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Kaluski E, Maher J, Gerula C, Tsai S, Randhawa P, Saric M, Oghlakian G, Alfano D, Palmaro J, Haider B, Klapholz M. Optimizing primary PCI beyond "door to intervention time"--are we there yet? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2010; 11:84-90. [PMID: 20347797 DOI: 10.1016/j.carrev.2009.04.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 04/09/2009] [Accepted: 04/13/2009] [Indexed: 10/19/2022]
Abstract
AIM To assess the effects of shortened door-to-intervention (DTI) time on appropriate clinical decisions regarding the four most critical and costly decisions during primary percutaneous coronary intervention (PCI): cath-lab activation (CLA), use of glycoprotein IIb/IIIa inhibitors (GPI), use of PCI, and deployment of drug-eluting stent (DES). BACKGROUND STEMI PCI patients are frequently subject to decision making based on abbreviated medical encounter and limited medical information. METHODS Clinical data were prospectively collected in a STEMI registry over 19 months. Retrospective chart reviews were conducted to determine the level of appropriateness of the above-mentioned decisions. RESULTS Between June 2006 and December 2007, 200 EKGs with suspected STEMI were transmitted; 88 (44%) resulted in CLA. Compared to prior year, DTI times decreased from 145.7 to 69.9 min (P=.00001). DTI was longer during nights and weekends (87.5 vs. 51.8 min, P=.001) and the initial 6 months of the registry (86.8 vs. 66.8 min, P=.07). Nineteen (21.6%) of the patients undergoing angiography did not require revascularization, 56 (63.6%) received GPIs, and 65 patients (73.8%) underwent at least one vessel PCI, and at least one DES was used in 39 patients (60% of PCI cohort). When assessed for appropriateness, CLA was appropriate in 81.8% of the time and rendered borderline or inappropriate in 5.7% and 12.5%, respectively. GPI use was appropriate in 66% of the patients but seemed borderline or inappropriate in 28.5% and 5.4%, respectively. PCI was appropriate in 90% of the lesions treated, and borderline or inappropriate in 7.1% and 2.9%, respectively. DES use was viewed appropriate in 38.4%, and borderline or inappropriate in 51% and 10.2% of the DES deployments, respectively. CONCLUSIONS (1) In view of expedited care, certain information required for decision-making process is either not available or ignored during primary PCI. (2) Appropriate use of resources in primary PCI needs to be better defined. (3) Measures of extracting patients' previous medical records and imaging studies along with in-lab immediate blood work and echocardiography and establishing new "time-out" protocols for STEMI patients may improve resource utilization and patient care and outcome.
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Rezaizadeh H, Sanchez-Ross M, Kaluski E, Klapholz M, Haider B, Gerula C. Acute eosinophilic myocarditis: diagnosis and treatment. ACTA ACUST UNITED AC 2010; 12:31-6. [PMID: 20201659 DOI: 10.3109/17482940903578998] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hypereosinophilic syndrome (HES) is a rare disorder of unregulated eosinophilia, which if untreated, may lead to systemic tissue infiltration and inflammation. Cardiac involvement is a common and serious associated complication. We describe a case of HES associated myocarditis mimicking a non-ST elevation MI (NSTEMI). Unlike myocarditis in general, our patient responded well to high dose methylprednisone, the standard of care in HES. We review the clinical presentation, pathophysiology, pathology and treatment of eosinophilic myocarditis related to HES.
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Kats Y, Solanki P, Waller AH, Maldjian PD, Hamirani K, Tsai SC, Dhruva V, Klapholz M, Saric M. An unusual combination of an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) and a right coronary artery system with two separate ostia from the aorta in an adult. Echocardiography 2010; 27:E13-7. [PMID: 20380659 DOI: 10.1111/j.1540-8175.2009.01040.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We describe a patient with an infrequent combination of variants in both the right and the left coronary arterial ostia, namely a combination of two separate right coronary artery (RCA) ostia from the aorta, and an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). To our knowledge, such a combination has not been previously reported. Based on published statistics for individual variants, such a combination is expected to occur approximately once for every 500,000 to one million live births. ALCAPA and dual RCA anatomy was characterized in our patient by echocardiography, conventional angiography, and multidetector computed tomography before and after Takeuchi repair.
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Kaluski E, Tsai S, Milo-Cotter O, Klapholz M. "Buddy in jail" or "buried wire" method: a critical review. Catheter Cardiovasc Interv 2010; 75:814; author reply 815. [PMID: 20146307 DOI: 10.1002/ccd.22371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Togo F, Natelson BH, Cherniack NS, Klapholz M, Rapoport DM, Cook DB. Sleep is not disrupted by exercise in patients with chronic fatigue syndromes. Med Sci Sports Exerc 2010; 42:16-22. [PMID: 20010134 DOI: 10.1249/mss.0b013e3181b11bc7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Patients with chronic fatigue syndrome (CFS) report that exertion produces dramatic symptom worsening. We hypothesized this might be due to the exacerbation of an underlying sleep disorder, which we have previously demonstrated to exist. METHODS Female patients with CFS and matched healthy controls with no evidence of major depressive disorder were studied with overnight polysomnography on a baseline night and on a night after their performance of a maximal exercise test. RESULTS CFS patients as a group had evidence for disturbed sleep compared with controls. Although exercise improved sleep for healthy subjects, it did not do this for the group as a whole. When we stratified the sample on the basis of self-reported sleepiness after a night's sleep, the patient group with reduced morning sleepiness showed improvement in sleep structure, whereas those with increased morning sleepiness continued to show evidence for sleep disruption. CONCLUSIONS Sleep is disturbed in CFS patients as a group, but exercise does not exacerbate this sleep disturbance. Approximately half the patients studied actually sleep better after exercise. Therefore, activity-related symptom worsening is not caused by worsened sleep.
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Solanki P, Gerula C, Randhawa P, Benz M, Maher J, Haider B, Klapholz M, Palmaro J, Alfano D, Kaluski E. Right coronary artery anatomical variants: where and how? THE JOURNAL OF INVASIVE CARDIOLOGY 2010; 22:103-106. [PMID: 20197575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Ectopic origin of the right coronary artery (RCA) occurs in approximately 1.0% of studied populations. We investigated the prevalence and location of ectopic RCAs among patients undergoing coronary angiography (CA) and assessed its effects on resource utilization. METHODS Cases of ectopic RCAs were prospectively collected over 21 months among patients undergoing cardiac catheterization at a University Hospital. "Ectopic RCA" was defined as a RCA originating outside the posterior two-thirds of the right coronary sinus. RESULTS The study population included 2,120 patients, of which 23 (1.1%) had ectopic RCAs. Of these, 15 (65%) originated from the anterior third of the right sinus, while 8 (35%) originated from the anterior half of the left sinus. Mean procedure and fluoroscopy times were 60 +/- 33 and 15 +/- 12 minutes (min) for the former, and 78 +/- 35 and 31 +/- 20 min for the latter, while mean contrast volume for CA was 112 +/- 62 ml and 192 +/- 85 ml, respectively. 26% required a second CA or a second intervention to image the RCA. CONCLUSION Ectopic RCAs pose a clinical problem, consuming time and resources. The search for an ectopic RCA should have < 90 degree boundaries limited to the anterior third of the right sinus and anterior half of the left sinus.
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Sanchez-Ross MG, Maher JM, Kasper M, Oghlakian G, Patel B, Dhruva VN, Kaluski E, Langley D, Dougan W, Alfano D, Klapholz M. RIPPLE EFFECTS OF A NOVEL D2B PATHWAY. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)61014-5] [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: 11/26/2022]
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Kaluski E, Uriel N, Milo-Cotter O, Klapholz M. Nitric oxide synthase inhibitors in cardiogenic shock: present and future. Future Cardiol 2009; 4:183-9. [PMID: 19804295 DOI: 10.2217/14796678.4.2.183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cardiogenic shock (CS) accompanying myocardial infarction carries a case fatality rate of 40-50%. Profound myocardial dysfunction is partially reversible, and possibly related to a state of inflammatory storm accompanied by nitric oxide (NO) overproduction. CS survivors enjoy satisfactory longevity and quality of life. The focus of this review is to describe the available data regarding NO synthase (NOS) inhibitors in CS. In view of supportive evidence from mammalian research (inducible-NOS-knockout mice are less susceptible to ischemic and reperfusion injury), therapies mitigating NO overproduction were tested in human CS subjects. Human randomized clinical trials project excellent safety but lack of efficacy. Although the Phase III, multicenter, prospective, randomized, double-blind, placebo-controlled Study to Assess the Safety and Efficacy of Tilarginine Acetate (L-N(G)-monomethyl arginine citrate [L-NMMA]) in CS (TRIUMPH) trial demonstrated lack of clinical benefit of 5-h infusion of L-NMMA in CS, major design issues regarding the optimal timing, dosing, duration and NOS inhibitor need to be addressed prior to rendering this therapy ineffective.
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Klapholz M, Abraham WT, Ghali JK, Ponikowski P, Anker SD, Knusel B, Sun Y, Wasserman SM, van Veldhuisen DJ. The safety and tolerability of darbepoetin alfa in patients with anaemia and symptomatic heart failure. Eur J Heart Fail 2009; 11:1071-7. [DOI: 10.1093/eurjhf/hfp130] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kaluski E, Gerula C, Randhawa P, Klapholz M. Funneling: enhancing results of small-vessel stenting. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2009; 10:255-8. [PMID: 19815174 DOI: 10.1016/j.carrev.2009.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 01/09/2009] [Indexed: 11/19/2022]
Abstract
Until October 2008, coronary drug-eluting stents with a diameter of < or =2.5 mm were not approved by the FDA. Target vessels of < or =2 mm in diameter pose a major challenge in view of high restenosis rates when stented bare metal stents (BMS) are used and distal edge dissection when oversized stents are deployed. Described is a method ("funneling") to optimize stenting of small vessels. This strategy combines stenting the distal part of the lesion with short (8-12 mm length) 2-mm bare metal stent while stenting with a larger-diameter (> or =2.5 mm) drug-eluting stent (DES) with considerable DES-BMS overlap (leaving only the distal 4-6 mm of the BMS not overlapped by a DES). The two stents create a funnel that is for the most part drug eluting. With funneling, both drug elution and larger diameter are attained, minimizing both edge dissection and restenosis.
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Mongal LS, Salat R, Anis A, Esrig BC, Oz M, Klapholz M, Maldjian P, Saric M. Enormous Right Atrial Hemangioma in an Asymptomatic Patient: A Case Report and Literature Review. Echocardiography 2009; 26:973-6. [DOI: 10.1111/j.1540-8175.2009.00947.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Kaluski E, Moussa ID, Heuser RR, Kern MJ, Weisz G, Klapholz M, Gerula C. Automated contrast injectors for angiography: Devices, methodology, and safety. Catheter Cardiovasc Interv 2009; 74:459-64. [DOI: 10.1002/ccd.22029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
The 2005 American Heart Association/American College of Cardiology heart failure (HF) guidelines contributed to a renewed focus on "at-risk" patients and emphasized HF as a progressive disease. Patient categorization by stages focused attention on customization of therapy to achieve optimal, evidence-based treatments across the HF continuum. Therapy for risk factors that predispose patients to left ventricular dysfunction or other symptoms may help reduce HF development. beta-Blockers are valuable for treatment of HF; however, the class is heterogeneous, and proper beta-blocker selection for each HF stage is important. beta-Blockers have been used routinely to treat patients with stage A HF with hypertension. Recent controversy regarding the detrimental effects that some beta-blockers have on metabolic parameters has raised inappropriate concerns about the use of any beta-blocker for diabetes. beta-Blockade is standard therapy for the patient with stage B HF who has had a myocardial infarction, but few data are available concerning use in asymptomatic patients with left ventricular dysfunction. Additionally, beta-blockers are part of the core therapy for stage C HF and selected patients with stage D HF. This review examines the role and use of beta-blockers in each HF stage through an evidence-based approach to provide better understanding of their importance in this progressive disease. PubMed searches (1980-2008) identified large clinical trials that evaluated cardiovascular events and outcomes in any HF stage or hypertension. Search terms were heart failure, hypertension, beta-blocker, ACEI, ARB, and calcium channel blocker AND blood pressure coronary artery disease, diabetes, efficacy, left ventricular dysfunction, metabolism, mortality, myocardial infarction, or stroke.
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Sedaghat D, Zakir RM, Choe J, Klapholz M, Saric M. Cardiac amyloidosis in a patient with multiple myeloma: a case report and review of literature. JOURNAL OF CLINICAL ULTRASOUND : JCU 2009; 37:179-184. [PMID: 19177424 DOI: 10.1002/jcu.20552] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We report a case of a 52-year-old man with multiple myeloma and rapidly progressive heart failure who died unexpectedly from a probable arrhythmia. Postmortem examination revealed infiltrative amyloid cardiomyopathy, a rare cause of predominantly diastolic myocardial disease. Cardiac amyloidosis should be considered in any patient presenting with congestive heart failure, preserved systolic function, and a discrepancy between a low QRS voltage on electrocardiography and an apparent left ventricular hypertrophy on sonogram. The pattern of left ventricular diastolic dysfunction changes during the course of amyloidosis and the classically described restrictive physiology occurs only in advanced stages of the disease.
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Shabari FR, Delgado R, Kar B, Civitello A, Loyalka P, Czerska B, Klapholz M, Haeusslein E, Brown S, Konstam M. 55: Clinical and Hemodynamic Findings with a System for Delivery of Aortic Flow Therapy in Patients with Acute Decompensated Heart Failure. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kaluski E, Hauptmann KE, Müller R, Tsai S, Klapholz M, Grube E. Coronary stenting with MGuard: first-in-man trial. THE JOURNAL OF INVASIVE CARDIOLOGY 2008; 20:511-515. [PMID: 18829994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
UNLABELLED MGuard is a bare-metal stent covered by an ultrathin polymer mesh sleeve on its external surface, designed to reduce embolization during coronary, cerebrovascular and peripheral interventions. AIM To evaluate the feasibility and safety of MGuard-based percutaneous coronary interventions (PCIs) of human native coronary arteries (NCs) and coronary vein grafts (VGs). METHODS MGuard-based PCI executed by 2 centers with postprocedural clinical and laboratory monitoring; including creatinine phosphokinase (CPK), troponin, electrocardiography and 6-month angiographic follow up. The primary endpoint was 30-day major adverse cardiac events (MACE) including cardiac death, myocardial infarction, stent thrombosis and repeat target lesion revascularization. The secondary endpoint was device and procedural success. RESULTS Twenty-nine patients with a mean age of 68.1 +/- 12 years were enrolled. The mean VG age (n = 17) was 12.6 years (range 8-19). All patients received heparin, clopidogrel and aspirin, while none received bivalirudin, glycoprotein IIb/IIIa inhibitors (GPIs) or an embolic protection device (EPD). Device and procedural success were 100% and 96.5%, respectively. One patient experienced a procedure-related CPK rise. No MACE were reported at 1 month. CONCLUSION MGuard-based PCI of NCs and VGs appears encouraging, especially in view of unfavorable patient and lesion characteristics. Both efficacy and safety need to be further established in larger-scale studies with longer follow-up periods.
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Pullicino PM, Wadley VG, McClure LA, Safford MM, Lazar RM, Klapholz M, Ahmed A, Howard VJ, Howard G. Factors contributing to global cognitive impairment in heart failure: results from a population-based cohort. J Card Fail 2008; 14:290-5. [PMID: 18474341 DOI: 10.1016/j.cardfail.2008.01.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Revised: 12/06/2007] [Accepted: 01/04/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Heart failure (HF) and cognitive impairment are both common in older adults. However, the association between the two has not been well studied. METHODS AND RESULTS We explored the relationship between very probable HF, determined by self-reported symptoms, and cognitive impairment, defined as four or fewer correct on the Six-item Screener, in 14,089 participants of the Reasons for Geographic and Racial Differences in Stroke cohort. We determined the effect of adding demographic, socioeconomic status (SES), health behavior, and comorbidity covariates. In the univariate model, participants with very probable HF were 1.51 (95% confidence interval: 1.15-1.96) times more likely to have cognitive impairment than those without HF. As covariates were added to the model, the relationship between HF and cognitive impairment was attenuated and lost statistical significance after adjustment for depression. Demographic variables, Stroke Belt location (1.28 [1.11-1.48]), SES factors, prior stroke (1.43 [1.18-1.73]), and depression (1.66 [1.38-2.01]) remained significant in the multivariable model. Higher hemoglobin was associated (0.95 [0.9-1.00]) with modestly reduced odds of cognitive impairment. CONCLUSIONS The relationship between cognitive impairment and HF can be accounted for by multiple demographic and SES factors, and by comorbidities, some of which are modifiable. Persons with HF and cognitive impairment should be screened for anemia and depression.
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Maher J, Rivero A, Zaim S, Pappas PJ, Labropoulos N, Klapholz M, Saric M. Massive arm edema following arteriovenous dialysis shunt creation in a patient with ipsilateral permanent pacemaker. JOURNAL OF CLINICAL ULTRASOUND : JCU 2008; 36:321-4. [PMID: 17702018 DOI: 10.1002/jcu.20405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Asymptomatic subclavian vein occlusion following insertion of a permanent pacemaker (PPM) or implantable cardioverter-defibrillator (ICD) is not uncommon. We report a case of a dual-chamber PPM in a patient with an unrecognized left subclavian vein occlusion who developed massive left arm edema following ipsilateral implantation of an arteriovenous (AV) hemodialysis graft. We recommend that patients with pre-existing PPM or ICD leads who are in need of vascular access for hemodialysis should have the AV shunts placed in the contralateral arm. If this is unavoidable, then preoperative subclavian vein screening for patency should be mandatory, even in asymptomatic patients. Sonography is an appropriate initial test in such a situation.
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Oghlakian G, Klapholz M. Cardiovascular Complications of Obesity. CURRENT RESPIRATORY MEDICINE REVIEWS 2008. [DOI: 10.2174/157339808784222632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Kaluski E, Tsai S, Klapholz M. Coronary stenting with MGuard: from conception to human trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2008; 9:88-94. [DOI: 10.1016/j.carrev.2007.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Revised: 12/03/2007] [Accepted: 12/04/2007] [Indexed: 10/22/2022]
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Kaluski E, Haider B, Milo-Cotter O, Klapholz M. Glycoprotein IIb/IIIa inhibitors: questioning indications and treatment algorithms. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2007; 8:281-8. [PMID: 18053951 DOI: 10.1016/j.carrev.2007.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Accepted: 03/30/2007] [Indexed: 11/27/2022]
Abstract
Glycoprotein inhibitors (GPI) are viewed as beneficial adjunctive pharmacotherapy agents for percutaneous coronary interventions (PCIs). The major benefit of GPI is derived from the reduction of ischemic events (mostly non-Q-wave myocardial infarctions) during PCI. There is no single randomized clinical trial demonstrating that any of these agents significantly reduces mortality in any clinical subset of patients. Studies of sustained oral GPI resulted in excessive death and myocardial infarctions. Reduction of ischemic end points was counteracted by excessive bleeding, vascular complications, and thrombocytopenia. These complications bear considerable medical and economic impact. The Acute Catheterization and Early Intervention Triage Strategy trial demonstrated that GPI, when added to heparin, enoxaparine, or bivalirudin, do not reduce mortality or ischemic events but significantly increase bleeding complications. Major bleeding resulted in threefold mortality at 1 year. In view of available data, the use of GPI should be limited to moderate-risk to high-risk PCI patients with low bleeding propensity. Protocols of abbreviated GPI administration and careful bleeding surveillance, in conjunction with lower doses of unfractionated heparin or new and possibly safer antithrombins, can potentially improve patient safety.
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Mendiolaza J, Baltasar JFT, Anis A, Harrison J, Chen F, Klapholz M, Saric M. Left ventricular non-Hodgkin lymphoma visualized on contrast echocardiography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2007; 35:462-4. [PMID: 17373683 DOI: 10.1002/jcu.20344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
We present a case of AIDS-related Burkitt's type cardiac lymphoma in a middle-aged woman with Epstein-Barr virus infection and profound immunodeficiency. The original features of our case include left ventricular location, female sex, and the use of contrast echocardiography to help establish the diagnosis.
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Anis A, Maldjian PD, Rafiq A, Abdelhadi S, Zakir R, Klapholz M. CORRELATION BETWEEN OBJECTIVE CHEST X-RAY FINDINGS WITH SERUM BRAIN NATRIURETIC PEPTIDE LEVELS, EJECTION FRACTION AND DIASTOLIC FUNCTION IN PATIENTS PRESENTING WITH AND WITHOUT DYSPNEA. Chest 2007. [DOI: 10.1378/chest.132.4_meetingabstracts.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Zakir RM, Patel R, Abro Z, Anis A, Saric M, Klapholz M. Hypertension in African Americans with Heart Failure: Progression from Hypertrophy to Dilatation; Perhaps Not. J Card Fail 2007. [DOI: 10.1016/j.cardfail.2007.06.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kaluski E, Groothuis A, Klapholz M, Seifart P, Edelman E. Coronary stenting with M-Guard: feasibility and safety porcine trial. THE JOURNAL OF INVASIVE CARDIOLOGY 2007; 19:326-30. [PMID: 17712199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
UNLABELLED M-Guard is an ultra-thin polymer mesh sleeve attached to the external stent surface. It is designed to minimize distal embolization during coronary, renal, carotid and vein graft stenting. The polymer net could also serve as a platform for more uniform drug delivery. AIM To evaluate coronary M-Guard stent deliverability and safety (stent thrombosis and restenosis) in comparison to bare-metal stents (BMS) in a porcine model of percutaneous coronary interventions (PCIs). METHODS Under general anesthesia using percutaneous technique, 6 swine received a total of 18 coronary stents: 5 BMS and 13 M-Guard-BMS. Quantitative coronary angiography (QCA) was obtained immediately prior to and post-PCI, and at 30 days post-stenting. At 30 days, all animals were sacrificed and hearts were sent to a core lab for coronary histology and histomorphometry. Primary endpoints were 30-day QCA percent diameter stenosis, late luminal loss and minimal luminal diameter (MLD). Secondary endpoints were procedural success, 30-day mortality and stent thrombosis. Exploratory endpoints were histology and histomorphometric analysis performed at 30 days on M-Guard stented segments. RESULTS All stents were delivered successfully. There were no procedural complications or porcine morbidity or mortality at 30 days. The M-Guard and BMS displayed similar results of MLD, late luminal loss and percent diameter stenosis at 1 month. CONCLUSION When compared to BMS, PCI with M-Guard-BMS is feasible, safe and yields similar inflammatory and restenotic response.
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