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Fath AR, Aglan M, Aglan A, Chilton RJ, Trakhtenbroit A, Al-Shammary OA, Oppong-Nkrumah O, Lenihan DJ, Dent SF, Otchere P. Cardioprotective Potential of Sodium-Glucose Cotransporter-2 Inhibitors in Patients With Cancer Treated With Anthracyclines: An Observational Study. Am J Cardiol 2024:S0002-9149(24)00315-1. [PMID: 38692401 DOI: 10.1016/j.amjcard.2024.04.032] [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] [Received: 02/13/2024] [Revised: 03/20/2024] [Accepted: 04/19/2024] [Indexed: 05/03/2024]
Abstract
Anthracyclines are pivotal in cancer treatment, yet their clinical utility is hindered by the risk of cardiotoxicity. Preclinical studies highlight the effectiveness of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in mitigating anthracycline-induced cardiotoxicity. Nonetheless, the translation of these findings to clinical practice remains uncertain. This study aims to evaluate the safety and potential of SGLT2i for preventing cardiotoxicity in patients with cancer, without preexisting heart failure (HF), receiving anthracyclines therapy. Using the TriNetX Global Research Network, patients with cancer without previous HF diagnosis receiving anthracycline therapy were identified and classified into 2 groups based on SGLT2i usage. A 1:1 propensity score matching was used to control for baseline characteristics between the 2 groups. Patients were followed for 2 years. The primary end point was new-onset HF, and the secondary end points were HF exacerbation, new-onset arrhythmia, myocardial infarction, all-cause mortality, and all-cause hospitalization. Safety outcomes included acute renal failure and creatinine levels. A total of 79,074 patients were identified, and 1,412 were included post-matching (706 in each group). They comprised 53% females, 62% White, with a mean age of 62.5 ± 11.4 years. Over the 2-year follow-up period, patients on SGLT2i had lower rates of new-onset HF (hazard ratio 0.147, 95% confidence interval 0.073 to 0.294) and arrhythmia (hazard ratio 0.397, 95% confidence interval 0.227 to 0.692) compared with those not on SGLT2i. The incidence of all-cause mortality, myocardial infarction, all-cause hospitalization, and safety outcomes were similar between both groups. In conclusion, among patients with cancer receiving anthracycline therapy without preexisting HF, SGLT2i use demonstrates both safety and effectiveness in reducing anthracycline-induced cardiotoxicity, with a decreased incidence of new-onset HF, HF exacerbation, and arrhythmias.
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Affiliation(s)
- Ayman R Fath
- Cardiology Department, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
| | - Mostafa Aglan
- Internal Medicine Department, Lahey Hospital and Medical Center, Burlington Massachusetts
| | - Amro Aglan
- Internal Medicine Department, Lahey Hospital and Medical Center, Burlington Massachusetts
| | - Robert J Chilton
- Cardiology Department, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Anatole Trakhtenbroit
- Cardiology Department, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Odaye A Al-Shammary
- Cardiology Department, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Oduro Oppong-Nkrumah
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Daniel J Lenihan
- Cardiology Department, Saint Francis Healthcare System, Cape Girardeau, Missouri
| | - Susan F Dent
- Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Prince Otchere
- Cardiology Department, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Aglan A, Maraey A, Fath AR, Elsharnoby H, Abdelmottaleb W, Elzanaty AM, Khalil M, Dani SS, Saad M, Elgendy IY. Association Between Clinical Trial Participation Status and Outcomes With Mitral Transcatheter Edge-to-Edge Repair. JACC Cardiovasc Interv 2024; 17:520-530. [PMID: 38418055 DOI: 10.1016/j.jcin.2023.10.063] [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: 06/08/2023] [Revised: 10/27/2023] [Accepted: 10/29/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND Clinical trials have demonstrated the efficacy and safety of mitral transcatheter edge-to-edge repair (M-TEER) for selected patients with severe mitral regurgitation. However, the generalizability of trial results to real-world patients remains uncertain. OBJECTIVES The authors aimed to compare baseline characteristics and in-hospital outcomes among trial participants with nonparticipants undergoing M-TEER. METHODS Using the National Inpatient Sample database years 2016-2020, M-TEER admissions were identified and categorized into trial participants vs none. We also identified a cohort of trial noneligible patients based on clinical exclusion criteria from pivotal trials. Multivariate regression analysis was performed to compare in-hospital outcomes. The primary outcome was in-hospital mortality, and secondary outcomes included in-hospital complications, length of stay, and hospitalization cost. RESULTS Among 38,770 M-TEER admissions from 2016 to 2020, 11,450 (29.5%) were trial participants, 22,975 (59.3%) were eligible nonparticipants, and 2,960 (7.6%) were noneligible. Baseline characteristics and comorbidity profiles were mostly similar between trial participants vs eligible nonparticipants. In-hospital mortality (adjusted OR [aOR]: 0.98; 95% CI: 0.60-1.62), cardiogenic shock (aOR: 1.06; 95% CI: 0.80-1.42), mechanical circulatory support (aOR: 0.91; 95% CI: 0.58-1.41), mechanical ventilation (aOR: 1.03; 95% CI: 0.74-1.42), and conversion to mitral valve surgery (aOR: 1.08; 95% CI: 0.57-2.03) were not different between both groups. Conversely, M-TEER for noneligible patients was associated with higher rates of mortality (aOR: 6.27; 95% CI: 3.75-10.45) and complications. CONCLUSIONS The majority of real-world M-TEER patients would have been eligible for clinical trial participation and had comparable clinical profiles and in-hospital outcomes to trial participants. However, noneligible patients had worse in-hospital outcomes compared with trial participants.
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Affiliation(s)
- Amro Aglan
- Department of Internal Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Ahmed Maraey
- Department of Internal Medicine, Carle Foundation Hospital, Urbana, Illinois, USA; Department of Cardiovascular Medicine, University of Toledo, Toledo, Ohio, USA
| | - Ayman R Fath
- Division of Cardiology, University of Texas Health Science Center at San Antonio, Texas, USA
| | - Hadeer Elsharnoby
- Department of Internal Medicine, Carle Foundation Hospital, Urbana, Illinois, USA
| | - Wael Abdelmottaleb
- Department of Internal Medicine, New York College of Medicine, Metropolitan Hospital, New York, New York, USA
| | - Ahmed M Elzanaty
- Department of Cardiovascular Medicine, University of Toledo, Toledo, Ohio, USA
| | - Mahmoud Khalil
- Department of Cardiovascular Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Sourbha S Dani
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Marwan Saad
- Division of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky, USA.
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Fath AR, Aglan A, Khurana A, Abuasbeh J, Eldaly AS, Mantha Y, Abraham B, Olagunju A, Prasad A. Transcatheter Aortic Valve Replacement: Variations in Use, Charges, and Geography in the United States. Am J Cardiol 2023; 205:363-368. [PMID: 37647820 DOI: 10.1016/j.amjcard.2023.07.151] [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: 05/05/2023] [Revised: 07/21/2023] [Accepted: 07/30/2023] [Indexed: 09/01/2023]
Abstract
The use of transcatheter aortic valve replacement (TAVR) in the United States has been increasing but with variability. We used a 100% sample of Medicare beneficiaries (MBs), from the Centers for Medicare and Medicaid Services database, who underwent TAVR by cardiologists between 2015 and 2019. We stratified data by geographic region, rural/urban areas, and provider's gender. We examined the average number of TAVRs performed per 100,000 MBs, the average number of TAVRs performed per individual cardiologist, and the average submitted charge (ASC) per procedure. The number of TAVR per 100,000 MBs was significantly variable among regions in all years (all P≤0.028), except in 2015 (P=0.103), with the highest rates being in the Northeast and the lowest being in the West. The number of TAVRs per cardiologist was significantly different among regions only in 2019 (P=0.04), with the Northeast showing the highest numbers and the South showing the lowest. The ASC was also significantly variable among regions in all years (all P≤0.01). The highest ASC was in the Midwest for all years, whereas the lowest was in the West in 2015 to 2016 and in the South in 2017 to 2019. In all years, the number of TAVRs per cardiologist was higher in urban areas than in rural areas (all P<0.05); however, rural cardiologists had higher ASCs (all P<0.05). The number of TAVR procedures per cardiologist was not significantly different between male and female cardiologists (all P>0.1). Female cardiologists had a significantly higher ASC only in 2015 (P=0.034). In conclusion, there are variations in TAVR use and charges for MBs according to geographic, urban, and rural regions and the performing cardiologist's gender.
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Affiliation(s)
- Ayman R Fath
- Department of Cardiovascular Diseases, University of Texas Health Science Center, San Antonio, Texas
| | - Amro Aglan
- Department of Internal Medicine, Beth Israel Lahey Health, Boston, Massachusetts
| | - Aditya Khurana
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Jumanah Abuasbeh
- Department of Public Health, University of Arizona, Phoenix, Arizona
| | | | - Yogamaya Mantha
- Department of Cardiovascular Diseases, University of Texas Health Science Center, San Antonio, Texas
| | - Bishoy Abraham
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona
| | | | - Anand Prasad
- Department of Cardiovascular Diseases, University of Texas Health Science Center, San Antonio, Texas.
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Aglan A, Fath AR, Khurana A, Aboasbeh J, Eldaly AS, Wadid M, Olagunju A, Nayak HM. Variations in Atrial Fibrillation Ablation Use and Charges in a Modern Cohort of Medicare Beneficiaries. Am J Cardiol 2023; 202:24-29. [PMID: 37413703 DOI: 10.1016/j.amjcard.2023.06.023] [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: 03/26/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 07/08/2023]
Abstract
Catheter ablation of atrial fibrillation (CAF) is increasingly being used in the United States. This study aimed to identify variations in CAF use among Medicare beneficiaries (MBs) over a 6-year period (2013 to 2019). Using the Center of Medicare and Medicaid Services database, a 100% sample of MBs who underwent CAF from 2013 to 2019 was included. We stratified CAF use data geographically (Northeast, South, West, and Midwest) and identified the number of CAFs per 100,000 MBs, number of electrophysiologists performing CAFs per 100,000 MBs, number of CAFs per individual electrophysiologist, and average submitted charge for CAF. In addition, we stratified the data per urban versus rural areas and gender of the operator. We found that the mean atrial fibrillation (AF) prevalence, rates of CAFs, number of electrophysiologists performing CAFs, and number of CAFs per electrophysiologist have increased steadily in all regions. The mean AF prevalence was different among regions, with the highest prevalence in the Northeast (p <0.001); however, there was a pattern of higher CAFs rates in the West and the South (p ≥0.057). The number of electrophysiologists performing CAFs was not different among regions; however, the number of CAFs per electrophysiologist was higher in the West and the South (p <0.001). The average submitted charge for CAF has decreased over years and was the lowest in the West and the South (p <0.001). There was no major difference in these variables regarding operator gender. In conclusion, there are significant variations in CAF use among MBs in the United States according to geographic and urban versus rural regions. These variations have the potential to impact the outcomes in MBs diagnosed with AF.
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Affiliation(s)
- Amro Aglan
- Department of Internal Medicine, Beth Israel Lahey Health, Burlington, Massachusetts.
| | - Ayman R Fath
- Division of Cardiology, University of Texas Health, San Antonio, Texas
| | - Aditya Khurana
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Jumanah Aboasbeh
- Department of Internal Medicine, Creighton University, Phoenix, Arizona
| | | | - Mark Wadid
- Department of Internal Medicine, Beth Israel Lahey Health, Burlington, Massachusetts
| | | | - Hemal M Nayak
- Division of Cardiology, University of Texas Health, San Antonio, Texas
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Olagunju A, Mihyawi N, Fath AR, Bhattarai B, Eldaly AS, Forst B, Mantha Y, Yeneneh BT. The relative risk of ischemic cerebrovascular accident in patients with Von Willebrand disease. J Investig Med 2023; 71:394-399. [PMID: 36695432 DOI: 10.1177/10815589221150642] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Cerebrovascular accident (CVA) is one of the leading causes of death in the United States. Von Willebrand factor plays an important role in platelet activation and adhesion. It remains unclear whether Von Willebrand disease (vWD) is associated with a decreased risk of developing CVA. The study aimed to compare the relative risk (RR) of CVA in patients with and without vWD. We queried the National Inpatient Sample from 2009 to 2014 for discharge data and records for vWD and CVA using International Classification of Diseases, Ninth-Revision codes. The unadjusted and adjusted RR of CVA in patients with and without vWD were estimated using log-binomial model. Descriptive measures including means, medians, standard deviations, and range were presented based on normality test of continuous data. The prevalence of CVA was lower in patients with vWD than in those without vWD (1.31% vs 2.04%), with a RR of 0.64 (95% confidence interval (CI): 0.60-0.68). After adjusting for common CVA risk factors, the RR remained lower in vWD patients: 0.81 (95% CI: 0.76-0.86). vWD is associated with a lower RR of developing CVA. This suggests that deficiency of Von Willebrand factor is potentially protective against the development of CVA. To the best of our knowledge, this is the first study in humans to compare the RR of CVA in patients with and without vWD. Future studies are needed to explore causal relationships and therapeutic benefits.
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Affiliation(s)
| | - Nawfal Mihyawi
- Cardiology Department, University of Texas at San Antonio, San Antonio, TX, USA
| | - Ayman R Fath
- Department of Medicine, Creighton University, Phoenix, AZ, USA
| | - Bikash Bhattarai
- Department of Biostatistics, Valleywise Health Medical Center, Phoenix, AZ, USA
| | | | - Beani Forst
- Department of Medicine, Creighton University, Phoenix, AZ, USA
| | - Yogamaya Mantha
- Cardiology Department, University of Texas at San Antonio, San Antonio, TX, USA
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Chao CJ, Seri A, Abraham B, Farina JM, Fennelly E, Campany M, Pereyra M, Said EF, Kenyon C, Fath AR, Smith S, Buckner-Petty S, Rayfield CA, Fortuin D, Sweeney JP, Yang EH, Ayoub C, Eleid MF, Alkhouli M, Rihal CS, Holmes DR, Pollak PM, El Sabbagh A, Oh JK, Arsanjani R. Impact of Persistent Iatrogenic Atrial Septal Defect following MitraClip. J Cardiovasc Dev Dis 2022; 10:jcdd10010001. [PMID: 36661896 PMCID: PMC9864604 DOI: 10.3390/jcdd10010001] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Prior studies have reported conflicting results of persistent iatrogenic atrial septal defect (iASD) and its impact following a transcatheter edge-to-edge repair (TEER) procedure. This study aims to evaluate the incidence of iASD and its clinical and hemodynamic impact after a TEER. METHODS Consecutive patients who underwent a TEER procedure from June 2014 to September 2020 at the Mayo Clinic were identified. The presence of iASD was retrospectively identified on post-procedure transthoracic echocardiography (TTE) to group patients into an iASD+ group and an iASD- group for comparison of prognosis and cardiac function. RESULTS A total of 316 patients were included; the mean age was 79.1 ± 9.1 years, and 67.7% were male. Persistent iASD was diagnosed in 108 (34.2%) patients. There was no difference concerning all-cause mortality, heart failure hospitalization, and stroke/TIA between groups at follow-up (median follow-up of 9 months). Post-procedure TTE demonstrated no differences regarding right ventricle (RV) and left ventricle (LV) dimensions and function, including TAPSE (15.2 ± 4.6 vs. 15.4 ± 5.5 mm, p = 0.875), and LV ejection fraction (51.1 ± 14.0% vs. 51.3 ± 13.9%, p = 0.933). However, patients with iASD had higher RV systolic pressure (48.7 ± 14.4 vs. 45.5 ± 14.5 mmHg, p = 0.042) compared with patients without iASD. CONCLUSION Notwithstanding higher RV pressures, patients with persistent iASD had no hemodynamic compromise and an equal prognosis compared with those without a residual atrial defect after a TEER procedure. These findings support the mid-term safety of procedures in which an interatrial defect needs to be created and would argue against the need for interventional closure.
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Affiliation(s)
- Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN 55902, USA
| | - Amith Seri
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Bishoy Abraham
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Juan M Farina
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Evelyn Fennelly
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Megan Campany
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Milagros Pereyra
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Ebram F Said
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Courtney Kenyon
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Ayman R Fath
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN 55902, USA
| | - Sean Smith
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Skye Buckner-Petty
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Corbin A Rayfield
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - John P Sweeney
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Eric H Yang
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Chadi Ayoub
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Mackram F Eleid
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN 55902, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN 55902, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN 55902, USA
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN 55902, USA
| | - Peter M Pollak
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Abdallah El Sabbagh
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Jae K Oh
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN 55902, USA
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
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7
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Mihyawi N, Ajmal M, Fath AR, Bhattarai B, Yeneneh B. The Cardioprotective Potential of von Willebrand Disease in Ischemic Heart Disease. Tex Heart Inst J 2022; 49:483736. [PMID: 35819472 DOI: 10.14503/thij-20-7402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
von Willebrand factor (vWF) aids coagulation at sites of vessel injury. Elevated vWF levels have been associated with an increased risk of ischemic heart disease (IHD); however, it is unclear whether vWF deficiency, seen in patients with von Willebrand disease (vWD), protects people against IHD. We determined and compared the prevalence and risk of IHD in patients with versus without vWD by using data from the National Inpatient Sample (2009-2014), excluding patients younger than 18 and older than 75 years. The primary outcome was the odds ratio (OR) of IHD in patients with versus without vWD. Secondary outcomes were major medical comorbidities and demographic characteristics in patients with vWD. Of 224,475,443 weighted hospital-discharge samples, we identified 82,809 patients with a vWD diagnosis. The odds of IHD were lower in patients with vWD than in those without (OR=0.54; 95% CI, 0.52-0.56). After multivariable logistic regression analysis and adjustment for age, sex, and typical IHD risk factors (hypertension, smoking, diabetes, hyperlipidemia, chronic kidney disease, obesity, and family history of IHD), the likelihood of IHD remained lower in patients with vWD than in patients without (OR=0.65; 95% CI, 0.63-0.67). Our study shows that vWF deficiency, as seen in patients with vWD, is associated with a decreased prevalence of IHD. Further investigation may confirm these findings.
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Affiliation(s)
- Nawfal Mihyawi
- Internal Medicine Department, Creighton University, Phoenix, Arizona
| | - Muhammad Ajmal
- Cardiology Department, University of Arizona, Tucson, Arizona
| | - Ayman R Fath
- Internal Medicine Department, Creighton University, Phoenix, Arizona
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8
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Venepally NR, Arsanjani R, Agasthi P, Wang P, Khetarpal BK, Barry T, Chao CJ, Fath AR, Mookadam F. A New Insight Into Nonbacterial Thrombotic Endocarditis: A Systematic Review of Cases. Anatol J Cardiol 2022; 26:743-749. [PMID: 36052565 PMCID: PMC9623215 DOI: 10.5152/anatoljcardiol.2022.1282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Nonbacterial thrombotic endocarditis is characterized by the presence of organized thrombi on cardiac valves, often associated with hypercoagulable states. There is a paucity of data regarding the predictors of mortality in patients with nonbacterial thrombotic endocarditis. Our primary aim was to identify predictors of in-hospital mortality in patients with nonbacterial thrombotic endocarditis. Methods: A systematic literature review of all published cases and case series was performed until May 2018 according to Preferred Reporting Items for Systematic Review and Meta-analyses statement guidelines. We applied random forest machine learning model to identify predictors of in-patient mortality in patients with nonbacterial thrombotic endocarditis. Results: Our search generated a total of 163 patients (mean age, 46 ± 17 years; women, 69%) with newly diagnosed nonbacterial thrombotic endocarditis. The in-hospital mortality rate in the study cohort was 30%. Among the patients who died in the hospital, initial presentation of pulmonary embolism (12.2 vs. 2.6%), splenic (38.7 vs. 10.5%), and renal (40.8 vs. 9.6%) infarcts were higher compared to patients alive at the time of discharge. Higher rates of malignancy (71.4 vs. 39.4%, P = .0003) and lower rates of antiphospholipid syndrome (8.1 vs. 48.2%, P = .0001) were noted in deceased patients. Random forest machine learning analysis showed that older age, presence of antiphospholipid syndrome, splenic infarct, renal infarct, peripheral thromboembolism, pulmonary embolism, myocardial infarction, and mitral valve regurgitation were significantly associated with increased risk of in-hospital mortality. Conclusion: Patients admitted with nonbacterial thrombotic endocarditis have a high rate of in-hospital mortality. Factors including older age, presence of antiphospholipid syndrome, splenic/renal infarct, lower limb thromboembolism, pulmonary embolism, myocardial infarction, and mitral valve regurgitation were significantly associated with increased risk of in-hospital mortality in patients with nonbacterial thrombotic endocarditis.
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Affiliation(s)
- Nithin R. Venepally
- Department of Internal Medicine, Division of Cardiology, Texas Tech University Health Science Center, Odessa, Texas, USA
- Corresponding author:Nithin R. Venepally, ✉
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona, USA
| | - Pradyumna Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona, USA
| | - Panwen Wang
- Department of Health Sciences Research, Mayo Clinic, Phoenix, Arizona, USA
| | - Banveet K. Khetarpal
- Department of Internal Medicine, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Timothy Barry
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona, USA
| | - Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona, USA
| | - Ayman R. Fath
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona, USA
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, University of Arizona, Phoenix, Arizona, USA
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Fath AR, Mookadam F, Aglan A, Eldaly AS, Jahanyar J, Shamoun F, Lee HR, Solsi A, Israr S, Mihyawi N, Agasthi P, Arsanjani R. Surgical Management of Aortic Regurgitation in Takayasu’s Arteritis: A Systematic Review of Techniques and Outcomes. Perm J 2022; 26:103-113. [DOI: 10.7812/tpp/21.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ayman R Fath
- Cardiovascular Diseases, University of Texas, San Antonio, Texas, USA
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ, USA
| | - Amro Aglan
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Abdullah S Eldaly
- Plastic and Reconstructive Surgery Department, Tanta University Hospitals, Tanta, Egypt
| | - Jama Jahanyar
- Department of Cardiothoracic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Fadi Shamoun
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ, USA
| | - Howard R Lee
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ, USA
| | - Anup Solsi
- Department of Internal Medicine, Creighton University, Phoenix, AZ, USA
| | - Sharjeel Israr
- Department of Internal Medicine, Creighton University, Phoenix, AZ, USA
| | - Nawfal Mihyawi
- Cardiovascular Diseases, University of Texas, San Antonio, Texas, USA
| | - Pradyumna Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ, USA
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ, USA
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10
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Eldaly AS, Mashaly SM, Fouda E, Emam OS, Aglan A, Abuasbeh J, Khurana A, Hamdar H, Fath AR. Systemic anti-inflammatory effects of mesenchymal stem cells in burn: A systematic review of animal studies. J Clin Transl Res 2022; 8:276-291. [PMID: 35991083 PMCID: PMC9389574] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 12/09/2022] Open
Abstract
Background Despite the advances in burn care, severe burns still impose significant morbidity and mortality. Severe burns are associated with an inflammatory response that ranges from alterations in vital signs to shock, multiorgan failure, and death. Mesenchymal stem cells (MSCs) are known for their anti-inflammatory and immunomodulatory effects. Therefore, MSCs were investigated for their potential benefits in modulating burn-induced inflammation and organ damage in several studies. Aim We have conducted a systematic review of the literature to evaluate the efficacy of MSCs in modulating burn-induced systemic inflammation and organ damage in animal models. Methods Four databases were searched: PubMed, Cumulative Index of Nursing and Allied Health Literature, Scopus, and Web of Science. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis as our basis of organization. Results Eight studies were included in the study. Bone marrow derived MSCs, umbilical cord derived MSCs (UC-MSCs), and UC-MSCs exosomes were used to modulate the burn-induced inflammation. MSCs therapy reduced serum levels of pro-inflammatory cytokines, improved renal function, inhibited tissue damage, and improved survival after burn. Furthermore, MSCs reversed all the burn-induced pathological changes in blood brain barrier (BBB). Conclusion MSCs may attenuate the burn-induced inflammation by decreasing serum levels of inflammatory cytokines. However, the effect on anti-inflammatory cytokines is conflicting and mandates more substantial evidence. Furthermore, MSCs reduce tissue inflammation, tissue damage, and apoptosis in the lungs and kidneys. In addition, MSCs reversed the burn-induced pathophysiologic changes in the BBB. The underlying mechanisms of these effects are poorly understood and should be the focus of future stem cell research. Relevance to Patients Severe burn patients are liable to systemic inflammation due to the release of inflammatory cytokines into the circulation. This inflammatory response has a broad spectrum of severity that ranges from alterations in vital signs to multiorgan failure and death. Despite the advances in burn care, burn-induced inflammation still imposes significant morbidity and mortality. This systematic review evaluates the potential benefits of stem cells in modulating burn-induced systemic inflammation in animal burn models.
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Affiliation(s)
- Abdullah S. Eldaly
- 1Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida,Corresponding author: Abdullah S. Eldaly, Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida. Tel.: +1 904-597-4771
| | - Sarah M. Mashaly
- 2Department of Dermatology, El-Menshawy General Hospital, Tanta, Egypt
| | - Eslam Fouda
- 3Division of Anesthesia and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida
| | - Omar S. Emam
- 1Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Amro Aglan
- 4Department of Internal Medicine, Lahey Clinic Beth Israel, Boston, Massachusetts
| | - Jumanah Abuasbeh
- 5Department of Public Health, University of Arizona, Phoenix, Arizona
| | - Aditya Khurana
- 6Department of Internal Medicine, Creighton University Health Education Alliance, Phoenix, Arizona
| | - Hiba Hamdar
- 7Department of Emergency Medicine, Notre Dame Maritime Hospital, Byblos, Lebanon
| | - Ayman R. Fath
- 6Department of Internal Medicine, Creighton University Health Education Alliance, Phoenix, Arizona
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11
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Eldaly AS, Fath AR, Mashaly SM. Will Radiomics Replace Sentinel Lymph Node Biopsy? Eur J Breast Health 2022; 18:203-204. [DOI: 10.4274/ejbh.galenos.2022.2022-2-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/19/2022] [Indexed: 12/01/2022]
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12
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Eldaly AS, Fath AR, Mashaly SM, Elhadi M. Acute pancreatitis associated with severe acute respiratory syndrome coronavirus-2 infection: a case report and review of the literature. J Med Case Rep 2021; 15:461. [PMID: 34503570 PMCID: PMC8426586 DOI: 10.1186/s13256-021-03026-7] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/23/2021] [Indexed: 01/09/2023] Open
Abstract
Introduction We report a case of Severe acute respiratory syndrome coronavirus-2 infection with acute pancreatitis as the only presenting symptom. To the best of our knowledge, there are few case reports of the same presentation. Case presentation An otherwise healthy 44-year-old white male from Egypt presented to the hospital with severe epigastric pain and over ten attacks of nonprojectile vomiting (first, gastric content, then bilious). Acute pancreatitis was suspected and confirmed by serum amylase, serum lipase, and computed tomography scan that showed mild diffuse enlargement of the pancreas. The patient did not have any risk factor for acute pancreatitis, and extensive investigations did not reveal a clear etiology. Given a potential occupational exposure, a nasopharyngeal swab for polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 was done, which was positive despite the absence of the typical symptoms of severe acute respiratory syndrome coronavirus 2 such as fever and respiratory symptoms. The patient was managed conservatively. For pancreatitis, he was kept nil per os for 2 days and received intravenous lactated Ringer’s (10 ml per kg per hour), nalbuphine, alpha chymotrypsin, omeprazole, and cyclizine lactate. For severe acute respiratory syndrome coronavirus 2, he received a 5-day course of intravenous azithromycin (500 mg per day). He improved quickly and was discharged by the fifth day. We know that abdominal pain is not a rare symptom of severe acute respiratory syndrome coronavirus 2, and we also know that elevated levels of serum amylase and lipase were reported in severe acute respiratory syndrome coronavirus-2 patients, especially those with severe symptoms. However, the association between severe acute respiratory syndrome coronavirus-2 infection and idiopathic acute pancreatitis is rare and has been reported only a few times. Conclusion We believe further studies should be conducted to determine the extent of pancreatic involvement in severe acute respiratory syndrome coronavirus-2 patients and the possible causality between severe acute respiratory syndrome coronavirus 2 and acute pancreatitis. We reviewed the literature regarding the association between severe acute respiratory syndrome coronavirus 2 and acute pancreatitis patients. Published data suggest that severe acute respiratory syndrome coronavirus 2 possibly could be a risk factor for acute pancreatitis.
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Affiliation(s)
- Abdullah S Eldaly
- Plastic and Reconstructive Surgery Department, Tanta University Hospital, Tanta, Egypt
| | - Ayman R Fath
- Internal Medicine Department, Creighton University Arizona Health Education Alliance, Phoenix, AZ, USA
| | | | - Muhammed Elhadi
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275, Tripoli, Libya.
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13
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Fath AR, Aglan A, Varkoly KS, Eldaly AS, Beladi RN, Forlemu A, Mihyawi N, Solsi A, Israr S, Lucas AR. Distinct Coagulopathy With Myocardial Injury and Pulmonary Embolism in COVID-19. J Investig Med High Impact Case Rep 2021; 9:23247096211019559. [PMID: 34036814 PMCID: PMC8161849 DOI: 10.1177/23247096211019559] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In this article, we report a case of a 61-year-old male who was diagnosed with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), presenting with acute respiratory distress syndrome requiring intubation and hemodynamic support, marked D-Dimer and troponin I elevation, worsening ST-elevation myocardial infarction on repeat electrocardiograms, and a negative coronary angiogram ruling out a coronary artery thrombosis or occlusion. With worsening diffuse ST-segment elevation on electrocardiograms and reduced ejection fraction on echocardiography in the setting of systemic inflammation, fulminant myocarditis was highly suspected. Despite optimal medical treatment, the patient’s condition deteriorated and was complicated by cardiac arrest that failed resuscitation. Although myocarditis was initially suspected, the autopsy revealed no evidence of myocarditis or pericarditis but did demonstrate multiple microscopic sites of myocardial ischemia together with thrombi in the left atrium and pulmonary vasculature. Additionally, scattered microscopic cardiomyocyte necrosis with pathological diagnosis of small vessel micro-thrombotic occlusions. These findings are potentially exacerbated by inflammation-induced coagulopathy, hypoxia, hypotension, and stress, that is, a multifactorial etiology. Further research and an improved understanding are needed to define the precise pathophysiology of the coagulopathic state causing widespread micro-thrombosis with subsequent myocardial and pulmonary injury.
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Affiliation(s)
| | - Amro Aglan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | | | | - Alexandra R Lucas
- Creighton University, Phoenix, AZ, USA.,Arizona State University, Tempe, AZ, USA
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14
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Fath AR, Eldaly AS, Aglan A, Varkoly KS, Beladi RN, Solsi A, Hahn MF, Karis JP, Nafisi S, Brady K, Bellamkonda P, Wakefield DN, Clapp WL, Lucas AR. Incidental Finding of a Large Right Atrial Thrombus in a Patient With Cerebral Lymphoma. J Investig Med High Impact Case Rep 2021; 9:23247096211001636. [PMID: 33749363 PMCID: PMC7985942 DOI: 10.1177/23247096211001636] [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: 11/17/2022] Open
Abstract
Right atrial (RA) masses are rare, challenging to diagnose, and potentially life-threatening with high mortality if untreated. We present a patient presenting with diffuse large B-cell lymphoma in the brain that was incidentally found to have a large RA mass. For a better definition of the RA mass, extensive workup using multimodality imaging including chest computed tomography, transthoracic echocardiography, transesophageal echocardiography, cardiac magnetic resonance imaging, and left heart catheterization was warranted. The imaging demonstrated a large RA mass extending through the tricuspid valve into the right ventricle and superior and inferior vena cava without a mobile component. The mass was then successfully resected, and further histology examination was performed to rule out lymphoma and rare subtypes of diffuse large B-cell lymphoma. The comprehensive workup proved the RA mass to be a calcified thrombus rather than a direct metastatic spread of lymphoma.
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Affiliation(s)
| | | | - Amro Aglan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | | | - Mary F Hahn
- St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | | | | | | | | | | | | | - Alexandra R Lucas
- Creighton University, Phoenix, AZ, USA.,Dignity Health, Phoenix, AZ, USA.,Arizona State University, Tempe, AZ, USA
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15
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Fath AR, Aglan A, Platt J, Yaron JR, Varkoly KS, Beladi RN, Gorgas D, Jean JT, Dasni P, Eldaly AS, Juby M, Lucas AR. Chronological Impact of Earthquakes on Blood Pressure: A Literature Review and Retrospective Study of Hypertension in Haiti Before and After the 2010 Earthquake. Front Public Health 2021; 8:600157. [PMID: 33520917 PMCID: PMC7844318 DOI: 10.3389/fpubh.2020.600157] [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] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/08/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: We review prior studies on the incidence of hypertension (HTN) after earthquakes and present a retrospective analysis of HTN after the 2010 earthquake in Haiti. Methods: Prior reports on HTN incidence were reviewed and a retrospective chart review for diagnosis of HTN in 4,308 patient charts was performed over a 7 year period (five clinics). A retrospective cohort study (RCS) was then performed on 11 patients with linear follow-up. Results: The Literature review revealed a significant increase in acute and subacute HTN following earthquakes. However, the chronic effects of earthquakes varied. Our chart review uncovered no significant difference in diagnosed HTN in a Fort-Liberté clinic 128 kilometers (km) distant and 4 weeks post-event. A secondary linear RCS for 11 individuals, prior to and after the earthquake, also did not detect a significant change in HTN prevalence. Conclusion: Prior studies demonstrate acute and subacute, increases in HTN after earthquakes, but late changes have varied. Retrospective studies in the Fort-Liberté clinic, 128 km distant and 4 weeks post-event, revealed no significant change in HTN, confirming prior findings that changes in HTN after earthquakes are early and local events. Further work examining HTN after earthquakes is needed to improve early health care after natural disasters.
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Affiliation(s)
- Ayman R Fath
- Internal Medicine Department, Creighton University, Phoenix, AZ, United States
| | - Amro Aglan
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Jeri Platt
- Glen Echo Presbyterian Church, Columbus, OH, United States
| | - Jordan R Yaron
- Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ, United States
| | - Kyle S Varkoly
- Kansas City University, Joplin, Kansas City, MO, United States
| | - Roxana N Beladi
- Kansas City University, Joplin, Kansas City, MO, United States
| | - Diane Gorgas
- Department of Emergency Medicine and Office of Global Health, Ohio State University's Wexner Medical Center, Columbus, OH, United States
| | - Jean Tom Jean
- Jerusalem Baptist Church, Fort-Liberté, Haiti.,Santiago Medical School, Santiago, Dominican Republic
| | | | - Abdullah S Eldaly
- Plastic and Reconstructive Surgery Department, Tanta University Hospitals, Tanta, Egypt
| | - Michael Juby
- Midwestern University Medical School, Phoenix, AZ, United States
| | - Alexandra R Lucas
- Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ, United States.,Internal Medicine Department, Creighton University Arizona Health Education Alliance, Phoenix, AZ, United States
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16
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Agasthi P, Chao CJ, Siegel RJ, Pujari SH, Mookadam F, Venepally NR, Wang P, Ashraf H, Marcotte F, Brown L, Semkiv OI, Fath AR, Allam MNA, Jokerst CE, Arsanjani R. Comparison of echocardiographic parameters with cardiac magnetic resonance imaging in the assessment of right ventricular function. Echocardiography 2020; 37:1792-1802. [PMID: 33012034 DOI: 10.1111/echo.14877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/27/2020] [Accepted: 09/12/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The right ventricle (RV) strain measured by speckle tracking (RVS) is an echocardiographic parameter used to assess RV function. We compared RVS to RV fractional area change (FAC%), tricuspid annular plane systolic excursion (TAPSE) and Doppler tissue imaging-derived peak systolic velocity (S') in the assessment of right ventricular (RV) systolic function measured using cardiac magnetic resonance imaging (MRI). METHODS We enrolled consecutive patients who underwent cardiac MRI between Jan 2012 and Dec 2017 and a transthoracic echocardiogram (TTE) within 1 month of the MRI with no interval event. Baseline clinical characteristics and MRI parameters were extracted from chart review. Echocardiographic parameters were measured prospectively. TTE parameters including RVS, TAPSE, S', and FAC% were tested for accuracy to identify impaired RV EF (EF < 45% & <30%) using receiver operator curves. RESULTS The study cohort included 500 patients with mean age 55 years ± 18 and peak tricuspid regurgitation velocity 2.7 ± 1.4 m/s. The area under ROC for RVS was 0.69 (95% CI 0.63-0.75) and 0.78 (95% CI 0.70-0.88) to predict RVEF < 45% & RVEF < 30%, respectively. The RV FAC% had second highest accuracy of predicting RVEF among all the TTE parameters tested in study. CONCLUSION Right ventricular strain is the most accurate echocardiographic method to detect impaired right ventricular systolic function when using MRI as the gold standard.
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Affiliation(s)
- Pradyumna Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Robert J Siegel
- Department of Cardiology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Sai Harika Pujari
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Nithin R Venepally
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Panwen Wang
- Department of Health Sciences Research, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Hasan Ashraf
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Francois Marcotte
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Lisa Brown
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Oksana I Semkiv
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Ayman R Fath
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Mohamed N A Allam
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
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17
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Solsi A, Findakly D, Mihyawi N, Fath AR. An Unusual Case of Neisseria flavescens/subflava Group Tricuspid Valve Endocarditis in a Patient With Previously Treated Methicillin-Resistant Staphylococcus aureus Endocarditis. Cureus 2020; 12:e9752. [PMID: 32944467 PMCID: PMC7489790 DOI: 10.7759/cureus.9752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Infective endocarditis (IE) is classified as an infection of any cardiac valve or endocardial surface and is often associated with high morbidity and mortality. Certain bacteria such as gram-positive cocci and viridans group streptococci have high predilection for both naïve and damaged cardiac valvular tissues, accounting for the majority of IE cases. In very infrequent instances, gram-negative bacteria (GNB), more specifically non-meningococcal, non-gonococcal GNB, have been shown to cause IE. The following is a case of a young male diagnosed with Neisseria flavescens/subflava tricuspid valve endocarditis after being previously treated for Methicillin-resistant Staphylococcus aureus (MRSA) endocarditis.
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18
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Mihyawi N, Fath AR, Findakly D, Forlemu A, Roy RR. Pericardial Effusion and Tamponade Complicating Acute Pericarditis in a Human Metapneumovirus-Infected Adult: A Unique Case Report. Cureus 2020; 12:e8454. [PMID: 32528782 PMCID: PMC7279685 DOI: 10.7759/cureus.8454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Acute pericarditis (AP), or pericardial sac inflammation, is a self-limited condition in healthy individuals. Viruses, including adenoviruses, enteroviruses, cytomegalovirus, and influenza virus, have been well documented to cause AP. In contrast, human metapneumovirus (hMPV), a relatively newer virus, has been described in a few cases to cause serious cardiac complications. Here we report a patient who developed an imminent cardiac tamponade associated with hMVP respiratory infection.
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19
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Fath AR, Jokerst CE, Aglan A, Mihyawi N, Mookadam F. Multimodality Imaging Demonstrating an Apical Variant Hypertrophic Cardiomyopathy in an Uncommon Pentad. J Investig Med High Impact Case Rep 2020; 8:2324709620934324. [PMID: 32551950 PMCID: PMC7303768 DOI: 10.1177/2324709620934324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 79-year-old man was admitted for a transcatheter aortic valve replacement due to severe aortic stenosis. A preoperative chest computed tomography with angiography revealed an apical variant hypertrophic cardiomyopathy with a prominent apical pouch. In addition, there was near-complete obliteration of the left ventricle in the mid to apical aspect during systole suggesting a midventricular gradient. Postoperative transthoracic echocardiography confirmed the apical variant hypertrophic cardiomyopathy with an apical aneurysm and a gradient with a peak velocity of 2 m/s, and mid-cavitary gradient with a peak velocity of 3 m/s. It also revealed a fusiform aneurysmal dilatation of the ascending aorta.
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Affiliation(s)
| | | | | | - Nawfal Mihyawi
- Creighton University Arizona Health Alliance/Valleywise Health Medical Center, Phoenix, AZ, USA
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20
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Agasthi P, Venepally NR, Mookadam F, Jokerst CE, Marcotte F, Brown L, Semkiv OI, Wang P, Konduru S, Fath AR, Arsanjani R. P614Comparison of echo parameters with cardiac MRI in the assessment of right ventricular function. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Systolic right ventricular (RV) function has prognostic significance both in acquired and congenital heart diseases. However accurate assessment of RV ejection fraction (EF) with transthoracic echocardiography (TTE) remains challenging due to the complex geometric shape of the RV. Magnetic resonance imaging (MRI) remains the gold standard modality for assessment of RV function; however the cost and availability limits the regular use of MRI in clinical practice. The RV strain measured by speckle tracking (RVS) is a novel method of assessing RV EF.
Purpose
The purpose of the study was to assess the accuracy of RVS compared RV fractional area change (FAC%), tricuspid annular peak systolic excursion (TAPSE) and Doppler tissue imaging-derived isovolumic acceleration and peak systolic velocity (S') at the lateral tricuspid annulus in the assessment of impaired RV EF.
Methods
We retrospectively identified patients who had a cardiac MRI between 2012- 2017 and only included patients with a TTE within 1 month of the MRI for our final analysis. Baseline characteristics, TTE and MRI parameters were extracted from chart review. RV strain was measured retrospectively using ECHOINSIGHT software. Four TTE parameters including RVS, TAPSE, S' and FAC% were tested for accuracy to identify impaired RV EF (defined as EF<45%) using receiver operator curves.
Results
The study cohort included 500 patients with mean age 55 yr ± 18 and right ventricular systolic pressure 33.7±13.6 mmHg. The proportion of female gender, diabetes, hypertension and obstructive sleep apnea were 38%, 15.6%, 43% & 19.8% respectively. The area under ROC for TAPSE, S', FAC% and RVS were 0.58 (95% confidence interval [CI] 0.51–0.65, p=0.03), 0.59 (95% CI 0.52–0.66, p=0.03), 0.67 (95% CI 0.61–0.73, p=0.03) and 0.70 (0.64–0.76, p=0.03) for assessing RV EF <45%.
Conclusion
Right ventricular strain most accurately detected impaired right ventricular ejection fraction as obtained by MRI.
Acknowledgement/Funding
None
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Affiliation(s)
- P Agasthi
- Mayo Clinic, Phoenix, United States of America
| | | | - F Mookadam
- Mayo Clinic, Phoenix, United States of America
| | - C E Jokerst
- Mayo Clinic, Phoenix, United States of America
| | - F Marcotte
- Mayo Clinic, Phoenix, United States of America
| | - L Brown
- Mayo Clinic, Phoenix, United States of America
| | - O I Semkiv
- Mayo Clinic, Phoenix, United States of America
| | - P Wang
- Mayo Clinic, Phoenix, United States of America
| | - S Konduru
- Mayo Clinic, Phoenix, United States of America
| | - A R Fath
- Mayo Clinic, Phoenix, United States of America
| | - R Arsanjani
- Mayo Clinic, Phoenix, United States of America
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21
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Siddiki H, Ravi S, Al-Qaisi MT, Fath AR, Ramirez F, Crowell MD, Pannala R, Faigel DO, Gurudu SR. Comparison of Small Versus Large Volume Split Dose Preparation for Colonoscopy: A Study of Colonoscopy Outcomes. Dig Dis Sci 2018; 63:2413-2418. [PMID: 29736830 DOI: 10.1007/s10620-018-5102-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 04/25/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Split dose bowel preparations (SDP) have superior outcomes for colonoscopy as compared to evening before regimens. However, the association of the actual volume of the SDP to colonoscopy outcome measures has not been well studied. AIMS Compare adenoma detection rate (ADR), sessile serrated polyp detection rate (SDR), mean bowel cleanse score, and predictors of inadequate exams between small volume SDP and large volume SDP. METHODS We have conducted a retrospective study in patients undergoing colonoscopy with small volume SDP versus large volume SDP between July 2014 and December 2014. Basic demographics (age, gender and BMI) along with clinical co-morbidities were recorded. Quality of the bowel preparation, ADR and SDR was compared between these groups. Univariate and multivariable logistic regressions were used to assess the determinants of inadequate exams in each group. RESULTS 1573 patients with split dose preparation were included in this retrospective study. 58.4% (920/1573) patients took small volume SDP. There was no difference in ADR (37.9 vs. 38.8%, p = 0.2); however, SDR was higher for small volume SDP compared to large volume SDP (11.9 vs. 7.9% p = 0.005). There was no difference in the rate of inadequate exams between the two groups (p = 0.7). A history of diabetes and constipation was associated with inadequate exams only in the small volume SDP. CONCLUSIONS SDR was higher in small volume SDP. There was no difference in rate of inadequate exams between the two groups. A history of diabetes and constipation was associated with inadequate exams only in patients with the small volume SDP.
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Affiliation(s)
- Hassan Siddiki
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Sreya Ravi
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Mohanad T Al-Qaisi
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Ayman R Fath
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Francisco Ramirez
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Michael D Crowell
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Rahul Pannala
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Douglas O Faigel
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Suryakanth R Gurudu
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA.
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22
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Fath AR, Kashou AH, Gheyath B, Kashou HE. Norepinephrine Type Pheochromocytoma With Concomitant Aortic Aneurysms: A Distinctive Association. J Med Cases 2017. [DOI: 10.14740/jmc2922w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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