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Leuchter RK, Gulhar R, Maynick JD, Dardick LD, Vorobiof G, Tabibiazar R, Yang RM, Sarkisian CA, Woo HE. Evaluation of an Electronic Health Record Tool to Identify Echocardiograms That Do Not Change Clinical Care. J Am Soc Echocardiogr 2023; 36:1329-1332. [PMID: 37640087 DOI: 10.1016/j.echo.2023.08.019] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Richard K Leuchter
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Radhika Gulhar
- Olive-View UCLA, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Lawrence D Dardick
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Gabriel Vorobiof
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ramin Tabibiazar
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Robert M Yang
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Catherine A Sarkisian
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California; Greater Los Angeles VA Healthcare System Geriatrics Research Education and Clinical Center (GRECC), Los Angeles, California
| | - Hawkin E Woo
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
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Truong KP, Press MC, Benharash P, Kar S, Lepor NE, Vorobiof G, Yang EH. Hemodynamic Manifestations of Concomitant Radiation-Induced Tricuspid Regurgitation and Pericardial Constriction Undergoing Transcatheter Tricuspid Valve Repair. Circ Heart Fail 2023; 16:e010170. [PMID: 37703079 DOI: 10.1161/circheartfailure.122.010170] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Affiliation(s)
- Katie P Truong
- Division of Cardiology, Department of Medicine, University of Washington, Seattle (K.P.T.)
| | - Marcella Calfon Press
- Division of Cardiology, Department of Medicine (M.C.P., G.V., E.H.Y.), University of California at Los Angeles
| | - Peyman Benharash
- Division of Cardiothoracic Surgery, Department of Surgery (P.B.), University of California at Los Angeles
| | - Saibal Kar
- Cardiovascular Institute, Los Robles Regional Medical Center, Thousand Oaks, CA (S.K.)
| | - Norman E Lepor
- Division of Cardiology, Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (N.E.L.)
| | - Gabriel Vorobiof
- Division of Cardiology, Department of Medicine (M.C.P., G.V., E.H.Y.), University of California at Los Angeles
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine (G.V., E.H.Y.), University of California at Los Angeles
- Cardiac PET Partners, Encino, CA (G.V.)
| | - Eric H Yang
- Division of Cardiology, Department of Medicine (M.C.P., G.V., E.H.Y.), University of California at Los Angeles
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine (G.V., E.H.Y.), University of California at Los Angeles
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3
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Tehrani DM, Wang J, Lai P, Desai PS, Nguyen HL, Bang L, Yang EH, Vorobiof G, Nsair A, Aksoy O, Press MC, Parikh RV. Change in Invasively Measured Mean Pulmonary Artery Pressure After Transcatheter Mitral Valve Repair Is Associated With Heart Failure Readmission. Cardiol Res 2021; 12:302-308. [PMID: 34691328 PMCID: PMC8510655 DOI: 10.14740/cr1284] [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: 05/27/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background Pre-existing pulmonary hypertension is associated with poor outcomes after transcatheter mitral valve repair (TMVr) for mitral regurgitation (MR). However, the impact of an immediate change in mean pulmonary artery pressure (ΔmPAP) following TMVr on outcomes is unknown. Methods Patients who underwent TMVr from December 2015 to February 18, 2020 at our institution for symptomatic 3-4+ MR and who had invasive hemodynamics measured immediately pre- and post-TMVR were included. Multivariate Cox regression analysis was performed to examine the association of ΔmPAP (post-TMVr - pre-TMVr mPAP) with the primary endpoint of heart failure (HF) readmission at 1 year. Secondary endpoints included all-cause mortality and the composite endpoint of HF readmission or all-cause mortality at 1 year. Results Among 55 patients, 55% were men, mean age was 72 ± 14.2 years, and mean ΔmPAP was -1.4 ± 8.2 mm Hg. Overall, HF readmission occurred in 14 (25%), death in 10 (18%), and the composite endpoint in 20 (36%) patients. In multivariable analyses, higher ΔmPAP was significantly associated with HF readmission (hazard ratio (HR) = 1.10, 95% confidence interval (CI): 1.00 - 1.21; P = 0.04). ΔmPAP was not associated with death (HR = 1.04, 95% CI: 0.96 - 1.14; P = 0.33), though there was a numerical but statistically non-significant trend towards the composite endpoint (HR = 1.06, 95% CI: 1.00 - 1.13; P = 0.06) driven by HF readmission. Conclusion Higher ΔmPAP immediately following TMVr was associated with increased HF readmission at 1 year. Larger prospective studies are needed to validate these data and further explore the utility of ΔmPAP as a novel hemodynamic parameter to predict post-TMVR outcomes.
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Affiliation(s)
- David M Tehrani
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Jiexi Wang
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Parntip Lai
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Pooja S Desai
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Heajung L Nguyen
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Lisa Bang
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Eric H Yang
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Gabriel Vorobiof
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Ali Nsair
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Olcay Aksoy
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Marcella Calfon Press
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.,These authors contributed equally to this article
| | - Rushi V Parikh
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.,These authors contributed equally to this article
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Hsiao R, Bae D, Shahid M, Tello J, Vorobiof G, Chonde M, DiVita M, Vucicevic D, Baas A, Kamath M. A HEART WITH AN UNUSUAL HOLE - HEART TRANSPLANTATION FOR ACUTE ENDOCARDITIS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)04259-5] [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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Nguyen HL, Chertboonmuang P, Yang E, Vorobiof G, Nsair A, Aksoy O, Calfon-Press M, Parikh R. IMPACT OF CHANGE IN PULMONARY ARTERY PULSATILITY INDEX ON ALL-CAUSE MORTALITY AFTER PERCUTANEOUS MITRAL VALVE REPAIR. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31939-2] [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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West BH, Low CG, Bista BB, Yang EH, Vorobiof G, Busuttil RW, Budoff MJ, Elashoff D, Tobis JM, Honda HM. Significance of Coronary Artery Calcium Found on Non-Electrocardiogram-Gated Computed Tomography During Preoperative Evaluation for Liver Transplant. Am J Cardiol 2019; 124:278-284. [PMID: 31122618 DOI: 10.1016/j.amjcard.2019.04.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 01/26/2019] [Revised: 04/09/2019] [Accepted: 04/15/2019] [Indexed: 01/25/2023]
Abstract
Guidelines to evaluate patients for coronary artery disease (CAD) during preoperative evaluation for orthotopic liver transplantation (OLT) are conflicting. Cardiac catheterization is not without risk in patients with end-stage liver disease. No study to date has looked at the utility of non-electrocardiogram-gated chest computed tomography (CT) in the preliver transplant population. Our hypothesis was that coronary artery calcium scores (CACSs) from chest CT scans ordered during the liver transplant workup can identify patients who would benefit from invasive angiography. Nine hundred and fifty-three patients who underwent coronary angiography as part of their OLT workup were considered. Charts were randomly selected and reviewed for the presence of a chest CT performed before coronary angiography during the OLT workup. Agatston and Weston scores were calculated. CACS results were compared with coronary angiography findings. Nine of 54 patients were found to have obstructive CAD by angiography. Receiver-operating characteristic analysis demonstrated that an Agatston score of 251 and a Weston score of 6 maximized sensitivity and specificity for detection of obstructive coronary disease. An Agatston score <4 or Weston score <2 excluded the presence of obstructive CAD; using these thresholds, 13 patients (24%) or 15 patients (28%), respectively, could have theoretically avoided catheterization without missing significant CAD. In conclusion, our data identify the strength of CACS in ruling out coronary disease in patients being evaluated for OLT. Calcium scoring from non-electrocardiogram-gated CT studies may be integrated into preoperative algorithms to rule out obstructive CAD and help avoid invasive angiography in this high-risk population.
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Affiliation(s)
- Brian H West
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.
| | - Christopher G Low
- Department of Medical Education, California Northstate University, Elk Grove, California
| | - Biraj B Bista
- Department of Radiology, UC Irvine Medical Center, Orange, California
| | - Eric H Yang
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Gabriel Vorobiof
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ronald W Busuttil
- Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Matthew J Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute, Harbor-UCLA, Torrance, California
| | - David Elashoff
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Biostatistics, UCLA, Los Angeles, California; Department of Biomathematics, UCLA, Los Angeles, California
| | - Jonathan M Tobis
- Division of Cardiology, Department of Medicine, Section of Interventional Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Henry M Honda
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
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Weber J, West B, Aksoy O, Suh W, Huchting J, Kwon M, Shemin RJ, Vorobiof G. PERFORMANCE OF AORTIC ANNULAR ASSESSMENT BY 3D TRANSESOPHAGEAL ECHOCARDIOGRAPHY OR MAGNETIC RESONANCE ANGIOGRAPHY WITH FERUMOXYTOL IN PATIENTS WITH CKD UNDERGOING TAVR. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32071-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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8
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Nguyen H, Shamsa K, Vorobiof G, Hsu L, He T, Yang E. TAMPONADE TO TAP OR NOT: PLEURAL EFFUSION CAUSING CARDIAC TAMPONADE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32968-7] [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: 11/28/2022]
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Ershoff B, Gordin J, Vorobiof G, Elashoff D, Steadman R, Scovotti J, Wray C. Improving the Prediction of Mortality in the High Model for End-Stage Liver Disease Score Liver Transplant Recipient: A Role for the Left Atrial Volume Index. Transplant Proc 2018; 50:1407-1412. [DOI: 10.1016/j.transproceed.2018.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/01/2018] [Indexed: 01/12/2023]
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Abstract
Cardiac amyloidosis in the United States is most often due to myocardial infiltration by immunoglobulin protein, such as in AL amyloidosis, or by the protein transthyretin, such as in hereditary and senile amyloidosis. Cardiac amyloidosis often portends a poor prognosis especially in patients with systemic AL amyloidosis. Despite better understanding of the pathophysiology of amyloid, many patients are still diagnosed late in the disease course. This review investigates the current understanding and new research on the diagnosis and treatment strategies in patients with cardiac amyloidosis. Myocardial amyloid infiltration distribution occurs in a variety of patterns. Structural and functional changes on echocardiography can suggest presence of amyloid, but CMR and nuclear imaging provide important complementary information on amyloid burden and the amyloid subtype, respectively. While for AL amyloid, treatment success largely depends on early diagnosis, for ATTR amyloid, new investigational agents that reduce production of transthyretin protein may have significant impact on clinical outcomes. Advancements in the non-invasive diagnostic detection and improvements in early disease recognition will undoubtedly facilitate a larger proportion of patients to receive early therapy when it is most effective.
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Affiliation(s)
- Mirela Tuzovic
- Division of Cardiology, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Eric H Yang
- Division of Cardiology, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Arnold S Baas
- Ahmanson-UCLA Cardiomyopathy Center, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Eugene C Depasquale
- Ahmanson-UCLA Cardiomyopathy Center, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Mario C Deng
- Ahmanson-UCLA Cardiomyopathy Center, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Daniel Cruz
- Ahmanson-UCLA Cardiomyopathy Center, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Gabriel Vorobiof
- Division of Cardiology, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA. .,Cardiovascular Center, 100 Medical Plaza, Suite 545, 100 UCLA Medical Plaza, Los Angeles, CA, 90095, USA.
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Tanoue M, West B, Nguyen H, Chatterjee D, Sekimura T, Vorobiof G, Yang EH, Aksoy O. ASSESSMENT OF RIGHT VENTRICULAR SYSTOLIC FUNCTION BY GLOBAL LONGITUDINAL STRAIN WITHIN 1 MONTH AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32093-x] [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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Asthana N, Mantha A, Yang EH, Suh W, Aksoy O, Shemin RJ, Vorobiof G, Benharash P. Myocardial functional changes in transfemoral versus transapical aortic valve replacement. J Surg Res 2018; 221:304-310. [DOI: 10.1016/j.jss.2017.08.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 07/19/2017] [Accepted: 08/16/2017] [Indexed: 10/18/2022]
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Lluri G, Renella P, Finn JP, Vorobiof G, Aboulhosn J, Deb A. Prognostic Significance of Left Ventricular Fibrosis in Patients With Congenital Bicuspid Aortic Valve. Am J Cardiol 2017; 120:1176-1179. [PMID: 28802508 DOI: 10.1016/j.amjcard.2017.06.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/12/2017] [Accepted: 06/29/2017] [Indexed: 10/19/2022]
Abstract
This study sought to evaluate the prognostic value of left ventricular (LV) fibrosis assessed by late gadolinium enhancement (LGE) of the myocardium during cardiac magnetic resonance (CMR) imaging in patients with bicuspid aortic valve (BAV), which is associated with early aortic valve fibrosis and calcification. To what degree the LV myocardial wall is affected by fibrosis and its prognostic value is currently unknown. This is a retrospective, single-center study evaluating all adult patients with BAV who had CMR and followed from March 2002 to March 2016. CMR and transthoracic echocardiogram images were reviewed. Clinical data were abstracted from the electronic medical record. A total of 29 patients were included in the study, of which 11 (38%) had CMR studies that demonstrated the presence of LGE. Patients with LGE had significantly higher aortic valve mean gradients by echocardiography when compared with LGE-negative patients (30.3 ± 7.2 mm Hg vs 14.7 ± 3.6 mm Hg, p = 0.049). They were also more likely to have LV hypertrophy. Patients with LGE were 10 times more likely to need aortic valve replacement within 1 year of the CMR study than did patients without LGE (55% vs 5.5%, p = 0.0028). In conclusion, evaluation of LGE by CMR as a marker of LV myocardial fibrosis can have additional prognostic value when evaluating patients with aortic stenosis secondary to BAV.
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Fischer M, Salehi A, Sopher MJ, Vorobiof G, Shemin RJ. Ruptured Papillary Muscles After Chordae-Preserving Bioprosthetic Mitral Valve Replacement. Ann Thorac Surg 2017; 104:e243-e245. [PMID: 28838517 DOI: 10.1016/j.athoracsur.2017.03.007] [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] [Received: 02/08/2017] [Revised: 02/27/2017] [Accepted: 03/01/2017] [Indexed: 11/28/2022]
Abstract
Bioprosthetic valve-associated masses in the perioperative period are rare. This report describes the case of a 68-year-old man with perivalvular masses that were initially discovered on a routine postoperative transthoracic echocardiogram 7 days after chordae-preserving mitral valve replacement and coronary artery bypass grafting. An intraoperative transesophageal echocardiogram demonstrated ruptured papillary muscles. This case report describes the differential diagnosis and surgical management of this rare finding.
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Affiliation(s)
- Matthew Fischer
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.
| | - Ali Salehi
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Michael J Sopher
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Gabriel Vorobiof
- Department of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Richard J Shemin
- Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
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Garg V, Ho JK, Vorobiof G. Changes in myocardial deformation after transcatheter and surgical aortic valve replacement. Echocardiography 2017; 34:603-613. [DOI: 10.1111/echo.13485] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Vinisha Garg
- Department of Medicine; Division of Cardiology; David Geffen School of Medicine at UCLA; Ronald Reagan UCLA Medical Center; Los Angeles CA USA
| | - Jonathan K. Ho
- Department of Anesthesiology & Perioperative Medicine; David Geffen School of Medicine at UCLA; Ronald Reagan UCLA Medical Center; Los Angeles CA USA
| | - Gabriel Vorobiof
- Department of Medicine; Division of Cardiology; David Geffen School of Medicine at UCLA; Ronald Reagan UCLA Medical Center; Los Angeles CA USA
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Sethi SS, Suh W, Cardoza K, Kwon M, Shemin R, FInn JP, Vorobiof G, Yang E, Aksoy O. THE USE OF MAGNETIC RESONANCE IMAGING WITH FERUMOXYTOL FOR ANNULUS SIZING IN PATIENTS WITH CHRONIC KIDNEY DISEASE UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34423-6] [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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17
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Pohost GM, Kim H, Vorobiof G, Contreras L, Madyoon H, Helfenstein J, Lepor N. Impact of ranolazine on myocardial metabolic ischemia detected by phosphorus-31 magnetic resonance spectroscopy. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032469 DOI: 10.1186/1532-429x-18-s1-p97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Wickramasinghe CD, Nguyen KL, Watson KE, Vorobiof G, Yang EH. Concepts in cardio-oncology: definitions, mechanisms, diagnosis and treatment strategies of cancer therapy-induced cardiotoxicity. Future Oncol 2016; 12:855-70. [PMID: 26829050 DOI: 10.2217/fon.15.349] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
There has been considerable improvement in cancer survival rates, primarily through improved preventive strategies and novel anticancer drugs. Cancer is now becoming a chronic illness and as such both short and long-term cardiotoxic effects of cancer therapy are becoming more apparent. This has led to the emergence of a new multidisciplinary specialty known as cardio-oncology, with the purpose of identifying patients who are at a higher risk for developing cardiotoxicity so that appropriate surveillance, treatment and follow-up strategies may be instituted early. The mechanisms of cardiotoxicity caused by commonly used anticancer agents are reviewed, along with the latest advances in diagnostic and preventative strategies, with the overall objective of allowing cancer patients to continue both lifesaving and palliative treatments for their malignancy.
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Affiliation(s)
- Chanaka D Wickramasinghe
- Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Kim-Lien Nguyen
- Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Karol E Watson
- Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Gabriel Vorobiof
- Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Eric H Yang
- Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
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Ajijola OA, Romero J, Vorobiof G, Suh WM, Shivkumar K, Tung R. Hyper-response to cardiac resynchronization with permanent His bundle pacing: Is parahisian pacing sufficient? HeartRhythm Case Rep 2015; 1:429-433. [PMID: 27722091 PMCID: PMC5053391 DOI: 10.1016/j.hrcr.2015.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 12/07/2022] Open
Affiliation(s)
- Olujimi A Ajijola
- UCLA Cardiac Arrhythmia Center, Los Angeles, California; Division of Cardiology, UCLA Health System, University of California, Los Angeles, Los Angeles, California
| | - Jorge Romero
- UCLA Cardiac Arrhythmia Center, Los Angeles, California
| | - Gabriel Vorobiof
- Division of Cardiology, UCLA Health System, University of California, Los Angeles, Los Angeles, California
| | - William M Suh
- Division of Cardiology, UCLA Health System, University of California, Los Angeles, Los Angeles, California
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, Los Angeles, California; Division of Cardiology, UCLA Health System, University of California, Los Angeles, Los Angeles, California
| | - Roderick Tung
- UCLA Cardiac Arrhythmia Center, Los Angeles, California; Division of Cardiology, UCLA Health System, University of California, Los Angeles, Los Angeles, California
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Moriarty J, Harris TJ, Vorobiof G, Kwon M, Aboulhosn J. Direct Percutaneous Repair of Left Ventricular Pseudoaneurysm via Transthoracic Deployment of a Ventricular Septal Defect Closure Device. Tex Heart Inst J 2015; 42:362-6. [PMID: 26413020 DOI: 10.14503/thij-14-4243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In this case report, we describe direct percutaneous delivery of a muscular-ventricular-septal-defect occluder device to close a left ventricular pseudoaneurysm. The occluder was positioned and deployed with the aid of concurrent transthoracic ultrasonography, transesophageal echocardiography, and fluoroscopy. In contrast with previously published reports, we describe and illustrate a direct transthoracic route across the pseudoaneurysmal sac, which obviated the need for indirect transfemoral or transapical approaches.
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Xia VW, Worapot A, Huang S, Dhillon A, Gudzenko V, Backon A, Agopian VG, Aksoy O, Vorobiof G, Busuttil RW, Steadman RH. Postoperative atrial fibrillation in liver transplantation. Am J Transplant 2015; 15:687-94. [PMID: 25657037 DOI: 10.1111/ajt.13034] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [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: 08/04/2014] [Revised: 09/18/2014] [Accepted: 09/21/2014] [Indexed: 01/25/2023]
Abstract
Postoperative atrial fibrillation (POAF) is common after major surgeries and is associated with increased morbidity and mortality. POAF after liver transplantation (LT) has not been reported. This study was undertaken to investigate the incidence, impact, and risk factors of POAF in LT patients. After IRB approval, LT between January 2006 and August 2013 at our center were retrospectively reviewed. POAF that occurred within 30 days after LT was included. Patients with and without POAF were compared and independent risk factors were identified by logistic regression. Of 1387 adults LT patients, 102 (7.4%) developed POAF during the study period. POAF was associated with significantly increased mortality, graft failure, acute kidney injury and prolonged hospital stay. Independent risk factors included age, body weight, MELD score, presence of previous history of AF, the vasopressors use prior to LT and pulmonary artery diastolic pressure at the end of LT surgery (odds ratios 2.0-7.2, all p < 0.05). A risk index of POAF was developed and patients with the high-risk index had more than 60% chance of developing POAF. These findings may be used to stratify patients and to guide prophylaxis for POAF in the posttransplant period.
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Affiliation(s)
- V W Xia
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Affiliation(s)
- Alexandra C Milin
- Department of Internal Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA
| | - Gabriel Vorobiof
- Department of Internal Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA
| | - Olcay Aksoy
- Department of Internal Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA
| | - Reza Ardehali
- Department of Internal Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA
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Yadlapati A, Diep J, Barnes MJ, Grogan T, Bethencourt DM, Vorobiof G. Comprehensive hemodynamic performance and frequency of patient-prosthesis mismatch of the St. Jude Medical Trifecta bioprosthetic aortic valve. J Heart Valve Dis 2014; 23:516-523. [PMID: 25803979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The study aim was to evaluate the performance of a new stented pericardial bioprosthesis, the Trifecta (St. Jude Medical, St. Paul, MN, USA), for aortic valve replacement (AVR) with respect to valvular hemodynamics and frequency of patient-prosthesis mismatch (PPM). PPM has been reported in a wide range of bioprosthetic valves following AVR, and has been associated with multiple adverse outcomes. It was hypothesized that the Trifecta aortic valve would have superior hemodynamics and an acceptable incidence of PPM following AVR. METHODS A prospective cohort study was performed between January 2010 and May 2012, following 75 patients (mean age 71.9 _ 11.1 years) who had undergone AVR with a Trifecta valve for aortic stenosis (88%) or regurgitation (12%) at the authors' institutions. Intraoperative three-dimensional and Doppler transesophageal echocardiography were used to evaluate hemodynamic variables before and after AVR, as well as pre-discharge. RESULTS Echocardiographic evaluation showed a preoperative average mean gradient (MG) of 40.6 ± 21.6 mmHg, an average peak gradient (PG) of 72.1 ± 19.4 mmHg, and an average effective orifice area index (EOAI) of 0.39 ± 0.20 cm2/m2. Postoperative mean pressure gradient measurements showed a postoperative average MG of 8.76 ± 3.75 mmHg (p < 0.001), an average PG of 19.4 ± 8.6 mmHg (p < 0.001), and EOAI of 1.09 ± 0.36 cm2/m2 (p < 0.001), which demonstrated a significantly improved hemodynamic performance across all valve sizes. Postoperative MG versus measured EOAI demonstrated a fairly linear relationship (R2 = 0.0703), rather than a rapid increase in MG with EOAI < 0.85 and < 0.65, as was seen with previous valve designs. Severe PPM (defined as EOAI ≤ 0.65 cm2/m2) was found in four patients (6%), while moderate PPM (EOAI > 0.65 and < 0.85 cm2/m2) was seen in 11 patients (16%). CONCLUSION The Trifecta pericardial valve demonstrated excellent hemodynamic performance at all valve sizes, and resulted in very low postoperative transvalvular pressure gradients and PPM, without the need for aortic root enlargement.
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Yadlapati A, Diep J, Barnes M, Grogan T, Bethencourt DM, Vorobiof G. Comprehensive Hemodynamic Comparison and Frequency of Patient-Prosthesis Mismatch between the St. Jude Medical Trifecta and Epic Bioprosthetic Aortic Valves. J Am Soc Echocardiogr 2014; 27:581-9. [DOI: 10.1016/j.echo.2014.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Indexed: 11/28/2022]
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25
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Saremi F, Vojdani E, Vorobiof G, Shavelle D, Wilcox A, Madanipour S, Lundquist R. Right to left shunting through communications between the left superior intercostal vein tributaries and the left atrium: a potential cause of paradoxical embolism. Int J Cardiol 2013; 167:2867-74. [PMID: 22882965 DOI: 10.1016/j.ijcard.2012.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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] [Received: 04/24/2012] [Revised: 06/30/2012] [Accepted: 07/21/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To investigate the role of collateral venous pathways between the left brachiocephalic vein (LBV) and the left atrium through an arcade comprising the left superior intercostal vein (LSICV), left vertical vein (LVV), and pulmonary veins as a potential cause of paradoxical embolism. METHODS A retrospective search was performed to find symptomatic patients with negative work up for paradoxical emboli whose chest CT or MR angiography by left arm contrast injection showed a visible right to left shunt through the LSICV/LVV collateral pathway (symptomatic group). We also evaluated the characteristics of this collateral pathway in 150 chest CT angiographies from general referrals (comparison group). RESULTS We found 7 symptomatic patients. Initial presentations included neurological symptoms in all patients and episodes of hypoxemia in three patients. Communications between the LBV and left atrium through the LSICV/LVV pathway was seen is all 7 cases and confirmed by transesophageal echocardiography in two. An abnormal LBV was seen in 6 cases (absence in one, stenosis in 5). Moderate superior vena cava stenosis was seen in one and acute right subclavian vein thrombosis in one. Six patients had past history of an upper extremity central line placement. In the comparison group, LSICV was seen in 73 (48%), connecting to the hemiazygos vein in 41, to a LVV in 19 and to the left atrium in 7. CONCLUSION LSICV/LVV collaterals are common and can be a potential route for paradoxical emboli especially when stenosis of a draining vein such as LBV exists.
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Affiliation(s)
- Farhood Saremi
- Department of Radiology, University of Southern California, Los Angeles, CA 90033, United States.
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26
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Suh WM, Vorobiof G, Shemin RJ, Kwon MH, Fusari M, Tobis JM. Treating aortic stenosis and mitral regurgitation with 1 transcatheter heart valve: 2 birds with 1 stone. J Am Coll Cardiol 2013; 61:e349. [PMID: 23603233 DOI: 10.1016/j.jacc.2012.12.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 12/11/2012] [Indexed: 11/25/2022]
Affiliation(s)
- William M Suh
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Gabriel Vorobiof
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Richard J Shemin
- Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Murray H Kwon
- Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Jonathan M Tobis
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California
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Catton K, Blurton D, Vorobiof G, Setty SP. Bilateral superior vena cavae with anomalous criss-cross atrial drainage. Pediatr Cardiol 2013; 34:769-70. [PMID: 23052679 DOI: 10.1007/s00246-012-0548-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 09/25/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Kirsti Catton
- Department of Pediatric and Adult Congenital Cardiac Surgery, Miller Children's Hospital and Long Beach Memorial Hospital, 2880 Atlantic Ave, Long Beach, CA, USA
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Yadlapati A, Barnes MJ, Diep J, Bethencourt D, Vorobiof G. COMPREHENSIVE HEMODYNAMIC COMPARISON AND FREQUENCY OF PATIENT PROSTHESIS MISMATCH BETWEEN THE ST. JUDE MEDICAL EPIC AND TRIFECTA BIOPROSTHETIC AORTIC VALVES. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61986-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Buttan AK, Yang EH, Budoff MJ, Vorobiof G. Evaluation of valvular disease by cardiac computed tomography assessment. J Cardiovasc Comput Tomogr 2012; 6:381-92. [DOI: 10.1016/j.jcct.2012.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 10/30/2012] [Accepted: 10/31/2012] [Indexed: 12/31/2022]
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Vorobiof G, Vorobiof DA. Apologising for Nazi medicine: too little too late. Lancet 2012; 380:1472. [PMID: 23101716 DOI: 10.1016/s0140-6736(12)61842-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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Vorobiof G, Vojdani E, Jalali P, Lundquist R, Shavelle D, Suh WM, Saremi F. A NEW CAUSE OF PARADOXICAL EMBOLISM AND CRYPTOGENIC STROKE: RIGHT TO LEFT SHUNTING BETWEEN SUPERIOR INTERCOSTAL VEINS AND THE LEFT ATRIUM. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)62100-7] [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: 10/28/2022]
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32
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Barseghian A, Bethencourt DM, Vorobiof G. Dual anterior and posterior mitral valve clefts evaluated by 3-dimensional echocardiography with robot-assisted surgical correction. J Thorac Cardiovasc Surg 2011; 143:503-4. [PMID: 22153721 DOI: 10.1016/j.jtcvs.2011.10.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 10/25/2011] [Indexed: 10/14/2022]
Affiliation(s)
- Ailin Barseghian
- Division of Cardiology, University of California Irvine, Irvine, Calif., USA
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Abstract
Coronary CT angiography is a rapidly growing technique that offers distinct advantages over traditional imaging techniques. However, because of rapid growth of this technique, radiation dose safety has been placed under the spotlight. There are several main determinants of total radiation dose, and these are outlined in this review. Integration of these dose-saving techniques will go a long way in maintaining diagnostic image quality and improving patient safety.
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Affiliation(s)
- Gabriel Vorobiof
- Memorial Heart & Vascular Institute, Department of Cardiology, Long Beach Memorial Medical Center, 2801 Atlantic Avenue, Long Beach, CA 90806, USA.
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34
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Saremi F, Goodman G, Wilcox A, Salibian R, Vorobiof G. Coronary Artery Ostial Atresia. JACC Cardiovasc Imaging 2011; 4:1320-3. [DOI: 10.1016/j.jcmg.2011.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 08/15/2011] [Accepted: 09/01/2011] [Indexed: 10/14/2022]
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35
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Saremi F, Vorobiof G. Aberrant penetrating posterior descending artery from proximal right coronary artery. Clin Anat 2011; 24:956-8. [DOI: 10.1002/ca.21250] [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] [Received: 06/07/2011] [Revised: 06/21/2011] [Accepted: 07/15/2011] [Indexed: 11/10/2022]
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Suh WM, Berdjis F, Rizi HR, Vorobiof G. Multimodality Evaluation and Transcatheter Closure of a Muscular Ventricular Septal Defect. J Am Coll Cardiol 2011; 58:e35. [DOI: 10.1016/j.jacc.2011.03.073] [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] [Received: 03/11/2011] [Accepted: 03/24/2011] [Indexed: 10/16/2022]
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Odigie-Okon E, Okon E, Dodson J, Vorobiof G. Stress-induced cardiomyopathy complicating severe babesiosis. Cardiol J 2011; 18:83-86. [PMID: 21305491] [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: 05/30/2023] Open
Abstract
A post-menopausal lady with severe babesiosis developed a basal-type stress-induced cardiomyopathy. Left ventricular function normalized at three months. We believe this is the first reported case of stress cardiomyopathy complicating severe babesiosis. Cardiac biomarker elevation disproportionate to the area of myocardial dysfunction, electrocardiographic changes, the patient's clinical condition, and close follow-up of left ventricular function parameters are all vital in diagnosing stress cardiomyopathy and may exclude the need for coronary angiography. There may be a possible association between severe babesiosis and stress cardiomyopathy.
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Affiliation(s)
- Esosa Odigie-Okon
- Department of Medicine, Yale University (Bridgeport Hospital), Bridgeport, CT, USA.
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Casey LM, Pistner AR, Belmonte SL, Migdalovich D, Stolpnik O, Nwakanma FE, Vorobiof G, Dunaevsky O, Matavel A, Lopes CMB, Smrcka AV, Blaxall BC. Small molecule disruption of G beta gamma signaling inhibits the progression of heart failure. Circ Res 2010; 107:532-9. [PMID: 20576935 DOI: 10.1161/circresaha.110.217075] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [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: 12/24/2022]
Abstract
RATIONALE Excess signaling through cardiac Gbetagamma subunits is an important component of heart failure (HF) pathophysiology. They recruit elevated levels of cytosolic G protein-coupled receptor kinase (GRK)2 to agonist-stimulated beta-adrenergic receptors (beta-ARs) in HF, leading to chronic beta-AR desensitization and downregulation; these events are all hallmarks of HF. Previous data suggested that inhibiting Gbetagamma signaling and its interaction with GRK2 could be of therapeutic value in HF. OBJECTIVE We sought to investigate small molecule Gbetagamma inhibition in HF. METHODS AND RESULTS We recently described novel small molecule Gbetagamma inhibitors that selectively block Gbetagamma-binding interactions, including M119 and its highly related analog, gallein. These compounds blocked interaction of Gbetagamma and GRK2 in vitro and in HL60 cells. Here, we show they reduced beta-AR-mediated membrane recruitment of GRK2 in isolated adult mouse cardiomyocytes. Furthermore, M119 enhanced both adenylyl cyclase activity and cardiomyocyte contractility in response to beta-AR agonist. To evaluate their cardiac-specific effects in vivo, we initially used an acute pharmacological HF model (30 mg/kg per day isoproterenol, 7 days). Concurrent daily injections prevented HF and partially normalized cardiac morphology and GRK2 expression in this acute HF model. To investigate possible efficacy in halting progression of preexisting HF, calsequestrin cardiac transgenic mice (CSQ) with extant HF received daily injections for 28 days. The compound alone halted HF progression and partially normalized heart size, morphology, and cardiac expression of HF marker genes (GRK2, atrial natriuretic factor, and beta-myosin heavy chain). CONCLUSIONS These data suggest a promising therapeutic role for small molecule inhibition of pathological Gbetagamma signaling in the treatment of HF.
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Affiliation(s)
- Liam M Casey
- Aab Cardiovascular Research Institute and Department of Medicine, University of Rochester School of Medicine and Dentistry, NY, USA
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Block R, Corsetti J, Goldenberg I, Vorobiof G, McNitt S, Ryan D, Zareba W, Moss AJ. The common apolipoprotein A-1 polymorphism -75A>G is associated with ethnic differences in recurrent coronary events after recovery from an acute myocardial infarction. Heart Int 2009; 4:e8. [PMID: 21152377 PMCID: PMC2997744 DOI: 10.4081/hi.2009.e8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 06/26/2009] [Accepted: 10/05/2009] [Indexed: 11/22/2022] Open
Abstract
Since data regarding the relationship between a common polymorphism (SNP) of the apoA1 gene with apoA1 levels and risk of coronary artery disease are inconsistent, we hypothesized that its association with recurrent coronary events differs for White and Black individuals with diagnosed coronary heart disease. The apoA1 -75G>A SNP was genotyped in a cohort of 834 Black (n=129) and White (n=705) post-myocardial infarction patients. Recurrent coronary events (coronary-related death, non-fatal myocardial infarction, or unstable angina) were documented during an average follow-up of 28 months. Thirty percent of White and 21% of Black patients carried the SNP. Cox proportional-hazards regression analysis, adjusting for clinical and laboratory covariates, demonstrated that the SNP was not associated with recurrent events in the total cohort (HR=1.37, 95% CI 0.95-1.97; p= 0.09) but was the only variable associated with an increased risk of recurrent cardiac events in Blacks (HR=2.40, 95% CI 1.07-5.40; p= 0.034). Conversely in Whites, the SNP was not associated with recurrent events (HR=1.12, 95% CI 0.75-1.67; p= 0.59) whereas apoB (HR=1.78, 95% CI 1.20 -2.65; p= 0.0042) and calcium channel blocker use (HR=2.53, 95% CI 1.72-3.72; p<0.001) were associated; p= 0.0024 for interaction between ethnicity and the SNP. A common apoA1 SNP is associated with a significantly increased risk of recurrent cardiac events among Black, but not White, postmyocardial infarction patients. Relationships with lipoproteins may help explain this finding.
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Affiliation(s)
- Robert Block
- Department of Community and Preventive Medicine, University of Rochester, Rochester, NY
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Vorobiof G. Coronary angiography by 64-row CT. N Engl J Med 2009; 360:2028-9; author reply 2030-1. [PMID: 19425192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Kwong RY, Sattar H, Wu H, Vorobiof G, Gandla V, Steel K, Siu S, Brown KA. Incidence and prognostic implication of unrecognized myocardial scar characterized by cardiac magnetic resonance in diabetic patients without clinical evidence of myocardial infarction. Circulation 2008; 118:1011-20. [PMID: 18725488 DOI: 10.1161/circulationaha.107.727826] [Citation(s) in RCA: 228] [Impact Index Per Article: 14.3] [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: 01/26/2023]
Abstract
BACKGROUND Silent myocardial infarctions (MIs) are prevalent among diabetic patients and inflict significant morbidity and mortality. Although late gadolinium enhancement (LGE) imaging by cardiac magnetic resonance (CMR) can provide sensitive characterization of myocardial scar, its prognostic significance in diabetic patients without any clinical evidence of MI is unknown. METHODS AND RESULTS We performed clinically indicated CMR imaging in 187 diabetic patients who were grouped by the absence (study group, n=109) or presence (control group, n=78) of clinical evidence of MI (clinical history of MI or Q waves on ECG). CMR imaging and follow-up were successful in 107 study patients (98%) and 74 control patients (95%). Cox regression analyses were performed to associate LGE with major adverse cardiovascular events (MACE), including death, acute MI, new congestive heart failure or unstable angina, stroke, and significant ventricular arrhythmias. LGE by CMR was present in 30 of 107 study patients (28%). At a median follow-up of 17 months, 38 of 107 patients (36%) experienced MACE, which included 18 deaths. Presence of LGE was associated with a >3-fold hazards increase for MACE and for death (hazard ratio, 3.71 and 3.61; P<0.001 and P=0.007, respectively). Adjusted to a model that combines patient age, sex, ST or T changes on ECG, and left ventricular end-systolic volume index, LGE maintained a >4-fold hazards increase for MACE (adjusted hazard ratio, 4.13; 95% confidence interval, 1.74 to 9.79; P=0.001). In addition, LGE provided significant prognostic value with MACE and with death adjusted to a diabetic-specific risk model for 5-year events. The presence of LGE was the strongest multivariable predictor of MACE and death by stepwise selection in the study patients. CONCLUSIONS CMR imaging can characterize occult myocardial scar consistent with MI in diabetic patients without clinical evidence of MI. This imaging finding demonstrates strong association with MACE and mortality hazards that is incremental to clinical, ECG, and left ventricular function combined.
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Affiliation(s)
- Raymond Y Kwong
- MPH, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
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Rybicki FJ, Otero HJ, Steigner ML, Vorobiof G, Nallamshetty L, Mitsouras D, Ersoy H, Mather RT, Judy PF, Cai T, Coyner K, Schultz K, Whitmore AG, Di Carli MF. Initial evaluation of coronary images from 320-detector row computed tomography. Int J Cardiovasc Imaging 2008; 24:535-46. [PMID: 18368512 DOI: 10.1007/s10554-008-9308-2] [Citation(s) in RCA: 385] [Impact Index Per Article: 24.1] [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] [Received: 03/03/2008] [Accepted: 03/19/2008] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate image quality and contrast opacification from coronary images acquired from 320-detector row computed tomography (CT). Patient dose is estimated for prospective and retrospective ECG-gating; initial correlation between 320-slice CT and coronary catheterization is illustrated. METHODS Retrospective image evaluation from forty consecutive patients included subjective assessment of image quality and contrast opacification (80 ml iopamidol 370 mg I/ml followed by 40 ml saline). Region of interest opacification measurements at the ostium and at 2.5 mm diameter were used to determine the gradient of contrast opacification (defined as the proximal minus distal HU measurements) in coronary arteries imaged in a single heartbeat. Estimated effective dose was compared for prospective versus retrospective ECG-gating, two body mass index categories (30 kg/m(2) cutoff), and single versus two heartbeat acquisition. When available, CT findings were correlated with those from coronary catheterization. RESULTS Over 89% of arterial segments (15 segment model) had excellent image quality. The most common reason for image degradation was cardiac motion. One segment in one patient was considered unevaluable. Contrast opacification was almost universally considered excellent. The mean Hounsfield units (HU) was greater than 350; the coronary contrast opacification gradient was 30-50 HU. Patient doses were greater for retrospective ECG-gating, larger patients, and those imaged with two heartbeats. For the most common (n=25) protocol (120 kV, 400 mA, prospective ECG-gating, 60-100% phase window, 16 cm craniocaudal coverage, single heartbeat), the mean dose was 6.8+/-1.4 mSv. All CT findings were confirmed in the four patients who underwent coronary catheterization. CONCLUSION Initial 320-detector row coronary CT images have consistently excellent quality and iodinated contrast opacification. These patients were scanned with conservative protocols with respect to iodine load, prospective ECG-gating phase window, and craniocaudal coverage. Future work will focus on lowering contrast and radiation dose while maintaining image quality.
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Affiliation(s)
- Frank J Rybicki
- Noninvasive Cardiovascular Imaging, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Hall B, Jeevanantham V, Simon R, Filippone J, Vorobiof G, Daubert J. Variation in left atrial transmural wall thickness at sites commonly targeted for ablation of atrial fibrillation. J Interv Card Electrophysiol 2007; 17:127-32. [PMID: 17226084 DOI: 10.1007/s10840-006-9052-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [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: 06/08/2006] [Accepted: 10/17/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND The number of catheter ablations performed for atrial fibrillation (AF) has increased dramatically over the past several years. Regional variation in left atrial (LA) wall thickness is known to exist but have not been described in detail. AF ablation success and complication rates may be related to regional differences in LA wall thickness. OBJECTIVE To evaluate differences in transmural wall thickness in five pre-defined anatomic areas within the LA which are commonly targeted for AF ablation. MATERIALS AND METHODS We measured LA wall transmural thickness in 34 human heart specimens using calipers in five anatomic areas frequently targeted during AF ablation (anterior wall, septum, mitral isthmus, posterior wall and roof). RESULTS The autopsied individuals were 53% female, 67.7% had CAD, 14.7% had atrial fibrillation, 61.8% had hypertension, and 21.6% had congestive heart failure. The roof was the thinnest region with mean thickness measuring significantly less than each other area (p 0.005 for the posterior wall and <0.001 for all other areas). The septum was the thickest region with mean thickness measuring significantly greater than each other area (p = 0.05, 0.001, <0.001, <0.001 measured against the anterior wall, isthmus, posterior wall and roof, respectively). CONCLUSIONS Significant regional differences exist for mean left atrial wall thickness among the different anatomic areas within the left atrium which are often targeted during catheter ablation of AF. These differences may have significant implications in determining the ideal intensity and total duration of radiofrequency energy required to achieve a safe and successful ablation.
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Affiliation(s)
- Burr Hall
- Electrophysiology Division, Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, NY 14642-8653, USA
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Vorobiof G, Schwartz RG. Encouragement to optimize medical therapy for coronary heart disease. Cardiol J 2007; 14:217-219. [PMID: 18651463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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Vorobiof G, Goldenberg I, Moss AJ, Zareba W, McNitt S. Effectiveness of the implantable cardioverter defibrillator in blacks versus whites (from MADIT-II). Am J Cardiol 2006; 98:1383-6. [PMID: 17134634 DOI: 10.1016/j.amjcard.2006.06.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [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: 03/30/2006] [Revised: 06/13/2006] [Accepted: 06/13/2006] [Indexed: 11/20/2022]
Abstract
The aim of this study was to examine the effectiveness of implantable cardioverter-defibrillator (ICD) therapy in whites and blacks who were enrolled in the Multicenter Automatic Defibrillator Implantation Trial-II (MADIT-II). The study population involved 1,232 subjects, with 1,073 white patients (87%) and 102 black patients (8%). Univariate analyses revealed a significant reduction in mortality in white patients treated with ICD therapy (p <0.02), but not in black patients (p = 0.96). White patients had a significant reduction of sudden cardiac death (p <0.01), but no benefit was evident in black patients (p = 0.62). Adjusting for relevant covariates, the ICD therapy/conventional therapy hazard ratios for total mortality were favorable in whites (0.75, 95% confidence interval [CI] 0.55 to 1.02), but not in blacks (1.25, 95% CI 0.42 to 3.60); the hazard ratios for sudden cardiac death were significantly (p = 0.04) lower in whites (0.29, 95% CI 0.17 to 0.49) than in blacks (1.71, 95% CI 0.33 to 8.84). Interaction analyses revealed a pattern of progressive improvement in ICD efficacy in whites as the end point became more specific for arrhythmic death, with exactly the reverse for blacks. In conclusion, ICD therapy in MADIT-II was associated with a reduction in total mortality, cardiac death, and sudden cardiac death in whites but not in blacks.
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Affiliation(s)
- Gabriel Vorobiof
- Heart Research Follow-Up Program, Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
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Abstract
Endothelin (ET) is an endogenous peptide secreted predominantly by endothelial cells that mediates its effects via vasoconstriction and hypertrophy of vascular smooth muscle. Because the role of ET has been described in multiple pathologic processes in cardiovascular disease, including hypertension, there has been a strong interest in the development of therapeutic agents that inhibit ET receptors. ET receptor antagonists have shown much promise in disease states such as pulmonary arterial hypertension, essential hypertension, and various forms of secondary hypertension. This review serves to summarize the current role of ET and ET receptor antagonists in both the pathophysiology and the treatment of hypertension.
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Affiliation(s)
- Gabriel Vorobiof
- Program in Heart Failure and Transplantation, University of Rochester, Cardiology Division, 601 Elmwood Avenue, Box 679T, Rochester, NY 14642-8679, USA
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Abstract
We report a rare case of primary osteosarcoma of the breast in a postmenopausal patient without any association to either trauma or an underlying tumor. Clinical, radiographic, and histologic illustrations as well as a review of the literature are presented.
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Vorobiof DA, Sitas F, Vorobiof G. Breast cancer incidence in South Africa. J Clin Oncol 2001; 19:125S-127S. [PMID: 11560987] [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: 02/21/2023] Open
Abstract
Cancer in South Africa is an emerging health problem, with breast cancer being one of the leading cancers in women, following similar worldwide statistics. Lifetime risks of developing breast cancer vary from a low of one in 81 in African women (similar to Japan) to a high of one in 13 among white women, similar to rates in Western countries. Age and stage at diagnosis vary considerably between the different races and populations (urban v rural) living in South Africa. Many different determinants (socioeconomic, cultural, geographic accessibility to medical centers with oncologic services, availability of traditional healers, and so on) affect patients with breast cancer (mainly rural black women) in their decisions to obtain early medical help as well as to refrain from the proposed therapeutic methods (surgery, radiotherapy, and chemotherapy). A brief overview of breast cancer in South Africa with special reference to some of the above determinants is presented.
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Affiliation(s)
- D A Vorobiof
- Sandton Oncology Center, University of the Witwatersrand, Johannesburg, South Africa.
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