Ricardo Chia M.D.

All Publications

• Associations Between Cardiac Function and Brain Health in Diverse Middle-Aged Adults: The Dallas Heart Study-2. JACC. Advances Giacona, J. M., Chia, R., Kositanurit, W., Wang, J., Ayers, C., Pandey, A., Kozlitina, J., Drazner, M. H., Garg, S., de Lemos, J. A., Zhang, R., Hajjar, I., Yu, F. F., Lacritz, L., Vongpatanasin, W. 2024; 3 (2): 100777

  Abstract

  Previous studies have linked cardiovascular risk factors during midlife to cognitive function in later life. However, few studies have looked at the association between cardiac function, brain structure, and cognitive function and even less have included diverse middle-aged populations.The objective of this study was to determine associations between cardiac and brain structure and function in a multiethnic cohort of middle-aged adults.A cross-sectional study was conducted in participants of the Dallas Heart Study phase 2 (N = 1,919; 46% Black participants). Left ventricular (LV) mass, LV ejection fraction, LV concentricity, and peak systolic strain (LV Ecc) were assessed by cardiac magnetic resonance imaging. White matter hyperintensities (WMH) volume was measured by fluid attenuated inversion recovery magnetic resonance imaging. The Montreal Cognitive Assessment was used to measure cognitive functioning. Associations between cardiac and brain measures were determined using multivariable linear regression after adjusting for cardiovascular risk factors, education level, and physical activity.LV ejection fraction was associated with total Montreal Cognitive Assessment score (β = 0.06 [95% CI: 0.003-0.12], P = 0.042) and LV Ecc was associated with WMH volume (β = 0.08 [95% CI: 0.01-0.14], P = 0.025) in the overall cohort without significant interaction by race/ethnicity. Higher LV mass and concentricity were associated with larger WMH volume in the overall cohort (β = 0.13 [95% CI: 0.03-0.23], P = 0.008 and 0.10 [95% CI: 0.03-0.17], P = 0.005). These associations were more predominant in Black than White participants (β = 0.17 [95% CI: 0.04-0.30] vs β = -0.009 [95% CI: -0.16 to 0.14], P = 0.036 and β = 0.22 [95% CI: 0.13-0.32] vs β = -0.11 [95% CI: -0.21 to -0.01], P < 0.0001, for LV mass and concentricity, respectively).Subclinical cardiac dysfunction indicated by LVEF was associated with lower cognitive function. Moreover, LV mass and concentric remodeling were associated with higher WMH burden, particularly among Black individuals.

  View details for DOI 10.1016/j.jacadv.2023.100777

  View details for PubMedID 38939405

  View details for PubMedCentralID PMC11198548

• Management of Aorto-Right Ventricular Fistulas after TAVR. JACC. CR Chia, R., Kalutota, C., Cao, K., Douedi, S., Chang, W., Pinciotti, D., Benzeapour, M., Joiner, J., Ice, D., Ross, R., Kovach, R., Chen, C., Raza, M. 2024
• Aortic Valve Thrombus and Acute Right Ventricular Failure in Recent Left Ventricular Assist Device Recipient: A Rare Case Circulation Chia, R., Boyer, B., Pietrandrea, P., Giyanani, N., Douedi, S., Singh, D., Ross, R., Moshiyakhov, M., Barn, K. 2023
• Associations Between Obesity and Outcomes After Left Ventricular Assist Device Implantation (A795) The Journal of Heart and Lung Transplantation Chia, R., Kazemian, P., Chec, L., Bhikadiya, B., Sobieraj, M., Balatsky, A., Moshiyakhov, M., Burns, P., Barn, K. 2023; 42 (4)

  View details for DOI 10.1016/j.healun.2023.02.809

• Gender Disparities In Patients With Heartmate 3 Left Ventricular Assist Device (A150) Journal of Cardiac Failure Chia, R., Sobieraj, M., Rosen, B., Balatsky, A., Price, T., Singh, V., Naftulin, J., Kazemian, P., Barn, K. 2023; 29 (4): 616-617

  View details for DOI 10.1016/j.cardfail.2022.10.174

• Clinical Outcomes in Patients Who Live Alone After Undergoing HeartMate III Implantation (A878) The Journal of Heart and Lung Transplantation Chia, R., Sobieraj, M., Rosen, B., Pinciotti, D., Kazemian, P., Barn, K. 2022; 41 (4)

  View details for DOI 10.1016/j.healun.2022.01.1457

• Assessment of patient and provider attitudes towards therapeutic drug monitoring to improve medication adherence in low-income patients with hypertension: a qualitative study. BMJ open Schesing, K. B., Chia, R., Elwood, B., Halm, E. A., Lee, S. J., Lodhi, H., Wu, B., Sharma, S., Smith, S. A., Jarrett, R. B., Das, S. R., Vongpatanasin, W. 2020; 10 (11): e039940

  Abstract

  Previous studies have implicated therapeutic drug monitoring (TDM), by measuring serum or urine drug levels, as a highly reliable technique for detecting medication non-adherence but the attitudes of patients and physicians toward TDM have not been evaluated previously. Accordingly, we solicited input from patients with uncontrolled hypertension and their physicians about their views on TDM.Prospective analysis of responses to a set of questions during semistructured interviews.Outpatient clinics in an integrated health system which provides care for a low-income, uninsured population.Patients with uncontrolled hypertension with either systolic blood pressure of at least 130 mm Hg or diastolic blood pressure of at least 80 mm Hg despite antihypertensive drugs and providers in the general cardiology and internal medicine clinics.Attitudes towards TDM and the potential impact on physician-patient relationship.We interviewed 11 patients and 10 providers and discussed the findings with 13 community advisory panel (CAP) members. Of the patients interviewed, 91% (10 of 11) and all 10 providers thought TDM was a good idea and should be used regularly to better understand the reasons for poorly controlled hypertension. However, 63% (7 of 11) of patients and 20% of providers expressed reservations that TDM could negatively impact the physician-patient relationship. Despite some concerns, the majority of patients, providers and CAP members believed that if test results are communicated without blaming patients, the potential benefits of TDM in identifying suboptimal adherence and eliciting barriers to adherence outweighed the risks.The idea of TDM is well accepted by patients and their providers. TDM information if delivered in a non-judgmental manner, to encourage an honest conversation between patients and physicians, has the potential to reduce patient-physician communication obstacles and to identify barriers to adherence which, when overcome, can improve health outcomes.

  View details for DOI 10.1136/bmjopen-2020-039940

  View details for PubMedID 33247015

  View details for PubMedCentralID PMC7703422

• Global Coronary Flow Reserve Measured During Stress Cardiac Magnetic Resonance Imaging Is an Independent Predictor of Adverse Cardiovascular Events. JACC. Cardiovascular imaging Indorkar, R., Kwong, R. Y., Romano, S., White, B. E., Chia, R. C., Trybula, M., Evans, K., Shenoy, C., Farzaneh-Far, A. 2019; 12 (8 Pt 2): 1686-1695

  Abstract

  The aim of this study was to evaluate the incremental prognostic value of global coronary flow reserve (CFR) in patients with known or suspected coronary artery disease who were undergoing stress cardiac magnetic resonance (CMR) imaging.Coronary microvascular dysfunction results in impaired global CFR and is implicated in the development of both atherosclerosis and heart failure. Although noninvasive assessment of CFR with positron emission tomography provides independent prognostic information, the incremental prognostic value of CMR-derived CFR remains unclear.Consecutive patients undergoing stress perfusion CMR were prospectively enrolled (n = 507). Coronary sinus flow was measured using phase-contrast imaging at baseline (pre) and immediately after stress (peak) perfusion. CFR was calculated as the ratio of peak to pre-flow. Patients were followed for major adverse cardiac events (MACE): death, nonfatal myocardial infarction, heart failure hospitalization, sustained ventricular tachycardia, and late revascularization. Cox proportional hazards regression modeling was used to examine the association between CFR and MACE. The incremental prognostic value of CFR was assessed in nested models.Over a median follow-up of 2.1 years, 80 patients experienced MACE. By Kaplan-Meier analysis, the risk of MACE was significantly higher in patients with CFR lower than the median (2.2) (log-rank p < 0.001); this remained significant after adjustment for the presence of ischemia and late gadolinium enhancement (LGE) (log-rank p < 0.001). CFR was significantly associated with the risk of MACE after adjustment for clinical and imaging risk factors, including ischemia extent, ejection fraction, and LGE size (hazard ratio: 1.238; p = 0.018). Addition of CFR in this model resulted in significant improvement in the C-index (from 0.70 to 0.75; p = 0.0087) and a continuous net reclassification improvement of 0.198 (95% confidence interval: 0.120 to 0.288).CMR-derived CFR is an independent predictor of MACE in patients with known or suspected coronary artery disease, incremental to common clinical and CMR risk factors. These findings suggest a role for CMR-derived CFR in identifying patients at risk of adverse events following stress CMR, even in the absence of ischemia and LGE.

  View details for DOI 10.1016/j.jcmg.2018.08.018

  View details for PubMedID 30409558

• Prognostic Implications of Mitral Annular Plane Systolic Excursion in Patients with Hypertension and a Clinical Indication for Cardiac Magnetic Resonance Imaging: A Multicenter Study. JACC. Cardiovascular imaging Romano, S., Judd, R. M., Kim, R. J., Kim, H. W., Heitner, J. F., Shah, D. J., Devereux, R. B., Salazar, P., Trybula, M., Chia, R. C., Evans, K., Farzaneh-Far, A. 2018

  Abstract

  This study sought to evaluate the prognostic value of cardiac magnetic resonance (CMR)-derived mitral annular plane systolic excursion (MAPSE) in a large multicenter population of patients with hypertension.In patients with hypertension, cardiac abnormalities are powerful predictors of adverse outcomes. Long-axis mitral annular movement plays a fundamental role in cardiac mechanics and is an early marker for a number of pathological processes. Given the adverse consequences of cardiac involvement in hypertension, the authors hypothesized that lateral MAPSE may provide incremental prognostic information in these patients.Consecutive patients with hypertension and a clinical indication for CMR at 4 U.S. medical centers were included in this study (n = 1,735). Lateral MAPSE was measured in the 4-chamber cine view. The primary endpoint was all-cause death. Cox proportional hazards regression modeling was used to examine the association between lateral MAPSE and death. The incremental prognostic value of lateral MAPSE was assessed in nested models.Over a median follow-up period of 5.1 years, 235 patients died. By Kaplan-Meier analysis, risk of death was significantly higher in patients with a lateral MAPSE < median (10 mm) (log-rank; p < 0.0001). Lateral MAPSE was associated with risk of death after adjustment for clinical and imaging risk factors (hazard ratio [HR]: 1.402-per-millimeter decrease; p < 0.001). Addition of lateral MAPSE in this model resulted in significant improvement in the C-statistic (0.735 to 0.815; p < 0.0001). Continuous net reclassification improvement was 0.739 (95% confidence interval: 0.601 to 0.902). Lateral MAPSE remained significantly associated with death even after adjustment for feature tracking global longitudinal strain (HR: 1.192-per-millimeter decrease; p < 0.001). Lateral MAPSE was independently associated with death among the subgroups of patients with preserved ejection fraction (HR = 1.339; p < 0.001) and in those without history of myocardial infarction (HR: 1.390; p < 0.001).CMR-derived lateral MAPSE is a powerful, independent predictor of mortality in patients with hypertension and a clinical indication for CMR, incremental to common clinical and CMR risk factors. These findings may suggest a role for CMR-derived lateral MAPSE in identifying hypertensive patients at highest risk of death.

  View details for DOI 10.1016/j.jcmg.2018.10.003

  View details for PubMedID 30409557

  View details for PubMedCentralID PMC6500768

• Lateral Mitral Annular Plane Excursion Measured Using Cardiac Magnetic Resonance Imaging is an Independent Predictor of All-Cause Mortality in Patients with Hypertension: a Multicenter Study (A268) European Heart Journal Romano, S., Salazar, P., Chia, R., Judd, R. M., Kim, R., Heitner, J., Shah, D. J., Al-Yafi, M., Farzaneh-Far, A. 2018; 39

  View details for DOI 10.1093/eurheartj/ehy564.P268

• Resistant hypertension-defining the scope of the problem. Progress in cardiovascular diseases Chia, R., Pandey, A., Vongpatanasin, W. 2020; 63 (1): 46-50

  Abstract

  The updated scientific statement by the American Heart Association has defined resistant hypertension (HTN;RH) as uncontrolled blood pressure (BP) ≥ 130/80 mmHg, despite concurrent use of 3 anti-HTN drug classes comprising a calcium channel blocker, a blocker of renin-angiotensin system, and a thiazide diuretic, preferably chlorthalidone. Using the updated BP criteria, the prevalence of RH in the United States is found to be modestly increased by approximately 3-4% among treated population. Meta-analysis of observational studies have demonstrated that pseudo-RH from white coat HTN or medication nonadherence is as much common as the truly RH. Thus, screening for pseudo-resistance in the evaluation of all apparent RH is of utmost importance as diagnosis of white-coat HTN requires no treatment, while medication nonadherence would benefit from identifying and targeting barriers to adherence.

  View details for DOI 10.1016/j.pcad.2019.12.006

  View details for PubMedID 31863785

  View details for PubMedCentralID PMC8272692

• Secundum atrial septal defect. QJM : monthly journal of the Association of Physicians Chia, R. C., Salazar, P., Al-Yafi, M., Romano, S., Farzaneh-Far, A. 2018; 111 (8): 571-572

  View details for DOI 10.1093/qjmed/hcy030

  View details for PubMedID 29462467