Publications by authors named "Nicholas S Hendren"

11 Publications

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Severe COVID-19 vaccine associated myocarditis: Zebra or unicorn?

Int J Cardiol 2021 11 21;343:197-198. Epub 2021 Sep 21.

Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA; Parkland Health and Hospital System, Dallas, TX, USA. Electronic address:

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http://dx.doi.org/10.1016/j.ijcard.2021.09.036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8453875PMC
November 2021

Association of Body Mass Index and Age With Morbidity and Mortality in Patients Hospitalized With COVID-19: Results From the American Heart Association COVID-19 Cardiovascular Disease Registry.

Circulation 2021 01 17;143(2):135-144. Epub 2020 Nov 17.

Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.A.d.L., C.A., S.R.D., A. Rao, S.C., A. Rosenblatt, A.A.H., M.H.D., J.L.G.).

Background: Obesity may contribute to adverse outcomes in coronavirus disease 2019 (COVID-19). However, studies of large, broadly generalizable patient populations are lacking, and the effect of body mass index (BMI) on COVID-19 outcomes- particularly in younger adults-remains uncertain.

Methods: We analyzed data from patients hospitalized with COVID-19 at 88 US hospitals enrolled in the American Heart Association's COVID-19 Cardiovascular Disease Registry with data collection through July 22, 2020. BMI was stratified by World Health Organization obesity class, with normal weight prespecified as the reference group.

Results: Obesity, and, in particular, class III obesity, was overrepresented in the registry in comparison with the US population, with the largest differences among adults ≤50 years. Among 7606 patients, in-hospital death or mechanical ventilation occurred in 2109 (27.7%), in-hospital death in 1302 (17.1%), and mechanical ventilation in 1602 (21.1%). After multivariable adjustment, classes I to III obesity were associated with higher risks of in-hospital death or mechanical ventilation (odds ratio, 1.28 [95% CI, 1.09-1.51], 1.57 [1.29-1.91], 1.80 [1.47-2.20], respectively), and class III obesity was associated with a higher risk of in-hospital death (hazard ratio, 1.26 [95% CI, 1.00-1.58]). Overweight and class I to III obese individuals were at higher risk for mechanical ventilation (odds ratio, 1.28 [95% CI, 1.09-1.51], 1.54 [1.29-1.84], 1.88 [1.52-2.32], and 2.08 [1.68-2.58], respectively). Significant BMI by age interactions were seen for all primary end points (-interaction<0.05 for each), such that the association of BMI with death or mechanical ventilation was strongest in adults ≤50 years, intermediate in adults 51 to 70 years, and weakest in adults >70 years. Severe obesity (BMI ≥40 kg/m) was associated with an increased risk of in-hospital death only in those ≤50 years (hazard ratio, 1.36 [1.01-1.84]). In adjusted analyses, higher BMI was associated with dialysis initiation and with venous thromboembolism but not with major adverse cardiac events.

Conclusions: Obese patients are more likely to be hospitalized with COVID-19, and are at higher risk of in-hospital death or mechanical ventilation, in particular, if young (age ≤50 years). Obese patients are also at higher risk for venous thromboembolism and dialysis. These observations support clear public health messaging and rigorous adherence to COVID-19 prevention strategies in all obese individuals regardless of age.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.120.051936DOI Listing
January 2021

Impact of body mass index on surgical coronary revascularization for ischaemic heart failure: insights from STICHES.

ESC Heart Fail 2020 Sep 13. Epub 2020 Sep 13.

Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Suite E5.310F, Dallas, TX, 75390-8830, USA.

Aims: Patients with obesity and ischaemic heart failure may counter-intuitively have better outcomes compared with patients with normal body weight due to an 'obesity paradox'. This study sought to determine if body mass index (BMI) impacts the treatment effects or safety outcomes of the treatment of ischaemic heart failure with coronary artery bypass grafting (CABG).

Methods And Results: We obtained and reviewed the Surgical Treatment of Ischaemic Heart Failure (STICHES) data for 1212 patients. We categorized obesity by the World Health Organization (WHO) classes to define baseline characteristics and test for treatment interactions for the primary and secondary STICHES outcomes by treatment groups. While CABG decreased the risk of death, there was no evidence of treatment interaction by BMI per 5 kg/m (P = 0.83) or WHO obesity class. For the overall cohort, there was no interaction by WHO obesity class for the cumulative incidence of death in either the medical therapy or CABG plus medical therapy (P-interaction = 0.90). There was a non-significant trend for higher BMI and a lower risk of death [hazard ratio 0.92, 95% confidence interval (CI) 0.85-1.00, P = 0.051]. Increasing body size (per 5 kg/m ) was associated with return to the operating room (odds ratio 2.48, 95% CI 1.45-4.26, P < 0.001) and infectious mediastinitis (odds ratio 2.09, 95% CI 1.10-3.97, P = 0.024) at 30 days but not other 30 day safety outcomes.

Conclusions: The benefit of CABG vs. medical therapy for ischaemic heart failure was consistent regardless of BMI or WHO obesity class for death or secondary clinical outcomes. However, higher BMI was associated with some short-term post-CABG complications.
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http://dx.doi.org/10.1002/ehf2.12954DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754770PMC
September 2020

Unique Patterns of Cardiovascular Involvement in Coronavirus Disease-2019.

J Card Fail 2020 Jun 14;26(6):466-469. Epub 2020 May 14.

Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address:

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http://dx.doi.org/10.1016/j.cardfail.2020.05.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7224644PMC
June 2020

Disease-Specific Biomarkers in Transthyretin Cardiac Amyloidosis.

Curr Heart Fail Rep 2020 06;17(3):77-83

Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.

Purpose Of Review: Transthyretin amyloidosis is an increasingly recognized cause of restrictive cardiomyopathy related to amyloid fibril deposition in cardiac tissues. As treatment therapies have emerged for transthyretin amyloidosis (ATTR), so has interest in using biomarkers to identify disease prior to advanced presentation.

Recent Findings: Lower levels of transthyretin and retinol binding protein-4 have been demonstrated in patients with pathogenic mutations of transthyretin either with or without clinical disease. Levels associate with the severity of mutations as well as response to treatment with transthyretin stabilizers or small interfering RNA molecules which silence transthyretin production. Transthyretin stability is the rate limiting step of amyloid fibril formation and directly measuring transthyretin kinetic stability has the potential to identify patients as risk as well as therapeutic response to treatment regardless of pathogenic or wild-type genetics. In addition, non-antibody protein-based peptide probes have been developed that directedly measure misfolded transthyretin oligomers due to transthyretin breakdown. Although promising, both TTR kinetic and protein peptide probes remain in early stages of clinical investigation. Transthyretin, retinol binding protein-4, transthyretin kinetic stability, and protein-based peptide probes have potential as biomarkers to facilitate an earlier ATTR diagnosis for patients with pathogenic transthyretin mutations.
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http://dx.doi.org/10.1007/s11897-020-00457-zDOI Listing
June 2020

Description and Proposed Management of the Acute COVID-19 Cardiovascular Syndrome.

Circulation 2020 06 16;141(23):1903-1914. Epub 2020 Apr 16.

Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (L.T.C.).

Coronavirus disease 2019 (COVID-19) is a rapidly expanding global pandemic caused by severe acute respiratory syndrome coronavirus 2, resulting in significant morbidity and mortality. A substantial minority of patients hospitalized develop an acute COVID-19 cardiovascular syndrome, which can manifest with a variety of clinical presentations but often presents as an acute cardiac injury with cardiomyopathy, ventricular arrhythmias, and hemodynamic instability in the absence of obstructive coronary artery disease. The cause of this injury is uncertain but is suspected to be related to myocarditis, microvascular injury, systemic cytokine-mediated injury, or stress-related cardiomyopathy. Although histologically unproven, severe acute respiratory syndrome coronavirus 2 has the potential to directly replicate within cardiomyocytes and pericytes, leading to viral myocarditis. Systemically elevated cytokines are also known to be cardiotoxic and have the potential to result in profound myocardial injury. Prior experience with severe acute respiratory syndrome coronavirus 1 has helped expedite the evaluation of several promising therapies, including antiviral agents, interleukin-6 inhibitors, and convalescent serum. Management of acute COVID-19 cardiovascular syndrome should involve a multidisciplinary team including intensive care specialists, infectious disease specialists, and cardiologists. Priorities for managing acute COVID-19 cardiovascular syndrome include balancing the goals of minimizing healthcare staff exposure for testing that will not change clinical management with early recognition of the syndrome at a time point at which intervention may be most effective. This article aims to review the best available data on acute COVID-19 cardiovascular syndrome epidemiology, pathogenesis, diagnosis, and treatment. From these data, we propose a surveillance, diagnostic, and management strategy that balances potential patient risks and healthcare staff exposure with improvement in meaningful clinical outcomes.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.120.047349DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314493PMC
June 2020

Implications of Perceived Dyspnea and Global Well-Being Measured by Visual Assessment Scales During Treatment for Acute Decompensated Heart Failure.

Am J Cardiol 2019 08 10;124(3):402-408. Epub 2019 May 10.

Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address:

Symptomatic improvement through decongestive therapy is a cornerstone for treatment of acute decompensated heart failure (ADHF). Visual analog scales (VAS) are instruments that can capture patients' perceptions of dyspnea (DVAS) or global well-being (GVAS). However, the clinical implications of these instruments and their changes over time during treatment for ADHF need further clarification. DVAS and GVAS were collected in 657 patients randomized in the DOSE-AHF and ROSE-AHF trials. To determine factors associated with symptom change, multivariable predictors of changes in DVAS and GVAS over 72 hours were determined. In addition, time-to-event analyses determined the association between these assessments and post-discharge clinical outcomes. The median baseline DVAS and GVAS scores were 54 (interquartile range 35 to 76) and 50 (30 to 66), respectively. These scores increased from baseline to 72 hours (ΔDVAS 16 [0 to 35] and ΔGVAS 19 [2 to 37]). Although changes in both scales were associated with their baseline values, 72-hour change in NT-proBNP was associated with each scale in multivariable analysis. However, there were additional variables associated with 72-hour change in GVAS including 72-hour change in creatinine, implantable cardioverter-defibrillator presence, baseline loop diuretic dose, and 72-hour total loop diuretic dose. There were no consistent associations between DVAS or GVAS and clinical composite outcomes at 60 days. In conclusion, DVAS and GVAS may be related to different clinical factors during treatment for ADHF and VAS scores were not consistently associated with clinical outcomes in ADHF. These findings inform the utility of the DVAS and GVAS instruments as measurements of symptom change for future ADHF clinical trials and registries.
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http://dx.doi.org/10.1016/j.amjcard.2019.05.011DOI Listing
August 2019

Edema and Ulceration of the Lower Extremities-All That's Red Is Not Infection: A Teachable Moment.

JAMA Intern Med 2018 02;178(2):277-278

Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.

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http://dx.doi.org/10.1001/jamainternmed.2017.7194DOI Listing
February 2018

Pasireotide for the treatment of refractory hypoglycaemia from malignant insulinoma.

Clin Endocrinol (Oxf) 2018 02 20;88(2):341-343. Epub 2017 Nov 20.

Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.

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http://dx.doi.org/10.1111/cen.13503DOI Listing
February 2018
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