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Kim S, Ren H, Charton J, Hu J, Maraboto Gonzalez CA, Khambhati J, Cheng J, DeFrancesco J, Waheed AA, Marciniak S, Moura F, Cardoso RN, Lima BB, McKinney S, Picard MH, Li X, Li Q. Assessment of valve regurgitation severity via contrastive learning and multi-view video integration. Phys Med Biol 2024; 69:045020. [PMID: 38271727 DOI: 10.1088/1361-6560/ad22a4] [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: 07/10/2023] [Accepted: 01/25/2024] [Indexed: 01/27/2024]
Abstract
Objective. This paper presents a novel approach for addressing the intricate task of diagnosing aortic valve regurgitation (AR), a valvular disease characterized by blood leakage due to incompetence of the valve closure. Conventional diagnostic techniques require detailed evaluations of multi-modal clinical data, frequently resulting in labor-intensive and time-consuming procedures that are vulnerable to varying subjective assessment of regurgitation severity.Approach. In our research, we introduce the multi-view video contrastive network, designed to leverage multiple color Doppler imaging inputs for multi-view video processing. We leverage supervised contrastive learning as a strategic approach to tackle class imbalance and enhance the effectiveness of our feature representation learning. Specifically, we introduce a contrastive learning framework to enhance representation learning within the embedding space through inter-patient and intra-patient contrastive loss terms.Main results. We conducted extensive experiments using an in-house dataset comprising 250 echocardiography video series. Our results exhibit a substantial improvement in diagnostic accuracy for AR compared to state-of-the-art methods in terms of accuracy by 9.60%, precision by 8.67%, recall by 9.01%, andF1-score by 8.92%. These results emphasize the capacity of our approach to provide a more precise and efficient method for evaluating the severity of AR.Significance. The proposed model could quickly and accurately make decisions about the severity of AR, potentially serving as a useful prescreening tool.
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Affiliation(s)
- Sekeun Kim
- Center of Advanced Medical Computing and Analysis, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Hui Ren
- Center of Advanced Medical Computing and Analysis, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Jerome Charton
- Center of Advanced Medical Computing and Analysis, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Jiang Hu
- Center of Advanced Medical Computing and Analysis, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | | | - Jay Khambhati
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Justin Cheng
- Brigham and Women's Hospital, Boston, MA, United States of America
| | | | - Anam A Waheed
- Brigham and Women's Hospital, Boston, MA, United States of America
| | - Sylwia Marciniak
- Brigham and Women's Hospital, Boston, MA, United States of America
| | - Filipe Moura
- Brigham and Women's Hospital, Boston, MA, United States of America
| | | | - Bruno B Lima
- Brigham and Women's Hospital, Boston, MA, United States of America
| | - Suzannah McKinney
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Michael H Picard
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Xiang Li
- Center of Advanced Medical Computing and Analysis, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Quanzheng Li
- Center of Advanced Medical Computing and Analysis, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
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2
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Khambhati J, Leopold JA. Shielding for Radiation Safety in the Cardiac Catheterization Laboratory. Circ Cardiovasc Interv 2023; 16:e013647. [PMID: 37955162 DOI: 10.1161/circinterventions.123.013647] [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: 11/14/2023]
Affiliation(s)
- Jay Khambhati
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jane A Leopold
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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3
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Almarzooq Z, Khambhati J, Baron S, Elmariah S, Khabbaz K, Khan S, Laham R, Pinto D, Poulin MF, Song Y, Yeh R, Shah P. TCT-473 Impact of Aortic Valve Gradient on Outcomes of Transcatheter Aortic Valve Implantation in the Boston Heart Valve Consortium Registry. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.558] [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: 10/14/2022]
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4
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Steiger N, Khambhati J, Kreidieh O, Whitaker J, Thurber CJ, Sharma E, Chang D, Batnyam U, Kapur S, Martin DT, Tadros TM, Zei PC, Sauer WH, Koplan BA, Tedrow UB. PO-672-03 TWO FOR THE PRICE OF ONE: BIDIRECTIONAL VENTRICULAR TACHYCARDIA FROM THE ANTEROLATERAL PAPILLARY MUSCLE. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.425] [Citation(s) in RCA: 1] [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] [Indexed: 11/29/2022]
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5
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Allard-Ratick M, Wadhwani N, Qin D, Khambhati J, Langer NB, Yucel E, Ptaszek LM, Mela T, Elmariah S. CHANGE IN TRICUSPID REGURGITATION SEVERITY OVER TIME AFTER TRANSVENOUS PACEMAKER AND DEFIBRILLATOR LEAD EXTRACTION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01571-6] [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: 12/01/2022]
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6
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Dhindsa DS, Khambhati J, Schultz WM, Tahhan AS, Quyyumi AA. Marital status and outcomes in patients with cardiovascular disease. Trends Cardiovasc Med 2019; 30:215-220. [PMID: 31204239 DOI: 10.1016/j.tcm.2019.05.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 04/28/2019] [Accepted: 05/28/2019] [Indexed: 11/15/2022]
Abstract
The national burden of cardiovascular disease (CVD) continues to impose significant risk of morbidity, mortality and increased costs. While traditional risk factors have been well-established, the evolving role of non-traditional risk factors, including socioeconomic and psychosocial factors, is increasingly being recognized. Several studies have acknowledged an association between marital status and the presence of CVD and its associated adverse outcomes. Across multiple U.S. and international cohorts, patients who are unmarried, including those who are divorced, separated, widowed, or never married, have an increased rate of adverse cardiovascular events when compared to their married counterparts. Some studies suggest that marriage may have a more protective role for men compared to women. Furthermore, dissatisfaction in a marriage and marriage quality have significant impact on cardiovascular risk. Psychosocial and socioeconomic factors, as well as other acute stressors, may contribute to the association between marital status and CVD outcomes, but the underlying mechanisms are not completely clear. Further investigation is required to identify potential targets for intervention and to determine whether more aggressive targeting of standard anti-atherosclerotic therapies can favorably impact CVD risk in unmarried patients.
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Affiliation(s)
- Devinder Singh Dhindsa
- Emory Clinical Cardiovascular Resaerch Institute, Emory University School of Medicine, Atlanta, GA, United States
| | - Jay Khambhati
- Emory Clinical Cardiovascular Resaerch Institute, Emory University School of Medicine, Atlanta, GA, United States
| | - William M Schultz
- Division of Cardiology, Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Ayman Samman Tahhan
- Emory Clinical Cardiovascular Resaerch Institute, Emory University School of Medicine, Atlanta, GA, United States
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Resaerch Institute, Emory University School of Medicine, Atlanta, GA, United States.
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7
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Allard-Ratick MP, Kindya BR, Khambhati J, Engels MC, Sandesara PB, Rosenson RS, Sperling LS. HDL: Fact, fiction, or function? HDL cholesterol and cardiovascular risk. Eur J Prev Cardiol 2019; 28:166–173. [PMID: 33838035 DOI: 10.1177/2047487319848214] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 04/14/2019] [Indexed: 11/17/2022]
Abstract
The measurement of high-density lipoprotein cholesterol is highly utilized by clinicians to help predict cardiovascular risk, but this measure is not causally associated with atherosclerotic cardiovascular disease events. The use of Mendelian randomization studies has led to a change in investigative attention from the high-density lipoprotein cholesterol concentration to its physiological functions. High-density lipoprotein plays key roles in important pathways related to the development of atherosclerotic disease including reverse cholesterol transport, oxidation and inflammation, and endothelial function as well as in other physiological systems including immune system modulation, cellular apoptosis, and endothelial progenitor cell homeostasis. The identification of dysfunctional high-density lipoprotein may better predict future cardiovascular events compared to numerical high-density lipoprotein cholesterol and aid in enhanced clinical risk stratification. The emergence of discrete physiological measurements of high-density lipoprotein, such as cholesterol efflux capacity and the high-density lipoprotein inflammatory index, may provide an opportunity for clinical application in the future. However, the validity of these measurements and their commercial availability remain barriers to a realistic transition to clinical medicine.
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Affiliation(s)
| | - Bryan R Kindya
- Department of Internal Medicine, Emory University School of Medicine, USA
| | - Jay Khambhati
- Department of Internal Medicine, Emory University School of Medicine, USA
| | - Marc C Engels
- Department of Internal Medicine, Emory University School of Medicine, USA
| | | | - Robert S Rosenson
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, USA
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Dhindsa D, Sandesara P, Mehta A, Topel M, Allard-Ratick M, O'Neal W, Khambhati J, Bakthadze B, Tahhan AS, Hayek S, Sperling LS, Quyyumi A. ASSOCIATION OF HIGH HDL IN PATIENTS WITH CORONARY ARTERY DISEASE: IMPACT OF RACE AND SEX. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)30731-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Sandesara PB, Dhindsa D, Khambhati J, Lee SK, Varghese T, O’Neal WT, Harzand A, Gaita D, Kotseva K, Connolly SB, Jennings C, Grace SL, Wood DA, Sperling L. Reconfiguring Cardiac Rehabilitation to Achieve Panvascular Prevention: New Care Models for a New World. Can J Cardiol 2018; 34:S231-S239. [DOI: 10.1016/j.cjca.2018.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/18/2018] [Accepted: 07/18/2018] [Indexed: 02/08/2023] Open
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Affiliation(s)
- M Allard-Ratick
- Emory University, Cardiology, Atlanta, United States of America
| | - J Khambhati
- Emory University, Cardiology, Atlanta, United States of America
| | - M Topel
- Emory University, Cardiology, Atlanta, United States of America
| | - P Sandesara
- Emory University, Cardiology, Atlanta, United States of America
| | - L Sperling
- Emory University, Cardiology, Atlanta, United States of America
| | - A Quyyumi
- Emory University, Cardiology, Atlanta, United States of America
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Khambhati J, Allard-Ratick M, Dhindsa D, Lee S, Chen J, Sandesara PB, O'Neal W, Quyyumi AA, Wong ND, Blumenthal RS, Sperling LS. Re: The art of cardiovascular risk assessment. Clinical Cardiology
2018;41(5):677-684. Clin Cardiol 2018; 41:1111. [DOI: 10.1002/clc.22998] [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: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 11/05/2022] Open
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12
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Khambhati J, Engels M, Allard-Ratick M, Sandesara PB, Quyyumi AA, Sperling L. Immunotherapy for the prevention of atherosclerotic cardiovascular disease: Promise and possibilities. Atherosclerosis 2018; 276:1-9. [PMID: 30006321 DOI: 10.1016/j.atherosclerosis.2018.07.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/27/2018] [Accepted: 07/05/2018] [Indexed: 12/23/2022]
Abstract
Cardiovascular disease remains the leading cause of death worldwide with coronary atherosclerotic heart disease being the largest contributor. The mechanisms behind the presence and progression of atherosclerosis remain an area of intense scientific focus. Immune dysregulation and inflammation are key contributors to the development of an atherosclerotic plaque and its progression to acute coronary syndromes. Increased circulating levels of biomarkers of systemic inflammation including hsCRP are correlated with a higher cardiovascular risk. Targeting specific inflammatory pathways implicated in atherosclerotic plaque formation is an exciting area of ongoing research. Target specific therapies directed at pro-inflammatory cytokines such as IL-1β, IL-6, TNFα, and CCL2 have demonstrated slowing in the progression of atherosclerosis in animal models and improved cardiovascular outcomes in human subjects. Most notably, treatment with the monoclonal antibody canakinumab, which directly targets and neutralizes IL-1β, was recently shown to be associated with reduced risk of adverse cardiovascular events compared to placebo in a randomized, placebo-controlled trial. Several other therapies including colchicine, methotrexate and leukotriene inhibitors demonstrate the potential for lowering cardiovascular risk through immunomodulation, though further studies are needed. Understanding the role of inflammation in atherosclerosis and the development of targeted immunotherapies continues to be an evolving area of research that is rapidly becoming clinically relevant for the 21st century cardiac patient.
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Affiliation(s)
- Jay Khambhati
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - Marc Engels
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Marc Allard-Ratick
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Pratik B Sandesara
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Laurence Sperling
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
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Sandesara PB, O'Neal WT, Tahhan AS, Hayek SS, Lee SK, Khambhati J, Topel ML, Hammadah M, Alkhoder A, Ko YA, Gafeer MM, Beshiri A, Murtagh G, Kim JH, Wilson P, Shaw L, Epstein SE, Sperling LS, Quyyumi AA. Comparison of the Association Between High-Sensitivity Troponin I and Adverse Cardiovascular Outcomes in Patients With Versus Without Chronic Kidney Disease. Am J Cardiol 2018; 121:1461-1466. [PMID: 29628129 DOI: 10.1016/j.amjcard.2018.02.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/07/2018] [Accepted: 02/16/2018] [Indexed: 10/17/2022]
Abstract
It is unknown whether the association of high-sensitivity troponin I (hs-TnI) with adverse cardiovascular outcomes varies by the presence of chronic kidney disease (CKD). We examined the association of hs-TnI with adverse cardiovascular outcomes in those with and without CKD in 4,107 (mean age, 64 years; 63% men; 20% black) patients from the Emory Cardiovascular Biobank who underwent coronary angiography. CKD (n = 1,073) was defined as estimated glomerular filtration rate <60 ml/min/1.73 m2 or urine albumin/creatinine ratio >30 mg/g at baseline. Cox regression was used to compute hazard ratios (HR) for the association between hs-TnI levels (per doubling of hs-TnI: log2[hs-TnI] + 1) and death, cardiovascular death, and major adverse cardiac events (MACE), separately. Hs-TnI was a stronger predictor of death (CKD: HR 1.23, 95% confidence interval [CI] 1.15 to 1.31; no CKD: HR 1.11, 95% CI 1.05 to 1.17, p-interaction = 0.023), cardiovascular death (CKD: HR 1.24, 95% CI 1.14 to 1.34; no CKD: HR 1.15, 95% CI 1.07 to 1.22, p-interaction = 0.12), and MACE (CKD: HR 1.18, 95% CI 1.11 to 1.25; no CKD: HR 1.11, 95% CI 1.06 to 1.16, p-interaction = 0.095) in CKD compared with non-CKD. The association between hs-TnI and death in patients with CKD was stronger for patients without obstructive coronary artery disease (no obstructive coronary artery disease: HR 1.60, 95% CI 1.27 to 2.01; obstructive coronary artery disease: HR 1.19, 95% CI 1.11 to 1.27, p-interaction = 0.041). In conclusion, hs-TnI is a stronger predictor of adverse cardiovascular events in patients who have CKD than those without, even in the absence of obstructive coronary artery disease. Hs-TnI may identify CKD patients who are high risk for adverse cardiovascular outcomes in whom aggressive risk factor modification strategies are warranted.
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Khambhati J, Allard-Ratick M, Dhindsa D, Lee S, Chen J, Sandesara PB, O'Neal W, Quyyumi AA, Wong ND, Blumenthal RS, Sperling LS. The art of cardiovascular risk assessment. Clin Cardiol 2018; 41:677-684. [PMID: 29746005 DOI: 10.1002/clc.22930] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 11/29/2017] [Revised: 02/12/2018] [Accepted: 02/17/2018] [Indexed: 12/16/2022] Open
Abstract
Cardiovascular disease (CVD) remains the leading cause of death in the United States. Healthcare expenditures have been principally allocated toward treatment of CVD at the end of the health/disease continuum, rather than toward health promotion and disease prevention. A focused effort on both primordial and primary prevention can promote cardiovascular health and reduce the burden of CVD. Risk-factor assessment for predicting atherosclerotic CVD events serves as the foundation of preventive cardiology and has been driven by population-based scoring algorithms based on traditional risk factors. Incorporating individual nontraditional risk factors, biomarkers, and selective use of noninvasive measures may help identify more at-risk patients as well as truly low-risk individuals, allowing for better targeting of treatment intensity. Using a combination of validated population-based atherosclerotic CVD risk-assessment tools, nontraditional risk factors, social health determinants, and novel markers of atherosclerotic disease, we should be able to improve our ability to assess CVD risk. Through scientific evidence, clinical judgment, and discussion between the patient and clinician, we can implement an effective evidence-based strategy to assess and reduce CVD risk.
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Affiliation(s)
- Jay Khambhati
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Marc Allard-Ratick
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Devinder Dhindsa
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Suegene Lee
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - John Chen
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Pratik B Sandesara
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Wesley O'Neal
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, California
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Heart Disease, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Laurence S Sperling
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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Abstract
This article reviews biomarkers that have been shown to identify subjects at increased risk for cardiovascular death within the general population, in those with established coronary artery disease, and in those with heart failure. Use of biomarkers for risk stratification for sudden cardiac death continues to evolve. It seems that a multimarker strategy for risk stratification using simple measures of circulating proteins and usual clinical risk factors, particularly in patients with known coronary artery disease, can be used to identify patients at near-term risk of death. Whether similar strategies in the general population will prove to be cost-effective needs to be investigated.
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Affiliation(s)
- Devinder S Dhindsa
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Road Northeast, Suite 507, Atlanta, GA 30322, USA
| | - Jay Khambhati
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Road Northeast, Suite 507, Atlanta, GA 30322, USA
| | - Pratik B Sandesara
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Road Northeast, Suite 507, Atlanta, GA 30322, USA
| | - Danny J Eapen
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Road Northeast, Suite 507, Atlanta, GA 30322, USA
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Road Northeast, Suite 507, Atlanta, GA 30322, USA.
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Lee SK, Khambhati J, Varghese T, Stahl EP, Kumar S, Sandesara PB, Wenger NK, Sperling LS. Comprehensive primary prevention of cardiovascular disease in women. Clin Cardiol 2017; 40:832-838. [PMID: 28846803 DOI: 10.1002/clc.22767] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/03/2017] [Accepted: 07/11/2017] [Indexed: 01/02/2023] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality in women. Historically, medical research has focused on male patients, and subsequently, there has been decreased awareness of the burden of ASCVD in females until recent years. The biological differences between sexes and differences in societal expectations defined by gender roles contribute to gender differences in ASCVD risk factors. With these differing risk profiles, risk assessment, risk stratification, and primary preventive measures of ASCVD are different in women and men. In this review article, clinicians will understand the risk factors unique to women, such as preeclampsia, gestational diabetes, and those that disproportionately affect them such as autoimmune disorders. With these conditions in mind, the approach to ASCVD risk assessment and stratification in women will be discussed. Furthermore, the literature behind the effects of primary preventive measures in women, including lifestyle modifications, aspirin, statins, and anticoagulation, will be reviewed. The aim of this review article was to ultimately improve ASCVD primary prevention by reducing gender disparities through education of physicians.
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Affiliation(s)
- Suegene K Lee
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Georgia
| | - Jay Khambhati
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Georgia
| | - Tina Varghese
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Georgia
| | - Eric P Stahl
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Georgia
| | - Sonali Kumar
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Georgia
| | - Pratik B Sandesara
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Georgia
| | - Nanette K Wenger
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Georgia
| | - Laurence S Sperling
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Georgia
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Lee S, Khambhati J, Sandesara P, O'Neal W, Samman Tahhan A, Hayek S, Hammadah M, Mohammad-Kelli M, Topel M, Alkhodar A, Aida H, Chivukula K, Sperling L, Quyyumi A. 956High-sensitivity troponin I predicts the risk of adverse outcomes in patients with chronic kidney disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Sandesara P, Samman Tahhan A, Ko Y, Hayek S, Khambhati J, Lee S, Alkhoder A, Aida H, Sperling L, Quyyumi A. P1555Using a decision tree analysis to risk stratify patients with coronary artery disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Khambhati J, Sandesara P, Tahhan AS, Topel M, Corrigan F, Kelli HM, Stahl E, Allard-Ratick M, Alkhoder A, Aida H, Gafeer MM, Hesaroieh I, Mahar E, Waller E, Vaccarino V, Ziegler TR, Sperling L, Brigham K, Martin G, Quyyumi A. CENTRAL OBESITY PREDICTS CIRCULATING PROGENITOR CELL LEVELS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35178-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sandesara P, Tahhan AS, Khambhati J, Stahl E, Hayek S, Hammadah M, Mohamed Kelli H, Topel M, Alkhoder A, Chivukula K, Aida H, Gafeer MM, Abdelhadi N, Hesaroieh I, Naqvi H, Mahar E, Waller E, Sperling L, Quyyumi A. ASSOCIATION BETWEEN CIRCULATING PROGENITOR CELLS AND OUTCOMES IN PATIENTS WITH CORONARY ARTERY DISEASE. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33449-6] [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: 10/20/2022]
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21
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Guan J, Khambhati J, Jones LW, Morgans A, Allaf M, Penson DF, Moslehi J. Cardiology Patient Page. ABCDE Steps for Heart and Vascular Wellness Following a Prostate Cancer Diagnosis. Circulation 2016; 132:e218-20. [PMID: 26527696 DOI: 10.1161/circulationaha.115.012521] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jian Guan
- From the Cardiovascular Division (J.G., J.K., J.M.), Cardio-Oncology Program (J.G., J.K., A.M., D.F.P., J.M.), Vanderbilt-Ingram Cancer Center (A.M., J.M.), Department of Urologic Surgery (D.F.P.), Vanderbilt University School of Medicine, Nashville, TN; Memorial Sloan Kettering Cancer Center, New York (L.W.J.); Department of Urologic Surgery, Johns Hopkins Hospital, Baltimore, MD (M.A.)
| | - Jay Khambhati
- From the Cardiovascular Division (J.G., J.K., J.M.), Cardio-Oncology Program (J.G., J.K., A.M., D.F.P., J.M.), Vanderbilt-Ingram Cancer Center (A.M., J.M.), Department of Urologic Surgery (D.F.P.), Vanderbilt University School of Medicine, Nashville, TN; Memorial Sloan Kettering Cancer Center, New York (L.W.J.); Department of Urologic Surgery, Johns Hopkins Hospital, Baltimore, MD (M.A.)
| | - Lee W Jones
- From the Cardiovascular Division (J.G., J.K., J.M.), Cardio-Oncology Program (J.G., J.K., A.M., D.F.P., J.M.), Vanderbilt-Ingram Cancer Center (A.M., J.M.), Department of Urologic Surgery (D.F.P.), Vanderbilt University School of Medicine, Nashville, TN; Memorial Sloan Kettering Cancer Center, New York (L.W.J.); Department of Urologic Surgery, Johns Hopkins Hospital, Baltimore, MD (M.A.)
| | - Alicia Morgans
- From the Cardiovascular Division (J.G., J.K., J.M.), Cardio-Oncology Program (J.G., J.K., A.M., D.F.P., J.M.), Vanderbilt-Ingram Cancer Center (A.M., J.M.), Department of Urologic Surgery (D.F.P.), Vanderbilt University School of Medicine, Nashville, TN; Memorial Sloan Kettering Cancer Center, New York (L.W.J.); Department of Urologic Surgery, Johns Hopkins Hospital, Baltimore, MD (M.A.)
| | - Mohamad Allaf
- From the Cardiovascular Division (J.G., J.K., J.M.), Cardio-Oncology Program (J.G., J.K., A.M., D.F.P., J.M.), Vanderbilt-Ingram Cancer Center (A.M., J.M.), Department of Urologic Surgery (D.F.P.), Vanderbilt University School of Medicine, Nashville, TN; Memorial Sloan Kettering Cancer Center, New York (L.W.J.); Department of Urologic Surgery, Johns Hopkins Hospital, Baltimore, MD (M.A.)
| | - David F Penson
- From the Cardiovascular Division (J.G., J.K., J.M.), Cardio-Oncology Program (J.G., J.K., A.M., D.F.P., J.M.), Vanderbilt-Ingram Cancer Center (A.M., J.M.), Department of Urologic Surgery (D.F.P.), Vanderbilt University School of Medicine, Nashville, TN; Memorial Sloan Kettering Cancer Center, New York (L.W.J.); Department of Urologic Surgery, Johns Hopkins Hospital, Baltimore, MD (M.A.)
| | - Javid Moslehi
- From the Cardiovascular Division (J.G., J.K., J.M.), Cardio-Oncology Program (J.G., J.K., A.M., D.F.P., J.M.), Vanderbilt-Ingram Cancer Center (A.M., J.M.), Department of Urologic Surgery (D.F.P.), Vanderbilt University School of Medicine, Nashville, TN; Memorial Sloan Kettering Cancer Center, New York (L.W.J.); Department of Urologic Surgery, Johns Hopkins Hospital, Baltimore, MD (M.A.).
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Abstract
The prevalence of chemotherapy-related cardiac disease is increasing and management demands a multidisciplinary approach from cardiologists and oncologists. Pretreatment identification of predisposing risk factors and assessment of cardiac function before and at intervals during and after therapy with cardiotoxic agents are necessary. In clinical practice, surveillance is largely performed using transthoracic echocardiography or multi-gated radionuclide angiography. Imaging strategies that detect cardiac injury before overt left ventricular systolic dysfunction provide an opportunity for early intervention and improved cardiac outcomes.
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Affiliation(s)
- John Groarke
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
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Thiel DD, Brisson TE, Heckman MG, Arnold M, Haley W, Khambhati J, Wehle MJ, Igel TC, Parker AS. Evaluation of pancreatic damage after extracorporeal shock wave lithotripsy, percutaneous stone surgery, and ureteroscopy. Urology 2011; 77:1288-91. [PMID: 21215433 DOI: 10.1016/j.urology.2010.08.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 08/10/2010] [Accepted: 08/21/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To complete a prospective evaluation of serum amylase and lipase levels before and after shock wave lithotripsy (SWL) for renal stones. We also compared these serum levels to those of patients undergoing percutaneous and ureteroscopic stone surgery. SWL injury to the pancreas should be noted by an increase in serum amylase and lipase. METHODS A prospective evaluation of 38 patients (16 who underwent SWL, 15 who underwent percutaneous nephrostolithotomy, and 7 who underwent ureteroscopic stone manipulation) who underwent treatment of renal calculi at our institution was completed. The control group was the combined group of patients who had undergone percutaneous nephrostolithotomy or ureteroscopic stone manipulation. The serum amylase and lipase levels were measured before the procedure, immediately after the procedure (2 hours), and ≥30 days after the procedure. RESULTS No statistically significant difference was found in the change from before to immediately after the procedure between the SWL group and the controls in amylase (median decrease 6 U/L vs 11 U/L, P = .45) or lipase (median decrease 4 U/L vs 9 U/L, P = .31). Also, no statistically significant evidence was seen in the change from before to >30 days after the procedure between the SWL group and controls in the amylase level (median increase 0 U/L vs 2 U/L, P = 1.00) or lipase (median change 2 U/L increase vs 1 U/L decrease, P = .96). CONCLUSIONS SWL does not appear to noticeably increase the serum amylase and lipase level directly postoperatively or >30 days after the procedure compared with baseline or compared with the controls.
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Affiliation(s)
- David D Thiel
- Department of Urology, Mayo Clinic Jacksonville, Jacksonville, Florida 32224, USA.
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