Rajat Kalra

Jaypee Institute of Information Technology | JIIT · Department of Biotechnology

Background Extracorporeal cardiopulmonary resuscitation improves outcomes after out‐of‐hospital cardiac arrest. However, bleeding and thrombosis are common complications. We aimed to describe the incidence and predictors of bleeding and thrombosis and their association with in‐hospital mortality. Methods and Results Consecutive patients presenting...

Introduction Epinephrine has been the main drug recommended for decades during cardiopulmonary resuscitation (CPR). But epinephrine’s ß-adrenergic effects might increase myocardial oxygen consumption and may cause arrythmias after ROSC. Norepinephrine has a weaker ß-adrenergic effect and could be useful during CPR. Studies on norepinephrine’s effec...

Background There is considerable debate about the hemodynamic effects of veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO). Aims To evaluate the changes in left ventricular (LV) function, volumes, and work in patients treated with VA‐ECMO using invasive LV catheterization and three‐dimensional echocardiographic volumes. Methods Patients...

Background: Extracorporeal cardiopulmonary resuscitation (eCPR) improves outcomes after out of hospital cardiac arrest (OHCA). However, bleeding and thrombosis are common complications. The post cardiac arrest syndrome including trauma and altered hemostasis creates challenges when balancing the risk of bleeding versus thrombosis. We aimed to descr...

Introduction: Post cardiac arrest syndrome is associated with altered hemostasis. This is aggravated further by the foreign surface in the extracorporeal circuit leading to a coagulofibrinolytic imbalance. Aim: We examined the serial changes of consumptive coagulopathy markers and their association with neurologic outcomes. Methods: A single-center...

Background: Targeted temperature management (TTM) at lower temperatures has shown variable neuroprotective benefits in clinical trials of cardiac arrest. We hypothesized that moderate hypothermia at the time of VA-ECMO reperfusion followed by early rewarming would reduce brain injury in a swine model of refractory VF, compared to mild hypothermia....

Background Pulmonary capillary wedge pressure (PCWP) is often used as a surrogate for left-ventricular end-diastolic pressure in patients (LVEDP) who are on veno-arterial extracorporeal membrane oxygenation (V-A ECMO) support for cardiogenic shock and cardiac arrest. However, the correlation between PCWP and LVEDP is not clear in the setting of V-A...

Unlabelled: There are 350,000 out-of-hospital cardiac arrest (OHCA) cases annually in the United States of America. Using automated external defibrillators (AEDs) has increased survival in cardiac arrests (CA) with an initial shockable rhythm. Thus, guidelines recommend complete geographical coverage with AEDs. To fill in the gaps in Minnesota, th...

Background: Chest compressions (CC) are the cornerstone of cardiopulmonary resuscitation (CPR). But CC are also known to cause injuries, specifically rib fractures. The effects of such fractures have not been examined yet. This study aimed to investigate hemodynamic effects of rib fractures during mechanical CPR in a porcine model of cardiac arres...

Background: Sex-associated differences in clinical outcomes among left ventricular assist device recipients in the United States have been recognized. However, an investigation of the social and clinical determinants of sex-associated differences is lacking. Methods: Left ventricular assist device receiving patients enrolled in Interagency Regis...

Background: Refractory out-of-hospital cardiac arrest (OHCA) treated with standard advanced cardiac life support (ACLS) has poor outcomes. Transport to hospital followed by in-hospital extracorporeal cardiopulmonary resuscitation (ECPR) initiation may improve outcomes. We performed a pooled individual patient data analysis of two randomised contro...

Aim: To assess the impact of body mass index (BMI) on survival to hospital discharge of patients presenting with refractory ventricular fibrillation treated with extracorporeal cardiopulmonary resuscitation. We hypothesize that due to limitations in pre-hospital care delivery, people with high BMI have worse survival after prolonged resuscitation...

Objective: Oversampling of Asian American individuals in the National Health and Nutrition Examination Survey (NHANES) provides a unique opportunity to assess the population-level cardiovascular health (CVH) in the fastest-growing racial group in the US. Methods: The Life's Essential 8 (LE8) score and its components were calculated in self-repor...

Background: Multiple randomized clinical trials have compared specific airway management strategies during ACLS with conflicting results. However, patients with refractory cardiac arrest died in almost all cases without the availability of extracorporeal cardiopulmonary resuscitation (ECPR). Our aim was to determine if endotracheal intubation (ETI...

Right ventricular failure (RVF) is a leading cause of morbidity and mortality in multiple cardiovascular diseases, but there are no approved treatments for RVF as therapeutic targets are not clearly defined. Contemporary transcriptomic/proteomic evaluations of RVF are predominately conducted in small animal studies, and data from large animal model...

Objective This study assessed cardiovascular health (CVH) in young adults using the 2022 AHA Life's Essential 8 (LE8) score and compared it with the Life's Simple 7 (LS7) score. Methods Individuals aged 18 to 44 years without a history of cardiovascular disease in the National Health and Nutrition Examination Survey (NHANES) cycles were included....

Background: Brain death is a major cause of death among refractory ventricular tachycardia/ventricular fibrillation (VT/VF) out-of-hospital cardiac arrest (OHCA) who are treated with extracorporeal cardiopulmonary resuscitation (ECPR). Studies regarding the clinical consequences of hyperoxemia in this population are lacking. We aimed to determine w...

Introduction: The survival to discharge of patients presenting with refractory out-of-hospital cardiac arrest (OHCA) in centers with a well-established extracorporeal cardiopulmonary resuscitation (ECPR) program has improved over the last decade. While quality of life is an important consideration for all survivors, long-term cardiac functional rec...

Introduction: Right ventricular (RV) dysfunction is the leading cause of death in pulmonary arterial hypertension (PAH), but the molecular determinants of RV dysfunction are not well defined. In addition, most molecular evaluations of RV dysfunction use small animal models, and data from large animal models is sparse. Methods: Control and pulmonary...

Background: The long-term outcomes of patients treated with extracorporeal cardiopulmonary resuscitation (ECPR) for refractory ventricular tachycardia/ventricular fibrillation (VT/VF) out-of-hospital cardiac arrest (OHCA) remain poorly defined. The purpose of this study was to describe the hospital length of stay and long-term survival of patients...

Aim Describe the lung injury patterns among patients presenting with refractory ventricular tachycardia/ventricular fibrillation out-of-hospital cardiac arrest (VT/VF OHCA) supported with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) facilitated resuscitation. Methods In this retrospective single-center cohort study including VT/VF O...

Purpose Refractory respiratory failure caused by the coronavirus SARS-CoV-2 is associated with a significant mortality rate. Patients unresponsive to conventional medical therapy may benefit from temporary veno-venous extracorporeal membrane oxygenation (VV-ECMO), which provides complete gas exchange while allowing the patient to recover. We sought...

Respiratory failure caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is associated with mortality. Patients unresponsive to conventional therapy may benefit from temporary venovenous extracorporeal membrane oxygenation (VV-ECMO). We investigated clinical and echocardiographic characteristics, particularly, right ventricular dy...

Background Black individuals have high incident diabetes risk, despite having paradoxically lower triglyceride and higher HDL (high-density lipoprotein) cholesterol levels. The basis of this is poorly understood. We evaluated the participants of SPRINT (Systolic Blood Pressure Intervention Trial) to assess the association of estimated European gene...

Introduction: Multiple clinical trials have failed to show significant differences in survival between use of endotracheal intubation (ETI) and supraglottic airway devices (SGA) in patients with out-of-hospital cardiac arrest (OHCA). However, treatment in these trials was limited to standard ACLS, which favors short duration of CPR. We sought to co...

Introduction: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a frequently used hemodynamic support strategy, but considerable debate exists about its hemodynamic effects. We evaluated changes in left ventricular (LV) function, volumes, and work in patients treated with VA-ECMO using invasive LV catheterization and three-dimensional...

Introduction: The burden of insulin resistance (IR) among young American adults has not been previously assessed. We evaluated the 1) trends and prevalence of IR and cardiometabolic risk factors and, 2) assessed the association between measures of adiposity and IR among adults aged 18-44 years without diabetes and preexisting cardiovascular disease...

Introduction: Pulmonary arterial hypertension (PAH) is a rare but lethal disease, which results in rightventricle (RV) failure. Unfortunately, there are no available therapies to directly combat RV failure and improvesurvival in PAH. We previously showed antagonism of the GP130 signaling pathway prevents microtubuleremodeling and enhances RV functi...

Introduction: Higher urinary excretion of sodium and albumin, and lower urinary excretion of potassium, is associated with adverse cardiovascular (CV) events. The differences in 24h urinary sodium, potassium, and albumin between non-Hispanic Black (NHB) and NH White (NHW) individuals and their association with AHA Life Simple 7 metrics of ideal CV...

The rising incidence and recognition of cardiogenic shock has led to an increase in the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). As clinical experience with this therapy has increased, there has also been a rapid growth in the body of observational and randomized data describing the clinical and logistical considerations...

Background Among patients receiving percutaneous coronary intervention (PCI), the role of a genotype-guided approach for antiplatelet therapy compared with usual care is unclear. We conducted a Bayesian analysis of the entire TAILOR-PCI (Tailored Antiplatelet Initiation to Lessen Outcomes Due to Decreased Clopidogrel Response After Percutaneous Cor...

Introduction We evaluated the incidence of change in serial 12-lead electrocardiogram (ECG) diagnostic classifications in patients resuscitated from out-of-hospital (OH) cardiac arrest (OHCA) comparing OH to emergency department (ED) ECGs. Methods This retrospective case series included: 1) adults (≥ 18 years old), 2) resuscitated OHCA, 3) ≥ 1 OH...

Sarcoidosis is a multisystem disease of unknown cause with heterogenous clinical manifestations and variable course. Spontaneous remissions occur in some patients while others have progressive disease impacting survival, organ function, and quality of life. Four high-risk sarcoidosis phenotypes associated with chronic inflammation have recently bee...

Background: The burden of insulin resistance (IR) among young American adults has not been previously assessed. We evaluated the 1) prevalence and trends of IR and cardiometabolic risk factors and, 2) assessed the association between measures of adiposity and IR among adults aged 18-44 years without diabetes and preexisting cardiovascular disease....

Background There are few data on sex differences in suspected cardiac sarcoidosis. Methods Consecutive patients with histologically proven sarcoidosis and suspected cardiac involvement were studied. We investigated sex differences in presenting features, cardiac involvement, and the long-term incidence of a primary composite end point of all-cause...

Introduction : The interplay between sleep duration and inflammation on the baseline and incident cardiovascular (CV) risk is unknown. We sought to evaluate the association between sleep duration, C-reactive protein (CRP), baseline CV risk, and incident CV mortality. Methods : We used data from the National Health and Nutrition Examination Survey...

Cardiogenic shock accounts for ~100,000 annual hospital admissions in the United States. Despite improvements in medical management strategies, in-hospital mortality remains unacceptably high. Multiple mechanical circulatory support devices have been developed with the aim to provide hemodynamic support and to improve outcomes in this population. V...

Objectives Evaluate the differences in coronary artery disease (CAD) burden between patients with ischemic resuscitated, ischemic refractory VT/VF OHCA events and N/STEMI. Background Refractory out-of-hospital cardiac arrest patients presenting with initial shockable rhythms (VT/VF OHCA) have the highest mortality among patients with acute cardiac...

Background: A metabolic paradox of lower triglyceride (TG) and higher high-density lipoprotein cholesterol (HDL-C) levels but a higher incidence of diabetes has been described in Blacks. We evaluated the association of genetic ancestry-related variants with the risk of incident diabetes in self-identified Black individuals in the Systolic Blood Pre...

Children and adolescents account for ~ 13% of total COVID-19 cases in the United States. However, little is known about the nature of the illness in children. The reopening of schools underlines the importance of understanding the epidemiology of pediatric COVID-19 infections. We sought to assess the clinical characteristics and outcomes in pediatr...

Introduction: While early enteral nutrition is generally preferred in critically ill patients, the optimal timing of feeding among refractory cardiac arrest patients is unknown. We examined the association between timing of enteral nutrition and patient survival and safety outcomes in patients with refractory out-of-hospital cardiac arrest (OHCA)...

Objective To evaluate the trends in cardiovascular, ischemic heart disease (IHD), stroke, and heart failure mortality in the stroke belt in comparison with the rest of the United States. Patients and Methods We evaluated the nationwide mortality data of all Americans from the Centers for Disease Control and Prevention Wide-Ranging Online Data for...

Objective To investigate the relative predictive value of circulating immune cell markers for cardiovascular mortality in ambulatory adults without cardiovascular disease. Methods We analyzed data of participants enrolled in the National Health and Nutrition Examination Survey from January 1, 1999, to December 31, 2010, with the total leukocyte co...

Background Obese patients have lower NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) levels. The prognostic implications of achieving NT‐proBNP levels ≤1000 pg/mL in obese patients with heart failure (HF) receiving biomarker‐guided therapy are not completely known. We evaluated the prognostic implications of obesity and having NT‐proBNP level...

Aims We sought to compare the generalizability and prognostic implications of heart failure with preserved ejection fraction (HFpEF) scores (HFA‐PEFF and H2FPEF score) in Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) and Phosphodiesterase‐5 Inhibition to Improve Clinical Status and Exercise Capacity i...

The 2017 American College of Cardiology/American Heart Association high blood pressure (BP) guidelines recommend risk assessment of atherosclerotic cardiovascular disease to inform hypertension treatment in adults with elevated BP or low-risk stage I hypertension. The use of coronary artery calcium (CAC) score to guide hypertension therapy has not...

Objective To evaluate the contemporary geographic trends in cardiovascular health in the United States and its relationship with geographic distribution of cardiovascular mortality. Methods By use of a retrospective cross-sectional design, the 2011-2017 Behavioral Risk Factor Surveillance System (BRFSS) was queried to determine the age-adjusted pr...

Objective There has been a substantial decline in patients presenting for emergent and routine cardiovascular care in the United States after the onset of the coronavirus disease-2019 (COVID-19) pandemic. We sought to assess the risk of adverse clinical outcomes among patients undergoing coronary artery bypass graft (CABG) surgery during the 2020 C...

Extracorporeal cardiopulmonary resuscitation (ECPR) is an emerging method of cardiopulmonary resuscitation to improve outcomes from cardiac arrest. This approach targets patients with out‐of‐hospital cardiac arrest previously unresponsive and refractory to standard treatment, combining approximately 1 h of standard CPR followed by venoarterial extr...

Nocturnal blood pressure (BP) is a stronger predictor of the development of adverse cardiovascular events in comparison with daytime or clinic BP. 1 Ambulatory BP monitoring (ABPM) helps to identify high-risk nocturnal BP phenotypes, such as non-dipping and riser pattern of nocturnal BP. These patterns are associated with increased end-organ damage...

Objective To evaluate the nationwide trends in mortality due to mitral regurgitation (MR) among American adults from 1999 to 2018. Patients and Methods Trends in mortality due to MR were assessed using retrospective cross-sectional analyses of nationwide mortality data from death certificates of all American residents between January 1, 1999, and...

Background: Post cardiac arrest syndrome includes significant pulmonary injury that is not clearly understood. Objectives: Describe the lung injury patterns among patients presenting with refractory ventricular tachycardia/ventricular fibrillation out-of-hospital cardiac arrest (VT/VF OHCA) patients who were treated with veno-arterial extracorporea...

Background: The prognostic implications of achieving NT-proBNP concentrations ≤1000 pg/mL among obese patients having heart failure with reduced ejection fraction (HFrEF) are not completely known. We evaluated the prognostic implications of body mass index (BMI), and achievement of target NT-proBNP levels of ≤1000 pg/mL in obese HF patients from th...

Introduction: Inflammation is associated with worse cardiovascular (CV) prognosis. We evaluated the impact of adding elevated monocyte lymphocyte ratio (MLR) to 10-year atherosclerotic CV disease (ASCVD) risk score. Hypothesis: Adding elevated MLR improves risk classification by 10-year ASCVD risk score. Methods: We used data from 6 cycles of NHANE...

Background: There are longstanding and pervasive geographic disparities in cardiovascular (CV) health in the US. We sought to evaluate the contemporary trends in CV risk factors by census regions from 2011-2017. The region-specific CV mortality for 2017 was evaluated to assess the geographic overlap between risk factors, CV mortality, and COVID-19...

Background: The growing epidemic of obesity in the United States (US) is associated with cardiovascular (CV) morbidity and mortality. We evaluated the impact of the increasing obesity prevalence on the CV health of young American adults. Methods: The age-adjusted weighted prevalence of hypertension, diabetes, and hypercholesterolemia was estimated...

Introduction: Cardiac sarcoidosis is increasingly recognized as a cause of cardiomyopathy and mortality. However, there are no data on sex differences in patients with suspected cardiac sarcoidosis. Hypothesis: We hypothesized that sex differences exist in the clinical presentation, cardiac involvement, and long-term clinical outcomes of patients w...

Background: The 2017 American College of Cardiology/American Heart Association high blood pressure (BP) guidelines recommend risk assessment of atherosclerotic cardiovascular disease (CVD) to inform hypertension (HTN) treatment in adults with elevated BP or low-risk stage 1 HTN. Use of coronary artery calcium (CAC) score, an excellent imaging risk-...

Introduction: Sleep disturbance is associated with higher inflammation and cardiovascular mortality. The interplay between sleep duration and inflammation as an effect modifier for cardiovascular risk is unknown. Hypothesis: We sought to evaluate the association between sleep duration, C-reactive protein (CRP), and cardiovascular mortality. Methods...

Background Among patients with out-of-hospital cardiac arrest (OHCA) and ventricular fibrillation, more than half present with refractory ventricular fibrillation unresponsive to initial standard advanced cardiac life support (ACLS) treatment. We did the first randomised clinical trial in the USA of extracorporeal membrane oxygenation (ECMO)-facili...

Objective: To evaluate the race-stratified state-level prevalence of health determinants and the racial disparities in coronavirus disease-2019 (COVID-19) cumulative incidence and mortality in the United States. Patients and methods: Age-adjusted race-stratified prevalence of comorbidities (hypertension, diabetes, dyslipidemia, obesity), preexis...

Background Despite numerous advances in the understanding of the pathophysiology, progression, and management of acute respiratory failure (ARF) and acute respiratory distress syndrome (ARDS), there is limited contemporary data on the mortality burden of ARF and ARDS in the United States (US). Research Question What are the contemporary trends and...

Background The phenotypically heterogeneous syndrome of heart failure with preserved ejection fraction (HFpEF) is challenging to diagnose. The HFA-PEFF and H2FPEF scores were developed to guide HFpEF diagnosis but have not been directly compared. We evaluated the generalizability and prognostic implications of the two scores in Treatment of Preserv...

Background The incidence and mortality of out‐of‐hospital cardiac arrest (OHCA) remains high, but predicting outcomes is challenging. Being able to better assess prognosis of hospitalized patients after return of spontaneous circulation would enable improved management of survival expectations. In this study, we assessed the predictive value of ECG...

Objective To evaluate the race-stratified trends for prevalence, awareness, treatment, and control of hypertension in young American adults aged 18 to 44 years. Patients and Methods The National Health and Nutrition Examination Survey data from 2005–2016 for adults aged 18 to 44 years was used to calculate age-adjusted (using 2005, 2010, and 2015...

Background The mechanisms and degree of myocardial recovery during treatment with venoarterial extracorporeal membrane oxygenation (VA-ECMO) are unclear. We performed a descriptive study to evaluate myocardial recovery and changes in parameters of myocardial loading using echocardiography. Methods We retrospectively evaluated patients with refract...

Background Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has emerged as a prominent therapy for patients with refractory cardiac arrest. However, optimal time of initiation remains unknown. Aim Assess the rate of survival to hospital discharge in adult patients with refractory ventricular fibrillation/pulseless ventricular tachycardi...

Treatment options for chronic thromboembolic pulmonary hypertension (CTEPH) that is not amenable to thromboendarterectomy or is recurrent/persistent after thromboendarterectomy (inoperable CTEPH) include pulmonary vasodilators or balloon pulmonary angioplasty (BPA). We compared efficacy and safety outcomes of BPA with or without pulmonary vasodilat...

Aims Prior evidence has implicated leucocyte expansion in several cardiovascular disorders, including heart failure (HF) with reduced ejection fraction (rEF). However, the prognostic importance of leucocyte count in HF with preserved EF (HFpEF) remains largely unexplored. Methods and results The Americas cohort of the treatment of preserved cardia...

We evaluated the impact of intensive blood pressure control on the incidence of new-onset atrial fibrillation/flutter (AF) and the prognostic implications of preexisting and new-onset AF in SPRINT (Systolic Blood Pressure Intervention Trial) participants. New-onset AF was defined as occurrence of AF in 12-lead electrocardiograms after randomization...

Introduction: Improvements in therapy and prevention have led to declining cardiovascular mortality in the United States, but it is not clear whether these improvements have narrowed geographic disparities in cardiovascular outcomes. We sought to compare mortality due to cardiovascular disease, heart failure, stroke, and ischemic heart disease in t...

Patients with heart failure with preserved ejection fraction (HFpEF) have a significantly elevated risk of sudden cardiac death (SCD). However, few imaging data have been correlated to this risk. We evaluated the value of multiple echocardiographic markers of left ventricular function to predict SCD in HFpEF patients. The TOPCAT-Americas cohort was...

Atrial fibrillation (AF) is a common perioperative arrhythmia. However, its occurrence and implications remain poorly defined in setting of non-cardiac procedures. We sought to define the incidence, prevalence, and prognostic implications of AF among patients with atherosclerotic cardiovascular disease (ASCVD) undergoing non-cardiac surgery. Using...

Aims Immunomodulation in heart failure (HF) has been studied in several randomized controlled trials (RCTs) with variable effects on cardiac structure, function, and outcomes. We sought to determine the effect of immunomodulation on left ventricular ejection fraction (LVEF), LV end‐diastolic dimension (LVEDD), and all‐cause mortality in patients wi...

Background Pulmonary arterial hypertension ( PAH ) is a lethal disease. In resource‐limited countries PAH outcomes are worse because therapy costs are prohibitive. To improve global outcomes, noninvasive and widely available biomarkers that identify high‐risk patients should be defined. Serum chloride is widely available and predicts mortality in l...

Introduction There are little contemporary data about cardiovascular risk factors among young adults. We defined trends in diabetes mellitus (DM), hypertension, and hypercholesterolemia in American adults aged 18–44 years. Methods The National Health and Nutrition Examination Study serial cross-sectional surveys were used to define three time peri...

We evaluated the impact of intensive blood pressure control on the incidence of new-onset atrial fibrillation/flutter (AF) and the prognostic implications of preexisting and new-onset AF in SPRINT (Systolic Blood Pressure Intervention Trial) participants. New-onset AF was defined as occurrence of AF in 12-lead electrocardiograms after randomization...

Anemia is a commonly occurring comorbidity among patients with heart failure with preserved ejection fraction (HFpEF) but limited data exists on the cardiovascular phenotype of anemia in HFpEF. We sought to characterize the clinical features, exercise capacity and outcomes in patients with HFpEF to elucidate the phenotype and pathophysiology of ane...

In this post-hoc analysis of the TOPCAT trial, we evaluated the prognostic role of anemia in adverse cardiovascular (CV) outcomes in heart failure with a preserved ejection fraction (HFpEF). Anemia was defined as hemoglobin of <12 g/dl in females and <13 g/dl in males. The primary outcome was a composite of CV mortality, aborted cardiac arrest (ACA...

Introduction: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to treat cardiogenic shock and refractory cardiac arrest. However, the degree and mechanisms of myocardial recovery remain unclear. Methods: We retrospectively evaluated myocardial recovery and parameters of myocardial loading with decreasing VA-ECMO suppo...

Background: Literature suggests that low hemoglobin (Hb) concentration in heart failure with a preserved ejection fraction (HFpEF) increases the risk of mortality and hospitalization. However, it is not clear what drives this increased risk of mortality. We evaluated the association of Hb with cause-specific mortality in HFpEF. Hypothesis: Low Hb...