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Dimitri DS, Parikh PV, Sharma S, Wang S, Souka A, Effat M. An Unusual Sticky Situation of New-Onset Right Sided Heart Failure. J Cardio Case Rep 2021; 4. [PMID: 36967731 PMCID: PMC10035051 DOI: 10.15761/jccr.1000168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This case highlights the importance of having constrictive pericarditis (CP) as a differential diagnosis in unexplained sign and symptoms of right-sided heart failure. This case portrays challenges in diagnosing CP caused by certain rheumatologic diseases despite advances in diagnostic modalities, clinical suspicion remains the most important tool for this diagnosis.
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Affiliation(s)
- Demetrio Sharp Dimitri
- Department of Internal Medicine, University of Cincinnati Medical Center, USA
- Correspondence to: Demetrio Sharp Dimitri, University of Cincinnati Medical Center, Department of Internal Medicine, 234 Goodman Street, Cincinnati, OH. 45229, USA,
| | - Priya V Parikh
- Department of Internal Medicine, University of Cincinnati Medical Center, USA
| | - Sneha Sharma
- Department of Internal Medicine, University of Cincinnati Medical Center, USA
| | - Sven Wang
- University of Cincinnati College of Medicine, USA
| | - Ahmed Souka
- Department of Internal Medicine, Division of Cardiology, Interventional Cardiology, University of Cincinnati Medical Center, USA
| | - Mohamed Effat
- Department of Internal Medicine, Division of Cardiology, Interventional Cardiology, University of Cincinnati Medical Center, USA
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Hakim D, Abdallah M, Effat M, Al Solaiman F, Alli O, Leesar MA. A new intravascular ultrasound‐guided stenting strategy compared with angiography on stent expansion and procedural outcomes in patients with positive lesion remodeling. Catheter Cardiovasc Interv 2020; 97:237-244. [DOI: 10.1002/ccd.28727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 12/08/2019] [Accepted: 01/03/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Diaa Hakim
- Division of Cardiology University of Alabama‐Birmingham Birmingham Alabama
- Department of cardiology, Suez Canal University Ismailia Egypt
| | | | - Mohamed Effat
- Division of Cardiology University of Cincinnati Cincinnati Ohio
| | - Firas Al Solaiman
- Division of Cardiology University of Alabama‐Birmingham Birmingham Alabama
| | - Oluseun Alli
- Division of Cardiology University of Alabama‐Birmingham Birmingham Alabama
| | - Massoud A. Leesar
- Division of Cardiology University of Alabama‐Birmingham Birmingham Alabama
- Division of Cardiology University of Cincinnati Cincinnati Ohio
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Abstract
Warfarin is one of the most commonly used anticoagulants in the management of thromboembolic events. Herein we report a rare case of warfarin induced leukocytoclastic vasculitis in a patient with history of rheumatic heart disease and a mechanical mitral valve prosthesis who presented with heart failure and palpable purpura. Upon clinical suspicion of cutaneous small vessel vasculitis, a comprehensive laboratory panel was performed. Warfarin induced vasculitis was suspected when withdrawal of warfarin, due to rising INR, led to improvement of the skin lesions. The diagnosis was finally confirmed when re-instatement of warfarin reproduced the skin lesions and a skin biopsy showed evidence for leukocytoclastic vasculitis with eosinophilic infiltration. A third of cases of leukocytoclastic vasculitis are due to drug hypersensitivity which being a diagnosis of exclusion with varying manifestations, requires a high index of clinical suspicion. Since drug induced leukocytoclastic vasculitis may affect multiple organ systems and even cause mortality, clinicians must be aware of this rare adverse event, promptly discontinue the drug, and commence anti-inflammatory or immunosuppressive treatment when necessary.
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Affiliation(s)
- Dina Elantably
- Faculty of Medicine, Cairo University Kasr Alainy, Cairo, Egypt.
| | - Ahmed Mourad
- Faculty of Medicine, Cairo University Kasr Alainy, Cairo, Egypt
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Alkhawam H, Muskula PR, Effat M, Rahman S, Elwing J, Helmy T. SLOW AND STEADY WINS THE RACE: MANAGEMENT OF PERICARDIAL TAMPONADE IN THE SETTING OF PULMONARY HYPERTENSION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)33449-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hakim D, Firas Al Solaiman, Effat M, Leesar M. TCT-424 A New Intravascular Ultrasound-Guided Stenting Strategy Compared with Angiography on Stent Expansion and Procedural Outcomes in Patients with Positive Lesion Remodeling. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Peelukhana SV, Banerjee RK, van de Hoef TP, Kolli KK, Effat M, Helmy T, Leesar M, Kerr H, Piek JJ, Succop P, Back L, Arif I. Evaluation of lesion flow coefficient for the detection of coronary artery disease in patient groups from two academic medical centers. Cardiovascular Revascularization Medicine 2018; 19:348-354. [DOI: 10.1016/j.carrev.2017.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 08/30/2017] [Indexed: 01/09/2023]
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Robbins N, Gilbert M, Kumar M, McNamara JW, Daly P, Koch SE, Conway G, Effat M, Woo JG, Sadayappan S, Rubinstein J. Probenecid Improves Cardiac Function in Patients With Heart Failure With Reduced Ejection Fraction In Vivo and Cardiomyocyte Calcium Sensitivity In Vitro. J Am Heart Assoc 2018; 7:JAHA.117.007148. [PMID: 29331959 PMCID: PMC5850150 DOI: 10.1161/jaha.117.007148] [Citation(s) in RCA: 18] [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] [Indexed: 01/06/2023]
Abstract
BACKGROUND Transient receptor potential vanilloid 2 is a calcium channel activated by probenecid. Probenecid is a Food and Drug Administration-approved uricosuric drug that has recently been shown to induce positive lusitropic and inotropic effects in animal models through cardiomyocyte transient receptor potential vanilloid 2 activation. The aim of this study was to test the hypothesis that oral probenecid can improve cardiac function and symptomatology in patients with heart failure with reduced ejection fraction and to further elucidate its calcium-dependent effects on myocyte contractility. METHODS AND RESULTS The clinical trial recruited stable outpatients with heart failure with reduced ejection fraction randomized in a single-center, double-blind, crossover design. Clinical data were collected including a dyspnea assessment, physical examination, ECG, echocardiogram to assess systolic and diastolic function, a 6-minute walk test, and laboratory studies. In vitro force generation studies were performed on cardiomyocytes isolated from murine tissue exposed to probenecid or control treatments. The clinical trial recruited 20 subjects (mean age 57 years, mean baseline fractional shortening of 13.6±1.0%). Probenecid therapy increased fractional shortening by 2.1±1.0% compared with placebo -1.7±1.0% (P=0.007). Additionally, probenecid improved diastolic function compared with placebo by decreasing the E/E' by -2.95±1.21 versus 1.32±1.21 in comparison to placebo (P=0.03). In vitro probenecid increased myofilament force generation (92.36 versus 80.82 mN/mm2, P<0.05) and calcium sensitivity (pCa 5.67 versus 5.60, P<0.01) compared with control. CONCLUSIONS Probenecid improves cardiac function with minimal effects on symptomatology and no significant adverse effects after 1 week in patients with heart failure with reduced ejection fraction and increases force development and calcium sensitivity at the cardiomyocyte level. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01814319.
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Affiliation(s)
- Nathan Robbins
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | - Mark Gilbert
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | - Mohit Kumar
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | - James W McNamara
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | - Patrick Daly
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | - Sheryl E Koch
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | - Ginger Conway
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | - Mohamed Effat
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | - Jessica G Woo
- Division of Biostatistics and Epidemiology, The Heart Institute Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Sakthivel Sadayappan
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | - Jack Rubinstein
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
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Peelukhana SV, Banerjee R, van de Hoef TP, Kolli K, Effat M, Helmy T, Leesar M, Kerr H, Piek JJ, Succop P, Back L, Arif I. CRT-200.29 Evaluation Of Lesion Flow Coefficient For The Detection Of Coronary Artery Disease In Patient Groups From Two Academic Medical Centers. JACC Cardiovasc Interv 2017. [DOI: 10.1016/j.jcin.2016.12.265] [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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Shizukuda Y, Effat M. A new variation of dual left anterior descending coronary artery. J Cardiol Cases 2016; 14:26-28. [PMID: 30546654 PMCID: PMC6283011 DOI: 10.1016/j.jccase.2016.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/26/2016] [Accepted: 03/11/2016] [Indexed: 11/26/2022] Open
Abstract
A 63-year-old male with past medical history of type II diabetes mellitus, hypertension, hyperlipidemia, stroke, and permanent pacemaker implant for poor chronotropic response to exercise underwent coronary computed tomography angiography (CCTA) for worsening atypical chest pain. The patient had normal myocardial perfusion by nuclear stress testing 3 months prior to this test. A rare variation of dual left anterior descending coronary artery (LAD) was identified by CCTA and subsequent coronary angiography confirmed a dual LAD and revealed no significant stenosis of the coronary arteries. Six types of dual LADs have been previously reported. However, this case showed a short LAD directly originating from the left coronary sinus and long LAD originating from the left main coronary artery. This configuration has not been reported previously in the literature to our knowledge. The short LAD main stem showed an intramyocardial course and provided septal perforators to the basal-mid interventricular septum (IVS) and right ventricular branches. The long LAD provided both diagonal branches and septal perforators to the distal IVS. CCTA in conjunction with coronary angiography played an essential role to characterize this anomaly and awareness of this anomaly merits reducing misinterpretation of coronary angiography for cardiology care providers. .
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Affiliation(s)
- Yukitaka Shizukuda
- Division of Cardiovascular Health and Disease, Department of Internal Medicine University of Cincinnati, Cincinnati, OH, USA
- Cincinnati VA Medical Center, Cincinnati, OH, USA
| | - Mohamed Effat
- Division of Cardiovascular Health and Disease, Department of Internal Medicine University of Cincinnati, Cincinnati, OH, USA
- Cincinnati VA Medical Center, Cincinnati, OH, USA
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Abo-Salem E, Alsidawi S, Jamali H, Effat M, Helmy T. Optimal Duration of Dual Antiplatelet Therapy after Drug-Eluting Stents: Meta-Analysis of Randomized Trials. Cardiovasc Ther 2016; 33:253-63. [PMID: 26010419 DOI: 10.1111/1755-5922.12137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 12/15/2022] Open
Abstract
INTRODUCTION The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent implantation (DES) is not certain. The AHA/ACC guidelines recommend 12 months of DAPT based on observational trials. Recently, several large randomized controlled trials (RCT) suggested a noninferiority of shorter duration of DAPT and other trials showed a benefit from extended duration of DAPT after 12 months of DES implantation. METHODS PubMed databases were searched for RCTs comparing the continued use of DAPT to shorter duration of DAPT (aspirin alone) for variable durations beyond 3 months of DES implantation. Our analysis was limited to trials with clinical outcomes. Odds ratio (OR) and 95% confidence intervals (CI) were calculated using fixed and random-effects models. Subgroup analyses were performed for second generation DES and for trials comparing 12 months of DAPT vs. earlier interruption or longer duration of DAPT. RESULTS We identified 10 RCTs including 32,136 subjects randomized to continued use of DAPT vs. aspirin alone for variable durations after 3 months of DES implantation. There was no significant heterogeneity among studies (Q test P > 0.1). Compared to shorter DAPT, longer DAPT resulted in a significant reduction in stent thrombosis (0.3% vs. 0.7%, P < 0.01) and myocardial infarction (1.3% vs. 2%, P < 0.01), and a significant increase in major bleeding (0.8% vs. 0.4%, P < 0.01). There was no difference in cardiac deaths or stroke. All-cause deaths were slightly lower with shorter DAPT compared to longer DAPT (OR 0.8, 95% CI 0.7 to 0.99, P = 0.04). A small number of subjects were included between 3 and 6 months after DES implantation. CONCLUSION DAPT continued beyond 6 months after second generation DES implantation decreases stent thrombosis and myocardial infarction, but increases major bleeding and all-causes mortality compared to shorter DAPT (aspirin alone). There was no difference in cardiac mortality or stroke.
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Affiliation(s)
- Elsayed Abo-Salem
- Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, OH, USA
| | - Said Alsidawi
- Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, OH, USA
| | - Hina Jamali
- Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, OH, USA
| | - Mohamed Effat
- Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, OH, USA
| | - Tarek Helmy
- Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, OH, USA
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Alsidawi S, Effat M, Rahman S, Abdallah M, Leesar M. The Role of Vascular Imaging in Guiding Routine Percutaneous Coronary Interventions: A Meta-Analysis of Bare Metal Stent and Drug-Eluting Stent Trials. Cardiovasc Ther 2015; 33:360-6. [DOI: 10.1111/1755-5922.12160] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Said Alsidawi
- Division of Cardiovascular Health and Diseases; University of Cincinnati College of Medicine; Cincinnati OH USA
| | - Mohamed Effat
- Division of Cardiovascular Health and Diseases; University of Cincinnati College of Medicine; Cincinnati OH USA
| | - Shahid Rahman
- Division of Cardiovascular Health and Diseases; University of Cincinnati College of Medicine; Cincinnati OH USA
| | - Mouhamad Abdallah
- Division of Cardiovascular Health and Diseases; University of Cincinnati College of Medicine; Cincinnati OH USA
| | - Massoud Leesar
- Division of Cardiovascular Diseases; University of Alabama; Birmingham AL USA
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Peelukhana SV, Effat M, Kolli KK, Arif I, Helmy T, Leesar M, Kerr H, Back LH, Banerjee R. Lesion flow coefficient: a combined anatomical and functional parameter for detection of coronary artery disease--a clinical study. J Invasive Cardiol 2015; 27:54-64. [PMID: 25589702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Invasive diagnosis of coronary artery disease utilizes either anatomical or functional measurements. In this study, we tested a futuristic parameter, lesion flow coefficient (LFC, defined as the ratio of percent coronary area stenosis (%AS) to the square root of the ratio of the pressure drop across the stenosis to the dynamic pressure in the throat region), that combines both the anatomical (%AS) and functional measurements (pressure and flow) for application in a clinical setting. In 51 vessels, simultaneous pressure and flow readings were obtained using a 0.014" Combowire (Volcano Corporation). Anatomical details were assessed using quantitative coronary angiography (QCA). Fractional flow reserve (FFR), coronary flow reserve (CFR), hyperemic stenosis resistance index (HSR), and hyperemic microvascular index (HMR) were obtained at baseline and adenosine-induced hyperemia. QCA data were corrected for the presence of guidewire and then the LFC values were calculated. LFC was correlated with FFR, CFR, HSR, and HMR, individually and in combination with %AS, under both baseline and hyperemic conditions. Further, in 5 vessels, LFC group mean values were compared between pre-PCI and post-PCI groups. P<.05 was considered statistically significant. LFC measured at hyperemia correlated significantly when the pressure-based FFR, flow-based CFR, and anatomically measured %AS were combined (r = 0.64; P<.05). Similarly, LFC correlated significantly when HSR, HMR, and %AS were combined (r = 0.72; P<.05). LFC was able to significantly distinguish between pre-PCI and post-PCI groups (0.42 ± 0.05 and 0.05 ± 0.004, respectively; P<.05). Similar results were obtained for the LFC at baseline conditions. LFC, a futuristic parameter that combines both the anatomical and functional endpoints, has potential for application in a clinical setting for stenosis evaluation, under both hyperemic and baseline conditions.
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Affiliation(s)
- Srikara V Peelukhana
- University of Cincinnati, Mechanical Engineering, 598 Rhodes Hall, University of Cincinnati, Cincinnati, OH 45221 USA.
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Peelukhana SV, Kerr H, Kolli KK, Fernandez-Ulloa M, Gerson M, Effat M, Arif I, Helmy T, Banerjee R. Benefit of cardiac N-13 PET CFR for combined anatomical and functional diagnosis of ischemic coronary artery disease: a pilot study. Ann Nucl Med 2014; 28:746-60. [DOI: 10.1007/s12149-014-0869-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/05/2014] [Indexed: 01/26/2023]
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Rahman S, Leesar T, Cilingiroglu M, Effat M, Arif I, Helmy T, Leesar MA. Impact of kissing balloon inflation on the main vessel stent volume, area, and symmetry after side-branch dilation in patients with coronary bifurcation lesions: a serial volumetric intravascular ultrasound study. JACC Cardiovasc Interv 2013; 6:923-31. [PMID: 23954062 DOI: 10.1016/j.jcin.2013.04.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/12/2013] [Accepted: 04/25/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Intravascular ultrasound (IVUS) was performed to investigate the impact of kissing balloon inflation (KBI) on the main vessel (MV) stent volume, area, and symmetry after side-branch (SB) dilation in patients with coronary bifurcation lesions (CBL). BACKGROUND It remains controversial whether KBI would restore the MV stent area and symmetry loss after SB dilation. METHODS A total of 88 serial IVUS examinations of the MV were performed after MV angioplasty, MV stenting, SB dilation, and KBI in 22 patients with CBL. The MV stent was divided into proximal, bifurcation, and distal segments; the stent volume index (SVI), minimal stent area (MSA), stent symmetry index (SSI), and external elastic membrane (EEM) volume index were measured in 198 stent segments and compared after MV stenting, SB dilation, and KBI. RESULTS In the bifurcation segment, SVI, MSA, and SSI were significantly smaller after SB dilation than after MV stenting and KBI (SVI was 6.10 ± 1.50 mm(3)/mm vs. 6.68 ± 1.60 mm(3)/mm and 6.57 ± 1.60 mm(3)/mm, respectively, p < 0.05; MSA was 5.15 ± 1.30 mm(2) vs. 6.08 ± 1.40 mm(2) and 5.86 ± 1.50 mm(2), respectively, p < 0.05; and SSI was 0.78 ± 0.02 mm(2) vs. 0.87 ± 0.03 mm(2) and 0.84 ± 0.03 mm(2), respectively, p < 0.05). KBI restored the MV SVI, MSA, and SSI after SB dilation. In the proximal segment, SVI, MSA, and EEM volume index were significantly larger, but SSI was smaller after KBI than after MV stenting and SB dilation. In the distal segment, neither SB dilation nor KBI had a significant impact on the MV stent volume or symmetry. CONCLUSIONS This is the first comprehensive volumetric IVUS analysis of CBL, to our knowledge, demonstrating that KBI restores the MV stent volume, area, and symmetry loss after SB dilation in the bifurcation segment, and induces asymmetric stent expansion in the proximal segment.
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Affiliation(s)
- Shahid Rahman
- Division of Cardiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Hakeem A, Helmy T, Munsif S, Bhatti S, Mazraeshahi R, Cilingiroglu M, Effat M, Leesar M, Arif I. Safety and efficacy of drug eluting stents compared with bare metal stents for saphenous vein graft interventions: A comprehensive meta-analysis of randomized trials and observational studies comprising 7,994 patients. Catheter Cardiovasc Interv 2010; 77:343-55. [PMID: 21328679 DOI: 10.1002/ccd.22720] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 06/22/2010] [Accepted: 06/26/2010] [Indexed: 11/06/2022]
Affiliation(s)
- Abdul Hakeem
- Division of Cardiovascular diseases, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio 45257-0542, USA.
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Hakeem A, Bhatti S, Arif I, Effat M, Cilingiroglu M. Fibrinolytic therapy for very late stent thrombosis--is it a viable option? Cardiovasc Revasc Med 2010; 11:264.e13-5. [PMID: 20934665 DOI: 10.1016/j.carrev.2009.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Revised: 11/16/2009] [Accepted: 11/20/2009] [Indexed: 11/17/2022]
Abstract
Stent thrombosis (ST) has a very high case fatality and morbidity rates. The risk of very late ST is significantly increased with drug-eluting stents (DES) compared to bare-metal stents for at least up to 4 years. Discontinuation of clopidogrel therapy is the single most important consistently identified risk factor. Immediate reperfusion, preferably by primary percutaneous coronary intervention (PCI), has been considered the therapy of choice. Compared to de novo ST-elevation myocardial infarction (STEMI), myocardial infarction (MI) related to ST has significantly higher major adverse cardiovascular events (MACE) and lower reperfusion rates. Due to the significantly higher mortality associated with STEMI due to ST, prompt revascularization assumes paramount significance. Our case reflects the potential utility of fibrinolytic therapy for STEMI due to very late ST. Systemic fibrinolysis should be considered for ST in the presence of ongoing significant ischemia and unavailability of prompt PCI.
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Affiliation(s)
- Abdul Hakeem
- Division of Cardiovascular Diseases, College of Medicine, University of Cincinnati, Cincinnati, OH 45257-0542, USA.
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Kolli KK, Helmy T, Effat M, Imran A, Leesar M, Schneeberger EW, Hand D, Gottliebson W, Succop P, Peelukhana SV, Banerjee RK. Influence of contractility and heart rate on pressure drop coefficient and fractional flow reserve for epicardial stenosis. Cardiovascular Revascularization Medicine 2010. [DOI: 10.1016/j.carrev.2010.03.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Leesar MA, Cilingiroglu M, Arif I, Effat M, Rahman S, Helmy T. INTRAVASCULAR ULTRASOUND VOLUMETRIC ANALYSIS OF CORONARY BIFURCATION LESIONS: CHANGES IN THE AREA AND VOLUME OF THE MAIN VESSEL STENT FOLLOWING SIDE-BRANCH AND FINAL KISSING BALLOON INFLATIONS. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)61914-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Helmy T, Effat M. Commentary: Alternative safe, effective and cost-efficient dosing for eptifibatide in low-risk patients. J Invasive Cardiol 2006; 18:492-3. [PMID: 17042095] [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] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Abstract
In 10 patients with atrial fibrillation, echocardiographic measures of left ventricular function-interval relations were used to assess contractility and to test the hypothesis that rhythm regularization produces a higher contractile state than is seen when the rhythm is irregular. Regularization, following direct-current cardioversion, did not augment ventricular contractility above that seen during atrial fibrillation.
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Affiliation(s)
- M Effat
- Department of Medicine, Lahey Clinic, Burlington, Massachusetts, USA
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