Richard K Cheng

University of Washington Seattle, Seattle, Washington, United States

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Publications (15)23.79 Total impact

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    ABSTRACT: The use of left ventricular assist devices has grown rapidly in recent years for patients with end-stage heart failure. A significant proportion of patients require both left- and right-sided support with biventricular assist devices (BiVADs) as a bridge to transplantation. Traditionally, these patients have waited in the hospital until they receive a transplant.
    The Journal of cardiovascular nursing. 06/2014;
  • Richard K Cheng, Jamil Aboulhosn, Ali Nsair
    JACC Cardiovascular Interventions 05/2014; · 7.42 Impact Factor
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    ABSTRACT: Our insights into different system levels of mechanisms by left ventricular assist device support are increasing and suggest a complex regulatory system of overlapping biological processes. To develop novel decision-making strategies and patient selection criteria, heart failure and reverse cardiac remodeling should be conceptualized and explored by a multifaceted research strategy of transcriptomics, metabolomics, proteomics, molecular biology, and bioinformatics. Knowledge of the molecular mechanisms of reverse cardiac remodeling is in its early stages, and comprehensive reconstruction of the underlying networks is necessary.
    Heart Failure Clinics 01/2014; 10(1 Suppl):S57-62.
  • Heart Failure Clinics 01/2014; 10(1):S57–S62.
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    ABSTRACT: Heart failure (HF) and obesity are commonly seen in the USA. Although obesity is associated with traditional cardiovascular disease, its relationship with HF is complex. Obesity is an accepted risk factor for incident HF. However, in patients with established HF, there exists a paradoxical correlation, with escalating BMI incrementally protective against adverse outcomes. Despite this relationship, patients with HF may desire to lose weight to reduce comorbidities or to improve quality of life. Thus far, studies have shown that intentional weight loss in obese patients with HF does not increase risk, with strategies including dietary modification, physical activity, pharmacotherapy, and/or surgical intervention.
    Expert Review of Cardiovascular Therapy 08/2013;
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    ABSTRACT: Objectives This retrospective study evaluated the outcomes of patients who underwent unprotected left main coronary artery (ULMCA) percutaneous coronary intervention (PCI) with different types of drug-eluting stents (DES).Background The standard of care for patients with ULMCA is coronary artery bypass surgery. However, current guidelines recommend PCI in clinical conditions where there is an increased risk of adverse surgical outcomes. Clinical outcomes of patients undergoing ULMCA PCI with different types of drug-eluting stents (DES) are unknown.Methods Data from a multicenter international registry, which included 239 consecutive patients from four institutions who ULMCA PCI with DES, were collected.ResultsThere were 42 patients receiving paclitaxel-eluting stent (PES), 158 patients receiving sirolimus-eluting stent (SES), and 39 patients receiving everolimus-eluting stent (EES). There was no statistical difference in major adverse cardiovascular events, cardiac death, myocardial infarction, target lesion revascularization, and stent thrombosis among PES, SES, and EES at 30 days and 1 year.Conclusions There are no differences in clinical events among patients receiving PES, SES, and EES for ULMCA disease.
    Journal of the Saudi Heart Association 04/2013; 25(2):75–78.
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    ABSTRACT: BACKGROUND: Hodgkin's lymphoma (HL) comprises of 4% of malignancies diagnosed in children from birth to 14 years of age. While overall survival rates have increased, HL survivors can be at risk of late cardiovascular complications from radiotherapy. HL survivors with a history of mediastinal RT have been found to have an increased incidence of myocardial infarction, angina, congestive heart failure, and valvular disorders compared to the general population. METHODS: A 33 year old female with a history of HL status post chemotherapy and mediastinal radiation 11 years ago became symptomatic with multivessel coronary artery disease with aggressive progression of her disease despite coronary bypass graft surgery, patch angioplasty of the left main coronary artery (LMCA) with an extracellular bioscaffold, and repeated percutaneous coronary intervention of the LMCA. She eventually underwent orthotopic heart transplant and did well postoperatively. RESULTS: Histopathological analysis of the explanted heart revealed a variety of sequelae of radiation arteritis, including thrombosis of both native vessels and arterial grafts, intimal hyperplasia and involvement of the bioscaffold in the left main coronary vasculature. The bioscaffold did not contribute significantly to the stenosis within the LMCA. CONCLUSION: Our case demonstrates an unusual indication for OHT due to severe refractory radiation induced CAD, as well the wide spectrum of the histopathologic manifestations of radiation induced arteritis.
    Cardiovascular pathology: the official journal of the Society for Cardiovascular Pathology 01/2013; · 1.63 Impact Factor
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    ABSTRACT: Prior studies have identified risk factors for survival in patients with end-stage heart failure (HF) requiring left ventricular assist device (LVAD) support. However, patients with biventricular HF may represent a unique cohort. We retrospectively evaluated a consecutive cohort of 113 adult, end-stage HF patients at University of California Los Angeles Medical Center who required BIVAD support between 2000 and 2009. Survival to transplant was 66.4%, with 1-year actuarial survival of 62.8%. All patients were Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Level 1 or 2 and received Thoratec (Pleasanton, CA) paracorporeal BIVAD as a bridge to transplant. Univariate analyses showed dialysis use, ventilator use, extracorporal membrane oxygenation use, low cardiac output, preserved LV ejection fraction (restrictive physiology), normal-to-high sodium, low platelet count, low total cholesterol, low high-density and high-density lipoprotein, low albumin, and elevated aspartate aminotransferase were associated with increased risk of death. We generated a scoring system for survival to transplant. Our final model, with age, sex, dialysis, cholesterol, ventilator, and albumin, gave a C-statistic of 0.870. A simplified system preserved a C-statistic of 0.844. Patients were divided into high-risk or highest-risk groups (median respective survival, 367 and 17 days), with strong discrimination between groups for death. We have generated a scoring system that offers high prognostic ability for patients requiring BIVAD support and hope that it may assist in clinical decision making. Further studies are needed to prospectively validate our scoring system.
    The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 08/2012; 31(8):831-8. · 3.54 Impact Factor
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    ABSTRACT: The aim of this study was to assess the clinical outcomes of percutaneous coronary intervention (PCI) with everolimus-eluting stents (EES) for the treatment of unprotected left main coronary artery (ULMCA) disease. The standard of care for the treatment of ULMCA disease is coronary artery bypass grafting (CABG). Data suggest that PCI with drug-eluting stents is a viable alternative to CABG for the treatment of ULMCA disease. Randomized trials demonstrated superior event-free survival with EES compared with paclitaxel-eluting stents in non-ULMCA lesions. However, data with ULMCA PCI with EES are limited. This multicenter international registry included 178 patients from the United States, South Korea, and Italy who underwent ULMCA PCI with EES from 2008 to 2010. The primary endpoint was freedom from target lesion failure (TLF), defined as cardiac death, myocardial infarction (MI), and ischemia-driven target lesion revascularization (TLR) at 1 year. At 30 days, 4 patients (2.2%) died from cardiac causes, and no patient experienced MI or TLR. One-year freedom from TLF was 94.4%. One-year freedom from cardiac death, MI, and ischemia-driven TLR was 96.6%, 98.9%, and 98.3%, respectively. Two patients (1.1%) had definite or probable stent thrombosis. PCI with EES is safe and effective and may be a viable option for the treatment of ULMCA disease.
    The Journal of invasive cardiology 07/2012; 24(7):316-9. · 1.57 Impact Factor
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    ABSTRACT: In the post-genome era, high throughput gene expression profiling has been successfully used to develop genomic biomarker panels (GBP) that can be integrated into clinical decision making. The development of GBPs in the context of personalized medicine is a scientifically challenging and resource-intense process. It needs to be accomplished in a systematic phased approach to address biological variation related to a clinical phenotype (e.g. disease etiology, gender, etc.) and minimize technical variation (noise). Here we present the methodological aspects of GBP development based on the experience of the Cardiac Allograft Rejection Gene Expression Observation (CARGO) study, a study that lead to the development of a molecular classifier for rejection screening in heart transplant patients.
    Current Genomics 06/2012; 13(4):334-41. · 2.48 Impact Factor
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    ABSTRACT: This retrospective study assessed long-term clinical outcomes of patients with orthotopic heart transplantation (OHT) and transplant coronary artery disease (TCAD) who developed in-stent restenosis (ISR) after percutaneous coronary intervention (PCI). TCAD is a major cause of morbidity and mortality after the first year after OHT. Description of outcomes in patients with ISR after revascularization for TCAD is limited. One hundred five patients underwent PCI with bare-metal stents or drug-eluting stents at the UCLA Medical Center from 1995 throughout 2009, of whom 83 patients (79.0%) underwent repeat angiography for clinical symptoms or surveillance. The primary end point was the composite of death, myocardial infarction, or repeat OHT. ISR occurred in 26 patients (31.3%) who underwent follow-up angiography. Initial treatment strategies for the 26 patients with ISR were target vessel revascularization in 19 (73.1%), repeat OHT in 3 (11.5%), and medical therapy in only 4 (15.4%). At 7 years freedom from the primary end point was lower in patients with ISR compared to patients without ISR (27.9% vs 63.2%, p = 0.006, log-rank test) primarily driven by a lower survival rate in patients with ISR (38.5% vs 84.2%, p <0.001, log-rank test). Although numerically smaller in patients with ISR, there were no statistically significant differences in freedom from myocardial infarction (80.8% vs 91.2%, log-rank p = 0.18) and freedom from repeat OHT (73.1% vs 84%, p = 0.22, long-rank test). In conclusion, patients with OHT who develop ISR after PCI have poor long-term prognosis. Improvements in prevention and treatment of TCAD such as increased pharmacotherapy are needed.
    The American journal of cardiology 03/2012; 109(12):1729-32. · 3.58 Impact Factor
  • Journal of Cardiac Failure - J CARD FAIL. 01/2011; 17(8).
  • Journal of Cardiac Failure - J CARD FAIL. 01/2011; 17(8).
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    Richard K Cheng, Tamara B Horwich, Gregg C Fonarow
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    ABSTRACT: High systolic blood pressure (SBP) is a predictor of survival for patients with heart failure (HF). Whether SBP predicts survival in both ischemic and nonischemic HF has not been well examined. We analyzed 2,178 patients with advanced HF (47.3% ischemic etiology, 75.5% men, 93.5% New York Heart Association class III or IV, age 52 +/- 13, left ventricular ejection fraction 24 +/- 9%) referred to a university center between 1983 and 2006. SBP and invasive hemodynamic variables were recorded after optimization of medical therapy. Patients were divided into SBP quartiles (<or=90, 91 to 100, 101 to 112, >or=113 mm Hg) based on SBP frequency. Survival free from death or urgent transplant in ischemic versus nonischemic HF was 53.2% versus 61.1% at 2 years. Higher SBP quartile was associated with increased survival in the total cohort and in subgroups of both nonischemic and ischemic HF. On multivariate analysis adjusting for age, left ventricular ejection fraction, cholesterol, gender, diabetes mellitus, pulmonary capillary wedge pressure, cardiac index, New York Heart Association class, beta-blocker use, angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker use, statin use, and smoking history, relative risk (95% confidence interval) of death or urgent transplant at 2 years for quartile 1 compared with quartile 4 was 1.9 (1.4 to 2.6) in the total cohort, 1.6 (1.1 to 2.5) in nonischemic HF, and 2.4 (1.5 to 3.7) in ischemic HF. In conclusion, SBP predicts HF survival in both ischemic and nonischemic HF independent of other risk factors and invasive hemodynamic variables.
    The American journal of cardiology 01/2009; 102(12):1698-705. · 3.58 Impact Factor
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    ABSTRACT: Purpose ARVC outcomes post-HT pts have not been well studied. Criteria were established in 1994 & revised in 2010. We sought to better characterize ARVC pts in a national cohort. Methods and Materials 30605 HT-only pts were identified from UNOS (1994-2011). Exclusions (24%):<18y, re-HT & follow up loss. Non-ARVC: ischemic, restrictive, dilated, hypertrophic & other. Survival was censored at 12y. Multivariate Cox proportional hazard regression analysis was adjusted for age, sex, DM, race, ischemic time, HD, life support, wait time & HLA mismatch. Results There were 65 ARVC & 30540 non-ARVC pts (2% restrictive, 2% hypertrophic, 44% dilated, 47% ischemic, 7% other). ARVC pts were younger (p=0.0002) with less VAD use (p=0.001), decreased pulmonary artery pressures (p=0.0001), & associated with higher PRA (p<0.001)(Table). Survival (1, 5 & 10y) was: ARVC (87, 80, 80%) & non-ARVC (87, 72, 53%) (Figure). Unadjusted HR for all-cause mortality was 0.57 (0.31-1.06). After adjustment: 0.77 (0.40-1.48, p=NS). ARVC survival was similar to hypertrophic, dilated & other while significantly better than restrictive & ischemic (1B). Conclusions This is the largest reported series of ARVC post-HT survival. Survival was similar to non-ARVC pts, with improved survival over ischemic & restrictives. ARVC was associated with less VAD use & lower filling pressures, suggestive of predominant right ventricular dysfunction.
    The Journal of Heart and Lung Transplantation. 32(4):S23.

Publication Stats

12 Citations
23.79 Total Impact Points

Institutions

  • 2013–2014
    • University of Washington Seattle
      • Division of Cardiology
      Seattle, Washington, United States
  • 2012–2013
    • University of California, Los Angeles
      • • Division of Cardiology
      • • Department of Medicine
      Los Angeles, CA, United States
  • 2009–2013
    • Harbor-UCLA Medical Center
      Torrance, California, United States