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Dhawan R, Omer M, Carpenter C, Friedman PA, Liu X. Successful prediction of left bundle branch block-induced cardiomyopathy and treatment effect by artificial intelligence-enabled electrocardiogram. Pacing Clin Electrophysiol 2024. [PMID: 38583090 DOI: 10.1111/pace.14980] [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: 03/05/2024] [Accepted: 03/22/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Left bundle branch block (LBBB) induced cardiomyopathy is an increasingly recognized disease entity. However, no clinical testing has been shown to be able to predict such an occurrence. CASE REPORT A 70-year-old male with a prior history of LBBB with preserved ejection fraction (EF) and no other known cardiovascular conditions presented with presyncope, high-grade AV block, and heart failure with reduced EF (36%). His coronary angiogram was negative for any obstructive disease. No other known etiologies for cardiomyopathy were identified. Artificial intelligence-enabled ECGs performed 6 years prior to clinical presentation consistently predicted a high probability (up to 91%) of low EF. The patient successfully underwent left bundle branch area (LBBA) pacing with correction of the underlying LBBB. Subsequent AI ECGs showed a large drop in the probability of low EF immediately after LBBA pacing to 47% and then to 3% 2 months post procedure. His heart failure symptoms markedly improved and EF normalized to 54% at the same time. CONCLUSIONS Artificial intelligence-enabled ECGS may help identify patients who are at risk of developing LBBB-induced cardiomyopathy and predict the response to LBBA pacing.
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Affiliation(s)
- Rahul Dhawan
- Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Mohamed Omer
- Mayo Clinic Health System, La Crosse, Wisconsin, USA
| | | | | | - Xiaoke Liu
- Mayo Clinic Rochester, Rochester, Minnesota, USA
- Mayo Clinic Health System, La Crosse, Wisconsin, USA
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Omer M, Trepanowski N, Yumeen S, Mirza FN, Goldbach HS, Joshipura D, Woo SB, Nuovo GJ, Robinson-Bostom L. Focal epithelial hyperplasia associated with human papillomavirus-13 in a healthy Haitian adult. JAAD Case Rep 2023; 42:52-55. [PMID: 38053542 PMCID: PMC10694523 DOI: 10.1016/j.jdcr.2023.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Affiliation(s)
- Mohamed Omer
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nicole Trepanowski
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Boston University School of Medicine, Boston, Massachusetts
| | - Sara Yumeen
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Fatima N. Mirza
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Hayley S. Goldbach
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Deep Joshipura
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Sook-Bin Woo
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gerard J. Nuovo
- Department of Pathology, Ohio State University Medical Center, Columbus, Ohio
- GnomeDX, Powell, Ohio
| | - Leslie Robinson-Bostom
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Saeed MK, Abdallah Y, Suilman A, Omer M, Ahmed AS. Patient Radiation Doses Assessment at Diagnostic X-rays Department of King Khalid hospital (KKH)-Majmaah. Curr Med Imaging 2023:CMIR-EPUB-130314. [PMID: 36946477 DOI: 10.2174/1573405619666230322102011] [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: 08/01/2022] [Revised: 01/11/2023] [Accepted: 01/26/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND The study was conducted on patients who received diagnostic X-rays in King Khalid Hospital (KKH), Majmaah. INTRODUCTION The study included the seven most frequently performed investigations, which were carried out on over 1504 patients using digital radiography equipment. METHODS The X-ray tube's output and exposure parameters were used to calculate the effective dose (ED) and patient entry surface air kerma (ESAK). Additionally, based on these results, conversion coefficients were determined. This study also examined the 75th percentile distributions of ESAK and KAP. The findings of this research were compared with the findings of other researchers throughout the country and the world. The study presents the uncertainty U values, as well as the mean ESAK, KAP, and ED values. RESULTS The results of the ESAK, KAP, and ED values were 0.12-5.74 mGy, 0.9-1.84 Gy cm2, and 0.01-0.23 mSv, respectively. As a result, the dosages were much lower than those previously published for the European DRL, national standards, and other studies. CONCLUSION The study concludes that during dose surveys, the importance of detecting and comprehending radiation doses, as well as the proper technique for taking the finest photos possible, can be emphasized to patients in order to assist them in avoiding radioactive particles and radiation exposure.
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Affiliation(s)
- Mohamed Khalil Saeed
- Radiological Sciences Departement, Applied Medical Sciences College, Najran University
| | - Yousif Abdallah
- Department of Radiological science and Medical Imaging, College of Applied Medical Science, Majmaah University, Al-Majmaah, 11952, Saudia Arabia
| | - Abdelmonen Suilman
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, P.O.Box 422, Alkharj, 11942, Saudi Arabia
| | - Mohamed Omer
- Radiologic Sciences Program, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Ali Sid Ahmed
- physics Department, Faculty of Science and Technology, Al Neelian University, P.O.Box 12702
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Hemu M, Abbasi MA, Omer M, Sandoval Y. Treatment of Highly Angulated Lesions Using SuperCross Microcatheter. Curr Probl Cardiol 2023; 48:101690. [PMID: 36893967 DOI: 10.1016/j.cpcardiol.2023.101690] [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: 02/21/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023]
Abstract
Unusually angulated coronary anatomy can decrease the success rate of coronary interventions by hindering successful wiring and equipment delivery. Additionally, due to the technical challenges involved, there is increased risk for complications such as perforations, dissections, stent loss, and equipment entrapment. In this case series, we illustrate the advantages of using angulated microcatheters to facilitate successful treatment of such patients in various clinical scenarios.
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Affiliation(s)
- Mohamad Hemu
- Department of Cardiology, Mayo Clinic, Rochester, MN
| | | | - Mohamed Omer
- Department of Cardiology, Mayo Clinic, Rochester, MN
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Sileno SM, Bi Y, Dorenkott SM, Omer M, Salih A, Ghoz HM, Valery JR, Harris DM, Rozen TD, Heckman MG, White LJ, Stancampiano FF. Comparison of Migraine Characteristics in Patients With and Without Inflammatory Bowel Disease: A Retrospective Cohort Study. J Prim Care Community Health 2023; 14:21501319231164307. [PMID: 36960555 PMCID: PMC10041579 DOI: 10.1177/21501319231164307] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Survey studies have found an increased prevalence of migraine in patients with inflammatory bowel disease (IBD). However, the clinical characteristics of migraines in this population are unknown. We conducted a retrospective medical record review study to characterize migraines in the IBD population. METHODS Six hundred seventy-five migraine patients (280 with IBD, 395 without IBD) who were evaluated at Mayo Clinic Rochester, Mayo Clinic Arizona, or Mayo Clinic Florida between July 2009 and March 2021 were included. Patients with ICD codes for migraine and either Crohn's disease (CD) or ulcerative colitis (UC) were selected. Electronic health care records were reviewed. Patients confirmed to have IBD and migraine were included. Demographic, IBD, and migraine characteristics were collected. Statistical analysis was completed using SAS. RESULTS Patients with IBD were less often male (8.6% vs 21.3%, P < .001) and had a higher Charlson Comorbidity Index (>2: 24.6% vs 15.7%, P = .003); 54.6% had CD and 39.3% had UC. Patients with IBD had migraine with aura and without aura more frequently ( OR 2.20, P < .001 and OR 2.79, P < .001, respectively) than non-IBD patients. Additionally, those with IBD less commonly had chronic migraine (OR 0.23, P < .001) and less commonly had chronic migraine or treatment for migraine (ORs 0.23-0.55, P ≤ .002). CONCLUSIONS Migraine with and without aura have increased prevalence in IBD patients. Further study of this topic will be helpful to clarify the prevalence of migraine, establish this population's response to treatment, and better understand the reason(s) for a low rate of treatment.
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Affiliation(s)
| | - Yan Bi
- Mayo Clinic Florida, Jacksonville, FL, USA
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Quaranta DV, Weaver RR, Baumann KK, Fujimoto T, Williams LM, Kim HC, Logsdon AF, Omer M, Reed MJ, Banks WA, Erickson MA. Transport of the Proinflammatory Chemokines C-C Motif Chemokine Ligand 2 (MCP-1) and C-C Motif Chemokine Ligand 5 (RANTES) across the Intact Mouse Blood-Brain Barrier Is Inhibited by Heparin and Eprodisate and Increased with Systemic Inflammation. J Pharmacol Exp Ther 2023; 384:205-223. [PMID: 36310035 PMCID: PMC9827507 DOI: 10.1124/jpet.122.001380] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/26/2022] [Accepted: 10/17/2022] [Indexed: 01/12/2023] Open
Abstract
One important function of the vascular blood-brain barrier (BBB) is to facilitate neuroimmune communication. The BBB fulfills this function, in part, through its ability to transport cytokines and chemokines. C-C motif chemokine receptor 2 (CCL2) (MCP-1) and C-C motif chemokine receptor 5 (CCL5) (RANTES) are proinflammatory chemokines that mediate neuroimmune responses to acute insults and aspects of brain injury and neurodegenerative diseases; however, a blood-to-brain transport system has not been evaluated for either chemokine in vivo. Therefore, we determined whether CCL2 and CCL5 in blood can cross the intact BBB and enter the brain. Using CD-1 mice, we found that 125I-labeled CCL2 and CCL5 crossed the BBB and entered the brain parenchyma. We next aimed to identify the mechanisms of 125I-CCL2 and 125I-CCL5 transport in an in situ brain perfusion model. We found that both heparin and eprodisate inhibited brain uptake of 125I-CCL2 and 125I-CCL5 in situ, whereas antagonists of their receptors, CCR2 or CCR5, respectively, did not, suggesting that heparan sulfates at the endothelial surface mediate BBB transport. Finally, we showed that CCL2 and CCL5 transport across the BBB increased following a single injection of 0.3 mg/kg lipopolysaccharide. These data demonstrate that CCL2 and CCL5 in the brain can derive, in part, from the circulation, especially during systemic inflammation. Further, binding to the BBB-associated heparan sulfate is a mechanism by which both chemokines can cross the intact BBB, highlighting a novel therapeutic target for treating neuroinflammation. SIGNIFICANCE STATEMENT: Our work demonstrates that C-C motif chemokine ligand 2 (CCL2) and C-C motif chemokine ligand 5 (CCL5) can cross the intact blood-brain barrier and that transport is robustly increased during inflammation. These data suggest that circulating CCL2 and CCL5 can contribute to brain levels of each chemokine. We further show that the transport of both chemokines is inhibited by heparin and eprodisate, suggesting that CCL2/CCL5-heparan sulfate interactions could be therapeutically targeted to limit accumulation of these chemokines in the brain.
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Affiliation(s)
- Daniel V Quaranta
- Geriatric Research Education and Clinical Center, VA Puget Sound Healthcare System, Seattle, Washington (D.V.Q., R.R.W., K.K.B., T.F., L.M.W., H.C.K., A.F.L., M.O., M.J.R., W.A.B., M.A.E.); Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (T.F.); and Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington (H.C.K., A.F.L., M.J.R., W.A.B., M.A.E.)
| | - Riley R Weaver
- Geriatric Research Education and Clinical Center, VA Puget Sound Healthcare System, Seattle, Washington (D.V.Q., R.R.W., K.K.B., T.F., L.M.W., H.C.K., A.F.L., M.O., M.J.R., W.A.B., M.A.E.); Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (T.F.); and Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington (H.C.K., A.F.L., M.J.R., W.A.B., M.A.E.)
| | - Kristen K Baumann
- Geriatric Research Education and Clinical Center, VA Puget Sound Healthcare System, Seattle, Washington (D.V.Q., R.R.W., K.K.B., T.F., L.M.W., H.C.K., A.F.L., M.O., M.J.R., W.A.B., M.A.E.); Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (T.F.); and Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington (H.C.K., A.F.L., M.J.R., W.A.B., M.A.E.)
| | - Takashi Fujimoto
- Geriatric Research Education and Clinical Center, VA Puget Sound Healthcare System, Seattle, Washington (D.V.Q., R.R.W., K.K.B., T.F., L.M.W., H.C.K., A.F.L., M.O., M.J.R., W.A.B., M.A.E.); Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (T.F.); and Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington (H.C.K., A.F.L., M.J.R., W.A.B., M.A.E.)
| | - Lindsey M Williams
- Geriatric Research Education and Clinical Center, VA Puget Sound Healthcare System, Seattle, Washington (D.V.Q., R.R.W., K.K.B., T.F., L.M.W., H.C.K., A.F.L., M.O., M.J.R., W.A.B., M.A.E.); Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (T.F.); and Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington (H.C.K., A.F.L., M.J.R., W.A.B., M.A.E.)
| | - Hyung Chan Kim
- Geriatric Research Education and Clinical Center, VA Puget Sound Healthcare System, Seattle, Washington (D.V.Q., R.R.W., K.K.B., T.F., L.M.W., H.C.K., A.F.L., M.O., M.J.R., W.A.B., M.A.E.); Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (T.F.); and Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington (H.C.K., A.F.L., M.J.R., W.A.B., M.A.E.)
| | - Aric F Logsdon
- Geriatric Research Education and Clinical Center, VA Puget Sound Healthcare System, Seattle, Washington (D.V.Q., R.R.W., K.K.B., T.F., L.M.W., H.C.K., A.F.L., M.O., M.J.R., W.A.B., M.A.E.); Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (T.F.); and Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington (H.C.K., A.F.L., M.J.R., W.A.B., M.A.E.)
| | - Mohamed Omer
- Geriatric Research Education and Clinical Center, VA Puget Sound Healthcare System, Seattle, Washington (D.V.Q., R.R.W., K.K.B., T.F., L.M.W., H.C.K., A.F.L., M.O., M.J.R., W.A.B., M.A.E.); Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (T.F.); and Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington (H.C.K., A.F.L., M.J.R., W.A.B., M.A.E.)
| | - May J Reed
- Geriatric Research Education and Clinical Center, VA Puget Sound Healthcare System, Seattle, Washington (D.V.Q., R.R.W., K.K.B., T.F., L.M.W., H.C.K., A.F.L., M.O., M.J.R., W.A.B., M.A.E.); Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (T.F.); and Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington (H.C.K., A.F.L., M.J.R., W.A.B., M.A.E.)
| | - William A Banks
- Geriatric Research Education and Clinical Center, VA Puget Sound Healthcare System, Seattle, Washington (D.V.Q., R.R.W., K.K.B., T.F., L.M.W., H.C.K., A.F.L., M.O., M.J.R., W.A.B., M.A.E.); Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (T.F.); and Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington (H.C.K., A.F.L., M.J.R., W.A.B., M.A.E.)
| | - Michelle A Erickson
- Geriatric Research Education and Clinical Center, VA Puget Sound Healthcare System, Seattle, Washington (D.V.Q., R.R.W., K.K.B., T.F., L.M.W., H.C.K., A.F.L., M.O., M.J.R., W.A.B., M.A.E.); Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (T.F.); and Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington (H.C.K., A.F.L., M.J.R., W.A.B., M.A.E.)
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Dumitrascu AG, Rojas CA, Stancampiano F, Johnson EM, Harris DM, Chirila RM, Omer M, Hata DJ, Meza-Villegas DM, Heckman MG, White LJ, Alvarez S. Invasive Nocardiosis Versus Colonization at a Tertiary Care Center: Clinical and Radiological Characteristics. Mayo Clin Proc Innov Qual Outcomes 2022; 7:20-30. [PMID: 36589733 PMCID: PMC9798119 DOI: 10.1016/j.mayocpiqo.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective To describe the clinical and radiographic findings in a large cohort of patients with positive cultures for Nocardia emphasizing the differences between invasive disease and colonization. Patients and Methods We conducted a single-center, retrospective cohort study of 133 patients with a positive Nocardia isolate between August 1, 1998, and November 30, 2018, and a computed tomography (CT) of the chest within 30 days before or after the bacteria isolation date. Results Patients with colonization were older (71 vs 65 years; P=.004), frequently with chronic obstructive pulmonary disease (56.8% vs 16.9%; P<.001) and coronary artery disease (47.7% vs 27%, P=.021), and had Nocardia isolated exclusively from lung specimens (100% vs 83.1%; P=.003). On CT of the chest, they had frequent airway disease (84.1% vs 51.7%; P<.001). Patients with invasive nocardiosis had significantly (P<.05) more diabetes, chronic kidney disease, solid organ transplant, use of corticosteroids, antirejection drugs, and prophylactic sulfa. They had more fever (25.8% vs 2.3%; P<.001), cutaneous lesions (14.6% vs 0%; P=.005), fatigue (18% vs 0%; P=.001), pulmonary nodules (52.8% vs 27.3%; P=.006), and free-flowing pleural fluid (63.6% vs 29.4%; P=.024). The patterns of nodule distribution were different-diffuse for invasive nocardiosis and peribronchiolar for Nocardia colonization. Conclusion The isolation of Nocardia in sputum from a patient with respiratory symptoms does not equal active infection. Only by combining clinical and chest CT findings, one could better differentiate between invasive nocardiosis and Nocardia colonization.
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Affiliation(s)
- Adrian G. Dumitrascu
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic Florida, Jacksonville, FL,Correspondence: Address to Adrian Dumitrascu, MD, Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224.
| | - Carlos A. Rojas
- Division of Cardiothoracic Radiology, Department of Radiology, Mayo Clinic Arizona, Scottsdale, AZ
| | - Fernando Stancampiano
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic Florida, Jacksonville, FL
| | - Elizabeth M. Johnson
- Division of Cardiothoracic Radiology, Department of Radiology, Mayo Clinic Florida, Jacksonville, FL
| | - Dana M. Harris
- Division of Medallion Medicine, Department of Medicine, Mayo Clinic Florida, Jacksonville, FL
| | - Razvan M. Chirila
- Division of International and Executive Medicine, Department of Medicine, Mayo Clinic Florida, Jacksonville, FL
| | - Mohamed Omer
- Division of Internal Medicine, Department of Medicine, Harlem Hospital Center/Columbia University, New York, NY
| | - D. Jane Hata
- Department of Laboratory Medicine and Pathology, Mayo Clinic Florida, Jacksonville, FL
| | | | - Michael G. Heckman
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic Florida, Jacksonville, FL
| | - Launia J. White
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic Florida, Jacksonville, FL
| | - Salvador Alvarez
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic Florida, Jacksonville, FL
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Terentes-Printzios D, Antonopoulos AS, Omer M, Panagiotopoulos I, Toutouzas K, Tsioufis K, Elgendy I, Vlachopoulos C. Cardiac amyloidosis remains significantly underdiagnosed in patients undergoing TAVR: analysis of National Inpatient Sample. Amyloid 2022:1-2. [PMID: 36541785 DOI: 10.1080/13506129.2022.2159369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Dimitrios Terentes-Printzios
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexios S Antonopoulos
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mohamed Omer
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Ioannis Panagiotopoulos
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Toutouzas
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Islam Elgendy
- Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Charalambos Vlachopoulos
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Sedhom R, Megaly M, Elbadawi A, Elgendy IY, Witzke CF, Kalra S, George JC, Omer M, Banerjee S, Jaber WA, Shishehbor MH. Contemporary National Trends and Outcomes of Pulmonary Embolism in the United States. Am J Cardiol 2022; 176:132-138. [PMID: 35637010 DOI: 10.1016/j.amjcard.2022.03.060] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 02/07/2023]
Abstract
Contemporary data on the national trends in pulmonary embolism (PE) admissions and outcomes are scarce. We aimed to analyze trends in mortality and different treatment methods in acute PE. We queried the Nationwide Readmissions Database (2016 to 2019) to identify hospitalizations with acute PE using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. We described the national trends in admissions, in-hospital mortality, readmissions, and different treatment methods in acute PE. We identified 1,427,491 hospitalizations with acute PE, 2.4% of them (n = 34,446) were admissions with high-risk PE. The rate of in-hospital mortality in all PE hospitalizations was 6.5%, and it remained unchanged throughout the study period. However, the rate of in-hospital mortality in high-risk PE decreased from 48.1% in the first quarter of 2016 to 38.9% in the last quarter of 2019 (p-trend <0.001). The rate of urgent 30-day readmission was 15.2% in all PE admissions and 19.1% in high-risk PE admissions. In all PE admissions, catheter-directed interventions (CDI) were used more often (2.5%) than systemic thrombolysis (ST) (2.1%). However, in admissions with high-risk PE, ST remained the most frequently used method (ST vs CDI: 11.3% vs 6.6%). In conclusion, this study showed that the rate of in-hospital mortality in high-risk PE decreased from 2016 to 2019. ST was the most frequently used method for achieving pulmonary reperfusion in high-risk PE, whereas CDI was the most frequently used method in the entire PE cohort. In-hospital death and urgent readmissions rates remain significantly high in patients with high-risk PE.
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Affiliation(s)
- Ramy Sedhom
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Michael Megaly
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | - Ayman Elbadawi
- Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Islam Y Elgendy
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Christian F Witzke
- Division of Cardiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Sanjog Kalra
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Jon C George
- Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Mohamed Omer
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Subhash Banerjee
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas; Veterans Affairs North Texas Healthcare System, Dallas, Texas
| | - Wissam A Jaber
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Mehdi H Shishehbor
- Harrington Heart and Vascular Institute and Case Western Reserve University School of Medicine, University Hospitals, Cleveland, Ohio.
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Cortés P, Ghoz HM, Stancampiano F, Omer M, Malviya B, Bowman AW, Palmer WC. Incidentalomas are associated with an increase in liver transplantation in patients with cirrhosis: a single-center retrospective study. BMC Gastroenterol 2022; 22:336. [PMID: 35818022 PMCID: PMC9275240 DOI: 10.1186/s12876-022-02379-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Incidentalomas, defined as incidental findings on imaging, are a growing concern. Our aim was to determine the impact and outcomes of extrahepatic incidentalomas on liver transplantation.
Methods Patients at a large liver transplant center, who had an initial MRI for hepatocellular carcinoma screening between January 2004 and March 2020 were identified. Clinical data were collected retrospectively. Survival analysis, utilizing Kaplan Meier estimates and Cox proportional hazards regression analysis, was utilized to determine factors associated with liver transplantation. Results 720 patients were included. NASH (24.9%), HCV (22.1%) and alcohol (20.6%) were the most common causes of cirrhosis. 79.7% of patients had an extrahepatic incidentaloma. Older age and having received a liver transplant by the end of the study were associated with an incidentaloma. MELD was not associated with the presence of an incidentaloma. On univariate Cox proportional hazards regression, male sex, history of moderate alcohol use, smoking history, MELD, and incidentalomas were predictors of liver transplantation. On multivariate analysis, only MELD and the presence of an incidentaloma were found to be significant. Discovery of an incidentaloma was associated with a 30% increase in the risk of liver transplantation. Median time to transplantation did not differ based on the presence on an incidentaloma. Patients with cirrhosis from alcohol or HCV had a significantly shorter median time to transplantation than those with NASH. Renal and pancreatic lesions comprised 91% of all incidentalomas. Conclusions In this single-center retrospective study, extrahepatic incidentalomas were common in patients with cirrhosis. The finding of an incidentaloma was associated with a higher risk of liver transplantation despite a similar median time to transplantation if no incidentaloma was discovered.
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Affiliation(s)
- Pedro Cortés
- Division of Community Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, 32224, USA
| | - Hassan M Ghoz
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Fernando Stancampiano
- Division of Community Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, 32224, USA
| | - Mohamed Omer
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Balkishan Malviya
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Andrew W Bowman
- Division of Hospital and Emergency Radiology, Mayo Clinic Florida, Jacksonville, FL, 32224, USA
| | - William C Palmer
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Popov V, Andreescu M, Patrinoiu O, Popescu M, Omer M, Mihai F, Ofiteru G, Despan C, Constantin O, Pirvu C, Grigorie A, Rus A, Badoiu Niculae MD, Badea A, Iliescu L. P1601: THE ASSESSMENT OF PREDICTIVE ROLE OF PROTEIN C AND S FOR CRITICAL FORM OF COVID-19. Hemasphere 2022. [PMCID: PMC9430941 DOI: 10.1097/01.hs9.0000849260.73241.b6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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12
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Koop AH, Salih A, Omer M, Kwon J, Ghoz HM, McCann M, Tome J, Palmer WC, Pardi DS, Stancampiano FF. Abnormal findings on abdominopelvic cross-sectional imaging in patients with microscopic colitis: a retrospective, multicenter study. Scand J Gastroenterol 2022; 57:298-304. [PMID: 34859738 DOI: 10.1080/00365521.2021.2007996] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Patients with microscopic colitis may have subtle macroscopic findings on colonoscopy such as erythema, edema, or altered vascular pattern; however, radiographic abnormalities on cross-sectional imaging have not been investigated. We aimed at identifying the abdominopelvic radiographic abnormalities in patients with microscopic colitis, as well as possible correlation with endoscopic findings and the need for extended duration of treatment. MATERIALS AND METHODS This was a retrospective study of patients with biopsy-proven microscopic colitis at two tertiary centers between 1 January 2010 and 30 April 2020. Patients underwent computed tomography scan or magnetic resonance imaging within 30 days of a diagnostic flexible sigmoidoscopy or colonoscopy. Patients with colon ischemia and other causes of colitis were excluded. Radiographic abnormalities from imaging reports included bowel wall thickening, mucosal hyperenhancement and mesenteric fat stranding. Univariate and multivariable logistic regression models were used to identify predictors of radiographic abnormalities. RESULTS 498 patients with microscopic colitis underwent abdominopelvic cross-sectional imaging within 30 days of flexible sigmoidoscopy/colonoscopy. Lymphocytic colitis was diagnosed in 54.6% of patients, and collagenous colitis in 45.4%. Endoscopic and radiographic abnormalities were identified in 16.1% and 12.4% of patients, respectively. Radiographic abnormalities were associated with the need for budesonide therapy (p = .029) and budesonide therapy long-term (p = .0028). Budesonide therapy long-term (p = .047) was associated with radiographic abnormalities in multivariate analysis. CONCLUSIONS Radiographic abnormalities may be present on abdominopelvic cross-sectional imaging in a minority of patients with biopsy-proven microscopic colitis, suggesting cross-sectional imaging has low clinical value in the evaluation and treatment of this disease.
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Affiliation(s)
- Andree H Koop
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Ahmed Salih
- Clinical Studies Unit, Mayo Clinic, Jacksonville, FL, USA
| | - Mohamed Omer
- Clinical Studies Unit, Mayo Clinic, Jacksonville, FL, USA
| | - Josh Kwon
- Division of Community Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Hassan M Ghoz
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Matthew McCann
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - June Tome
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - William C Palmer
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Darrell S Pardi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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13
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Elbadawi A, Tan BEX, Sammour Y, Saad M, Omer M, Baron SJ, Sharaf B, Abbott JD, Gordon PC. Sex-related differences in the trends and outcomes of trans-septal transcatheter mitral valve replacement: Insights from the National Readmissions Database. Catheter Cardiovasc Interv 2022; 99:1636-1644. [PMID: 35132765 DOI: 10.1002/ccd.30072] [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: 08/24/2021] [Revised: 11/26/2021] [Accepted: 12/25/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is a paucity of data regarding the sex-related differences in the trends and outcomes of trans-septal transcatheter mitral valve replacement (TS-TMVR). METHODS The Nationwide Readmissions Database (2015-2018) was queried for admissions for TS-TMVR. Propensity matched analysis was conducted to compare outcomes with hospitalizations for TS-TMVR among women versus men. The main study outcome was in-hospital mortality. RESULTS Our final analysis included 2063 hospitalizations for TS-TMVR; of whom, 58.1% were women. The proportion of women among those undergoing TS-TMVR increased from 50% in 2015 to 60.2% in 2018 (Ptrend = 0.04). Compared with men, women undergoing TS-TMVR were slightly younger, and had a distinct profile of comorbidities. After matching, there was no significant difference in in-hospital mortality among women versus men undergoing TS-TMVR (7.8% vs. 6.1%, OR = 1.30; 95% CI: 0.79-2.13). Subgroup analyzes showed an interaction toward higher mortality with women versus men among patients with CKD (Pinteraction = 0.07). There were no significant differences between women and men in in-hospital complications or length of stay after TS-TMVR. Compared with men, women undergoing TS-TMVR were more likely to be discharged to a nursing facility (17.7% vs. 11.5%, p = 0.01) and had higher rates of 30-day readmissions (22.4% vs. 13.6%, p = 0.01). CONCLUSION This nationwide analysis showed an increase in the proportion of women among patients undergoing TS-TMVR during the study years. There were no differences in in-hospital mortality, in-hospital complications, or length of stay between both sexes following TS-TMVR. Women were more likely to be discharged to nursing facilities and had higher rates of readmission at 30 days even after propensity matching.
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Affiliation(s)
- Ayman Elbadawi
- Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Bryan E-Xin Tan
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Yasser Sammour
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Marwan Saad
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mohamed Omer
- Division of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Suzanne J Baron
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Barry Sharaf
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - J Dawn Abbott
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Paul C Gordon
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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14
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Abdelfattah OM, Abushouk AI, Saad AM, Gad MM, Isogai T, Saleh Y, Shekhar S, Iskander M, Omer M, Kaple R, Krishnaswamy A, Kapadia SR. Impact of post-procedural length of stay on short-term outcomes and readmissions after TAVR and MitraClip. Am Heart J Plus 2022; 13:100130. [PMID: 38560061 PMCID: PMC10978317 DOI: 10.1016/j.ahjo.2022.100130] [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] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/10/2022] [Accepted: 03/22/2022] [Indexed: 04/04/2024]
Abstract
Background Post-procedural hospital length of stay (P-LOS) is an important determinant of cost-related outcomes. In the present study, we aimed to assess the impact of P-LOS on short-term outcomes after transcatheter aortic valve replacement (TAVR) and MitraClip. Methods We performed a retrospective cohort study, retrieving data from the National Readmissions Database (NRD) for patients who underwent transfemoral TAVR and MitraClip between January 2014 and December 2017. We employed multivariable logistic regression to evaluate the association between P-LOS and 30-day all-cause mortality and readmissions. Results A total of 65,726 and 7347 patients underwent TAVR and MitraClip, respectively within the study period. After 30 days of discharge, 13.7% and 15.1% of TAVR and MitraClip patients were readmitted for any reason, while 0.5% and 0.9% died within the readmission hospitalization. A longer P-LOS was associated with an increased risk of 30-day all-cause readmission in both TAVR (OR = 1.027, 95% CI [1.023-1.032]) and MitraClip (OR = 1.025, 95%CI [1.012-1.038]) patients. This finding remained true for patients who developed or did not develop complications after both procedures. In terms of 30-day inhospital mortality, a longer P-LOS was associated with a higher risk in TAVR patients (OR = 1.039, 95%CI [1.028-1.049]), but no increased risk in MitraClip patients (OR = 1.014, 95%CI [0.985-1.044]). Other predictors of 30-day readmission after both procedures included heart failure, post-procedural acute kidney injury, and discharge with disability. Conclusion The current study shows that shorter P-LOS was associated with reduced risk of short-term readmission after both TAVR and MitraClip and reduced short-term mortality after TAVR (mainly in patients who developed post-procedural complications). Shorter P-LOS is a predictor of readmission and sicker patient group. Patients requiring longer LOS should be followed closely to prevent readmission and enhance better outcomes. Future studies evaluating P-LOS impact on long-term and patient-oriented outcomes are needed.
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Affiliation(s)
- Omar M. Abdelfattah
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
- Internal Medicine Department, Morristown Medical Center, Atlantic Health System, Morristown, NJ, USA
| | - Abdelrahman I. Abushouk
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anas M. Saad
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamed M. Gad
- Internal Medicine Department, Cleveland Clinic, Cleveland, OH, USA
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yehia Saleh
- Department of Cardiovascular Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Shashank Shekhar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mina Iskander
- Department of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Mohamed Omer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ryan Kaple
- Department of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir R. Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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Xenogiannis I, Alaswad K, Krestyaninov O, Khelimskii D, Khatri JJ, Choi JW, Jaffer FA, Patel M, Mahmud E, Doing AH, Dattilo P, Koutouzis M, Tsiafoutis I, Uretsky B, Jefferson BK, Patel T, Jaber W, Samady H, Sheikh AM, Yeh RW, Tamez H, Elbarouni B, Love MP, Abi Rafeh N, Maalouf A, Fadi AJ, Toma C, Shah AR, Chandwaney RH, Omer M, Megaly MS, Vemmou E, Nikolakopoulos I, Rangan BV, Garcia S, Abdullah S, Banerjee S, Burke MN, Karmpaliotis D, Brilakis ES. Impacto de la adherencia a un algoritmo híbrido para la selección de la estrategia inicial de cruce en la intervención coronaria percutánea de oclusiones crónicas. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Al-Fakeh MS, Osman SOM, Gassoumi M, Rabhi M, Omer M. Characterization, Antimicrobial and Anticancer Properties of Palladium Nanoparticles Biosynthesized Optimally Using Saudi Propolis. Nanomaterials (Basel) 2021; 11:2666. [PMID: 34685107 PMCID: PMC8540078 DOI: 10.3390/nano11102666] [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] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/30/2021] [Accepted: 10/02/2021] [Indexed: 01/09/2023]
Abstract
Due to their unique physicochemical characteristics, palladium nanoparticles (Pd-NPs) have shown tremendous promise in biological applications. The biosynthesis of Pd-NPs employing Saudi propolis has been designed to be environmental, fast, controlled, and cost-effective. The formation and stability of biosynthesized Pd-NPs by Saudi propolis extract were proved by ultraviolet-visible spectrophotometry (UV-Vis), Fourier-transform infrared spectroscopy (FT-IR), and Zeta potential analysis. Transmission electron microscopy (TEM), scanning electron microscopy (SEM), and X-ray diffraction (XRD) findings show that the average particle size of Pd-NPs is between 3.14 and 4.62 nm, which is in quantum scale. The Saudi propolis enhanced the antimicrobial activity against B. subtilis, S. aureus, E. coli, K. pneumoniae, and C. albicans. Pd-NPs show effective anticancer activity against ductal carcinoma (MCF-7) with IC50 of 104.79 µg/mL.
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Affiliation(s)
- Maged S. Al-Fakeh
- Department of Chemistry, College of Science, Qassim University, Buraidah 51452, Saudi Arabia;
- Taiz University, Taiz 3086, Republic of Yemen
| | - Samir Osman Mohammed Osman
- Department of Physics, College of Science, Ibb University, Ibb 009674, Yemen
- Engineer College, Aljanad University for Science & Technology, Taiz 009674, Yemen
| | - Malek Gassoumi
- Department of Physics, College of Science, Qassim University, P.O. 64, Buraidah 51452, Saudi Arabia;
- Unite de Recherche Matériaux Advances et Nanotechnologies, Institut Supérieur des Sciences Appliquées et de Technologie de Kasserine, Université de Kairouan, BP 471, 1200 Kasserine, Tunisia
| | - Mokded Rabhi
- Department of Plant Production and Protection, College of Agriculture and Veterinary Medicine, Qassim University, Qassim 51452, Saudi Arabia;
| | - Mohamed Omer
- Department of Radiologic Science, College of Applied Medical Sciences, Buraidah 51452, Saudi Arabia;
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17
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Nikolakopoulos I, Patel T, Jefferson BK, Sheikh AM, Jaber W, Samady H, Khatri JJ, Yeh RW, Tamez H, Koutouzis M, Tsiafoutis I, Jaffer FA, Doing AH, Dattilo P, Uretsky BF, Toma C, Elbarouni B, Alaswad K, Choi JW, Lembo NJ, Parikh M, Kirtane AJ, Ali ZA, Omer M, Vemmou E, Xenogiannis I, Karacsonyi J, Rangan BV, Abdullah S, Banerjee S, Garcia S, Burke MN, Brilakis ES, Karmpaliotis D. Distal Radial Access in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry. J Invasive Cardiol 2021; 33:E717-E722. [PMID: 34433693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND The outcomes of distal radial access (dRA) in chronic total occlusion percutaneous coronary intervention (CTO-PCI) have received limited study. METHODS We compared the clinical, angiographic, and procedural characteristics of 120 CTO-PCIs performed via dRA access with 2625 CTO-PCIs performed via proximal radial access (pRA) in a large, multicenter registry. RESULTS The dRA group had lower mean PROGRESS-CTO score than the pRA group (1.0 ± 1 vs 1.2 ± 1, respectively; P=.05), while J-CTO score (2.4 ± 1.2 vs 2.3 ± 1.3; P=.43) and PROGRESS-CTO Complications score (2.8 ± 1.8 vs 2.6 ± 1.9; P=.16) were similar in the dRA vs pRA groups, respectively. Technical success was similar in the 2 groups (90% dRA vs 86% pRA; P=.14). Concomitant use of femoral access did not alter procedural success. The incidence of major periprocedural adverse cardiac events was similar in the 2 groups (0.8% dRA vs 2.4% pRA; P=.26), whereas the incidence of tamponade requiring pericardiocentesis was lower with dRA (0% dRA vs 4.69% pRA; P<.001), as was air kerma radiation dose (median, 1.7 Gy; interquartile range [IQR], 0.97-2.63 Gy in the dRA group vs median, 2.27 Gy; IQR, 1.2-3.9 Gy in the pRA group; P<.001). CONCLUSIONS Use of dRA in CTO-PCI is associated with similar procedural success and risk of complications as compared with pRA.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Emmanouil S Brilakis
- Minneapolis Heart Institute, 920 E. 28th Street #300, Minneapolis, MN 55407 USA.
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18
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Xenogiannis I, Jaffer F, Shah A, Omer M, Megaly M, Vemmou E, Nikolakopoulos I, Rangan B, Garcia S, Lesser J, Cavalcante J, Burke M, Brilakis E. Computed tomography angiography co-registration with real-time fluoroscopy in percutaneous coronary intervention for chronic total occlusions. EUROINTERVENTION 2021; 17:e433-e435. [PMID: 32657275 PMCID: PMC9724964 DOI: 10.4244/eij-d-20-00175] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 11/23/2022]
Affiliation(s)
- Iosif Xenogiannis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, Minneapolis, MN, USA
| | - Farouc Jaffer
- Interventional Cardiology Department, Massachusetts General Hospital, Boston, MA, USA
| | - Alpesh Shah
- Interventional Cardiology Department, Houston Methodist Hospital, Houston, TX, USA
| | - Mohamed Omer
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, Minneapolis, MN, USA
| | - Michael Megaly
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, Minneapolis, MN, USA
| | - Evangelia Vemmou
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, Minneapolis, MN, USA
| | - Ilias Nikolakopoulos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, Minneapolis, MN, USA
| | - Bavana Rangan
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, Minneapolis, MN, USA
| | - Santiago Garcia
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, Minneapolis, MN, USA
| | - John Lesser
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, Minneapolis, MN, USA
| | - João Cavalcante
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, Minneapolis, MN, USA
| | - M. Burke
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, Minneapolis, MN, USA
| | - Emmanouil Brilakis
- Minneapolis Heart Institute, 920 E 28th Street #300, Minneapolis, MN 55407, USA
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Elbadawi A, Elgendy IY, Omer M, Abdelazeem M, Nambi V, Krittanawong C, Hira RS, Tamis-Holland J, Ballantyne C, Jneid H. Outcomes of Acute Myocardial Infarction in Patients with Familial Hypercholesteremia. Am J Med 2021; 134:992-1001.e4. [PMID: 33872584 DOI: 10.1016/j.amjmed.2021.03.013] [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] [Received: 01/27/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is a paucity of contemporary data regarding the outcomes of acute myocardial infarction among patients with familial hypercholesteremia. METHODS We queried the Nationwide Readmissions Database (2016-2018) for hospitalizations with acute myocardial infarction. Multivariable regression analysis was used to compare in-hospital outcomes and 30-day readmissions among patients with and without familial hypercholesteremia. RESULTS The analysis included 1,363,488 hospitalizations with acute myocardial infarction. The prevalence of familial hypercholesteremia was 0.07% among acute myocardial infarction admissions. Compared with those without familial hypercholesteremia, admissions with familial hypercholesteremia were younger and had less comorbidities but were more likely to have had prior infarct and revascularization. Admissions with familial hypercholesteremia were more likely to present with ST-elevation myocardial infarction and undergo revascularization. After multivariable adjustment, there was no difference in in-hospital case fatality among patients with hypercholesteremia compared with those without it (adjusted odds ratio [aOR] = 0.76; 95% confidence interval [CI] 0.41-1.39). Admissions with acute myocardial infarction and familial hypercholesteremia had higher adjusted rates of cardiac arrest and utilization of mechanical support. There were no group differences in overall 30-day readmission (aOR 0.75; 95% CI 0.51-1.10) or 30-day readmission for acute myocardial infarction. However, a nonsignificant trend toward higher readmission for percutaneous coronary intervention was observed among patients with familial hypercholesteremia (aOR 1.89; 95% CI 0.98-3.64). CONCLUSION In this contemporary nationwide observational analysis, patients with familial hypercholesteremia represent a small proportion of the overall population with acute myocardial infarction and have a distinctive clinical profile but do not appear to have worse in-hospital case fatality compared with those without familial hypercholesteremia.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston
| | - Islam Y Elgendy
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Mohamed Omer
- Division of Cardiology, Mayo Clinic, Rochester, Minn
| | - Mohamed Abdelazeem
- Department of Internal Medicine, St. Elizabeth's Medical Center, Brighton, Mass
| | - Vijay Nambi
- Section of Cardiology, Baylor School of Medicine, Houston, Tex
| | | | - Ravi S Hira
- Pulse Heart Institute, Tacoma, Wash; Foundation for Health Care Quality, Seattle, Wash
| | | | | | - Hani Jneid
- Section of Cardiology, Baylor School of Medicine, Houston, Tex.
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Megaly M, Sorajja P, Cavalcante JL, Pershad A, Gössl M, Abraham B, Omer M, Elbadawi A, Garcia S. Ischemic Stroke With Cerebral Protection System During Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2021; 13:2149-2155. [PMID: 32972578 DOI: 10.1016/j.jcin.2020.05.039] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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: 03/02/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate in-hospital outcomes with use of the Sentinel cerebral protection system (CPS) in transcatheter aortic valve replacement (TAVR). BACKGROUND The role of the Sentinel CPS in preventing clinical ischemic stroke has been controversial. METHODS The Nationwide Inpatient Sample database from the last three quarters of 2017, after the approval of the Sentinel CPS device, was queried to identify hospitalizations for TAVR. A 1:2 propensity score-matched analysis to compare in-hospital outcomes with versus without use of the CPS. The primary outcome was the occurrence of ischemic strokes. RESULTS A total of 36,220 weighted discharges of patients who underwent TAVR (525 with the CPS and 35,695 without) were identified. The overall percentages of ischemic and hemorrhagic strokes were 2.4% and 0.2%, respectively. After propensity score matching (525 CPS, 1,050 no CPS), the risk for ischemic stroke was lower with use of the CPS (1 % vs. 3.8%, odd ratio [OR]: 0.243 (95% confidence interval: 0.095 to 0.619); p = 0.003). The cost of the index hospitalization was higher with use of the CPS ($47,783 vs. $44,578; p = 0.002). In multivariate regression analysis, use of the CPS was independently associated with a lower risk for ischemic stroke (OR: 0.380; 95% confidence interval: 0.157 to 0.992; p = 0.032). CONCLUSIONS Use of the Sentinel CPS in patients undergoing TAVR is associated with a lower incidence of ischemic stroke and in-hospital mortality, without an increased risk for procedural complications but with an increased cost of the index hospitalization.
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Affiliation(s)
- Michael Megaly
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota; Division of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - João L Cavalcante
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Ashish Pershad
- Division of Cardiology, Banner University Medical Center, University of Arizona, Phoenix, Arizona
| | - Mario Gössl
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Bishoy Abraham
- Division of Internal Medicine, Ascension St. John Hospital, Detroit, Michigan
| | - Mohamed Omer
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota; Division of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Ayman Elbadawi
- Division of Cardiology, University of Texas Medical Branch, Galveston, Texas
| | - Santiago Garcia
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.
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Stancampiano F, Omer M, Harris D, Valery J, Heckman M, White L, Libertin C. Clinical Characteristics and Outcomes of Patients Hospitalized for COVID-19 Pneumonia Who Developed Bradycardia. South Med J 2021; 114:432-437. [PMID: 34215897 PMCID: PMC8231014 DOI: 10.14423/smj.0000000000001269] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Multiple systemic abnormalities have been described in patients with coronavirus disease 2019, including various degrees of cardiovascular involvement ranging from mild myocarditis to severe pulmonary hypertension, ventricular dysfunction, and arrhythmias. This article describes the clinical characteristics and outcomes of patients with coronavirus disease 2019 pneumonia who developed bradycardia. Supplemental digital content is available in the text. To assess the clinical characteristics and clinical outcomes of bradycardic patients with coronavirus disease 2019 (COVID-19) pneumonia.
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Affiliation(s)
- Fernando Stancampiano
- From the Division of Community Internal Medicine, the Clinical Research Unit, the Division of Biomedical Statistics and Informatics, and the Division of Infectious Diseases, Mayo Clinic Florida, Jacksonville
| | - Mohamed Omer
- From the Division of Community Internal Medicine, the Clinical Research Unit, the Division of Biomedical Statistics and Informatics, and the Division of Infectious Diseases, Mayo Clinic Florida, Jacksonville
| | - Dana Harris
- From the Division of Community Internal Medicine, the Clinical Research Unit, the Division of Biomedical Statistics and Informatics, and the Division of Infectious Diseases, Mayo Clinic Florida, Jacksonville
| | - Jose Valery
- From the Division of Community Internal Medicine, the Clinical Research Unit, the Division of Biomedical Statistics and Informatics, and the Division of Infectious Diseases, Mayo Clinic Florida, Jacksonville
| | - Michael Heckman
- From the Division of Community Internal Medicine, the Clinical Research Unit, the Division of Biomedical Statistics and Informatics, and the Division of Infectious Diseases, Mayo Clinic Florida, Jacksonville
| | - Launia White
- From the Division of Community Internal Medicine, the Clinical Research Unit, the Division of Biomedical Statistics and Informatics, and the Division of Infectious Diseases, Mayo Clinic Florida, Jacksonville
| | - Claudia Libertin
- From the Division of Community Internal Medicine, the Clinical Research Unit, the Division of Biomedical Statistics and Informatics, and the Division of Infectious Diseases, Mayo Clinic Florida, Jacksonville
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22
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Sedhom R, Megaly M, Abdelmaseeh P, Elbadawi A, Omer M, Janzer S, Garcia S, Brilakis ES. Complications and failure modes of the Penumbra Indigo CAT RX aspiration system in percutaneous coronary intervention: Insights from the MAUDE database. Cardiovasc Revasc Med 2021; 37:147-148. [PMID: 34315676 DOI: 10.1016/j.carrev.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Ramy Sedhom
- Department of Medicine, Albert Einstein Health System, Philadelphia, PA, USA
| | - Michael Megaly
- Division of Cardiology, Banner University Medical Center/University of Arizona, Phoenix, AZ, USA
| | - Peter Abdelmaseeh
- Department of Medicine, Albert Einstein Health System, Philadelphia, PA, USA
| | - Ayman Elbadawi
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Mohamed Omer
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Sean Janzer
- Department of Cardiology, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Santiago Garcia
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
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23
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Elbadawi A, Elzeneini M, Omer M, Megaly M, Abowali H, Mohamed AH, Saleh M, Hamed M, Shahin HI, Kleiman NS, Goel SS. Transcatheter Edge to Edge Repair With MitraClip Among Renal Transplant Recipients. Am J Cardiol 2021; 148:178-180. [PMID: 33689696 DOI: 10.1016/j.amjcard.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 10/22/2022]
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24
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Elbadawi A, Elzeneini M, Thakker R, Shnoda M, Omer M, Shahin HI, Kapadia SR, Kleiman NS, Reardon MJ, Goel SS. Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Combined Chronic Kidney and Liver Disease. JACC Cardiovasc Interv 2021; 14:1047-1049. [PMID: 33958167 DOI: 10.1016/j.jcin.2021.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
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25
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Han CY, Kang I, Harten IA, Gebe JA, Chan CK, Omer M, Alonge KM, den Hartigh LJ, Gomes Kjerulf D, Goodspeed L, Subramanian S, Wang S, Kim F, Birk DE, Wight TN, Chait A. Adipocyte-Derived Versican and Macrophage-Derived Biglycan Control Adipose Tissue Inflammation in Obesity. Cell Rep 2021; 31:107818. [PMID: 32610121 DOI: 10.1016/j.celrep.2020.107818] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 01/24/2020] [Revised: 04/20/2020] [Accepted: 06/04/2020] [Indexed: 12/18/2022] Open
Abstract
Obesity is characterized by adipose tissue inflammation. Because proteoglycans regulate inflammation, here we investigate their role in adipose tissue inflammation in obesity. We find that adipose tissue versican and biglycan increase in obesity. Versican is produced mainly by adipocytes and biglycan by adipose tissue macrophages. Both proteoglycans are also present in adipose tissue from obese human subjects undergoing gastric bypass surgery. Deletion of adipocyte-specific versican or macrophage-specific biglycan in mice reduces macrophage accumulation and chemokine and cytokine expression, although only adipocyte-specific versican deletion leads to sustained improvement in glucose tolerance. Macrophage-derived biglycan activates inflammatory genes in adipocytes. Versican expression increases in cultured adipocytes exposed to excess glucose, and adipocyte-conditioned medium stimulates inflammation in resident peritoneal macrophages, in part because of a versican breakdown product, versikine. These findings provide insights into the role of adipocyte- and macrophage-derived proteoglycans in adipose tissue inflammation in obesity.
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Affiliation(s)
- Chang Yeop Han
- Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, WA, USA
| | - Inkyung Kang
- Matrix Biology Program, Benaroya Research Institute, Seattle, WA, USA
| | - Ingrid A Harten
- Matrix Biology Program, Benaroya Research Institute, Seattle, WA, USA
| | - John A Gebe
- Matrix Biology Program, Benaroya Research Institute, Seattle, WA, USA
| | - Christina K Chan
- Matrix Biology Program, Benaroya Research Institute, Seattle, WA, USA
| | - Mohamed Omer
- Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, WA, USA
| | - Kimberly M Alonge
- Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, WA, USA
| | - Laura J den Hartigh
- Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, WA, USA
| | - Diego Gomes Kjerulf
- Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, WA, USA
| | - Leela Goodspeed
- Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, WA, USA
| | - Savitha Subramanian
- Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, WA, USA
| | - Shari Wang
- Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, WA, USA
| | - Francis Kim
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - David E Birk
- Department of Molecular Pharmacology & Physiology, University of South Florida, Tampa, FL, USA
| | - Thomas N Wight
- Matrix Biology Program, Benaroya Research Institute, Seattle, WA, USA
| | - Alan Chait
- Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, WA, USA.
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Elbadawi A, Elgendy IY, Saad M, Elzeneini M, Megaly M, Omer M, Banerjee S, Drachman DE, Aronow HD. Contemporary Revascularization Strategies and Outcomes Among Patients With Diabetes With Critical Limb Ischemia: Insights From the National Inpatient Sample. JACC Cardiovasc Interv 2021; 14:664-674. [PMID: 33640391 DOI: 10.1016/j.jcin.2020.11.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/10/2020] [Accepted: 11/17/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate temporal trends in the frequency of revascularization and associated outcomes in patients with diabetes mellitus and critical limb ischemia (CLI). BACKGROUND Little is known about outcomes following revascularization for CLI in patients with diabetes mellitus. METHODS Temporal trends in hospitalization for CLI among patients with diabetes were determined using the 2002-2015 National Inpatient Sample database. Propensity score matching was used to compare patients who underwent revascularization with those who did not and, separately, to compare those who underwent endovascular versus surgical revascularization. The main study outcome was in-hospital mortality. RESULTS The analysis included 1,222,324 hospitalizations. The number of hospitalizations for CLI among patients with diabetes increased over time (ptrend < 0.001). There was an increase in the use of lower extremity revascularization, paralleled by a decline in in-hospital mortality during the study period. In the matched cohort, patients who were revascularized had lower in-hospital mortality (odds ratio [OR]: 0.68; 95% confidence interval [CI]: 0.63 to 0.72) and major amputation (OR: 0.25; 95% CI: 0.24 to 0.27) compared with those who were treated medically. Compared with endovascular revascularization, those who underwent surgical revascularization had higher rates of in-hospital mortality (OR: 1.18; 95% CI: 1.04 to 1.35) but lower rates of major amputation (OR: 0.75; 95% CI: 0.70 to 0.81). Major bleeding, blood transfusion, post-operative infection, respiratory complications, discharges to nursing facility, and longer length of hospital stay were also more common among those who underwent surgery. CONCLUSIONS In this national analysis of patients with DM and CLI, we demonstrated an increase in hospitalization for CLI among patients with diabetes in the United States. Although in-hospital mortality decreased over time regardless of the treatment strategy used, this outcome occurred less frequently among those who underwent revascularization than not. Compared with surgical revascularization, endovascular revascularization was associated with lower in-hospital mortality but higher rates of major amputation.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Islam Y Elgendy
- Division of Cardiology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Marwan Saad
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mohammed Elzeneini
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Michael Megaly
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Mohamed Omer
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Subhash Banerjee
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | | | - Herbert D Aronow
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
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Omer M, Amir-Khalili A, Sojoudi A, Thao Le T, A Cook S, Faye Toh D, Bryant J, Chin C, Miguel Paiva J, Fung K, Aung N, Y Khanji M, Rauseo E, Cooper J, E Petersen S. Assessing automated CMR contouring algorithms using systematic contour quality scoring analysis. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): SmartHeart EPSRC programme grant (www.nihr.ac.uk), London Medical Imaging and AI Centre for Value-Based Healthcare
Background
Quality measures for machine learning algorithms include clinical measures such as end-diastolic (ED) and end-systolic (ES) volume, volumetric overlaps such as Dice similarity coefficient and surface distances such as Hausdorff distance. These measures capture differences between manually drawn and automated contours but fail to capture the trust of a clinician to an automatically generated contour.
Purpose
We propose to directly capture clinicians’ trust in a systematic way. We display manual and automated contours sequentially in random order and ask the clinicians to score the contour quality. We then perform statistical analysis for both sources of contours and stratify results based on contour type.
Data
The data selected for this experiment came from the National Health Center Singapore. It constitutes CMR scans from 313 patients with diverse pathologies including: healthy, dilated cardiomyopathy (DCM), hypertension (HTN), hypertrophic cardiomyopathy (HCM), ischemic heart disease (IHD), left ventricular non-compaction (LVNC), and myocarditis. Each study contains a short axis (SAX) stack, with ED and ES phases manually annotated. Automated contours are generated for each SAX image for which manual annotation is available. For this, a machine learning algorithm trained at Circle Cardiovascular Imaging Inc. is applied and the resulting predictions are saved to be displayed in the contour quality scoring (CQS) application.
Methods: The CQS application displays manual and automated contours in a random order and presents the user an option to assign a contour quality score
1: Unacceptable, 2: Bad, 3: Fair, 4: Good. The UK Biobank standard operating procedure is used for assessing the quality of the contoured images. Quality scores are assigned based on how the contour affects clinical outcomes. However, as images are presented independent of spatiotemporal context, contour quality is assessed based on how well the area of the delineated structure is approximated. Consequently, small contours and small deviations are rarely assigned a quality score of less than 2, as they are not clinically relevant. Special attention is given to the RV-endo contours as often, mostly in basal images, two separate contours appear. In such cases, a score of 3 is given if the two disjoint contours sufficiently encompass the underlying anatomy; otherwise they are scored as 2 or 1.
Results
A total of 50991 quality scores (24208 manual and 26783 automated) are generated by five expert raters. The mean score for all manual and automated contours are 3.77 ± 0.48 and 3.77 ± 0.52, respectively. The breakdown of mean quality scores by contour type is included in Fig. 1a while the distribution of quality scores for various raters are shown in Fig. 1b.
Conclusion
We proposed a method of comparing the quality of manual versus automated contouring methods. Results suggest similar statistics in quality scores for both sources of contours.
Abstract Figure 1
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Affiliation(s)
- M Omer
- Circle Cardiovascular Imaging Inc., Calgary, Canada
| | | | - A Sojoudi
- Circle Cardiovascular Imaging Inc., Calgary, Canada
| | - T Thao Le
- National Heart Centre Singapore, Singapore, Singapore
| | - S A Cook
- National Heart Centre Singapore, Singapore, Singapore
| | - D Faye Toh
- National Heart Centre Singapore, Singapore, Singapore
| | - J Bryant
- National Heart Centre Singapore, Singapore, Singapore
| | - C Chin
- National Heart Centre Singapore, Singapore, Singapore
| | | | - K Fung
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - N Aung
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - M Y Khanji
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - E Rauseo
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - J Cooper
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - S E Petersen
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
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Harris DM, Dumitrascu AG, Chirila RM, Omer M, Stancampiano FF, Hata DJ, Meza Villegas DM, Heckman MG, Cochuyt JJ, Alvarez S. Invasive Nocardiosis in Transplant and Nontransplant Patients: 20-Year Experience in a Tertiary Care Center. Mayo Clin Proc Innov Qual Outcomes 2021; 5:298-307. [PMID: 33997629 PMCID: PMC8105525 DOI: 10.1016/j.mayocpiqo.2020.10.009] [Citation(s) in RCA: 3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective To present the clinical characteristics and outcome of transplant and nontransplant patients with invasive nocardiosis. Patients and Methods We conducted a retrospective chart review of 110 patients 18 years and older diagnosed with culture-proven invasive nocardiosis (defined as the presence of clinical signs and/or radiographic abnormalities) between August 1, 1998, and November 30, 2018. Information on demographic, clinical, radiographic, and microbiological characteristics as well as mortality was collected. Results One hundred ten individuals with invasive nocardiosis were identified, of whom 54 (49%) were transplant and 56 nontransplant (51%) patients. Most transplant patients were kidney and lung recipients. The overall mean age was 64.9 years, and transplant patients had a higher prevalence of diabetes and chronic kidney disease. A substantial proportion of nontransplant patients were receiving corticosteroids (39%), immunosuppressive medications (16%), and chemotherapy (9%) and had chronic obstructive pulmonary disease (20%), rheumatologic conditions (18%), and malignant neoplasia (18%). A higher proportion of transplant patients (28%) than nontransplant patients (4%) received trimethoprim-sulfamethoxazole prophylaxis. In both groups, the lung was the most common site of infection. Seventy percent of all Nocardia species isolated were present in almost equal proportion: N brasiliensis (16%), N farcinica (16%), N nova (15%), N cyriacigeorgia (13%), and N asteroides (11%). More than 90% of isolates were susceptible to trimethoprim-sulfamethoxazole, linezolid, and amikacin. There was no significant difference in mortality between the 2 groups at 1, 6, and 12 months after the initial diagnosis. Conclusion The frequency of invasive Nocardia infection was similar in transplant and nontransplant patients and mortality at 1, 6, and 12 months was similar in both groups. Trimethoprim-sulfamethoxazole prophylaxis failed to prevent Nocardia infection.
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Affiliation(s)
- Dana M Harris
- Division of Community Internal Medicine, Mayo Clinic, FL
| | | | - Razvan M Chirila
- Division of International and Executive Medicine, Mayo Clinic, FL
| | | | | | - D Jane Hata
- Division of Laboratory Medicine and Pathology, Mayo Clinic, FL
| | | | | | - Jordan J Cochuyt
- Division of Biomedical Statistics and Informatics, Mayo Clinic, FL
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Megaly M, Han K, Sedhom R, Aboulhosn J, Moga F, Mudy K, Daniels MJ, Elbadawi A, Omer M, Mosleh W, Cavalcante JL, Garcia S. Outcomes of percutaneous and surgical pulmonary valve implantation. Cardiovasc Revasc Med 2021; 32:27-32. [PMID: 33422413 DOI: 10.1016/j.carrev.2020.12.035] [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: 06/28/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The objective of this study is to describe the recent trends and in-hospital outcomes with percutaneous pulmonic valve implantation (PPVI) and surgical pulmonic valve implantation (SPVR) in adult hospitals in the US after the availability of both the Melody valve (Medtronic Inc., Minneapolis, Minnesota) and the Sapien XT valve (Edwards Lifesciences, Irvine, CA). METHODS We queried the National Inpatient Sample database (NIS) from January 2016 to December 2017 to identify hospitalizations for PPVI and SPVR. RESULTS We identified 5455 weighted discharges with PPVI and SPVR (PPVI=1140, SPVR=4305). PPVI procedures had increased in number over 2016 and 2017 (115 procedure at the first quarter of 2016, 195 procedures in the final quarter of 2017, P-trend=0.086), while SPVR volume remained constant. The incidence of in-hospital mortality was low with both procedures (SPRV: 1.6% vs. PPVI: 0.9%, p=0.071). SPVR had worse in-hospital outcomes, was associated with a longer length of stay [5 days vs. 1 day, p<0.001], and comparable cost of index hospitalization [$51,657 vs. $51,193] compared with PPVI. CONCLUSION After approval of the Sapien valve for commercial use in 2016, PPVI procedures have increased in frequency. PPVI is associated with lower procedural complications than SPVR, however, both carry a low risk of mortality. Despite the higher cost of the valves and delivery systems, PPVI is associated with a slightly lower cost of index hospitalization compared with SPVR, likely due to the higher in-hospital complications and LOS of the latter.
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Affiliation(s)
- Michael Megaly
- Banner University Medical Center-UA college of Medicine, Phoenix, AZ, United States of America
| | - Kelly Han
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States of America
| | - Ramy Sedhom
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, United States of America
| | - Jamil Aboulhosn
- Department of Pediatric Interventional Cardiology, UCLA, Los Angeles, CA, United States of America
| | - Francis Moga
- Division of Pediatric Cardiothoracic Surgery, Children's Heart Clinic, Minneapolis, MN, United States of America
| | - Karol Mudy
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States of America
| | - Matthew J Daniels
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, UK
| | - Ayman Elbadawi
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, United States of America
| | - Mohamed Omer
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States of America
| | - Wassim Mosleh
- Division of Cardiology, University of Connecticut, Farmington, CT, United States of America
| | - João L Cavalcante
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States of America
| | - Santiago Garcia
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States of America.
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30
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Gomes Kjerulf D, Wang S, Omer M, Pathak A, Subramanian S, Han CY, Tang C, den Hartigh LJ, Shao B, Chait A. Glycation of HDL blunts its anti-inflammatory and cholesterol efflux capacities in vitro, but has no effect in poorly controlled type 1 diabetes subjects. J Diabetes Complications 2020; 34:107693. [PMID: 32900591 PMCID: PMC7669727 DOI: 10.1016/j.jdiacomp.2020.107693] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND High-density lipoproteins (HDL) modified by glycation have been reported to be dysfunctional. Little is known regarding the anti-inflammatory effects on adipocytes of glycated HDL. AIMS We tested whether modification of HDL in vitro by glycolaldehyde (GAD), malondialdehyde (MDA) or glucose affected HDL's anti-inflammatory properties and ability to promote cholesterol efflux. To determine whether similar changes occur in vivo, we examined modifications of apolipoprotein A1 (APOA1) and APOA2 and anti-inflammatory and cholesterol efflux properties of HDL isolated from subjects with type 1 diabetes in poor glycemic control. RESULTS In vitro modification with both GAD and MDA blunted HDL's ability to inhibit palmitate-induced inflammation and cholesterol efflux in adipocytes. Modification of HDL by glucose had little impact on HDL function, like the response using HDL isolated from subjects with diabetes. Mass spectrophotometric analysis revealed that lysine residues in APOA1 and APOA2 of HDL modified by GAD and MDA in vitro differed from those modified by glucose, which resembled that seen with HDL from patients with type1 diabetes. CONCLUSIONS Modification of lysine residues in HDL by GAD and MDA in vitro does not mirror the HDL glycation in vivo in patients with diabetes, but resembles HDL modified in vitro by glucose.
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Affiliation(s)
- Diego Gomes Kjerulf
- Department of Medicine, Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Shari Wang
- Department of Medicine, Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Mohamed Omer
- Department of Medicine, Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Asha Pathak
- Department of Medicine, Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Savitha Subramanian
- Department of Medicine, Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Chang Yeop Han
- Department of Medicine, Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Chongren Tang
- Department of Medicine, Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Laura J den Hartigh
- Department of Medicine, Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Baohai Shao
- Department of Medicine, Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Alan Chait
- Department of Medicine, Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA, United States of America.
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31
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Xenogiannis I, Alaswad K, Krestyaninov O, Khelimskii D, Khatri JJ, Choi JW, Jaffer FA, Patel M, Mahmud E, Doing AH, Dattilo P, Koutouzis M, Tsiafoutis I, Uretsky B, Jefferson BK, Patel T, Jaber W, Samady H, Sheikh AM, Yeh RW, Tamez H, Elbarouni B, Love MP, Abi Rafeh N, Maalouf A, Fadi AJ, Toma C, Shah AR, Chandwaney RH, Omer M, Megaly MS, Vemmou E, Nikolakopoulos I, Rangan BV, Garcia S, Abdullah S, Banerjee S, Burke MN, Karmpaliotis D, Brilakis ES. Impact of adherence to the hybrid algorithm for initial crossing strategy selection in chronic total occlusion percutaneous coronary intervention. ACTA ACUST UNITED AC 2020; 74:1023-1031. [PMID: 33189636 DOI: 10.1016/j.rec.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/04/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES The hybrid algorithm was designed to assist with initial and subsequent crossing strategy selection in chronic total occlusion (CTO) percutaneous coronary interventions (PCIs). However, the success of the initially selected strategy has received limited study. METHODS We examined the impact of adherence to the hybrid algorithm recommendation for initial CTO crossing technique selection in 4178 CTO PCIs from a large multicenter registry. RESULTS The initial crossing strategy was concordant with the hybrid algorithm recommendation in 1833 interventions (44%). Patients in the concordant group had a similar age to those in the discordant group but a lower mean J-CTO score (2.0 ± 1.4 vs 2.8 ± 1.1; P < .01). The concordant group showed higher technical success with the first crossing strategy (68% vs 48%; P < .01) and higher overall technical success (88% vs 83%; P < .01) with no difference in the incidence of in-hospital major adverse events (1.8% vs 2.3%; P = .26). In multivariable analysis, after adjustment for age, prior myocardial infarction, prior PCI, prior coronary artery bypass grafting, J-CTO score, and scheduled CTO PCI, nonadherence to the hybrid algorithm was independently associated with lower technical success of the initial crossing strategy (odds ratio, 0.55; 95% confidence interval, 0.48-0.64; P < .01). CONCLUSIONS Adherence to the hybrid algorithm for initial crossing strategy selection is associated with higher CTO PCI success but similar in-hospital major adverse cardiac events.
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Affiliation(s)
- Iosif Xenogiannis
- Coronary Artery Disease Science Center, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States
| | - Khaldoon Alaswad
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan, United States
| | | | | | | | - James W Choi
- Department of Cardiology, Baylor Heart and Vascular Hospital, Dallas, Texas, United States
| | - Farouc A Jaffer
- Department of Cardiology, Massachusetts General Hospital, Boston, Massachussetts, United States
| | - Mitul Patel
- VA San Diego Healthcare System, La Jolla, California, United States
| | - Ehtisham Mahmud
- VA San Diego Healthcare System, La Jolla, California, United States
| | - Anthony H Doing
- Department of Cardiology, Medical Center of the Rockies, Loveland, Colorado, United States
| | - Phil Dattilo
- Department of Cardiology, Medical Center of the Rockies, Loveland, Colorado, United States
| | | | | | - Barry Uretsky
- Department of Cardiology, VA Central Arkansas Healthcare System, Little Rock, Arkansas, United States
| | - Brian K Jefferson
- Department of Cardiology, Tristar Centennial Medical Center, Nashville, Tennessee, United States
| | - Taral Patel
- Department of Cardiology, Tristar Centennial Medical Center, Nashville, Tennessee, United States
| | - Wissam Jaber
- Department of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia, United States
| | - Habib Samady
- Department of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia, United States
| | - Abdul M Sheikh
- Wellstar Health System, Marietta, Georgia, United States
| | - Robert W Yeh
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Hector Tamez
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Basem Elbarouni
- Department of Cardiology, St. Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Michael P Love
- Department of Cardiology, St. Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Nidal Abi Rafeh
- Department of Cardiology, St. George Hospital University Medical Center, Beirut, Lebanon
| | - Assaad Maalouf
- Department of Cardiology, St. George Hospital University Medical Center, Beirut, Lebanon
| | - Abou Jaoudeh Fadi
- Department of Cardiology, St. George Hospital University Medical Center, Beirut, Lebanon
| | - Catalin Toma
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Alpesh R Shah
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas, United States
| | | | - Mohamed Omer
- Coronary Artery Disease Science Center, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States
| | - Michael S Megaly
- Coronary Artery Disease Science Center, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States
| | - Evangelia Vemmou
- Coronary Artery Disease Science Center, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States
| | - Ilias Nikolakopoulos
- Coronary Artery Disease Science Center, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States
| | - Bavana V Rangan
- Coronary Artery Disease Science Center, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States
| | - Santiago Garcia
- Coronary Artery Disease Science Center, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States
| | - Shuaib Abdullah
- Department of Cardiology, VA North Texas Health Care System, Dallas, Texas, United States
| | - Subhash Banerjee
- Department of Cardiology, VA North Texas Health Care System, Dallas, Texas, United States
| | - M Nicholas Burke
- Coronary Artery Disease Science Center, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States
| | | | - Emmanouil S Brilakis
- Coronary Artery Disease Science Center, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States.
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Xenogiannis I, Nikolakopoulos I, Krestyaninov O, Khelimskii D, Khatri JJ, Doing AH, Dattilo P, Alaswad K, Toma C, Sheikh AM, Jaffer FA, Jefferson BK, Patel T, Chandwaney RH, Jaber W, Samady H, Patel M, Mahmud E, Choi J, Koutouzis M, Tsiafoutis I, Megaly M, Omer M, Vemmou E, Rangan BV, Garcia S, Abdullah S, Banerjee S, Burke N, Brilakis ES, Karmpaliotis D. Impact of Successful Chronic Total Occlusion Percutaneous Coronary Interventions on Subsequent Clinical Outcomes. J Invasive Cardiol 2020; 32:433-439. [PMID: 32568095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The impact of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) on angina and subsequent incidence of major adverse cardiovascular event (MACE) rate remains controversial. METHODS We compared patient- reported angina change and the incidence of MACE (defined as death, myocardial infarction [MI], target-vessel revascularization) between successful vs failed CTO-PCI in 1612 patients participating in a large, multicenter registry. RESULTS CTO-PCI was successful in 1387 patients (86%). Compared with failed CTO-PCI, successful CTO-PCI patients were less likely to have history of heart failure (33% vs 41%; P=.02), prior MI (49% vs 62%; P<.01), or prior coronary revascularization (63% vs 71% [P=.03] for PCI and 30% vs 40% [P<.01] for coronary artery bypass graft surgery). Patients in the successful CTO-PCI group had lower J-CTO scores (2.4 ± 1.3 vs 3.1 ± 1.1; P<.01) and lower PROGRESS-CTO Complications scores (1.1 ± 1.0 vs 1.6 ± 1.0; P<.01). After a mean follow-up of 181 ± 153 days, patients with successful PCI were more likely to have angina improvement (83% vs 38%; P<.01) and had lower incidence of 1-year MACE (8% vs 15%; P<.01), death (3% vs 7%; P<.01), and MI (2% vs 4%; P=.02). On multivariable analysis, however, CTO-PCI success was not independently associated with MACE. CONCLUSION Compared with failed CTO-PCI, successful CTO-PCI is associated with better angina improvement and lower incidence of MACE (on univariable analysis) during follow-up.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Emmanouil S Brilakis
- Minneapolis Heart Institute, 920 E 28th Street #300, Minneapolis, Minnesota 55407 USA.
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Elbadawi A, Mahtta D, Elgendy IY, Saad M, Krittanawong C, Hira RS, Omer M, Ogunbayo GO, Garratt K, Rao SV, Jneid H. Trends and Outcomes of Fibrinolytic Therapy for STEMI: Insights and Reflections in the COVID-19 Era. JACC Cardiovasc Interv 2020; 13:2312-2314. [PMID: 33032721 PMCID: PMC7535804 DOI: 10.1016/j.jcin.2020.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/29/2020] [Accepted: 07/07/2020] [Indexed: 11/08/2022]
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Megaly M, Pershad A, Glogoza M, Elbadawi A, Omer M, Saad M, Mentias A, Elgendy I, Burke MN, Capodanno D, Brilakis ES. Use of Intravascular Imaging in Patients With ST-Segment Elevation Acute Myocardial Infarction. Cardiovasc Revasc Med 2020; 30:59-64. [PMID: 33032963 DOI: 10.1016/j.carrev.2020.09.032] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The use and impact of intravascular imaging in ST-elevation myocardial infarction (STEMI) patients has received limited study. METHODS We queried the National Inpatient Sample database (NIS) between January 2016 and December 2017 to identify hospitalizations of STEMI patients who underwent percutaneous coronary intervention (PCI). We used a 1:2 propensity-score (PS) matched analysis to compare in-hospital outcomes in patients with vs. without use of intravascular imaging. We conducted a multivariable regression analysis to identify variables independently associated with in-hospital mortality. RESULTS We identified 252,970 weighted discharges of PCI in STEMI patients, 5.5% of which included intravascular imaging. Patients in whom intravascular imaging was used were more likely to have acute stent thrombosis (4.7% vs. 1.4%, p < 0.001) and present with anterior STEMI (48.1% vs. 39.1%, p < 0.001). After PS matching (intravascular imaging n = 14,015, no intravascular imaging n = 28,025), the use of intravascular imaging was associated with lower in-hospital mortality (3.6% vs. 4.8%, p = 0.010). The risk of in-hospital complications and discharge to a facility (nursing facility or short-term acute hospital) was similar between both groups before and after PS matching. The use of intravascular imaging was associated with a higher index hospitalization cost [$25,218 vs. $20,515, p < 0.001]. On multivariable analysis, intravascular imaging was independently associated with lower in-hospital mortality [OR 0.735 (95% CI 0.662-0.816), p < 0.001]. CONCLUSION Intravascular imaging was used in 5.5% of PCIs in STEMI patients and was independently associated with lower in-hospital mortality and higher index hospitalization cost.
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Affiliation(s)
- Michael Megaly
- Division of Cardiology, Banner University Medical Center, University of Arizona, Phoenix, AZ, USA
| | - Ashish Pershad
- Division of Cardiology, Banner University Medical Center, University of Arizona, Phoenix, AZ, USA
| | - Matthew Glogoza
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Ayman Elbadawi
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Mohamed Omer
- Division of Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Marwan Saad
- Division of Cardiology, The Warren Alpert School of Medicine at Brown University, Providence, RI, USA
| | - Amgad Mentias
- Division of Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Islam Elgendy
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
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Elbadawi A, Elgendy IY, Megaly M, Elzeneini M, Mentias A, Omer M, Ogunbayo G, Rai D, Drachman DE, Shishehbor MH. Temporal trends and outcomes of critical limb ischemia among patients with chronic kidney disease. Vasc Med 2020; 26:155-163. [PMID: 33002372 DOI: 10.1177/1358863x20951270] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is a paucity of data on the outcomes and revascularization strategies for critical limb ischemia (CLI) among patients with chronic kidney disease (CKD). Hence, we conducted a nationwide analysis to evaluate the trends and outcomes of hospitalizations for CLI with CKD. The National Inpatient Sample database (2002-2015) was queried for hospitalizations for CLI. The trends of hospitalizations for CLI with CKD were reported, and endovascular versus surgical revascularization strategies for CLI with CKD were compared. The main study outcome was in-hospital mortality. The analysis included 2,139,640 hospitalizations for CLI, of which 484,224 (22.6%) had CKD. There was an increase in hospitalizations for CLI with CKD (Ptrend = 0.01), but a reduction in hospitalizations for CLI without CKD (Ptrend = 0.01). Patients with CLI and CKD were less likely to undergo revascularization compared with patients without CKD. CLI with CKD had higher rates of in-hospital mortality (4.8% vs 2.5%, adjusted odds ratio (OR) 2.01; 95% CI 1.93-2.11) and major amputation compared with no CKD. Revascularization for CLI with CKD was associated with lower rates of mortality (3.7% vs 5.3%, adjusted-OR 0.78; 95% CI 0.72-0.84) and major amputation compared with no revascularization. Compared with endovascular revascularization, surgical revascularization for CLI with CKD was associated with higher rates of in-hospital mortality (4.7% vs 2.7%, adjusted-OR 1.67; 95% CI 1.43-1.94). In conclusion, this contemporary observational analysis showed an increase in hospitalizations for CLI among patients with CKD. CLI with CKD was associated with higher in-hospital mortality compared with no CKD. Compared with endovascular therapy, surgical revascularization for CLI with CKD was associated with higher in-hospital mortality.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Michael Megaly
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Mohammed Elzeneini
- Division of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Amgad Mentias
- Division of Cardiology, University of Iowa, Iowa City, IA, USA
| | - Mohamed Omer
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - Devesh Rai
- Division of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Douglas E Drachman
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mehdi H Shishehbor
- Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Vemmou E, Khatri J, Doing AH, Dattilo P, Toma C, Sheikh A, Alaswad K, Jefferson BK, Patel TN, Chandwaney RH, Jaffer FA, Jaber W, Samady H, Gkargkoulas F, Moses JW, Lembo NJ, Kirtane AJ, Parikh M, Ali ZA, Megaly M, Omer M, Nikolakopoulos I, Xenogiannis I, Stanberry L, Garberich RF, Rangan BV, Garcia S, Burke MN, Abdullah S, Banerjee S, Brilakis ES, Karmpaliotis D. Impact of Intravascular Ultrasound Utilization for Stent Optimization on 1-Year Outcomes After Chronic Total Occlusion Percutaneous Coronary Intervention. J Invasive Cardiol 2020; 32:392-399. [PMID: 32694224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The impact of intravascular ultrasound (IVUS) utilization for stent optimization on the long-term outcomes in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. METHODS We examined the outcomes of CTO-PCI with and without IVUS use for stent optimization in 922 CTO-PCIs performed between 2012 and 2019 at 12 United States centers. Major adverse cardiac event (MACE) was defined as the composite of cardiac death, acute coronary syndrome, and target-vessel revascularization. RESULTS IVUS was used in 344 procedures (37%) for stent optimization. Mean patient age was 65 ± 10 years and 83% were men. Patients in the IVUS group were less likely to have a prior myocardial infarction (39% vs 50%; P<.01), more likely to undergo right coronary artery CTO-PCI (49% vs 55%; P=.01), and had higher mean J-CTO score (2.6 ± 1.1 vs 2.4 ± 1.2; P=.04). The final crossing strategy in patients in the IVUS group was less likely to be antegrade wire escalation (54% vs 57%) and more likely to be retrograde (29% vs 21%; P<.01). Median follow-up was 141 days (interquartile range, 30-365 days). The incidence of 12-month MACE was similar in the IVUS and no-IVUS groups (20.3% vs 18.3%; log-rank P=.67). CONCLUSION IVUS was used for stent optimization in approximately one-third of CTO-PCIs. Despite higher lesion complexity in the IVUS group, the incidence of MACE was similar during follow-up.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Emmanouil S Brilakis
- Minneapolis Heart Institute, 920 East 28th Street #300, Minneapolis, MN 55407 USA.
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Han CY, Kang I, Omer M, Wang S, Wietecha T, Wight TN, Chait A. Serum amyloid A-containing HDL binds adipocyte-derived versican and macrophage-derived biglycan, reducing its antiinflammatory properties. JCI Insight 2020; 5:142635. [PMID: 32970631 PMCID: PMC7605543 DOI: 10.1172/jci.insight.142635] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/16/2020] [Indexed: 12/25/2022] Open
Abstract
The ability of HDL to inhibit inflammation in adipocytes and adipose tissue is reduced when HDL contains serum amyloid A (SAA) that is trapped by proteoglycans at the adipocyte surface. Because we recently found that the major extracellular matrix proteoglycan produced by hypertrophic adipocytes is versican, whereas activated adipose tissue macrophages produce mainly biglycan, we further investigated the role of proteoglycans in determining the antiinflammatory properties of HDL. The distributions of versican, biglycan, apolipoprotein A1 (the major apolipoprotein of HDL), and SAA were similar in adipose tissue from obese mice and obese human subjects. Colocalization of SAA-enriched HDL with versican and biglycan at the cell surface of adipocyte and peritoneal macrophages, respectively, was blocked by silencing these proteoglycans, which also restored the antiinflammatory property of SAA-enriched HDL despite the presence of SAA. Similar to adipocytes, normal HDL exerted its antiinflammatory function in macrophages by reducing lipid rafts, reactive oxygen species generation, and translocation of Toll-like receptor 4 and NADPH oxidase 2 into lipid rafts, effects that were not observed with SAA-enriched HDL. These findings imply that SAA present in HDL can be trapped by adipocyte-derived versican and macrophage-derived biglycan, thereby blunting HDL’s antiinflammatory properties. Versican in adiopcytes and biglycan in macrophages trap serum amyloid A-containing HDL, thereby blocking HDL’s anti-inflammatory properties.
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Affiliation(s)
- Chang Yeop Han
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Inkyung Kang
- Matrix Biology Program, Benaroya Research Institute, Seattle, Washington, USA
| | - Mohamed Omer
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Shari Wang
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Tomasz Wietecha
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Thomas N Wight
- Matrix Biology Program, Benaroya Research Institute, Seattle, Washington, USA
| | - Alan Chait
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, Washington, USA
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Abraham B, Sedhom R, Megaly M, Saad M, Elbadawi A, Elgendy IY, Omer M, Narayanan MA, Mena‐Hurtado C, Pershad A, Shamoun F, Lalonde T, Attallah A. Outcomes with
catheter‐directed
thrombolysis compared with anticoagulation alone in patients with acute deep venous thrombosis. Catheter Cardiovasc Interv 2020; 97:E61-E70. [DOI: 10.1002/ccd.29226] [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: 03/18/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 01/23/2023]
Affiliation(s)
- Bishoy Abraham
- Department of Medicine Ascension Saint John Hospital Detroit Michigan
| | - Ramy Sedhom
- Department of Medicine Albert Einstein Medical Center Philadelphia Pennsylvania
| | - Michael Megaly
- Minneapolis Heart Institute Abbott Northwestern Hospital Minneapolis Minnesota
- Division of Cardiovascular Medicine Department of Medicine, Hennepin Healthcare Minneapolis Minnesota
| | - Marwan Saad
- Cardiovascular Institute The Warren Alpert Medical School of Brown University Providence Rhode Island
| | - Ayman Elbadawi
- Department of Cardiovascular Medicine University of Texas Medical Branch Galveston Texas
| | - Islam Y. Elgendy
- Division of Cardiology Massachusetts General Hospital and Harvard Medical School Boston Massachusetts
| | - Mohamed Omer
- Minneapolis Heart Institute Abbott Northwestern Hospital Minneapolis Minnesota
- Division of Cardiovascular Medicine Department of Medicine, Hennepin Healthcare Minneapolis Minnesota
| | | | - Carlos Mena‐Hurtado
- Section of Cardiovascular Medicine Yale New Haven Hospital New Haven Connecticut
| | - Ashish Pershad
- Division of Cardiology Banner University Medical Center/University of Arizona Phoenix Arizona
| | - Fadi Shamoun
- Division of Cardiovascular Diseases Mayo Clinic Phoenix Arizona
| | - Thomas Lalonde
- Division of Cardiology Department of Medicine, Ascension Saint John Hospital Detroit Michigan
| | - Antonious Attallah
- Division of Cardiology Department of Medicine, Ascension Saint John Hospital Detroit Michigan
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Megaly M, Glogoza M, Xenogiannis I, Vemmou E, Nikolakopoulos I, Omer M, Saad M, Willson L, Monyak DJ, Sullivan P, Pershad A, Chavez I, Mooney M, Traverse J, Wang Y, Garcia S, Poulose A, Burke MN, Brilakis ES. Coronary Intravascular Brachytherapy for Recurrent Coronary Drug-Eluting Stent In-Stent Restenosis: A Systematic Review and Meta-Analysis. Cardiovasc Revasc Med 2020; 23:28-35. [PMID: 32883584 DOI: 10.1016/j.carrev.2020.08.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To examine the outcomes with intravascular brachytherapy (IVBT) in recurrent in-stent restenosis (ISR). BACKGROUND Recurrent ISR can be challenging to treat and IVBT can be used for recurrent ISR but has received limited study. METHODS We performed a systematic review and meta-analysis of five observational studies, including 917 patients (1014 lesions) with recurrent ISR, defined as having at least two prior ISR episodes with previous treatment with a stent, who underwent treatment with IVBT. Outcomes of interest included target vessel revascularization (TVR), myocardial infarction (MI), and all-cause mortality. RESULTS During a mean follow-up of 24 ± 7 months, the incidence of TVR was 29.2% (95% CI 18.0-40.4%). The incidence of MI and all-cause mortality were 4.3% (95% CI 1.7%-6.9%) and 7.3% (95% CI 3.2-11.5%), respectively. At one- and two-years after PCI the incidence of TVR was 17.5% (95% CI 13.6%-21.4%) and 26.7% (95% CI 16.6%-36.9%), respectively and the incidence of MI was 3.1% (95% CI 2-4.2%) and 3.9% (95% CI 1-6.8%), respectively. CONCLUSION Intravascular brachytherapy can be used to treat recurrent ISR, although TVR is needed in approximately one of four patients at two years.
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Affiliation(s)
- Michael Megaly
- Banner University Medical Center, UA College of Medicine-Phoenix, AZ, USA
| | | | | | - Evangelia Vemmou
- Minneapolis Heart Institute at Abbott Northwestern Hospital, USA
| | | | | | - Marwan Saad
- Division of Cardiovascular Medicine, The Warren Alpert School of Medicine at Brown University, Providence, RI, USA
| | | | - David J Monyak
- Minneapolis Heart Institute at Abbott Northwestern Hospital, USA
| | - Patsa Sullivan
- Minneapolis Heart Institute at Abbott Northwestern Hospital, USA
| | - Ashish Pershad
- Banner University Medical Center, UA College of Medicine-Phoenix, AZ, USA
| | - Ivan Chavez
- Minneapolis Heart Institute at Abbott Northwestern Hospital, USA
| | - Michael Mooney
- Minneapolis Heart Institute at Abbott Northwestern Hospital, USA
| | - Jay Traverse
- Minneapolis Heart Institute at Abbott Northwestern Hospital, USA
| | - Yale Wang
- Minneapolis Heart Institute at Abbott Northwestern Hospital, USA
| | - Santiago Garcia
- Minneapolis Heart Institute at Abbott Northwestern Hospital, USA
| | - Anil Poulose
- Minneapolis Heart Institute at Abbott Northwestern Hospital, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute at Abbott Northwestern Hospital, USA
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Buda KG, Megaly MS, Omer M, Xenogiannis I, Brilakis ES. Use of Radiation Protection Measures in Live Percutaneous Coronary Interventions Cases at Interventional Scientific Meetings. JACC Cardiovasc Interv 2020; 13:905-906. [PMID: 32273104 DOI: 10.1016/j.jcin.2019.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/12/2019] [Accepted: 11/26/2019] [Indexed: 10/24/2022]
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Elbadawi A, Omer M, Ogunbayo G, Owens P, Mix D, Lyden SP, Cameron SJ. Antiplatelet Medications Protect Against Aortic Dissection and Rupture in Patients With Abdominal Aortic Aneurysms. J Am Coll Cardiol 2020; 75:1609-1610. [PMID: 32241378 DOI: 10.1016/j.jacc.2020.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/29/2020] [Accepted: 02/03/2020] [Indexed: 02/06/2023]
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Megaly M, Abraham B, Abdelsalam M, Saad M, Omer M, Elbadawi A, Mentias A, Narayanan MA, Gafoor S, Brilakis ES, Goessl M, Cavalcante JL, Garcia S, Kapadia S, Pershad A, Sorajja P, Sengupta J. Short- and Long-Term Outcomes in Patients With New-Onset Persistent Left Bundle Branch Block After Transcatheter Aortic Valve Replacement. Cardiovasc Revasc Med 2020; 21:1299-1304. [PMID: 33246556 DOI: 10.1016/j.carrev.2020.03.009] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/05/2020] [Accepted: 03/05/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The impact of new-onset persistent left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR) on all-cause mortality has been controversial. METHODS We conducted a systematic review and meta-analysis of eleven studies (7398 patients) comparing the short- and long- outcomes in patients who had new-onset LBBB after TAVR vs. those who did not. RESULTS During a mean follow-up of 20.5±14months, patients who had new-onset persistent LBBB after TAVR had a higher incidence of all-cause mortality (29.7% vs. 23.6%; OR 1.28 (1.04-1.58), p=0.02), rehospitalization for heart failure (HF) (19.5% vs. 17.3%; OR 1.4 (1.13-1.73), p=0.002), and permanent pacemaker implantation (PPMi) (19.7% vs. 7.1%; OR 2.4 (1.64-3.52), p<0.001) compared with those who did not. Five studies (4180 patients) reported adjusted hazard ratios (HR) for all-cause mortality; new LBBB remained associated with a higher risk of mortality (adjusted HR 1.43 (1.08-1.9), p<0.01, I2=81%). CONCLUSION Post-TAVR persistent LBBB is associated with higher PPMi, HF hospitalizations, and all-cause mortality. While efforts to identify patients who need post-procedural PPMi are warranted, more studies are required to evaluate the best follow-up and treatment strategies, including the type of pacing device if required, to improve long-term outcomes in these patients.
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Affiliation(s)
- Michael Megaly
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA; Division of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Bishoy Abraham
- Division of Internal Medicine, Ascension St. John Hospital, Detroit, MI, USA
| | - Mahmoud Abdelsalam
- Division of Internal Medicine, Temple University/Conemaugh Memorial Medical Center, Johnstown, PA, USA
| | - Marwan Saad
- Division of Cardiovascular Medicine, The Warren Alpert School of Medicine at Brown University, Providence, RI, USA; Division of Cardiology, Ain Shams University, Cairo, Egypt
| | - Mohamed Omer
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA; Division of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Ayman Elbadawi
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Amgad Mentias
- Division of Cardiovascular Medicine, Roy and Lucille J. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Sameer Gafoor
- Heart and Vascular Institute, Swedish Medical Centre, Seattle, WA, USA
| | | | - Mario Goessl
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - João L Cavalcante
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Santiago Garcia
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Samir Kapadia
- Division of Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ashish Pershad
- Division of Cardiology, Banner University Medical Center, Phoenix, AZ, USA
| | - Paul Sorajja
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Jay Sengupta
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
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Megaly M, Abraham B, Omer M, Elbadawi A, Saad M, Mentias A, Xenogiannis I, Narayanan MA, Banerjee S, Alaswad K, Rinfret S, Garcia S, Pershad A, Azzalini L, Knaapen P, Tsuchikane E, Gershlick A, Burke MN, Brilakis E. OUTCOMES OF CHRONIC TOTAL OCCLUSION PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH PRIOR CORONARY ARTERY BYPASS GRAFT SURGERY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31826-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: 10/24/2022]
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Buda K, Megaly M, Omer M, Xenogiannis I, Brilakis E. USE OF RADIATION PROTECTION MEASURES IN LIVE PERCUTANEOUS CORONARY INTERVENTIONS CASES IN INTERVENTIONAL SCIENTIFIC MEETINGS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31790-3] [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: 10/24/2022]
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Elbadawi A, Elgendy I, Omer M, Ogunbayo G, Paniagua D, Jneid H. TEMPORAL TRENDS AND OUTCOMES OF ELECTIVE THORACIC AORTIC ANEURYSM REPAIR VERSUS ANEURYSM RELATED ACUTE AORTIC SYNDROMES, INSIGHTS FROM A NATIONAL DATABASE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32851-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Omer M, Garberich R, Sharkey SW, Brilakis E, Sorajja P, Henry TD, Gossl M, Schmidt C, Chavez I, Mooney M, Burke MN, Megaly M, Hryniewicz K, Wang Y, Traverse J, Garcia S. CLINICAL CHARACTERISTICS AND OUTCOMES OF ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION PATIENTS WITH CARDIOGENIC SHOCK AND CARDIAC ARREST. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30745-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Vemmou E, Khatri J, Doing A, Dattilo P, Toma C, Jaffer F, Karmpaliotis D, Sheikh A, Samady H, Alaswad K, Chandwaney R, Garcia S, Megaly M, Omer M, Stanberry L, Xenogiannis I, Nikolakopoulos I, Gkargkoulas F, Jaber WA, Patel T, Jefferson B, Rangan B, Burke MN, Banerjee S, Brilakis E. INTRAVASCULAR ULTRASOUND USE FOR STENT OPTIMIZATION AND 1-YEAR OUTCOMES IN PATIENTS UNDERGOING CTO-PCI: INSIGHTS FROM THE PROGRESS-CTO REGISTRY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31744-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Elbadawi A, Mahmoud A, Elgendy I, Omer M, Ogunbayo G, Denktas A, Paniagua D, Jneid H. TEMPORAL TRENDS AND OUTCOMES OF ELECTIVE AORTIC REPAIR AND ACUTE AORTIC SYNDROMES IN PATIENTS WITH BICUSPID AORTIC VALVES. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32850-3] [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: 11/26/2022]
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Alarfaj R, Aljihani S, Alzayer M, Johani SA, Balkhy H, Yassin A, Omer M, AlKhulaifi M, Alghoribi M, Halwani M. The Inhibitory activity of Tobramycin and Liposomal-Tobramycin-N-Acetylcysteine formulations Against Uropathogenic Escherichia coli (UPEC) Biofilms. J Infect Public Health 2020. [DOI: 10.1016/j.jiph.2020.01.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Omer M, Xenogiannis I, Brilakis ES. Why every interventionalist should know when and how to deploy coils. Int J Cardiol 2020; 298:22-24. [DOI: 10.1016/j.ijcard.2019.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022]
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