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Khalil C, Pham M, Sawant AC, Sinibaldi E, Bhardwaj A, Ramanan T, Qureshi R, Khan S, Ibrahim A, Gowda SN, Pomakov A, Sadawarte P, Lahoti A, Hansen R, Baldo S, Colern G, Pershad A, Iyer V. Neutrophil-to-lymphocyte ratio predicts heart failure readmissions and outcomes in patients undergoing transcatheter aortic valve replacement. Indian Heart J 2019; 70 Suppl 3:S313-S318. [PMID: 30595282 PMCID: PMC6310731 DOI: 10.1016/j.ihj.2018.08.002] [Citation(s) in RCA: 5] [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: 05/10/2018] [Revised: 07/29/2018] [Accepted: 08/01/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Neutrophil-to-lymphocyte ratio (NLR) has prognostic value in acute coronary syndromes. We investigated its utility for predicting heart failure (HF) admissions and major adverse cardiac outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). METHODS Data on clinical, laboratory, procedural, HF admissions, and major adverse cardiac events (MACEs) (all-cause mortality, recurrence of myocardial infarction requiring intervention, stroke) for 298 consecutive patients who underwent TAVR between 2012 and 2016 in our tertiary center were collected. RESULTS Analysis included 298 patients. The mean age was 83 ± 8 years, 51% were males, and 95% were Caucasians. The median Society of Thoracic Surgeons risk score was 9 (interquartile range: 6.3-11.8). Receiver-operating curve analysis identified a cutoff value of NLR of 4.0 for MACE after TAVR and sensitivity of 68% and specificity of 68% {area under the curve [AUC] = 0.65 [95% confidence interval (CI): 0.51-0.79], p = 0.03}. An NLR of 4.0 for HF hospitalizations after TAVR and sensitivity of 60% and specificity of 57% [AUC = 0.61 (95% CI: 0.53-0.69), p = 0.01]. NLR ≥4.0 before TAVR significantly predicted MACE after TAVR (68.4% vs. 31.6%, p = 0.02) and HF hospitalizations (58.3% vs. 41.7%, p = 0.03). NLR with TAVR risk score increased the predictive value for MACE after TAVR from AUC = 0.61 (95% CI: 0.50-0.72, p = 0.06) to AUC = 0.69 (95% CI: 0.57-0.80, p = 0.007). CONCLUSION NLR predicts all-cause mortality, MACE, and HF hospitalization 1 year after TAVR. NLR with TAVR risk score improved predictability for MACE. Further studies for prognostication using NLR are warranted.
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Affiliation(s)
- Charl Khalil
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Michael Pham
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Abhishek C Sawant
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Everett Sinibaldi
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Aishwarya Bhardwaj
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Tharmathai Ramanan
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Reema Qureshi
- Dept of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Sahoor Khan
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Amira Ibrahim
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Smitha N Gowda
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Alexander Pomakov
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | | | - Ankush Lahoti
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Rosemary Hansen
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Shannon Baldo
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Gerald Colern
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Ashish Pershad
- Division of Interventional Cardiology, Banner University Medical Center, Phoenix, AZ, USA
| | - Vijay Iyer
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA.
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Bhardwaj A, Ramanan T, Sawant AC, Sinibaldi E, Pham M, Khan S, Qureshi R, Agrawal N, Khalil C, Hansen R, Baldo S, Colern G, Corbelli J, Pershad A, Beck H, Iyer V. Quality of life outcomes in transcatheter aortic valve replacement patients requiring pacemaker implantation. J Arrhythm 2018; 34:441-449. [PMID: 30167016 PMCID: PMC6111478 DOI: 10.1002/joa3.12065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Received: 12/24/2017] [Accepted: 03/31/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Permanent pacemaker implantation is the most common complication after Transcatheter aortic valve replacement (TAVR) and is associated with worse outcomes and mortality. However, its impact on quality-of-life (QoL) outcomes remains unknown. METHODS We included 383 consecutive patients undergoing TAVR from January 2012 to 2016 who completed a baseline Kansas City Cardiomyopathy Questionnaire (KCCQ-12) health survey. The clinical, laboratory, angiographic, QoL, mortality, and occurrence of poor outcomes (KCCQ-12 score < 45 or KCCQ decrease of ≥10 points) were obtained. RESULTS The mean age was 83 ± 8 years, 51% were men, and majority were Caucasians (n = 364, 95%). Permanent pacemaker (PPM) was implanted in 11.5% of patients post-TAVR. PPM patients were more likely to have prior conduction disease including RBBB (25% vs 12%, P = .02) and PQ interval >250 ms (11% vs 5%, P = .07). One-month median KCCQ-12 scores were significantly lower among PPM patients (84.7 vs 68.8, P = .04), but did not differ significantly at 1-year (86.5 vs 90.6, P = .5) post-TAVR. Occurrence of poor outcomes did not differ significantly among those with or without PPM at 1 month (11% vs 7%, P = .39) and 1 year (13% vs 9%, P = .45), respectively. However, patients with poor QoL outcomes at 1 month post-TAVR also had significantly worse mortality during follow-up in unadjusted (31.3% vs 4.5%, P < .001) and adjusted (HR = 5.30, 95% [CI: 1.85-15.22, P = .002])analyses, respectively. CONCLUSION Permanent pacemaker implantation is associated with short-term reduction in QoL without long-term implications post-TAVR. Patients with poor QoL post-TAVR also have significantly higher mortality.
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Affiliation(s)
- Aishwarya Bhardwaj
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - Tharmathai Ramanan
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - Abhishek C. Sawant
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - Everett Sinibaldi
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - Michael Pham
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - Sahoor Khan
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - Reema Qureshi
- Department of MedicineDivision of CardiologyWarren Alpert Medical School of Brown UniversityProvidenceRIUSA
| | - Nikhil Agrawal
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - Charl Khalil
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - Rosemary Hansen
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - Shannon Baldo
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - Gerald Colern
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - John Corbelli
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - Ashish Pershad
- Department of MedicineDivision of Interventional CardiologyBanner University Medical CenterPhoenixAZUSA
| | - Hiroko Beck
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - Vijay Iyer
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
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Bhardwaj A, Sawant A, Hansen R, Sadawarte P, Agrawal N, Ramanan T, Sinibaldi E, Lahoti A, Kumar A, Sato K, Fernandez S, Sharma U, Iyer V. SYSTOLIC IMPEDANCE AND DIASTOLIC WALL STRESS ARE NOVEL PREDICTORS OF HEART FAILURE HOSPITALIZATIONS IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32098-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Ramanan T, Sawant A, Bhardwaj A, Hansen R, Sinibaldi E, Pham M, Khalil C, Sharma A, Kumar A, Iyer V. THE AMERICAN COLLEGE OF CARDIOLOGY: TRANSCATHETER AORTIC VALVE REPLACEMENT RISK CALCULATOR ACCURATELY PREDICTS HEART FAILURE READMISSIONS AND QUALITY OF LIFE OUTCOMES. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31963-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Agrawal N, Sawant A, Bhardwaj A, Ramanan T, Hansen R, Sinibaldi E, Sadawarte P, Lahoti A, Kumar A, Sato K, Elango K, Shah T, Fernandez S, Sharma U, Iyer V. CHANGE IN LEFT VENTRICULAR SYSTOLIC WALL STRESS PREDICTS HEART FAILURE READMISSIONS IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31950-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Pizzichelli G, Kehlet B, Evju Ø, Martin BA, Rognes ME, Mardal KA, Sinibaldi E. Numerical study of intrathecal drug delivery to a permeable spinal cord: effect of catheter position and angle. Comput Methods Biomech Biomed Engin 2017; 20:1599-1608. [DOI: 10.1080/10255842.2017.1393805] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- G. Pizzichelli
- Istituto Italiano di Tecnologia, Center for Micro-BioRobotics, Pontedera, Italy
| | - B. Kehlet
- Simula Research Laboratory, Lysaker, Norway
| | - Ø. Evju
- Simula Research Laboratory, Lysaker, Norway
| | - B. A. Martin
- Department of Biological Engineering, The University of Idaho, Moscow, ID, USA
| | - M. E. Rognes
- Simula Research Laboratory, Lysaker, Norway
- Departments of Mathematics and Informatics, University of Oslo, Oslo, Norway
| | - K. A. Mardal
- Simula Research Laboratory, Lysaker, Norway
- Departments of Mathematics and Informatics, University of Oslo, Oslo, Norway
| | - E. Sinibaldi
- Istituto Italiano di Tecnologia, Center for Micro-BioRobotics, Pontedera, Italy
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Khalil C, Pham M, Sawant A, Bhardwaj A, Ramanan T, Sinibaldi E, Hansen R, Baldo S, Colern G, Iyer V. TCT-223 Predictive Value of Neutrophil to Lymphocyte Ratio in Transcatheter Aortic Valve Replacement Patients. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Celletti C, Sinibaldi E, Pierelli F, Monari G, Camerota F. Focal Muscle Vibration and Progressive Modular Rebalancing with neurokinetic facilitations in post- stroke recovery of upper limb. Clin Ter 2017; 168:e33-e36. [PMID: 28240760 DOI: 10.7417/ct.2017.1979] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Stroke is one of the leading causes for disability worldwide. Exercise therapy is a key element of stroke rehabilitation but no evidence are present in literature. Moreover recently focal muscle vibrationis described as a useful therapeutic approach in the post stroke recovery. In this study the efficacy of the vibration therapy in association to progressive modular re balancing rehabilitative approach has been evaluated and compared to the conventional therapy alone and associated to the muscle vibration. METHODS A pilot randomized controlled trial, using a pragmatic triple-blind, parallel-group study design in chronic stroke patients upper limb function. RESULTS Functional outcomes resulted increased in the group treated with vibration therapy and in particular in the group associated to progressive modular rebalancing approach. CONCLUSION The combining neurophysiologically-based rehabilitative technique and vibration therapy may improve functional recovery in chronic stroke patients.
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Affiliation(s)
- C Celletti
- Physical Medicine and Rehabilitation Unit, Department of Orthopedics, University of Rome "Sapienza"
| | - E Sinibaldi
- Unit, Department of Neurology and Psichiatry, University of Rome "Sapienza"
| | - F Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - G Monari
- Unit, Department of Neurology and Psichiatry, University of Rome "Sapienza"
| | - F Camerota
- Unit, Department of Neurology and Psichiatry, University of Rome "Sapienza"
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Pizzichelli G, Di Michele F, Sinibaldi E. An analytical model for nanoparticles concentration resulting from infusion into poroelastic brain tissue. Math Biosci 2015; 272:6-14. [PMID: 26656677 DOI: 10.1016/j.mbs.2015.11.008] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 11/17/2015] [Accepted: 11/20/2015] [Indexed: 02/05/2023]
Abstract
We consider the infusion of a diluted suspension of nanoparticles (NPs) into poroelastic brain tissue, in view of relevant biomedical applications such as intratumoral thermotherapy. Indeed, the high impact of the related pathologies motivates the development of advanced therapeutic approaches, whose design also benefits from theoretical models. This study provides an analytical expression for the time-dependent NPs concentration during the infusion into poroelastic brain tissue, which also accounts for particle binding onto cells (by recalling relevant results from the colloid filtration theory). Our model is computationally inexpensive and, compared to fully numerical approaches, permits to explicitly elucidate the role of the involved physical aspects (tissue poroelasticity, infusion parameters, NPs physico-chemical properties, NP-tissue interactions underlying binding). We also present illustrative results based on parameters taken from the literature, by considering clinically relevant ranges for the infusion parameters. Moreover, we thoroughly assess the model working assumptions besides discussing its limitations. While not laying any claims of generality, our model can be used to support the development of more ambitious numerical approaches, towards the preliminary design of novel therapies based on NPs infusion into brain tissue.
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Affiliation(s)
- G Pizzichelli
- Istituto Italiano di Tecnologia, Center for Micro-BioRobotics, Viale R. Piaggio 34, 56025 Pontedera, Italy; Scuola Superiore Sant'Anna, The BioRobotics Institute, Viale R. Piaggio 34, 56025 Pontedera, Italy
| | - F Di Michele
- Istituto Italiano di Tecnologia, Center for Micro-BioRobotics, Viale R. Piaggio 34, 56025 Pontedera, Italy
| | - E Sinibaldi
- Istituto Italiano di Tecnologia, Center for Micro-BioRobotics, Viale R. Piaggio 34, 56025 Pontedera, Italy.
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Di Michele F, Pizzichelli G, Mazzolai B, Sinibaldi E. On the preliminary design of hyperthermia treatments based on infusion and heating of magnetic nanofluids. Math Biosci 2015; 262:105-16. [DOI: 10.1016/j.mbs.2014.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 12/05/2014] [Accepted: 12/17/2014] [Indexed: 10/24/2022]
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Sinibaldi E, Puleo GL, Mattioli F, Mattoli V, Di Michele F, Beccai L, Tramacere F, Mancuso S, Mazzolai B. Osmotic actuation modelling for innovative biorobotic solutions inspired by the plant kingdom. Bioinspir Biomim 2013; 8:025002. [PMID: 23648821 DOI: 10.1088/1748-3182/8/2/025002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Osmotic-driven plant movements are widely recognized as impressive examples of energy efficiency and low power consumption. These aspects motivate the interest in developing an original biomimetic concept of new actuators based on the osmotic principle exploited by plants. This study takes a preliminary step in this direction, by modelling the dynamic behaviour of two exemplificative yet relevant implementations of an osmotic actuator concept. In more detail, the considered implementations differ from each other in the way actuation energy storage is achieved (through a piston displacement in the former case, through membrane bulging in the latter). The dynamic problem is analytically solved for both cases; scaling laws for the actuation figures of merit (namely characteristic time, maximum force, maximum power, power density, cumulated work and energy density) as a function of model parameters are obtained for the bulging implementation. Starting from such performance indicators, a preliminary dimensioning of the envisaged osmotic actuator is exemplified, based on design targets/constraints (such as characteristic time and/or maximum force). Moreover, model assumptions and limitations are discussed towards effective prototypical development and experimental testing. Nonetheless, this study takes the first step towards the design of new actuators based on the natural osmotic principle, which holds potential for disruptive innovation in many fields, including biorobotics and ICT solutions.
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Affiliation(s)
- E Sinibaldi
- Center for Micro-BioRobotics@SSSA, Istituto Italiano di Tecnologia, Viale Rinaldo Piaggio 34, I-56025 Pontedera, Italy
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Stefanini C, Orofino S, Manfredi L, Mintchev S, Marrazza S, Assaf T, Capantini L, Sinibaldi E, Grillner S, Wallén P, Dario P. A novel autonomous, bioinspired swimming robot developed by neuroscientists and bioengineers. Bioinspir Biomim 2012; 7:025001. [PMID: 22619181 DOI: 10.1088/1748-3182/7/2/025001] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This paper describes the development of a new biorobotic platform inspired by the lamprey. Design, fabrication and implemented control are all based on biomechanical and neuroscientific findings on this eel-like fish. The lamprey model has been extensively studied and characterized in recent years because it possesses all basic functions and control mechanisms of higher vertebrates, while at the same time having fewer neurons and simplified neural structures. The untethered robot has a flexible body driven by compliant actuators with proprioceptive feedback. It also has binocular vision for vision-based navigation. The platform has been successfully and extensively experimentally tested in aquatic environments, has high energy efficiency and is ready to be used as investigation tool for high level motor tasks.
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Affiliation(s)
- C Stefanini
- The BioRobotics Institute, Scuola Superiore Sant’Anna (SSSA), Viale Rinaldo Piaggio 34, 56025 Pontedera (Pisa), Italy
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