Tushar Acharya

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Courses

Scholarly Contributions

Chapters

• Acharya, T., & Deedwania, P. (2015). New Risk Factors of Cardiovascular Disease. In Controversies in Cardiology(pp 3-19). Switzerland: Springer. doi:10.1007/978-3-319-20415-4

Journals/Publications

• Lancaster, J., Grijalva, A., Fink, J., Ref, J., Daugherty, S., Whitman, S., Fox, K., Gorman, G., Lancaster, L., Avery, R., Acharya, T., McArthur, A., Strom, J., Pierce, M. L., Moukabary, T., Borgstrom, M., Benson, D., Mangiola, M., Pandey, A., , Zile, M., et al. (2023). Biologically derived epicardial patch induces macrophage mediated pathophysiologic repair in chronically infarcted swine hearts. Communications Biology.
• Ajmal, M., Singh, A., Kubba, S., Hershman, M., & Acharya, T. (2021). Statin-Induced Triad of Autoimmune Myocarditis, Myositis, and Transaminitis. Case reports in cardiology, 2021, 6660362.
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  Despite well-established cardiovascular benefits, statins have been associated with myopathic side effects ranging from myalgias to rhabdomyolysis and autoimmune necrotizing myositis. Statins have not been previously shown to cause myocarditis. Our case highlights this rare entity.
• Chacon-Portillo, M., Acharya, T., & Janardhanan, R. (2021). Imaging in heart failure with preserved ejection fraction: insights into echocardiography and cardiac magnetic resonance imaging. Reviews in Cardiovascular Medicine. doi:10.31083/?
• Joseph, J. J., Ortiz, R., Acharya, T., Golden, S. H., López, L., & Deedwania, P. (2021). Cardiovascular Impact of Race and Ethnicity in Patients With Diabetes and Obesity: JACC Focus Seminar 2/9. Journal of the American College of Cardiology, 78(24), 2471-2482.
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  Obesity and type 2 diabetes mellitus are highly prevalent and increasing in the United States among racial/ethnic minority groups. Type 2 diabetes mellitus, which is driven by many factors including elevated levels of adiposity, is an exemplar health disparities disease. Pervasive disparities exist at every level from risk factors through outcomes for U.S. racial/ethnic minority groups, including African American, Hispanic/LatinX American, and Asian American populations. Disparities in clinical care exist including hemoglobin A1c control, lower prescription rates of newer antihyperglycemic medications, along with greater rates of complications postbariatric surgery. Underpinning these disparities are the social determinants of health affecting provider-patient interactions, access to resources, and healthy built environments. We review the best practices to address cardiometabolic disparities in the current cardiovascular guidelines and describe recommendations for cross-cutting strategies to advance equity in obesity and type 2 diabetes across U.S. racial/ethnic groups.
• Acharya, T., & Deedwania, P. (2020). Cardiovascular outcome trials of the newer anti-diabetic medications. Progress in cardiovascular diseases, 62(4), 342-348.
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  Concerns of elevated cardiovascular disease (CVD) risk with some anti-diabetic medications warranted phase 4 clinical trials to demonstrate CVD safety of newly marketed anti-diabetic drugs. Although initially designed to evaluate safety, some of these CVD outcome trials (CVOTs) have in fact shown CVD benefits. New medication classes, like glucagon-like peptide 1 (GLP-1) analogues and sodium-glucose co-transporter 2 (SGLT2) inhibitors, have shown reductions in the risk of major adverse cardiovascular events (MACE) including, myocardial infarction, stroke, CV death, and heart failure (HF). Perhaps more importantly, SGLT2 inhibitors demonstrated reduction in the risk of HF hospitalizations, being the first class of anti-diabetic drugs to do so. Conversely, dipeptidyl peptidase 4 (DPP-4) inhibitors did not significantly affect atherosclerotic CVD end-points and some actually increased the risk of HF hospitalizations. Further, the adverse/beneficial CVD effects of these medications may not be class specific. This review focuses on the main results of these CVOTs while highlighting the heterogeneity of CVD end-points within each class and discusses important mechanistic insights and adverse effect profiles.
• Groves, D. W., Acharya, T., Steveson, C., Schuzer, J. L., Rollison, S. F., Nelson, E. A., Sirajuddin, A., Sathya, B., Bronson, K., Shanbhag, S. M., & Chen, M. Y. (2020). Performance of single-energy metal artifact reduction in cardiac computed tomography: A clinical and phantom study. Journal of cardiovascular computed tomography, 14(6), 510-515.
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  To investigate the performance of a reconstruction algorithm, single-energy metal artifact reduction (SEMAR), against standard reconstruction in cardiac computed tomography (CT) studies of patients with implanted metal and in a defibrillator lead phantom.
• Hu-Wang, E., Kureshi, F., Leifer, E. S., Acharya, T., Sathya, B., Yu, J. H., Groves, D. W., Bandettini, W. P., Shanbhag, S. M., & Chen, M. Y. (2020). Comparison of professional medical society guidelines for appropriate use of coronary computed tomography angiography. Journal of cardiovascular computed tomography, 14(6), 478-482.
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  Multiple appropriate use criteria (AUC) exist for the evaluation of coronary artery disease (CAD), but there is little data on the agreement between AUC from different professional medical societies. The aim of this study is to compare the appropriateness of coronary computed tomography angiography (CCTA) exams assessed using multimodality AUC from the American College of Cardiology Foundation (ACCF) versus the American College of Radiology (ACR).
• Shenoy, S., Singh, A., & Acharya, T. (2021). Incidental isolated septal infarct in a young patient with colon cancer. European heart journal.
• Siordia, J., Angus, C., Shenoy, S., Acharya, T., & Lassar, T. (2020). Stress-Induced NSTEMI Reveals Absent Left Main and Mid Left Anterior Descending Arteries. Cath Lab Digest, 28(7).
• Acharya, T., Launer, L., & Arai, A. E. (2019). Interpreting the Prognostic Value of Unrecognized Myocardial Infarction Among Older Adults-Reply. JAMA cardiology, 4(4), 391-392.
• Deedwania, P., & Acharya, T. (2019). Cardiovascular Protection with Anti-hyperglycemic Agents. American journal of cardiovascular drugs : drugs, devices, and other interventions, 19(3), 249-257.
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  Diabetes mellitus is a major risk factor for cardiovascular (CV) disease. Conversely, CV disease is responsible for a majority of the deaths in patients with diabetes. Many drug trials have concentrated on blood glucose (hemoglobin A) reduction. This strategy, while reducing microvascular outcomes like nephropathy and neuropathy, has little or no effect on reducing macrovascular events like heart attack, stroke, and heart failure. It has been postulated that hypoglycemia may counterbalance some of the beneficial effects of anti-hyperglycemic agents, but this is not proven. Further, trial evidence for thiazolidinediones (rosiglitazone and pioglitazone) showed increased risk of heart failure and raised concerns about increased myocardial infarction. This heightened awareness of potentially harmful CV effects of otherwise effective hypoglycemic drugs resulted in regulatory mandates for CV outcome trials to ascertain the safety of newer anti-hypoglycemic agents appearing on the market. Three new classes of anti-hyperglycemic agents have been introduced in recent years. While dipeptidyl peptidase-4 (DPP-4) inhibitors exhibited increased heart failure hospitalization in the SAVOR-TIMI 53 trial evaluating saxagliptin and in the secondary analysis of the EXAMINE trial for alogliptin, the effects of glucagon-like peptide-1 (GLP-1) analogs and sodium-glucose co-transporter-2 (SGLT2) inhibitors on CV outcomes in diabetes have largely been positive. The LEADER and SUSTAIN-6 trials evaluating the safety and efficacy of the GLP-1 analogs liraglutide and semaglutide, respectively, showed a statistically significant reduction in the primary outcome (major adverse cardiac events [MACE]: CV death, myocardial infarction, and stroke) and the secondary combined outcome when compared to placebo. Results of the TECOS trial for sitagliptin were, however, neutral (no net CV benefit or harm), questioning the class effect of GLP-1 analogs. Results of the SGLT2 inhibitor trials were more uniform. While EMPA-REG (evaluating empagliflozin) and CANVAS (evaluating canagliflozin) showed a reduction in the MACE end point, dapagliflozin had a net neutral effect on MACE in DECLARE-TIMI 58. All three SGLT2 inhibitors, however, showed a significant reduction in heart failure hospitalizations. Although initially designed to keep potentially harmful anti-hyperglycemic agents off the market, the CV outcome trials have provided clinicians with a new set of anti-hyperglycemic drugs with proven CV benefit in patients with diabetes and CV disease, thus expanding the field of CV secondary prevention. There is a need to inculcate GLP-1 analogs and SGLT2 inhibitors that reduce major CV events and heart failure hospitalizations (alongside lifestyle management and metformin) in the treatment of patients with diabetes and CV disease.
• Groves, D. W., Acharya, T., Shanbhag, S. M., Bandettini, W. P., Arai, A. E., & Chen, M. Y. (2019). Dynamic nature of caseous mitral annular calcification. Journal of cardiovascular computed tomography, 12(5), 444-446.
• Katikireddy, C. K., & Acharya, T. (2019). Myocardial segmental thickness variability on echocardiography is a highly sensitive and specific marker to distinguish ischemic and non-ischemic dilated cardiomyopathy in new onset heart failure. The international journal of cardiovascular imaging, 35(5), 791-798.
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  The aim of this study was to determine non-invasive diagnostic markers by echocardiography that differentiate ischemic dilated (ICM) from non-ischemic dilated cardiomyopathy (NICM) in patients with new onset heart failure. We identified 100 consecutive new heart failure patients with dilated cardiomyopathy (valvular etiology excluded). Clinical risk factors, medication history, serum biomarkers, ECG and echocardiographic variables were compared between the ICM and NICM groups (as confirmed by coronary angiography). Mean age, left ventricular size and ejection fraction were 56 years, 6.1 cm and 26% respectively. A total of 24% had ICM. Patients with ICM were older (65 vs. 53 years; P 
• Katikireddy, C. K., Singh, M., Muhyieddeen, K., Acharya, T., Ambrose, J. A., & Samim, A. (2019). Left Atrial Area and Right Ventricle Dimensions in Non-gated Axial Chest CT can Differentiate Pulmonary Hypertension Due to Left Heart Disease from Other Causes. Journal of cardiovascular computed tomography, 10(3), 246-50.
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  It is unknown whether axial non-gated CT can distinguish World Health Organization Group 2 pulmonary hypertension (pulmonary hypertension due to left heart disease) from non-Group 2 pulmonary hypertension.
• Acharya, T., Aspelund, T., Jonasson, T. F., Schelbert, E. B., Cao, J. J., Sathya, B., Dyke, C. K., Aletras, A. H., Sigurdsson, S., Thorgeirsson, G., Eiriksdottir, G., Harris, T., Launer, L. J., Gudnason, V., & Arai, A. E. (2018). Association of Unrecognized Myocardial Infarction With Long-term Outcomes in Community-Dwelling Older Adults: The ICELAND MI Study. JAMA cardiology, 3(11), 1101-1106.
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  Cardiac magnetic resonance (CMR) imaging can identify unrecognized myocardial infarction (UMI) in the general population. Unrecognized myocardial infarction by CMR portends poor prognosis in the short term but, to our knowledge, long-term outcomes are not known.
• Acharya, T., Patricia Bandettini, W., Arai, A. E., & Chen, M. Y. (2018). The pulmonary embolism that wasn't: a case of pulmonary pseudosequestration. European heart journal cardiovascular Imaging, 19(11), 1310.
• Acharya, T., Deewania, P., Kotak, K., Fonarow, G. C., Cannon, C. P., Laskey, W. K., Peacock, W. F., Pan, W., & Bhatt, D. L. (2017). Compliance with Guideline Directed Therapy in Diabetic Patients Admitted with Acute Coronary Syndrome: Findings from AHA Get with the Guidelines – Coronary Artery Disease Program. American Heart Journal, 78-87.
• Acharya, T., Salisbury, A. C., Spertus, J. A., Kennedy, K. F., Bhullar, A., Reddy, H. K., Joshi, B. K., & Ambrose, J. A. (2017). In-Hospital Outcomes of Percutaneous Coronary Intervention in America's Safety Net: Insights From the NCDR Cath-PCI Registry. JACC. Cardiovascular interventions, 10(15), 1475-1485.
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  This study compared risk-adjusted percutaneous coronary intervention (PCI) outcomes of safety-net hospitals (SNHs) and non-SNHs.
• Deedwania, P., & Acharya, T. (2017). Anticoagulation in Atrial Fibrillation: Is the Paradigm Really Shifting?. Journal of the American College of Cardiology, 69(7), 786-788.
• Deedwania, P., & Acharya, T. (2017). Hearty Breakfast for Healthier Arteries. Journal of the American College of Cardiology, 70(15), 1843-1845.
• Deedwania, P., Acharya, T., Kotak, K., Fonarow, G. C., Cannon, C. P., Laskey, W. K., Peacock, W. F., Pan, W., Bhatt, D. L., & , G. S. (2017). Compliance with guideline-directed therapy in diabetic patients admitted with acute coronary syndrome: Findings from the American Heart Association's Get With The Guidelines-Coronary Artery Disease (GWTG-CAD) program. American heart journal, 187, 78-87.
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  To evaluate and compare baseline characteristics, outcomes and compliance with guideline based therapy at discharge among diabetic and non-diabetic patients admitted with acute coronary syndromes (ACS).
• LaRocca, G., Aspelund, T., Greve, A. M., Eiriksdottir, G., Acharya, T., Thorgeirsson, G., Harris, T. B., Launer, L. J., Gudnason, V., & Arai, A. E. (2017). Fibrosis as measured by the biomarker, tissue inhibitor metalloproteinase-1, predicts mortality in Age Gene Environment Susceptibility-Reykjavik (AGES-Reykjavik) Study. European heart journal, 38(46), 3423-3430.
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  Fibrosis is a key pathological process in many chronic inflammatory disease states.
• Acharya, T., Huang, J., Tringali, S., Frei, C. R., Mortensen, E. M., & Mansi, I. A. (2016). Statin Use and the Risk of Kidney Disease With Long-Term Follow-Up (8.4-Year Study). The American journal of cardiology, 117(4), 647-655.
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  Few studies have examined long-term effects of statin therapy on kidney diseases. The objective of this study was to determine the association of statin use with incidence of acute and chronic kidney diseases after prolonged follow-up. In this retrospective cohort study, we analyzed data from the San Antonio area military health care system from October 2003 through March 2012. Statin users were propensity score matched to nonusers using 82 baseline characteristics including demographics, co-morbidities, medications, and health care utilization. Study outcomes were acute kidney injury, chronic kidney disease (CKD), and nephritis/nephrosis/renal sclerosis. Of the 43,438 subjects included, we propensity score matched 6,342 statin users with 6,342 nonusers. Statin users had greater odds of acute kidney injury (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.14 to 1.48), CKD (OR 1.36, 95% CI 1.22 to 1.52), and nephritis/nephrosis/renal sclerosis (OR 1.35, 95% CI 1.05 to 1.73). In a subset of patients without co-morbidities, the association of statin use with CKD remained significant (OR 1.53, 95% CI 1.27 to 1.85). In a secondary analysis, adjusting for diseases/conditions that developed during follow-up weakened this association. In conclusion, statin use is associated with increased incidence of acute and chronic kidney disease. These findings are cautionary and suggest that long-term effects of statins in real-life patients may differ from shorter term effects in selected clinical trial populations.
• Ambrose, J. A., Acharya, T., & Roberts, M. J. (2016). Finding the High-Risk Patient in Primary Prevention Is Not as Easy as a Conventional Risk Score!. The American journal of medicine, 129(12), 1329.e1-1329.e7.
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  Patients with coronary artery disease or its equivalent are an appropriate target for guideline-directed therapy. However, finding and treating the individuals at risk for myocardial infarction or sudden death in primary prevention has been problematic. Most initial cardiovascular events are acute syndromes, and only a minority of these occurs in those deemed high risk by contemporary algorithms. Even newer noninvasive modalities cannot detect a majority of those at risk. Furthermore, accurate and early detection of high risk/vulnerability does not guarantee event prevention. Until new tools can be identified, one should consider a few simplistic solutions. In addition to a greater emphasis on lifestyle, earlier use of statins than currently recommended and a direct assault on tobacco could go a long way in reducing acute syndromes and cardiovascular mortality. To achieve the tobacco goal, the medical community would have to be directly and communally engaged.
• Deedwania, P., & Acharya, T. (2016). Clinical Implications of Recent Therapeutic Trials in Hypertension: Insights from SPRINT and HOPE-3 Trials. Hypertension Journal, 4, 194-199.
• Deedwania, P., & Acharya, T. (2016). Mechanical Circulatory Support and Rationale for Future Research-Reply. JAMA internal medicine, 176(5), 715-6.
• Acharya, T., & Deedwania, P. (2015). An evidence-based review of edoxaban and its role in stroke prevention in patients with nonvalvular atrial fibrillation. Core evidence, 10, 63-73.
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  Atrial fibrillation is the most common arrhythmia in the elderly. It is responsible for significant morbidity and mortality from cardioembolic complications like stroke. As a result, atrial fibrillation patients are risk-stratified using the CHADS2 or CHA2DS2-VASc scoring systems. Those at intermediate-to-high risk have traditionally been treated with therapeutic anticoagulation with warfarin for stroke prevention. Although effective, warfarin use is fraught with multiple concerns, such as a narrow therapeutic window, drug-drug and drug-food interactions, and excessive bleeding. Novel oral anticoagulant agents have recently become available as viable alternatives for warfarin therapy. Direct thrombin inhibitor dabigatran and factor Xa inhibitors like rivaroxaban and apixaban have already been approved by the US Food and Drug Administration (FDA) for stroke prevention in patients with nonvalvular atrial fibrillation. Edoxaban is the latest oral direct factor Xa inhibitor studied in the largest novel oral anticoagulant trial so far: ENGAGE AF-TIMI 48. Treatment with a 30 mg or 60 mg daily dose of edoxaban was found to be noninferior to dose-adjusted warfarin in reducing the rate of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, with a lower incidence of bleeding complications and cardiovascular deaths. Edoxaban was recently reviewed by an FDA advisory committee and recommended as a stroke-prophylaxis agent. Once approved, it promises to provide another useful alternative to warfarin therapy.
• Acharya, T., Tringali, S., Bhullar, M., Nalbandyan, M., Ilineni, V. K., Carbajal, E., & Deedwania, P. (2015). Frequent Atrial Premature Complexes and Their Association With Risk of Atrial Fibrillation. The American journal of cardiology, 116(12), 1852-7.
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  Identification of precursors of atrial fibrillation (AF) may lead to early detection and prevent associated morbidity and mortality. This study aimed to examine the association between frequent atrial premature complexes (APCs) and incidence of AF. For this retrospective cohort study, we analyzed Holter recordings obtained from 2000 to 2010 of 1,357 veterans free of AF at baseline. All pertinent data in electronic medical records were reviewed to ascertain baseline characteristics. Holter groups with frequent (≥100/day) and infrequent (
• Ambrose, J. A., & Acharya, T. (2015). Reducing acute coronary events: the solution is not so difficult!. The American journal of medicine, 128(2), 105-6.
• Deedwania, P., & Acharya, T. (2015). Is Increased Use of Mechanical Circulatory Support Devices Justified? A Cause for Concern. JAMA internal medicine, 175(12), 1982-3.
• Acharya, T., Tringali, S., Singh, M., & Huang, J. (2014). Resistant hypertension and associated comorbidities in a veterans affairs population. Journal of clinical hypertension (Greenwich, Conn.), 16(10), 741-5.
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  Resistant hypertension (RH) is understudied and its reported prevalence varies with study populations. The authors sought to determine its prevalence and association with certain comorbid conditions in a Veterans Affairs population. This cross-sectional study utilized demographic and clinical data from 17,466 patients. Chi-square or t test was used for comparing groups with and without RH. Multivariate logistic regression analysis was used to determine independent associations. Overall, the prevalence of RH was 9%, and 13% of all hypertensive patients met criteria for RH. After adjusting for confounding variables, RH was significantly associated with older age (odds ratio [OR], 1.007), higher body mass index (OR, 1.04), Framingham score (OR, 1.14), and coexisting coronary artery disease, cerebrovascular accident/transient ischemic attack, peripheral vascular disease, congestive heart failure, chronic kidney disease, diabetes mellitus, erectile dysfunction, and metabolic syndrome (OR, 1.3, 1.32, 1.29, 2.88, 2.13, 1.2, 1.12, and 1.2, respectively; all P
• Acharya, T., Acharya, S., Tringali, S., & Huang, J. (2013). Association of antidepressant and atypical antipsychotic use with cardiovascular events and mortality in a veteran population. Pharmacotherapy, 33(10), 1053-61.
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  To determine the patterns of antidepressant and atypical antipsychotic use in a veteran population with depression, and to determine if an association exists between specific antidepressant classes and atypical antipsychotics and the occurrence of cardiovascular events and all-cause mortality.

Presentations

• Acharya, T. (2021, July). Coronary CTA/CT FFR. Non-Invasive Diagnostic Cardiology Conference.

Poster Presentations

• Acharya, T., Leifer, E. S., Aspelund, T., Eiriksdottir, G., Harris, T., Launer, L. J., Gudnason, V., & Arai, A. E. (2018, Sprin). High-Sensitivity Troponin Assays Exhibit Prohibitively High False Positive Rates for Myocardial Infarction in the Elderly - Findings from the AGES Reykjavik Study. American College of Cardiology Annual Scientific Session. Orlando, FL.
• Hu-Wang, E., Acharya, T., Sathya, B., Kureshi, F., Rollison, S., Bronson, K., Bandettini, W. P., Shanbhag, S., & Chen, M. (2018, Spring). Prevalence of layered testing for coronary artery disease and cost analysis of coronary computed tomography angiography as the initial diagnostic test. American College of Cardiology Scientific Session. Orlando, FL.
• Acharya, T., Khoury, P., Sirajuddin, A., Marcus, Y., Chen, A., & Bandettini, W. P. (2017, Spring). Infiltrative aortitis causing sinus of Valsalva pseudoaneurysm in a patient with lymphocytic variant hypereosinophilic syndrome. Society of Cardiovascular Magnetic Resonance 20th Annual Scientific Session. Washington, DC.

Others

• Acharya, T., & Deewania, P. (2019, May). The Role of Newer Anti-Diabetic Drugs in Cardiovascular Disease.. American College of Cardiology website. http://www.acc.org/latest-in-cardiology/articles/2018/05/22/16/59/the-role-of-newer-anti-diabetic-drugs-in-cv-disease
• Acharya, T., & Deewania, P. (2016, March). Comprehensive Cardiovascular Risk Factor Control Improves Survival in Patients With Diabetes and Ischemic Heart Disease: The BARI 2D Trial. American College of Cardiology website. http://www.acc.org/latest-in-cardiology/articles/2016/03/08/11/54/comprehensive-cv-risk-factor-control-improves-survival-in-patients-with-diabetes-and-ihd?w_nav=LC#sthash.CC4i2JVE.dpuf.