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Gamero MT, Uber P, Brailovsky Y, Gibson G, Rame E, Alvarez R, Huang Y, Rajapreyar I. The dilemma of the role of the non-HLA antibodies in AMR. Clin Transplant 2024; 38:e15274. [PMID: 38485673 DOI: 10.1111/ctr.15274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Maria T Gamero
- Department of Medicine, Division of Cardiovascular Disease, Jefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Patricia Uber
- Department of Medicine, Division of Cardiovascular Disease, Jefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Yevgeniy Brailovsky
- Department of Medicine, Division of Cardiovascular Disease, Jefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Gregory Gibson
- Department of Medicine, Division of Cardiovascular Disease, Jefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Eduardo Rame
- Department of Medicine, Division of Cardiovascular Disease, Jefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Rene Alvarez
- Department of Medicine, Division of Cardiovascular Disease, Jefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Yanping Huang
- Department of Pathology and Genomic Medicine, Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Indranee Rajapreyar
- Department of Medicine, Division of Cardiovascular Disease, Jefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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2
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Romero J, Garcia M, Diaz JC, Gabr M, Rodriguez-Taveras J, Braunstein ED, Purkayastha S, Gamero MT, Alviz I, Marín J, Aristizábal J, Reynbakh O, Peralta AO, Duque M, Dave KP, Rodriguez D, Nino C, Briceno D, Velasco A, Ferrick K, Slipczuk L, Natale A, Di Biase L. Anatomical considerations and clinical interpretation of the 12-lead ECG in the prone position: a prospective multicentre study. Europace 2023; 25:175-184. [PMID: 36196043 PMCID: PMC10103558 DOI: 10.1093/europace/euac099] [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] [Received: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS The aim of this study is to provide guidance for the clinical interpretation of electrocardiograms (ECGs) in prone position and to establish the electroanatomic explanations for the possible differences to supine position ECGs that may be observed. Additionally, to determine if prone back ECG can be used as an alternative to standard ECG in patients who may benefit from prone position. METHODS AND RESULTS The ECG in supine (standard ECG), prone back (precordial leads placed on the patient's back), and prone anterior position (precordial leads placed in the standard position with the subjects in prone position) were prospectively examined on 85 subjects. Comparisons of ECG parameters between these positions were performed. Computed tomography (CT) scans were performed in both positions to determine possible electroanatomic aetiologies for prone-associated ECG changes. There were significant differences in QRS amplitude in Leads V1-V5 between supine and prone positions. Q waves were more frequently observed in prone back position vs. supine position (V1: 74.1 vs. 10.6%, P < 0.0001; V2: 23.5 vs. 0%, P < 0.0001, respectively). Flat and inverted T waves were more common in prone back leads (V1: 98 vs. 66%, P < 0.0001; V2: 96 vs. 8%, P < 0.0001; V3: 45 vs. 7%, P < 0.0001). The 3D-CT reconstructions measurements corroborated the significant inverse correlation between QRS amplitude and the distance from the centre of the heart to the estimated lead positions. CONCLUSION In prone back position ECG, low QRS amplitude should not be misinterpreted as low voltage conditions, neither should Q waves and abnormal T waves are considered anteroseptal myocardial infarction. These changes can be explained by an increased impedance (due to interposing lung tissue) and by the increased distance between the electrodes to the centre of the heart.
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Affiliation(s)
- Jorge Romero
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Mario Garcia
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | | | - Mohamed Gabr
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Joan Rodriguez-Taveras
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Eric D Braunstein
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Sutopa Purkayastha
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Maria T Gamero
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Isabella Alviz
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Jorge Marín
- Cardiology Department, Clínica Las Americas, Medellín, Colombia
| | | | - Olga Reynbakh
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Adelqui O Peralta
- VA Boston Healthcare System, Division of Cardiology, Harvard Medical School, Boston, MA, USA
| | - Mauricio Duque
- Cardiology Department, Universidad CES, Medellín, Colombia
| | - Kartikeya P Dave
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Daniel Rodriguez
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Cesar Nino
- Cardiology Department, Clínica Las Americas, Medellín, Colombia
| | - David Briceno
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Alejandro Velasco
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Kevin Ferrick
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Leandro Slipczuk
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas, USA
| | - Luigi Di Biase
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
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3
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Romero J, Gabr M, Diaz JC, Purkayastha S, Gamero MT, Reynbakh O, Matias J, Alviz I, Velasco A, Della Rocca DG, Mohanty S, Lin A, Zou F, Natale A, Di Biase L. Electrocardiographic Features of Patients with COVID-19: An Updated Review. Card Electrophysiol Clin 2022; 14:63-70. [PMID: 35221086 PMCID: PMC8556537 DOI: 10.1016/j.ccep.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Numerous systemic manifestations, including cardiac involvement in the form of myocardial infarction, myocarditis, and electrocardiographic changes, have been associated with COVID-19..In this review, the authors describe the electrocardiographic features that have been reported to date in patients affected by this disease and their possible underlying mechanisms.
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Affiliation(s)
- Jorge Romero
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mohamed Gabr
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Sutopa Purkayastha
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Maria T Gamero
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Olga Reynbakh
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jose Matias
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Isabella Alviz
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alejandro Velasco
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Aung Lin
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Fengwei Zou
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Luigi Di Biase
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, NY, USA.
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4
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Della Rocca DG, Magnocavallo M, Lavalle C, Romero J, Forleo GB, Tarantino N, Chimenti C, Alviz I, Gamero MT, Garcia MJ, Di Biase L, Natale A. Evidence of systemic endothelial injury and microthrombosis in hospitalized COVID-19 patients at different stages of the disease. J Thromb Thrombolysis 2020; 51:571-576. [PMID: 33156441 PMCID: PMC7645404 DOI: 10.1007/s11239-020-02330-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 01/13/2023]
Affiliation(s)
| | - Michele Magnocavallo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Universitario Umberto I, Sapienza University of Rome, Viale del Policlinico, 155- 00161, Rome, Italy.
| | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Universitario Umberto I, Sapienza University of Rome, Viale del Policlinico, 155- 00161, Rome, Italy
| | | | | | | | - Cristina Chimenti
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Universitario Umberto I, Sapienza University of Rome, Viale del Policlinico, 155- 00161, Rome, Italy
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5
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Angelini P, Gamero MT. Opportunities and Limitations in the Study of Transient Takotsubo Syndrome in Animal Models. J Clin Med Res 2020; 12:325-328. [PMID: 32587648 PMCID: PMC7295555 DOI: 10.14740/jocmr4225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Paolo Angelini
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA
| | - Maria T Gamero
- Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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Bellido-Caparó A, Gamero MT, Espinoza-Ríos J, Medina F, Bussalleu A, Tagle-Arrospide M. Hypoxic hepatitis in an extensive aortic disecction: case report. Rev Gastroenterol Peru 2019; 39:88-90. [PMID: 31042244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Hypoxic hepatitis is an uncommon cause of hepatic damage characterized by a centrolobular necrosis. Its pathophysiology remains unclear. Aortic dissection is a rare but frequently catastrophic event. It is caused by an aortic intimal tear with propagation of a false channel in the media. Depending on the site and extension, it can cause hypoperfusion of any organ leading to cellular ischemia and necrosis. We are presenting a case of hypoxic hepatitis in a patient with an extensive aortic dissection who present to the emergency department.
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Affiliation(s)
- Alvaro Bellido-Caparó
- Divisionof Gastroenterology, Hospital Cayetano Heredia. Lima, Peru; Faculty Member, School of Medicine, Universidad Peruana Cayetano Heredia. Lima, Peru
| | - Maria T Gamero
- School of Medicine, Universidad Peruana Cayetano Heredia. Lima, Peru
| | - Jorge Espinoza-Ríos
- Division of Gastroenterology, Hospital Cayetano Heredia. Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia. Lima, Peru
| | - Félix Medina
- School of Medicine, Universidad Peruana Cayetano Heredia. Lima, Peru; Division of Cardiology, Hospital Cayetano Heredia. Lima, Peru
| | - Alejandro Bussalleu
- Divisionof Gastroenterology, Hospital Cayetano Heredia. Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia. Lima, Peru
| | - Martin Tagle-Arrospide
- School of Medicine, Universidad Peruana Cayetano Heredia. Lima, Peru; Division of Gastroenterology, Clinica Anglo Americana. Lima, Peru
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7
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Vasquez-Rios G, Gamero MT, De la Cruz J, Hernandez GA, Hernandez E, Dueñas R. Insidious onset of intermittent claudication as the primary manifestation of infective endocarditis. Int J Gen Med 2017; 10:11-14. [PMID: 28123312 PMCID: PMC5234559 DOI: 10.2147/ijgm.s113385] [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: 11/23/2022] Open
Abstract
Musculoskeletal manifestations of infective endocarditis are well-described in the literature. However, insidious onset of localized calf pain is an uncommon presentation of embolization and may represent a diagnostic challenge owing to the nonspecific nature of the symptoms. This study reviewed the literature and reports a case of infective endocarditis in a patient who presented with bilateral calf pain as the primary complaint and reason for seeking medical attention.
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Affiliation(s)
- George Vasquez-Rios
- Alexander Von Humboldt Tropical Medicine Institute, Cayetano Heredia University, Lima, Peru
- Alberto Hurtado School of Medicine, Cayetano Heredia University, Lima, Peru
- Correspondence: George Vasquez-Rios, Alexander Von Humboldt Tropical Medicine Institute, Cayetano Heredia University, Av. Honorio Delgado 430, San Martin de Porres 15102, Peru, Email
| | - Maria T Gamero
- Alberto Hurtado School of Medicine, Cayetano Heredia University, Lima, Peru
| | - Jesus De la Cruz
- Internal Medicine Department, Cayetano Heredia Hospital, Lima, Peru
| | - Gabriel A Hernandez
- Department of Cardiology, Miller School of Medicine, University of Miami, Miami, FL
| | - Eduardo Hernandez
- Department of Adult Cardiology, St. Luke’s Episcopal Hospital, Houston, TX, USA
| | - Roy Dueñas
- Cardiology Department, Cayetano Heredia Hospital, Lima, Peru
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8
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Vasquez-Rios G, Machicado JD, Gamero MT, Pezua A, Betancourt AB, Terashima A, Marcos LA. Evaluating the role of intestinal parasites in the high rates of irritable bowel syndrome in South America: a pilot study. Folia Parasitol (Praha) 2015; 62. [PMID: 26725757 DOI: 10.14411/fp.2015.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 10/12/2015] [Indexed: 11/19/2022]
Affiliation(s)
- George Vasquez-Rios
- Facultad de Medicina, Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru;,Instituto de Medicina Tropical Alexander von Humboldt, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Jorge D Machicado
- Instituto de Medicina Tropical Alexander von Humboldt, Hospital Nacional Cayetano Heredia, Lima, Peru;,Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Maria T Gamero
- Facultad de Medicina, Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Adriana Pezua
- Facultad de Medicina, Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Angel B Betancourt
- Facultad de Medicina, Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Angelica Terashima
- Facultad de Medicina, Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru;,Instituto de Medicina Tropical Alexander von Humboldt, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Luis A Marcos
- Instituto de Medicina Tropical Alexander von Humboldt, Hospital Nacional Cayetano Heredia, Lima, Peru;,Department of Medicine and Molecular Genetics and Microbiology, Stony Brook University, Stony Brook, New York, USA
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