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Paul Forfia

Stephan P L Altmayer, Q Joyce Han, Karima Addetia, Amit R Patel, Paul R Forfia, Yuchi Han
Right ventricular (RV) end-diastolic volume (EDV) to left ventricular (LV) EDV ratio using cardiovascular magnetic resonance imaging (CMR) is an important parameter for RV size evaluation in additional to indexed EDV. We explore the severity partition for RV dilation using mortality in a population of 62 patients with pulmonary hypertension (PH). Cine short-axis images were acquired with a 1.5 T MR scanner using a steady-state free precession sequence. The optimal cutoff to classify severe RV dilation was determined by a receiver-operating curve (ROC) analysis based on mortality...
May 8, 2018: Scientific Reports
Andrew Peters, Mara Caroline, Huaqing Zhao, Matthew R Baldwin, Paul R Forfia, Emily J Tsai
BACKGROUND: Outcomes in peripartum cardiomyopathy (PPCM) vary. We sought to determine whether severity of left or right ventricular dysfunction (RVD) at PPCM diagnosis differentially associates with adverse outcomes. METHODS AND RESULTS: We conducted a single-center retrospective cohort study of 53 patients with PPCM. The primary outcome was a composite of left ventricular assist device implantation, cardiac transplantation, or death. We used Kaplan-Meier curves to examine event-free survival and Cox proportional hazards models to examine associations of left ventricular (LV) ejection fraction <30%, LV end-diastolic diameter ≥60 mm, and moderate-to-severe RVD at PPCM diagnosis with the primary outcome...
April 23, 2018: Journal of the American Heart Association
Yuchi Han, Paul R Forfia, Anjali Vaidya, Jeremy A Mazurek, Myung H Park, Gautam Ramani, Stephen Y Chan, Aaron B Waxman
Introduction: A major determining factor on outcomes in patients with pulmonary arterial hypertension (PAH) is right ventricular (RV) function. Ranolazine, which is currently approved for chronic stable angina, has been shown to improve RV function in an animal model and has been shown to be safe in small human studies with PAH. We aim to study the effect of ranolazine on RV function using cardiovascular magnetic resonance (CMR) in patients with pulmonary hypertension (non-group 2 patients) and monitor the effect of ranolazine on metabolism using metabolic profiling and changes of microRNA...
2018: Open Heart
Farhan Raza, Catherine Dillane, Arslan Mirza, Yevgeniy Brailovsky, Sheila Weaver, Martin G Keane, Paul Forfia
BACKGROUND: The aim of study was to assess whether a specific morphology of the right ventricle (RV) by 2D echo predicts the hemodynamic nature of pulmonary hypertension (PH). METHODS: We reviewed clinical, 2D echo, and hemodynamic data of 100 patients with PH: divided into three groups: PH from pulmonary vascular disease (PHPVD ; n = 34) with pulmonary vascular resistance (PVR) > 3 mm Hg/L/min (Wood unit [WU]) and pulmonary artery wedge pressure (PAWP) ≤ 15 mm Hg, pulmonary venous hypertension (PVH; n = 33) with PVR < 3 WU and PAWP > 15 mm Hg and PHMIXED (n = 33) with PVR > 3 WU and PAWP > 15 mm Hg...
November 2017: Echocardiography
Farhan Raza, Anjali Vaidya, Anne-Sophie Lacharite-Roberge, Vladimir Lakhter, Hayan Al-Maluli, Irfan Ahsan, Pamela Boodram, Chandra Dass, Frances Rogers, Martin G Keane, Sheila Weaver, Riyaz Bashir, Yoshiya Toyoda, Paul Forfia
BACKGROUND: Pulmonary thromboendarterectomy (PTE) is the treatment of choice for eligible patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, access to CTEPH and PTE care is limited. There is a paucity of published data on PTE efficacy and outcomes from alternative, regional centers of excellence in CTEPH and PTE care in the USA, outside a single national and international referral center. METHODS: We performed a retrospective review of patients undergoing PTE at our institution from June 2013 to December 2016 (42 months), and collected clinical, echocardiographic and hemodynamic data on our patients pre- and post-PTE (N...
June 2018: Journal of Cardiovascular Surgery
Jeremy A Mazurek, Anjali Vaidya, Stephen C Mathai, Justin D Roberts, Paul R Forfia
Few studies have examined the utility of serial echocardiography in the evaluation, management, and prognosis of patients with pulmonary arterial hypertension (PAH). Therefore, we sought to evaluate the prognostic significance of follow-up tricuspid annular plane systolic excursion (TAPSE) in PAH. We prospectively studied 70 consecutive patients with PAH who underwent baseline right heart catheterization (RHC) and transthoracic echocardiogram, who survived to follow-up echocardiogram after initiation of PAH therapy...
April 2017: Pulmonary Circulation
Paul Sorajja, Barry A Borlaug, Vasiliki V Dimas, James C Fang, Paul R Forfia, Michael M Givertz, Navin K Kapur, Morton J Kern, Srihari S Naidu
No abstract text is available yet for this article.
June 1, 2017: Catheterization and Cardiovascular Interventions
Paul Sorajja, Barry A Borlaug, Vivian Dimas, James C Fang, Paul R Forfia, Michael M Givertz, Navin K Kapur, Morton J Kern, Srihari S Naidu
No abstract text is available yet for this article.
June 1, 2017: Catheterization and Cardiovascular Interventions
Michael M Givertz, James C Fang, Paul Sorajja, Vivian Dimas, Paul R Forfia, Navin K Kapur, Morton J Kern, Srihari S Naidu, Barry A Borlaug
No abstract text is available yet for this article.
June 2017: Journal of Cardiac Failure
Joseph A Sivak, Amresh Raina, Paul R Forfia
Total right heart function requires normal function of both the right ventricle and the right atrium. However, the degree to which right atrial (RA) function and right ventricular (RV) function each contribute to total right heart function has not been quantified. In this study, we aimed to quantify the contribution of RA function to total right heart function in a group of pulmonary arterial hypertension (PAH) patients compared to a cohort of normal controls without cardiovascular disease. The normal cohort comprised 35 subjects with normal clinical echocardiograms, while the PAH cohort included 37 patients, of whom 31 had echocardiograms before and after initiation of PAH-specific therapy...
September 2016: Pulmonary Circulation
Saad Kubba, Carlos D Davila, Paul R Forfia
Right ventricular function (RVF) carries great prognostic significance in heart failure and pulmonary hypertension (PH). Although there is considerable focus on RVF in pulmonary arterial hypertension, RVF is also of great importance in group 2 PH. This article will discuss assessment of RVF and evaluation of the Right Ventricle-Pulmonary Artery (RV-PA) coupling relationship. Cardiac imaging modalities allow direct visualization and assessment of RVF. Imaging modalities include the commonly utilized echo-Doppler imaging evaluating RV fractional area change, tricuspid annular plane systolic excursion and Tissue Doppler Imaging, in addition to the increasingly utilized cardiac magnetic resonance...
July 2016: Progress in Cardiovascular Diseases
Brian P O'Neill, Grayson Wheatley, Riyaz Bashir, Daniel Edmundowicz, Brian O'Murchu, William W O'Neill, Pravin Patil, Andrew Chen, Paul Forfia, Howard A Cohen
BACKGROUND: Tricuspid regurgitation (TR) is an under treated disease. Although surgery for TR remains an effective therapy, many patients are considered to be at a high risk or otherwise inoperable. Caval valve implant (CAVI) offers an alternative to surgery in these patients. Trials assessing the safety and efficacy of caval valve implant are lacking. METHODS: The Heterotopic Implantation Of the Edwards-Sapien XT Transcatheter Valve in the Inferior VEna cava for the treatment of severe Tricuspid Regurgitation (HOVER) trial is an FDA approved, physician initiated, prospective, non-blinded (open label), non-randomized safety and feasibility study to determine the safety and efficacy of the heterotopic implantation of the Edwards-Sapien XT valve in the inferior vena cava for the treatment of severe TR in patients who are at high risk or inoperable...
August 2016: Catheterization and Cardiovascular Interventions
Imad Hussain, Selma F Mohammed, Paul R Forfia, Gregory D Lewis, Barry A Borlaug, Dianne S Gallup, Margaret M Redfield
BACKGROUND: Right ventricular (RV) dysfunction (RVD) is a poor prognostic factor in heart failure with preserved ejection fraction (HFpEF). The physiological perturbations associated with RVD or RV function indexed to load (RV-pulmonary arterial [PA] coupling) in HFpEF have not been defined. HFpEF patients with marked impairment in RV-PA coupling may be uniquely sensitive to sildenafil. METHODS AND RESULTS: In a subset of HFpEF patients enrolled in the Phosphodiesteas-5 Inhibition to Improve Clinical Status And Exercise Capacity in Diastolic Heart Failure (RELAX) trial, physiological variables and therapeutic effect of sildenafil were examined relative to the severity of RVD (tricuspid annular plane systolic excursion [TAPSE]) and according to impairment in RV-PA coupling (TAPSE/pulmonary artery systolic pressure) ratio...
April 2016: Circulation. Heart Failure
Q Joyce Han, Francisco Contijoch, Paul R Forfia, Yuchi Han
No abstract text is available yet for this article.
September 21, 2016: European Heart Journal
Stephan P L Altmayer, Amit R Patel, Karima Addetia, Mardi Gomberg-Maitland, Paul R Forfia, Yuchi Han
PURPOSE: To determine the normal range of the ratio of right ventricular (RV) end-diastolic volume to left ventricular (LV) end-diastolic volume by magnetic resonance imaging (MRI) and examine whether combining this volume ratio with RVEDV indexed to body surface area (RVEDVi) increased the detection of RV dilation in patients with pulmonary arterial hypertension (PAH). MATERIALS AND METHODS: MRI-derived ventricular function and volumes were measured in a control group (n = 152) and in patients with PAH (n = 46)...
June 2016: Journal of Magnetic Resonance Imaging: JMRI
Q Joyce Han, Walter R T Witschey, Christopher M Fang-Yen, Jeffrey S Arkles, Alex J Barker, Paul R Forfia, Yuchi Han
INTRODUCTION: Right ventricular (RV) function has increasingly being recognized as an important predictor for morbidity and mortality in patients with pulmonary arterial hypertension (PAH). The increased RV after-load increase RV work in PAH. We used time-resolved 3D phase contrast MRI (4D flow MRI) to derive RV kinetic energy (KE) work density and energy loss in the pulmonary artery (PA) to better characterize RV work in PAH patients. METHODS: 4D flow and standard cardiac cine images were obtained in ten functional class I/II patients with PAH and nine healthy subjects...
2015: PloS One
Amresh Raina, Zachary M Gertz, William T O'Donnell, Howard C Herrmann, Paul R Forfia
Previous studies have suggested that pulmonary hypertension (PH) in severe aortic stenosis (AS) is a risk factor for operative mortality with aortic valve replacement (AVR). Conversely, others have shown that patients with AS and PH extract a large symptomatic and survival benefit from AVR compared with those patients not treated surgically. We sought to evaluate the prevalence, severity, and mechanism of PH in an elderly patient cohort with severe AS. We prospectively evaluated 41 patients aged ≥80 years with severe AS...
September 2015: Pulmonary Circulation
Vimal Ramjee, Anne V Grossestreuer, Yuan Yao, Sarah M Perman, Marion Leary, James N Kirkpatrick, Paul R Forfia, Daniel M Kolansky, Benjamin S Abella, David F Gaieski
OBJECTIVE: Determination of clinical outcomes following resuscitation from cardiac arrest remains elusive in the immediate post-arrest period. Echocardiographic assessment shortly after resuscitation has largely focused on left ventricular (LV) function. We aimed to determine whether post-arrest right ventricular (RV) dysfunction predicts worse survival and poor neurologic outcome in cardiac arrest patients, independent of LV dysfunction. METHODS: A single-center, retrospective cohort study at a tertiary care university hospital participating in the Penn Alliance for Therapeutic Hypothermia (PATH) Registry between 2000 and 2012...
November 2015: Resuscitation
Farhan Raza, Mohamad Alkhouli, Frances Rogers, Anjali Vaidya, Paul Forfia
Patients with end-stage renal disease (ESRD) with arteriovenous dialysis access (AVDA) can develop symptoms of heart failure and pulmonary hypertension (PH). We report on 5 patients with ESRD and AVDA who presented with shortness of breath, heart failure, and PH. All patients had partial or complete closure of AVDA and were reevaluated after AVDA revision. All 5 subjects had clinical and echocardiographic evidence of heart failure, hypertensive heart disease, left ventricular diastolic dysfunction, and PH at baseline...
June 2015: Pulmonary Circulation
Carlos D Davila, Paul R Forfia
Pulmonary hypertension (PH) is simply defined as a mean pulmonary artery pressure greater than 25 mmHg at rest; however, may result from varying combinations of abnormal pulmonary artery (PA) blood flow, pulmonary vascular resistance (PVR), PA compliance, and pulmonary venous pressure. Mitral regurgitation (MR) allows for partial transmission of systemic arterial pressure into the pulmonary venous system. Mitral stenosis (MS) prevents pulmonary venous drainage into the left ventricle. In either case, the direct result is marked pressurization of the pulmonary venous system, with the primary cause of PH in significant mitral valve disease (PHMVD) being pulmonary venous hypertension (PVH)...
June 2015: Current Treatment Options in Cardiovascular Medicine
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