1
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Zern EK, Gupta T, Ryoo Ali HJ, Thakker P, Reza N. A Leadership Program to Support Career Development of Cardiovascular Chief Fellows. J Am Coll Cardiol 2024; 83:1623-1625. [PMID: 38631779 PMCID: PMC11064848 DOI: 10.1016/j.jacc.2024.02.030] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 04/19/2024]
Affiliation(s)
- Emily K Zern
- Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California, USA. https://twitter.com/emilyzernMD
| | - Tripti Gupta
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Prashanth Thakker
- Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Nosheen Reza
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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2
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Kashou AH, Noseworthy PA, Beckman TJ, Anavekar NS, Cullen MW, Angstman KB, Sandefur BJ, Shapiro BP, Wiley BW, Kates AM, Sadhu J, Thakker P, Huneycutt D, Braisted A, Smith SW, Baranchuk A, Grauer K, O'Brien K, Kaul V, Gambhir HS, Knohl SJ, Restrepo D, May AM. EDUCATE: An international, randomized controlled trial for teaching electrocardiography. Curr Probl Cardiol 2024; 49:102409. [PMID: 38232918 PMCID: PMC10922800 DOI: 10.1016/j.cpcardiol.2024.102409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 01/14/2024] [Indexed: 01/19/2024]
Abstract
INTRODUCTION Despite the critical role of electrocardiograms (ECGs) in patient care, evident gaps exist in ECG interpretation competency among healthcare professionals across various medical disciplines and training levels. Currently, no practical, evidence-based, and easily accessible ECG learning solution is available for healthcare professionals. The aim of this study was to assess the effectiveness of web-based, learner-directed interventions in improving ECG interpretation skills in a diverse group of healthcare professionals. METHODS In an international, prospective, randomized controlled trial, 1206 healthcare professionals from various disciplines and training levels were enrolled. They underwent a pre-intervention test featuring 30 12-lead ECGs with common urgent and non-urgent findings. Participants were randomly assigned to four groups: (i) practice ECG interpretation question bank (question bank), (ii) lecture-based learning resource (lectures), (iii) hybrid question- and lecture-based learning resource (hybrid), or (iv) no ECG learning resources (control). After four months, a post-intervention test was administered. The primary outcome was the overall change in ECG interpretation performance, with secondary outcomes including changes in interpretation time, self-reported confidence, and accuracy for specific ECG findings. Both unadjusted and adjusted scores were used for performance assessment. RESULTS Among 1206 participants, 863 (72 %) completed the trial. Following the intervention, the question bank, lectures, and hybrid intervention groups each exhibited significant improvements, with average unadjusted score increases of 11.4 % (95 % CI, 9.1 to 13.7; P<0.01), 9.8 % (95 % CI, 7.8 to 11.9; P<0.01), and 11.0 % (95 % CI, 9.2 to 12.9; P<0.01), respectively. In contrast, the control group demonstrated a non-significant improvement of 0.8 % (95 % CI, -1.2 to 2.8; P=0.54). While no differences were observed among intervention groups, all outperformed the control group significantly (P<0.01). Intervention groups also excelled in adjusted scores, confidence, and proficiency for specific ECG findings. CONCLUSION Web-based, self-directed interventions markedly enhanced ECG interpretation skills across a diverse range of healthcare professionals, providing an accessible and evidence-based solution.
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Affiliation(s)
- Anthony H Kashou
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Thomas J Beckman
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Michael W Cullen
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Kurt B Angstman
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Benjamin J Sandefur
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | | | - Brandon W Wiley
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andrew M Kates
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Justin Sadhu
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Prashanth Thakker
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | | | | | - Stephen W Smith
- Hennepin County Medical Center and University of Minnesota, Minneapolis, MN, USA
| | | | - Ken Grauer
- University of Florida, Gainesville, FL, USA
| | | | - Viren Kaul
- SUNY Upstate Medical University, Syracuse, NY, USA
| | | | | | - Daniel Restrepo
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Adam M May
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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3
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Salik JR, Zern EK, McCarthy IR, Theriot P, West K, Thakker P, Weissman G, Rose-Jones LJ. In-Person vs Virtual Interview Format for Fellowships in Cardiovascular Disease: A Nationwide Survey of Fellows-in-Training. J Am Coll Cardiol 2023; 82:465-468. [PMID: 37495283 DOI: 10.1016/j.jacc.2023.05.039] [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] [Received: 04/26/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Jonathan R Salik
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
| | - Emily K Zern
- Providence Heart Institute, Center for Cardiovascular Analytics, Research, and Data Science (CARDS), Providence St Joseph Health, Portland, Oregon, USA
| | - Inbar R McCarthy
- Cardiology Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Paul Theriot
- American College of Cardiology, Washington, DC, USA
| | - Kristin West
- American College of Cardiology, Washington, DC, USA
| | - Prashanth Thakker
- Cardiovascular Division, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Gaby Weissman
- MedStar Heart and Vascular Institute, MedStar Health and Georgetown University School of Medicine, Washington, DC, USA
| | - Lisa J Rose-Jones
- Division of Cardiovascular Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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4
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Pehrsson M, Alexdóttir MS, Karsdal MA, Thakker P, Mortensen JH. Novel fibro-inflammatory biomarkers associated with disease activity in patients with Crohn's disease. Expert Rev Gastroenterol Hepatol 2023:1-13. [PMID: 37165883 DOI: 10.1080/17474124.2023.2212158] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Crohn's disease (CD) is a complex disease, and assessing activity is challenging due to pathobiologic process e.g. ECM remodeling, mucosal damage, and intestinal fibrosis, which greatly limits current disease activity assessments through e.g. endoscopy and imaging techniques. AREAS COVERED The review highlights the importance of novel biomarkers reflecting ECM remodeling and immune cell activity that accurately reflect CD activity and progression. Such biomarkers could include collagen formation and degradation fragments and a serum fragment of calprotectin, reflecting neutrophil activity. A new concept, fibro-inflammation, is also introduced in the review, in which all aspects of mucosal damage, such as inflammation, mucosal damage, tissue remodeling, intestinal fibrosis, and fibrosis resolution, should be assessed. Pubmed searches performed from July 2022 - November 2022 provided the scientific information included in the review. EXPERT OPINION Current data suggest intestinal fibrosis may sustain and exacerbate chronic inflammation, leading to non-response to anti-inflammatory treatments. Therefore, evaluating novel biomarkers reflecting different stages of fibro-inflammatory disease activity should be done in a clinical setting and considered for clinical trials. This approach will help accurately assess disease activity, leading to better management and treatment of CD.
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Affiliation(s)
| | | | | | - P Thakker
- Nordic Bioscience A/S, Herlev hovedgade 207, Herlev, 2730 Denmark
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5
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Whitman W, Sandberg M, Hingu J, Thakker P, Rong A, Bercu C, Greenberg J, Davis R, Hemal A, Tsivian M. Risk factors for acute urinary retention following transperineal prostate biopsy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00239-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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6
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Frandsen EL, Vigdor A, Thakker P, Chang K, Reza N. MOCK-TALES: PREPARING CARDIOVASCULAR MEDICINE FELLOWSHIP APPLICANTS FOR VIRTUAL RECRUITMENT DURING COVID-19. J Am Coll Cardiol 2021. [PMCID: PMC9090495 DOI: 10.1016/s0735-1097(21)04698-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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7
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Soares A, Thakker P, Deych E, Jain S, Bhayani RK. The Impact of COVID-19 on Dual-Physician Couples: A Disproportionate Burden on Women Physicians. J Womens Health (Larchmt) 2021; 30:665-671. [PMID: 33751922 DOI: 10.1089/jwh.2020.8903] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Currently, physicians face an unprecedented crisis with the novel coronavirus disease 2019 (COVID-19) pandemic. The impact of the pandemic on dual-physician households remains unknown. In this survey study, we examined the impact of the COVID-19 pandemic on dual-physician families and described gendered differences related to the impact of the pandemic. Methods: This was a cross-sectional survey distributed via e-mail and social media, with results collected from April 30, 2020 until May 26, 2020. Respondents were members of a dual-physician couple. Respondents provided information on demographic characteristics and the impact of the pandemic on their professional lives, personal lives, and well-being. Categorical variables were compared using chi-squared or Fisher's exact test. Ordinal variables were compared between genders using Cochran-Armitage trend test. Feeling emotionally and physically drained compared to pre-pandemic was analyzed as a binary outcome in a multivariable logistic model. Results: Of the 1799 physicians who completed the survey, 52% were between 30 and 39 years old, 81% self-identified as women, and 62% were white. Women were more likely to report increased worry about their job security, finances, personal health, partner's health, and children's health (p = 0.02, p = 0.01, p < 0.001, p < 0.001, and p < 0.001, respectively). Seventy-eight percent of respondents reported feeling more drained during the pandemic. Multivariable analysis revealed that female gender (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.7-3.3, p < 0.001), and having children younger than 5 years of age (OR 1.43, 95% CI 1.05-1.95, p = 0.02) were associated with an increased risk of feeling more drained. Conclusions: Women were more likely to report increased worry about job security, finances, and health and had an increased risk of feeling more drained during the pandemic. While the COVID-19 pandemic is a significant stress for all physicians, women in dual-physician families were disproportionately affected, demonstrating the need for increased support from hospital administrations.
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Affiliation(s)
- Andrea Soares
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Prashanth Thakker
- Division of Cardiovascular Medicine, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Elena Deych
- Division of Cardiovascular Medicine, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Shikha Jain
- Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Rakhee K Bhayani
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
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8
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Husaini M, Soyama Y, Kagiyama N, Thakker P, Thangam M, Haque N, Deych E, Sintek M, Lasala J, Gorcsan J, Zajarias A. Clinical and Echocardiographic Features Associated With Improved Survival in Patients With Severe Aortic Stenosis Undergoing Balloon Aortic Valvuloplasty (BAV). J Invasive Cardiol 2020; 32:E277-E285. [PMID: 33130594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Balloon aortic valvuloplasty (BAV) is used in high-risk patients with severe aortic stenosis (AS) when the benefit of transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) is unclear. Our objective was to identify clinical or echocardiographic features that identify patients likely to benefit from BAV. METHODS We studied 141 consecutive patients who underwent BAV from July, 2011 to October, 2017. Clinical characteristics, routine echocardiographic parameters, and speckle tracking imaging of global longitudinal strain (GLS) were assessed before and after BAV. The primary outcome was all-cause mortality as ascertained by the National Death Index. RESULTS There were 141 patients, median age, 80 years (interquartile range [IQR], 74-87 years) with severe AS (median aortic valve area, 0.66 cm²; IQR, 0.53-0.79 cm²) and median mean gradient of 36 mm Hg (IQR, 27-48 mm Hg) who underwent BAV. The 1-year mortality rate was 52%. Characteristics associated with survival were New York Heart Association class I symptoms, lower brain natriuretic peptide level, higher left ventricular ejection fraction (LVEF) >53%, and higher GLS (>13.2%; absolute values were used for GLS). Landmark analysis at 60 days showed the 47 patients who underwent TAVR/SAVR after BAV had significantly better 1-year survival than those who did not (P<.001). CONCLUSION A high 1-year mortality rate was observed in severe AS patients selected for BAV. LVEF and left ventricular (LV)-GLS offer similar prognostic value for 1-year mortality; however, LV-GLS may have potentially increased clinical utility, as it provides a clear threshold for predicting poor outcomes compared with LVEF. As patients who undergo TAVR/SAVR have markedly improved mortality, careful consideration should be given to advance definitive valve therapy in carefully selected BAV patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Alan Zajarias
- Division of Cardiology, Department of Medicine, Washington University/Barnes Jewish Hospital, 660 S. Euclid Ave, CB 8086, St. Louis, MO 63110 USA.
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9
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Fares A, Alaiti MA, Alkhalil A, Al-Kindi S, Chami T, Martin B, Thakker P, Nadeem F, Rajagopalan S, Simon D, Gilkeson R, Bezerra HG. Real World Utilization of Computed Tomography Derived Fractional Flow Reserve: Single Center Experience in the United States. Cardiovasc Revasc Med 2019; 20:1043-1047. [PMID: 30833210 DOI: 10.1016/j.carrev.2019.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/08/2018] [Revised: 01/12/2019] [Accepted: 01/14/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Fractional flow reserve derived from computed tomography (FFRct) has shown higher accuracy for detection of significant coronary artery disease (CAD) compared to coronary computed tomography angiography (CCTA). The performance of a combined comprehensive qualitative interpretation of both CCTA and FFRct in patient management is unknown. We aimed to explore the clinical application of this combined approach. METHODS We retrospectively reviewed cases referred to FFRct testing at our institution over a one-year period. Patients had documentation of whether invasive coronary angiography (ICA) was performed and revascularization were needed. Interpretations and recommendations of the adopted comprehensive approach (C-FFRct), that took into account focal versus diffuse disease, depth of ischemia and myocardium at risk, were compared to those of CCTA (binary > 50% stenosis) alone and FFRct binary approach (FFRct ≤ 0.8). C-FFRct performance was measured against the decision made upon revascularization. RESULTS A total of 207 cases were referred to FFRct testing, 163 (79%) accepted and 44 (21%) rejected for quality. C-FFRct changed interpretations and recommendations of 39 (24%) and 14 (9%) CCTA and FFRct, respectively. ICA was deferred in 32 (59%) and 13 (32%) cases; whereas ICA referral rate was 7 (6%) and 1 (0.8%) cases, based on CCTA and FFRct, respectively. No major cardiac events were observed during follow up time (median = 6 months). C-FFRct sensitivity, specificity, and accuracy compared to decision upon revascularization were 89%, 79% and 82%. C-FFRct number needed to treat was 4, and 6, compared to CCTA and FFRct, respectively. CONCLUSION FFRct is a feasible tool to improve the diagnostic performance of CCTA in CAD real-world workup. However, qualitative interpretation of the FFRct report combined with CCTA findings may yield more impactful results on patient management. Further prospective studies are warranted to validate the application of this approach and better define its components.
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Affiliation(s)
- Anas Fares
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Mohamad Amer Alaiti
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Ahmad Alkhalil
- Division of Cardiology, Department of Medicine, Rutgers University School of Medicine, Newark, NJ, USA
| | - Sadeer Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Tarek Chami
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Bradley Martin
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Prashanth Thakker
- Division of Cardiology, Department of Medicine, Barnes Jewish Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Fahd Nadeem
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Daniel Simon
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Robert Gilkeson
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Hiram G Bezerra
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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10
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Thangam M, Thakker P, Husaini M, Posenau J, Sintek M, Kachroo P, Lasala J, Melby S, Quader N, Maniar H, Singh J, Kurz H, Bach R, Amin A, Zajarias A. OUTCOMES ASSOCIATED WITH PERCUTANEOUS CORONARY INTERVENTION PRIOR TO TRANSCATHETER AORTIC VALVE IMPLANTATION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31922-9] [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: 10/27/2022]
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11
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Thakker P, Husaini M, Zhang K, Zajarias A, Bach R, Braverman A. RECURRENT CATASTROPHIC IN-STENT THROMBOSIS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32840-2] [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: 10/27/2022]
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12
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Thakker P, Zhang K, Lenihan D, Ahmad H. THE HUNT FOR THE SHUNT: UNUSUAL ETIOLOGY OF HYPOXEMIA. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32755-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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13
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Li J, Patel SM, Nadeem F, Thakker P, Al-Kindi S, Thomas R, Makani A, Hornick JM, Patel T, Lipinski J, Ichibori Y, Davis A, Markowitz AH, Bezerra HG, Simon DI, Costa MA, Kalra A, Attizzani GF. Impact of residual coronary atherosclerosis on transfemoral transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2019; 93:545-552. [PMID: 30312990 DOI: 10.1002/ccd.27894] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/13/2018] [Accepted: 08/29/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES This study reports on the clinical effects of complete vs incompletely revascularized coronary artery disease on transcatheter aortic valve replacement (TAVR). BACKGROUND There is a high prevalence of active coronary artery disease (CAD) in patients undergoing TAVR but preemptive revascularization remains controversial. METHODS Patients were categorized into three cohorts: complete revascularization (CR), incomplete revascularization of a major epicardial artery (IR Major), and incomplete revascularization of a minor epicardial artery only (IR Minor). When feasible, SYNTAX scoring was performed for exploratory analysis. Analyses were performed using Cox proportional hazard models and Kaplan-Meier method. RESULTS A total of 323 patients with active CAD were included. Adjusted outcomes showed that patients with IR Major had increased incidence of acute myocardial infarction (AMI) or revascularization compared with those in the CR cohort (HR 3.72, P = 0.048). No difference was noted in all-cause mortality or all-cause readmission rates. Exploratory secondary analysis with residual SYNTAX scores showed a significant interaction between disease burden and AMI/revascularization, as well as all-cause readmission. All-cause mortality remained unaffected based on residual SYNTAX scores. CONCLUSIONS This is a retrospective single-center study reporting on pre-TAVR revascularization outcomes in patients with active CAD. In this analysis, we found that patients undergoing TAVR benefited from achieving complete revascularization to abate future incidence of AMI/revascularization. Despite this finding, all-cause mortality remained unaffected. Future efforts should focus on the role of functional assessment of the coronaries, as well as the long-term effects of complete revascularization in a larger patient cohort.
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Affiliation(s)
- Jun Li
- The Valve and Structural Heart Disease Intervention Center, Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sandeep M Patel
- The Valve and Structural Heart Disease Intervention Center, Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Interventional Cardiology, Heart Specialists of St. Rita's, St. Rita's Medical Center, Mercy Health, Lima, Ohio
| | - Fahd Nadeem
- The Valve and Structural Heart Disease Intervention Center, Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Prashanth Thakker
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Division of Cardiology, Department of Medicine, Barnes Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri
| | - Sadeer Al-Kindi
- The Valve and Structural Heart Disease Intervention Center, Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Rahul Thomas
- The Valve and Structural Heart Disease Intervention Center, Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Amber Makani
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John M Hornick
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Toral Patel
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jerry Lipinski
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Yasuhiro Ichibori
- The Valve and Structural Heart Disease Intervention Center, Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Angela Davis
- The Valve and Structural Heart Disease Intervention Center, Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Alan H Markowitz
- The Valve and Structural Heart Disease Intervention Center, Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Hiram G Bezerra
- The Valve and Structural Heart Disease Intervention Center, Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Daniel I Simon
- The Valve and Structural Heart Disease Intervention Center, Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Marco A Costa
- The Valve and Structural Heart Disease Intervention Center, Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Ankur Kalra
- The Valve and Structural Heart Disease Intervention Center, Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Guilherme F Attizzani
- The Valve and Structural Heart Disease Intervention Center, Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
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14
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Thakker P, Sodhi S, Smith TW, Noheria A. Alternating Wenckebach cycles with right bundle branch block. J Electrocardiol 2018; 51:981-982. [PMID: 30497760 DOI: 10.1016/j.jelectrocard.2018.08.002] [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: 06/23/2018] [Revised: 07/30/2018] [Accepted: 08/06/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Prashanth Thakker
- Washington University School of Medicine/Barnes Jewish Hospital, Department of Medicine, Division of Cardiology, 660 South Euclid Avenue, St. Louis, MO 63110-1093, United States of America.
| | - Sandeep Sodhi
- Washington University School of Medicine/Barnes Jewish Hospital, Department of Medicine, Division of Cardiology, 660 South Euclid Avenue, St. Louis, MO 63110-1093, United States of America
| | - Timothy W Smith
- Washington University School of Medicine/Barnes Jewish Hospital, Department of Medicine, Division of Cardiology, 660 South Euclid Avenue, St. Louis, MO 63110-1093, United States of America
| | - Amit Noheria
- Washington University School of Medicine/Barnes Jewish Hospital, Department of Medicine, Division of Cardiology, 660 South Euclid Avenue, St. Louis, MO 63110-1093, United States of America
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Fares A, Alkhalil A, Martin B, Alaiti A, Nadeem F, Thakker P, Simon D, Gilkeson R, Bezerra H. TCT-12 Real World Utilization of Computed Tomography Derived Fractional Flow Reserve: Single Center Initial Experience in the United States. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Brahler CJ, Merriman H, Price S, Duncan M, Pertner A, Hahn H, Anaya-Cisneros M, Thakker P. PHYSICAL ACTIVITY, BMI AND SMOKING HISTORY AFFECT OT INTERVAL DURATION IN CARDIAC PATIENTS. Cardiopulm Phys Ther J 2013. [DOI: 10.1097/01823246-201324040-00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Pung YF, Sam WJ, Stevanov K, Enrick M, Chen CL, Kolz C, Thakker P, Hardwick JP, Chen YR, Dyck JRB, Yin L, Chilian WM. Mitochondrial oxidative stress corrupts coronary collateral growth by activating adenosine monophosphate activated kinase-α signaling. Arterioscler Thromb Vasc Biol 2013; 33:1911-9. [PMID: 23788766 DOI: 10.1161/atvbaha.113.301591] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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: 12/21/2022]
Abstract
OBJECTIVE Our goal was to determine the mechanism by which mitochondrial oxidative stress impairs collateral growth in the heart. APPROACH AND RESULTS Rats were treated with rotenone (mitochondrial complex I inhibitor that increases reactive oxygen species production) or sham-treated with vehicle and subjected to repetitive ischemia protocol for 10 days to induce coronary collateral growth. In control rats, repetitive ischemia increased flow to the collateral-dependent zone; however, rotenone treatment prevented this increase suggesting that mitochondrial oxidative stress compromises coronary collateral growth. In addition, rotenone also attenuated mitochondrial complex I activity and led to excessive mitochondrial aggregation. To further understand the mechanistic pathway(s) involved, human coronary artery endothelial cells were treated with 50 ng/mL vascular endothelial growth factor, 1 µmol/L rotenone, and rotenone/vascular endothelial growth factor for 48 hours. Vascular endothelial growth factor induced robust tube formation; however, rotenone completely inhibited this effect (P<0.05 rotenone versus vascular endothelial growth factor treatment). Inhibition of tube formation by rotenone was also associated with significant increase in mitochondrial superoxide generation. Immunoblot analyses of human coronary artery endothelial cells with rotenone treatment showed significant activation of adenosine monophosphate activated kinase (AMPK)-α and inhibition of mammalian target of rapamycin and p70 ribosomal S6 kinase. Activation of AMPK-α suggested impairments in energy production, which was reflected by decrease in O2 consumption and bioenergetic reserve capacity of cultured cells. Knockdown of AMPK-α (siRNA) also preserved tube formation during rotenone, suggesting the negative effects were mediated by the activation of AMPK-α. Conversely, expression of a constitutively active AMPK-α blocked tube formation. CONCLUSIONS We conclude that activation of AMPK-α during mitochondrial oxidative stress inhibits mammalian target of rapamycin signaling, which impairs phenotypic switching necessary for the growth of blood vessels.
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Affiliation(s)
- Yuh Fen Pung
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA
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Thakker P. Poster 88: Subjective and Objective Outcome Analyses of Total Alloplastic Stock Temporomandibular Joint Replacement Surgery: The Allegheny General Hospital Experience. J Oral Maxillofac Surg 2012. [DOI: 10.1016/j.joms.2012.06.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ibrahim CPH, Thakker P, Miller PA, Barron D. Cardiac rhabdomyoma presenting as left ventricular outflow tract obstruction in a neonate. Interact Cardiovasc Thorac Surg 2003; 2:572-4. [PMID: 17670126 DOI: 10.1016/s1569-9293(03)00150-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
A case of congenital cardiac rhabdomyoma presenting as left ventricular outflow tract obstruction is reported. Congenital cardiac tumours are rare. Rhabdomyomas are the most common. Fifty-one to 86% of them are associated with tuberous sclerosis. They have a tendency for spontaneous regression. The indications for surgery include haemodynamic compromise and intractable arrhythmias.
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Affiliation(s)
- C P H Ibrahim
- Department of Paediatrics, Wordsley Hospital, West Midlands, UK.
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Abstract
The design and synthesis of novel beta-C-mannosides that inhibit the binding of sialyl Lewis x to E-selectin are described. Compounds that contained a phenyl substituent at the C-6 position were found to have increased potency.
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Affiliation(s)
- N Kaila
- Department of Chemical Sciences, Wyeth Research, Cambridge, MA 02140, USA.
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21
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Affiliation(s)
- P Thakker
- Department of Anaesthesia, Royal Children's Hospital, Parkville, Vic
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