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Barrera N, Jou K, Gallegos-Koyner FJ, Chamay S, Garcia MJ, Cerrud-Rodriguez R. Acute Transient Contrast-Induced Neurologic Deficit as a Complication of Percutaneous Coronary Intervention. Tex Heart Inst J 2024; 51:e238353. [PMID: 38715399 PMCID: PMC11076990 DOI: 10.14503/thij-23-8353] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Acute transient contrast-induced neurologic deficit is an uncommon condition triggered by the administration of intra-arterial contrast during angiography. It can present with encephalopathy, cortical blindness, seizures, or focal deficits. This report describes a patient who presented with severe neurologic deficits after percutaneous coronary intervention, with complete symptom resolution within 72 hours.
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Affiliation(s)
- Nelson Barrera
- Department of Internal Medicine, SBH Health System, Bronx, New York
| | - Katerina Jou
- Department of Internal Medicine, SBH Health System, Bronx, New York
| | | | - Salomon Chamay
- Department of Internal Medicine, SBH Health System, Bronx, New York
| | - Mario J. Garcia
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Bronx, New York
| | - Roberto Cerrud-Rodriguez
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Bronx, New York
- Section of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, Connecticut
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2
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Yalçin F, Abraham MR, Garcia MJ. Stress and Heart in Remodeling Process: Multiple Stressors at the Same Time Kill. J Clin Med 2024; 13:2597. [PMID: 38731125 DOI: 10.3390/jcm13092597] [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: 03/13/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Myocardial remodeling is developed by increased stress in acute or chronic pathophysiologies. Stressed heart morphology (SHM) is a new description representing basal septal hypertrophy (BSH) caused by emotional stress and chronic stress due to increased afterload in hypertension. Acute stress cardiomyopathy (ASC) and hypertension could be together in clinical practice. Therefore, there are some geometric and functional aspects regarding this specific location, septal base under acute and chronic stress stimuli. The findings by our and the other research groups support that hypertension-mediated myocardial involvement could be pre-existed in ASC cases. Beyond a frequently seen predominant base, hyperkinetic tissue response is detected in both hypertension and ASC. Furthermore, hypertension is the responsible factor in recurrent ASC. The most supportive prospective finding is BSH in which a hypercontractile base takes a longer time to exist morphologically than an acutely developed syndrome under both physiologic exercise and pressure overload by transaortic binding in small animals using microimaging. However, cardiac decompensation with apical ballooning could mask the possible underlying hypertensive disease. In fact, enough time for the assessment of previous hypertension history or segmental analysis could not be provided in an emergency unit, since ASC is accepted as an acute coronary syndrome during an acute episode. Additional supportive findings for SHM are increased stress scores in hypertensive BSH and the existence of similar tissue aspects in excessive sympathetic overdrive like pheochromocytoma which could result in both hypertensive disease and ASC. Exercise hypertension as the typical form of blood pressure variability is the sum of physiologic exercise and pathologic increased blood pressure and results in increased mortality. Hypertension is not rare in patients with a high stress score and leads to repetitive attacks in ASC supporting the important role of an emotional component as well as the potential danger due to multiple stressors at the same time. In the current review, the impact of multiple stressors on segmental or global myocardial remodeling and the hazardous potential of multiple stressors at the same time are discussed. As a result, incidentally determined segmental remodeling could be recalled in patients with multiple stressors and contribute to the early and combined management of both hypertension and chronic stress in the prevention of global remodeling and heart failure.
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Affiliation(s)
- Fatih Yalçin
- Department of Cardiology, UCSF HEALTH, School of Medicine, Cardiac Imaging, San Francisco, CA 94143, USA
- Department of Medicine, University of California at San Francisco, Cardiology UCSF Health, 505 Parnassus Avenue, Rm M314AUCSF, P.O. Box 0214, San Francisco, CA 94117, USA
| | - Maria Roselle Abraham
- Department of Cardiology, UCSF HEALTH, School of Medicine, Cardiac Imaging, San Francisco, CA 94143, USA
| | - Mario J Garcia
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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3
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Lorenzatti D, Piña P, Huang D, Apple SJ, Fernandez-Hazim C, Ippolito P, Abdullah A, Rodriguez-Guerra M, Skendelas JP, Scotti A, Kuno T, Latib A, Schenone AL, Nasir K, Blankstein R, Blaha MJ, Berman DS, Dey D, Virani SS, Garcia MJ, Slipczuk L. Interaction Between Risk Factors, Coronary Calcium, and CCTA Plaque Characteristics in Patients Age 18-45. Eur Heart J Cardiovasc Imaging 2024:jeae094. [PMID: 38578944 DOI: 10.1093/ehjci/jeae094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024] Open
Abstract
AIMS The atherosclerotic profile and advanced plaque subtype burden in symptomatic patients ≤45 years old have not been established. This study aimed to assess the prevalence and predictors of coronary artery calcium (CAC), plaque subtypes, and plaque burden by coronary computed tomography angiography (CCTA) in symptomatic young patients. METHODS AND RESULTS We included 907 symptomatic young patients (18-45 years) from Montefiore undergoing CCTA for chest pain evaluation. Prevalence and predictors of CAC, plaque subtypes, and burden were evaluated using semi-automated software. In the overall population (55% female and 44% Hispanic), 89% had CAC = 0. The likelihood of CAC or any plaque by CCTA increased with >3 risk factors (RF, OR 7.13 [2.14-23.7] and OR 10.26 [3.36-31.2], respectively). Any plaque by CCTA was present in 137 (15%); the strongest independent predictors were age ≥35 years (OR 3.62 [2.05-6.41]) and family history of premature CAD (FHx) (OR 2.76 [1.67-4.58]). Stenosis ≥50% was rare (1.8%), with 31% of those having CAC = 0. Significant non-calcified (NCP, 37.2%) and low-attenuation (LAP, 4.24%) plaque burdens were seen, even in those with non-obstructive stenosis. Among patients with CAC = 0, 5% had plaque, and the only predictor of exclusively non-calcified plaque was FHx (OR 2.29 [1.08-4.86]). CONCLUSIONS In symptomatic young patients undergoing CCTA, the prevalence of CAC or any coronary atherosclerosis was not negligible, and the likelihood increased with RF burden. The presence of coronary stenosis ≥50% was rare and most often accompanied by CAC > 0 but there was a significant burden of NCP and LAP even within the non-obstructive group.
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Affiliation(s)
- Daniel Lorenzatti
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Pamela Piña
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
- Department of Cardiology, CEDIMAT. Santo Domingo, Dominican Republic
| | - Dou Huang
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Samuel J Apple
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Carol Fernandez-Hazim
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Paul Ippolito
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Aftab Abdullah
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Miguel Rodriguez-Guerra
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - John P Skendelas
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Andrea Scotti
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Toshiki Kuno
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Azeem Latib
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Aldo L Schenone
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness. Houston Methodist DeBakey Heart & Vascular Center. Houston Methodist. Houston, TX, USA
| | - Ron Blankstein
- Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital. Boston, MA, USA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine. Baltimore, MD, USA
| | - Daniel S Berman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center. Los Angeles, CA, USA
| | - Damini Dey
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center. Los Angeles, CA, USA
| | - Salim S Virani
- Office of the Vice Provost (Research), The Aga Khan University. Karachi, Pakistan. Division of Cardiology, The Texas Heart Institute/Baylor College of Medicine. Houston, TX, USA
| | - Mario J Garcia
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Leandro Slipczuk
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
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Mohamed M, Bosserdt M, Wieske V, Dubourg B, Alkadhi H, Garcia MJ, Leschka S, Zimmermann E, Shabestari AA, Nørgaard BL, Meijs MFL, Øvrehus KA, Diederichsen ACP, Knuuti J, Halvorsen BA, Mendoza-Rodriguez V, Wan YL, Bettencourt N, Martuscelli E, Buechel RR, Mickley H, Sun K, Muraglia S, Kaufmann PA, Herzog BA, Tardif JC, Schütz GM, Laule M, Newby DE, Achenbach S, Budoff M, Haase R, Biavati F, Mézquita AV, Schlattmann P, Dewey M. Combination of computed tomography angiography with coronary artery calcium score for improved diagnosis of coronary artery disease: a collaborative meta-analysis of stable chest pain patients referred for invasive coronary angiography. Eur Radiol 2024; 34:2426-2436. [PMID: 37831139 PMCID: PMC10957619 DOI: 10.1007/s00330-023-10223-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/29/2023] [Accepted: 07/30/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES Coronary computed tomography angiography (CCTA) has higher diagnostic accuracy than coronary artery calcium (CAC) score for detecting obstructive coronary artery disease (CAD) in patients with stable chest pain, while the added diagnostic value of combining CCTA with CAC is unknown. We investigated whether combining coronary CCTA with CAC score can improve the diagnosis of obstructive CAD compared with CCTA alone. METHODS A total of 2315 patients (858 women, 37%) aged 61.1 ± 10.2 from 29 original studies were included to build two CAD prediction models based on either CCTA alone or CCTA combined with the CAC score. CAD was defined as at least 50% coronary diameter stenosis on invasive coronary angiography. Models were built by using generalized linear mixed-effects models with a random intercept set for the original study. The two CAD prediction models were compared by the likelihood ratio test, while their diagnostic performance was compared using the area under the receiver-operating-characteristic curve (AUC). Net benefit (benefit of true positive versus harm of false positive) was assessed by decision curve analysis. RESULTS CAD prevalence was 43.5% (1007/2315). Combining CCTA with CAC improved CAD diagnosis compared with CCTA alone (AUC: 87% [95% CI: 86 to 89%] vs. 80% [95% CI: 78 to 82%]; p < 0.001), likelihood ratio test 236.3, df: 1, p < 0.001, showing a higher net benefit across almost all threshold probabilities. CONCLUSION Adding the CAC score to CCTA findings in patients with stable chest pain improves the diagnostic performance in detecting CAD and the net benefit compared with CCTA alone. CLINICAL RELEVANCE STATEMENT CAC scoring CT performed before coronary CTA and included in the diagnostic model can improve obstructive CAD diagnosis, especially when CCTA is non-diagnostic. KEY POINTS • The combination of coronary artery calcium with coronary computed tomography angiography showed significantly higher AUC (87%, 95% confidence interval [CI]: 86 to 89%) for diagnosis of coronary artery disease compared to coronary computed tomography angiography alone (80%, 95% CI: 78 to 82%, p < 0.001). • Diagnostic improvement was mostly seen in patients with non-diagnostic C. • The improvement in diagnostic performance and the net benefit was consistent across age groups, chest pain types, and genders.
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Affiliation(s)
- Mahmoud Mohamed
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Maria Bosserdt
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Viktoria Wieske
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Benjamin Dubourg
- Radiology Department, Clinique Saint Augustin, 112-114 avenue d'Arès, 33000, Bordeaux, France
| | - Hatem Alkadhi
- Diagnostic and Interventional, Radiology University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mario J Garcia
- Department of Cardiology, Montefiore, University Hospital for the Albert Einstein College of Medicine, New York City, NY, USA
| | - Sebastian Leschka
- Department of Radiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Elke Zimmermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Abbas A Shabestari
- Department of Radiology, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus Universtity Hospital, Aarhus, Denmark
| | - Matthijs F L Meijs
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, Netherlands
| | | | | | - Juhani Knuuti
- Turku University Hospital and University of Turku, Turku, Finland
| | | | | | - Yung-Liang Wan
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 333, Taoyuan City, Taiwan
| | - Nuno Bettencourt
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Eugenio Martuscelli
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Kai Sun
- Department of Radiology, Baotou Central Hospital, Inner Mongolia Province, Baotou, China
| | | | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Georg M Schütz
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Laule
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthew Budoff
- Department of Cardiology, Lundquist Institute at Harbor-UCLA, Torrance, CA, USA
| | - Robert Haase
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Federico Biavati
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Data Science, University Hospital of Friedrich Schiller University Jena, Jena, Germany
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Berlin Institute of Health, 10117, Berlin, Germany.
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5
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Piña P, Lorenzatti D, Castagna F, Miles J, Kuno T, Scotti A, Arce J, Feinberg A, Huang D, Gilman J, Leiderman E, Daich J, Ippolito P, Gongora CA, Schenone AL, Zhang L, Rodriguez CJ, Blaha MJ, Dey D, Berman DS, Virani SS, Levsky JM, Garcia MJ, Slipczuk L. Association of cardiometabolic and vascular atherosclerosis phenotypes on non-contrast chest CT with incident heart failure in patients with severe hypercholesterolemia. J Clin Lipidol 2024:S1933-2874(24)00020-5. [PMID: 38368138 DOI: 10.1016/j.jacl.2024.02.001] [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: 06/16/2023] [Revised: 11/16/2023] [Accepted: 02/01/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Coronary artery calcium (CAC), thoracic aorta calcification (TAC), non-alcoholic fatty liver disease (NAFLD), and epicardial adipose tissue (EAT) are associated with atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF). OBJECTIVES We aimed to determine whether these cardiometabolic and atherosclerotic risk factors identified by non-contrast chest computed tomography (CT) are associated with HF hospitalizations in patients with LDL-C≥ 190 mg/dL. METHODS We conducted a retrospective cohort analysis of patients with LDL-C ≥190 mg/dL, aged ≥40 years without established ASCVD or HF, who had a non-contrast chest CT within 3 years of LDL-C measurement. Ordinal CAC, ordinal TAC, EAT, and NAFLD were measured. Kaplan-Meier curves and multivariable Cox regression models were built to ascertain the association with HF hospitalization. RESULTS We included 762 patients with median age 60 (53-68) years, 68% (n=520) female, and median LDL-C level of 203 (194-216) mg/dL. Patients were followed for 4.7 (IQR 2.75-6.16) years, and 107 (14%) had a HF hospitalization. Overall, 355 (47%) patients had CAC=0, 210 (28%) had TAC=0, 116 (15%) had NAFLD, and median EAT was 79 mL (49-114). Moderate-Severe CAC (log-rank p<0.001) and TAC (log-rank p=0.006) groups were associated with increased HF hospitalizations. This association persisted when considering myocardial infarction (MI) as a competing risk. NAFLD and EAT volume were not associated with HF. CONCLUSIONS In patients without established ASCVD and LDL-C≥190 mg/dL, CAC was independently associated with increased HF hospitalizations while TAC, NAFLD and EAT were not.
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Affiliation(s)
- Pamela Piña
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk); Division of Cardiology, CEDIMAT, Santo Domingo, Dominican Republic (Dr Piña)
| | - Daniel Lorenzatti
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Francesco Castagna
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Jeremy Miles
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Andrea Scotti
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Javier Arce
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Ari Feinberg
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Dou Huang
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Jake Gilman
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Ephraim Leiderman
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Jonathan Daich
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Paul Ippolito
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Carlos A Gongora
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Aldo L Schenone
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Lili Zhang
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Carlos J Rodriguez
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Michael J Blaha
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA (Dr Blaha)
| | - Damini Dey
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA (Drs Dey and Berman)
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA (Drs Dey and Berman)
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, The Aga Khan University, Karachi, Pakistan. Section of Cardiology, Texas Heart Institute & Baylor College of Medicine, Houston, TX, USA (Dr Virani)
| | - Jeffrey M Levsky
- Division of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA (Dr Levsky)
| | - Mario J Garcia
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk)
| | - Leandro Slipczuk
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA (Drs Piña, Lorenzatti, Castagna, Miles, Kuno, Scotti, Arce, Feinberg, Huang, Gilman, Leiderman, Daich, Ippolito, Gongora, Schenone, Zhang, Rodriguez, Garcia, and Slipczuk).
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6
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Miles J, Scotti A, Castagna F, Kuno T, Leone PP, Coisne A, Ludwig S, Lavie CJ, Joshi PH, Latib A, Garcia MJ, Rodriguez CJ, Shapiro MD, Virani SS, Slipczuk L. Long-Term Mortality in Patients With Severe Hypercholesterolemia Phenotype From a Racial and Ethnically Diverse US Cohort. Circulation 2024; 149:417-426. [PMID: 37970713 PMCID: PMC10872875 DOI: 10.1161/circulationaha.123.064566] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 10/11/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Tools for mortality prediction in patients with the severe hypercholesterolemia phenotype (low-density lipoprotein cholesterol ≥190 mg/dL) are limited and restricted to specific racial and ethnic cohorts. We sought to evaluate the predictors of long-term mortality in a large racially and ethnically diverse US patient cohort with low-density lipoprotein cholesterol ≥190 mg/dL. METHODS We conducted a retrospective analysis of all patients with a low-density lipoprotein cholesterol ≥190 mg/dL seeking care at Montefiore from 2010 through 2020. Patients <18 years of age or with previous malignancy were excluded. The primary end point was all-cause mortality. Analyses were stratified by age, sex, and race and ethnicity. Patients were stratified by primary and secondary prevention. Cox regression analyses were used to adjust for demographic, clinical, and treatment variables. RESULTS A total of 18 740 patients were included (37% non-Hispanic Black, 30% Hispanic, 12% non-Hispanic White, and 2% non-Hispanic Asian patients). The mean age was 53.9 years, and median follow-up was 5.2 years. Both high-density lipoprotein cholesterol and body mass index extremes were associated with higher mortality in univariate analyses. In adjusted models, higher low-density lipoprotein cholesterol and triglyceride levels were associated with an increased 9-year mortality risk (adjusted hazard ratio [HR], 1.08 [95% CI, 1.05-1.11] and 1.04 [95% CI, 1.02-1.06] per 20-mg/dL increase, respectively). Clinical factors associated with higher mortality included male sex (adjusted HR, 1.31 [95% CI, 1.08-1.58]), older age (adjusted HR, 1.19 per 5-year increase [95% CI, 1.15-1.23]), hypertension (adjusted HR, 2.01 [95% CI, 1.57-2.57]), chronic kidney disease (adjusted HR, 1.68 [95% CI, 1.36-2.09]), diabetes (adjusted HR, 1.79 [95% CI, 1.50-2.15]), heart failure (adjusted HR, 1.51 [95% CI, 1.16-1.95]), myocardial infarction (adjusted HR, 1.41 [95% CI, 1.05-1.90]), and body mass index <20 kg/m2 (adjusted HR, 3.36 [95% CI, 2.29-4.93]). A significant survival benefit was conferred by lipid-lowering therapy (adjusted HR, 0.57 [95% CI, 0.42-0.77]). In the primary prevention group, high-density lipoprotein cholesterol <40 mg/dL was independently associated with higher mortality (adjusted HR, 1.49 [95% CI, 1.06-2.09]). Temporal trend analyses showed a reduction in statin use over time (P<0.001). In the most recent time period (2019-2020), 56% of patients on primary prevention and 85% of those on secondary prevention were on statin therapy. CONCLUSIONS In a large, diverse cohort of US patients with the severe hypercholesterolemia phenotype, we identified several patient characteristics associated with increased 9-year all-cause mortality and observed a decrease in statin use over time, in particular for primary prevention. Our results support efforts geared toward early recognition and consistent treatment for patients with severe hypercholesterolemia.
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Affiliation(s)
- Jeremy Miles
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Andrea Scotti
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Francesco Castagna
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Toshiki Kuno
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Pier Pasquale Leone
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Augustin Coisne
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Sebastian Ludwig
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Parag H Joshi
- Division of Cardiology, Department of Internal Medicine. UT Southwestern Medical Center, Dallas, TX, USA
| | - Azeem Latib
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Mario J Garcia
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Carlos J Rodriguez
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, The Aga Khan University, Karachi, Pakistan. Section of Cardiology, Texas Heart Institute & Baylor College of Medicine, Houston, TX, USA
| | - Leandro Slipczuk
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine. Bronx, NY, USA
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7
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Lorenzatti D, Piña P, Daich J, Scotti A, Perez-Cervera J, Miranda R, Feinberg AJ, Halliburton SS, Ivanc TB, Schenone AL, Kuno T, Latib A, Dey D, Pibarot P, Dweck MR, Garcia MJ, Slipczuk L. Diagnostic accuracy of virtual non-contrast CT for aortic valve stenosis severity evaluation. J Cardiovasc Comput Tomogr 2024; 18:50-55. [PMID: 38314547 DOI: 10.1016/j.jcct.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/13/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Computed tomography aortic valve calcium (AVC) score has accepted value for diagnosing and predicting outcomes in aortic stenosis (AS). Multi-energy CT (MECT) allows virtual non-contrast (VNC) reconstructions from contrast scans. We aim to compare the VNC-AVC score to the true non-contrast (TNC)-AVC score for assessing AS severity. METHODS We prospectively included patients undergoing a MECT for transcatheter aortic valve replacement (TAVR) planning. TNC-AVC was acquired before contrast, and VNC-AVC was derived from a retrospectively gated contrast-enhanced scan. The Agatston scoring method was used for quantification, and linear regression analysis to derive adjusted-VNC values. RESULTS Among 109 patients (55% female) included, 43% had concordant severe and 14% concordant moderate AS. TNC scan median dose-length product was 116 mGy∗cm. The median TNC-AVC was 2,107 AU (1,093-3,372), while VNC-AVC was 1,835 AU (1293-2,972) after applying the coefficient (1.46) and constant (743) terms. A strong correlation was demonstrated between methods (r = 0.93; p < 0.001). Using accepted thresholds (>1,300 AU for women and >2,000 AU for men), 65% (n = 71) of patients had severe AS by TNC-AVC and 67% (n = 73) by adjusted-VNC-AVC. After estimating thresholds for adjusted-VNC (>1,564 AU for women and >2,375 AU for men), 56% (n = 61) had severe AS, demonstrating substantial agreement with TNC-AVC (κ = 0.77). CONCLUSIONS MECT-derived VNC-AVC showed a strong correlation with TNC-AVC. After adjustment, VNC-AVC demonstrated substantial agreement with TNC-AVC, potentially eliminating the requirement for an additional scan and enabling reductions in both radiation exposure and acquisition time.
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Affiliation(s)
- Daniel Lorenzatti
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Pamela Piña
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA; Division of Cardiology, CEDIMAT, Santo Domingo, Dominican Republic
| | - Jonathan Daich
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Andrea Scotti
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | | | - Rita Miranda
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Ari J Feinberg
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | | | - Thomas B Ivanc
- CT Clinical Science, Philips Healthcare, Cleveland, OH, USA
| | - Aldo L Schenone
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Université Laval, Québec, Canada
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Mario J Garcia
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Leandro Slipczuk
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA.
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8
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Gaznabi S, Miranda J, Lorenzatti D, Piña P, Balasubramanian SS, Desai D, Desai A, Ho EC, Scotti A, Gongora CA, Schenone AL, Garcia MJ, Latib A, Parwani P, Slipczuk L. Multimodality Imaging in Aortic Stenosis: Beyond the Valve - Focusing on the Myocardium. Interv Cardiol Clin 2024; 13:101-114. [PMID: 37980060 DOI: 10.1016/j.iccl.2023.09.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Current guidelines of aortic stenosis (AS) management focus on valve parameters, LV systolic dysfunction, and symptoms; however, emerging data suggest that there may be benefit of aortic valve replacement before it becomes severe by present criteria. Myocardial assessment using novel multimodality imaging techniques exhibits subclinical myocardial injury and remodeling at various stages before guideline-directed interventions, which predicts adverse outcomes. This raises the question of whether implementing serial myocardial assessment should become part of the standard appraisal, thereby identifying high-risk patients aiming to minimize adverse outcomes.
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Affiliation(s)
- Safwan Gaznabi
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA; Division of Cardiology, University of Chicago at Northshore University Health System, 1000 Central Street, Evanston, IL 60201, USA
| | - Jeirym Miranda
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA; Division of Cardiology, Mount Sinai Morningside. 419 West 114th Street, NY 10025, USA
| | - Daniel Lorenzatti
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Pamela Piña
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA; Division of Cardiology, CEDIMAT. Arturo Logroño, Plaza de la Salud, Dr. Juan Manuel Taveras Rodríguez, C. Pepillo Salcedo esq. Santo Domingo, Dominican Republic
| | - Senthil S Balasubramanian
- Division of Cardiology, University of Chicago at Northshore University Health System, 1000 Central Street, Evanston, IL 60201, USA
| | - Darshi Desai
- Department of Internal Medicine, University of California Riverside School of Medicine. 900 University Avenue, Riverside, CA 92521, USA
| | - Aditya Desai
- Department of Internal Medicine, University of California Riverside School of Medicine. 900 University Avenue, Riverside, CA 92521, USA
| | - Edwin C Ho
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Andrea Scotti
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Carlos A Gongora
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Aldo L Schenone
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Mario J Garcia
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, 11234 Anderson Street, Loma Linda, CA 92354, USA
| | - Leandro Slipczuk
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA.
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9
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Piña P, Fernandez C, Lorenzatti D, Castagna F, Miles J, Kuno T, Scotti A, Arce J, Gongora CA, Schenone AL, Budoff MJ, Nasir K, Blankstein R, Blaha MJ, Dey D, Berman DS, Levsky JM, Virani SS, Garcia MJ, Slipczuk L. Subclinical atherosclerosis on chest computed tomography and mortality in young patients with severe hypercholesterolemia. Prog Cardiovasc Dis 2023; 81:105-108. [PMID: 37926153 DOI: 10.1016/j.pcad.2023.11.002] [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: 11/07/2023]
Affiliation(s)
- Pamela Piña
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA; Division of Cardiology, CEDIMAT, Santo Domingo, Dominican Republic
| | - Carol Fernandez
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Daniel Lorenzatti
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Francesco Castagna
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jeremy Miles
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrea Scotti
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Javier Arce
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Carlos A Gongora
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Aldo L Schenone
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Matthew J Budoff
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist, Houston, TX, USA
| | - Ron Blankstein
- Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael J Blaha
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Damini Dey
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jeffrey M Levsky
- Division of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, The Aga Khan University, Karachi, Pakistan. Section of Cardiology, Texas Heart Institute & Baylor College of Medicine, Houston, TX, USA
| | - Mario J Garcia
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Leandro Slipczuk
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
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Kottam A, Hanneman K, Schenone A, Daubert MA, Sidhu GD, Gropler RJ, Garcia MJ. State-of-the-Art Imaging of Infiltrative Cardiomyopathies: A Scientific Statement From the American Heart Association. Circ Cardiovasc Imaging 2023; 16:e000081. [PMID: 37916407 DOI: 10.1161/hci.0000000000000081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Infiltrative cardiomyopathies comprise a broad spectrum of inherited or acquired conditions caused by deposition of abnormal substances within the myocardium. Increased wall thickness, inflammation, microvascular dysfunction, and fibrosis are the common pathological processes that lead to abnormal myocardial filling, chamber dilation, and disruption of conduction system. Advanced disease presents as heart failure and cardiac arrhythmias conferring poor prognosis. Infiltrative cardiomyopathies are often diagnosed late or misclassified as other more common conditions, such as hypertrophic cardiomyopathy, hypertensive heart disease, ischemic or other forms of nonischemic cardiomyopathies. Accurate diagnosis is also critical because clinical features, testing methodologies, and approach to treatment vary significantly even within the different types of infiltrative cardiomyopathies on the basis of the type of substance deposited. Substantial advances in noninvasive cardiac imaging have enabled accurate and early diagnosis. thereby eliminating the need for endomyocardial biopsy in most cases. This scientific statement discusses the role of contemporary multimodality imaging of infiltrative cardiomyopathies, including echocardiography, nuclear and cardiac magnetic resonance imaging in the diagnosis, prognostication, and assessment of response to treatment.
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11
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Chalhoub G, Kamel A, Levsky J, Schenone A, Garcia MJ. A Large Cyst in an Unlikely Location: The Interventricular Septum. CASE (Phila) 2023; 7:401-404. [PMID: 37970483 PMCID: PMC10635888 DOI: 10.1016/j.case.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
•A large cardiac cyst was discovered in an extremely rare location: the IVS. •Pre- and postcontrast imaging is essential in the evaluation of a cystic mass. •When identifying a cardiac cyst, malignancy and infection must be considered. •The benefit of excising a cardiac cyst is unclear in an asymptomatic older patient.
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Affiliation(s)
- George Chalhoub
- Department of Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Andrew Kamel
- Department of Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Jeffrey Levsky
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Aldo Schenone
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Mario J. Garcia
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
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12
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Gaznabi S, Miranda J, Lorenzatti D, Piña P, Balasubramanian SS, Desai D, Desai A, Ho EC, Scotti A, Gongora CA, Schenone AL, Garcia MJ, Latib A, Parwani P, Slipczuk L. Multimodality Imaging in Aortic Stenosis: Beyond the Valve - Focusing on the Myocardium. Heart Fail Clin 2023; 19:491-504. [PMID: 37714589 DOI: 10.1016/j.hfc.2023.05.010] [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] [Indexed: 09/17/2023]
Abstract
Current guidelines of aortic stenosis (AS) management focus on valve parameters, LV systolic dysfunction, and symptoms; however, emerging data suggest that there may be benefit of aortic valve replacement before it becomes severe by present criteria. Myocardial assessment using novel multimodality imaging techniques exhibits subclinical myocardial injury and remodeling at various stages before guideline-directed interventions, which predicts adverse outcomes. This raises the question of whether implementing serial myocardial assessment should become part of the standard appraisal, thereby identifying high-risk patients aiming to minimize adverse outcomes.
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Affiliation(s)
- Safwan Gaznabi
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA; Division of Cardiology, University of Chicago at Northshore University Health System, 1000 Central Street, Evanston, IL 60201, USA
| | - Jeirym Miranda
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA; Division of Cardiology, Mount Sinai Morningside. 419 West 114th Street, NY 10025, USA
| | - Daniel Lorenzatti
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Pamela Piña
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA; Division of Cardiology, CEDIMAT. Arturo Logroño, Plaza de la Salud, Dr. Juan Manuel Taveras Rodríguez, C. Pepillo Salcedo esq. Santo Domingo, Dominican Republic
| | - Senthil S Balasubramanian
- Division of Cardiology, University of Chicago at Northshore University Health System, 1000 Central Street, Evanston, IL 60201, USA
| | - Darshi Desai
- Department of Internal Medicine, University of California Riverside School of Medicine. 900 University Avenue, Riverside, CA 92521, USA
| | - Aditya Desai
- Department of Internal Medicine, University of California Riverside School of Medicine. 900 University Avenue, Riverside, CA 92521, USA
| | - Edwin C Ho
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Andrea Scotti
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Carlos A Gongora
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Aldo L Schenone
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Mario J Garcia
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, 11234 Anderson Street, Loma Linda, CA 92354, USA
| | - Leandro Slipczuk
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA.
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13
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Kuno T, Arce J, Fattouh M, Sarkar S, Skendelas JP, Daich J, Schenone AL, Zhang L, Rodriguez CJ, Virani SS, Slomka PJ, Shaw LJ, Williamson EE, Berman DS, Garcia MJ, Dey D, Slipczuk L. Cardiometabolic predictors of high-risk CCTA phenotype in a diverse patient population. Am J Prev Cardiol 2023; 15:100578. [PMID: 37675408 PMCID: PMC10477443 DOI: 10.1016/j.ajpc.2023.100578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/06/2023] [Accepted: 08/13/2023] [Indexed: 09/08/2023] Open
Abstract
Introduction Low-attenuation non-calcified plaque (LAP) burden and vascular inflammation by pericoronary adipose tissue (PCAT) measured from coronary CT angiography (CCTA) have shown to be predictors of cardiovascular outcomes. We aimed to investigate the relationships of cardiometabolic risk factors including lipoprotein(a) and epicardial adipose tissue (EAT) with CCTA high-risk imaging biomarkers, LAP and vascular inflammation. Methods The patient population consisted of consecutive patients who underwent CCTA for stable chest pain and had a complete cardiometabolic panel including lipoprotein(a). Plaque, PCAT and EAT were measured from CT using semiautomated software. Elevated LAP burden and PCAT attenuation were defined as ≥4% and ≥70.5 HU, respectively. The primary clinical end-point was a composite of myocardial infarction, revascularization or cardiovascular death. Results A total of 364 consecutive patients were included (median age 56 years, 64% female); the majority of patients were of Hispanic (60%), and the rest were of non-Hispanic Black (21%), non-Hispanic White (6%) and non-Hispanic Asian (4%) race/ethnicity. The prevalence of elevated LAP burden and PCAT attenuation was 31 and 18%, respectively, while only 8% had obstructive stenosis. There were significant differences in plaque characteristics among different racial/ethnic groups (p<0.001). Lipoprotein(a) correlated with LAP burden in Hispanic patients. Patients with elevated LAP were older, more likely to be have diabetes, hypertension, hyperlipidemia and smoke with higher CAC and EAT volume (all P<0.05). Patients with elevated LAP were more likely to develop the primary clinical outcome (p<0.001) but those with elevated PCAT were not (p=0.797). Conclusion The prevalence of LAP and PCAT attenuation were 31 and 18%, respectively. Lipoprotein(a) levels correlated with LAP burden in Hispanic patients. Age, male sex, hypertension and hyperlipidemia increased the odds of elevated LAP, which showed prognostic significance.
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Affiliation(s)
- Toshiki Kuno
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - Javier Arce
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - Michael Fattouh
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - Sharmila Sarkar
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - John P Skendelas
- Cardiothoracic and Vascular Surgery Department, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States
| | - Jonathan Daich
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - Aldo L Schenone
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - Lili Zhang
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - Carlos J Rodriguez
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - Salim S Virani
- Office of the Vice Provost (Research), The Aga Khan University, Karachi, Pakistan
- Division of Cardiology, The Texas Heart Institute/Baylor College of Medicine, Houston, TX, United States
| | - Piotr J Slomka
- Division of Cardiology, The Texas Heart Institute/Baylor College of Medicine, Houston, TX, United States
| | - Leslee J Shaw
- Departments of Medicine (Cardiology) and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Daniel S Berman
- Division of Cardiology, The Texas Heart Institute/Baylor College of Medicine, Houston, TX, United States
| | - Mario J Garcia
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - Damini Dey
- Department of Imaging, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA, United States
| | - Leandro Slipczuk
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
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14
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Fattouh M, Kuno T, Pina P, Skendelas JP, Lorenzatti D, Arce J, Daich J, Duarte G, Fernandez-Hazim C, Rodriguez-Guerra M, Neshiwat P, Schenone AL, Zhang L, Rodriguez CJ, Arbab-Zadeh A, Slomka PJ, Virani SS, Blaha MJ, Berman DS, Dey D, Garcia MJ, Slipczuk L. Interplay Between Zero CAC, Quantitative Plaque Analysis, and Adverse Events in a Diverse Patient Cohort. Circ Cardiovasc Imaging 2023; 16:e015236. [PMID: 37582155 PMCID: PMC10430772 DOI: 10.1161/circimaging.123.015236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 07/18/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Coronary artery calcium scoring (CAC) has garnered attention in the diagnostic approach to chest pain patients. However, little is known about the interplay between zero CAC, sex, race, ethnicity, and quantitative coronary plaque analysis. METHODS We conducted a retrospective analysis from our computed tomography registry of patients with stable angina without prior myocardial infarction or revascularization undergoing coronary computed tomography angiography at Montefiore Healthcare System. Follow-up end points collected included invasive angiography, type-1 myocardial infarction, coronary revascularization, cardiovascular and all-cause death. RESULTS A total of 2249 patients were included (66% female). The median follow-up was 5.5 years. The median age of those without CAC was 52 years (interquartile range, 44-59) and 60 years (interquartile range, 53-68) in those with CAC. Most patients were Hispanic (58%), and the rest were non-Hispanic Black (28%), non-Hispanic White (10%), and non-Hispanic Asian (5%). The majority had CAC=0 (55%). The negative predictive value of CAC=0 was 92.8%, 99.9%, and 99.9% for any plaque, obstructive coronary artery stenosis, and the composite outcome of all-cause death, myocardial infarction, or coronary revascularization, respectively. Among patients without CAC (n=1237), 89 patients (7%) had evidence of plaque on their coronary computed tomography angiography with a median low-attenuation noncalcified plaque burden of 4% (2-7). There were no significant differences in the negative predictive value for CAC=0 by sex, race, or ethnicity. Patients with ≥2 risk factors had higher odds of having plaque with zero CAC. CONCLUSIONS In summary, no sex, race, or ethnicity differences were demonstrated in the negative predictive value of a zero CAC; however, patients with ≥2 risk factors had a higher prevalence of plaque. A small percentage (7%) of symptomatic patients undergoing coronary computed tomography angiography with zero CAC had noncalcified coronary plaque, with the implication that caution is needed for downscaling of preventive treatment in patients with zero CAC, chest pain, and multiple risk factors.
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Affiliation(s)
- Michael Fattouh
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY
| | - Pamela Pina
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY
| | - John P Skendelas
- Cardiothoracic and Vascular Surgery Department. Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY
| | - Daniel Lorenzatti
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY
| | - Javier Arce
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY
| | - Jonathan Daich
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY
| | - Gustavo Duarte
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY
| | - Carol Fernandez-Hazim
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY
| | - Miguel Rodriguez-Guerra
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY
| | - Patrick Neshiwat
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY
| | - Aldo L Schenone
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY
| | - Lili Zhang
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY
| | - Carlos J Rodriguez
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY
| | - Armin Arbab-Zadeh
- Division of Cardiology, Johns Hopkins University School of Medicine. Baltimore, MD
| | - Piotr J Slomka
- Department of Imaging, Cedars-Sinai Medical Center. Los Angeles, CA
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, The Aga Khan University. Karachi, Pakistan. Section of Cardiology, Texas Heart Institute & Baylor College of Medicine. Houston, TX, USA
| | - Michael J Blaha
- Division of Cardiology, Johns Hopkins University School of Medicine. Baltimore, MD
| | - Daniel S. Berman
- Department of Imaging, Cedars-Sinai Medical Center. Los Angeles, CA
| | - Damini Dey
- Department of Imaging, Cedars-Sinai Medical Center. Los Angeles, CA
| | - Mario J Garcia
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY
| | - Leandro Slipczuk
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY
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15
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Lorenzatti D, Piña P, Csecs I, Schenone AL, Gongora CA, Garcia MJ, Blaha MJ, Budoff MJ, Williams MC, Dey D, Berman DS, Virani SS, Slipczuk L. Does Coronary Plaque Morphology Matter Beyond Plaque Burden? Curr Atheroscler Rep 2023; 25:167-180. [PMID: 36808390 DOI: 10.1007/s11883-023-01088-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE OF REVIEW Imaging of adverse coronary plaque features by coronary computed tomography angiography (CCTA) has advanced greatly and at a fast pace. We aim to describe the evolution, present and future in plaque analysis, and its value in comparison to plaque burden. RECENT FINDINGS Recently, it has been demonstrated that in addition to plaque burden, quantitative and qualitative assessment of coronary plaque by CCTA can improve the prediction of future major adverse cardiovascular events in diverse coronary artery disease scenarios. The detection of high-risk non-obstructive coronary plaque can lead to higher use of preventive medical therapies such as statins and aspirin, help identify culprit plaque, and differentiate between myocardial infarction types. Even more, over traditional plaque burden, plaque analysis including pericoronary inflammation can potentially be useful tools for tracking disease progression and response to medical therapy. The identification of the higher risk phenotypes with plaque burden, plaque characteristics, or ideally both can allow the allocation of targeted therapies and potentially monitor response. Further observational data are now required to investigate these key issues in diverse populations, followed by rigorous randomized controlled trials.
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Affiliation(s)
- Daniel Lorenzatti
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Pamela Piña
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine, Bronx, NY, USA
- Cardiology Division, CEDIMAT Cardiovascular Center, Santo Domingo, Dominican Republic
| | - Ibolya Csecs
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Aldo L Schenone
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Carlos A Gongora
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mario J Garcia
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Michelle C Williams
- BHF Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, UK
| | - Damini Dey
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Section of Cardiology, Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Leandro Slipczuk
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine, Bronx, NY, USA.
- Clinical Cardiology, Advanced Cardiac Imaging, CV Atherosclerosis and Lipid Disorder Center, Montefiore Health System, NewYork, USA.
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16
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Cui Z, Castagna F, Hanif W, Apple SJ, Zhang L, Tauras JM, Braunschweig I, Kaur G, Janakiram M, Wang Y, Fang Y, Diaz JC, Hoyos C, Marin J, Pellikka PA, Romero JE, Garcia MJ, Verma AK, Shah N, Slipczuk L. Global Longitudinal Strain Is Associated with Mortality in Patients with Multiple Myeloma. J Clin Med 2023; 12:2595. [PMID: 37048679 PMCID: PMC10095531 DOI: 10.3390/jcm12072595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Patients with multiple myeloma (MM) are at a high risk for developing cardiovascular complications. Global longitudinal strain (GLS) can detect early functional impairment before structural abnormalities develop. It remains unknown if reduced GLS is associated with reduced survival in patients with MM. We conducted a retrospective cohort analysis of patients diagnosed with MM between 1 January 2000 and 31 December 2017 at our institution. Patients with a 2D transthoracic echocardiogram completed within 1 year of MM diagnosis, left ventricular ejection fraction (LVEF) greater than 40%, and no history of myocardial infarction prior to MM diagnosis were included. GLS was measured using an artificial-intelligence-powered software (EchoGo Core), with reduced GLS defined as an absolute value of <18%. The primary outcome of interest was overall survival since myeloma diagnosis. Our cohort included 242 patients with a median follow up of 4.28 years. Fifty-two (21.5%) patients had reduced average GLS. Patients with reduced GLS were more likely to have an IVSd ≥ 1.2cm, E/E' > 9.6, LVEF/GLS > 4.1, higher LV mass index, and low-voltage ECG. A Total of 126 (52.1%) deaths occurred during follow-up. Overall survival was lower among patients with reduced GLS (adjusted HR: 1.81, CI: 1.07-3.05).
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Affiliation(s)
- Zhu Cui
- Department of Internal Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Francesco Castagna
- Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Waqas Hanif
- Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Samuel J. Apple
- Department of Internal Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Lili Zhang
- Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - James M. Tauras
- Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Ira Braunschweig
- Oncology Department, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Gurbakhash Kaur
- Hematology Oncology Division, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Murali Janakiram
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN 55812, USA
| | - Yanhua Wang
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Yanan Fang
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | | | - Carolina Hoyos
- Heart and Vascular Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jorge Marin
- Clínica Las Americas, Medellin 50025, Colombia
| | | | - Jorge E. Romero
- Heart and Vascular Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Mario J. Garcia
- Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Amit K. Verma
- Oncology Department, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Nishi Shah
- Oncology Department, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Leandro Slipczuk
- Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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17
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Yuan Y, Herrington DM, Lima JA, Stacey B, Zhao DXM, Thomas JD, Garcia MJ, Pu M. LEFT VENTRICULAR FLOW STATE IS ASSOCIATED WITH CARDIOVASCULAR DISEASE AND ALL-CAUSE MORTALITY IN AN ASYMPTOMATIC POPULATION WITH NORMAL LEFT VENTRICULAR FUNCTION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02126-5] [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: 03/06/2023]
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18
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Barzallo D, Torrado J, Terre J, Wiley JM, Garcia MJ, Latib A. BAIL-OUT USE OF VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION (VA-ECMO) FOR SUICIDE LEFT VENTRICLE AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03562-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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19
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Lorenzatti D, Santana PP, Feinberg A, Arce J, Scotti A, Garcia MJ, Latib A, Slipczuk L. CARDIOVASCULAR COMPUTED TOMOGRAPHY (CCT) IN TAVR DYSFUNCTION - AN UNUSUAL CASE OF OBSTRUCTIVE BIOPROSTHETIC VALVE THROMBOSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04100-1] [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: 03/06/2023]
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20
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Santana PP, Lorenzatti D, Amacher K, Gilman JT, Aftab A, Pellikka PA, Pu M, Verma AJ, Shah N, Gongora CA, Schenone A, Jorde UP, Biase LD, Garcia MJ, Slipczuk L. PROGNOSTIC VALUE OF LEFT ATRIAL STRAIN IN PATIENTS WITH MULTIPLE MYELOMA. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01836-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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21
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Moya CJB, Barzallo D, Flatow E, Torrado J, Apple SJ, Palaiodimos L, Kokkinidis D, Schenone A, Slipczuk L, Garcia MJ. HEART RATE CONTROL STRATEGIES FOR OPTIMAL CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY IN ADULTS: A SYSTEMATIC REVIEW. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01869-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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22
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Piña P, Lorenzatti D, Paula R, Daich J, Schenone AL, Gongora C, Garcia MJ, Blaha MJ, Budoff MJ, Berman DS, Virani SS, Slipczuk L. Imaging subclinical coronary atherosclerosis to guide lipid management, are we there yet? Am J Prev Cardiol 2022; 13:100451. [PMID: 36619296 PMCID: PMC9813535 DOI: 10.1016/j.ajpc.2022.100451] [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: 10/08/2022] [Revised: 12/07/2022] [Accepted: 12/17/2022] [Indexed: 12/23/2022] Open
Abstract
Atherosclerotic cardiovascular disease risk (ASCVD) is an ongoing epidemic, and lipid abnormalities are its primordial cause. Most individuals suffering a first ASCVD event are previously asymptomatic and often do not receive preventative therapies. The cornerstone of primary prevention has been the identification of individuals at risk through risk calculators based on clinical and laboratory traditional risk factors plus risk enhancers. However, it is well accepted that a clinical risk calculator misclassifies a significant proportion of individuals leading to the prescription of a lipid-lowering medication with very little yield or a missed opportunity for lipid-lowering agents with a potentially preventable event. The development of coronary artery calcium scoring (CAC) and CT coronary angiography (CCTA) provide complementary tools to directly visualize coronary plaque and other risk-modifying imaging components that can potentially provide individualized lipid management. Understanding patient selection for CAC or potentially CCTA and the risk implications of the different parameters provided, such as CAC score, coronary stenosis, plaque characteristics and burden, epicardial adipose tissue, and pericoronary adipose tissue, have grown more complex as technologies evolve. These parameters directly affect the shared decision with patients to start or withhold lipid-lowering therapies, to adjust statin intensity or LDL cholesterol goals. Emerging lipid lowering studies with non-invasive imaging as a guide to patient selection and treatment efficacy, plus the evolution of lipid lowering therapies from statins to a diverse armament of newer high-cost agents have pushed these two fields forward with a complex interaction. This review will discuss existing risk estimators, and non-invasive imaging techniques for subclinical coronary atherosclerosis, traditionally studied using CAC and more recently CCTA with qualitative and quantitative measurements. We will also explore the current data, gaps of knowledge and future directions on the use of these techniques in the risk-stratification and guidance of lipid management.
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Affiliation(s)
- Pamela Piña
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Daniel Lorenzatti
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Rita Paula
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Jonathan Daich
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Aldo L Schenone
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Carlos Gongora
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Mario J Garcia
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease. Baltimore, MD, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Salim S Virani
- Section of Cardiology, Department of Medicine. Baylor College of Medicine, and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- The Aga Khan University, Karachi, Pakistan
| | - Leandro Slipczuk
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
- Corresponding author.
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23
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Scotti A, Sturla M, Granada JF, Kodali SK, Coisne A, Mangieri A, Godino C, Ho E, Goldberg Y, Chau M, Jorde UP, Garcia MJ, Maisano F, Bapat VN, Ailawadi G, Latib A. Outcomes of isolated tricuspid valve replacement: a systematic review and meta-analysis of 5,316 patients from 35 studies. EUROINTERVENTION 2022; 18:840-851. [PMID: 36197445 PMCID: PMC10167545 DOI: 10.4244/eij-d-22-00442] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Transcatheter tricuspid valve replacement (TTVR) is rapidly emerging as a therapeutic option amongst patients with secondary tricuspid regurgitation. Historical data from surgical tricuspid valve replacement (TVR) studies may serve as a benchmark for the development of TTVR trials. AIMS The aim of the study was to investigate the early and late outcomes following isolated surgical TVR. METHODS Multiple electronic databases were searched to identify studies on isolated surgical TVR. The prespecified primary endpoint was operative mortality; secondary endpoints were early and late outcomes. Overall estimates of proportions and incidence rates with 95% confidence intervals (CI) were calculated using random-effects models. Multiple sensitivity analyses accounting for baseline characteristics, country and the operative period were applied. Results: A total of 35 studies (5,316 patients) were included in this meta-analysis. The operative period ranged from 1974 to 2019. The overall rate of operative mortality was 12% (95% CI: 9-15), with higher mortality for patients who were operated on before 1995, who had prior cardiac surgeries, or who had liver disease. The most frequent clinical events were pacemaker implantation (10% [95% CI: 6-16]), bleeding (12% [95% CI: 8-17]), acute kidney injury (15% [95% CI: 9-24]) and respiratory complications (15% [95% CI: 12-20]). At follow-up analysis of the bioprosthetic TVR, there was an incidence rate per 100 person-years of 6 (95% CI: 2-13) for death and 8 (95% CI: 5-13) for recurrence of significant tricuspid regurgitation. CONCLUSIONS This meta-analysis provides an overview of the historical clinical outcomes following isolated surgical TVR. These findings can support the development of future clinical trials in the tricuspid space by providing thresholds for clinical outcomes.
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Affiliation(s)
- Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Matteo Sturla
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Juan F Granada
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Susheel K Kodali
- Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Augustin Coisne
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy and Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Cosmo Godino
- Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Edwin Ho
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ythan Goldberg
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mei Chau
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ulrich P Jorde
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mario J Garcia
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Francesco Maisano
- Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vinayak N Bapat
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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24
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Arce J, Kuno T, Fattouh M, Sarkar S, Skendelas J, Daich J, Schenone A, Zhang L, Slomka PJ, Shaw LJ, Williamson E, Berman DS, Garcia MJ, Dey D, Slipczuk L. Cardiometabolic predictors of quantitative high-risk plaque features in a diverse patient population. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.215] [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: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
Little is known about the prevalence of high-risk plaque features or cardiometabolic predictors in diverse patient populations with underrepresented minorities, in the setting of stable chest pain.
Purpose
The goals of our study are to 1) describe plaque characteristics in a diverse patient population with underrepresented minorities and 2) characterize cardiometabolic risk factors associated with high prevalence of high-risk quantitative low attenuation noncalcified plaque (LDNCP) burden.
Methods
Our study included patients with chest pain undergoing CCTA between June 2016 and October 2021 for stable chest pain, who had a complete cardiometabolic panel including lipoprotein(a) and lipid panel, and at least one blood pressure recording before CCTA. Patients with prior PCI or CABG where excluded. CACS was performed before CCTA as per Agatston method and quantified in Agatston Units (AU). Stenosis was graded as per SCCT guidelines by cardiologists and radiologists with level 3 cardiac CT expertise. Plaque measurements were performed using previously validated semiautomated software (AutoPlaque version 2.5) in all patients with CAD-RADS >0 by expert readers blinded from patients' characteristics. Coronary atherosclerotic plaque volumes were measured. Independent predictors for plaque on CCTA among patients were examined using Wilcox multivariate logistic regression.
Results
A total of 227 consecutive patients were included in our study (see table; age 55.00 [47.50–62.00] years, 63% female, 16% diabetes, 44% hypertension, 40% hyperlipidemia and 32% with current or previous smoking history). Majority of patients were Hispanic (64%) and the rest were Black (27%), White (6%) and Asian (3%).
Patients with LDNCP burden >4% were older (60.00 [52.00–66.50] vs 53.00 [43.75–61.00]; p<0.001), more likely to be diabetic (27.7 vs 11.5%; p=0.005), hypertensive (67.7 vs 33.8%; p<0.001), hyperlipidemic (64.6 vs 29.9%; p<0.001) and present smokers (31.3 vs 13.9%; p=0.003). Almost all patients (63/67) with LDNCP burden >4% had non-obstructive disease (CAD-RADS<4).
Patient with LDNCP burden >4% were more likely to be on statin therapy (46.0 vs 30.4%; p=0.041). There was no differences in ethnicity, hemoglobin A1C, TC, LDL-C, HLD-C, TGs, lipoprotein(a), SBP or DBP.
By logistic regression analysis, age (OR [CI]: 1.06 [1.01–1.08]), hypertension (2.20, [1.06–4.63]) and hyperlipidemia (2.73 [1.37–5.47]) increased the likelihood of LDNCP burden >4%, but not Lipoprotein (a)>175 nmol/L (OR [CI]: 1.07 [0.48–2.31].
Conclusions
In our cohort of patients with high number of unrepresented minorities presenting with stable chest pain, almost all patients (94%) with LDNCP burden >4% had non-obstructive CAD (CAD-RADS<4). There were no differences in prevalence of LDNCP or CAD-RADS among different ethnic groups. Age, hypertension and hyperlipidemia, were the cardiometabolic factors related to LDNCP burden >4%.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Arce
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - T Kuno
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - M Fattouh
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - S Sarkar
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - J Skendelas
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - J Daich
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - A Schenone
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - L Zhang
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - P J Slomka
- Cedars-Sinai Medical Center , Los Angeles , United States of America
| | - L J Shaw
- Mount Sinai Heart , New York , United States of America
| | - E Williamson
- Mayo Clinic , Rochester , United States of America
| | - D S Berman
- Cedars-Sinai Medical Center , Los Angeles , United States of America
| | - M J Garcia
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - D Dey
- Cedars-Sinai Medical Center , Los Angeles , United States of America
| | - L Slipczuk
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
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25
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Cui Z, Castagna F, Hanif W, Apple S, Zhang L, Tauras J, Braunschweig I, Kaur G, Janakiram M, Wang Y, Fang Y, Pellikka PA, Garcia MJ, Shah N, Slipczuk L. Amyloidosis-related echo features and mortality in patients with multiple myeloma. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.050] [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: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
Patients with multiple myeloma (MM) are at increased risk of developing AL amyloidosis. It was determined by screening fat pad and bone marrow biopsy that 38% MM patients had amyloidosis at time of diagnosis and the majority were asymptomatic (1). However, whether amyloidosis-related echo features in MM affect survival remains unknown (1, 2).
Purpose
The goals of our study are to: 1) characterize prevalence of amyloidosis-related echo features in patients with multiple myeloma, 2) investigate whether decrease in longitudinal strain affect survival outcomes.
Methods
Patients diagnosed with MM between Jan 1, 2000 and Dec 31, 2017 at our institution were identified through Clinical Looking Glass. Those with echo within 1 year after myeloma diagnosis and left ventricular ejection fraction (LVEF) greater than 40% were included. Global longitudinal strain (GLS) and LVEF measurements were done using EchoGo (Ultromics, Oxford, UK). The average of GLS obtained from apical 4-chamber and apical 2-chamber views was used for analysis, with decreased GLS defined as absolute value less than 18%. Statistical analysis was conducted with STATA13, using Chi square test and Kruskal-Wallis for univariable analysis and Cox regression model for survival analysis.
Results
From a total cohort of 909 patients, 252 met inclusion criteria, of which 59 (23.4%) patients had decreased average GLS (see Table 1). Patients' mean age was 63±11 years, 44.8% were male and most were Black (42.7%) and the rest Hispanic (33.3%) and White (7.9%). Median follow up time was 4.25 years. The group with decreased GLS had lower percentage of females (22% vs 51.8%, p<0.01), higher percentage of previous MI (11.9% vs 1.6%, p<0.01) and more prior diagnosis of heart failure (20.3% vs 1.6%, p<0.01).
Among patients with decreased GLS, five-year mortality rate was 63.3% compared to 46.0% in those with preserved GLS (p<0.036). Median survival time was 3.9 years among those with reduced GLS and 4.3 years in those without (see Figure 1; p<0.01). Reduced GLS correlated with decreased survival (HR 1.6, p=0.03) even after adjusting for demographic variables (age, gender, race), history of MI, history of CHF, Charlson comorbidity index, myeloma RISS stage, and LVEF (≥50% vs 40–50%).
Forty-seven (18.6%) patients had end diastolic inter-ventricular septum (IVSd) thickness ≥1.2cm. Median GLS in patients with increased IVSd thickness was 19% compared to 21% in those without (p=0.01). Nine patients had the apical sparing strain pattern for amyloidosis.
Total of 158 patients had bone marrow specimen stained with Congo-red with 7 (4.4%) testing positive. Median GLS was 19% in the group staining positive for Congo-red compared 21% in the group with negative stain (p=0.03).
Conclusions
Decrease in GLS on baseline echo correlates with increased mortality in patients with MM and may be due to subclinical cardiac amyloidosis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Z Cui
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - F Castagna
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - W Hanif
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - S Apple
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - L Zhang
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - J Tauras
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - I Braunschweig
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - G Kaur
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - M Janakiram
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - Y Wang
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - Y Fang
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - P A Pellikka
- Mayo Clinic , Rochester , United States of America
| | - M J Garcia
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - N Shah
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
| | - L Slipczuk
- Montefiore Medical Center Albert Einstein College of Medicine , New York , United States of America
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26
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Yalcin F, Garcia MJ. It Is Time to Focus on “Segmental Remodeling” with Validated Biomarkers as “Stressed Heart Morphology” in Prevention of Heart Failure. J Clin Med 2022; 11:jcm11144180. [PMID: 35887943 PMCID: PMC9316885 DOI: 10.3390/jcm11144180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/14/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Fatih Yalcin
- Department of Cardiology, UCSF HEALTH, School of Medicine, Cardiac Imaging, San Francisco, CA 94143, USA
- Correspondence:
| | - Mario J. Garcia
- Cardiology Division, Montefiore Medical Center, Bronx, NY 10461, USA;
- Albert Einstein College of Medicine, Bronx, NY 10461, USA
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27
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Edvardsen T, Asch FM, Davidson B, Delgado V, DeMaria A, Dilsizian V, Gaemperli O, Garcia MJ, Kamp O, Lee DC, Neglia D, Neskovic AN, Pellikka PA, Plein S, Sechtem U, Shea E, Sicari R, Villines TC, Lindner JR, Popescu BA. Non-Invasive Imaging in Coronary Syndromes: Recommendations of The European Association of Cardiovascular Imaging and the American Society of Echocardiography, in Collaboration with The American Society of Nuclear Cardiology, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Cardiovasc Comput Tomogr 2022; 16:362-383. [PMID: 35729014 DOI: 10.1016/j.jcct.2022.05.006] [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] [Indexed: 10/18/2022]
Affiliation(s)
- Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway.
| | - Federico M Asch
- MedStar Health Research Institute, Georgetown University, Washington, District of Columbia
| | - Brian Davidson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; VA Portland Health Care System, Portland, Oregon
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Maryland
| | | | - Mario J Garcia
- Division of Cardiology, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, New York
| | - Otto Kamp
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Daniel C Lee
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Danilo Neglia
- Department of Cardiology, Istituto di Scienze della Vita Scuola Superiore Sant Anna Pisa, Pisa, Italy
| | - Aleksandar N Neskovic
- Faculty of Medicine, Department of Cardiology, Clinical Hospital Center Zemun, University of Belgrade, Belgrade, Serbia
| | - Patricia A Pellikka
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Rochester, Minnesota
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Udo Sechtem
- Cardiologicum Stuttgart and Department of Cardiology, Robert Bosch Krankenhaus, Stuttgart, Germany
| | - Elaine Shea
- Alta Bates Summit Medical Center, Berkeley and Oakland, Berkeley, California
| | - Rosa Sicari
- CNR, Institute of Clinical Physiology, Pisa, Italy
| | - Todd C Villines
- Division of Cardiovascular Medicine, University of Virginia Health System, University of Virginia Health Center, Charlottesville, Virginia
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy Carol Davila Euroecolab, Emergency Institute for Cardiovascular Diseases Prof. Dr. C. C. Iliescu, Bucharest, Romania
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28
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Castagna F, Miles J, Arce J, Leiderman E, Neshiwat P, Ippolito P, Friedmann P, Schenone A, Zhang L, Rodriguez CJ, Blaha MJ, Levsky JM, Garcia MJ, Slipczuk L. Visual Coronary and Aortic Calcium Scoring on Chest Computed Tomography Predict Mortality in Patients With Low-Density Lipoprotein-Cholesterol ≥190 mg/dL. Circ Cardiovasc Imaging 2022; 15:e014135. [PMID: 35727870 DOI: 10.1161/circimaging.122.014135] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Current guidelines recommend coronary artery calcium (CAC) scoring for stratification of atherosclerotic cardiovascular disease risk only in patients with borderline to intermediate risk score by the pooled cohort equation with low-density lipoprotein-cholesterol (LDL-C) of 70 to 190 mg/dL. It remains unknown if CAC or thoracic aorta calcification (TAC), detected on routine chest computed tomography, can provide further risk stratification in patients with LDL-C≥190 mg/dL. METHODS From a multisite medical center, we retrospectively identified all patients from March 2005 to June 2021 age ≥40 years, without established atherosclerotic cardiovascular disease and LDL-C≥190 mg/dL who had non-gated non-contrast chest computed tomography within 3 years of LDL-C measurement. Ordinal CAC and TAC scores were measured by visual inspection. Kaplan-Meier curves and multivariable Cox-regression models were built to ascertain the association of CAC and TAC scores with all-cause mortality. RESULTS We included 811 patients with median age 59 (53-68) years, 262 (32.3%) were male, and LDL-C median level was 203 (194-217) mg/dL. Patients were followed for 6.2 (3.29-9.81) years, and 109 (13.4%) died. Overall, 376 (46.4%) of patients had CAC=0 and 226 (27.9%) had TAC=0. All-cause mortality increased with any CAC and moderate to severe TAC. In a multivariate model, patients with CAC had a significantly higher mortality compared with those without CAC: mild hazard ratio (HR), 1.71 (1.03-2.83), moderate HR, 2.12 (1.14-3.94), and severe HR, 3.49 (1.94-6.27). Patients with moderate TAC (HR, 2.34 [1.19-4.59]) and those with severe TAC (HR, 3.02 [1.36-6.74]) had higher mortality than those without TAC. CONCLUSIONS In patients without history of atherosclerotic cardiovascular disease and LDL-C≥190 mg/dL, the presence and severity of CAC and TAC are independently associated with all-cause mortality.
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Affiliation(s)
- Francesco Castagna
- Cardiology Division, Montefiore Medical Center, Bronx, NY (F.C., J.M., J.A., E.L., P.N., P.I., A.S., L.Z., C.J.R., M.J.G., L.S.).,Albert Einstein College of Medicine' Bronx, NY (F.C., A.S., L.Z., C.J.R., J.M.L., M.J.G., L.S.)
| | - Jeremy Miles
- Albert Einstein College of Medicine' Bronx, NY (F.C., A.S., L.Z., C.J.R., J.M.L., M.J.G., L.S.)
| | - Javier Arce
- Cardiology Division, Montefiore Medical Center, Bronx, NY (F.C., J.M., J.A., E.L., P.N., P.I., A.S., L.Z., C.J.R., M.J.G., L.S.)
| | - Ephraim Leiderman
- Cardiology Division, Montefiore Medical Center, Bronx, NY (F.C., J.M., J.A., E.L., P.N., P.I., A.S., L.Z., C.J.R., M.J.G., L.S.)
| | - Patrick Neshiwat
- Cardiology Division, Montefiore Medical Center, Bronx, NY (F.C., J.M., J.A., E.L., P.N., P.I., A.S., L.Z., C.J.R., M.J.G., L.S.)
| | - Paul Ippolito
- Cardiology Division, Montefiore Medical Center, Bronx, NY (F.C., J.M., J.A., E.L., P.N., P.I., A.S., L.Z., C.J.R., M.J.G., L.S.)
| | - Patricia Friedmann
- Departments of Surgery and Cardiothoracic and Vascular Surgery, Albert Einstein College of Medicine' Bronx, NY (P.F.)
| | - Aldo Schenone
- Cardiology Division, Montefiore Medical Center, Bronx, NY (F.C., J.M., J.A., E.L., P.N., P.I., A.S., L.Z., C.J.R., M.J.G., L.S.).,Albert Einstein College of Medicine' Bronx, NY (F.C., A.S., L.Z., C.J.R., J.M.L., M.J.G., L.S.)
| | - Lili Zhang
- Cardiology Division, Montefiore Medical Center, Bronx, NY (F.C., J.M., J.A., E.L., P.N., P.I., A.S., L.Z., C.J.R., M.J.G., L.S.).,Albert Einstein College of Medicine' Bronx, NY (F.C., A.S., L.Z., C.J.R., J.M.L., M.J.G., L.S.)
| | - Carlos J Rodriguez
- Albert Einstein College of Medicine' Bronx, NY (F.C., A.S., L.Z., C.J.R., J.M.L., M.J.G., L.S.)
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease' Baltimore, MD (M.J.B.)
| | - Jeffrey M Levsky
- Albert Einstein College of Medicine' Bronx, NY (F.C., A.S., L.Z., C.J.R., J.M.L., M.J.G., L.S.).,Radiology Department, Montefiore Medical Center, Bronx, NY (J.M.L., M.J.G.)
| | - Mario J Garcia
- Albert Einstein College of Medicine' Bronx, NY (F.C., A.S., L.Z., C.J.R., J.M.L., M.J.G., L.S.).,Radiology Department, Montefiore Medical Center, Bronx, NY (J.M.L., M.J.G.)
| | - Leandro Slipczuk
- Albert Einstein College of Medicine' Bronx, NY (F.C., A.S., L.Z., C.J.R., J.M.L., M.J.G., L.S.)
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29
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Gianni C, Sanchez JE, Chen Q, Della Rocca DG, Mohanty S, Trivedi C, Al-Ahmad A, Bassiouny MA, Burkhardt JD, Gallinghouse GJ, Horton RP, Hranitzky PM, Romero JE, Di Biase L, Garcia MJ, Natale A. Transesophageal Echocardiography Following Left Atrial Appendage Electrical Isolation: Diagnostic Pitfalls and Clinical Implications. Circ Arrhythm Electrophysiol 2022; 15:e010975. [PMID: 35617267 DOI: 10.1161/circep.122.010975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Following left atrial appendage (LAA) electrical isolation, the decision on whether to continue oral anticoagulation after successful atrial fibrillation ablation is based on the study of its mechanical function on transesophageal echocardiography (TEE). In this cohort, LAA contraction is absent and the incorrect interpretation of emptying flow velocities can lead to unwanted clinical sequelae. METHODS One hundred and sixty consecutive TEE exams performed to evaluate the LAA mechanical function following its electrical isolation were reviewed by an experienced operator blinded to the original diagnosis of LAA dysfunction. The rate of diagnostic discrepancy in the assessment LAA dysfunction and its clinical implications were evaluated. RESULTS Diagnostic discrepancy with misclassification of the LAA mechanical function occurred 36% (58/160) of TEE exams. In most cases (57/58), such discrepancy was observed in the setting of an incorrect original diagnosis of a normal LAA mechanical function despite absent/reduced or inconsistent LAA contraction. This main source of this wrong diagnosis was the wrong interpretation of passive LAA flows (34/57; 60%), followed by failure to identify dissociated firing (15/57; 26%). In rare cases (8/57; 14%), velocities of surrounding structures were interpreted as LAA flow due to misplacement of the pulsed-wave Doppler sample volume. Following LAA isolation, the proportion of patients who experienced a cerebrovascular event while off oral anticoagulation due to the misclassification of their LAA mechanical function was 70% (7/10 [95% CI, 40%-89%]). CONCLUSIONS Underdiagnosis of LAA mechanical dysfunction is common in TEEs performed following LAA electrical isolation, and it is associated with an increased risk of cerebrovascular events owing to oral anticoagulation discontinuation despite absent/reduced LAA contraction. Careful review of the TEE exam by an operator with specific expertise in LAA imaging and familiar with the functional implications of LAA isolation is necessary before interrupting oral anticoagulation in this cohort.
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Affiliation(s)
- Carola Gianni
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Qiong Chen
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.).,Department of Cardiopulmonary Function Test, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, China (Q.C.)
| | - Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Mohamed A Bassiouny
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - G Joseph Gallinghouse
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.).,Department of Biomedical Engineering, University of Texas, Austin (R.P.H.)
| | - Patrick M Hranitzky
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Jorge E Romero
- Electrophysiology (J.E.R., L.D.B., A.N.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.).,Electrophysiology (J.E.R., L.D.B., A.N.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.,Department of Clinical and Experimental Medicine, University of Foggia, Italy (L.D.B.)
| | - Mario J Garcia
- Division of Cardiology (M.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.).,Electrophysiology (J.E.R., L.D.B., A.N.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.,HCA Healthcare, Nashville, TN (A.N.).,Interventional Electrophysiology, Scripps Clinic, La Jolla, CA (A.N.).,Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH (A.N.)
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Hernández-Camba A, Arranz L, Vera I, Carpio D, Calafat M, Lucendo AJ, Taxonera C, Marín S, Garcia MJ, Marín GS, Rodríguez ES, Carbajo AY, De Castro ML, Iborra M, Martin-Cardona A, Rodríguez-Lago I, Busquets D, Bertoletti F, Ausín MS, Tardillo C, Malaves JH, Bujanda L, Castaño A, Domènech E, Ramos L. Real-world use of mycophenolate mofetil in inflammatory bowel disease: Results from the ENEIDA registry. Dig Liver Dis 2022; 54:635-641. [PMID: 34862115 DOI: 10.1016/j.dld.2021.10.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/22/2021] [Accepted: 10/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Studies to evaluate the use of mycophenolate mofetil (MMF) in inflammatory bowel disease (IBD) are limited after the appearance of biological treatments. AIMS Our primary objective was to evaluate the effectiveness and safety of MMF in IBD. METHODS IBD patients who had received MMF were retrieved from the ENEIDA registry. Clinical activity as per the Harvey-Bradshaw Index (HBI), partial Mayo score (pMS), physician global assessment (PGA) and C-reactive protein (CRP) were reviewed at baseline, at 3 and 6 months, and at final follow-up. Adverse events and causes of treatment discontinuation were documented. RESULTS A total of 83 patients were included (66 Crohn's disease, 17 ulcerative colitis), 90% of whom had previously received other immunosuppressants. In 61% of patients systemic steroids were used at initiation of MMF, and in 27.3% biological agents were co-administered with MMF. Overall clinical effectiveness was observed in 64.7% of the population. At the end of treatment, 45.6% and 19.1% of subjects showed remission and clinical response, respectively. MMF treatment was maintained for a median of 28.9 months (IQR: 20.4-37.5). CONCLUSION Our study suggests, in the largest cohort to date, that MMF may be an effective alternative to thiopurines and methotrexate in IBD.
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Affiliation(s)
- A Hernández-Camba
- Hospital Universitario Nuestra Señora de la Candelaria, Gastroenterology Dept., Santa Cruz de Tenerife, Spain.
| | - L Arranz
- Hospital Universitario Nuestra Señora de la Candelaria, Gastroenterology Dept., Santa Cruz de Tenerife, Spain
| | - I Vera
- Hospital Universitario Puerta de Hierro Majadahonda, Gastroenterology Dept., Madrid, Spain
| | - D Carpio
- Complexo Hospitalario Universitario de Pontevedra, Gastroenterology Dept., Pontevedra, Spain. Instituto de Investigación Sanitaria Galicia Sur
| | - M Calafat
- Hospital Universitario Germans Trias i Pujol, Gastroenterology Dept., Badalona, and CIBEREHD, Madrid, Spain
| | - A J Lucendo
- Hospital General de Tomelloso, Gastroenterology Dept., Tomelloso, and CIBEREHD, Spain
| | - C Taxonera
- Hospital Clínico Universitario San Carlos, Gastroenterology Dept., Madrid, Spain
| | - S Marín
- Hospital Reina Sofía, Gastroenterology Dept., Córdoba, Spain
| | - M J Garcia
- Hospital Universitario Marqués de Valdecilla, IDIVAL, Gastroenterology Dept., Santander, Spain
| | - G Suris Marín
- Hospital Universitari de Bellvitge, Gastroenterology Dept., Barcelona, Spain
| | | | - A Y Carbajo
- Hospital Universitario Río Hortega, Gastroenterology Dept., Valladolid, Spain
| | - M L De Castro
- Complexo H. Universitario de Vigo, Gastroenterology Dept., Vigo, Spain
| | - M Iborra
- Hospital Universitari La Fe de Valencia and CIBEREHD, Gastroenterology Dept., Valencia, Spain
| | - A Martin-Cardona
- Hospital Universitari Mútua Terrassa and CIBEREHD, Gastroenterology Dept., Barcelona, Spain
| | - I Rodríguez-Lago
- Hospital General de Tomelloso, Gastroenterology Dept., Tomelloso, and CIBEREHD, Spain; Hospital de Galdakao, Gastroenterology Dept., and Biocruces Bizkaia Health Research Institute, Galdakao, Spain
| | - D Busquets
- Hospital Universitari Dr. Josep Trueta, Gastroenterology Dept., Girona, Spain
| | - F Bertoletti
- Hospital de la Santa Creu i Sant Pau, Gastroenterology Dept., Barcelona, Spain
| | - M Sierra Ausín
- Complejo Asistencial Universitario de León, Gastroenterology Dept., León, Spain
| | - C Tardillo
- Hospital Universitario Nuestra Señora de la Candelaria, Gastroenterology Dept., Santa Cruz de Tenerife, Spain
| | - J Huguet Malaves
- Hospital General Universitario de Valencia, Gastroenterology Dept., Valencia, Spain
| | - L Bujanda
- Hospital Universitario de Donostia - Instituto Biodonostia - Universidad del País Vasco UPV/EHU- and CIBEREHD, Gastroenterology Dept., Donostia, Spain
| | - A Castaño
- Hospital Universitario Central de Asturias, Gastroenterology Dept., Oviedo, Spain
| | - E Domènech
- Hospital Universitario Germans Trias i Pujol, Gastroenterology Dept., Badalona, and CIBEREHD, Madrid, Spain
| | - L Ramos
- Hospital Universitario de Canarias, Gastroenterology Dept., La Laguna, Spain
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Wieske V, Walther M, Dubourg B, Alkadhi H, Nørgaard BL, Meijs MFL, Diederichsen ACP, Wan YL, Mickley H, Nikolaou K, Shabestari AA, Halvorsen BA, Martuscelli E, Sun K, Herzog BA, Marcus RP, Leschka S, Garcia MJ, Ovrehus KA, Knuuti J, Mendoza-Rodriguez V, Bettencourt N, Muraglia S, Buechel RR, Kaufmann PA, Zimmermann E, Tardif JC, Budoff MJ, Schlattmann P, Dewey M. Correction to: Computed tomography angiography versus Agatston score for diagnosis of coronary artery disease in patients with stable chest pain: individual patient data meta-analysis of the international COME-CCT Consortium. Eur Radiol 2022; 32:8052-8053. [PMID: 35467114 DOI: 10.1007/s00330-022-08760-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Viktoria Wieske
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Mario Walther
- Department of Fundamental Sciences, Jena University of Applied Sciences, Jena, Germany
| | - Benjamin Dubourg
- Cardiac Imaging Unit, Department of Radiology, Rouen University Hospital, Rouen, France
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Matthijs F L Meijs
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, Netherlands
| | | | - Yung-Liang Wan
- Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Chang Gung Memorial Hospital at Linkou, Taoyaun City, Taiwan
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Abbas A Shabestari
- Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Eugenio Martuscelli
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Kai Sun
- Department of Radiology, Baotou Central Hospital, Baotou, Inner Mongolia Province, China
| | | | - Roy P Marcus
- Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Sebastian Leschka
- Department of Radiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Mario J Garcia
- Department of Cardiology, Montefiore, University Hospital for the Albert Einstein College of Medicine, New York, NY, USA
| | | | - Juhani Knuuti
- Turku University Hospital and University of Turku, Turku, Finland
| | | | - Nuno Bettencourt
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | | | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Elke Zimmermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | | | | | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Data Science, University Hospital of Friedrich Schiller University Jena, Jena, Germany
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Edvardsen T, Asch FM, Davidson B, Delgado V, DeMaria A, Dilsizian V, Gaemperli O, Garcia MJ, Kamp O, Lee DC, Neglia D, Neskovic AN, Pellikka PA, Plein S, Sechtem U, Shea E, Sicari R, Villines TC, Lindner JR, Popescu BA. Non-Invasive Imaging in Coronary Syndromes: Recommendations of The European Association of Cardiovascular Imaging and the American Society of Echocardiography, in Collaboration with The American Society of Nuclear Cardiology, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2022; 35:329-354. [PMID: 35379446 DOI: 10.1016/j.echo.2021.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Indexed: 12/18/2022]
Affiliation(s)
- Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway.
| | - Federico M Asch
- MedStar Health Research Institute, Georgetown University, Washington, District of Columbia
| | - Brian Davidson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; VA Portland Health Care System, Portland, Oregon
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Maryland
| | | | - Mario J Garcia
- Division of Cardiology, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, New York
| | - Otto Kamp
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Daniel C Lee
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Danilo Neglia
- Department of Cardiology, Istituto di Scienze della Vita Scuola Superiore Sant'Anna - Pisa, Pisa, Italy
| | - Aleksandar N Neskovic
- Faculty of Medicine, Department of Cardiology, Clinical Hospital Center Zemun, University of Belgrade, Belgrade, Serbia
| | - Patricia A Pellikka
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Rochester, Minnesota
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Udo Sechtem
- Cardiologicum Stuttgart and Department of Cardiology, Robert Bosch Krankenhaus, Stuttgart, Germany
| | - Elaine Shea
- Alta Bates Summit Medical Center, Berkeley and Oakland, Berkeley, California
| | - Rosa Sicari
- CNR, Institute of Clinical Physiology, Pisa, Italy
| | - Todd C Villines
- Division of Cardiovascular Medicine, University of Virginia Health System, University of Virginia Health Center, Charlottesville, Virginia
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
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Wieske V, Walther M, Dubourg B, Alkadhi H, Nørgaard BL, Meijs MFL, Diederichsen ACP, Wan YL, Mickley H, Nikolaou K, Shabestari AA, Halvorsen BA, Martuscelli E, Sun K, Herzog BA, Marcus RP, Leschka S, Garcia MJ, Ovrehus KA, Knuuti J, Mendoza-Rodriguez V, Bettencourt N, Muraglia S, Buechel RR, Kaufmann PA, Zimmermann E, Tardif JC, Budoff MJ, Schlattmann P, Dewey M. Computed tomography angiography versus Agatston score for diagnosis of coronary artery disease in patients with stable chest pain: individual patient data meta-analysis of the international COME-CCT Consortium. Eur Radiol 2022; 32:5233-5245. [PMID: 35267094 PMCID: PMC9279219 DOI: 10.1007/s00330-022-08619-4] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/05/2022] [Accepted: 01/28/2022] [Indexed: 11/29/2022]
Abstract
Objectives There is conflicting evidence about the comparative diagnostic accuracy of the Agatston score versus computed tomography angiography (CTA) in patients with suspected obstructive coronary artery disease (CAD). Purpose To determine whether CTA is superior to the Agatston score in the diagnosis of CAD. Methods In total 2452 patients with stable chest pain and a clinical indication for invasive coronary angiography (ICA) for suspected CAD were included by the Collaborative Meta-analysis of Cardiac CT (COME-CCT) Consortium. An Agatston score of > 400 was considered positive, and obstructive CAD defined as at least 50% coronary diameter stenosis on ICA was used as the reference standard. Results Obstructive CAD was diagnosed in 44.9% of patients (1100/2452). The median Agatston score was 74. Diagnostic accuracy of CTA for the detection of obstructive CAD (81.1%, 95% confidence interval [CI]: 77.5 to 84.1%) was significantly higher than that of the Agatston score (68.8%, 95% CI: 64.2 to 73.1%, p < 0.001). Among patients with an Agatston score of zero, 17% (101/600) had obstructive CAD. Diagnostic accuracy of CTA was not significantly different in patients with low to intermediate (1 to < 100, 100–400) versus moderate to high Agatston scores (401–1000, > 1000). Conclusions Results in our international cohort show CTA to have significantly higher diagnostic accuracy than the Agatston score in patients with stable chest pain, suspected CAD, and a clinical indication for ICA. Diagnostic performance of CTA is not affected by a higher Agatston score while an Agatston score of zero does not reliably exclude obstructive CAD. Key Points • CTA showed significantly higher diagnostic accuracy (81.1%, 95% confidence interval [CI]: 77.5 to 84.1%) for diagnosis of coronary artery disease when compared to the Agatston score (68.8%, 95% CI: 64.2 to 73.1%, p < 0.001). • Diagnostic performance of CTA was not affected by increased amount of calcium and was not significantly different in patients with low to intermediate (1 to <100, 100–400) versus moderate to high Agatston scores (401–1000, > 1000). • Seventeen percent of patients with an Agatston score of zero showed obstructive coronary artery disease by invasive angiography showing absence of coronary artery calcium cannot reliably exclude coronary artery disease. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-022-08619-4.
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Affiliation(s)
- Viktoria Wieske
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Mario Walther
- Department of Fundamental Sciences, Jena University of Applied Sciences, Jena, Germany
| | - Benjamin Dubourg
- Cardiac Imaging Unit, Department of Radiology, Rouen University Hospital, Rouen, France
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Matthijs F L Meijs
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, Netherlands
| | | | - Yung-Liang Wan
- Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Chang Gung Memorial Hospital at Linkou, Taoyaun City, Taiwan
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Abbas A Shabestari
- Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Eugenio Martuscelli
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Kai Sun
- Department of Radiology, Baotou Central Hospital, Baotou, Inner Mongolia Province, China
| | | | - Roy P Marcus
- Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Sebastian Leschka
- Department of Radiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Mario J Garcia
- Department of Cardiology, Montefiore, University Hospital for the Albert Einstein College of Medicine, New York, NY, USA
| | | | - Juhani Knuuti
- Turku University Hospital and University of Turku, Turku, Finland
| | | | - Nuno Bettencourt
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | | | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Elke Zimmermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | | | | | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Data Science, University Hospital of Friedrich Schiller University Jena, Jena, Germany
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Castagna F, Miles J, Leiderman E, Arce J, Neshiwat P, Ippolito P, Schenone A, Zhang L, Rodriguez CJ, Levsky J, Garcia MJ, Slipczuk L. RISK STRATIFICATION BY CORONARY ARTERY CALCIFICATION IN PATIENTS WITH LDL>190 MG/DL. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02191-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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Castagna F, Xue X, Saeed O, Kataria R, Puius YA, Patel SR, Garcia MJ, Racine AD, Sims DB, Jorde UP. Hospital bed occupancy rate is an independent risk factor for COVID-19 inpatient mortality: a pandemic epicentre cohort study. BMJ Open 2022; 12:e058171. [PMID: 35168984 PMCID: PMC8852235 DOI: 10.1136/bmjopen-2021-058171] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 01/26/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION COVID-19 first struck New York City in the spring of 2020, resulting in an unprecedented strain on our healthcare system and triggering multiple changes in public health policy governing hospital operations as well as therapeutic approaches to COVID-19. We examined inpatient mortality at our centre throughout the course of the pandemic. METHODS This is a retrospective chart review of clinical characteristics, treatments and outcome data of all patients admitted with COVID-19 from 1 March 2020 to 28 February 2021. Patients were grouped into 3-month quartiles. Hospital strain was assessed as per cent of occupied beds based on a normal bed capacity of 1491. RESULTS Inpatient mortality decreased from 25.0% in spring to 10.8% over the course of the year. During this time, use of remdesivir, steroids and anticoagulants increased; use of hydroxychloroquine and other antibiotics decreased. Daily bed occupancy ranged from 62% to 118%. In a multivariate model with all year's data controlling for demographics, comorbidities and acuity of illness, percentage of bed occupancy was associated with increased 30-day in-hospital mortality of patients with COVID-19 (0.7% mortality increase for each 1% increase in bed occupancy; HR 1.007, CI 1.001 to 1.013, p=0.004) CONCLUSION: Inpatient mortality from COVID-19 was associated with bed occupancy. Early reduction in epicentre hospital bed occupancy to accommodate acutely ill and resource-intensive patients should be a critical component in the strategic planning for future pandemics.
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Affiliation(s)
- Francesco Castagna
- Albert Einstein College of Medicine, Bronx, New York, USA
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Omar Saeed
- Albert Einstein College of Medicine, Bronx, New York, USA
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Rachna Kataria
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yoram A Puius
- Albert Einstein College of Medicine, Bronx, New York, USA
- Division of Infectious Diseases, Montefiore Medical Center, Bronx, New York, USA
| | - Snehal R Patel
- Albert Einstein College of Medicine, Bronx, New York, USA
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Mario J Garcia
- Albert Einstein College of Medicine, Bronx, New York, USA
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Andrew D Racine
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Pediatrics, Montefiore Medical Center, Bronx, New York, USA
| | - Daniel B Sims
- Albert Einstein College of Medicine, Bronx, New York, USA
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Ulrich P Jorde
- Albert Einstein College of Medicine, Bronx, New York, USA
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
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Adlam D, Zarebinski M, Uren NG, Ptaszynski P, Oldroyd KG, Munir S, Zaman A, Contractor H, Kiss RG, Édes I, Szachniewicz J, Nagy GG, Garcia MJ, Tomcsanyi J, Irving J, Sharp ASP, Musialek P, Lupkovics G, Shirodaria C, Selvanayagam JB, Quinn P, Ng L, Roth M, Insko MA, Haber B, Hill S, Siegel L, Tulloch S, Channon KM. A Randomized, double-blind, dose ranging clinical trial of intravenous FDY-5301 in acute STEMI patients undergoing primary PCI. Int J Cardiol 2022; 347:1-7. [PMID: 34774885 DOI: 10.1016/j.ijcard.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 08/31/2021] [Accepted: 11/07/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Ischemia-reperfusion injury remains a major clinical problem in patients with ST-elevation myocardial infarction (STEMI), leading to myocardial damage despite early reperfusion by primary percutaneous coronary intervention (PPCI). There are no effective therapies to limit ischemia-reperfusion injury, which is caused by multiple pathways activated by rapid tissue reoxygenation and the generation of reactive oxygen species (ROS). FDY-5301 contains sodium iodide, a ubiquitous inorganic halide and elemental reducing agent that can act as a catalytic anti-peroxidant. We tested the feasibility, safety and potential utility of FDY-5301 as a treatment to limit ischemia-reperfusion injury, in patients with first-time STEMI undergoing emergency PPCI. METHODS STEMI patients (n = 120, median 62 years) presenting within 12 h of chest pain onset were randomized at 20 PPCI centers, in a double blind Phase 2 clinical trial, to receive FDY-5301 (0.5, 1.0 or 2.0 mg/kg) or placebo prior to reperfusion, to evaluate the feasibility endpoints. Participants underwent continuous ECG monitoring for 14 days after PPCI to address pre-specified cardiac arrhythmia safety end points and cardiac magnetic resonance imaging (MRI) at 72 h and at 3 months to assess exploratory efficacy end points. RESULTS Intravenous FDY-5301 was delivered before re-opening of the infarct-related artery in 97% participants and increased plasma iodide levels ~1000-fold within 2 min. There was no significant increase in the primary safety end point of incidence of cardiac arrhythmias of concern. MRI at 3 months revealed median final infarct sizes in placebo vs. 2.0 mg/kg FDY-5301-treated patients of 14.9% vs. 8.5%, and LV ejection fractions of 53.9% vs. 63.2%, respectively, although the study was not powered to detect statistical significance. In patients receiving FDY-5301, there was a significant reduction in the levels of MPO, MMP2 and NTproBNP after PPCI, but no reduction with placebo. CONCLUSIONS Intravenous FDY-5301, delivered immediately prior to PPCI in acute STEMI, is feasible, safe, and shows potential efficacy. A larger trial is justified to test the effects of FDY-5301 on acute ischemia-reperfusion injury and clinical outcomes. CLINICAL TRIAL REGISTRATION CT.govNCT03470441; EudraCT 2017-000047-41.
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Affiliation(s)
- David Adlam
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, UK
| | - Maciej Zarebinski
- Invasive Cardiology Dept. Western Hospital, Grodzisk Mazowiecki, Poland
| | - Neal G Uren
- Edinburgh Heart Centre, Royal Infirmary, Edinburgh, UK
| | - Pawel Ptaszynski
- Department of Electrocardiology, Medical University of Lodz, Poland; Central University Hospital, Lodz, Poland
| | - Keith G Oldroyd
- West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Shahzad Munir
- Cardiology Department, Wolverhampton Heart and Lung Centre, New Cross Hospital, Wolverhampton Road, Wolverhampton, UK
| | - Azfar Zaman
- Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - Hussain Contractor
- Department of Cardiovascular Medicine, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | | | - István Édes
- Department of Cardiology, Debrecen University, Debrecen, Hungary
| | | | - Gergely Gyorgy Nagy
- Borsod-Abauj-Zemplen County Central Hospital and University Teaching Hospital, 1st Department of Internal Medicine and Cardiology, Miskolc, Hungary
| | - Mario J Garcia
- Division of Cardiology, Montefiore Medical Center, Bronx, NY, USA
| | - János Tomcsanyi
- Department of Cardiology, St. John of Brother of God Hospital, Budapest, Hungary
| | - John Irving
- Department of Cardiology, Ninewells Hospital, Dundee, UK
| | | | - Piotr Musialek
- Jagiellonian University Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Géza Lupkovics
- Department of Cardiology, St. Raphael Hospital of Zala County, Zalaegerszeg, Hungary
| | | | - Joseph B Selvanayagam
- Flinders University and South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Pauline Quinn
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, UK
| | - Leong Ng
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, UK
| | - Mark Roth
- Faraday Pharmaceuticals Inc., Seattle, USA
| | | | - Ben Haber
- Faraday Pharmaceuticals Inc., Seattle, USA
| | | | | | | | - Keith M Channon
- Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, National Institute for Health (NIHR) Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust and University of Oxford, John Radcliffe Hospital, Oxford, UK.
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Aguilar F, Lo KB, Quintero EE, Torres RJ, Hung WA, Albano JC, Alviz I, Rodriguez C, Garcia MJ, Romero J, Slipczuk L. Off-label direct oral anticoagulants dosing in atrial fibrillation and venous thromboembolism is associated with higher mortality. Expert Rev Cardiovasc Ther 2021; 19:1119-1126. [PMID: 34879208 DOI: 10.1080/14779072.2021.2013816] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Direct oral anticoagulants (DOAC) off-label use data is lacking. Our study aimed to assess the clinical outcomes in a racially mixed population treated for atrial fibrillation (AF) and venous thromboembolism (VTE). METHODS We retrospectively evaluated six months of DOAC prescriptions for AF or VTE treatment. Prescriptions were classified as off-label or appropriate following FDA labeling. The off-label group was sub-classified as under or overdosing. RESULTS Of the 1,087 DOAC prescriptions, 67% were for AF. African Americans and Caucasians were equally represented. There were 171 (16%) inappropriate prescriptions, with 106 (62%), being underdosed. The off-label group had a higher 30-day readmissions risk (OR = 1.69, 95% CI:1.11-2.54, p = 0.012) and 1-year all-cause mortality (OR = 1.90, 95% CI:1.02-3.37, p = 0.032). There was no difference in major bleeding (OR = 1.27, 95% CI:0.63-2.37, p = 0.480) or new thromboembolism (OR = 1.27, 95% CI:0.73-2.13, p = 0.369) between the groups. Underdosing carried a higher risk of new thromboembolism (OR = 3.15, 95% CI:1.09-9.15, p = 0.024). CONCLUSIONS One in every six patients received off-label DOACs dosing. Off-label use had increased 30-day readmissions and 1-year all-cause mortality. Underdosing was associated with a higher risk of new thromboembolism.
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Affiliation(s)
- Francisco Aguilar
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Kevin B Lo
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | | | - Ricardo J Torres
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Wikien A Hung
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Jeri C Albano
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Isabella Alviz
- Division of Cardiology, Montefiore Medical Center, Bronx, NY, USA
| | - Carlos Rodriguez
- Division of Cardiology, Montefiore Medical Center, Bronx, NY, USA
| | - Mario J Garcia
- Division of Cardiology, Montefiore Medical Center, Bronx, NY, USA
| | - Jorge Romero
- Division of Cardiology, Montefiore Medical Center, Bronx, NY, USA
| | - Leandro Slipczuk
- Division of Cardiology, Montefiore Medical Center, Bronx, NY, USA
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Kataria R, Castagna F, Madan S, Kim P, Saeed O, Adjepong YA, Melainis AA, Taub C, Garcia MJ, Latib A, Jorde UP. Severity of Functional Mitral Regurgitation on Admission for Acute Decompensated Heart Failure Predicts Long-Term Risk of Rehospitalization and Death. J Am Heart Assoc 2021; 11:e022908. [PMID: 34935442 PMCID: PMC9075195 DOI: 10.1161/jaha.121.022908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Functional mitral regurgitation (FMR) has emerged as a therapeutic target in patients with chronic heart failure and left ventricular systolic dysfunction. The significance of FMR in acute decompensated heart failure remains obscure. We systematically investigated the prevalence and clinical significance of FMR on admission in patients admitted with acute decompensated heart failure and left ventricular systolic dysfunction. Methods and Results The study was a single‐center, retrospective review of patients admitted with acute decompensated heart failure and left ventricular systolic dysfunction between 2012 and 2017. Patients were divided into 3 groups of FMR: none/mild, moderate, and moderate‐to‐severe/severe FMR. The primary outcome was 1‐year post‐discharge all‐cause mortality. We also compared these groups for 6‐month heart failure hospitalization rates. Of 2303 patients, 39% (896) were women. Median left ventricular ejection fraction was 25%. Four hundred and fifty‐three (20%) patients had moderate‐to‐severe/severe FMR, which was independently associated with 1‐year all‐cause mortality. Moderate or worse FMR was found in 1210 (53%) patients and was independently associated with 6‐month heart failure hospitalization. Female sex was independently associated with higher severity of FMR. Conclusions More than half of patients hospitalized with acute decompensated heart failure and left ventricular systolic dysfunction had at least moderate FMR, which was associated with increased readmission rates and mortality. Intensified post‐discharge follow‐up should be undertaken to eliminate FMR amenable to pharmacological therapy and enable timely and appropriate intervention for persistent FMR. Further studies are needed to examine sex‐related disparities in FMR.
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Affiliation(s)
- Rachna Kataria
- Montefiore-Einstein Heart and Vascular CenterMontefiore Medical Center and Albert Einstein College of Medicine Bronx NY
| | - Francesco Castagna
- Montefiore-Einstein Heart and Vascular CenterMontefiore Medical Center and Albert Einstein College of Medicine Bronx NY
| | - Shivank Madan
- Montefiore-Einstein Heart and Vascular CenterMontefiore Medical Center and Albert Einstein College of Medicine Bronx NY
| | - Paul Kim
- Montefiore-Einstein Heart and Vascular CenterMontefiore Medical Center and Albert Einstein College of Medicine Bronx NY
| | - Omar Saeed
- Montefiore-Einstein Heart and Vascular CenterMontefiore Medical Center and Albert Einstein College of Medicine Bronx NY
| | - Yaw A Adjepong
- Department of Medicine Yale School of Medicine New Haven CT
| | - Angelos A Melainis
- Division of Medicine Jacobi Medical CenterAlbert Einstein College of Medicine Bronx NY
| | - Cynthia Taub
- Section of Cardiovascular Medicine Dartmouth-Hitchcock Medical Center Lebanon NH
| | - Mario J Garcia
- Montefiore-Einstein Heart and Vascular CenterMontefiore Medical Center and Albert Einstein College of Medicine Bronx NY
| | - Azeem Latib
- Montefiore-Einstein Heart and Vascular CenterMontefiore Medical Center and Albert Einstein College of Medicine Bronx NY
| | - Ulrich P Jorde
- Montefiore-Einstein Heart and Vascular CenterMontefiore Medical Center and Albert Einstein College of Medicine Bronx NY
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Edvardsen T, Asch FM, Davidson B, Delgado V, DeMaria A, Dilsizian V, Gaemperli O, Garcia MJ, Kamp O, Lee DC, Neglia D, Neskovic AN, Pellikka PA, Plein S, Sechtem U, Shea E, Sicari R, Villines TC, Lindner JR, Popescu BA. Non-invasive Imaging in Coronary Syndromes - Recommendations of the European Association of Cardiovascular Imaging and the American Society of Echocardiography, in Collaboration with the American Society of Nuclear Cardiology, Society of Cardiovascular Computed Tomography and Society for Cardiovascular Magnetic Resonance. Eur Heart J Cardiovasc Imaging 2021; 23:e6-e33. [PMID: 34751391 DOI: 10.1093/ehjci/jeab244] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 11/14/2022] Open
Abstract
Coronary artery disease (CAD) is one of the major causes of mortality and morbidity worldwide, with a high socioeconomic impact.(1) Non-invasive imaging modalities play a fundamental role in the evaluation and management of patients with known or suspected CAD. Imaging end-points have served as surrogate markers in many observational studies and randomized clinical trials that evaluated the benefits of specific therapies for CAD.(2) A number of guidelines and recommendations have been published about coronary syndromes by cardiology societies and associations, but have not focused on the excellent opportunities with cardiac imaging. The recent European Society of Cardiology (ESC) 2019 guideline on chronic coronary syndromes (CCS) and 2020 guideline on acute coronary syndromes in patients presenting with non-ST-segment elevation (NSTE-ACS) highlight the importance of non-invasive imaging in the diagnosis, treatment, and risk assessment of the disease.(3)(4) The purpose of the current recommendations is to present the significant role of non-invasive imaging in coronary syndromes in more detail. These recommendations have been developed by the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE), in collaboration with the American Society of Nuclear Cardiology, the Society of Cardiovascular Computed Tomography, and the Society for Cardiovascular Magnetic Resonance, all of which have approved the final document.
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Affiliation(s)
- Thor Edvardsen
- Dept of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo Norway, and University of Oslo, Norway
| | - Federico M Asch
- MedStar Health Research Institute, Georgetown University, Washington, DC, . USA
| | - Brian Davidson
- Knight Cardiovascular Institute, Oregon Health & Science University; VA Portland Health Care System, Portland, OR, USA
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, 2300RC, Leiden, The Netherlands
| | | | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, USA
| | | | - Mario J Garcia
- Division of Cardiology, Montefiore-Einstein Center for Heart and Vascular Care, 111 East 210th Street, Bronx, New York, 10467, USA
| | - Otto Kamp
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, The Netherlands
| | - Daniel C Lee
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Danilo Neglia
- Department of Cardiology, Fondazione Toscana G. Monastrerio, Pisa, Italy
| | - Aleksandar N Neskovic
- Dept of Cardiology, Clinical Hospital Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Patricia A Pellikka
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Udo Sechtem
- Cardiologicum Stuttgart and Department of Cardiology, Robert Bosch Krankenhaus, Stuttgart, Germany
| | - Elaine Shea
- Alta Bates Summit Medical Center, Berkeley and Oakland, California, ., USA
| | - Rosa Sicari
- CNR, Institute of Clinical Physiology, Pisa and Milan, Italy
| | - Todd C Villines
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Jonathan R Lindner
- Knight Cardiovascular Institute and Oregon National Primate Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila" - Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
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Shitole SG, Lazar JM, Hanna DB, Kim RS, Anastos K, Garcia MJ, Tien PC, Lima JAC, Kaplan RC, Kizer JR. HIV, hepatitis C virus and risk of new-onset left ventricular dysfunction in women. AIDS 2021; 35:1647-1655. [PMID: 33859109 PMCID: PMC8286303 DOI: 10.1097/qad.0000000000002920] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND HIV and HCV have each been linked with cardiac dysfunction. Studies of HIV have often lacked appropriate controls and primarily involved men, whereas data for HCV are sparse. METHODS We performed repeat echocardiography over a median interval of 12 years in participants from the Women's Interagency HIV Study in order to evaluate the relationships of HIV and HCV with incident left ventricular (LV) dysfunction (systolic or diastolic). RESULTS Of the 311 women included (age 39 ± 9), 70% were HIV-positive and 20% HCV-positive. Forty three participants (13.8%) developed LV dysfunction, of which 79.1% was diastolic. Compared with participants with neither infection, the group with HIV--HCV coinfection showed a significantly increased risk of incident LV dysfunction after adjustment for risk factors [RR = 2.96 (95% CI = 1.05-8.31)], but associations for the HCV monoinfected and HIV monoinfected groups were not statistically significant [RR = 2.54 (0.83-7.73) and RR = 1.66 (0.65-4.25), respectively]. Comparison of HCV-positive and HCV-negative women showed a significantly increased risk independent of covariates [RR = 1.96 (1.02-3.77)] but this was not the case for HIV-positive vs. HIV-negative women [RR = 1.43 (0.76-2.69)]. There was no evidence of HCV-by-HIV interaction. A more restrictive definition of LV diastolic dysfunction led to fewer incident cases, but a similar, though nonsignificant, risk estimate for HCV. CONCLUSION Among mostly middle-aged women, HCV but not HIV infection was associated with a pronounced risk of incident LV dysfunction. Although the influence of residual confounding cannot be excluded, these findings bolster the potential benefits that could be realized by adopting recent recommendations for expanding HCV screening and treatment.
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Affiliation(s)
- Sanyog G Shitole
- Cardiology Section, San Francisco VA Healthcare System and Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Jason M Lazar
- Division of Cardiology, Department of Medicine, State University of New York Health Science Center - Brooklyn, Brooklyn
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine
| | - Ryung S Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine
| | - Kathryn Anastos
- Division of General Internal Medicine, Department of Medicine
| | - Mario J Garcia
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Health System, Bronx, NY
| | - Phyllis C Tien
- Section of Infectious Diseases, San Francisco VA Healthcare System, and Departments of Medicine and Clinical Pharmacy, University of California San Francisco, San Francisco, CA
| | - João A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jorge R Kizer
- Cardiology Section, San Francisco VA Healthcare System and Department of Medicine, University of California San Francisco, San Francisco, CA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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Slipczuk L, Castagna F, Schonberger A, Novogrodsky E, Dey D, Jorde UP, Levsky JM, Di Biase L, Garcia MJ. Incidence of new-onset atrial fibrillation in COVID-19 is associated with increased epicardial adipose tissue. J Interv Card Electrophysiol 2021; 64:383-391. [PMID: 34231098 PMCID: PMC8260236 DOI: 10.1007/s10840-021-01029-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/24/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Coronary artery calcium (CAC) and epicardial adipose tissue (EAT) can predict AF in the general population. We aimed to determine if CAC and EAT measured by computed tomographic (CT) scanning can predict new-onset AF in patients admitted with COVID-19 disease. METHODS We performed a retrospective, post hoc analysis of all patients admitted to Montefiore Medical Center with a confirmed COVID-19 diagnosis from March 1st to June 23rd, 2020, who had a non-contrast CT of the chest within 5 years prior to admission. We determined ordinal CAC scores and quantified the EAT volume and examined their relationship with inpatient mortality. RESULTS A total of 379 patients were analyzed. There were 16 events of new-onset AF (4.22%). Patients who developed AF during the index admission were more likely to be male (75 vs 47%, p < 0.001) and had higher EAT (129.5 [76.3-197.3] vs 91.0 [60.0-129.0] ml, p = 0.049). There were no differences on age (68 [56-71] vs 68 [58-76] years; p = 0.712), BMI (28.5 [25.3-30.8] vs 26.9 [23.1-31.8] kg/m2; p = 0.283), ordinal CAC score (3 [1-6] vs 2 [0-4]; p = 0.482), or prevalence of diabetes (56.3 vs 60.1%; p = 0.761), hypertension (75.0 vs 87.3%, p = 0.153), or coronary artery disease (50.0 vs 39.4%, p = 0.396). Patients with new-onset AF had worse clinical outcomes (death/intubation/vasopressors) (87.5 vs 44.1%; p = 0.001). CONCLUSION Increased EAT measured by non-contrast chest CT identifies patients hospitalized with COVID-19 at higher risk of developing new-onset AF. Patients with new-onset AF have worse clinical outcomes.
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Affiliation(s)
- Leandro Slipczuk
- Cardiology Division, Montefiore Medical Center, 111 E 210th, Bronx, NY, 10467, USA. .,Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Francesco Castagna
- Cardiology Division, Montefiore Medical Center, 111 E 210th, Bronx, NY, 10467, USA
| | | | | | - Damini Dey
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ulrich P Jorde
- Cardiology Division, Montefiore Medical Center, 111 E 210th, Bronx, NY, 10467, USA.,Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jeffrey M Levsky
- Albert Einstein College of Medicine, Bronx, NY, USA.,Radiology Division, Montefiore Medical Center, Bronx, NY, USA
| | - Luigi Di Biase
- Cardiology Division, Montefiore Medical Center, 111 E 210th, Bronx, NY, 10467, USA.,Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mario J Garcia
- Cardiology Division, Montefiore Medical Center, 111 E 210th, Bronx, NY, 10467, USA.,Albert Einstein College of Medicine, Bronx, NY, USA.,Radiology Division, Montefiore Medical Center, Bronx, NY, USA
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Slipczuk L, Castagna F, Schonberger A, Novogrodsky E, Sekerak R, Dey D, Jorde UP, Levsky JM, Garcia MJ. Coronary artery calcification and epicardial adipose tissue as independent predictors of mortality in COVID-19. Int J Cardiovasc Imaging 2021; 37:3093-3100. [PMID: 33978937 PMCID: PMC8113796 DOI: 10.1007/s10554-021-02276-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/03/2021] [Indexed: 12/17/2022]
Abstract
Recent epidemiological studies have demonstrated that common cardiovascular risk factors are strongly associated with adverse outcomes in COVID-19. Coronary artery calcium (CAC) and epicardial fat (EAT) have shown to outperform traditional risk factors in predicting cardiovascular events in the general population. We aim to determine if CAC and EAT determined by Computed Tomographic (CT) scanning can predict all-cause mortality in patients admitted with COVID-19 disease. We performed a retrospective, post-hoc analysis of all patients admitted to Montefiore Medical Center with a confirmed COVID-19 diagnosis from March 1st, 2020 to May 2nd, 2020 who had a non-contrast CT of the chest within 5 years prior to admission. We determined ordinal CAC scores and quantified the epicardial (EAT) and thoracic (TAT) fat volume and examined their relationship with inpatient mortality. A total of 493 patients were analyzed. There were 197 deaths (39.95%). Patients who died during the index admission had higher age (72, [64–80] vs 68, [57–76]; p < 0.001), CAC score (3, [0–6] vs 1, [0–4]; p < 0.001) and EAT (107, [70–152] vs 94, [64–129]; p = 0.023). On a competing risk analysis regression model, CAC ≥ 4 and EAT ≥ median (98 ml) were independent predictors of mortality with increased mortality of 63% (p = 0.003) and 43% (p = 0.032), respectively. As a composite, the group with a combination of CAC ≥ 4 and EAT ≥ 98 ml had the highest mortality. CAC and EAT measured from chest CT are strong independent predictors of inpatient mortality from COVID-19 in this high-risk cohort.
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Affiliation(s)
- Leandro Slipczuk
- Cardiology Division, Montefiore Medical Center, 111 E 210th, Bronx, NY, 10467, USA. .,Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Francesco Castagna
- Cardiology Division, Montefiore Medical Center, 111 E 210th, Bronx, NY, 10467, USA
| | | | | | | | - Damini Dey
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ulrich P Jorde
- Cardiology Division, Montefiore Medical Center, 111 E 210th, Bronx, NY, 10467, USA.,Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jeffrey M Levsky
- Albert Einstein College of Medicine, Bronx, NY, USA.,Radiology Division, Montefiore Medical Center, Bronx, NY, USA
| | - Mario J Garcia
- Cardiology Division, Montefiore Medical Center, 111 E 210th, Bronx, NY, 10467, USA.,Albert Einstein College of Medicine, Bronx, NY, USA.,Radiology Division, Montefiore Medical Center, Bronx, NY, USA
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Saeed O, Zhang S, Patel SR, Jorde UP, Garcia MJ, Bulcha N, Gupta T, Xian Y, Matsouaka R, Shah S, Smith EE, Schwamm LH, Fonarow GC. Oral Anticoagulation and Adverse Outcomes after Ischemic Stroke in Heart Failure Patients without Atrial Fibrillation. J Card Fail 2021; 27:857-864. [PMID: 33975786 DOI: 10.1016/j.cardfail.2021.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/28/2020] [Revised: 02/25/2021] [Accepted: 02/27/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The safety and effectiveness of oral anticoagulation (OAC) after an ischemic stroke in older patients with heart failure (HF) without atrial fibrillation remains uncertain. METHODS Utilizing Get With The Guidelines Stroke national clinical registry data linked to Medicare claims from 2009-2014, we assessed the outcomes of eligible patients with a history of HF who were initiated on OAC during a hospitalization for an acute ischemic stroke. The cumulative incidences of adverse events were calculated using Kaplan-Meier curves and adjusted Cox proportional hazard ratios were compared between patients discharged on or off OAC. RESULTS A total of 8,261 patients from 1,370 sites were discharged alive after an acute ischemic stroke and met eligibility criteria. Of those, 747 (9.0%) were initiated on OAC. Patients on OAC were younger (77.2±8.0 vs. 80.5±8.9 years, p<0.01). After adjustment for clinical covariates, the likelihood of 1 year mortality was higher in those on OAC (aHR: 1.22, 95% CI 1.05-1.41, p<0.01), while no significant differences were noted for ICH (aHR: 1.34, 95% CI 0.69-2.59, p=0.38) and recurrent ischemic stroke (aHR: 0.78, 95% CI 0.54-1.15, p = 0.21). The likelihood of all-cause bleeding (aHR: 1.59, 95% CI 1.29-1.96, p<0.01) and all-cause re-hospitalization (aHR: 1.14, 95% CI 1.02-1.27, p = 0.02) was higher for those on OAC. CONCLUSION Initiation of OAC after an ischemic stroke in older patients with HF in the absence of atrial fibrillation is associated with death, bleeding and re-hospitalization without an associated reduction in recurrent ischemic stroke. If validated, these findings raise caution for prescribing OAC to such patients.
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Affiliation(s)
- Omar Saeed
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY.
| | - Shuaiqi Zhang
- Department of Neurology, Duke University School of Medicine, Raleigh, NC
| | - Snehal R Patel
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY
| | - Ulrich P Jorde
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY
| | - Mario J Garcia
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY
| | - Nurilign Bulcha
- Division of Cardiology, University of Pennsylvania Hospital Center, Philadelphia, PA
| | - Tanush Gupta
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Ying Xian
- Department of Neurology, Duke University School of Medicine, Raleigh, NC
| | - Roland Matsouaka
- Department of Neurology, Duke University School of Medicine, Raleigh, NC
| | | | - Eric E Smith
- Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Canada
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Gregg C Fonarow
- Division of Cardiology, University of California, Los Angeles, Los Angeles, CA
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Saeed O, Castagna F, Agalliu I, Xue X, Patel SR, Rochlani Y, Kataria R, Vukelic S, Sims DB, Alvarez C, Rivas‐Lasarte M, Garcia MJ, Jorde UP. Statin Use and In-Hospital Mortality in Patients With Diabetes Mellitus and COVID-19. J Am Heart Assoc 2020; 9:e018475. [PMID: 33092446 PMCID: PMC7955378 DOI: 10.1161/jaha.120.018475] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/13/2020] [Indexed: 02/07/2023]
Abstract
Background Severe coronavirus disease 2019 (COVID-19) is characterized by a proinflammatory state with high mortality. Statins have anti-inflammatory effects and may attenuate the severity of COVID-19. Methods and Results An observational study of all consecutive adult patients with COVID-19 admitted to a single center located in Bronx, New York, was conducted from March 1, 2020, to May 2, 2020. Patients were grouped as those who did and those who did not receive a statin, and in-hospital mortality was compared by competing events regression. In addition, propensity score matching and inverse probability treatment weighting were used in survival models to examine the association between statin use and death during hospitalization. A total of 4252 patients were admitted with COVID-19. Diabetes mellitus modified the association between statin use and in-hospital mortality. Patients with diabetes mellitus on a statin (n=983) were older (69±11 versus 67±14 years; P<0.01), had lower inflammatory markers (C-reactive protein, 10.2; interquartile range, 4.5-18.4 versus 12.9; interquartile range, 5.9-21.4 mg/dL; P<0.01) and reduced cumulative in-hospital mortality (24% versus 39%; P<0.01) than those not on a statin (n=1283). No difference in hospital mortality was noted in patients without diabetes mellitus on or off statin (20% versus 21%; P=0.82). Propensity score matching (hazard ratio, 0.88; 95% CI, 0.83-0.94; P<0.01) and inverse probability treatment weighting (HR, 0.88; 95% CI, 0.84-0.92; P<0.01) showed a 12% lower risk of death during hospitalization for statin users than for nonusers. Conclusions Statin use was associated with reduced in-hospital mortality from COVID-19 in patients with diabetes mellitus. These findings, if validated, may further reemphasize administration of statins to patients with diabetes mellitus during the COVID-19 era.
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Affiliation(s)
- Omar Saeed
- Division of CardiologyDepartment of MedicineMontefiore Medical CenterAlbert Einstein College of MedicineNew YorkNY
| | - Francesco Castagna
- Division of CardiologyDepartment of MedicineMontefiore Medical CenterAlbert Einstein College of MedicineNew YorkNY
| | - Ilir Agalliu
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineNew YorkNY
| | - Xiaonan Xue
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineNew YorkNY
| | - Snehal R. Patel
- Division of CardiologyDepartment of MedicineMontefiore Medical CenterAlbert Einstein College of MedicineNew YorkNY
| | - Yogita Rochlani
- Division of CardiologyDepartment of MedicineMontefiore Medical CenterAlbert Einstein College of MedicineNew YorkNY
| | - Rachna Kataria
- Division of CardiologyDepartment of MedicineMontefiore Medical CenterAlbert Einstein College of MedicineNew YorkNY
| | - Sasa Vukelic
- Division of CardiologyDepartment of MedicineMontefiore Medical CenterAlbert Einstein College of MedicineNew YorkNY
| | - Daniel B. Sims
- Division of CardiologyDepartment of MedicineMontefiore Medical CenterAlbert Einstein College of MedicineNew YorkNY
| | - Chikezie Alvarez
- Division of CardiologyDepartment of MedicineMontefiore Medical CenterAlbert Einstein College of MedicineNew YorkNY
| | - Mercedes Rivas‐Lasarte
- Division of CardiologyDepartment of MedicineMontefiore Medical CenterAlbert Einstein College of MedicineNew YorkNY
| | - Mario J. Garcia
- Division of CardiologyDepartment of MedicineMontefiore Medical CenterAlbert Einstein College of MedicineNew YorkNY
| | - Ulrich P. Jorde
- Division of CardiologyDepartment of MedicineMontefiore Medical CenterAlbert Einstein College of MedicineNew YorkNY
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Wiegers SE, Ryan T, Arrighi JA, Brown SM, Canaday B, Damp JB, Diaz-Gomez JL, Figueredo VM, Garcia MJ, Gillam LD, Griffin BP, Kirkpatrick JN, Klarich KW, Lui GK, Maffett S, Naqvi TZ, Patel AR, Poulin MF, Rose GA, Swaminathan M, Arrighi JA, Mendes LA, Adams JE, Brush JE, Dec GW, Denktas A, Fernandes S, Freeman R, Hahn RT, Halperin JL, Housholder-Hughes SD, Khan SS, Klarich KW, Lin CH, Marine JE, McPherson JA, Niazi K, Ryan T, Solomon MA, Spicer RL, Tam M, Wang A, Weissman G, Weitz HH, Williams ES. 2019 ACC/AHA/ASE Advanced Training Statement on Echocardiography (Revision of the 2003 ACC/AHA Clinical Competence Statement on Echocardiography): A Report of the ACC Competency Management Committee. J Am Soc Echocardiogr 2020; 32:919-943. [PMID: 31378259 DOI: 10.1016/j.echo.2019.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Della Rocca DG, Magnocavallo M, Lavalle C, Romero J, Forleo GB, Tarantino N, Chimenti C, Alviz I, Gamero MT, Garcia MJ, Di Biase L, Natale A. Evidence of systemic endothelial injury and microthrombosis in hospitalized COVID-19 patients at different stages of the disease. J Thromb Thrombolysis 2020; 51:571-576. [PMID: 33156441 PMCID: PMC7645404 DOI: 10.1007/s11239-020-02330-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 01/13/2023]
Affiliation(s)
| | - Michele Magnocavallo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Universitario Umberto I, Sapienza University of Rome, Viale del Policlinico, 155- 00161, Rome, Italy.
| | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Universitario Umberto I, Sapienza University of Rome, Viale del Policlinico, 155- 00161, Rome, Italy
| | | | | | | | - Cristina Chimenti
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Universitario Umberto I, Sapienza University of Rome, Viale del Policlinico, 155- 00161, Rome, Italy
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Massera D, McClelland RL, Ambale-Venkatesh B, Gomes AS, Hundley WG, Kawel-Boehm N, Yoneyama K, Owens DS, Garcia MJ, Sherrid MV, Kizer JR, Lima JAC, Bluemke DA. Prevalence of Unexplained Left Ventricular Hypertrophy by Cardiac Magnetic Resonance Imaging in MESA. J Am Heart Assoc 2020; 8:e012250. [PMID: 30957681 PMCID: PMC6507185 DOI: 10.1161/jaha.119.012250] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Hypertrophic cardiomyopathy is defined as unexplained left ventricular (LV) hypertrophy (wall thickness ≥15 mm) and is prevalent in 0.2% of adults (1:500) in population‐based studies using echocardiography. Cardiac magnetic resonance imaging (MRI) allows for more accurate wall thickness measurement across the entire ventricle than echocardiography. The prevalence of unexplained LV hypertrophy by cardiac MRI is unknown. MESA (Multi‐Ethnic Study of Atherosclerosis) recruited individuals without overt cardiovascular disease 45 to 84 years of age. Methods and Results We studied 4972 individuals who underwent measurement of regional LV wall thickness by cardiac MRI as part of the MESA baseline exam. American Heart Association criteria were used to define LV segments. We excluded participants with hypertension, LV dilation (≥95% predicted end‐diastolic volume) or dysfunction (ejection fraction ≤50%), moderate‐to‐severe left‐sided valve lesions by cardiac MRI, severe aortic valve calcification by cardiac computed tomography (aortic valve Agatston calcium score >1200 in women or >2000 in men), obesity (body mass index >35 kg/m2), diabetes mellitus, and current smoking. Sixty‐seven participants (aged 64±10 years, 9% female) had unexplained LV hypertrophy (wall thickness ≥15 mm in at least 2 adjacent LV segments), representing 1.4% (1 in 74) participants, 2.6% of men and 0.2% of women. Prevalence was similar across categories of race/ethnicity. Hypertrophy was focal in 17 (25.4%), intermediate in 44 (65.7%), and diffuse in 5 (7.5%) participants. Conclusions The prevalence of unexplained LV hypertrophy in a population‐based cohort using cardiac MRI was 1.4%. This may have implications for the diagnosis of patients with hypertrophic cardiomyopathy and will require further study.
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Affiliation(s)
| | | | | | | | | | | | - Kihei Yoneyama
- 7 St. Marianna University School of Medicine Kawasaki Japan
| | | | | | | | - Jorge R Kizer
- 9 San Francisco Veterans Affairs Health Care System and University of California San Francisco San Francisco CA
| | | | - David A Bluemke
- 10 University of Wisconsin School of Medicine and Public Health Madison WI
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Garcia MJ, Kwong RY, Scherrer-Crosbie M, Taub CC, Blankstein R, Lima J, Bonow RO, Eshtehardi P, Bois JP. State of the Art: Imaging for Myocardial Viability: A Scientific Statement From the American Heart Association. Circ Cardiovasc Imaging 2020; 13:e000053. [PMID: 32833510 DOI: 10.1161/hci.0000000000000053] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A substantial proportion of patients with acute myocardial infarction develop clinical heart failure, which remains a common and major healthcare burden. It has been shown that in patients with chronic coronary artery disease, ischemic episodes lead to a global pattern of cardiomyocyte remodeling and dedifferentiation, hallmarked by myolysis, glycogen accumulation, and alteration of structural proteins. These changes, in conjunction with an impaired global coronary reserve, may eventually become irreversible and result in ischemic cardiomyopathy. Moreover, noninvasive imaging of myocardial scar and hibernation can inform the risk of sudden cardiac death. Therefore, it would be intuitive that imaging of myocardial viability is an essential tool for the proper use of invasive treatment strategies and patient prognostication. However, this notion has been challenged by large-scale clinical trials demonstrating that, in the modern era of improved guideline-directed medical therapies, imaging of myocardial viability failed to deliver effective guidance of coronary bypass surgery to a reduction of adverse cardiac outcomes. In addition, current available imaging technologies in this regard are numerous, and they target diverse surrogates of structural or tissue substrates of myocardial viability. In this document, we examine these issues in the current clinical context, collect current evidence of imaging technology by modality, and inform future directions.
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Kargoli F, Levsky J, Bulcha N, Mustehsan MH, Brown-Manhertz D, Furlani A, Polanco D, Mizrachi S, Makkiya M, Golive A, Haramati L, Taub C, Garcia MJ. Comparison Between Anatomical and Functional Imaging Modalities for Evaluation of Chest Pain in the Emergency Department. Am J Cardiol 2020; 125:1809-1814. [PMID: 32345475 DOI: 10.1016/j.amjcard.2020.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 11/30/2022]
Abstract
Evaluation of chest pain in the emergency department (ED) frequently employs a noninvasive strategy, including coronary computed tomography angiography (CCTA), stress echocardiography (SE), or myocardial perfusion imaging (MPI). We sought to report the real-world experience of utilizing CCTA compared with SE and MPI at an urban hospital ED. We conducted a retrospective cohort study of consecutively enrolled patients presenting with chest pain who had normal or nondiagnostic electrocardiogram (ECG), negative initial troponin-T, at least intermediate risk based on modified Diamond-Forrester criteria, and who underwent CCTA, SE, or MPI based on their individual test eligibility criteria. The primary outcome was ED discharge time. Secondary outcomes included test utilization and 30-days rehospitalization rates. The 2,143 patients who were included (mean age was 56 ± 12 years; 55% women) utilization rate (test performed/eligible) was lower for CCTA (n = 354/1,329) and MPI (n = 530/1,435) compared with SE (n = 1,259/1,650), p <0.001. Mean ED discharge times for both CCTA and SE were 12.5 ± 7.4 versus 16 ± 7.3 hours for MPI (p <0.0001). Patients with SE and CCTA were less likely to undergo coronary angiography (29%, 25%, vs 52% for MPI). There was a 1% cardiac-related 30-days rehospitalization rate in the CCTA group versus 1% in SE and 3% in the MPI group (p <0.01). In conclusion, CCTA and SE were associated with faster ED discharge and lower frequency of diagnostic coronary angiography. Notwithstanding its clinical utility, CCTA was underutilized at our large urban ED setting.
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Affiliation(s)
- Faraj Kargoli
- Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
| | - Jeffrey Levsky
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Nurilign Bulcha
- Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Mohammad Hashim Mustehsan
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Durline Brown-Manhertz
- Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Andrea Furlani
- Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Dalvert Polanco
- Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Sarah Mizrachi
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Mohammed Makkiya
- Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Anjani Golive
- Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Linda Haramati
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Cynthia Taub
- Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Mario J Garcia
- Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
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Cerrud-Rodriguez RC, Rashid SMI, Shaqra H, Alkhalil A, Algodi M, Chudow JJ, Garcia MJ, Tauras JM, Weisz G. An Overlap Presentation of Pericardial Decompression Syndrome and Stress Cardiomyopathy Following Therapeutic Pericardiocentesis. JACC Case Rep 2020; 2:1009-1013. [PMID: 34317403 PMCID: PMC8302087 DOI: 10.1016/j.jaccas.2020.04.029] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 11/30/2022]
Abstract
Pericardial decompression syndrome, defined as paradoxical hypotension and pulmonary edema after pericardiocentesis, is a rare complication of pericardiocentesis. Stress cardiomyopathy, caused by excess catecholamine response resulting in left ventricular dysfunction and elevated cardiac enzymes, can overlap with pericardial decompression syndrome, and both might belong to the same spectrum of disease. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Roberto C. Cerrud-Rodriguez
- Address for correspondence: Dr. Roberto C. Cerrud-Rodriguez, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, New York 10467.
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