According to current heart failure guidelines, CRT is recommended in patients with a QRS duration of ≥120 ms. However, there is some ambiguity from clinical trial data regarding the benefit of patients with a QRS duration of 120-130 ms. The main EchoCRT trial was prematurely terminated due to futility. For the current subgroup analysis we compared data for CRT-ON vs. -OFF in patients with QRS < 120 (n = 661) and QRS 120-130 ms (n = 139). On uni- and multivariable analyses, no significant interaction was observed between the two groups and randomized treatment for the primary or any of the secondary endpoints. On multivariable analysis, a higher risk for the primary endpoint was observed in patients with a QRS duration of 120-130 ms randomized to CRT-ON vs. CRT-OFF (hazard ratio 2.18, 95% CI 1.02-4.65; P = 0.044). However, no statistically significant interaction, compared with patients with QRS < 120 ms randomized to CRT-ON vs. CRT-OFF, was noted (P-interaction = 0.160). In this pre-specified subgroup analysis of EchoCRT, no benefit of CRT was evident in patients with a QRS duration of 120-130 ms. These data further question the usefulness of CRT in this patient population. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.
    European Heart Journal 05/2015; DOI:10.1093/eurheartj/ehv242 · 14.72 Impact Factor
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    ABSTRACT: The objective of this clinical trial was to assess the safety and efficacy of carotid BAT in advanced HF. Increased sympathetic and decreased parasympathetic activity contribute to heart failure (HF) symptoms and disease progression. Baroreflex activation therapy (BAT) results in centrally mediated reduction of sympathetic outflow and increased parasympathetic activity. Patients with New York Heart Association (NYHA) functional class III HF and ejection fractions ≤ 35% on chronic stable guideline-directed medical therapy (GDMT) were enrolled at 45 centers in the United States, Canada, and Europe. They were randomly assigned to receive ongoing GDMT alone (control group) or ongoing GDMT plus BAT (treatment group) for 6 months. The primary safety end point was system- and procedure-related major adverse neurological and cardiovascular events. The primary efficacy end points were changes in NYHA class, quality-of-life score, and 6-minute hall walk distance. One hundred forty-six patients were randomized, 70 to control and 76 to treatment. The major adverse neurological and cardiovascular event-free rate was 97.2% (lower 95% confidence bound 91.4%). Patients assigned to BAT, compared with control group patients, experienced improvements in the distance walked in 6 min (59.6 ± 14 m vs. 1.5 ± 13.2 m, p = 0.004), quality-of-life score (-17.4 ± 2.8 points vs. 2.1 ± 3.1 points, p < 0.001), and NYHA class ranking (p = 0.002 for change in distribution). BAT significantly reduced N-terminal pro-brain natriuretic peptide (p = 0.02) and was associated with a trend toward fewer days hospitalized for HF (p = 0.08). BAT is safe and improves functional status, quality of life, exercise capacity, N-terminal pro-brain natriuretic peptide, and possibly the burden of heart failure hospitalizations in patients with GDMT-treated NYHA class III HF. (Barostim Neo System in the Treatment of Heart Failure; NCT01471860; Barostim HOPE4HF (Hope for Heart Failure) Study; NCT01720160). Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
    05/2015; 128(6). DOI:10.1016/j.jchf.2015.02.006
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    ABSTRACT: Daily measurements of left atrial pressure may be useful for guiding adjustments in medical therapy that prevent clinical decompensation in patients with severe heart failure. LAPTOP-HF is a prospective, multicenter, randomized, controlled clinical trial where the safety and clinical effectiveness of a physician-directed, patient self-management therapeutic strategy based on left atrial pressure measured twice daily by an implantable sensor, will be compared with a control group receiving optimal medical therapy, in ambulatory patients with advanced heart failure. The trial will enroll up to 730 patients with NYHA Class III symptoms and either a hospitalization for HF during the prior 12 months or an elevated Brain Natriuretic Peptide level, irrespective of ejection fraction, at up to 75 investigational centers. Randomization to the Treatment group or Control group will be a 1:1 ratio, in three strata based on the ejection fraction (EF > or ≤ 35%) and the presence of a de-novo CRT device indication. The LAPTOP-HF trial will provide essential information about the role of implantable LAP monitoring in conjunction with a new HF treatment paradigm across the spectrum of HF patients. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of cardiac failure 04/2015; 21(6). DOI:10.1016/j.cardfail.2015.04.012 · 3.07 Impact Factor
  • 04/2015; 3(4):343-4. DOI:10.1016/j.jchf.2014.12.011
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    ABSTRACT: The aim of this study was to evaluate chronic, transvenous, unilateral phrenic nerve stimulation to treat central sleep apnea (CSA) in a prospective, multicenter, nonrandomized study. CSA occurs predominantly in patients with heart failure and increases the risk for morbidity and mortality. Established therapies for CSA are lacking, and those available are limited by poor patient adherence. Fifty-seven patients with CSA underwent baseline polysomnography followed by transvenous phrenic nerve stimulation system implantation and follow-up. Feasibility was assessed by implantation success rate and therapy delivery. Safety was evaluated by monitoring of device- and procedure-related adverse events. Efficacy was evaluated by changes in the apnea-hypopnea index at 3 months. Quality of life at 6 months was evaluated using a sleepiness questionnaire, patient global assessment, and, in patients with heart failure at baseline, the Minnesota Living With Heart Failure Questionnaire. The study met its primary end point, demonstrating a 55% reduction in apnea-hypopnea index from baseline to 3 months (49.5 ± 14.6 episodes/h vs. 22.4 ± 13.6 episodes/h of sleep; p < 0.0001; 95% confidence interval for change: -32.3 to -21.9). Central apnea index, oxygenation, and arousals significantly improved. Favorable effects on quality of life and sleepiness were noted. In patients with heart failure, the Minnesota Living With Heart Failure Questionnaire score significantly improved. Device- or procedure-related serious adverse events occurred in 26% of patients through 6 months post therapy initiation, predominantly due to lead repositioning early in the study. Therapy was well tolerated. Efficacy was maintained at 6 months. Transvenous, unilateral phrenic nerve stimulation appears safe and effective for treating CSA. These findings should be confirmed in a prospective, randomized, controlled trial. (Chronic Evaluation of Respicardia Therapy; NCT01124370). Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
    03/2015; 3(5). DOI:10.1016/j.jchf.2014.12.013
  • Journal of the American College of Cardiology 03/2015; 65(10):A790. DOI:10.1016/S0735-1097(15)60790-2 · 15.34 Impact Factor
  • Melike Bayram, J A St Cyr, William T Abraham
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    ABSTRACT: Objectives: The incidence of heart failure continues to escalate with >550,000 newly diagnosed patients annually worldwide. More than half of the patients with heart failure have preserved ejection fraction or isolated diastolic dysfunction, for which no current effective therapies for diastolic dysfunction exist. Every cell requires adequate levels of high energy phosphates to maintain integrity and function. Previous studies have demonstrated that diastolic function is energy dependent and supplemental d-ribose has shown to improve diastolic dysfunction. This study investigated what role d-ribose might play in congestive heart failure patients with preserved systolic function and diastolic dysfunction.
    Therapeutic Advances in Cardiovascular Disease 02/2015; 9(3). DOI:10.1177/1753944715572752 · 2.13 Impact Factor
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    ABSTRACT: We conducted a prospective multicenter study to assess the prognostic value of combined baseline pre-implant plasma levels of the biomarkers cardiac troponin T (TnT) and BNP among CRT-D recipients. At CRT-D implant, patients were stratified based on detectable TnT (≥0.01 ng/ml) and elevated BNP (predefined as >440 pg/ml) levels. Patients were classified into 3 groups high (both detectable TnT and high BNP), intermediate (either detectable TnT or high BNP), or low (non-detectable TnT and low BNP). Patients were followed for 12 months. Survival curves free from mortality or HFH were assessed. To assess the predictive value of biomarker category, we constructed a multivariate Cox regression model, including the covariates of age, NYHA class, LVEF, and QRS duration. A total of 267 patients (age 66 ± 12 years, males 80%, LVEF 25% ± 8%, ischemic CM 52%, QRSd 155 ± 26 ms) were studied. After one year, there were 13 deaths and 25 HFH events. A significant difference in event free survival among the 3 groups was observed, with high and intermediate categories having worse survival than low (log-rank test, p <0.001). In the multivariate model, risk category was a significant predictor of outcome: Hazard ratios were 7.34 (95% CI: 2.48 to 21.69) and 2.50 (95% CI: 1.04 to 6.04) for high and intermediate risk groups respectively (p<0.0001). Among CRT-D recipients, baseline TnT and BNP values alone or in combination provide significant prognostic value for the outcome of mortality or HFH. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Pacing and Clinical Electrophysiology 02/2015; 38(5). DOI:10.1111/pace.12610 · 1.25 Impact Factor
  • William T. Abraham
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    ABSTRACT: Heart failure is associated with high rates of hospitalization and rehospitalization, resulting in substantial clinical and economic burden. Current approaches to monitoring patients with heart failure have done little to reduce these high rates of heart failure hospitalization. Implantable hemodynamic monitors have been developed to remotely provide direct measurement of intracardiac and pulmonary artery pressures in ambulatory patients with heart failure. These devices have the potential to direct day-to-day management of patients with heart failure to reduce hospitalization rates. The use of a pulmonary artery pressure measurement system has been shown to reduce the risk of heart failure hospitalization in patients with systolic and diastolic heart failure. Copyright © 2015 Elsevier Inc. All rights reserved.
    Heart Failure Clinics 02/2015; 11(2). DOI:10.1016/j.hfc.2014.12.011 · 1.41 Impact Factor
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    ABSTRACT: While right heart catheterization (RHC) remains the gold standard for assessment of hemodynamics in patients with known or suspected pulmonary hypertension (PH), there are significant limitations to this type of assessment. The current study evaluates the limitations of RHC in the diagnosis of left heart related PH (WHO Group II) among patient enrolled in the CHAMPION trial and discusses insights into patient risk from the home implantable hemodynamic monitor (IHM) data that were not identified at the time of the RHC procedure.
    The Journal of Heart and Lung Transplantation 02/2015; 34(3). DOI:10.1016/j.healun.2015.01.983 · 5.61 Impact Factor
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    ABSTRACT: Hospitalizations for heart failure are associated with a high post-discharge risk for mortality. Identification of modifiable predictors of post-discharge mortality during hospitalization may improve outcome. Sleep disordered breathing (SDB) is the most common co-morbidity in heart failure patients. Prospective cohort study of patients hospitalized with acute heart failure (AHF) in a single academic heart hospital. Between January 2007 and December 2010, all patients hospitalized with AHF who have left ventricular ejection fraction (LVEF) ≤ 45% and were not already diagnosed with SDB were the target population. Patients underwent in-hospital attended polygraphy testing for SDB and were followed for a median of 3 years post-discharge. Mortality was recorded using national and state vital statistics databases. During the study period, 1117 hospitalized AHF patients underwent successful sleep testing. Three hundred and forty-four patients (31%) had central sleep apnoea (CSA), 525(47%) patients had obstructive sleep apnoea (OSA), and 248 had no or minimal SDB (nmSDB). Of those, 1096 patients survived to discharge and were included in the mortality analysis. Central sleep apnoea was independently associated with mortality. The multivariable hazard ratio (HR) for time to death for CSA vs. nmSDB was 1.61 (95% CI: 1.1, 2.4, P = 0.02). Obstructive sleep apnoea was also independently associated with mortality with a multivariable HR vs. nmSDB of 1.53 (CI: 1.1, 2.2, P = 0.02). The Cox proportional hazards model adjusted for the following covariates: LVEF, age, BMI, sex, race, creatinine, diabetes, type of cardiomyopathy, coronary artery disease, chronic kidney disease, discharge systolic blood pressure <110, hypertension, discharge medications, initial length of stay, admission sodium, haemoglobin, and BUN. This is the largest study to date to evaluate the effect of SDB on post-discharge mortality in patients with AHF. Newly diagnosed CSA and OSA during AHF hospitalization are independently associated with post-discharge mortality. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.
    European Heart Journal 01/2015; DOI:10.1093/eurheartj/ehu522 · 14.72 Impact Factor
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    ABSTRACT: Central sleep apnea (CSA) is a highly prevalent, though often unrecognized, comorbidity in patients with heart failure (HF). Data from HF population studies suggest that it may present in 30% to 50% of HF patients. CSA is recognized as an important contributor to the progression of HF and to HF-related morbidity and mortality. Over the past 2 decades, an expanding body of research has begun to shed light on the pathophysiologic mechanisms of CSA. Armed with this growing knowledge base, the sleep, respiratory, and cardiovascular research communities have been working to identify ways to treat CSA in HF with the ultimate goal of improving patient quality of life and clinical outcomes. In this paper, we examine the current state of knowledge about the mechanisms of CSA in HF and review emerging therapies for this disorder. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
    Journal of the American College of Cardiology 01/2015; 65(1):72-84. DOI:10.1016/j.jacc.2014.10.025 · 15.34 Impact Factor
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    ABSTRACT: Heart failure hospitalizations (HFHs) cost the US health care system ∼$20 billion annually. Identifying patients at risk of HFH to enable timely intervention and prevent expensive hospitalization remains a challenge. Implantable cardioverter defibrillators (ICDs) and cardiac resynchronization devices with defibrillation capability (CRT-Ds) collect a host of diagnostic parameters that change with HF status and collectively have the potential to signal an increasing risk of HFH. These device-collected diagnostic parameters include activity, day and night heart rate, atrial tachycardia/atrial fibrillation (AT/AF) burden, mean rate during AT/AF, percent CRT pacing, number of shocks, and intrathoracic impedance. There are thresholds for these parameters that when crossed trigger a notification, referred to as device observation, which gets noted on the device report. We investigated if these existing device observations can stratify patients at varying risk of HFH.
    Heart and Lung The Journal of Acute and Critical Care 12/2014; 44(2). DOI:10.1016/j.hrtlng.2014.07.007 · 1.32 Impact Factor
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    ABSTRACT: Chronic obstructive pulmonary disease (COPD) is a frequent co-morbidity in patients with heart failure (HF). Elevated pulmonary artery (PA) pressure can be seen in both conditions and has been shown to predict morbidity and mortality. 550 subjects with New York Heart Association functional class III HF were randomly assigned to the Treatment (n=270) and Control groups (n=280) in the CHAMPION Trial. Physicians had access to the PA pressure measurements in the Treatment group only, which HF therapy was used to lower the elevated pressures. HF and respiratory hospitalizations were compared in both groups. 187 subjects met criteria for classification into the COPD subgroup. In the entire cohort, the Treatment group had a 37% reduction in HF hospitalization rates (p<0.0001) and a 49% reduction in respiratory hospitalization rates (p=0.0061). In the COPD subgroup, the Treatment group had a 41% reduction in HF hospitalization rates (p=0.0009) and a 62% reduction in respiratory hospitalization rates (p=0.0023). The rate of respiratory hospitalizations in subjects without COPD was not statistically different (p=0.76). HF management incorporating hemodynamic information from an implantable PA pressure monitor significantly reduces HF and respiratory hospitalizations in heart failure subjects with comorbid COPD over standard of care. Copyright © 2014 Elsevier Inc. All rights reserved.
    Journal of Cardiac Failure 12/2014; 21(3). DOI:10.1016/j.cardfail.2014.12.008 · 3.07 Impact Factor
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    ABSTRACT: Cardiac resynchronization therapy (CRT) decreases mortality, improves functional status and induces reverse left ventricular (LV) remodeling in selected populations with heart failure (HF). The magnitude of reverse remodeling predicts survival with many HF medical therapies. However, there are little data assessing the impact of remodeling on long term survival with CRT. To assess the impact of CRT induced reverse remodeling on long term survival in mild HF. REVERSE was a multi-center, double-blind, randomized trial of CRT among patients with mild HF. Long-term follow-up for 5 years was pre-planned. The present analysis was confined to the 353 patients who were randomized to CRT ON with paired echocardiographic studies at baseline and 6 months post-implant. Left ventricular end systolic volume index (LVESVi) was measured by a core laboratory and was an independently powered endpoint of REVERSE. A 68% reduction in mortality was observed among patients with ≥15% decrease in LVESVi compared to the rest of the patients (p=0.0004). Multivariable analysis showed that the change in LVESVi was a strong independent predictor (p=0.0002) with a 14% reduction of mortality for every 10% decrease of LVESVi. Other remodeling parameters, including left ventricular end diastolic volume index and ejection fraction showed a similar relationship with mortality. Change in left ventricular end systolic volume over 6 months of CRT is a strong independent predictor of long term survival in mild HF. http://clinicaltrials.gov/ct2/show/NCT00271154. Unique identifier: NCT00271154. Copyright © 2014. Published by Elsevier Inc.
    Heart rhythm: the official journal of the Heart Rhythm Society 11/2014; 12(3). DOI:10.1016/j.hrthm.2014.11.014 · 4.92 Impact Factor
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    ABSTRACT: -No treatment strategies have been demonstrated to be beneficial for the population for patients with heart failure and preserved ejection fraction.
    Circulation Heart Failure 10/2014; 7(6). DOI:10.1161/CIRCHEARTFAILURE.113.001229 · 5.95 Impact Factor
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    ABSTRACT: Cardiac contractility modulation (CCM) signals are nonexcitatory electrical signals delivered during the cardiac absolute refractory period that enhance the strength of cardiac muscular contraction. The FIX-HF-5 study was a prospective, randomized study comparing CCM plus optimal medical therapy (OMT) to OMT alone that included 428 NYHA Class III or IV heart failure patients with ejection fractions (EF) ≤45% by core laboratory assessment. The study met its primary safety endpoint, but did not reach its primary efficacy endpoint: a responders analysis of changes in ventilatory anaerobic threshold (VAT). However, in a pre-specified subgroup analysis, significant improvements in primary and secondary endpoints, including the responder VAT endpoint, were observed in patients with EF ranging from 25% to 45% (inclusive), who comprised about half of the study subjects. We therefore designed a new study to prospectively confirm the efficacy of CCM in this population. A hierarchical Bayesian statistical analysis plan was developed to take advantage of the data already available from the first study. In addition, based on technical difficulties encountered in reliably quantifying VAT and the relatively large amount of non-quantifiable studies, the primary efficacy endpoint was changed to peak VO2, with significant measures incorporated to minimize the influence of placebo effect. In this paper, we provide the details and rationale of the FIX-HF-5C study design to study CCM plus OMT compared to OMT alone in subjects with normal QRS duration, NYHA III or IV and EF 25% to 45%. This study is registered on HYPERLINKError! Hyperlink reference not valid. NCT01381172.
    Journal of Cardiac Failure 10/2014; DOI:10.1016/j.cardfail.2014.09.011 · 3.07 Impact Factor
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    ABSTRACT: The study sought to assess feasibility, safety, and potential efficacy of a novel implantable extra-aortic counterpulsation system (C-Pulse) in functional class III and ambulatory functional class IV heart failure (HF) patients.
    10/2014; 2(5):526-33. DOI:10.1016/j.jchf.2014.04.014

Publication Stats

32k Citations
4,119.57 Total Impact Points

Institutions

  • 2015
    • Columbus State University
      Columbus, Georgia, United States
  • 2003–2015
    • The Ohio State University
      • • Division of Cardiovascular Medicine
      • • Division of Cardiology
      Columbus, Ohio, United States
    • Universitair Ziekenhuis Ghent
      Gand, Flemish, Belgium
    • University of Oklahoma Health Sciences Center
      • Department of Physiology
      Oklahoma City, OK, United States
    • National University (California)
      San Diego, California, United States
    • University of Colorado
      • Department of Medicine
      Denver, CO, United States
    • Duke University Medical Center
      Durham, North Carolina, United States
  • 2011
    • Thomas Jefferson University
      • Division of Hospital Medicine
      Filadelfia, Pennsylvania, United States
    • Medtronic
      Minneapolis, Minnesota, United States
  • 2010–2011
    • Medical University of South Carolina
      • Division of Cardiology
      Charleston, South Carolina, United States
    • Karolinska University Hospital
      • Department of Cardiology
      Tukholma, Stockholm, Sweden
    • Oregon State University
      Corvallis, Oregon, United States
  • 2009
    • Columbia University
      • Division of Cardiology
      New York City, NY, United States
  • 2004–2008
    • University of California, Los Angeles
      • Department of Medicine
      Los Angeles, CA, United States
    • VA San Diego Healthcare System
      San Diego, California, United States
  • 2003–2008
    • University of Alabama at Birmingham
      • Division of Cardiovascular Disease
      Birmingham, Alabama, United States
  • 2007
    • Cornell University
      Итак, New York, United States
    • Johns Hopkins Medicine
      Baltimore, Maryland, United States
    • Baylor University
      Waco, Texas, United States
  • 2006–2007
    • Campbell University
      North Carolina, United States
    • European Hospital
      Roma, Latium, Italy
    • Brigham and Women's Hospital
      Boston, Massachusetts, United States
    • Allegheny General Hospital
      • Department of Cardiology
      Pittsburgh, Pennsylvania, United States
  • 1990–2007
    • University of Colorado Hospital
      • Department of Medicine
      Denver, Colorado, United States
  • 2005
    • Lexington College
      Lexington, Kentucky, United States
    • Blue Water Task Force
      Big Sky, Montana, United States
  • 2002–2005
    • University of Oslo
      Kristiania (historical), Oslo, Norway
    • University of Kentucky
      Lexington, Kentucky, United States
    • University of Maryland Medical Center
      Baltimore, Maryland, United States
    • Cincinnati Children's Hospital Medical Center
      • Division of Cardiology
      Cincinnati, Ohio, United States
  • 2003–2004
    • University of California, San Diego
      • Division of Cardiology
      San Diego, California, United States
  • 1999–2004
    • University of Cincinnati
      • • Division of Pulmonary, Critical Care & Sleep Medicine
      • • Department of Pharmacology and Cell Biophysics
      • • Department of Emergency Medicine
      Cincinnati, Ohio, United States
    • University of Sioux Falls
      Sioux Falls, South Dakota, United States
    • Saint Louis University
      Сент-Луис, Michigan, United States
  • 1997–2002
    • University of Utah
      Salt Lake City, Utah, United States
  • 2000
    • Beverly Hospital, Boston MA
      Beverly, Massachusetts, United States
  • 1995
    • Montreal Heart Institute
      Montréal, Quebec, Canada