1
|
Adalja D, Tagliaferri A, Rezkalla A, Taha B. Diffuse B-Cell Lymphoma of the Mandible Disguised as Acute Osteomyelitis. Eur J Case Rep Intern Med 2024; 11:004243. [PMID: 38352811 PMCID: PMC10860914 DOI: 10.12890/2024_004243] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/18/2023] [Indexed: 02/16/2024] Open
Abstract
Background Primary bone lymphoma (PBL) is a rare form of extra nodal non-Hodgkin's lymphoma (NHL). Case description We describe a 39-year-old-male with no medical history who presented with unilateral facial swelling following a tooth extraction. Initial diagnoses after various presentations over the course of three weeks, based on inflammatory and infectious aetiologies. However, the patient was ultimately diagnosed with diffuse large B-cell lymphoma. Discussion Symptoms of PBL are very similar to inflammatory and infectious diseases of the bone, such as osteomyelitis or osteonecrosis. Clinical features of PBL involving the head and neck include persistent jaw pain, tooth mobility secondary to extensive destruction of bone, and in advanced cases, lip numbness and swelling. On examination it may present as an exposed necrotic bone with surrounding soft tissue oedema. Misdiagnosis of these lesions as an infectious or inflammatory aetiology may lead to an unnecessary delay in lymphoma treatment, and subsequently worsen the prognosis if caught at a later stage. Therefore, any concerning lesion, especially in the oral cavity, must be subjected to early histopathological evaluation to differentiate PBL from osteomyelitis and/or osteonecrosis. Conclusion This case report highlights the importance of an early histopathological evaluation to prevent delay in the diagnosis of primary bone lymphomas. LEARNING POINTS Resemblance in symptoms: Primary bone lymphoma (PBL) symptoms overlap with bone infections, necessitating careful consideration and differential diagnosis to prevent misjudgment.Head and neck manifestations: recognising PBL's signs in the head and neck region, such as jaw pain and bone destruction, aids in timely identification and treatment.Timely biopsy significance: swift histopathological assessment for suspicious lesions is critical to avoid delays in diagnosing primary bone lymphomas.
Collapse
Affiliation(s)
- Devina Adalja
- Department of Internal Medicine, St Joseph’s University Medical Center, Paterson, USA
| | - Ariana Tagliaferri
- Department of Gastroenterology and Transplant Hepatology, Creighton University, Phoenix, USA
| | - Abraam Rezkalla
- Department of Internal Medicine, St Joseph’s University Medical Center, Paterson, USA
| | - Basil Taha
- Department of Infectious Diseases, St Joseph’s University Medical Center, Paterson, USA
| |
Collapse
|
2
|
Adalja D, Kania BE, Soliman IM, Sanchez J, Kalatoudis H. Initially Suspected Anaphylaxis Following Iodinated Contrast: Jod-Basedow Phenomenon in a 73-Year-Old Female Without a History of Thyroid Dysfunction. Cureus 2023; 15:e38415. [PMID: 37273337 PMCID: PMC10233164 DOI: 10.7759/cureus.38415] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 06/06/2023] Open
Abstract
The Jod-Basedow phenomenon (JB phenomenon), also referred to as "iodine-induced hyperthyroidism," rarely occurs. Radiological imaging using iodinated contrast contains a dose of 300 to 1221 mg of iodine per kilogram, which can transiently induce clinically significant hyperthyroidism (referred to as Jod-Basedow Syndrome) in euthyroid patients. Hence, the reporting of such events is important for clinicians to be aware of, to prevent unnecessary iodine-based imaging. Underlying thyroid abnormalities, including latent Graves' disease, autoimmune thyroiditis, use of iodine-containing foods or medications, such as amiodarone, and Lugol's iodine have been shown to increase the risk of JB phenomenon. In terms of the pathophysiology of the JB phenomenon, when iodine exposure is in excess, increased iodine leads to increased hormone synthesis, and with an absence of auto-regulation, this can lead to thyrotoxicosis. In this case report, we describe the iodine-induced JB phenomenon in a 73-year-old female with no prior thyroid dysfunction, who was initially admitted for pyelonephritis and was eventually transferred to the intensive care unit secondary to suspected anaphylaxis.
Collapse
Affiliation(s)
- Devina Adalja
- Internal Medicine, St. Joseph's Medical Center, Paterson, USA
| | - Brooke E Kania
- Internal Medicine, St. Joseph's Medical Center, Paterson, USA
| | - Isaac M Soliman
- Medicine, Rowan School of Osteopathic Medicine, Stratford, USA
| | - Jessimar Sanchez
- Critical Care Medicine, St. Joseph's Medical Center, Paterson, USA
| | - Haris Kalatoudis
- Critical Care Medicine, St. Joseph's Medical Center, Paterson, USA
| |
Collapse
|
3
|
Adalja D, Zala H, Victor V, Sheth A, Willyard C, Suzuki E, Patel HP, Majmundar M, Vallabhajosyula S, Doshi R. Incidence, Current Guidelines and Management of Gastrointestinal Bleeding after Transcatheter Aortic Valve Replacement: A Systematic Review. Curr Cardiol Rev 2023; 19:e230622206351. [PMID: 35747979 PMCID: PMC10201885 DOI: 10.2174/1573403x18666220623150830] [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: 02/24/2022] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is a significant increase in morbidity and mortality in patients complicated by major bleeding following transcatheter aortic valve replacement (TAVR). It has become more challenging to manage such complications when the patient needs to be on anticoagulation or antiplatelet agent post-procedure to prevent thrombotic/embolic complications. METHODS We systematically reviewed all available randomized controlled trials and observational studies to identify incidence rates of gastrointestinal bleeding post-procedure. After performing a systematic search, a total of 8731 patients from 15 studies (5 RCTs and 10 non-RCTs) were included in this review. RESULTS The average rate of gastrointestinal bleeding during follow-up was 3.0% in randomized controlled trials and 1.9% among observational studies. CONCLUSION Gastrointestinal bleeding has been noted to be higher in the RCTs as compared to observational studies. This review expands knowledge of current guidelines and possible management of patients undergoing TAVR.
Collapse
Affiliation(s)
- Devina Adalja
- Department of Internal Medicine, St Joseph's University Medical Center, Paterson, NJ, USA
| | - Harshvardhan Zala
- Department of Clinical Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Varun Victor
- Department of Internal Medicine, Canton Medical Education Foundation, Canton, OH, USA
| | - Aakash Sheth
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Charles Willyard
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV, USA
| | - Emi Suzuki
- Department of Pediatrics, UCSF- Fresno, Fresno, CA, USA
| | - Harsh P. Patel
- Department of Internal Medicine, Louis A Weiss Memorial Hospital, Chicago, IL, USA
| | - Monil Majmundar
- Department of Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
| | | | - Rajkumar Doshi
- Department of Cardiology, St Joseph's University Medical Center, Paterson, NJ, USA
| |
Collapse
|
4
|
Bathobakae L, Shahid A, Wilkinson T, Adalja D, Sanchez J, Agnelli M, Suh J, Solis R. Tuberculous Bronchopleural Fistula: A Rare and Life-Threatening Disease. J Investig Med High Impact Case Rep 2023; 11:23247096231220466. [PMID: 38130119 DOI: 10.1177/23247096231220466] [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] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Tuberculous bronchopleural fistula (BPF) is a rare and potentially life-threatening complication of pulmonary tuberculosis, in which abnormal connections form between the bronchial tree and the pleural space. These abnormal connections allow air and secretions to pass from the lungs into the pleural space, causing a range of symptoms from benign cough to acute tension pneumothorax. The management of tuberculous BPF requires an individualized approach based on the patient's condition and response to treatment. Anti-tuberculosis therapy is essential for controlling the active tuberculosis infections. Intercostal drainage and suction are also commonly used to drain air and fluid from the pleural space, providing relief from the symptoms. For some patients, more invasive surgeries, such as decortication, thoracoplasty or pleuropneumonectomy are required to definitively close the fistula when medical management alone is insufficient. Herein, we describe a rare case of tuberculous BPF in a young adult female, who was treated with anti-tuberculosis medications and open thoracotomy.
Collapse
Affiliation(s)
| | - Aneeqa Shahid
- St. Joseph's University Medical Center, Paterson, NJ, USA
| | | | - Devina Adalja
- St. Joseph's University Medical Center, Paterson, NJ, USA
| | | | | | - Jin Suh
- St. Joseph's University Medical Center, Paterson, NJ, USA
| | - Roberto Solis
- St. Joseph's University Medical Center, Paterson, NJ, USA
| |
Collapse
|
5
|
Patel HP, Decter D, Thakkar S, Anantha-Narayanan M, Kumar A, Sheth AR, Zahid S, Patel BA, Patel T, Devani H, Shah V, Doshi PM, Patel S, Shariff M, Adalja D, Vallabhajosyula S, Doshi R. Impact of Chronic Kidney Disease on In-Hospital Outcomes of Hospitalizations With Acute Limb Ischemia Undergoing Endovascular Therapy. J Endovasc Ther 2022:15266028221134887. [PMID: 36401519 DOI: 10.1177/15266028221134887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE Studies on outcomes related to endovascular treatment (EVT) in advanced stages of chronic kidney disease (CKD) and end-stage renal disease (ESRD) among hospitalizations with acute limb ischemia (ALI) are limited. METHODS The Nationwide Inpatient Sample was quarried from October 2015 to December 2017 to identify the hospitalizations with ALI and undergoing EVT. The study population was subdivided into 3 groups based on their CKD stages: group 1 (No CKD, stage I, stage II), group 2 (CKD stage III, stage IV), and group 3 (CKD stage V and ESRD). The primary outcome was all-cause in-hospital mortality. RESULTS A total of 51 995 hospitalizations with ALI undergoing EVT were identified. The in-hospital mortality was significantly higher in group 2 (OR = 1.17; 95% CI 1.04 - 1.32, p=0.009) and group 3 (OR = 3.18; 95% CI 2.74-3.69, p<0.0001) compared with group 1. Odds of minor amputation, vascular complication, atherectomy, and blood transfusion were higher among groups 2 and 3 compared with group 1. Group 2 had higher odds of access site hemorrhage compared with groups 1 and 3, whereas group 3 had higher odds of major amputation, postprocedural infection, and postoperative hemorrhage compared with groups 1 and 2. Besides, groups 2 and 3 had lower odds of discharge to home compared with group 1. Finally, the length of hospital stay and cost of care was significantly higher with the advancing CKD stages. CONCLUSION Advanced CKD stages and ESRD are associated with higher mortality, worse in-hospital outcomes and higher resource utilization among ALI hospitalizations undergoing EVT. CLINICAL IMPACT Current guidelines are not clear for the optimum first line treatment of acute limb ischemia, especially in patients with advanced kidney disease as compared to normal/mild kidney disease patients. We found that advanced kidney disease is a significant risk factor for worse in-hospital morbidity and mortality. Furthermore, patients with acute limb ischemia and advanced kidney disease is associated with significantly higher resource utilization as compared to patients with normal/mild kidney disease. This study suggests shared decision making between treating physician and patients when considering endovascular therapy for the treatment of acute limb ischemia in patients with advanced kidney disease.
Collapse
Affiliation(s)
- Harsh P Patel
- Department of Internal Medicine, Louis A. Weiss Memorial Hospital, Chicago, IL, USA
| | - Dean Decter
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Mahesh Anantha-Narayanan
- Department of Interventional Cardiology, The University of Arizona and Banner University Medical Center, Phoenix, AZ, USA
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Aakash R Sheth
- Department of Internal Medicine, Louisiana State University, Shreveport, LA, USA
| | - Salman Zahid
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Bhavin A Patel
- Department of Cardiology, Apex Heart Institute, Ahmedabad, India
| | - Toralben Patel
- Department of Cardiovascular Diseases, AdventHealth Medical Group, Orlando, FL, USA
| | - Hiteshkumar Devani
- Department of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vrushali Shah
- Department of Endocrinology, University of Massachusetts, Worcester, MA, USA
| | | | - Smit Patel
- Department of Internal Medicine, Vassar Brothers Medical Center, Poughkeepsie, NY, USA
| | | | - Devina Adalja
- Department of Medicine, Gujarat Medical Education & Research Society Gotri Medical College, Vadodara, India
| | | | - Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, NV, USA
| |
Collapse
|
6
|
Majmundar M, Doshi R, Zala H, Shah P, Adalja D, Shariff M, Kumar A. Prognostic role of anemia in heart failure with preserved ejection fraction: A systematic review and meta-analysis. Indian Heart J 2021; 73:521-523. [PMID: 34474772 PMCID: PMC8424263 DOI: 10.1016/j.ihj.2021.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 10/12/2020] [Revised: 01/12/2021] [Accepted: 06/20/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Monil Majmundar
- Department of Internal Medicine, Metropolitan Medical Center, New York, NY, USA
| | - Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV, USA
| | - Harshvardhan Zala
- Department of Internal Medicine, Amidhara Hospital, Surat, Gujarat, India
| | - Palak Shah
- Department of Internal Medicine, Dhiraj General Hospital, SBKS Medical School and Research Institute, Vadodara, Gujarat, India
| | - Devina Adalja
- Department of Medicine, GMERS Gotri Medical College, Vadodara, Gujarat, India
| | - Mariam Shariff
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Ashish Kumar
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India.
| |
Collapse
|
7
|
Khan MZ, Patel K, Patel KA, Doshi R, Shah V, Adalja D, Waqar Z, Franklin S, Gupta N, Gul MH, Jesani S, Kutalek S, Figueredo V. Burden of atrial fibrillation in patients with rheumatic diseases. World J Clin Cases 2021; 9:3252-3264. [PMID: 34002134 PMCID: PMC8107898 DOI: 10.12998/wjcc.v9.i14.3252] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/06/2021] [Accepted: 03/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Studies have suggested that atrial fibrillation (AF) in patients with rheumatic diseases (RD) may be due to inflammation.
AIM To determine the highest association of AF among hospitalized RD patients and to determine morbidity and mortality associated with AF in hospitalized patients with RD.
METHODS The National inpatient sample database from October 2015 to December 2017 was analyzed to identify hospitalized patients with RD with and without AF. A subgroup analysis was performed comparing outcomes of AF among different RD.
RESULTS The prevalence of AF was 23.9% among all patients with RD (n = 3949203). Among the RD subgroup, the prevalence of AF was highest in polymyalgia rheumatica (33.2%), gout (30.2%), and pseudogout (27.1%). After adjusting for comorbidities, the odds of having AF were increased with gout (1.25), vasculitis (1.19), polymyalgia rheumatica (1.15), dermatopolymyositis (1.14), psoriatic arthropathy (1.12), lupus (1.09), rheumatoid arthritis (1.05) and pseudogout (1.04). In contrast, enteropathic arthropathy (0.44), scleroderma (0.96), ankylosing spondylitis (0.96), and Sjorgen’s syndrome (0.94) had a decreased association of AF. The mortality, length of stay, and hospitalization costs were higher in patients with RD having AF vs without AF. Among the RD subgroup, the highest mortality was found with scleroderma (4.8%), followed by vasculitis (4%) and dermatopolymyositis (3.5%).
CONCLUSION A highest association of AF was found with gout followed by vasculitis, and polymyalgia rheumatica when compared to other RD. Mortality was two-fold higher in patients with RD with AF.
Collapse
Affiliation(s)
- Muhammad Zubair Khan
- Department of Internal Medicine, St. Mary Medical Center, Langhorne, PA 19047, United States
| | - Kirtenkumar Patel
- Division of Cardiology, North Shore University Hospital, Manhasset, NY 11030, United States
| | - Krunalkumar A Patel
- Department of Internal Medicine, St. Mary Medical Center, Langhorne, PA 19047, United States
| | - Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV 89502, United States
| | - Vraj Shah
- Division of Cardiology, Medical College of Baroda, Baroda 390001, India
| | - Devina Adalja
- Department of Internal Medicine, GMERS Gotri Medical College, Vadodara 390021, India
| | - Zainulabedin Waqar
- Department of Internal Medicine, Mercy St. Vincent Medical Center, Toledo, OH 43608, United States
| | - Sona Franklin
- Department of Internal Medicine, St. Mary Medical Center, Langhorne, PA 19047, United States
| | - Neelesh Gupta
- Department of Internal Medicine, Nazareth Hospital, Philadelphia, PA 19115, United States
| | - Muhammad Hamdan Gul
- Department of Internal Medicine, Saint Joseph Hospital, Chicago, IL 60657, United States
| | - Shruti Jesani
- Department of Internal Medicine, Trinitas Regional Medical Center, Elizabeth, NJ 07202, United States
| | - Steven Kutalek
- Department of Cardiology, St. Mary Medical Center, Langhorne, PA 19047, United States
| | - Vincent Figueredo
- Department of Cardiology, St. Mary Medical Center, Langhorne, PA 19047, United States
| |
Collapse
|
8
|
Sheth A, Patel H, Patel K, Thakkar S, Adalja D, Patel K, Patel R, Kutom F, Patel T, Patel M, Virmitra D, Parisha F, Doshi R, Panaich S. ANALYZING THE EFFECT OF RENAL FUNCTION IN PATIENTS WITH CHRONIC LIMB ISCHEMIA UNDERGOING ENDOVASCULAR TREATMENT. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02363-9] [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: 10/21/2022]
|
9
|
Dave M, Kumar A, Majmundar M, Adalja D, Shariff M, Shah P, Desai R, Patel K, Jagirdhar GSK, Vallabhajosyula S, Gullapalli N, Doshi R. Frequency, Trend, Predictors, and Impact of Gastrointestinal Bleeding in Atrial Fibrillation Hospitalizations. Am J Cardiol 2021; 146:29-35. [PMID: 33529616 DOI: 10.1016/j.amjcard.2021.01.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 12/18/2022]
Abstract
Anticoagulation alone or in combination with other treatment strategies are implemented to reduce the risk of stroke in patients with atrial fibrillation (AF). Gastrointestinal bleeding (GIB) is a common complication of oral anticoagulation with a prevalence of 1% to 3% in patients on long term oral anticoagulation. We analyzed the national inpatient sample database from the year 2005 to 2015 to report evidence on the frequency, trends, predictors, clinical outcomes, and economic burden of GIB among AF hospitalizations. A total of 34,260,000 AF hospitalizations without GIB and 1,846,259 hospitalizations with GIB (5.39%) were included. The trend of AF hospitalizations with GIB per 100 AF hospitalizations remained stable from the year 2005 to 2015 (p value = 0.0562). AF hospitalizations with GIB had a higher frequency of congestive heart failure, long term kidney disease, long term liver disease, anemia, and alcohol abuse compared with AF hospitalizations without GIB. AF hospitalizations with GIB had a higher odds of in-hospital mortality (Odds ratio (OR) 1.47; 95% Confidence interval (CI): 1.46 to 1.48, p-value <0.0001), mechanical ventilation (OR 1.69; 95% CI: 1.68 to 1.70, p-value <0.0001), and blood transfusion (OR 7.2; 95% CI: 7.17 to 7.22, P-value <0.0001) compared with AF hospitalizations without GIB. AF hospitalizations with GIB had a lower odds of stroke (OR 0.51; 95% CI: 0.51 to 0.52, p-value <0.0001) compared with AF hospitalizations without GIB. Further, AF hospitalizations with GIB had a higher median length of stay and cost of hospitalization compared with AF hospitalizations without GIB. In conclusion, the frequency of GIB is 5.4% in AF hospitalizations and the frequency of GIB remained stable in the last decade as shown in this analysis. When GIB occurs, it is associated with higher resource utilization. This study addresses a significant knowledge gap highlighting national temporal trends of GIB and associated outcomes in AF hospitalizations.
Collapse
Affiliation(s)
- Mihir Dave
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, Nevada
| | - Ashish Kumar
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Monil Majmundar
- Department of Internal Medicine, New York Medical College, Metropolitan Hospital Center, New York, New York
| | - Devina Adalja
- Department of Medicine, GMERS Gotri Medical College, Vadodara, Gujarat, India
| | - Mariam Shariff
- Department of Internal Medicine, New York Medical College, Metropolitan Hospital Center, New York, New York
| | - Palak Shah
- Department of Internal Medicine, New York Medical College, Metropolitan Hospital Center, New York, New York
| | - Rupak Desai
- Department of Cardiology, Atlanta VA Medical Center, Decatur, Georgia
| | - Krunalkumar Patel
- Department of Internal Medicine, St. Mary Medical Center, Langhorn, Pennsylvania
| | | | - Saraschandra Vallabhajosyula
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Nageshwara Gullapalli
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, Nevada
| | - Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, Nevada.
| |
Collapse
|
10
|
Patel H, Sheth A, Majmundar M, Patel K, Patel K, Thakkar S, Adalja D, Patel R, Patel T, Parisha F, Patel M, Desai V, Doshi R, Panaich S. SEX BASED DIFFERENCES IN OUTCOMES OF PATIENTS WITH CHRONIC LIMB ISCHEMIA UNDERGOING ENDOVASCULAR TREATMENT. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02362-7] [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]
|
11
|
Thakkar S, Patel H, Patel K, Kumar A, Patel S, Tan BEX, Barssoum K, Jani C, Patel T, Patel M, Bhushan T, Adalja D, Parikh V, Feitell S. IMPACT OF RIGHT HEART CATHETERIZATION IN ACUTE HEART FAILURE WITH REDUCED EJECTION FRACTION. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02085-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
12
|
Patel K, Patel K, Khan MZ, Patel H, Patel A, Thakkar S, Adalja D, Patel U, Figueredo V. PROPENSITY SCORE MATCHED OUTCOMES OF HEART FAILURE WITH PRESERVED EJECTION FRACTION PATIENTS WITH PULMONARY HYPERTENSION. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02159-8] [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: 11/28/2022]
|
13
|
Ilyas I, Kumar A, Adalja D, Shariff M, Desai R, Sattar Y, Vallabhajosyula S, Gullapalli N, Doshi R. Intracoronary brachytherapy for the treatment of recurrent drug-eluting stent in-stent restenosis: A systematic review and meta-analysis. World J Cardiol 2021; 13:95-102. [PMID: 33968308 PMCID: PMC8069516 DOI: 10.4330/wjc.v13.i4.95] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/08/2021] [Accepted: 03/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We performed a meta-analysis on observational studies since randomized control trials are not available. We studied intracoronary brachytherapy (ICBT) and recurrent drug eluting stent in-stent restenosis (DES-ISR) to evaluate the procedural success, target lesion revascularization (TLR), incidence of myocardial infarction (MI) and all-cause mortality at 2 years follow-up.
AIM To perform meta-analysis for patients undergoing ICBT for recurrent DES-ISR.
METHODS We performed a systematic search of the PubMed/MEDLINE, Cochrane and DARE databases to identify relevant articles. Studies were excluded if intra-coronary brachytherapy was used as a treatment modality for initial ISR and studies with bare metal stents. We used a random-effect model with DerSimonian & Laird method to calculate summary estimates. Heterogeneity was assessed using I2 statistics.
RESULTS A total of 6 observational studies were included in the final analysis. Procedural angiographic success following intra-coronary brachytherapy was 99.8%. Incidence of MI at 1-year was 2% and 4.1% at 2-years, respectively. The incidence of TLR 14.1% at 1-year and 22.7% at 2-years, respectively. All-cause mortality at 1- and 2-year follow-up was 3% and 7.5%, respectively.
CONCLUSION Given the observational nature of the studies included in the analysis, heterogeneity was significantly higher for outcomes. While there are no randomized controlled trials or definitive guidelines available for recurrent ISR associated with DES, this analysis suggests that brachytherapy might be the alternative approach for recurrent DES-ISR. Randomized controlled trials are required to confirm results from this study.
Collapse
Affiliation(s)
- Irtqa Ilyas
- Department ofInternal Medicine, University of Nevada Reno School of Medicine, Reno, NV 89509, United States
| | - Ashish Kumar
- Department of Critical Care Medicine, Saint John's Medical College Hospital, Bangalore 560034, Karnataka, India
| | - Devina Adalja
- Department of Internal Medicine, GMERS Gotri Medical College, Vadodara 380021, Gujarat, India
| | - Mariam Shariff
- Department of Critical Care Medicine, Saint John's Medical College Hospital, Bangalore 560034, Karnataka, India
| | - Rupak Desai
- Department of Cardiology, Atlanta VA Medical Center, Decatur, GA 30033, United States
| | - Yasar Sattar
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Elmhurst, New York, NY 11373, United States
| | | | - Nageshwara Gullapalli
- Department ofInternal Medicine, University of Nevada Reno School of Medicine, Reno, NV 89509, United States
| | - Rajkumar Doshi
- Department ofInternal Medicine, University of Nevada Reno School of Medicine, Reno, NV 89509, United States
| |
Collapse
|
14
|
Majmundar M, Kumar A, Doshi R, Shah P, Arora S, Shariff M, Adalja D, Visco F, Amin H, Vallabhajosyula S, Gullapalli N, Kapadia SR, Kalra A, Panaich SS. Meta-Analysis of Transcatheter Aortic Valve Implantation in Patients With Stenotic Bicuspid Versus Tricuspid Aortic Valve. Am J Cardiol 2021; 145:102-110. [PMID: 33460604 DOI: 10.1016/j.amjcard.2020.12.085] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/28/2020] [Accepted: 12/31/2020] [Indexed: 01/10/2023]
Abstract
Most of the trials investigating the role of transcatheter aortic valve implantation (TAVI) across various strata of risk categories have excluded patients with bicuspid aortic stenosis (BAS) due to its anatomical complexities. The aim of this study was to perform a meta-analysis with meta-regression of studies comparing clinical, procedural, and after-procedural echocardiographic outcomes in BAS versus tricuspid aortic stenosis (TAS) patients who underwent TAVI. We searched the PubMed and Cochrane databases for relevant articles from the inception of the database to October 2019. Continuous and categorical variables were pooled using inverse variance and Mantel-Haenszel method, respectively, using the random-effect model. To rate the certainty of evidence for each outcome, we used the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach. Nineteen articles were included in the final analysis. There was no difference in the risk of 30-day mortality, 1-year mortality, 30-day cardiovascular mortality, major and/or life-threatening bleeding, major vascular complications, acute kidney injury, permanent pacemaker implantation, device success, annular rupture, after-procedural aortic valve area, and mean pressure gradient between the 2 groups. BAS patients who underwent TAVI had a higher risk of 30-day stroke, conversion to surgery, need for second valve implantation, and moderate to severe paravalvular leak. In conclusion, the present meta-analysis supports the feasibility of TAVI in surgically ineligible patients with BAS. However, the incidence of certain procedural complications such as stroke, conversion to surgery, second valve implantation, and paravalvular leak is higher among BAS patients compared with TAS patients, which must be discussed with the patient during the decision-making process.
Collapse
|
15
|
Doshi R, Dave M, Majmundar M, Kumar A, Adalja D, Shariff M, Desai R, Ziaeian B, Vallabhajosyula S. National rates and trends of tobacco and substance use disorders among atrial fibrillation hospitalizations. Heart Lung 2021; 50:244-251. [PMID: 33359929 PMCID: PMC8310779 DOI: 10.1016/j.hrtlng.2020.12.009] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Atrial Fibrillation (AF) has been associated with various behavioral risk factors such as tobacco, alcohol, and/or substances abuse. OBJECTIVE The main objective is to describe the national trends and burden of tobacco and substance abuse in AF hospitalizations. Also, this study identifies potential population who are more vulnerable to these substance abuse among AF hospitalizations. METHODS The National Inpatient Sample database from 2007 to 2015 was utilized and the hospitalizations with AF were identified using the international classification of disease, Ninth Revision, Clinical Modification code. They were stratified into without abuse, tobacco use disorder (TUD), substance use disorder (SUD), alcohol use disorder (AUD) and drug use disorder (DUD). RESULTS Of 3,631,507 AF hospitalizations, 852,110 (23.46%) had TUD, 1,851,170 (5.1%) had SUD, 155,681 (4.29%) had AUD and 42,667 (1.17%) had DUD. The prevalence of TUD, SUD, AUD, and DUD was substantially increased across all age groups, races, and gender during the study period. Female sex was associated with lower odds TUD, SUD, AUD, and DUD. Among AF hospitalizations, the black race was associated with higher odds of SUD, and DUD. The younger age group (18-35 years), male, Medicare/Medicaid as primary insurance, and lower socioeconomic status were associated with increased risk of both TUD and SUDs. CONCLUSION TUD and SUD among AF hospitalizations in the United States mainly affects males, younger individuals, white more than black, and those of lower socioeconomic status which demands for the development of preventive strategies to address multilevel influences.
Collapse
Affiliation(s)
- Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, , 1155 Mill St, W-11, Reno, NV 89502, USA.
| | - Mihir Dave
- Department of Internal Medicine, University of Nevada Reno School of Medicine, , 1155 Mill St, W-11, Reno, NV 89502, USA
| | - Monil Majmundar
- Department of Internal Medicine, Metropolitan Medical Center, New York, NY, USA
| | - Ashish Kumar
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Devina Adalja
- Department of Medicine, GMERS Gotri Medical College, Vadodara, Gujarat, India
| | - Mariam Shariff
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Rupak Desai
- Department of Cardiology, Atlanta VA Medical Center, Decatur, GA, United States
| | - Boback Ziaeian
- Division of Cardiology, David Geffen School of Medicine at University of California, Los Angeles, CA, USA; Division of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Saraschandra Vallabhajosyula
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, MN, USA
| |
Collapse
|
16
|
Doshi R, Kumar A, Shariff M, Adalja D, Patel K, Patel K, Desai R, Gullapalli N, Vallabhajosyula S. Comparison of procedural outcomes in patients undergoing catheter vs surgical ablation for atrial fibrillation and heart failure with reduced ejection fraction. J Arrhythm 2021; 37:60-69. [PMID: 33664887 PMCID: PMC7896461 DOI: 10.1002/joa3.12451] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/22/2020] [Accepted: 10/17/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is a lack of research comparing procedural outcomes of surgical ablation (SA) and catheter ablation (CA) among patients with heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation (AF). The main objective was to compare the short-term procedural outcomes of SA and CA in patients with HFrEF. METHODS We used the national inpatient sample to identify hospitalizations over 18 years with HFrEF hospitalization and AF, and undergoing SA and CA from 2016 to 2017. Furthermore, the clinical outcomes of SA vs CA in AF stratified as nonparoxysmal and paroxysmal were analyzed. RESULTS A total of 1,770 HFrEF hospitalizations with AF who underwent SA and 1,620 HFrEF hospitalizations with AF who underwent CA were included in the analysis. Hospitalizations with CA had higher baseline comorbidities. The in-hospital mortality among HFrEF with AF undergoing SA as compared with CA was similar (2.8% vs 1.9%, respectively, adjusted P-value 0.09). Hospitalizations with SA had a significantly longer length of hospital stay, a higher percentage of postprocedural, and cardiac complications. In HFrEF hospitalizations with nonparoxysmal AF, SA as compared with CA was associated with a higher percentage of in-hospital mortality (2.4% vs 1%, adjusted P-value <.05), a longer length of stay, a higher cost of treatment, and a higher percentage of cardiac complications. CONCLUSION CA is associated with lower in-hospital adverse procedural outcomes as compared with SA among HFrEF hospitalizations with AF. Further research with freedom from AF as one of the outcome is needed between two groups for HFrEF.
Collapse
Affiliation(s)
- Rajkumar Doshi
- Department of Internal MedicineUniversity of Nevada Reno School of MedicineRenoNVUSA
| | - Ashish Kumar
- Department of Critical Care MedicineSt John’s Medical College HospitalBengaluruIndia
| | - Mariam Shariff
- Department of Critical Care MedicineSt John’s Medical College HospitalBengaluruIndia
| | - Devina Adalja
- Department of MedicineGMERS Gotri Medical CollegeVadodaraIndia
| | | | - Kirtenkumar Patel
- Department of CardiologyNorth Shore University HospitalManhassetNYUSA
| | - Rupak Desai
- Department of CardiologyAtlanta VA Medical CenterDecaturGAUSA
| | - Nageshwara Gullapalli
- Department of Internal MedicineUniversity of Nevada Reno School of MedicineRenoNVUSA
| | - Saraschandra Vallabhajosyula
- Section of Interventional CardiologyDivision of Cardiovascular MedicineDepartment of MedicineEmory University School of MedicineAtlantaGAUSA
| |
Collapse
|
17
|
Shariff M, Kumar A, Hirji SA, Majmundar M, Adalja D, Doshi R. Ten Years Mortality Trends of Tricuspid Regurgitation in the United States, 2008 to 2018. Am J Cardiol 2021; 140:156-157. [PMID: 33259799 DOI: 10.1016/j.amjcard.2020.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/24/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Mariam Shariff
- Department of Critical Care Medicine, St. John's Medical College Hospital, Bengaluru, India
| | - Ashish Kumar
- Department of Critical Care Medicine, St. John's Medical College Hospital, Bengaluru, India
| | - Sameer A Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Monil Majmundar
- Department of Internal Medicine, New York Medical College, Metropolitan Medical Hospital Center, New York, New York
| | - Devina Adalja
- Department of Medicine, GMERS Gotri Medical College, Vadodara, Gujarat, India
| | - Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, Nevada.
| |
Collapse
|
18
|
Doshi R, Thakkar S, Patel K, Majmundar M, Shlofmitz E, Kumar A, Gupta N, Adalja D, Patel HP, Jauhar R, Meraj P. Short term outcomes of rotational atherectomy versus orbital atherectomy in patients undergoing complex percutaneous coronary intervention: a systematic review and meta-analysis. SCAND CARDIOVASC J 2021; 55:129-137. [PMID: 33461347 DOI: 10.1080/14017431.2021.1875139] [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] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Coronary artery calcification (CAC) is one of the paramount hurdles for percutaneous coronary intervention (PCI) since it impedes stent delivery and complete expansion. This study intended to evaluate the short-term clinical and procedural outcomes comparing rotational atherectomy (RA) and orbital atherectomy (OA) in patients with heavily calcified coronary lesions undergoing PCI. Design: This systematic review and meta-analysis included all head-to-head published comparisons of coronary RA versus OA. Procedural endpoints and post-procedural clinical outcomes (30 days/in-hospital), were compared. RevMan 5.3 software was used for data analysis. Results: Seven retrospective observational investigations with a total of 4623 patients, including 3203 patients in the RA group and 1420 patients in the OA group, were incorporated. Compared with OA, the RA group was associated with a higher incidence of myocardial infarction at short-term follow-up (OR: 1.56, 95% CI: 1.07-2.29, p = .02, I2 = 0%). No difference was noted among other short-term post-procedural clinical outcomes including all-cause mortality, target vessel revascularization, or major adverse cardiac events. Among procedural complications, RA was associated with reduced coronary artery dissection and arterial perforation. Increased fluoroscopy time was observed in the RA cohort as compared with OA (MD: 4.78, 95% CI: 2.25-7.30, p = .0002, I2 = 80%). Conclusion: RA was associated with fewer vascular complications, but at a cost of higher incidence of myocardial infarction and higher fluoroscopy time compared with OA, at short term follow-up. OA is a safe and effective alternative for the management of CAC.
Collapse
Affiliation(s)
- Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV, USA
| | - Samarthkumar Thakkar
- Department of Internal Medicine, Rochester Regional Hospital, Rochester, NY, USA
| | - Krunalkumar Patel
- Department of Internal Medicine, St. Mary Medical Center, Langhorne, PA, USA
| | - Monil Majmundar
- Department of Internal Medicine, Metropolitan Hospital Center, New York Medical College, New York, NY, USA
| | - Evan Shlofmitz
- Department of Cardiology, St. Francis Hospital, Roslyn, NY, USA
| | - Ashish Kumar
- Department of Critical Care, St John's Medical College Hospital, Bangalore, India
| | - Neelesh Gupta
- Department of Internal Medicine, University of South Alabama, Mobile, AL, USA
| | - Devina Adalja
- Department of Medicine, GMERS Gotri Medical College, Vadodara, India
| | - Harsh P Patel
- Department of Internal Medicine, Louis A. Weiss Memorial Hospital, Chicago, IL, USA
| | - Rajiv Jauhar
- Department of Cardiology, North Shore University Hospital, Manhasset, NY, USA
| | - Perwaiz Meraj
- Department of Cardiology, North Shore University Hospital, Manhasset, NY, USA
| |
Collapse
|
19
|
Doshi R, Adalja D, Kumar A, Dave M, Shariff M, Shah J, Gullapalli N, Desai R, Rupareliya C, Sattar Y, Vallabhajosyula S. Frequency, Trends, and Outcomes of Cerebrovascular Events Associated With Atrial Fibrillation Hospitalizations. Am J Cardiol 2021; 138:53-60. [PMID: 33058804 DOI: 10.1016/j.amjcard.2020.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 09/03/2020] [Revised: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 11/15/2022]
Abstract
The main objective is to estimate the frequency, temporal trends, and outcomes of cerebrovascular events associated with atrial fibrillation (AF) hospitalization in the United States. The national inpatient sample data was utilized to identify hospitalizations with a primary or secondary diagnosis of AF from January 1, 2005 through September 31, 2015 for the present analysis. Jonckheere-Terpstra Trend was utilized to analyze trends from 2005 to 2015. Global Wald score was used to assess relative contributions of various covariates towards stroke among AF hospitalizations. Between the years 2005 and 2015, there were 36,457,323 (95.2%) AF hospitalizations without cerebrovascular events and 1,824,608 (4.8%) with cerebrovascular events included in the final analysis. There was a statistically significant increase in the proportion of overall stroke, AIS, and AHS (ptrend value <0.001) per 1,000 AF hospitalizations. The frequency of stroke per 1,000 AF hospitalizations was highest among patients with CHA2DS2VASc score ≥3 and Charlson's comorbidity index ≥3. The trend of in-hospital mortality decreased during the study period, however, it remained higher in those with cerebrovascular events compared to those without. Lastly, hypertension, advancing age, and chronic lung disease were major stroke predicting factors among AF hospitalizations. These cerebrovascular events were associated with longer length of stay and higher costs. In conclusion, the incidence of cerebrovascular events associated with AF hospitalizations remained significantly high and the trend continues to ascend despite technological advancements. Strategies should improve to reduce the risk of AF-related stroke in the United States.
Collapse
Affiliation(s)
- Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, Nevada.
| | - Devina Adalja
- Department of Medicine, GMERS Gotri Medical College, Vadodara, Gujarat, India
| | - Ashish Kumar
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Mihir Dave
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, Nevada
| | - Mariam Shariff
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Jay Shah
- Department of Cardiology, Mercy St Vincent Medical Center, Toledo, Ohio
| | - Nageshwara Gullapalli
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, Nevada
| | - Rupak Desai
- Department of Cardiology, Atlanta VA Medical Center, Decatur, Georgia
| | | | - Yasar Sattar
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Elmhurst Hospital, Queens, New York
| | - Saraschandra Vallabhajosyula
- Division of Cardiovascular Medicine, Section of Interventional Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
20
|
Shariff M, Doshi R, Pedreira Vaz I, Adalja D, Krishnan A, Hegde S, Kumar A. Impella versus intra-aortic balloon pump in cardiogenic shock: a meta-analysis assessing 30-days mortality. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Cardiogenic shock is linked with eminent morbidity and mortality despite advances in treatment modality. Adjuvant treatment modalities to provide mechanical haemodynamic support in the form of intra-aortic balloon pump (IABP) or Impella are being used among patients with cardiogenic shock. The Impella prunes left ventricular preload, whereas, IABP persuades after load reduction and both contribute to improved cardiac output. A few underpowered randomised control trials (RCTs) and observational studies compared short term mortality benefit of Impella juxtaposed to IABP among patients with cardiogenic shock.
Purpose
A meta-analysis of RCTs and observational studies researching the short-term mortality in cardiogenic shock comparing Impella to IABP was executed.
Methods
The databases PubMed, EMBASE and Cochrane were searched systematically to identify relevant RCTs and observational studies contrasting Impella to IABP and reporting 30-days mortality as outcomes. The search terms used were “Impella”, “IAPB”, “intra-aortic balloon pump” and all word variations were utilised. The search was conducted from the debut of the databases up to January 2020. Two reviewers independently and in tandem performed data screening and extraction from identified articles. Inverse variance method with Paule-Mandel estimator for tau2 and Hartung-Knapp adjustment was used to calculate Risk Ratio with 95% confidence interval. Heterogeneity was assessed using I2 statistics. Furthermore, we calculated the 95% predictive interval for the pooled estimate. All statistical analysis for this meta-analysis was carried out using R statistical software version 3.6.2 using the package meta ( ). Additionally, Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria were used to assess the certainty of evidence.
Results
Five studies constituting 728 patients were included in the final analysis. Two were RCTs (ISAR-SHOCK trial and IMPRESS in Severe Shock trial), one study was a propensity score matched observational study and two were unmatched observational studies. There was no difference in the risk of 30-days mortality in patients treated with Impella as compared to IABP [Risk Ratio: 0.97, 95% confidence interval: 0.66–1.41, I2: 32%]. To account for the heterogeneity, we calculated 95% predictive interval: 0.46–2.02. Thus, very low certainty of evidence concluded no difference in the risk of 30-days mortality among cardiogenic shock patients treated with Impella in opposition to IABP.
Conclusion
This meta-analysis comparing Impella juxtaposed with IABP demonstrated no difference in the risk of 30-days mortality among patients with cardiogenic shock.
30-days Mortality
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- M Shariff
- St John's Medical College Hospital, Critical Care Medicine, Bangalore, India
| | - R Doshi
- University of Nevada, Internal Medicine, Reno, United States of America
| | - I Pedreira Vaz
- Jackson Memorial Hospital, Internal Medicine, Miami, United States of America
| | - D Adalja
- Gotri Medical Education and Research Centre, Internal Medicine, Vadodara, India
| | - A Krishnan
- JJM Medical College, Internal Medicine, Davangere, India
| | - S Hegde
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Cardiology, Mysore, India
| | - A Kumar
- St John's Medical College Hospital, Critical Care Medicine, Bangalore, India
| |
Collapse
|
21
|
Shariff M, Pedreira Vaz I, Doshi R, Adalja D, Krishnan A, Kumar A. Mortality benefit with remote ischemic preconditioning in STEMI: a frequentist and Bayesian meta-analysis of randomized controlled trials. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Myocardial infarction related morbidity and mortality remains substantial despite perpetual improvement in patient care. Remote ischemic preconditioning among patients with myocardial infarction has exhibited to improve surrogate markers of ischemia. However, its effect on all-cause mortality is not well established.
Purpose
An updated frequentist and Bayesian meta-analysis of randomised control trials [RCTs] investigating remote ischemic preconditioning among patients with ST segment elevation myocardial infarction [STEMI] and its effect on all-cause mortality.
Methods
A systematic search across PubMed, EMBASE and Cochrane databases was performed. The inclusion criteria was RCTs comparing remote ischemic preconditioning with standard treatment juxtaposed to standard treatment alone among patients with STEMI and reporting all-cause mortality. Data extraction was carried out by two independent authors and looked for reproducibility. Inverse variance method with Paule-Mandel estimator for tau2 and Hartung-Knapp adjustment was used to calculate Risk Ratio with 95% confidence interval. Heterogeneity was assessed using I2 statistics. We estimated the robustness of our pooled effect size using Bayesian meta-analysis. A weakly informative prior [normal (0, 1) for intercept and uniform (0, 2) for standard deviation] and 20000 iterations [10000 warm-up + 10000 sampling] were used for Bayesian meta-analysis. We used meta ( ) and brm ( ) package in R for frequentist and Bayesian meta-analysis, respectively. All statistical analysis was carried out using R statistical software version 3.6.2. The certainty of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE).
Results
Five RCTs comprising a total of 6043 patients [3010 intervention and 3033 controls] were included in the final analysis. The largest included RCT was the CONDI-2/ERIC-PPCI 2019 trial. Remote ischemic preconditioning among patients with STEMI had no effect on all-cause mortality at follow-up [RR=0.70, 95% confidence interval = 0.26–1.87, I2=60%] [Figure 1, Panel A]. Similar results were obtained from hierarchical Bayesian meta-analysis [RR=0.55, 95% credibility interval = 0.23–1.38] [Figure 1, Panel B]. Low certainty of evidence as per GARDE, reports no benefit of remote ischemic preconditioning in reducing the risk of all-cause mortality in STEMI.
Conclusion
Remote ischemic preconditioning among patients with STEMI has no effect on all-cause mortality at follow-up.
Figure 1
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- M Shariff
- St John's Medical College Hospital, Critical Care Medicine, Bangalore, India
| | - I Pedreira Vaz
- Jackson Memorial Hospital, Internal Medicine, Miami, United States of America
| | - R Doshi
- University of Nevada, Internal Medicine, Reno, United States of America
| | - D Adalja
- Gotri Medical Education and Research Centre, Internal Medicine, Vadodara, India
| | - A Krishnan
- JJM Medical College, Internal Medicine, Davangere, India
| | - A Kumar
- St John's Medical College Hospital, Critical Care Medicine, Bangalore, India
| |
Collapse
|
22
|
Doshi R, Kumar A, Adalja D, Vaz I, Shariff M. Meta-analysis of Usefulness of Drug Coated Balloon Versus Standard Balloon in the Treatment of Femoropopliteal In-Stent-Restenosis. Am J Cardiol 2020; 133:170-171. [PMID: 32778336 DOI: 10.1016/j.amjcard.2020.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/14/2020] [Accepted: 07/17/2020] [Indexed: 11/25/2022]
|
23
|
Thakkar S, Doshi R, Shariff M, Vaz IP, Adalja D, Majmundar M, Kumar A. Is natriuretic peptide lowering strategy superior to symptomatically based management of chronic heart failure with reduced ejection fraction? Eur J Intern Med 2020; 79:145-146. [PMID: 32471734 DOI: 10.1016/j.ejim.2020.05.028] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 05/11/2020] [Accepted: 05/16/2020] [Indexed: 10/24/2022]
Affiliation(s)
| | - Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV, USA
| | - Mariam Shariff
- Department of Critical Care Medicine, St John's Medical College Hospital, Koramangala, Bengaluru 560034, Karnataka, India
| | - Igor Pedreira Vaz
- Department of Internal Medicine, University of Miami/ Jackson Memorial Hospital, Miami, USA
| | - Devina Adalja
- Department of Medicine, Gotri Medical Education and Research Center, Vadodara, Gujrat, India
| | - Monil Majmundar
- Department of Internal Medicine, Metropolitan Hospital, New York Medical College, New York, USA
| | - Ashish Kumar
- Department of Critical Care Medicine, St John's Medical College Hospital, Koramangala, Bengaluru 560034, Karnataka, India.
| |
Collapse
|
24
|
Antwi‐Amoabeng D, Doshi R, Adalja D, Kumar A, Desai R, Islam R, Gullapalli N. Burden of arrythmias in transgender patients hospitalized for gender-affirming surgeries. J Arrhythm 2020; 36:797-800. [PMID: 32782660 PMCID: PMC7411199 DOI: 10.1002/joa3.12360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/15/2020] [Accepted: 05/03/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND We sought to describe the burden of arrhythmias and their impact on in-hospital outcomes in transgender patients who underwent gender re-assignment surgery. METHODS The study utilized data from the National Inpatient Sample from January 2012 to September 2015. RESULTS 16 555 adult transgender patients were included in this study. A total of 610 adults developed arrhythmia out of which atrial fibrillation (N = 475, 2.87%) was the most frequent arrhythmia. In-hospital mortality increased substantially with arrhythmias. CONCLUSIONS New-onset arrythmias, while infrequent in the inpatient setting is associated with significantly higher in-hospital mortality and resource utilization.
Collapse
Affiliation(s)
- Daniel Antwi‐Amoabeng
- Department of Internal MedicineUniversity of Nevada Reno School of MedicineRenoNVUSA
| | - Rajkumar Doshi
- Department of Internal MedicineUniversity of Nevada Reno School of MedicineRenoNVUSA
| | - Devina Adalja
- Department of MedicineGMERS Gotri Medical CollegeVadodaraGujaratIndia
| | - Ashish Kumar
- Department of Critical CareSt John’s Medical College HospitalBengaluruIndia
| | - Rupak Desai
- Division of CardiologyAtlanta Veterans Affairs Medical CenterDecaturGAUSA
| | - Raheel Islam
- Department of Internal MedicineUniversity of Nevada Reno School of MedicineRenoNVUSA
| | - Nageshwara Gullapalli
- Department of Internal MedicineUniversity of Nevada Reno School of MedicineRenoNVUSA
| |
Collapse
|
25
|
Kumar A, Al-Khafaji J, Shariff M, Vaz IP, Adalja D, Doshi R. Percutaneous mitral valve repair for secondary mitral valve regurgitation: A systematic review and meta-analysis. Eur J Intern Med 2020; 78:107-112. [PMID: 32094019 DOI: 10.1016/j.ejim.2020.02.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/14/2020] [Accepted: 02/16/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND The first two randomized control trials (RCTs) studying the role of MitraClip in patients with secondary mitral regurgitation (MR) had antagonizing results. We, therefore, performed an updated meta-analysis of RCTs and propensity score-matched observational studies investigating the role of MitraClips in patients with secondary MR. A novel method of Kaplan Meier Curve reconstruction from derived individual patient data will be used to compare the survival probability of control groups in COAPT and MITRA HF trail, and hence, access inter-study heterogeneity. METHODS Medline and Cochrane databases was used for systematic search. We used the Mantel-Haenszel method with a random-effect model to calculate risk ratio (RR) with 95% confidence interval (CI) and inverse variance method with a random-effect model to calculate the mean difference (MD) with 95% confidence interval (CI). We used a fixed-effect approach for meta-regression. RESULTS MitraClip reduced the risk of all-cause mortality [RR: 0.72, CI: 0.55-0.95, P value = 0.02, I2 = 55%, χ2P-value = 0.08] and readmission [RR: 0.62, CI: 0.42-0.92, P value = 0.02, I2 = 90%, χ2P-value<0.01] at two years follow-up. There was no effect of MitraClip on change in cardiovascular mortality and 6 m walking distance at 12 months follow-up. Meta-regression indicated left ventricular end diastolic volume and age among the factors affecting outcomes. Reconstructed Kaplan Meier curves confirmed considerable heterogeneity among patients randomized in MITRA HF and COAPT trial. CONCLUSION The present meta-analysis confirms the beneficial role of percutaneous mitral valve repair in patients with secondary MR. However, all the results were associated with considerable heterogeneity.
Collapse
Affiliation(s)
- Ashish Kumar
- Department of Critical Care, St John's Medical college hospital, Bengaluru, Karnataka, India
| | - Jaafar Al-Khafaji
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, Nevada, USA
| | - Mariam Shariff
- Department of Critical Care, St John's Medical college hospital, Bengaluru, Karnataka, India
| | - Igor Pedreira Vaz
- Department of internal medicine, Jackson Memorial Hospital/University of Miami, Florida, USA
| | - Devina Adalja
- GMERS Gotri Medical College, Vadodara, Gujarat, India
| | - Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, Nevada, USA.
| |
Collapse
|
26
|
Antwi-Amoabeng D, Meghji Z, Thakkar S, Ulanja MB, Taha M, Adalja D, Al-Khafaji J, Gullapalli N, Beutler BD, Boampong-Konam K, Doshi R. Survival Differences in Men and Women With Primary Malignant Cardiac Tumor: An Analysis Using the Surveillance, Epidemiology and End Results (SEER) Database From 1973 to 2015. J Am Heart Assoc 2020; 9:e014846. [PMID: 32389047 PMCID: PMC7660836 DOI: 10.1161/jaha.119.014846] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 01/12/2023]
Abstract
Background No data are available on sex disparities in prevalence and survival for primary malignant cardiac tumors (PMCT). This study aimed to compare male and female PMCT prevalence and long-term survival rates. Methods and Results We utilized the Surveillance, Epidemiology, and End Results (SEER) 18 database from the National Cancer Institute for all PMCTs diagnosed between 1973 and 2015. From a total of 7 384 580 cases of cancer registered in SEER, we identified 327 men and 367 women with PMCTs. The majority (78%) of patients were white. Sarcoma was the most common type of PMCT in both men and women (≈60%). Individuals diagnosed with lymphoma exhibited better survival than those with other types of PMCTs. Men were diagnosed at a younger age than women; however, there was no significant difference in overall survival between the sexes. Men diagnosed with PMCT between the ages of 51 and 65 years demonstrated prolonged survival compared with those diagnosed at younger or older ages. There was no difference in survival rates among women based on age at diagnosis. Conclusions PMCTs are rare in both men and women. Tumors tend to be diagnosed at an earlier age in men compared with women, but there is no sex disparity in survival rate. Sarcoma is the most common type of PMCT, and lymphoma is associated with the highest survival rate among both sexes.
Collapse
Affiliation(s)
- Daniel Antwi-Amoabeng
- Department of Internal Medicine University of Nevada Reno School of Medicine Reno NV
| | - Zahara Meghji
- Department of Internal Medicine University of Nevada Reno School of Medicine Reno NV
| | | | - Mark B Ulanja
- Department of Internal Medicine University of Nevada Reno School of Medicine Reno NV
| | - Mohamed Taha
- Department of Internal Medicine University of Nevada Reno School of Medicine Reno NV.,Department of Internal Medicine University of Iowa Hospitals and Clinics Iowa City IA
| | - Devina Adalja
- Department of General Medicine Gotri Medical Education and Research Center Vadodara Gujarat India
| | - Jaafar Al-Khafaji
- Department of Internal Medicine University of Nevada Reno School of Medicine Reno NV
| | - Nageshwara Gullapalli
- Department of Internal Medicine University of Nevada Reno School of Medicine Reno NV
| | - Bryce D Beutler
- Department of Internal Medicine University of Nevada Reno School of Medicine Reno NV
| | | | - Rajkumar Doshi
- Department of Internal Medicine University of Nevada Reno School of Medicine Reno NV
| |
Collapse
|
27
|
Shariff M, Kumar A, Adalja D, Doshi R. Inferior vena cava filters reduce symptomatic but not fatal pulmonary emboli after major trauma: a meta-analysis with trial sequential analysis. Eur J Trauma Emerg Surg 2020; 47:1805-1811. [PMID: 32221636 DOI: 10.1007/s00068-020-01350-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 01/08/2020] [Accepted: 03/16/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The prophylactic use of inferior vena cava filters among patients with major trauma is researched by several controlled studies with contradicting results. We performed an updated meta-analysis with trial sequential analysis of controlled studies probing the prophylactic use of inferior cava filters on the development of symptomatic and fatal pulmonary embolism (PE) in patients with major trauma. METHODS A systematic electronic search across PubMed, Cochrane and DARE databases was executed from the debut of the databases up to September 15, 2019 for pertinent articles. The inclusion criteria being, controlled trials (randomized/ observational) investigating the prophylactic inferior vena cava filter placement among patients with major trauma juxtaposed to controls and reporting PE. Major trauma was defined as an injury severity score (ISS) > 15 or any trauma delaying the initiation of pharmacological venous thromboembolic [VTE] prophylaxis. RESULTS A total of ten studies were included in the final analysis, of which two were randomized control trials. The use of prophylactic inferior vena cava filters was associated with a reduced risk of symptomatic PE among subjects with major trauma, RR: 0.27, CI 0.12-0.58, P value < 0.05, I2 = 0%, χ2 p-value = 0.85, the evidence was further reinforced by a trial sequential analysis. However, the use of inferior vena cava filters was not associated with a decreased risk of fatal PE among subjects with major trauma, RR: 0.29, CI 0.08-1.10, P value = 0.07, I2 = 0%, χ2 p-value = 0.73. CONCLUSION The use of inferior vena cava filters curtailed the risk of symptomatic PE, the result further strengthened by trial sequential analysis. However, the present evidence fails to delineate a beneficial role of prophylactic inferior vena cava filter placement in reducing fatal PE among patients with major trauma. The possibility of Type II error cannot be excluded from this estimate.
Collapse
Affiliation(s)
- Mariam Shariff
- Department of Critical Care Medicine, St John's Medical College Hospital, Koramangala, Bangalore, India, 560034
| | - Ashish Kumar
- Department of Critical Care Medicine, St John's Medical College Hospital, Koramangala, Bangalore, India, 560034.
| | - Devina Adalja
- Department of Medicine, Gotri Medical Education and Research Center, Vadodara, India
| | - Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV, USA
| |
Collapse
|
28
|
Doshi RP, Kumar A, Adalja D, Shah J, Meraj PM, Jauhar R. ABBREVIATED DAPT FOLLOWED BY P2Y12 MONOTHERAPY AS COMPARED TO STANDARD DAPT POST-PCI: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30698-7] [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: 11/24/2022]
|
29
|
Shah J, Avula S, Khan M, Doshi RP, Adalja D. IN HOSPITAL OUTCOMES OF HEART FAILURE HOSPITALIZATION IN MEDICAID BENEFICIARIES VERSUS PRIVATELY INSURED. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31578-3] [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]
|
30
|
Doshi R, Kumar A, Thakkar S, Shariff M, Adalja D, Doshi A, Taha M, Gupta R, Desai R, Shah J, Gullapalli N. Meta-analysis Comparing Combined Use of Eicosapentaenoic Acid and Statin to Statin Alone. Am J Cardiol 2020; 125:198-204. [PMID: 31740020 DOI: 10.1016/j.amjcard.2019.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 01/12/2023]
Abstract
Role of omega-3-Fatty acids, especially eicosapentaenoic acid (EPA), in reducing cardiovascular events is not clear. We conducted a meta-analysis including trial sequential analysis (TSA) of all available randomized controlled trials (RCTs) assessing the impact of EPA + statin on cardiovascular risk reduction. The aim is to appraise cardiovascular risk reduction with EPA and statin taken together. A comprehensive search of PubMed and EMBASE databases was conducted for all RCTs that compared EPA + Statin versus statin alone and included outcomes related to cardiovascular health. We calculated a comprehensive odds ratio (ORs) and 95% confidence intervals (CIs) using a random-effects model. We included 5 RCTs totaling 27,415 patients. Our results demonstrated that EPA + statin resulted in 18% reduction in the incidence of MACE (OR = 0.78; 95% CI: 0.65 to 0.93, I2 = 54%, p value <0.01) and 30% reduction in myocardial infarction (MI) (OR = 0.71; 95% CI: 0.61 to 0.82, I2 = 0% p value <0.01) as compared with statin alone. With respect to MACE, the number needed to treat was 49. The statistical significance for reduction in the incidence of MACE with EPA+ statin was further augmented with trial sequential analysis. However, combined therapy of EPA + statin demonstrated no significant association on incidence of stroke when compared with statin alone or all-cause mortality. In conclusion, this meta-analysis demonstrated that EPA significantly reduced the incidence of MACE when combined with statin therapy, which is mainly driven by a significant reduction in myocardial infarction.
Collapse
|
31
|
Doshi R, Meghji Z, Kumar A, Shariff M, Adalja D. Do we have enough evidence to support the use of SGLT2 inhibitors for MACE reduction in patients with advance kidney disease? Eur J Intern Med 2019; 70:e25-e26. [PMID: 31685351 DOI: 10.1016/j.ejim.2019.10.014] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/12/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St W11, Reno, NV 89502, United States.
| | - Zahara Meghji
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St W11, Reno, NV 89502, United States
| | - Ashish Kumar
- Department of Critical Care Medicine, St John's Medical College Hospital, Bangalore, Karnataka, India
| | - Mariam Shariff
- Department of Critical Care Medicine, St John's Medical College Hospital, Bangalore, Karnataka, India
| | - Devina Adalja
- Department of General Medicine, Gotri Medical Education and Research Center, Vadodara, Gujarat, India
| |
Collapse
|
32
|
Doshi R, Pisipati S, Taha M, Dave M, Shah J, Adalja D, Gullapalli N. Incidence, 30-day readmission rates and predictors of readmission after new onset atrial fibrillation who underwent transcatheter aortic valve replacement. Heart Lung 2019; 49:186-192. [PMID: 31690493 DOI: 10.1016/j.hrtlng.2019.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 07/30/2019] [Revised: 09/27/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION New onset Atrial Fibrillation (NOAF) is frequently seen post transcatheter aortic valve replacement (TAVR). NOAF in the setting of TAVR has also been recognized as predictor of worse outcomes, including higher readmission rates. Data assessing the effect and predictors of NOAF on 30-day readmission rates post TAVR is limited. OBJECTIVE To assess the incidence, 30-day readmission rate and predictors of NOAF in patients who underwent TAVR. METHODS Nationwide Readmissions Database was used to identify patients who developed NOAF post-TAVR between 2012 and 2015. RESULTS A total of 24,076 patients were included in this study, of which 54% were males, and the mean age was 82.4 ± 7.2. NOAF was developed in 10,847 (45%) patients. Overall readmission rates with NOAF was 19.7% and trend in the readmissions reduced during the course of the study (21.9% to 18.7%, Ptrend < 0.001). Thirty-day readmission rate in patients who developed NOAF post-TAVR was significantly higher compared to TAVR patients without NOAF (OR 1.39; 95% CI, 1.28-1.51; p < 0.001). Similarly, rate of ischemic stroke was significantly higher among patients who developed NOAF (OR 1.22; 95% CI, 1.07-1.4; p = 0.004). Predictors of readmissions in NOAF group were mostly non-cardiac, and included age, and comorbidities with chronic liver disease, renal failure and chronic lung disease been the most common comorbidities, in that order. CONCLUSIONS Incidence of NOAF is associated with increased risk of readmissions and ischemic stroke. Future research should focus on interventions to prevent avoidable readmissions and associated morbidity and mortality.
Collapse
Affiliation(s)
- Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV 89502, United States.
| | - Sailaja Pisipati
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV 89502, United States
| | - Mohamed Taha
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV 89502, United States
| | - Mihir Dave
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV 89502, United States; Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jay Shah
- Department of Internal Medicine, Mercy St. Vincent Medical Center, Toledo, OH, USA
| | - Devina Adalja
- Department of General Medicine, Gotri Medical Education and Research Center, Vadodara, Gujarat, India
| | - Nageshwara Gullapalli
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV 89502, United States
| |
Collapse
|
33
|
Kumar A, Shariff M, Adalja D, Doshi R. Intravascular ultrasound versus angiogram guided drug eluting stent implantation. A systematic review and updated meta-analysis with trial sequential analysis. Int J Cardiol Heart Vasc 2019; 25:100419. [PMID: 31517035 PMCID: PMC6732761 DOI: 10.1016/j.ijcha.2019.100419] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 01/23/2023]
Abstract
Background Further advances have been achieved in the field of intravenous ultrasound (IVUS) guided drug eluting stent (DES) implantation and hence there was a need to rejuvenate the evidence. Hence, we performed a cumulative meta-analysis with trial sequential analysis (TSA) of randomized controlled trials (RCTs) comparing IVUS versus angiogram guided DES implantation. Methodology We searched PubMed/Medline and Cochrane database for relevant articles using predefined inclusion and exclusion criteria. Outcomes of interest were cardiovascular mortality, myocardial infarction (MI), target lesion revascularisation (TLR), stent thrombosis (ST). We used Mantel-Haenszel method with random error model to calculate odds ratio (OR) with 95% confidence interval (CI). We also performed TSA to accommodate for possible type I error. Results A total of 11 RCTs with 5352 patients were included in the final analysis. Follow up duration of included studies varied from 12 to 24 months. IVUS use was associated with significantly reduced incidence of cardiovascular mortality [OR: 0.45, CI: 0.25–0.80, p value = 0.007, I2 = 0%, χ2p-value = 0.98], TLR [OR: 0.56, CI: 0.41–0.77, p value = 0.0004, I2 = 0%, χ2p-value = 0.95] and ST [OR: 0.47, CI: 0.24–0.94, p value = 0.03, I2 = 0%, χ2p-value = 0.75]. IVUS use had no effect on incidence of MI on follow up. The cumulative z curve crosses the TSA boundary indicating sufficient evidence without type I error for reduced incidence of cardiovascular mortality and TLR with the use IVUS. Conclusion IVUS-guided DES implantation should be the standard of care as it significantly reduced cardiovascular mortality and TLR.
Collapse
Affiliation(s)
- Ashish Kumar
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Mariam Shariff
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Devina Adalja
- Department of Medicine, Gotri Medical Education and Research Centre, Vadodara, Gujarat, India
| | - Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV, USA
| |
Collapse
|