Resham Baruah - Academia.edu (original) (raw)

Papers by Resham Baruah

European Heart Journal, Aug 1, 2017

TAVI: a new standard for aortic valve replacement? / Dilated cardiomyopathy: the clinical relevan... more TAVI: a new standard for aortic valve replacement? / Dilated cardiomyopathy: the clinical relevance of genetic assessment 821 5.9±3.3%; p=0.21) were identical between groups. No difference was observed in procedure times. The incidence of more-than-mild aortic regurgitation post-TAVI was 6 (4.2%) in each group. Calculated aortic valve area post-TAVI was 1.57±0.37 vs. 1.60±0.34 cm 2 (p=0.53). The rates of 30-day mortality were 1 (0.5%) vs. 4 (1.9%) (p=0.18) and of one-year mortality 10 (4.7%) vs. 31 (14.3%) (p=0.001). Conclusions: To our knowledge this is the first study comparing the outcome after TAVI of patients with AS and normal EF but high vs. low transvalvular gradients in completely matched study populations. Patients with PLGAS had a threefold higher one-year mortality than patients with HGAS. Neither baseline parameters nor postprocedural results were able to explain this considerable difference. Further work is necessary to unmask essential factors that have such a strong influence on the outcome in these patients.

European Heart Journal, Oct 18, 2022

European Journal of Heart Failure

The delivery of effective healthcare entails the configuration and resourcing of health economies... more The delivery of effective healthcare entails the configuration and resourcing of health economies to address the burden of disease, including acute and chronic heart failure, that affects local populations. Increasing migration is leading to more multicultural and ethnically diverse societies worldwide, with migration research suggesting that minority populations are often subject to discrimination, socio‐economic disadvantage, and inequity of access to optimal clinical support. Within these contexts, the provision of person‐centred care requires medical and nursing staff to be aware of and become adept in navigating the nuances of cultural diversity, and how that can impact some individuals and families entrusted to their care. This paper will examine current evidence, provide practical guidance, and signpost professionals on developing cultural competence within the setting of patients with advanced heart failure who may benefit from palliative care.

Circulation, Nov 19, 2019

JACC: Heart Failure, Oct 31, 2023

Circulation, Nov 8, 2022

Introduction: Diabetes mellitus (DM) is common amongst patients with heart failure (HF) and assoc... more Introduction: Diabetes mellitus (DM) is common amongst patients with heart failure (HF) and associated with adverse outcomes. Historically this has been attributed to the association with atherosclerotic disease. We assessed the effect of DM on phenotype and outcomes in patients with non-ischaemic dilated cardiomyopathy (DCM). Methods: Prospective observational cohort study of 727 patients with DCM. All underwent a cardiac MRI and long-term follow up. The primary endpoint was CV death. Results: Of 727 patients with DCM (472 men, mean age 55 years, median LVEF 40%), 88 (12.1%) had DM at enrolment, of whom 19 (21.6%) were managed with insulin, 52 (59.0%) with oral hypoglycaemic agents (OHA) alone and 17 (19.3%) by diet alone. Enrolment predated guideline recommendations for SGLT2 inhibitors for HF. Patients with DM were older, had higher BMI, higher NYHA class, more were hypertensive and treated with loop diuretics (all p<0.001), ACEi/ARB (p=0.02) and mineralocorticoid receptor antagonists (p=0.002). Compared to patients without DM, those with DM had lower LVEF (mean difference -4% [95%CI -7 to -1], p=0.007) and more had myocardial fibrosis (OR 1.81 [1.13 to 2.91] adjusted for age and sex). After median follow up 7.7 years, 71 patients died from CV causes. DM was associated with higher cumulative incidence of CV death on univariate analysis (log rank p<0.001, Figure), but not after adjusting for age, sex, LVEF, NYHA, fibrosis, LAVi and RVEF (HR 1.66, 0.91 to 3.02, p=0.10). Patients with DM treated with insulin or OHA were at greater risk of CV death even after adjusting for the above variables (HR 2.02, 1.11 to 3.67, p=0.04). DM managed by diet alone was not associated with excess risk. Conclusions: DM is associated with adverse LV remodelling and fibrosis in patients with DCM; the subset requiring OHA or insulin had worse CV prognosis. Risk factor and lifestyle management may improve outcomes. Further studies are needed to assess whether added risk is attenuated by SGLT2 inhibitors.

Heart, Aug 11, 2021

Objective The effect of moderate excess alcohol consumption is widely debated and has not been we... more Objective The effect of moderate excess alcohol consumption is widely debated and has not been well defined in dilated cardiomyopathy (DCM). There is need for a greater evidence base to help advise patients. We sought to evaluate the effect of moderate excess alcohol consumption on cardiovascular structure, function and outcomes in DCM. Methods Prospective longitudinal observational cohort study. Patients with DCM (n=604) were evaluated for a history of moderate excess alcohol consumption (UK government guidelines; >14 units/week for women, >21 units/week for men) at cohort enrolment, had cardiovascular magnetic resonance and were followed up for the composite endpoint of cardiovascular death, heart failure and arrhythmic events. Patients meeting criteria for alcoholic cardiomyopathy were not recruited. Results DCM patients with a history of moderate excess alcohol consumption (n=98, 16%) had lower biventricular function and increased chamber dilatation of the left ventricle, right ventricle and left atrium, as well as increased left ventricular hypertrophy compared with patients without moderate alcohol consumption. They were more likely to be male (alcohol excess group: n=92, 94% vs n=306, 61%, p=<0.001). After adjustment for biological sex, moderate excess alcohol was not associated with adverse cardiac structure. There was no difference in midwall myocardial fibrosis between groups. Prior moderate excess alcohol consumption did not affect prognosis (HR 1.29, 95% CI 0.73 to 2.26, p=0.38) during median follow-up of 3.9 years. Conclusion DCM patients with moderate excess alcohol consumption have adverse cardiac structure and function at presentation, but this is largely due to biological sex. Alcohol may contribute to sex-specific phenotypic differences in DCM. These findings help to inform lifestyle discussions for patients with DCM.

Circulation, Nov 16, 2021

Heart, Apr 1, 2017

Figure 1 Perfusion map in apical HCM. Long axis (far left) and basal-mid-apical short axis slices... more Figure 1 Perfusion map in apical HCM. Long axis (far left) and basal-mid-apical short axis slices (to the right) at stress (upper panel) and rest (lower panel). There is a circumferential endocardial perfusion defect in the apical segments at stress. Each pixel represents myocardial blood flow (MBF). MBF falls in the apical segments during stress.

Journal of the American College of Cardiology, Jun 1, 2022

Journal of the American College of Cardiology, Oct 1, 2017

BACKGROUND Improved understanding of dilated cardiomyopathy (DCM) due to titin truncation (TTNtv)... more BACKGROUND Improved understanding of dilated cardiomyopathy (DCM) due to titin truncation (TTNtv) may help guide patient stratification. OBJECTIVES The purpose of this study was to establish relationships among TTNtv genotype, cardiac phenotype, and outcomes in DCM. METHODS In this prospective, observational cohort study, DCM patients underwent clinical evaluation, late gadolinium enhancement cardiovascular magnetic resonance, TTN sequencing, and adjudicated follow-up blinded to genotype for the primary composite endpoint of cardiovascular death, and major arrhythmic and major heart failure events. RESULTS Of 716 subjects recruited (mean age 53.5 AE 14.3 years; 469 men [65.5%]; 577 [80.6%] New York Heart Association function class I/II), 83 (11.6%) had TTNtv. Patients with TTNtv were younger at enrollment (49.0 years vs. 54.1 years; p ¼ 0.002) and had lower indexed left ventricular mass (5.1 g/m 2 reduction; p adjusted ¼ 0.03) compared with patients without TTNtv. There was no difference in biventricular ejection fraction between TTNtv þ/À groups. Overall, 78 of 604 patients (12.9%) met the primary endpoint (median follow-up 3.9 years; interquartile range: 2.0 to 5.8 years), including 9 of 71 patients with TTNtv (12.7%) and 69 of 533 (12.9%) without. There was no difference in the composite primary outcome of cardiovascular death, heart failure, or arrhythmic events, for patients with or without TTNtv (hazard ratio adjusted for primary endpoint: 0.92 [95% confidence interval: 0.45 to 1.87]; p ¼ 0.82). CONCLUSIONS In this large, prospective, genotype-phenotype study of ambulatory DCM patients, we show that prognostic factors for all-cause DCM also predict outcome in TTNtv DCM, and that TTNtv DCM does not appear to be associated with worse medium-term prognosis.

Journal of the American College of Cardiology

Heart, 2021

ObjectiveThe effect of moderate excess alcohol consumption is widely debated and has not been wel... more ObjectiveThe effect of moderate excess alcohol consumption is widely debated and has not been well defined in dilated cardiomyopathy (DCM). There is need for a greater evidence base to help advise patients. We sought to evaluate the effect of moderate excess alcohol consumption on cardiovascular structure, function and outcomes in DCM.MethodsProspective longitudinal observational cohort study. Patients with DCM (n=604) were evaluated for a history of moderate excess alcohol consumption (UK government guidelines; >14 units/week for women, >21 units/week for men) at cohort enrolment, had cardiovascular magnetic resonance and were followed up for the composite endpoint of cardiovascular death, heart failure and arrhythmic events. Patients meeting criteria for alcoholic cardiomyopathy were not recruited.ResultsDCM patients with a history of moderate excess alcohol consumption (n=98, 16%) had lower biventricular function and increased chamber dilatation of the left ventricle, right...

European Journal of Heart Failure, 2020

The Heart Failure Association of the European Society of Cardiology has published a previous posi... more The Heart Failure Association of the European Society of Cardiology has published a previous position paper and various guidelines over the past decade recognizing the value of palliative care for those affected by this burdensome condition. Integrating palliative care into evidence‐based heart failure management remains challenging for many professionals, as it includes the identification of palliative care needs, symptom control, adjustment of drug and device therapy, advance care planning, family and informal caregiver support, and trying to ensure a ‘good death’. This new position paper aims to provide day‐to‐day practical clinical guidance on these topics, supporting the coordinated provision of palliation strategies as goals of care fluctuate along the heart failure disease trajectory. The specific components of palliative care for symptom alleviation, spiritual and psychosocial support, and the appropriate modification of guideline‐directed treatment protocols, including drug...

European Journal of Cardiovascular Nursing, 2020

Journal of the American College of Cardiology, Jan 31, 2017

Improved understanding of dilated cardiomyopathy (DCM) due to titin truncation (TTNtv) may help g... more Improved understanding of dilated cardiomyopathy (DCM) due to titin truncation (TTNtv) may help guide patient stratification. The purpose of this study was to establish relationships among TTNtv genotype, cardiac phenotype, and outcomes in DCM. In this prospective, observational cohort study, DCM patients underwent clinical evaluation, late gadolinium enhancement cardiovascular magnetic resonance, TTN sequencing, and adjudicated follow-up blinded to genotype for the primary composite endpoint of cardiovascular death, and major arrhythmic and major heart failure events. Of 716 subjects recruited (mean age 53.5 ± 14.3 years; 469 men [65.5%]; 577 [80.6%] New York Heart Association function class I/II), 83 (11.6%) had TTNtv. Patients with TTNtv were younger at enrollment (49.0 years vs. 54.1 years; p = 0.002) and had lower indexed left ventricular mass (5.1 g/m2 reduction; padjusted = 0.03) compared with patients without TTNtv. There was no difference in biventricular ejection fraction ...