1
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Bjelic M, Goldenberg I, Younis A, Chen AY, Huang DT, Yoruk A, Aktas MK, Rosero S, Cutter K, McNitt S, Sotoodehnia N, Kudenchuk PJ, Rea TD, Arking DE, Zareba W, Ackerman MJ, Goldenberg I. Risk Prediction in Male Adolescents With Congenital Long QT Syndrome: Implications for Sex-Specific Risk Stratification in Potassium Channel-Mediated Long QT Syndrome. J Am Heart Assoc 2024; 13:e028902. [PMID: 38240206 DOI: 10.1161/jaha.122.028902] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 07/06/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Sex-specific risk management may improve outcomes in congenital long QT syndrome (LQTS). We recently developed a prediction score for cardiac events (CEs) and life-threatening events (LTEs) in postadolescent women with LQTS. In the present study, we aimed to develop personalized risk estimates for the burden of CEs and LTEs in male adolescents with potassium channel-mediated LQTS. METHODS AND RESULTS The prognostic model was derived from the LQTS Registry headquartered in Rochester, NY, comprising 611 LQT1 or LQT2 male adolescents from age 10 through 20 years, using the following variables: genotype/mutation location, QTc-specific thresholds, history of syncope, and β-blocker therapy. Anderson-Gill modeling was performed for the end point of CE burden (total number of syncope, aborted cardiac arrest, and appropriate defibrillator shocks). The applicability of the CE prediction model was tested for the end point of the first LTE (excluding syncope and adding sudden cardiac death) using Cox modeling. A total of 270 CEs occurred during follow-up. The genotype-phenotype risk prediction model identified low-, intermediate-, and high-risk groups, comprising 74%, 14%, and 12% of the study population, respectively. Compared with the low-risk group, high-risk male subjects experienced a pronounced 5.2-fold increased risk of recurrent CEs (P<0.001), whereas intermediate-risk patients had a 2.1-fold (P=0.004) increased risk . At age 20 years, the low-, intermediate-, and high-risk adolescent male patients had on average 0.3, 0.6, and 1.4 CEs per person, respectively. Corresponding 10-year adjusted probabilities for a first LTE were 2%, 6%, and 8%. CONCLUSIONS Personalized genotype-phenotype risk estimates can be used to guide sex-specific management in male adolescents with potassium channel-mediated LQTS.
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Affiliation(s)
- Milica Bjelic
- Clinical Cardiovascular Research Center, Division of Cardiology University of Rochester Medical Center Rochester NY USA
- Department of Anesthesiology St. Elizabeth's Medical Center Boston University School of Medicine Boston MA USA
| | - Ido Goldenberg
- Clinical Cardiovascular Research Center, Division of Cardiology University of Rochester Medical Center Rochester NY USA
- Department of Medicine, Rochester Regional Health Rochester NY USA
| | - Arwa Younis
- Clinical Cardiovascular Research Center, Division of Cardiology University of Rochester Medical Center Rochester NY USA
- Department of Cardiovascular Medicine Cleveland Clinic Cleveland OH USA
| | - Anita Y Chen
- Department of Biostatistics and Computational Biology University of Rochester Medical Center Rochester NY USA
| | - David T Huang
- Department of Medicine, Division of Cardiology University of Rochester Medical Center Rochester NY USA
| | - Ayhan Yoruk
- Division of Cardiology The University of California, San Francisco Medical Center San Francisco CA USA
| | - Mehmet K Aktas
- Department of Medicine, Division of Cardiology University of Rochester Medical Center Rochester NY USA
| | - Spencer Rosero
- Department of Medicine, Division of Cardiology University of Rochester Medical Center Rochester NY USA
| | - Kristina Cutter
- Clinical Cardiovascular Research Center, Division of Cardiology University of Rochester Medical Center Rochester NY USA
| | - Scott McNitt
- Clinical Cardiovascular Research Center, Division of Cardiology University of Rochester Medical Center Rochester NY USA
| | - Nona Sotoodehnia
- Department of Medicine, Division of Cardiology University of Washington Seattle WA USA
| | | | - Thomas D Rea
- Department of Medicine University of Washington Seattle WA USA
| | - Dan E Arking
- The McKusick-Nathans Institute, Department of Genetic Medicine John Hopkins University School of Medicine Baltimore MD USA
| | - Wojciech Zareba
- Clinical Cardiovascular Research Center, Division of Cardiology University of Rochester Medical Center Rochester NY USA
| | - Michael J Ackerman
- Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Genetic Heart Rhythm Clinic and Windland Smith Rice Sudden Death Genomics Laboratory Mayo Clinic Rochester MN USA
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center, Division of Cardiology University of Rochester Medical Center Rochester NY USA
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Tankut S, Gosev I, Yoruk A, Younis A, McNitt S, Bjelic M, Vidula H, Wu I, Aktas MK, Goldenberg I, Huang DT. Intraoperative Ventricular Tachycardia Ablation During Left Ventricular Assist Device Implantation in High-Risk Heart Failure Patients. Circ Arrhythm Electrophysiol 2022; 15:e010660. [PMID: 35617273 DOI: 10.1161/circep.121.010660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sinan Tankut
- Department of Cardiology (S.T., H.V., M.K.A., D.T.H.), University of Rochester, NY
| | - Igor Gosev
- Clinical Cardiovascular Research Center (I.Goldenberg, S.M., M.B., I.G.), University of Rochester, NY.,Department of Cardiac Surgery (I.Gosev), University of Rochester, NY
| | - Ayhan Yoruk
- Department of Electrophysiology, University of California San Francisco (A.Y.)
| | - Arwa Younis
- Department of Electrophysiology, University of California San Francisco (A.Y.)
| | - Scott McNitt
- Clinical Cardiovascular Research Center (I.Goldenberg, S.M., M.B., I.G.), University of Rochester, NY
| | - Milica Bjelic
- Clinical Cardiovascular Research Center (I.Goldenberg, S.M., M.B., I.G.), University of Rochester, NY
| | - Himabindu Vidula
- Department of Cardiology (S.T., H.V., M.K.A., D.T.H.), University of Rochester, NY
| | - Isaac Wu
- Department of Cardiac Anesthesia (I.W.), University of Rochester, NY
| | - Mehmet K Aktas
- Department of Cardiology (S.T., H.V., M.K.A., D.T.H.), University of Rochester, NY
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center (I.Goldenberg, S.M., M.B., I.G.), University of Rochester, NY
| | - David T Huang
- Department of Cardiology (S.T., H.V., M.K.A., D.T.H.), University of Rochester, NY
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Yoruk A, Cheung CC, Surget E, Rosenthal DG, Sardana M, Baskar S, Tanel RE, Haissaguerre M, Scheinman MM. PO-679-02 FLECAINIDE THERAPY FOR PURKINJE-TRIGGERED PREMATURE VENTRICULAR COMPLEXES AND SHORT-COUPLED TORSADES DE POINTES. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.486] [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: 11/04/2022]
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4
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Yoruk A, Scheinman M. Sudden death in a "healthy" youth: Lessons learned. Heart Rhythm 2021; 18:1886-1887. [PMID: 34752259 DOI: 10.1016/j.hrthm.2021.06.1199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Ayhan Yoruk
- Division of Cardiology, University of California San Francisco, San Francisco, California
| | - Melvin Scheinman
- Division of Cardiology, University of California San Francisco, San Francisco, California.
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Li Y, Wei J, Guo W, Sun B, Estillore JP, Wang R, Yoruk A, Roston TM, Sanatani S, Wilde AAM, Gollob MH, Roberts JD, Tseng ZH, Jensen HK, Chen SRW. Human RyR2 (Ryanodine Receptor 2) Loss-of-Function Mutations: Clinical Phenotypes and In Vitro Characterization. Circ Arrhythm Electrophysiol 2021; 14:e010013. [PMID: 34546788 DOI: 10.1161/circep.121.010013] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Yanhui Li
- Department of Physiology and Pharmacology, Libin Cardiovascular Institute, University of Calgary, AB, Canada (Y.L., J.W., W.G., B.S., J.P.E., R.W., S.R.W.C.).,Department of Internal Medicine, Institute of Hypertension, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Y.L.)
| | - Jinhong Wei
- Department of Physiology and Pharmacology, Libin Cardiovascular Institute, University of Calgary, AB, Canada (Y.L., J.W., W.G., B.S., J.P.E., R.W., S.R.W.C.)
| | - Wenting Guo
- Department of Physiology and Pharmacology, Libin Cardiovascular Institute, University of Calgary, AB, Canada (Y.L., J.W., W.G., B.S., J.P.E., R.W., S.R.W.C.)
| | - Bo Sun
- Department of Physiology and Pharmacology, Libin Cardiovascular Institute, University of Calgary, AB, Canada (Y.L., J.W., W.G., B.S., J.P.E., R.W., S.R.W.C.).,Medical School, Kunming University of Science and Technology, China (B.S.)
| | - John Paul Estillore
- Department of Physiology and Pharmacology, Libin Cardiovascular Institute, University of Calgary, AB, Canada (Y.L., J.W., W.G., B.S., J.P.E., R.W., S.R.W.C.)
| | - Ruiwu Wang
- Department of Physiology and Pharmacology, Libin Cardiovascular Institute, University of Calgary, AB, Canada (Y.L., J.W., W.G., B.S., J.P.E., R.W., S.R.W.C.)
| | - Ayhan Yoruk
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco (A.Y., Z.H.T.)
| | - Thomas M Roston
- Division of Cardiology, Department of Medicine (T.M.R.), University of British Columbia, Vancouver, Canada
| | - Shubhayan Sanatani
- Child and Family Research Institute, Department of Pediatrics (S.S.), University of British Columbia, Vancouver, Canada
| | - Arthur A M Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Centre, location AMC, the Netherlands (A.A.M.W.).,Member of the European Reference Network 'ERN GUARD-Heart' (A.A.M.W.)
| | - Michael H Gollob
- Inherited Arrhythmia and Cardiomyopathy Program, Arrhythmia Service, Division of Cardiology, Toronto General Hospital (M.H.G.), University of Toronto, ON, Canada.,Department of Physiology (M.H.G.), University of Toronto, ON, Canada
| | - Jason D Roberts
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada (J.D.R.)
| | - Zian H Tseng
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco (A.Y., Z.H.T.)
| | - Henrik K Jensen
- Department of Cardiology, Aarhus University Hospital and Department of Clinical Medicine, Health, Aarhus University, Denmark (H.K.J.)
| | - S R Wayne Chen
- Department of Physiology and Pharmacology, Libin Cardiovascular Institute, University of Calgary, AB, Canada (Y.L., J.W., W.G., B.S., J.P.E., R.W., S.R.W.C.)
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Tankut S, Yoruk A, Younis A, McNitt S, Bjelic M, Vidula H, Gosev I, Aktas MK, Goldenberg I, Huang DT. B-PO04-129 INTRAOPERATIVE VENTRICULAR TACHYCARDIA ABLATION DURING LEFT VENTRICULAR ASSIST DEVICE IMPLANTATION IN HIGH-RISK HEART FAILURE PATIENTS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.823] [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: 11/26/2022]
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Younis A, Zareba W, Kharsa A, Bodurian Scott McNitt C, Aktas MK, Kutyifa V, Polonsky B, Sotoodehnia N, Kudenchuk PJ, Rea TD, Arking D, Yoruk A, Huang DT, Goldenberg I. B-PO05-024 BIOLOGICAL LIFE-STAGE, MENARCHE ONSET, AND THE BURDEN OF CARDIAC EVENTS IN WOMEN WITH CONGENITAL LONG QT SYNDROME. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.944] [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: 11/27/2022]
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Goldenberg I, Younis A, Huang DT, Yoruk A, Rosero SZ, Cutter K, Kutyifa V, McNitt S, Sotoodehnia N, Kudenchuk PJ, Rea TD, Arking DE, Polonski B, Zareba W, Aktas MK. Use of oral contraceptives in women with congenital long QT syndrome. Heart Rhythm 2021; 19:41-48. [PMID: 34339849 DOI: 10.1016/j.hrthm.2021.07.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/05/2021] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Use of oral contraceptives (OCs) may modulate the clinical course of women with congenital long QT syndrome (LQTS). The safety of OC use by sex hormone content has not been assessed in women with LQTS. OBJECTIVE We aimed to evaluate the association of OCs with the risk of cardiac events (CEs) in women with LQTS. METHODS Beginning in 2010, information on menarche onset, OC use, pregnancy, and menopause were obtained from women enrolled in the Rochester LQTS Registry. Type of OC was categorized as progestin-only, estrogen-only, or combined (estrogen/progestin). Andersen-Gill multivariate modeling was used to evaluate the association of time-dependent OC use with the burden of CE (total number of syncope, aborted cardiac arrest, and LQTS-related sudden cardiac death) from menarche onset through 40 years. Findings were adjusted for genotype, corrected QT duration, and time-dependent β-blocker therapy. RESULTS A total of 1659 women with LQTS followed through March 2021, of whom 370 (22%) were treated with an OC. During a cumulative follow-up of 35,797 years, there were a total of 2027 CE. Multivariate analysis showed that progestin-only OC was associated with a pronounced 2.8-fold (P = .01) increased risk of CEs in women who did not receive β-blocker therapy, while β-blockers were highly protective during progestin-only OC treatment (hazard ratio 0.22; P = .01; P = .006 for β-blocker-by-OC interaction). The risk associated with OC use without concomitant β-blocker treatment was pronounced in women with LQTS type 2. CONCLUSION Our findings suggest that progestin-only OC should not be administered in women with LQTS without concomitant β-blocker therapy. OCs should be used with caution in women with LQTS type 2.
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Affiliation(s)
- Ilan Goldenberg
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester Medical Center, Rochester, New York.
| | - Arwa Younis
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester Medical Center, Rochester, New York
| | - David T Huang
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester Medical Center, Rochester, New York
| | - Ayhan Yoruk
- Division of Cardiology, The University of California, San Francisco Medical Center, San Francisco, California
| | - Spencer Z Rosero
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester Medical Center, Rochester, New York
| | - Kris Cutter
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester Medical Center, Rochester, New York
| | - Valentina Kutyifa
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester Medical Center, Rochester, New York
| | - Scott McNitt
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester Medical Center, Rochester, New York
| | - Nona Sotoodehnia
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
| | - Peter J Kudenchuk
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
| | - Thomas D Rea
- Center for Progress in Resuscitation, University of Washington, Seattle, Washington
| | - Dan E Arking
- The McKusick-Nathans Institute, Department of Genetic Medicine, John Hopkins University School of Medicine, Baltimore, Maryland
| | - Bronislava Polonski
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester Medical Center, Rochester, New York
| | - Wojciech Zareba
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester Medical Center, Rochester, New York
| | - Mehmet K Aktas
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester Medical Center, Rochester, New York
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9
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Goldenberg I, Bos JM, Yoruk A, Chen AY, Lopes C, Huang DT, Kutyifa V, Younis A, Aktas MK, Z Rosero S, McNitt S, Sotoodehnia N, Kudenchuk PJ, Rea TD, Arking DE, Scott CG, Briske KA, Sorensen K, J Ackerman M, Zareba W. Risk Prediction in Women With Congenital Long QT Syndrome. J Am Heart Assoc 2021; 10:e021088. [PMID: 34238014 PMCID: PMC8483453 DOI: 10.1161/jaha.121.021088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background We aimed to provide personalized risk estimates for cardiac events (CEs) and life‐threatening events in women with either type 1 or type 2 long QT. Methods and Results The prognostic model was derived from the Rochester Long QT Syndrome Registry, comprising 767 women with type 1 long QT (n=404) and type 2 long QT (n=363) from age 15 through 60 years. The risk prediction model included the following variables: genotype/mutation location, QTc‐specific thresholds, history of syncope, and β‐blocker therapy. A model was developed with the end point of CEs (syncope, aborted cardiac arrest, or long QT syndrome–related sudden cardiac death), and was applied with the end point of life‐threatening events (aborted cardiac arrest, sudden cardiac death, or appropriate defibrillator shocks). External validation was performed with data from the Mayo Clinic Genetic Heart Rhythm Clinic (N=467; type 1 long QT [n=286] and type 2 long QT [n=181]). The cumulative follow‐up duration among the 767 enrolled women was 22 243 patient‐years, during which 323 patients (42%) experienced ≥1 CE. Based on genotype‐phenotype data, we identified 3 risk groups with 10‐year projected rates of CEs ranging from 15%, 29%, to 51%. The corresponding 10‐year projected rates of life‐threatening events were 2%, 5%, and 14%. C statistics for the prediction model for the 2 respective end points were 0.68 (95% CI 0.65–0.71) and 0.71 (95% CI 0.66–0.76). Corresponding C statistics for the model in the external validation Mayo Clinic cohort were 0.65 (95% CI 0.60–0.70) and 0.77 (95% CI 0.70–0.84). Conclusions This is the first risk prediction model that provides absolute risk estimates for CEs and life‐threatening events in women with type 1 or type 2 long QT based on personalized genotype‐phenotype data. The projected risk estimates can be used to guide female‐specific management in long QT syndrome.
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Affiliation(s)
- Ilan Goldenberg
- Division of Cardiology Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester NY
| | - J Martijn Bos
- Departments of Cardiovascular Medicine (Division of Heart Rhythm Services), Pediatric and Adolescent Medicine (Division of Pediatric Cardiology and the Windland Smith Rice Genetic Heart Rhythm Clinic), and Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory) Mayo Clinic Rochester MN
| | - Ayhan Yoruk
- Division of Cardiology The University of California, San Francisco Medical Center San Francisco CA
| | - Anita Y Chen
- Division of Cardiology Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester NY.,Department of Biostatistics and Computational Biology University of Rochester Medical Center Rochester NY
| | - Coeli Lopes
- Division of Cardiology Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester NY
| | - David T Huang
- Division of Cardiology Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester NY
| | - Valentina Kutyifa
- Division of Cardiology Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester NY
| | - Arwa Younis
- Division of Cardiology Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester NY
| | - Mehmet K Aktas
- Division of Cardiology Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester NY
| | - Spencer Z Rosero
- Division of Cardiology Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester NY
| | - Scott McNitt
- Division of Cardiology Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester NY
| | - Nona Sotoodehnia
- Division of Cardiology Department of Medicine University of Washington Seattle WA
| | - Peter J Kudenchuk
- Division of Cardiology Department of Medicine University of Washington Seattle WA
| | - Thomas D Rea
- Center for Progress in Resuscitation University of Washington Seattle WA
| | - Dan E Arking
- Department of Genetic Medicine The McKusick-Nathans InstituteJohn Hopkins University School of Medicine Baltimore MD
| | - Christopher G Scott
- Division of Biostatistics and Informatics Department of Health Sciences Research Mayo Clinic Rochester MN
| | - Kaylie A Briske
- Departments of Cardiovascular Medicine (Division of Heart Rhythm Services), Pediatric and Adolescent Medicine (Division of Pediatric Cardiology and the Windland Smith Rice Genetic Heart Rhythm Clinic), and Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory) Mayo Clinic Rochester MN
| | - Katrina Sorensen
- Departments of Cardiovascular Medicine (Division of Heart Rhythm Services), Pediatric and Adolescent Medicine (Division of Pediatric Cardiology and the Windland Smith Rice Genetic Heart Rhythm Clinic), and Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory) Mayo Clinic Rochester MN
| | - Michael J Ackerman
- Departments of Cardiovascular Medicine (Division of Heart Rhythm Services), Pediatric and Adolescent Medicine (Division of Pediatric Cardiology and the Windland Smith Rice Genetic Heart Rhythm Clinic), and Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory) Mayo Clinic Rochester MN
| | - Wojciech Zareba
- Division of Cardiology Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester NY
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Moss JD, Yoruk A. Open Chest Epicardial VT Ablation After LVAD: Ounce of Prevention or Pound of Cure? JACC Case Rep 2021; 3:1061-1063. [PMID: 34317684 PMCID: PMC8311373 DOI: 10.1016/j.jaccas.2021.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Joshua D. Moss
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | - Ayhan Yoruk
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California, USA
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Riordan M, Opaskar A, Yoruk A, Younis A, Ali A, McNitt S, Sahin B, Rosero S, Goldenberg I, Aktas MK. Predictors of Atrial Fibrillation During Long-Term Implantable Cardiac Monitoring Following Cryptogenic Stroke. J Am Heart Assoc 2020; 9:e016040. [PMID: 32689866 PMCID: PMC7792281 DOI: 10.1161/jaha.120.016040] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Following cryptogenic stroke, guidelines recommend cardiac monitoring for occult atrial fibrillation (AF). We aimed to evaluate predictors of AF during long‐term implantable cardiac monitoring. Methods and Results We studied 293 consecutive patients who underwent implantable cardiac monitor implant (Medtronic LINQ) following hospitalization for cryptogenic stroke at the University of Rochester Medical Center from January 2013 to September 2018. Multivariable Cox proportional hazards regression modeling was used to identify predictors of AF during long‐term monitoring. At 36 months of follow‐up, the cumulative rate of implantable cardiac monitor–detected AF events was 32% in the total study population. Multivariable analysis identified age ≥70 years as the most powerful predictor of the development of AF events during follow‐up (hazard ratio, 2.28 [95% CI, 1.39–3.76]; P=0.001). Replacing age with the CHA2DS2‐VASc (congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease, age, sex category) score resulted in a weaker association, for which each 1‐point increment in the CHA2DS2‐VASC score was associated with an 18% increased risk of developing AF (95% CI, 1.00–1.38; P=0.047). Consistent results were shown using Kaplan–Meier analysis by age and by the CHA2DS2VASc score. Conclusions Cryptogenic stroke patients continue to develop AF episodes during 36 months of implantable cardiac monitoring following the index event. Age is the most powerful predictor of occult AF in this population.
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Affiliation(s)
- Michael Riordan
- Department of Cardiology and Neurology Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester New York
| | - Amanda Opaskar
- Department of Cardiology and Neurology Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester New York
| | - Ayhan Yoruk
- Department of Cardiology and Neurology Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester New York
| | - Arwa Younis
- Department of Cardiology and Neurology Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester New York
| | - Adil Ali
- Department of Cardiology and Neurology Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester New York
| | - Scott McNitt
- Department of Cardiology and Neurology Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester New York
| | - Bogachan Sahin
- Department of Cardiology and Neurology Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester New York
| | - Spencer Rosero
- Department of Cardiology and Neurology Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester New York
| | - Ilan Goldenberg
- Department of Cardiology and Neurology Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester New York
| | - Mehmet K Aktas
- Department of Cardiology and Neurology Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester New York
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Yoruk A, Aktas M, Huang D, Gosev I, Black C, Kutyifa V, Goldenberg I, Chen L. Assessment of Arrhythmia Burden through the Use of an Implantable Cardiac Monitor in Patients with a Continuous Flow Left Ventricular Assist Device. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.782] [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: 10/24/2022] Open
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Tankut S, Yoruk A, Vinocur J. ENDOCARDIAL TRANSBAFFLE LEAD PLACEMENT FOR CARDIAC RESYNCHRONIZATION AFTER ATRIAL SWITCH. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33471-9] [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: 11/28/2022]
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Riordan M, Yoruk A, Younis A, Ali A, Opaskar A, Sahin B, McNitt S, Goldenberg I, Aktas M. PREDICTORS OF ATRIAL FIBRILLATION DURING LONG-TERM ARRHYTHMIA MONITORING FOLLOWING CRYPTOGENIC STROKE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31124-4] [Citation(s) in RCA: 1] [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: 10/24/2022]
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15
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Yoruk A, Goldenberg I, Huang D. TO ICD OR NOT TO ICD: CLINICAL DECISION MAKING IN AN LONG QT SYNDROME MALE PATIENT. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33868-7] [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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16
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Tankut S, Yoruk A, Vinocur J. EMERGENCY TEMPORARY TRANSBAFFLE PACING FOR COMPLETE HEART BLOCK AFTER FONTAN PALLIATION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33470-7] [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: 11/30/2022]
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17
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Yoruk A, Tankut S, Riordan M, Ling F, Aktas M. CLEANING UP THE MESS: ANGIOVAC DEBULKING IN ENDOCARDITIS PATIENT WITH LARGE, DEVICE-RELATED VEGETATIONS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32939-9] [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: 10/24/2022]
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18
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Kutyifa V, Rice J, Jones R, Mathias A, Yoruk A, Vermilye K, Johnson B, Strawderman R, Lowenstein C. Impact of non-cardiovascular disease burden on thirty-day hospital readmission in heart failure patients. Cardiol J 2019; 25:691-700. [PMID: 30600831 DOI: 10.5603/cj.2018.0147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/06/2018] [Accepted: 07/07/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Little is known about the impact of non-cardiovascular disease (CVD) burden on 30- -day readmission in heart failure (HF) patients. The aim of the study was to assess the role of non-CVD burden on 30-day readmission in HF patients. \ METHODS: We analyzed the effect of non-CVD burden by frequency of ICD-9 code categories on readmis-sions of patients discharged with a primary diagnosis of HF. We first modeled the probability of readmis-sion within 30 days as a function of demographic and clinical covariates in a randomly selected training dataset of the total cohort. Variable selection was carried out using a bootstrap LASSO procedure with 1000 bootstrap samples, the final model was tested on a validation dataset. Adjusted odds ratios and confidence intervals were reported in the validation dataset. RESULTS There were a total of 6228 HF hospitalizations, 1523 (24%) with readmission within 30 days of discharge. The strongest predictor for 30-day readmissions was any hospital admission in the prior year (p < 0.001). Cardiovascular risk factors did not enter the final model. However, digestive system diseases increased the risk for readmission by 17% for each diagnosis (p = 0.046), while respiratory diseases and genitourinary diseases showed a trend toward a higher risk of readmission (p = 0.07 and p = 0.09, respectively). Non-CVDs out-competed cardiovascular covariates previously reported to predict readmission. CONCLUSIONS In patients with HF hospitalization, prior admissions predicted 30-day readmission. Diseases of the digestive system also increase 30-day readmission rates. Assessment of non-CVD burden in HF patients could serve as an important risk marker for 30-day readmissions.
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Affiliation(s)
- Valentina Kutyifa
- University of Rochester School of Medicine and Dentistry, Rochester, United States.
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19
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Yoruk A, Russack A, Riordan M, Ling F, Rao K. THINGS ARE NOT ALWAYS WHAT THEY SEEM: SADDLE PULMONARY EMBOLISM MASQUERADING AS AN ACUTE INFERIOR MYOCARDIAL INFARCTION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)33444-8] [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: 11/26/2022]
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20
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Gleber C, Yoruk A, Eastburg L, Goldman BI, Cameron SJ. Conduction Dysfunction and Near Expunction: Giant Cell Myocarditis. Am J Med 2018; 131:1317-1320. [PMID: 29729236 PMCID: PMC6431261 DOI: 10.1016/j.amjmed.2018.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/17/2018] [Accepted: 04/17/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Conrad Gleber
- Department of Medicine, Division of General Internal Medicine
| | - Ayhan Yoruk
- Department of Medicine, Division of Cardiology
| | - Luke Eastburg
- Department of Medicine, Division of General Internal Medicine
| | | | - Scott J Cameron
- Department of Medicine, Division of General Internal Medicine; Department of Medicine, Division of Cardiology; Department of Surgery, Division of Cardiac Surgery, University of Rochester School of Medicine, Rochester, NY.
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21
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Yoruk A, Boulos PK, Bisognano JD. The State of Hypertension in Sub-Saharan Africa: Review and Commentary. Am J Hypertens 2018; 31:387-388. [PMID: 29136102 DOI: 10.1093/ajh/hpx196] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 12/30/2022] Open
Affiliation(s)
- Ayhan Yoruk
- Department of Cardiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Peter K Boulos
- Department of Cardiology, University of Rochester Medical Center, Rochester, New York, USA
| | - John D Bisognano
- Department of Cardiology, University of Rochester Medical Center, Rochester, New York, USA
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22
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Naqvi SY, Yoruk A, Pressman E, Olson-Chen C, Prasad S, Barrus B, Gosev I, Alexis J, Thomas S. CARDIOMYOPATHY BRIDGED TO HEART TRANSPLANT WITH AMBULATORY EXTRACORPOREAL MEMBRANE OXYGENATION IN A PERIPARTUM PATIENT. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32959-0] [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: 10/17/2022]
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23
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Abstract
Cardiac transplantation is the gold standard treatment for patients with advanced congestive heart failure that is refractory to maximal medical therapy. However, donor heart availability remains the major limiting factor, resulting in a large number of patients waiting long periods of time before transplantation. As a result, mechanical circulatory support devices have been increasingly used as a 'bridge' in order to sustain organ function and stabilise haemodynamics while patients remain on the transplant waiting list or undergo left ventricular assist device surgery. Intra aortic balloon pumps (IABP) are commonly used for temporary circulatory support in patients with advanced heart failure. IABP is traditionally placed percutaneously through the transfemoral artery approach. The major limitation with this approach is ambulatory restriction that can promote deconditioning, particularly in situations of prolonged circulatory support. A subclavian/axillary artery approach IABP insertion allows patients to be ambulatory during the pre-transplant period. In this review, we aim to summarise the physiology of IABP, the evidence for its use in advanced CHF and the efficacy and safety of subclavian artery IABP insertion.
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Affiliation(s)
- Syed Yaseen Naqvi
- Department of Cardiology, Advanced Heart Transplant Program, University of Rochester Medical Center Rochester, USA
| | | | - Ayhan Yoruk
- Department of Cardiology, Advanced Heart Transplant Program, University of Rochester Medical Center Rochester, USA
| | - Leway Chen
- Department of Cardiology, Advanced Heart Transplant Program, University of Rochester Medical Center Rochester, USA
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24
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Schneider M, Yoruk A, Gassler JP. Baroreceptor Activation for Hypertension and Heart Failure. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00107-8] [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: 10/17/2022]
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25
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Kutyifa V, Rice J, Jones R, Mathias A, Yoruk A, Vermilye K, Johnson B, Strawderman R, Lowenstein C. P606Impact of non-cardiovascular disease burden on thirty-day hospital readmission in heart failure patients. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p606] [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: 11/13/2022] Open
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26
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Abstract
Hypertension (HTN) is a worldwide epidemic. When untreated, HTN places patients at an elevated risk for several health conditions, including cardiovascular disease and end-organ damage. This effect is particularly pronounced in a subset of patients who experience treatment-resistant HTN despite the utilization of conventional medication and lifestyle interventions. For these challenging patients, ongoing research efforts continue to explore and develop novel nonpharmacologic therapies for resistant HTN. One such avenue is the regulation of the sympathetic nervous system, a large component of circulatory physiology. Innovative therapies have evolved to harness the ability to deliver electrical stimulation to baroreceptors in an effort to modulate the sympathetic system involvement in HTN. This review discusses baroreflex activation therapy and its role in the management of resistant HTN.
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Affiliation(s)
- Ayhan Yoruk
- University of Rochester Medical Center, Rochester, New York, USA
| | - John D Bisognano
- University of Rochester Medical Center, Rochester, New York, USA
| | - John P Gassler
- University of Rochester Medical Center, Rochester, New York, USA
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27
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Yoruk A, Sherazi S, Massey HT, Kutyifa V, McNitt S, Hallinan W, Huang DT, Chen L, Aktas MK. Predictors and clinical relevance of ventricular tachyarrhythmias in ambulatory patients with a continuous flow left ventricular assist device. Heart Rhythm 2016; 13:1052-1056. [PMID: 26829113 DOI: 10.1016/j.hrthm.2016.01.033] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [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: 09/13/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients with a left ventricular assist device (LVAD) are at high risk for ventricular tachyarrhythmias (VTAs). OBJECTIVE We aimed to identify clinical predictors of VTAs and subsequent outcomes after VTA in ambulatory LVAD patients. METHODS A retrospective study of 149 patients with a continuous flow HeartMate II LVAD who survived to discharge from index hospitalization after LVAD implantation was performed from January 10, 2005, to September 3, 2013. A multivariate Cox model was used to assess clinical predictors of VTAs. RESULTS During a mean follow-up period of 2.1 ± 1.2 years, 41 patients (28%) experienced VTAs; 30 of these patients (71%) had ventricular tachycardia, and 11 (29%) had ventricular fibrillation. History of VTAs before LVAD (hazard ratio [HR] 3.06; 95% confidence interval [CI] 1.57-5.96; P = .001) and history of atrial fibrillation (AF) (HR 3.13; 95% CI 1.60-6.11; P = .008) were the most powerful predictors of VTAs after LVAD implantation. There were 19 deaths (46%) among patients with VTAs and 15 deaths (14%) among patients without VTAs (P < .001). In multivariate analysis, time-dependent VTAs after LVAD implantation were associated with a significantly higher risk of all-cause mortality when compared with those without VTAs (HR 7.28; 95% CI 3.50-15.15; P < .001). CONCLUSION In ambulatory LVAD patients, history of VTAs before LVAD implantation and history of AF predict VTAs after LVAD implantation. VTAs are associated with an increased risk of mortality. In such patients, aggressive measures to control VTAs and AF should be considered.
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Affiliation(s)
- Ayhan Yoruk
- University of Rochester Medical Center, Rochester, New York
| | - Saadia Sherazi
- University of Rochester Medical Center, Rochester, New York
| | - H Todd Massey
- University of Rochester Medical Center, Rochester, New York
| | | | - Scott McNitt
- University of Rochester Medical Center, Rochester, New York
| | | | - David T Huang
- University of Rochester Medical Center, Rochester, New York
| | - Leway Chen
- University of Rochester Medical Center, Rochester, New York
| | - Mehmet K Aktas
- University of Rochester Medical Center, Rochester, New York.
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28
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Guren Dolu M, Canbolat Ayhan A, Erguven M, Timur C, Yoruk A, Ozdemir S. Bone mineralization defects after treatment of acute lymphoblastic leukemia ın children. Minerva Pediatr 2015; 67:419-425. [PMID: 26377781] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM Aim of the study was to assess bone metabolism disturbances in children with acute lymphoblastic leukemia following cessation of chemotherapy. For this purpose we measured bone mineral density (BMD) and evaluated bone metabolism markers. METHODS Seventy-five patients (37 female, 38 males, mean age 10.77±3.80 years) were included. Lumbar spine BMD was measured by dual energy X-ray absorptiometry and serum calcium, phosphorus, magnesium, alkaline phosphatase, parathyroid hormone and 25OH vitamin D levels were analyzed. For characteristics of all patients at diagnosis data were retreived from hospital records and analyzed retrospectively. RESULTS A total of 18.66% (14 patients) of patients were osteoporotic (z score <-2 SD), 22.67% (17 patients) were osteopenic (z-score between -2 and -1 SD) and 58.67% (44 patients) presented normal z-scores (>-1 SD). There were no statisticaly significant differences between normal, osteopenic and osteoporotic groups for mean serum vitamine D (P=0.677), calcium (P=0.280), phosphorus (P=0.179), magnesium (P=0.675), ALP (P=0.092) and serum PTH (P=0.915) levels. According to ages (P=0.745) and gender (P=0.810) there were no significant differences in BMD. There were no significant differences between normal, osteopenic and osteoporotic patients for the total dose of prednisolone (P=0.334), dexamethasone, (P=0.734), methotrexate (P=0.911), granulocyte colony-stimulating factor (P=0.173) and cranial irradiation (P=0.912) they have received during chemotherapy. Bone fracture and aseptic necrosis rates were 12%, 8%, respectively. CONCLUSION Osteoporosis and osteopenia are still observed in high rates after chemotherapy. We must be aware of this morbidity and must screen the patients for decreased BMD during the long duration of leukemia treatment. Supportive treatments should be evaluated to minimize these serious complications.
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Affiliation(s)
- M Guren Dolu
- Istanbul Medeniyet University Goztepe Education and Research Hospital Pediatric Hematology-Oncology Department, Istanbul, Turkey -
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29
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Abstract
Spontaneous remission/regression of cancer is defined as partial or complete disappearance of malignant disease temporarily or permanently in the absence of medical treatment. This event is named as spontaneous regression for solid tumors and spontaneous remission for leukemia. The authors report the case of a girl aged 4 years and 3 months, who presented with mediastinal mass and leukemic findings in the bone marrow both of which reappeared after spontaneous regression and remission, respectively.
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Affiliation(s)
- A Yoruk
- The Ministry of Health, Goztepe Educational and Research Hospital, Pediatric Hematology and Oncology Department, Istanbul, Turkey.
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30
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Affiliation(s)
- C U Durakbasa
- Department of Pediatric Surgery, SB Goztepe Children's Hospital, Istanbul, Turkey
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31
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Ozkan A, Arslanoglu I, Yoruk A, Timur C. Evaluation of growth hormone secretion and insulin-like growth factor I in children with thalassemia. Indian Pediatr 2001; 38:534-9. [PMID: 11359982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- A Ozkan
- Department of Pediatric Hematology, Cerrahpasa Medical Faculty, University of Istanbul, Turkey.
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Ozkan A, Yoruk A, Celkan T, Apak H, Yildiz I, Ozbay G. The vanishing bile duct syndrome in a child with Hodgkin disease. Med Pediatr Oncol 2001; 36:398-9. [PMID: 11241447 DOI: 10.1002/mpo.1096] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- A Ozkan
- Department of Pediatric Hematology-Oncology, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey.
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