Scholars@Duke
Vishal Narasinga Rao

Vishal Narasinga Rao

Adjunct Assistant Professor in the Department of Medicine
Medicine, Cardiology
2301 Erwin Road, Durham, NC 27710

Selected Publications

Heart Failure With Preserved Ejection Fraction Across the Spectrum of Body Mass Index: Hemodynamic and Echocardiographic Characteristics and Outcomes.

Journal Article JACC Heart Fail · November 17, 2025 BACKGROUND: Limited data are available on the relationship between body mass index (BMI) and heart failure (HF) physiology or clinical outcomes in patients with heart failure with preserved ejection fraction (HFpEF). OBJECTIVES: This study aims to assess t ... Full text Link to item Cite

Association of Moderate to Severe Tricuspid Regurgitation With Exercise Hemodynamics and Outcomes in Patients With Heart Failure With Preserved Ejection Fraction: Multicenter Study.

Journal Article J Card Fail · November 2025 BACKGROUND: The clinical significance of at least moderate tricuspid regurgitation (TR) during evaluation for unexplained dyspnea is unclear. This study describes the characteristics, exercise hemodynamics, and 5-year outcomes among patients with moderate ... Full text Link to item Cite

Beyond GDMT: bridging the therapeutic gap in heart failure.

Journal Article Heart Fail Rev · September 2025 Guideline-directed medical therapy is the backbone of heart failure treatment. However, patients continue to experience heart failure symptoms, impaired quality of life, and reduced functional status despite guideline-directed medical and device treatment. ... Full text Link to item Cite

Epicardial Fat in Heart Failure and Preserved Ejection Fraction: Novel Insights and Future Perspectives.

Journal Article Curr Heart Fail Rep · March 19, 2025 PURPOSE OF REVIEW: Cardiovascular effects of obesity may be driven, in part, by the distribution of fat. More recently, epicardial adipose tissue (EAT) has gained recognition as an adverse visceral fat impacting cardiac dysfunction in heart failure with pr ... Full text Open Access Link to item Cite

Implementing guideline-directed medical therapy: Stakeholder-identified barriers and facilitators.

Journal Article Am Heart J · March 2025 BACKGROUND: Despite strong evidence and Class I recommendations to support the use of guideline-directed medical therapy (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF), use of these medications remain suboptimal. There is a g ... Full text Link to item Cite

Heart or lungs? Why not both!

Journal Article Eur Respir J · February 2025 Full text Link to item Cite

Baroreflex Function in Cardiovascular Disease.

Journal Article J Card Fail · January 2025 The baroreflex system is involved in modulating several physiological functions of the cardiovascular system and can modulate cardiac output, blood pressure, and cardiac electrophysiology directly and indirectly. In addition, it is involved in regulating n ... Full text Link to item Cite

Optimal Medical Therapy and Outcomes Among Patients With Chronic Heart Failure With Reduced Ejection Fraction.

Journal Article JACC Heart Fail · November 2024 BACKGROUND: Optimal medical therapy (OMT) scoring may stratify clinical risk in real-world chronic heart failure with reduced ejection fraction (HFrEF) by integrating use and dosing of guideline-directed medical therapy (GDMT) for HFrEF. OBJECTIVES: The pu ... Full text Link to item Cite

Aortic Root Thromboembolism and Associated Acute Myocardial Infarction in Patients With Contemporary Durable LVADs.

Journal Article JACC Case Rep · August 7, 2024 Patients with HeartMate 3 left ventricular assist devices may develop aortic root thrombus, yet its prevalence and associated risks are unknown. We present 2 patients who developed aortic root thromboembolism and acute coronary occlusions. We additionally ... Full text Link to item Cite

Feasibility of a Novel Augmented 6-Minute Incremental Step Test: A Simplified Cardiorespiratory Fitness Assessment Tool.

Journal Article JACC Adv · August 2024 BACKGROUND: The cardiopulmonary exercise test (CPET) is considered a gold standard in assessing cardiorespiratory fitness (CRF) but has limited accessibility due to competency requirements and cost. Incorporating portable sensor devices into a simple bedsi ... Full text Open Access Link to item Cite

Regional variation in cause of death in patients with type 2 diabetes: Insights from EXSCEL.

Journal Article Am Heart J · May 2024 AIMS: Type 2 diabetes (T2D) is a risk factor for cardiovascular and non-cardiovascular mortality. However, global distribution of cause-specific deaths in T2D is poorly understood. We characterized cause-specific deaths by geographic region among individua ... Full text Link to item Cite

Improving Guideline-Directed Medical Therapy for Patients With Heart Failure With Reduced Ejection Fraction: A Review of Implementation Strategies.

Journal Article J Card Fail · February 2024 Despite recent advances in the use of guideline-directed medical therapy (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF), achievement of target GDMT use and up-titration to goal dosages continue to be modest. In recent years, ... Full text Open Access Link to item Cite

Ferric Carboxymaltose in Heart Failure with Iron Deficiency.

Journal Article N Engl J Med · September 14, 2023 BACKGROUND: Ferric carboxymaltose therapy reduces symptoms and improves quality of life in patients who have heart failure with a reduced ejection fraction and iron deficiency. Additional evidence about the effects of ferric carboxymaltose on clinical even ... Full text Link to item Cite

Electronic health record characterization and outcomes of heart failure with preserved ejection fraction.

Conference Am Heart J · September 2023 BACKGROUND: Electronic health record (EHR)-based identification of heart failure with preserved ejection fraction (HFpEF) in the clinical setting may facilitate screening for clinical trials by improving the understanding of its epidemiology and outcomes; ... Full text Link to item Cite

Pressure-Volume Profiles in Heart Failure Across Sexes and Phenotypes.

Journal Article J Cardiovasc Transl Res · June 2023 Studies have shown poor correlation between intra-cardiac pressures and blood volume (BV) measurements including HF. The impact of sex and left ventricular ejection fraction (LVEF) on this relationship has not been studied. We obtained pressure (pulmonary ... Full text Link to item Cite

Long-term outcomes of phenoclusters in severe tricuspid regurgitation.

Journal Article Eur Heart J · June 1, 2023 AIMS: Severe tricuspid regurgitation (TR) exhibits high 1-year morbidity and mortality, yet long-term cardiovascular risk overall and by subgroups remains unknown. This study characterizes 5-year outcomes and identifies distinct clinical risk profiles of s ... Full text Link to item Cite

Practical Patient Care Considerations With Use of Vericiguat After Worsening Heart Failure Events.

Journal Article J Card Fail · March 2023 Vericiguat is a soluble guanylate cyclase stimulator approved by multiple global regulatory bodies and recommended in recently updated clinical practice guidelines to reduce morbidity and mortality in patients with worsening chronic heart failure (HF) with ... Full text Link to item Cite

In-Hospital Virtual Peer-to-Peer Consultation to Increase Guideline-Directed Medical Therapy for Heart Failure: A Pilot Randomized Trial.

Journal Article Circ Heart Fail · February 2023 BACKGROUND: Guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) improves clinical outcomes and quality of life. Optimizing GDMT in the hospital is associated with greater long-term use in HFrEF. This study aim ... Full text Link to item Cite

Machine learning to define phenotypes and outcomes of patients hospitalized for heart failure with preserved ejection fraction: Findings from ASCEND-HF.

Journal Article Am Heart J · December 2022 BACKGROUND: Heart Failure with Preserved Ejection Fraction (HFpEF) is a heterogenous disease with few therapies proven to provide clinical benefit. Machine learning can characterize distinct phenotypes and compare outcomes among patients with HFpEF who are ... Full text Link to item Cite

Neighborhood Socioeconomic Disadvantage and Hospitalized Heart Failure Outcomes in the American Heart Association Get With The Guidelines-Heart Failure Registry.

Journal Article Circ Heart Fail · November 2022 BACKGROUND: Neighborhood socioeconomic status (SES) is associated with worse health outcomes, yet its relationship with in-hospital heart failure (HF) outcomes and quality metrics are underexplored. We examined the association between socioeconomic neighbo ... Full text Link to item Cite

The Association of Digital Health Application Use With Heart Failure Care and Outcomes: Insights From CONNECT-HF.

Journal Article J Card Fail · October 2022 BACKGROUND: It is unknown whether digital applications can improve guideline-directed medical therapy (GDMT) and outcomes in heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS: Care Optimization Through Patient and Hospital Engagemen ... Full text Link to item Cite

Quantitative Blood Volume Analysis and Hemodynamic Measures of Vascular Compliance in Patients With Worsening Heart Failure.

Journal Article J Card Fail · September 2022 BACKGROUND: The role of blood volume (BV) expansion vs a change in vascular compliance in worsening heart failure (HF) remains under debate. We aimed to assess the relationship between BV and resting and stress hemodynamics in worsening HF and to further e ... Full text Link to item Cite

Emergency Department Visits Versus Hospital Readmissions Among Patients Hospitalized for Heart Failure.

Journal Article J Card Fail · June 2022 BACKGROUND: Worsening heart failure (HF) often requires hospitalization but in some cases may be managed in the outpatient or emergency department (ED) settings. The predictors and clinical significance of ED visits without admission vs hospitalization are ... Full text Link to item Cite

Pericardial Adipose Tissue Volume and Left Ventricular Assist Device-Associated Outcomes.

Journal Article J Card Fail · January 2022 BACKGROUND: Pericardial adipose tissue (PAT) is associated with adverse cardiovascular outcomes in those with and without established heart failure (HF). However, it is not known whether PAT is associated with adverse outcomes in patients with end-stage HF ... Full text Link to item Cite

Breaking Clinical Inertia in Heart Failure Management.

Journal Article Jt Comm J Qual Patient Saf · January 2022 Full text Link to item Cite

Nonalcoholic Fatty Liver Disease and Risk of Heart Failure Among Medicare Beneficiaries.

Journal Article J Am Heart Assoc · November 16, 2021 Background Nonalcoholic fatty liver disease (NAFLD) and heart failure (HF) are increasing in prevalence. The independent association between NAFLD and downstream risk of HF and HF subtypes (HF with preserved ejection fraction and HF with reduced ejection f ... Full text Link to item Cite

In-Hospital Initiation of Sodium-Glucose Cotransporter-2 Inhibitors for Heart Failure With Reduced Ejection Fraction.

Journal Article J Am Coll Cardiol · November 16, 2021 Sodium-glucose cotransporter-2 inhibitor therapy is well suited for initiation during the heart failure hospitalization, owing to clinical benefits that accrue rapidly within days to weeks, a strong safety and tolerability profile, minimal to no effects on ... Full text Link to item Cite

Relationship of Nonalcoholic Fatty Liver Disease and Heart Failure With Preserved Ejection Fraction.

Journal Article JACC Basic Transl Sci · November 2021 Although there is an established bidirectional relationship between heart failure with reduced ejection fraction and liver disease, the association between heart failure with preserved ejection fraction (HFpEF) and liver diseases, such as nonalcoholic fatt ... Full text Link to item Cite

Hepatocyte Growth Factor and Incident Heart Failure Subtypes: The Multi-Ethnic Study of Atherosclerosis (MESA).

Journal Article J Card Fail · September 2021 BACKGROUND: Hepatocyte growth factor (HGF) is a cytokine and marker of cardiovascular disease (CVD) risk. Less is known about HGF and incident heart failure (HF). We examined the association of HGF with incident HF and its subtypes in a multiethnic cohort. ... Full text Link to item Cite

Regional Adiposity and Risk of Heart Failure and Mortality: The Jackson Heart Study.

Journal Article J Am Heart Assoc · July 20, 2021 Background Visceral adipose tissue (VAT) is associated with incident heart failure (HF) and HF with preserved ejection fraction, yet it is unknown how pericardial and abdominal adiposity affect HF and mortality risks in Black individuals. We examined the a ... Full text Link to item Cite

Acute cardiovascular hospitalizations and illness severity before and during the COVID-19 pandemic.

Journal Article Clin Cardiol · May 2021 BACKGROUND: Cardiovascular disease (CVD) hospitalizations declined worldwide during the COVID-19 pandemic. It is unclear how shelter-in-place orders affected acute CVD hospitalizations, illness severity, and outcomes. HYPOTHESIS: COVID-19 pandemic was asso ... Full text Link to item Cite

Regional adiposity and heart failure with preserved ejection fraction.

Journal Article Eur J Heart Fail · September 2020 The role of obesity in the pathogenesis of heart failure (HF), and in particular HF with preserved ejection fraction (HFpEF), has drawn significant attention in recent years. The prevalence of both obesity and HFpEF has increased worldwide over the past de ... Full text Link to item Cite

Association of the Novel Inflammatory Marker GlycA and Incident Heart Failure and Its Subtypes of Preserved and Reduced Ejection Fraction: The Multi-Ethnic Study of Atherosclerosis.

Journal Article Circ Heart Fail · August 2020 BACKGROUND: GlycA, a nuclear magnetic resonance composite marker of systemic inflammation, reflects serum concentration and glycosylation state of main acute phase reactants. Prior studies have shown plasma GlycA levels were associated with cardiovascular ... Full text Link to item Cite

Lawn Mower Versus Left Ventricular Assist Device: A Case of Traumatic Coronary Injury.

Journal Article JACC Case Rep · March 2020 A 77-year-old man with history of ischemic cardiomyopathy and left ventricular assist device (LVAD) presented with abdominal pain after a lawn mower accident. Examination and imaging revealed a displaced LVAD driveline and a pericardial hematoma secondary ... Full text Open Access 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

Adiposity and Incident Heart Failure and its Subtypes: MESA (Multi-Ethnic Study of Atherosclerosis).

Journal Article JACC Heart Fail · December 2018 OBJECTIVES: This study sought to compare various measures of adiposity with risk for incident hospitalized heart failure (HF) with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF). BACKGROUND: Obesity is a risk factor for HF, parti ... Full text Link to item Cite

Body Mass Index From Early-, Mid-, and Older-Adulthood and Risk of Heart Failure and Atherosclerotic Cardiovascular Disease: MESA.

Journal Article J Am Heart Assoc · November 20, 2018 Background Obesity contributes significantly to risk of atherosclerotic cardiovascular disease (ASCVD) and especially for heart failure (HF). An elevated body mass index (BMI) in older adults might not carry the same risk as in younger adults, but measured ... Full text Link to item Cite

AMBULATORY BLOOD PRESSURE PATTERNS IN PATIENTS WITH RETINAL VEIN OCCLUSION.

Journal Article Retina · December 2016 PURPOSE: Failure of blood pressure (BP) to dip during sleep (nondipper pattern) is associated with cardiovascular disease and stroke. The prevalence and degree of nondipping and masked hypertension in patients with retinal vein occlusion (RVO), which is as ... Full text Link to item Cite

The effect of numeracy level on completeness of home blood pressure monitoring.

Journal Article J Clin Hypertens (Greenwich) · January 2015 Home blood pressure monitoring (HBPM) readings predict the increased risks of cardiovascular events and end-organ damage independent of office blood pressure (BP). Numeracy (the ability to handle numbers) may limit the feasibility of patients' performing H ... Full text Link to item Cite