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Abdel-Razek O, Jung RG, Di Santo P, Mathew R, Hibbert B. Impact of hypoxic hepatitis in cardiogenic shock: a substudy of the DOREMI trial. Eur Heart J Open 2024; 4:oeae024. [PMID: 38708291 PMCID: PMC11065344 DOI: 10.1093/ehjopen/oeae024] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/21/2024] [Accepted: 02/02/2024] [Indexed: 05/07/2024]
Affiliation(s)
- Omar Abdel-Razek
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02446, USA
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y4W7 Ontario, Canada
| | - Richard G Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y4W7 Ontario, Canada
- Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y4W7 Ontario, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, K1H8L6 Ontario, Canada
- Division of Internal Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, K1H8L6 Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y4W7 Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, 501 Smyth Road, Ottawa, K1H8L6 Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y4W7 Ontario, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y4W7 Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y4W7 Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y4W7 Ontario, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
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2
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Joseph J, Scerbo J, Di Santo P, Hibbert B. Percutaneous repair of a sinotubular junction aortic pseudoaneurysm with an atrial septal defect occluder: a case report. Eur Heart J Case Rep 2023; 7:ytad597. [PMID: 38089125 PMCID: PMC10711535 DOI: 10.1093/ehjcr/ytad597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 11/21/2023] [Accepted: 11/24/2023] [Indexed: 03/07/2024]
Abstract
Background Aortic pseudoaneurysms are complications that arise following cardiac surgery, thoracic trauma, infections, or inflammatory conditions. The mainstay treatment for aortic pseudoaneurysm is surgical management. Given significant morbidity and mortality related to thoracotomy, high-risk patients are not considered for cardiac surgery. Novel percutaneous repair using a variety of devices are being explored, especially in those with prohibitive risk for cardiac surgery. Case summary This case describes the use of an Amplatzer atrial septal defect (ASD) occluder device to manage an aortic pseudoaneurysm in a 69-year-old male who had previously undergone coronary artery bypass graft surgery and pericardial drainage for purulent pericarditis. Following successful implant, there were no complications seen after 2 years of follow-up. Discussion Percutaneous closure of a mycotic pseudoaneurysm with an Amplatzer ASD occluder device can be a safe and efficacious treatment option, especially in patients with prohibitive surgical risk.
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Affiliation(s)
- Joanne Joseph
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Pietro Di Santo
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
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Motazedian P, Marbach JA, Prosperi-Porta G, Parlow S, Di Santo P, Abdel-Razek O, Jung R, Bradford WB, Tsang M, Hyon M, Pacifici S, Mohanty S, Ramirez FD, Huggins GS, Simard T, Hon S, Hibbert B. Diagnostic accuracy of point-of-care ultrasound with artificial intelligence-assisted assessment of left ventricular ejection fraction. NPJ Digit Med 2023; 6:201. [PMID: 37898711 PMCID: PMC10613290 DOI: 10.1038/s41746-023-00945-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/13/2023] [Indexed: 10/30/2023] Open
Abstract
Focused cardiac ultrasound (FoCUS) is becoming standard practice in a wide spectrum of clinical settings. There is limited data evaluating the real-world use of FoCUS with artificial intelligence (AI). Our objective was to determine the accuracy of FoCUS AI-assisted left ventricular ejection fraction (LVEF) assessment and compare its accuracy between novice and experienced users. In this prospective, multicentre study, participants requiring a transthoracic echocardiogram (TTE) were recruited to have a FoCUS done by a novice or experienced user. The AI-assisted device calculated LVEF at the bedside, which was subsequently compared to TTE. 449 participants were enrolled with 424 studies included in the final analysis. The overall intraclass coefficient was 0.904, and 0.921 in the novice (n = 208) and 0.845 in the experienced (n = 216) cohorts. There was a significant bias of 0.73% towards TTE (p = 0.005) with a level of agreement of 11.2%. Categorical grading of LVEF severity had excellent agreement to TTE (weighted kappa = 0.83). The area under the curve (AUC) was 0.98 for identifying an abnormal LVEF (<50%) with a sensitivity of 92.8%, specificity of 92.3%, negative predictive value (NPV) of 0.97 and a positive predictive value (PPV) of 0.83. In identifying severe dysfunction (<30%) the AUC was 0.99 with a sensitivity of 78.1%, specificity of 98.0%, NPV of 0.98 and PPV of 0.76. Here we report that FoCUS AI-assisted LVEF assessments provide highly reproducible LVEF estimations in comparison to formal TTE. This finding was consistent among senior and novice echocardiographers suggesting applicability in a variety of clinical settings.
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Affiliation(s)
- Pouya Motazedian
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey A Marbach
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Sciences University, Portland, OR, USA
| | - Graeme Prosperi-Porta
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Simon Parlow
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Omar Abdel-Razek
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Richard Jung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - William B Bradford
- Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Miranda Tsang
- Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Michael Hyon
- Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Stefano Pacifici
- Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Sharanya Mohanty
- Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - F Daniel Ramirez
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Gordon S Huggins
- Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Stephanie Hon
- Division of Pulmonary and Critical Care Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Benjamin Hibbert
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
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Abdel-Razek O, Marbach JA, Simard T, Almufleh A, Di Santo P, Jung R, Parlow S, Mathew R, Hibbert B, Froeschl M. Formalized Research Training Increases Fellowship and Early Career Academic Productivity: A Five-Year Follow-up. Can J Cardiol 2023; 39:1310-1312. [PMID: 37149217 DOI: 10.1016/j.cjca.2023.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/26/2023] [Accepted: 04/30/2023] [Indexed: 05/08/2023] Open
Affiliation(s)
- Omar Abdel-Razek
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jeffrey A Marbach
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Knight Cardiovascular Center, Division of Cardiovascular Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Trevor Simard
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Aws Almufleh
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, Queens University, Kingston, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, Division of Critical Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard Jung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Simon Parlow
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Medicine, Division of Critical Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Froeschl
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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Simard T, Jung R, Di Santo P, Sarathy K, Majeed K, Motazedian P, Short S, Dhaliwal S, Labinaz A, Sarma D, Ramirez FD, Froeschl M, Labinaz M, Holmes DR, Alkhouli M, Hibbert B. Evaluation of a Rabbit Model of Vascular Stent Healing: Application of Optical Coherence Tomography. J Cardiovasc Transl Res 2023; 16:1194-1204. [PMID: 37227686 DOI: 10.1007/s12265-023-10399-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
Percutaneous coronary intervention (PCI) is a management strategy for symptomatic obstructive coronary artery disease (CAD). Despite advancements, in-stent restenosis (ISR) still imparts a 1-2% annual rate of repeat revascularization-a focus of ongoing translational research. Optical coherence tomography (OCT) provides high resolution virtual histology of stents. Our study evaluates the use of OCT for virtual histological assessment of stent healing in a rabbit aorta model, enabling complete assessment of intraluminal healing throughout the stent. ISR varies based on intra-stent location, stent length, and stent type in a rabbit model-important considerations for translational experimental design. Atherosclerosis leads to more prominent ISR proliferation independent of stent-related factors. The rabbit stent model mirrors clinical observations, while OCT-based virtual histology demonstrates utility for pre-clinical stent assessment. Pre-clinical models should incorporate clinical and stent factors as feasible to maximize translation to clinical practice.
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Affiliation(s)
- Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
| | - Richard Jung
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
| | - Pietro Di Santo
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Kiran Sarathy
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | - Kamran Majeed
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Pouya Motazedian
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Spencer Short
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Shan Dhaliwal
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Alisha Labinaz
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Dhruv Sarma
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - F Daniel Ramirez
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Michael Froeschl
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Marino Labinaz
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Benjamin Hibbert
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada.
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada.
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Di Santo P, Hibbert B. Timing of Transcatheter Edge-to-Edge Repair for Acute Mitral Regurgitation: When Do We Clip? Can J Cardiol 2023; 39:1390-1391. [PMID: 37327973 DOI: 10.1016/j.cjca.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/18/2023] Open
Affiliation(s)
- Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Critical Care Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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Simard T, Jung R, Di Santo P, Labinaz A, Short S, Motazedian P, Dhaliwal S, Sarma D, Rasheed A, Ramirez FD, Froeschl M, Labinaz M, Holmes DR, Alkhouli M, Hibbert B. Dipyridamole and vascular healing following stent implantation. Front Cardiovasc Med 2023; 10:1130304. [PMID: 37745122 PMCID: PMC10514894 DOI: 10.3389/fcvm.2023.1130304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Patients undergoing coronary stent implantation incur a 2% annual rate of adverse events, largely driven by in-stent restenosis (ISR) due to neointimal (NI) tissue proliferation, a process in which smooth muscle cell (SMC) biology may play a central role. Dipyridamole (DP) is an approved therapeutic agent with data supporting improved vascular patency rates. Pre-clinical data supports that DP may enact its vasculoprotective effects via adenosine receptor-A2B (ADOR-A2B). We sought to evaluate the efficacy of DP to mitigate ISR in a pre-clinical rabbit stent model. Methods & Results 24 New Zealand White Rabbits were divided into two cohorts-non-atherosclerosis and atherosclerosis (n = 12/cohort, 6 male and 6 female). Following stent implantation, rabbits were randomized 1:1 to control or oral dipyridamole therapy for 6 weeks followed by optical coherence tomography (OCT) and histology assessment of NI burden and stent strut healing. Compared to control, DP demonstrated a 16.6% relative reduction in NI volume (14.7 ± 0.8% vs. 12.5 ± 0.4%, p = 0.03) and a 36.2% relative increase in optimally healed stent struts (37.8 ± 2.8% vs. 54.6 ± 2.5%, p < 0.0001). Atherosclerosis demonstrated attenuated effect with no difference in NI burden (15.2 ± 1.0% vs. 16.9 ± 0.8%, p = 0.22) and only a 14.2% relative increase in strut healing (68.3 ± 4.1% vs. 78.7 ± 2.5%, p = 0.02). DP treated rabbits had a 44.6% (p = 0.045) relative reduction in NI SMC content. In vitro assessment of DP and coronary artery SMCs yielded dose-dependent reduction in SMC migration and proliferation. Selective small molecule antagonism of ADOR-A2B abrogated the effects of DP on SMC proliferation. DP modulated SMC phenotypic switching with ADOR-A2B siRNA knockdown supporting its role in the observed effects. Conclusion Dipyridamole reduces NI proliferation and improves stent healing in a preclinical model of stent implantation with conventional antiplatelets. Atherosclerosis attenuates the observed effect. Clinical trials of DP as an adjunctive agent may be warranted to evaluate for clinical efficacy in stent outcomes.
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Affiliation(s)
- Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Richard Jung
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Pietro Di Santo
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Alisha Labinaz
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Spencer Short
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Pouya Motazedian
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Shan Dhaliwal
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Dhruv Sarma
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Adil Rasheed
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Department of BMI, Faculty of Medicine, Ottawa, ON, Canada
| | - F. Daniel Ramirez
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Michael Froeschl
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Marino Labinaz
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - David R. Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Benjamin Hibbert
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
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Sterling LH, Fernando SM, Talarico R, Qureshi D, van Diepen S, Herridge MS, Price S, Brodie D, Fan E, Di Santo P, Jung RG, Parlow S, Basir MB, Scales DC, Combes A, Mathew R, Thiele H, Tanuseputro P, Hibbert B. Long-Term Outcomes of Cardiogenic Shock Complicating Myocardial Infarction. J Am Coll Cardiol 2023; 82:985-995. [PMID: 37648357 DOI: 10.1016/j.jacc.2023.06.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Cardiogenic shock secondary to acute myocardial infarction (AMI-CS) is associated with substantial short-term mortality; however, there are limited data on long-term outcomes and trends. OBJECTIVES This study sought to examine long-term outcomes of AMI-CS patients. METHODS This was a population-based, retrospective cohort study in Ontario, Canada of critically ill adult patients with AMI-CS who were admitted to hospitals between April 1, 2009 and March 31, 2019. Outcome data were captured using linked health administrative databases. RESULTS A total of 9,789 consecutive patients with AMI-CS from 135 centers were included. The mean age was 70.5 ± 12.3 years, and 67.7% were male. The incidence of AMI-CS was 8.2 per 100,000 person-years, and it increased over the study period. Critical care interventions were common, with 5,422 (55.4%) undergoing invasive mechanical ventilation, 1,425 (14.6%) undergoing renal replacement therapy, and 1,484 (15.2%) receiving mechanical circulatory support. A total of 2,961 patients (30.2%) died in the hospital, and 4,004 (40.9%) died by 1 year. Mortality at 5 years was 58.9%. Small improvements in short- and long-term mortality were seen over the study period. Among survivors to discharge, 2,870 (42.0%) required increased support in care from their preadmission baseline, 3,244 (47.5%) were readmitted to the hospital within 1 year, and 1,047 (15.3%) died within 1 year. The mean number of days at home in the year following discharge was 307.9 ± 109.6. CONCLUSIONS Short- and long-term mortality among patients with AMI-CS is high, with minimal improvement over time. AMI-CS survivors experience significant morbidity, with high risks of readmission and death. Future studies should evaluate interventions to minimize postdischarge morbidity and mortality among AMI-CS survivors.
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Affiliation(s)
- Lee H Sterling
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Shannon M Fernando
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Critical Care, Lakeridge Health Corporation, Oshawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Robert Talarico
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Danial Qureshi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ICES, Toronto, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Sean van Diepen
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada; Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Margaret S Herridge
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Susanna Price
- Royal Brompton & Harefield Hospitals, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Daniel Brodie
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard G Jung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Simon Parlow
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Mir B Basir
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Damon C Scales
- ICES, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Alain Combes
- Institute of Cardiometabolism and Nutrition, Sorbonne University, Paris, France; Service de Médecine Intensive-Réanimation, Hôpitaux Universitaires Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris, France
| | - Rebecca Mathew
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ICES, Toronto, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Abdel-Razek O, Di Santo P, Jung RG, Parlow S, Motazedian P, Prosperi-Porta G, Visintini S, Marbach JA, Ramirez FD, Simard T, Labinaz M, Mathew R, Hibbert B. Efficacy of Milrinone and Dobutamine in Cardiogenic Shock: An Updated Systematic Review and Meta-Analysis. Crit Care Explor 2023; 5:e0962. [PMID: 37649849 PMCID: PMC10465094 DOI: 10.1097/cce.0000000000000962] [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] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES Inotropic support is commonly used in patients with cardiogenic shock (CS). High-quality data guiding the use of dobutamine or milrinone among this patient population is limited. We compared the efficacy and safety of these two inotropes among patients with low cardiac output states (LCOS) or CS. DATA SOURCES MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched up to February 1, 2023, using key terms and index headings related to LCOS or CS and inotropes. DATA EXTRACTION Two independent reviewers included studies that compared dobutamine to milrinone on all-cause in-hospital mortality, length of ICU stay, length of hospital stay, and significant arrhythmias in hospitalized patients. DATA SYNTHESIS A total of eleven studies with 21,084 patients were included in the meta-analysis. Only two randomized controlled trials were identified. The primary outcome, all-cause mortality, favored milrinone in observational studies only (odds ratio [OR] 1.19 (95% CI, 1.02-1.39; p = 0.02). In-hospital length of stay (LOS) was reduced with dobutamine in observational studies only (mean difference -1.85 d; 95% CI -3.62 to -0.09; p = 0.04). There was no difference in the prevalence of significant arrhythmias or in ICU LOS. CONCLUSIONS Only limited data exists supporting the use of one inotropic agent over another exists. Dobutamine may be associated with a shorter hospital LOS; however, there is also a potential for increased all-cause mortality. Larger randomized studies sufficiently powered to detect a difference in these outcomes are required to confirm these findings.
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Affiliation(s)
- Omar Abdel-Razek
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard G Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Internal Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Simon Parlow
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pouya Motazedian
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Graeme Prosperi-Porta
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sarah Visintini
- Berkman Library, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jeffrey A Marbach
- Division of Cardiovascular Medicine, Knight Cardiovascular Center, Oregon Health and Science University, Portland, OR
| | - F Daniel Ramirez
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Trevor Simard
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Marino Labinaz
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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Roy R, Han J, Mathew R, Di Santo P, Hibbert B, Neyestanak M, Grinstein J, Belkin MN. Sex-Based Differences in Hemodynamic Response to Inotropes: A Subanalysis of the DOREMI Trial. JACC Heart Fail 2023; 11:1275-1277. [PMID: 37480883 DOI: 10.1016/j.jchf.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 07/24/2023]
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11
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Fernando SM, Mathew R, Sadeghirad B, Rochwerg B, Hibbert B, Munshi L, Fan E, Brodie D, Di Santo P, Tran A, McLeod SL, Vaillancourt C, Cheskes S, Ferguson ND, Scales DC, Lin S, Sandroni C, Soar J, Dorian P, Perkins GD, Nolan JP. Epinephrine in Out-of-Hospital Cardiac Arrest: A Network Meta-analysis and Subgroup Analyses of Shockable and Nonshockable Rhythms. Chest 2023; 164:381-393. [PMID: 36736487 DOI: 10.1016/j.chest.2023.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/12/2022] [Revised: 01/20/2023] [Accepted: 01/21/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Epinephrine is the most commonly used drug in out-of-hospital cardiac arrest (OHCA) resuscitation, but evidence supporting its efficacy is mixed. RESEARCH QUESTION What are the comparative efficacy and safety of standard dose epinephrine, high-dose epinephrine, epinephrine plus vasopressin, and placebo or no treatment in improving outcomes after OHCA? STUDY DESIGN AND METHODS In this systematic review and network meta-analysis of randomized controlled trials, we searched six databases from inception through June 2022 for randomized controlled trials evaluating epinephrine use during OHCA resuscitation. We performed frequentist random-effects network meta-analysis and present ORs and 95% CIs. We used the the Grading of Recommendations, Assessment, Development, and Evaluation approach to rate the certainty of evidence. Outcomes included return of spontaneous circulation (ROSC), survival to hospital admission, survival to discharge, and survival with good functional outcome. RESULTS We included 18 trials (21,594 patients). Compared with placebo or no treatment, high-dose epinephrine (OR, 4.27; 95% CI, 3.68-4.97), standard-dose epinephrine (OR, 3.69; 95% CI, 3.32-4.10), and epinephrine plus vasopressin (OR, 3.54; 95% CI, 2.94-4.26) all increased ROSC. High-dose epinephrine (OR, 3.53; 95% CI, 2.97-4.20), standard-dose epinephrine (OR, 3.00; 95% CI, 2.66-3.38), and epinephrine plus vasopressin (OR, 2.79; 95% CI, 2.27-3.44) all increased survival to hospital admission as compared with placebo or no treatment. However, none of these agents may increase survival to discharge or survival with good functional outcome as compared with placebo or no treatment. Compared with placebo or no treatment, standard-dose epinephrine improved survival to discharge among patients with nonshockable rhythm (OR, 2.10; 95% CI, 1.21-3.63), but not in those with shockable rhythm (OR, 0.85; 95% CI, 0.39-1.85). INTERPRETATION Use of standard-dose epinephrine, high-dose epinephrine, and epinephrine plus vasopressin increases ROSC and survival to hospital admission, but may not improve survival to discharge or functional outcome. Standard-dose epinephrine improved survival to discharge among patients with nonshockable rhythm, but not those with shockable rhythm. TRIAL REGISTRY Center for Open Science: https://osf.io/arxwq.
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Affiliation(s)
- Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, ON, Canada; Department of Emergency Medicine, University of Ottawa, ON, Canada; CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Rebecca Mathew
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Behnam Sadeghirad
- Department of Anesthesia, Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence, and Impact, Department of Medicine, McMaster University, Hamilton, ON, Canada; Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Benjamin Hibbert
- Department of Cellular and Molecular Medicine, University of Ottawa, ON, Canada; CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Laveena Munshi
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, ON, Canada; Department of Medicine, Sinai Health System and University Health Network, Toronto, ON, Canada
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, ON, Canada; Department of Medicine, Sinai Health System and University Health Network, Toronto, ON, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY; Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY
| | - Pietro Di Santo
- Division of Critical Care, Department of Medicine, University of Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, ON, Canada; CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Alexandre Tran
- Division of Critical Care, Department of Medicine, University of Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, ON, Canada
| | - Shelley L McLeod
- Department of Health Research Methods, Evidence, and Impact, Department of Medicine, McMaster University, Hamilton, ON, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada; Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada
| | - Christian Vaillancourt
- Department of Emergency Medicine, University of Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sheldon Cheskes
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada; Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Niall D Ferguson
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, ON, Canada; Department of Medicine, Sinai Health System and University Health Network, Toronto, ON, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Damon C Scales
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Steve Lin
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Claudio Sandroni
- Institute of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Intensive Care, Emergency Medicine and Anesthesiology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, England
| | - Paul Dorian
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, Warwick University, Gibbet Hill, Coventry, England
| | - Jerry P Nolan
- Warwick Clinical Trials Unit, Warwick Medical School, Warwick University, Gibbet Hill, Coventry, England; Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, England
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12
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Simard T, Jung R, Di Santo P, Sarathy K, Majeed K, Motazedian P, Short S, Dhaliwal S, Labinaz A, Sarma D, Ramirez FD, Froeschl M, Labinaz M, Holmes DR, Alkhouli M, Hibbert B. Correction to: Evaluation of a Rabbit Model of Vascular Stent Healing: Application of Optical Coherence Tomography. J Cardiovasc Transl Res 2023:10.1007/s12265-023-10406-5. [PMID: 37407867 DOI: 10.1007/s12265-023-10406-5] [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: 07/07/2023]
Affiliation(s)
- Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
| | - Richard Jung
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
| | - Pietro Di Santo
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Kiran Sarathy
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | - Kamran Majeed
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Pouya Motazedian
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Spencer Short
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Shan Dhaliwal
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Alisha Labinaz
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Dhruv Sarma
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - F Daniel Ramirez
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Michael Froeschl
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Marino Labinaz
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Benjamin Hibbert
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada.
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada.
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Di Santo P, Abdel-Razek O, Jung R, Parlow S, Poulin A, Bernick J, Morgan B, Robinson L, Feagan H, Wade J, Goh CY, Singh K, Froeschl M, Labinaz M, Fergusson DA, Coyle D, Kyeremanteng K, Abunassar J, Wells GA, Simard T, Hibbert B. Rationale and Design of the Rivaroxaban Post-Transradial Access for the Prevention of Radial Artery Occlusion Trial (CAPITAL-RAPTOR). BMJ Open 2023; 13:e070720. [PMID: 37173116 DOI: 10.1136/bmjopen-2022-070720] [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: 05/15/2023] Open
Abstract
INTRODUCTION Transradial access (TRA) has rapidly emerged as the preferred vascular access site for coronary angiography and percutaneous coronary intervention. Radial artery occlusion (RAO) remains as an important complication of TRA as it precludes future ipsilateral transradial procedures. While intraprocedural anticoagulation has been studied extensively, the definitive role of postprocedural anticoagulation has not yet been established. METHODS AND ANALYSIS The Rivaroxaban Post-Transradial Access for the Prevention of Radial Artery Occlusion trial is a multicentre, prospective, randomised, open-label, blinded-endpoint design study investigating the efficacy and safety of rivaroxaban to reduce the incidence of RAO. Eligible patients will undergo randomisation to receive either rivaroxaban 15 mg once daily for 7 days or to no additional postprocedural anticoagulation. Doppler ultrasound to assess radial artery patency will be performed at 30 days. ETHICS AND DISSEMINATION The study protocol has been approved by the Ottawa Health Science Network Research Ethics Board (approval number 20180319-01H). The study results will be disseminated via conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03630055.
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Affiliation(s)
- Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Critical Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Omar Abdel-Razek
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Richard Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Simon Parlow
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Anthony Poulin
- Division of Cardiology, Quebec Heart and Lung Institute, Quebec, Québec, Canada
| | - Jordan Bernick
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Baylie Morgan
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Lisa Robinson
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Hannah Feagan
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jilliane Wade
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Cheng Yee Goh
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kuljit Singh
- Department of Cardiology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Michael Froeschl
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marino Labinaz
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Joseph Abunassar
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Trevor Simard
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Parlow S, Santo PD, Sterling LH, Goodliffe L, Motazedian P, Prosperi-Porta G, Morgan B, Koopman Z, Jung RG, Lepage-Ratte MF, Robinson L, Feagan H, Simard T, Wells GA, Kyeremanteng K, Ainsworth C, Amin F, Marbach JA, Fernando SM, Labinaz M, Belley-Cote EP, Hibbert B, Mathew R. Inotrope versus Placebo Therapy in Cardiogenic Shock: Rationale and Study Design of the CAPITAL DOREMI2 Trial. Am Heart J 2023; 262:83-89. [PMID: 37094667 DOI: 10.1016/j.ahj.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Cardiogenic shock (CS) is a state of end-organ hypoperfusion related to cardiac dysfunction. Current guidelines recommend consideration of inotrope therapy in patients with CS, however no robust data support their use. The purpose of the CAPITAL DOREMI2 trial is to examine the efficacy and safety of inotrope therapy against placebo in the initial resuscitation of patients with CS. METHODS AND DESIGN This is a multi-center, double-blind, randomized, placebo-controlled trial comparing single-agent inotrope therapy to placebo in patients with CS. A total of 346 participants with Society for Cardiovascular Angiography and Interventions class C or D CS will be randomized in a 1:1 fashion to inotrope or placebo therapy, which will be administered over a 12-hour period. After this period, participants will continue open-label therapies at the discretion of the treating team. The primary outcome is a composite of all-cause in-hospital death, and, as measured during the 12-hour intervention period, any of: sustained hypotension or high dose vasopressor requirements, lactate greater than 3.5 mmol/L at 6 hours or thereafter, need for mechanical circulatory support, arrhythmia leading to emergent electrical cardioversion, and resuscitated cardiac arrest. All participants will be followed for the duration of their hospitalization, and secondary outcomes will be assessed at the time of discharge. IMPLICATION This trial will be the first to establish the safety and efficacy of inotrope therapy against placebo in a population of patients with CS and has the potential to alter the standard care provided to this group of patients.
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Affiliation(s)
- Simon Parlow
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Critical Care Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Lee H Sterling
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Laura Goodliffe
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Pouya Motazedian
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Graeme Prosperi-Porta
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Baylie Morgan
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Zandra Koopman
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Richard G Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Melissa Fay Lepage-Ratte
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lisa Robinson
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Hannah Feagan
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Trevor Simard
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Cardiovascular Research Methods Center, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Craig Ainsworth
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Faizan Amin
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey A Marbach
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Sciences University, Portland, Oregon, USA
| | - Shannon M Fernando
- Department of Critical Care, Lakeridge Health Corporation, Oshawa, Ontario, Canada
| | - Marino Labinaz
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Emilie P Belley-Cote
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Benjamin Hibbert
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Rebecca Mathew
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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Parlow S, Di Santo P, Abdel-Razek O, Jung RG, Motazedian P, Robinson L, Feagan H, Morgan B, Wade J, Toeg H, Al-Atassi T, Ruel M, Kuhar P, Bernick J, Wells GA, Simard T, Marbach JA, Froeschl M, Mathew R, Labinaz M, Chan V, Hibbert B. Utility of a Smartphone Application in Assessing Palmar Circulation Before Radial Artery Harvesting for Coronary Artery Bypass Grafting. Circulation 2023; 147:1183-1185. [PMID: 37036908 DOI: 10.1161/circulationaha.122.063795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Affiliation(s)
- Simon Parlow
- CAPITAL (Cardiovascular Percutaneous Intervention Trials) Research Group (S.P., P.D.S., O.A.-R., R.G.J., P.M., L.R., H.F., B.M., J.W., R.M., B.H.), University of Ottawa, Canada
- Division of Cardiology (S.P., P.D.S., O.A.-R., P.M., M.F., R.M., M.L., B.H.), University of Ottawa, Canada
| | - Pietro Di Santo
- CAPITAL (Cardiovascular Percutaneous Intervention Trials) Research Group (S.P., P.D.S., O.A.-R., R.G.J., P.M., L.R., H.F., B.M., J.W., R.M., B.H.), University of Ottawa, Canada
- Division of Cardiology (S.P., P.D.S., O.A.-R., P.M., M.F., R.M., M.L., B.H.), University of Ottawa, Canada
- Heart Institute, School of Epidemiology, Public Health and Preventative Medicine (P.D.S., R.G.J., P.M., J.B., G.A.W.), University of Ottawa, Canada
- Division of Critical Care Medicine (P.D.S.), Ottawa Hospital, Canada
| | - Omar Abdel-Razek
- CAPITAL (Cardiovascular Percutaneous Intervention Trials) Research Group (S.P., P.D.S., O.A.-R., R.G.J., P.M., L.R., H.F., B.M., J.W., R.M., B.H.), University of Ottawa, Canada
- Division of Cardiology (S.P., P.D.S., O.A.-R., P.M., M.F., R.M., M.L., B.H.), University of Ottawa, Canada
| | - Richard G Jung
- CAPITAL (Cardiovascular Percutaneous Intervention Trials) Research Group (S.P., P.D.S., O.A.-R., R.G.J., P.M., L.R., H.F., B.M., J.W., R.M., B.H.), University of Ottawa, Canada
- Heart Institute, School of Epidemiology, Public Health and Preventative Medicine (P.D.S., R.G.J., P.M., J.B., G.A.W.), University of Ottawa, Canada
- Division of Internal Medicine (R.G.J.), Ottawa Hospital, Canada
| | - Pouya Motazedian
- CAPITAL (Cardiovascular Percutaneous Intervention Trials) Research Group (S.P., P.D.S., O.A.-R., R.G.J., P.M., L.R., H.F., B.M., J.W., R.M., B.H.), University of Ottawa, Canada
- Division of Cardiology (S.P., P.D.S., O.A.-R., P.M., M.F., R.M., M.L., B.H.), University of Ottawa, Canada
- Heart Institute, School of Epidemiology, Public Health and Preventative Medicine (P.D.S., R.G.J., P.M., J.B., G.A.W.), University of Ottawa, Canada
| | - Lisa Robinson
- CAPITAL (Cardiovascular Percutaneous Intervention Trials) Research Group (S.P., P.D.S., O.A.-R., R.G.J., P.M., L.R., H.F., B.M., J.W., R.M., B.H.), University of Ottawa, Canada
| | - Hannah Feagan
- CAPITAL (Cardiovascular Percutaneous Intervention Trials) Research Group (S.P., P.D.S., O.A.-R., R.G.J., P.M., L.R., H.F., B.M., J.W., R.M., B.H.), University of Ottawa, Canada
| | - Baylie Morgan
- CAPITAL (Cardiovascular Percutaneous Intervention Trials) Research Group (S.P., P.D.S., O.A.-R., R.G.J., P.M., L.R., H.F., B.M., J.W., R.M., B.H.), University of Ottawa, Canada
| | - Jilliane Wade
- CAPITAL (Cardiovascular Percutaneous Intervention Trials) Research Group (S.P., P.D.S., O.A.-R., R.G.J., P.M., L.R., H.F., B.M., J.W., R.M., B.H.), University of Ottawa, Canada
| | - Hadi Toeg
- Division of Cardiac Surgery (H.T., T.A.-A., M.R., V.C.), University of Ottawa, Canada
| | - Talal Al-Atassi
- Division of Cardiac Surgery (H.T., T.A.-A., M.R., V.C.), University of Ottawa, Canada
| | - Marc Ruel
- Division of Cardiac Surgery (H.T., T.A.-A., M.R., V.C.), University of Ottawa, Canada
| | | | - Jordan Bernick
- Cardiovascular Research Methods Centre (J.B., G.A.W.), University of Ottawa, Canada
- Heart Institute, School of Epidemiology, Public Health and Preventative Medicine (P.D.S., R.G.J., P.M., J.B., G.A.W.), University of Ottawa, Canada
| | - George A Wells
- Cardiovascular Research Methods Centre (J.B., G.A.W.), University of Ottawa, Canada
- Heart Institute, School of Epidemiology, Public Health and Preventative Medicine (P.D.S., R.G.J., P.M., J.B., G.A.W.), University of Ottawa, Canada
| | - Trevor Simard
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, MN (T.S.)
| | - Jeffrey A Marbach
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Sciences University, Portland (J.A.M.)
| | - Michael Froeschl
- Division of Cardiology (S.P., P.D.S., O.A.-R., P.M., M.F., R.M., M.L., B.H.), University of Ottawa, Canada
| | - Rebecca Mathew
- CAPITAL (Cardiovascular Percutaneous Intervention Trials) Research Group (S.P., P.D.S., O.A.-R., R.G.J., P.M., L.R., H.F., B.M., J.W., R.M., B.H.), University of Ottawa, Canada
- Division of Cardiology (S.P., P.D.S., O.A.-R., P.M., M.F., R.M., M.L., B.H.), University of Ottawa, Canada
| | - Marino Labinaz
- Division of Cardiology (S.P., P.D.S., O.A.-R., P.M., M.F., R.M., M.L., B.H.), University of Ottawa, Canada
| | - Vincent Chan
- Division of Cardiac Surgery (H.T., T.A.-A., M.R., V.C.), University of Ottawa, Canada
| | - Benjamin Hibbert
- CAPITAL (Cardiovascular Percutaneous Intervention Trials) Research Group (S.P., P.D.S., O.A.-R., R.G.J., P.M., L.R., H.F., B.M., J.W., R.M., B.H.), University of Ottawa, Canada
- Division of Cardiology (S.P., P.D.S., O.A.-R., P.M., M.F., R.M., M.L., B.H.), University of Ottawa, Canada
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16
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Willner N, Prosperi-Porta G, Lau L, Nam Fu AY, Boczar K, Poulin A, Di Santo P, Unni RR, Visintini S, Ronksley PE, Chan KL, Beauchesne L, Burwash IG, Messika-Zeitoun D. Aortic Stenosis Progression: A Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging 2023; 16:314-328. [PMID: 36648053 DOI: 10.1016/j.jcmg.2022.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 06/28/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Aortic valve stenosis is a progressive disorder with variable progression rates. The factors affecting aortic stenosis (AS) progression remain largely unknown. OBJECTIVES This systematic review and meta-analysis sought to determine AS progression rates and to assess the impact of baseline AS severity and sex on disease progression. METHODS The authors searched Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception to July 1, 2020, for prospective studies evaluating the progression of AS with the use of echocardiography (mean gradient [MG], peak velocity [PV], peak gradient [PG], or aortic valve area [AVA]) or computed tomography (calcium score [AVC]). Random-effects meta-analysis was performed to evaluate the rate of AS progression for each parameter stratified by baseline severity, and meta-regression was performed to determine the impact of baseline severity and of sex on AS progression rate. RESULTS A total of 24 studies including 5,450 patients (40% female) met inclusion criteria. The pooled annualized progression of MG was +4.10 mm Hg (95% CI: 2.80-5.41 mm Hg), AVA -0.08 cm2 (95% CI: 0.06-0.10 cm2), PV +0.19 m/s (95% CI: 0.13-0.24 m/s), PG +7.86 mm Hg (95% CI: 4.98-10.75 mm Hg), and AVC +158.5 AU (95% CI: 55.0-261.9 AU). Increasing baseline severity of AS was predictive of higher rates of progression for MG (P < 0.001), PV (P = 0.001), and AVC (P < 0.001), but not AVA (P = 0.34) or PG (P = 0.21). Only 4 studies reported AS progression stratified by sex, with only PV and AVC having 3 studies to perform a meta-analysis. No difference between sex was observed for PV (P = 0.397) or AVC (P = 0.572), but the level of confidence was low. CONCLUSIONS This study provides progression rates for both hemodynamic and anatomic parameters of AS and shows that increasing hemodynamic and anatomic baseline severity is associated with faster AS progression. More studies are needed to determine if sex differences affect AS progression. (Aortic Valve Stenosis Progression Rate: A Systematic Review and Meta-Analysis; CRD42021207726).
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Affiliation(s)
- Nadav Willner
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | | | - Lawrence Lau
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Angel Yi Nam Fu
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Kevin Boczar
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Anthony Poulin
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Pietro Di Santo
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Rudy R Unni
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Sarah Visintini
- Berkman Library, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kwan-Leung Chan
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Luc Beauchesne
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Ian G Burwash
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
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17
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Parlow S, Di Santo P, Jung RG, Fam N, Czarnecki A, Horlick E, Abdel-Razek O, Chan V, Hynes M, Nicholson D, Dryden A, Fernando SM, Wells GA, Bernick J, Labinaz M, Mathew R, Simard T, Hibbert B. Transcatheter mitral valve repair for inotrope dependent cardiogenic shock - Design and rationale of the CAPITAL MINOS trial. Am Heart J 2022; 254:81-87. [PMID: 36002047 DOI: 10.1016/j.ahj.2022.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 04/18/2022] [Revised: 08/11/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Functional mitral regurgitation (MR) is an important clinical consideration in patients with heart failure. Transcatheter edge-to-edge repair (TEER) has emerged as a useful therapeutic tool for patients with chronic heart failure, however the role of TEER in patients with cardiogenic shock (CS) and MR has not yet been studied in a randomized trial. The Transcatheter Mitral Valve Repair for Inotrope Dependent Cardiogenic Shock (CAPITAL MINOS) trial was therefore designed to determine if TEER improves clinical outcomes in the CS population. METHODS AND DESIGN The CAPITAL MINOS trial is an open-label, multi-center randomized clinical trial comparing TEER to medical therapy in patients with CS and MR. A total of 144 patients with Society for Cardiovascular Angiography and Interventions (SCAI) class C or D CS and at least 3+ MR will be randomized in a 1:1 ratio to TEER or medical therapy alone. The primary outcome will be a composite of in-hospital all-cause mortality, cardiac transplantation, implantation of durable left ventricular assist device, or discharge on palliative inotropic therapy. Patients will be followed for the duration of their index hospitalization for the primary outcome. Secondary outcomes include 6 month mortality. IMPLICATIONS The CAPITAL MINOS trial will determine whether TEER improves outcomes in patients with CS and MR and will be an important step in optimizing treatment for this high-risk patient population.
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Affiliation(s)
- Simon Parlow
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard G Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Neil Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Czarnecki
- Division of Cardiology, Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Eric Horlick
- Division of Cardiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Omar Abdel-Razek
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Vincent Chan
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Mark Hynes
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Donna Nicholson
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Adam Dryden
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Shannon M Fernando
- Division of Critical Care Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Cardiovascular Research Methods Center, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jordan Bernick
- Cardiovascular Research Methods Center, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marino Labinaz
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Rebecca Mathew
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Trevor Simard
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Benjamin Hibbert
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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18
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Gillmore T, Jung RG, Moreland R, Di Santo P, Stotts C, Makwana D, Abdel-Razek O, Ahmed Z, Chung K, Parlow S, Simard T, Froeschl M, Labinaz M, Hibbert B. Impact of intracoronary assessments on revascularization decisions: A contemporary evaluation. Catheter Cardiovasc Interv 2022; 100:955-963. [PMID: 36259740 DOI: 10.1002/ccd.30417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 09/06/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To investigate the real-world implementation of intracoronary assessment (ICA) techniques and evaluate their impact on clinical decisions regarding the management of coronary artery disease (CAD) in contemporary practice. BACKGROUND Coronary angiogram is the gold standard used to diagnose vessel stenosis and guide percutaneous coronary intervention (PCI); however, it is limited by its two-dimensional imaging capabilities. ICA techniques like intravascular ultrasound and optical coherence tomography capture the vessel in three-dimensional images. Comparatively, fractional flow reserve provides information on the physiologic significance of coronary stenosis. Both techniques may improve PCI outcomes if they routinely change physician behavior. METHODS Patients who underwent ICA between August 2015 and March 2020 were included in the study. The primary outcome was the clinical impact of ICA on physician clinical decision making of a stenotic vessel. The secondary outcome was the clinical changes that occurred following ICA. RESULTS A total of 1135 patients were included in the study. Physiologic assessment (PA) and image assessment (IA) were performed in 61.4% and 38.6% respectively. Management plans were changed in 38.1% and 23.9% of patients who received PA and IA. Over half of the management change resulted in physicians deciding to not intervene on the stenotic vessel. One-year outcome of these decisions showed no significant increase in major adverse cardiac events (hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.40-1.15; p = 0.15) or unplanned revascularization (HR, 0.78; 95% CI, 0.35-1.74; p = 0.55) suggesting reliance on PA/IA data did not increase risk. CONCLUSION Selected ICA alters physician management of CAD in one-third of patients being evaluated for revascularization-typically leading to fewer interventions. All cause death is numerally lower in patients that received a change in management. However, the 1-year outcome of these altered decisions does not appear to be significantly different.
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Affiliation(s)
- Taylor Gillmore
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard G Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert Moreland
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Cameron Stotts
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dwipen Makwana
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Omar Abdel-Razek
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Zeeshan Ahmed
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kevin Chung
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Simon Parlow
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Trevor Simard
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michael Froeschl
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marino Labinaz
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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19
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Tritschler T, Patel A, Kraaijpoel N, Bhatt DL, De Luca G, Di Santo P, Feres F, Costa RA, Hibbert B, Isshiki T, Le Gal G, Castellucci LA. Case‐fatality rate of major bleeding events in patients on dual antiplatelet therapy after percutaneous coronary intervention: A systematic review and meta‐analysis. Res Pract Thromb Haemost 2022; 6:e12834. [PMID: 36349260 PMCID: PMC9634492 DOI: 10.1002/rth2.12834] [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] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
Background Assessment of the case-fatality rate (CFR) of major bleeding on dual antiplatelet therapy (DAPT) may improve balancing risks and benefits of different durations of DAPT following percutaneous coronary intervention (PCI). Objectives To determine the CFR of major bleeding in patients on DAPT after PCI and to compare rates among different durations of DAPT. Methods Medline, Embase, and CENTRAL were searched from inception to August 2021 for randomized trials that reported fatal bleeding among patients who were randomized to ≥1 month of DAPT following PCI. Summary estimates for CFRs of major bleeding were calculated using the random-effects inverse-variance method. Statistical heterogeneity was evaluated using the I 2 statistic. Results Of 2777 citations obtained by the search, 15 (48%) of 31 potentially eligible studies were excluded because fatal bleeding was not reported, leaving 16 studies that were included in the analysis. Overall, there were 823 major bleeding events including 91 fatal events in 48,884 patients who were assigned to receive DAPT during study follow-up. The CFR of major bleeding was 10.8% (95% confidence interval [CI], 7.1-16.2; I 2 = 50%) in the entire study population, and 13.8% (95% CI, 6.5-27.1; I 2 = 28%), 11.2% (95% CI, 6.7-18.0; I 2 = 0%), and 5.8% (95% CI, 3.0-11.1; I 2 = 0%) in those on short-term (≤6 months; n = 16,553), standard-term (12 months; n = 19,453), and long-term DAPT (>12 months; n = 10,238), respectively. Conclusion Fatal bleeding is not reported in many studies evaluating DAPT after PCI. The CFR of major bleeding on DAPT is substantial and may be higher in the first 12 months of DAPT than during long-term DAPT.
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Affiliation(s)
- Tobias Tritschler
- Department of General Internal Medicine Inselspital, Bern University Hospital, University of Bern Bern Switzerland
- Department of Medicine Ottawa Hospital Research Institute, University of Ottawa Ottawa Ontario Canada
| | - Anuj Patel
- Department of Medicine Ottawa Hospital Research Institute, University of Ottawa Ottawa Ontario Canada
| | - Noémie Kraaijpoel
- Department of Vascular Medicine, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Deepak L. Bhatt
- Brigham and Women's Hospital Heart and Vascular Center Harvard Medical School, Boston Boston Massachusetts USA
| | - Giuseppe De Luca
- Division of Cardiology Azienda Ospedaliera‐Universitaria “Maggiore della Carità”, Eastern Piedmont University Novara Italy
| | | | - Fausto Feres
- Department of Invasive Cardiology Instituto Dante Pazzanese de Cardiologia Sao Paulo Brazil
| | - Ricardo A. Costa
- Department of Invasive Cardiology Instituto Dante Pazzanese de Cardiologia Sao Paulo Brazil
| | | | - Takaaki Isshiki
- Division of Cardiology Teikyo University Hospital Tokyo Japan
| | - Grégoire Le Gal
- Department of Medicine Ottawa Hospital Research Institute, University of Ottawa Ottawa Ontario Canada
| | - Lana A. Castellucci
- Department of Medicine Ottawa Hospital Research Institute, University of Ottawa Ottawa Ontario Canada
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20
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Jung RG, Di Santo P, Mathew R, Simard T, Parlow S, Weng W, Abdel-Razek O, Malhotra N, Cheung M, Hutson JH, Marbach JA, Motazedian P, Thibert MJ, Fernando SM, Nery PB, Nair GM, Russo JJ, Hibbert B, Ramirez FD. Arrhythmic events and mortality in patients with cardiogenic shock on inotropic support: results of the DOREMI randomized trial. Can J Cardiol 2022; 39:394-402. [PMID: 36150583 DOI: 10.1016/j.cjca.2022.09.013] [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] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Inotropic support is widely used in the management of cardiogenic shock (CS). Existing data on the incidence and significance of arrhythmic events in patients with CS on inotropic support is at high risk of bias. METHODS The DObutamine compaREd to MIlrinone (DOREMI) trial randomized patients to receive dobutamine or milrinone in a double-blind fashion. Patients with and without arrhythmic events (defined as arrhythmias requiring intervention or sustained ventricular arrhythmias) were compared to (1) identify factors associated with their occurrence and (2) examine their association with in-hospital mortality and secondary outcomes. RESULTS Ninety-two patients (47.9%) had arrhythmic events, occurring equally with dobutamine and milrinone (P=0.563). The need for vasopressor support at inotrope initiation and a history of atrial fibrillation were positively associated with arrhythmic events whereas predominant right ventricular dysfunction, previous myocardial infarction, and increasing left ventricular ejection fraction were negatively associated with them. Supraventricular arrhythmic events were not associated with mortality (RR 0.97, 95% CI 0.68-1.40, P=0.879) but were positively associated with resuscitated cardiac arrests and hospital length of stay. Ventricular arrhythmic events were positively associated with mortality (RR 1.66, 95% CI 1.13-2.43; P=0.026) and resuscitated cardiac arrests. Arrhythmic events were most often treated with amiodarone (97%) and electrical cardioversion (27%), which were not associated with mortality. CONCLUSIONS Clinically relevant arrhythmic events occur in approximately half of patients with CS treated with dobutamine or milrinone and are associated with adverse clinical outcomes. Five factors may help identify patients most at risk of arrhythmic events.
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Affiliation(s)
- Richard G Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Trevor Simard
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Simon Parlow
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Willy Weng
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Omar Abdel-Razek
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Nikita Malhotra
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Matthew Cheung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jordan H Hutson
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Critical Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey A Marbach
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Pouya Motazedian
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michael J Thibert
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Shannon M Fernando
- Division of Critical Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Pablo B Nery
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Girish M Nair
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Juan J Russo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - F Daniel Ramirez
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
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21
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Jung RG, Duchez AC, Simard T, Dhaliwal S, Gillmore T, Di Santo P, Labinaz A, Ramirez FD, Rasheed A, Robichaud S, Ouimet M, Short S, Clifford C, Xiao F, Lordkipanidzé M, Burger D, Gadde S, Rayner KJ, Hibbert B. Plasminogen Activator Inhibitor-1–Positive Platelet-Derived Extracellular Vesicles Predicts MACE and the Proinflammatory SMC Phenotype. JACC Basic Transl Sci 2022; 7:985-997. [PMID: 36337926 PMCID: PMC9626902 DOI: 10.1016/j.jacbts.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/02/2022] [Accepted: 05/02/2022] [Indexed: 12/01/2022]
Abstract
This study shows the existence of PAI-1+ PEVs. Approximately 20% of plasma PAI-1 is composed of PAI-1+ PEVs. Elevated PAI-1+ PEV levels were predictive of 1-year major adverse cardiac events in both the discovery and the validation cohort, with larger effect sizes than other clinical biomarkers. High PAI-1+ PEV levels did not affect thrombogenicity. Increasing doses of PAI-1+ PEVs promoted the proinflammatory VSMC state by enhancing proliferation and migration. Inhibition of the PAI-1:low-density lipoprotein–related receptor-1 pathway dampened the proinflammatory VSMC changes. PAI-1+ PEV is a promising biomarker for major adverse cardiac events, and targeting the PAI-1+ PEV–VSMC interaction may offer a novel target to modulate cardiac events in patients with coronary artery disease.
Patients with established coronary artery disease remain at elevated risk of major adverse cardiac events. The goal of this study was to evaluate the utility of plasminogen activator inhibitor-1–positive platelet-derived extracellular vesicles as a biomarker for major adverse cardiac events and to explore potential underlying mechanisms. Our study suggests these extracellular vesicles as a potential biomarker to identify and a therapeutic target to ameliorate neointimal formation of high-risk patients.
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Affiliation(s)
- Richard G. Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Anne-Claire Duchez
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Trevor Simard
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Shan Dhaliwal
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Taylor Gillmore
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Alisha Labinaz
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - F. Daniel Ramirez
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Adil Rasheed
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sabrina Robichaud
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mireille Ouimet
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Spencer Short
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Cole Clifford
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Fengxia Xiao
- Kidney Research Centre, Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Marie Lordkipanidzé
- Faculté de Pharmacie, Université de Montréal, Montréal, Québec, Canada
- Research Center, Montreal Heart Institute, Montréal, Québec, Canada
| | - Dylan Burger
- Kidney Research Centre, Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Suresh Gadde
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Katey J. Rayner
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Address for correspondence: Dr Benjamin Hibbert, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.
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22
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Jung RG, Abdel-Razek O, Di Santo P, Gillmore T, Stotts C, Makwana D, Soriano J, Moreland R, Verreault-Julien L, Goh CY, Parlow S, Sypkes C, Ramirez DF, Sadek M, Chan V, Toeg H, Simard T, Froeschl MPV, Labinaz M, Hibbert B. Impact of atrial fibrillation on the risk of major adverse cardiac events following coronary revascularisation. Open Heart 2022; 9:openhrt-2022-002012. [PMID: 36150746 PMCID: PMC9511650 DOI: 10.1136/openhrt-2022-002012] [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: 03/06/2022] [Accepted: 08/05/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Atrial fibrillation (AF) remains a highly prevalent arrhythmia with significant burden on morbidity and mortality. The impact of AF in the revascularised population remains incompletely described. Given the high prevalence of AF in the revascularised population, we sought to evaluate the incidence and prognosis in patients with pre-existing and new-onset AF following revascularisation. METHODS We used the University of Ottawa Heart Institute Revascularisation Registry to identify patients who underwent revascularisation between August 2015 and March 2020, who were prospectively followed for an average of one year. We conducted a retrospective cohort study analysing the association between AF and clinical outcomes. The primary outcome of interest was 1-year major adverse cardiac events (MACE) defined as a composite of death, myocardial infarction, unplanned revascularisation and cerebrovascular accidents. Moreover, secondary outcomes include the individual components of MACE and bleeding. RESULTS A total of 6704 patients underwent revascularisation and completed 1-year clinical follow-up. Median time to follow-up was 12.8 (IQR 11.2-15.9) months. One-year MACE occurred in 166 (21.8%) and 683 (11.5%) patients in AF and non-AF groups, respectively (adjusted HR, 1.61; 95% CI 1.29 to 2.01; p<0.0001). AF was independently predictive of 1-year mortality, myocardial infarction, unplanned revascularisation, cerebrovascular accident and bleeding. Within 1 year, 299 (4.5%) episodes of new-onset AF was observed. New-onset AF following revascularisation was also associated with 1-year MACE, mortality, myocardial infarction, cerebrovascular accident and unplanned revascularisation. CONCLUSIONS Preprocedural and new-onset AF following revascularisation remains highly predictive 1-year MACE. AF should be considered in addition to traditional risk factors for adverse outcomes following revascularisation.
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Affiliation(s)
- Richard G Jung
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Omar Abdel-Razek
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | | | | | - Robert Moreland
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Cheng Yee Goh
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Simon Parlow
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Daniel F Ramirez
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Mouhannad Sadek
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Vincent Chan
- Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Hadi Toeg
- Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Michael P V Froeschl
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marino Labinaz
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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23
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Abdel-Razek O, Jung Y, Jung R, Skanes S, Dhaliwal S, Stotts C, Di Santo P, Goh CY, Verreault-Julien L, Visintini S, Bradley J, Simard T, Ramirez FD, Russo JJ, Froeschl M, Labinaz M, Hibbert B. Safety of same-day discharge in patients with left main percutaneous intervention. Coron Artery Dis 2022; 33:415-418. [PMID: 35170549 PMCID: PMC9239435 DOI: 10.1097/mca.0000000000001121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/12/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Omar Abdel-Razek
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa
| | - Young Jung
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton
| | - Richard Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa
- Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | | | - Shan Dhaliwal
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Cameron Stotts
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa
| | - Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa
- Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa
- School of Epidemiology and Public Health, University of Ottawa, Ottawa
| | - Cheng Yee Goh
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa
| | | | - Sarah Visintini
- Berkman Library, University of Ottawa Heart Institute, Ottawa, Canada
| | - Jennifer Bradley
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa
| | - Trevor Simard
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - F. Daniel Ramirez
- Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Juan J. Russo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa
| | - Michael Froeschl
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa
| | - Marino Labinaz
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa
- Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa
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24
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Prosperi-Porta G, Motazedian P, Di Santo P, Jung RG, Parlow S, Abdel-Razek O, Simard T, Hutson J, Malhotra N, Fu A, Ramirez FD, Froeschl M, Mathew R, Hibbert B. No sex-based difference in cardiogenic shock: A post-hoc analysis of the DOREMI trial. J Cardiol 2022; 80:358-364. [PMID: 35725945 DOI: 10.1016/j.jjcc.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/19/2022] [Accepted: 06/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cardiogenic shock (CS) is associated with significant morbidity and mortality; however, there are limited randomized data evaluating the association between sex and clinical outcomes in patients with CS. Patients with CS enrolled in the DObutamine compaREd with MIlrinone (DOREMI) trial were evaluated in this post-hoc analysis. METHODS The primary outcome was a composite of all-cause mortality, resuscitated cardiac arrest, cardiac transplant or mechanical circulatory support, non-fatal myocardial infarction, transient ischemic attack or stroke, or initiation of renal replacement therapy. Secondary outcomes included the individual components of the primary outcome. We analyzed the primary and secondary outcomes using unadjusted relative risks and performed adjusted analysis for the primary outcome and all-cause mortality using the covariates mean arterial pressure <70 mmHg at inotrope initiation, age, and acute myocardial infarction CS. RESULTS Among 192 participants in the DOREMI study, 70 patients (36 %) were female. The primary outcome occurred in 38 female patients (54 %) compared to 61 male patients (50 %) [adjusted relative risk (aRR) 1.23; 95 % CI 0.78-1.95, p = 0.97]. When stratified by inotrope, there was no difference in the primary outcome comparing females to males receiving dobutamine (RR 1.14; 95 % CI 0.79-1.65, p = 0.50) nor milrinone (RR 1.03; 95 % CI 0.68-1.57, p = 0.87). There was no difference in all-cause mortality comparing females to males (aRR 1.51; 95 % CI 0.78-2.94, p = 0.88). Additionally, there were no differences in any secondary outcomes between males and females (p > 0.05 for all endpoints). CONCLUSION In patients presenting with CS treated with milrinone or dobutamine, no differences in clinical outcomes were observed between males and females.
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Affiliation(s)
- Graeme Prosperi-Porta
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pouya Motazedian
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard G Jung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Simon Parlow
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Omar Abdel-Razek
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Trevor Simard
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Jordan Hutson
- Division of Critical Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Nikita Malhotra
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Angel Fu
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - F Daniel Ramirez
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michael Froeschl
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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25
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Marbach JA, Faugno AJ, Pacifici S, Chweich H, Marbach JK, Rabinowitz JB, Thayer KL, Di Santo P, Kapur NK. Strategies to reduce limb ischemia in peripheral venoarterial extracorporeal membrane oxygenation: A systematic review and Meta-analysis. Int J Cardiol 2022; 361:77-84. [PMID: 35523371 DOI: 10.1016/j.ijcard.2022.04.084] [Citation(s) in RCA: 8] [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: 01/13/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 11/05/2022]
Abstract
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides cardiovascular and respiratory support for patients in cardiogenic shock; yet, complications are a frequent source of morbidity and mortality. Limb ischemia can be potentially mitigated by limp perfusion protection strategies (LPPS). We performed a systematic review and meta-analysis to evaluate the safety and efficacy of two LPPS in patients treated with peripheral VA-ECMO - prophylactic insertion of a distal perfusion catheter (DPC) and small bore (<17 Fr) arterial return cannula. Among 22 included studies, limb ischemia was reduced in patients receiving a small arterial cannula (OR 0.40, 95% CI 0.24-0.65; p < 0.001) and in patients receiving a prophylactic DPC (OR 0.31, 95% CI 0.21-0.47; p < 0.001). Mortality was not significantly reduced with either a small arterial cannula (OR 0.70, 95% CI 0.23-2.18; p = 0.54) or prophylactic DPC strategy (OR 0.89, 95% CI 0.67-1.17; p = 0.40). As such, prophylactic insertion of a DPC or smaller bore arterial return cannula appear to reduce the risk of lower limb ischemia in this analysis. Further data are needed to confirm these findings. Registration: Registered in PROSPERO Database (Registration CRD42020215677).
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Affiliation(s)
- Jeffrey A Marbach
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center and Tufts University School of Medicine, United States of America; CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, United States of America; The Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, United States of America
| | - Anthony J Faugno
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center and Tufts University School of Medicine, United States of America; The Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, United States of America
| | - Stefano Pacifici
- Department of Medicine, Tufts Medical Center and Tufts University School of Medicine, United States of America
| | - Haval Chweich
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center and Tufts University School of Medicine, United States of America; The Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, United States of America
| | | | - Judy B Rabinowitz
- Hirsh Health Sciences Library, Tufts University, United States of America
| | - Katherine L Thayer
- The Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, United States of America
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, United States of America
| | - Navin K Kapur
- Department of Medicine, Tufts Medical Center and Tufts University School of Medicine, United States of America; The Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, United States of America.
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26
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Parlow S, Fay Lepage-Ratte M, Jung RG, Fernando SM, Visintini S, Sterling LH, Di Santo P, Simard T, Russo JJ, Labinaz M, Hibbert B, Nolan JP, Rochwerg B, Mathew R. Inhaled anaesthesia compared with conventional sedation in post cardiac arrest patients undergoing temperature control: a systematic review and meta-analysis. Resuscitation 2022; 176:74-79. [DOI: 10.1016/j.resuscitation.2022.05.015] [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] [Received: 03/16/2022] [Revised: 05/19/2022] [Accepted: 05/21/2022] [Indexed: 10/18/2022]
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Goh CY, Parlow S, Di Santo P, Simard T, Jung R, Ahmed Z, Verreault-Julien L, Kuhar P, Chan V, Al-Atassi T, Toeg H, Bernick J, Wells GA, Ruel M, Hibbert B. Utility of a smartphone application in assessing palmar circulation prior to radial artery harvesting for coronary artery bypass grafting: rationale and design of the randomised CAPITAL iRADIAL-CABG trial. BMJ Open 2022; 12:e055580. [PMID: 35396289 PMCID: PMC8995949 DOI: 10.1136/bmjopen-2021-055580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION There is emerging evidence supporting the use of the radial artery (RA) as a preferred secondary conduit for coronary artery bypass grafting (CABG) as it is associated with higher rates of graft patency at 5 years when compared with saphenous vein grafts (SVG). The modified Allen's test (MAT) is traditionally regarded as the standard of care in the assessment of ulnar artery (UA) patency prior to RA harvesting. Unfortunately, due to high false-positive rates, a substantial number of pre-CABG patients are found to have an abnormal MAT despite normal UA patency, resulting in inappropriate exclusion from RA harvesting. The SVG is generally used in its place when this occurs, resulting in potentially lower rates of long-term graft patency. METHODS AND ANALYSIS The CAPITAL iRADIAL-CABG trial is currently enrolling participants 18 years of age or older undergoing CABG for whom the treating physician is considering the use of an RA conduit. Eligible patients will be randomised in a 1:1 fashion to MAT or smartphone-based photoplethysmography application assessment to assess collateral palmar circulation prior to RA harvesting. The primary outcome of the trial is the use of the RA as a conduit during CABG. The primary safety outcome is postoperative palmar ischaemia as determined by clinical assessment or requirement of vascular intervention. Secondary outcomes include vascular complications, early graft failure, need for rescue percutaneous coronary intervention during the index hospitalisation and a composite cardiovascular outcome of myocardial infarction, stroke and cardiovascular death prior to discharge from hospital. A total of 236 participants are planned to be recruited. ETHICS AND DISSEMINATION The study was approved by the Ottawa Heart Science Network Research Ethics Board (approval number 20180865-01H). The study results will be disseminated via conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03810729.
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Affiliation(s)
- Cheng Yee Goh
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Simon Parlow
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Trevor Simard
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Richard Jung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Zeeshan Ahmed
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Louis Verreault-Julien
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Peter Kuhar
- Azumio Inc, Redwood City, San Francisco, USA
| | - Vincent Chan
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Talal Al-Atassi
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Hadi Toeg
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jordan Bernick
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
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28
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Parlow S, Weng W, Di Santo P, Jung RG, Lepage-Ratte MF, Motazedian P, Prosperi-Porta G, Abdel-Razek O, Simard T, Chan V, Labinaz M, Froeschl M, Mathew R, Hibbert B. Significant valvular dysfunction and outcomes in cardiogenic shock: insights from the randomized DOREMI trial. Can J Cardiol 2022; 38:1211-1219. [DOI: 10.1016/j.cjca.2022.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 04/02/2022] [Accepted: 04/03/2022] [Indexed: 12/15/2022] Open
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29
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Marbach JA, Di Santo P, Kapur NK, Thayer KL, Simard T, Jung RG, Parlow S, Abdel-Razek O, Fernando SM, Labinaz M, Froeschl M, Mathew R, Hibbert B. Lactate Clearance as a Surrogate for Mortality in Cardiogenic Shock: Insights From the DOREMI Trial. J Am Heart Assoc 2022; 11:e023322. [PMID: 35261289 PMCID: PMC9075306 DOI: 10.1161/jaha.121.023322] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Recent studies have shown improved outcomes in cardiogenic shock through protocols directed toward early identification and initiation of mechanical circulatory support. However, objective therapeutic targets—based on clinical and/or laboratory data—to guide real‐time clinical decision making are lacking. Lactate clearance has been suggested as a potential treatment target because of its independent association with mortality. Methods and Results In a post hoc analysis of the DOREMI (Dobutamine Compared to Milrinone in the Treatment of Cardiogenic Shock) trial—a randomized, double‐blind, controlled trial comparing milrinone to dobutamine in the treatment of cardiogenic shock—we used prospectively collected lactate data to evaluate lactate clearance as a surrogate marker for in‐hospital mortality. In total, 82 (57.7%) patients survived to hospital discharge (survivors). In multivariate logistic regression analysis, complete lactate clearance, percentage lactate clearance, and percentage lactate clearance per hour were independently associated with survival beginning as early as 8 hours after enrollment. Complete lactate clearance was the strongest predictor of survival at all time points, with odds ratios ranging between 2.46 (95% CI, 1.09–5.55; P=0.03) at 8 hours to 5.44 (95% CI, 2.14–13.8; P<0.01) at 24 hours. Conclusions Complete lactate clearance is a strong and independent predictor of in‐hospital survival in patients with cardiogenic shock. Together with previously published data, these results further support the validity of lactate clearance as an appropriate surrogate for mortality and as a potential therapeutic target in future cardiogenic shock trials. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03207165.
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Affiliation(s)
- Jeffrey A Marbach
- CAPITAL Research Group Division of Cardiology Department of Medicine University of Ottawa Heart Institute Ottawa Canada.,Division of Pulmonary Critical Care and Sleep Medicine Tufts Medical Center and Tufts University School of Medicine Boston MA.,Division of Cardiology Beth Israel Deaconess Medical Center Boston MA
| | - Pietro Di Santo
- CAPITAL Research Group Division of Cardiology Department of Medicine University of Ottawa Heart Institute Ottawa Canada.,Faculty of Medicine University of Ottawa Canada.,School of Epidemiology and Public Health University of Ottawa Canada
| | - Navin K Kapur
- Department of Medicine Tufts Medical Center and Tufts University School of Medicine Boston MA.,The Cardiovascular Center Tufts Medical Center and Tufts University School of Medicine Boston MA
| | - Katherine L Thayer
- The Cardiovascular Center Tufts Medical Center and Tufts University School of Medicine Boston MA
| | - Trevor Simard
- CAPITAL Research Group Division of Cardiology Department of Medicine University of Ottawa Heart Institute Ottawa Canada.,Division of Cardiology Mayo Clinic Rochester MN
| | - Richard G Jung
- CAPITAL Research Group Division of Cardiology Department of Medicine University of Ottawa Heart Institute Ottawa Canada.,Faculty of Medicine University of Ottawa Canada.,Department of Cellular and Molecular Medicine University of Ottawa Canada
| | - Simon Parlow
- CAPITAL Research Group Division of Cardiology Department of Medicine University of Ottawa Heart Institute Ottawa Canada.,Faculty of Medicine University of Ottawa Canada
| | - Omar Abdel-Razek
- CAPITAL Research Group Division of Cardiology Department of Medicine University of Ottawa Heart Institute Ottawa Canada.,Faculty of Medicine University of Ottawa Canada
| | - Shannon M Fernando
- Faculty of Medicine University of Ottawa Canada.,Division of Critical Care Department of Medicine University of Ottawa Canada
| | - Marino Labinaz
- CAPITAL Research Group Division of Cardiology Department of Medicine University of Ottawa Heart Institute Ottawa Canada.,Faculty of Medicine University of Ottawa Canada
| | - Michael Froeschl
- CAPITAL Research Group Division of Cardiology Department of Medicine University of Ottawa Heart Institute Ottawa Canada.,Faculty of Medicine University of Ottawa Canada
| | - Rebecca Mathew
- CAPITAL Research Group Division of Cardiology Department of Medicine University of Ottawa Heart Institute Ottawa Canada.,Faculty of Medicine University of Ottawa Canada.,Division of Critical Care Department of Medicine University of Ottawa Canada
| | - Benjamin Hibbert
- CAPITAL Research Group Division of Cardiology Department of Medicine University of Ottawa Heart Institute Ottawa Canada.,Faculty of Medicine University of Ottawa Canada.,Department of Cellular and Molecular Medicine University of Ottawa Canada
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Verreault-Julien L, Bhatt DL, Jung RG, Di Santo P, Simard T, Avram R, Hibbert B. Predictors of angina resolution after percutaneous coronary intervention in stable coronary artery disease. Coron Artery Dis 2022; 33:98-104. [PMID: 34148973 DOI: 10.1097/mca.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Elective percutaneous coronary intervention (PCI) is performed to relieve symptoms of angina. Identifying patients who will benefit symptomatically after PCI would be clinically advantageous but robust predictors of symptom resolution are ill-defined. METHODS Prospective indexing of baseline angina status, clinical, and procedural characteristics were collected over a 5-year period in a regional revascularization registry. At 1-year follow-up, angina resolution was assessed. We performed a stepwise selection algorithm to identify predictors of persistent angina at 1 year. RESULTS A total of 777 patients were included in the analysis and the median follow-up was 387 days. Mean age of the cohort was 66.6 years, 23.8% were female and 23.3% had baseline Canadian Cardiovascular Society class 3 or 4 angina. Overall, 13.1% had persistent angina. The only predictor of persistent angina was the presence of a residual chronic total occlusion after PCI with odds ratio of 3.06 (95% confidence interval, 1.81-5.17). Residual stenoses 50-69%, 70-89%, and 90-99% were not associated with residual angina after PCI. CONCLUSION Most patients achieved symptom resolution with PCI and optimal medical therapy. A residual chronic total occlusion after PCI was associated with persistent angina. Other degrees of stenoses were not associated with persistent angina.
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Affiliation(s)
- Louis Verreault-Julien
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Harvard T.H. Chan School of Public Health, Harvard University
| | - Deepak L Bhatt
- Department of Medicine, Brigham and Women's Hospital Heart & Vascular Center
- Harvard Medical School, Boston, MA, USA
| | - Richard G Jung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine
- School of Epidemiology and Public Health
| | - Trevor Simard
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert Avram
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine
- School of Epidemiology and Public Health
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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31
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Parlow S, Cheung M, Verreault-Julien L, Wu KY, Berardi P, Nair V, Di Santo P, Jung RG, Mathew R, Hibbert B. An Unusual Case of Obstructive Shock. JACC Case Rep 2021; 3:1913-1917. [PMID: 34984352 PMCID: PMC8693255 DOI: 10.1016/j.jaccas.2021.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/20/2021] [Accepted: 10/29/2021] [Indexed: 11/18/2022]
Abstract
A 54-year-old man presented in profound obstructive shock. Investigations revealed a right atrial mass causing severe right ventricular inflow obstruction and compromised cardiac output. The patient was treated with emergency balloon catheter intervention to relieve the obstruction, with resulting hemodynamic stability. The pathology report later returned a positive result for diffuse large B-cell lymphoma. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Simon Parlow
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Matthew Cheung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Louis Verreault-Julien
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kai Yi Wu
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Philip Berardi
- Department of Pathology and Laboratory Medicine, University of Ottawa and Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Vidhya Nair
- Department of Pathology and Laboratory Medicine, University of Ottawa and Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard G. Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Mathew R, Fernando SM, Parlow S, Santo PD, Hibbert B. Inotropes for cardiogenic shock - Six of one, half a dozen of the other. Anaesth Crit Care Pain Med 2021; 41:101004. [PMID: 34906748 DOI: 10.1016/j.accpm.2021.101004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Rebecca Mathew
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Simon Parlow
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Simard T, Jung RG, Di Santo P, Harnett DT, Abdel-Razek O, Ramirez FD, Motazedian P, Parlow S, Labinaz A, Moreland R, Marbach J, Poulin A, Levi A, Majeed K, Boland P, Couture E, Sarathy K, Promislow S, Russo JJ, Chong AY, So D, Froeschl M, Dick A, Labinaz M, Le May M, Holmes DR, Hibbert B. Modifiable Risk Factors and Residual Risk Following Coronary Revascularization: Insights From a Regionalized Dedicated Follow-Up Clinic. Mayo Clin Proc Innov Qual Outcomes 2021; 5:1138-1152. [PMID: 34934904 PMCID: PMC8654638 DOI: 10.1016/j.mayocpiqo.2021.09.001] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To ensure compliance with optimal secondary prevention strategies and document the residual risk of patients following revascularization, we established a postrevascularization clinic for risk-factor optimization at 1 year, with outcomes recorded in a web-based registry. Although coronary revascularization can reduce ischemia, medical treatment of coronary artery disease (CAD) remains the cornerstone of ongoing risk reduction. While standardized referral pathways and protocols for revascularization are prevalent and well studied, post-revascularization care is often less formalized. PATIENTS AND METHODS The University of Ottawa Heart Institute is a tertiary-care center providing coronary revascularization services. From 2015 to 2019, data were prospectively recorded in the CAPITAL revascularization registry, and patient-level procedural, clinical, and outcome data are collected in the year following revascularization. Major adverse cardiovascular event (MACE) was defined as death, myocardial infarction, unplanned revascularization, or cerebrovascular accident. Kaplan-Meier curves were generated to evaluate time-to-event data for clinical outcomes by risk-factor management, and comparisons were performed using log-rank tests and reported by hazard ratio (HR) and 95% confidence intervals (CIs). RESULTS A cohort of 4147 patients completed 1-year follow-up after revascularization procedure that included 3462 undergoing percutaneous coronary intervention (PCI), 589 undergoing coronary artery bypass graft (CABG), and 96 undergoing both PCI and CABG. In the year following revascularization (median follow-up 13.3 months-interquartile range [IQR]: 11.9-16.5) 11% of patients experienced MACE, with female patients being disproportionately at risk. Moreover, 47.7% of patients had ≥2 risk factors (diabetes, dyslipidemia, overweight, active smoker) at the time of follow-up, with 45.0% of patients with diabetes failing to achieve target hemoglobin (Hb) A1c, 54.8% of smokers continuing to smoke, and 27.1% of patients failing to achieve guideline-directed lipid targets. CONCLUSION Patients who have undergone revascularization procedures remain at elevated risk for MACE, and inadequately controlled risk factors are prevalent in follow-up. This highlights the need for aggressive secondary prevention strategies and implementation of programs to optimize postrevascularization care.
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Key Words
- ACS, acute coronary syndrome
- CABG, coronary artery bypass grafting
- CAD, coronary artery disease
- CAPITAL, Cardiovascular And Percutaneous clinical TriALs
- DM, diabetes mellitus
- HR, hazard ratio
- HbA1c, hemoglobin A1C
- MACE, major adverse cardiovascular event
- MI, myocardial infarction
- NSTEMI, non-ST elevation MI
- PCI, percutaneous coronary intervention
- STEMI, ST elevation MI
- UA, unstable angina
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Affiliation(s)
- Trevor Simard
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Richard G. Jung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David T. Harnett
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Omar Abdel-Razek
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - F. Daniel Ramirez
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
- L’Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Pouya Motazedian
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simon Parlow
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Alisha Labinaz
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Robert Moreland
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jeffrey Marbach
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Anthony Poulin
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Amos Levi
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kamran Majeed
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia
- School of Medicine, University of Western Australia, Perth, Western Australia
| | - Paul Boland
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Etienne Couture
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kiran Sarathy
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Steven Promislow
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Juan J. Russo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Aun Yeong Chong
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Derek So
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michael Froeschl
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Alexander Dick
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marino Labinaz
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michel Le May
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David R. Holmes
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Jung RG, Di Santo P, Mathew R, Abdel-Razek O, Parlow S, Simard T, Marbach JA, Gillmore T, Mao B, Bernick J, Theriault-Lauzier P, Fu A, Lau L, Motazedian P, Russo JJ, Labinaz M, Hibbert B. Implications of Myocardial Infarction on Management and Outcome in Cardiogenic Shock. J Am Heart Assoc 2021; 10:e021570. [PMID: 34713704 PMCID: PMC8751815 DOI: 10.1161/jaha.121.021570] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background The randomized DOREMI (Dobutamine Compared to Milrinone) clinical trial evaluated the efficacy and safety of milrinone and dobutamine in patients with cardiogenic shock. Whether the results remain consistent when stratified by acute myocardial infarction remains unknown. In this substudy, we sought to evaluate differences in clinical management and outcomes of acute myocardial infarction complicated by cardiogenic shock (AMICS) versus non-AMICS. Methods and Results Patients in cardiogenic shock (n=192) were randomized 1:1 to dobutamine or milrinone. The primary composite end point in this subgroup analysis was all-cause in-hospital mortality, cardiac arrest, non-fatal myocardial infarction, cerebrovascular accident, the need for mechanical circulatory support, or initiation of renal replacement therapy (RRT) at 30-days. Outcomes were evaluated in patients with (n=65) and without (n=127) AMICS. The primary composite end point was significantly higher in AMICS versus non-AMICS (hazard ratio [HR], 2.21; 95% CI, 1.47-3.30; P=0.0001). The primary end point was driven by increased rates of all-cause mortality, mechanical circulatory support, and RRT. No differences in other secondary outcomes including cardiac arrest or cerebrovascular accident were observed. AMICS remained associated with the primary composite outcome, 30-day mortality, and RRT after adjustment for age, sex, procedural contrast use, multivessel disease, and inotrope type. Conclusions AMI was associated with increased rates of adverse clinical outcomes in cardiogenic shock along with increased rates of mortality and initiation of mechanical circulatory support and RRT. Contrast administration during revascularization likely contributes to increased rates of RRT. Heterogeneity of outcomes in AMICS versus non-AMICS highlights the need to study interventions in specific subgroups of cardiogenic shock. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03207165.
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Affiliation(s)
- Richard G Jung
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Faculty of Medicine University of Ottawa Ontario Canada.,Department of Cellular and Molecular Medicine University of Ottawa Ontario Canada
| | - Pietro Di Santo
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,School of Epidemiology and Public Health University of Ottawa Ontario Canada.,Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Rebecca Mathew
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Division of Critical Care Department of Medicine University of Ottawa Ontario Canada
| | - Omar Abdel-Razek
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Simon Parlow
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Trevor Simard
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Department of Cellular and Molecular Medicine University of Ottawa Ontario Canada.,Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Jeffrey A Marbach
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Division of Critical Care Tufts Medical Center Boston MA
| | | | - Brennan Mao
- Faculty of Medicine University of Ottawa Ontario Canada
| | - Jordan Bernick
- Cardiovascular Research Methods Centre University of Ottawa Heart Institute Ottawa Canada
| | - Pascal Theriault-Lauzier
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Angel Fu
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Lawrence Lau
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
| | | | - Juan J Russo
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Marino Labinaz
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Benjamin Hibbert
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Department of Cellular and Molecular Medicine University of Ottawa Ontario Canada.,School of Epidemiology and Public Health University of Ottawa Ontario Canada.,Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
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Jung RG, Stotts C, Makwana D, Motazedian P, Di Santo P, Goh CY, Verreault-Julien L, Simard T, Ramirez FD, Hibbert B. Methodological Rigor in Preclinical Cardiovascular Research: Contemporary Performance of AHA Scientific Publications. Circ Res 2021; 129:887-889. [PMID: 34521221 DOI: 10.1161/circresaha.121.319921] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Richard G Jung
- CAPITAL Research Group (R.G.J., C.S., D.M., P.M., P.D.S., C.-Y.G., L.V.-J., T.S., F.D.R., B.H.), University of Ottawa Heart Institute, Ontario, Canada.,Vascular Biology and Experimental Medicine Laboratory (R.G.J., P.M., P.D.S., T.S., B.H.), University of Ottawa Heart Institute, Ontario, Canada.,Cellular and Molecular Medicine, Faculty of Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ontario, Canada
| | - Cameron Stotts
- CAPITAL Research Group (R.G.J., C.S., D.M., P.M., P.D.S., C.-Y.G., L.V.-J., T.S., F.D.R., B.H.), University of Ottawa Heart Institute, Ontario, Canada.,Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine (C.S.), University of Ottawa, Ontario, Canada
| | - Dwipen Makwana
- CAPITAL Research Group (R.G.J., C.S., D.M., P.M., P.D.S., C.-Y.G., L.V.-J., T.S., F.D.R., B.H.), University of Ottawa Heart Institute, Ontario, Canada
| | - Pouya Motazedian
- CAPITAL Research Group (R.G.J., C.S., D.M., P.M., P.D.S., C.-Y.G., L.V.-J., T.S., F.D.R., B.H.), University of Ottawa Heart Institute, Ontario, Canada.,Vascular Biology and Experimental Medicine Laboratory (R.G.J., P.M., P.D.S., T.S., B.H.), University of Ottawa Heart Institute, Ontario, Canada.,Division of Cardiology (P.M., P.D.S., C.-Y.G., L.V.-J., F.D.R., B.H.), University of Ottawa Heart Institute, Ontario, Canada.,Cumming School of Medicine, University of Calgary, Alberta, Canada (P.M.)
| | - Pietro Di Santo
- CAPITAL Research Group (R.G.J., C.S., D.M., P.M., P.D.S., C.-Y.G., L.V.-J., T.S., F.D.R., B.H.), University of Ottawa Heart Institute, Ontario, Canada.,Vascular Biology and Experimental Medicine Laboratory (R.G.J., P.M., P.D.S., T.S., B.H.), University of Ottawa Heart Institute, Ontario, Canada.,Division of Cardiology (P.M., P.D.S., C.-Y.G., L.V.-J., F.D.R., B.H.), University of Ottawa Heart Institute, Ontario, Canada.,School of Epidemiology (P.D.S.), University of Ottawa, Ontario, Canada
| | - Cheng-Yee Goh
- CAPITAL Research Group (R.G.J., C.S., D.M., P.M., P.D.S., C.-Y.G., L.V.-J., T.S., F.D.R., B.H.), University of Ottawa Heart Institute, Ontario, Canada.,Division of Cardiology (P.M., P.D.S., C.-Y.G., L.V.-J., F.D.R., B.H.), University of Ottawa Heart Institute, Ontario, Canada
| | - Louis Verreault-Julien
- CAPITAL Research Group (R.G.J., C.S., D.M., P.M., P.D.S., C.-Y.G., L.V.-J., T.S., F.D.R., B.H.), University of Ottawa Heart Institute, Ontario, Canada.,Division of Cardiology (P.M., P.D.S., C.-Y.G., L.V.-J., F.D.R., B.H.), University of Ottawa Heart Institute, Ontario, Canada
| | - Trevor Simard
- CAPITAL Research Group (R.G.J., C.S., D.M., P.M., P.D.S., C.-Y.G., L.V.-J., T.S., F.D.R., B.H.), University of Ottawa Heart Institute, Ontario, Canada.,Vascular Biology and Experimental Medicine Laboratory (R.G.J., P.M., P.D.S., T.S., B.H.), University of Ottawa Heart Institute, Ontario, Canada.,Division of Cardiology (P.M., P.D.S., C.-Y.G., L.V.-J., F.D.R., B.H.), University of Ottawa Heart Institute, Ontario, Canada.,Cellular and Molecular Medicine, Faculty of Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ontario, Canada.,Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, MN (T.S.)
| | - F Daniel Ramirez
- CAPITAL Research Group (R.G.J., C.S., D.M., P.M., P.D.S., C.-Y.G., L.V.-J., T.S., F.D.R., B.H.), University of Ottawa Heart Institute, Ontario, Canada.,Division of Cardiology (P.M., P.D.S., C.-Y.G., L.V.-J., F.D.R., B.H.), University of Ottawa Heart Institute, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group (R.G.J., C.S., D.M., P.M., P.D.S., C.-Y.G., L.V.-J., T.S., F.D.R., B.H.), University of Ottawa Heart Institute, Ontario, Canada.,Vascular Biology and Experimental Medicine Laboratory (R.G.J., P.M., P.D.S., T.S., B.H.), University of Ottawa Heart Institute, Ontario, Canada.,Division of Cardiology (P.M., P.D.S., C.-Y.G., L.V.-J., F.D.R., B.H.), University of Ottawa Heart Institute, Ontario, Canada.,Cellular and Molecular Medicine, Faculty of Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ontario, Canada
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36
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Parlow S, Di Santo P, Mathew R, Jung RG, Simard T, Gillmore T, Mao B, Abdel-Razek O, Ramirez FD, Marbach JA, Dick A, Glover C, Russo JJ, Froeschl M, Labinaz M, Fernando SM, Hibbert B. The association between mean arterial pressure and outcomes in patients with cardiogenic shock: insights from the DOREMI trial. Eur Heart J Acute Cardiovasc Care 2021; 10:712-720. [PMID: 34382063 DOI: 10.1093/ehjacc/zuab052] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/18/2021] [Accepted: 06/26/2021] [Indexed: 11/14/2022]
Abstract
AIMS Cardiogenic shock (CS) is a state of low cardiac output resulting in end-organ hypoperfusion. Despite high in-hospital mortality rates, little evidence exists regarding the optimal mean arterial pressure (MAP) target in CS. We therefore evaluated the relationship between achieved MAP and clinical outcomes in patients with CS. METHODS AND RESULTS We performed a post hoc analysis of the CAPITAL DOREMI trial: a randomized, double-blind trial comparing dobutamine to milrinone in patients with CS. We divided patients into a high MAP group (average MAP ≥ 70 mmHg over the 36 h following randomization), and a low MAP group (average MAP < 70 mmHg). Our primary outcome included in-hospital all-cause mortality, resuscitated cardiac arrest, need for cardiac transplantation or mechanical circulatory support, non-fatal myocardial infarction, transient ischaemic attack or stroke, or initiation of renal replacement therapy. In total, 71 (37.0%) patients achieved an average MAP < 70 mmHg, and 121 (63.0%) achieved an average MAP ≥ 70 mmHg. The primary outcome occurred in 48 (67.6%) patients in the low MAP group and 51 (42.2%) patients in the high MAP group [adjusted relative risk (aRR) 0.70; 95% confidence interval (CI) 0.53-0.92; P = 0.01]. All-cause mortality occurred in 41 (57.8%) and 35 (28.9%) patients in the low and high MAP groups, respectively (aRR 0.56; 95% CI 0.40-0.79; P < 0.01). There were no significant differences in any secondary outcomes between each group. CONCLUSIONS In patients with CS treated with inotrope therapy, low MAP is associated with worse clinical outcomes. Randomized data evaluating optimal MAP targets in CS is needed to guide medical therapy.
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Affiliation(s)
- Simon Parlow
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, Ontario, K1G 5Z3, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada
| | - Richard G Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, Ontario, K1H 8M5, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Room #3206, Ottawa, Ontario, K1H 8M5, Canada
| | - Trevor Simard
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Room #3206, Ottawa, Ontario, K1H 8M5, Canada.,Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, 200 First St. SW, Rochester, Minnesota, 55905, USA
| | - Taylor Gillmore
- Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, Ontario, K1H 8M5, Canada
| | - Brennan Mao
- Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, Ontario, K1H 8M5, Canada
| | - Omar Abdel-Razek
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada
| | - F Daniel Ramirez
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada
| | - Jeffrey A Marbach
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts Medical Center, 800 Washington Street, Boston, Massachusetts, 02111, USA
| | - Alexander Dick
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada
| | - Christopher Glover
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada
| | - Juan J Russo
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada
| | - Michael Froeschl
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada
| | - Marino Labinaz
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada
| | - Shannon M Fernando
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Critical Care, Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, Ontario K1Y 4W7, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Room #3206, Ottawa, Ontario, K1H 8M5, Canada
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Di Santo P, Mathew R, Jung RG, Simard T, Skanes S, Mao B, Ramirez FD, Marbach JA, Abdel-Razek O, Motazedian P, Parlow S, Boczar KE, D'Egidio G, Hawken S, Bernick J, Wells GA, Dick A, So DY, Glover C, Russo JJ, McGuinty C, Hibbert B. Impact of baseline beta-blocker use on inotrope response and clinical outcomes in cardiogenic shock: a subgroup analysis of the DOREMI trial. Crit Care 2021; 25:289. [PMID: 34376218 PMCID: PMC8356445 DOI: 10.1186/s13054-021-03706-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/19/2021] [Indexed: 12/29/2022]
Abstract
Background Cardiogenic shock (CS) is associated with significant morbidity and mortality. The impact of beta-blocker (BB) use on patients who develop CS remains unknown. We sought to evaluate the clinical outcomes and hemodynamic response profiles in patients treated with BB in the 24 h prior to the development of CS. Methods Patients with CS enrolled in the DObutamine compaREd to MIlrinone trial were analyzed. The primary outcome was a composite of all-cause mortality, resuscitated cardiac arrest, need for cardiac transplant or mechanical circulatory support, non-fatal myocardial infarction, transient ischemic attack or stroke, or initiation of renal replacement therapy. Secondary outcomes included the individual components of the primary composite and hemodynamic response profiles derived from pulmonary artery catheters. Results Among 192 participants, 93 patients (48%) had received BB therapy. The primary outcome occurred in 47 patients (51%) in the BB group and in 52 (53%) in the no BB group (RR 0.96; 95% CI 0.73–1.27; P = 0.78) throughout the in-hospital period. There were fewer early deaths in the BB group (RR 0.41; 95% CI 0.18–0.95; P = 0.03). There were no differences in other individual components of the primary outcome or in hemodynamic response between the two groups throughout the remainder of the hospitalization. Conclusions BB therapy in the 24 h preceding the development of CS did not negatively influence clinical outcomes or hemodynamic parameters. On the contrary, BB use was associated with fewer deaths in the early resuscitation period, suggesting a paradoxically protective effect in patients with CS. Trial registration ClinicalTrials.gov Identifier: NCT03207165
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Affiliation(s)
- Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Richard G Jung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Trevor Simard
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Brennan Mao
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - F Daniel Ramirez
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France.,LIRYC (L'Institut de Rythmologie Et Modélisation Cardiaque), Bordeaux-Pessac, France
| | - Jeffrey A Marbach
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Division of Critical Care, Tufts Medical Center, Boston, MA, USA
| | - Omar Abdel-Razek
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Pouya Motazedian
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Department of Medicine, Cumming School of Medicine, Calgary, AB, Canada
| | - Simon Parlow
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kevin E Boczar
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Gianni D'Egidio
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Steven Hawken
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jordan Bernick
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - George A Wells
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Alexander Dick
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Derek Y So
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Christopher Glover
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Juan J Russo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Caroline McGuinty
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada. .,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. .,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada.
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38
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Mathew R, Di Santo P, Jung RG, Marbach JA, Hutson J, Simard T, Ramirez FD, Harnett DT, Merdad A, Almufleh A, Weng W, Abdel-Razek O, Fernando SM, Kyeremanteng K, Bernick J, Wells GA, Chan V, Froeschl M, Labinaz M, Le May MR, Russo JJ, Hibbert B. Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock. N Engl J Med 2021; 385:516-525. [PMID: 34347952 DOI: 10.1056/nejmoa2026845] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [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] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cardiogenic shock is associated with substantial morbidity and mortality. Although inotropic support is a mainstay of medical therapy for cardiogenic shock, little evidence exists to guide the selection of inotropic agents in clinical practice. METHODS We randomly assigned patients with cardiogenic shock to receive milrinone or dobutamine in a double-blind fashion. The primary outcome was a composite of in-hospital death from any cause, resuscitated cardiac arrest, receipt of a cardiac transplant or mechanical circulatory support, nonfatal myocardial infarction, transient ischemic attack or stroke diagnosed by a neurologist, or initiation of renal replacement therapy. Secondary outcomes included the individual components of the primary composite outcome. RESULTS A total of 192 participants (96 in each group) were enrolled. The treatment groups did not differ significantly with respect to the primary outcome; a primary outcome event occurred in 47 participants (49%) in the milrinone group and in 52 participants (54%) in the dobutamine group (relative risk, 0.90; 95% confidence interval [CI], 0.69 to 1.19; P = 0.47). There were also no significant differences between the groups with respect to secondary outcomes, including in-hospital death (37% and 43% of the participants, respectively; relative risk, 0.85; 95% CI, 0.60 to 1.21), resuscitated cardiac arrest (7% and 9%; hazard ratio, 0.78; 95% CI, 0.29 to 2.07), receipt of mechanical circulatory support (12% and 15%; hazard ratio, 0.78; 95% CI, 0.36 to 1.71), or initiation of renal replacement therapy (22% and 17%; hazard ratio, 1.39; 95% CI, 0.73 to 2.67). CONCLUSIONS In patients with cardiogenic shock, no significant difference between milrinone and dobutamine was found with respect to the primary composite outcome or important secondary outcomes. (Funded by the Innovation Fund of the Alternative Funding Plan for the Academic Health Sciences Centres of Ontario; ClinicalTrials.gov number, NCT03207165.).
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Affiliation(s)
- Rebecca Mathew
- From the CAPITAL Research Group, Division of Cardiology (R.M., P.D.S., R.G.J., J.A.M., T.S., F.D.R., D.T.H., O.A.-R., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Cardiovascular Research Methods Centre (J.B., G.A.W.), and the Division of Cardiac Surgery (V.C.), University of Ottawa Heart Institute, and the Faculty of Medicine (R.M., P.D.S., R.G.J., J.H., D.T.H., W.W., O.A.-R., S.M.F., K.K., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Division of Critical Care, Department of Medicine (R.M., J.H., S.M.F., K.K.), the School of Epidemiology and Public Health (P.D.S.), and the Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ottawa, the Division of Cardiology, University of Toronto, Toronto (A.M.), and the Division of Cardiology, University of British Columbia, Vancouver (A.A.) - all in Canada; the Division of Critical Care, Tufts Medical Center, Boston (J.A.M.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.S.); and Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire Bordeaux (F.D.R.), and LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque) (F.D.R.) - both in Bordeaux-Pessac, France
| | - Pietro Di Santo
- From the CAPITAL Research Group, Division of Cardiology (R.M., P.D.S., R.G.J., J.A.M., T.S., F.D.R., D.T.H., O.A.-R., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Cardiovascular Research Methods Centre (J.B., G.A.W.), and the Division of Cardiac Surgery (V.C.), University of Ottawa Heart Institute, and the Faculty of Medicine (R.M., P.D.S., R.G.J., J.H., D.T.H., W.W., O.A.-R., S.M.F., K.K., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Division of Critical Care, Department of Medicine (R.M., J.H., S.M.F., K.K.), the School of Epidemiology and Public Health (P.D.S.), and the Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ottawa, the Division of Cardiology, University of Toronto, Toronto (A.M.), and the Division of Cardiology, University of British Columbia, Vancouver (A.A.) - all in Canada; the Division of Critical Care, Tufts Medical Center, Boston (J.A.M.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.S.); and Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire Bordeaux (F.D.R.), and LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque) (F.D.R.) - both in Bordeaux-Pessac, France
| | - Richard G Jung
- From the CAPITAL Research Group, Division of Cardiology (R.M., P.D.S., R.G.J., J.A.M., T.S., F.D.R., D.T.H., O.A.-R., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Cardiovascular Research Methods Centre (J.B., G.A.W.), and the Division of Cardiac Surgery (V.C.), University of Ottawa Heart Institute, and the Faculty of Medicine (R.M., P.D.S., R.G.J., J.H., D.T.H., W.W., O.A.-R., S.M.F., K.K., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Division of Critical Care, Department of Medicine (R.M., J.H., S.M.F., K.K.), the School of Epidemiology and Public Health (P.D.S.), and the Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ottawa, the Division of Cardiology, University of Toronto, Toronto (A.M.), and the Division of Cardiology, University of British Columbia, Vancouver (A.A.) - all in Canada; the Division of Critical Care, Tufts Medical Center, Boston (J.A.M.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.S.); and Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire Bordeaux (F.D.R.), and LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque) (F.D.R.) - both in Bordeaux-Pessac, France
| | - Jeffrey A Marbach
- From the CAPITAL Research Group, Division of Cardiology (R.M., P.D.S., R.G.J., J.A.M., T.S., F.D.R., D.T.H., O.A.-R., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Cardiovascular Research Methods Centre (J.B., G.A.W.), and the Division of Cardiac Surgery (V.C.), University of Ottawa Heart Institute, and the Faculty of Medicine (R.M., P.D.S., R.G.J., J.H., D.T.H., W.W., O.A.-R., S.M.F., K.K., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Division of Critical Care, Department of Medicine (R.M., J.H., S.M.F., K.K.), the School of Epidemiology and Public Health (P.D.S.), and the Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ottawa, the Division of Cardiology, University of Toronto, Toronto (A.M.), and the Division of Cardiology, University of British Columbia, Vancouver (A.A.) - all in Canada; the Division of Critical Care, Tufts Medical Center, Boston (J.A.M.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.S.); and Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire Bordeaux (F.D.R.), and LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque) (F.D.R.) - both in Bordeaux-Pessac, France
| | - Jordan Hutson
- From the CAPITAL Research Group, Division of Cardiology (R.M., P.D.S., R.G.J., J.A.M., T.S., F.D.R., D.T.H., O.A.-R., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Cardiovascular Research Methods Centre (J.B., G.A.W.), and the Division of Cardiac Surgery (V.C.), University of Ottawa Heart Institute, and the Faculty of Medicine (R.M., P.D.S., R.G.J., J.H., D.T.H., W.W., O.A.-R., S.M.F., K.K., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Division of Critical Care, Department of Medicine (R.M., J.H., S.M.F., K.K.), the School of Epidemiology and Public Health (P.D.S.), and the Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ottawa, the Division of Cardiology, University of Toronto, Toronto (A.M.), and the Division of Cardiology, University of British Columbia, Vancouver (A.A.) - all in Canada; the Division of Critical Care, Tufts Medical Center, Boston (J.A.M.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.S.); and Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire Bordeaux (F.D.R.), and LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque) (F.D.R.) - both in Bordeaux-Pessac, France
| | - Trevor Simard
- From the CAPITAL Research Group, Division of Cardiology (R.M., P.D.S., R.G.J., J.A.M., T.S., F.D.R., D.T.H., O.A.-R., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Cardiovascular Research Methods Centre (J.B., G.A.W.), and the Division of Cardiac Surgery (V.C.), University of Ottawa Heart Institute, and the Faculty of Medicine (R.M., P.D.S., R.G.J., J.H., D.T.H., W.W., O.A.-R., S.M.F., K.K., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Division of Critical Care, Department of Medicine (R.M., J.H., S.M.F., K.K.), the School of Epidemiology and Public Health (P.D.S.), and the Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ottawa, the Division of Cardiology, University of Toronto, Toronto (A.M.), and the Division of Cardiology, University of British Columbia, Vancouver (A.A.) - all in Canada; the Division of Critical Care, Tufts Medical Center, Boston (J.A.M.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.S.); and Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire Bordeaux (F.D.R.), and LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque) (F.D.R.) - both in Bordeaux-Pessac, France
| | - F Daniel Ramirez
- From the CAPITAL Research Group, Division of Cardiology (R.M., P.D.S., R.G.J., J.A.M., T.S., F.D.R., D.T.H., O.A.-R., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Cardiovascular Research Methods Centre (J.B., G.A.W.), and the Division of Cardiac Surgery (V.C.), University of Ottawa Heart Institute, and the Faculty of Medicine (R.M., P.D.S., R.G.J., J.H., D.T.H., W.W., O.A.-R., S.M.F., K.K., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Division of Critical Care, Department of Medicine (R.M., J.H., S.M.F., K.K.), the School of Epidemiology and Public Health (P.D.S.), and the Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ottawa, the Division of Cardiology, University of Toronto, Toronto (A.M.), and the Division of Cardiology, University of British Columbia, Vancouver (A.A.) - all in Canada; the Division of Critical Care, Tufts Medical Center, Boston (J.A.M.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.S.); and Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire Bordeaux (F.D.R.), and LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque) (F.D.R.) - both in Bordeaux-Pessac, France
| | - David T Harnett
- From the CAPITAL Research Group, Division of Cardiology (R.M., P.D.S., R.G.J., J.A.M., T.S., F.D.R., D.T.H., O.A.-R., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Cardiovascular Research Methods Centre (J.B., G.A.W.), and the Division of Cardiac Surgery (V.C.), University of Ottawa Heart Institute, and the Faculty of Medicine (R.M., P.D.S., R.G.J., J.H., D.T.H., W.W., O.A.-R., S.M.F., K.K., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Division of Critical Care, Department of Medicine (R.M., J.H., S.M.F., K.K.), the School of Epidemiology and Public Health (P.D.S.), and the Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ottawa, the Division of Cardiology, University of Toronto, Toronto (A.M.), and the Division of Cardiology, University of British Columbia, Vancouver (A.A.) - all in Canada; the Division of Critical Care, Tufts Medical Center, Boston (J.A.M.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.S.); and Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire Bordeaux (F.D.R.), and LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque) (F.D.R.) - both in Bordeaux-Pessac, France
| | - Anas Merdad
- From the CAPITAL Research Group, Division of Cardiology (R.M., P.D.S., R.G.J., J.A.M., T.S., F.D.R., D.T.H., O.A.-R., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Cardiovascular Research Methods Centre (J.B., G.A.W.), and the Division of Cardiac Surgery (V.C.), University of Ottawa Heart Institute, and the Faculty of Medicine (R.M., P.D.S., R.G.J., J.H., D.T.H., W.W., O.A.-R., S.M.F., K.K., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Division of Critical Care, Department of Medicine (R.M., J.H., S.M.F., K.K.), the School of Epidemiology and Public Health (P.D.S.), and the Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ottawa, the Division of Cardiology, University of Toronto, Toronto (A.M.), and the Division of Cardiology, University of British Columbia, Vancouver (A.A.) - all in Canada; the Division of Critical Care, Tufts Medical Center, Boston (J.A.M.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.S.); and Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire Bordeaux (F.D.R.), and LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque) (F.D.R.) - both in Bordeaux-Pessac, France
| | - Aws Almufleh
- From the CAPITAL Research Group, Division of Cardiology (R.M., P.D.S., R.G.J., J.A.M., T.S., F.D.R., D.T.H., O.A.-R., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Cardiovascular Research Methods Centre (J.B., G.A.W.), and the Division of Cardiac Surgery (V.C.), University of Ottawa Heart Institute, and the Faculty of Medicine (R.M., P.D.S., R.G.J., J.H., D.T.H., W.W., O.A.-R., S.M.F., K.K., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Division of Critical Care, Department of Medicine (R.M., J.H., S.M.F., K.K.), the School of Epidemiology and Public Health (P.D.S.), and the Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ottawa, the Division of Cardiology, University of Toronto, Toronto (A.M.), and the Division of Cardiology, University of British Columbia, Vancouver (A.A.) - all in Canada; the Division of Critical Care, Tufts Medical Center, Boston (J.A.M.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.S.); and Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire Bordeaux (F.D.R.), and LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque) (F.D.R.) - both in Bordeaux-Pessac, France
| | - Willy Weng
- From the CAPITAL Research Group, Division of Cardiology (R.M., P.D.S., R.G.J., J.A.M., T.S., F.D.R., D.T.H., O.A.-R., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Cardiovascular Research Methods Centre (J.B., G.A.W.), and the Division of Cardiac Surgery (V.C.), University of Ottawa Heart Institute, and the Faculty of Medicine (R.M., P.D.S., R.G.J., J.H., D.T.H., W.W., O.A.-R., S.M.F., K.K., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Division of Critical Care, Department of Medicine (R.M., J.H., S.M.F., K.K.), the School of Epidemiology and Public Health (P.D.S.), and the Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ottawa, the Division of Cardiology, University of Toronto, Toronto (A.M.), and the Division of Cardiology, University of British Columbia, Vancouver (A.A.) - all in Canada; the Division of Critical Care, Tufts Medical Center, Boston (J.A.M.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.S.); and Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire Bordeaux (F.D.R.), and LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque) (F.D.R.) - both in Bordeaux-Pessac, France
| | - Omar Abdel-Razek
- From the CAPITAL Research Group, Division of Cardiology (R.M., P.D.S., R.G.J., J.A.M., T.S., F.D.R., D.T.H., O.A.-R., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Cardiovascular Research Methods Centre (J.B., G.A.W.), and the Division of Cardiac Surgery (V.C.), University of Ottawa Heart Institute, and the Faculty of Medicine (R.M., P.D.S., R.G.J., J.H., D.T.H., W.W., O.A.-R., S.M.F., K.K., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Division of Critical Care, Department of Medicine (R.M., J.H., S.M.F., K.K.), the School of Epidemiology and Public Health (P.D.S.), and the Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ottawa, the Division of Cardiology, University of Toronto, Toronto (A.M.), and the Division of Cardiology, University of British Columbia, Vancouver (A.A.) - all in Canada; the Division of Critical Care, Tufts Medical Center, Boston (J.A.M.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.S.); and Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire Bordeaux (F.D.R.), and LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque) (F.D.R.) - both in Bordeaux-Pessac, France
| | - Shannon M Fernando
- From the CAPITAL Research Group, Division of Cardiology (R.M., P.D.S., R.G.J., J.A.M., T.S., F.D.R., D.T.H., O.A.-R., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Cardiovascular Research Methods Centre (J.B., G.A.W.), and the Division of Cardiac Surgery (V.C.), University of Ottawa Heart Institute, and the Faculty of Medicine (R.M., P.D.S., R.G.J., J.H., D.T.H., W.W., O.A.-R., S.M.F., K.K., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Division of Critical Care, Department of Medicine (R.M., J.H., S.M.F., K.K.), the School of Epidemiology and Public Health (P.D.S.), and the Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ottawa, the Division of Cardiology, University of Toronto, Toronto (A.M.), and the Division of Cardiology, University of British Columbia, Vancouver (A.A.) - all in Canada; the Division of Critical Care, Tufts Medical Center, Boston (J.A.M.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.S.); and Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire Bordeaux (F.D.R.), and LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque) (F.D.R.) - both in Bordeaux-Pessac, France
| | - Kwadwo Kyeremanteng
- From the CAPITAL Research Group, Division of Cardiology (R.M., P.D.S., R.G.J., J.A.M., T.S., F.D.R., D.T.H., O.A.-R., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Cardiovascular Research Methods Centre (J.B., G.A.W.), and the Division of Cardiac Surgery (V.C.), University of Ottawa Heart Institute, and the Faculty of Medicine (R.M., P.D.S., R.G.J., J.H., D.T.H., W.W., O.A.-R., S.M.F., K.K., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Division of Critical Care, Department of Medicine (R.M., J.H., S.M.F., K.K.), the School of Epidemiology and Public Health (P.D.S.), and the Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ottawa, the Division of Cardiology, University of Toronto, Toronto (A.M.), and the Division of Cardiology, University of British Columbia, Vancouver (A.A.) - all in Canada; the Division of Critical Care, Tufts Medical Center, Boston (J.A.M.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.S.); and Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire Bordeaux (F.D.R.), and LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque) (F.D.R.) - both in Bordeaux-Pessac, France
| | - Jordan Bernick
- From the CAPITAL Research Group, Division of Cardiology (R.M., P.D.S., R.G.J., J.A.M., T.S., F.D.R., D.T.H., O.A.-R., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Cardiovascular Research Methods Centre (J.B., G.A.W.), and the Division of Cardiac Surgery (V.C.), University of Ottawa Heart Institute, and the Faculty of Medicine (R.M., P.D.S., R.G.J., J.H., D.T.H., W.W., O.A.-R., S.M.F., K.K., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Division of Critical Care, Department of Medicine (R.M., J.H., S.M.F., K.K.), the School of Epidemiology and Public Health (P.D.S.), and the Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ottawa, the Division of Cardiology, University of Toronto, Toronto (A.M.), and the Division of Cardiology, University of British Columbia, Vancouver (A.A.) - all in Canada; the Division of Critical Care, Tufts Medical Center, Boston (J.A.M.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.S.); and Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire Bordeaux (F.D.R.), and LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque) (F.D.R.) - both in Bordeaux-Pessac, France
| | - George A Wells
- From the CAPITAL Research Group, Division of Cardiology (R.M., P.D.S., R.G.J., J.A.M., T.S., F.D.R., D.T.H., O.A.-R., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Cardiovascular Research Methods Centre (J.B., G.A.W.), and the Division of Cardiac Surgery (V.C.), University of Ottawa Heart Institute, and the Faculty of Medicine (R.M., P.D.S., R.G.J., J.H., D.T.H., W.W., O.A.-R., S.M.F., K.K., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Division of Critical Care, Department of Medicine (R.M., J.H., S.M.F., K.K.), the School of Epidemiology and Public Health (P.D.S.), and the Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ottawa, the Division of Cardiology, University of Toronto, Toronto (A.M.), and the Division of Cardiology, University of British Columbia, Vancouver (A.A.) - all in Canada; the Division of Critical Care, Tufts Medical Center, Boston (J.A.M.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.S.); and Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire Bordeaux (F.D.R.), and LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque) (F.D.R.) - both in Bordeaux-Pessac, France
| | - Vincent Chan
- From the CAPITAL Research Group, Division of Cardiology (R.M., P.D.S., R.G.J., J.A.M., T.S., F.D.R., D.T.H., O.A.-R., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Cardiovascular Research Methods Centre (J.B., G.A.W.), and the Division of Cardiac Surgery (V.C.), University of Ottawa Heart Institute, and the Faculty of Medicine (R.M., P.D.S., R.G.J., J.H., D.T.H., W.W., O.A.-R., S.M.F., K.K., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Division of Critical Care, Department of Medicine (R.M., J.H., S.M.F., K.K.), the School of Epidemiology and Public Health (P.D.S.), and the Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ottawa, the Division of Cardiology, University of Toronto, Toronto (A.M.), and the Division of Cardiology, University of British Columbia, Vancouver (A.A.) - all in Canada; the Division of Critical Care, Tufts Medical Center, Boston (J.A.M.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.S.); and Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire Bordeaux (F.D.R.), and LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque) (F.D.R.) - both in Bordeaux-Pessac, France
| | - Michael Froeschl
- From the CAPITAL Research Group, Division of Cardiology (R.M., P.D.S., R.G.J., J.A.M., T.S., F.D.R., D.T.H., O.A.-R., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Cardiovascular Research Methods Centre (J.B., G.A.W.), and the Division of Cardiac Surgery (V.C.), University of Ottawa Heart Institute, and the Faculty of Medicine (R.M., P.D.S., R.G.J., J.H., D.T.H., W.W., O.A.-R., S.M.F., K.K., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Division of Critical Care, Department of Medicine (R.M., J.H., S.M.F., K.K.), the School of Epidemiology and Public Health (P.D.S.), and the Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ottawa, the Division of Cardiology, University of Toronto, Toronto (A.M.), and the Division of Cardiology, University of British Columbia, Vancouver (A.A.) - all in Canada; the Division of Critical Care, Tufts Medical Center, Boston (J.A.M.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.S.); and Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire Bordeaux (F.D.R.), and LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque) (F.D.R.) - both in Bordeaux-Pessac, France
| | - Marino Labinaz
- From the CAPITAL Research Group, Division of Cardiology (R.M., P.D.S., R.G.J., J.A.M., T.S., F.D.R., D.T.H., O.A.-R., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Cardiovascular Research Methods Centre (J.B., G.A.W.), and the Division of Cardiac Surgery (V.C.), University of Ottawa Heart Institute, and the Faculty of Medicine (R.M., P.D.S., R.G.J., J.H., D.T.H., W.W., O.A.-R., S.M.F., K.K., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Division of Critical Care, Department of Medicine (R.M., J.H., S.M.F., K.K.), the School of Epidemiology and Public Health (P.D.S.), and the Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ottawa, the Division of Cardiology, University of Toronto, Toronto (A.M.), and the Division of Cardiology, University of British Columbia, Vancouver (A.A.) - all in Canada; the Division of Critical Care, Tufts Medical Center, Boston (J.A.M.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.S.); and Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire Bordeaux (F.D.R.), and LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque) (F.D.R.) - both in Bordeaux-Pessac, France
| | - Michel R Le May
- From the CAPITAL Research Group, Division of Cardiology (R.M., P.D.S., R.G.J., J.A.M., T.S., F.D.R., D.T.H., O.A.-R., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Cardiovascular Research Methods Centre (J.B., G.A.W.), and the Division of Cardiac Surgery (V.C.), University of Ottawa Heart Institute, and the Faculty of Medicine (R.M., P.D.S., R.G.J., J.H., D.T.H., W.W., O.A.-R., S.M.F., K.K., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Division of Critical Care, Department of Medicine (R.M., J.H., S.M.F., K.K.), the School of Epidemiology and Public Health (P.D.S.), and the Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ottawa, the Division of Cardiology, University of Toronto, Toronto (A.M.), and the Division of Cardiology, University of British Columbia, Vancouver (A.A.) - all in Canada; the Division of Critical Care, Tufts Medical Center, Boston (J.A.M.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.S.); and Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire Bordeaux (F.D.R.), and LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque) (F.D.R.) - both in Bordeaux-Pessac, France
| | - Juan J Russo
- From the CAPITAL Research Group, Division of Cardiology (R.M., P.D.S., R.G.J., J.A.M., T.S., F.D.R., D.T.H., O.A.-R., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Cardiovascular Research Methods Centre (J.B., G.A.W.), and the Division of Cardiac Surgery (V.C.), University of Ottawa Heart Institute, and the Faculty of Medicine (R.M., P.D.S., R.G.J., J.H., D.T.H., W.W., O.A.-R., S.M.F., K.K., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Division of Critical Care, Department of Medicine (R.M., J.H., S.M.F., K.K.), the School of Epidemiology and Public Health (P.D.S.), and the Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ottawa, the Division of Cardiology, University of Toronto, Toronto (A.M.), and the Division of Cardiology, University of British Columbia, Vancouver (A.A.) - all in Canada; the Division of Critical Care, Tufts Medical Center, Boston (J.A.M.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.S.); and Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire Bordeaux (F.D.R.), and LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque) (F.D.R.) - both in Bordeaux-Pessac, France
| | - Benjamin Hibbert
- From the CAPITAL Research Group, Division of Cardiology (R.M., P.D.S., R.G.J., J.A.M., T.S., F.D.R., D.T.H., O.A.-R., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Cardiovascular Research Methods Centre (J.B., G.A.W.), and the Division of Cardiac Surgery (V.C.), University of Ottawa Heart Institute, and the Faculty of Medicine (R.M., P.D.S., R.G.J., J.H., D.T.H., W.W., O.A.-R., S.M.F., K.K., M.F., M.L., M.R.L.M., J.J.R., B.H.), the Division of Critical Care, Department of Medicine (R.M., J.H., S.M.F., K.K.), the School of Epidemiology and Public Health (P.D.S.), and the Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, Ottawa, the Division of Cardiology, University of Toronto, Toronto (A.M.), and the Division of Cardiology, University of British Columbia, Vancouver (A.A.) - all in Canada; the Division of Critical Care, Tufts Medical Center, Boston (J.A.M.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.S.); and Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire Bordeaux (F.D.R.), and LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque) (F.D.R.) - both in Bordeaux-Pessac, France
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Simard T, Motazedian P, Dhaliwal S, Di Santo P, Jung RG, Ramirez FD, Labinaz A, Short S, Parlow S, Joseph J, Rasheed A, Rockley M, Marbach J, Domecq MC, Russo JJ, Chong AY, Beanlands RS, Hibbert B. Revisiting the Evidence for Dipyridamole in Reducing Restenosis: A Systematic Review and Meta-analysis. J Cardiovasc Pharmacol 2021; 77:450-457. [PMID: 33760800 DOI: 10.1097/fjc.0000000000000976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 11/25/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT Atherosclerosis remains a leading cause of morbidity and mortality, with revascularization remaining a cornerstone of management. Conventional revascularization modalities remain challenged by target vessel reocclusion-an event driven by mechanical, thrombotic, and proliferative processes. Despite considerable advancements, restenosis remains the focus of ongoing research. Adjunctive agents, including dipyridamole, offer a multitude of effects that may improve vascular homeostasis. We sought to quantify the potential therapeutic impact of dipyridamole on vascular occlusion. We performed a literature search (EMBASE and MEDLINE) examining studies that encompassed 3 areas: (1) one of the designated medical therapies applied in (2) the setting of a vascular intervention with (3) an outcome including vascular occlusion rates and/or quantification of neointimal proliferation/restenosis. The primary outcome was vascular occlusion rates. The secondary outcome was the degree of restenosis by neointimal quantification. Both human and animal studies were included in this translational analysis. There were 6,839 articles screened, from which 73 studies were included, encompassing 16,146 vessels followed up for a mean of 327.3 days (range 7-3650 days). Preclinical studies demonstrate that dipyridamole results in reduced vascular occlusion rates {24.9% vs. 48.8%, risk ratio 0.53 [95% confidence interval (CI) 0.40-0.70], I2 = 39%, P < 0.00001}, owing to diminished neointimal proliferation [standardized mean differences -1.13 (95% CI -1.74 to -0.53), I2 = 91%, P = 0.0002]. Clinical studies similarly demonstrated reduced occlusion rates with dipyridamole therapy [23.5% vs. 31.0%, risk ratio 0.77 (95% CI 0.67-0.88), I2 = 84%, P < 0.0001]. Dipyridamole may improve post-intervention vascular patency and mitigate restenosis. Dedicated studies are warranted to delineate its role as an adjunctive agent after revascularization.
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Affiliation(s)
- Trevor Simard
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Pouya Motazedian
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shan Dhaliwal
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Richard G Jung
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Francisco Daniel Ramirez
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
- L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Alisha Labinaz
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Spencer Short
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Simon Parlow
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Joanne Joseph
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Adil Rasheed
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Mark Rockley
- Division of Vascular Surgery, the Ottawa Hospital, Ottawa, Ontario, Canada ; and
| | - Jeffrey Marbach
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Juan J Russo
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Aun-Yeong Chong
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Rob S Beanlands
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Marbach JA, Wells G, Santo PD, So D, Chong AY, Russo J, Labinaz M, Dick A, Froeschl M, Glover C, Hibbert B, Marquis JF, MacDougall A, Kass M, Paddock V, Quraishi AUR, Chandrasekhar J, Ghosh N, Bernick J, Le May M. Acute kidney injury after radial or femoral artery access in ST-segment elevation myocardial infarction: AKI-SAFARI. Am Heart J 2021; 234:12-22. [PMID: 33422518 DOI: 10.1016/j.ahj.2020.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/31/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) complicating primary percutaneous coronary intervention (PCI) is an independent predictor of short- and long-term outcomes in patients presenting with ST-elevation myocardial infarction (STEMI). Prior studies suggest a lower incidence of AKI in patients undergoing PCI through radial artery compared to femoral artery access; however, no randomized clinical trials have specifically investigated this question in patients presenting with STEMI. METHODS To determine whether radial access (RA) is associated with a reduced frequency of AKI following primary PCI, we performed a substudy of the SAFARI-STEMI trial. The SAFARI-STEMI trial was an open-label, multicenter trial, which randomized patients presenting with STEMI to RA or femoral access (FA), between July 2011 and December 2018. The primary outcome of this post hoc analysis was the incidence of AKI, defined as an absolute (>0.5 mg/dL) or relative (>25%) increase in serum creatinine from baseline. RESULTS In total 2,285 (99.3%) of the patients enrolled in SAFARI-STEMI were included in the analysis-1,132 RA and 1,153 FA. AKI occurred in 243 (21.5%) RA patients and 226 (19.6%) FA patients (RR: 0.91, 95% CI: 0.78-1.07, P = .27). An absolute increase in serum creatinine >0.5 mg/dL was seen in 49 (4.3%) radial and 52 (4.5%) femoral patients (RR: 1.04, 95% CI: 0.71-1.53, P = .83). AKI was lower in both groups when the KDIGO definition was applied (RA 11.9% vs FA 10.8%; RR: 0.90, 95% CI: 0.72-1.13, P = .38). CONCLUSIONS Among STEMI patients enrolled in the SAFARI-STEMI trial, there was no association between catheterization access site and AKI, irrespective of the definition applied. These results challenge the independent association between catheterization access site and AKI noted in prior investigations.
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Di Santo P, Simard T, Wells GA, Jung RG, Ramirez FD, Boland P, Marbach JA, Parlow S, Kyeremanteng K, Coyle D, Fergusson D, Russo JJ, Chong AY, Froeschl M, So DY, Dick A, Glover C, Labinaz M, Hibbert B, Le May M. Transradial Versus Transfemoral Access for Percutaneous Coronary Intervention in ST-Segment-Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis. Circ Cardiovasc Interv 2021; 14:e009994. [PMID: 33685220 DOI: 10.1161/circinterventions.120.009994] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,School of Epidemiology and Public Health (P.D.S., D.C., D.F., G.A.W.), University of Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Trevor Simard
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada.,Department of Cellular and Molecular Medicine (T.S., R.G.J., B.H.), University of Ottawa, Canada
| | - George A Wells
- Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ottawa, Canada.,School of Epidemiology and Public Health (P.D.S., D.C., D.F., G.A.W.), University of Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Richard G Jung
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada.,Department of Cellular and Molecular Medicine (T.S., R.G.J., B.H.), University of Ottawa, Canada
| | - F Daniel Ramirez
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, France (F.D.R.).,LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Bordeaux-Pessac, France (F.D.R.)
| | - Paul Boland
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Jeffrey A Marbach
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Simon Parlow
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Kwadwo Kyeremanteng
- Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada.,Division of Critical Care, Department of Medicine (K.K.), University of Ottawa, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health (P.D.S., D.C., D.F., G.A.W.), University of Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Dean Fergusson
- School of Epidemiology and Public Health (P.D.S., D.C., D.F., G.A.W.), University of Ottawa, Canada
| | - Juan J Russo
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Aun-Yeong Chong
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Michael Froeschl
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Derek Y So
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Alexander Dick
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Christopher Glover
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Marino Labinaz
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada.,Department of Cellular and Molecular Medicine (T.S., R.G.J., B.H.), University of Ottawa, Canada
| | - Michel Le May
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
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Jung RG, Di Santo P, Clifford C, Prosperi-Porta G, Skanes S, Hung A, Parlow S, Visintini S, Ramirez FD, Simard T, Hibbert B. Methodological quality of COVID-19 clinical research. Nat Commun 2021; 12:943. [PMID: 33574258 PMCID: PMC7878793 DOI: 10.1038/s41467-021-21220-5] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [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] [Received: 07/16/2020] [Accepted: 01/13/2021] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic began in early 2020 with major health consequences. While a need to disseminate information to the medical community and general public was paramount, concerns have been raised regarding the scientific rigor in published reports. We performed a systematic review to evaluate the methodological quality of currently available COVID-19 studies compared to historical controls. A total of 9895 titles and abstracts were screened and 686 COVID-19 articles were included in the final analysis. Comparative analysis of COVID-19 to historical articles reveals a shorter time to acceptance (13.0[IQR, 5.0–25.0] days vs. 110.0[IQR, 71.0–156.0] days in COVID-19 and control articles, respectively; p < 0.0001). Furthermore, methodological quality scores are lower in COVID-19 articles across all study designs. COVID-19 clinical studies have a shorter time to publication and have lower methodological quality scores than control studies in the same journal. These studies should be revisited with the emergence of stronger evidence. During the early phase of the COVID-19 pandemic there was a need for rapid dissemination of clinical findings. Here, Jung, Di Santo et al. perform a systematic review and cohort study providing evidence for lower methodological quality scores and faster time to publication of clinical studies related to COVID-19 than comparable studies.
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Affiliation(s)
- Richard G Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Cole Clifford
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | | | | | - Annie Hung
- Division of Internal Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Simon Parlow
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sarah Visintini
- Berkman Library, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - F Daniel Ramirez
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Bordeaux-Pessac, France.,L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Trevor Simard
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Benjamin Hibbert
- Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. .,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. .,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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Simard T, Jung RG, Di Santo P, Ramirez FD, Labinaz A, Gaudet C, Motazedian P, Parlow S, Joseph J, Moreland R, Marbach J, Boland P, Promislow S, Russo JJ, Chong AY, So D, Froeschl M, Le May M, Hibbert B. Performance of Plasma Adenosine as a Biomarker for Predicting Cardiovascular Risk. Clin Transl Sci 2020; 14:354-361. [PMID: 33264483 PMCID: PMC7877863 DOI: 10.1111/cts.12886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/23/2020] [Indexed: 11/29/2022] Open
Abstract
Adenosine boasts promising preclinical and clinical data supporting a vital role in modulating vascular homeostasis. Its widespread use as a diagnostic and therapeutic agent have been limited by its short half-life and complex biology, though adenosine-modulators have shown promise in improving vascular healing. Moreover, circulating adenosine has shown promise in predicting cardiovascular (CV) events. We sought to delineate whether circulating plasma adenosine levels predict CV events in patients undergoing invasive assessment for coronary artery disease. Patients undergoing invasive angiography had clinical data prospectively recorded in the Cardiovascular and Percutaneous ClInical TriALs (CAPITAL) revascularization registry and blood samples collected in the CAPITAL Biobank from which adenosine levels were quantified. Tertile-based analysis was used to assess prediction of major adverse cardiovascular events (MACE; composite of death, myocardial infarction, unplanned revascularization, and cerebrovascular accident). Secondary analyses included MACE subgroups, clinical subgroups and adenosine levels. There were 1,815 patients undergoing angiography who had blood collected with adenosine quantified in 1,323. Of those quantified, 51.0% were revascularized and 7.3% experienced MACE in 12 months of follow-up. Tertile-based analysis failed to demonstrate any stratification of MACE rates (log rank, P = 0.83), when comparing low-to-middle (hazard ratio (HR) 1.10, 95% confidence interval (CI) 0.68-1.78, P = 0.70) or low-to-high adenosine tertiles (HR 0.95, 95% CI 0.56-1.57, P = 0.84). In adjusted analysis, adenosine similarly failed to predict MACE. Finally, adenosine did not predict outcomes in patients with acute coronary syndrome nor in those revascularized or treated medically. Plasma adenosine levels do not predict subsequent CV outcomes or aid in patient risk stratification.
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Affiliation(s)
- Trevor Simard
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard G Jung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - F Daniel Ramirez
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Bordeaux-Pessac, France.,L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Alisha Labinaz
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Chantal Gaudet
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pouya Motazedian
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simon Parlow
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Joanne Joseph
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Robert Moreland
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jeffrey Marbach
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Paul Boland
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Steven Promislow
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Juan J Russo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Aun-Yeong Chong
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Derek So
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michael Froeschl
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michel Le May
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Fernando SM, Qureshi D, Tanuseputro P, Talarico R, Hibbert B, Mathew R, Rochwerg B, Belley-Côté EP, Fan E, Combes A, Brodie D, Schmidt M, Simard T, Di Santo P, Kyeremanteng K. Long-term mortality and costs following use of Impella® for mechanical circulatory support: a population-based cohort study. Can J Anaesth 2020; 67:1728-1737. [PMID: 32671805 DOI: 10.1007/s12630-020-01755-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/02/2020] [Revised: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The Impella® device is a form of mechanical circulatory support (MCS) used in critically ill adults with cardiogenic shock. We sought to evaluate short- and long-term outcomes following the use of Impella, including mortality, healthcare utilization, and costs. METHODS Population-based, retrospective cohort study of adult patients (≥ 16 yr) receiving Impella in Ontario, Canada (1 April 2012-31March 2019). We captured outcomes through linkage to health administrative databases. The primary outcome was mortality during hospitalization. Secondary outcomes included mortality at 30 days, 90 days, and one year following Impella insertion. We analyzed health system costs in Canadian dollars in the year following the date of the index admission, including the costs of inpatient admission. RESULTS We included 162 patients. Mean (standard deviation) age was 59.2 (14.5) yr, and 73.5% of patients were male. Median [interquartile range (IQR)] time to Impella insertion from date of hospital admission was 2 [1-9] days. In-hospital mortality was 56.8%, and a significant proportion of patients were bridged to a ventricular assist device (67.9%). Mortality at one year was 61.7%. Among hospital survivors, only 38.6% were discharged home independently. Median [IQR] total cost in the year following admission among all patients was $88,397 [32,718-225,628], of which $66,529 [22,789-183,165] was attributed to inpatient care. CONCLUSIONS In-hospital mortality among patients with cardiogenic shock receiving Impella is high, but with minimal increase at one year. While Impella patients accrued substantial costs, these largely reflected inpatient costs, and not costs incurred following hospital discharge.
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Affiliation(s)
- Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Danial Qureshi
- ICES, Toronto, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Peter Tanuseputro
- ICES, Toronto, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Robert Talarico
- ICES, Toronto, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Benjamin Hibbert
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Rebecca Mathew
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Emilie P Belley-Côté
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Alain Combes
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Pitié Salpêtrière, Paris, France
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA
| | - Matthieu Schmidt
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Pitié Salpêtrière, Paris, France
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
| | - Trevor Simard
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Pietro Di Santo
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
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Mathew R, Di Santo P, Marbach J, Hutson J, Simard T, Jung R, Merdad A, Almufleh A, Weng W, Abdel-Razek O, Fernando S, Kyeremanteng K, Bernick J, Wells G, Froeschl M, Labinaz M, Le May MR, Russo JJ, Hibbert BM. Abstract 125: Capital Do-Re-Mi: A Randomized Trial of Dobutamine Compared to Milrinone in Cardiogenic Shock. Circulation 2020. [DOI: 10.1161/circ.142.suppl_4.125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Cardiogenic shock (CS) is associated with significant morbidity and mortality. Although inotropic support is a mainstay of medical therapy for CS, little evidence exists to guide the selection of inotropic agents in clinical practice.
Methods:
In this double blind randomized controlled trial, we assigned patients with SCAI class B to E shock to either milrinone or dobutamine for inotropic support. Therapy was titrated based on clinical, biochemical and hemodynamic response as evaluated by the treating physician. The primary outcome was a combined endpoint of in hospital mortality, non-fatal MI, stroke, new initiation of renal replacement therapy (RRT), need for MCS or cardiac transplant, or cardiac arrest with successful resuscitation. Secondary outcomes included individual components of the primary outcome.
Results:
Among 192 participants, there was no significant difference in the primary outcome, occurring in 49% (47 of 96) of patients in the milrinone arm and 54% (52 of 96) patients in the dobutamine group (RR 0.90, 95% CI of 0.69-1.19, p-value = 0.47). There were also no differences in important secondary outcomes between milrinone and dobutamine, including in-hospital mortality 37% (35 of 96) vs 43% (41 of 96) (RR 0.85, 95% CI 0.60-1.21, p-value = 0.38) or need for RRT 22% (21 of 96) vs 17% (16 of 96) (RR 1.31, 95% CI 0.73-2.36, p-value = 0.36).
Conclusions:
In this randomized clinical trial of milrinone and dobutamine in CS, there was no difference in the primary composite outcome or in important secondary outcomes. The selection of inotropic agent could reasonably be based on physician comfort, cost and individual response to therapy.
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Affiliation(s)
| | | | | | - Jordan Hutson
- Cardiology and Critical Care Medicine, Ottawa, Canada
| | | | | | | | | | | | | | | | | | - Jordan Bernick
- Cardiovascular Rsch Methods Cntr, Ottawa Heart Institute, Ottawa, Canada
| | - George Wells
- Dept of Medicine and Cardiovascular Rsch Methods Cntr, Ottawa Heart Institute, Ottawa, Canada
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Jung RG, Simard T, Kovach C, Flint K, Don C, Di Santo P, Adamo M, Branca L, Valentini F, Benito-González T, Fernández-Vázquez F, Estévez-Loureiro R, Berardini A, Conti N, Rapezzi C, Biagini E, Parlow S, Shorr R, Levi A, Manovel A, Cardenal-Piris R, Diaz Fernandez J, Shuvy M, Haberman D, Sala A, Alkhouli MA, Marini C, Bargagna M, Schiavi D, Denti P, Markovic S, Buzzatti N, Chan V, Hynes M, Mesana T, Labinaz M, Pappalardo F, Taramasso M, Hibbert B. Transcatheter Mitral Valve Repair in Cardiogenic Shock and Mitral Regurgitation: A Patient-Level, Multicenter Analysis. JACC Cardiovasc Interv 2020; 14:1-11. [PMID: 33069653 DOI: 10.1016/j.jcin.2020.08.037] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/12/2020] [Accepted: 08/25/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the outcome of transcatheter mitral valve repair (TMVr) in patients with cardiogenic shock and significant mitral regurgitation (MR). BACKGROUND Patients in cardiogenic shock with severe MR have a poor prognosis in the setting of conventional medical therapy. Because of its favorable safety profile, TMVr is being increasingly used as an acute therapy in this population, though its efficacy remains unknown. METHODS A multicenter, collaborative, patient-level analysis was conducted. Patients with cardiogenic shock and moderate to severe (3+) or severe (4+) MR who were not surgical candidates were treated with TMVr. The primary outcome was in-hospital mortality. Secondary outcomes included 90-day mortality, heart failure (HF) hospitalization, and the combined event rate of 90-day mortality and HF hospitalization following dichotomization by TMVr device success. RESULTS Between January 2011 and February 2019, 141 patients across 14 institutions met the inclusion criteria. In-hospital mortality occurred in 22 patients (15.6%), at 90 days in 38 patients (29.5%), and at one year in 55 patients (42.6%). Median length of hospital stay following TMVr was 10 days (interquartile range: 6 to 20 days). HF hospitalization occurred in 26 patients (18.4%) at a median of 73 days (interquartile range: 26 to 546 days). When stratified by TMVr procedural results, successful TMVr reduced rates of in-hospital mortality (hazard ratio [HR]: 0.36; 95% confidence interval [CI]: 0.13 to 0.98; p = 0.04), 90-day mortality (HR: 0.36; 95% CI: 0.16 to 0.78; p = 0.01), and the composite of 90-day mortality and HF hospitalization (HR: 0.41; 95% CI: 0.19 to 0.90; p = 0.03). CONCLUSIONS TMVr may improve short- and intermediate-term mortality in high-risk patients with cardiogenic shock and moderate to severe MR. Randomized studies are needed to definitively establish MR as a therapeutic target in patients with cardiogenic shock.
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Affiliation(s)
- Richard G Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Trevor Simard
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Christopher Kovach
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado; Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Kelsey Flint
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado; Rocky Mountain Regional VA Medical Center, Medicine Services, Cardiology, Aurora, Colorado, USA
| | - Creighton Don
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marianna Adamo
- Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy
| | - Luca Branca
- Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy
| | - Francesca Valentini
- Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy
| | | | | | | | - Alessandra Berardini
- Cardiology Unit, Cardio-Thoracic-Vascular Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Nicolina Conti
- Cardiology Unit, Cardio-Thoracic-Vascular Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Claudio Rapezzi
- Cardiological Center, Universitario di Ferrara, University of Ferrara, Italy; Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Elena Biagini
- Cardiology Unit, Cardio-Thoracic-Vascular Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Simon Parlow
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Risa Shorr
- University of Ottawa Health Sciences Library, Ottawa, Ontario, Canada
| | - Amos Levi
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ana Manovel
- Juan Ramon Jimenez University Hospital, Huelva, Spain
| | | | | | - Mony Shuvy
- Cardiovascular Research Centre, Heart Institute, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Dan Haberman
- Heart Center, Kaplan Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alessandra Sala
- Department of Cardiovascular Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy
| | - Mohamad A Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Claudia Marini
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Marta Bargagna
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | | | - Paolo Denti
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Sinisa Markovic
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | - Nicola Buzzatti
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Vincent Chan
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Mark Hynes
- Department of Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario
| | - Thierry Mesana
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marino Labinaz
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Maurizio Taramasso
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy; University Heart Center Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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47
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Jung RG, Di Santo P, Hibbert B. Commentary: Geographic variation in the statin trials - underrepresentation of Asian populations. Int J Cardiol 2020; 316:47-48. [PMID: 32710987 DOI: 10.1016/j.ijcard.2020.07.023] [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] [Received: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Richard G Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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48
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Jung R, Simard T, Don C, Di Santo P, Adamo M, Valentini F, Benito-González T, Fernandez-Vazquez F, Estevez-Loureiro R, Conti N, Rapezzi C, Biagini E, Parlow S, Shorr R, Levi A, Diaz Fernandez JF, Haberman D, Alessandra S, Alkhouli M, Marini C, Bargagna M, Schiavi D, Denti P, Buzzatti N, Hynes M, Mesana T, Labinaz M, Markovic S, Pappalardo F, Taramasso M, Hibbert B. TCT CONNECT-336 Transcatheter Mitral Valve Repair in Cardiogenic Shock and Mitral Regurgitation: A Patient-Level, Multicenter Analysis. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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49
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Simard T, Motazedian P, Majeed K, Sarathy K, Jung RG, Feder J, Ramirez FD, Di Santo P, Marbach J, Dhaliwal S, Short S, Labinaz A, Schultz C, Russo JJ, So D, Chong AY, Le May M, Hibbert B. Contrast-free optical coherence tomography:Systematic evaluation of non-contrast media for intravascular assessment. PLoS One 2020; 15:e0237588. [PMID: 32817672 PMCID: PMC7446899 DOI: 10.1371/journal.pone.0237588] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/29/2020] [Indexed: 11/18/2022] Open
Abstract
Background Coronary revascularization using imaging guidance is rapidly becoming the standard of care. Intravascular optical coherence tomography uses near-infrared light to obtain high resolution intravascular images. Standard optical coherence tomography imaging technique employs iodinated contrast dye to achieve the required blood clearance during acquisition. We sought to systematically evaluate the technical performance of saline as an alternative to iodinated contrast for intravascular optical coherence tomography assessment. Methods and results We performed bench top optical coherence tomography analysis on nylon tubing with sequential contrast/saline dilutions to empirically derive adjustment coefficients. We then applied these coefficients in vivo in an established rabbit abdominal stenting model with both saline and contrast optical coherence tomography imaging. In this model, we assessed the impact of saline on both quantitative and qualitative vessel assessment. Nylon tubing assessment demonstrated a linear relationship between saline and contrast for both area and diameter. We then derived adjustment coefficients, allowing for accurate calculation of area and diameter when converting saline into both contrast and reference dimensions. In vivo studies confirmed reduced area with saline versus contrast [7.43 (5.67–8.36) mm2 versus 8.2 (6.34–9.39) mm2, p = 0.001] and diameter [3.08 mm versus 3.23 mm, p = 0.001]. Following correction, a strong relationship was achieved in vivo between saline and contrast in both area and diameter without compromising image quality, artefact, or strut assessment. Conclusion Saline generates reduced dimensions compared to contrast during intravascular optical coherence tomography imaging. The relationship across physiologic coronary diameters is linear and can be corrected with high fidelity. Saline does not adversely impact image quality, artefact, or strut assessment.
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Affiliation(s)
- Trevor Simard
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Pouya Motazedian
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kamran Majeed
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Kiran Sarathy
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Richard G. Jung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Joshua Feder
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - F. Daniel Ramirez
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
- L’Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jeffrey Marbach
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Shan Dhaliwal
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Spencer Short
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Alisha Labinaz
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Carl Schultz
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Juan J. Russo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Derek So
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Aun-Yeong Chong
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michel Le May
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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50
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Simard T, Thangarasa T, Di Santo P, Labinaz A, Hibbert B. The balloon impasse sign in percutaneous transvenous mitral valvuloplasty. Oxf Med Case Reports 2020; 2020:omaa062. [PMID: 32793366 PMCID: PMC7416822 DOI: 10.1093/omcr/omaa062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 06/15/2020] [Accepted: 06/26/2020] [Indexed: 11/14/2022] Open
Abstract
Percutaneous transvenous mitral valvuloplasty (PTMV) is an established therapy for rheumatic mitral stenosis (MS). While the Wilkins score standardizes the description of valve anatomy and predicts successful PTMV, echocardiographic assessment has some limitations. The 'balloon impasse' sign is the inability to cross a stenotic valve with a deflated Inoue balloon. This sign was described in the 1990s as an indicator of severe subvalvular thickening (regardless of the echocardiographic findings), portending an increased risk of severe mitral regurgitation (MR) post-PTMV. Despite its implications for management, it has been seldom reported. A 57-year-old woman with symptomatic, severe MS and a Wilkins score of 7 underwent PTMV. The 'balloon impasse' sign was observed when attempting to cross the stenotic valve. When the balloon was fully inflated, severe MR was noted, and the patient required mitral valve replacement. This case demonstrates the continued importance of the 'balloon impasse' sign and its implications for the therapeutic efficacy of PTMV.
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Affiliation(s)
- Trevor Simard
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Tharshika Thangarasa
- Faculty of Undergraduate Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Alisha Labinaz
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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