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Shah RP, Bolaji O, Duhan S, Ariaga AC, Keisham B, Paul T, Aljaroudi W, Alraies MC. Superior Vena Cava Syndrome: An Umbrella Review. Cureus 2023; 15:e42227. [PMID: 37605686 PMCID: PMC10439982 DOI: 10.7759/cureus.42227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
Superior vena cava syndrome (SVCS) is a medical emergency that encompasses an array of signs and symptoms due to obstruction of blood flow through the superior vena cava (SVC). It poses a significant healthcare burden due to its associated morbidity and mortality. Its impact on the healthcare system continues to grow due to the increasing incidence of the condition. This incidence trend has been attributed to the growing use of catheters, pacemakers, and defibrillators, although it is a rare complication of these devices. The most common cause of SVCS remains malignancies accounting for up to 60% of the cases. Understanding the pathophysiology of SVCS requires understanding the anatomy, the SVC drains blood from the right and left brachiocephalic veins, which drain the head and the upper extremities accounting for about one-third of the venous blood to the heart. The most common presenting symptoms of SVCS are swelling of the face and hand, chest pain, respiratory symptoms (dyspnea, stridor, cough, hoarseness, and dysphagia), and neurologic manifestations (headaches, confusion, or visual/auditory disturbances). Symptoms generally worsen in a supine position. Diagnosis typically requires imaging, and SVCS can be graded based on classification schemas depending on the severity of symptoms and the location, understanding, and degree of obstruction. Over the past decades, the management modalities of SVCS have evolved to meet the increasing burden of the condition. Here, we present an umbrella review providing an overall assessment of the available information on SVCS, including the various management options, their indications, and a comparison of the advantages and disadvantages of these modalities.
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Affiliation(s)
- Rajendra P Shah
- Department of Internal Medicine, Vassar Brothers Medical Center, Poughkeepsie, USA
| | - Olayiwola Bolaji
- Department of Internal Medicine, University of Maryland Capital Regional Medical Center, Largo, USA
| | - Sanchit Duhan
- Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, USA
| | - Anderson C Ariaga
- Department of Internal Medicine, Vassar Brothers Medical Center, Poughkeepsie, USA
| | - Bijeta Keisham
- Sinai Center for Thrombosis and Research, Sinai Hospital of Baltimore, Baltimore, USA
| | - Timir Paul
- Section of Interventional Cardiology, University of Tennessee at Nashville/Ascension Saint Thomas Hospital, Nashville, USA
| | - Wael Aljaroudi
- Department of Cardiology, Augusta University Medical College of Georgia, Augusta, USA
| | - M Chadi Alraies
- Department of Cardiology, Detroit Medical Center, Detroit, USA
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2
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Hritani R, Ramsey Z, Lee R, Bates WB, Williams H, Garcia D, Kutlar A, Aljaroudi W. An unusual left atrial Rosai-Dorfman involvement in sickle cell disease patient. J Nucl Cardiol 2023; 30:1286-1289. [PMID: 35316451 DOI: 10.1007/s12350-022-02944-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Rama Hritani
- Division of Cardiology, Department of Medicine, Medical College of Georgia-Augusta University, 1120 15th St, BBR 6515B, Augusta, GA, 30912, USA.
| | - Zach Ramsey
- Department of Pathology, Medical College of Georgia-Augusta University, Augusta, GA, USA
| | - Richard Lee
- Division of Cardiothoracic surgery, Department of Surgery, Medical College of Georgia-Augusta University, Augusta, GA, USA
| | - William B Bates
- Department of Radiology and Imaging, Medical College of Georgia-Augusta University, Augusta, GA, USA
| | - Hadyn Williams
- Department of Radiology and Imaging, Medical College of Georgia-Augusta University, Augusta, GA, USA
| | - Daniel Garcia
- Department of Medicine, Medical College of Georgia-Augusta University, Augusta, GA, USA
| | - Abdullah Kutlar
- Division of Hematology and Oncology, Department of Medicine, Medical College of Georgia-Augusta University, Augusta, GA, USA
| | - Wael Aljaroudi
- Division of Cardiology, Department of Medicine, Medical College of Georgia-Augusta University, 1120 15th St, BBR 6515B, Augusta, GA, 30912, USA
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3
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Hritani R, Shahbazian K, Schwade M, Voong CM, Sharma GK, Aljaroudi W, Weintraub NL. PREDICTORS FOR HEART FAILURE RE-HOSPITALIZATIONS IN PERIPARTUM CARDIOMYOPATHY: A RETROSPECTIVE SINGLE CENTER STUDY IN THE UNITED STATES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02646-3] [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: 03/06/2023]
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4
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Essa A, Patel H, Schwade M, Barmore W, West A, Mansouri S, Aljaroudi W. A NEW HEMODYNAMIC INDEX ALONG WITH STANDARD SIX-MINUTE WALK IN PREDICTING OUTCOMES IN CARDIAC REHAB PATIENTS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02185-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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5
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Mansour M, Chammas E, Winkler M, Aljaroudi W. Clinical significance of the hemodynamic gain index in patients undergoing exercise stress testing and coronary computed tomography angiography. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2455] [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: 11/12/2022] Open
Abstract
Abstract
Background
Many hemodynamic parameters are used during exercise stress testing but provide limited information regarding obstructive coronary artery disease (CAD) when exercise is suboptimal. Hemodynamic gain index (HGI) is a recently developed and sensitive indicator of ischemia which has been associated with increased mortality.
Purpose
This study sought to evaluate the clinical impact of HGI in patients who underwent concomitant exercise testing and coronary computed tomography angiography (CCTA).
Methods
Consecutive patients from the executive health program between 2010 and 2018 were identified. Resting and peak heart rate (HR) and systolic blood pressure (SBP) were recorded. Framingham risk score (FRS), Duke treadmill score (DTS) and HGI [(HRpeak × SBPpeak) − (HRrest × SBPrest)] / (HRrest × SBPrest) were calculated. The latter was divided into quartiles. The presence or absence of any CAD on CCTA was confirmed. Multivariate analysis and artificial neural network were used to determine the independent predictors of obstructive CAD.
Results
There were 284 patients (mean age 53 years, 83% male). Mean HGI was 1.74±0.67, with severely blunted HGI cut-off of ≤1.25 (Quartile 4). Patients with blunted HGI were older, had higher FRS, and worse DTS. Patients with obstructive CAD showed lower HGI when compared to control (1.36±0.53 vs. 1.77±0.67, P-value 0.005) and had more prevalence of severely blunted HGI ≤1.25 (44% vs. 22%, P-value 0.019). In the multivariate analysis, after adjusting for traditional risk factors, HGI remained independent predictor of obstructive CAD while severely blunted HGI ≤1.25 was associated with 3-fold increased odds of obstructive CAD (P-value 0.05). Using artificial intelligence analysis, blunted HGI remained an independent predictor of obstructive CAD an area under the curve of 0.83 and 0.96, and normalized importance of HGI of 100% and 63%, respectively for different models.
Conclusions
Among patients who underwent concomitant exercise testing and CCTA, blunted HGI ≤1.25 was strongly associated with obstructive CAD after adjusting for traditional risk factors. HGI is robust, practical, and allows clinicians to reclassify patients, change management, and thus improve prognosis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Mansour
- Montreal University Hospital Center, Department of Cardiology , Montreal , Canada
| | - E Chammas
- Clemenceau Medical Center, Division of Cardiology , Beirut , Lebanon
| | - M Winkler
- Medical College of Georgia, Department of Cardiovascular Medicine , Augusta , United States of America
| | - W Aljaroudi
- Medical College of Georgia, Department of Cardiovascular Medicine , Augusta , United States of America
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Sattar Y, Almas T, Arshad J, Zghouzi M, Ullah W, Mir T, Mohamed MO, Elgendy IY, Aljaroudi W, Prasad A, Shlofmitz R, Mamas MA, Kereiakes DJ, Chadi Alraies M. Clinical and angiographic success and safety comparison of coronary intravascular lithotripsy: An updated meta-analysis. IJC Heart & Vasculature 2022; 39:100975. [PMID: 35242998 PMCID: PMC8881660 DOI: 10.1016/j.ijcha.2022.100975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 11/25/2022]
Abstract
Background Intravascular lithotripsy (IVL) can be used to assist stent deployment in severe coronary artery calcifications (CAC). Methods Studies employing IVL for CAC lesions were included. The primary outcomes included clinical and angiographic success. The secondary outcomes, including lumen gain, maximum calcium thickness, and calcium angle at the final angiography site, minimal lumen area site, and minimal stent area site, were analyzed by the random-effects model to calculate the pooled standardized mean difference. Tertiary outcomes included safety event ratios. Results Seven studies (760 patients) were included. The primary outcomes: pooled clinical and angiographic success event ratio parentage of IVL was 94.4% and 94.8%, respectively. On a random effect model for standard inverse variance for secondary outcomes showed: minimal lumen diameter increase with IVL was 4.68 mm (p-value < 0.0001, 95% CI 1.69–5.32); diameter decrease in the stenotic area after IVL session was −5.23 mm (95 CI –22.6–12.8). At the minimal lumen area (MLA) and final minimal stent area (MSA) sites, mean lumen area gain was 1.42 mm2 (95% CI 1.06–1.63; p < 0.00001) and 1.34 mm2 (95% CI 0.71–1.43; p < 0.00001), respectively. IVL reduced calcium thickness at the MLA site (SMD −0.22; 95% CI −0.40–0.04; P = 0.02); calcium angle was not affected at the MLA site. The tertiary outcomes: most common complication was major adverse cardiovascular events (n = 48/669), and least common complication was abrupt closure of the vessel (n = 1/669). Conclusions Evidence suggests that IVL safely and effectively facilitates stent deployment with high angiographic and clinical success rates in treating severely calcified coronary lesions.
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Fu W, Gates L, Issa M, Bates WB, Carr JJ, Aljaroudi W, Sorrell V, Winkler MA. Swiss cheese interventricular septum presenting with catastrophic stroke: the potential role of ECG-gated CTA. BJR Case Rep 2022; 8:20210069. [PMID: 35136633 PMCID: PMC8803220 DOI: 10.1259/bjrcr.20210069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 10/22/2021] [Accepted: 11/04/2021] [Indexed: 11/05/2022] Open
Abstract
Ventricular septal defect is a common congenital cardiac condition that presents in a variety of morphologies. Less commonly, when an individual patient is found to have multiple ventricular septal defects, the term “Swiss cheese ventricular septal defect” is applied. Although not routinely utilized in clinical practice, electrocardiogram (ECG)-gated computed tomographic angiography (CTA) has been shown to provide utility in detecting intracardiac shunts, demonstrating promise in preventing acute strokes secondary to a paradoxical embolus from occurring; this is especially important when atypical cardiac septa are suspected. This case seeks to illustrate how usage of ECG-gated CTA can assist in early detection and prevention of adverse outcomes resulting from an atypical presentation of a ventricular septal defect.
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Affiliation(s)
- Weibo Fu
- Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Lauren Gates
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mohamed Issa
- University of Kentucky College of Medicine, Lexington, Kentucky
| | - William B. Bates
- Medical College of Georgia at Augusta University, Augusta, Georgia
| | - J. Jeff Carr
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wael Aljaroudi
- Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Vincent Sorrell
- University of Kentucky College of Medicine, Lexington, Kentucky
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Sattar Y, Abdul Razzack A, Kompella R, Alhajri N, Arshad J, Ullah W, Zghouzi M, Mir T, Power D, Qureshi WT, Aljaroudi W, Elgendy IY, Mamas MA, Alraies MC. Outcomes of intravascular ultrasound versus optical coherence tomography guided percutaneous coronary angiography: A meta regression-based analysis. Catheter Cardiovasc Interv 2021; 99:E1-E11. [PMID: 34668640 DOI: 10.1002/ccd.29976] [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: 05/28/2021] [Revised: 08/18/2021] [Accepted: 09/29/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Studies comparing clinical outcomes with intravascular ultrasound (IVUS) versus optical coherence tomography (OCT) guidance for percutaneous coronary intervention (PCI) in patients presenting with coronary artery disease, including stable angina or acute coronary syndrome, are limited. METHODS We performed a detailed search of electronic databases (PubMed, Embase, and Cochrane) for randomized controlled trials and observational studies that compared cardiovascular outcomes of IVUS versus OCT. Data were aggregated for the primary outcome measure using the random-effects model as pooled risk ratio (RR). The primary outcome of interest was major adverse cardiac events (MACE), cardiac mortality, and all-cause mortality. Secondary outcomes included myocardial infarction (MI), stent thrombosis (ST), target lesion revascularization (TLR), and stroke. RESULTS A total of seven studies met the inclusion criteria, comprising 5917 patients (OCT n = 2075; IVUS n = 3842). OCT-PCI versus IVUS-guided PCI comparison yielded no statistically significant results for all the outcomes; MACE (RR 0.78; 95% confidence interval [CI], 0.57-1.09; p = 0.14), cardiac mortality (RR 0.97; 95% CI, 0.27-3.46; p = 0.96), all-cause mortality (RR 0.74; 95% CI, 0.39-1.39; p = 0.35), MI (RR 1.27; 95% CI, 0.52-3.07; p = 0.60), ST (RR 0.70; 95% CI, 0.13-3.61; p = 0.67), TLR (RR 1.09; 95% CI, 0.53-2.25; p = 0.81), and stroke (RR 2.32; 95% CI, 0.42-12.90; p = 0.34). Furthermore, there was no effect modification on meta-regression including demographics, comorbidities, lesion location, lesion length, and stent type. CONCLUSIONS In this meta-analysis, OCT-guided PCI was associated with no difference in clinical outcomes compared with IVUS-guided PCI.
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Affiliation(s)
- Yasar Sattar
- Cardiology, West Virginia University, Morgantown, West Virginia, USA
| | | | - Ritika Kompella
- Internal Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Noora Alhajri
- Public Health, Khalifa University College of Medicine and Health Science, Abu Dhabi, UAE
| | - Junaid Arshad
- Cardiology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Waqas Ullah
- Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Tanveer Mir
- Cardiology, Detroit Medical Center, Detroit, Michigan, USA
| | - David Power
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Waqas T Qureshi
- Cardiology, University of Massachusetts, Worcester, Massachusetts, USA
| | | | | | - Mamas A Mamas
- Cardiology, Keele University School of Medicine, Keele Cardiovascular Research Group, Stoke-on-Trent, UK
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9
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Mansour M, Chammas E, Hamoui O, Honeine W, Aljaroudi W. P808 Association between left ventricular diastolic dysfunction and subclinical coronary artery calcification. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.463] [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: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
None
Background
Assessment of diastolic dysfunction (DD) by echocardiography is an integral part of the evaluation of patients with normal ejection fraction (EF) and symptoms suggestive of heart failure. However, many patients with DD are asymptomatic. Computed tomography calcium scoring (CTCS) is often used to assess patients at low-intermediate risk for coronary artery disease (CAD).
Aim
The purpose of this study is to evaluate the association of DD with subclinical coronary artery calcification.
Methods
Consecutive patients presenting for executive check-up who underwent resting transthoracic echocardiography followed by CTCS were retrospectively identified between January 2010 and December 2014. Two‑dimensional and tissue Doppler imaging parameters were analyzed for assessing and grading of DD. Coronary artery calcium (CAC) score was quantified.
Results
A total of 191 patients (mean age 52 ± 12 years, 17% age ≥ 65, 20% with diabetes) were included. Of them, 69 (36%) patients had DD. Patients with higher CAC score were older, had more comorbidities, lower e’ velocity, and were more likely to have DD. In the multivariate analysis, DD alone, age > 65 years, or both were associated with almost 3-fold increase of subclinical atherosclerosis. After propensity analysis, DD was still associated with increased odds ratio (OR) for subclinical CAC (OR 3.66 [1.54-8.72], P = 0.03), and similarly for e’< 10 cm/s. Compared to patients age < 65 years and normal diastolic function, those age > 65 years or DD had OR 3.49 (1.45-8.35) for subclinical coronary atherosclerosis (CAC > 0), whereas those age > 65 years and DD had OR 9.30 (2.00-42), (P = 0.005 and P = 0.004, respectively).
Conclusions
Our analysis suggests that DD was strongly associated with CAC > 0 even after adjusting for age and comorbidities. Assessment of CAC as part of the routine clinical evaluation of patients with normal EF and atypical symptoms without a history of coronary atherosclerotic disease is warranted for further risk stratification.
Table 1
Abstract P808 Figure. Baseline characteristics
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Affiliation(s)
- M Mansour
- Clemenceau Medical Center, Division of Cardiology , Beirut, Lebanon
| | - E Chammas
- Clemenceau Medical Center, Division of Cardiology , Beirut, Lebanon
| | - O Hamoui
- Clemenceau Medical Center, Division of Cardiology , Beirut, Lebanon
| | - W Honeine
- Clemenceau Medical Center, Division of Cardiology , Beirut, Lebanon
| | - W Aljaroudi
- Clemenceau Medical Center, Division of Cardiology , Beirut, Lebanon
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10
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Abstract
A 9-year-old boy with hypereosinophilic syndrome (HES) was referred for cardiac magnetic resonance (CMR) imaging following an abnormal echocardiogram that showed a large mass layered on the inferolateral wall of the left ventricle, causing secondary severe mitral regurgitation. Cardiac involvement in HES usually affects the ventricular apex. In our case, CMR confirmed the presence of a large mural thrombus of 0.9 cm × 4.2 cm. This unusual cardiac involvement in HES was diagnosed in its intermediate thrombotic stage. CMR is very sensitive and specific in staging the disease. It explained the etiology of mitral regurgitation and guided therapy, especially when echocardiography was nonconclusive.
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Affiliation(s)
- Mohamad Jihad Mansour
- Division of Cardiology, Faculty of Medical Sciences, Lebanese University, Hadath, Beirut, Lebanon.,Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon
| | - Malek Rahal
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon
| | - Elie Chammas
- Division of Cardiology, Faculty of Medical Sciences, Lebanese University, Hadath, Beirut, Lebanon.,Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon
| | - Omar Hamoui
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon
| | - Wael Aljaroudi
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon
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11
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Mansour MJ, Aljaroudi W, Mroueh A, Hamoui O, Honeine W, Khoury N, Nassif JA, Chammas E. Stress-induced Worsening of Left Ventricular Diastolic Function as a Marker of Myocardial Ischemia. J Cardiovasc Echogr 2017; 27:45-51. [PMID: 28465992 PMCID: PMC5412746 DOI: 10.4103/jcecho.jcecho_44_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Echocardiography has been the subject of interest in diagnosing diastolic dysfunction and estimating left ventricular filling pressures (LVFPs). The present study is set to estimate the correlation between the worsening of diastolic parameters and the evidence of inducible ischemia during an exercise stress echocardiography (SE) in comparison with the results of coronary computed tomographic angiogram (CCTA). Methods: A total of 191 consecutive patients from the executive screening program who underwent exercise SE followed by CCTA were evaluated. Baseline demographics, heart rate, and blood pressure measurements were extracted for analysis. Standard two-dimensional and tissue Doppler imaging parameters were analyzed. Diastolic function was graded at rest and peak exercise. Results: Patients who had worsening of diastolic function by at least one grade had had 2–3-fold higher odds of having abnormal SE. In addition, patients with worsening of diastolic function had higher stress LVFPs (E/e’ = 11.7 ± 2.7 vs. E/e’ 8.0 ± 2.0; P < 0.0001), more E/e’ change >25% (48% vs. 22%, P = 0.012), and were more likely to have obstructive coronary artery disease (CAD) on CCTA (23.8% vs. 9.2%; P = 0.045). A change in E/e’ >25% (stress-rest) was highly associated with a positive stress test and abnormal CCTA result. Patients with no change or improvement in diastolic function with stress had a 92% negative predictive value of having normal SE and 91% of normal/nonobstructive CCTA. Conclusion: A worsening of diastolic function and a change in E/e’ >25% (stress-rest) were associated with abnormal SE, positive stress test, and obstructive CAD when compared to CCTA results.
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Affiliation(s)
- Mohamad Jihad Mansour
- Division of Cardiology, Lebanese University, Faculty of Medical Sciences, Hadath, Lebanon.,Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon
| | - Wael Aljaroudi
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon
| | - Ali Mroueh
- Division of Cardiology, Lebanese University, Faculty of Medical Sciences, Hadath, Lebanon
| | - Omar Hamoui
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon
| | - Walid Honeine
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon
| | - Nada Khoury
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon
| | - Jinane Abi Nassif
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon
| | - Elie Chammas
- Division of Cardiology, Lebanese University, Faculty of Medical Sciences, Hadath, Lebanon.,Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon
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Shahgaldi K, Hegner T, Da Silva C, Fukuyama A, Takeuchi M, Uema A, Kado Y, Nagata Y, Hayashi A, Otani K, Fukuda S, Yoshitani H, Otsuji Y, Morhy S, Lianza A, Afonso T, Oliveira W, Tavares G, Rodrigues A, Vieira M, Warth A, Deutsch A, Fischer C, Tezynska-Oniszk I, Turska-Kmiec A, Kawalec W, Dangel J, Maruszewski B, Bokiniec R, Burczynski P, Borszewska-Kornacka K, Ziolkowska L, Zuk M, Troshina A, Dzhalilova D, Poteshkina N, Hamitov F, Warita S, Kawasaki M, Tanaka R, Yagasaki H, Minatoguchi S, Wanatabe T, Ono K, Noda T, Wanatabe S, Minatoguchi S, Angelis A, Ageli K, Vlachopoulos C, Felekos I, Ioakimidis N, Aznaouridis K, Vaina S, Abdelrasoul M, Tsiamis E, Stefanadis C, Cameli M, Sparla S, D'ascenzi F, Fineschi M, Favilli R, Pierli C, Henein M, Mondillo S, Lindqvist P, Tossavainen E, Gonzalez M, Soderberg S, Henein M, Holmgren A, Strachinaru M, Catez E, Jousten I, Pavel O, Janssen C, Morissens M, Chatzistamatiou E, Moustakas G, Memo G, Konstantinidis D, Mpampatzeva Vagena I, Manakos K, Traxanas K, Vergi N, Feretou A, Kallikazaros I, Tsai WC, Sun YT, Lee WH, Yang LT, Liu YW, Lee CH, Li WT, Mizariene V, Bieseviciene M, Karaliute R, Verseckaite R, Vaskelyte J, Lesauskaite V, Chatzistamatiou E, Mpampatseva Vagena I, Manakos K, Moustakas G, Konstantinidis D, Memo G, Mitsakis O, Kasakogias A, Syros P, Kallikazaros I, Hristova K, Cornelissen G, Singh R, Shiue I, Coisne D, Madjalian AM, Tchepkou C, Raud Raynier P, Degand B, Christiaens L, Baldenhofer G, Spethmann S, Dreger H, Sanad W, Baumann G, Stangl K, Stangl V, Knebel F, Azzaz S, Kacem S, Ouali S, Risos L, Dedobbeleer C, Unger P, Sinem Cakal S, Elif Eroglu E, Baydar O, Beytullah Cakal B, Mehmet Vefik Yazicioglu M, Mustafa Bulut M, Cihan Dundar C, Kursat Tigen K, Birol Ozkan B, Ali Metin Esen A, Tournoux F, Chequer R, Sroussi M, Hyafil F, Rouzet F, Leguludec D, Baum P, Stoebe S, Pfeiffer D, Hagendorff A, Fang F, Lau M, Zhang Q, Luo X, Wang X, Chen L, Yu C, Zaborska B, Smarz K, Makowska E, Kulakowski P, Budaj A, Bengrid TM, Zhao Y, Henein MY, Caminiti G, D'antoni V, Cardaci V, Conti V, Volterrani M, Warita S, Kawasaki M, Yagasaki H, Minatoguchi S, Nagaya M, Ono K, Noda T, Watanabe S, Houle H, Minatoguchi S, Gillebert TC, Chirinos JA, Claessens TC, Raja MW, De Buyzere ML, Segers P, Rietzschel ER, Kim K, Cha J, Chung H, Kim J, Yoon Y, Lee B, Hong B, Rim S, Kwon H, Choi E, Pyankov V, Aljaroudi W, Matta S, Al-Shaar L, Habib R, Gharzuddin W, Arnaout S, Skouri H, Jaber W, Abchee A, Bouzas Mosquera A, Peteiro J, Broullon F, Constanso Conde I, Bescos Galego H, Martinez Ruiz D, Yanez Wonenburger J, Vazquez Rodriguez J, Alvarez Garcia N, Castro Beiras A, Gunyeli E, Oliveira Da Silva C, Shahgaldi K, Manouras A, Winter R, Meimoun P, Abouth S, Martis S, Boulanger J, Elmkies F, Zemir H, Detienne J, Luycx-Bore A, Clerc J, Rodriguez Palomares JF, Gutierrez L, Maldonado G, Garcia G, Galuppo V, Gruosso D, Teixido G, Gonzalez Alujas M, Evangelista A, Garcia Dorado D, Rechcinski T, Wierzbowska-Drabik K, Wejner-Mik P, Szymanska B, Jerczynska H, Lipiec P, Kasprzak J, El-Touny K, El-Fawal S, Loutfi M, El-Sharkawy E, Ashour S, Boniotti C, Carminati M, Fusini L, Andreini D, Pontone G, Pepi M, Caiani E, Oryshchyn N, Kramer B, Hermann S, Liu D, Hu K, Ertl G, Weidemann F, Ancona F, Miyazaki S, Slavich M, Figini F, Latib A, Chieffo A, Montorfano M, Alfieri O, Colombo A, Agricola E, Nogueira M, Branco L, Rosa S, Portugal G, Galrinho A, Abreu J, Cacela D, Patricio L, Fragata J, Cruz Ferreira R, Igual Munoz B, Erdociain Perales M, Maceira Gonzalez A, Estornell Erill Jordi J, Donate Bertolin L, Vazquez Sanchez Alejandro A, Miro Palau Vicente V, Cervera Zamora A, Piquer Gil M, Montero Argudo A, Girgis HYA, Illatopa V, Cordova F, Espinoza D, Ortega J, Khan U, Islam A, Majumder A, Girgis HYA, Bayat F, Naghshbandi E, Naghshbandi E, Samiei N, Samiei N, Malev E, Omelchenko M, Vasina L, Zemtsovsky E, Piatkowski R, Kochanowski J, Budnik M, Scislo P, Opolski G, Kochanowski J, Piatkowski R, Scislo P, Budnik M, Marchel M, Opolski G, Abid L, Ben Kahla S, Abid D, Charfeddine S, Maaloul I, Ben Jmaa M, Kammoun S, Hashimoto G, Suzuki M, Yoshikawa H, Otsuka T, Isekame Y, Yamashita H, Kawase I, Ozaki S, Nakamura M, Sugi K, Benvenuto E, Leggio S, Buccheri S, Bonura S, Deste W, Tamburino C, Monte IP, Gripari P, Fusini L, Muratori M, Tamborini G, Ghulam Ali S, Bottari V, Cefalu' C, Bartorelli A, Agrifoglio M, Pepi M, Zambon E, Iorio A, Di Nora C, Abate E, Lo Giudice F, Di Lenarda A, Agostoni P, Sinagra G, Timoteo AT, Galrinho A, Moura Branco L, Rio P, Aguiar Rosa S, Oliveira M, Silva Cunha P, Leal A, Cruz Ferreira R, Zemanek D, Tomasov P, Belehrad M, Kostalova J, Kara T, Veselka J, Hassanein M, El Tahan S, El Sharkawy E, Shehata H, Yoon Y, Choi H, Seo H, Lee S, Kim H, Youn T, Kim Y, Sohn D, Choi G, Mielczarek M, Huttin O, Voilliot D, Sellal J, Manenti V, Carillo S, Olivier A, Venner C, Juilliere Y, Selton-Suty C, Butz T, Faber L, Brand M, Piper C, Wiemer M, Noelke J, Sasko B, Langer C, Horstkotte D, Trappe H, Maysou L, Tessonnier L, Jacquier A, Serratrice J, Copel C, Stoppa A, Seguier J, Saby L, Verschueren A, Habib G, Petroni R, Bencivenga S, Di Mauro M, Acitelli A, Cicconetti M, Romano S, Petroni A, Penco M, Maceira Gonzalez AM, Cosin-Sales J, Igual B, Sancho-Tello R, Ruvira J, Mayans J, Choi J, Kim S, Almeida A, Azevedo O, Amado J, Picarra B, Lima R, Cruz I, Pereira V, Marques N, Chatzistamatiou E, Konstantinidis D, Manakos K, Mpampatseva Vagena I, Moustakas G, Memo G, Mitsakis O, Kasakogias A, Syros P, Kallikazaros I, Cho E, Kim J, Hwang B, Kim D, Jang S, Jeon H, Cho J, Chatzistamatiou E, Konstantinidis D, Memo G, Mpapatzeva Vagena I, Moustakas G, Manakos K, Traxanas K, Vergi N, Feretou A, Kallikazaros I, Jedrzejewska I, Konopka M, Krol W, Swiatowiec A, Dluzniewski M, Braksator W, Sefri Noventi S, Sugiri S, Uddin I, Herminingsih S, Arif Nugroho M, Boedijitno S, Caro Codon J, Blazquez Bermejo Z, Valbuena Lopez SC, Lopez Fernandez T, Rodriguez Fraga O, Torrente Regidor M, Pena Conde L, Moreno Yanguela M, Buno Soto A, Lopez-Sendon JL, Stevanovic A, Dekleva M, Kim M, Kim S, Kim Y, Shim J, Park S, Park S, Kim Y, Shim W, Kozakova M, Muscelli E, Morizzo C, Casolaro A, Paterni M, Palombo C, Bayat F, Nazmdeh M, Naghshbandi E, Nateghi S, Tomaszewski A, Kutarski A, Brzozowski W, Tomaszewski M, Nakano E, Harada T, Takagi Y, Yamada M, Takano M, Furukawa T, Akashi Y, Lindqvist G, Henein M, Backman C, Gustafsson S, Morner S, Marinov R, Hristova K, Geirgiev S, Pechilkov D, Kaneva A, Katova T, Pilosoff V, Pena Pena M, Mesa Rubio D, Ruiz Ortin M, Delgado Ortega M, Romo Penas E, Pardo Gonzalez L, Rodriguez Diego S, Hidalgo Lesmes F, Pan Alvarez-Ossorio M, Suarez De Lezo Cruz-Conde J, Gospodinova M, Sarafov S, Guergelcheva V, Vladimirova L, Tournev I, Denchev S, Mozenska O, Segiet A, Rabczenko D, Kosior D, Gao S, Eliasson M, Polte C, Lagerstrand K, Bech-Hanssen O, Morosin M, Piazza R, Leonelli V, Leiballi E, Pecoraro R, Cinello M, Dell' Angela L, Cassin M, Sinagra G, Nicolosi G, Savu O, Carstea N, Stoica E, Macarie C, Moldovan H, Iliescu V, Chioncel O, Moral S, Gruosso D, Galuppo V, Teixido G, Rodriguez-Palomares J, Gutierrez L, Evangelista A, Jansen Klomp WW, Peelen L, Spanjersberg A, Brandon Bravo Bruinsma G, Van 'T Hof A, Laveau F, Hammoudi N, Helft G, Barthelemy O, Michel P, Petroni T, Djebbar M, Boubrit L, Le Feuvre C, Isnard R, Bandera F, Generati G, Pellegrino M, Alfonzetti E, Labate V, Villani S, Gaeta M, Guazzi M, Gabriels C, Lancellotti P, Van De Bruaene A, Voilliot D, De Meester P, Buys R, Delcroix M, Budts W, Cruz I, Stuart B, Caldeira D, Morgado G, Almeida A, Lopes L, Fazendas P, Joao I, Cotrim C, Pereira H, Weissler Snir A, Greenberg G, Shapira Y, Weisenberg D, Monakier D, Nevzorov R, Sagie A, Vaturi M, Bando M, Yamada H, Saijo Y, Takagawa Y, Sawada N, Hotchi J, Hayashi S, Hirata Y, Nishio S, Sata M, Jackson T, Sammut E, Siarkos M, Lee L, Carr-White G, Rajani R, Kapetanakis S, Ciobotaru V, Yagasaki H, Kawasaki M, Tanaka R, Minatoguchi S, Sato N, Amano K, Warita S, Ono K, Noda T, Minatoguchi S, Breithardt OA, Razavi H, Nabutovsky Y, Ryu K, Gaspar T, Kosiuk J, John S, Prinzen F, Hindricks G, Piorkowski C, Nemchyna O, Tovstukha V, Chikovani A, Golikova I, Lutai M, Nemes A, Kalapos A, Domsik P, Lengyel C, Orosz A, Forster T, Nordenfur T, Babic A, Giesecke A, Bulatovic I, Ripsweden J, Samset E, Winter R, Larsson M, Blazquez Bermejo Z, Lopez Fernandez T, Caro Codon J, Valbuena S, Caro Codon J, Mori Junco R, Moreno Yanguela M, Lopez-Sendon J, Pinto-Teixeira P, Branco L, Galrinho A, Oliveira M, Cunha P, Silva T, Rio P, Feliciano J, Nogueira-Silva M, Ferreira R, Shkolnik E, Vasyuk Y, Nesvetov V, Shkolnik L, Varlan G, Bajraktari G, Ronn F, Ibrahimi P, Jashari F, Jensen S, Henein M, Kang MK, Mun HS, Choi S, Cho JR, Han S, Lee N, Cho IJ, Heo R, Chang H, Shin S, Shim C, Hong G, Chung N. Poster session 3: Thursday 4 December 2014, 14:00-18:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ather S, Iqbal F, Gulotta J, Aljaroudi W, Heo J, Iskandrian AE, Hage FG. Comparison of three commercially available softwares for measuring left ventricular perfusion and function by gated SPECT myocardial perfusion imaging. J Nucl Cardiol 2014; 21:673-81. [PMID: 24715622 DOI: 10.1007/s12350-014-9885-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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: 12/20/2013] [Accepted: 02/13/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND The three softwares, Quantitative Perfusion SPECT (QPS), Emory Cardiac Toolbox, and 4 Dimension-Myocardial SPECT (4DM) are widely used with myocardial perfusion imaging (MPI) to determine perfusion defect size (PDS) and left ventricular (LV) function. There are limited data on the degree of agreement between these methods in quantifying the LV perfusion pattern and function. METHODS AND RESULTS In 120 consecutive patients who had abnormal regadenoson SPECT MPI with a visually derived summed stress score ≥4, the correlation between the softwares for measurements of PDS, reversible, and fixed defects was poor to fair (Spearman's ρ = 0.18-0.72). Overall, estimation of defect size was smaller by QPS and larger by 4DM. There was discordance among the softwares in 62% of the cases in defining PDS as small/moderate/large. The correlation between the softwares was better for measuring LVEF, volumes and mass (ρ = 0.84-0.97), and discrepant results for defining normal/mild-moderate/severe LV systolic dysfunction were prevalent in 28% of the patients. CONCLUSION There are significant differences between the softwares in measuring PDS as well as LV function, and more importantly in defining small, moderate, or large ischemic burden. These results suggest the necessity of using the same software when assessing interval changes by serial imaging.
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Affiliation(s)
- Sameer Ather
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, 35294, USA,
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Sadat K, Ather S, Aljaroudi W, Heo J, Iskandrian AE, Hage FG. The effect of bone marrow mononuclear stem cell therapy on left ventricular function and myocardial perfusion. J Nucl Cardiol 2014; 21:351-67. [PMID: 24379128 DOI: 10.1007/s12350-013-9846-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 07/10/2013] [Accepted: 12/08/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Bone marrow stem cell (BMC) transfer is an emerging therapy with potential to salvage cardiomyocytes during acute myocardial infarction and promote regeneration and endogenous repair of damaged myocardium in patients with left ventricular (LV) dysfunction. We performed a meta-analysis to examine the association between administration of BMC and LV functional recovery as assessed by imaging. METHODS AND RESULTS Our meta-analysis included data from 32 trials comprising information on 1,300 patients in the treatment arm and 1,006 patients in the control arm. Overall, BMC therapy was associated with a significant increase in LV ejection fraction by 4.6% ± 0.7% (P < .001) (control-adjusted increase of 2.8% ± 0.9%, P = .001), and a significant decrease in perfusion defect size by 9.5% ± 1.4% (P < .001) (control-adjusted decrease of 3.8% ± 1.2%, P = .002). The effect of BMC therapy was similar whether the cells were administered via intra-coronary or intra-myocardial routes and was not influenced by baseline ejection fraction or perfusion defect size. CONCLUSIONS BMC transfer appears to have a positive impact on LV recovery in patients with acute coronary syndrome and those with stable coronary disease with or without heart failure. Most studies were small and a minority used a core laboratory for image analysis.
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Affiliation(s)
- Kamel Sadat
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Lyons-Harrison Research Building 314, 1900 University Blvd, Birmingham, AL, 35294, USA,
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Alraies MC, Aljaroudi W, Khan UA, Alraiyes AH. Deep T waves and chest pain. Cleve Clin J Med 2014; 81:21-2. [PMID: 24391102 DOI: 10.3949/ccjm.81a.12176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- M Chadi Alraies
- Clinical Assistant Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, Department of Hospital Medicine, Cleveland Clinic
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Alraies MC, Aljaroudi W, Chamsi-Pasha M, Senapati A, Klein AL. Predictors of qrs voltage recovery post-pericardiectomy in patients with constrictive pericarditis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4485] [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: 11/12/2022] Open
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Chamsi-Pasha MAR, Aljaroudi W, Alraiyes AH, Alraies MC. McConnell sign and S1Q3T3 pattern in pulmonary embolism: revisited. Case Reports 2013; 2013:bcr-2013-009623. [DOI: 10.1136/bcr-2013-009623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Chadi Alraies M, Aljaroudi W, Klein AL. Cardiac MRI guided therapy decreases recurrence of acute pericarditis. J Saudi Heart Assoc 2013. [DOI: 10.1016/j.jsha.2013.03.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Chadi Alraies M, Aljaroudi W, Zurick A, Yarmohammadi H, Dahiya A, Klein AL. Cardiac magnetic resonance is a marker of active inflammation in constrictive pericarditis. J Saudi Heart Assoc 2013. [DOI: 10.1016/j.jsha.2013.03.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Negishi K, Seicean S, Negishi T, Yingchoncharoen T, Aljaroudi W, Marwick TH. Relation of heart-rate recovery to new onset heart failure and atrial fibrillation in patients with diabetes mellitus and preserved ejection fraction. Am J Cardiol 2013; 111:748-53. [PMID: 23273718 DOI: 10.1016/j.amjcard.2012.11.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 11/03/2012] [Accepted: 11/03/2012] [Indexed: 12/17/2022]
Abstract
Diabetic autonomic neuropathy is a possible link between abnormal metabolism in type 2 diabetes mellitus (T2DM) and risk for atrial fibrillation (AF) and heart failure (HF). The aim of this study was to elucidate the association between attenuated heart rate recovery (HRR) and these manifestations of myocardial dysfunction in T2DM. Nine hundred fourteen consecutive patients with T2DM (mean age 56 ± 11 years, 508 men) without diabetes mellitus complications, with negative results on stress echocardiography, were enrolled. Patients with known cardiac disease were excluded. Demographics, clinical assessment, co-morbidities, and insulin use were collected prospectively. The association of HRR with new-onset HF and AF was sought using a Cox proportional-hazards model. There were 47 events (22 HF and 25 AF) during a median follow-up period of 7.8 years. Events were associated with age, exercise capacity, HRR, and left atrial volume index but not with baseline glycosylated hemoglobin, left ventricular mass index, or standard markers of diastolic function. In sequential Cox models for the combined outcomes, the model based on clinical data (age and gender; overall chi-square = 5.5) was not significantly improved by left atrial volume index (chi-square = 8.6, p = 0.10) or maximum METs (chi-square = 8.7, p = 0.07) but was significantly improved by adding HRR (chi-square = 19.7, p = 0.004). In addition, HRR provided significant incremental prognostic value regarding the composite end point (net reclassification improvement 19.2%, p = 0.04; integrated discrimination improvement 1.58%, p = 0.004). In conclusion, the association of HRR with subsequent HF and AF, independent of and incremental to left atrial volume index and other markers of abnormal cardiac structure and function, indicates a role for autonomic neuropathy as the link between metabolic and cardiac risk in patients with T2DM.
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Affiliation(s)
- Patrick Collier
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Kumar V, Venkataraman R, Aljaroudi W, Osorio J, Heo J, Iskandrian AE, Hage FG. Implications of left bundle branch block in patient treatment. Am J Cardiol 2013; 111:291-300. [PMID: 23111137 DOI: 10.1016/j.amjcard.2012.09.029] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 09/01/2012] [Accepted: 09/01/2012] [Indexed: 11/27/2022]
Abstract
Left bundle branch block (LBBB) causes an abnormal pattern of cardiac activation and affects regional myocardial function. Although recognition of LBBB on the surface electrocardiogram is straightforward, dissecting its effect on patient treatment and outcome can be more challenging. The altered pattern of cardiac activation in LBBB causes electrical and mechanical ventricular dyssynchrony, influences ischemia detection on the surface electrocardiogram, and affects stress testing and imaging modalities dependent on wall motion and thickening. Restoration of synchrony by biventricular pacing can improve symptoms and longevity in carefully selected patients. The diagnostic, prognostic, and therapeutic implications of LBBB across this spectrum are discussed in this review.
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Cikes M, Tong L, Jasaityte R, Hamilton J, Sutherland G, D'hooge J, Yurdakul S, Oner F, Avci BK, Sahin S, Direskeneli H, Aytekin S, Fang F, Chan A, Zhang Q, Sanderson J, Kwong J, Yu C, Zaidi A, Raju H, Ghani S, Gati S, Cox A, Sheikh N, Sharma R, Sharma S, Kutty S, Kottam A, Padiyath A, Gao S, Drvol L, Lof J, Li L, Rangamani S, Danford D, Kuehne T, Rosner A, Avenarius D, Malm S, Iqbal A, Baltabaeva A, Schirmer H, Bijnens B, Myrmel T, Magalhaes A, Silva Marques J, Martins S, Carrilho Ferreira P, Jorge C, Silva D, Placido R, Goncalves S, Almeida A, Nunes Diogo A, Poulidakis E, Aggeli C, Sideris S, Dilaveris P, Gatzoulis K, Felekos I, Koutagiar I, Sfendouraki E, Roussakis G, Stefanadis C, Zhang Q, Sun J, Gao R, Feng Y, Liu X, Sheng W, Liu F, Yu C, Hallioglu O, Citirik D, Buyukakilli B, Ozeren M, Gurgul S, Tasdelen B, Rodriguez Lopez A, Rodriguez Lopez A, Garcia Cuenllas L, Garcia Cuenllas L, Medrano C, Medrano C, Granja S, Granja S, Marin C, Marin C, Maroto E, Maroto E, Alvarez T, Alvarez T, Ballesteros F, Ballesteros F, Camino M, Camino M, Centeno M, Centeno M, Alraies M, Aljaroudi W, Halley C, Rodriguez L, Grimm R, Thomas J, Jaber W, Knight D, Coghlan J, Muthurangu V, Grasso A, Toumpanakis C, Caplin M, Taylor A, Davar J, Mohlkert LA, Halvorsen C, Hallberg J, Sjoberg G, Norman M, Cameli M, Losito M, Lisi M, Natali B, Massoni A, Maccherini M, Chiavarelli M, Massetti M, Mondillo S, Sljivic A, Stojcevski B, Celic V, Pencic B, Majstorovic A, Cosic Z, Backovic S, Ilic-Djordjevic I, Muraru D, Gripari P, Esposito R, Tamborini G, Galderisi M, Ermacora D, Maffessanti F, Santoro C, Pepi M, Badano L, Bombardini T, Cini D, Picano E, Shahgaldi K, Gunyeli E, Sahlen A, Manouras A, Winter R, Banovic M, Vukcevic V, Ostojic M, Markovic Z, Mladenovic A, Trifunovic D, Stojkovic S, Bacic D, Dedovic D, Seferovic P, Huttin O, Coulibaly S, Mercy M, Schwartz J, Zinzius P, Sellal J, Popovic B, Marie P, Juilliere Y, Selton-Suty C, Gurzun MM, Ionescu A, Bahlay B, Jones G, Rimbas R, Enescu O, Mihaila S, Ciobanu A, Vinereanu D, Vlasseros I, Koumoulidis A, Tousoulis D, Veioglanis S, Avgeropoulou A, Katsi V, Stefanadis C, Kallikazaros I, Kiviniemi T, Ylitalo A, Airaksinen K, Lehtinen T, Saraste A, Pietila M, Karjalainen P, Trifunovic D, Ostojic M, Stankovic S, Vujisic-Tesic B, Petrovic M, Banovic M, Boricic M, Draganic G, Petrovic M, Stepanovic J, Kuznetsov V, Yaroslavskaya E, Pushkarev G, Krinochkin D, Zyrianov I, Dekleva M, Stevanovic A, Kleut M, Suzic Lazic J, Markovic Nikolic N, Akhunova S, Saifullina G, Sadykov A, Loudon M, D'arcy J, Arnold L, Reynolds R, Mabbet C, Prendergast B, Dahl J, Videbaek L, Poulsen M, Rudbaek T, Pellikka P, Rasmussen L, Moller J, Lowery C, Frenneaux M, Dawson D, Dwivedi G, Singh S, Rudd A, Mahadevan D, Srinivasan J, Jiminez D, Sahinarslan A, Vecchio F, Maccarthy P, Wendler O, Monaghan M, Harimura Y, Seo Y, Ishizu T, Noguchi Y, Aonuma K, Urdaniz MM, Palomares JFR, Rius JB, Surribas IB, Tura GT, Garcia-Moreno LG, Alujas TG, Masip AE, Mas PT, Dorado DG, Meimoun P, Germain A, Clerc J, Elmkies F, Zemir H, Luycx-Bore A, Nasr GM, Erraki A, Dulgheru R, Magne J, Capoulade R, Elhonsali Z, Pierard LA, Pibarot P, Lancellotti P, Wrideier S, Butz T, Schilling I, Gkiouras G, Sasko B, Van Bracht M, Prull M, Trappe HJ, Castillo Bernal F, Mesa Rubio M, Ruiz Ortiz M, Delgado Ortega M, Morenate Navio M, Baeza Garzon M, Del Pino ML, Toledano Delgado F, Mazuelos F, Suarez de Lezo Herreros de Tejada J, Prinz C, Schumann M, Burghardt A, Seggewiss H, Oldenburg O, Horstkotte D, Faber L, Bistola V, Banner N, Hedger M, Simon A, Rahman Haley S, Baltabaeva A, Adamyan K, Tumasyan LR, Chilingaryan A, Makavos G, Kouris N, Kostopoulos V, Stamatelatou M, Damaskos D, Kartsagoulis E, Olympios C, Sade L, Eroglu S, Bircan A, Pirat B, Sezgin A, Aydinalp A, Muderrisoglu H, Sargento L, Satendra M, Sousa C, Longo S, Lousada N, Dos Reis RP, Kuznetsov V, Krinochkin D, Gapon L, Vershinina A, Shurkevich N, Bessonova M, Yaroslavskaya E, Kolunin G, Sargento L, Satendra M, Sousa C, Lousada N, Dos Reis RP, Azevedo O, Lourenco M, Machado I, Guardado J, Medeiros R, Pereira A, Quelhas I, Lourenco A, Duman D, Sargin F, Kilicaslan B, Inan A, Ozgunes N, Goktas P, Ikonomidis I, Tzortzis S, Paraskevaidis I, Andreadou I, Katseli C, Katsimbri P, Papadakis I, Pavlidis G, Anastasiou-Nana M, Lekakis J, Charalampopoulos A, Howard L, Davies R, Gin-Sing W, Tzoulaki I, Grapsa I, Gibbs J, Dobson RA, Cuthbertson DJ, Burgess M, Lichodziejewska B, Kurnicka K, Goliszek S, Kostrubiec M, Dzikowska-Diduch O, Ciurzynski M, Krupa M, Grudzka K, Palczewski P, Pruszczyk P, Mansencal N, Marcadet D, Montalvan B, Dubourg O, Matveeva N, Nartsissova G, Chernjavskiy A, Eicher JC, Berthier S, Lorcerie B, Philip JL, Wolf JE, Wiesen P, Ledoux D, Massion P, Piret S, Canivet JL, Cusma-Piccione M, Zito C, Imbalzano E, Saitta A, Donato D, Madaffari A, Luzza G, Pipitone V, Tripodi R, Carerj S, Bombardini T, Gherardi S, Arpesella G, Maccherini M, Serra W, Del Bene R, Sicari R, Picano E, Al-Mallah M, Ananthasubramaniam K, Alam M, Chattahi J, Zweig B, Boedeker S, Song T, Khoo J, Davies J, Ang KL, Galinanes M, Chin D, Papamichael ND, Karassavidou D, Mpougialkli M, Antoniou S, Giannitsi S, Chachalos S, Gouva C, Naka K, Katopodis K, Michalis L, Tsang W, Cui V, Ionasec R, Takeuchi M, Houle H, Weinert L, Roberson D, Lang R, Altman M, Aussoleil A, Bergerot C, Sibellas F, Bonnefoy-Cudraz E, Derumeaux GA, Thibault H, Mohamed A, Omran A, Hussein M, Shahgaldi K, Gunyeli E, Sahlen A, Manouras A, Winter R, Squeri A, Binno S, Ferdenzi E, Reverberi C, Baldelli M, Barbieri A, Iaccarino D, Naldi M, Bosi S, Kalinowski M, Szulik M, Streb W, Stabryla J, Nowak J, Rybus-Kalinowska B, Kukulski T, Kalarus Z, Ouss A, Riezebos R, Nestaas E, Skranes J, Stoylen A, Brunvand L, Fugelseth D, Magalhaes A, Silva Marques J, Martins S, Carrilho Ferreira P, Placido R, Jorge C, Silva D, Goncalves S, Almeida A, Nunes Diogo A, Nagy A, Kovats T, Apor A, Nagy A, Vago H, Toth A, Toth M, Merkely B, Ranjbar S, Karvandi M, Hassantash S, Da Silva SG, Marin C, Rodriguez A, Marcos C, Rodriguez-Ogando A, Maroto E, Medrano C, Del Valle DI, Lopez-Fernandez T, Gemma D, Gomez-Rubin M, De Torres F, Feliu J, Canales M, Buno A, Ramirez E, Lopez-Sendon J, Magalhaes A, Silva Marques J, Martins S, Placido R, Silva D, Jorge C, Calisto C, Goncalves S, Almeida A, Nunes Diogo A, Jorge C, Cortez-Dias N, Goncalves S, Ribeiro S, Santos L, Silva D, Barreiros C, Bernardes A, Carpinteiro L, Sousa J, Kim SH, Choi W, Chidambaram S, Arunkumar R, Venkatesan S, Gnanavelu G, Dhandapani V, Ravi M, Karthikeyan G, Meenakshi K, Muthukumar D, Swaminathan N, Vitarelli A, Barilla F, Capotosto L, Truscelli G, Dettori O, Caranci F, D-Angeli I, De Maio M, De Cicco V, Bruno P, Doesch C, Sueselbeck T, Haghi D, Streitner F, Borggrefe M, Papavassiliu T, Laser K, Schaefer F, Fischer M, Habash S, Degener F, Moysich A, Haas N, Kececioglu D, Burchert W, Koerperich H, Dwivedi G, Al-Shehri H, Dekemp R, Ali I, Alghamdi A, Klein R, Scullion A, Beanlands R, Ruddy T, Chow B, Lipiec P, Szymczyk E, Michalski B, Wozniakowski B, Rotkiewicz A, Stefanczyk L, Szymczyk K, Kasprzak J, Angelov A, Yotov Y, Mircheva L, Kisheva A, Kunchev O, Ikonomidis I, Tsantes A, Triantafyllidi H, Tzortzis S, Dima K, Trivilou P, Papadopoulos C, Travlou A, Anastasiou-Nana M, Lekakis J, Bader R, Agoston-Coldea L, Lupu S, Mocan T, Loegstrup B, Hofsten D, Christophersen T, Moller J, Bjerre M, Flyvbjerg A, Botker H, Egstrup K, Park Y, Choi J, Yun K, Lee S, Han D, Kim J, Kim J, Kim J, Chun K. Poster Session Wednesday 5 December all day Display * Determinants of left ventricular performance. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Aljaroudi W, Alraies MC, Brunken R, Cerquiera M, Jaber WA. Paradoxical septal motion from prior coronary artery bypass graft surgery does not impact left ventricular mechanical dyssynchrony by gated myocardial perfusion imaging. J Nucl Cardiol 2012; 19:1190-7. [PMID: 23054841 DOI: 10.1007/s12350-012-9627-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 07/19/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Phase analysis of gated myocardial perfusion imaging (MPI) provides automated and reproducible assessment of left ventricular (LV) mechanical dyssynchrony (LVMD) (phase standard deviation [SD]). Many patients undergoing gated MPI have history of prior coronary artery bypass graft surgery (CABG). The latter is often associated with paradoxical septal wall motion (PSM). The effect of prior CABG and PSM on LVMD has not been evaluated. METHODS AND RESULTS From the single-photon emission computed tomography (SPECT) and positron emission tomography (PET) MPI clinical database maintained at the Cleveland Clinic, we identified 200 consecutive patients with SPECT (100 control with normal LV ejection fraction [EF], MPI, and QRS < 120 ms; and 100 with LVEF < 35%), and 631 patients with LVEF < 35% with gated PET. Patients with QRS ≥ 120 ms, bundle branch block, ventricular pacing or isolated non-CABG surgery were excluded. There were 162 patients with gated SPECT (46 with prior CABG), and 568 with gated PET (220 with prior CABG) that were left for analysis. Phase SD was derived using Emory Cardiac Toolbox (ECTb) (for gated SPECT) and Corridor 4DM (4DM) (for gated SPECT and PET images). Multivariate linear regression analysis was performed to assess whether prior CABG was an independent predictor of worse LV mechanical dyssynchrony. After adjusting for patients' demographics, co-morbidities, medications, and MPI data, history of prior CABG was not and independent predictor of LV mechanical dyssynchrony (P = .67 with 4DM, P = .97 with ECTb) in patients undergoing gated SPECT or among patients undergoing gated PET imaging (P = .18). CONCLUSIONS Although paradoxical septal wall motion is commonly seen after cardiac surgery, prior CABG does not affect or impact LV mechanical dyssynchrony indices measured from gated SPECT or PET images. Whether dyssynchrony measurements with echocardiography that has higher temporal resolution might uncover intraventricular delays, remains to be determined.
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Affiliation(s)
- Wael Aljaroudi
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue/J1-5, Cleveland, OH 44195, USA.
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Aljaroudi W, Halley C, Houghtaling P, Agarwal S, Menon V, Rodriguez L, Grimm RA, Thomas JD, Jaber WA. Impact of body mass index on diastolic function in patients with normal left ventricular ejection fraction. Nutr Diabetes 2012; 2:e39. [PMID: 23448803 PMCID: PMC3432184 DOI: 10.1038/nutd.2012.14] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [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] [Indexed: 01/20/2023] Open
Abstract
Background: Obesity is a major public health epidemic and is associated with increased risk of heart failure and mortality. We evaluated the impact of body mass index (BMI) on the prevalence of diastolic dysfunction (DD). Methods: We reviewed clinical records and echocardiogram of patients with baseline echocardiogram between 1996 and 2005 that showed normal left ventricular ejection fraction (LVEF). Diastolic function was labeled as normal, stage 1, stage 2 or stage 3/4 dysfunction. Patients were categorized as normal weight (BMI <25 kg m−2), overweight (25–29.9 kg m−2), obese (30–39.9 kg m−2) and morbidly obese (⩾40 kg m−2). Multivariable ordinal and ordinary logistic regression were performed to identify factors associated with DD, and evaluate the independent relationship of BMI with DD. Results: The cohort included 21 666 patients (mean (s.d.) age, 57.1 (15.1); 55.5% female). There were 7352 (33.9%) overweight, 5995 (27.6%) obese and 1616 (7.4%) morbidly obese patients. Abnormal diastolic function was present in 13 414 (61.9%) patients, with stage 1 being the most common. As BMI increased, the prevalence of normal diastolic function decreased (P<0.0001). Furthermore, there were 1733 patients with age <35 years; 460 (26.5%) and 407 (23.5%) were overweight and obese, respectively, and had higher prevalence of DD (P<0.001). Using multivariable logistic regression, BMI remained significant in both ordinal (all stages of diastolic function) and binary (normal versus abnormal). Also, obesity was associated with increased odds of DD in all patients and those aged <35 years. Conclusions: In patients with normal LVEF, higher BMI was independently associated with worsening DD.
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Affiliation(s)
- W Aljaroudi
- Department of Cardiovascular Medicine, Heart and Vascular Imaging Institute, Cleveland, OH, USA
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Aljaroudi W, Mundkur M, Heo J, Iskandrian AE. The relation between left ventricular ejection fraction and perfusion defect size by gated SPECT myocardial perfusion imaging in patients with coronary artery disease. Q J Nucl Med Mol Imaging 2011; 55:688-693. [PMID: 21068715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM Left ventricular (LV) ejection fraction (EF) and perfusion defect size (PDS) provide independent and incremental prognostic information in patients with coronary artery disease (CAD). The purpose of this study was to examine the correlation between EF and PDS. METHODS LVEF and PDS were measured in 96 consecutive patients with CAD and abnormal perfusion scan using well-validated automated programs. The PDS was expressed as % of LV myocardium as total (reversible plus fixed), fixed or reversible. RESULTS The EF was 49±15% (range 17-84), the total PDS was 29±15% (2-77) and the fixed PDS was 20±13% (2-58). The end-diastolic volume (EDV) was 131±59 mL (29-342) and end-systolic volume (ESV) was 72±51 mL (4-283). There were moderate but significant correlations between EF and total PDS (r=-0.46, P<0.0001) and fixed PDS (r=-0.45, P<0.0001) but not with reversible PDS. In the subgroup analysis, the correlations were stronger in patients with history of prior coronary artery bypass grafting than without, and higher in men than women. The highest correlations were seen between EF and EDV in both men and women (r=-0.68 and -0.74 respectively, P<0.0001 each), and between EF and ESV (r =-0.80, P<0.0001). CONCLUSION Although there is a statistically significant correlation between PDS and EF, the correlation is not strong. This observation provides supportive evidence of why PDS and EF provide incremental prognostic information. It also supports the incremental prognostic merits of LV volume measurements.
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Affiliation(s)
- W Aljaroudi
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-0006, USA.
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Aljaroudi W, Aggarwal H, Iqbal F, Heo J, Iskandrian AE. Left ventricular dyssynchrony in patients with end-stage liver disease. J Nucl Cardiol 2011; 18:451-5. [PMID: 21479756 DOI: 10.1007/s12350-010-9332-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/11/2010] [Accepted: 12/13/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Limited published data suggested that patients with end-stage liver disease (ESLD) might have "cirrhotic cardiomyopathy," which could have an earlier stage manifested by mechanical dyssynchrony before left ventricular (LV) dysfunction. METHODS AND RESULTS We studied consecutive patients with ESLD who had a stress-gated Tc-99m sestamibi myocardial perfusion imaging between 2008 and 2010 prior to liver transplant. Patients with LVEF < 50%, abnormal perfusion, or QRS ≥ 120 ms were excluded. Baseline demographics, co-morbidities, model for ESLD (MELD) score, LV volumes, mass, ejection fraction (EF), and dyssynchrony indices (standard deviation and bandwidth) were extracted. The phase indices were compared to a normal cohort. There were 179 patients with a mean age 53 ± 8 years, LVEF 72 ± 10%. Hepatitis C, non-alcoholic steatohepatitis, and alcohol abuse were the most common cause of liver cirrhosis (40%, 18%, and 14%, respectively). Patients with ESLD had similar standard deviation (14 ± 8° vs 15 ± 6°, P = NS) and bandwidth (41 ± 25° vs 42 ± 14°, P = NS) to the normal cohort. Only four patients (2%) had a standard deviation >27° (mean + 2 SD of the control group). The phase standard deviations and bandwidth similar in patients with MELD scores of ≤10, 11-18, 19-24, and ≥25 (P = NS for both). There was no correlation between the MELD score and standard deviation or bandwidth (r = -0.044 and -0.068, respectively, P = NS for both). Also, there was no correlation between the QTc and dyssynchrony indices. After 1-year follow-up, 22 patients died (12%). The dyssynchrony indices were similar among those who died and those who survived. CONCLUSION Patients with ESLD and normal EF have no evidence for LV dyssynchrony.
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Affiliation(s)
- Wael Aljaroudi
- Division of Cardiovascular Medicine, Section of Cardiovascular Imaging, Cleveland Clinic, Mail Code J1-5, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Venkataraman R, Aljaroudi W, Belardinelli L, Heo J, Iskandrian AE. The effect of ranolazine on the vasodilator-induced myocardial perfusion abnormality. J Nucl Cardiol 2011; 18:456-62. [PMID: 21432000 DOI: 10.1007/s12350-011-9364-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 01/11/2011] [Accepted: 02/20/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND We previously reported that ranolazine improved myocardial ischemia during exercise myocardial perfusion imaging (MPI). Since the mechanism of reversible perfusion defects is different in exercise than vasodilator MPI, and based on the mechanism of action of ranolazine, we hypothesized that vasodilator stress MPI may fail to show improvement in myocardial perfusion pattern. METHODS Patients (n = 18) with known coronary artery disease and with reversible perfusion defects on a clinically indicated vasodilator stress MPI were re-studied 4 weeks after ranolazine (500-1000 mg PO BID) was added to their conventional treatment in an open-label trial. Perfusion pattern was assessed using automated methods. RESULTS The baseline left ventricular ejection fraction was 59% ± 14%. The total perfusion defect (measured by polar maps) was 22% ± 13% before and 21% ± 16% of LV myocardium after treatment (P = NS). The reversible defect size was 14% ± 10% before and 14% ± 11% of LV myocardium after treatment (P = NS). The automated-derived summed stress score was 12 ± 8 before and 12 ± 10 after treatment (P = NS) and the automated-derived summed difference score was 6 ± 5 before and 6 ± 5 after treatment (P = NS). Only 3 patients showed a decrease in reversible perfusion defect size with treatment. CONCLUSION Vasodilator stress MPI failed to show improvement in perfusion pattern after ranolazine treatment in most patients with baseline reversible defects. This is consistent with the unique anti-ischemic mechanism of ranolazine, which acts on the late I Na channel.
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Affiliation(s)
- Rajesh Venkataraman
- Division of Cardiovascular Disease, University of Alabama at Birmingham, 314 LHRB, 1900 University BLVD, Birmingham, AL 35294-0007, USA.
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Aljaroudi W, Iqbal F, Koneru J, Bhambhvani P, Heo J, Iskandrian AE. Safety of regadenoson in patients with end-stage liver disease. J Nucl Cardiol 2011; 18:90-5. [PMID: 20848256 DOI: 10.1007/s12350-010-9288-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [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: 07/12/2010] [Accepted: 08/23/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Regadenoson is a selective A(2A) receptor agonist that is used for vasodilator stress myocardial perfusion imaging (MPI). Since the drug is partially metabolized by the liver, its safety in patients with end-stage liver disease (ESLD) needs to be determined. METHODS AND RESULTS We studied 168 consecutive patients with ESLD who had regadenoson stress gated single photon emission computed tomography MPI between January 2008 and March 2010 before planned orthotopic liver transplantation and compared the hemodynamic responses and safety profile to 168 control patients. There were 72 women (43%) in ESLD versus 87 (52%) in the control group (P = .1). The patients with ESLD were younger (58 ± 7 vs 62 ± 12 years, P = .0002), but more likely to be Caucasians (P = .002). The MPI images were normal in 161 patients (96%) in each group. The left ventricular ejection fraction was 72 ± 10% in ESLD and 66 ± 11% in the control patients (P = .0001). The heart rate increase in response to regadenoson was lower in patients with ESLD than in the control group (16 ± 11 vs 23 ± 16 bpm, P = .0001), but the changes in systolic and diastolic blood pressures were similar (-9 ± 12 vs -11 ± 14 mmHg and -6 ± 8 vs -7 ± 10 mmHg, respectively, P = NS). There were no deaths or medication-related adverse events that required hospitalization in either group within 30 days of the study. CONCLUSION This is the first study to document the tolerability and safety profile of regadenoson in patients with ESLD.
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Affiliation(s)
- Wael Aljaroudi
- Division of Cardiovascular Medicine, Cleveland Clinic, Cleveland 44195, OH, USA.
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Aljaroudi W, Koneru J, Heo J, Iskandrian AE. Impact of ischemia on left ventricular dyssynchrony by phase analysis of gated single photon emission computed tomography myocardial perfusion imaging. J Nucl Cardiol 2011; 18:36-42. [PMID: 21104361 DOI: 10.1007/s12350-010-9296-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [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: 06/24/2010] [Accepted: 09/12/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is increasing awareness of the value of phase analysis of gated tomographic myocardial perfusion imaging in assessing left ventricular (LV) dyssynchrony. A concern repeatedly raised in many studies is whether reversible defects in the stress images "ischemia" could affect the phase-derived standard deviation and bandwidth, the two commonly used dyssynchrony indices. We hypothesized that the stress and rest images should provide comparable information because the images are acquired 1 hour after the tracer injection. METHODS AND RESULTS We studied two groups of patients with normal LV ejection fraction and no fixed perfusion defects. In group-1 (N = 20), the patients had reversible perfusion defects involving > 10% of the LV myocardium and in group-2 (N = 20), the patients had normal images. All patients underwent stress/rest-gated single photon emission computed tomography sestamibi imaging (the stress study was acquired with the lower dose) between January and March 2010. Patients with left bundle branch block or ventricular pacing were excluded. The patients in group-1 had a mean age of 61 ± 9 years, 65% were men, 75% Caucasians, and 70% had known prior coronary artery disease. The size of the reversible perfusion defect was 20 ± 13% (range 11%-50%) of the LV myocardium. The rest and stress phase-derived standard deviation (16 ± 6° vs 18 ± 8° and 16 ± 7° vs. 19 ± 6°) and the rest and stress bandwidth (42 ± 14° vs 46 ± 16° and 45 ± 17° vs 52 ± 12°), respectively, (P = NS for all) were similar in the two groups. The change (stress-rest) in standard deviation and bandwidth in groups 1 and 2 were not statistically significant (0.2 ± 3.1° vs 1.4 ± 4.7°, and 2 ± 13° vs 5 ± 13°, respectively, P = NS). There was no significant change from rest to stress in the standard deviation and the bandwidth in group-1 (P = .8 and .4, respectively) and group-2 (P = .2 and .08, respectively). There was no correlation between the size of the reversible perfusion defect and the change in phase standard deviation or bandwidth (r = 0.07 and 0.12, respectively, P = NS). CONCLUSIONS The presence of even a large reversible perfusion defect does not alter the indices of mechanical dyssynchrony by phase analysis. Further, comparable information is obtained whether using a low dose or a high dose of the radiotracer.
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Affiliation(s)
- Wael Aljaroudi
- Division of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Aljaroudi W, Koneru J, Iqbal F, Aggarwal H, Heo J, Iskandrian AE. Left ventricular mechanical dyssynchrony by phase analysis of gated single photon emission computed tomography in end-stage renal disease. Am J Cardiol 2010; 106:1042-7. [PMID: 20854972 DOI: 10.1016/j.amjcard.2010.05.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [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: 04/21/2010] [Revised: 05/17/2010] [Accepted: 05/18/2010] [Indexed: 11/17/2022]
Abstract
The presence and degree of left ventricular (LV) dyssynchrony in patients with end-stage renal disease (ESRD) has not been well studied. We hypothesized that these patients would be more likely to have mechanical dyssynchrony than a control cohort. The indexes of LV mechanical dyssynchrony were measured by automated analysis of gated single photon emission computed tomography myocardial perfusion imaging in 290 patients with ESRD and 109 control patients. Only patients with normal myocardial perfusion imaging findings and a narrow QRS duration were included. The following variables were derived: LV ejection fraction (EF), volume, mass, and 2 indexes of dyssynchrony, the standard deviation and bandwidth. The standard deviation and bandwidth were significantly greater in those with ESRD (23° ± 13° vs 15° ± 6° and 65° ± 40° vs 42° ± 14°, respectively, p <0.001 for each). The LV volumes and LV mass were significantly lower and LVEF significantly greater in the control group than in the patients with ESRD (p <0.001 for each). The subgroup of 217 patients with ESRD and normal LVEF also had a significantly greater standard deviation and bandwidth than did the control group (21° ± 12° and 57° ± 35°, p <0.001 for each). However, their values were lower than those of the 73 patients with ESRD and a LVEF <50% (30° ± 13° and 90° ± 45°, p <0.001 for each). Finally, 25 patients (9%) with ESRD and none of the control group had a standard deviation >43° (p = 0.01). In conclusion, patients with ESRD had significantly more mechanical dyssynchrony than did the control group, even in absence of electrical dyssynchrony and abnormal LV perfusion or function.
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Affiliation(s)
- Wael Aljaroudi
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Hage FG, Venkataraman R, Aljaroudi W, Bravo PE, McLarry J, Faulkner M, Heo J, Iskandrian AE. The impact of viability assessment using myocardial perfusion imaging on patient management and outcome. J Nucl Cardiol 2010; 17:378-89. [PMID: 20186583 DOI: 10.1007/s12350-010-9199-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [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: 11/14/2009] [Accepted: 02/04/2010] [Indexed: 01/25/2023]
Abstract
BACKGROUND Prior studies show that ischemic cardiomyopathy (ICM) patients with substantial viable myocardium have better survival with coronary revascularization (CR) than medical therapy (MT). When myocardial perfusion imaging (MPI) is used, the analysis is often based on visual scoring. We sought to determine the value of automated quantitative viability analysis in guiding management and predicting outcome. METHODS We identified 246 consecutive ICM patients who had rest-redistribution gated SPECT thallium-201 MPI. Size and severity of perfusion defects were assessed by automated method. Regions with <50% activity vs normal were considered nonviable. Mortality was verified against the social security death index database. RESULTS Of the 246 patients, 37% underwent CR within 3 months of MPI. The initial images showed a total perfusion defect size of 32 +/- 17%, redistribution of 3.5 +/- 4.6% and nonviable myocardium of 13 +/- 14%LV. Using multivariate logistic regression analysis, independent predictors of CR included chest pains (OR 2.74) and rest-delayed transient ischemic dilatation (OR 4.49), while a prior history of CR or ventricular arrhythmias favored MT. The cohort was followed-up for 41 +/- 30 m during which 111 patients (45%) died. Survival was better with CR than MT (P < .0001). For CR, survival was better for those with a smaller area of nonviable myocardium (risk of death increased by 5%/1% increase in size of nonviable myocardium, P = .009) but this was not seen in MT. CR had a mortality advantage over MT when the area of nonviable myocardium was CONCLUSIONS Automated quantitative analysis of MPI is useful in predicting survival in ICM, but the decision for or against CR is a complex one as it depends on multiple other factors and "viability testing" is just one variable that needs to be incorporated in the decision-making process.
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Affiliation(s)
- Fadi G Hage
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Zeigler Research Building 1024, 1530 3rd AVE S, Birmingham, AL 35294, USA.
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Hage FG, Aqel R, Aljaroudi W, Heo J, Pothineni K, Hansalia S, Lawson D, Dubovsky E, Iskandrian AE. Correlation between serum cardiac markers and myocardial infarct size quantified by myocardial perfusion imaging in patients with hypertrophic cardiomyopathy after alcohol septal ablation. Am J Cardiol 2010; 105:261-6. [PMID: 20102929 DOI: 10.1016/j.amjcard.2009.08.680] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 08/25/2009] [Accepted: 08/25/2009] [Indexed: 11/24/2022]
Abstract
Myocardial infarct (MI) size is a well-established prognostic marker but the association of serum markers with MI size, as measured by myocardial perfusion imaging (MPI), has not been well studied in patients with hypertrophic cardiomyopathy (HC) after alcohol septal ablation (ASA). Creatine kinase (CK), CK-MB, troponin I, and brain natriuretic peptide were measured before and at multiple points after ASA in patients with HC and were correlated with MI size measured by MPI. MPI at rest was performed in 54 patients with HC at a median of 2 days after ASA. CK, CK-MB, and troponin I increased after ASA to peak levels at 12 hours and their cumulative levels (area under the curve) showed significant correlation with size of MI by MPI (r = 0.544, 0.408, and 0.477, p <0.001, 0.003, and 0.001, respectively). The best marker was level of CK at 12 hours (r = 0.609, p <0.0001) after ASA. Brain natriuretic peptide level did not change significantly after ASA (p = 1.0) and only weakly correlated with MI size by MPI (r = 0.130, p = 0.007). In conclusion, CK, CK-MB, and troponin I measured at 12 hours, at peak, and as the area under the curve correlated well with infarct size, but CK level at 12 hours was the best marker. CK continues to be a useful marker of MI size despite the introduction of newer, more specific markers, especially when infarct onset is known with certainty as in patients with HC undergoing ASA.
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Aljaroudi W, Hermann D, Hage F, Heo J, Iskandrian AE. Safety of regadenoson in patients with end-stage renal disease. Am J Cardiol 2010; 105:133-5. [PMID: 20102905 DOI: 10.1016/j.amjcard.2009.08.663] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 08/04/2009] [Accepted: 08/04/2009] [Indexed: 10/20/2022]
Abstract
Regadenoson is a selective A(2A) receptor agonist that was recently approved by the Food and Drug Administration for vasodilator stress myocardial perfusion imaging. Because the drug is cleared by renal excretion, its safety in patients with end-stage renal disease (ESRD) needs to be determined. We studied 277 consecutive patients with ESRD who had undergone regadenoson stress gated single photon emission computed tomography myocardial perfusion imaging and compared their side effect profile and safety outcome to those of 134 patients with normal kidney function. The ESRD group included 164 men (59%) and the control group included 73 men (54%; p = NS). The patients with ESRD were younger than the controls (52 +/- 11 years vs 61 +/- 12 years; p <0.001). The myocardial perfusion imaging findings were abnormal in 53 patients (19%) with ESRD and in 24 patients in the control group (18%; p = NS). The left ventricular ejection fraction was 57 +/- 12% in the ESRD group and 64 +/- 12% in the control group (p <0.001). The changes in heart rate and systolic blood pressure (from baseline to peak stress) were 20 +/- 12 beats/min versus 22 +/- 13 beats/min and -11 +/- 24 mm Hg versus -12 +/- 23 mm Hg in the ESRD and control groups, respectively (p = NS for both). Very few patients in either group reported symptoms during the stress test. No medication-related hospitalizations, serious events, or death occurred in either group within 30 days of the study. In conclusion, this is the first study to document the safety of regadenoson in a large number of patients with ESRD. The drug was well tolerated, and the hemodynamic and side effect profiles were similar to those of patients with normal renal function.
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Aqel RA, Aljaroudi W, Hage FG, Tallaj J, Rayburn B, Nanda NC. Left Ventricular Collapse Secondary to Pericardial Effusion Treated with Pericardicentesis and Percutaneous Pericardiotomy in Severe Pulmonary Hypertension. Echocardiography 2008; 25:658-61. [DOI: 10.1111/j.1540-8175.2008.00661.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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