Publications by authors named "Agastya D Belur"

Background: Heart failure (HF) affects millions globally, causing severe symptoms and poor prognosis. Cardiac resynchronization therapy (CRT) has been shown to improve heart function and quality of life in HF patients with electrical dyssynchrony, but its effectiveness in diabetic patients remains unclear due to the complexities associated with diabetes.

Objective: This study evaluates the impact of diabetes mellitus on CRT by comparing outcomes between diabetic and nondiabetic patients through a meta-analysis.

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Article Synopsis
  • - Endovascular aortic repair is gaining attention for treating abdominal aortic aneurysms, with a key focus on comparing transfemoral access (TFA) and upper extremity access (UEA).
  • - A study involving 9,403 participants found that TFA significantly reduced the risk of stroke, myocardial infarction, and spinal cord ischemia, while also requiring less contrast agent and shortening fluoroscopy time.
  • - Despite benefits in certain risk factors, there were no significant differences in technical success, 30-day mortality rates, or hospital stay duration between the two access methods, indicating the need for more large-scale studies.
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Background: There has been an evolution in the disease severity and complexity of patients presenting to the cardiac intensive care unit (CICU). There are limited data evaluating the role of palliative care in contemporary CICU practice.

Methods: PubMed Central, CINAHL, EMBASE, Medline, Cochrane Library, Scopus, and Web of Science databases were evaluated for studies on palliative care in adults (≥18 years) admitted with acute cardiovascular conditions - acute myocardial infarction, cardiogenic shock, cardiac arrest, advanced heart failure, post-cardiac surgery, spontaneous coronary artery dissection, Takotsubo cardiomyopathy, and pulmonary embolism - admitted to the CICU, coronary care unit or cardiovascular intensive care unit from 1/1/2000 to 8/8/2022.

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Renal denervation (RDN) is a minimally invasive intervention performed by denervation of the nervous fibers in the renal plexus, which decreases sympathetic activity. These sympathetic nerves influence various physiological functions that regulate blood pressure (BP), including intravascular volume, electrolyte composition, and vascular tone. Although proven effective in some trials, controversial trials, such as the Controlled Trial of Renal Denervation for Resistant Hypertension (SYMPLICITY-HTN3), have demonstrated contradictory results for the effectiveness of RDN in resistant hypertension (HTN).

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Aortic stenosis (AS) is a common valve disorder among the elderly, and these patients frequently have concomitant coronary artery disease (CAD). Risk factors for calcific AS are similar to those for CAD. Historically, the treatment of these conditions involved simultaneous surgical replacement of the aortic valve (AV) with coronary artery bypass grafting.

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Takotsubo cardiomyopathy involves transient systolic dysfunction of the left ventricle thought to be caused by a physiologic stress response and associated catecholamine release. We present a previously undocumented cause of this stress response involving a 53-year-old man with hepatocellular carcinoma and alcohol-associated cirrhosis who initially presented for liver transplantation. Shortly after successful transplantation, the patient developed a COVID-19 infection and takotsubo cardiomyopathy.

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The established benefits of cooling along with development of sophisticated methods to safely and precisely induce, maintain, monitor, and reverse hypothermia have led to the development of targeted temperature management (TTM). Early trials in human subjects showed that hypothermia conferred better neurological outcomes when compared to normothermia among survivors of cardiac arrest, leading to guidelines recommending targeted hypothermia in this patient population. Multiple studies have sought to explore and compare the benefit of hypothermia in various subgroups of patients, such as survivors of out-of-hospital cardiac arrest versus in-hospital cardiac arrest, and survivors of an initial shockable versus non-shockable rhythm.

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Atherosclerosis is a multifactorial, lipoprotein-driven condition that leads to plaque formation within the arterial tree, leading to subsequent arterial stenosis and thrombosis that accounts for a large burden of cardiovascular morbidity and mortality globally. Atherosclerosis of the lower extremities is called peripheral artery disease and is a major cause of loss in mobility, amputation, and critical limb ischemia. Peripheral artery disease is a common condition with a gamut of clinical manifestations that affects an estimated 10 million people in the United States of America and 200 million people worldwide.

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BRASH syndrome is a relatively novel clinical entity with profound bradycardia secondary to simultaneous metabolic derangement and drug toxicity. The syndrome is a clinical pentad of bradycardia, acute kidney injury, use of atrioventricular nodal blocking agents, shock, and hyperkalemia. It is widely underrecognized with selectively few reports, mainly in the elderly population.

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Article Synopsis
  • Psoriasis is linked to an increased risk of coronary artery disease, potentially through elevated levels of soluble LOX-1, a receptor that interacts with oxidized lipoproteins.
  • A cohort study at the National Institutes of Health involved 175 psoriasis patients to analyze the relationship between soluble LOX-1 and noncalcified coronary burden over time.
  • Results showed that psoriasis patients had higher levels of soluble LOX-1 compared to matched controls, suggesting a potential connection to cardiovascular risk.
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  • The study investigates the effects of biologic therapy on coronary plaque in psoriasis patients, particularly focusing on inflammation-driven plaque types associated with an increased risk of myocardial infarction (MI).
  • The research involved 290 participants, with 121 biologic treatment-naïve individuals being analyzed over a one-year period, revealing reduced non-calcified plaque burden and necrotic core in those receiving biologics.
  • Results showed a notable 6% reduction in non-calcified plaque and a significant difference in plaque progression between biologic and non-biologic treatments, indicating potential cardiovascular benefits from biologic therapy in these patients.
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  • The study explores the links between chronic stress, as measured by resting amygdala activity, and various cardiovascular health markers in patients with psoriasis, a stress-related inflammatory condition.
  • Researchers analyzed data from 164 psoriasis patients and 47 healthy participants, using advanced imaging techniques to assess amygdala and hematopoietic system activity along with cardiovascular indicators.
  • Results showed higher amygdala activity in psoriasis patients, correlating with increased hematopoietic activity and subclinical cardiovascular disease markers; treatment of severe psoriasis led to improvements in both skin condition and stress-related measures over one year.
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  • Inflammation plays a key role in the development of atherosclerosis, and psoriasis serves as a model to study early cardiovascular issues due to its association with chronic inflammation.
  • This study aims to explore the relationship between aortic vascular inflammation (VI) and various coronary artery disease (CAD) indices in patients with psoriasis.
  • Results showed that increased aortic VI correlates with a higher total plaque burden, more luminal stenosis, and a greater presence of high-risk plaques, suggesting a potential link between chronic inflammation and early CAD development.
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Inflammation is critical to atherogenesis. Psoriasis is a chronic inflammatory skin disease that accelerates atherosclerosis in humans and provides a compelling model to understand potential pathways linking these diseases. A murine model capturing the vascular and metabolic diseases in psoriasis would accelerate our understanding and provide a platform to test emerging therapies.

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