Nirmanmoh Bhatia

Vanderbilt University | Vander Bilt · Division of Cardiovascular Medicine

Background: Ischemic stroke is a major cause of mortality and disability. Transient ischemic attack (TIA) is a harbinger of stroke. The etiology of stroke in as many as 40% of patients remains undetermined after extensive evaluation. It was hypothesized that intrapulmonary shunt is a potential facilitator of cerebrovascular accident (CVA) or TIA....

The number of cancer survivors in the United States has exceeded 12 million and is increasing. After secondary malignancies, cardiovascular disease is the leading cause of late morbidity and death among cancer survivors. The cardiovascular needs of cancer survivors have not been described. We describe the clinical characteristics of 53 patients see...

THE STUDY AIMS TO DETERMINE THE: 1. frequency of inappropriate catheterization in medical wards and the reasons for doing it. 2. various risk factors associated with inappropriate catheterization, catheter associated urinary tract infections (CAUTI) and bacterial colonization on Foley's catheters (BCFC). Hospital-based prospective study. One hundre...

C ase Presentation: A 74-year-old man with a new diagnosis of locally advanced prostate cancer is referred to the cardio-oncology clinic for optimization of his cardiovascular health after treatment with degarelix, a gonadotropin-releasing hormone (GnRH) receptor antagonist, for his prostate cancer. Two years ago, he had a myocardial infarction res...

There are no large reports of comparative outcomes of transcatheter pulmonic valve implantation (TPVI) and surgical pulmonic valve replacement (SPVR). Prospective studies are unlikely to be feasible in the future also. Thus, we utilized a large adult inpatient database to compare the two with respect to temporal trends, in hospital outcomes and cos...

Objectives The aim of this study was to determine the prevalence of peripheral artery disease (PAD) and its association with in‐hospital outcomes after endovascular transcatheter aortic valve replacement (EV‐TAVR). Background TAVR is an established treatment for patients at prohibitive, high, or intermediate surgical risk. PAD is a significant com...

Although aspirin monotherapy is considered the standard of care after coronary artery bypass grafting (CABG), more recent evidence has suggested a benefit with dual antiplatelet therapy (DAPT) after CABG. We performed a meta-analysis of observational studies and randomized controlled trials comparing outcomes of aspirin monotherapy with DAPT in pat...

Eptifibatide is a glycoprotein (GP) IIb/IIIa inhibitor used mostly in the treatment of acute coronary syndrome (ACS). The GP IIb/IIIa antagonists occupy the fibrinogen binding site at the GP IIb/IIIa and block thrombocyte aggregation independent of the initial activation pathway. Severe thrombocytopenia has been reported with eptifibatide use. Thro...

Aerococcus viridans is a gram positive microaerophilic lactic acid coccus which is known to cause an infection in lobsters called Gaffkaemia. Consumption of gaffekaemia affected lobsters is considered to be safe if properly cooked even though there hasn't been any research on potential transmission by this route. Though uncommon, A. viridans is cap...

Background: Complete revascularization of patients with ST-elevation myocardial infarction and multivessel coronary artery disease reduces adverse events compared to infarct-related artery only revascularization. Whether complete revascularization should be done as multivessel intervention during index procedure or as a staged procedure remains co...

The outcomes of patients with end stage renal disease on dialysis (chronic kidney disease stage 5 on dialysis (CKD 5D)) who undergo transcatheter aortic valve implantation (TAVI) are not well described due to the exclusion of this group in randomized trials. We analyzed the National Inpatient Sample (NIS) database and compared clinical characterist...

The prognostic significance of chronic medical illness in comatose survivors of cardiac arrest who undergo targeted temperature management (TTM) remains largely unknown. We sought to assess the association between overall burden of pre-existing medical comorbidity and neurological outcomes in survivors of cardiac arrest undergoing TTM. We analyzed...

Advances in drug discovery have led to the use of effective targeted agents in the treatment of hematologic malignancies. Drugs such as proteasome inhibitors in multiple myeloma and tyrosine kinase inhibitors in chronic myeloid leukemia and non-Hodgkin lymphoma have changed the face of treatment of hematologic malignancies. There are several report...

Objective To analyze contemporary trends in the incidence, management, and clinical outcomes of heart failure (HF) complications in patients hospitalized for ST-segment elevation myocardial infarction (STEMI) in the United States. Patients and Methods Using the 2003 through 2010 Nationwide Inpatient Sample databases, all patients with STEMI who we...

Background: Patients with ST elevation myocardial infarction(STEMI) admitted on weekends have worse outcomes as compared tothose admitted on weekdays. Reasons for this “weekend effect” are notclear. Thrombolysis is associated with higher mortality versus primarypercutaneous coronary intervention in STEMI. We hypothesized thatincreased rates of thro...

Background: Despite early diagnosis and significant advancement in medical treatment of pulmonary hypertension (PH) over the last decade,rates of hospitalization and PH-related mortality remain high. Atrial sep-tostomy (AS) is performed in advanced centers as a bridge to lung trans-plantation, for palliation of symptoms and in cases where medical t...

Background Thyroid storm (TS) constitutes an endocrine emergency with an incidence of up to 10% of all admission for thyrotoxicosis. Cardiogenic shock (CS) is a rare complication of TS and very limited data exists on its incidence and outcomes. We aimed to estimate the national trends in incidence and outcomes of CS among patients admitted to US ho...

Dialysis patients are at high risk for infective endocarditis (IE); however, no large contemporary data exist on this issue. We examined outcomes of 44 816 patients with IE on dialysis and 202 547 patients with IE not on dialysis from the Nationwide Inpatient Sample database from 2006 thorough 2011. Dialysis patients were younger (59 ± 15 years vs...

There is controversy regarding in-hospital mortality, revascularization, and other adverse outcomes in patients with ST-segment elevation (STEMI) and chronic obstructive pulmonary disease (COPD). We queried the 2003-2011 Nationwide Inpatient Sample (NIS) databases to identify patients >18 years old with a primary diagnosis of STEMI. Univariate and...

Short-term complications, particularly rehospitalization, following a diagnosis of Takotsubo Cardiomyopathy (TTC) are poorly described. We sought to characterize the rates, causes, clinical associations, and prognostic implications of early rehospitalization in this patient population. We performed a retrospective observational study of all adult s...

Introduction: Recent studies on comatose survivors of cardiac arrest undergoing targeted temperature management (TTM) have shown similar outcomes at multiple target temperatures. However, details regarding core temperature variability during TTM and its prognostic implications remain largely unknown. We sought to assess the association between cor...

Acute mitral regurgitation is a very rare complication of an Impella device. We report a case of a 52-year-old man who had an Impella CP device placed for cardiogenic shock and developed acute mitral regurgitation following removal of the Impella. This was managed with the placement of TandemHeart device.

Introduction: Thyroid storm (TS) accounts for approximately 1-2% of admissions for thyrotoxicosis and is accompanied by profound hemodynamic derangements and development of atrial fibrillation (AF), which result in circulatory collapse and development of cardiogenic shock (CS). While the pathophysiology for this process is well described, epidemiol...

Introduction: Evidence regarding the significance of pre-existing medical comorbidity in comatose survivors of cardiac arrest who undergo targeted temperature management (TTM) remains limited. Hypothesis: Increasing burden of medical comorbidity will predict poor neurological outcomes following TTM. Methods: We analyzed a prospectively collected co...

Introduction: Recent studies on comatose survivors of cardiac arrest undergoing targeted temperature management (TTM) have reported similar outcomes at multiple target temperatures. However, details regarding core temperature variability during TTM and its prognostic implications remain unknown. Hypothesis: Increasing core temperature variability d...

AIM: Platelet function is intricately linked to the pathophysiology of critical Illness, and some studies have shown that antiplatelet therapy (APT) may decrease mortality and incidence of acute respiratory distress syndrome (ARDS) in these patients. Our objective was to understand the efficacy of APT by conducting a meta-analysis. MATERIALS AND ME...

Aim Platelet function is intricately linked to the pathophysiology of critical Illness, and some studies have shown that antiplatelet therapy (APT) may decrease mortality and incidence of acute respiratory distress syndrome (ARDS) in these patients. Our objective was to understand the efficacy of APT by conducting a meta-analysis. Materials and Me...

Background: Left ventricular assist devices (LVADs) and implantable cardioverter defibrillators (ICD) are each known to improve mortality in patients with advanced congestive heart failure (CHF). If ICDs contribute to improved survival specifically in recipients of LVADs is currently unknown. Aim: To evaluate the impact of presence of ICD on mor...

Background: Cardiovascular (CV) disease is the second most common cause of mortality and morbidity in cancer survivors (CS). Limited data exist on the knowledge and awareness of CS about CV effects of cancer therapies and its effect on lifestyle of survivors. It is important to identify gaps in CV care of CS. Materials and methods: A brief volun...

Sensitivity analysis for acute lung injury/acute respiratory distress syndrome which reveals that there is a nonsignificant trend toward decreased need for mechanical ventilation after removal of a study by Valerio-Rojas et al.[33] (APT: Antiplatelet therapy)

Funnel plots: All-cause mortality (a), duration of hospitalization (b), acute lung injury/acute respiratory distress syndrome (c), need for mechanical ventilation (d)

Cumulative meta-analysis: All-cause mortality; duration of hospitalization; acute lung injury/acute respiratory distress syndrome; need for mechanical ventilation (APT: Antiplatelet therapy, ALI: Acute lung injury, ARDS: Acute respiratory distress syndrome)

Flowchart of search strategy for systematic review

Tests for publication bias: All-cause mortality (a); duration of hospitalization (b); acute lung injury/acute respiratory distress syndrome (c); need for mechanical ventilation (d)

Introduction: African-American (AA) patients have poorer outcomes as compared to Caucasian patients for many cardiovascular diseases. Whether such racial differences exist in outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) is not clearly established.Methods: We analyzed the National Inpatient Sample (NIS) database and...

Background There is a paucity of data on the use of induction immunosuppression in patients with active infections undergoing orthotopic heart transplantation (OHT). We hypothesized that induction immunosuppression in patients with ventricular assist device (VAD) undergoing OHT with localized active driveline infection (DLI) does not lead to worse...

Cardio-embolic phenomenon is believed to underlie a significant proportion of cryptogenic strokes. We recently showed that intrapulmonary shunt (IPS) was associated with cryptogenic stroke and transient ischemic attack (TIA). We hypothesized that patients with prior cryptogenic stroke or TIA that had an IPS were at a higher risk for recurrent ische...

Determining aortic stenosis (AS) severity is clinically important. Calculating aortic valve (AV) area by means of the continuity equation assumes a circular left ventricular outflow tract (LVOT). The full impact of this assumption in calculating AV area is unknown. Predictors of noncircular LVOT shape in patients with AS are undefined. In 109 adult...

Background: Cardiovascular (CV) disease is the second most common cause of mortality and morbidity in cancer survivors (CS). Limited data exist on the knowledge and awareness of CS about CV effects of cancer therapies and its effect on lifestyle of survivors. It is important to identify gaps in CV care of CS. Materials and Methods: A brief voluntar...

The quantitative analysis of cardiac motion from echocardiographic images helps clinicians in the diag-nosis and therapy of patients suffering from heart disease. Quantitative analysis is usually based on TDI (Tissue Dop-pler Imaging) or speckle tracking. These methods are based on two techniques which to a large degree are independent - the Dopple...

The quantitative analysis of cardiac motion from echocardiographic images helps clinicians in the diagnosis and therapy of patients suffering from heart disease. Quantitative analysis is usually based on TDI (Tissue Doppler Imaging) or speckle tracking. These methods are based on two techniques which to a large degree are independent—the Doppler ph...

Patent foramen ovale (PFO) and intra-pulmonary shunt (IPS) are potential causes of stroke. The most optimum cardiac cycle cutoff for bubbles to appear in the left heart on saline contrast transthoracic echocardiography (TTE) as criteria to differentiate the 2 entities is unknown. Ninety-five adult patients had saline contrast transesophageal echoca...

Background: Ischemic stroke is a major cause of mortality and disability. Transient ischemic attack (TIA) is a harbinger of stroke. After an extensive evaluation, the etiology of stroke in as many as 40 percent of patients remains undetermined. It was hypothesized that intrapulmonary shunt is a potential independent facilitator of cerebrovascular a...

Background: Quantitative analysis of strain in cardiac imaging is crucial in treatment of cardiac disorders. Thus far, cardiac motion detection is based on tissue Doppler imaging (TDI) or speckle tracking echocardiography (STE). These techniques are based on two independent methods; Doppler effect and image processing. Doppler techniques are angle...

Myocardial infarction (MI) and massive pulmonary embolism (MPE) are common causes of cardiac arrest. We present two cases with similar clinical presentation and EKG findings but different initial rhythms. Case 1. A 55-year-old African American male (AAM) was brought to the emergency room (ER) with cardiac arrest and pulseless electrical activity (P...