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Gaipov A, Molnar MZ, Potukuchi PK, Sumida K, Szabo Z, Akbilgic O, Streja E, Rhee CM, Koshy SKG, Canada RB, Kalantar-Zadeh K, Kovesdy CP. Acute kidney injury following coronary revascularization procedures in patients with advanced CKD. Nephrol Dial Transplant 2020; 34:1894-1901. [PMID: 29986054 DOI: 10.1093/ndt/gfy178] [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: 02/23/2018] [Accepted: 05/12/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Previous studies reported that compared with percutaneous coronary interventions (PCIs), coronary artery bypass grafting (CABG) is associated with a reduced risk of mortality and repeat revascularization in patients with mild to moderate chronic kidney disease (CKD) and end-stage renal disease (ESRD). Information about outcomes associated with CABG versus PCI in patients with advanced stages of CKD is limited. We evaluated the incidence and relative risk of acute kidney injury (AKI) associated with CABG versus PCI in patients with advanced CKD. METHODS We examined 730 US veterans with incident ESRD who underwent a first CABG or PCI up to 5 years prior to dialysis initiation. The association of CABG versus PCI with AKI was examined in multivariable adjusted logistic regression analyses. RESULTS A total of 466 patients underwent CABG and 264 patients underwent PCI. The mean age was 64 ± 8 years, 99% were male, 20% were African American and 84% were diabetic. The incidence of AKI in the CABG versus PCI group was 67% versus 31%, respectively (P < 0.001). The incidence of all stages of AKI were higher after CABG compared with PCI. CABG was associated with a 4.5-fold higher crude risk of AKI {odds ratio [OR] 4.53 [95% confidence interval (CI) 3.28-6.27]; P < 0.001}, which remained significant after multivariable adjustments [OR 3.50 (95% CI 2.03-6.02); P < 0.001]. CONCLUSION CABG was associated with a 4.5-fold higher risk of AKI compared with PCI in patients with advanced CKD. Despite other benefits of CABG over PCI, the extremely high risk of AKI associated with CABG should be considered in this vulnerable population when deciding on the optimal revascularization strategy.
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Affiliation(s)
- Abduzhappar Gaipov
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Extracorporeal Hemocorrection, National Scientific Medical Research Center, Astana, Kazakhstan
| | - Miklos Z Molnar
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, USA.,Department of Surgery and Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Praveen K Potukuchi
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Keiichi Sumida
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Zoltan Szabo
- Department of Cardiothoracic Surgery and Anesthesia, Linköping University Hospital, Linköping, Sweden.,Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Oguz Akbilgic
- Center for Biomedical Informatics, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Elani Streja
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, CA, USA
| | - Connie M Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, CA, USA
| | - Santhosh K G Koshy
- Division of Cardiology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Robert B Canada
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, CA, USA
| | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Nephrology Section, Memphis VA Medical Center, Memphis, TN, USA
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Koshy SKG, George MK, George LK. Value of early detection of left ventricular mechanical dyssynchrony for assessing long‐term outcomes. Echocardiography 2019; 36:1970-1971. [DOI: 10.1111/echo.14527] [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] [Indexed: 11/29/2022] Open
Affiliation(s)
- Santhosh K. G. Koshy
- Department of Internal Medicine Texas Tech University Health Sciences Center Lubbock Texas
| | - Mathew K. George
- Department of Anatomy and Neurobiology University of Tennessee Health Sciences Center Memphis Tennessee
| | - Lekha K. George
- Department of Internal Medicine Texas Tech University Health Sciences Center Lubbock Texas
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Gaipov A, Molnar MZ, Potukuchi PK, Sumida K, Canada RB, Akbilgic O, Kabulbayev K, Szabo Z, Koshy SKG, Kalantar-Zadeh K, Kovesdy CP. Predialysis coronary revascularization and postdialysis mortality. J Thorac Cardiovasc Surg 2019; 157:976-983.e7. [PMID: 31431793 PMCID: PMC6701475 DOI: 10.1016/j.jtcvs.2018.08.107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objectives Coronary artery bypass grafting (CABG) is associated with better survival than percutaneous coronary intervention (PCI) in patients with mild-to-moderate chronic kidney disease (CKD) and End-Stage Renal Disease (ESRD). However, the optimal strategy for coronary artery revascularization in advanced CKD patients who transition to ESRD is unclear. Methods We examined a contemporary national cohort of 971 US veterans with incident ESRD, who underwent first CABG or PCI up to 5 years prior to dialysis initiation. We examined the association of a history of CABG versus PCI with all-cause mortality following transition to dialysis, using Cox proportional hazards models adjusted for time between procedure and dialysis initiation, socio-demographics, comorbidities and medications. Results 582 patients underwent CABG and 389 patients underwent PCI. The mean age was 66±8 years, 99% of patients were male, 79% were white, 19% were African Americans, and 84% were diabetics. The all-cause post-dialysis mortality rates after CABG and PCI were 229/1000 patient-years (PY) [95% CI: 205-256] and 311/1000PY [95% CI: 272-356], respectively. Compared to PCI, patients who underwent CABG had 34% lower risk of death [multivariable adjusted Hazard Ratio (95% CI) 0.66 (0.51-0.86), p=0.002] after initiation of dialysis. Results were similar in all subgroups of patients stratified by age, race, type of intervention, presence/absence of myocardial infarction, congestive heart failure and diabetes. Conclusion CABG in advanced CKD patients was associated lower risk of death after initiation of dialysis compared to PCI.
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Affiliation(s)
- Abduzhappar Gaipov
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
- Department of Extracorporeal Hemocorrection, National Scientific Medical Research Center, Astana, Kazakhstan
| | - Miklos Z Molnar
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, USA
- Department of Surgery and Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Praveen K Potukuchi
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Keiichi Sumida
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Robert B Canada
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Oguz Akbilgic
- Center for Biomedical Informatics, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Kairat Kabulbayev
- Department of Nephrology, Kazakh National Medical University, Almaty, Kazakhstan
| | - Zoltan Szabo
- Department of Cardiothoracic Surgery and Anesthesia, Linköping University Hospital, Linkoping, Sweden
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Santhosh K G Koshy
- Division of Cardiology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange, CA, United States
| | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
- Nephrology Section, Memphis VA Medical Center, Memphis, TN, United States
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Koshy SKG, George EK, George LK. Value of echocardiogram in predicting sudden cardiac death: A look beyond ejection fraction. Echocardiography 2019; 36:431-432. [DOI: 10.1111/echo.14298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Santhosh K. G. Koshy
- Department of Internal Medicine; Texas Tech University Health Sciences Center; Lubbock Texas
| | - Elizabeth K. George
- Department of Internal Medicine; Texas Tech University Health Sciences Center; Lubbock Texas
| | - Lekha K. George
- Department of Internal Medicine; Texas Tech University Health Sciences Center; Lubbock Texas
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Morsy M, Slomka T, Shukla A, Uppal D, Bomb R, Akinseye OA, Koshy SKG, Garg N. Clinical and echocardiographic predictors of new-onset atrial fibrillation in patients admitted with blunt trauma. Echocardiography 2018; 35:1519-1524. [DOI: 10.1111/echo.14090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | - Anuj Shukla
- Division of Cardiology; UTHSC; Memphis TN USA
| | - Dipan Uppal
- Division of Cardiology; UTHSC; Memphis TN USA
| | - Ritin Bomb
- Division of Cardiology; UTHSC; Memphis TN USA
| | | | | | - Nadish Garg
- Division of Cardiology; UTHSC; Memphis TN USA
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Affiliation(s)
- Santhosh K G Koshy
- Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | - Lekha K George
- Regional One Health, Memphis, TN, USA.,Department of Medicine, Department of Physician Assistant Studies, University of Tennessee Health Sciences Center, Memphis, TN, USA
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George LK, Koshy SKG, Molnar MZ, Thomas F, Lu JL, Kalantar-Zadeh K, Kovesdy CP. Heart Failure Increases the Risk of Adverse Renal Outcomes in Patients With Normal Kidney Function. Circ Heart Fail 2017; 10:e003825. [PMID: 28765150 PMCID: PMC5557387 DOI: 10.1161/circheartfailure.116.003825] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 07/03/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Heart failure (HF) is associated with poor cardiac outcomes and mortality. It is not known whether HF leads to poor renal outcomes in patients with normal kidney function. We hypothesized that HF is associated with worse long-term renal outcomes. METHODS AND RESULTS Among 3 570 865 US veterans with estimated glomerular filtration rate (eGFR) ≥60 mL min-1 1.73 m-2 during October 1, 2004 to September 30, 2006, we identified 156 743 with an International Classification of Diseases, Ninth Revision, diagnosis of HF. We examined the association of HF with incident chronic kidney disease (CKD), the composite of incident CKD or mortality, and rapid rate of eGFR decline (slopes steeper than -5 mL min-1 1.73 m-2 y-1) using Cox proportional hazard analyses and logistic regression. Adjustments were made for various confounders. The mean±standard deviation baseline age and eGFR of HF patients were 68±11 years and 78±14 mL min-1 1.73 m-2 and in patients without HF were 59±14 years and 84±16 mL min-1 1.73 m-2, respectively. HF patients had higher prevalence of hypertension, diabetes mellitus, cardiac, peripheral vascular and chronic lung diseases, stroke, and dementia. Incidence of CKD was 69.0/1000 patient-years in HF patients versus 14.5/1000 patient-years in patients without HF, and 22% of patients with HF had rapid decline in eGFR compared with 8.5% in patients without HF. HF patients had a 2.12-, 2.06-, and 2.13-fold higher multivariable-adjusted risk of incident CKD, composite of CKD or mortality, and rapid eGFR decline, respectively. CONCLUSIONS HF is associated with significantly higher risk of incident CKD, incident CKD or mortality, and rapid eGFR decline. Early diagnosis and management of HF could help reduce the risk of long-term renal complications.
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Affiliation(s)
- Lekha K George
- From the Division of Nephrology, Department of Medicine (L.K.G., M.Z.M., J.L.L., C.P.K.), Division of Cardiology, Department of Medicine (S.K.G.K.), and Division of Biostatistics and Epidemiology, Department of Preventive Medicine (F.T.), University of Tennessee Health Sciences Center, Memphis; Regional One Health, Memphis, TN (S.K.G.K.); Division of Nephrology, University of California, Irvine (K.K.-Z.); and Nephrology Section, Memphis Veterans Affairs Medical Center, TN (C.P.K.)
| | - Santhosh K G Koshy
- From the Division of Nephrology, Department of Medicine (L.K.G., M.Z.M., J.L.L., C.P.K.), Division of Cardiology, Department of Medicine (S.K.G.K.), and Division of Biostatistics and Epidemiology, Department of Preventive Medicine (F.T.), University of Tennessee Health Sciences Center, Memphis; Regional One Health, Memphis, TN (S.K.G.K.); Division of Nephrology, University of California, Irvine (K.K.-Z.); and Nephrology Section, Memphis Veterans Affairs Medical Center, TN (C.P.K.)
| | - Miklos Z Molnar
- From the Division of Nephrology, Department of Medicine (L.K.G., M.Z.M., J.L.L., C.P.K.), Division of Cardiology, Department of Medicine (S.K.G.K.), and Division of Biostatistics and Epidemiology, Department of Preventive Medicine (F.T.), University of Tennessee Health Sciences Center, Memphis; Regional One Health, Memphis, TN (S.K.G.K.); Division of Nephrology, University of California, Irvine (K.K.-Z.); and Nephrology Section, Memphis Veterans Affairs Medical Center, TN (C.P.K.)
| | - Fridtjof Thomas
- From the Division of Nephrology, Department of Medicine (L.K.G., M.Z.M., J.L.L., C.P.K.), Division of Cardiology, Department of Medicine (S.K.G.K.), and Division of Biostatistics and Epidemiology, Department of Preventive Medicine (F.T.), University of Tennessee Health Sciences Center, Memphis; Regional One Health, Memphis, TN (S.K.G.K.); Division of Nephrology, University of California, Irvine (K.K.-Z.); and Nephrology Section, Memphis Veterans Affairs Medical Center, TN (C.P.K.)
| | - Jun L Lu
- From the Division of Nephrology, Department of Medicine (L.K.G., M.Z.M., J.L.L., C.P.K.), Division of Cardiology, Department of Medicine (S.K.G.K.), and Division of Biostatistics and Epidemiology, Department of Preventive Medicine (F.T.), University of Tennessee Health Sciences Center, Memphis; Regional One Health, Memphis, TN (S.K.G.K.); Division of Nephrology, University of California, Irvine (K.K.-Z.); and Nephrology Section, Memphis Veterans Affairs Medical Center, TN (C.P.K.)
| | - Kamyar Kalantar-Zadeh
- From the Division of Nephrology, Department of Medicine (L.K.G., M.Z.M., J.L.L., C.P.K.), Division of Cardiology, Department of Medicine (S.K.G.K.), and Division of Biostatistics and Epidemiology, Department of Preventive Medicine (F.T.), University of Tennessee Health Sciences Center, Memphis; Regional One Health, Memphis, TN (S.K.G.K.); Division of Nephrology, University of California, Irvine (K.K.-Z.); and Nephrology Section, Memphis Veterans Affairs Medical Center, TN (C.P.K.)
| | - Csaba P Kovesdy
- From the Division of Nephrology, Department of Medicine (L.K.G., M.Z.M., J.L.L., C.P.K.), Division of Cardiology, Department of Medicine (S.K.G.K.), and Division of Biostatistics and Epidemiology, Department of Preventive Medicine (F.T.), University of Tennessee Health Sciences Center, Memphis; Regional One Health, Memphis, TN (S.K.G.K.); Division of Nephrology, University of California, Irvine (K.K.-Z.); and Nephrology Section, Memphis Veterans Affairs Medical Center, TN (C.P.K.).
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Reddy HK, Koshy SKG, Wasson S, Quan EE, Pagni S, Roberts AM, Joshua IG, Tyagi SC. Adaptive-Outward and Maladaptive-Inward Arterial Remodeling Measured by Intravascular Ultrasound in Hyperhomocysteinemia and Diabetes. J Cardiovasc Pharmacol Ther 2016; 11:65-76. [PMID: 16703221 DOI: 10.1177/107424840601100106] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Coronary artery remodeling implies structural changes in the vessel wall in response to various pathophysiologic conditions. However, the classification of remodeling is unclear. We hypothesized that the adaptive, positive-outward remodeling is a reactive and compensatory response to the stress. The maladaptive negative-inward constrictive remodeling is a passive atherosclerotic condition in which the vessel becomes stiffer. Methods: Patients with atherosclerotic lesions underwent intravascular ultrasound (IVUS) scans. The size of the vessels distal to and proximal to plaques were analyzed by IVUS. Diabetes was created in mice by an intraperitoneal injection of alloxan (65 mg/kg). To reduce remodeling, mice received ciglitazone, an agonist of peroxisome proliferators activated receptor-g (PPARg) in drinking water. After 8 weeks, atherosclerotic vessels were analyzed for collagen and elastin. Results: IVUS data suggest an adaptive coronary arterial remodeling was a positive compensatory response to various pathologic stimuli; for example, with the deposition of atherosclerotic plaque, coronary arterial segments enlarged to maintain luminal area. This phenomenon was commonly observed during the initial phases of the development of atherosclerosis. However, negative coronary artery remodeling, or a decrease in vessel area with the formation of atherosclerotic plaque, was maladaptive and was associated with smoking, hypertension, hyperhomocysteinemia, diabetes mellitus, and also after percutaneous coronary interventions (restenosis). In diabetic mice, there was increased collagen and decreased elastin contents; however, treatment with ciglitazone ameliorated the decrease in elastin contents. Conclusion: Global enlargement of the coronary vascular tree occurs during pressure and volume overload associated with ventricular hypertrophic states such as athletic conditioning, hypertensive heart disease, and dilated cardiomyopathy. On the other hand, maladaptive coronary arterial remodeling occurs in patients with severe deconditioning, diabetes mellitus, after coronary artery bypass surgery, and in some instances, postintervention.
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Affiliation(s)
- Hanumanth K Reddy
- Division of Cardiology, University of Missouri Hospital, Columbia, MO, USA
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George LK, Molnar MZ, Lu JL, Kalantar-Zadeh K, Koshy SKG, Kovesdy CP. Association of Pre-Operative Albuminuria with Post-Operative Outcomes after Coronary Artery Bypass Grafting. Sci Rep 2015; 5:16458. [PMID: 26548590 PMCID: PMC4637927 DOI: 10.1038/srep16458] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 07/17/2015] [Accepted: 10/09/2015] [Indexed: 11/18/2022] Open
Abstract
The effect on post-operative outcomes after coronary artery bypass graft(CABG) surgery is not clear. Among 17,812 patients who underwent CABG during October 1,2006-September 28,2012 in any Department of US Veterans Affairs(VA) hospital, we identified 5,968 with available preoperative urine albumin-creatinine ratio(UACR) measurements. We examined the association of UACR<30, 30–299 and >=300 mg/g with 30/90/180/365-day and overall all-cause mortality, and hospitalization length >10 days, and with acute kidney injury(AKI). Mean ± SD baseline age and eGFR were 66 ± 8 years and 77 ± 19 ml/min/1.73 m2, respectively. 788 patients(13.2%) died during a median follow-up of 3.2 years, and 26.8% patients developed AKI(23.1%-Stage 1; 2.9%-Stage 2; 0.8%-Stage 3) within 30 days of CABG. The median lengths of stay were 8 days(IQR: 6–13 days), 10 days(IQR: 7–14 days) and 12 days(IQR: 8–19 days) for groups with UACR < 30 mg/g, 30–299 mg/g and ≥300 mg/g, respectively. Higher UACR conferred 72 to 85% higher 90-, 180-, and 365-day mortality compared to UACR<30 mg/g (odds ratio and 95% confidence interval for UACR≥300 vs. <30 mg/g: 1.72(1.01–2.95); 1.85(1.14–3.01); 1.74(1.15–2.61), respectively). Higher UACR was also associated with significantly longer hospitalizations and higher incidence of all stages of AKI. Higher UACR is associated with significantly higher odds of mortality, longer post-CABG hospitalization, and higher AKI incidence.
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Affiliation(s)
- Lekha K George
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, 956 Court Ave, Memphis, TN, 38163, USA.,Regional One Health, Memphis, 877 Jefferson Ave, Memphis, TN, 38103, USA
| | - Miklos Z Molnar
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, 956 Court Ave, Memphis, TN, 38163, USA
| | - Jun L Lu
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, 956 Court Ave, Memphis, TN, 38163, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, University of California, Irvine, 101 The City Drive, Orange, CA 92868, USA
| | - Santhosh K G Koshy
- Regional One Health, Memphis, 877 Jefferson Ave, Memphis, TN, 38103, USA.,Division of Cardiology, Department of Medicine, University of Tennessee Health Sciences Center, Memphis, 956 Court Ave, Memphis, TN, 38163, USA
| | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, 956 Court Ave, Memphis, TN, 38163, USA.,Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, 1030 Jefferson Ave., Memphis TN 38104, USA
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Koshy SKG, George LK. Predicting left ventricular function recovery after reperfusion in ST elevation myocardial infarction: can we balance cost and accuracy? Echocardiography 2014; 32:613-4. [PMID: 25418115 DOI: 10.1111/echo.12776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Santhosh K G Koshy
- Regional One Health, Memphis, Tennessee; University of Tennessee Health Sciences Center, Memphis, Tennessee
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Shaheen MH, Das P, Koshy SKG, Jha SK, Kabra R. An anticoagulation option for nonvalvular atrial fibrillation. J Fam Pract 2012; 61:E1-E6. [PMID: 22670241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Mazen H Shaheen
- Division of Cardiology, Department of Internal Medicine, University of Tennessee Health Sciences Center, Memphis, TN 38104, USA
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Abstract
Intracardiac echocardiography (ICE) broadens the spectrum of available echocardiographic techniques and provides the operator direct visualization of cardiac structures in real time. ICE has clear advantages over fluoroscopy, transthoracic echocardiography, and transesophageal echocardiography as the imaging modality of choice in the cardiac catheterization and electrophysiological laboratories. With the development of steerable phased array catheters with low frequency and Doppler qualities, there is marked improvement in visualization of left-sided structures from the right heart. Appropriate utilization of ICE is likely to maximize safety and efficacy of complex interventional procedures and may improve patient outcomes. Future advances in ICE imaging will further improve the ease of device guidance and, in combination with new imaging modalities, could dramatically improve other applications of echocardiography which may result in improved patient outcomes. This review describes the technical evolution of ICE, the use of ICE in guiding percutaneous interventional procedures and possible future applications of ICE in the ever-growing field of interventional cardiology.
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Affiliation(s)
- Sheharyar Ali
- Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Koshy SKG, Kleiman NS, George LK, Misra V, Hillegass WB, Brott BC. Vascular changes and black hole phenomenon after coronary brachytherapy: a pathologically distinct entity. J Invasive Cardiol 2008; 20:560-562. [PMID: 18830004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Restenosis remains an important issue even after coronary brachytherapy despite its efficacy in the treatment for in-stent restenosis. The acute and chronic changes in vascular wall are unique following brachytherapy. The restenotic tissue post coronary brachytherapy is relatively acellular and appears echolucent in intravascular ultrasound examination. This is dubbed the "black hole" phenomenon. Despite the similarity in the mode of action of brachytherapy and drug eluting stent implantation, the black hole phenomenon seems to be uncommon after drug-eluting stent implantation except in those patients who have had prior brachytherapy, bare-metal placement and after treatment of saphenous venous graft stenosis. It is possible that not all neointima in stents are created equal. We should propose that neointima be considered primary neointima if it forms after bare metal stenting, secondary neointima if it forms after CBT or DES, and perhaps tertiary if after combined CBT and DES. This type of classification may prove useful for research or clinical purposes. Almost certainly black hole phenomenon results from a modified neointima. However, we do not know whether this is the same restenotic tissue that was present before CBT but just depleted of its cellular element secondary to autolysis or a newly formed tertiary neointima? It is also not clear whether the changes in vascular wall and restenosis are similar after CBT or drug-eluting stent placement. However, there are some unique vascular changes that seem to be common after both of these procedures.
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Affiliation(s)
- Santhosh K G Koshy
- Department of Medicine, University of Tennessee Health Science Center, 1211 Union Avenue, Suite 340, Memphis, TN 38104, USA.
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Abstract
BACKGROUND Coronary artery remodeling is a structural change in the vessel wall and typically in response to atherosclerotic plaque. The nature of coronary remodeling has been described in different clinical situations. However, remodeling characteristics of coronary arteries of diabetic patients have never been studied. HYPOTHESIS We tested the hypothesis that positive remodeling of coronary artery in response to atherosclerotic plaque in diabetic patients would be less compared to nondiabetic patients. METHODS Coronary intravascular ultrasound analysis of data in 26 consecutive patients (12 diabetic and 14 nondiabetic) was performed. Linear regression analyses of vessel area versus plaque area were carried out to establish a relation between the degree of plaque and the extent of remodeling in diabetic and nondiabetic groups. RESULTS The positive remodeling quantified as the slope of the regression line was similar in both the groups (diabetic group 1.32 and nondiabetic group 0.80) when all segments with different plaque areas were considered (P > 0.05). However, the diabetic group had greater positive remodeling in segments with plaque area less than 55%, as the slope for diabetic group was 2.01 and nondiabetic group was 1.40 (P < 0.05). CONCLUSIONS Both the diabetic and nondiabetic patients had positive remodeling in response to atherosclerotic plaque formation. Diabetics had greater positive remodeling in the early stages of atherosclerosis compared to nondiabetics, thus providing evidence against our hypothesis. The adverse clinical outcomes in diabetics may not be due to inadequate positive remodeling of coronary arteries as previously thought.
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Affiliation(s)
- Hanumanth K Reddy
- Department of Internal Medicine, Division of Cardiology, University of Missouri-Columbia, Columbia, Missouri, USA.
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Reddy HK, Koshy SKG, Sturek M, Jayam VK, Bedi A, McCullough PA. Rationale and methods for assessment of coronary flow prior to coronary intervention: where are we headed? J Interv Cardiol 2002; 15:335-41. [PMID: 12238433 DOI: 10.1111/j.1540-8183.2002.tb01114.x] [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] [Indexed: 11/29/2022] Open
Affiliation(s)
- Hanumanth K Reddy
- University of Missouri-Columbia School of Medicine, Department of Internal Medicine, Division of Cardiology, Dalton Cardiovascular Research Center, Columbia, USA
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