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Alkhouli M, Makkar A, Freeman JV, Ellis CR, Shah AP, Gada H, Coylewright M, Lo M, Agarwal H, Lakkireddy D. Amulet Occluder Implantation in Patients With Failed Prior Left Atrial Appendage Occlusion: EMERGE LAA Insights. JACC Cardiovasc Interv 2024; 17:457-459. [PMID: 38355277 DOI: 10.1016/j.jcin.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/09/2023] [Accepted: 12/11/2023] [Indexed: 02/16/2024]
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Alkhouli M, Freeman JV, Ellis CR, Shah AP, Gada H, Coylewright M, Lo M, Makkar A, Agarwal H, Lakkireddy D. First Experience With Amulet in the United States: Early Insights From EMERGE LAA Postapproval Study. JACC Cardiovasc Interv 2024:S1936-8798(23)01553-4. [PMID: 38310499 DOI: 10.1016/j.jcin.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND The Food and Drug Administration approved the Amulet occluder (Abbott) after demonstrating safety and effectiveness in the Amulet IDE (AMPLATZER Amulet LAA Occluder) trial. OBJECTIVES The aim of the EMERGE Left Atrial Appendage study is to evaluate early postapproval outcomes of the Amulet occluder in the United States using data from the National Cardiovascular Data Registry Left Atrial Appendage Occlusion Registry. METHODS Patients with a commercial Amulet occluder implant attempt between Food and Drug Administration approval (August 14, 2021) and December 31, 2022, were included. The safety composite endpoint included all-cause death, ischemic stroke, systemic embolism, or device/procedure-related events requiring open cardiac surgery or endovascular intervention between device implantation and 7 days or hospital discharge (whichever is later). Major adverse events through 45 days were also reported and stratified by operator experience (early [<10 cases], moderate [10-29 cases], and high [30+ cases]). RESULTS A total of 5,499 patients underwent attempted Amulet occluder implantation. Implant success was 95.8%, and complete closure was 97.2% post-left atrial appendage occlusion and 87.1% at 45 days. A safety composite endpoint event occurred in 0.76% patients. Any major adverse event occurred in 2.9% and 5.7% of patients in-hospital and through 45 days, respectively, driven by major bleeding and pericardial effusion (PE) requiring intervention. PE requiring surgery or percutaneous intervention decreased significantly with increasing experience both in-hospital (early vs high operator experience 1.8% vs 1.1%; P = 0.006) and at 45 days (2.3% vs 1.5%; P = 0.012). CONCLUSIONS The EMERGE Left Atrial Appendage study demonstrates favorable safety and effectiveness of the Amulet occluder in the real-world setting. More experienced operators had improved implant success and fewer PEs, suggesting a learning curve effect implanting this dual occlusive mechanism device.
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Affiliation(s)
| | - James V Freeman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Atman P Shah
- The University of Chicago, Chicago, Illinois, USA
| | - Hemal Gada
- University of Pittsburgh Medical Center, Wormleysburg, Pennsylvania, USA
| | - Megan Coylewright
- Erlanger and University of Tennessee Health Science Center, College of Medicine, Chattanooga, Tennessee
| | - Monica Lo
- Arkansas Heart Hospital, Little Rock, Arkansas, USA
| | - Akash Makkar
- Arizona Heart Arrhythmia Associates, Phoenix, Arizona, USA
| | - Himanshu Agarwal
- CHI Creighton University School of Medicine, Bergan Mercy Hospital, Omaha, Nebraska, USA
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA
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Lador A, Peterson LE, Swarup V, Schurmann PA, Makkar A, Doshi RN, DeLurgio D, Athill CA, Ellenbogen KA, Natale A, Koneru J, Dave AS, Giorgberidze I, Afshar H, Guthrie ML, Bunge R, Morillo CA, Kleiman NS, Valderrábano M. Determinants of outcome impact of vein of Marshall ethanol infusion when added to catheter ablation of persistent atrial fibrillation: A secondary analysis of the VENUS randomized clinical trial. Heart Rhythm 2021; 18:1045-1054. [PMID: 33482387 DOI: 10.1016/j.hrthm.2021.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/01/2021] [Accepted: 01/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Vein of Marshall Ethanol for Untreated Persistent AF (VENUS) trial demonstrated that adding vein of Marshall (VOM) ethanol infusion to catheter ablation (CA) improves ablation outcomes in persistent atrial fibrillation (AF). There was significant heterogeneity in the impact of VOM ethanol infusion on rhythm control. OBJECTIVE The purpose of this study was to assess the association between outcomes and (1) achievement of bidirectional perimitral conduction block and (2) procedural volume. METHODS The VENUS trial randomized patients with persistent AF (N = 343) to CA combined with VOM ethanol or CA alone. The primary outcome (freedom from AF or atrial tachycardia [AT] lasting longer than 30 seconds after a single procedure) was analyzed by 2 categories: (1) successful vs no perimitral block and (2) high- (>20 patients enrolled) vs low-volume centers. RESULTS In patients with perimitral block, the primary outcome was reached 54.3% after VOM-CA and 37% after CA alone (P = .01). Among patients without perimitral block, freedom from AF/AT was 34.0% after VOM-CA and 37.0% after CA (P = .583). In high-volume centers, the primary outcome was reached in 56.4% after VOM-CA and 40.2% after CA (P = .01). In low-volume centers, freedom from AF/AT was 30.77% after VOM-CA and 32.61% after CA (P = .84). In patients with successful perimitral block from high-volume centers, the primary outcome was reached in 59% after VOM-CA and 39.1% after CA (P = .01). Tests for interaction were significant (P = .002 for perimitral block and P = .04 for center volume). CONCLUSION Adding VOM ethanol infusion to CA has a greater impact on outcomes when associated with perimitral block and performed in high-volume centers. Perimitral block should be part of the VOM procedure.
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Affiliation(s)
- Adi Lador
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | - Leif E Peterson
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | | | - Paul A Schurmann
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas; Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | | | - Rahul N Doshi
- Division of Cardiology, Keck-USC University Hospital, University of Southern California, Los Angeles, California
| | - David DeLurgio
- Division of Cardiology, Emory St. Joseph's Hospital, Emory University, Atlanta, Georgia
| | - Charles A Athill
- San Diego Cardiac Center, Sharp Memorial Hospital, San Diego, California
| | - Kenneth A Ellenbogen
- Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas
| | - Jayanthi Koneru
- Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Amish S Dave
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | | | - Hamid Afshar
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Michelle L Guthrie
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | - Raquel Bunge
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | - Carlos A Morillo
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | - Miguel Valderrábano
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas.
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Valderrábano M, Peterson LE, Swarup V, Schurmann PA, Makkar A, Doshi RN, DeLurgio D, Athill CA, Ellenbogen KA, Natale A, Koneru J, Dave AS, Giorgberidze I, Afshar H, Guthrie ML, Bunge R, Morillo CA, Kleiman NS. Effect of Catheter Ablation With Vein of Marshall Ethanol Infusion vs Catheter Ablation Alone on Persistent Atrial Fibrillation: The VENUS Randomized Clinical Trial. JAMA 2020; 324:1620-1628. [PMID: 33107945 PMCID: PMC7592031 DOI: 10.1001/jama.2020.16195] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Catheter ablation of persistent atrial fibrillation (AF) has limited success. Procedural strategies beyond pulmonary vein isolation have failed to consistently improve results. The vein of Marshall contains innervation and AF triggers that can be ablated by retrograde ethanol infusion. OBJECTIVE To determine whether vein of Marshall ethanol infusion could improve ablation results in persistent AF when added to catheter ablation. DESIGN, SETTING, AND PARTICIPANTS The Vein of Marshall Ethanol for Untreated Persistent AF (VENUS) trial was an investigator-initiated, National Institutes of Health-funded, randomized, single-blinded trial conducted in 12 centers in the United States. Patients (N = 350) with persistent AF referred for first ablation were enrolled from October 2013 through June 2018. Follow-up concluded in June 2019. INTERVENTIONS Patients were randomly assigned to catheter ablation alone (n = 158) or catheter ablation combined with vein of Marshall ethanol infusion (n = 185) in a 1:1.15 ratio to accommodate for 15% technical vein of Marshall ethanol infusion failures. MAIN OUTCOMES AND MEASURES The primary outcome was freedom from AF or atrial tachycardia for longer than 30 seconds after a single procedure, without antiarrhythmic drugs, at both 6 and 12 months. Outcome assessment was blinded to randomization treatment. There were 12 secondary outcomes, including AF burden, freedom from AF after multiple procedures, perimitral block, and others. RESULTS Of the 343 randomized patients (mean [SD] age, 66.5 [9.7] years; 261 men), 316 (92.1%) completed the trial. Vein of Marshall ethanol was successfully delivered in 155 of 185 patients. At 6 and 12 months, the proportion of patients with freedom from AF/atrial tachycardia after a single procedure was 49.2% (91/185) in the catheter ablation combined with vein of Marshall ethanol infusion group compared with 38% (60/158) in the catheter ablation alone group (difference, 11.2% [95% CI, 0.8%-21.7%]; P = .04). Of the 12 secondary outcomes, 9 were not significantly different, but AF burden (zero burden in 78.3% vs 67.9%; difference, 10.4% [95% CI, 2.9%-17.9%]; P = .01), freedom from AF after multiple procedures (65.2% vs 53.8%; difference, 11.4% [95% CI, 0.6%-22.2%]; P = .04), and success achieving perimitral block (80.6% vs 51.3%; difference, 29.3% [95% CI, 19.3%-39.3%]; P < .001) were significantly improved in vein of Marshall-treated patients. Adverse events were similar between groups. CONCLUSIONS AND RELEVANCE Among patients with persistent AF, addition of vein of Marshall ethanol infusion to catheter ablation, compared with catheter ablation alone, increased the likelihood of remaining free of AF or atrial tachycardia at 6 and 12 months. Further research is needed to assess longer-term efficacy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01898221.
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Affiliation(s)
- Miguel Valderrábano
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | - Leif E. Peterson
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | | | - Paul A. Schurmann
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | | | - Rahul N. Doshi
- Keck-USC University Hospital, University of Southern California, Los Angeles
| | - David DeLurgio
- Emory St Joseph’s Hospital, Emory University, Atlanta, Georgia
| | | | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David’s Medical Center, Austin
| | - Jayanthi Koneru
- Virginia Commonwealth University School of Medicine, Richmond
| | - Amish S. Dave
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | | | - Hamid Afshar
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Michelle L. Guthrie
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | - Raquel Bunge
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | - Carlos A. Morillo
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Neal S. Kleiman
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
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Kaur S, Gupta R, Khan ID, Jindal S, Prajapati S, Makkar A, Rajmohan KS. INFRASTRUCTURE, RESOURCES, SERVICES EVALUATION AND GAP ANALYSIS OF INTEGRATED MATERNAL AND CHILD DEVELOPMENT SERVICES IN INDIA. IJMMR 2019. [DOI: 10.11603/ijmmr.2413-6077.2018.2.9286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background. Integrated Child Development Services (ICDS) is an Indian community-centric government program organized under Anganwadi centres catering to supplementary nutrition, health and preschool education, primary healthcare, growth monitoring and counselling the children under six years old along with their mothers. It is the world’s largest outreach program in a developing country covering a population of 1.35 billion; the variations in service delivery were analysed involving cross-sectional rural and urban Anganwadi centers in New Delhi.
Methods. Data were collected by assessment of children and mothers, interview of Anganwadi workers and observation of service delivery parameters and conduction of activities. Infrastructural, beneficiaries, services and content were evaluated by a suitable pre-tested questionnaire based on the National Institute of Public Cooperation and Child Development (NIPCCD) evaluation proforma. The data was analysed by a descriptive statistics.
Results. Gaps were found in respect of infrastructure, resources, health and nutrition facilities especially at rural Anganwadi centre which was inadequate in terms of implementation of nutrition and health program, supplementary nutrition, preschool education and nutrition rehabilitation centre for existing beneficiaries. Both Anganwadi centres were not catering for new WHO growth standards and adolescent health.
Conclusions. Gaps found in respect of infrastructure, resources, health and nutrition facilities can affect performance of ICDS program and the services delivered by Anganwadi centres, which need a boost. Both urban and rural centres have a direct opportunity towards delivering adolescent health program focusing on nutrition and education of girls prior to their pregnancy, and adoption of new WHO growth standards.
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Makkar A, Indushekar KR, Saraf BG, Sardana D, Sheoran N. A cross sectional study to evaluate the oral health status of children with intellectual disabilities in the National Capital Region of India (Delhi-NCR). J Intellect Disabil Res 2019; 63:31-39. [PMID: 30338591 DOI: 10.1111/jir.12553] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 09/06/2018] [Accepted: 09/23/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Children with intellectual disabilities (ID) have usually been reported to have poorer levels of oral hygiene and higher prevalence of dental caries than their compeers. The present study was conducted to assess the status of dental caries and oral hygiene in different categories of institutionalised children with ID (syndromic and non-syndromic) registered in various special schools of Delhi (National Capital Region, India). METHODS The present cross sectional study was conducted on 269 children [52 with cerebral palsy (CP), 35 with Down syndrome (DS), 30 with autism and 152 with non-syndromic intellectual disability] attending nine special schools who were examined for dental caries [Decayed, Missing and Filled Teeth index for permanent teeth (DMFT); decayed, missing/indicated for extraction, filled index for primary teeth (dmft) and prevalence of caries] and oral hygiene status [Oral Hygiene Index-simplified (OHI-S)]. The levels of disability were classified according to Stanford Binet scale as severe (IQ ≤ 35), moderate (IQ = 36-51) and mild (IQ = 52-67). Statistical analysis was performed using one way analysis of variance and post hoc test to compare the levels between groups at a significance level of P < 0.05. RESULTS Mean DMFT, dmft and OHI-S indices scores for all the children irrespective of the category and the level of ID were 2.12 ± 1.95, 0.97 ± 1.60 and 2.05 ± 1.07, respectively. As the level of ID increased among these children, the mean DMFT index and OHI-S index increased with no significant effect on dmft. However, children with severe ID had higher OHI-S and DMFT scores than children with mild or moderate ID. The dental caries prevalence was 86.53%, 68.57%, 76% and 86.18% in children with CP, DS, autism and non-syndromic intellectual disability, respectively. CONCLUSIONS The level of caries in permanent teeth and oral hygiene deteriorated with the increasing severity of ID as indicated by DMFT and OHI-S scores (severe > mild, moderate). However, the level of caries (dmft) was not affected by the level of ID in primary dentition. The prevalence of dental caries was highest among children with CP and least among children with DS.
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Affiliation(s)
- A Makkar
- Department of Paediatric Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad, India
| | - K R Indushekar
- Department of Paediatric Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad, India
| | - B G Saraf
- Department of Paediatric Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad, India
| | - D Sardana
- Faculty of Dentistry, Prince Philip Dental Hospital, The University of Hong Kong, Hong Kong, S.A.R
| | - N Sheoran
- Department of Paediatric Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad, India
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Turagam MK, Nagarajan DV, Bartus K, Makkar A, Swarup V. Use of a pocket compression device for the prevention and treatment of pocket hematoma after pacemaker and defibrillator implantation (STOP-HEMATOMA-I). J Interv Card Electrophysiol 2017; 49:197-204. [DOI: 10.1007/s10840-017-0235-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/22/2017] [Indexed: 11/28/2022]
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Al-Qaisi SA, Ali M, Makkar A, Swarup V. WATCHMAN DEVICE ASSOCIATED THROMBI: A NOVEL TREATMENT APPROACH. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33881-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Parikh V, Lavu M, Jazayeri MA, Lakshmi Kishan Vuddanda V, Bommana S, Atkins D, Mohanty M, Di Biase L, Dendi R, Makkar A, Swarup V, Natale A, Reddy M, Lakkireddy D. USE OF AN ESOPHAGEAL RETRACTOR TO PREVENT THERMAL INJURIES DURING ATRIAL FIBRILLATION ABLATION: A MULTI-CENTER EXPERIENCE. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33795-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Prisciandaro JI, Makkar A, Fox CJ, Hayman JA, Horwood L, Pelosi F, Moran JM. Dosimetric review of cardiac implantable electronic device patients receiving radiotherapy. J Appl Clin Med Phys 2015; 16:5189. [PMID: 25679176 PMCID: PMC5689988 DOI: 10.1120/jacmp.v16i1.5189] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/15/2014] [Accepted: 10/10/2014] [Indexed: 11/23/2022] Open
Abstract
A formal communication process was established and evaluated for the management of patients with cardiac implantable electronic devices (CIEDs) receiving radiation therapy (RT). Methods to estimate dose to the CIED were evaluated for their appropriateness in the management of these patients. A retrospective, institutional review board (IRB) approved study of 69 patients with CIEDs treated with RT between 2005 and 2011 was performed. The treatment sites, techniques, and the estimated doses to the CIEDs were analyzed and compared to estimates from published peripheral dose (PD) data and three treatment planning systems (TPSs) — UMPlan, Eclipse's AAA and Acuros algorithms. When measurements were indicated, radiation doses to the CIEDs ranged from 0.01–5.06 Gy. Total peripheral dose estimates based on publications differed from TLD measurements by an average of 0.94 Gy (0.05–4.49 Gy) and 0.51 Gy (0–2.74 Gy) for CIEDs within 2.5 cm and between 2.5 and 10 cm of the treatment field edge, respectively. Total peripheral dose estimates based on three TPSs differed from measurements by an average of 0.69 Gy (0.02–3.72 Gy) for CIEDs within 2.5 cm of the field edge. Of the 69 patients evaluated in this study, only two with defibrillators experienced a partial reset of their device during treatment. Based on this study, few CIED‐related events were observed during RT. The only noted correlation with treatment parameters for these two events was beam energy, as both patients were treated with high‐energy photon beams (16 MV). Differences in estimated and measured CIED doses were observed when using published PD data and TPS calculations. As such, we continue to follow conservative guidelines and measure CIED doses when the device is within 10 cm of the field or the estimated dose is greater than 2 Gy for pacemakers or 1 Gy for defibrillators. PACS number: 87.55.N‐
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Makkar A, Mishima T, Chang G, Scifres C, Sadovsky Y. Fatty acid binding protein-4 is expressed in the mouse placental labyrinth, yet is dispensable for placental triglyceride accumulation and fetal growth. Placenta 2014; 35:802-7. [PMID: 25096952 DOI: 10.1016/j.placenta.2014.07.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 07/07/2014] [Accepted: 07/15/2014] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Fatty Acid Binding Protein-4 (FABP4) is a member of a family of FABP proteins that regulate intracellular lipid trafficking in diverse tissues. We recently showed that FABP4 regulates triglyceride accumulation in primary human trophoblasts. To assess the function of placental FABP4 in vivo, we tested the hypothesis that FABP4 is expressed in the murine placenta, and regulates placenta triglyceride accumulation. METHODS C57Bl/6 wild type or Fabp4-null mice were time-bred, and fetuses and placentas harvested at different time points during pregnancy. Placental FABP4 expression was assessed at different gestational ages, using quantitative PCR, immunohistochemistry, immunofluorescence and western immunoblotting. FABPs expression was examined by RT-qPCR. Placental lipids were extracted using the Folch method and triglyceride levels determined using a colorimetric quantification kit. RESULTS Using immunohistochemistry, we found that FABP4 was expressed in the placental labyrinthine layer, predominantly in endothelial cells in association with CD31 positive fetal capillaries. The level of placental FABP4 mRNA and protein increased from E12.5 to E16.5 and slightly decreased at E18.5. Breeding of Fabp4 heterozygous mice resulted in embryonic genotypes that followed a Mendelian distribution and exhibited normal weight and morphology, triglyceride content, and expression of other FABP family members. Exposure to hypoxia (O2 = 12%) between E12.5-E18.5 did not uncover a difference between wild type and Fabp4-null mice. CONCLUSIONS FABP4 is expressed in the mouse placental labyrinth, with highest expression at E16.5. FABP4 is dispensable for feto-placental growth and placental lipid accumulation.
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Affiliation(s)
- A Makkar
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA; Department of Pediatrics, University of Pittsburgh, USA
| | - T Mishima
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - G Chang
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA; Tsinghua University School of Medicine Education Program, Beijing, China
| | - C Scifres
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Y Sadovsky
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA; Department of Microbiology and Molecular Genetics, University of Pittsburgh, Pittsburgh, PA, USA.
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Huang HD, Makkar A, Birnbaum Y. A patient with recurrent falls. J Electrocardiol 2013; 46:724-6. [DOI: 10.1016/j.jelectrocard.2013.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kim ET, Makkar A, Saeed M, Birnbaum Y. Is it pacemaker malfunction? J Electrocardiol 2013; 46:721-3. [DOI: 10.1016/j.jelectrocard.2013.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Malhotra P, Makkar A, Guru Murthy GS, Varma N, Varma S, Chakrabarti A. Empirical Amphotericin B therapy on Day 4 or Day 8 of Febrile Neutropenia. Mycoses 2013; 57:110-5. [DOI: 10.1111/myc.12108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 05/29/2013] [Accepted: 06/21/2013] [Indexed: 01/29/2023]
Affiliation(s)
- Pankaj Malhotra
- Department of Internal Medicine; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Akash Makkar
- Department of Internal Medicine; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | | | - Neelam Varma
- Department of Haematology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Subhash Varma
- Department of Internal Medicine; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology; Postgraduate Institute of Medical Education and Research; Chandigarh India
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Makkar A, Birnbaum Y. ECG quiz: a challenging ECG in a patient with shortness of breath. J Electrocardiol 2013; 46:89, 173-4. [PMID: 23620873 DOI: 10.1016/j.jelectrocard.2013.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yokokawa M, Latchamsetty R, Ghanbari H, Belardi D, Makkar A, Roberts B, Saint-Phard W, Sinno M, Carrigan T, Kennedy R, Suwanagool A, Good E, Crawford T, Jongnarangsin K, Pelosi F, Bogun F, Oral H, Morady F, Chugh A. Characteristics of atrial tachycardia due to small vs large reentrant circuits after ablation of persistent atrial fibrillation. Heart Rhythm 2013; 10:469-76. [DOI: 10.1016/j.hrthm.2012.12.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Indexed: 11/24/2022]
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Huang HD, Tamarisa R, Mathur N, Alam M, Makkar A, Birnbaum Y, Afshar-Kharaghan H. Stellate ganglion block: a therapeutic alternative for patients with medically refractory inappropriate sinus tachycardia? J Electrocardiol 2013; 46:693-6. [PMID: 23313383 DOI: 10.1016/j.jelectrocard.2012.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Indexed: 11/17/2022]
Abstract
Inappropriate sinus tachycardia (IST) is a clinical syndrome characterized by presence of non-paroxysmal tachyarrhythmia manifesting with increased resting heart rate and exaggerated or persistent response to exercise or position. When IST is intolerable and medically refractory, invasive therapies such as sinus node modification or atrioventricular node ablation with placement of permanent pacemaker are tried to control symptoms. We present a 34 year old patient with symptomatic IST unresponsive to medical therapy who underwent anesthetic block of the right and left stellate ganglia. At four month follow up the patient demonstrated sustained improvement in heart rate and reported freedom from previous symptoms.
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Affiliation(s)
- Henry D Huang
- Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA.
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Prisciandaro J, Fox C, Horwood L, Hayman J, Makkar A, Moran J, Pelosi F. SU-E-T-183: Managing and Assessing Patients Receiving Radiotherapy with Implantable Cardiac Devices. Med Phys 2012; 39:3745. [DOI: 10.1118/1.4735242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Makkar A, Siddiqui TS, Stoddard MF, Lewis RK, Dawn B. Impact of Valvular Calcification on the Diagnostic Accuracy of Transesophageal Echocardiography for the Detection of Congenital Aortic Valve Malformation. Echocardiography 2007; 24:745-9. [PMID: 17651104 DOI: 10.1111/j.1540-8175.2007.00459.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Degeneration of congenital bicuspid or unicuspid aortic valves can progress more rapidly than that of tricuspid valves, and an early diagnosis significantly impacts decision making and outcome. We hypothesized that the extent of valvular calcification would negatively influence the diagnostic accuracy of multiplane transesophageal echocardiography (TEE) for the diagnosis of congenital aortic valve disease. METHODS TEE was performed in 57 patients undergoing aortic valve replacement surgery for aortic stenosis (n = 46), pure regurgitation (n = 9), or significant regurgitation with less than severe aortic stenosis (n = 2). The degree of aortic valve calcification and the number of valve cusps were determined at surgery. RESULTS Surgical inspection confirmed 14 bicuspid and 43 tricuspid aortic valves. Sensitivity and specificity of TEE for the diagnosis of congenital aortic valve malformation was 93% (13/14) and 91% (39/43) (P = 0.0001), respectively. In patients with no or mild aortic valve calcification (n = 13), sensitivity and specificity of TEE for the diagnosis of congenitally malformed aortic valve was 100% (5/5) and 100% (8/8) (P = 0.001), respectively. In patients with moderate or marked aortic valve calcification (n = 44), sensitivity and specificity of TEE for the diagnosis of congenitally malformed aortic valve was 89% (8/9) and 89% (31/35) (P<0.0001), respectively. In this subgroup of 44 patients, there were four false-positive and one false-negative diagnoses due to valvular calcification. CONCLUSIONS Although TEE is highly sensitive and specific for the detection of congenital aortic valve malformations, presence of moderate or marked calcification of the aortic valve may result in false positive and false negative diagnoses.
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Affiliation(s)
- Akash Makkar
- Division of Cardiology, Department of Medicine, University of Louisville, Louisville, KY 40292, USA
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Bedi HS, Singh RP, Makkar A, Goel V, Yakhmi R, Jain S. Post cardiac surgery transfusion associated graft versus host disease—an uncommon but potentially lethal complication. Indian J Thorac Cardiovasc Surg 2004. [DOI: 10.1007/s12055-004-0446-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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21
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Bhargava JS, Kumar R, Singh RB, Makkar A. Civilian vascular trauma: an experience of 54 cases. J Indian Med Assoc 1996; 94:47-9. [PMID: 8810175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fifty-four patients with civilian vascular injuries of the extremities caused by blunt trauma in 41 patients and by penetrating trauma in 13 patients were evaluated. Twenty-nine patients (53.7%) had associated fractures/dislocations and 19 sustained concomitant venous injuries. Twenty-nine patients (53.7%) came with a lagging period of more than 12 hours. Vascular injuries were diagnosed both clinically and by Doppler examination. In patients with equivocal findings, arteriography was performed. Arterial repair was done in 19 patients and saphenous vein interposition grafting was done in 2 patients. Fifteen patients required fasciotomy. Amputation was done in 13 patients (24.07%). It is concluded that the time lag, incorrect and incomplete assessment, and the reluctance to perform fasciotomy early and completely are some of the factors responsible for poor results.
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Affiliation(s)
- J S Bhargava
- Department of Surgery, Pt BD Sharma Medical College, Rohtak
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