Peter A. McCullough M.D.

Barker, C.M., Cork, D.P., McCullough, P.A., Mehta, H.S., Van Houten, J., Gunnarsson, C., Ryan, M., Irish, W., Mollenkopf, S. and Verta, P. (2020). “Comparison of Survival in Patients with Clinically Significant Tricuspid Regurgitation with and without Heart Failure (From the Optum Integrated File).” Am J Cardiol Dec 29;S0002-9149(20)31422-3. [Epub ahead of print].

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This study aimed to quantify survival rates for patients with Tricuspid Regurgitation (TR) using real-world data. Several clinical conditions are associated with tricuspid regurgitation (TR), including heart failure (HF), other valve disease (OVD), right-sided heart disease (RSHD), and others that impact mortality. Optum data from January 1, 2007, through December 31, 2018 included patients age ≥18 years with TR and 12 months of continuous health plan enrollment before TR. Exclusion criteria were end-stage renal disease or known/primary organ pathology. Cohorts were created hierarchically: (1) TR with HF; (2) TR with OVD (no HF); (3) TR with RSHD only (no OVD or HF); (4) TR only. Survival was estimated using a Cox hazard model with an interaction term for TR severity and adjusted for patient demographics and Elixhauser comorbidities. A total of 33,686 met study inclusion (1) TR with HF (26.6%); (2) TR with OVD (36.7%); (3) TR with RSHD only (17.1%); (4) TR only (19.6%). TR Patients (regardless of severity) with HF, OVD or RSHD had an increased risk of mortality compared to patients with TR alone. TR severity was also significantly associated (hazard ratio= 1.33; P=0.0002) with an increased risk of all-cause mortality. In conclusion, TR severity is significantly associated with an increased risk of all-cause mortality, independent of associated conditions including HF, OVD, or RSHD. In patients with severe TR, the mortality risk is most pronounced for patients who had RSHD without HF or OVD prior to their TR diagnosis.

Rahimi, G., Tecson, K.M., Elsaid, O. and McCullough, P.A. (2020). “Role of Ischemic Heart Disease in Major Adverse Renal and Cardiac Events Among Individuals with Heart Failure with Preserved Ejection Fraction (From the TOPCAT Trial).” Am J Cardiol Dec 3;S0002-9149(20)31296-0. [Epub ahead of print.].

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Despite improvements in the prognosis of patients with heart failure with reduced ejection fraction (HFrEF), established therapy for heart failure patients with preserved ejection fraction (HFpEF) is lacking. Additionally, ischemic heart disease adversely impacts the clinical course of HFrEF patients; however, its role in HFpEF is not fully understood. We conducted a post hoc analysis of propensity score matched patients from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial to compare HFpEF patients with versus without myocardial ischemia in terms of major adverse renal and/or cardiac events (MARCE). Of 3445 participants, the prevalence of ischemia was 59%. For this analysis, we included 1747 ischemic patients and 1207 propensity matched non-ischemic patients. Ischemia was associated with a 20% increased risk (HR=1.20, 95% CI=1.042-1.382, p-value=0.0112) of MARCE in adjusted analyses. Other important predictors of MARCE were diabetes (HR=1.60, 95% CI=1.38-1.87, p <0.0001), dyslipidemia (HR=1.30, 95% CI=1.10-1.52, p=0.001) and smoking (HR=1.33, 95% CI=1.04-1.69, p= 0.0197). Revascularization was not significantly associated with MARCE in the subgroup of ischemic HFpEF patients. Future work is warranted to develop tailored interventions for patients with both HFpEF and ischemic heart disease to mitigate the risk of MARCE .

Palazzuoli, A., Mancone, M., De Ferrari, G.M., Forleo, G., Secco, G.G., Ruocco, G.M., D’Ascenzo, F., Monticone, S., Paggi, A., Vicenzi, M., Palazzo, A.G., Landolina, M., Taravelli, E., Tavazzi, G., Blasi, F., Infusino, F., Fedele, F., De Rosa, F.G., Emmett, M., Schussler, J.M., Tecson, K.M. and McCullough, P.A. (2020). “Antecedent Administration of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Antagonists and Survival After Hospitalization for COVID-19 Syndrome.” J Am Heart Assoc 9(22): e017364.

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Antecedent Administration of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Antagonists and Survival After Hospitalization for COVID-19 Syndrome.

Elsaid, O., McCullough, P.A., Tecson, K.M., Williams, R.S. and Yoon, A. (2020). “Ventricular Fibrillation Storm in Coronavirus 2019.” Am J Cardiol 135: 177-180.

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Cardiac arrhythmia is a known manifestation of novel coronavirus 2019 (COVID-19) infection. Herein, we describe the clinical course of an otherwise healthy patient who experienced persistent ventricular tachycardia and fibrillation which is believed to be directly related to inflammation, as opposed to acute myocardial injury or medications that can prolong the QT interval.

McCullough, P.A. (2020). “Favipiravir and the Need for Early Ambulatory Treatment of SARS-CoV-2 Infection (COVID-19).” Antimicrob Agents Chemother 64(12).

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It is becoming increasingly clear that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), like most human viral infections, will require multiple drugs in combination to treat COVID-19 illness. In this issue of the Journal, Doi and colleagues describe successful treatment of patients with early COVID-19 with favipiravir, an oral polymerase inhibitor, to rapidly and substantially clear SARS-CoV-2 from nasal secretions irrespective if it was started relatively early or later within the first week of infection. These data support the concept that favipiravir could be paired with at least one more off-target antiviral agent (doxycycline, azithromycin, or ivermectin) followed by corticosteroids and antithrombotics to prevent COVID-19 hospitalization and death in those over age 50 and/or those with one or more comorbidities. Clinical trials and advanced practice should immediately pivot to combination/sequential drug therapy for ambulatory COVID-19 illness.