W H Wilson Tang

Lerner Research Institute, Cleveland, Ohio, United States

Are you W H Wilson Tang?

Claim your profile

Publications (467)3003.67 Total impact

  • Dhssraj Singh, Akanksha Thakur, W H Wilson Tang
    [Show abstract] [Hide abstract]
    ABSTRACT: The success achieved in advances in cancer therapy has been marred by development of cardiotoxicity, which causes significant morbidity and mortality. This has led to the development of surveillance protocols for cardiotoxicity utilizing multimodality imaging techniques and investigation of various drugs to treat and prevent cardiotoxicity in this subset of patients. Cardiac biomarkers hold important diagnostic and prognostic value in various cardiac diseases. In this review, we discuss the use of biomarkers in patients receiving chemotherapy, highlighting data behind the use of troponin, B-type natriuretic peptide, and myeloperoxidase. We also discuss the use of dexrazoxane, angiotensin-converting enzyme inhibitors, and beta blockers in the treatment and prevention of chemotherapy-induced cardiotoxicity. Cardiac biomarkers may serve an important role in selecting patients that are at high risk of cardiotoxicity and can potentially be used to guide the administration of drugs to treat and prevent cardiotoxicity.
    Current Heart Failure Reports 04/2015; DOI:10.1007/s11897-015-0258-4
  • American Heart Journal 04/2015; DOI:10.1016/j.ahj.2015.04.006 · 4.56 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The benefits of biventricular pacing in patients with cardiac resynchronization therapy (CRT) remain poorly understood in those with right bundle branch block (RBBB). The aim of this study was to examine the differences in several speckle tracking-derived parameters, including left ventricular torsion and longitudinal strain with CRT on and off for patients with underlying left bundle branch block (LBBB) and RBBB. Twelve patients with CRT and RBBB were compared with a similar group of patients with underlying LBBB who were sent for evaluation and atrioventricular optimization. Echocardiographic images were acquired with biventricular pacing on and off. The 2 groups had similar baseline characteristics, including age, the ejection fraction, and QRS duration. During intrinsic conduction (CRT off), patients with LBBB had lower torsion angles than those with RBBB (2.3 ± 1.0° in those with LBBB vs 6.3 ± 1.0° in those with RBBB, p = 0.03) but trended toward improvements in torsional parameters, including torsional angle and peak untwisting velocity with CRT on, whereas these parameters worsened in patients with RBBB. Compared with CRT off, analyses of septal and lateral strain curves showed significant improvements in septal strain during 100% and 200% of systole with CRT on in patients with LBBB, whereas biventricular pacing resulted in a trend toward worsening of septal strain in patients with RBBB. Negligible changes were noted in lateral strain values. In conclusion, CRT favorably improves regional mechanics in patients with LBBB primarily involving the ventricular septum, with a negligible positive impact on cardiac function in patients with underlying RBBB. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Cardiology 04/2015; 115(7). DOI:10.1016/j.amjcard.2015.01.018 · 3.43 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Discordance between left- and right-sided filling pressures occurs in a subset of patients presenting with acute decompensated heart failure (ADHF). We hypothesized that a disproportionately increased right atrial pressure (RAP) relative to the pulmonary capillary wedge pressure (PCWP) would be associated with both renal dysfunction and mortality in ADHF.
    American Heart Journal 02/2015; DOI:10.1016/j.ahj.2015.02.017 · 4.56 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Hyponatremia frequently poses a therapeutic challenge in acute decompensated heart failure (ADHF). Treating physicians should differentiate between depletional versus dilutional hyponatremia. The former is caused by diuretic agents, which enhance sodium excretion, often with concomitant potassium/magnesium losses. This can be treated with isotonic saline, whereas potassium/magnesium administration may be helpful if plasma concentrations are low. In contrast, as impaired water excretion, rather than sodium deficiency, is the culprit in dilutional hyponatremia, isotonic saline administration may further depress the serum sodium concentration. Because free water excretion is achieved by continuous sodium reabsorption in distal nephron segments with low water permeability, diuretic agents that impair this mechanism (e.g., thiazide-type diuretic agents and mineralocorticoid receptor antagonists) should be avoided, and proximally acting agents (e.g., acetazolamide and loop diuretic agents) are preferred. Vasopressin antagonists, which promote low water permeability in the collecting ducts and, hence, free water excretion, remain under investigation for dilutional hyponatremia in ADHF. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
    Journal of the American College of Cardiology 02/2015; 65(5):480-492. DOI:10.1016/j.jacc.2014.12.010 · 15.34 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The current understanding of heart failure (HF) does not fully explain the spectrum of HF symptoms. Most HF hospitalizations are related to sodium (Na(+)) and fluid retention resulting from neurohumoral up-regulation. Recent insights suggest that Na(+) is not distributed in the body solely as a free cation, but that it is also bound to large interstitial glycosaminoglycan (GAG) networks in different tissues, which have an important regulatory function. In HF, high Na(+) intake and neurohumoral alterations disrupt GAG structure, leading to loss of the interstitial buffer capacity and disproportionate interstitial fluid accumulation. Moreover, a diminished endothelial GAG network (the endothelial glycocalyx) results in increased vascular resistance and disturbed endothelial nitric oxide production. New imaging modalities can help evaluate interstitial Na(+) and endothelial glycocalyx integrity. Furthermore, several therapies have been proven to stabilize interstitial GAG networks. Hence, a better appreciation of this new Na(+) "compartment" might improve current management of HF. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
    Journal of the American College of Cardiology 02/2015; 65(4):378-388. DOI:10.1016/j.jacc.2014.11.025 · 15.34 Impact Factor
  • Srisakul Chirakarnjanakorn, W H Wilson Tang
    Clinical Journal of the American Society of Nephrology 01/2015; 10(2). DOI:10.2215/CJN.12761214 · 5.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Net fluid and weight loss are ubiquitously employed to monitor diuretic response in acute decompensated heart failure research and patient care. However, the performance of these metrics has never been critically evaluated. The weight and volume of aqueous fluids such as urine should be nearly perfectly correlated and with very good agreement. As a result significant discrepancy between fluid and weight loss during the treatment of acute decompensated heart failure would indicate measurement error in one or both of the parameters. The correlation and agreement (Bland-Altman method) between diuretic-induced fluid/weight loss were examined in three acute decompensated heart failure trials and cohorts: 1) DOSE (n=254) 2) ESCAPE (n=348) the 3) Penn (n=486). The correlation between fluid and weight loss was modest (DOSE r=0.55; ESCAPE r=0.48; Penn r=0.51; p<0.001 for all) and the 95% limits of agreement were wide (DOSE -7.9 to 6.4 Kg-L; ESCAPE -11.6 to 7.5 Kg-L; Penn -14.5 to 11.3 Kg-L). The median relative disagreement ranged from ± 47.0% to 63.5%. A bias toward greater fluid than weight loss was found across populations (-0.74 to -2.1 Kg-L p≤0.002). A consistent pattern of baseline characteristics or in-hospital treatment parameters that could identify patients at risk of discordant fluid and weight loss was not found. Considerable discrepancy between fluid balance and weight loss is common in patients treated for acute decompensated heart failure. Awareness of the limitations inherent to these commonly used metrics and efforts to develop more reliable measures of diuresis are critical for both patient care and research in acute decompensated heart failure. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Medicine 01/2015; DOI:10.1016/j.amjmed.2014.12.020 · 5.30 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patients with ambulatory New York Heart Association (NYHA) class IV heart failure were significantly underrepresented in clinical trials of cardiac resynchronization therapy (CRT). The natural long-term trajectory of survival free of left ventricular assist device (LVAD) or heart transplant in patients with ambulatory class IV symptoms who underwent CRT has not been established. We extracted clinical data on 723 consecutive patients with NYHA class III or ambulatory class IV heart failure, left ventricular ejection fraction ≤35%, and a QRS duration ≥120 ms who underwent CRT from September 30, 2003, to August 6, 2007. Chart notes immediately before CRT were reviewed to confirm NYHA class status before CRT. Kaplan-Meier curves and a multivariate Cox proportional hazards model were constructed to determine long-term survival free of heart transplant and LVAD based on NYHA class status. Of the 723 patients, 52 had ambulatory class IV symptoms. Over a mean follow-up of 5.0 ± 2.5 years controlling for many possible confounders, ambulatory NYHA class IV status was independently associated with poor long-term outcomes. The 1-, 2-, 3-, 4-, and 5-year survival free of LVAD or heart transplant for class III versus ambulatory class IV patients was 92.0%, 84.0%, 75.0%, 68.1%, and 63.2% versus 75.0%, 61.5%, 52.0%, 45%, and 40.4%, respectively. Although patients with ambulatory class IV heart failure receiving CRT have inferior long-term outcomes compared with those with class III symptoms, survival in class IV patients continues to parallel class III patients over an extended follow-up. At 5 years, survival free of LVAD or heart transplant in ambulatory class IV patients receiving CRT is 40%. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Cardiology 01/2015; 115(1):82-5. DOI:10.1016/j.amjcard.2014.09.052 · 3.43 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Heart failure is a complex clinical syndrome and has become the most common reason for adult hospitalization in developed countries. Two subtypes of heart failure, ischemic heart disease (ISCH) and dilated cardiomyopathy (DCM), have been studied using microarray platforms. However, microarray has limited resolution. Here we applied RNA sequencing (RNA-Seq) to identify gene signatures for heart failure from six individuals, including three controls, one ISCH and two DCM patients. Using genes identified from this small RNA-Seq dataset, we were able to accurately classify heart failure status in a much larger set of 313 individuals. The identified genes significantly overlapped with genes identified via genome-wide association studies for cardiometabolic traits and the promoters of those genes were enriched for binding sites for transcriptions factors. Our results indicate that it is possible to use RNA-Seq to classify disease status for complex diseases such as heart failure using an extremely small training dataset. Copyright © 2014. Published by Elsevier Inc.
    Genomics 12/2014; 105(2). DOI:10.1016/j.ygeno.2014.12.002 · 2.79 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Myocardial infarction (MI), a leading cause of death around the world, displays a complex pattern of inheritance. When MI occurs early in life, genetic inheritance is a major component to risk. Previously, rare mutations in low-density lipoprotein (LDL) genes have been shown to contribute to MI risk in individual families, whereas common variants at more than 45 loci have been associated with MI risk in the population. Here we evaluate how rare mutations contribute to early-onset MI risk in the population. We sequenced the protein-coding regions of 9,793 genomes from patients with MI at an early age (≤50 years in males and ≤60 years in females) along with MI-free controls. We identified two genes in which rare coding-sequence mutations were more frequent in MI cases versus controls at exome-wide significance. At low-density lipoprotein receptor (LDLR), carriers of rare non-synonymous mutations were at 4.2-fold increased risk for MI; carriers of null alleles at LDLR were at even higher risk (13-fold difference). Approximately 2% of early MI cases harbour a rare, damaging mutation in LDLR; this estimate is similar to one made more than 40 years ago using an analysis of total cholesterol16. Among controls, about 1 in 217 carried an LDLR coding-sequence mutation and had plasma LDL cholesterol > 190 mg dl−1. At apolipoprotein A-V (APOA5), carriers of rare non-synonymous mutations were at 2.2-fold increased risk for MI. When compared with non-carriers, LDLR mutation carriers had higher plasma LDL cholesterol, whereas APOA5 mutation carriers had higher plasma triglycerides. Recent evidence has connected MI risk with coding-sequence mutations at two genes functionally related to APOA5, namely lipoprotein lipase15, 17 and apolipoprotein C-III. Combined, these observations suggest that, as well as LDL cholesterol, disordered metabolism of triglyceride-rich lipoproteins contributes to MI risk.
    Nature 12/2014; advance online publication. DOI:10.1038/nature13917 · 42.35 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Ceruloplasmin (Cp) is a copper-binding acute-phase protein that is increased in inflammatory states and deficient in Wilson's disease. Recent studies demonstrate increased levels of Cp are associated with increased risk of developing heart failure. Our objective is to test the hypothesis that serum Cp provides incremental and independent prediction of survival in stable patients with heart failure. Methods and Results We measured serum Cp levels in 890 patients with stable heart failure undergoing elective cardiac evaluation that included coronary angiography. We examine the role of Cp levels in predicting survival over 5-years of follow-up. Mean Cp level was 26.6±6.9 mg/dL, and demonstrated relatively weak correlation with BNP (r=0.187, p<0.001). Increased Cp levels were associated with increased 5 year all-cause mortality (Q4 vs Q1 HR 1.9, 95%CI 1.4-2.8, p<0.001). When controlled for coronary disease traditional risk factors, creatinine clearance, dialysis, body mass index, medications, history of myocardial infarction, BNP, LVEF, heart rate, QRS duration, left bundle branch blockage and ICD, higher Cp remained an independent predictor of increased mortality (Q4 vs Q1 HR1.7, 95%CI 1.1 – 2.6, p<0.05). Model quality was improved with addition of Cp to aforementioned co-variables (NRI of 9.3%, p<0.001) Conclusions Ceruloplasmin is an independent predictor of all-cause mortality in patients with heart failure. Use of Cp may help to identify patients at heightened mortality risk.
    Journal of Cardiac Failure 12/2014; 20(12). DOI:10.1016/j.cardfail.2014.08.001 · 3.07 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: AimsTo study pulmonary vascular response patterns to exercise in heart failure with reduced ejection fraction (HFrEF) and pulmonary hypertension (PH).Methods and resultsIn this prospective single-centre cohort study, consecutive symptomatic HFrEF patients (n = 40) with mean pulmonary arterial pressure (MPAP) ≥25 mmHg, pulmonary artery wedge pressure (PAWP) >15 mmHg, and cardiac index <2.5 L/min.m2, received protocol-driven titrated sodium nitroprusside (SNP) and diuretics to reach mean arterial blood pressure 65–75 mmHg and PAWP ≤15 mmHg. Patients performed symptom-limited supine bicycle testing under continued SNP administration. Afterwards, SNP was gradually withdrawn, renin–angiotensin system blockers uptitrated, and hydralazine added to maintain haemodynamic targets. Subsequently, bicycle testing was repeated. Patients presented with pulmonary vascular resistance (PVR) = 3.8 ± 1.4 Wood Units at rest, decreasing to 2.9 ± 0.9 Wood Units after decongestion, with PH was completely reversed (MPAP <25 mmHg) in 22%. From rest to maximal exercise, the cardiac index did not change significantly (P = 0.334 under SNP; P-value = 0.552 under oral therapy). A dynamic exercise-induced PVR increase >3.5 Wood Units was noted in 19 patients (48%) under oral therapy vs. five (13%) under SNP. Such exercise-induced PVR increase was associated with a 33% relative decrease in right ventricular stroke work index (P = 0.037).Conclusions Even after thorough decongestion and under continuous afterload reduction, PH secondary to HFrEF is completely reversible in only a minority of patients. Others demonstrate an exercise-induced PVR increase, associated with impaired right ventricular stroke work, which might be ameliorated by nitric oxide donor support.
    European Journal of Heart Failure 12/2014; 20(8):S4. DOI:10.1016/j.cardfail.2014.06.017 · 6.58 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Trimethylamine-N-oxide (TMAO) has been linked to increased cardiovascular risk. We aim to determine the prognostic value of TMAO and its dietary precursors, choline and betaine, in heart failure (HF).Methods and ResultsIn 112 patients with chronic systolic HF with comprehensive echocardiographic evaluation, we measured plasma TMAO, choline, and betaine by mass spectrometry. Median TMAO levels, choline, and betaine levels were 5.8 [3.6, 12.1] μM, 10.9 [8.4, 14.0] μM, 43.8 [37.1, 53.0] μM, respectively, and were correlated with each other (all p<0.0001 for both). TMAO levels were significantly higher in patients with diabetes mellitus (9.4 [4.9, 13.2] vs 4.8 [3.4, 9.8] μM, p=0.005) and in subjects with New York Heart Association (NYHA) class III or greater (7.0 [4.7, 14.8] vs 4.7 [3.4, 11.3] μM, p=0.02). Elevated TMAO, choline, and betaine levels were each associated with higher plasma NT-proBNP levels and more advanced left ventricular diastolic dysfunction, but not systolic dysfunction or inflammatory and endothelial biomarkers. Higher choline (Hazard ratio (HR) 1.64 [95% CI: 1.22 2.20], p=0.001), betaine (HR 1.51 [1.10-2.08], p=0.01), and TMAO (HR 1.48 [1.10-1.96], p=0.01) predicted increased risk for 5-year adverse clinical events (death/transplant). Only higher TMAO levels predicted incident adverse clinical events independent of age, eGFR, mitral E/septal Ea, and NT-proBNP levels (HR 1.46 [1.03 2.14], p=0.03).Conclusion Elevated plasma TMAO, choline and betaine levels are each associated with more advanced left ventricular diastolic dysfunction and portend poorer long-term adverse clinical outcomes in chronic systolic HF. However, only higher plasma TMAO levels was associated with poor prognosis after adjustment for cardio-renal indices.
    Journal of Cardiac Failure 11/2014; DOI:10.1016/j.cardfail.2014.11.006 · 3.07 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to investigate the predictive values of baseline and changes in cystatin C (CysC) and its derived equations for short-term adverse outcomes and the effect of nesiritide therapy on CysC in acute decompensated heart failure (ADHF). Newer renal biomarkers or their derived estimates of renal function have demonstrated long-term prognostic value in chronic heart failure. CysC levels were measured in sequential plasma samples from 811 subjects with ADHF who were enrolled in the ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) biomarker sub-study (randomized to nesiritide therapy vs. placebo), and followed for all-cause death (180 days) and recurrent hospital stay (30 days). Median CysC levels were 1.49 (interquartile range [IQR]: 1.20 to 1.96) mg/l at baseline, 1.56 (IQR: 1.28 to 2.13) mg/l at 48 to 72 h, and 1.58 (IQR: 1.24 to 2.11) mg/l at 30 days. Higher baseline (but not follow-up) CysC levels were associated with increased risk of 30-day adverse events and less improvement in dyspnea after 24 h as well as 180-day mortality, although not incremental to blood urea nitrogen. Worsening renal function (defined as a 0.3 mg/l increase in CysC) occurred in 161 of 701 (23%) patients, but it was not predictive of adverse events. Changes in CysC levels were similar between the nesiritide and placebo groups. Our findings confirmed the prognostic value of baseline CysC levels in the setting of ADHF. However, worsening renal function based on CysC rise was not predictive of adverse events. Nesiritide did not worsen renal function compared with placebo. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
    11/2014; 3(1). DOI:10.1016/j.jchf.2014.06.014
  • [Show abstract] [Hide abstract]
    ABSTRACT: L-carnitine, a nutrient in red meat, was recently reported to accelerate atherosclerosis via a metaorganismal pathway involving gut microbial trimethylamine (TMA) formation and host hepatic conversion into trimethylamine-N-oxide (TMAO). Herein, we show that following L-carnitine ingestion, gamma-butyrobetaine (gamma BB) is produced as an intermediary metabolite by gut microbes at a site anatomically proximal to and at a rate similar to 1,000-fold higher than the formation of TMA. Moreover, we show that gamma BB is the major gut microbial metabolite formed from dietary L-carnitine in mice, is converted into TMA and TMAO in a gut microbiota-dependent manner (like dietary L-carnitine), and accelerates atherosclerosis. Gut microbial composition and functional metabolic studies reveal that distinct taxa are associated with the production of gamma BB or TMA/TMAO from dietary L-carnitine. Moreover, despite their close structural similarity, chronic dietary exposure to L-carnitine or gamma BB promotes development of functionally distinct microbial communities optimized for the metabolism of L-carnitine or gamma BB, respectively.
    Cell Metabolism 11/2014; 20(5):799–812. DOI:10.1016/j.cmet.2014.10.006 · 16.75 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Glomerular filtration rate (GFR) and natriuretic response to diuretics represent important treatment targets in acute decompensated heart failure (ADHF). Methods and Results: Consecutive ADHF patients (n = 50) with ejection fraction <= 45% and clinical signs of volume overload received protocol-driven decongestive therapy. Serum creatinine (Cr), cystatin C (CysC), and beta-trace protein (beta TP) were measured on admission and three subsequent days of treatment. Worsening renal function (WRF) was defined as a >= 0.3 increase in absolute biomarker levels or >= 20% decrease in estimated GFR. Consecutive 24-hour urinary collections were simultaneously performed to measure Cr clearance and natriuresis. Serum Cr, CysC, and beta TP were strongly correlated at admission (p = 0.788-0.909) and during decongestive treatment (p = 0.884-888). Moreover, derived GFR estimates correlated well with Cr clearance (p = 0.820-0.908.). Nevertheless, WRF incidence differed markedly according to Cr- (26%-30%), CysC- (46%-54%), or beta TP-based definitions (31%-48%). WRF by any definition was not associated with all-cause mortality or ADHF readmission, in contrast to stronger natriuresis per loop diuretic dose [hazard ratio 0.20 (95% confidence interval 0.06-0.64); P = .007]. Conclusions: Serial measurements of CysC/beta TP, compared with serum Cr, more frequently indicate WRF during decongestive treatment in ADHF. However, adverse clinical outcome in such patients might be better predicted by the natriuretic response to diuretic therapy.
    Journal of Cardiac Failure 11/2014; 20(11). DOI:10.1016/j.cardfail.2014.08.002 · 3.07 Impact Factor
  • 10/2014; 3(2). DOI:10.1016/j.jchf.2014.10.005
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Cardiac troponin levels offer prognostic information for patients with heart failure. Highly sensitive assays detect levels of cTn much lower than the 99th percentile of standard cTn assays. We hypothesize that cardiac troponin (cTn) levels measured by a high sensitivity assay provide better prognostic value compared to cTn levels measured by a standard assay in patients with chronic heart failure. Methods We measured high sensitivity cTnT (hs-cTnT) and standard cTnI levels, as well as aminoterminal pro B-type natriuretic peptide (NT-proBNP) in 504 sequential stable patients with a history of heart failure who underwent elective coronary angiography, without acute coronary syndrome, and with 5-year follow-up of all-cause mortality. Results The median hs-cTnT level was 21.2 [interquartile range 12.3, 40.9] ng/L and 170 subjects died over 5-years. In a head-to-head overall comparison, hs-cTnT provided increased prognostic utility compared to cTnI (area under the curve [AUC] 66.1% and AUC 69.4%, respectively, p=0.03; 9.0% integrated discrimination improvement, p<.001; and 13.6% event-specific reclassification, p<.001), and was independent of NT-proBNP and renal function. Even within the subset of patients where cTn levels by both assays were above the limit of quantification, higher hs-cTnT is associated with a 2-fold increase in 5-year mortality risk after adjusting for traditional risk factors (tertile 1 vs. 3: Hazard ratio [95% confidence interval] 2.0 [1.3-3.2]; p=0.0002). Conclusion Cardiac troponin can be detected by the high sensitivity assay in more patients with chronic heart failure than the standard assay, and may yield independent and better prognostic accuracy for mortality prediction than standard assay.
    The American Journal of Medicine 10/2014; 128(3). DOI:10.1016/j.amjmed.2014.09.029 · 5.30 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Recent reports raised concerns regarding renal outcomes in patients with decompensated acute heart failure (HF) treated with slow continuous ultrafiltration (SCUF). The purpose of the study is to identify risk factors for renal failure (RF) requiring dialysis in patients with acute HF initiated on SCUF. We studied 63 consecutive patients with acute HF who required SCUF due to congestion refractory to hemodynamically-guided intensive medical therapy. Median serum creatinine at SCUF initiation was higher in patients who developed RF requiring dialysis [2.5(1.8,3.3) vs. 1.6(1.2,2.3) mg/dL, p < .001]. Weight loss within 48 hours of SCUF initiation was larger in patients who did not progress to RF [-6(-10,-2) vs. -4(-6,-2), p = .03]. Systolic perfusion pressure had a nonlinear association with RF requiring dialysis with a threshold effect noted at 90 mmHg. Twelve month mortality in patients who were transitioned to dialysis vs. those who didn't was 95%vs.35% (p < .001). In patients with acute HF initiated on SCUF, onset of RF requiring dialysis is associated with high mortality. Systolic perfusion pressure which incorporates both perfusion and venous congestion parameters may present a modifiable risk factor for worsening RF during SCUF in acute HF patients. Copyright © 2014 Elsevier Inc. All rights reserved.
    Journal of Cardiac Failure 10/2014; 21(2). DOI:10.1016/j.cardfail.2014.10.005 · 3.07 Impact Factor

Publication Stats

7k Citations
3,003.67 Total Impact Points


  • 2008–2014
    • Lerner Research Institute
      • Department of Cellular and Molecular Medicine
      Cleveland, Ohio, United States
    • Rede Sarah de Hospitais de Reabilitação
      Brasília, Federal, Brazil
  • 2003–2014
    • Cleveland Clinic
      • • Department of Cardiovascular Medicine
      • • Department of Cardiology
      Cleveland, Ohio, United States
  • 2013
    • University of Washington Seattle
      • Department of Epidemiology
      Seattle, Washington, United States
    • MetroHealth Medical Center
      Cleveland, Ohio, United States
  • 2012–2013
    • Universiteit Hasselt
      • Faculty of Medicine and Life Sciences
      Hasselt, Flanders, Belgium
    • NCI-Frederick
      Фредерик, Maryland, United States
    • Baylor College of Medicine
      Houston, Texas, United States
    • Cleveland Clinic Laboratories
      Cleveland, Ohio, United States
  • 2005–2013
    • Case Western Reserve University
      • Division of Cardiovascular Medicine
      Cleveland, Ohio, United States
    • University of Alabama at Birmingham
      • Department of Medicine
      Birmingham, Alabama, United States
  • 2011
    • Allegheny General Hospital
      Pittsburgh, Pennsylvania, United States
  • 1999–2011
    • Stanford Medicine
      • Division of Cardiovascular Medicine
      Stanford, California, United States
  • 2010
    • The University of Chicago Medical Center
      • Department of Medicine
      Chicago, IL, United States
  • 2008–2010
    • Metropolitan Heart and Vascular Institute
      Minneapolis, Minnesota, United States
  • 2009
    • University of Western Sydney
      • School of Nursing and Midwifery
      Penrith, New South Wales, Australia
  • 2007
    • IST Austria
      Klosterneuberg, Lower Austria, Austria
    • VA San Diego Healthcare System
      San Diego, California, United States
  • 2006
    • University of Maryland, Baltimore
      Baltimore, Maryland, United States
    • University of Kentucky
      Lexington, Kentucky, United States
  • 2004
    • University of North Carolina at Chapel Hill
      North Carolina, United States
    • University of Texas Southwestern Medical Center
      • Department of Internal Medicine
      Dallas, Texas, United States
    • Duke University
      Durham, North Carolina, United States
  • 2001–2004
    • Stanford University
      • Division of Cardiovascular Medicine
      Palo Alto, California, United States