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Michel Georges Khouri

Associate Professor of Medicine
Medicine, Cardiology
Duke South Clinic, Box 3254 DUMC, Durham, NC 27710

Selected Publications


Cardiovascular Burden of the V142I Transthyretin Variant.

Journal Article JAMA · June 4, 2024 IMPORTANCE: Individual cohort studies concur that the amyloidogenic V142I variant of the transthyretin (TTR) gene, present in 3% to 4% of US Black individuals, increases heart failure (HF) and mortality risk. Precisely defining carrier risk across relevant ... Full text Link to item Cite

Factors Associated With Coronary Angiography Performed Within 6 Months of Randomization to the Conservative Strategy in the ISCHEMIA Trial.

Journal Article Circ Cardiovasc Interv · June 2024 BACKGROUND: ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) did not find an overall reduction in cardiovascular events with an initial invasive versus conservative management strategy in chronic coron ... Full text Link to item Cite

The Cardiac Amyloidosis Registry Study (CARS): Rationale, Design and Methodology.

Journal Article J Card Fail · May 2024 BACKGROUND: CARS (Cardiac Amyloidosis Registry Study) is a multicenter registry established in 2019 that includes patients with transthyretin (ATTR, wild-type and variant) and light chain (AL) cardiac amyloidosis (CA) evaluated at major amyloidosis centers ... Full text Link to item Cite

Transthyretin amyloid cardiomyopathy among patients hospitalized for heart failure and performance of an adapted wild-type ATTR-CM machine learning model: Findings from GWTG-HF.

Conference Am Heart J · November 2023 BACKGROUND: An 11-factor random forest model has been developed among ambulatory heart failure (HF) patients for identifying potential wild-type amyloidogenic TTR cardiomyopathy (wtATTR-CM). The model has not been evaluated in a large sample of patients ho ... Full text Open Access Link to item Cite

Evaluation of Myocardial Stiffness in Cardiac Amyloidosis Using Acoustic Radiation Force Impulse and Natural Shear Wave Imaging.

Journal Article Ultrasound Med Biol · August 2023 OBJECTIVE: Increased myocardial stiffness (MS) is an important hallmark of cardiac amyloidosis (CA) caused by myocardial amyloid deposition. Standard echocardiography metrics assess MS indirectly via downstream effects of cardiac stiffening. The ultrasound ... Full text Link to item Cite

Pressures do not equal volumes: implications for heart failure management in patients with CardioMEMS.

Journal Article ESC Heart Fail · February 2023 Pulmonary arterial pressures are often used as surrogates for intravascular blood volume. However, the relationship between pressure and volume remains controversial. To contextualize and provide concrete examples and impact on clinical management, we repo ... Full text Link to item Cite

Cardiometabolic Comorbidities in Cancer Survivors: JACC: CardioOncology State-of-the-Art Review.

Journal Article JACC CardioOncol · June 2022 There are nearly 17 million cancer survivors in the United States, including those who are currently receiving cancer therapy with curative intent and expected to be long-term survivors, as well as those with chronic cancers such as metastatic disease or c ... Full text Open Access Link to item Cite

A randomized controlled trial comparing changes in fitness with or without supervised exercise in patients initiated on enzalutamide and androgen deprivation therapy for non-metastatic castration-sensitive prostate cancer (EXTEND).

Journal Article Prostate Cancer Prostatic Dis · March 2022 BACKGROUND: Androgen deprivation therapy (ADT) and androgen receptor signaling inhibitors (ARSI) are associated with deleterious physical effects, which exercise may mitigate; however, exercise has never been studied in patients initiating treatment with A ... Full text Link to item Cite

Leveraging Clinical Informatics Tools to Extract Cumulative Anthracycline Exposure, Measure Cardiovascular Outcomes, and Assess Guideline Adherence for Children With Cancer.

Journal Article JCO Clin Cancer Inform · October 2021 PURPOSE: Cardiovascular disease is a significant cause of late morbidity and mortality in survivors of childhood cancer. Clinical informatics tools could enhance provider adherence to echocardiogram guidelines for early detection of late-onset cardiomyopat ... Full text Link to item Cite

Natural History of Patients With Ischemia and No Obstructive Coronary Artery Disease: The CIAO-ISCHEMIA Study.

Journal Article Circulation · September 28, 2021 BACKGROUND: Ischemia with no obstructive coronary artery disease (INOCA) is common and has an adverse prognosis. We set out to describe the natural history of symptoms and ischemia in INOCA. METHODS: CIAO-ISCHEMIA (Changes in Ischemia and Angina over One Y ... Full text Link to item Cite

Electrical storm in patients with left ventricular assist devices: Risk factors, incidence, and impact on survival.

Journal Article Heart Rhythm · August 2021 BACKGROUND: Ventricular arrhythmias (VAs) and electrical storm (ES) are recognized complications following left ventricular assist device (LVAD) implantation; however, their association with long term-outcomes remains poorly understood. OBJECTIVE: The purp ... Full text Link to item Cite

Initial Invasive Versus Conservative Management of Stable Ischemic Heart Disease in Patients With a History of Heart Failure or Left Ventricular Dysfunction: Insights From the ISCHEMIA Trial.

Journal Article Circulation · November 3, 2020 BACKGROUND: Whether an initial invasive strategy in patients with stable ischemic heart disease and at least moderate ischemia improves outcomes in the setting of a history of heart failure (HF) or left ventricular dysfunction (LVD) when ejection fraction ... Full text Link to item Cite

Cardiovascular Burden of the V142I Transthyretin Variant.

Journal Article JAMA · June 4, 2024 IMPORTANCE: Individual cohort studies concur that the amyloidogenic V142I variant of the transthyretin (TTR) gene, present in 3% to 4% of US Black individuals, increases heart failure (HF) and mortality risk. Precisely defining carrier risk across relevant ... Full text Link to item Cite

Factors Associated With Coronary Angiography Performed Within 6 Months of Randomization to the Conservative Strategy in the ISCHEMIA Trial.

Journal Article Circ Cardiovasc Interv · June 2024 BACKGROUND: ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) did not find an overall reduction in cardiovascular events with an initial invasive versus conservative management strategy in chronic coron ... Full text Link to item Cite

The Cardiac Amyloidosis Registry Study (CARS): Rationale, Design and Methodology.

Journal Article J Card Fail · May 2024 BACKGROUND: CARS (Cardiac Amyloidosis Registry Study) is a multicenter registry established in 2019 that includes patients with transthyretin (ATTR, wild-type and variant) and light chain (AL) cardiac amyloidosis (CA) evaluated at major amyloidosis centers ... Full text Link to item Cite

Transthyretin amyloid cardiomyopathy among patients hospitalized for heart failure and performance of an adapted wild-type ATTR-CM machine learning model: Findings from GWTG-HF.

Conference Am Heart J · November 2023 BACKGROUND: An 11-factor random forest model has been developed among ambulatory heart failure (HF) patients for identifying potential wild-type amyloidogenic TTR cardiomyopathy (wtATTR-CM). The model has not been evaluated in a large sample of patients ho ... Full text Open Access Link to item Cite

Evaluation of Myocardial Stiffness in Cardiac Amyloidosis Using Acoustic Radiation Force Impulse and Natural Shear Wave Imaging.

Journal Article Ultrasound Med Biol · August 2023 OBJECTIVE: Increased myocardial stiffness (MS) is an important hallmark of cardiac amyloidosis (CA) caused by myocardial amyloid deposition. Standard echocardiography metrics assess MS indirectly via downstream effects of cardiac stiffening. The ultrasound ... Full text Link to item Cite

Pressures do not equal volumes: implications for heart failure management in patients with CardioMEMS.

Journal Article ESC Heart Fail · February 2023 Pulmonary arterial pressures are often used as surrogates for intravascular blood volume. However, the relationship between pressure and volume remains controversial. To contextualize and provide concrete examples and impact on clinical management, we repo ... Full text Link to item Cite

Cardiometabolic Comorbidities in Cancer Survivors: JACC: CardioOncology State-of-the-Art Review.

Journal Article JACC CardioOncol · June 2022 There are nearly 17 million cancer survivors in the United States, including those who are currently receiving cancer therapy with curative intent and expected to be long-term survivors, as well as those with chronic cancers such as metastatic disease or c ... Full text Open Access Link to item Cite

A randomized controlled trial comparing changes in fitness with or without supervised exercise in patients initiated on enzalutamide and androgen deprivation therapy for non-metastatic castration-sensitive prostate cancer (EXTEND).

Journal Article Prostate Cancer Prostatic Dis · March 2022 BACKGROUND: Androgen deprivation therapy (ADT) and androgen receptor signaling inhibitors (ARSI) are associated with deleterious physical effects, which exercise may mitigate; however, exercise has never been studied in patients initiating treatment with A ... Full text Link to item Cite

Leveraging Clinical Informatics Tools to Extract Cumulative Anthracycline Exposure, Measure Cardiovascular Outcomes, and Assess Guideline Adherence for Children With Cancer.

Journal Article JCO Clin Cancer Inform · October 2021 PURPOSE: Cardiovascular disease is a significant cause of late morbidity and mortality in survivors of childhood cancer. Clinical informatics tools could enhance provider adherence to echocardiogram guidelines for early detection of late-onset cardiomyopat ... Full text Link to item Cite

Natural History of Patients With Ischemia and No Obstructive Coronary Artery Disease: The CIAO-ISCHEMIA Study.

Journal Article Circulation · September 28, 2021 BACKGROUND: Ischemia with no obstructive coronary artery disease (INOCA) is common and has an adverse prognosis. We set out to describe the natural history of symptoms and ischemia in INOCA. METHODS: CIAO-ISCHEMIA (Changes in Ischemia and Angina over One Y ... Full text Link to item Cite

Electrical storm in patients with left ventricular assist devices: Risk factors, incidence, and impact on survival.

Journal Article Heart Rhythm · August 2021 BACKGROUND: Ventricular arrhythmias (VAs) and electrical storm (ES) are recognized complications following left ventricular assist device (LVAD) implantation; however, their association with long term-outcomes remains poorly understood. OBJECTIVE: The purp ... Full text Link to item Cite

Initial Invasive Versus Conservative Management of Stable Ischemic Heart Disease in Patients With a History of Heart Failure or Left Ventricular Dysfunction: Insights From the ISCHEMIA Trial.

Journal Article Circulation · November 3, 2020 BACKGROUND: Whether an initial invasive strategy in patients with stable ischemic heart disease and at least moderate ischemia improves outcomes in the setting of a history of heart failure (HF) or left ventricular dysfunction (LVD) when ejection fraction ... Full text Link to item Cite

Catheter ablation of atrial fibrillation in cardiac amyloidosis.

Journal Article Pacing Clin Electrophysiol · September 2020 BACKGROUND: Cardiac amyloidosis is a progressive infiltrative disease involving deposition of amyloid fibrils in the myocardium and cardiac conduction system that frequently manifests with heart failure (HF) and arrhythmias, most frequently atrial fibrilla ... Full text Link to item Cite

Cardiac Implantable Electronic Devices: A Window Into the Evolution of Conduction Disease in Cardiac Amyloidosis.

Journal Article JACC Clin Electrophysiol · September 2020 OBJECTIVES: This study characterized the relationship between conduction disease and cardiac amyloidosis (CA) through longitudinal analysis of cardiac implantable electronic device (CIED) data. BACKGROUND: Bradyarrhythmias and tachyarrhythmias are commonly ... Full text Link to item Cite

Identification of Undetected Monogenic Cardiovascular Disorders.

Journal Article J Am Coll Cardiol · August 18, 2020 BACKGROUND: Monogenic diseases are individually rare but collectively common, and are likely underdiagnosed. OBJECTIVES: The purpose of this study was to estimate the prevalence of monogenic cardiovascular diseases (MCVDs) and potentially missed diagnoses ... Full text Link to item Cite

Outcomes following cardioversion for patients with cardiac amyloidosis and atrial fibrillation or atrial flutter.

Journal Article American heart journal · April 2020 Atrial arrhythmias commonly occur in patients with cardiac amyloidosis (CA), but there is limited data on safety or efficacy of cardioversion (DCCV) for management of these rhythms in CA. We identified 25 patients with CA (20 with transthyretin (TTR) and 5 ... Full text Cite

Effects of Exercise Therapy Dosing Schedule on Impaired Cardiorespiratory Fitness in Patients With Primary Breast Cancer: A Randomized Controlled Trial.

Journal Article Circulation · February 18, 2020 BACKGROUND: Current exercise guidelines for clinical populations recommend an exercise therapy (ET) prescription of fixed intensity (moderate), duration (40-50 minutes per session), and volume (120-160 min/wk). A critical overarching element of exercise pr ... Full text Link to item Cite

Best Practices for Prognostic Evaluation of a Patient With Transthyretin Amyloid Cardiomyopathy.

Journal Article JACC CardioOncol · December 2019 Transthyretin amyloid cardiomyopathy (ATTR-CM) has emerged as an increasingly identified etiology of heart failure. Fortunately, the disease now has an approved therapy, with many others under development. Assessment of prognosis in ATTR-CM is critical to ... Full text Open Access Link to item Cite

Baseline Characteristics and Risk Profiles of Participants in the ISCHEMIA Randomized Clinical Trial.

Journal Article JAMA Cardiol · March 1, 2019 IMPORTANCE: It is unknown whether coronary revascularization, when added to optimal medical therapy, improves prognosis in patients with stable ischemic heart disease (SIHD) at increased risk of cardiovascular events owing to moderate or severe ischemia. O ... Full text Link to item Cite

High-Density Lipoprotein Particle Subfractions in Heart Failure With Preserved or Reduced Ejection Fraction.

Journal Article J Am Coll Cardiol · January 22, 2019 BACKGROUND: Circulating high-density lipoprotein particle (HDL-P) subfractions impact atherogenesis, inflammation, and endothelial function, all of which are implicated in the pathobiology of heart failure (HF). OBJECTIVES: The authors sought to identify k ... Full text Link to item Cite

Echocardiography Core Laboratory Reproducibility of Cardiac Safety Assessments in Cardio-Oncology.

Journal Article J Am Soc Echocardiogr · March 2018 BACKGROUND: As the potential for cancer therapy-related cardiac dysfunction is increasingly recognized, there is a need for the standardization of echocardiographic measurements and cut points to guide treatment. The aim of this study was to determine the ... Full text Link to item Cite

Efficacy and Safety of Apixaban Versus Warfarin in Patients with Atrial Fibrillation and a History of Cancer: Insights from the ARISTOTLE Trial.

Conference Am J Med · December 2017 BACKGROUND: Cancer is associated with a prothrombotic state and increases the risk of thrombotic events in patients with atrial fibrillation. We described the clinical characteristics and outcomes and assessed the safety and efficacy of apixaban versus war ... Full text Link to item Cite

Left ventricular global longitudinal strain in patients with heart failure with preserved ejection fraction: outcomes following an acute heart failure hospitalization.

Conference ESC Heart Fail · November 2017 AIMS: While abnormal resting LV GLS has been described in patients with chronic heart failure with preserved ejection fraction (HFpEF), its prognostic significance when measured during an acute heart failure hospitalization remains unclear. We assessed the ... Full text Link to item Cite

Assessment of cardiac allograft systolic function by global longitudinal strain: From donor to recipient.

Conference Clin Transplant · May 2017 BACKGROUND: Cardiac allografts are routinely evaluated by left ventricular ejection fraction (LVEF) before and after transplantation. However, myocardial deformation analyses with LV global longitudinal strain (GLS) are more sensitive for detecting impaire ... Full text Link to item Cite

Cardiac Dysfunction and Heart Failure in Hematopoietic Cell Transplantation Survivors: Emerging Paradigms in Pathophysiology, Screening, and Prevention.

Journal Article Heart Fail Clin · April 2017 Hematopoietic cell transplantation (HCT) has been used for curative intent in patients with hematologic and nonhematologic malignancies, resulting in an increasing number of HCT survivors. These survivors are at risk for serious and life-threatening compli ... Full text Link to item Cite

Efficacy and Safety of Tolvaptan in Patients Hospitalized With Acute Heart Failure.

Journal Article J Am Coll Cardiol · March 21, 2017 BACKGROUND: The oral vasopressin-2 receptor antagonist tolvaptan causes aquaresis in patients with volume overload, potentially facilitating decongestion and improving the clinical course of patients with acute heart failure (AHF). OBJECTIVES: The TACTICS- ... Full text Link to item Cite

Metabolomic Profiling Identifies Novel Circulating Biomarkers of Mitochondrial Dysfunction Differentially Elevated in Heart Failure With Preserved Versus Reduced Ejection Fraction: Evidence for Shared Metabolic Impairments in Clinical Heart Failure.

Journal Article J Am Heart Assoc · July 29, 2016 BACKGROUND: Metabolic impairment is an important contributor to heart failure (HF) pathogenesis and progression. Dysregulated metabolic pathways remain poorly characterized in patients with HF and preserved ejection fraction (HFpEF). We sought to determine ... Full text Open Access Link to item Cite

Ventricular-Arterial Coupling in Breast Cancer Patients After Treatment With Anthracycline-Containing Adjuvant Chemotherapy.

Conference Oncologist · February 2016 BACKGROUND: Anthracycline-containing chemotherapy (Anth-C) is associated with long-term cardiovascular mortality. Although cardiovascular risk assessment has traditionally focused on the heart, evidence has demonstrated that vascular dysfunction also occur ... Full text Link to item Cite

Association of a 4-Tiered Classification of LV Hypertrophy With Adverse CV Outcomes in the General Population.

Journal Article JACC Cardiovasc Imaging · September 2015 OBJECTIVES: This study was performed to determine whether a 4-tiered classification of left ventricular hypertrophy (LVH) defines subgroups in the general population that are at variable risks of adverse cardiovascular (CV) outcomes. BACKGROUND: We recentl ... Full text Link to item Cite

Relationship Between Cancer and Cardiovascular Outcomes Following Percutaneous Coronary Intervention.

Journal Article J Am Heart Assoc · July 6, 2015 BACKGROUND: Cardiovascular disease and cancer increasingly coexist, yet relationships between cancer and long-term cardiovascular outcomes post-percutaneous coronary intervention (PCI) are not well studied. METHODS AND RESULTS: We examined stented PCI pati ... Full text Open Access Link to item Cite

Current and emerging modalities for detection of cardiotoxicity in cardio-oncology.

Journal Article Future Cardiol · July 2015 Advancements in diagnostic tools and curative-intent therapies have improved cancer-specific survival. With prolonged survival, patients are now subject to increased aging and development of cardiovascular risk factors such that further improvements in can ... Full text Link to item Cite

ECHOCARDIOGRAPHY CORE LAB REPRODUCIBILITY OF CARDIAC SAFETY ASSESSMENTS IN CARDIO-ONCOLOGY

Conference Journal of the American College of Cardiology · March 2015 Full text Cite

Pre-exercise participation cardiovascular screening in a heterogeneous cohort of adult cancer patients.

Journal Article Oncologist · September 2014 BACKGROUND: The purpose of this study was to investigate the extent of pre-exercise participation ("preparticipation") health screening in a heterogeneous cohort of adult cancer patients. METHODS: Patients (n = 413) with histologically confirmed solid or h ... Full text Link to item Cite

Safety and efficacy of aerobic training in patients with cancer who have heart failure: an analysis of the HF-ACTION randomized trial.

Journal Article J Clin Oncol · August 10, 2014 PURPOSE: To investigate the efficacy and safety of aerobic training (AT) in patients with cancer with medically stable heart failure (HF). PATIENTS AND METHODS: A retrospective analysis of 90 patients with cancer who have HF and who were randomly assigned ... Full text Link to item Cite

Effects of nonlinear aerobic training on erectile dysfunction and cardiovascular function following radical prostatectomy for clinically localized prostate cancer.

Journal Article Eur Urol · May 2014 UNLABELLED: Erectile dysfunction (ED) is a major adverse effect of radical prostatectomy (RP). We conducted a randomized controlled trial to examine the efficacy of aerobic training (AT) compared with usual care (UC) on ED prevalence in 50 men (n=25 per gr ... Full text Link to item Cite

GLOBAL LONGITUDINAL STRAIN BECOMES IMPAIRED IN CHEMOTHERAPY TREATED BREAST CANCER PATIENTS

Journal Article Journal of the American College of Cardiology · April 2014 Full text Cite

Utility of 3-dimensional echocardiography, global longitudinal strain, and exercise stress echocardiography to detect cardiac dysfunction in breast cancer patients treated with doxorubicin-containing adjuvant therapy.

Journal Article Breast Cancer Res Treat · February 2014 Conventional resting left ventricular ejection fraction (LVEF) assessments have limitations for detecting doxorubicin (DOX)-related cardiac dysfunction. Novel resting echocardiographic parameters, including 3-dimensional echocardiography (3DE) and global l ... Full text Link to item Cite

Preventing Cardiovascular Complications of Breast Cancer Treatment: The Utility of Effective Exercise Prescription

Journal Article Current Cardiovascular Risk Reports · August 1, 2013 Advances in early detection and adjuvant therapy have led to dramatic improvements in longevity following a cancer diagnosis. As a result, approximately 3 million breast cancer survivors are alive in the US, with this figure projected to increase to 3.7 mi ... Full text Cite

Exercise therapy as treatment for cardiovascular and oncologic disease after a diagnosis of early-stage cancer.

Journal Article Semin Oncol · April 2013 Advances in early detection and adjuvant therapy have led to dramatic improvements in longevity after a cancer diagnosis. As a result, there are ~13.7 million cancer survivors alive in the United States, with this figure projected to increase to 18 million ... Full text Link to item Cite

Mechanical dyssynchrony evaluated by tissue Doppler cross-correlation analysis is associated with long-term survival in patients after cardiac resynchronization therapy.

Journal Article Eur Heart J · January 2013 AIMS: Pre-implant assessment of longitudinal mechanical dyssynchrony using cross-correlation analysis (XCA) was tested for association with long-term survival and compared with other tissue Doppler imaging (TDI)-derived indices. METHODS AND RESULTS: In 131 ... Full text Link to item Cite

Variability of global left ventricular deformation analysis using vendor dependent and independent two-dimensional speckle-tracking software in adults.

Journal Article J Am Soc Echocardiogr · November 2012 BACKGROUND: Evaluation of myocardial deformation by two-dimensional speckle-tracking is useful for clinical and research purposes. However, differences may exist among different ultrasound machines, software packages, frame rates, and observers. METHODS: T ... Full text Link to item Cite

A 4-tiered classification of left ventricular hypertrophy based on left ventricular geometry: the Dallas heart study.

Journal Article Circ Cardiovasc Imaging · March 2010 BACKGROUND: Left ventricular hypertrophy (LVH) is traditionally classified as concentric or eccentric, based on the ratio of LV wall thickness to chamber dimension. We propose a 4-tiered LVH classification based on LV concentricity(0.67) (mass/end-diastoli ... Full text Link to item Cite

Assessment of age-related changes in left ventricular structure and function by freehand three-dimensional echocardiography.

Journal Article Am J Geriatr Cardiol · 2005 To determine age-related changes in left ventricular (LV) structure and function, the authors used freehand three-dimensional echocardiography, a previously validated tomographic technique, to measure LV mass, volumes, and derived parameters in 94 sedentar ... Full text Link to item Cite