1
|
Babapoor-Farrokhran S, Alzubi J, Port Z, Kaul R, Rasekhi RT, Farrokhran AB, Sooknanan N, Wiener PC, Khraisha O, Frishman WH, Mainigi SK, Aronow WS. Left Atrial Appendage Closure: What Do We Know? Cardiol Rev 2023:00045415-990000000-00146. [PMID: 37643211 DOI: 10.1097/crd.0000000000000601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in the United States and the most common cause of embolic cerebrovascular events, with the majority of these thrombi originating in the left atrial appendage. The left atrial appendage (LAA) has separate developmental, ultrastructural, and physiological characteristics from the left atrium. Although LAA anatomy is highly variable, it can be categorized into 4 types: cactus, cauliflower, chicken wing, and windsock. The cauliflower type is associated with higher stroke risk in patients with nonvalvular AF. Although the cornerstone of therapy to prevent embolic strokes from AF has been anticoagulation with thrombin inhibitors, a large group of patients are unable to tolerate anticoagulation due to bleeding. This has led to the development and advancement of multiple surgical and percutaneous LAA closure devices to prevent embolic cerebrovascular accidents without the need for anticoagulation. In this article, we discuss the outcomes of major studies that utilized surgical LAA occlusion and its effectiveness. Furthermore, we summarize nonsurgical methods of LAA closure and future directions regarding LAA closure.
Collapse
Affiliation(s)
- Savalan Babapoor-Farrokhran
- From the Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, NY
| | - Jafar Alzubi
- vision of Cardiology, Department of Medicine, Einstein Medical Center, Philadelphia, PA
| | - Zachary Port
- vision of Cardiology, Department of Medicine, Einstein Medical Center, Philadelphia, PA
| | - Risheek Kaul
- From the Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, NY
| | | | | | - Naveen Sooknanan
- vision of Cardiology, Department of Medicine, Einstein Medical Center, Philadelphia, PA
| | - Philip C Wiener
- Department of Internal Medicine, Division of Cardiology, Washington University in St. Louis, St. Louis, MO
| | - Ola Khraisha
- vision of Cardiology, Department of Medicine, Einstein Medical Center, Philadelphia, PA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - William H Frishman
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Sumeet K Mainigi
- vision of Cardiology, Department of Medicine, Einstein Medical Center, Philadelphia, PA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| |
Collapse
|
2
|
Rasekhi RT, Hosseini N, Babapoor-Farrokhran S, Farrokhran AB, Behzad B. A rare case of primary adult cardiac rhabdomyosarcoma with lower extremity metastasis. Radiol Case Rep 2023; 18:1666-1670. [PMID: 36873043 PMCID: PMC9982449 DOI: 10.1016/j.radcr.2023.01.089] [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: 12/25/2022] [Accepted: 01/26/2023] [Indexed: 02/27/2023] Open
Abstract
Primary cardiac tumors are uncommon. Rhabdomyosarcomas are among the rarest type of cardiac sarcomas. Echocardiography, cardiac MRI, and computed tomography scan can help the diagnosis and presurgical management. In this article, we report a rare case of primary cardiac rhabdomyosarcoma originating from the mitral valve with left femoral metastasis in a patient in her 60s. The diagnosis was made using transesophageal echocardiography and cardiac MRI. A metastatic lesion was found in an extended PET scan in one of her clinical follow-ups due to her leg pain. Based on this report, we suggest that extending PET scan to the lower extremities could be helpful in the early diagnosis and treatment of remote metastases of cardiac rhabdomyosarcomas.
Collapse
Affiliation(s)
| | | | - Savalan Babapoor-Farrokhran
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, NY, USA
| | | | - Barzin Behzad
- Department of Radiology, Division of Musculoskeletal, University of Pennsylvania, 3737 Market St, Mialbox #4, Philadelphia, PA 19104
| |
Collapse
|
3
|
Babapoor S, Port Z, Wiener PC, Rasekhi RT, Farrokhran AB, Mainigi SK. COVID-19 Can Unveil Brugada: A Rare Case. Acta Medica (Hradec Kralove) 2023; 66:68-71. [PMID: 37930096 DOI: 10.14712/18059694.2023.18] [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] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Brugada syndrome (BRS) is a channelopathy with three characteristic electrocardiogram patterns and an increased risk of sudden cardiac death (SCD), in the absence of gross structural heart disease. Fever is shown to precipitate ventricular arrhythmias in patients with BRS. Here, we report a rare case of Brugada pattern in a patient with Coronavirus Disease 2019 (COVID-19) without fever. A baseline ECG should be considered for patients with COVID-19, even in the absence of fever. COVID-19 by itself may be a factor that can induce Brugada pattern ECGs.
Collapse
Affiliation(s)
- Savalan Babapoor
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, NY, USA.
| | - Zachary Port
- Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia, PA, USA
| | - Philip C Wiener
- Department of Internal Medicine, Division of Cardiology, Washington University in St. Louis, St. Louis, MO, USA
| | | | | | - Sumeet K Mainigi
- Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia, PA, USA
| |
Collapse
|
4
|
Tarighati Rasekhi R, Devlin KN, Sperling MR, Nei M. Response: SUDEP-7 Inventory: Validation in a retrospective cohort study. Epilepsia 2021; 62:2873-2874. [PMID: 34545575 DOI: 10.1111/epi.17073] [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: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Roozbeh Tarighati Rasekhi
- Department of Radiology and Imaging Sciences, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Kathryn N Devlin
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Michael R Sperling
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Maromi Nei
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| |
Collapse
|
5
|
Tarighati Rasekhi R, Devlin KN, Mass JA, Donmez M, Asma B, Sperling MR, Nei M. Improving prediction of sudden unexpected death in epilepsy: From SUDEP-7 to SUDEP-3. Epilepsia 2021; 62:1536-1545. [PMID: 34086290 DOI: 10.1111/epi.16928] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Sudden unexpected death in epilepsy (SUDEP) is a significant cause of mortality in epilepsy. The aim of this study is to evaluate the validity of the SUDEP-7 inventory and its components as tools for predicting SUDEP risk, and to develop and validate an improved inventory. METHODS The study included 28 patients who underwent video-electroencephalography (EEG) monitoring and later died of SUDEP, and 56 age- and sex-matched control patients with epilepsy. The SUDEP-7 score, its individual components, and an alternative inventory were examined as predictors of SUDEP. RESULTS SUDEP-7 scores were significantly higher among SUDEP patients compared with controls, both at time of admission (p = 0.024) and most recent follow-up (p = 0.016). SUDEP-7 scores declined only among controls, who demonstrated reduced seizure frequency. Seizure freedom after epilepsy surgery was also associated with survival. Several components of the SUDEP-7 inventory were independently associated with higher risk of SUDEP, including more than three generalized tonic-clonic (GTC) seizures (p = 0.002), one or more GTC seizures (p = 0.001), or one or more seizures of any type within the last year (p = 0.013), and intellectual disability (p = 0.031). In stepwise regression models, SUDEP-7 scores did not enhance the prediction of SUDEP over either GTC seizure frequency or seizure frequency alone. A novel SUDEP-3 inventory comprising GTC seizure frequency, seizure frequency, and intellectual disability (p < 0.001) outperformed the SUDEP-7 inventory (p = 0.010) in predicting SUDEP. SIGNIFICANCE Our findings demonstrate the limitations of the SUDEP-7 inventory. We propose a new three-item SUDEP-3 inventory, which predicts SUDEP better than the SUDEP-7.
Collapse
Affiliation(s)
- Roozbeh Tarighati Rasekhi
- Department of Radiology and Imaging Sciences, School of Medicine, Emory University, Atlanta, GA, USA
| | - Kathryn N Devlin
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Joely A Mass
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mustafa Donmez
- Deprtment of Neurology, University of Massachusetts Memorial Medical Center, Worcester, MA, USA
| | - Burcu Asma
- Department of Neurology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Michael R Sperling
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Maromi Nei
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| |
Collapse
|
6
|
Babapoor-Farrokhran S, Tarighati Rasekhi R, Gill D, Alzubi J, Mainigi SK. How transforming growth factor contributes to atrial fibrillation? Life Sci 2020; 266:118823. [PMID: 33309721 DOI: 10.1016/j.lfs.2020.118823] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 12/12/2022]
Abstract
Atrial fibrillation (AF) is the most common clinically significant arrhythmia. There are four fundamental pathophysiological mechanisms of AF including: electrical remodeling, structural remodeling, autonomic nervous system changes, and Ca2+ handling abnormalities. The transforming growth factor-β (TGF-β) superfamily are cytokines that have the ability to regulate numerous cell functions including proliferation, differentiation, apoptosis, epithelial-mesenchymal transition, and production of extracellular matrix. During the last decade numerous studies have demonstrated that TGF-β affects the architecture of the heart. TGF-β1 has been shown to be involved in the development and propagation of atrial fibrillation (AF). Investigators have studied TGF-β signaling in AF with the aim of discovering potential therapeutic agents. In this review we discuss the role of TGF-β in atrial fibrillation and specifically its role in atrial structural and electrical remodeling.
Collapse
Affiliation(s)
| | - Roozbeh Tarighati Rasekhi
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Deanna Gill
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Jafar Alzubi
- Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia, PA 19141, USA
| | - Sumeet K Mainigi
- Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia, PA 19141, USA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| |
Collapse
|
7
|
Barfejani AH, Jafarvand M, Seyedsaadat SM, Rasekhi RT. Donepezil in the treatment of ischemic stroke: Review and future perspective. Life Sci 2020; 263:118575. [DOI: 10.1016/j.lfs.2020.118575] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 01/18/2023]
|
8
|
Zhand S, Saghaeian Jazi M, Mohammadi S, Tarighati Rasekhi R, Rostamian G, Kalani MR, Rostamian A, George J, Douglas MW. COVID-19: The Immune Responses and Clinical Therapy Candidates. Int J Mol Sci 2020; 21:E5559. [PMID: 32756480 PMCID: PMC7432271 DOI: 10.3390/ijms21155559] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 02/06/2023] Open
Abstract
The pandemic of coronavirus disease 2019 (COVID-19), with rising numbers of patients worldwide, presents an urgent need for effective treatments. To date, there are no therapies or vaccines that are proven to be effective against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several potential candidates or repurposed drugs are under investigation, including drugs that inhibit SARS-CoV-2 replication and block infection. The most promising therapy to date is remdesivir, which is US Food and Drug Administration (FDA) approved for emergency use in adults and children hospitalized with severe suspected or laboratory-confirmed COVID-19. Herein we summarize the general features of SARS-CoV-2's molecular and immune pathogenesis and discuss available pharmacological strategies, based on our present understanding of SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV) infections. Finally, we outline clinical trials currently in progress to investigate the efficacy of potential therapies for COVID-19.
Collapse
Affiliation(s)
- Sareh Zhand
- School of Biomedical Engineering, University of Technology Sydney, Sydney, NSW 2007, Australia;
- Department of Microbiology, Faculty of Biological Sciences and technology, Shahid Beheshti University, Tehran 1983969411, Iran
| | - Marie Saghaeian Jazi
- Metabolic Disorders Research Center, Golestan University of Medcial Sciences, Gorgan 4934174515, Iran;
- Stem Cell Research Center, Golestan University of Medical Sciences, Gorgan 4934174515, Iran;
| | - Saeed Mohammadi
- Stem Cell Research Center, Golestan University of Medical Sciences, Gorgan 4934174515, Iran;
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan 4934174515, Iran
| | - Roozbeh Tarighati Rasekhi
- Department of Radiology and Imaging Sciences, School of Medicine, Emory University, Atlanta, GA 30322, USA;
| | | | - Mohammad Reza Kalani
- Medical Cellular and Molecular Research Centre, Golestan University of Medical Sciences, Gorgan 4934174515, Iran;
| | - Aida Rostamian
- Department of Clinical Sciences, Faculty of Veterinary Science, Islamic Azad University of Karaj, Alborz 3149968111, Iran;
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, NSW 2145, Australia
| | - Mark W Douglas
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, NSW 2145, Australia
- Centre for Infectious Diseases and Microbiology, Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney at Westmead Hospital, Sydney, NSW 2145, Australia
| |
Collapse
|
9
|
Babapoor-Farrokhran S, Gill D, Rasekhi RT. The role of long noncoding RNAs in atrial fibrillation. Heart Rhythm 2020; 17:1043-1049. [DOI: 10.1016/j.hrthm.2020.01.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/14/2020] [Indexed: 12/18/2022]
|
10
|
Babapoor-Farrokhran S, Gill D, Walker J, Rasekhi RT, Bozorgnia B, Amanullah A. Myocardial injury and COVID-19: Possible mechanisms. Life Sci 2020; 253:117723. [PMID: 32360126 PMCID: PMC7194533 DOI: 10.1016/j.lfs.2020.117723] [Citation(s) in RCA: 269] [Impact Index Per Article: 67.3] [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] [Received: 04/15/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 02/07/2023]
Abstract
Coronavirus Disease 2019 (COVID-19) has quickly progressed to a global health emergency. Respiratory illness is the major cause of morbidity and mortality in these patients with the disease spectrum ranging from asymptomatic subclinical infection, to severe pneumonia progressing to acute respiratory distress syndrome. There is growing evidence describing pathophysiological resemblance of SARS-CoV-2 infection with other coronavirus infections such as Severe Acute Respiratory Syndrome coronavirus and Middle East Respiratory Syndrome coronavirus (MERS-CoV). Angiotensin Converting Enzyme-2 receptors play a pivotal role in the pathogenesis of the virus. Disruption of this receptor leads to cardiomyopathy, cardiac dysfunction, and heart failure. Patients with cardiovascular disease are more likely to be infected with SARS-CoV-2 and they are more likely to develop severe symptoms. Hypertension, arrhythmia, cardiomyopathy and coronary heart disease are amongst major cardiovascular disease comorbidities seen in severe cases of COVID-19. There is growing literature exploring cardiac involvement in SARS-CoV-2. Myocardial injury is one of the important pathogenic features of COVID-19. As a surrogate for myocardial injury, multiple studies have shown increased cardiac biomarkers mainly cardiac troponins I and T in the infected patients especially those with severe disease. Myocarditis is depicted as another cause of morbidity amongst COVID-19 patients. The exact mechanisms of how SARS-CoV-2 can cause myocardial injury are not clearly understood. The proposed mechanisms of myocardial injury are direct damage to the cardiomyocytes, systemic inflammation, myocardial interstitial fibrosis, interferon mediated immune response, exaggerated cytokine response by Type 1 and 2 helper T cells, in addition to coronary plaque destabilization, and hypoxia.
Collapse
Affiliation(s)
| | - Deanna Gill
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Jackson Walker
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Roozbeh Tarighati Rasekhi
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Behnam Bozorgnia
- Division of Cardiology, Department of Medicine, Einstein Medical Center, Philadelphia, PA 19141, USA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Aman Amanullah
- Division of Cardiology, Department of Medicine, Einstein Medical Center, Philadelphia, PA 19141, USA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| |
Collapse
|