Publications by authors named "Chandra K Katikireddy"

11 Publications

  • Page 1 of 1

Myocardial viability assessment and utility in contemporary management of ischemic cardiomyopathy.

Clin Cardiol 2022 Feb 25;45(2):152-161. Epub 2022 Jan 25.

VA CCHCS UCSF, Fresno, California, USA.

Background: In clinical practice, we encounter ischemic cardiomyopathy (ICM) with underlying viable, dysfunctional myocardium on a regular basis. Evidence from the Surgical Treatment for Ischemic Heart failure (STICH) and its Extension Study is supportive of improved outcomes with coronary revascularization, irrespective of myocardial viable status. However, Dobutamine stress echocardiography (DSE) and single-photon emission computed tomography (SPECT), used in STICH to assess myocardial viability may fail to distinguish hibernating myocardium from scar due to suboptimal image resolution and poor tissue characterization.

Hypothesis: Cardiac magnetic resonance (CMR) and positron emission tomography (PET) can precisely quantify myocardial scar and identify metabolically active, viable myocardium respectively. Unlike DSE and SPECT, CMR and PET allow examining myocardial status as a contiguous spectrum from viable to partially viable myocardium with varying degrees of subendocardial scar and nonviable myocardium with predominantly transmural scar, the therapeutic and prognostic determinants of ICM.

Methods: Under the guidance of CMR and PET imaging, myocardium can be distinguished viable from partially viable with subendocardial scar and predominantly transmural scar. In ICM, optimal medical therapy and coronary revascularization of viable/partially viable myocardium but not transmural scar may improve outcomes in patients with acceptable procedural risk.

Results: Coronary revascularization of partially viable and viable myocardial territory may improve clinical outcomes by preventing future ischemic, infarct events and further worsening of left ventricular remodeling and function.

Conclusions: When deciding if coronary revascularization is appropriate in a patient with ICM, it is essential to take a patient-tailored, comprehensive approach incorporating myocardial viability, ischemia, and scar data with others such as procedural risk, and patient's comorbidities.
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http://dx.doi.org/10.1002/clc.23779DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8860488PMC
February 2022

Myocardial segmental thickness variability on echocardiography is a highly sensitive and specific marker to distinguish ischemic and non-ischemic dilated cardiomyopathy in new onset heart failure.

Int J Cardiovasc Imaging 2019 May 29;35(5):791-798. Epub 2018 Dec 29.

Division of Cardiology, UCSF Fresno, 155 N Fresno St, Fresno, CA, USA.

The aim of this study was to determine non-invasive diagnostic markers by echocardiography that differentiate ischemic dilated (ICM) from non-ischemic dilated cardiomyopathy (NICM) in patients with new onset heart failure. We identified 100 consecutive new heart failure patients with dilated cardiomyopathy (valvular etiology excluded). Clinical risk factors, medication history, serum biomarkers, ECG and echocardiographic variables were compared between the ICM and NICM groups (as confirmed by coronary angiography). Mean age, left ventricular size and ejection fraction were 56 years, 6.1 cm and 26% respectively. A total of 24% had ICM. Patients with ICM were older (65 vs. 53 years; P < 0.001). No significant difference was observed between ICM and NICM among 18 clinical variables, 7 laboratory tests, 6 EKG parameters and 10 of the 13 echocardiographic markers evaluated. Segmental wall thickness variability, regional wall motion abnormality and RV enlargement on echocardiogram (echo) differentiated ICM from NICM. Segmental thickness variability outperformed wall motion abnormality in diagnosing ICM with a sensitivity and specificity of 79.2 and 98.7% versus 62.5 and 84.2% respectively. RV enlargement was not sensitive but 90.6% specific for predicting NICM. Myocardial segmental thickness variability on echo, resulting from thinned infarcted or hibernating myocardium, is a highly sensitive and specific marker to differentiate ICM from NICM in new onset heart failure.
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http://dx.doi.org/10.1007/s10554-018-01515-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6486529PMC
May 2019

Left Atrial Area and Right Ventricle Dimensions in Non-gated Axial Chest CT can Differentiate Pulmonary Hypertension Due to Left Heart Disease from Other Causes.

J Cardiovasc Comput Tomogr 2016 May-Jun;10(3):246-50. Epub 2016 Jan 30.

UCSF Fresno, Cardiovascular Division, 2823 Fresno St, Fresno, CA 93721, USA.

Background: It is unknown whether axial non-gated CT can distinguish World Health Organization Group 2 pulmonary hypertension (pulmonary hypertension due to left heart disease) from non-Group 2 pulmonary hypertension.

Objective: The study was performed to identity imaging parameters in non-gated chest CT that differentiate Group 2 from non-Group 2 pulmonary hypertension.

Methods: Among 158 patients who underwent right heart catheterization for evaluation of pulmonary hypertension, 112 had sufficient data and chest CT for review. Invasive hemodynamic data and numerous variables obtained from axial CT images (maximum diameters of main, right, left pulmonary arteries, ascending aorta, main pulmonary artery to ascending aorta diameter ratio, right atrial diameter, left atrial area and right ventricular size) were collected. CT variables were validated against hemodynamic data to identify parameters that would allow to differentiate pulmonary hypertension due to left heart disease (Group 2) from non-Group 2 pulmonary hypertension.

Results: Based on right heart catheterization data, we identified 53 patients with Group 2 pulmonary hypertension, 50 patients with non-Group 2 pulmonary hypertension, and 9 subjects with no pulmonary hypertension. In patients with a dilated pulmonary artery (n = 84), the ROC curve for left atrial area (area under the ROC curve 0.76 ± 0.06) independently distinguished patients with Group 2 pulmonary hypertension (n = 42) from patients with non-Group 2 pulmonary hypertension (n = 42). A dilated left atrium (>20 mm(2)) in combination with a normal right ventriuclar size had a sensitivity of 77% and specificity of 94% for Group 2 pulmonary hypertension.

Conclusions: In patients with a dilated pulmonary artery on chest CT, left atrial area and right ventricular dimensions may aid to diagnose pulmonary hypertension and to distinguish underlying cardiac disease from other causes.
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http://dx.doi.org/10.1016/j.jcct.2016.01.014DOI Listing
April 2017

Evaluation of myocardial ischemia and viability by noninvasive cardiac imaging.

Expert Rev Cardiovasc Ther 2012 Jan;10(1):55-73

Department of Medicine, Division of Cardiovascular Disease, Stony Brook University Medical Center, Stony Brook, NY 11794-8167, USA.

Noninvasive cardiac imaging plays a central role in the diagnosis of coronary artery disease and cardiomyopathy, as well as in the decision making for therapeutic interventions. Proper assessment of the degree of myocardial ischemia and viability is essential to aid in therapies that may improve patient outcomes. In addition, a wealth of evidence exists on the prognostic value of the information obtained from noninvasive imaging. One must utilize an imaging study or studies in an organized fashion, incorporating the latest scientific evidence, guidelines and appropriateness criteria. This review summarizes the advantages, disadvantages and relevant literature on various imaging modalities currently available for the evaluation of myocardial ischemia and viability.
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http://dx.doi.org/10.1586/erc.11.161DOI Listing
January 2012

Nasal continuous positive airway pressure improves myocardial perfusion reserve and endothelial-dependent vasodilation in patients with obstructive sleep apnea.

J Cardiovasc Magn Reson 2010 Sep 3;12:50. Epub 2010 Sep 3.

Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA.

Background: Obstructive sleep apnea (OSA) has been associated with cardiovascular disease (CVD), but whether OSA is an independent risk factor for CVD is controversial. The purpose of this study is to determine if patients with OSA have subclinical cardiovascular disease that is detectable by multi-modality cardiovascular imaging and whether these abnormalities improve after nasal continuous positive airway pressure (nCPAP).

Results: Of the 35 consecutive subjects with newly diagnosed moderate to severe OSA recruited from the Stanford Sleep Disorders Clinic, 20 patients were randomized to active vs. sham nCPAP. Active nCPAP was titrated to pressures that would prevent sleep disordered breathing based on inpatient polysomnography. OSA patients had baseline vascular function abnormalities including decreased myocardial perfusion reserve (MPR), brachial flow mediated dilation (FMD) and nitroglycerin-induced coronary vasodilation. Patients randomized to active nCPAP had improvement of MPR (1.5 ± 0.5 vs. 3.0 ± 1.3, p = 0.02) and brachial FMD (2.5% ± 5.7% vs. 9.0% ± 6.5%, p = 0.03) after treatment, but those randomized to sham nCPAP showed no significant improvement. There were no significant changes seen in chamber sizes, systolic and diastolic function, valvular function and coronary vasodilation to nitroglycerin.

Conclusions: Patients with moderate to severe OSA had decreased MPR and brachial FMD that improved after 3 months of nCPAP. These findings suggest that relief of apnea in OSA may improve microvascular disease and endothelial dysfunction, which may prevent the development of overt cardiovascular disease. Further study in a larger patient population may be warranted.
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http://dx.doi.org/10.1186/1532-429X-12-50DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945335PMC
September 2010

Quantitative characterization of myocardial infarction by cardiovascular magnetic resonance predicts future cardiovascular events in patients with ischemic cardiomyopathy.

J Cardiovasc Magn Reson 2008 Apr 9;10:17. Epub 2008 Apr 9.

Division of cardiovascular medicine, department of medicine, Stanford university, Stanford, CA, USA.

Background: Cardiovascular magnetic resonance (CMR) can provide quantitative data of the myocardial tissue utilizing high spatial and temporal resolution along with exquisite tissue contrast. Previous studies have correlated myocardial scar tissue with the occurrence of ventricular arrhythmia. This study was conducted to evaluate whether characterization of myocardial infarction by CMR can predict cardiovascular events in patients with ischemic cardiomyopathy (ICM).

Results: We consecutively studied 86 patients with ICM (LVEF < 50%, mean LVEF: 26 +/- 12%) with CMR before revascularization or medication therapy +/- implantable cardiac defibrillator, determined the amount of myocardial scar, and followed for development of cardiovascular events. Thirty-three patients (38%) had cardiovascular events (mean follow-up: 20 +/- 16 months). Patients who developed cardiovascular events had larger scar volume and scar percentage of the myocardium than those who did not develop cardiovascular events (16.8 +/- 12.4 cm3 vs. 11.7 +/- 12.6 cm3, p = 0.023 and 10.2 +/- 6.9% vs. 7.2 +/- 6.7%, p = 0.037, respectively). There were no significant differences in LVEDV, LVESV and LVEF between the patients with and without cardiovascular events (231 +/- 76 ml vs. 230 +/- 88 ml; 180 +/- 73 ml vs. 175 +/- 90 ml; and 25 +/- 10% vs. 27 +/- 13%, respectively).

Conclusion: Quantification of the scar volume and scar percentage by CMR is superior to LVEDV, LVESV, and LVEF in prognosticating the future likelihood of the development of cardiovascular events in patients with ICM.
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http://dx.doi.org/10.1186/1532-429X-10-17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2322993PMC
April 2008

Critical care medicine update: essentials for the nonintensivist, part 2.

Compr Ther 2006 ;32(2):82-9

Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA.

In Part 2 of this update on the essentials of critical care medicine for the nonintensivist, we continue our review of common problems encountered in the intensive care unit (ICU). The focus of this part is on renal failure, acid-base disturbances, common ICU complications, nutrition management, endocrine disorders, prognostic indicators and principles of patient- and family-centered care.
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http://dx.doi.org/10.1385/comp:32:2:82DOI Listing
November 2006

Critical care medicine update: essentials for the nonintensivist, part 1.

Compr Ther 2006 ;32(2):74-81

Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA.

The intensive care unit (ICU) can be a challenging environment for health care practitioners who are not trained in critical care medicine. A structured approach to patient care is necessary in order to achieve optimal clinical outcomes. The purpose of this two-part article is to review essential highlights of critical care medicine for the nonintensivist. We provide a structured overview of the management of the critically ill patient and focus on problems commonly encountered in the heterogeneous ICU patient population. In Part 1 we review (a) altered states of consciousness and sedation, (b) respiratory failure and ventilators, (c) cardiovascular monitoring and management, and (d) fluid and electrolyte disorders.
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http://dx.doi.org/10.1385/comp:32:2:74DOI Listing
November 2006

A 35-year-old man with fever, dyspnea, and diffuse reticular opacities.

Chest 2006 Feb;129(2):482-487

Division of Pulmonary and Critical Care and Department of Medicine, Stanford University Hospital, Division of Pulmonary and Critical Care, VA Medical Center, Palo Alto, CA.

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http://dx.doi.org/10.1378/chest.129.2.482DOI Listing
February 2006

A 24-year-old woman with bilateral pulmonary infiltrates, pericardial effusion, and bilateral pleural effusions.

Chest 2005 Dec;128(6):4013-7

Division of Pulmonary Medicine, 3801 Miranda Ave, Palo Alto, CA 94304-1290, USA.

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http://dx.doi.org/10.1378/chest.128.6.4013DOI Listing
December 2005

A trial of intrapleural streptokinase.

N Engl J Med 2005 May;352(21):2243-5; author reply 2243-5

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http://dx.doi.org/10.1056/NEJM200505263522118DOI Listing
May 2005
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