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Persits I, Mirzai S, Sarnaik KS, Volk MC, Yun J, Harb S, Puri R, Kapadia S, Krishnaswamy A, Chen PH, Reed G, Tang WHW. Low Muscle Mass by Preprocedural Computed Tomography Is Associated With Worse Short-Term Outcomes in Transcatheter Aortic Valve Replacement Recipients. Am J Cardiol 2024; 217:86-93. [PMID: 38432333 DOI: 10.1016/j.amjcard.2024.02.028] [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: 10/28/2023] [Revised: 02/03/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
Low muscle mass (LMM) is associated with worse outcomes in various clinical situations. Traditional frailty markers have been used for preoperative risk stratification in patients who underwent transcatheter aortic valve replacement (TAVR). However, preoperative imaging provides an opportunity to directly quantify skeletal muscle mass to identify patients at higher risk of procedural complications. We reviewed all TAVR recipients from January to December 2018 and included subjects with preprocedural chest computed tomography. Multi-slice automated measurements of skeletal muscle mass were made from the ninth to twelfth thoracic vertebrae and normalized by height squared to obtain skeletal muscle index (cm2/m2). LMM was defined as the lowest gender-stratified skeletal muscle index tertile. Strength testing was collected during pre-TAVR evaluation. Primary outcome was a composite of perioperative complications, 1-year rehospitalization, or 1-year mortality. In our cohort, 238 patients met inclusion criteria, and 80 (33.6%) were identified to have LMM. Patients with LMM were older with lower body mass index, decreased grip strength, lower hemoglobin A1c, and higher N-terminal pro-brain natriuretic peptide. They had greater rates of the composite outcome and 2-year all-cause mortality, which remained significant on multivariable adjustment (hazard ratio 1.71, 95% confidence interval 1.05 to 2.78, p = 0.030 and hazard ratio 2.31, 95% confidence interval 1.02 to 5.24, p = 0.045, respectively) compared with patients without LMM; there was no significant difference in 5-year all-cause mortality. In conclusion, LMM was associated with an increase in the primary composite outcome and 2-year all-cause mortality in TAVR recipients. Using automatic muscle processing software on pre-TAVR computed tomography scans may serve as an additional preoperative risk stratification tool.
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Affiliation(s)
- Ian Persits
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Saeid Mirzai
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio; Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Kunaal S Sarnaik
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - James Yun
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Serge Harb
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rishi Puri
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir Kapadia
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amar Krishnaswamy
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Po-Hao Chen
- Section of Musculoskeletal Imaging, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Grant Reed
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - W H Wilson Tang
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
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Shekhar S, Krishnaswamy A, Reed G, Puri R, Yun J, Kapadia S. Cerebral Embolic Protection in Valve-in-Valve Transcatheter Aortic Valve Replacement. Am J Cardiol 2024; 216:110-111. [PMID: 38402923 DOI: 10.1016/j.amjcard.2024.02.013] [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: 01/31/2024] [Accepted: 02/10/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Shashank Shekhar
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Grant Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - James Yun
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
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Kumar A, Shariff M, Singal A, Bhat V, Stulak J, Reed G, Kalra A. A Bayesian meta-analysis of double kissing (DK) crush or provisional stenting for coronary artery bifurcation lesions. Indian Heart J 2024:S0019-4832(24)00049-X. [PMID: 38537883 DOI: 10.1016/j.ihj.2024.03.004] [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] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/15/2024] Open
Abstract
OBJECTIVE Despite the development of dedicated, two-stent strategies, including the double kissing (DK) crush technique, the ideal technique for coronary artery bifurcation stenting has not been identified. We aimed to compare and determine the absolute risk difference (ARD) of the DK crush technique alone versus provisional stenting approaches for coronary bifurcation lesions, using the Bayesian technique. METHOD We queried PubMed/MEDLINE to identify randomized controlled trials (RCTs) that compared DK crush technique with provisional stenting for bifurcation lesions, published till January 2023. We used Bayesian methods to calculate the ARD and 95% credible interval (CrI). RESULTS We included three RCTs, with 916 patients, in the final analysis. The ARD of cardiac death was centered at -0.01 (95% CrI: -0.04 to 0.02; Tau: 0.02, 85% probability of ARD of DK crush vs. provisional stenting <0). ARD for myocardial infarction was centered at -0.03 (95%CrI: -0.9 to 0.03; Tau: 0.05, 87% probability of ARD of DK crush vs. provisional stenting <0). ARD for stent thrombosis was centered at 0.00 (95% CrI: -0.04 to 0.03, Tau: 0.03, 51% probability of ARD for DK crush vs. provisional stenting <0). Finally, ARD for target lesion revascularization was centered at -0.05 (95% CrI: -0.08 to -0.03, Tau: 0.02, 99.97% probability of ARD for DK crush vs. provisional stenting <0). CONCLUSIONS Bayesian analysis demonstrated a lower probability of cardiac death, myocardial infarction and target lesion revascularization, with DK crush compared with provisional stenting techniques, and a minimal probability of difference in stent thrombosis.
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Affiliation(s)
- Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA; Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mariam Shariff
- Department of General Surgery, Mayo Clinic, Rochester, MN, USA; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Aayush Singal
- Department of Cardiology, Aakash Healthcare, New Delhi, India
| | - Vivek Bhat
- Department of Medicine, St. John's Medical College, Bangalore, India
| | - John Stulak
- Department of General Surgery, Mayo Clinic, Rochester, MN, USA; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Grant Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ankur Kalra
- Franciscan Health, Lafayette, IN, USA; Krannert Cardiovascular Research Center, Indianapolis, IN, USA.
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Shekhar S, Kaw R, Agrawal A, Isogai T, Lak H, Mahalwar G, Pampori A, Reed G, Menon V, Kapadia SR. Outcomes of obesity in cardiogenic shock patients requiring mechanical circulatory support. Catheter Cardiovasc Interv 2023; 102:914-916. [PMID: 37675980 DOI: 10.1002/ccd.30824] [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: 08/01/2023] [Revised: 08/20/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Shashank Shekhar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Roop Kaw
- Departments of Hospital Medicine and Anesthesiology Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hassan Lak
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gauranga Mahalwar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Adam Pampori
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Grant Reed
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Venu Menon
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Abadie B, Ali AH, Martyn T, Higgins A, Krishnaswamy A, Reed G, Puri R, Yun J, Cremer P, Hanna M, Tang WHW, Kapadia S, Jaber W. Prevalence of ATTR-CA and high-risk features to guide testing in patients referred for TAVR. Eur J Nucl Med Mol Imaging 2023; 50:3910-3916. [PMID: 37606857 DOI: 10.1007/s00259-023-06374-2] [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] [Received: 05/25/2023] [Accepted: 07/29/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Transthyretin cardiac amyloidosis (ATTR-CA) is thought to be prevalent in patients with severe aortic stenosis (AS) who are referred for transcatheter aortic valve replacement (TAVR). However, prior studies were published when TAVR was only offered to elderly, inoperable, and high-risk patients. The aim of this study was to reevaluate the prevalence of ATTR-CA in a contemporary TAVR population and identify high-risk features to guide referral for technetium-99 pyrophosphate scan (99mTc-PyP scan) screening. METHODS Patients seen in a multidisciplinary TAVR clinic for severe AS 70 years and older were referred for a 99mTc-PyP scan to evaluate for ATTR-CA. The primary outcome was the percent with a positive scan. The discriminatory ability of high-risk features was assessed to develop a more judicious screening system. RESULTS Over the study period, 380 patients underwent screening, and 20 patients (5.3%) had a positive scan, with 17 patients having confirmed ATTR-CA, 1 patient deferring confirmatory testing (combined 4.7%), 1 having light chain amyloidosis, and 1 negative on biopsy. Compared to other patient and echocardiographic measures, elevated NT-pro BNP (> 1000 ng/L) was the best discriminator on who should be referred for 99mTc-PyP scan screening, with a sensitivity of 90% and a negative predictive value of 99%. CONCLUSION The prevalence of ATTR-CA may be lower in a contemporary TAVR population due to its expanded indication for low-risk patients. NT-pro BNP is a simple test that can improve screening yield and more judiciously guide screening for ATTR-CA in this at-risk population. Comparison of the original versus the proposed algorithm.
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Affiliation(s)
- Bryan Abadie
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Adel Hajj Ali
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Trejeeve Martyn
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Andrew Higgins
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Amar Krishnaswamy
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Grant Reed
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Rishi Puri
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - James Yun
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Paul Cremer
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mazen Hanna
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - W H Wilson Tang
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Samir Kapadia
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Wael Jaber
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J1-5 Main Campus, Cleveland, OH, 44195, USA.
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Shekhar S, Kaw R, Agrawal A, Pampori A, Isogai T, Lak H, Mahalwar G, Krishnaswamy A, Puri R, Reed G, Yun J, Kapadia SR. Use of Balloon Aortic Valvuloplasty in Contemporary Era. Am J Cardiol 2023; 206:380-382. [PMID: 37743146 DOI: 10.1016/j.amjcard.2023.08.055] [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: 08/01/2023] [Revised: 08/04/2023] [Accepted: 08/12/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Shashank Shekhar
- Department of Cardiovascular Medicine, Heart and Vascular Institute
| | - Roop Kaw
- Department of Hospital Medicine; Department of Anesthesiology Outcomes Research
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Heart and Vascular Institute
| | - Adam Pampori
- Department of Cardiovascular Medicine, Heart and Vascular Institute
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart and Vascular Institute
| | - Hassan Lak
- Department of Cardiovascular Medicine, Heart and Vascular Institute
| | | | | | - Rishi Puri
- Department of Cardiovascular Medicine, Heart and Vascular Institute
| | - Grant Reed
- Department of Cardiovascular Medicine, Heart and Vascular Institute
| | - James Yun
- Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute
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Braghieri L, Badwan OZ, Reed G, Menon V, Ziada K, Kapadia SR. Dual Antiplatelet Therapy Duration After Percutaneous Coronary Interventions of Left Main Coronary Artery Disease: A Meta-Analysis. Am J Cardiol 2023; 205:422-424. [PMID: 37660668 DOI: 10.1016/j.amjcard.2023.08.052] [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: 06/27/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Lorenzo Braghieri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Osamah Z Badwan
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Grant Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Venu Menon
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Khaled Ziada
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
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8
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Kondoleon NP, Layoun H, Spilias N, Sipko J, Kanaan C, Harb S, Reed G, Puri R, Yun J, Krishnaswamy A, Kapadia SR. Effectiveness of Pre-TAVR CTA as a Screening Tool for Significant CAD Before TAVR. JACC Cardiovasc Interv 2023; 16:1990-2000. [PMID: 37648347 DOI: 10.1016/j.jcin.2023.05.030] [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: 02/06/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Computed tomography angiography (CTA) and invasive coronary angiography (ICA) are routinely performed before transcatheter aortic valve replacement (TAVR) to assess aortic root anatomy and screen for coronary artery disease (CAD), respectively. OBJECTIVES This study explored the efficacy of CTA as a screening tool for significant proximal CAD before TAVR. METHODS With proper ethical oversight, patients undergoing TAVR at Cleveland Clinic with a preprocedural CTA and invasive coronary angiography (ICA), and no prior percutaneous intervention, were identified from 2015 to 2021. Blinded to ICA results, the authors reviewed the left main, proximal left anterior descending coronary artery, proximal left circumflex coronary artery, and proximal right coronary artery by CTA coronary reconstruction to assess for nonsignificant stenosis (0% to 49%), moderate stenosis (50% to 69%), and severe stenosis (≥70%). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen Kappa statistic were analyzed. RESULTS 2,217 patients (53.4% male, age 79.2 ± 8.5 years) met inclusion criteria. CTA evaluation revealed a sensitivity of 90%, specificity of 92%, PPV of 74%, and NPV of 97% for detecting ≥50% stenosis. Using a ≥70% stenosis cutoff, evaluation revealed a sensitivity of 91%, specificity of 97%, PPV of 83%, and NPV of 99%. Assessment of bypass graft patency revealed a sensitivity of 86%, specificity of 97%, PPV of 84%, and NPV of 98%. Cohen Kappa analysis indicated substantial to near perfect agreement between pre-TAVR CTA and ICA. CONCLUSIONS Pre-TAVR CTA has a high NPV for high-grade proximal stenosis of each coronary artery. As a result, CTA can be used as a screening tool to rule out significant proximal CAD in patients undergoing TAVR.
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Affiliation(s)
- Nicholas P Kondoleon
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA. https://twitter.com/npkondo
| | - Habib Layoun
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Nikolaos Spilias
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Joseph Sipko
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Christopher Kanaan
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Serge Harb
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Grant Reed
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - James Yun
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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Shekhar S, Kaw R, Ramu SK, Pampori A, Isogai T, Krishnaswamy A, Puri R, Reed G, Harb SC, Yun J, Kapadia SR. Outcomes After Isolated Aortic Valve Replacements in Patients With Chronic Obstructive Pulmonary Disease. Am J Cardiol 2023; 200:72-74. [PMID: 37302283 DOI: 10.1016/j.amjcard.2023.04.044] [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: 02/22/2023] [Revised: 04/16/2023] [Accepted: 04/30/2023] [Indexed: 06/13/2023]
Affiliation(s)
| | - Roop Kaw
- Departments of Hospital Medicine; Departments of Anesthesiology Outcomes Research
| | | | | | | | | | | | | | | | - James Yun
- Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
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Bazarbashi N, Hsiung I, Spilias N, Ahuja K, Patel J, Kaur S, Hill A, Rossi J, Gad M, Abdelfattah O, Popovic Z, Miyasaka R, Yun J, Unai S, Rishi puri, Reed G, Krishnaswamy A, Kapadia S. CRT-700.15 Left Main Protection During Transcatheter Aortic Valve Replacement With a Balloon Expandable Valve. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.277] [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: 02/22/2023]
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Abadie B, Held M, Puri R, Krishnaswamy A, Yun J, Hanna M, Reed G, Kapadia S, Jaber W. Incidence and predictors of transthyretin cardiac amyloidosis in patients with degenerative aortic stenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1619] [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
Background
The approval of new therapies for treating transthyretin (TTR) cardiac amyloidosis has led to significant interest in identifying patients at high risk for this disease. Investigators have identified a correlation between severe degenerative aortic stenosis (AS) and TTR cardiac amyloidosis in older patients, with several studies finding up to 20% of patients who undergo transcatheter aortic valve replacement (TAVR) having TTR cardiac amyloidosis. These initial TAVR studies were conducted when TAVR was performed almost exclusively in high surgical risk populations. Therefore, the true incidence of TTR cardiac amyloidosis in an all-comers with severe degenerative AS referred for TAVR is unknown.
Purpose
To identify the true burden of TTR cardiac amyloidosis in a contemporary population of severe degenerative AS undergoing TAVR screening.
Methods
All patients ≥70 years with severe native valve degenerative AS seen in a multidisciplinary valve clinic were referred for technetium-99m pyrophosphate cardiac scintigraphy (PYP scan) for evaluation of cardiac amyloidosis. Diagnosis was made via combination of planar grade and heart to contralateral lung ratio, confirmed on single positron emission computed tomography/computed tomography (SPECT/CT). Patients with a positive PYP scan were referred to a heart failure clinic where they underwent testing for AL amyloidosis.
Results
Over a 10 month period, 247 patients seen in valve clinic underwent a PYP scan. Of this cohort, 203 patients ultimately underwent TAVR, 15 surgical aortic valve replacement, and 2 balloon valvuloplasty with 27 patients having not yet undergone a procedure. The positivity rate was 4% (10/247) with 1 patient having an equivocal result. The patients with a positive PYP scan had higher rate of low-flow low-gradient (LFLG) AS (64% vs 29%, p=0.006) and classical LFLG AS (27% vs 8%, p=0.02). Echocardiographic measures associated with a positive PYP scan include a lower global longitudinal strain (−10.0% vs −16.1%, p=0.008), lower average e' (4.5 vs 6.5, p=0.003), and an increased E/A ratio (1.8 vs 1.1, p=0.018).
Conclusions
The incidence of TTR amyloidosis in a contemporary, severe AS population ≥70 years undergoing TAVR screening appears much lower than previously described in the literature. Echocardiographic traits may be able to predict which patients with severe AS should undergo evaluation for TTR cardiac amyloidosis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- B Abadie
- Cleveland Clinic Foundation , Cleveland , United States of America
| | - M Held
- Cleveland Clinic Foundation , Cleveland , United States of America
| | - R Puri
- Cleveland Clinic Foundation , Cleveland , United States of America
| | - A Krishnaswamy
- Cleveland Clinic Foundation , Cleveland , United States of America
| | - J Yun
- Cleveland Clinic Foundation , Cleveland , United States of America
| | - M Hanna
- Cleveland Clinic Foundation , Cleveland , United States of America
| | - G Reed
- Cleveland Clinic Foundation , Cleveland , United States of America
| | - S Kapadia
- Cleveland Clinic Foundation , Cleveland , United States of America
| | - W Jaber
- Cleveland Clinic Foundation , Cleveland , United States of America
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Isogai T, Agrawal A, Shekhar S, Spilias N, Puri R, Krishnaswamy A, Yun J, Kapadia S, Reed G. TCT-449 Outcomes of Transfemoral Transcatheter Aortic Valve Replacement Requiring Concomitant Peripheral Vascular Intervention. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.528] [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: 11/25/2022]
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13
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Hussein AA, Alvarez P, Reed G, Heresi GA. Off-Label Use and Inappropriate Dosing of Direct Oral Anticoagulants in Cardiopulmonary Disease. Chest 2022; 161:1360-1369. [PMID: 35101404 DOI: 10.1016/j.chest.2022.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 12/28/2022] Open
Abstract
Direct oral anticoagulants (DOACs) are increasingly used in clinical practice and have become essential in the management of atrial fibrillation and VTE. The enthusiasm for DOACs has fueled the off-label application of these agents in cardiopulmonary disease, and their use has often outpaced the evidence supporting their application. This article reviews the evidence and current off-label use of DOACs in various cardiopulmonary disease states.
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Affiliation(s)
- Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland, OH.
| | - Paulino Alvarez
- Section of Heart Failure, Department of Cardiovascular Medicine, Cleveland, OH
| | - Grant Reed
- Section of Interventional Cardiology, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Gustavo A Heresi
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH
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14
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Kumar A, Doshi R, Khan SU, Shariff M, Baby J, Majmundar M, Kanaa'N A, Hedrick DP, Puri R, Reed G, Mehran R, Kapadia S, Khot UN, Kalra A. Revascularization or optimal medical therapy for stable ischemic heart disease: A Bayesian meta-analysis of contemporary trials. Cardiovasc Revasc Med 2021; 40:42-47. [PMID: 35210188 DOI: 10.1016/j.carrev.2021.12.005] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The role of revascularization in patients with stable ischemic heart disease (SIHD) has been controversial, more so in the present era of drug-eluting stents. AIMS To examine the absolute risk difference (ARD) between revascularization plus optimal medical therapy (OMT) versus OMT alone among patients with SIHD using Bayesian approach. METHODS PubMed/MEDLINE and Cochrane citation indices were utilized to identify randomized controlled trials (RCTs) through March 31, 2020. Among trials comparing initial revascularization plus OMT with initial OMT alone, revascularization arm must have comprised >50% of patients receiving either percutaneous or surgical revascularization, and >50% of patients must have received aspirin and statin as OMT in both arms. RESULTS Seven RCTs (12,494) were included in the final analysis. The ARD of all-cause mortality for revascularization with respect to OMT was centred at -0.002 (95% CrI: -0.01; 0.01, Tau: 0.01, 67% probability of ARD of revascularization vs. OMT < 0). The ARD for cardiac mortality was centred at -0.0025 (95%CrI: -0.01; 0.01, Tau: 0.01, 77% probability of ARD of revascularization vs. OMT < 0). The ARD for MI was -0.02 (95% CrI: -0.06; 0.00, Tau: 0.02, 97% probability of ARD for revascularization vs. OMT < 0). There was 96% probability of ARD for unstable angina with revascularization vs. OMT < 0, 4.5% probability of ARD for freedom from angina with revascularization vs. OMT < 0, and 6% probability of ARD for stroke with revascularization vs. OMT < 0. CONCLUSIONS Bayesian analysis demonstrated minimal probability of difference in all-cause mortality and cardiac mortality in patients with SIHD who underwent revascularization compared with OMT alone. However, revascularization was associated with lower probability of MI, unstable angina, and increased freedom from angina, but a higher risk of stroke compared with OMT alone. PROSPERO The protocol of this systematic review and meta-analysis was registered in PROSPERO [CRD42020160540].
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Affiliation(s)
- Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Rajkumar Doshi
- Department of Cardiology, St. Joseph's Medical Centre, Paterson, NJ, USA
| | - Safi U Khan
- Department of Internal Medicine, West Virginia University, Morgantown, WV, USA
| | - Mariam Shariff
- Department of General Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jeswin Baby
- Division of Epidemiology and Biostatistics, St John's Research Institute, Bangalore, India; Department of Statistical Sciences, Kannur University, Kerala, India
| | - Monil Majmundar
- Department of Internal Medicine, New York Medical College, Metropolitan Hospital Center, NYC, USA
| | - Anmar Kanaa'N
- Heart, Vascular and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA
| | - David P Hedrick
- Heart, Vascular and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA; Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Grant Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Umesh N Khot
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ankur Kalra
- Heart, Vascular and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA; Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
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15
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Isogai T, Shekhar S, Abdelfattah O, Tarakji K, Wazni O, Kalra A, Yun J, Krishnaswamy A, Reed G, Puri R, Kapadia S. TCT-488 Conduction Disturbance, Pacemaker Rates, and Hospital Length of Stay Following Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1341] [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: 10/20/2022]
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16
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Lak H, Sammour Y, Chahine J, Chawla S, Kadri A, Popovic Z, Tarakji K, Svensson LG, Reed G, Puri R, Krishnaswamy A, Kapadia S. Impact of new-onset left bundle branch block on clinical and echocardiographic outcomes after TAVR with SAPIEN-3 valve. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2179] [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
Background
New left bundle branch block (LBBB) is a common finding after transcatheter aortic valve replacement (TAVR) that can result in worse outcomes after TAVR. We aim to investigate the impact of new-onset LBBB after TAVR using the SAPIEN-3 (S3) valve.
Methods
Consecutive patients who underwent transfemoral-TAVR with S3 valve between April 2015 and December 2018 were included. Exclusion criteria included pre-existing LBBB, right bundle branch block, left anterior hemiblock, left posterior hemiblock, wide QRS ≥120 msec, prior permanent pacemaker (PPM), and non-transfemoral access.
Results
Among 612 patients, 11.4% developed new-onset LBBB upon discharge. Implantation depth was the only predictor of new-onset LBBB (OR 1.294; 95% CI 1.121–1.493; p<0.001). The median (IQR) length of stay was longer with new-onset LBBB [3 (2–5) days vs. 2 (1–3) days; p<0.001]. New-onset LBBB was associated with higher thirty-day PPM requirement (18.6% vs. 5.4%; p<0.001) including those implanted after discharge (4.3% vs. 0.9%; p=0.02). There was no difference in 3-year all-cause mortality between both groups (30.9% vs. 30.6%; log-rank p=0.829). Further, new-onset LBBB was associated with lower left ventricular ejection fraction (LVEF) at both 30 days (55.9±11.4% vs. 59.3±9%; p=0.026) and 1 year (55±12% vs. 60.1±8.9%; p=0.002) despite no differences at baseline. These changes were still present when we stratified patients according to baseline LVEF (≥50% or <50%). We also noted higher mean LV end-diastolic volume index (51.4±18.6 vs. 46.4±15.1 ml/m2; p=0.036), and LV end-systolic volume index (23.2±14.1 vs. 18.9±9.7 ml/m2; p=0.009) with new-onset LBBB at 1 year. Lastly, there were significantly higher rates of heart failure readmissions at 1 year with new-onset LBBB (10.7% vs. 4.4%; log-rank p=0.033).
Conclusion
Among our cohort of S3 recipients, new-onset LBBB was associated with higher PPM requirement, worse LVEF, higher LV volumes and increased risk of heart failure hospitalizations. However, it did not affect mortality in the short-to-intermediate post-TAVR period.
Funding Acknowledgement
Type of funding sources: None. Figure 1. All-cause Survival
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Affiliation(s)
- H Lak
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - Y Sammour
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - J Chahine
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - S Chawla
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - A Kadri
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - Z Popovic
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - K Tarakji
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - L G Svensson
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - G Reed
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - R Puri
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - A Krishnaswamy
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - S Kapadia
- Cleveland Clinic Foundation, Cleveland, United States of America
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Lak H, Chawla S, Verma B, Vural A, Gad M, Shekhar S, Nair R, Yun J, Burns D, Puri R, Reed G, Harb S, Krishnaswamy A, Kapadia S. Outcomes of transfemoral-transcatheter aortic valve replacement with Sapien-3 valve in liver cirrhosis patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2177] [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
Background
Little is known about the outcomes of liver cirrhosis patients with severe aortic stenosis (AS) who undergo transcatheter aortic valve replacement (TAVR).
Methods
We undertook a retrospective analysis of consecutive patients with severe symptomatic AS who underwent transfemoral-TAVR with Sapien-3 valve at our Clinic between April 2015 and December 2018, yielding 32 patients with liver cirrhosis on imaging including ultrasound and/or computed tomography. Their baseline characteristics, procedural and long-term outcomes after TAVR with the non-cirrhotic group were compared, along with their management strategies as per the hepatology team.
Results
Among 1028 patients, 32 were assigned to the cirrhosis, and 996 were assigned to the non-cirrhosis (control) group. Compared with the control group cirrhotic patients were slightly younger in age (74.5 vs 81.2 years), had a slightly higher BMI (31.3 vs 29.3), and had a higher incidence of prior history of myocardial infarction (38% vs 33%). Baseline variables including the history of smoking, hypertension, diabetes, and atrial fibrillation were comparable in both groups. Among cirrhotic patients (n=32), the most common etiologies were non-alcoholic steatohepatitis (NASH) (37.5%), Alcoholism (18.75%), and Hepatitis C (12.5%). The mean MELD-NA score was 11.8 and 67% of patients were Child PUGH Class A and 33% were Child PUGH Class B and all patients had a Child PUGH score of ≥5. 53% of patients (n=17) in the cirrhosis group were evaluated by Hepatology and 12.5% (n=4) were evaluated for a liver transplant but only 1 patient had a liver transplant post-TAVR. Compared with the control group cirrhotic patients had similar 1-year mortality (12% vs 12%, p=1), had a lower rate of 30-day new pacemaker post tavr (6% vs 9% p=0.85), had a higher rate of 1-year readmission for heart failure (12% vs 5% p=0.12) and similar 1-year major adverse cardiac and cerebrovascular event (MACCE) rate (15% vs 14% p=0.98)
Conclusion
Patients with severe AS undergoing TAVR with concomitant liver cirrhosis demonstrate comparable outcomes compared with their non- cirrhotic counterparts. NASH followed by alcoholic cirrhosis was found to be most common etiology.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- H Lak
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - S Chawla
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - B Verma
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - A Vural
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Gad
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - S Shekhar
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - R Nair
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - J Yun
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - D Burns
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - R Puri
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - G Reed
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - S Harb
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - A Krishnaswamy
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - S Kapadia
- Cleveland Clinic Foundation, Cleveland, United States of America
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18
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Kadri AN, Chahine J, Gad MM, Sammour YM, Krishnaswamy A, Khatri J, Ellis S, Campbell J, Puri R, Reed G, Kapadia SR. Characteristics and Outcomes of Patients With Acute Coronary Syndrome Who Received Percutaneous Coronary Intervention During Snowy Days. J Invasive Cardiol 2021; 33:E791-E796. [PMID: 34609326] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Acute coronary syndrome (ACS) is affected by several weather conditions. Studies from different geographical locations have yielded mixed results regarding the outcomes of patients presenting with ACS during snowy days, and we aim to report the Cleveland Clinic experience. METHODS Patients who presented with an ACS and underwent percutaneous coronary intervention (PCI) from July 1, 2009 to September 30, 2017 were divided into ST-segment elevation myocardial infarction (STEMI), and non-ST segment elevation ACS (NSTE-ACS). According to snowy day arrival, we compared in-hospital mortality, culprit lesion anatomy, and door-to-balloon (DTB) time (in STEMI patients). Findings were confirmed in propensity-score matched cohorts. RESULTS A total of 6878 patients were included: 1608 patients with STEMI (139 snowy-day vs 1469 non-snowy day PCIs) and 5270 NSTE-ACS (419 snowy-day vs 4851 non-snowy day PCIs). Right coronary artery territories accounted for most of the stented culprit lesions in all STEMI and NSTE-ACS snowy-day PCIs. While left anterior descending artery lesions were predominant in NSTE-ACS non-snowy day PCIs. There was no difference in in-hospital mortality between the snowy-day vs non-snowy day groups (4.3% vs 4.5% in the STEMI group [P=.92] and 1.2% vs 1.7% in the NSTE-ACS group [P=41]). In STEMI patients, mean DTB times were similar (43 ± 55.1 minutes vs 46.7 ± 59.6 minutes; P=.61), which remained true after hours, during weekends and holidays. Outcomes were similar in propensity-score matched cohorts. CONCLUSION At our institution, snowy days do not seem to affect in-patient mortality. In STEMI patients, DTB times were similar in those who underwent PCI regardless of the snowfall.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Samir R Kapadia
- Department of Cardiovascular Medicine, Aortic Valve Center, Cleveland Clinic, Mail Code J2-3, 9500 Euclid Avenue, Cleveland, OH 44195 USA.
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19
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Verma BR, Sharma V, Shekhar S, Kaur M, Khubber S, Bansal A, Singh J, Ahuja KR, Nazir S, Chetrit M, Menon V, Reed G, Kapadia S. Coronary Angiography in Patients With Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation: A Systematic Review and Meta-Analysis. JACC Cardiovasc Interv 2021; 13:2193-2205. [PMID: 33032706 DOI: 10.1016/j.jcin.2020.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 04/14/2020] [Revised: 07/09/2020] [Accepted: 07/14/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The authors conducted a meta-analysis to study clinical outcomes in patients who underwent early versus nonearly coronary angiography (CAG) in the setting of out-of-hospital cardiac arrest (OHCA) without ST-segment elevation. BACKGROUND The benefit of performing early CAG in patients with OHCA without STE remains disputed. METHODS MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from inception until February 21, 2020. Early and nonearly CAG patients were identified on the basis of the definitions mentioned in respective published studies. The primary outcome studied was 30-day mortality. Secondary outcomes were neurological status and the rate of percutaneous coronary intervention (PCI) following cardiac arrest. RESULTS Of 4,516 references, 11 studies enrolling 3,581 patients were included in the final meta-analysis. Random-effects analysis showed no differences in 30-day mortality (risk ratio [RR]: 0.86; 95% confidence interval [CI]: 0.71 to 1.04; p = 0.12; I2 = 74%), neurological status (RR: 1.08; 95% CI: 0.94 to 1.24; p = 0.28; I2 = 69%), and rate of PCI (RR: 1.22; 95% CI: 0.94 to 1.59; p = 0.13; I2 = 67%) between the 2 groups. Diabetes mellitus, chronic renal failure, previous PCI, and lactate level were found to be significant predictors of 30-day mortality on meta-regression (p < 0.05). CONCLUSIONS This analysis shows that there is no significant difference in 30-day mortality, neurological status, or rate of PCI among patients with OHCA without STE treated with early versus nonearly CAG. Thirty-day mortality is determined by presentation comorbidities rather than revascularization.
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Affiliation(s)
- Beni R Verma
- Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Vikram Sharma
- Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Shashank Shekhar
- Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Manpreet Kaur
- Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Shameer Khubber
- Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Agam Bansal
- Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Jarmanjeet Singh
- Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Keerat Rai Ahuja
- Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Salik Nazir
- Department of Cardiology, University of Toledo, Toledo, Ohio
| | - Michael Chetrit
- Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Venu Menon
- Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Grant Reed
- Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Samir Kapadia
- Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio.
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20
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Bansal A, Agrawal A, Jain V, Harb SC, Miyasaka R, Yun J, Reed G, Krishnaswamy A, Kapadia SR. Short Term Outcomes of Transcatheter Mitral Valve Repair in Renal Transplant Recipients. Am J Cardiol 2021; 150:124-126. [PMID: 33775633 DOI: 10.1016/j.amjcard.2021.03.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/02/2021] [Revised: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Agam Bansal
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Vardhmaan Jain
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rhonda Miyasaka
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - James Yun
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Grant Reed
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
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21
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Brizneda MV, Bansal A, Jain V, Kapadia S, Svensson LG, Menon V, Cremer P, Reed G, Rampersad P, Grimm R, Griffin BP, Xu B. Coronavirus disease and the cardiovascular system: a narrative review of the mechanisms of injury and management implications. Cardiovasc Diagn Ther 2021; 11:939-953. [PMID: 34295715 DOI: 10.21037/cdt-20-779] [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] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/21/2020] [Indexed: 12/15/2022]
Abstract
Coronavirus disease (COVID-19), first identified in Wuhan, China, in December 2019, is now a pandemic, having already spread to 188 countries, with more than 28,280,000 infections worldwide. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the responsible infectious agent, and similar to other human coronaviruses, uses membrane-bound angiotensin-converting enzyme 2 (membrane-bound ACE2) for entry into the host cells. COVID-19 has important cardiovascular implications, especially for patients with pre-existing cardiovascular co-morbidities, potentially mediated through several mechanisms, including direct myocardial injury, worsening of those pre-existing cardiovascular co-morbidities, and adverse cardiovascular effects of potential therapies for COVID-19. The disease is causing a significant burden on health systems worldwide. Elective surgeries and procedures were postponed for a considerable period of time, and many patients with known cardiovascular disease (CVD) risk factors presented late to hospitals, for fear of contracting COVID-19, with serious adverse consequences. Significant negative impact on a population level is highlighted by prolonged isolation, decreased exercise and physical activity, and higher levels of depression and anxiety, all predisposing to elevated cardiovascular risk. This article provides a timely overview of COVID-19 and its impact on the cardiovascular system, focusing on the pathogenesis, potential adverse cardiovascular events, the potential treatment options, protection for health care providers and patients, and what the cardiovascular community could do to mitigate the impact of COVID-19.
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Affiliation(s)
- Maria Vega Brizneda
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Agam Bansal
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Vardhmaan Jain
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Samir Kapadia
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Venu Menon
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Paul Cremer
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Grant Reed
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Penelope Rampersad
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Richard Grimm
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Brian P Griffin
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Bo Xu
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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22
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Zheng W, Huded C, Kumar A, Johnson M, Kravitz K, Reed G, Krishnaswamy A, Lincoff A, Meldon SW, Damon KM, Kapadia S, Khot U. FIVE-YEAR IMPLEMENTATION OF A COMPREHENSIVE ST-ELEVATION MYOCARDIAL INFARCTION PROTOCOL LEADS TO SUSTAINED IMPROVEMENTS IN DOOR-TO-BALLOON TIME, IN-HOSPITAL MORTALITY RATE, AND BLEEDING COMPLICATION RATE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02293-2] [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: 10/21/2022]
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23
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Bansal A, Kumar A, Jain V, Reed G, Puri R, Kalra A, Krishnaswamy A, Harb SC, Kapadia SR. Impact of Hospital Procedural Volume on Use and Outcomes of Urgent/Emergent Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2021; 10:e019670. [PMID: 33899503 PMCID: PMC8200767 DOI: 10.1161/jaha.120.019670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Agam Bansal
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Ashish Kumar
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Vardhmaan Jain
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Grant Reed
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Rishi Puri
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Ankur Kalra
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Serge C Harb
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Samir R Kapadia
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH
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24
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Nagaraja V, Krishnaswamy A, Reed G, Yun J, Kapadia SR. Novel Electrosurgical Bailout Technique for Acute Left Main Occlusion Post Redo-Transcatheter Aortic Valve Replacement in a Surgical Bioprosthesis: A New Arsenal in a Structural Interventionalist's Armamentarium. Circ Cardiovasc Interv 2021; 14:e010466. [PMID: 33877863 DOI: 10.1161/circinterventions.120.010466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Vinayak Nagaraja
- Department of Cardiovascular Medicine (V.N., A.K., G.R., S.R.K.), Cleveland Clinic Foundation, OH
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine (V.N., A.K., G.R., S.R.K.), Cleveland Clinic Foundation, OH
| | - Grant Reed
- Department of Cardiovascular Medicine (V.N., A.K., G.R., S.R.K.), Cleveland Clinic Foundation, OH
| | - James Yun
- Department of Thoracic and Cardiovascular Surgery (J.Y.), Cleveland Clinic Foundation, OH
| | - Samir R Kapadia
- Department of Cardiovascular Medicine (V.N., A.K., G.R., S.R.K.), Cleveland Clinic Foundation, OH
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Rebello T, Reed G. The impact of COVID-19 on clinical practice and well-being of global mental health professionals. Eur Psychiatry 2021. [PMCID: PMC9471401 DOI: 10.1192/j.eurpsy.2021.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Some of the most direct and brutal effects of the COVID-19 pandemic are experienced by health care professionals who are working in demanding environments while having to deal with their own fears of infection and mortality. To assess the impact of COVID-19 on the practice and well-being of global mental health professionals, we designed a three-part, longitudinal, internet-based study. Here we present data from part 1, implemented in June-July 2020 in six languages to members of WHO’s Global Clinical Practice Network composed of 15,500 mental health practitioners. The study assessed COVID-19’s impact on: work circumstances; occupational well-being; use and transition to telehealth; and expectations, needs and recommendations. 2,505 mental health professionals from 126 countries responded to the study (47% psychiatrists). 93.7% of respondents were currently practicing and 70.9% continued to see patients in person. The impact on clinical workload varied in terms of direction and extent depending on type of service provided and country of practice. Most participants had started or increased their use of telehealth services, and we identified a need for training to support telehealth use. Overall, clinicians scored high on well-being indices. However, a subset scored above the cutoff for low well-being and reported a significant number of post-traumatic symptoms. Five factors affected work-related stress: fear of infection, severe COVID-related events, life disruption, lack of adequate protection and role disruption. Data from this study will provide information relevant for the design, development, and integration of mental health services in the continuing pandemic, and in similar future scenarios.
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Tsutsui RS, Sammour Y, Kalra A, Reed G, Krishnaswamy A, Ellis S, Nair R, Khatri J, Kapadia S, Puri R. Excimer Laser Atherectomy in Percutaneous Coronary Intervention: A Contemporary Review. Cardiovasc Revasc Med 2020; 25:75-85. [PMID: 33158754 DOI: 10.1016/j.carrev.2020.10.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022]
Abstract
Excimer laser coronary atherectomy (ELCA) during percutaneous coronary intervention (PCI) has been in use for more than twenty years. While early experiences were not favorable over balloon angioplasty alone, with improvement in operator technique, patient selection and technology, ELCA has established its own niche in contemporary PCI as a safe and effective atherectomy strategy. With growing experience in complex coronary interventions worldwide, ELCA has become one of the essential atherectomy tools offering unique advantages over other atherectomy devices. In the modern era, ELCA is commonly used for patients with in-stent restenosis, stent under expansion, balloon uncrossable lesions and chronic total occlusions. Technical success rates are reported to be >80% in most situations while procedural complication rates such as vessel dissection and perforation among others are reported to average 9% over the past 25 years with improvement over time. In this review, we provide a comprehensive systematic review of the ELCA system, its practical use, indications, and procedural techniques in the contemporary PCI era.
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Affiliation(s)
- Rayji S Tsutsui
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America; Division of Cardiology, Straub Medical Center, Hawaii Pacific Health, Honolulu, HI, United States of America
| | - Yasser Sammour
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Grant Reed
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Stephen Ellis
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Ravi Nair
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Jaikirshan Khatri
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America.
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Ahuja KR, Nazir S, Isogai T, Saad A, Alamir MA, Shekhar S, Abdelfattah O, Yun J, Reed G, Puri R, Krishnaswamy A, Kapadia S. TCT CONNECT-71 Outcomes of Urgent/Emergent Endovascular Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Stenosis. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.085] [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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28
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Krishnaswamy A, Sammour Y, Mangieri A, Kadri A, Karrthik A, Banerjee K, Kaur M, Giannini F, Pagliaro B, Ancona M, Pagnesi M, Laricchia A, Weisz G, Lyden M, Bazarbashi N, Gad M, Ahuja K, Mick S, Svensson L, Puri R, Reed G, Rickard J, Colombo A, Kapadia S, Latib A. The Utility of Rapid Atrial Pacing Immediately Post-TAVR to Predict the Need for Pacemaker Implantation. JACC Cardiovasc Interv 2020; 13:1046-1054. [DOI: 10.1016/j.jcin.2020.01.215] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/07/2020] [Accepted: 01/14/2020] [Indexed: 12/16/2022]
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29
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Wang TKM, Miyasaka R, Reed G, Krishnaswamy A, Kapadia SR, Harb SC. Be Prepared for the Unexpected: Importance of Careful Intraprocedural Transesophageal Echocardiography Assessment During MitraClip. JACC Case Rep 2020; 2:549-554. [PMID: 34317292 PMCID: PMC8298544 DOI: 10.1016/j.jaccas.2019.12.046] [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: 09/30/2019] [Revised: 12/12/2019] [Accepted: 12/28/2019] [Indexed: 06/13/2023]
Abstract
Transesophageal echocardiography plays a central role in the evaluation and guidance of mitral valve interventions. Our case highlights the importance of thorough intraprocedural valve evaluation using 3-dimensional and multiplanar reconstruction transesophageal echocardiography, discovering an unexpected mechanism for mitral regurgitation, to guide an alternative intervention strategy by an experienced interventional team. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Tom Kai Ming Wang
- Department of Cardiovascular Medicine, Cardiovascular Imaging Section, Cleveland Clinic, Cleveland, Ohio
| | - Rhonda Miyasaka
- Department of Cardiovascular Medicine, Cardiovascular Imaging Section, Cleveland Clinic, Cleveland, Ohio
| | - Grant Reed
- Department of Cardiovascular Medicine, Cardiovascular Interventional Section, Cleveland Clinic, Cleveland, Ohio
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Cardiovascular Interventional Section, Cleveland Clinic, Cleveland, Ohio
| | - Samir R. Kapadia
- Department of Cardiovascular Medicine, Cardiovascular Interventional Section, Cleveland Clinic, Cleveland, Ohio
| | - Serge C. Harb
- Department of Cardiovascular Medicine, Cardiovascular Imaging Section, Cleveland Clinic, Cleveland, Ohio
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Tsutsui RS, Simsolo E, Saijo Y, Gentry J, Puri R, Reed G, Krishnaswamy A, Gillinov M, Popovic Z, Kapadia S. Severe Mitral Stenosis in Patients With Severe Mitral Annular Calcification. JACC Cardiovasc Interv 2019; 12:2566-2568. [DOI: 10.1016/j.jcin.2019.08.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 10/25/2022]
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31
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Ahuja KR, Gad MM, Bazarbashi N, Karrthik AK, Raheja H, Goel S, Reed G, Puri R, Krishnaswamy A, Kapadia SR. Impact of Hospital Transcatheter Aortic Valve Replacement Volume on Incidence and Outcomes of Cardiac Tamponade. JACC Cardiovasc Interv 2019; 12:2232-2234. [DOI: 10.1016/j.jcin.2019.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/12/2019] [Accepted: 07/16/2019] [Indexed: 10/25/2022]
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32
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Sammour Y, Sato K, Kumar A, Banerjee K, Kaur M, Patel J, Incognito C, Lak H, Gad M, Ahuja KR, Svensson L, Wazni O, Bakaeen F, Puri R, Reed G, Yun J, Krishnaswamy A, Kapadia S. TCT-533 New Permanent Pacemaker Implantation Does Not Affect Survival After Transcatheter Aortic Valve Replacement With Sapien-3 Valve. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.635] [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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33
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Khan M, Yamani N, Deo S, Lateef N, Riaz H, Khan S, Hassan H, Kanaa’n A, Reed G, Krishnaswamy A, Puri C, Kapadia S. TCT-687 Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement With or Without Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.814] [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: 10/25/2022]
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34
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Baranda J, Bur A, Tsue T, Shnayder L, Kakarala K, Telfah M, Lin T, Williamson S, Al-Kasspooles M, Ashcraft J, Lakis N, Madan R, Khan Q, Saeed A, Reed G, Weir S, Godwin A, Thomas S, Komiya T, Iwakuma T. A window of opportunity trial of atorvastatin targeting p53 mutant malignancies. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz268.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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35
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Goel S, Pasam RT, Raheja H, Gotesman J, Gidwani U, Ahuja KR, Reed G, Puri R, Khatri JK, Kapadia SR. Left main percutaneous coronary intervention—Radial versus femoral access: A systematic analysis. Catheter Cardiovasc Interv 2019; 95:E201-E213. [DOI: 10.1002/ccd.28451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 06/30/2019] [Revised: 07/22/2019] [Accepted: 08/01/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Sunny Goel
- Department of CardiologyMaimonides Medical Center Brooklyn New York
| | - Ravi T. Pasam
- Department of CardiologyMaimonides Medical Center Brooklyn New York
| | - Hitesh Raheja
- Department of CardiologyMaimonides Medical Center Brooklyn New York
| | - Joseph Gotesman
- Department of CardiologyMaimonides Medical Center Brooklyn New York
| | - Umesh Gidwani
- Department of CardiologyIcahn School of Medicine at Mount Sinai New York New York
| | - Keerat R. Ahuja
- Department of CardiologyHeart and Vascular Institute, Cleveland Clinic Cleveland Ohio
| | - Grant Reed
- Department of CardiologyHeart and Vascular Institute, Cleveland Clinic Cleveland Ohio
| | - Rishi Puri
- Department of CardiologyHeart and Vascular Institute, Cleveland Clinic Cleveland Ohio
| | - Jai K. Khatri
- Department of CardiologyHeart and Vascular Institute, Cleveland Clinic Cleveland Ohio
| | - Samir R. Kapadia
- Department of CardiologyHeart and Vascular Institute, Cleveland Clinic Cleveland Ohio
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Telukuntla K, Bhat P, Higgins A, Reed G, Krishnaswamy A, Menon V. Root Cause of Heart Failure. Circ Heart Fail 2019; 12:e005896. [PMID: 31039617 DOI: 10.1161/circheartfailure.119.005896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kartik Telukuntla
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Pavan Bhat
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Andrew Higgins
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Grant Reed
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Venu Menon
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH
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37
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Riaz H, Reed G, Wang Q, Wisniewski L, Wolski K, Lincoff A, Nissen S. CLINICAL PREDICTORS OF CARDIOVASCULAR OUTCOMES IN PATIENTS ON CELECOXIB, IBUPROFEN, AND NAPROXEN. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32385-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: 11/28/2022]
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38
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Krishnaswamy A, Sammour Y, Kadri A, Karrthik A, Banerjee K, Bazarbashi N, Kaur M, Lyden M, Mick S, Svensson L, Reed G, Mangieri A, Kapadia S, Latib A. PREDICTING PERMANENT PACEMAKER NEED AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT BY ASSESSING POST-DEPLOYMENT ATRIAL PACING RESPONSE: A MULTI-CENTER STUDY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31979-5] [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: 10/27/2022]
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39
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Agarwal M, Garg L, Aggarwal S, Reed G. 5803Contemporary trends of incidence, management and outcomes of non-acute coronary syndrome associated cardiogenic shock: data from 2003 to 2011. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.5803] [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: 11/12/2022] Open
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40
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Abstract
How to interpret and manage troponin elevations after noncardiac surgery is a common clinical question for cardiologists and internists. An estimated 5% to 25% of patients who undergo noncardiac surgery have an elevated postoperative troponin level. Patients with troponin elevation are at higher short-term and long-term risk of morbidity and mortality. Current guidelines provide few recommendations on how to manage these patients. The authors review the evidence and guidelines and propose treatment strategies.
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Affiliation(s)
- Samuel Horr
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA. E-mail:
| | - Grant Reed
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Venu Menon
- Departments of Cardiovascular Medicine, Diagnostic Radiology, and Critical Care, Cleveland Clinic, Cleveland, OH, USA.,Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.,Principal Investigator, Study of Ticagrelor Versus Aspirin Treatment in Patients With Myocardial Injury Post Major Non-Cardiac Surgery (INTREPID)
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41
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Mentias A, Naji P, Gillinov AM, Rodriguez LL, Reed G, Mihaljevic T, Suri RM, Sabik JF, Svensson LG, Grimm RA, Griffin BP, Desai MY. Strain Echocardiography and Functional Capacity in Asymptomatic Primary Mitral Regurgitation With Preserved Ejection Fraction. J Am Coll Cardiol 2016; 68:1974-1986. [DOI: 10.1016/j.jacc.2016.08.030] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 07/22/2016] [Accepted: 08/01/2016] [Indexed: 11/26/2022]
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42
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Parenti D, Reed G, Kafka S, Ellis L, Greenberg J, DeHoratius R. THU0130 Comorbidities and Efficacy of anti-TNF Therapies: History of Depression as A Possible Indicator of Lower Response:. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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43
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Cohen S, Reed G, Magner R, Kafka S, Ellis L, DeHoratius R, Greenberg J. THU0156 Achievement of Low Disease Activity in Patients Initiating Infliximab with and without Dose Escalation. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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44
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Kavanaugh A, Greenberg J, Reed G, Griffith J, Friedman A, Saunders K, Ganguli A. FRI0105 Benefit of Biologic Initiation in Moderate VS Severe Rheumatoid Arthritis: Evidence from a Real-World Registry. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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45
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Raeisi-Giglou P, Reed G, Shishehbor M. INCIDENCE AND CAUSES OF 30-DAY READMISSION AND MORTALITY IN PATIENTS WITH CRITICAL LIMB ISCHEMIA TREATED WITH ENDOVASCULAR THERAPY. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61742-9] [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: 10/23/2022]
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46
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Baranda J, Reed G, Williamson S, Stoltz M, Perez R, Mackay C, Madan R, Scott J, Godwin A. A Phase I Trial of Irinotecan (Iri) and Buparlisib in Previously Treated Patients (Pts) with Metastatic Colorectal Cancer (Mcrc): Final Results. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu333.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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47
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Geier J, Saunders K, Reed G. AB1057 Contextualisation of Safety Endpoints in the Tofacitinib Rheumatoid Arthritis (RA) Development Programme: Collaboration with the Consortium of Rheumatology Researchers of North America (CORRONA) Registry. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2474] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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48
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Harrold L, Greenberg J, Bao Y, Grant S, Kremer J, Reed G, Florentinus S, Karki C, Lacerda A, Ganguli A. THU0180 Time to Biologic Therapy Driven by Rheumatoid Arthritis Disease Activity and Severity. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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49
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Reed G, Ganguli A, Saunders K, Magner R, Greenberg J. FRI0177 Biologic Drug Initiators: Real World Patterns of Monotherapy and Combination Therapy after One Year. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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50
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Yoshida K, Radner H, Mjaavatten M, Greenberg J, Kavanaugh A, Kishimoto M, Matsui K, Okada M, Reed G, Saeki Y, Tohma S, Kremer J, Solomon D. THU0179 Cross-National Comparison of Biological Disease-Modifying Antirheumatic Drug Discontinuation Practice among Rheumatoid Arthritis Patients in Remission: Corrona and Ninja Collaboration. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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