26
|
Kumar A, Sammour Y, Reginauld S, Sato K, Agrawal N, Meenakshisundaram C, Kamioka N, Sawant AC, Devireddy C, Krishnaswamy A, Greenbaum AB, Mavromatis K, Grubb K, Byku I, Svensson L, Tuzcu M, Block PC, Iyer V, Kapadia S, Babaliaros V. CRT-600.08 A Comparison of Clinical Outcomes According to the Timing of PCI and TAVR: A Pooled Analysis From a Multicenter Registry. JACC Cardiovasc Interv 2020. [DOI: 10.1016/j.jcin.2020.01.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
27
|
Mosleh W, Amer MR, Joshi S, Mather JF, Gandhi S, Iyer V, Curtis L, Kiernan FJ, McMahon S, Duvall L, McKay RG. Comparative Outcomes of Balloon-Expandable S3 Versus Self-Expanding Evolut Bioprostheses for Transcatheter Aortic Valve Implantation. Am J Cardiol 2019; 124:1621-1629. [PMID: 31547995 DOI: 10.1016/j.amjcard.2019.08.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 12/20/2022]
Abstract
To date, comparisons between the balloon-expandable Edwards Sapien S3 (S3) versus the self-expanding Evolut R or PRO (Evolut) valves have been limited with respect to procedural outcomes. We aim to compare the safety, efficacy, and procedural efficiency of the S3 versus the Medtronic Evolut bioprostheses in patients who underwent transcatheter aortic valve implantation for severe aortic stenosis. Retrospective analysis was performed of all consecutive transcatheter aortic valve implantation procedures performed through the transfemoral approach with either S3 or Evolut at our hospital between September 2015 and January 2019. A total of 581 patients were included. There were no significant differences between S3 (n = 452) and Evolut (n = 129) concerning in-hospital or 30-day safety outcomes. S3 was associated with significantly shorter fluoroscopy times, lower fluoroscopy Air Kerma, and higher contrast use. S3 had lower postprocedure aortic valve area (1.71 ± 0.45 vs 1.84 ± 0.50 cm2, p = 0.004), larger peak gradient at 30 days (10.7 ± 3.8 vs 7.0 ± 3.2 mm Hg, p <0.001), and lower aortic regurgitation (AR) rates postprocedure (47% vs 33%, p = 0.024) and at 30 days (50% vs 33%, p = 0.008), driven by mild AR. Device type was an independent predictor of AR postprocedure and at 30 days. Patients with ≥mild AR were more likely to have had Evolut valves (odds ratio = 2.94, p <0.001), especially in larger valves (>26 mm). Severe prosthesis-patient mismatch was higher in S3 (14.8% vs 7.9%, p <0.001). In conclusion, S3 is associated with less radiation exposure, higher contrast use, and lower incidence of AR at 30 days. Alternately, S3 has a higher transaortic gradient at 30 days, and higher levels of severe prosthesis-patient mismatch.
Collapse
|
28
|
Li Y, Halliwill K, Adams C, Iyer V, Riva L, Rosario RD, Fredlund E, Adams D, Balmain A. Genomic Mutational Signatures in Tumors Induced By High and Low Energy Radiation in Trp53-deficient Mouse Models. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
29
|
Kumamaru KK, Angel E, Sommer KN, Iyer V, Wilson MF, Agrawal N, Bhardwaj A, Kattel SB, Kondziela S, Malhotra S, Manion C, Pogorzelski K, Ramanan T, Sawant AC, Suplicki MM, Waheed S, Fujimoto S, Sharma UC, Rybicki FJ, Ionita CN. Inter- and Intraoperator Variability in Measurement of On-Site CT-derived Fractional Flow Reserve Based on Structural and Fluid Analysis: A Comprehensive Analysis. Radiol Cardiothorac Imaging 2019; 1:e180012. [PMID: 33778507 DOI: 10.1148/ryct.2019180012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 05/17/2019] [Accepted: 06/24/2019] [Indexed: 11/11/2022]
Abstract
Purpose To measure the inter- and intraobserver variability among operators of varying expertise in conducting CT-derived fractional flow reserve (CT FFR) measurements on-site by using structural and fluid analysis and to evaluate differences in reproducibility between two different training methods for end users. Materials and Methods This retrospective analysis of the prospectively enrolled cohort included 22 symptomatic patients who underwent both 320-detector row coronary CT angiography and catheter-derived fractional flow reserve (FFR) within 90 days. Thirteen operators of varying expertise were assigned to one of two training arms: arm 1, on-site training by a specialist in CT FFR technology; arm 2, self-training through use of written materials. After the training, all 13 operators reviewed the CT data and measured CT FFR in 24 vessels in 22 patients. Inter- and intraoperator variability and agreements between CT FFR and catheter-derived FFR measurements were evaluated. Results The overall intraclass correlation coefficient (ICC) among operators was 0.71 (95% confidence interval: 0.58, 0.83) with a mean absolute difference (± standard deviation) of 0.027 ± 0.022. The operators in arm 2 showed greater interoperator differences than those in arm 1 (0.031 ± 0.024 vs 0.023 ± 0.018; P = .024). Among operators who recalculated CT FFR, the mean CT FFR value did not significantly differ between the first and second calculations (ICC, 0.66; 95% confidence interval: 0.46, 0.87), with the medical specialists producing the lowest intraoperator variability (0.053 ± 0.060). The overall correlation coefficient between CT FFR and catheter FFR was r = 0.61, with a mean absolute difference of 0.096 ± 0.089. Conclusion Good reproducibility of CT FFR values calculated on-site on the basis of structural and fluid analysis was observed among operators of varying expertise. Face-to-face training sessions may cause less variability.© RSNA, 2019Supplemental material is available for this article.
Collapse
|
30
|
Weil BR, Suzuki G, Young RF, Iyer V, Canty JM. Troponin Release and Reversible Left Ventricular Dysfunction After Transient Pressure Overload. J Am Coll Cardiol 2019; 71:2906-2916. [PMID: 29929614 DOI: 10.1016/j.jacc.2018.04.029] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/28/2018] [Accepted: 04/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The authors previously demonstrated that brief ischemia elicits cardiac troponin I (cTnI) release and myocyte apoptosis in the absence of necrosis. It remains uncertain whether other pathophysiological stresses can produce apoptosis and transient cTnI release without ischemia. OBJECTIVES This study sought to determine whether a transient increase in left ventricular (LV) preload elicits cTnI release in the absence of ischemia. METHODS Propofol-anesthetized swine (N = 13) received intravenous phenylephrine (PE) (300 μg/min) for 1 h to increase left ventricular end-diastolic pressure (LVEDP) to ∼30 mm Hg. Serial cTnI and echocardiographic function were assessed for 24 h, and myocardial tissue was analyzed for apoptosis and necrosis. RESULTS PE infusion increased systolic blood pressure from 137 ± 14 mm Hg to 192 ± 11 mm Hg (mean ± SD; p < 0.001) and increased LVEDP from 17 ± 2 mm Hg to 30 ± 5 mm Hg (p < 0.001). Myocardial flow measurements demonstrated no evidence of ischemia. Hemodynamics normalized rapidly after PE, but LV ejection fraction remained depressed (32 ± 21% vs. 58 ± 7%; p < 0.01) with normalization after 24 h (51 ± 16%; p = 0.31). Baseline transcoronary cTnI release was low (16 ± 20 ng/l) but increased to 856 ± 956 ng/l (p = 0.01) 1 h after LVEDP elevation. Circulating cTnI rose above the 99th percentile within 30 min and remained elevated at 24 h (1,462 ± 1,691 ng/l). Pathological analysis demonstrated myocyte apoptosis at 3 h (31.3 ± 11.9 myocytes/cm2 vs. 4.6 ± 3.7 myocytes/cm2; p < 0.01), that normalized after 24 h (6.2 ± 5.6 myocytes/cm2; p = 0.46) without histological necrosis. CONCLUSIONS Transient elevations of LVEDP lead to cTnI release, apoptosis, and reversible stretch-induced stunning in the absence of ischemia. Thus, preload-induced myocyte injury may explain many cTnI elevations seen in the absence of clinical signs or symptoms of myocardial ischemia.
Collapse
|
31
|
Agrawal N, Kattel S, Waheed S, Kapoor A, Singh V, Sharma A, Page BJ, Attwood KM, Iyer V, Pokharel S, Sharma UC. Clinical Outcomes after Transcatheter Aortic Valve Replacement in Cancer Survivors Treated with Ionizing Radiation. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2019; 5:8. [PMID: 31815000 PMCID: PMC6897372 DOI: 10.1186/s40959-019-0044-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Improved cancer survival in patients treated with thoracic ionizing radiation (XRT) has resulted in unanticipated surge of aortic stenosis. Transcatheter aortic valve replacement (TAVR) has revolutionized the management of severe aortic stenosis. However, long-term clinical outcomes in radiation-exposed cohorts undergoing TAVR are unknown. We compared the all-cause mortality and major adverse cardiac events (MACE) in patients with prior chest XRT (C-XRT) undergoing TAVR. METHODS This is an observational cohort study in subjects who underwent TAVR for symptomatic severe aortic stenosis from 2012 to 2017 in a tertiary care referral center. We examined the all-cause mortality and MACE using cox proportional hazard analysis to identify the clinical predictors of survival in the cohort of patients who had a history of prior C-XRT for malignancy. RESULTS Of the 610 patients who underwent TAVR for symptomatic severe aortic stenosis, 75 had prior C-XRT. The majority of C-XRT patients had prior breast cancer (44%) followed by Hodgkin's lymphoma (31%), with the median time from XRT to TAVR of 19.0 years. During a mean follow up of 17.1 months after TAVR, all-cause mortality was 17%. Those with prior C-XRT had higher all-cause mortality (XRT: 29%; non-XRT:15%, p<0.01) and MACE (XRT: 57%; non-XRT: 27%, p<0.001) after TAVR. Patients with prior XRT had a higher incidence of atrial fibrillation (XRT: 48 %; non-XRT: 2.4%, p<0.01) and high-grade heart block (XRT: 20%; non-XRT: 9.1%, p=0.007) requiring pacemaker implant after TAVR. On multivariate cox proportional hazard analysis, prior XRT (HR: 2.07, p=0.003), poor renal function (HR: 1.29, p<0.001) and post-operative anemia requiring transfusion (HR: 1.16, p:0.001) were the strongest predictors of reduced survival. CONCLUSIONS Cancer survivors with prior C- XRT have higher incidence of all-cause mortality and MACE after TAVR. Careful patient selection and follow-up strategies are needed to improve outcomes.
Collapse
|
32
|
Potrony M, Puig‐Butille J, Ribera‐Sola M, Iyer V, Robles‐Espinoza C, Aguilera P, Carrera C, Malvehy J, Badenas C, Landi M, Adams D, Puig S. POT1 and TERT promoter molecular screening in Spanish melanoma families. Br J Dermatol 2019. [DOI: 10.1111/bjd.18055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
33
|
Potrony M, Puig‐Butille J, Ribera‐Sola M, Iyer V, Robles‐Espinoza C, Aguilera P, Carrera C, Malvehy J, Badenas C, Landi M, Adams D, Puig S. 在一组西班牙黑色素瘤家族中,与黑色素瘤易感性有关的是 POT1
生殖系突变而非 TERT
启动子突变. Br J Dermatol 2019. [DOI: 10.1111/bjd.18074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
34
|
Potrony M, Puig-Butille J, Ribera-Sola M, Iyer V, Robles-Espinoza C, Aguilera P, Carrera C, Malvehy J, Badenas C, Landi M, Adams D, Puig S. POT1 germline mutations but not TERT promoter mutations are implicated in melanoma susceptibility in a large cohort of Spanish melanoma families. Br J Dermatol 2019; 181:105-113. [PMID: 30451293 PMCID: PMC6526091 DOI: 10.1111/bjd.17443] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Germline mutations in telomere-related genes such as POT1 and TERT predispose individuals to familial melanoma. OBJECTIVES To evaluate the prevalence of germline mutations in POT1 and TERT in a large cohort of Spanish melanoma-prone families (at least two affected first- or second-degree relatives). METHODS Overall, 228 CDKN2A wild-type melanoma-prone families were included in the study. Screening of POT1 was performed in one affected person from each family and TERT was sequenced in one affected patient from 202 families (26 families were excluded owing to DNA exhaustion/degradation). TERT promoter sequencing was extended to an additional 30 families with CDKN2A mutation and 70 patients with sporadic multiple primary melanoma (MPM) with a family history of other cancers. RESULTS We identified four families with potentially pathogenic POT1 germline mutations: a missense variant c.233T>C (p.Ile78Thr); a nonsense variant c.1030G>T (p.Glu344*); and two other variants, c.255G>A (r.125_255del) and c.1792G>A (r.1791_1792insAGTA, p.Asp598Serfs*22), which we confirmed disrupted POT1 mRNA splicing. A TERT promoter variant of unknown significance (c.-125C>A) was detected in a patient with MPM, but no germline mutations were detected in TERT promoter in cases of familial melanoma. CONCLUSIONS Overall, 1·7% of our CDKN2A/CDK4-wild type Spanish melanoma-prone families carry probably damaging mutations in POT1. The frequency of TERT promoter germline mutations in families with melanoma in our population is extremely rare.
Collapse
|
35
|
Asleh R, Schettle S, Maltais S, Daly R, Iyer V, Stulak J, Rodeheffer R. Promising Novel Treatment with Intravenous Bevacizumab for Refractory Gastrointestinal Bleeding from Angiodysplastic Lesions in Patients Supported with a Continuous-Flow Left Ventricular Assist Device: A Pilot Study. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
|
36
|
Agnese R, Aralis T, Aramaki T, Arnquist I, Azadbakht E, Baker W, Banik S, Barker D, Bauer D, Binder T, Bowles M, Brink P, Bunker R, Cabrera B, Calkins R, Cameron R, Cartaro C, Cerdeño D, Chang YY, Cooley J, Cornell B, Cushman P, De Brienne F, Doughty T, Fascione E, Figueroa-Feliciano E, Fink C, Fritts M, Gerbier G, Germond R, Ghaith M, Golwala S, Harris H, Herbert N, Hong Z, Hoppe E, Hsu L, Huber M, Iyer V, Jardin D, Jastram A, Jena C, Kelsey M, Kennedy A, Kubik A, Kurinsky N, Lawrence R, Loer B, Lopez Asamar E, Lukens P, MacDonell D, Mahapatra R, Mandic V, Mast N, Miller E, Mirabolfathi N, Mohanty B, Morales Mendoza J, Nelson J, Neog H, Orrell J, Oser S, Page W, Partridge R, Pepin M, Ponce F, Poudel S, Pyle M, Qiu H, Rau W, Reisetter A, Ren R, Reynolds T, Roberts A, Robinson A, Rogers H, Saab T, Sadoulet B, Sander J, Scarff A, Schnee R, Scorza S, Senapati K, Serfass B, Speller D, Stanford C, Stein M, Street J, Tanaka H, Toback D, Underwood R, Villano A, von Krosigk B, Watkins S, Wilson J, Wilson M, Winchell J, Wright D, Yellin S, Young B, Zhang X, Zhao X. Search for low-mass dark matter with CDMSlite using a profile likelihood fit. Int J Clin Exp Med 2019. [DOI: 10.1103/physrevd.99.062001] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
37
|
Shepard LM, Sommer KN, Angel E, Iyer V, Wilson MF, Rybicki FJ, Mitsouras D, Molloi S, Ionita CN. Initial evaluation of three-dimensionally printed patient-specific coronary phantoms for CT-FFR software validation. J Med Imaging (Bellingham) 2019; 6:021603. [PMID: 30891468 DOI: 10.1117/1.jmi.6.2.021603] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 02/19/2019] [Indexed: 12/17/2022] Open
Abstract
We developed three-dimensionally (3D) printed patient-specific coronary phantoms that are capable of sustaining physiological flow and pressure conditions. We assessed the accuracy of these phantoms from coronary CT acquisition, benchtop experimentation, and CT-FFR software. Five patients with coronary artery disease underwent 320-detector row coronary CT angiography (CCTA) (Aquilion ONE, Canon Medical Systems) and a catheter lab procedure to measure fractional flow reserve (FFR). The aortic root and three main coronary arteries were segmented (Vitrea, Vital Images) and 3D printed (Eden 260V, Stratasys). Phantoms were connected into a pulsatile flow loop, which replicated physiological flow and pressure gradients. Contrast was introduced and the phantoms were scanned using the same CT scanner model and CCTA protocol as used for the patients. Image data from the phantoms were input to a CT-FFR research software (Canon Medical Systems) and compared to those derived from the clinical data, along with comparisons between image measurements and benchtop FFR results. Phantom diameter measurements were within 1 mm on average compared to patient measurements. Patient and phantom CT-FFR results had an absolute mean difference of 4.34% and Pearson correlation of 0.95. We have demonstrated the capabilities of 3D printed patient-specific phantoms in a diagnostic software.
Collapse
|
38
|
Agrawal N, Kattel S, Singh V, Kapoor A, Sharma A, Iyer V, Sharma U. PROGNOSTIC IMPACT OF PRIOR RADIATION EXPOSURE IN CANCER SURVIVORS WITH SEVERE AORTIC STENOSIS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31700-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
39
|
Agnese R, Aralis T, Aramaki T, Arnquist IJ, Azadbakht E, Baker W, Banik S, Barker D, Bauer DA, Binder T, Bowles MA, Brink PL, Bunker R, Cabrera B, Calkins R, Cartaro C, Cerdeño DG, Chang YY, Cooley J, Cornell B, Cushman P, Di Stefano PCF, Doughty T, Fascione E, Figueroa-Feliciano E, Fink C, Fritts M, Gerbier G, Germond R, Ghaith M, Golwala SR, Harris HR, Hong Z, Hoppe EW, Hsu L, Huber ME, Iyer V, Jardin D, Jena C, Kelsey MH, Kennedy A, Kubik A, Kurinsky NA, Lawrence RE, Leyva JV, Loer B, Lopez Asamar E, Lukens P, MacDonell D, Mahapatra R, Mandic V, Mast N, Miller EH, Mirabolfathi N, Mohanty B, Morales Mendoza JD, Nelson J, Orrell JL, Oser SM, Page WA, Partridge R, Pepin M, Phipps A, Ponce F, Poudel S, Pyle M, Qiu H, Rau W, Reisetter A, Reynolds T, Roberts A, Robinson AE, Rogers HE, Romani RK, Saab T, Sadoulet B, Sander J, Scarff A, Schnee RW, Scorza S, Senapati K, Serfass B, So J, Speller D, Stanford C, Stein M, Street J, Tanaka HA, Toback D, Underwood R, Villano AN, von Krosigk B, Watkins SL, Wilson JS, Wilson MJ, Winchell J, Wright DH, Yellin S, Young BA, Zhang X, Zhao X. Erratum: First Dark Matter Constraints from a SuperCDMS Single-Charge Sensitive Detector [Phys. Rev. Lett. 121, 051301 (2018)]. PHYSICAL REVIEW LETTERS 2019; 122:069901. [PMID: 30822060 DOI: 10.1103/physrevlett.122.069901] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Indexed: 06/09/2023]
Abstract
This corrects the article DOI: 10.1103/PhysRevLett.121.051301.
Collapse
|
40
|
Wilson MF, Sommer KN, Shepard LM, Iyer V, Sharma U, Rybicki FJ, Mitsouras D, Angel E, Ionita CN. FFR As A Gold Standard For CT-FFR Validation. Does The FFR Measurement Device Alter The Flow? J Cardiovasc Comput Tomogr 2019. [DOI: 10.1016/j.jcct.2018.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
41
|
Khalil C, Pham M, Sawant AC, Sinibaldi E, Bhardwaj A, Ramanan T, Qureshi R, Khan S, Ibrahim A, Gowda SN, Pomakov A, Sadawarte P, Lahoti A, Hansen R, Baldo S, Colern G, Pershad A, Iyer V. Neutrophil-to-lymphocyte ratio predicts heart failure readmissions and outcomes in patients undergoing transcatheter aortic valve replacement. Indian Heart J 2019; 70 Suppl 3:S313-S318. [PMID: 30595282 PMCID: PMC6310731 DOI: 10.1016/j.ihj.2018.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/29/2018] [Accepted: 08/01/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Neutrophil-to-lymphocyte ratio (NLR) has prognostic value in acute coronary syndromes. We investigated its utility for predicting heart failure (HF) admissions and major adverse cardiac outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). METHODS Data on clinical, laboratory, procedural, HF admissions, and major adverse cardiac events (MACEs) (all-cause mortality, recurrence of myocardial infarction requiring intervention, stroke) for 298 consecutive patients who underwent TAVR between 2012 and 2016 in our tertiary center were collected. RESULTS Analysis included 298 patients. The mean age was 83 ± 8 years, 51% were males, and 95% were Caucasians. The median Society of Thoracic Surgeons risk score was 9 (interquartile range: 6.3-11.8). Receiver-operating curve analysis identified a cutoff value of NLR of 4.0 for MACE after TAVR and sensitivity of 68% and specificity of 68% {area under the curve [AUC] = 0.65 [95% confidence interval (CI): 0.51-0.79], p = 0.03}. An NLR of 4.0 for HF hospitalizations after TAVR and sensitivity of 60% and specificity of 57% [AUC = 0.61 (95% CI: 0.53-0.69), p = 0.01]. NLR ≥4.0 before TAVR significantly predicted MACE after TAVR (68.4% vs. 31.6%, p = 0.02) and HF hospitalizations (58.3% vs. 41.7%, p = 0.03). NLR with TAVR risk score increased the predictive value for MACE after TAVR from AUC = 0.61 (95% CI: 0.50-0.72, p = 0.06) to AUC = 0.69 (95% CI: 0.57-0.80, p = 0.007). CONCLUSION NLR predicts all-cause mortality, MACE, and HF hospitalization 1 year after TAVR. NLR with TAVR risk score improved predictability for MACE. Further studies for prognostication using NLR are warranted.
Collapse
|
42
|
Lazkani M, Sawant AC, Taase A, Khan S, Fang K, Iyer V, Pershad A. Left atrial hemodynamics and left ventricular remodeling -predictors of outcomes after Transcatheter mitral valve repair with the MitraClip device. Catheter Cardiovasc Interv 2018; 93:128-133. [DOI: 10.1002/ccd.27804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/01/2018] [Accepted: 07/12/2018] [Indexed: 11/11/2022]
|
43
|
Agnese R, Aralis T, Aramaki T, Arnquist IJ, Azadbakht E, Baker W, Banik S, Barker D, Bauer DA, Binder T, Bowles MA, Brink PL, Bunker R, Cabrera B, Calkins R, Cartaro C, Cerdeño DG, Chang YY, Cooley J, Cornell B, Cushman P, Di Stefano PCF, Doughty T, Fascione E, Figueroa-Feliciano E, Fink C, Fritts M, Gerbier G, Germond R, Ghaith M, Golwala SR, Harris HR, Hong Z, Hoppe EW, Hsu L, Huber ME, Iyer V, Jardin D, Jena C, Kelsey MH, Kennedy A, Kubik A, Kurinsky NA, Lawrence RE, Leyva JV, Loer B, Lopez Asamar E, Lukens P, MacDonell D, Mahapatra R, Mandic V, Mast N, Miller EH, Mirabolfathi N, Mohanty B, Morales Mendoza JD, Nelson J, Orrell JL, Oser SM, Page WA, Partridge R, Pepin M, Phipps A, Ponce F, Poudel S, Pyle M, Qiu H, Rau W, Reisetter A, Reynolds T, Roberts A, Robinson AE, Rogers HE, Romani RK, Saab T, Sadoulet B, Sander J, Scarff A, Schnee RW, Scorza S, Senapati K, Serfass B, So J, Speller D, Stanford C, Stein M, Street J, Tanaka HA, Toback D, Underwood R, Villano AN, von Krosigk B, Watkins SL, Wilson JS, Wilson MJ, Winchell J, Wright DH, Yellin S, Young BA, Zhang X, Zhao X. First Dark Matter Constraints from a SuperCDMS Single-Charge Sensitive Detector. PHYSICAL REVIEW LETTERS 2018; 121:051301. [PMID: 30118251 DOI: 10.1103/physrevlett.121.051301] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/20/2018] [Indexed: 06/08/2023]
Abstract
We present the first limits on inelastic electron-scattering dark matter and dark photon absorption using a prototype SuperCDMS detector having a charge resolution of 0.1 electron-hole pairs (CDMS HVeV, a 0.93 g CDMS high-voltage device). These electron-recoil limits significantly improve experimental constraints on dark matter particles with masses as low as 1 MeV/c^{2}. We demonstrate a sensitivity to dark photons competitive with other leading approaches but using substantially less exposure (0.49 g d). These results demonstrate the scientific potential of phonon-mediated semiconductor detectors that are sensitive to single electronic excitations.
Collapse
|
44
|
Bhardwaj A, Ramanan T, Sawant AC, Sinibaldi E, Pham M, Khan S, Qureshi R, Agrawal N, Khalil C, Hansen R, Baldo S, Colern G, Corbelli J, Pershad A, Beck H, Iyer V. Quality of life outcomes in transcatheter aortic valve replacement patients requiring pacemaker implantation. J Arrhythm 2018; 34:441-449. [PMID: 30167016 PMCID: PMC6111478 DOI: 10.1002/joa3.12065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 03/31/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Permanent pacemaker implantation is the most common complication after Transcatheter aortic valve replacement (TAVR) and is associated with worse outcomes and mortality. However, its impact on quality-of-life (QoL) outcomes remains unknown. METHODS We included 383 consecutive patients undergoing TAVR from January 2012 to 2016 who completed a baseline Kansas City Cardiomyopathy Questionnaire (KCCQ-12) health survey. The clinical, laboratory, angiographic, QoL, mortality, and occurrence of poor outcomes (KCCQ-12 score < 45 or KCCQ decrease of ≥10 points) were obtained. RESULTS The mean age was 83 ± 8 years, 51% were men, and majority were Caucasians (n = 364, 95%). Permanent pacemaker (PPM) was implanted in 11.5% of patients post-TAVR. PPM patients were more likely to have prior conduction disease including RBBB (25% vs 12%, P = .02) and PQ interval >250 ms (11% vs 5%, P = .07). One-month median KCCQ-12 scores were significantly lower among PPM patients (84.7 vs 68.8, P = .04), but did not differ significantly at 1-year (86.5 vs 90.6, P = .5) post-TAVR. Occurrence of poor outcomes did not differ significantly among those with or without PPM at 1 month (11% vs 7%, P = .39) and 1 year (13% vs 9%, P = .45), respectively. However, patients with poor QoL outcomes at 1 month post-TAVR also had significantly worse mortality during follow-up in unadjusted (31.3% vs 4.5%, P < .001) and adjusted (HR = 5.30, 95% [CI: 1.85-15.22, P = .002])analyses, respectively. CONCLUSION Permanent pacemaker implantation is associated with short-term reduction in QoL without long-term implications post-TAVR. Patients with poor QoL post-TAVR also have significantly higher mortality.
Collapse
|
45
|
Sommer KN, Shepard L, Karkhanis NV, Iyer V, Angel E, Wilson MF, Rybicki FJ, Mitsouras D, Rudin S, Ionita CN. 3D Printed Cardiovascular Patient Specific Phantoms Used for Clinical Validation of a CT-derived FFR Diagnostic Software. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2018; 10578. [PMID: 29899591 DOI: 10.1117/12.2292736] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Purpose 3D printed patient specific vascular models provide the ability to perform precise and repeatable benchtop experiments with simulated physiological blood flow conditions. This approach can be applied to CT-derived patient geometries to determine coronary flow related parameters such as Fractional Flow Reserve (FFR). To demonstrate the utility of this approach we compared bench-top results with non-invasive CT-derived FFR software based on a computational fluid dynamics algorithm and catheter based FFR measurements. Materials and Methods Twelve patients for whom catheter angiography was clinically indicated signed written informed consent to CT Angiography (CTA) before their standard care that included coronary angiography (ICA) and conventional FFR (Angio-FFR). The research CTA was used first to determine CT-derived FFR (Vital Images) and second to generate patient specific 3D printed models of the aortic root and three main coronary arteries that were connected to a programmable pulsatile pump. Benchtop FFR was derived from pressures measured proximal and distal to coronary stenosis using pressure transducers. Results All 12 patients completed the clinical study without any complication, and the three FFR techniques (Angio-FFR, CT-FFR, and Benchtop FFR) are reported for one or two main coronary arteries. The Pearson correlation among Benchtop FFR/Angio-FFR, CT-FFR/ Benchtop FFR, and CT-FFR/ Angio-FFR are 0.871, 0.877, and 0.927 respectively. Conclusions 3D printed patient specific cardiovascular models successfully simulated hyperemic blood flow conditions, matching invasive Angio-FFR measurements. This benchtop flow system could be used to validate CT-derived FFR diagnostic software, alleviating both cost and risk during invasive procedures.
Collapse
|
46
|
Bhardwaj A, Sawant A, Hansen R, Sadawarte P, Agrawal N, Ramanan T, Sinibaldi E, Lahoti A, Kumar A, Sato K, Fernandez S, Sharma U, Iyer V. SYSTOLIC IMPEDANCE AND DIASTOLIC WALL STRESS ARE NOVEL PREDICTORS OF HEART FAILURE HOSPITALIZATIONS IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32098-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
47
|
Ramanan T, Sawant A, Bhardwaj A, Hansen R, Sinibaldi E, Pham M, Khalil C, Sharma A, Kumar A, Iyer V. THE AMERICAN COLLEGE OF CARDIOLOGY: TRANSCATHETER AORTIC VALVE REPLACEMENT RISK CALCULATOR ACCURATELY PREDICTS HEART FAILURE READMISSIONS AND QUALITY OF LIFE OUTCOMES. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31963-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
48
|
Agrawal N, Sawant A, Bhardwaj A, Ramanan T, Hansen R, Sinibaldi E, Sadawarte P, Lahoti A, Kumar A, Sato K, Elango K, Shah T, Fernandez S, Sharma U, Iyer V. CHANGE IN LEFT VENTRICULAR SYSTOLIC WALL STRESS PREDICTS HEART FAILURE READMISSIONS IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31950-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
49
|
Singh V, Iyer V, Mursleen A, Hansen R, Fernandez S, Malhotra S. ACUTE CHANGE IN MYOCARDIAL DEFORMATION DOES NOT PREDICT HEART FAILURE READMISSION AFTER TAVR AMONG PATIENTS WITH A LOW FLOW LOW GRADIENT PHYSIOLOGY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31953-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
50
|
Singh V, Iyer V, Mursleen A, Hansen E, Fernandez S, Malhotra S. MYOCARDIAL CONTRACTILITY PREDICTS SYMPTOMATIC IMPROVEMENT ACROSS ALL FLOW-GRADIENT PATTERNS OF AORTIC STENOSIS AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31954-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|