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Wann DG, Baird AS, Wang NC, Mulukutla SR, Thoma FW, Sezer A, Canterbury AM, Barakat AF, Gardner MW, Skowronski JN, Aronis KN, Voigt AH, Jain SK, Saba SF, Bhonsale A, Estes NM, Keebler ME, Hickey GW, Bazaz RR, Kancharla K. Association of pre-left ventricular assist device defibrillator shocks for ventricular arrhythmia with clinical outcomes after left ventricular assist device implantation. Heart Rhythm O2 2023; 4:708-714. [PMID: 38034894 PMCID: PMC10685166 DOI: 10.1016/j.hroo.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Background Implantable cardioverter-defibrillation (ICD) shocks after left ventricular assist device therapy (LVAD) are associated with adverse clinical outcomes. Little is known about the association of pre-LVAD ICD shocks on post-LVAD clinical outcomes and whether LVAD therapy affects the prevalence of ICD shocks. Objectives The purpose of this study was to determine whether pre-LVAD ICD shocks are associated with adverse clinical outcomes post-LVAD and to compare the prevalence of ICD shocks before and after LVAD therapy. Methods Patients 18 years or older with continuous-flow LVADs and ICDs were retrospectively identified within the University of Pittsburgh Medical Center system from 2006-2020. We analyzed the association between appropriate ICD shocks within 1 year pre-LVAD with a primary composite outcome of death, stroke, and pump thrombosis and secondary outcomes of post-LVAD ICD shocks and ICD shock hospitalizations. Results Among 309 individuals, average age was 57 ± 12 years, 87% were male, 80% had ischemic cardiomyopathy, and 42% were bridge to transplantation. Seventy-one patients (23%) experienced pre-LVAD shocks, and 69 (22%) experienced post-LVAD shocks. The overall prevalence of shocks pre-LVAD and post-LVAD were not different. Pre-LVAD ICD shocks were not associated with the composite outcome. Pre-LVAD ICD shocks were found to predict post-LVAD shocks (hazard ratio [HR] 5.7; 95% confidence interval [CI] 3.42-9.48; P <.0001) and hospitalizations related to ICD shocks from ventricular arrhythmia (HR 10.34; 95% CI 4.1-25.7; P <.0001). Conclusion Pre-LVAD ICD shocks predicted post-LVAD ICD shocks and hospitalizations but were not associated with the composite outcome of death, pump thrombosis, or stroke at 1 year. The prevalence of appropriate ICD shocks was similar before and after LVAD implantation in the entire cohort.
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Affiliation(s)
- Daniel G. Wann
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew S. Baird
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
| | - Norman C. Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Suresh R. Mulukutla
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Floyd W. Thoma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ahmet Sezer
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ann M. Canterbury
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amr F. Barakat
- Cardiology Department, Ascension St. Vincent’s Medical Center, Jacksonville, Florida
| | | | - Jenna N. Skowronski
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Konstantinos N. Aronis
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew H. Voigt
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sandeep K. Jain
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Samir F. Saba
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Aditya Bhonsale
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - N.A. Mark Estes
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mary E. Keebler
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Gavin W. Hickey
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Raveen R. Bazaz
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Krishna Kancharla
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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2
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Hamed M, Elseidy SA, Abdelazeem M, Morcos R, Abdallah A, Sammour Y, Barakat AF, Khalife W, Ramu V, Mamas MA, Elbadawi A. Role of oesophageal cooling in the prevention of oesophageal injury in atrial fibrillation catheter ablation: a systematic review and meta-analysis of randomized controlled trials. Europace 2023; 25:euad080. [PMID: 37021812 PMCID: PMC10227763 DOI: 10.1093/europace/euad080] [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] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/28/2023] [Indexed: 04/07/2023] Open
Abstract
AIMS To evaluate the efficacy of oesophageal cooling in the prevention of oesophageal injury in patients undergoing atrial fibrillation (AF) catheter ablation. METHODS AND RESULTS Comprehensive search of MEDLINE, EMBASE, and Cochrane databases through April 2022 for randomized controlled trials (RCTs) evaluating the role of oesophageal cooling compared with control in the prevention of oesophageal injury during AF catheter ablation. The study primary outcome was the incidence of any oesophageal injury. The meta-analysis included 4 RCTs with a total of 294 patients. There was no difference in the incidence of any oesophageal injury between oesophageal cooling and control [15% vs. 19%; relative risk (RR) 0.86; 95% confidence interval (CI) 0.31-2.41]. Compared with control, oesophageal cooling showed lower risk of severe oesophageal injury (1.5% vs. 9%; RR 0.21; 95% CI 0.05-0.80). There were no significant differences among the two groups in mild to moderate oesophageal injury (13.6% vs. 12.1%; RR 1.09; 95% CI 0.28-4.23), procedure duration [standardized mean difference (SMD) -0.03; 95% CI -0.36-0.30], posterior wall radiofrequency (RF) time (SMD 0.27; 95% CI -0.04-0.58), total RF time (SMD -0.50; 95% CI -1.15-0.16), acute reconnection incidence (RR 0.93; 95% CI 0.02-36.34), and ablation index (SMD 0.16; 95% CI -0.33-0.66). CONCLUSION Among patients undergoing AF catheter ablation, oesophageal cooling did not reduce the overall risk of any oesophageal injury compared with control. Oesophageal cooling might shift the severity of oesophageal injuries to less severe injuries. Further studies should evaluate the long-term effects after oesophageal cooling during AF catheter ablation.
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Affiliation(s)
- Mohamed Hamed
- Department of Internal Medicine, Florida Atlantic University, 777 Glades Road BC-71, Boca Raton, FL 33431, USA
| | - Sheref A Elseidy
- Department of Internal Medicine, Rochester General Hospital, 1425 Portland Ave, Rochester, NY 14621, USA
| | - Mohamed Abdelazeem
- Department of Internal Medicine, St. Elizabeth’s Medical Center, 736 Cambridge St, Brighton, MA 02135, USA
| | - Ramez Morcos
- Division of Cardiology, Florida Atlantic University, 777 Glades Road BC-71, Boca Raton, FL 33431, USA
| | - Ahmed Abdallah
- Division of Cardiology, East Tennessee State University, 1276 Gilbreath Dr, Johnson City, TN 37614, USA
| | - Yasser Sammour
- Division of Cardiology, Houston Methodist Hospital, 6565 Fannin St, Houston, TX 77030, USA
| | - Amr F Barakat
- UPMC Heart and Vascular Institute, University of Pittsburgh, 3550 Terrace St, Pittsburgh, PA 15213, USA
| | - Wissam Khalife
- Division of Cardiology, University of Texas Medical Branch, 1302 Mechanic St, Galveston, TX 77550, USA
| | - Vijay Ramu
- Division of Cardiology, East Tennessee State University, 1276 Gilbreath Dr, Johnson City, TN 37614, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, Newcastle ST5 5BG, UK
| | - Ayman Elbadawi
- Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
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Shen CP, Freed BC, Walter DP, Perry JC, Barakat AF, Elashery ARA, Shah KS, Kutty S, McGillion M, Ng FS, Khedraki R, Nayak KR, Rogers JD, Bhavnani SP. Convolution Neural Network Algorithm for Shockable Arrhythmia Classification Within a Digitally Connected Automated External Defibrillator. J Am Heart Assoc 2023; 12:e026974. [PMID: 36942628 DOI: 10.1161/jaha.122.026974] [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: 03/23/2023]
Abstract
Background Diagnosis of shockable rhythms leading to defibrillation remains integral to improving out-of-hospital cardiac arrest outcomes. New machine learning techniques have emerged to diagnose arrhythmias on ECGs. In out-of-hospital cardiac arrest, an algorithm within an automated external defibrillator is the major determinant to deliver defibrillation. This study developed and validated the performance of a convolution neural network (CNN) to diagnose shockable arrhythmias within a novel, miniaturized automated external defibrillator. Methods and Results There were 26 464 single-lead ECGs that comprised the study data set. ECGs of 7-s duration were retrospectively adjudicated by 3 physician readers (N=18 total readers). After exclusions (N=1582), ECGs were divided into training (N=23 156), validation (N=721), and test data sets (N=1005). CNN performance to diagnose shockable and nonshockable rhythms was reported with area under the receiver operating characteristic curve analysis, F1, and sensitivity and specificity calculations. The duration for the CNN to output was reported with the algorithm running within the automated external defibrillator. Internal and external validation analyses included CNN performance among arrhythmias, often mistaken for shockable rhythms, and performance among ECGs modified with noise to mimic artifacts. The CNN algorithm achieved an area under the receiver operating characteristic curve of 0.995 (95% CI, 0.990-1.0), sensitivity of 98%, and specificity of 100% to diagnose shockable rhythms. The F1 scores were 0.990 and 0.995 for shockable and nonshockable rhythms, respectively. After input of a 7-s ECG, the CNN generated an output in 383±29 ms (total time of 7.383 s). The CNN outperformed adjudicators in classifying atrial arrhythmias as nonshockable (specificity of 99.3%-98.1%) and was robust against noise artifacts (area under the receiver operating characteristic curve range, 0.871-0.999). Conclusions We demonstrate high diagnostic performance of a CNN algorithm for shockable and nonshockable rhythm arrhythmia classifications within a digitally connected automated external defibrillator. Registration URL: https://clinicaltrials.gov/ct2/show/NCT03662802; Unique identifier: NCT03662802.
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Affiliation(s)
- Christine P Shen
- Division of Cardiology Healthcare Innovation Laboratory Scripps Clinic San Diego CA
| | | | | | - James C Perry
- University of California San Diego, Rady Children's Hospital San Diego CA
| | - Amr F Barakat
- University of Pittsburg Medical Center Pittsburgh PA
| | | | - Kevin S Shah
- University of Utah Health Sciences Center Salt Lake City UT
| | | | | | - Fu Siong Ng
- Imperial College of London London United Kingdom
| | - Rola Khedraki
- Division of Cardiology Healthcare Innovation Laboratory Scripps Clinic San Diego CA
| | - Keshav R Nayak
- Division of Interventional Cardiology Scripps Mercy Hospital San Diego CA
| | - John D Rogers
- Division of Cardiology Healthcare Innovation Laboratory Scripps Clinic San Diego CA
| | - Sanjeev P Bhavnani
- Division of Cardiology Healthcare Innovation Laboratory Scripps Clinic San Diego CA
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Razzack AA, Lak HM, Erasani G, Rahman S, Hussain N, Ali BF, Eapi S, Yasmin F, Najeeb H, Mustafa A, Chawla S, Munir MB, Barakat AF, Saliba W, Wazni O, Hussein AA. Long-Term Efficacy and Safety of Left Atrial Appendage Occlusion (LAAO) vs Direct Oral Anticoagulation (DOAC) in Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis. Rev Cardiovasc Med 2023. [DOI: 10.31083/j.rcm2402044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Ibrahim J, Nieves RA, Barakat AF, Hynal K, Shpilsky D, Soman P. DSPECT-specific normative limits for left ventricular size and function. J Nucl Cardiol 2022; 29:3293-3299. [PMID: 35274213 DOI: 10.1007/s12350-022-02932-7] [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] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/03/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Differences in spatial resolution and image filtering between the solid-state DSPECT and traditional Anger SPECT (ASPECT) cameras are likely to result in differences in LV measurements. However, DSPECT-specific normal values are not available. The traditional approach of using patients deemed to have a low (< 5%) probability of coronary artery disease for the derivation of normative values has a number of limitations. We used healthy organ-donor subjects without known disease or medication use for derivation of normal values. METHODS Subjects were 92 consecutive kidney or liver donors who underwent single-day rest (5 mCi)-stress (15 mCi) Tc-99m sestamibi-gated SPECT myocardial perfusion imaging (MPI) on the DSPECT camera for pre-operative evaluation and had normal perfusion and LV function. Exclusion criteria included any known cardiac disease or medications. LV measurements were made on the post-stress supine stress images using QGS®. RESULTS Of 92 subjects (mean age 54.4 ± 15.0 and 39% men), mean EF ± 2SD for women and men was 77.2% ± 14.1% and 70.0 % ± 14.7%, respectively. Mean end-diastolic volume ± 2SD for women and men was 67.0 ± 32.2 mL and 99.6 ± 51.6 mL (indexed 38.3 ± 17.2 mL/m2 and 48.1 ± 25.9 mL/m2), respectively. Mean end-systolic volume ± 2SD for women and men was 16.1 ± 15.7 mL and 31.2 ± 29.2 mL (indexed 9.2 ± 8.8 mL/m2 and 15.0 ± 14.2 mL/m2), respectively. Mean LV wall volume ± 2SD for women and men was 95.9 ± 26.0 mL and 112.0 ± 48.8 mL (indexed 55.0 ± 13.8 mL/m2 and 54.1 ± 24.6 mL/m2), respectively. CONCLUSION We report DSPECT-specific LV measurements from normal subjects from which limits of normality can be derived for clinic use. Organ donors who undergo pre-operative MPI are a suitable cohort for the derivation of normal values.
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Affiliation(s)
- Joseph Ibrahim
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ricardo A Nieves
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Amr F Barakat
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kevin Hynal
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Daniel Shpilsky
- Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Prem Soman
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Elbadawi A, Sedhom R, Gad M, Hamed M, Elwagdy A, Barakat AF, Khalid U, Mamas MA, Birnbaum Y, Elgendy IY, Jneid H. Screening for atrial fibrillation in the elderly: A network meta-analysis of randomized trials. Eur J Intern Med 2022; 105:38-45. [PMID: 35953337 DOI: 10.1016/j.ejim.2022.07.015] [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] [Received: 05/19/2022] [Revised: 07/08/2022] [Accepted: 07/26/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Randomized controlled trials (RCTs) investigating the optimal screening strategy for atrial fibrillation (AF) have yielded conflicting results. OBJECTIVE To examine the comparative efficacy of different AF screening strategies in older adults. METHODS We searched MEDLINE, EMBASE and Cochrane without language restrictions through January 2022, for RCTs evaluating the outcomes of non-invasive AF screening approaches among adults ≥65 years. We conducted a pairwise meta-analysis comparing any AF screening approach versus no screening, and a network meta-analysis comparing systematic screening versus opportunistic screening versus no screening. The primary outcome was new AF detection. RESULTS The final analysis included 9 RCTs with 85,209 patients. The weighted median follow-up was 12 months. The mean age was 73.4 years and men represented 45.6%. On pairwise meta-analysis, any AF screening (either systematic or opportunistic) was associated with higher AF detection (1.8% vs. 1.3%; risk ratio [RR] 2.10; 95% confidence interval [CI] 1.20-3.65) and initiation of oral anticoagulation (RR 3.26; 95%CI 1.15-9.23), compared with no screening. There was no significant difference between any AF screening versus no screening in all-cause mortality (RR 0.97; 95%CI 0.93-1.01) or acute cerebrovascular accident (CVA) (RR 0.92; 95%CI 0.84-1.01). On network meta-analysis, only systematic screening was associated with higher AF detection (RR 2.73; 95% CI 1.62-4.59) and initiation of oral anticoagulation (RR 5.67; 95% CI 2.68-11.99), but not with the opportunistic screening, compared with no screening. CONCLUSION Systematic AF screening using non-invasive tools was associated with higher rate of new AF detection and initiation of OAC, but opportunistic screening was not associated with higher detection rates. There were no significant differences between the various AF screening approaches with respect to rates of all-cause mortality or CVA events. However, these analyses are likely underpowered and future RCTs are needed to examine the impact of systematic AF screening on mortality and CVA outcomes. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Ayman Elbadawi
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, USA
| | - Ramy Sedhom
- Division of Cardiology, Loma Linda University Health, Loma Linda, CA, USA
| | - Mohamed Gad
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Mohamed Hamed
- Division of Internal Medicine, Florida Atlantic University, Boca Raton, Florida, United States
| | - Amr Elwagdy
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, United States
| | - Amr F Barakat
- UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Umair Khalid
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, England; Institute of Population Health, University of Manchester, England
| | - Yochai Birnbaum
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, USA
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, United States
| | - Hani Jneid
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, USA.
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7
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Morcos R, Al Taii H, Rubens M, Saxena A, Ramamoorthy V, Hamed M, Barakat AF, Kulkarni N, Khalili H, Garcia S, Megaly M, Veledar E, Stavrakis S. Hospital outcomes of patients receiving catheter ablation of atrial fibrillation, left atrial appendage closure, or both. J Interv Card Electrophysiol 2022; 66:913-921. [PMID: 36114936 DOI: 10.1007/s10840-022-01370-2] [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: 07/04/2022] [Accepted: 09/06/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Catheter ablation (CA) and left atrial appendage closure (LAAC) require transseptal access; combining both in a single procedure may have advantages. However, the safety of this approach has not been extensively studied. The objective of this study was to compare in hospital outcomes among patients receiving CA, LAAC, and combination of both treatments on the same day. METHODS We conducted a retrospective cohort analysis of the National Inpatient Sample database. The primary outcome was the presence of major adverse cardiovascular and cerebrovascular events (MACCE) during index hospitalization. Secondary outcomes included stroke, pericardial effusion, pericardiocentesis, and bleeding. RESULTS A total of 69,285 hospitalizations with AF were included in the analysis, of which 71.7% received LAAC, 27.8% received CA, and 0.5% received combination of both treatments on the same day. MACEE (OR, 1.63; 95% CI, 0.39-6.70), stroke (OR, 2.98; 95% CI, 0.55-16.01), pericardial effusion (OR, 0.33; 95% CI, 0.07-1.41), pericardiocentesis (OR, 1.00; 95% CI, 0.25-3.86), and bleeding (OR, 3.25; 95% CI, 0.87-12.07) did not differ significantly between CA and combination treatment. Similarly, MACCE (OR, 1.11; 95% CI, 0.28-4.41), stroke (OR, 1.03; 95% CI, 0.24-4.35), pericardial effusion (OR, 0.45; 95% CI, 0.11-1.90), pericardiocentesis (OR, 0.63; 95% CI, 0.14-2.83), and bleeding (OR, 2.04; 95% CI, 0.65-6.39) did not differ significantly between LAAC and combination treatment. CONCLUSIONS The combined approach is infrequently used in clinical practice (< 1%). However, major life-threatening adverse events did not differ between CA and LAAC when performed in isolation or combined in a single procedural stage on the same day.
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Affiliation(s)
- Ramez Morcos
- Division of Cardiology, Florida Atlantic University, Boca Raton, FL, USA
| | - Haider Al Taii
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, 800 Stanton L Young Blvd, Suite 5400, Oklahoma City, OK, 73104, USA
| | - Muni Rubens
- Baptist Health South Florida, Miami, FL, USA
- Florida International University, Miami, FL, USA
| | - Anshul Saxena
- Baptist Health South Florida, Miami, FL, USA
- Florida International University, Miami, FL, USA
| | | | - Mohamed Hamed
- Division of Cardiology, Florida Atlantic University, Boca Raton, FL, USA
| | - Amr F Barakat
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nitin Kulkarni
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Houman Khalili
- Division of Cardiology, Florida Atlantic University, Boca Raton, FL, USA
| | - Santiago Garcia
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH, USA
| | | | - Emir Veledar
- Baptist Health South Florida, Miami, FL, USA
- Florida International University, Miami, FL, USA
| | - Stavros Stavrakis
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, 800 Stanton L Young Blvd, Suite 5400, Oklahoma City, OK, 73104, USA.
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8
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Wann DG, Baird A, Mulukutla S, Thoma F, Sezer A, Canterbury A, Barakat AF, Gardner MW, Skowronski J, Jain S, Saba S, Bhonsale A, Estes NM, Hickey G, Voigt A, Kaczorowski D, Keebler M, Bazaz R, Kancharla K. Association Of Pre-LVAD ICD Shocks With Post-LVAD Outcomes. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.253] [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: 11/30/2022]
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9
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Razzack AA, Lak HM, Pothuru S, Rahman S, Hassan SA, Hussain N, Najeeb H, Reddy KT, Syeda H, Yasmin F, Mustafa A, Chawla S, Munir MB, Barakat AF, Saliba W, Wazni O, Hussein AA. Efficacy and Safety of Catheter Ablation vs Antiarrhythmic Drugs as Initial Therapy for Management of Symptomatic Paroxysmal Atrial Fibrillation: A Meta-Analysis. Rev Cardiovasc Med 2022; 23:112. [PMID: 35345279 DOI: 10.31083/j.rcm2303112] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 11/11/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Catheter ablation is an effective treatment for atrial fibrillation (AF), primarily performed in patients who fail antiarrhythmic drugs. Whether early catheter ablation, as first-line therapy, is associated with improved clinical outcomes remains unclear. METHODS Electronic databases (PubMed, Scopus, Embase) were searched until March 28th, 2021. Randomized controlled trials (RCTs) compared catheter ablation vs antiarrhythmic drug therapy as first-line therapy were included. The primary outcome of interest was the first documented recurrence of any atrial tachyarrhythmia (symptomatic or asymptomatic; AF, atrial flutter, and atrial tachycardia). Secondary outcomes included symptomatic atrial tachyarrhythmia (AF, atrial flutter, and atrial tachycardia) and serious adverse events. Unadjusted risk ratios (RR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance considered if the confidence interval (CI) excludes one and p < 0.05. RESULTS A total of six RCTs with 1212 patients (Ablation n = 609; Antiarrhythmic n = 603) were included. Follow- up period ranged from 1-2 years. Patients who underwent ablation were less likely to experience any recurrent atrial tachyarrhythmia when compared to patients receiving antiarrhythmic drugs (RR 0.63; 95% CI 0.55-0.73; p < 0.00001). Symptomatic atrial tachyarrhythmia was also lower in the ablation arm (RR 0.53; 95% CI 0.32-0.87; p = 0.01). No statistically significant differences were noted for overall any type of adverse events (RR 0.93; 95% CI 0.68-1.27; p = 0.64) and cardiovascular adverse events (RR 0.90; 95% CI 0.56-1.44; p = 0.65) respectively. CONCLUSIONS Catheter ablation, as first-line therapy, was associated with a significantly lower rate of tachyarrhythmia recurrence compared to conventional antiarrhythmic drugs, with a similar adverse effect risk profile. These findings support a catheter ablation strategy as first-line therapy among patients with symptomatic paroxysmal atrial fibrillation.
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Affiliation(s)
- Aminah Abdul Razzack
- Department of Medicine, Dr. N.T.R University of Health Sciences, 520010 Vijayawada, India
| | - Hassan Mehmood Lak
- Section of Clinical Cardiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Suveenkrishna Pothuru
- Department of Internal Medicine, Ascension via Christi Hospital, Manhattan, KS 66503, USA
| | - Sajedur Rahman
- Jalalabad Ragib-Rabeya Medical College and Hospital, Sylhet 3100, Bangladesh
| | - Syed Adeel Hassan
- Department of Internal Medicine, University of Louisville, Louisville, KY 40203, USA
| | - Nabeel Hussain
- Saba University School of Medicine, P.O. Box 1000 The Bottom, Saba, Dutch Caribbean
| | - Hala Najeeb
- Department of Medicine, Dow University of Health Sciences, 74400 Karachi, Pakistan
| | - Krishna Theja Reddy
- UHS Southern California Medical Education Consortium, Temecula, CA 92590, USA
| | - Humera Syeda
- UHS Southern California Medical Education Consortium, Temecula, CA 92590, USA
| | - Farah Yasmin
- Department of Medicine, Dow University of Health Sciences, 74400 Karachi, Pakistan
| | - Ahmad Mustafa
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY 10301, USA
| | - Sanchit Chawla
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Muhammad Bilal Munir
- Section of Electrophysiology, Department of Cardiovascular Medicine, University of California, San Diego, CA 92101, USA
| | - Amr F Barakat
- Section of Electrophysiology, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Walid Saliba
- Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Oussama Wazni
- Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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10
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Barakat AF, Amuthan R, Hariri E, Chana R, Gupta N, Ibrahim J, Bashir ZS, Hu B, Sezer A, Thoma F, Soman P, Mulukutla S, Barzilai B, Ellis SG, Jaber W, Rothberg MB. A Validated Model to Identify Patients With Low Likelihood of High-Risk Coronary Artery Disease Anatomy. Am J Cardiol 2022; 167:27-34. [PMID: 35031112 DOI: 10.1016/j.amjcard.2021.11.037] [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: 09/15/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022]
Abstract
In stable coronary artery disease (CAD), revascularization improves outcomes only for patients with high-risk coronary anatomy (HRCA). We sought to derive and validate a prediction model, incorporating clinical and exercise stress test characteristics, to identify patients with HRCA. We conducted a retrospective analysis of patients undergoing exercise stress testing at Cleveland Clinic (2005 to 2014), followed by invasive coronary angiography within 3 months. We excluded patients with acute coronary syndrome, known CAD or ejection fraction <50%. HRCA was defined as left main, 3-vessel, or 2-vessel disease involving the proximal left anterior descending artery. Clinical and stress test predictors of HRCA were identified in a multivariable logistic regression model, internally validated with 1,000-fold bootstrapping. The model was then externally validated at the University of Pittsburgh Medical Center (2017 to 2019). The model was derived from 2,758 patients with complete data. HRCA was identified in 418 patients (15.2%) in the derivation cohort. The model consisted of 10 variables: age, male gender, hypertension, hypercholesterolemia, diabetes mellitus, family history of premature CAD, high-density lipoprotein, chest pain, exercise time, and Duke Treadmill Score. Bias-corrected c-statistic was 0.79 (95% confidence interval 0.77 to 0.81) with excellent calibration. In all, 762 patients (27.6%) had a predicted probability and observed prevalence of HRCA <5%. In the validation cohort, the model had a c-statistic of 0.79 (95% confidence interval 0.74 to 0.85) and 210 patients had an observed prevalence of HRCA <5% (40%). In conclusion, an externally validated prediction model, based on clinical characteristics and exercise stress test variables, can identify stable patients with CAD who have HRCA.
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Affiliation(s)
- Amr F Barakat
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ram Amuthan
- Cardiovascular Division, Department of Medicine, State University of New York, University at Buffalo, Buffalo, New York
| | - Essa Hariri
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rajdeep Chana
- Department of Cardiovascular Medicine, Guthrie Robert Packer Hospital, Sayre, Pennsylvania
| | - Niyati Gupta
- Department of Medicine, NYC Health+ Hospitals, New York, New York
| | - Joseph Ibrahim
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Zubair S Bashir
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Bo Hu
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ahmet Sezer
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Floyd Thoma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Prem Soman
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Suresh Mulukutla
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Benico Barzilai
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Stephen G Ellis
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Wael Jaber
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Michael B Rothberg
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio; Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio.
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11
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Bukhari S, Fatima S, Barakat AF, Fogerty AE, Weinberg I, Elgendy IY. Venous thromboembolism during pregnancy and postpartum period. Eur J Intern Med 2022; 97:8-17. [PMID: 34949492 DOI: 10.1016/j.ejim.2021.12.013] [Citation(s) in RCA: 2] [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: 08/17/2021] [Revised: 11/11/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022]
Abstract
Venous thromboembolism (VTE) is one of the leading causes of maternal mortality. Rates of VTE during pregnancy and the postpartum period have not decreased over the past two decades and pregnancyassociated VTE continues to pose a significant health challenge. Pregnant and postpartum women are at a higher risk for VTE owing to many factors. There are hormonally mediated and pregnancy-specific alterations of coagulation that favor thrombosis, including increased production of clotting factors. There are physiologic and anatomic mechanisms that also contribute, including a decreased rate of venous blood flow from the lower extemities as pregnancy progresses. Cesarean delivery also introduces VTE risk. In addition, studies have demonstrated that pregnancy-associated complications such as pre-eclampsia or peri-partum infections are associated with increased VTE rates. In this review, we discuss the recent epidemiological studies, pathogenesis, risk factors and clinical presentation as well as therapeutic options for VTE during pregnancy and the postpartum period. We also provide proposed diagnostic algorithms for diagnosis and management of VTE during pregnancy and the postpartum period based on updated evidence. Finally, we highlight knowledge gaps to guide future research.
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Affiliation(s)
- Syed Bukhari
- Department of Medicine, Temple University, Philadelphia, PA
| | - Shumail Fatima
- Department of Medicine, University of Pittsburgh Medical Center McKeesport Hospital, McKeesport, PA
| | - Amr F Barakat
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Annemarie E Fogerty
- Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ido Weinberg
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Islam Y Elgendy
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar.
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12
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Morcos R, Megaly M, Saad M, Barakat AF, Rubens M, Saxena A, Elbadawi A, Kucharik M, Luna M, Garcia S, Veledar E, Maini B, Khalili H. In‐hospital outcomes of transesophageal versus intracardiac echocardiography guided left atrial appendage closure. Catheter Cardiovasc Interv 2022; 99:1572-1581. [DOI: 10.1002/ccd.30086] [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: 11/07/2021] [Accepted: 01/07/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Ramez Morcos
- Division of Cardiology Florida Atlantic University Boca Raton Florida USA
| | - Michael Megaly
- Division of Cardiology Banner University Medical Center/University of Arizona Phoenix Arizona USA
| | - Marwan Saad
- Division of Cardiology Brown University Providence Rhode Island USA
| | - Amr F. Barakat
- Division of Cardiology University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA
| | - Muni Rubens
- Baptist Health South Florida Miami Florida USA
- School of Public Health Florida International University Miami Florida USA
| | - Anshul Saxena
- Baptist Health South Florida Miami Florida USA
- School of Public Health Florida International University Miami Florida USA
| | - Ayman Elbadawi
- Section of Cardiology Baylor College of Medicine Houston Texas USA
| | - Michael Kucharik
- Charles E. Schmidt College of Medicine Florida Atlantic University Boca Raton Florida USA
| | - Michael Luna
- School of Medicine University of Texas Southwestern Dallas Texas USA
| | - Santiago Garcia
- Minneapolis Heart Institute Abbott Northwestern Hospital Minneapolis Minnesota USA
| | - Emir Veledar
- Baptist Health South Florida Miami Florida USA
- School of Public Health Florida International University Miami Florida USA
| | - Brijeshwar Maini
- Division of Cardiology Florida Atlantic University Boca Raton Florida USA
| | - Houman Khalili
- Division of Cardiology Florida Atlantic University Boca Raton Florida USA
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13
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Elsayed M, Abdelfattah OM, Sayed A, Prasad RM, Barakat AF, Elgendy IY, Andrade J, Jared Bunch T, Thosani A, Saliba WI, Wazni OM, Hussein AA. Bayesian network meta-analysis comparing cryoablation, radiofrequency ablation, and antiarrhythmic drugs as initial therapies for atrial fibrillation. J Cardiovasc Electrophysiol 2021; 33:197-208. [PMID: 34855270 DOI: 10.1111/jce.15308] [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: 09/16/2021] [Revised: 10/27/2021] [Accepted: 11/22/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Antiarrhythmic drugs (AADs) and catheter ablation are first line treatments of paroxysmal atrial fibrillation (PAF), however, there exists a paucity of data regarding the potential benefit of different catheter ablation technologies versus AADs as an early rhythm strategy. OBJECTIVE To assess the safety and efficacy of cryoablation versus radiofrequency ablation (RFA) versus AADs as a first line therapy of PAF. METHODS MEDLINE, Embase, Scopus and CENTRAL were searched to retrieve randomized clinical trials (RCTs) comparing cryoablation, RFA or AADs to one another as first line therapies for atrial fibrillation (AF). The primary outcome was overall freedom from arrhythmia recurrence (AF, atrial flutter [AFL], atrial tachycardia). Secondary outcomes included freedom from symptomatic arrhythmia recurrence, hospitalization, and serious adverse events. A random-effects Bayesian network meta-analysis was used to calculate odds ratios (OR) and 95% credible intervals (CrI). RESULTS Six RCTs (N = 1212) met the inclusion criteria (605 AADs, 365 Cryoablation, and 245 RFA). Compared with AADs, overall recurrence was reduced with RFA (OR: 0.31; 95% CrI: 0.10-0.71) and cryoablation (OR: 0.39; 95% CrI: 0.16-1.00). Comparing ablation (cryoablation and RFA) with AADs in respect to freedom from symptomatic AF recurrence, neither cryoablation (OR: 0.35; 95% CrI: 0.06-1.96) nor RFA (OR: 0.34; 95% CrI: 0.07-1.27) resulted in statistically significant reductions individually compared to AADs, though pooled ablation with both technologies showed lower odds of arrhythmia recurrence (OR: 0.35; 95% CrI: 0.13-0.79). In terms of serious adverse events rates, neither cryoablation (OR: 0.77; 95% CrI: 0.44-1.39) nor RFA (OR: 1.45; 95% CrI: 0.67-3.23) were significantly different to AADs. RFA resulted in a statistically significant reduction in hospitalizations compared to AAD (OR: 0.08; 95% CrI: 0.01-0.99), whereas cryoablation did not (OR: 0.77; 95% CrI: 0.44-1.39). The surface under the cumulative ranking curve showed RFA to be the most effective treatment at reducing overall rates of recurrence, symptomatic recurrence and hospitalizations; whereas cryoablation was most likely to reduce serious adverse events. CONCLUSION Cryoablation and RFA are both effective and safe first line therapies for AF compared to AADs, with RFA being the most effective at reducing recurrences.
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Affiliation(s)
- Mahmoud Elsayed
- Department of Cardiovascular Medicine, Cardiovascular Institute at Allegheny Health Network, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Omar M Abdelfattah
- Department of Internal Medicine, Morristown Medical Center, Atlantic Health System, Morristown, New Jersey, USA
| | - Ahmed Sayed
- Department of Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rohan Madhu Prasad
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Amr F Barakat
- Division of Cardiovascular Disease, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Islam Y Elgendy
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Jason Andrade
- Division of Cardiology, Montreal Heart Institute, Université de Montréal, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Jared Bunch
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Amit Thosani
- Division of Cardiac Electrophysiology, Department of Cardiology, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Walid I Saliba
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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14
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Mahtta D, Altibi A, Gad MM, Samara A, Barakat AF, Bagur R, Mansoor H, Jneid H, Virani SS, Mamas MA, Masri A, Elgendy IY. Methodological Rigor and Temporal Trends of Cardiovascular Medicine Meta-Analyses in Highest-Impact Journals. J Am Heart Assoc 2021; 10:e021367. [PMID: 34533035 PMCID: PMC8649500 DOI: 10.1161/jaha.121.021367] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Well‐conducted meta‐analyses are considered to be at the top of the evidence‐based hierarchy pyramid, with an expansion of these publications within the cardiovascular research arena. There are limited data evaluating the trends and quality of such publications. The objective of this study was to evaluate the methodological rigor and temporal trends of cardiovascular medicine‐related meta‐analyses published in the highest impact journals. Methods and Results Using the Medline database, we retrieved cardiovascular medicine‐related systematic reviews and meta‐analyses published in The New England Journal of Medicine, The Lancet, Journal of the American Medical Association, The British Medical Journal, Annals of Internal Medicine, Circulation, European Heart Journal, and Journal of American College of Cardiology between January 1, 2012 and December 31, 2018. Among 6406 original investigations published during the study period, meta‐analyses represented 422 (6.6%) articles, with an annual decline in the proportion of published meta‐analyses (8.7% in 2012 versus 4.6% in 2018, Ptrend=0.002). A substantial number of studies failed to incorporate elements of Preferred Reporting Items for Systematic Reviews and Meta‐Analyses or Meta‐Analysis of Observational Studies in Epidemiology guidelines (51.9%) and only a minority of studies (10.4%) were registered in PROSPERO (International Prospective Register of Systematic Reviews). Fewer manuscripts failed to incorporate the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses or Meta‐Analysis of Observational Studies in Epidemiology elements over time (60.2% in 2012 versus 40.0% in 2018, Ptrend<0.001) whereas the number of meta‐analyses registered at PROSPERO has increased (2.4% in 2013 versus 17.5% in 2018, Ptrend<0.001). Conclusions The proportion of cardiovascular medicine‐related meta‐analyses published in the highest impact journals has declined over time. Although there is an increasing trend in compliance with quality‐based guidelines, the overall compliance remains low.
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Affiliation(s)
- Dhruv Mahtta
- Section of Cardiology Baylor College of Medicine Houston TX
| | - Ahmed Altibi
- Knight Cardiovascular InstituteOregon Health & Science University Portland OR
| | - Mohamed M Gad
- Department of Medicine Cleveland Clinic Foundation OH
| | - Amjad Samara
- Department of Psychiatry Washington University School of Medicine St Louis MO
| | - Amr F Barakat
- Heart and Vascular Institute University of Pittsburgh Medical Center PA
| | - Rodrigo Bagur
- London Health Science CentreWestern University London Canada.,Keele Cardiovascular Research Group Centre for Prognosis Research Keele University Stoke-on-Trent UK
| | - Hend Mansoor
- College of Health and Life Sciences Hamad Bin Khalifa University Doha Qatar
| | - Hani Jneid
- Section of Cardiology Baylor College of Medicine Houston TX
| | - Salim S Virani
- Section of Cardiology Baylor College of Medicine Houston TX.,Michael E. DeBakey Veterans Affairs Medical Center Houston TX
| | - Mamas A Mamas
- Keele Cardiovascular Research Group Centre for Prognosis Research Keele University Stoke-on-Trent UK
| | - Ahmad Masri
- Knight Cardiovascular InstituteOregon Health & Science University Portland OR
| | - Islam Y Elgendy
- Department of Medicine Weill Cornell Medicine-Qatar Doha Qatar
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15
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Abuzaid A, Saad M, Addoumieh A, Ha LD, Elbadawi A, Mahmoud AN, Elgendy A, Abdelaziz HK, Barakat AF, Mentias A, Adeola O, Elgendy IY, Qasim A, Budoff M. Coronary artery calcium score and risk of cardiovascular events without established coronary artery disease: a systemic review and meta-analysis. Coron Artery Dis 2021; 32:317-328. [PMID: 33417339 DOI: 10.1097/mca.0000000000000974] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Coronary artery calcium (CAC) is an indicator of atherosclerosis, and the CAC score is a useful noninvasive assessment of coronary artery disease. OBJECTIVE To compare the risk of cardiovascular outcomes in patients with CAC > 0 versus CAC = 0 in asymptomatic and symptomatic population in patients without an established diagnosis of coronary artery disease. METHODS A systematic search of electronic databases was conducted until January 2018 for any cohort study reporting cardiovascular events in patients with CAC > 0 compared with absence of CAC. RESULTS Forty-five studies were included with 192 080 asymptomatic 32 477 symptomatic patients. At mean follow-up of 11 years, CAC > 0 was associated with an increased risk of major adverse cardiovascular and cerebrovascular events (MACE) compared to a CAC = 0 in asymptomatic arm [pooled risk ratio (RR) 4.05, 95% confidence interval (CI) 2.91-5.63, P < 0.00001, I2 = 80%] and symptomatic arm (pooled RR 6.06, 95% CI 4.23-8.68, P < 0.00001, I2 = 69%). CAC > 0 was also associated with increased risk of all-cause mortality in symptomatic population (pooled RR 7.94, 95% CI 2.61-24.17, P < 0.00001, I2 = 85%) and in asymptomatic population CAC > 0 was associated with higher all-cause mortality (pooled RR 3.23, 95% CI 2.12-4.93, P < 0.00001, I2 = 94%). In symptomatic population, revascularization in CAC > 0 was higher (pooled RR 15, 95% CI 6.66-33.80, P < 0.00001, I2 = 72) compared with CAC = 0. Additionally, CAC > 0 was associated with more revascularization in asymptomatic population (pooled RR 5.34, 95% CI 2.06-13.85, P = 0.0006, I2 = 93). In subgroup analysis of asymptomatic population by gender, CAC > 0 was associated with higher MACE (RR 6.39, 95% CI 3.39-12.84, P < 0.00001). CONCLUSION Absence of CAC is associated with low risk of cardiovascular events compared with any CAC > 0 in both asymptomatic and symptomatic population without coronary artery disease.
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Affiliation(s)
- Ahmed Abuzaid
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California
- Department of Cardiology, Alaska Heart and Vascular Institute, Anchorage, Alaska, USA
- Department of Cardiology, Ain Shams University, Cairo, Egypt
| | - Marwan Saad
- Department of Cardiology, Ain Shams University, Cairo, Egypt
- Department of Cardiology, Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Le Dung Ha
- Departement of Cardiology, New York Presbyterian - Brooklyn Methodist Hospital, New York
| | - Ayman Elbadawi
- Department of Cardiology, Ain Shams University, Cairo, Egypt
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Ahmed N Mahmoud
- Department of Cardiology, Ain Shams University, Cairo, Egypt
- Cardiovascular Department, University Hospitals, Case Western, Ohio
| | - Akram Elgendy
- Department of Cardiology, Lancashire Cardiac Center, Blackpool, UK
| | - Hesham K Abdelaziz
- Department of Cardiology, Ain Shams University, Cairo, Egypt
- Department of Cardiology, Lancashire Cardiac Center, Blackpool, UK
| | - Amr F Barakat
- Department of Cardiology, Ain Shams University, Cairo, Egypt
- UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amgad Mentias
- Department of Cardiology, Ain Shams University, Cairo, Egypt
- Department of cardiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Oluwaseun Adeola
- Division of Cardiovascular Medicine, Vanderbilt, Nashville, Tennessee
| | - Islam Y Elgendy
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Atif Qasim
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Matthew Budoff
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance CA
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16
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Brazile T, Barakat AF, Bukhari S, Schelbert EB, Soman P. A 25-Year-Old Man with Refractory Schizophrenia and Clozapine-Induced Myocarditis Diagnosed by Non-Invasive Cardiovascular Magnetic Resonance. Am J Case Rep 2021; 22:e930103. [PMID: 33990535 PMCID: PMC8130977 DOI: 10.12659/ajcr.930103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 11/20/2022]
Abstract
Patient: Male, 25-year-old Final Diagnosis: Clozapine-induced myocarditis Symptoms: Elevated troponin • fever • leukocytosis • somnolence • tachycardia Medication: — Clinical Procedure: Cardiovascular magnetic resonance • electrocardiogram • transthoracic echocardiogram Specialty: Cardiology • General and Internal Medicine
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Affiliation(s)
- Tiffany Brazile
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Amr F Barakat
- Department of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Syed Bukhari
- Department of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Erik B Schelbert
- Department of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Prem Soman
- Department of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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17
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Elgendy IY, Nimri N, Barakat AF, Ibrahim J, Mandrola J, Foy A. A systematic bias assessment of top-cited full-length original clinical investigations related to COVID-19. Eur J Intern Med 2021; 86:104-106. [PMID: 33541829 PMCID: PMC7826014 DOI: 10.1016/j.ejim.2021.01.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 01/14/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Islam Y Elgendy
- Division of Cardiology, Weill Cornell Medicine-Qatar, Doha, Qatar.
| | - Nayef Nimri
- Division of Cardiology, University of Cincinnati, Cincinnati, OH
| | - Amr F Barakat
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Joseph Ibrahim
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Andrew Foy
- Division of Cardiology, Penn State Heart and Vascular Institute, Hershey, PA
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18
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Bukhari S, Barakat AF, Eisele YS, Nieves R, Jain S, Saba S, Follansbee WP, Brownell A, Soman P. Prevalence of Atrial Fibrillation and Thromboembolic Risk in Wild-Type Transthyretin Amyloid Cardiomyopathy. Circulation 2021; 143:1335-1337. [PMID: 33779268 DOI: 10.1161/circulationaha.120.052136] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 01/15/2023]
Affiliation(s)
- Syed Bukhari
- Division of Cardiology, Department of Medicine, University of Pittsburgh, PA
| | - Amr F Barakat
- Division of Cardiology, Department of Medicine, University of Pittsburgh, PA
| | - Yvonne S Eisele
- Division of Cardiology, Department of Medicine, University of Pittsburgh, PA
| | - Ricardo Nieves
- Division of Cardiology, Department of Medicine, University of Pittsburgh, PA
| | - Sandeep Jain
- Division of Cardiology, Department of Medicine, University of Pittsburgh, PA
| | - Samir Saba
- Division of Cardiology, Department of Medicine, University of Pittsburgh, PA
| | | | - Amy Brownell
- Division of Cardiology, Department of Medicine, University of Pittsburgh, PA
| | - Prem Soman
- Division of Cardiology, Department of Medicine, University of Pittsburgh, PA
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19
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Abstract
Maternal mortality rates have been steadily increasing in the United States, and cardiovascular mortality is the leading cause of death among pregnant and postpartum women. Maternal stroke accounts for a significant burden of cardiovascular mortality. Data suggest that rates of maternal stroke have been increasing in recent years. Advancing maternal age at the time of birth and the increasing prevalence of traditional cardiovascular risk factors, and other risk factors, as well, such as hypertensive disorders of pregnancy, migraine, and infections, may contribute to increased rates of maternal stroke. In this article, we provide an overview of the epidemiology of maternal stroke, explore mechanisms that may explain increasing rates of stroke among pregnant women, and identify key knowledge gaps for future investigation in this area.
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Affiliation(s)
- Islam Y Elgendy
- Division of Cardiology, Weill Cornell Medicine-Qatar, Doha (I.Y.E.)
| | - Syed Bukhari
- Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (S.B., A.F.B.)
| | - Amr F Barakat
- Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (S.B., A.F.B.)
| | - Carl J Pepine
- Division of Cardiovascular Medicine, University of Florida, Gainesville (C.J.P.)
| | - Kathryn J Lindley
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, MO (K.J.L.)
| | - Eliza C Miller
- Department of Neurology, Division of Stroke and Cerebrovascular Disease, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (E.C.M.)
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20
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Elkaryoni A, Barssoum K, Barakat AF, Elgendy IY, Elsayed M, Muhanna A, Arnason A, Shatla I, Darki A, Wimmer AP. Safety and Effectiveness of Long-Term Anticoagulation for Atrial Fibrillation Among Nonagenarians: A Real-World Analysis. Am J Cardiol 2021; 140:151-152. [PMID: 33188735 DOI: 10.1016/j.amjcard.2020.11.001] [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: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
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21
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Elbadawi A, Elgendy IY, Mahmoud K, Barakat AF, Mentias A, Mohamed AH, Ogunbayo GO, Megaly M, Saad M, Omer MA, Paniagua D, Abbott JD, Jneid H. Temporal Trends and Outcomes of Mechanical Complications in Patients With Acute Myocardial Infarction. JACC Cardiovasc Interv 2020; 12:1825-1836. [PMID: 31537282 DOI: 10.1016/j.jcin.2019.04.039] [Citation(s) in RCA: 151] [Impact Index Per Article: 37.8] [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: 12/31/2018] [Revised: 04/22/2019] [Accepted: 04/30/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The aim of this study was to examine the temporal trends and outcomes of mechanical complications after myocardial infarction in the contemporary era. BACKGROUND Data regarding temporal trends and outcomes of mechanical complications after ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) are limited in the contemporary era. METHODS The National Inpatient Sample database (2003 to September 2015) was queried to identify all STEMI and NSTEMI hospitalizations. Temporal trends and outcomes of mechanical complications after STEMI and NSTEMI, including papillary muscle rupture, ventricular septal defect, and free wall rupture, were described. RESULTS The analysis included 3,951,861 STEMI and 5,114,270 NSTEMI hospitalizations. Mechanical complications occurred in 10,726 of STEMI hospitalizations (0.27%) and 3,041 of NSTEMI hospitalizations (0.06%), with no changes in trends (p = 0.13 and p = 0.83, respectively). The rates of in-hospital mortality in patients with mechanical complications were 42.4% after STEMI and 18.0% after NSTEMI, with no significant trend changes (p = 0.62 and p = 0.12, respectively). After multivariate adjustment, patients who had mechanical complications after myocardial infarction had higher in-hospital mortality, cardiogenic shock, acute kidney injury, hemodialysis, and respiratory complications compared with those without mechanical complications. Predictors of lower mortality in patients with mechanical complications who developed cardiogenic shock included surgical repair in the STEMI and NSTEMI cohorts and percutaneous coronary intervention in the STEMI cohort. CONCLUSIONS Contemporary data from a large national database show that the rates of mechanical complications are low in patients presenting with STEMI and NSTEMI. Post-myocardial infarction mechanical complications continue to be associated with high mortality rates, which did not improve during the study period.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas; Division of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida.
| | - Karim Mahmoud
- Department of Internal Medicine, Houston Medical Center, Warner Robbins, Georgia
| | - Amr F Barakat
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amgad Mentias
- Division of Cardiovascular Medicine, University of Iowa, Iowa City, Iowa
| | - Ahmed H Mohamed
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Gbolahan O Ogunbayo
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Michael Megaly
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota; Department of Cardiology, Hennepin Healthcare, Minneapolis, Minnesota
| | - Marwan Saad
- Division of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt; Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mohamed A Omer
- Department of Cardiovascular Medicine, University of Missouri Kansas City, Kansas City, Missouri
| | - David Paniagua
- Division of Cardiology, Baylor School of Medicine and the Michael E DeBakey VAMC, Houston, Texas
| | - J Dawn Abbott
- Division of Cardiovascular Medicine, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| | - Hani Jneid
- Division of Cardiology, Baylor School of Medicine and the Michael E DeBakey VAMC, Houston, Texas
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22
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Elgendy AY, Barakat AF, Ibrahim J, Alkukhun L, Mamas MA, Elgendy IY. The Landscape of Medical Literature in the Era of COVID-19: Original Research Versus Opinion Pieces. J Gen Intern Med 2020; 35:2813-2815. [PMID: 32642930 PMCID: PMC7343379 DOI: 10.1007/s11606-020-06021-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/30/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Akram Y Elgendy
- Division of Cardiovascular Medicine, University of California San Fransisco, San Fransisco, CA, USA
| | - Amr F Barakat
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Joseph Ibrahim
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Laith Alkukhun
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
| | - Islam Y Elgendy
- Division of Cardiology, Weill Cornell Medicine-Qatar, Doha, Qatar.
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23
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Barakat AF, Inashvili A, Alkukhun L, Shalaby AA, Wang NC, Bhonsale A, Wann D, Gardner M, Khan M, Bidani S, Skowronski J, Jain S, Voigt A, Bazaz R, Estes NM, Saba S, Kancharla K. Use Trends and Adverse Reports of SelectSecure 3830 Lead Implantations in the United States. Circ Arrhythm Electrophysiol 2020; 13:e008577. [DOI: 10.1161/circep.120.008577] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/16/2022]
Affiliation(s)
- Amr F. Barakat
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
| | - Ana Inashvili
- Department of Medicine, University of Pittsburgh Medical Center, PA (A.I., M.K.)
| | - Laith Alkukhun
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
| | - Alaa A. Shalaby
- Cardiology Division, Pittsburgh VA Healthcare System, PA (A.A.S.)
| | - Norman C. Wang
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
| | - Aditya Bhonsale
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
| | - Dan Wann
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
| | - Michael Gardner
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
| | - Muzammil Khan
- Department of Medicine, University of Pittsburgh Medical Center, PA (A.I., M.K.)
| | - Shruti Bidani
- University of Pittsburgh School of Medicine, Pittsburgh, PA (S.B.)
| | - Jenna Skowronski
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
| | - Sandeep Jain
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
| | - Andrew Voigt
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
| | - Raveen Bazaz
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
| | - N.A. Mark Estes
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
| | - Samir Saba
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
| | - Krishna Kancharla
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
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24
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Barakat AF, Asif A, Inashvili A, Szeto L, Noor A, Thalappillil A, Adhikari S, Fatima S, Pasupula DK, Ahmad S, Mathew D, Bhonsale A, Kancharla K, Wang NC, Jain S, Mark Estes NA, Saba S. Documentation of shared decision making around primary prevention defibrillator implantations. Pacing Clin Electrophysiol 2020; 43:100-109. [DOI: 10.1111/pace.13846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/27/2019] [Revised: 11/13/2019] [Accepted: 11/18/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Amr F. Barakat
- Heart and Vascular InstituteUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Anum Asif
- Department of MedicineUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Ana Inashvili
- Department of MedicineUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Libby Szeto
- School of MedicineUniversity of Pittsburgh Pittsburgh Pennsylvania
| | - Ahmed Noor
- Department of MedicineUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Alvin Thalappillil
- Department of MedicineUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Shubash Adhikari
- Department of MedicineUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Shumail Fatima
- Department of MedicineUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Deepak Kumar Pasupula
- Department of MedicineUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Shahzad Ahmad
- Department of MedicineUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Don Mathew
- Department of MedicineUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Aditya Bhonsale
- Heart and Vascular InstituteUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Krishna Kancharla
- Heart and Vascular InstituteUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Norman C. Wang
- Heart and Vascular InstituteUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Sandeep Jain
- Heart and Vascular InstituteUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - N. A. Mark Estes
- Heart and Vascular InstituteUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Samir Saba
- Heart and Vascular InstituteUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
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25
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Martin B, Gabris B, Barakat AF, Henry BL, Giannini M, Reddy RP, Wang X, Romero G, Salama G. Relaxin reverses maladaptive remodeling of the aged heart through Wnt-signaling. Sci Rep 2019; 9:18545. [PMID: 31811156 PMCID: PMC6897890 DOI: 10.1038/s41598-019-53867-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 02/05/2019] [Accepted: 10/30/2019] [Indexed: 11/09/2022] Open
Abstract
Healthy aging results in cardiac structural and electrical remodeling that increases susceptibility to cardiovascular diseases. Relaxin, an insulin-like hormone, suppresses atrial fibrillation, inflammation and fibrosis in aged rats but the mechanisms-of-action are unknown. Here we show that relaxin treatment of aged rats reverses pathological electrical remodeling (increasing Nav1.5 expression and localization of Connexin43 to intercalated disks) by activating canonical Wnt signaling. In isolated adult ventricular myocytes, relaxin upregulated Nav1.5 (EC50 = 1.3 nM) by a mechanism inhibited by the addition of Dickkopf-1. Furthermore, relaxin increased the levels of connexin43, Wnt1, and cytosolic and nuclear β-catenin. Treatment with Wnt1 or CHIR-99021 (a GSK3β inhibitor) mimicked the relaxin effects. In isolated fibroblasts, relaxin blocked TGFβ-induced collagen elevation in a Wnt dependent manner. These findings demonstrate a close interplay between relaxin and Wnt-signaling resulting in myocardial remodeling and reveals a fundamental mechanism of great therapeutic potential.
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Affiliation(s)
- Brian Martin
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA.,Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Beth Gabris
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Amr F Barakat
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Brian L Henry
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Marianna Giannini
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, 15261, USA.,Scuola Superiore Sant' Anna, Institute of Life Sciences, Pisa, Italy
| | - Rajiv P Reddy
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Xuewen Wang
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, 15261, USA.,Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Guillermo Romero
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Guy Salama
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA. .,Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, 15261, USA.
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26
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Elkaryoni A, Thakker J, Barakat AF, Ellakany K, Khan G, Elkafrawy A, Younis M. P2668Causes and predictors of 30 and 90 days readmission after cardiac arrest: insights from the nationwide readmission database. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0986] [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
Cardiac arrest (CA) is a lethal condition with high public health burden and grave long-term implications. We aimed to evaluate the rate and predictors of readmission after CA
Methods
We used the Nationwide Readmission Database 2014 to determine patient with index admission CA by using relevant ICD-9 codes. We excluded patients <18 years and admissions in October, November, and December to allow 90 days readmission follow up. We evaluated rates and causes of 30 and 90 days readmission. We investigated disposition options for CA survivors and rates of readmissions. Multivariable analysis was done for relevant variables to demonstrated predictors of readmission.
Results
A total cohort of 71,780 patients suffered CA and survived to hospital discharge. Mean age was 63.9±15 years and 61.3% were males. Mean length of stay was 14.2±18.3 days, primary payer was Medicare 58%, 42.2% were discharged home, 33% to skilled nursing/intermediate care facility, 18.5% to home with home health services, 5% to short term hospital, and 0.8% left against medical advice (AMA). All-cause 30 and 90 days readmission rates were 18% and 28.9%, respectively. According to each disposition group 30/90 days readmission rates were; home 13.6/23%, facility 22/35.7%, home health 21/31.9%, short term hospital 16.8/24.1%, and 33.7/42.4% left AMA. The most common causes of readmission at 30 and 90 days were congestive heart failure and infection (11% each). CA on readmission was 1.5% at 30 and 90 days. The most common predictors of readmission were CHF odds ratio (OR) 1.3, (95% CI: 1.3–1.4; P<0.001), renal failure OR 1.7, (95% CI: 1.7–1.8; P<0.001), chronic lung disease OR 1.3, (95% CI: 1.2–1.; P<0.001), and depression OR 1.1 (95% CI: 1.1–1.2; P<0.001).
Conclusion
Readmissions are common at 30 and 90 days in CA survivors and are associated with high cost. CHF and infection are the most common causes of 30 and 90-day readmission, while renal failure is the strongest predictor of readmission after adjusting for unbalanced covariates. Discharge to home was the most common disposition, and had the lowest rate for readmission. Leaving AMA had the highest rate of readmission.
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Affiliation(s)
- A Elkaryoni
- University of Missouri - Kansas City, Kansas City, United States of America
| | - J Thakker
- University of Missouri - Kansas City, Kansas City, United States of America
| | - A F Barakat
- University of Pittsburgh, Cardiovascular Disease, Pittsburgh, United States of America
| | - K Ellakany
- Alexandria University, Cardiovascular Disease, Alexandria, Egypt
| | - G Khan
- University of Missouri - Kansas City, Kansas City, United States of America
| | - A Elkafrawy
- University of Missouri - Kansas City, Kansas City, United States of America
| | - M Younis
- University of Missouri - Kansas City, Kansas City, United States of America
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27
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Saad M, Mahmoud AN, Barakat AF, Mentias A, Elbadawi A, Elgendy IY, Abuzaid A, Elgendy AY, Jneid H. In-Hospital Outcomes After Transcatheter Aortic Valve Implantation in Patients With Versus Without Chronic Thrombocytopenia. Am J Cardiol 2019; 124:1106-1112. [PMID: 31378322 DOI: 10.1016/j.amjcard.2019.07.011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/23/2019] [Accepted: 07/02/2019] [Indexed: 11/28/2022]
Abstract
Patients with chronic thrombocytopenia (cTCP) were excluded from the pivotal transcatheter aortic valve implantation (TAVI) trials. The National Inpatient Sample was queried and propensity score matching was performed to evaluate the prevalence and impact of cTCP on in-hospital clinical outcomes after TAVI. The main outcome was in-hospital mortality in patients with versus without cTCP. Among 38,855 TAVI hospitalizations, 7,105 had a diagnosis of cTCP (18.3%). In-hospital mortality was similar in both groups (ORadjusted 0.79; 95% confidence interval [CI] 0.57 to 1.09); however, cTCP was associated with higher risk of acute kidney injury (ORadjusted 1.29; 95% CI 1.08 to 1.54), vascular complications (ORadjusted 1.99; 95% CI 1.22 to 3.25), perioperative blood product transfusion (ORadjusted 1.69; 95% CI 1.42 to 2.01), cardiac tamponade (ORadjusted 4.04; 95% CI 1.51 to 10.82), cardiogenic shock (ORadjusted 1.52; 95% CI 1.07 to 2.15), and use of extracorporeal membrane oxygenation (ORadjusted 2.32; 95% CI 1.1 to 4.9). In conclusion, cTCP is common in patients who underwent TAVI and is associated with worse postprocedure clinical outcomes, however, with similar in-hospital mortality.
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Affiliation(s)
- Marwan Saad
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ahmed N Mahmoud
- Division of Cardiovascular Medicine, University of Washington, Seattle, Washington.
| | - Amr F Barakat
- UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amgad Mentias
- Division of Cardiovascular Medicine, University of Iowa, Iowa City, Iowa
| | - Ayman Elbadawi
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Islam Y Elgendy
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Ahmed Abuzaid
- Division of Cardiology, University of California at San Francisco, San Francisco, California
| | - Akram Y Elgendy
- Division of Cardiology, University of Florida, Gainesville, Florida
| | - Hani Jneid
- Division of Cardiology, Baylor College of Medicine, Houston, Texas
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28
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Masri A, Samara A, Baghal M, Saeed A, Altibi A, Barakat AF, Elgendy IY. The role of open access in the dissemination of cardiovascular science in the era of social media. Eur Heart J Qual Care Clin Outcomes 2019; 5:388-389. [PMID: 31297510 DOI: 10.1093/ehjqcco/qcz036] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ahmad Masri
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, Scaife Hall, S-553, Pittsburgh, PA, USA
| | - Amjad Samara
- Department of Medicine, School of Medicine, Washington University, 660 S Euclid Ave, St. Louis, MO, USA
| | - Moaaz Baghal
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, Scaife Hall, S-553, Pittsburgh, PA, USA
| | - Anum Saeed
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, Scaife Hall, S-553, Pittsburgh, PA, USA
| | - Ahmed Altibi
- Department of Medicine, Henry Ford Health System, 205 N East Ave, Jackson, MI, USA
| | - Amr F Barakat
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, Scaife Hall, S-553, Pittsburgh, PA, USA
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, 1600 SW Archer Rd M509, Gainesville, FL, USA
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29
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Hutt E, Wazni OM, Kaur S, Saliba WI, Tarakji KG, Kapadia S, Aguilera J, Barakat AF, Abdallah M, Jaber W, Rasmussen P, Hussain S, Uchino K, Wisco D, Lindsay BD, Kanj M, Hussein AA. Left atrial appendage closure device implantation in patients at very high risk for stroke. Heart Rhythm 2019; 17:27-32. [PMID: 31302250 DOI: 10.1016/j.hrthm.2019.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 05/26/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Little is known about the role of left atrial appendage closure using the Watchman device (Boston Scientific) in patients who are at very high risk for stroke. OBJECTIVE The purpose of this study was to assess the role of Watchman in patients with CHA2DS2-VASc ≥5. METHODS All patients undergoing procedures for Watchman implant at our institution were enrolled in a prospective registry. All 104 consecutive recipients with CHA2DS2-VASc ≥5 were included. RESULTS Median patient age was 78.5 ± 6.4 years, 56% were male, mean CHA2DS2-VASc was 5.7 ± 0.9, and mean HASBLED was 4.0 ± 1.0. Indications for implantation were significant prior bleeding (73%), unacceptable bleeding risk (21%), and unacceptable stroke and bleeding risk (6%). Watchman implantation was successful in all patients. All but 2 patients completed 45 days of postprocedural anticoagulation; 56% used warfarin and 44% used a novel oral anticoagulant. Transesophageal echocardiogram at 45 days revealed no significant peridevice leak. One patient was found to have a small mobile, filamentous echodensity attached on the medial aspect of the Watchman device. This resolved with longer anticoagulation with dabigatran and did not result in adverse outcome. At 1-year follow up, ischemic stroke had occurred in 3 patients (2.8%) at 96, 119, and 276 days after the procedure. CONCLUSION In a population of patients with mean CHA2DS2-VASc of 5.7, Watchman implantation seemed to be safe and efficacious, with a residual annual ischemic stroke risk of 2.8%. In an atrial fibrillation population with a similar CHA2DS2-VASc score, the estimated annual risk of stroke is ≈12% off anticoagulation and >4% on warfarin.
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Affiliation(s)
- Erika Hutt
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Oussama M Wazni
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Simrat Kaur
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Walid I Saliba
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Khaldoun G Tarakji
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Samir Kapadia
- Section Head of Invasive and Interventional Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jose Aguilera
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Amr F Barakat
- Department of Cardiovascular Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mouin Abdallah
- Section of Clinical Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Wael Jaber
- Section of Cardiovascular Imaging, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Peter Rasmussen
- Department of Cerebrovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Shazam Hussain
- Department of Cerebrovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ken Uchino
- Department of Cerebrovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Dolora Wisco
- Department of Cerebrovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Bruce D Lindsay
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Mohamed Kanj
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio.
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30
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Barakat AF, Thalappillil A, Qin D, Ladejobi A, Bhonsale A, Kancharla K, Wang NC, Adelstein E, Jain S, Estes NM, Saba S. Implications of Neurological Status on Defibrillator Therapy and Long-Term Mortality of Sudden Cardiac Arrest Survivors. JACC Clin Electrophysiol 2019; 5:843-850. [DOI: 10.1016/j.jacep.2019.04.003] [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] [Received: 12/13/2018] [Revised: 03/26/2019] [Accepted: 04/18/2019] [Indexed: 11/25/2022]
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Barakat AF, Zmaili MA, Tarakji KG, Shah S, Abdur Rehman K, Martin DO, Brunner MP, Saliba WI, Kanj M, Ballout J, Baranowski B, Cantillon D, Niebauer M, Callahan T, Dresing T, Rickard J, Lindsay BD, Wilkoff BL, Wazni OM, Hussein AA. Transvenous Lead Extraction in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy. JACC Clin Electrophysiol 2019; 5:665-670. [PMID: 31221352 DOI: 10.1016/j.jacep.2019.05.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to evaluate the effectiveness and safety of transvenous lead extraction (TLE) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). BACKGROUND ARVC is an increasingly diagnosed cardiomyopathy that often requires device implantation to prevent sudden death. Little is known about TLE in this setting, which has potential challenges and risks, primarily due to right ventricular (RV) wall thinning and fragility. METHODS All consecutive patients with ARVC who underwent TLE at our institution between 1996 and 2016 were included. When extraction tools were used, sheaths were advanced to the RV with countertraction at the lead tip. Success and complications were defined in concordance with Heart Rhythm Society guidelines. RESULTS Twenty-two TLE procedures in patients with ARVC involved extraction of 27 leads (22 defibrillators and 5 pacemakers). TLEs were performed due to evidence of lead malfunction (n = 17; 77%) or device infection (n = 5; 23%). Twenty-four leads (89%) were RV, and 3 leads (11%) were right atrial. The median age of the oldest extracted lead was 1,691 days (interquartile range [IQR]: 1,168 to 2,726 days). Specialized extraction tools were required in 20 procedures (91%). None required the use of a snare or a femoral workstation. The median procedural and fluoroscopic times were 152 min (IQR: 129 to 185 min) and 11 min (IQR: 6 to 18 min), respectively. Complete procedural success with removal of all leads was achieved in all cases. There were no major complications. CONCLUSIONS In a high-volume center, TLE in patients with ARVC was associated with a high success rate and a low rate of complications when guideline-established techniques and tools were used.
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Affiliation(s)
- Amr F Barakat
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Khaldoun G Tarakji
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shailee Shah
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | - David O Martin
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael P Brunner
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Walid I Saliba
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mohamed Kanj
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jad Ballout
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Bryan Baranowski
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Daniel Cantillon
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mark Niebauer
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Callahan
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Dresing
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - John Rickard
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bruce D Lindsay
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bruce L Wilkoff
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Oussama M Wazni
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ayman A Hussein
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
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Hutt E, Wazni OM, Saliba WI, Kanj M, Tarakji KG, Aguilera J, Barakat AF, Rasmussen P, Uchino K, Russman A, Hussain S, Wisco D, Kapadia S, Lindsay BD, Hussein AA. Left atrial appendage closure device implantation in patients with prior intracranial hemorrhage. Heart Rhythm 2019; 16:663-668. [DOI: 10.1016/j.hrthm.2018.11.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Indexed: 12/16/2022]
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Abdur Rehman K, Wazni OM, Barakat AF, Saliba WI, Shah S, Tarakji KG, Rickard J, Bassiouny M, Baranowski B, Tchou PJ, Bhargava M, Dresing TJ, Callahan TD, Cantillon DJ, Chung M, Kanj M, Irefin S, Lindsay B, Hussein AA. Life-Threatening Complications of Atrial Fibrillation Ablation. JACC Clin Electrophysiol 2019; 5:284-291. [DOI: 10.1016/j.jacep.2018.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 11/17/2022]
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Masri A, Altibi AM, Erqou S, Zmaili MA, Saleh A, Al-Adham R, Ayoub K, Baghal M, Alkukhun L, Barakat AF, Jain S, Saba S, Adelstein E. Wearable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death: A Systematic Review and Meta-Analysis. JACC Clin Electrophysiol 2019; 5:152-161. [PMID: 30784684 DOI: 10.1016/j.jacep.2018.11.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/15/2018] [Accepted: 11/20/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVES This study sought to synthesize the available evidence on the use of the wearable cardioverter-defibrillator (WCD). BACKGROUND Observational WCD studies for the prevention of sudden cardiac death have provided conflicting data. The VEST (Vest Prevention of Early Sudden Death) trial was the first randomized controlled trial (RCT) showing no reduction in sudden cardiac death as compared to medical therapy only. METHODS We searched PubMed, EMBASE, and Google Scholar for studies reporting on the outcomes of patients wearing WCDs from January 1, 2001, through March 20, 2018. Rates of appropriate and inappropriate WCD therapies were pooled. Estimates were derived using DerSimonian and Laird's method. RESULTS Twenty-eight studies were included (N = 33,242; 27 observational, 1 RCT-WCD arm). The incidence of appropriate WCD therapy was 5 per 100 persons over 3 months (95% confidence interval [CI]: 3.0 to 6.0, I2 = 93%). In studies on ischemic cardiomyopathy, the appropriate WCD therapy incidence was lower in the VEST trial (1 per 100 persons over 3 months; 95% CI: 1.0 to 2.0) as compared with observational studies (11 per 100 persons over 3 months; 95% CI: 11.0 to 20.0; I2 = 93%). The incidence of inappropriate therapy was 2 per 100 persons over 3 months (95% CI: 1.0 to 3.0; I2 = 93%). Mortality while wearing WCD was rare at 0.7 per 100 persons over 3 months (95% CI: 0.3 to 1.7; I2 = 94%). CONCLUSIONS The rate of appropriately treated WCD patients over 3 months of follow-up was substantial; higher in-observational studies as compared with the VEST trial. There was significant heterogeneity. More RCTs are needed to justify continued use of WCD in primary prevention.
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Affiliation(s)
- Ahmad Masri
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Ahmed M Altibi
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sebhat Erqou
- Department of Medicine, Providence VA Medical Center and Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mohammad A Zmaili
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ala Saleh
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Raed Al-Adham
- Department of Medicine, University of Arizona, Phoenix, Arizona
| | - Karam Ayoub
- Division of Cardiology, Department of Medicine, University of Kentucky, Lexington, Kentucky
| | - Moaaz Baghal
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Laith Alkukhun
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amr F Barakat
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sandeep Jain
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Samir Saba
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Evan Adelstein
- Division of Cardiology, Albany Medical College, Albany, New York
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Elbadawi A, Elgendy IY, Mahmoud AH, Ogunbayo GO, Saad M, Megaly M, Alotaki E, Mentias A, Barakat AF, London B. Outcomes of Surgical Ablation in Patients With Atrial Fibrillation Undergoing Cardiac Surgeries. Ann Thorac Surg 2018; 107:1395-1400. [PMID: 30481521 DOI: 10.1016/j.athoracsur.2018.10.040] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/18/2018] [Accepted: 10/10/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Surgical ablation procedure is commonly performed in patients with atrial fibrillation (AF) undergoing cardiac surgeries; however, the evidence regarding its impact on in-hospital cardiovascular outcomes is controversial. METHODS We queried the Nationwide Inpatient Sample Database for patients with AF who underwent cardiac surgeries from 1998 to 2013. We performed a propensity-score matching including 21 various baseline characteristics to compare those who underwent surgical ablation with those who had not. RESULTS A total of 47,964 hospitalizations were included in our final analysis. On propensity matching, 23,975 were in the surgical ablation group and 23,990 in the control group. The primary outcome of in-hospital mortality was lower in the surgical ablation group compared with the control group (3.6% versus 4.2%, p < 0.001). The surgical ablation group was associated with lower in-hospital cerebrovascular accident (2.0% versus 2.8%, p < 0.001), cardiogenic shock (2.6% versus 3.6%, p < 0.001), use of intraaortic balloon pump (5.1% versus 5.8%, p = 0.001), and shorter length of hospital stay (12.3 ± 10.1 versus 12.5 ± 10.3 days, p = 0.008). There was no difference between the surgical ablation and control groups in the incidence of cardiac tamponade (0.4% versus 0.3%, p = 0.296). The surgical ablation group was associated with a higher rate of complete heart block (5.2% versus 4.3%, p < 0.001) and permanent pacemaker insertion (8.6% versus 8.0%, p = 0.01). CONCLUSIONS In this large analysis of almost 50,000 patients with AF undergoing cardiac surgery, surgical ablation appears to be safe in the short term. Future studies should focus on evaluating the long-term effectiveness of this procedure.
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Affiliation(s)
- Ayman Elbadawi
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas; Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt.
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Ahmed H Mahmoud
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Gbolahan O Ogunbayo
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Marwan Saad
- Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt; Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Michael Megaly
- Minneapolis Heart Institute at Abbot Northwestern Hospital, Minneapolis, Minnesota
| | - Erfan Alotaki
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Amgad Mentias
- Department of Cardiovascular Medicine, University of Iowa, Iowa City, Iowa
| | - Amr F Barakat
- UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Barry London
- Department of Cardiovascular Medicine, University of Iowa, Iowa City, Iowa
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Shah S, Barakat AF, Saliba WI, Abdur Rehman K, Tarakji KG, Rickard J, Bassiouny M, Baranowski B, Tchou P, Bhargava M, Chung M, Dresing T, Callahan T, Cantillon D, Kanj M, Lindsay BD, Wazni OM, Hussein AA. Recurrent Atrial Fibrillation After Initial Long-Term Ablation Success. Circ Arrhythm Electrophysiol 2018; 11:e005785. [DOI: 10.1161/circep.117.005785] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [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] [Received: 08/21/2017] [Accepted: 02/23/2018] [Indexed: 11/16/2022]
Abstract
Background:
Atrial fibrillation recurrence after initial long-term success of catheter ablation has been described, yet not well studied. We assessed the electrophysiological findings and outcomes of repeat ablation procedures in this setting.
Methods and Results:
Between 2000 and 2015, 10 378 patients underwent atrial fibrillation ablation and were enrolled in a prospectively maintained data registry. From this registry, we included all 137 consecutive patients who had initial long-term success, defined as freedom from recurrent arrhythmia for >36 months off antiarrhythmics, then underwent repeat ablation for recurrent atrial fibrillation. The median arrhythmia-free period that defined long-term success was 52 months (41–68 months). In redo ablations, reconnection along at least one of the pulmonary veins (PVs) was found in 111 (81%) patients. Reconnection along a left superior, left inferior, right superior, and right inferior PV was found in 64%, 62%, 50%, and 54% of patients, respectively, and were reisolated. Additional non-PV ablations were performed in 127 (92.7%) patients: posterior wall (46%), septal to right PVs (49%), superior vena cava (35%), roof lines (52%), and cavotricuspid isthmus (33%). After a median follow-up of 17 months (5–36.9 months), 103 patients (75%) were arrhythmia free (79 off antiarrhythmics, 24 on antiarrhythmics).
Conclusions:
PV reconnection is the most common electrophysiological finding in patients with atrial fibrillation recurrence after long-term success, but with lower rates than what had been reported for early recurrences. In our experience, repeat ablations in this setting involve complex ablation approaches to reisolate the PVs and modify the atrial substrate and are associated with good success rates.
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Affiliation(s)
- Shailee Shah
- Department of Medicine (S.S., A.F.B., K.A.R.) and Center for Atrial Fibrillation (W.I.S., K.G.T., J.R., M.B., B.B., P.T., M.B., M.C., T.D., T.C., D.C., M.K., B.D.L., O.M.W., A.A.H.), Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Amr F. Barakat
- Department of Medicine (S.S., A.F.B., K.A.R.) and Center for Atrial Fibrillation (W.I.S., K.G.T., J.R., M.B., B.B., P.T., M.B., M.C., T.D., T.C., D.C., M.K., B.D.L., O.M.W., A.A.H.), Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Walid I. Saliba
- Department of Medicine (S.S., A.F.B., K.A.R.) and Center for Atrial Fibrillation (W.I.S., K.G.T., J.R., M.B., B.B., P.T., M.B., M.C., T.D., T.C., D.C., M.K., B.D.L., O.M.W., A.A.H.), Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Karim Abdur Rehman
- Department of Medicine (S.S., A.F.B., K.A.R.) and Center for Atrial Fibrillation (W.I.S., K.G.T., J.R., M.B., B.B., P.T., M.B., M.C., T.D., T.C., D.C., M.K., B.D.L., O.M.W., A.A.H.), Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Khaldoun G. Tarakji
- Department of Medicine (S.S., A.F.B., K.A.R.) and Center for Atrial Fibrillation (W.I.S., K.G.T., J.R., M.B., B.B., P.T., M.B., M.C., T.D., T.C., D.C., M.K., B.D.L., O.M.W., A.A.H.), Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - John Rickard
- Department of Medicine (S.S., A.F.B., K.A.R.) and Center for Atrial Fibrillation (W.I.S., K.G.T., J.R., M.B., B.B., P.T., M.B., M.C., T.D., T.C., D.C., M.K., B.D.L., O.M.W., A.A.H.), Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Mohamed Bassiouny
- Department of Medicine (S.S., A.F.B., K.A.R.) and Center for Atrial Fibrillation (W.I.S., K.G.T., J.R., M.B., B.B., P.T., M.B., M.C., T.D., T.C., D.C., M.K., B.D.L., O.M.W., A.A.H.), Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Bryan Baranowski
- Department of Medicine (S.S., A.F.B., K.A.R.) and Center for Atrial Fibrillation (W.I.S., K.G.T., J.R., M.B., B.B., P.T., M.B., M.C., T.D., T.C., D.C., M.K., B.D.L., O.M.W., A.A.H.), Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Patrick Tchou
- Department of Medicine (S.S., A.F.B., K.A.R.) and Center for Atrial Fibrillation (W.I.S., K.G.T., J.R., M.B., B.B., P.T., M.B., M.C., T.D., T.C., D.C., M.K., B.D.L., O.M.W., A.A.H.), Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Mandeep Bhargava
- Department of Medicine (S.S., A.F.B., K.A.R.) and Center for Atrial Fibrillation (W.I.S., K.G.T., J.R., M.B., B.B., P.T., M.B., M.C., T.D., T.C., D.C., M.K., B.D.L., O.M.W., A.A.H.), Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Mina Chung
- Department of Medicine (S.S., A.F.B., K.A.R.) and Center for Atrial Fibrillation (W.I.S., K.G.T., J.R., M.B., B.B., P.T., M.B., M.C., T.D., T.C., D.C., M.K., B.D.L., O.M.W., A.A.H.), Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Thomas Dresing
- Department of Medicine (S.S., A.F.B., K.A.R.) and Center for Atrial Fibrillation (W.I.S., K.G.T., J.R., M.B., B.B., P.T., M.B., M.C., T.D., T.C., D.C., M.K., B.D.L., O.M.W., A.A.H.), Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Thomas Callahan
- Department of Medicine (S.S., A.F.B., K.A.R.) and Center for Atrial Fibrillation (W.I.S., K.G.T., J.R., M.B., B.B., P.T., M.B., M.C., T.D., T.C., D.C., M.K., B.D.L., O.M.W., A.A.H.), Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Daniel Cantillon
- Department of Medicine (S.S., A.F.B., K.A.R.) and Center for Atrial Fibrillation (W.I.S., K.G.T., J.R., M.B., B.B., P.T., M.B., M.C., T.D., T.C., D.C., M.K., B.D.L., O.M.W., A.A.H.), Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Mohamed Kanj
- Department of Medicine (S.S., A.F.B., K.A.R.) and Center for Atrial Fibrillation (W.I.S., K.G.T., J.R., M.B., B.B., P.T., M.B., M.C., T.D., T.C., D.C., M.K., B.D.L., O.M.W., A.A.H.), Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Bruce D. Lindsay
- Department of Medicine (S.S., A.F.B., K.A.R.) and Center for Atrial Fibrillation (W.I.S., K.G.T., J.R., M.B., B.B., P.T., M.B., M.C., T.D., T.C., D.C., M.K., B.D.L., O.M.W., A.A.H.), Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Oussama M. Wazni
- Department of Medicine (S.S., A.F.B., K.A.R.) and Center for Atrial Fibrillation (W.I.S., K.G.T., J.R., M.B., B.B., P.T., M.B., M.C., T.D., T.C., D.C., M.K., B.D.L., O.M.W., A.A.H.), Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Ayman A. Hussein
- Department of Medicine (S.S., A.F.B., K.A.R.) and Center for Atrial Fibrillation (W.I.S., K.G.T., J.R., M.B., B.B., P.T., M.B., M.C., T.D., T.C., D.C., M.K., B.D.L., O.M.W., A.A.H.), Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
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Mahmoud AN, Mentias A, Elgendy AY, Qazi A, Barakat AF, Saad M, Mohsen A, Abuzaid A, Mansoor H, Mojadidi MK, Elgendy IY. Migraine and the risk of cardiovascular and cerebrovascular events: a meta-analysis of 16 cohort studies including 1 152 407 subjects. BMJ Open 2018; 8:e020498. [PMID: 29593023 PMCID: PMC5875642 DOI: 10.1136/bmjopen-2017-020498] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To perform an updated meta-analysis to evaluate the long-term cardiovascular and cerebrovascular outcomes among migraineurs. SETTING A meta-analysis of cohort studies performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES The MEDLINE, Web of Science and Cochrane Central Register of Controlled Trials databases were searched for relevant articles. PARTICIPANTS A total of 16 cohort studies (18 study records) with 394 942 migraineurs and 757 465 non-migraineurs were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES Major adverse cardiovascular and cerebrovascular events (MACCE), stroke (ie, ischaemic, haemorrhagic or non-specified), myocardial infarction (MI) and all-cause mortality. The outcomes were reported at the longest available follow-up. DATA ANALYSIS Summary-adjusted hazard ratios (HR) were calculated by random-effects Der-Simonian and Liard model. The risk of bias was assessed by the Newcastle-Ottawa Scale. RESULTS Migraine was associated with a higher risk of MACCE (adjusted HR 1.42, 95% confidence interval [CI] 1.26 to 1.60, P<0.001, I2=40%) driven by a higher risk of stroke (adjusted HR 1.41, 95% CI 1.25 to 1.61, P<0.001, I2=72%) and MI (adjusted HR 1.23, 95% CI 1.03 to 1.43, P=0.006, I2=59%). There was no difference in the risk of all-cause mortality (adjusted HR 0.93, 95% CI 0.78 to 1.10, P=0.38, I2=91%), with a considerable degree of statistical heterogeneity between the studies. The presence of aura was an effect modifier for stroke (adjusted HR aura 1.56, 95% CI 1.30 to 1.87 vs adjusted HR no aura 1.11, 95% CI 0.94 to 1.31, P interaction=0.01) and all-cause mortality (adjusted HR aura 1.20, 95% CI 1.12 to 1.30 vs adjusted HR no aura 0.96, 95% CI 0.86 to 1.07, Pinteraction<0.001). CONCLUSION Migraine headache was associated with an increased long-term risk of cardiovascular and cerebrovascular events. This effect was due to an increased risk of stroke (both ischaemic and haemorrhagic) and MI. There was a moderate to severe degree of heterogeneity for the outcomes, which was partly explained by the presence of aura. PROSPERO REGISTRATION NUMBER CRD42016052460.
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Affiliation(s)
- Ahmed N Mahmoud
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Amgad Mentias
- Department of Medicine, Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Akram Y Elgendy
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Abdul Qazi
- Department of Medicine, Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Amr F Barakat
- Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marwan Saad
- Department of Medicine, Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ala Mohsen
- Department of Medicine, Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Ahmed Abuzaid
- Department of Cardiovascular Medicine, Jefferson University Hospital/Christiana Care Health System, Newark, Delaware, USA
| | - Hend Mansoor
- Department of Health Services Research, Management, and Policy, College of Public Health, University of Florida, Gainesville, Florida, USA
| | - Mohammad K Mojadidi
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Islam Y Elgendy
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
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Barakat AF, Raza MQ, Banerjee K, Tsutsui RS, Mentias A, Abdur Rehman K, Thakkar B, Gul S, Faruqui R, Krishnaswamy A, Rodriguez LL, Grimm R, Griffin B, Tuzcu EM, Kapadia SR. Long-term mortality in patients with severe secondary mitral regurgitation and normal left ventricular ejection fraction: interventional perspective. EUROINTERVENTION 2018; 13:1881-1888. [PMID: 29313818 DOI: 10.4244/eij-d-17-00561] [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: 11/23/2022]
Abstract
AIMS Patients with severe secondary mitral regurgitation (MR) and normal ejection fraction are being excluded from clinical trials evaluating transcatheter mitral devices. We sought to evaluate the long-term mortality with medical management alone in this patient population. METHODS AND RESULTS We retrospectively evaluated patients diagnosed with ≥3+ MR at our institution over 15 years. Only patients with an ejection fraction ≥60% were included in the study. Those with degenerative mitral valve disease, papillary muscle dysfunction, or hypertrophic cardiomyopathy, and those who underwent mitral valve intervention were excluded. The study included 400 patients (age 71.1±14.8, 25.1% male, ejection fraction 62.5±3.6%). Mechanism of secondary MR was restricted valve motion, annular dilation and apical tethering in 91.5, 4.5 and 4%, respectively. One-year and three-year mortality were 19.1 and 26.3%, respectively. On multivariable Cox proportional regression analysis, older age, New York Heart Association functional Class III or IV, >3+ MR and larger left atrium were independent predictors of mortality. CONCLUSIONS Severe secondary MR with normal left ventricular systolic function has significant mortality with medical management alone. This initial observation needs to be confirmed in larger prospective studies. These patients should be included in future transcatheter clinical trials.
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Affiliation(s)
- Amr F Barakat
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
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Barakat AF, Wazni OM, Saliba WI, Yzeiraj E, Amuthan R, Abdur Rehman K, Tarakji KG, Bassiouny M, Baranowski B, Tchou P, Bhargava M, Dresing T, Callahan T, Cantillon D, Kanj M, Chung M, Lindsay BD, Hussein AA. Repeat ablation or medical management alone for recurrent arrhythmias after ablation of persistent atrial fibrillation. J Cardiovasc Electrophysiol 2018; 29:551-558. [DOI: 10.1111/jce.13434] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 07/21/2017] [Revised: 11/24/2017] [Accepted: 01/02/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Amr F. Barakat
- Department of Medicine; Cleveland Clinic Foundation; Cleveland OH USA
| | - Oussama M. Wazni
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute; Cleveland Clinic Foundation; Cleveland OH USA
| | - Walid I. Saliba
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute; Cleveland Clinic Foundation; Cleveland OH USA
| | - Edlira Yzeiraj
- Department of Medicine; Cleveland Clinic Foundation; Cleveland OH USA
| | - Ram Amuthan
- Department of Medicine; Cleveland Clinic Foundation; Cleveland OH USA
| | | | - Khaldoun G. Tarakji
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute; Cleveland Clinic Foundation; Cleveland OH USA
| | - Mohamed Bassiouny
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute; Cleveland Clinic Foundation; Cleveland OH USA
| | - Bryan Baranowski
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute; Cleveland Clinic Foundation; Cleveland OH USA
| | - Patrick Tchou
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute; Cleveland Clinic Foundation; Cleveland OH USA
| | - Mandeep Bhargava
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute; Cleveland Clinic Foundation; Cleveland OH USA
| | - Thomas Dresing
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute; Cleveland Clinic Foundation; Cleveland OH USA
| | - Thomas Callahan
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute; Cleveland Clinic Foundation; Cleveland OH USA
| | - Daniel Cantillon
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute; Cleveland Clinic Foundation; Cleveland OH USA
| | - Mohamed Kanj
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute; Cleveland Clinic Foundation; Cleveland OH USA
| | - Mina Chung
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute; Cleveland Clinic Foundation; Cleveland OH USA
| | - Bruce D. Lindsay
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute; Cleveland Clinic Foundation; Cleveland OH USA
| | - Ayman A. Hussein
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute; Cleveland Clinic Foundation; Cleveland OH USA
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Mahmoud AN, Barakat AF, Elgendy AY, Schneibel E, Mentias A, Abuzaid A, Elgendy IY. Long-Term Efficacy and Safety of Everolimus-Eluting Bioresorbable Vascular Scaffolds Versus Everolimus-Eluting Metallic Stents: A Meta-Analysis of Randomized Trials. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.005286. [PMID: 28468954 DOI: 10.1161/circinterventions.117.005286] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/11/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Data regarding the long-term efficacy and safety of everolimus-eluting bioresorbable vascular scaffolds (BVS) compared with everolimus-eluting stents are limited. This meta-analysis aimed to compare the long-term outcomes with both devices. METHODS AND RESULTS Randomized trials reporting clinical outcomes beyond 1 year and comparing BVS with everolimus-eluting stents were included. Summary estimates risk ratios (RRs) were constructed. The primary efficacy outcome was target lesion failure, defined as cardiac death, target vessel myocardial infarction, and ischemia-driven target lesion revascularization, and the primary safety outcome was definite or probable stent/scaffold thrombosis. Six trials with 5392 patients were included (mean follow-up, 25 months). BVS had a higher rate of target lesion failure (RR, 1.33; 95% confidence interval [CI], 1.11-1.58) driven by the higher rates of target vessel myocardial infarction (RR, 1.65; 95% CI, 1.26-2.17) and target lesion revascularization (RR, 1.39; 95% CI, 1.08-1.78). The risk of definite or probable stent/scaffold thrombosis (RR, 3.22; 95% CI, 1.89-5.49) and very late stent/scaffold thrombosis (>1 year; RR, 4.78; 95% CI, 1.66-13.8) was higher with BVS. The risk of cardiac and all-cause mortality was similar in both groups. CONCLUSIONS Compared with everolimus-eluting stents, BVS is associated with increased risk of target lesion failure driven by the increased rates of target vessel myocardial infarction and ischemia-driven target lesion revascularization in these studies (mean follow-up, 25 months). The risk of definite or probable stent/scaffold thrombosis and very late stent/scaffold thrombosis seems to be higher with BVS. Further information from randomized trials is critical to evaluate clinical outcomes with BVS on complete resolution of the scaffold.
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Affiliation(s)
- Ahmed N Mahmoud
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville (A.N.M., A.Y.E., E.S., I.Y.E.); Department of Medicine, Cleveland Clinic Foundation, OH (A.F.B.); Division of Cardiovascular Medicine, Department of Medicine, University of Iowa Carver College of Medicine (A.M.); and Department of Cardiovascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, DE (A.A.)
| | - Amr F Barakat
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville (A.N.M., A.Y.E., E.S., I.Y.E.); Department of Medicine, Cleveland Clinic Foundation, OH (A.F.B.); Division of Cardiovascular Medicine, Department of Medicine, University of Iowa Carver College of Medicine (A.M.); and Department of Cardiovascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, DE (A.A.)
| | - Akram Y Elgendy
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville (A.N.M., A.Y.E., E.S., I.Y.E.); Department of Medicine, Cleveland Clinic Foundation, OH (A.F.B.); Division of Cardiovascular Medicine, Department of Medicine, University of Iowa Carver College of Medicine (A.M.); and Department of Cardiovascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, DE (A.A.)
| | - Erik Schneibel
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville (A.N.M., A.Y.E., E.S., I.Y.E.); Department of Medicine, Cleveland Clinic Foundation, OH (A.F.B.); Division of Cardiovascular Medicine, Department of Medicine, University of Iowa Carver College of Medicine (A.M.); and Department of Cardiovascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, DE (A.A.)
| | - Amgad Mentias
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville (A.N.M., A.Y.E., E.S., I.Y.E.); Department of Medicine, Cleveland Clinic Foundation, OH (A.F.B.); Division of Cardiovascular Medicine, Department of Medicine, University of Iowa Carver College of Medicine (A.M.); and Department of Cardiovascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, DE (A.A.)
| | - Ahmed Abuzaid
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville (A.N.M., A.Y.E., E.S., I.Y.E.); Department of Medicine, Cleveland Clinic Foundation, OH (A.F.B.); Division of Cardiovascular Medicine, Department of Medicine, University of Iowa Carver College of Medicine (A.M.); and Department of Cardiovascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, DE (A.A.)
| | - Islam Y Elgendy
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville (A.N.M., A.Y.E., E.S., I.Y.E.); Department of Medicine, Cleveland Clinic Foundation, OH (A.F.B.); Division of Cardiovascular Medicine, Department of Medicine, University of Iowa Carver College of Medicine (A.M.); and Department of Cardiovascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, DE (A.A.)
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Mahmoud AN, Shah NH, Elgendy IY, Agarwal N, Elgendy AY, Mentias A, Barakat AF, Mahtta D, David Anderson R, Bavry AA. Safety and efficacy of second-generation drug-eluting stents compared with bare-metal stents: An updated meta-analysis and regression of 9 randomized clinical trials. Clin Cardiol 2018; 41:151-158. [PMID: 29369375 DOI: 10.1002/clc.22855] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/16/2017] [Accepted: 11/21/2017] [Indexed: 01/13/2023] Open
Abstract
The efficacy of second-generation drug-eluting stents (DES; eg, everolimus and zotarolimus) compared with bare-metal stents (BMS) in patients undergoing percutaneous coronary intervention was challenged recently by new evidence from large clinical trials. Thus, we aimed to conduct an updated systematic review and meta-analysis of randomized clinical trials (RCTs) evaluating the efficacy and safety of second-generation DES compared with BMS. Electronic databases were systematically searched for all RCTs comparing second-generation DES with BMS and reporting clinical outcomes. The primary efficacy outcome was major adverse cardiac events (MACE); the primary safety outcome was definite stent thrombosis. The DerSimonian and Laird method was used for estimation of summary risk ratios (RR). A total of 9 trials involving 17 682 patients were included in the final analysis. Compared with BMS, second-generation DES were associated with decreased incidence of MACE (RR: 0.78, 95% confidence interval [CI]: 0.69-0.88), driven by the decreased incidence of myocardial infarction (MI) (RR: 0.67, 95% CI: 0.48-0.95), target-lesion revascularization (RR: 0.47, 95% CI: 0.42-0.53), definite stent thrombosis (RR: 0.57, 95% CI: 0.41-0.78), and definite/probable stent thrombosis (RR: 0.54, 95% CI: 0.38-0.80). The incidence of all-cause mortality was similar between groups (RR: 0.94, 95% CI: 0.79-1.10). Meta-regression showed lower incidences of MI with DES implantation in elderly and diabetic patients (P = 0.026 and P < 0.0001, respectively). Compared with BMS, second-generation DES appear to be associated with a lower incidence of MACE, mainly driven by lower rates of target-lesion revascularization, MI, and stent thrombosis. However, all-cause mortality appears similar between groups.
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Affiliation(s)
- Ahmed N Mahmoud
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville
| | - Nikhil H Shah
- Department of Medicine, University of Florida, Gainesville
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville
| | - Nayan Agarwal
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville
| | - Akram Y Elgendy
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville
| | - Amgad Mentias
- Division of Cardiovascular Medicine, University of Iowa, Iowa City
| | - Amr F Barakat
- UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dhruv Mahtta
- Department of Medicine, University of Florida, Gainesville
| | - R David Anderson
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville
| | - Anthony A Bavry
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville.,North Florida/South Georgia Veterans Health System, Gainesville, Florida
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Barakat AF, Wazni OM, Tarakji KG, Callahan T, Nimri N, Saliba WI, Shah S, Abdur Rehman K, Rickard J, Brunner MP, Martin DO, Kanj M, Baranowski B, Cantillon D, Niebauer M, Dresing T, Lindsay BD, Wilkoff BL, Hussein AA. Transvenous Lead Extraction in Chronic Kidney Disease and Dialysis Patients With Infected Cardiac Devices. Circ Arrhythm Electrophysiol 2018; 11:e005706. [DOI: 10.1161/circep.117.005706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 07/31/2017] [Accepted: 11/08/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Amr F. Barakat
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Oussama M. Wazni
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Khaldoun G. Tarakji
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Thomas Callahan
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Nayef Nimri
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Walid I. Saliba
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Shailee Shah
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Karim Abdur Rehman
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - John Rickard
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Michael P. Brunner
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - David O. Martin
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Mohamed Kanj
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Bryan Baranowski
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Daniel Cantillon
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Mark Niebauer
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Thomas Dresing
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Bruce D. Lindsay
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Bruce L. Wilkoff
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Ayman A. Hussein
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
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Barakat AF, Wazni OM, Tarakji K, Saliba WI, Nimri N, Rickard J, Brunner M, Bhargava M, Kanj M, Baranowski B, Martin DO, Cantillon D, Callahan T, Dresing T, Niebauer M, Chung M, Lindsay BD, Wilkoff B, Hussein AA. Transvenous lead extraction at the time of cardiac implantable electronic device upgrade: Complexity, safety, and outcomes. Heart Rhythm 2017; 14:1807-1811. [DOI: 10.1016/j.hrthm.2017.08.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Indexed: 10/19/2022]
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Mentias A, Raza MQ, Barakat AF, Youssef D, Raymond R, Menon V, Simpfendorfer C, Franco I, Ellis S, Tuzcu EM, Kapadia SR. Effect of Shorter Door-to-Balloon Times Over 20 Years on Outcomes of Patients With Anterior ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Am J Cardiol 2017; 120:1254-1259. [PMID: 28838603 DOI: 10.1016/j.amjcard.2017.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/05/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
Abstract
Cardiovascular disease remains the most common cause of mortality. We studied the change in outcomes for anterior ST-elevation myocardial infarction (STEMI) between 1995 and 2014. Over the past 20 years, 1,658 patients presenting to our center with anterior STEMI underwent primary percutaneous coronary intervention within 12 hours of presentation. We divided these into 4 quartiles, 1995 to 1999 (n = 312), 2000 to 2004 (n = 408), 2005 to 2009 (n = 428), and 2010 to 2014 (n = 510). Across the 4 quartiles, mean age decreased (64.4, 62, 60.3, and 60 years, p <0.01). In all groups, there was a significant rise in prevalence of smoking, hypertension, and obesity. The median length of hospital stay decreased (6, 4.4, 4.2, and 3.6 days, p <0.01), as did the median door-to-balloon time (DBT) (217, 194, 135, and 38 minutes, p <0.01). Thirty-day and 1-year mortality improved over time (14.4%, 11.8%, 8.4%, and 7.8%; and 20.5%, 16.4%, 15.9%, and 13.9%) (p = 0.01 both). Also, 3-year mortality improved (25.3%, 21.6%, 21.3%, and 16.5%, p = 0.02). After adjusting for age, gender, co-morbidities, ejection fraction, clinical shock, and mitral regurgitation, shorter DBT was associated with lower long-term mortality (compared with DBT <60 minutes; 60 to 90 minutes hazard ratio [HR] 1.67, 95% confidence interval [CI] 0.93 to 3.00, p = 0.084; 90 to 120 minutes, HR 1.74, 95% CI 1.02 to 2.95, p = 0.04; >120 minutes, HR 1.91, 95% CI 1.23 to 2.96, p = 0.004). In conclusion, over the past 2 decades, long-term outcomes improved in patients presenting with anterior STEMI associated with shortening of DBT.
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Barakat AF, Mahmoud AN, Elgendy IY. Primary prevention implantable cardioverter defibrillator in patients with reduced ejection fraction: for ischemic or non-ischemic cardiomyopathy or both? J Thorac Dis 2017; 9:2749-2751. [PMID: 29221231 DOI: 10.21037/jtd.2017.08.97] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Amr F Barakat
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ahmed N Mahmoud
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
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Mahmoud AN, Barakat AF, Elgendy AY, Schneibel E, Mentias A, Abuzaid A, Elgendy IY. Response by Mahmoud et al to Letter Regarding Article, “Long-Term Efficacy and Safety of Everolimus-Eluting Bioresorbable Vascular Scaffolds Versus Everolimus-Eluting Metallic Stents: A Meta-Analysis of Randomized Trials”. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005673. [DOI: 10.1161/circinterventions.117.005673] [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: 11/16/2022]
Affiliation(s)
- Ahmed N. Mahmoud
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville
| | - Amr F. Barakat
- Division of Cardiovascular Medicine, University of Pittsburgh Medical Center, PA
| | - Akram Y. Elgendy
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville
| | - Erik Schneibel
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville
| | - Amgad Mentias
- Division of Cardiovascular Medicine, University of Iowa, Iowa City
| | - Ahmed Abuzaid
- Department of Cardiovascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, Delaware
| | - Islam Y. Elgendy
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville
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Mentias A, Hill E, Barakat AF, Raza MQ, Youssef D, Banerjee K, Sawant AC, Ellis S, Murat Tuzcu E, Kapadia SR. An alarming trend: Change in the risk profile of patients with ST elevation myocardial infarction over the last two decades. Int J Cardiol 2017; 248:69-72. [PMID: 28693891 DOI: 10.1016/j.ijcard.2017.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 11/26/2016] [Revised: 04/24/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) is the leading cause of mortality around the world. We sought to study changes in the risk profile of patients presenting with ST elevation myocardial infarction (STEMI). METHODS We retrospectively studied all patients presenting with STEMI to our center between 1995 and 2014. Patients were divided into four quartiles, 5years each. Baseline risk factors and comorbidities were recorded. Sub-analysis was done for patients with established CAD and their household incomes. RESULTS A total of 3913 patients (67.9% males) were included; 42.5% presented with anterior STEMI and 57.5% inferior STEMI. Ages were 64±12, 62±13, 61±13 and 60±13 in the four quartiles respectively. Obesity prevalence was 31, 37, 38 and 40% and diabetes mellitus prevalence was 24, 25, 24 and 31%, while hypertension was 55, 67, 70 and 77%, respectively, p<0.01 for all. Smoking prevalence was 28, 32, 42 and 46, p<0.01. When subgroup analysis was done for patients with history of CAD, prevalence of smoking, obesity, diabetes and hypertension significantly increased across the four quartiles. When patients were divided to four groups based on household income (poor, low middle, middle and high income), prevalence of diabetes, hypertension, smoking and obesity were significantly higher in patients with low income. CONCLUSION Despite better understanding of cardiovascular risk factors and more focus on preventive cardiology, patients presenting with STEMI over the past 20years are getting younger and more obese, with more prevalence of smoking, hypertension, and diabetes mellitus. This trend is greater in the lower income population.
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Affiliation(s)
- Amgad Mentias
- Heart and Vascular Institute, Cleveland Clinic, OH, United States
| | - Elizabeth Hill
- Heart and Vascular Institute, Cleveland Clinic, OH, United States
| | - Amr F Barakat
- Heart and Vascular Institute, Cleveland Clinic, OH, United States
| | - Mohammad Q Raza
- Heart and Vascular Institute, Cleveland Clinic, OH, United States
| | - Dalia Youssef
- Heart and Vascular Institute, Cleveland Clinic, OH, United States
| | - Kinjal Banerjee
- Heart and Vascular Institute, Cleveland Clinic, OH, United States
| | | | - Stephen Ellis
- Heart and Vascular Institute, Cleveland Clinic, OH, United States
| | - E Murat Tuzcu
- Heart and Vascular Institute, Cleveland Clinic, OH, United States
| | - Samir R Kapadia
- Heart and Vascular Institute, Cleveland Clinic, OH, United States.
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Barakat AF, Saad M, Elgendy AY, Mentias A, Abuzaid A, Mahmoud AN, Elgendy IY. Primary prevention implantable cardioverter defibrillator in patients with non-ischaemic cardiomyopathy: a meta-analysis of randomised controlled trials. BMJ Open 2017. [PMID: 28637742 PMCID: PMC5726098 DOI: 10.1136/bmjopen-2017-016352] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The objective of this meta-analysis of randomised controlled trials (RCTs) is to evaluate the role of primary prevention implantable cardioverter defibrillator (ICD) in patients with non-ischaemic cardiomyopathy (NICM). SETTING A meta-analysis of RCTs performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. DATA SOURCES The PubMed, MEDLINE, Embase and Cochrane Central Register of Controlled Trials databases were searched for relevant articles. PARTICIPANTS A total of 5 RCTs with 2573 patients with NICM were included. INTERVENTION Primary prevention ICD, compared with medical therapy alone. PRIMARY AND SECONDARY OUTCOME MEASURES All-cause mortality (primary outcome) and sudden cardiac death (SCD, secondary outcome). DATA ANALYSIS Summary estimate HR were constructed using the random-effect DerSimonian and Laird's model. Multiple study-level subgroup analyses were performed, and interaction was tested using random-effect analysis. RESULTS Compared with medical therapy alone, ICD placement was associated with lower risk of all-cause mortality (HR 0.79; 95% CI 0.64 to 0.93; p<0.001; I2=0%) at a mean follow-up of 4.2 years. The risk of SCD was also lower with ICD placement (RR 0.47; 95% CI 0.30 to 0.73; p=0.001; I2=0%) compared with control. On subgroup analyses, there was a suggestion of possible effect modification by age, in which benefit was observed in age group <60 years (HR 0.64; 95% CI 0.47 to 0.89), but not with age ≥60 years (HR 0.82; 95% CI 0.65 to 1.03) (Pinteraction=0.058), but not with other study-level variables. CONCLUSIONS Compared with medical therapy alone, primary prevention ICD therapy in patients with NICM is associated with a significant reduction in all-cause mortality, especially in younger patients. Future dedicated studies are needed to investigate the role of primary prevention ICD in the elderly population. PROSPEROREGISTRATIONNUMBER PROSPERO CRD42016052010.
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Affiliation(s)
- Amr F Barakat
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Marwan Saad
- Department of Medicine, Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Akram Y Elgendy
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Amgad Mentias
- Department of Medicine, Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Ahmed Abuzaid
- Department of Medicine, Division of Cardiovascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, Delaware, USA
| | - Ahmed N Mahmoud
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Islam Y Elgendy
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
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Barakat AF, Hussein AA, Saliba WI, Bassiouny M, Tarakji K, Kanj M, Jaber W, Rodriguez LL, Grimm R, Hussain MS, Russman A, Uchino K, Wisco D, Rasmussen P, Bain M, Vargo J, Zuccaro G, Gottesman D, Lindsay BD, Wazni OM. Initial Experience With High-Risk Patients Excluded From Clinical Trials: Safety of Short-Term Anticoagulation After Left Atrial Appendage Closure Device. Circ Arrhythm Electrophysiol 2017; 9:CIRCEP.116.004004. [PMID: 27225288 DOI: 10.1161/circep.116.004004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 02/08/2016] [Accepted: 04/25/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The implantation of left atrial appendage closure device (WATCHMAN, Boston Scientific, Natick, MA) is an alternative option to oral anticoagulation (OAC) for stroke prevention in atrial fibrillation. Patients require short-term OAC after implantation to avoid device thrombosis. The 2 clinical trials that assessed this device excluded patients thought not to be candidates for OAC. As such, little is known about the safety of this strategy in patients with previous major bleeding events. METHODS AND RESULTS All 20 consecutive patients with history of spontaneous major bleeding while on OAC who had subsequently undergone WATCHMAN device implantation at our institution were included. A newly conceived multidisciplinary Atrial Fibrillation Stroke Prevention Center evaluated patients for candidacy for device implantation and subsequent antithrombotic therapy. The primary outcome was spontaneous major bleeding while receiving short-term postprocedural OAC. Median CHA2DS2-VASc and HAS-BLED scores were 5 (quartiles 5-6) and 5 (quartiles 4-5), respectively. Previous major bleeding events were major gastrointestinal bleeding, intracranial bleeding, spontaneous hemopericardium with cardiac tamponade, and hemarthrosis in 11, 7, 1, and 1 patients, respectively. None of the patients had spontaneous major bleeding during the course of OAC after device implantation. In 1 patient, OAC was discontinued after 40 days because of mechanical fall with head trauma resulting in subdural hematoma with no associated neurological deficits; this was managed conservatively. CONCLUSIONS With careful multidisciplinary evaluation, a short course of OAC after WATCHMAN device implantation in patients with previous spontaneous major bleeding events is associated with low risk of recurrent spontaneous major bleeding.
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Affiliation(s)
- Amr F Barakat
- From the Department of Medicine (A.F.B.), Heart and Vascular Institute (A.A.H., W.I.S., M.B., K.T., M.K., W.J., L.L.R., R.G., B.D.L., O.M.W.), Cerebrovascular Center (M.S.H., A.R., K.U., D.W., P.R., M.B.), and Digestive Disease Institute (J.V., G.Z., D.G.), Cleveland Clinic Foundation, Cleveland, OH
| | - Ayman A Hussein
- From the Department of Medicine (A.F.B.), Heart and Vascular Institute (A.A.H., W.I.S., M.B., K.T., M.K., W.J., L.L.R., R.G., B.D.L., O.M.W.), Cerebrovascular Center (M.S.H., A.R., K.U., D.W., P.R., M.B.), and Digestive Disease Institute (J.V., G.Z., D.G.), Cleveland Clinic Foundation, Cleveland, OH
| | - Walid I Saliba
- From the Department of Medicine (A.F.B.), Heart and Vascular Institute (A.A.H., W.I.S., M.B., K.T., M.K., W.J., L.L.R., R.G., B.D.L., O.M.W.), Cerebrovascular Center (M.S.H., A.R., K.U., D.W., P.R., M.B.), and Digestive Disease Institute (J.V., G.Z., D.G.), Cleveland Clinic Foundation, Cleveland, OH
| | - Mohammed Bassiouny
- From the Department of Medicine (A.F.B.), Heart and Vascular Institute (A.A.H., W.I.S., M.B., K.T., M.K., W.J., L.L.R., R.G., B.D.L., O.M.W.), Cerebrovascular Center (M.S.H., A.R., K.U., D.W., P.R., M.B.), and Digestive Disease Institute (J.V., G.Z., D.G.), Cleveland Clinic Foundation, Cleveland, OH
| | - Khaldoun Tarakji
- From the Department of Medicine (A.F.B.), Heart and Vascular Institute (A.A.H., W.I.S., M.B., K.T., M.K., W.J., L.L.R., R.G., B.D.L., O.M.W.), Cerebrovascular Center (M.S.H., A.R., K.U., D.W., P.R., M.B.), and Digestive Disease Institute (J.V., G.Z., D.G.), Cleveland Clinic Foundation, Cleveland, OH
| | - Mohamed Kanj
- From the Department of Medicine (A.F.B.), Heart and Vascular Institute (A.A.H., W.I.S., M.B., K.T., M.K., W.J., L.L.R., R.G., B.D.L., O.M.W.), Cerebrovascular Center (M.S.H., A.R., K.U., D.W., P.R., M.B.), and Digestive Disease Institute (J.V., G.Z., D.G.), Cleveland Clinic Foundation, Cleveland, OH
| | - Wael Jaber
- From the Department of Medicine (A.F.B.), Heart and Vascular Institute (A.A.H., W.I.S., M.B., K.T., M.K., W.J., L.L.R., R.G., B.D.L., O.M.W.), Cerebrovascular Center (M.S.H., A.R., K.U., D.W., P.R., M.B.), and Digestive Disease Institute (J.V., G.Z., D.G.), Cleveland Clinic Foundation, Cleveland, OH
| | - L Leonardo Rodriguez
- From the Department of Medicine (A.F.B.), Heart and Vascular Institute (A.A.H., W.I.S., M.B., K.T., M.K., W.J., L.L.R., R.G., B.D.L., O.M.W.), Cerebrovascular Center (M.S.H., A.R., K.U., D.W., P.R., M.B.), and Digestive Disease Institute (J.V., G.Z., D.G.), Cleveland Clinic Foundation, Cleveland, OH
| | - Richard Grimm
- From the Department of Medicine (A.F.B.), Heart and Vascular Institute (A.A.H., W.I.S., M.B., K.T., M.K., W.J., L.L.R., R.G., B.D.L., O.M.W.), Cerebrovascular Center (M.S.H., A.R., K.U., D.W., P.R., M.B.), and Digestive Disease Institute (J.V., G.Z., D.G.), Cleveland Clinic Foundation, Cleveland, OH
| | - M Shazam Hussain
- From the Department of Medicine (A.F.B.), Heart and Vascular Institute (A.A.H., W.I.S., M.B., K.T., M.K., W.J., L.L.R., R.G., B.D.L., O.M.W.), Cerebrovascular Center (M.S.H., A.R., K.U., D.W., P.R., M.B.), and Digestive Disease Institute (J.V., G.Z., D.G.), Cleveland Clinic Foundation, Cleveland, OH
| | - Andrew Russman
- From the Department of Medicine (A.F.B.), Heart and Vascular Institute (A.A.H., W.I.S., M.B., K.T., M.K., W.J., L.L.R., R.G., B.D.L., O.M.W.), Cerebrovascular Center (M.S.H., A.R., K.U., D.W., P.R., M.B.), and Digestive Disease Institute (J.V., G.Z., D.G.), Cleveland Clinic Foundation, Cleveland, OH
| | - Ken Uchino
- From the Department of Medicine (A.F.B.), Heart and Vascular Institute (A.A.H., W.I.S., M.B., K.T., M.K., W.J., L.L.R., R.G., B.D.L., O.M.W.), Cerebrovascular Center (M.S.H., A.R., K.U., D.W., P.R., M.B.), and Digestive Disease Institute (J.V., G.Z., D.G.), Cleveland Clinic Foundation, Cleveland, OH
| | - Dolora Wisco
- From the Department of Medicine (A.F.B.), Heart and Vascular Institute (A.A.H., W.I.S., M.B., K.T., M.K., W.J., L.L.R., R.G., B.D.L., O.M.W.), Cerebrovascular Center (M.S.H., A.R., K.U., D.W., P.R., M.B.), and Digestive Disease Institute (J.V., G.Z., D.G.), Cleveland Clinic Foundation, Cleveland, OH
| | - Peter Rasmussen
- From the Department of Medicine (A.F.B.), Heart and Vascular Institute (A.A.H., W.I.S., M.B., K.T., M.K., W.J., L.L.R., R.G., B.D.L., O.M.W.), Cerebrovascular Center (M.S.H., A.R., K.U., D.W., P.R., M.B.), and Digestive Disease Institute (J.V., G.Z., D.G.), Cleveland Clinic Foundation, Cleveland, OH
| | - Mark Bain
- From the Department of Medicine (A.F.B.), Heart and Vascular Institute (A.A.H., W.I.S., M.B., K.T., M.K., W.J., L.L.R., R.G., B.D.L., O.M.W.), Cerebrovascular Center (M.S.H., A.R., K.U., D.W., P.R., M.B.), and Digestive Disease Institute (J.V., G.Z., D.G.), Cleveland Clinic Foundation, Cleveland, OH
| | - John Vargo
- From the Department of Medicine (A.F.B.), Heart and Vascular Institute (A.A.H., W.I.S., M.B., K.T., M.K., W.J., L.L.R., R.G., B.D.L., O.M.W.), Cerebrovascular Center (M.S.H., A.R., K.U., D.W., P.R., M.B.), and Digestive Disease Institute (J.V., G.Z., D.G.), Cleveland Clinic Foundation, Cleveland, OH
| | - Gregory Zuccaro
- From the Department of Medicine (A.F.B.), Heart and Vascular Institute (A.A.H., W.I.S., M.B., K.T., M.K., W.J., L.L.R., R.G., B.D.L., O.M.W.), Cerebrovascular Center (M.S.H., A.R., K.U., D.W., P.R., M.B.), and Digestive Disease Institute (J.V., G.Z., D.G.), Cleveland Clinic Foundation, Cleveland, OH
| | - David Gottesman
- From the Department of Medicine (A.F.B.), Heart and Vascular Institute (A.A.H., W.I.S., M.B., K.T., M.K., W.J., L.L.R., R.G., B.D.L., O.M.W.), Cerebrovascular Center (M.S.H., A.R., K.U., D.W., P.R., M.B.), and Digestive Disease Institute (J.V., G.Z., D.G.), Cleveland Clinic Foundation, Cleveland, OH
| | - Bruce D Lindsay
- From the Department of Medicine (A.F.B.), Heart and Vascular Institute (A.A.H., W.I.S., M.B., K.T., M.K., W.J., L.L.R., R.G., B.D.L., O.M.W.), Cerebrovascular Center (M.S.H., A.R., K.U., D.W., P.R., M.B.), and Digestive Disease Institute (J.V., G.Z., D.G.), Cleveland Clinic Foundation, Cleveland, OH
| | - Oussama M Wazni
- From the Department of Medicine (A.F.B.), Heart and Vascular Institute (A.A.H., W.I.S., M.B., K.T., M.K., W.J., L.L.R., R.G., B.D.L., O.M.W.), Cerebrovascular Center (M.S.H., A.R., K.U., D.W., P.R., M.B.), and Digestive Disease Institute (J.V., G.Z., D.G.), Cleveland Clinic Foundation, Cleveland, OH.
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Barakat AF, Sperry BW, Starling RC, Mentias A, Popovic ZB, Griffin BP, Desai MY. Prognostic Utility of Right Ventricular Free Wall Strain in Low Risk Patients After Orthotopic Heart Transplantation. Am J Cardiol 2017; 119:1890-1896. [PMID: 28390683 DOI: 10.1016/j.amjcard.2017.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/01/2017] [Accepted: 03/01/2017] [Indexed: 01/13/2023]
Abstract
Global longitudinal strain (GLS) by speckle-tracking echocardiography is a sensitive measure of regional left and right ventricular (LV and RV) dysfunction, before onset of overt systolic dysfunction. We sought to evaluate the prognostic utility of measuring LV-GLS and RV free wall strain (FWS) in low risk patients at 1 year after orthotopic heart transplantation (OHT). We retrospectively studied 96 OHT recipients (age 52 ± 14 years, 64% men) free of antibody-mediated rejection or moderate to severe coronary allograft vasculopathy (CAV, grade 2 to 3) at 1 year after transplant. LV-GLS and RV-FWS were calculated using EchoPAC software. Cox models were developed after adjusting for the Index for Mortality Prediction After Cardiac Transplantation (IMPACT) score (post-transplant risk score), with the primary outcome of death, moderate to severe CAV, or treated rejection. At 1 year after transplant, LV ejection fraction and RV fractional area change (FAC) were 58 ± 7% and 42 ± 10%, respectively. LV-GLS was -17.0 ± 3.3% and RV-FWS -16.4 ± 4.5%. At an average follow-up of 4.5 years, 28 patients met the primary end point (10 death, 5 vasculopathy, 17 rejection). In sequential Cox models, markers of RV function were associated with the primary outcome (RV-FAC, p = 0.012; RV-FWS, p = 0.022), while LV ejection fraction and LV-GLS were not. We conclude that in low risk patients 1 year after OHT, markers of RV function (RV-FAC and RV-FWS) are independently associated with incident rejection, CAV, and death. Markers of RV dysfunction could potentially be incorporated into risk scores and future prospective studies to risk stratify patients after OHT.
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