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Malik AA, Lloyd JW, Anavekar NS, Luis SA. Acute and Complicated Inflammatory Pericarditis: A Guide to Contemporary Practice. Mayo Clin Proc 2024; 99:795-811. [PMID: 38702128 DOI: 10.1016/j.mayocp.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 11/15/2023] [Accepted: 01/25/2024] [Indexed: 05/06/2024]
Abstract
Inflammatory disease of the pericardium represents a relatively common presentation, especially among the young. For the most part, inflammatory pericardial disease can be expeditiously and effectively managed without significant sequelae. However, some individuals present with severe and recurrent illness, representing significant therapeutic challenges. During the past decade, there have been great strides made in developing an evidence-based approach to management of inflammatory pericardial disease, the result of which has been the development of (1) a systematic, protocoled approach to initial care; (2) targeted therapeutics; and (3) specialized, collaborative, and integrated care pathways. Herein we present a review of the current state of the art as it pertains to the diagnostic evaluation and therapeutic considerations in inflammatory pericardial disease with a focus on acute and complicated pericarditis.
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Affiliation(s)
- Awais A Malik
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
| | - James W Lloyd
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Sushil Allen Luis
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
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Luis SA, Michelena HI, Nkomo VT. Navigating the Complex Landscape of Atrial Functional Mitral Regurgitation: Insights, Challenges, and Emerging Interventions. Am J Cardiol 2024; 213:170-172. [PMID: 38103768 DOI: 10.1016/j.amjcard.2023.11.065] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 11/29/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Sushil Allen Luis
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Hector I Michelena
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Vuyisile T Nkomo
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Naser JA, Luis SA, Pislaru SV, Michelena HI, Kennedy AM, Eleid MF, Crestanello JA, Chebib FT, Pellikka PA, Nkomo VT. Impact on Kidney Function and Medium-Term Outcomes of Transcatheter Aortic Valve Replacement in Patients With Chronic Kidney Disease. Am J Cardiol 2024; 210:163-171. [PMID: 37863302 DOI: 10.1016/j.amjcard.2023.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 10/22/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is now widely approved for the treatment of aortic stenosis, regardless of the patients' surgical risk. However, the outcomes of TAVR and their determinants in patients with chronic kidney disease (CKD) beyond 1 year of follow-up are unknown. We aimed to assess the medium-term outcomes of TAVR in CKD, develop a risk score to estimate the 2-year mortality in patients with CKD, and evaluate the changes in kidney function at discharge after TAVR. Adults who underwent TAVR were retrospectively identified. The CKD stage was determined using the Chronic Kidney Disease Epidemiology 2021 creatinine formula. Improved kidney function was defined as post-TAVR creatinine ≤50% of pre-TAVR creatinine or decrease in creatinine of ≥0.3 mg/100 ml compared with pre-TAVR creatinine. Overall, 1,523 patients (median age 82 years; 59% men; 735 with CKD stage II or less, 661 with CKD III, 83 with CKD IV, and 44 with CKD V [of whom 40 were on dialysis]) were included. The all-cause mortality was higher in CKD stages IV and V on the multivariable analysis (p <0.001) at median follow-up of 2.9 (interquartile range 2.0 to 4.2) years. Moderate or severe tricuspid regurgitation, anemia, right ventricular systolic pressure >40 mm Hg and CKD stages IV and V were independent predictors of 2-year mortality and were used to develop a risk score. At hospital discharge, persisting acute kidney injury after TAVR occurred in 88 of 1,466 patients (6%), whereas improved kidney function occurred in 170 of 1,466 patients (12%). In conclusion, CKD stage was an independent determinant of mortality beyond 2 years after TAVR. Kidney function was more likely to improve than worsen at the time of hospital discharge after TAVR.
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Affiliation(s)
- Jwan A Naser
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sushil Allen Luis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Austin M Kennedy
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Fouad T Chebib
- Department of Nephrology and Hypertension Division, Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida
| | | | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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Luis SA, Chung R, Stefanescu Schmidt AC, Clark JW, Pearson DS. Case 33-2023: An 86-Year-Old Man with Shortness of Breath. N Engl J Med 2023; 389:1602-1613. [PMID: 37888920 DOI: 10.1056/nejmcpc2300908] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Affiliation(s)
- Sushil Allen Luis
- From the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A.L.); and the Departments of Radiology (R.C.), Medicine (A.C.S.S., J.W.C.), and Pathology (D.S.P.), Massachusetts General Hospital, and the Departments of Radiology (R.C.), Medicine (A.C.S.S., J.W.C.), and Pathology (D.S.P.), Harvard Medical School - both in Boston
| | - Ryan Chung
- From the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A.L.); and the Departments of Radiology (R.C.), Medicine (A.C.S.S., J.W.C.), and Pathology (D.S.P.), Massachusetts General Hospital, and the Departments of Radiology (R.C.), Medicine (A.C.S.S., J.W.C.), and Pathology (D.S.P.), Harvard Medical School - both in Boston
| | - Ada C Stefanescu Schmidt
- From the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A.L.); and the Departments of Radiology (R.C.), Medicine (A.C.S.S., J.W.C.), and Pathology (D.S.P.), Massachusetts General Hospital, and the Departments of Radiology (R.C.), Medicine (A.C.S.S., J.W.C.), and Pathology (D.S.P.), Harvard Medical School - both in Boston
| | - Jeffrey W Clark
- From the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A.L.); and the Departments of Radiology (R.C.), Medicine (A.C.S.S., J.W.C.), and Pathology (D.S.P.), Massachusetts General Hospital, and the Departments of Radiology (R.C.), Medicine (A.C.S.S., J.W.C.), and Pathology (D.S.P.), Harvard Medical School - both in Boston
| | - Daniel S Pearson
- From the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A.L.); and the Departments of Radiology (R.C.), Medicine (A.C.S.S., J.W.C.), and Pathology (D.S.P.), Massachusetts General Hospital, and the Departments of Radiology (R.C.), Medicine (A.C.S.S., J.W.C.), and Pathology (D.S.P.), Harvard Medical School - both in Boston
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Reddy P, Kane GC, Oh JK, Luis SA. The Evolving Etiologic and Epidemiologic Portrait of Pericardial Disease. Can J Cardiol 2023; 39:1047-1058. [PMID: 37217161 DOI: 10.1016/j.cjca.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 05/24/2023] Open
Abstract
Pericardial disease includes a variety of conditions, including inflammatory pericarditis, pericardial effusions, constrictive pericarditis, pericardial cysts, and primary and secondary pericardial neoplasms. The true incidence of this varied condition is not well established, and the causes vary greatly across the world. This review aims to describe the changing pattern of epidemiology of pericardial disease and to provide an overview of causative etiologies. Idiopathic pericarditis (assumed most often to be viral) remains the most common etiology for pericardial disease globally, with tuberculous pericarditis being most common in developing countries. Other important etiologies include fungal, autoimmune, autoinflammatory, neoplastic (both benign and malignant), immunotherapy-related, radiation therapy-induced, metabolic, postcardiac injury, postoperative, and postprocedural causes. Improved understanding of the immune pathophysiological pathways has led to identification and reclassification of some idiopathic pericarditis cases into autoinflammatory etiologies, including immunoglobulin G (IgG)4-related pericarditis, tumour necrosis factor receptor-associated periodic syndrome (TRAPS), and familial Mediterranean fever in the current era. Contemporary advances in percutaneous cardiac interventions and the recent COVID-19 pandemic have also resulted in changes in the epidemiology of pericardial diseases. Further research is needed to improve our understanding of the etiologies of pericarditis, using the assistance of contemporary advanced imaging techniques and laboratory testing. Careful consideration of the range of potential causes and local epidemiologic patterns of causality are important for the optimization of diagnostic and therapeutic approaches.
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Affiliation(s)
- Prajwal Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sushil Allen Luis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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Thomas GK, Bonaventura A, Vecchié A, van Tassell B, Imazio M, Klein A, Luis SA, Abbate A. Interleukin-1 blockers for the treatment of recurrent pericarditis: pathophysiology, patient reported outcomes and perspectives. J Cardiovasc Pharmacol 2023:00005344-990000000-00180. [PMID: 37163222 DOI: 10.1097/fjc.0000000000001435] [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: 05/11/2023]
Abstract
ABSTRACT Recurrent pericarditis (RP) is the most troublesome complication of acute pericarditis reflecting an unresolving inflammation of the pericardial sac around the heart and associated with significant morbidity. Recent studies have shown interleukin-1 (IL-1) signaling to be central to the pathophysiology of cases of RP with evidence of activation of systemic inflammation. We herein review the literature and clinical trials discussing the utility of IL-1 blockade for RP. The early experience of IL-1 blockade with anakinra (Kineret) and its favorable safety profile paved the way for the clinical development of rilonacept (Arcalyst) and subsequent approval by the US FDA for RP. In patients with RP who have become colchicine-resistant and glucocorticoid-dependent, IL-1 blockade with rilonacept or anakinra effectively treats recurrences and prevents future flares, and significantly improves quality of life.
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Affiliation(s)
- Georgia K Thomas
- VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Aldo Bonaventura
- Department of Internal Medicine, ASST Sette Laghi, Varese, Italy
| | | | - Benjamin van Tassell
- VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Massimo Imazio
- Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", Udine, Italy
| | - Allan Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland clinic, Cleveland, OH, United States
| | - Sushil Allen Luis
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Rochester, Minnesota, USA
| | - Antonio Abbate
- Robert M. Berne Cardiovascular Research Center and Division of Cardiology, Department of Internal Medicine, Heart and Vascular Center, University of Virginia, Charlottesville, VA, USA
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Herrera RA, Smith MM, Mauermann WJ, Nkomo VT, Luis SA. Perioperative management of aortic stenosis in patients undergoing non-cardiac surgery. Front Cardiovasc Med 2023; 10:1145290. [PMID: 37089878 PMCID: PMC10117820 DOI: 10.3389/fcvm.2023.1145290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
Aortic stenosis is one of the most common cardiac valve pathologies in the world and its prevalence increases with age. Although previously associated with increased perioperative mortality, more recent studies suggest that mortality rates may be decreasing. Recent guidelines suggest that major non-cardiac surgery can be performed safely in asymptomatic severe aortic stenosis patients with close hemodynamic monitoring. Among symptomatic patients, the guidelines recommend aortic valve intervention prior to major non-cardiac surgery because of a reduction in the incidence of postoperative heart failure and improved rates of long-term overall survival. This review provides a comprehensive and contemporary review of the perioperative management of patients with severe aortic valve stenosis.
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Affiliation(s)
- Roberto A. Herrera
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Mark M. Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - William J. Mauermann
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Vuyisile T. Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Sushil Allen Luis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- Correspondence: Sushil Allen Luis
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Ristic M, Miranda WR, Greason K, Luis SA, Oh JK. PERICARDIECTOMY FOLLOWING ANAKINRA TREATMENT FOR PATIENTS WITH RECURRENT PERICARDITIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01349-9] [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: 03/06/2023]
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Brucato A, Wheeler A, Luis SA, Abbate A, Cremer PC, Zou L, Insalaco A, Lewinter M, Lewis BS, Lin D, Nicholls S, Pancrazi M, Klein AL, Imazio M, Paolini JF. Transition to rilonacept monotherapy from oral therapies in patients with recurrent pericarditis. Heart 2023; 109:297-304. [PMID: 36316102 PMCID: PMC9887401 DOI: 10.1136/heartjnl-2022-321328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/29/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Polypharmacy management of recurrent pericarditis (RP) often involves long-term therapies, often with negative effects. Slow tapering of oral therapies is often required to avoid recurrence. A post hoc analysis of the phase III trial Rilonacept inHibition of interleukin-1 Alpha and beta for recurrent Pericarditis: a pivotal Symptomatology and Outcomes Study (RHAPSODY) evaluated investigator approaches to transitioning to IL-1 blockade monotherapy with rilonacept, which was hypothesised to allow accelerated withdrawal of common multidrug pericarditis regimens. METHODS RHAPSODY was a multicentre (Australia, Israel, Italy, USA), double-blind, placebo-controlled, randomised-withdrawal trial in adults and adolescents with RP. Investigators initiated rilonacept at the labelled dose level and discontinued oral pericarditis therapies during the 12-week run-in; randomised patients received study drug as monotherapy. Time to rilonacept monotherapy was quantified in patients receiving multidrug regimens at baseline who achieved rilonacept monotherapy during run-in. RESULTS In 86 enrolled patients, mean time to rilonacept monotherapy was 7.9 weeks, with no recurrences. Of these, 64% (n=55) entered on multidrug regimens: non-steroidal anti-inflammatory drugs (NSAIDs) plus colchicine (44% (24/55)), colchicine plus glucocorticoids (24% (13/55)), or NSAIDs, colchicine, plus glucocorticoids (33% (18/55)). Investigators transitioned patients receiving colchicine and glucocorticoids at baseline to rilonacept monotherapy without recurrence regardless of taper approach: sequential (n=14; median, 7.7 weeks) or concurrent (n=17; median, 8.0 weeks). Median time to rilonacept monotherapy was similar regardless of glucocorticoid dose and duration: ≤15 mg/day (n=21): 7.3 weeks; >15 mg/day (n=18): 8.0 weeks; long-term (≥28 days): 7.6 weeks. CONCLUSIONS Rapid discontinuation of oral RP therapies while transitioning to rilonacept monotherapy was feasible without triggering pericarditis recurrence. TRIAL REGISTRATION NUMBER NCT03737110.
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Affiliation(s)
- Antonio Brucato
- Department of Biomedical and Clinical Sciences "Sacco", University of Milano, Milano, Italy
| | - Alistair Wheeler
- Clinical Development, Kiniksa Pharmaceuticals Corp, Lexington, Massachusetts, USA
| | - Sushil Allen Luis
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Antonio Abbate
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Paul C Cremer
- Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Liangxing Zou
- Clinical Development, Kiniksa Pharmaceuticals Corp, Lexington, Massachusetts, USA
| | - Antonella Insalaco
- Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, Roma, Lazio, Italy
| | - Martin Lewinter
- Cardiology Unit, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Basil S Lewis
- Department of Cardiology, Lady Davies Carmel Medical Center, Haifa, Haifa, Israel
| | - David Lin
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Stephen Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
| | - Massimo Pancrazi
- Department of Internal Medicine, Fatebenefratelli Hospital, Milan, Italy
| | - Allan L Klein
- Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Massimo Imazio
- Cardiothoracic Department, Santa Maria della Misericordia University Hospital, Udine, Friuli-Venezia Giulia, Italy
| | - John F Paolini
- Clinical Development, Kiniksa Pharmaceuticals Corp, Lexington, Massachusetts, USA
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Brucato A, Lim-Watson MZ, Klein A, Imazio M, Cella D, Cremer P, LeWinter MM, Luis SA, Lin D, Lotan D, Pancrazi M, Trotta L, Klooster B, Litcher-Kelly L, Zou L, Magestro M, Wheeler A, Paolini JF. Interleukin-1 Trap Rilonacept Improved Health-Related Quality of Life and Sleep in Patients With Recurrent Pericarditis: Results From the Phase 3 Clinical Trial RHAPSODY. J Am Heart Assoc 2022; 11:e023252. [PMID: 36250662 DOI: 10.1161/jaha.121.023252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Recurrent pericarditis is characterized by painful flares and inflammation, which negatively impact health-related quality of life. RHAPSODY (rilonacept inhibition of interleukin-1 alpha and beta for recurrent pericarditis: a pivotal symptomatology and outcomes study) evaluated the efficacy and safety of rilonacept (IL-1α and -β cytokine trap) in recurrent pericarditis. A secondary analysis of these data evaluated the patient-reported outcome questionnaire score change during the trial. Methods and Results Participants completed 5 patient-reported outcome (PRO) questionnaires assessing pericarditis pain, health-related quality of life, general health status, sleep impact, and overall symptom severity. PRO score changes during the treatment run-in period (12 weeks) and the blinded randomized withdrawal period (up to 24 weeks) were evaluated using descriptive statistics and mixed model repeated measures analyses. Participants with PRO data from the run-in period (n=84) and the randomized withdrawal period (n=61; 30 rilonacept, 31 placebo) were included in analyses. Run-in baseline PRO scores indicated that pericarditis symptoms during pericarditis recurrence impacted health-related quality of life. All PRO scores significantly improved (P<0.001) on rilonacept treatment during the run-in period. For the randomized withdrawal period, PRO scores were maintained for participants receiving rilonacept. For those receiving placebo and who experienced a recurrence, PRO scores deteriorated at the time of recurrence and then improved following rilonacept bailout. At randomized withdrawal Week 24/End of Study, scores of participants who received bailout rilonacept were similar to those of participants who had continued rilonacept. Conclusions These results demonstrate the burden of pericarditis recurrences and the improved physical and emotional health of patients with recurrent pericarditis while on rilonacept treatment. These findings extend prior rilonacept efficacy results, demonstrating improvements in patient-reported health-related quality of life, sleep, pain, and global symptom severity while on treatment. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03737110.
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Affiliation(s)
| | | | | | - Massimo Imazio
- Cardiology, Cardiothoracic Department University Hospital "Santa Maria della Misericordia," ASUFC Udine Italy
| | | | | | | | | | - David Lin
- Minneapolis Heart Institute Minneapolis MN
| | - Dor Lotan
- Sheba Medical Center and Sackler School of Medicine Tel Aviv University Israel
| | | | - Lucia Trotta
- Università di Milano Fatebenefratelli Hospital Milan Italy
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Naser J, Gochanour BR, Scott CG, Luis SA, Greason KL, Crestanello JA, Gulati R, Eleid MF, Nkomo VT, Pislaru SV. The use of warfarin as part of antithrombotic strategy after transcutaneous aortic valve replacement is not associated with better medium-term outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Bioprosthetic valve thrombosis is currently a well-recognized cause of bioprosthetic valve dysfunction. It was found to be associated with accelerated degeneration of the bioprosthesis with higher rates of valve re-replacement, even after treatment with anticoagulation. We hypothesized that the use of warfarin for three months after transcatheter aortic valve replacement (TAVR) protects against accelerated valve degeneration and is therefore associated with better outcomes compared to dual antiplatelet therapy (DAPT).
Methods
Consecutive adult patients who underwent TAVR in our clinic between 2012 and 2019 were identified retrospectively. Patients with atrial fibrillation were excluded. Subsequently, patients who received DAPT were propensity matched to up to 2 patients who received three months of warfarin as part of their anti-thrombotic regimen. Matching was performed for variables that were significantly different at baseline between the two groups and included diabetes mellitus, prior myocardial infarctions, chronic lung disease, peripheral arterial disease, hemoglobin at time of TAVR, kidney function [creatinine>2], use of angiotensin-converting enzyme inhibitors / angiotensin II receptor blockers, beta blockers, the Society of Thoracic Surgeons (STS) score [STS ≥8, STS 4–8, STS<4], and valve size. The two groups were then compared for outcomes of ischemic stroke, death, valve re-replacement/intervention, the composite endpoint of the aforementioned three outcomes, as well as the three-month outcome of hemorrhagic strokes. Kaplan Meier was used for outcome analysis, and discharge date was considered time zero. Patients who had their anti-thrombotic therapy interrupted were censored at that time point.
Results
A total of 1,373 patients who underwent TAVR were identified. Of these, 576 patients with atrial fibrillation were excluded. Baseline characteristics were compared between 633 patients who received three months of warfarin and 164 patients who received DAPT after TAVR. After matching the two groups, 435 patients were included in the final analysis [warfarin in 281, DAPT in 154; median time to last follow up 2.61 years], Table 1. There was no difference in matched (Figure 1) or unmatched analysis (not shown) in outcomes of ischemic stroke, death, valve re-replacement/intervention, their composite endpoint, or hemorrhagic strokes (p>0.05 for all).
Conclusion
Antithrombotic regimen including three months of warfarin after TAVR was not associated with better outcomes of ischemic strokes, deaths, and valve re-replacement/intervention or with increased risk of hemorrhagic strokes compared to DAPT.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Naser
- Mayo Clinic , Rochester , United States of America
| | | | - C G Scott
- Mayo Clinic , Rochester , United States of America
| | - S A Luis
- Mayo Clinic , Rochester , United States of America
| | - K L Greason
- Mayo Clinic , Rochester , United States of America
| | | | - R Gulati
- Mayo Clinic , Rochester , United States of America
| | - M F Eleid
- Mayo Clinic , Rochester , United States of America
| | - V T Nkomo
- Mayo Clinic , Rochester , United States of America
| | - S V Pislaru
- Mayo Clinic , Rochester , United States of America
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Luis SA, Ayoub C, Padang R. Paroxysmal sinus deceleration: an under-recognized show stopper. Eur Heart J Case Rep 2022; 6:ytac389. [PMID: 36420418 PMCID: PMC9593067 DOI: 10.1093/ehjcr/ytac389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
| | - Chadi Ayoub
- Division of Cardiac Imaging and Stress Testing, Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ, USA
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Luis SA, LeWinter MM, Magestro M, DerSarkissian M, Duh MS, Chang R, Kponee-Shovein K, Muthukumar A, Hu X, Lim-Watson MZ, Klein AL. Estimating the US pericarditis prevalence using national health encounter surveillance databases. Curr Med Res Opin 2022; 38:1385-1389. [PMID: 35470753 DOI: 10.1080/03007995.2022.2070381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To obtain a nationally representative annualized estimate of the prevalence of pericarditis (inflammation of the pericardium) in the United States (US) in order to better understand the potential burden on the health care system. METHODS Three nationally representative datasets were used to estimate the annualized period prevalence and prevalence rate of pericarditis from 2007 to 2016: the National Ambulatory Medical Care Survey (NAMCS), the National Hospital Ambulatory Medical Care Survey (NHAMCS), and the Nationwide Inpatient Sample (NIS). Across all data sources, ICD-9/10 codes were used to identify healthcare encounters with ≥1 primary or secondary diagnosis related to pericarditis irrespective of duration or etiology. The prevalence of pericarditis in 2020 was extrapolated by multiplying the average annualized prevalence rate from 2007 to 2016 by the total US population as of March 2020. RESULTS Data from NAMCS/NHAMCS (2007-2016) yielded an average annualized estimate of 125,209 patients with pericarditis, resulting in a pooled average annualized prevalence estimate of 40 patients with pericarditis per 100,000 persons. Data from NIS (2007-2016) yielded an average annualized estimate of 34,441 patients with pericarditis, resulting in a pooled average annualized prevalence estimate of 11 hospitalized patients with pericarditis per 100,000 persons. Extrapolation of these results based on the March 2020 population estimates from the US Census Bureau of 329,436,928 resulted in an estimated US prevalence of pericarditis to be approximately160,000. CONCLUSION Despite certain methodologic limitations, our analysis of data from nationally representative sources support that pericarditis is a rare disease affecting substantially fewer than 200,000 persons in the US.
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Affiliation(s)
- Sushil Allen Luis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | | | | | - Xingdi Hu
- Kiniksa Pharmaceuticals Corp, Lexington, MA, USA
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Lee JC, Luis SA. The Role of Functional Imaging When Coronary Artery Calcium Is Low or Zero. Am J Cardiol 2022; 169:165-166. [PMID: 35248390 DOI: 10.1016/j.amjcard.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 11/24/2022]
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Siddiqi TJ, Usman MS, Abid M, Menezes R, Hall ME, Khan MS, Luis SA. IS STOPPING MINERALOCORTICOID RECEPTOR ANTAGONISTS AFTER HYPERKALEMIA ASSOCIATED WITH INCREASED MORTALITY IN HEART FAILURE? A SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01397-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Brucato A, Lim-Watson MZ, Imazio M, Klein A, Andreis A, Andreis A, Cella D, Cremer P, Lewinter M, Luis SA, Lin D, Lotan D, Trotta L, Zou L, Wheeler A, Paolini JF. Health-related quality of life in patients with recurrent pericarditis: results from RHAPSODY, a phase 3 study of rilonacept. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Recurrent pericarditis (RP) patients report that painful, debilitating flares negatively impact their health-related quality of life (HRQoL). RHAPSODY, the Phase 3 trial of rilonacept (IL-1α/IL-1β cytokine trap), included a daily pain diary and patient-reported outcome SF-36v2 to measure HRQoL throughout the trial.
Purpose
The purpose of this research is to evaluate the effect of rilonacept on HRQoL in relation to changes in pain for RP patients who have a recurrence.
Methods
RHAPSODY enrolled 86 patients with acute symptomatic RP to receive weekly rilonacept for a 12-week run-in (RI) period and randomized 61 patients (1:1) to receive placebo (n=31) or continue rilonacept (n=30) for the event-driven randomized-withdrawal (RW) period. Patients on placebo who experienced a qualifying recurrence during RW (return of pericarditis pain and increase in C-reactive protein) were rescued with bailout rilonacept. Patients reported daily pericarditis pain electronically, using a 0–10 numeric rating scale (NRS), and completed the SF-36v2 at study visits prior to clinician interaction. Scores from RI Baseline (BL), RI Week 12 (RW BL), Recurrence visit, and RW up to Week 24 (or end of study; EOS) were evaluated for patients who experienced recurrence in RW. Analyses exclude one patient randomized to placebo who had a recurrence after Week 24 of the RW period.
Results
Analyses focused on the 22 of 30 patients (73%) in the placebo group who experienced a recurrence before Week 24 of RW (median time from RW BL to recurrence: 8.6 weeks). During RI, daily pain scores decreased while on rilonacept (Cohen's effect size [ES] d=−2.0), and SF-36v2 scores improved, with scores at RI BL (Fig. 1 red line) below the general population average of 50 and near or above average at RI Week 12 (Fig. 1 blue line); ES were all large (d>0.8), ranging from 0.917 (Mental Component Summary) to 2.021 (Bodily Pain). At recurrence, pain scores increased (d=6.5; Fig. 2) and SF-36v2 scores were below the population average (Fig. 1 orange line), with largest reductions between RI Week 12 (RW BL) and recurrence for Bodily Pain (−13.4) and Physical Component Summary (−10.6). Following rilonacept bailout, average pain decreased (d=−2.1; Fig. 2), and by RW Week 24/EOS, SF-36v2 scores returned to similar levels as at the end of the RI period (Fig. 1 green line).
Conclusion
Impaired RI BL SF-36v2 scores indicate negative impact of RP on HRQOL in RP patients. While receiving rilonacept, HRQoL scores improved to near or above population averages, in conjunction with patient-reported pain. After discontinuing rilonacept during RW, HRQoL scores worsened at recurrence and improved upon receipt of bail-out rilonacept, similar to pain. These results provide support for the broader benefit of rilonacept treatment beyond pain, when administered on top of conventional therapies and as mono-therapy, providing evidence of its potential to improve HRQoL in this patient population.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Kiniksa Pharmaceuticals, Ltd.
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Affiliation(s)
- A Brucato
- Fatebenefratelli Hospital, Milan, Italy
| | - M Z Lim-Watson
- Kiniksa Pharmaceuticals Corp, Lexington, Massachusetts, United States of America
| | - M Imazio
- University Hospital Santa Maria della Misericordia, Udine, Italy
| | - A Klein
- Cleveland Clinic, Cleveland, United States of America
| | - A Andreis
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - A Andreis
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - D Cella
- Northwestern University, Evanston, Illinois, United States of America
| | - P Cremer
- Cleveland Clinic, Cleveland, United States of America
| | - M Lewinter
- The University of Vermont Medical Center, Burlington, United States of America
| | - S A Luis
- Mayo Clinic, Rochester, United States of America
| | - D Lin
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - D Lotan
- Sheba Medical Center, Tel Aviv, Israel
| | - L Trotta
- Fatebenefratelli Hospital, Milan, Italy
| | - L Zou
- Kiniksa Pharmaceuticals Corp, Lexington, Massachusetts, United States of America
| | - A Wheeler
- Kiniksa Pharmaceuticals Corp, Lexington, Massachusetts, United States of America
| | - J F Paolini
- Kiniksa Pharmaceuticals Corp, Lexington, Massachusetts, United States of America
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Reid A, Klein A, Lin D, Abbate A, Luis SA, Petersen J, Portman M, Winnowski D, Malinowski A, Marden L, Paolini JF, Martin D. RESONANCE Registry: rationale and design of the retrospective and prospective longitudinal, observational registry in pediatric and adult patients with recurrent pericarditis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Annually in the United States (US), an estimated 80–90,000 patients are diagnosed with acute pericarditis and 15–30% experience recurrent pericarditis (RP), resulting in increased morbidity and reduced health-related quality of life (HRQoL). Treatment options include non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine. Corticosteroids (CS) are often added to the treatment plan in RP despite CS-associated adverse events and inherent potentiation of recurrence with long-term treatment. A recent Phase 3 clinical trial RHAPSODY (NCT03737110) demonstrated efficacy and safety of rilonacept, an interleukin-1 α and β cytokine trap, in patients with RP. RHAPSODY data helped support FDA approval of the first therapy for RP. With the emergence of this targeted therapy, there is increased interest to learn more about this disease with the goal to better inform treatment and management decisions and improve long-term outcomes.
Purpose
RESONANCE Registry aims to evaluate the natural history of RP by collecting retrospective and prospective, longitudinal physician- and patient-reported outcomes data in real-world clinical practice across the US.
Methods
RP patients with active disease (recurrence within 3 years) will have both retrospective and prospective data collected (Figure 1) for as long as their RP is managed up to 5 years. For patients with inactive disease (no recurrence within 3 years), data collection will be retrospective (Figure 2). Up to 500 patients in the US are planned for enrollment at pediatric and adult medical centers, with the potential for expansion to European sites. Additionally, patients will be recruited through a novel, internet-based technology platform and screened for eligibility at a “decentralized” trial site. The registry will include variables obtained from health records, including baseline characteristics and medical history, as well as patient reported outcome (PRO) measures collected every 3 months. The RESONANCE protocol is designed to include a broad population of pediatric and adult patients, regardless of etiology or treatment course, including patients treated with rilonacept. Data will be analyzed to understand disease heterogeneity, variability in treatment and management, and impact on HRQoL. The protocol and Case Report Forms (CRFs) were developed in collaboration with physicians, patients, and patient advocates.
Conclusions
Registries utilize real-world data to fill knowledge gaps in the management of less common diseases such as RP. The RESONANCE Registry is the first RP registry designed to collect data across a broad range of patients regardless of treatment. The registry will also serve as a connection point for physicians to further educate and empower patients with information about their disease. In addition, PRO data may enable greater insights into the understanding of the burden of RP from the patient's perspective.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Kiniksa Pharmaceuticals
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Affiliation(s)
- A Reid
- Kiniksa Pharmaceuticals Corp., Lexington, United States of America
| | - A Klein
- Cleveland Clinic, Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Cleveland, United States of America
| | - D Lin
- Abbott Northwestern Hospital, Minneapolis Heart Institute, Minneapolis, United States of America
| | - A Abbate
- Virginia Commonwealth University, VCU Pauley Heart Center, Richmond, United States of America
| | - S A Luis
- Mayo Clinic, Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Rochester, United States of America
| | - J Petersen
- Swedish Medical Center, Seattle, United States of America
| | - M Portman
- Seattle Children's Hospital, Seattle, United States of America
| | - D Winnowski
- Pericarditis Alliance, Albany, United States of America
| | - A Malinowski
- Kiniksa Pharmaceuticals Corp., Lexington, United States of America
| | - L Marden
- Kiniksa Pharmaceuticals Corp., Lexington, United States of America
| | - J F Paolini
- Kiniksa Pharmaceuticals Corp., Lexington, United States of America
| | - D Martin
- Kiniksa Pharmaceuticals Corp., Lexington, United States of America
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Lee JC, Luis SA, Alghamry A. Using Thoracic Artery Calcium Score to Predict Stroke. Am J Cardiol 2021; 153:146-147. [PMID: 34148632 DOI: 10.1016/j.amjcard.2021.05.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Joseph C Lee
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia.
| | - Sushil Allen Luis
- Faculty of Medicine, University of Queensland, Brisbane, Australia; Department of Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Alaa Alghamry
- Faculty of Medicine, University of Queensland, Brisbane, Australia; Internal Medicine Services, The Prince Charles Hospital, Brisbane, Australia
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19
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George MP, Esquer Garrigos Z, Vijayvargiya P, Anavekar NS, Luis SA, Wilson WR, Baddour LM, Sohail MR. Discriminative Ability and Reliability of Transesophageal Echocardiography in Characterizing Cases of Cardiac Device Lead Vegetations Versus Noninfectious Echodensities. Clin Infect Dis 2021; 72:1938-1943. [PMID: 32533828 DOI: 10.1093/cid/ciaa472] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 01/14/2020] [Accepted: 04/22/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Approximately one-third of cases of cardiovascular implantable electronic device (CIED) infection present as CIED lead infection. The precise transesophageal echocardiographic (TEE) definition and characterization of "vegetation" associated with CIED lead infection remain unclear. METHODS We identified a sample of 25 consecutive cases of CIED lead infection managed at our institution between January 2010 and December 2017. Cases of CIED lead infection were classified using standardized definitions. Similarly, a sample of 25 noninfected patients who underwent TEE that showed a defined lead echodensity during the study period was included as a control group. TEEs were reviewed by 2 independent echocardiologists who were blinded to all linked patient demographic, clinical, and microbiological information. Reported echocardiographic variables of the infected vs noninfected cases were compared, and the overall diagnostic performance was analyzed. RESULTS Descriptions of lead echodensities were variable and there were no significant differences in median echodensity diameter or mobility between infected vs noninfected groups. Among infected cases, blinded echocardiogram reports by either reviewer correctly made a prediction of infection in 6 of 25 (24%). Interechocardiologist agreement was 68%. Sensitivity of blinded TEEs ranged from 31.5% to 37.5%. CONCLUSIONS Infectious vs noninfectious lead echodensities could not be reliably distinguished on the basis of size, mobility, and general shape descriptors obtained from a retrospective blinded TEE examination without knowledge of clinical and microbiological parameters. Therefore, a reanalysis of criteria used to support a diagnosis of CIED lead infection may be warranted.
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Affiliation(s)
- Merit P George
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Zerelda Esquer Garrigos
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Prakhar Vijayvargiya
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Sushil Allen Luis
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Walter R Wilson
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.,Division of Cardiac Imaging, Department of Radiology, Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.,Division of Cardiac Imaging, Department of Radiology, Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - M Rizwan Sohail
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.,Division of Cardiac Imaging, Department of Radiology, Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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20
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Luis SA, Luis CR, Habibian M, Lwin MT, Gadowski TC, Chan J, Hamilton-Craig C, Raffel OC. Prognostic Value of Cardiac Magnetic Resonance Imaging in Acute Coronary Syndrome Patients With Troponin Elevation and Nonobstructive Coronary Arteries. Mayo Clin Proc 2021; 96:1822-1834. [PMID: 33992454 DOI: 10.1016/j.mayocp.2020.11.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 10/27/2020] [Accepted: 11/04/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To define the diagnostic yield of cardiac magnetic resonance (CMR) in differentiating the underlying causes of myocardial infarction with nonobstructive coronary arteries (MINOCA) and to determine the long-term prognostic implications of such diagnoses. METHODS Cardiac magnetic resonance evaluation was performed in 227 patients (mean age, 56.4±14.9 years; 120 [53%] female) with a "working diagnosis" of MINOCA as defined by presentation with a troponin-positive acute coronary syndrome (troponin I >0.04 μg/L) and nonobstructed coronary arteries between January 1, 2007, and February 28, 2013. Follow-up was performed to assess the primary composite end point of myocardial infarction, heart failure, and all-cause mortality. RESULTS Cardiac magnetic resonance identified nonstructural cardiomyopathies in 97 (43%) patients, myocardial infarction in 55 (24%) patients, structural cardiomyopathies in 27 (12%) patients, and pulmonary embolism in 1 patient. No CMR abnormalities were identified in the remaining patients. Kaplan-Meier analysis demonstrated the ability of a CMR diagnosis to predict the risk of the primary composite end point (P=.005) at 5-year follow-up. Worse outcomes were seen among patients with "true" MINOCA and a normal CMR image compared with those with CMR-confirmed myocardial infarction (P=.02). Use of antiplatelets (78% [37/45] vs 95% [52/55]; P=.01), beta blockers (56% [25/45] vs 82% [45/55]; P=.004), and statins (64% [29/45] vs 85% [47/55]; P=.01) was significantly lower in patients with true MINOCA with normal CMR imaging compared with those with CMR-confirmed myocardial infarction. CONCLUSIONS Cardiac magnetic resonance carries a high diagnostic yield in patients with MINOCA and predicts long-term prognosis. Patients with MINOCA with normal CMR imaging had an increased rate of major adverse cardiac events and lower use of guideline-recommended myocardial infarction therapy compared with those with CMR-confirmed myocardial infarction.
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Affiliation(s)
- Sushil Allen Luis
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - Chris R Luis
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| | - Mohsen Habibian
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| | - Myo T Lwin
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia
| | - Tahlia C Gadowski
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia
| | - Jonathan Chan
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia; School of Medicine, Griffith University, Gold Coast, Australia
| | - Christian Hamilton-Craig
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| | - Owen Christopher Raffel
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
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Lin D, Klein A, Cella D, Beutler A, Fang F, Magestro M, Cremer P, LeWinter MM, Luis SA, Abbate A, Ertel A, Litcher-Kelly L, Klooster B, Paolini JF. Health-related quality of life in patients with recurrent pericarditis: results from a phase 2 study of rilonacept. BMC Cardiovasc Disord 2021; 21:201. [PMID: 33882846 PMCID: PMC8061027 DOI: 10.1186/s12872-021-02008-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 02/04/2021] [Accepted: 04/12/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Impact of recurrent pericarditis (RP) on patient health-related quality of life (HRQoL) was evaluated through qualitative patient interviews and as an exploratory endpoint in a Phase 2 trial evaluating the efficacy and safety of rilonacept (IL-1α/IL-1β cytokine trap) to treat RP. METHODS Qualitative interviews were conducted with ten adults with RP to understand symptoms and HRQoL impacts, and the 10-item Patient-Reported Outcomes Measurement Information System Global Health (PROMIS GH) v1.2 was evaluated to determine questionnaire coverage of patient experience. The Phase 2 trial enrolled participants with active symptomatic RP (A-RP, n = 16) and corticosteroid-dependent participants with no active recurrence at baseline (CSD-RP, n = 9). All participants received rilonacept weekly during a 6-week base treatment period (TP) plus an optional 18-week extension period (EP). Tapering of concomitant medications, including corticosteroids (CS), was permitted during EP. HRQoL was assessed using the PROMIS GH, and patient-reported pain and blood levels of c-reactive protein (CRP) were collected at Baseline and follow-up periods. A secondary, descriptive analysis of the Phase 2 trial efficacy results was completed using HRQoL measures to characterize both the impact of RP and the treatment effect of rilonacept. RESULTS Information from qualitative interviews demonstrated that PROMIS GH concepts are relevant to adults with RP. From the Phase 2 trial, both participant groups showed impacted HRQoL at Baseline (mean PROMIS Global Physical Health [GPH] and Global Mental Health [GMH], were lower than population norm average). In A-RP, GPH/MPH improved by end of base TP and were sustained through EP (similar trends were observed for pain and CRP). Similarly, in CSD-RP, GPH/MPH improved by end of TP and further improved during EP, during CS tapering or discontinuation, without disease recurrence (low pain scores and CRP levels continued during the TP and EP). CONCLUSION This is the first study demonstrating impaired HRQoL in RP. Rilonacept treatment was associated with HRQoL improvements using PROMIS GH scores. Maintained/improved HRQoL during tapering/withdrawal of CS without recurrence suggests that rilonacept may provide an alternative to CS. TRIAL REGISTRATION ClinicalTrials.Gov; NCT03980522; 5 June 2019, retrospectively registered; https://clinicaltrials.gov/ct2/show/NCT03980522 .
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Affiliation(s)
- David Lin
- Abbott Northwestern's Heart Hospital, Minneapolis Heart Institute, 800 East 28th Street, 2nd Floor, Minneapolis, MN, 55407, USA.
| | | | | | - Anna Beutler
- Kiniksa Pharmaceuticals Corp., 100 Hayden Avenue, Lexington, MA, 02421, USA
| | - Fang Fang
- Kiniksa Pharmaceuticals Corp., 100 Hayden Avenue, Lexington, MA, 02421, USA
| | - Matt Magestro
- Kiniksa Pharmaceuticals Corp., 100 Hayden Avenue, Lexington, MA, 02421, USA
| | | | | | | | | | - Andrew Ertel
- Medstar Heart and Vascular Institute, Washington, DC, USA
| | | | | | - John F Paolini
- Kiniksa Pharmaceuticals Corp., 100 Hayden Avenue, Lexington, MA, 02421, USA
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Fritz AV, Luis SA, Bagameri G, Bird J. A case of mistaken identity: pseudoaneurysm masquerading as pericardial effusion following premature ventricular contraction ablation. Eur Heart J Cardiovasc Imaging 2021; 22:e140. [PMID: 33712821 DOI: 10.1093/ehjci/jeab047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/04/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ashley Virginia Fritz
- Division of Cardiovascular Anesthesia, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Sushil Allen Luis
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Jared Bird
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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23
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Anand V, Yang L, Luis SA, Padang R, Michelena HI, Tsay JL, Mehta RA, Scott CG, Pislaru SV, Nishimura RA, Pellikka PA. Association of Left Ventricular Volume in Predicting Clinical Outcomes in Patients with Aortic Regurgitation. J Am Soc Echocardiogr 2020; 34:352-359. [PMID: 33253815 DOI: 10.1016/j.echo.2020.11.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Aortic regurgitation (AR) is a common valvular lesion associated with increased mortality once the left ventricle enlarges significantly or develops systolic dysfunction (ejection fraction < 50%). Valve guidelines recommend aortic valve repair or replacement (AVR) for left ventricular (LV) linear end-systolic dimension ≥ 50 mm or end-diastolic dimension ≥ 65 mm. However, chamber quantification guidelines recommend using LV volume for LV size determination because linear measurements may not accurately reflect LV remodeling. The aim of this study was to evaluate the correlation of LV volumes with linear dimensions, interobserver variability in the estimation of volumes, and the association of volumes with outcomes in patients with AR. METHODS A total of 1,100 consecutive patients with chronic moderate to severe and severe AR on echocardiography between 2004 and 2019 were retrospectively analyzed. The modified Simpson disk summation method was used for LV volume estimation. The primary outcome was all-cause mortality; the secondary outcome was mortality censored at AVR. RESULTS Patients' age was 60 ± 17 years, and 198 were women (18%). Volumes were measured using the biplane method in 939 patients (85%) and the monoplane method in 161 (15%); end-systolic volume was normal in 169 (11%). Correlations between volumes and linear dimensions were 0.5 for end-diastolic volume and 0.6 for end-systolic volume. At median follow-up of 5.4 years (interquartile range, 2.4-10.0 years), 216 patients had died and 539 had undergone AVR. Indexed LV end-systolic volume (iLVESV) and indexed left ventricular end-systolic dimension were both associated with mortality and symptoms, but the association of iLVESV was stronger. iLVESV, age, male gender, Charlson comorbidity index, New York Heart Association functional class III or IV, and time-dependent AVR were independently associated with all-cause mortality. Interobserver variability in the estimation of LV volumes in 200 patients included intraclass coefficients of 0.94 (95% CI, 0.92-0.95) for end-diastolic volume and 0.88 (95% CI, 0.78-0.93) for end-systolic volume. Patients with iLVESV ≥ 45 mL/m2 had lower survival and a higher prevalence of symptoms than those with volumes < 45 mL/m2. CONCLUSIONS Echocardiographic LV volume assessment had good reproducibility in patients with moderate to severe and severe AR. The correlation between linear dimensions and volumes was limited. Both iLVESV and indexed left ventricular end-systolic dimension were associated with worse outcomes, but the association of iLVESV was stronger. iLVESV ≥ 45 mL/m2 was associated with worse outcomes.
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Affiliation(s)
- Vidhu Anand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Litan Yang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sushil Allen Luis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Julie L Tsay
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ramila A Mehta
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Christopher G Scott
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Klein AL, Lin D, Cremer PC, Nasir S, Luis SA, Abbate A, Ertel A, LeWinter M, Beutler A, Fang F, Paolini JF. Efficacy and safety of rilonacept for recurrent pericarditis: results from a phase II clinical trial. Heart 2020; 107:heartjnl-2020-317928. [PMID: 33229362 PMCID: PMC7925818 DOI: 10.1136/heartjnl-2020-317928] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/20/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Recurrent pericarditis (RP) incurs significant morbidity. Rilonacept inhibits both interleukin-1 alpha (IL-1α) and IL-1β; these cytokines are thought to play a major role in RP. This phase II study evaluated rilonacept efficacy and safety in RP. METHODS This multicentre, open-label study enrolled adult patients with idiopathic or postpericardiotomy RP, symptomatic (≥2 pericarditis recurrences) or corticosteroid (CS) dependent (≥2 recurrences prior).Patients received rilonacept 320 mg SC load/160 mg SC weekly maintenance in a 6-week base treatment period (TP) followed by an optional 18-week on-treatment extension period (EP) (option to wean background therapy). RESULTS Outcomes: pericarditis pain (numeric rating scale (NRS)) and inflammation (C reactive protein (CRP)) for symptomatic patients; disease activity after CS taper for CS-dependent patients. SECONDARY OUTCOMES health-related quality of life (HRQOL), pericarditis manifestations and additional medications. 25 unique patients enrolled, while 23 completed the EP (seven colchicine failures and five CS failures). In symptomatic patients, NRS and CRP decreased; response was observed after first rilonacept dose. NRS decreased from 4.5 at baseline to 0.7, and CRP decreased from 4.62 mg/dL at baseline to 0.38 mg/dL at end of TP. Median time to CRP normalisation: 9 days. Pericarditis manifestations resolved. 13 patients on CS at baseline completed the EP; 11 (84.6%) discontinued CS, and 2 tapered; CRP and NRS remained low without recurrence. Mean HRQOL scores improved in symptomatic patients. One serious adverse event (SAE) resulted in discontinuation of rilonacept. CONCLUSIONS Rilonacept led to rapid and sustained improvement in pain, inflammation (CRP and pericarditis manifestations) and HRQOL. CSs were successfully tapered or discontinued; safety was consistent with known rilonacept safety profile. TRIAL REGISTRATION NUMBER NCT03980522.
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Affiliation(s)
- Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - David Lin
- The Minneapolis HeartInstitute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Paul C Cremer
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Sushil Allen Luis
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Rochester, Minnesota, USA
| | - Antonio Abbate
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Andrew Ertel
- Heart and Vascular Institute, Medstar Washington Hospital Center, Washington, DC, USA
| | - Martin LeWinter
- Cardiology Unit, University of Vermont Medical Center, Burlington, Vermont, USA
| | | | - Fang Fang
- Kiniksa Pharmaceuticals Corp, Lexington, Massachusetts, USA
| | - John F Paolini
- Kiniksa Pharmaceuticals Corp, Lexington, Massachusetts, USA
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Shabtaie SA, Luis SA, Ward RC, Karki R, Connolly HM, Pellikka PA, Kapa S, Asirvatham SJ, Packer DL, DeSimone CV. Catheter Ablation in Patients With Neuroendocrine (Carcinoid) Tumors and Carcinoid Heart Disease: Outcomes, Peri-Procedural Complications, and Management Strategies. JACC Clin Electrophysiol 2020; 7:151-160. [PMID: 33602395 DOI: 10.1016/j.jacep.2020.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This report describes a series of patients with neuroendocrine tumors with or without carcinoid heart disease undergoing catheter ablation at the authors' institution. BACKGROUND Neuroendocrine (carcinoid) tumors are a rare form of neoplasm with the potential for systemic vasoactive effects and cardiac valvular involvement. These tumors can create peri-operative management challenges for the electrophysiologist. However, there are few data regarding ablation outcomes, periprocedural complications, and management of these patients. METHODS All patients with neuroendocrine tumors undergoing catheter ablation at the Mayo Clinic, Rochester, Minnesota over a 25-year period were retrospectively reviewed. From this cohort, the type of arrhythmias ablated, the recurrence of arrhythmia, perioperative complications, and mortality were reviewed and analyzed. RESULTS A total of 17 patients (52.9% male; mean age 62.4 ± 9.3 years) with neuroendocrine tumors underwent catheter ablation during the study period. Primary tumor sites included the gastrointestinal tract (n = 11), lung (n = 4), ovary (n = 1), and lymph node (n = 1). Nine patients had metastatic disease, 5 of whom were on somatostatin analog therapy at the time of ablation. Three patients had active symptoms of carcinoid syndrome at the time of ablation, and 2 of those patients had carcinoid heart disease. Ablations were performed mainly for atrial arrhythmias (76.5%): atrioventricular nodal re-entry tachycardia (n = 7), atrial fibrillation (n = 4), and atrial flutter (n = 2). Four patients underwent ablation of ventricular arrhythmias. During a mean follow-up of 19.2 ± 26.2 months, arrhythmia recurred in 35.3% of patients. Three patients (17.6%) had periprocedural complications: pericardial effusion (n = 1), groin site hematoma (n = 1), and carcinoid crisis (n = 1). No deaths were noted in the peri-operative period. CONCLUSIONS In a unique cohort of patients with neuroendocrine tumors, catheter ablation was feasible in patients with or without carcinoid syndrome. Carcinoid crisis may occur during the periprocedural period, which can be life-threatening, and a specified protocol for management is important to mitigate this risk.
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Affiliation(s)
| | - Sushil Allen Luis
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert C Ward
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Roshan Karki
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Heidi M Connolly
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Patricia A Pellikka
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Suraj Kapa
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Douglas L Packer
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher V DeSimone
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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Bird JG, Morant K, Al-Souri D, Scott CG, Padang R, McCully RB, Kane GC, Pellikka PA, Luis SA. Impact of Anemia on Exercise and Pharmacologic Stress Echocardiography. J Am Soc Echocardiogr 2020; 33:1067-1076. [PMID: 32709477 DOI: 10.1016/j.echo.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The safety and diagnostic accuracy of stress testing in anemic patients have not been well studied. Despite a lack of data, significant anemia may be considered a relative contraindication to stress testing because of safety concerns related to insufficient myocardial oxygen supply. METHODS The authors reviewed 28,829 consecutive patients with blood hemoglobin drawn within 48 hours of stress echocardiography (15,624 exercise and 13,205 dobutamine). The associations of blood hemoglobin concentration with arrhythmia and other stress echocardiographic findings were examined. Additionally, the effect of anemia on the positive predictive value of stress echocardiography for the detection of significant coronary artery stenosis (≥50%) was assessed in patients who subsequently underwent coronary angiography. RESULTS Anemia was present in 6,401 patients (22.2%) and was severe (hemoglobin < 8.0 g/dL) in 52. Stress testing with either exercise or dobutamine was safe, with no significant increase in serious arrhythmia events or need for hospitalization. In the exercise cohort, worsening anemia was associated with reduced treadmill exercise time, lower peak heart rate, peak rate-pressure product, and achieved workload. In the dobutamine stress cohort, worsening anemia was associated with higher resting heart rate, more use of atropine, and fewer patients attaining target heart rate. The positive predictive value of stress echocardiography was higher in patients with moderate anemia compared with those without anemia (71.8% vs 60.2%, P = .01). CONCLUSIONS This study demonstrates that stress testing is safe in patients with mild and moderately anemia, albeit with a small increase in mild supraventricular arrhythmias with exercise. However, worsening anemia was associated with a significant reduction in exercise capacity. Additionally, worsening anemia was associated with an improvement in the positive predictive value of stress echocardiography. Extrapolation of these data to patients with severe anemia should be performed with caution given the limited number of patients with severe anemia in this study.
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Affiliation(s)
- Jared G Bird
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kareem Morant
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Deema Al-Souri
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Robert B McCully
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Sushil Allen Luis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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Abstract
PURPOSE OF REVIEW This review summarizes the optimal techniques for the performance of pericardiocentesis in contemporary practice, highlighting the indications, contraindications, and techniques used. Routine pericardial catheter management and the diagnostic role of pericardial fluid analysis are described. RECENT FINDINGS Echocardiographic-guided pericardiocentesis should be considered the therapy of choice in current clinical practice and may be performed safely despite the presence of coagulopathy and thrombocytopenia in the hands of expert operators. Computed tomography (CT)-guided techniques may provide a useful adjunctive tool in patients with poor acoustic windows or complex loculated effusions. Conservative management utilizing pericardiocentesis may be considered in select patients with device lead and interventional-related pericardial effusions. Echocardiographic-guided pericardiocentesis with extended pericardial drainage (goal output < 50 mL/24 h) should be considered the standard of care in contemporary practice. Pericardial fluid analysis should be tailored based on the clinical history and appearances of the pericardial fluid.
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Affiliation(s)
- Sushil Allen Luis
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Chris R Luis
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Lawrence J Sinak
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Mathew J, Geske JB, Luis SA, Schaff HV. An unusual coronary embolus in a patient with prosthetic endocarditis. Eur Heart J 2020; 41:2179. [PMID: 31848587 DOI: 10.1093/eurheartj/ehz883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jessey Mathew
- Department of Cardiothoracic Surgery, Mayo Clinic, 200 First Street SW,Rochester, MN 55905, USA
| | - Jeffrey B Geske
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW,Rochester, MN 55905, USA
| | - Sushil Allen Luis
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW,Rochester, MN 55905, USA
| | - Hartzell V Schaff
- Department of Cardiothoracic Surgery, Mayo Clinic, 200 First Street SW,Rochester, MN 55905, USA
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Luis SA, Dohaei A, Chandrashekar P, Scott CG, Padang R, Lokineni S, Kane GC, Crestanello JA, Abel MD, Nkomo VT, Pislaru SV, Pellikka PA. Impact of Aortic Valve Replacement for Severe Aortic Stenosis on Perioperative Outcomes Following Major Noncardiac Surgery. Mayo Clin Proc 2020; 95:727-737. [PMID: 32247346 DOI: 10.1016/j.mayocp.2019.10.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 10/10/2019] [Accepted: 10/21/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the incidence of major adverse cardiac events and death among severe aortic stenosis patients with and without aortic valve replacement (AVR) before noncardiac surgery. PATIENTS AND METHODS We retrospectively evaluated 491 severe aortic stenosis patients undergoing non-emergency/non-urgent elevated-risk noncardiac surgery between January 1, 2000, and December 31, 2013, including 203 patients (mean age, 74±10 years, 63.5% men) with previous AVR and 288 patients (mean age, 77±12 years, 55.6% men) without prior AVR. RESULTS The incidence of major adverse cardiac events was significantly lower in the AVR group (5.4% vs 20.5%; P<.001), primarily because of the lower incidence of new or worsening heart failure (2.5% vs 17.7%; P<.001), compared with the non-AVR group. No significant differences were observed between the groups with and without AVR in the incidence of death (2.5% vs 3.5%; P=.56), myocardial infarction (0.5% vs 1.4%; P=.48), ventricular arrhythmia (0.0% vs 0.7%; P=.51), or stroke (0.0% vs 0.7%; P=.51) at 30-days. At a median follow-up of 4.2 (interquartile range,1.3-7.5) years, overall mortality was significantly worse in patients without versus with AVR (5-year rate: 57.0% vs 32.7%; P<.001). Symptomatic patients without AVR (n=35) had the worst outcomes overall, including increased 30-day and overall mortality rates, compared with the AVR-group and asymptomatic non-AVR patients. CONCLUSION In patients with severe aortic stenosis, AVR before noncardiac surgery was associated with decreased incidence of heart failure after noncardiac surgery and improved overall survival without differences in 30-day survival, myocardial infarction, ventricular arrhythmia, or stroke. Preoperative AVR should be considered in symptomatic patients for whom the benefit of AVR is greatest.
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Affiliation(s)
| | - Abolfazl Dohaei
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Christopher G Scott
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Sravani Lokineni
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Martin D Abel
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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30
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Bird J, Morant K, Kane G, Mccully R, Pellikka P, Luis SA. 1678 Impact of anemia in exercise stress echocardiography: effects on exercise capacity and stress testing safety. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
None
Background/Purpose:
Anemia is a common condition in patients with cardiovascular disease. The effect of anemia in exercise stress testing has not been evaluated in a large cohort of patients.
Methods
We performed a retrospective review of patients undergoing exercise stress echocardiography over a 10 year period who had blood hemoglobin assessed within 48 hours of stress testing. World Health Organization cutoffs were used in defining the degree of anemia. The effect of anemia on exercise capacity and stress testing safety outcomes was assessed.
Results
In 15,652 patients, 90.3% were non-anemic, 7.6% mildly anemic, 2.1% moderately anemic, and 0.1% severely anemic. The incidence of serious supraventricular or ventricular arrhythmias and need to transfer to the hospital was low (0.1%) and did not correlate to anemia severity (p = 0.25). There was an increased incidence of non-sustained SVT or atrial fibrillation with moderate anemia and increased incidence of hypotension with stress testing with mild and moderate anemia. There was a significant reduction in duration of exercise (p < 0.001) and METS (p < 0.001) achieved with worsening anemia.
Conclusion
Our study demonstrates that exercise stress testing is safe in patients with mild and moderate anemia, albeit with reduced exercise capacity. Low numbers of severely anemic patients despite a large study population limit generalizability of these results in this group.
Exercise Capacity Severe Anemia (N = 9) Moderate Anemia (N = 332) Mild Anemia (N = 1183) Non-anemic (N = 14128) P value Resting heart rate 81 ± 13 # 79 ± 14 # 72 ± 14 74 ± 13 <0.001* Peak heart rate 148 ± 22 139 ± 24 # 138 ± 23 # 147 ±22 <0.001* Exercise duration 5.3 ± 2.5 # 6.3 ± 2.1 # 7.2 ± 2.5 # 8.6 ± 2.7 <0.001* METS 6.3 ± 2.5 # 7.1 ± 2.2 # 8.0 ± 2.5 # 9.5 ± 2.7 <0.001* Safety Hypotension with stress 0 (0%) 31 (9.4%) # 94 (8.0%) # 437 (3.1%) <0.001* Mild supraventricular arrhythmia 1 (11.1%) 15 (4.5%) # 20 (1.7%) # 237 (2.3%) 0.04* Severe supraventricular arrhythmia 0 (0%) 0 (0%) 0 (0%) 7 (0.1%) 0.99 Mild ventricular arrhythmia 0 (0%) 20 (6.0%) 74 (6.3%) 756 (5.4%) 0.94 Moderate ventricular arrhythmia 0 (0%) 3 (0.9%) 13 (1.1%) 182 (1.3%) 0.78 Severe ventricular arrhythmia 0 (0%) 1 (0.3%) 2 (0.2%) 1 (0.0%) 0.02 Transfer to hospital 0 (0%) 2 (0.6%) 1 (0.1%) 9 (0.1%) 0.29 Any severe arrhythmia or hospitalization 0 (0%) 2 (0.6%) 3 (0.3%) 17 (0.1%) 0.25 # Multi-comparison adjusted P-value <0.05 compared to non-anemic when group P < 0.05
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Affiliation(s)
- J Bird
- Mayo Clinic, Division of Cardiology, Rochester, United States of America
| | - K Morant
- Mayo Clinic, Division of Cardiology, Rochester, United States of America
| | - G Kane
- Mayo Clinic, Division of Cardiology, Rochester, United States of America
| | - R Mccully
- Mayo Clinic, Division of Cardiology, Rochester, United States of America
| | - P Pellikka
- Mayo Clinic, Division of Cardiology, Rochester, United States of America
| | - S A Luis
- Mayo Clinic, Division of Cardiology, Rochester, United States of America
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Imazio M, Andreis A, De Ferrari GM, Cremer PC, Mardigyan V, Maestroni S, Luis SA, Lopalco G, Emmi G, Lotan D, Marcolongo R, Lazaros G, De Biasio M, Cantarini L, Dagna L, Cercek AC, Pivetta E, Varma B, Berkson L, Tombetti E, Iannone F, Prisco D, Caforio ALP, Vassilopoulos D, Tousoulis D, De Luca G, Giustetto C, Rinaldi M, Oh JK, Klein AL, Brucato A, Adler Y. Anakinra for corticosteroid-dependent and colchicine-resistant pericarditis: The IRAP (International Registry of Anakinra for Pericarditis) study. Eur J Prev Cardiol 2019; 27:956-964. [DOI: 10.1177/2047487319879534] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims Novel therapies are needed for recurrent pericarditis, particularly when corticosteroid dependent and colchicine resistant. Based on limited data, interleukin-1 blockade with anakinra may be beneficial. The aim of this multicentre registry was to evaluate the broader effectiveness and safety of anakinra in a ‘real world’ population. Methods and results This registry enrolled consecutive patients with recurrent pericarditis who were corticosteroid dependent and colchicine resistant and treated with anakinra. The primary outcome was the pericarditis recurrence rate after treatment. Secondary outcomes included emergency department visits, hospitalisations, corticosteroid use and adverse events. Among 224 patients (46 ± 14 years old, 63% women, 75% idiopathic), the median duration of disease was 17 months (interquartile range 9–33). Most patients had elevated C-reactive protein (91%) and pericardial effusion (88%). After a median treatment of 6 months (3–12), pericarditis recurrences were reduced six-fold (2.33–0.39 per patient per year), emergency department admissions were reduced 11-fold (1.08–0.10 per patient per year), hospitalisations were reduced seven-fold (0.99–0.13 per patient per year). Corticosteroid use was decreased by anakinra (respectively from 80% to 27%; P < 0.001). No serious adverse events occurred; adverse events consisted mostly of transient skin reactions (38%) at the injection site. Adverse events led to discontinuation in 3%. A full-dose treatment duration of over 3 months followed by a tapering period of over 3 months were the therapeutic schemes associated with a lower risk of recurrence. Conclusion In patients with recurrent pericarditis, anakinra appears efficacious and safe in reducing recurrences, emergency department admissions and hospitalisations.
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Affiliation(s)
- Massimo Imazio
- Coordinating Center: University Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Italy
| | - Alessandro Andreis
- Coordinating Center: University Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Italy
| | - Gaetano Maria De Ferrari
- Coordinating Center: University Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Italy
| | | | | | | | | | - Giuseppe Lopalco
- Department of Emergency and Organ Transplantation (DETO), University of Bari, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Italy
| | - Dor Lotan
- Leviev Heart Center, Chaim Sheba Medical Center (affiliated to Tel Aviv University), Israel
| | - Renzo Marcolongo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Policlinico Universitario, Italy
| | - George Lazaros
- 1st Cardiology Clinic, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
| | | | - Luca Cantarini
- Research Center of Systemic Autoinflammatory Diseases, University of Siena, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Italy
| | | | - Emanuele Pivetta
- Emergency Medicine Division and High Dependency Unit and CPO Piemonte, A.O.U. Città della Salute e della Scienza di Torino, Italy
| | - Beni Varma
- Heart and Vascular Institute, Cleveland Clinic, USA
| | | | - Enrico Tombetti
- Dipartimento Scienze Cliniche e biomediche Luigi Sacco, ASST Fatebenefratelli-Sacco, Università degli Studi di Milano, Italy
| | - Florenzo Iannone
- Department of Emergency and Organ Transplantation (DETO), University of Bari, Italy
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Firenze, Italy
| | - Alida Linda P Caforio
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Policlinico Universitario, Italy
| | - Dimitrios Vassilopoulos
- 1st Cardiology Clinic, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Dimitrios Tousoulis
- 1st Cardiology Clinic, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Italy
| | - Carla Giustetto
- Coordinating Center: University Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Italy
| | - Mauro Rinaldi
- Coordinating Center: University Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Italy
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, USA
| | | | - Antonio Brucato
- Dipartimento Scienze Cliniche e biomediche Luigi Sacco, ASST Fatebenefratelli-Sacco, Università degli Studi di Milano, Italy
| | - Yehuda Adler
- Leviev Heart Center, Chaim Sheba Medical Center (affiliated to Tel Aviv University), Israel
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Lee JC, Chong JW, Luis SA. Blood Flow Reserve at Common Caffeine Levels. JACC Cardiovasc Imaging 2019; 12:1597-1598. [DOI: 10.1016/j.jcmg.2019.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/23/2019] [Indexed: 11/29/2022]
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Affiliation(s)
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Joseph G Murphy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
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Majid A, Jamali M, Ashrafi MM, Ul Haq Z, Irfan R, Rehan A, Memon MM, Khan MA, Kumar J, Singh PK, Luis SA, Ram P, Lasrado S, Imtiaz F, Menezes RG. Knowledge and Attitude Towards Cardiopulmonary Resuscitation Among Doctors of a Tertiary Care Hospital in Karachi. Cureus 2019; 11:e4182. [PMID: 31106082 PMCID: PMC6504012 DOI: 10.7759/cureus.4182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective Cardiac arrest is an emergency, which can be managed effectively by sound knowledge and practice of basic life support (BLS) skills. However, it has been globally reported that the knowledge of doctors regarding cardiopulmonary resuscitation (CPR) and BLS is sub-standard. We conducted this study with the aim to assess the knowledge and attitude of doctors toward CPR in Dr. Ruth K.M. Pfau Civil Hospital, one of the largest tertiary care hospitals, in Pakistan. Methods We conducted a cross-sectional study, in Dr. Ruth K.M. Pfau Civil Hospital located in Karachi, Pakistan, using cluster sampling. A total of 285 doctors were interviewed. Results A majority of the doctors were unaware of the revised rate and depth of chest compressions (65.6% and 75.8% respectively). While many know the abbreviations of BLS and CPR (96.55% and 95.4%, respectively), 56.5% did not know what automated external defibrillator (AED) stood for. CPR was preferred over chest compression-only resuscitation (CCR) by 91.6% of the doctors. Half of the participants rated their knowledge as average. Most stated that they will not be reluctant to perform CPR in an emergency situation. The majority also agreed that BLS training should be an integral part of the medical curriculum. Conclusion There is an evident lack of knowledge of CPR among healthcare professionals, particularly regarding the updates made in the 2015 American Heart Association (AHA) guidelines. However, an overall positive attitude was observed.
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Affiliation(s)
- Aamina Majid
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Momal Jamali
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | - Zaiyn Ul Haq
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Rafia Irfan
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Aiman Rehan
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | - Muhammad A Khan
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Jai Kumar
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Pankaj Kumar Singh
- Forensic Medicine, Kathmandu University School of Medical Sciences, Kathmandu, NPL
| | | | - Pradhum Ram
- Internal Medicine, Albert Einstein Medical Center, Philadelphia, USA
| | - Savita Lasrado
- Internal Medicine, Father Muller Medical College, Mangalore, IND
| | - Fouzia Imtiaz
- Genetics, Dow University of Health Sciences, Karachi, PAK
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Affiliation(s)
- Juan Simon Rico-Mesa
- Department of Medicine, University of Texas Health, San Antonio, TX, USA.,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Carlos Uribe
- Interventional Cardiologist, Associate Professor of Medicine, CES University, Medellin, Colombia.,Program director of Interventional Cardiology, UPB University, Clinica CardioVID, Hospital Pablo Tobon Uribe, Medellin, Colombia
| | - Megha Prasad
- Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Sushil Allen Luis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Murphy JG, Luis SA, Wright RS. A New Fix for the Bishop's Hat, Let's Give It Time to Wear Before We Pass Judgment. Mayo Clin Proc 2019; 94:4-6. [PMID: 30611452 DOI: 10.1016/j.mayocp.2018.11.019] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 11/21/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Joseph G Murphy
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
| | | | - R Scott Wright
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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Senthilkumaran S, Menezes RG, Hussain SA, Luis SA, Thirumalaikolundusubramanian P. Russell's Viper Envenomation-Associated Addisonian Crisis. Wilderness Environ Med 2018; 29:504-507. [PMID: 30309826 DOI: 10.1016/j.wem.2018.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 01/03/2018] [Revised: 05/30/2018] [Accepted: 06/04/2018] [Indexed: 11/18/2022]
Abstract
Snakebite envenomation is an important public health problem in tropical countries. We report a case of bilateral adrenal hemorrhage in a 28-y-old man with Russell's viper bite that occurred in the Sathyamangalam forest range in the Indian state of Tamil Nadu. In this case, a combination of early bite recognition, hospital-based supportive care, corticosteroid therapy, and timely administration of polyvalent antivenom resulted in a favorable clinical outcome.
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Affiliation(s)
| | - Ritesh G Menezes
- Forensic Medicine Division, Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (Prof Menezes).
| | - Syed Ather Hussain
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan (Dr Hussain)
| | - Sushil Allen Luis
- School of Medicine, The University of Queensland, Brisbane, Australia (Dr Luis)
| | - Ponniah Thirumalaikolundusubramanian
- Department of Internal Medicine, Trichy SRM Medical College Hospital and Research Center, Irungalur, Trichy, India (Prof Thirumalaikolundusubramanian)
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Parsons C, Cha S, Shen WK, Chamberlain AM, Luis SA, Keddis M, Shamoun F. Usefulness of the Addition of Renal Function to the CHA2DS2-VASc Score as a Predictor of Thromboembolism and Mortality in Patients Without Atrial Fibrillation. Am J Cardiol 2018; 122:597-603. [PMID: 29970238 DOI: 10.1016/j.amjcard.2018.04.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/11/2018] [Accepted: 04/13/2018] [Indexed: 01/08/2023]
Abstract
Research is conflicting whether kidney function should be incorporated in thromboembolism risk prediction. Our published data showed that the CHA2DS2-VASc score predicts thromboembolism and mortality in those without atrial fibrillation. We used the Rochester Epidemiology Project medical records system to retrospectively evaluate whether adding renal impairment (1 point) to the CHA2DS2-VASc score (-R) enhances the score's prediction of mortality, thromboembolism, and atrial fibrillation in patients without atrial fibrillation. We identified patients that had an implantable cardiac monitoring device placed from January 1, 2004 to December 31, 2013, which was defined as the start date. Follow-up was through March 7, 2016. An implantable device was required to discern the absence of atrial fibrillation. Renal impairment was defined as chronic kidney disease stage 3 or greater. The population (n = 1,606) had a mean age of 69.8 years and median follow-up of 4.8 years. Baseline renal impairment was predictive of mortality (hazard ratio [HR] 2.06, 95% confidence interval [CI] 1.64 to 2.60, p <0.001), thromboembolism (HR 1.34, 95% CI 0.96 to 1.87, p = 0.09), and atrial fibrillation (HR 1.31, 95% CI 0.98 to 1.74, p = 0.07). Lower glomerular filtration rate correlated significantly with mortality. Increasing CHA2DS2-VASc-R score correlated significantly with mortality, thromboembolism, and incident atrial fibrillation. The addition of renal impairment to the CHA2DS2-VASc score improved the C-statistics for thromboembolism and survival from 0.72 to 0.73 (p = 0.01) and 0.70 to 0.72 (p <0.001). Adding renal impairment to the CHA2DS2-VASc score improves the score's prediction of thromboembolism and mortality in a population without atrial fibrillation, although the incremental benefit appears mild.
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Menezes RG, Usman MS, Hussain SA, Madadin M, Siddiqi TJ, Fatima H, Ram P, Pasha SB, Senthilkumaran S, Fatima TQ, Luis SA. Cerbera odollam toxicity: A review. J Forensic Leg Med 2018; 58:113-116. [PMID: 29778924 DOI: 10.1016/j.jflm.2018.05.007] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 03/03/2018] [Accepted: 05/06/2018] [Indexed: 01/24/2023]
Abstract
Cerbera odollam is a plant species of the Apocynaceae family. It is often dubbed the 'suicide tree' due to its strong cardiotoxic effects, which make it a suitable means to attempt suicide. The plant grows in wet areas in South India, Madagascar, and Southeast Asia; and its common names include Pong-Pong and Othalanga. The poison rich part of the plant is the kernel which is present at the core of its fruit. The bioactive toxin in the plant is cerberin, which is a cardiac glycoside of the cardenolide class. Cerberin has a mechanism of action similar to digoxin; hence, Cerbera odollam toxicity manifests similar to acute digoxin poisoning. Ingestion of its kernel causes nausea, vomiting, hyperkalemia, thrombocytopenia, and ECG abnormalities. Exposure to high doses of Cerbera odollam carries the highest risk of mortality. Initial management includes supportive therapy and administration of atropine followed by temporary pacemaker insertion. Administration of digoxin immune Fab may be considered in severe cases, although efficacy is variable and data limited to isolated case reports.
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Affiliation(s)
- Ritesh G Menezes
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | | | - Syed Ather Hussain
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Mohammed Madadin
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Huda Fatima
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Pradhum Ram
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Syed Bilal Pasha
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - S Senthilkumaran
- Department of Emergency Medicine and Critical Care, Be Well Hospital, Erode, India
| | - Tooba Qadir Fatima
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Sushil Allen Luis
- School of Medicine, The University of Queensland, Brisbane, Australia
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Nicoara A, Allen Luis S. The Perfect Storm: Carcinoid Heart Disease and Acute Right Ventricular Failure. J Cardiothorac Vasc Anesth 2018; 32:846-847. [DOI: 10.1053/j.jvca.2017.12.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 12/31/2017] [Indexed: 11/11/2022]
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Ram P, Menezes RG, Sirinvaravong N, Luis SA, Hussain SA, Madadin M, Lasrado S, Eiger G. Breaking your heart-A review on CPR-related injuries. Am J Emerg Med 2017; 36:838-842. [PMID: 29310980 DOI: 10.1016/j.ajem.2017.12.063] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 12/24/2017] [Accepted: 12/27/2017] [Indexed: 12/30/2022] Open
Abstract
Cardiopulmonary resuscitation (CPR) has been shown to increase survival after cardiac arrest, but is associated with the risk of acquired injuries to the patient. While traumatic chest wall injuries are most common, other injuries include upper airway, pulmonary and intra-abdominal injuries. This review discusses the risk factors and prevalence of CPR-related injuries.
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Affiliation(s)
- Pradhum Ram
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA 19141, USA.
| | - Ritesh G Menezes
- Forensic Medicine Division, Department of Pathology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Natee Sirinvaravong
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA 19141, USA
| | - Sushil Allen Luis
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Syed Ather Hussain
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Mohammed Madadin
- Forensic Medicine Division, Department of Pathology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Savita Lasrado
- Department of Otorhinolaryngology and Head and Neck Surgery, Father Muller Medical College Hospital, Father Muller Medical College, Mangalore, India; Father Muller Simulation and Skills Center, Mangalore, India
| | - Glenn Eiger
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA 19141, USA
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Luis SA, Blauwet LA, Samardhi H, West C, Mehta RA, Luis CR, Scalia GM, Miller FA, Burstow DJ. Usefulness of Mitral Valve Prosthetic or Bioprosthetic Time Velocity Index Ratio to Detect Prosthetic or Bioprosthetic Mitral Valve Dysfunction. Am J Cardiol 2017; 120:1373-1380. [PMID: 28826894 DOI: 10.1016/j.amjcard.2017.07.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/05/2017] [Accepted: 07/12/2017] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate the utility of transthoracic echocardiographic (TTE) Doppler-derived parameters in detection of mitral prosthetic dysfunction and to define optimal cut-off values for identification of such dysfunction by valve type. In total, 971 TTE studies (647 mechanical prostheses; 324 bioprostheses) were compared with transesophageal echocardiography for evaluation of mitral prosthesis function. Among all prostheses, mitral valve prosthesis (MVP) ratio (ratio of time velocity integral of MVP to that of left ventricular outflow tract; odds ratio [OR] 10.34, 95% confidence interval [95% CI] 6.43 to 16.61, p<0.001), E velocity (OR 3.23, 95% CI 1.61 to 6.47, p<0.001), and mean gradient (OR 1.13, 95% CI 1.02 to 1.25, p=0.02) provided good discrimination of clinically normal and clinically abnormal prostheses. Optimal cut-off values by receiver operating characteristic analysis for differentiating clinically normal and abnormal prostheses varied by prosthesis type. Combining MVP ratio and E velocity improved specificity (92%) and positive predictive value (65%) compared with either parameter alone, with minimal decline in negative predictive value (92%). Pressure halftime (OR 0.99, 95% CI 0.98 to 1.00, p=0.04) did not differentiate between clinically normal and clinically abnormal prostheses but was useful in discriminating obstructed from normal and regurgitant prostheses. In conclusion, cut-off values for TTE-derived Doppler parameters of MVP function were specific to prosthesis type and carried high sensitivity and specificity for identifying prosthetic valve dysfunction. MVP ratio was the best predictor of prosthetic dysfunction and, combined with E velocity, provided a useful parameter for determining likelihood of dysfunction and need for further assessment.
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Affiliation(s)
- Sushil Allen Luis
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
| | - Lori A Blauwet
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Himabindu Samardhi
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Cathy West
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Ramila A Mehta
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Chris R Luis
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Gregory M Scalia
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Fletcher A Miller
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Darryl J Burstow
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia
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Luis SA, Maleszewski JJ, Young PM, Schaff HV, Pereira NL. Previously Unreported in Women
Galactosidase Alpha
Pro409Ser Variant Is Associated With Fabry Disease. ACTA ACUST UNITED AC 2017; 10:e001661. [DOI: 10.1161/circgenetics.116.001661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sushil Allen Luis
- From the Department of Cardiovascular Diseases (S.A.L., H.V.S., N.L.P.), Department of Laboratory Medicine and Pathology (J.J.M.), and Department of Radiology (P.M.Y.), Mayo Clinic, Rochester, MN
| | - Joseph J. Maleszewski
- From the Department of Cardiovascular Diseases (S.A.L., H.V.S., N.L.P.), Department of Laboratory Medicine and Pathology (J.J.M.), and Department of Radiology (P.M.Y.), Mayo Clinic, Rochester, MN
| | - Phillip M. Young
- From the Department of Cardiovascular Diseases (S.A.L., H.V.S., N.L.P.), Department of Laboratory Medicine and Pathology (J.J.M.), and Department of Radiology (P.M.Y.), Mayo Clinic, Rochester, MN
| | - Hartzell V. Schaff
- From the Department of Cardiovascular Diseases (S.A.L., H.V.S., N.L.P.), Department of Laboratory Medicine and Pathology (J.J.M.), and Department of Radiology (P.M.Y.), Mayo Clinic, Rochester, MN
| | - Naveen L. Pereira
- From the Department of Cardiovascular Diseases (S.A.L., H.V.S., N.L.P.), Department of Laboratory Medicine and Pathology (J.J.M.), and Department of Radiology (P.M.Y.), Mayo Clinic, Rochester, MN
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Abstract
Commotio cordis is an increasingly reported fatal mechano-electric syndrome and is the second most common cause of sudden cardiac death in young athletes. It is most commonly associated with a sports-related injury, wherein, there is a high-velocity impact between a projectile and the precordium. By virtue of this impact, malignant arrhythmias consequently develop leading to the individual's immediate demise, accompanied by a relatively normal post-mortem analysis. The importance of an autopsy remains paramount to exclude other causes of sudden death. With increasing awareness and reporting, survival rates are beginning to improve; however, prevention of the development of this condition remains the best approach for survival.
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Affiliation(s)
- Ritesh G Menezes
- 1 Forensic Medicine Division, Department of Pathology, College of Medicine, King Fahd Hospital of the University, University of Dammam, Dammam, Saudi Arabia (KSA)
| | - Huda Fatima
- 2 Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed Ather Hussain
- 2 Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Saba Ahmed
- 2 Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Pankaj Kumar Singh
- 3 Department of Forensic Medicine, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | | | - Mohammed Madadin
- 1 Forensic Medicine Division, Department of Pathology, College of Medicine, King Fahd Hospital of the University, University of Dammam, Dammam, Saudi Arabia (KSA)
| | - Pradhum Ram
- 5 Albert Einstein Medical Centre, Philadelphia, PA, USA
| | - Sadip Pant
- 6 Division of Cardiovascular Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Sushil Allen Luis
- 7 School of Medicine, The University of Queensland, Brisbane, Australia
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Parsons C, Patel SI, Cha S, Shen WK, Desai S, Chamberlain AM, Luis SA, Aguilar MI, Demaerschalk BM, Mookadam F, Shamoun F. CHA 2DS 2-VASc Score: A Predictor of Thromboembolic Events and Mortality in Patients With an Implantable Monitoring Device Without Atrial Fibrillation. Mayo Clin Proc 2017; 92:360-369. [PMID: 28259228 PMCID: PMC5641434 DOI: 10.1016/j.mayocp.2016.10.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 06/20/2016] [Revised: 09/16/2016] [Accepted: 10/04/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine if the CHA2DS2-VASc score (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65-74 years, sex category) predicts thromboembolism and death in patients without atrial fibrillation in a population with implantable cardiac monitoring devices. PATIENTS AND METHODS A retrospective review utilizing the Rochester Epidemiology Project research infrastructure was conducted to evaluate the CHA2DS2-VASc tool as a predictor of mortality and ischemic stroke, transient ischemic attack, or systemic embolism in patients without atrial fibrillation. An implantable device was required in the inclusion criteria to discern the absence of atrial fibrillation. The study period was January 1, 2004, through March 7, 2016. RESULTS The study population (N=1606) had a mean (SD) age of 69.8 (12.6) years and median follow-up of 4.8 years (range, 0-12 years; quartile 1, 2.6 years and quartile 3, 8.1 years). The number of thromboembolic and mortality events stratified by CHA2DS2-VASc score groupings of 0 to 2 (399 patients), 3 to 5 (756 patients), and 6 to 9 (451 patients) were 12 (3.0%), 109 (14.4%), and 123 (27.3%) and 22 (5.5%), 205 (27.1%), and 214 (47.4%), respectively. The CHA2DS2-VASc score predicted thromboembolism and death. The hazard ratios (HRs) for thromboembolic events for CHA2DS2-VASc scores 3 to 5 and 6 to 9 were 4.84 (95% CI, 2.66-8.80) and 10.53 (95% CI, 5.77-19.21) (reference group, scores 0-2). The HRs for death for the corresponding score categories were 4.45 (95% CI, 2.86-6.91) and 8.18 (95% CI, 5.23-12.78). The CHA2DS2-VASc score also predicted development of atrial fibrillation, for which the HRs for scores 3 to 5 and 6 to 9 were 1.51 (95% CI, 1.13-2.00) and 2.17 (95% CI, 1.60-2.95). CONCLUSION The CHA2DS2-VASc tool predicts thromboembolic events and overall mortality in patients without atrial fibrillation who have implantable devices.
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Affiliation(s)
| | | | - Stephen Cha
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ
| | - Win-Kuang Shen
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ
| | - Santosh Desai
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ
| | | | | | | | | | - Farouk Mookadam
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ
| | - Fadi Shamoun
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ.
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Luis SA, Mankad S, Pellikka P, Pislaru S. AORTIC REGURGITATION: A CHALLENGING POST-PROCEDURE DIAGNOSIS IN AORTIC VALVE INTERVENTION. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60713-0] [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: 10/25/2022]
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Camuglia AC, Luis SA, Sengupta A, Bett JHN, Walters DL. Pre-hospital fibrinolysis in the management of patients with ST elevation acute coronary syndrome: review of the evidence, implementation and future directions. Cardiovasc Hematol Disord Drug Targets 2013; 13:243-255. [PMID: 24479721 DOI: 10.2174/1871529x1303140129155809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 08/10/2013] [Accepted: 09/11/2013] [Indexed: 06/03/2023]
Abstract
Time to reperfusion is among the strongest predictors of clinical outcome in patients who present with ST elevation acute myocardial infarction. When time to access is equivalent, primary percutaneous coronary intervention has demonstrated superior outcomes to fibrinolysis. However, where significant delays exist in accessing percutaneous intervention, fibrinolysis has an important role. The potential for fibrinolysis delivery in the pre-hospital setting means that delays to primary percutaneous intervention need to be considered from the time that the patient becomes eligible for fibrinolysis in the field. This can be particularly challenging in patients with symptom duration ofless than two hours, as some evidence suggests fibrinolysis may be particularly beneficial in this early phase. Additionally, access to primary percutaneous intervention provided by an experienced operator, in a timely manner at any time of the day or night, is not an available option in many healthcare settings. This review focuses on the current evidence and practice of pre-hospital fibrinolysis and assesses potential roles for this therapy in the future.
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Affiliation(s)
| | | | | | | | - D L Walters
- Director of Cardiology, The Prince Charles Hospital, Rode Rd, Chermside, Brisbane, Queensland, Australia.
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Luis SA, Poon K, Luis C, Shukla A, Bett N, Hamilton-Craig C. Massive left atrial thrombus in a patient with rheumatic mitral stenosis and atrial fibrillation while anticoagulated with dabigatran. Circ Cardiovasc Imaging 2013; 6:491-2. [PMID: 23696587 DOI: 10.1161/circimaging.113.000253] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sushil Allen Luis
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia.
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Luis SA, Roper D, Incani A, Poon K, Haqqani H, Walters DL. Non-pharmacological therapy for atrial fibrillation: managing the left atrial appendage. Cardiol Res Pract 2012; 2012:304626. [PMID: 22666618 PMCID: PMC3361153 DOI: 10.1155/2012/304626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 03/12/2012] [Accepted: 03/12/2012] [Indexed: 11/17/2022] Open
Abstract
The prevalence of atrial fibrillation (AF) is increasing in parallel with an ageing population leading to increased morbidity and mortality. The most feared complication of AF is stroke, with the arrhythmia being responsible for up to 20% of all ischemic strokes. An important contributor to this increased risk of stroke is the left atrial appendage (LAA). A combination of the LAA's unique geometry and atrial fibrillation leads to low blood flow velocity and stasis, which are precursors to thrombus formation. It has been hypothesized for over half a century that excision of the LAA would lead to a reduction in the incidence of stroke. It has only been in the last 20-25 years that the knowledge and technology has been available to safely carry out such a procedure. We now have a number of viable techniques, both surgical and percutaneous, which will be covered in this paper.
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Affiliation(s)
- Sushil Allen Luis
- Department of Cardiology, The Prince Charles Hospital, Rode Road, Chermside, QLD 4032, Australia
| | - Damian Roper
- Department of Cardiology, The Prince Charles Hospital, Rode Road, Chermside, QLD 4032, Australia
| | - Alexander Incani
- Department of Cardiology, The Prince Charles Hospital, Rode Road, Chermside, QLD 4032, Australia
| | - Karl Poon
- Department of Cardiology, The Prince Charles Hospital, Rode Road, Chermside, QLD 4032, Australia
| | - Haris Haqqani
- Department of Cardiology, The Prince Charles Hospital, Rode Road, Chermside, QLD 4032, Australia
| | - Darren L. Walters
- Department of Cardiology, The Prince Charles Hospital, Rode Road, Chermside, QLD 4032, Australia
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Luis SA, Christie DRH, Kaminski A, Kenny L, Peres MH. Pregnancy and radiotherapy: Management options for minimising risk, case series and comprehensive literature review. J Med Imaging Radiat Oncol 2009; 53:559-68. [DOI: 10.1111/j.1754-9485.2009.02124.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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