Amit Alam M.D.

Alam, A., Doshi, H., Patel, D.N., Patel, K., James, D. and Almendral, J. (2022). “Myocardial infarction and factor VIII elevation in a 36-year-old man.” Proc (Bayl Univ Med Cent) 35(1): 93-95.

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An association has been reported between factor VIII and arterial thrombosis such as ischemic stroke and myocardial infarction. We report a 36-year-old man who had a myocardial infarction despite lacking traditional cardiac risk factors. He developed end-stage heart failure and renal insufficiency necessitating a HeartMate II left ventricular assist device (LVAD). While on the transplant list, he experienced two episodes of LVAD thrombosis 6 months apart, prompting device exchange and escalation of anticoagulation therapy. He eventually underwent a successful heart-kidney transplant before suffering an extensive left lower extremity deep vein thrombosis 6 weeks later. A thrombophilia workup revealed elevated factor VIII activity of 319% (normal range, 50%-150%). He was placed on indefinite anticoagulation with apixaban with no further thrombotic episode in 18 months of follow-up to date.

Alam, A. (2021). “Effect of Near Monopoly in the Left Ventricular Assist Device Market.” Am J Cardiol Oct 24;S0002-9149(21)00957-7. [Epub ahead of print].

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These 2 devices were the most implanted LVADs in the world. However, on June 3, 2021, Medtronic announced that it would stop distribution of the HVAD, given the malfunctioning of the device’s start and stop mechanisms in addition to a high frequency of neurologic events. With HVADs no longer being implanted, will HM3 now monopolize the LVAD market? Herein a brief overview of LVADs that are within the horizon of our time.[No abstract; excerpt from article].

Alam, A., G. P. Milligan and T. Gong (2021). “The dominant left ventricular assist device: lessons from an era.” ESC Heart Fail. [Epub ahead of print].

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The production and distribution of the HeartWare ventricular assist device has come to an abrupt end, but with this end comes the opportunity to reflect upon lessons learned from its lifespan. Running counter to the standard of evidence-based practice, the era of the HeartWare ventricular assist device was marred with fragmented data in relation to its primary counterpart, the HeartMate III. This created an incomplete understanding of devices, limited individualized patient care, and effectively positioned providers to make inferences regarding device superiority. We briefly review pertinent literature on this topic among the most commonly implanted durable devices from the era, detail the inherent limitations of this data, and argue the necessity of randomized clinical trials among novel devices towards the optimization of patient care.

Alam, A., Burkhoff, D., Enter, D.H. and Jermyn, R. (2021). “Underutilized Fuel: Angiotensin II for Vasoplegia in the Heart Failure Patient Population.” J Cardiothorac Vasc Anesth.

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In this trial, patients who received ANG-II were more likely to achieve a mean arterial pressure of 75 mmHg or an increase in mean arterial pressure by 10 mmHg above that seen in patients who received placebo in as little as three hours. Furthermore, the median pressor dose decreased from baseline by 76.5% in the ANG-II group compared with an increase of 7.8% in the placebo group (p ≤ 0.05). [No abstract; excerpt from Letter].

Cogswell, R., Alam, A. and Joseph, S.M. (2021). “Letter by Cogswell et al Regarding Article, “Polypharmacy in Older Adults Hospitalized for Heart Failure”.” Circ Heart Fail 14(3): e008160.

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In the era of modern medicine, the older adult HF patient with reduced ejection fraction will be at least on a 4-drug regimen to help reduce morbidity and mortality, at the expense of polypharmacy. While the issues highlighted by Unlu and Denny et al demonstrate the need for further research in the domain of polypharmacy, our own community must standardize basic fundamental definitions and engage in research to inform our recommendations. Without this, the right polypharmacy may not be achieved. [No abstract; excerpt from article].