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Alfaddagh A, Khraishah H, Romeo GR, Kassab MB, McMillan Z, Chandra-Strobos N, Blumenthal R, Albaghdadi M. Cardiovascular Outcomes Among Patients with Acute Coronary Syndromes and Diabetes: Results from ACS QUIK Trial in India. Glob Heart 2024; 19:37. [PMID: 38681971 PMCID: PMC11049669 DOI: 10.5334/gh.1290] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/21/2023] [Indexed: 05/01/2024] Open
Abstract
Background Despite cardiovascular disease being the leading cause of death in India, limited data exist regarding the factors associated with outcomes in patients with diabetes who suffer acute myocardial infarction (AMI). Methods We examined 21,374 patients with AMI enrolled in the ACS QUIK trial. We compared in-hospital and 30-day major adverse cardiac events including death, re-infarction, stroke, or major bleeding in those with and without diabetes. The associations between diabetes and cardiac outcomes were adjusted for presentation and in-hospital management using logistic regression. Results Mean ± SD age was 60.1 ± 12.0 years, 24.3% were females, and 44.4% had diabetes. Those with diabetes were more likely to be older, female, hypertensive, and have higher Killip class but less likely to present with STEMI. Patients with diabetes had longer symptoms onset-to-arrival (median 225 vs 290 min; P < 0.001) and, in case of STEMI, longer door-to-balloon times (median, 75 vs 91 min; P < 0.001). Diabetes was independently associated with higher in-hospital death (adjusted odds ratio [aOR], 1.46; 95% CI, 1.12-1.89), in-hospital reinfarction (aOR, 1.52; 95% CI, 1.15-2.02), 30-day MACE (aOR, 1.33; 95% CI, 1.14-1.55) and 30-day death (aOR, 1.40; 95%CI, 1.16-1.69) but not 30-day stroke or 30-day major bleeding. Conclusion Among patients presenting with AMI in Kerala, India, a considerable proportion has diabetes and are at increased risk for in-hospital and 30-day adverse cardiovascular outcomes. Increased awareness of the increased cardiovascular risk and attention to the implementation of established cardiovascular therapies are indicated for patients with diabetes in lower-middle-income countries who develop AMI. Clinical Trial registration ClinicalTrials.gov Unique identifier: NCT02256658.
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Affiliation(s)
- Abdulhamied Alfaddagh
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Haitham Khraishah
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US
| | - Giulio R. Romeo
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, US
| | - Mohamad B. Kassab
- Cardiovascular research center, Massachusetts General Hospital, Boston, MA, US
| | - Zeb McMillan
- Department of Anesthesiology, Division of Critical Care, UC San Diego, San Diego, CA, USA
| | - Nisha Chandra-Strobos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Roger Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Mazen Albaghdadi
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, US
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Albaghdadi M, Young MN, Al-Bawardy R, Monteleone P, Hawkins B, Armstrong E, Kassab M, Khraishah H, Chowdhury M, Tripathi A, Kennedy KK, Secemsky EA. Outcomes of atherectomy in patients undergoing lower extremity revascularisation. EUROINTERVENTION 2023; 19:e955-e963. [PMID: 37750241 PMCID: PMC10719741 DOI: 10.4244/eij-d-23-00432] [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: 05/30/2023] [Accepted: 08/21/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND There is a paucity of real-world data on the in-hospital (IH) and post-discharge outcomes in patients undergoing lower extremity peripheral vascular intervention (PVI) with adjunctive atherectomy. AIMS In this retrospective, registry-based study, we evaluated IH and post-discharge outcomes among patients undergoing PVI, treated with or without atherectomy, in the National Cardiovascular Data Registry PVI Registry. METHODS The IH composite endpoint included procedural complications, bleeding or thrombosis. The primary out-of-hospital endpoint was major amputation at 1 year. Secondary endpoints included repeat endovascular or surgical revascularisation and death. Multivariable regression was used to identify predictors of atherectomy use and its association with clinical endpoints. RESULTS A total of 30,847 patients underwent PVI from 2014 to 2019, including 10,971 (35.6%) treated with atherectomy. The unadjusted rate of the IH endpoint occurred in 524 (4.8%) of the procedures involving atherectomy and 1,041 (5.3%) of non-atherectomy procedures (p=0.07). After adjustment, the use of atherectomy was not associated with an increased risk of the combined IH endpoint (p=0.68). In the 6,889 (22.4%) patients with out-of-hospital data, atherectomy was associated with a reduced risk of amputation (adjusted hazard ratio [aHR] 0.67, 95% confidence interval [CI]: 0.51-0.85; p<0.01) and surgical revascularisation (aHR 0.63, 95% CI: 0.44-0.89; p=0.017), no difference in death rates (p=0.10), but an increased risk of endovascular revascularisation (aHR 1.21, 95% CI: 1.06-1.39; p<0.01) at 1 year. CONCLUSIONS The use of atherectomy during PVI is common and is not associated with an increase in IH adverse events. Longitudinally, patients treated with atherectomy undergo repeat endovascular reintervention more frequently but experience a reduced risk of amputation and surgical revascularisation.
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Affiliation(s)
| | - Michael N Young
- Division of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA and Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA
| | - Rasha Al-Bawardy
- National Guard Health Affairs, King Saud bin Abdulaziz University, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMARC), Jeddah, Saudi Arabia
| | - Peter Monteleone
- Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Ascension Texas Cardiovascular, Austin, TX, USA
| | | | - Ehrin Armstrong
- Adventist Heart Institute, Adventist Health St. Helena, St. Helena, CA, USA
| | - Mohamad Kassab
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Haitham Khraishah
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mohammed Chowdhury
- Division of Vascular Surgery, Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | | | - Kevin K Kennedy
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA and Harvard Medical School, Boston, MA, USA and Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Mutagaywa RK, Cramer MJ, Chillo P, Barongo A, Kifai E, Chamuleau S, Eze-Nliam C, Vera NB, Nkya D, Loth A, Alencherry B, Mongella S, Mayala H, Kisenge P, Mwinchete S, Joseph AB, Kwesigabo G, Kamuhabwa A, Albaghdadi M, Ghobrial J, Janabi M. Characteristics and immediate outcomes of patients who underwent percutaneous balloon mitral valvuloplasty at the Jakaya Kikwete Cardiac Institute, Tanzania. Cardiovasc J Afr 2023; 34:1-11. [PMID: 36745007 DOI: 10.5830/cvja-2022-068] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/06/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND For rheumatic mitral stenosis (MS), a multidisciplinary evaluation is mandatory to determine the optimal treatment: medical, percutaneous balloon mitral valvuloplasty (PBMV) or valve surgery. Clinical and imaging evaluations are essential for procedural risk assessment and outcomes. PBMV interventions are increasingly available in Africa and are feasible options for selected candidates. Enhancing PBMV training/skills transfer across most of African countries is possible. OBJECTIVES The aim of this study was to provide insight into the clinical practice of patients with rheumatic MS evaluated for PBMV in a Tanzanian teaching hospital and to define the role of imaging, and evaluate the heart team and training/skills transfer in PBMV interventions. METHODS From August 2019 to May 2022, 290 patients with rheumatic MS were recruited consecutively in the Tanzania Mitral Stenosis study. In total, 43 (14.8%) patients were initially evaluated for eligibility for PBMV by a heart team. We carried out the clinical assessment, laboratory investigations, transthoracic/oesophageal echocardiography (TTE/TEE) and electrocardiography. RESULTS The median age was 31 years (range 11-68), and two-thirds of the patients were female (four diagnosed during pregnancy). Two patients had symptomatic MS at six and eight years. Nine patients had atrial fibrillation with left atrial thrombus in three, and two were detected by TEE. Nine patients in normal sinus rhythm had spontaneous echo contrast. The mean Wilkins score was 8.6 (range 8-12). With re-evaluation by the local and visiting team, 17 patients were found to have unfavourable characteristics: Bi-commissural calcification (four), ≥ grade 2/4 mitral regurgitation (six), high scores and left atrial thrombus (three), left atrial thrombus (two), and severe pulmonary hypertension (two). Three patients died before the planned PBMV. Eleven patients were on a waiting list. We performed PBMV in 12 patients, with success in 10 of these, and good short-term outcomes [mean pre-PBMV (16.03 ± 5.52 mmHg) and post-PBMV gradients (3.08 ± 0.44 mmHg, p < 0.001)]. There were no complications. CONCLUSIONS PBMV had good outcomes for selected candidates. TEE is mandatory in pre-PBMV screening and for procedural guidance. In our cohort, patients with Wilkins score of up to 11 underwent successful PBMV. We encourage PBMV skills expansion in low- and middle-income countries, concentrating on expertise centres.
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Affiliation(s)
- Reuben K Mutagaywa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania; Department of Cardiology, Division of Heart and Lung, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Maarten J Cramer
- Department of Cardiology, Division of Heart and Lung, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Pilly Chillo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Aileen Barongo
- Department of Paediatric and Child Health, Mwananyamala Regional Hospital, Dar es Salaam, Tanzania
| | | | - Steven Chamuleau
- Amsterdam Heart Centre, Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Chete Eze-Nliam
- Department of Clinical and Interventional Cardiology, Cleveland Clinic; Heart, Vascular, and Thoracic Institute, Cleveland, USA
| | - Nelson B Vera
- Department of Clinical and Interventional Cardiology, Cleveland Clinic; Heart, Vascular, and Thoracic Institute, Cleveland, USA
| | - Deogratias Nkya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Alex Loth
- Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Ben Alencherry
- Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania; Department of Clinical and Interventional Cardiology, Cleveland Clinic; Heart, Vascular, and Thoracic Institute, Cleveland, USA
| | | | - Henry Mayala
- Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Peter Kisenge
- Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | | | - Alex B Joseph
- Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Gideon Kwesigabo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | | | - Joanna Ghobrial
- Department of Clinical and Interventional Cardiology, Cleveland Clinic; Heart, Vascular, and Thoracic Institute, Cleveland, USA
| | - Mohamed Janabi
- Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
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Khraishah H, Alahmad B, Ostergard RL, AlAshqar A, Albaghdadi M, Vellanki N, Chowdhury MM, Al-Kindi SG, Zanobetti A, Gasparrini A, Rajagopalan S. Climate change and cardiovascular disease: implications for global health. Nat Rev Cardiol 2022; 19:798-812. [PMID: 35672485 DOI: 10.1038/s41569-022-00720-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [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] [Accepted: 05/04/2022] [Indexed: 12/15/2022]
Abstract
Climate change is the greatest existential challenge to planetary and human health and is dictated by a shift in the Earth's weather and air conditions owing to anthropogenic activity. Climate change has resulted not only in extreme temperatures, but also in an increase in the frequency of droughts, wildfires, dust storms, coastal flooding, storm surges and hurricanes, as well as multiple compound and cascading events. The interactions between climate change and health outcomes are diverse and complex and include several exposure pathways that might promote the development of non-communicable diseases such as cardiovascular disease. A collaborative approach is needed to solve this climate crisis, whereby medical professionals, scientific researchers, public health officials and policymakers should work together to mitigate and limit the consequences of global warming. In this Review, we aim to provide an overview of the consequences of climate change on cardiovascular health, which result from direct exposure pathways, such as shifts in ambient temperature, air pollution, forest fires, desert (dust and sand) storms and extreme weather events. We also describe the populations that are most susceptible to the health effects caused by climate change and propose potential mitigation strategies, with an emphasis on collaboration at the scientific, governmental and policy levels.
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Affiliation(s)
- Haitham Khraishah
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. .,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Barrak Alahmad
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.,Environmental & Occupational Health Department, Faculty of Public Health, Kuwait University, Hawalli, Kuwait
| | | | - Abdelrahman AlAshqar
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Mazen Albaghdadi
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nirupama Vellanki
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mohammed M Chowdhury
- Department of Vascular and Endovascular Surgery, Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Sadeer G Al-Kindi
- University Hospitals, Harrington Heart & Vascular Institute, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Antonio Gasparrini
- Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK.,Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK.,Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Sanjay Rajagopalan
- University Hospitals, Harrington Heart & Vascular Institute, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Khraishah H, Karout L, Jeong SY, Alahmad B, AlAshqar A, Belanger MJ, Welty FK, Michos ED, Albaghdadi M. Clinical characteristics and cardiovascular outcomes among young patients with acute myocardial infarction in Kerala, India: A secondary analysis of ACS QUIK trial. Atheroscler Plus 2022; 50:25-31. [PMID: 36643797 PMCID: PMC9833239 DOI: 10.1016/j.athplu.2022.08.003] [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] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/12/2022] [Accepted: 08/22/2022] [Indexed: 01/18/2023]
Abstract
Background Limited data exist on the risk profile and outcomes among young patients with acute myocardial infarction(AMI) in low-and middle-income countries(LMICs). This study explored differences in the clinical characteristics, medical care, and outcomes of AMI in young adults in India with a subanalysis focusing on sex disparities amongst the young. Methods Using the Acute Coronary Syndrome Quality Improvement in Kerala trial database, we compared baseline characteristics, management, and outcomes amongst the young patients(≤50 years) and their older counterparts. The primary outcomes were the rates of in-hospital and 30-day composite of in-hospital major adverse cardiovascular events(MACE). Results Of the 21,374 adults enrolled, 4762(22%) were young, of which 614 (12.9%) were females. Young patients with AMI were more likely to be smokers(41.9% vs. 27.8%;P < 0.001) and undergo coronary angiography (66.3%vs.57.3%;P < 0.001) and percutaneous coronary intervention (PCI)(57.5% vs. 47.0%;P < 0.001), compared to older patients. After adjustment for potential confounders, younger patients had a lower likelihood of in-hospital (RR = 0.49; 95%CI 0.40-0.61;P < 0.001) and 30-day MACE (RR = 0.54; 95%CI 0.46-0.64;P < 0.001). Subgroup analysis comparing young males and females revealed worse cardiovascular risk profile among young women except for smoking. In-hospital MACE(RR = 1.60; 95%CI, 1.0-2.45;P = 0.048) were higher for young women compared to men. Conclusion Young AMI patients had higher prevalence of modifiable risk factors, were more likely to receive reperfusion therapy, and had better short and intermediate outcomes, compared to older patients. Compared to young men with AMI, young women had worse cardiovascular risk profile, were less likely to be treated with diagnostic angiography or PCI and experienced higher in-hospital death and MACE.
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Affiliation(s)
- Haitham Khraishah
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA,Corresponding author. Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Lina Karout
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sun Young Jeong
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Barrak Alahmad
- Department of Environmental Health Department, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Abdelrahman AlAshqar
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew J. Belanger
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Francine K. Welty
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mazen Albaghdadi
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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Kazahura PT, Mushi TL, Pallangyo P, Janabi M, Kisenge R, Albaghdadi M, Majani N, Kija E. Prevalence and risk factors for Subclinical Rheumatic Heart Disease among primary school children in Dar es Salaam, Tanzania: a community based cross-sectional study. BMC Cardiovasc Disord 2021; 21:610. [PMID: 34930122 PMCID: PMC8686380 DOI: 10.1186/s12872-021-02377-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Received: 10/16/2020] [Accepted: 11/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) is the most common acquired heart disease occurring in children and adolescents. RHD is associated with significant morbidity and mortality particularly in low and middle- income countries (LMICs) where the burden is estimated to be higher compared to high income countries. Subclinical RHD is the presence of valvular lesion diagnosed by echocardiography in a person with no clinical manifestation of RHD. This study aimed at determining the prevalence, types and factors associated with subclinical RHD among primary school children in Dar Es Salaam, Tanzania. METHODS A descriptive community-based cross-sectional study was conducted in primary school children from February to May 2019. A standardized structured questionnaire was used to collect demographic characteristics, history of upper respiratory tract infections (URTIs), anthropometric measurements, and chest auscultation findings. Moreover echocardiographic screening was done to all children recruited into the study. World Heart Federation echocardiographic classification was used to define the types and prevalence of subclinical RHD. RESULTS A total of 949 primary school children were enrolled with females being predominant (57.1%). The prevalence of subclinical RHD was 34 per 1000. All the participants had mitral valve disease only whereby 17 had definite disease and 15 had a borderline disease. The associated factors for subclinical RHD were older age of more than 9 years (OR 10.8, 95% CI 1.4-82.2, P = 0.02) having three or more episodes of URTI in previous six months (OR 21, 95% CI 9.6-46, P = 0.00) and poor hygiene (OR 3, 95% CI 1.3-6.8, P = 0.009). CONCLUSION Subclinical RHD as detected by echocardiographic screening is prevalent in primary school children, uniformly affects the mitral valve, and is associated with potentially modifiable risk factors. Children with a history of more than three episodes of URTI in six months represents a high-risk population that should be targeted for RHD screening.
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Affiliation(s)
- Parvina Titus Kazahura
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania.
- Department of Paediatric Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 54141, Dar es Salaam, Tanzania.
| | - Theophylly L Mushi
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
- Department of Paediatric Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 54141, Dar es Salaam, Tanzania
| | - Pedro Pallangyo
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 54141, Dar es Salaam, Tanzania
| | - Mohamed Janabi
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 54141, Dar es Salaam, Tanzania
| | - Rodrick Kisenge
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Mazen Albaghdadi
- Division of Cardiology and Section of Vascular Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Naizihijwa Majani
- Department of Paediatric Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 54141, Dar es Salaam, Tanzania
| | - Edward Kija
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
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Aguilar-Pineda JA, Albaghdadi M, Jiang W, Vera-Lopez KJ, Nieto-Montesinos R, Alvarez KLF, Davila Del-Carpio G, Gómez B, Lindsay ME, Malhotra R, Lino Cardenas CL. Structural and Functional Analysis of Female Sex Hormones against SARS-CoV-2 Cell Entry. Int J Mol Sci 2021; 22:11508. [PMID: 34768939 PMCID: PMC8584232 DOI: 10.3390/ijms222111508] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Received: 09/02/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 12/13/2022] Open
Abstract
Emerging evidence suggests that males are more susceptible to severe infection by the SARS-CoV-2 virus than females. A variety of mechanisms may underlie the observed gender-related disparities including differences in sex hormones. However, the precise mechanisms by which female sex hormones may provide protection against SARS-CoV-2 infectivity remains unknown. Here we report new insights into the molecular basis of the interactions between the SARS-CoV-2 spike (S) protein and the human ACE2 receptor. We further report that glycosylation of the ACE2 receptor enhances SARS-CoV-2 infectivity. Importantly, estrogens can disrupt glycan-glycan interactions and glycan-protein interactions between the human ACE2 and the SARS-CoV-2 thereby blocking its entry into cells. In a mouse model of COVID-19, estrogens reduced ACE2 glycosylation and thereby alveolar uptake of the SARS-CoV-2 spike protein. These results shed light on a putative mechanism whereby female sex hormones may provide protection from developing severe infection and could inform the development of future therapies against COVID-19.
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Affiliation(s)
- Jorge Alberto Aguilar-Pineda
- Laboratory of Genomics and Neurovascular Diseases, Vicerrectorado de Investigación, Universidad Católica de Santa María, Arequipa 04001, Peru; (J.A.A.-P.); (K.J.V.-L.); (R.N.-M.); (K.L.F.A.); (G.D.D.-C.); (B.G.)
| | - Mazen Albaghdadi
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (M.A.); (W.J.); (M.E.L.)
| | - Wanlin Jiang
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (M.A.); (W.J.); (M.E.L.)
| | - Karin J. Vera-Lopez
- Laboratory of Genomics and Neurovascular Diseases, Vicerrectorado de Investigación, Universidad Católica de Santa María, Arequipa 04001, Peru; (J.A.A.-P.); (K.J.V.-L.); (R.N.-M.); (K.L.F.A.); (G.D.D.-C.); (B.G.)
| | - Rita Nieto-Montesinos
- Laboratory of Genomics and Neurovascular Diseases, Vicerrectorado de Investigación, Universidad Católica de Santa María, Arequipa 04001, Peru; (J.A.A.-P.); (K.J.V.-L.); (R.N.-M.); (K.L.F.A.); (G.D.D.-C.); (B.G.)
| | - Karla Lucia F. Alvarez
- Laboratory of Genomics and Neurovascular Diseases, Vicerrectorado de Investigación, Universidad Católica de Santa María, Arequipa 04001, Peru; (J.A.A.-P.); (K.J.V.-L.); (R.N.-M.); (K.L.F.A.); (G.D.D.-C.); (B.G.)
| | - Gonzalo Davila Del-Carpio
- Laboratory of Genomics and Neurovascular Diseases, Vicerrectorado de Investigación, Universidad Católica de Santa María, Arequipa 04001, Peru; (J.A.A.-P.); (K.J.V.-L.); (R.N.-M.); (K.L.F.A.); (G.D.D.-C.); (B.G.)
| | - Badhin Gómez
- Laboratory of Genomics and Neurovascular Diseases, Vicerrectorado de Investigación, Universidad Católica de Santa María, Arequipa 04001, Peru; (J.A.A.-P.); (K.J.V.-L.); (R.N.-M.); (K.L.F.A.); (G.D.D.-C.); (B.G.)
| | - Mark E. Lindsay
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (M.A.); (W.J.); (M.E.L.)
| | - Rajeev Malhotra
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (M.A.); (W.J.); (M.E.L.)
| | - Christian L. Lino Cardenas
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (M.A.); (W.J.); (M.E.L.)
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8
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Kellnberger S, Wissmeyer G, Albaghdadi M, Piao Z, Li W, Mauskapf A, Rauschendorfer P, Tearney GJ, Ntziachristos V, Jaffer FA. Intravascular molecular-structural imaging with a miniaturized integrated near-infrared fluorescence and ultrasound catheter. J Biophotonics 2021; 14:e202100048. [PMID: 34164943 PMCID: PMC8492488 DOI: 10.1002/jbio.202100048] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/11/2021] [Accepted: 06/10/2021] [Indexed: 05/29/2023]
Abstract
Coronary artery disease (CAD) remains a leading cause of mortality and warrants new imaging approaches to better guide clinical care. We report on a miniaturized, hybrid intravascular catheter and imaging system for comprehensive coronary artery imaging in vivo. Our catheter exhibits a total diameter of 1.0 mm (3.0 French), equivalent to standalone clinical intravascular ultrasound (IVUS) catheters but enables simultaneous near-infrared fluorescence (NIRF) and IVUS molecular-structural imaging. We demonstrate NIRF-IVUS imaging in vitro in coronary stents using NIR fluorophores, and compare NIRF signal strengths for prism and ball lens sensor designs in both low and high scattering media. Next, in vivo intravascular imaging in pig coronary arteries demonstrates simultaneous, co-registered molecular-structural imaging of experimental CAD inflammation on IVUS and distance-corrected NIRF images. The obtained results suggest substantial potential for the NIRF-IVUS catheter to advance standalone IVUS, and enable comprehensive phenotyping of vascular disease to better assess and treat patients with CAD.
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Affiliation(s)
- Stephan Kellnberger
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Boston, MA 02114
| | - Georg Wissmeyer
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Boston, MA 02114
| | - Mazen Albaghdadi
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Boston, MA 02114
| | - Zhonglie Piao
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114
| | - Wenzhu Li
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Boston, MA 02114
| | - Adam Mauskapf
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Boston, MA 02114
| | - Philipp Rauschendorfer
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging, Central Institute for Translational Cancer Research (TranslaTUM), Technical University of Munich, Germany
| | - Guillermo J. Tearney
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114
| | - Vasilis Ntziachristos
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging, Central Institute for Translational Cancer Research (TranslaTUM), Technical University of Munich, Germany
| | - Farouc A. Jaffer
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Boston, MA 02114
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114
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9
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Osborn EA, Ughi GJ, Verjans JW, Piao Z, Gerbaud E, Albaghdadi M, Khraishah H, Kassab MB, Takx RAP, Cui J, Mauskapf A, Shen C, Yeh RW, Klimas MT, Tawakol A, Tearney GJ, Jaffer FA. Intravascular Molecular-Structural Assessment of Arterial Inflammation in Preclinical Atherosclerosis Progression. JACC Cardiovasc Imaging 2021; 14:2265-2267. [PMID: 34419392 DOI: 10.1016/j.jcmg.2021.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022]
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10
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Babaee S, Shi Y, Abbasalizadeh S, Tamang S, Hess K, Collins JE, Ishida K, Lopes A, Williams M, Albaghdadi M, Hayward AM, Traverso G. Kirigami-inspired stents for sustained local delivery of therapeutics. Nat Mater 2021; 20:1085-1092. [PMID: 34127823 DOI: 10.1038/s41563-021-01031-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/29/2021] [Indexed: 06/12/2023]
Abstract
Implantable drug depots have the capacity to locally meet therapeutic requirements by maximizing local drug efficacy and minimizing potential systemic side effects. Tubular organs including the gastrointestinal tract, respiratory tract and vasculature all manifest with endoluminal disease. The anatomic distribution of localized drug delivery for these organs using existing therapeutic modalities is limited. Application of local depots in a circumferential and extended longitudinal fashion could transform our capacity to offer effective treatment across a range of conditions. Here we report the development and application of a kirigami-based stent platform to achieve this. The stents comprise a stretchable snake-skin-inspired kirigami shell integrated with a fluidically driven linear soft actuator. They have the capacity to deposit drug depots circumferentially and longitudinally in the tubular mucosa of the gastrointestinal tract across millimetre to multi-centimetre length scales, as well as in the vasculature and large airways. We characterize the mechanics of kirigami stents for injection, and their capacity to engage tissue in a controlled manner and deposit degradable microparticles loaded with therapeutics by evaluating these systems ex vivo and in vivo in swine. We anticipate such systems could be applied for a range of endoluminal diseases by simplifying dosing regimens while maximizing drug on-target effects through the sustained release of therapeutics and minimizing systemic side effects.
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Affiliation(s)
- Sahab Babaee
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yichao Shi
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Saeed Abbasalizadeh
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Siddartha Tamang
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Kaitlyn Hess
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Joy E Collins
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Keiko Ishida
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aaron Lopes
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Williams
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Mazen Albaghdadi
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alison M Hayward
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Giovanni Traverso
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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11
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Tzafriri AR, Marlevi D, Budrewicz J, Bailey L, Markham P, Albaghdadi M, Nezami FR, Edelman ER. Atraumatic Endoluminal Microincisions Enhance Balloon-Based Drug Delivery in Complex Porcine Restenotic Lesions. Cardiovascular Revascularization Medicine 2021. [DOI: 10.1016/j.carrev.2021.06.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Khraishah H, Alahmad B, Alfaddagh A, Jeong SY, Mathenge N, Kassab MB, Kolte D, Michos ED, Albaghdadi M. Sex disparities in the presentation, management and outcomes of patients with acute coronary syndrome: insights from the ACS QUIK trial. Open Heart 2021; 8:openhrt-2020-001470. [PMID: 33504633 PMCID: PMC7843306 DOI: 10.1136/openhrt-2020-001470] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/22/2020] [Accepted: 12/28/2020] [Indexed: 12/18/2022] Open
Abstract
Aims Our aim was to explore sex differences and inequalities in terms of medical management and cardiovascular disease (CVD) outcomes in a low/middle-income country (LMIC), where reports are scarce. Methods We examined sex differences in presentation, management and clinical outcomes in 21 374 patients presenting with acute coronary syndrome (ACS) in Kerala, India enrolled in the Acute Coronary Syndrome Quality Improvement in Kerala trial. The main outcomes were the rates of in-hospital and 30-day major adverse cardiovascular events (MACEs) defined as composite of death, reinfarction, stroke and major bleeding. We fitted log Poisson multivariate random effects models to obtain the relative risks comparing women with men, and adjusted for clustering by centre and for age, CVD risk factors and cardiac presentation. Results A total of 5191 (24.3%) patients were women. Compared with men, women presenting with ACS were older (65±12 vs 58±12 years; p<0.001), more likely to have hypertension and diabetes. They also had longer symptom onset to hospital presentation time (median, 300 vs 238 min; p<0.001) and were less likely to receive primary percutaneous coronary intervention for ST-elevation myocardial infarction (45.9% vs 49.8% of men, p<0.001). After adjustment, women were more likely to experience in-hospital (adjusted relative risk (RR)=1.53; 95% CI 1.32 to 1.77; p<0.001) and 30-day MACE (adjusted RR=1.39; 95% CI 1.23 to 1.57, p<0.001). Conclusion Women presenting with ACS in Kerala, India had greater burden of CVD risk factors, including hypertension and diabetes mellitus, longer delays in presentation, and were less likely to receive guideline-directed management. Women also had worse in-hospital and 30-day outcomes. Further efforts are needed to understand and reduce cardiovascular care disparities between men and women in LMICs.
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Affiliation(s)
- Haitham Khraishah
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Barrak Alahmad
- Environmental Health Department, T H Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Abdulhamied Alfaddagh
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sun Young Jeong
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Njambi Mathenge
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Dhaval Kolte
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mazen Albaghdadi
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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13
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Aarntzen E, Achilefu S, Akam EA, Albaghdadi M, Beer AJ, Bharti S, Bhujwalla ZM, Bischof GN, Biswal S, Boss M, Botnar RM, Brinson Z, Brom M, Buitinga M, Bulte JW, Caravan P, Chan HP, Chandy M, Chaney AM, Chen DL, Chen X(S, Chenevert TL, Coughlin JM, Covington MF, Cumming P, Daldrup-Link HE, Deal EM, de Galan B, Derlin T, Dewhirst MW, Di Paolo A, Drzezga A, Du Y, Thi-Quynh Duong M, Ehman RL, Eriksson O, Galli F, Gatenby RA, Gelovani J, Giehl K, Giger ML, Goel R, Gold G, Gotthardt M, Graham MM, Gropler RJ, Gründer G, Gulhane A, Hadjiiski L, Hajhosseiny R, Hammoud DA, Helfer BM, Hicks RJ, Higuchi T, Hoffman JM, Honer M, Huang SC(H, Hung J, Hwang DW, Jackson IM, Jacobs AH, Jaffer FA, Jain SK, James ML, Jansen T, Johansson L, Joosten L, Kakkad S, Kamson D, Kang SR, Kelly KA, Knopp MI, Knopp MV, Kogan F, Krishnamachary B, Künnecke B, Lee DS, Libby P, Luker GD, Luker KE, Makowski MR, Mankoff DA, Massoud TF, Meyer CR, Miller Z, Min JJ, Mondal SB, Montesi SB, Navin PJ, Nekolla SG, Niu G, Notohamiprodjo S, Ordoñez AA, Osborn EA, Pacheco-Torres J, Pagano G, Palmer GM, Paulmurugan R, Penet MF, Phinikaridou A, Pomper MG, Prieto C, Qi H, Raghunand N, Ramar T, Reynolds F, Ropella-Panagis K, Ross BD, Rowe SP, Rudin M, Sadaghiani MS, Sager H, Samala R, Saraste A, Schelhaas S, Schwaiger M, Schwarz SW, Seiberlich N, Shapiro MG, Shim H, Signore A, Solnes LB, Suh M, Tsien C, van Eimeren T, Varasteh Z, Venkatesh SK, Viel T, Waerzeggers Y, Wahl RL, Weber W, Werner RA, Winkeler A, Wong DF, Wright CL, Wu AM, Wu JC, Yoon D, You SH, Yuan C, Yuan H, Zanzonico P, Zhao XQ, Zhou IY, Zinnhardt B. Contributors. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.01004-8] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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14
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Osborn EA, Albaghdadi M, Libby P, Jaffer FA. Molecular Imaging of Atherosclerosis. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00086-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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15
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Eslami P, Thondapu V, Karady J, Hartman EMJ, Jin Z, Albaghdadi M, Lu M, Wentzel JJ, Hoffmann U. Physiology and coronary artery disease: emerging insights from computed tomography imaging based computational modeling. Int J Cardiovasc Imaging 2020; 36:2319-2333. [PMID: 32779078 PMCID: PMC8323761 DOI: 10.1007/s10554-020-01954-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/23/2020] [Indexed: 12/15/2022]
Abstract
Improvements in spatial and temporal resolution now permit robust high quality characterization of presence, morphology and composition of coronary atherosclerosis in computed tomography (CT). These characteristics include high risk features such as large plaque volume, low CT attenuation, napkin-ring sign, spotty calcification and positive remodeling. Because of the high image quality, principles of patient-specific computational fluid dynamics modeling of blood flow through the coronary arteries can now be applied to CT and allow the calculation of local lesion-specific hemodynamics such as endothelial shear stress, fractional flow reserve and axial plaque stress. This review examines recent advances in coronary CT image-based computational modeling and discusses the opportunity to identify lesions at risk for rupture much earlier than today through the combination of anatomic and hemodynamic information.
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Affiliation(s)
- Parastou Eslami
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Vikas Thondapu
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Julia Karady
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eline M J Hartman
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands
| | - Zexi Jin
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mazen Albaghdadi
- Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Lu
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jolanda J Wentzel
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands
| | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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16
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Butala NM, Patel NK, Chhatwal J, Vahdat V, Pomerantsev EV, Albaghdadi M, Sakhuja R, Rosenzweig A, Elmariah S. Patient and Provider Risk in Managing ST-Elevation Myocardial Infarction During the COVID-19 Pandemic: A Decision Analysis. Circ Cardiovasc Interv 2020; 13:e010027. [PMID: 33167699 DOI: 10.1161/circinterventions.120.010027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The optimal treatment strategy for treating ST-segment-elevation myocardial infarction (STEMI) in context of the coronavirus disease 2019 (COVID-19) pandemic is unclear given the potential risk of occupational exposure during primary percutaneous coronary intervention (PPCI). We quantified the impact of different STEMI treatment strategies on patient outcomes and provider risk in context of the COVID-19 pandemic. METHODS Using a decision-analytic framework, we evaluated the effect of PPCI versus the pharmaco-invasive strategy for managing STEMI on 30-day patient mortality and individual provider infection risk based on presence of cardiogenic shock, suspected coronary territory, and presence of known or presumptive COVID-19 infection. RESULTS For patients with low suspicion for COVID-19, PPCI had mortality benefit over the pharmaco-invasive strategy, and the risk of cardiac catheterization laboratory provider infection remained very low (<0.25%) across all subgroups. For patients with presumptive COVID-19 with cardiogenic shock, PPCI offered substantial mortality benefit to patients relative to the pharmaco-invasive strategy (7.9% absolute decrease in 30-day mortality), but also greater risk of provider infection (2.3% absolute increase in risk of provider infection). For patients with presumptive COVID-19 with nonanterior STEMI without cardiogenic shock, PPCI offered a 0.4% absolute mortality benefit over the pharmaco-invasive strategy with a 0.2% greater absolute risk of provider infection, and the tradeoff between patient and provider risk with PPCI became more apparent in sensitivity analysis with more severe COVID-19 infections. CONCLUSIONS Usual care with PPCI remains the appropriate treatment strategy in the majority of cases presenting with STEMI in the setting of the COVID-19 pandemic. However, utilization of a pharmaco-invasive strategy in selected patients with STEMI with presumptive COVID-19 and low likelihood of mortality from STEMI and use of preventive strategies such as preprocedural intubation in high risk patients when PPCI is the preferred strategy may be reasonable to reduce provider risk of COVID-19 infection.
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Affiliation(s)
- Neel M Butala
- Division of Cardiology (N.B., N.P., E.P., M.A., R.S., A.R., S.E.), Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, MA (N.B., N.P., J.C., V.V., E.P., M.A., R.S., A.R., S.E.)
| | - Nilay K Patel
- Division of Cardiology (N.B., N.P., E.P., M.A., R.S., A.R., S.E.), Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, MA (N.B., N.P., J.C., V.V., E.P., M.A., R.S., A.R., S.E.)
| | - Jagpreet Chhatwal
- Institute for Technology Assessment (J.C., V.V.), Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, MA (N.B., N.P., J.C., V.V., E.P., M.A., R.S., A.R., S.E.)
| | - Vahab Vahdat
- Institute for Technology Assessment (J.C., V.V.), Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, MA (N.B., N.P., J.C., V.V., E.P., M.A., R.S., A.R., S.E.)
| | - Eugene V Pomerantsev
- Division of Cardiology (N.B., N.P., E.P., M.A., R.S., A.R., S.E.), Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, MA (N.B., N.P., J.C., V.V., E.P., M.A., R.S., A.R., S.E.)
| | - Mazen Albaghdadi
- Division of Cardiology (N.B., N.P., E.P., M.A., R.S., A.R., S.E.), Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, MA (N.B., N.P., J.C., V.V., E.P., M.A., R.S., A.R., S.E.)
| | - Rahul Sakhuja
- Division of Cardiology (N.B., N.P., E.P., M.A., R.S., A.R., S.E.), Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, MA (N.B., N.P., J.C., V.V., E.P., M.A., R.S., A.R., S.E.)
| | - Anthony Rosenzweig
- Division of Cardiology (N.B., N.P., E.P., M.A., R.S., A.R., S.E.), Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, MA (N.B., N.P., J.C., V.V., E.P., M.A., R.S., A.R., S.E.)
| | - Sammy Elmariah
- Division of Cardiology (N.B., N.P., E.P., M.A., R.S., A.R., S.E.), Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, MA (N.B., N.P., J.C., V.V., E.P., M.A., R.S., A.R., S.E.)
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17
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Adler A, Albaghdadi M, Siddiqui U, Bitton-Worms K, Racheli N, Gordon U, Kuck KH. Detection of Leak From Left Atrial Appendage Occlusion Using Dielectric Imaging. IEEE Trans Biomed Eng 2020; 68:2110-2116. [PMID: 32960760 DOI: 10.1109/tbme.2020.3025992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Peri-device leak (PDL) following left atrial appendage occlusion (LAAO) may lead to an increased risk of thrombosis. However, current modalities for PDL detection, such as trans-esophageal echo (TEE) and cardiac CT do not provide quantitative measures of PDL. OBJECTIVE to use dielectric imaging (DI) to measure PDL from a Watchman (WM) LAAO device. METHODS A conductivity contrast agent is injected into the left atrium (LA) through the WM delivery system, while making DI measurements. Recordings are analyzed with a two-compartment model and the flow from the left atrial appendage (LAA) characterized by a "% clearance / beat" (CPB) parameter. With ethics approval, four dogs (26 ± 1.8 kg) were anesthetized and ventilated. Body-surface electrodes were placed and impedance data continuously acquired. WM devices (0-35% oversized) were introduced and placed into the LAA. During the study, the WM was either fully or partial deployed. At each deployment level, 10 mL of conductivity contrast was injected through the WM delivery sheath. At twenty-two deployment conditions, Doppler-flow TEE measurements were made, and compared to the DI-based value. RESULTS In all cases, CPB values correctly predicted the TEE-based assessment of PDL (100% sensitivity/specificity). The TEE leak size also corresponded to CPB values with a correlation of r = 0.914 (p 0.001). CONCLUSION Using DI signals, the leak flow from the WM LAAO can be measured and yields comparative results to TEE for detection of PDL. The DI method requires no other imaging modality or ionizing radiation and iodine contrast agent injection.
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18
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Tzafriri AR, Muraj B, Garcia-Polite F, Salazar-Martín AG, Markham P, Zani B, Spognardi A, Albaghdadi M, Alston S, Edelman ER. Balloon-based drug coating delivery to the artery wall is dictated by coating micro-morphology and angioplasty pressure gradients. Biomaterials 2020; 260:120337. [PMID: 32937269 DOI: 10.1016/j.biomaterials.2020.120337] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 05/06/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
Paclitaxel coated balloon catheters (PCB) were developed as a polymer-free non-implantable alternative to drug eluting stents, delivering similar drug payloads in a matter of minutes. While PCB have shown efficacy in treating peripheral arterial disease in certain patient groups, restenosis rates remain high and there is no class effect. To help further optimize these devices, we developed a scanning electron microscopy (SEM) imaging technique and computational modeling approach that provide insights into the coating micromorphology dependence of in vivo drug transfer and retention. PCBs coated with amorphous/flaky or microneedle coatings were inflated for 60 sec in porcine femoral arteries. Animals were euthanized at 0.5, 24 and 72 h and treated arteries processed for SEM to image endoluminal coating distribution followed by paclitaxel quantification by mass spectrometry (MS). Endoluminal surfaces exhibited sparse coating patches at 0.5 h, predominantly protruding (13.71 vs 0.59%, P < 0.001), with similar micro-morphologies to nominal PCB surfaces. Microneedle coating covered a 1.5-fold endoluminal area (16.1 vs 10.7%, P = 0.0035) owing to higher proximal and distal delivery, and achieved 1.5-fold tissue concentrations by MS (1933 vs 1298 μg/g, P = 0.1745) compared to amorphous/flaky coating. Acute longitudinal coating distribution tracked computationally predicted microindentation pressure gradients (r = 0.9, P < 0.001), with superior transfer of the microneedle coatings attributed to their amplification of angioplasty contact pressures. By 24 h, paclitaxel concentration and coated tissue areas both declined by >93% even as nonprotruding coating levels were stable between 0.5 and 72 h, and 2.7-fold higher for microneedle vs flaky coating (0.64 vs 0.24%, P = 0.0195). Tissue retained paclitaxel concentrations at 24-72 h trended 1.7-fold higher post treatment with microneedle coating compared to the amorphous/flaky coating (69.9 vs 39.9 μg/g, P = 0.066). Thus, balloon based drug delivery is critically dependent on coating micromorphologies, with superior performance exhibited by micromorphologies that amplify angioplasty pressures.
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Affiliation(s)
| | - Benny Muraj
- CBSET Inc, 500 Shire Way, Lexington, MA, USA
| | | | | | | | - Brett Zani
- CBSET Inc, 500 Shire Way, Lexington, MA, USA
| | | | - Mazen Albaghdadi
- CBSET Inc, 500 Shire Way, Lexington, MA, USA; Cardiovascular Research Center and Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Steve Alston
- W.L. Gore & Associates, 1505 N Fourth St, Flagstaff, AZ, 86004, USA
| | - Elazer R Edelman
- IMES, MIT, 77 Massachusetts Avenue Cambridge, MA, USA; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Aguilar-Pineda JA, Albaghdadi M, Jiang W, Lopez KJV, Del-Carpio GD, Valdez BG, Lindsay ME, Malhotra R, Lino Cardenas CL. Structural and functional analysis of female sex hormones against SARS-Cov2 cell entry. bioRxiv 2020. [PMID: 32766583 DOI: 10.1101/2020.07.29.227249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Emerging evidence suggests that males are more susceptible to severe infection by the SARS-CoV-2 virus than females. A variety of mechanisms may underlie the observed gender-related disparities including differences in sex hormones. However, the precise mechanisms by which female sex hormones may provide protection against SARS-CoV-2 infectivity remains unknown. Here we report new insights into the molecular basis of the interactions between the SARS-CoV-2 spike (S) protein and the human ACE2 receptor. We further observed that glycosylation of the ACE2 receptor enhances SARS-CoV-2 infectivity. Importantly estrogens can disrupt glycan-glycan interactions and glycan-protein interactions between the human ACE2 and the SARS-CoV2 thereby blocking its entry into cells. In a mouse model, estrogens reduced ACE2 glycosylation and thereby alveolar uptake of the SARS-CoV-2 spike protein. These results shed light on a putative mechanism whereby female sex hormones may provide protection from developing severe infection and could inform the development of future therapies against COVID-19.
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Eslami P, Hartman E, Karady J, Thondapu V, Albaghdadi M, Jin Z, Cefalo N, Marsden A, Coksun A, Lu M, Stone P, Wentzel J, Hoffmann U. Endothelial Shear Stress Calculation In Human Coronary Arteries: Comparison Between 3d Reconstructions Based On Invasive And Noninvasive Imaging. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.083] [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: 10/23/2022]
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Alahmad B, Khraishah H, Shakarchi AF, Albaghdadi M, Rajagopalan S, Koutrakis P, Jaffer FA. Cardiovascular Mortality and Exposure to Heat in an Inherently Hot Region: Implications for Climate Change. Circulation 2020; 141:1271-1273. [PMID: 32223316 PMCID: PMC9060422 DOI: 10.1161/circulationaha.119.044860] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Barrak Alahmad
- Environmental Health Department, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Environmental and Occupational Health Department, Faculty of Public Health, Kuwait University, Kuwait City, Kuwait
| | - Haitham Khraishah
- Cardiovascular Research Center, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ahmed F. Shakarchi
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mazen Albaghdadi
- Cardiovascular Research Center, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sanjay Rajagopalan
- University Hospitals, Harrington Heart & Vascular Institute, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Petros Koutrakis
- Environmental Health Department, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Farouc A. Jaffer
- Cardiovascular Research Center, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Albaghdadi M, Gacia-Polite F, Zani B, Keating J, Melidone R, Spognardi A, Markham P, Tzafriri A. TCT-561 Splenic Artery Denervation: Rationale, Feasibility, and Early Pre-Clinical Experience in a Porcine Model of Inflammatory Arthritis. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1750] [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: 11/26/2022]
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Al-Bawardy R, Rosenfield K, Borges J, Young MN, Albaghdadi M, Rosovsky R, Kabrhel C. Extracorporeal membrane oxygenation in acute massive pulmonary embolism: a case series and review of the literature. Perfusion 2018; 34:22-28. [DOI: 10.1177/0267659118786830] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Extracorporeal membrane oxygenation (ECMO) has been used to stabilize patients with massive pulmonary embolism though few reports describe this approach. We describe the presentation, management and outcomes of patients who received ECMO for massive pulmonary embolism (PE) in our pulmonary embolism response team (PERT) registry. Methods: We enrolled a consecutive cohort of patients with confirmed PE for whom PERT was activated and selected patients treated with ECMO. We prospectively captured clinical, therapeutic and outcome data at the time of PERT activation and during the follow-up period for up to 365 days. Results: Thirteen patients who had PERT activation with confirmed PE diagnosis have undergone ECMO since the initiation of our PERT program in 2012. The mean age was 49 ± 19 years. Six (46%) patients were female. All the patients had cardiac arrest, either as an initial presentation or in-hospital cardiac arrest after presentation. All the patients exhibited right ventricular (RV) dilation on echocardiogram with RV hypokinesis. Eight (62%) patients received systemic thrombolysis with intravenous tissue plasminogen activator (tPA) and three (23%) patients underwent catheter-directed thrombolysis therapy using the EKOS system (EKOS Corporation, Bothell, WA, USA). Four (31%) patients underwent surgical embolectomy. Mean ECMO duration was 5.5 days, ranging from 2-18 days. Thirty-day mortality was 31% and one-year mortality was 54%. Conclusions: Patients with massive pulmonary embolism who suffer a cardiac arrest have high morbidity and mortality. ECMO can be used in conjunction with systemic thrombolysis, catheter-directed therapy or as a bridge to surgical embolectomy.
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Affiliation(s)
- Rasha Al-Bawardy
- Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Kenneth Rosenfield
- Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jorge Borges
- Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Michael N. Young
- Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Mazen Albaghdadi
- Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Rachel Rosovsky
- Department of Hematology, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher Kabrhel
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
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Albaghdadi M, Jaffer FA. Wire-Free and Adenosine-Free Fractional Flow Reserve Derived From the Angiogram: A Promising Future Awaiting Outcomes Data. Circ Cardiovasc Imaging 2018; 11:e007594. [PMID: 29555837 DOI: 10.1161/circimaging.118.007594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mazen Albaghdadi
- From the Cardiovascular Research Center and Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Farouc A Jaffer
- From the Cardiovascular Research Center and Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston.
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Ain DL, Albaghdadi M, Giri J, Abtahian F, Jaff MR, Rosenfield K, Roy N, Villavicencio-Theoduloz M, Sundt T, Weinberg I. Extra-corporeal membrane oxygenation and outcomes in massive pulmonary embolism: Two eras at an urban tertiary care hospital. Vasc Med 2017; 23:60-64. [PMID: 29125047 DOI: 10.1177/1358863x17739697] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Mortality associated with high-risk pulmonary embolism (PE) remains high. Extra-corporeal membrane oxygenation (ECMO) allows for acute hemodynamic stabilization and potentially for administration of other disease process altering therapies. We sought to compare two eras: pre-ECMO and post-ECMO in relation to high-risk PE treatment and mortality. A single-center retrospective chart review was conducted of high-risk PE patients. High-risk PE was defined as acute PE and cardiac arrest or shock. A total of 60 patients were identified, 31 in the pre-ECMO era and 29 in the post-ECMO era. Mean age was 56.1±21.1 years and 51.7% were women. More patients in the post-ECMO era were identified with computed tomography (82.8% vs 51.6%, p=0.011) and more patients in the post-ECMO era had right ventricular dysfunction on echocardiography (96.4% vs 78.3%, p=0.045). No other differences were noted in baseline characteristics or clinical, laboratory and imaging data between the two groups. In total, ECMO was used in 13 (44.8%) patients in the post-ECMO era. There was greater utilization of catheter-directed therapies in the post-ECMO era compared to the pre-ECMO era ( n = 7 (24.1%) vs n = 1 (3.2%), p=0.024). Thirty-day survival increased from 17.2% in patients who presented in the pre-ECMO era to 41.4% in the post-ECMO era ( p=0.043). While more work is necessary to better identify those PE patients who stand to benefit from mechanical circulatory support, our findings have important implications for the management of such patients.
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Affiliation(s)
- David L Ain
- 1 Cardiovascular Medicine Division, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jay Giri
- 1 Cardiovascular Medicine Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Farhad Abtahian
- 3 Cardiology, Sands Constellation Heart Institute, Rochester, NY, USA
| | - Michael R Jaff
- 4 Administration, Newton-Wellesley Hospital, Newton, MA, USA
| | | | - Nathalie Roy
- 5 Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | | | - Thoralf Sundt
- 5 Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Ido Weinberg
- 2 Cardiology, Massachusetts General Hospital, Boston, MA, USA
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Young MN, Albaghdadi M, Al-Bawardy R, Borges J, Rosenfield K. Treatment of an Acute Limb Due to Inferior Vena Cava Filter Thrombosis. JACC Cardiovasc Interv 2017; 10:e189-e192. [PMID: 28964763 DOI: 10.1016/j.jcin.2017.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 06/10/2017] [Accepted: 06/20/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Michael N Young
- Fireman Vascular Center, Massachusetts General Hospital, Boston, Massachusetts.
| | - Mazen Albaghdadi
- Fireman Vascular Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Rasha Al-Bawardy
- Fireman Vascular Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Jorge Borges
- Fireman Vascular Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Kenneth Rosenfield
- Fireman Vascular Center, Massachusetts General Hospital, Boston, Massachusetts
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Essandoh M, Dalia AA, Albaghdadi M, George B, Stoicea N, Shabsigh M, Rao SV. Perioperative Management of Dual-Antiplatelet Therapy in Patients With New-Generation Drug-Eluting Metallic Stents and Bioresorbable Vascular Scaffolds Undergoing Elective Noncardiac Surgery. J Cardiothorac Vasc Anesth 2017; 31:1857-1864. [PMID: 28826683 DOI: 10.1053/j.jvca.2017.04.046] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Indexed: 11/11/2022]
Abstract
Dual-antiplatelet therapy (DAPT) is considered mandatory after new-generation drug-eluting coronary stent implantation to reduce ischemic complications such as stent thrombosis, but the need for DAPT makes the timing of elective surgery difficult. Interrupting DAPT places patients at risk for stent thrombosis, and surgery in the setting of DAPT may lead to bleeding. The 2016 American College of Cardiology/American Heart Association guideline recommends delaying elective noncardiac surgery for a minimum 6-month period to reduce ischemic risks after the implantation of a second-generation metallic drug-eluting stent (DES). However, the guideline fails to appropriately stratify surgical patients based on the indication for second-generation metallic DES implantation and other patient characteristics. The Absorb bioresorbable vascular scaffold (Abbott Vascular, Abbott Park, IL), which has a higher propensity for stent thrombosis compared with second-generation metallic DES, also produces DAPT management challenges in patients presenting for elective noncardiac surgery. Due to the novelty of bioresorbable vascular scaffold therapy, there are no guidelines available for the management of patients undergoing elective noncardiac surgery. This review addresses DAPT management in patients undergoing noncardiac surgery less than 12 months after new-generation metallic DES or bioresorbable vascular scaffold implantation and provides further guidance for anesthesiologists who encounter these challenging cases.
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Affiliation(s)
- Michael Essandoh
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH.
| | - Adam A Dalia
- Department of Anesthesiology, Pain Medicine, and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Mazen Albaghdadi
- Department of Interventional Cardiology, Massachusetts General Hospital, Harvard Medical School Boston, MA
| | - Barry George
- Department of Internal Medicine, Division of Cardiovascular Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Nicoleta Stoicea
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Muhammad Shabsigh
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Sunil V Rao
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
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Albaghdadi M, Thomas S, Ellinor PT, Rosenfield K, Jaffer F. SUCCESSFUL INTRA-AORTIC BALLOON PUMP-SUPPORTED PERCUTANEOUS CORONARY INTERVENTION IN A PATIENT WITH A LATE PRESENTING MYOCARDIAL INFARCTION, MULTIVESSEL CORONARY ARTERY DISEASE COMPLICATED BY HEPARIN-INDUCED THROMBOCYTOPENIA, BIVENTRICULAR THROMBUS, AND REFRACTORY VENTRICULAR ARRHYTHMIA. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35859-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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30
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Al-Bawardy R, Schainfeld R, Borges JC, Young M, Albaghdadi M, Sakhuja R. DIGIT ISCHEMIA WORK-UP AND AN UNCOMMON DIAGNOSIS: HYPOTHENAR HAMMER SYNDROME. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35839-4] [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: 11/26/2022]
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31
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Dalia AA, Bamira D, Albaghdadi M, Essandoh M, Rosenfield K, Dudzinski D. Four-Dimensional Transesophageal Echocardiography-Guided AngioVac Debulking of a Tricuspid Valve Vegetation. J Cardiothorac Vasc Anesth 2016; 31:1713-1716. [PMID: 28215497 DOI: 10.1053/j.jvca.2016.11.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Adam A Dalia
- Department of Anesthesiology, Pain Medicine, and Critical Care, The Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - Daniel Bamira
- Department of Cardiology, The Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Mazen Albaghdadi
- Department of Interventional Cardiology, The Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Michael Essandoh
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Kenneth Rosenfield
- Department of Interventional Cardiology, The Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - David Dudzinski
- Department of Cardiology, The Massachusetts General Hospital, Harvard Medical School, Boston, MA
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32
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Barker AJ, van Ooij P, Bandi K, Garcia J, Albaghdadi M, McCarthy P, Bonow RO, Carr J, Collins J, Malaisrie SC, Markl M. Viscous energy loss in the presence of abnormal aortic flow. Magn Reson Med 2014; 72:620-8. [PMID: 24122967 PMCID: PMC4051863 DOI: 10.1002/mrm.24962] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 08/29/2013] [Accepted: 08/31/2013] [Indexed: 01/12/2023]
Abstract
PURPOSE To present a theoretical basis for noninvasively characterizing in vivo fluid-mechanical energy losses and to apply it in a pilot study of patients known to express abnormal aortic flow patterns. METHODS Four-dimensional flow MRI was used to characterize laminar viscous energy losses in the aorta of normal controls (n = 12, age = 37 ± 10 yr), patients with aortic dilation (n = 16, age = 52 ± 8 yr), and patients with aortic valve stenosis matched for age and aortic size (n = 14, age = 46 ± 15 yr), using a relationship between the three-dimensional velocity field and viscous energy dissipation. RESULTS Viscous energy loss was elevated significantly in the thoracic aorta in patients with dilated aorta (3.6 ± 1.3 mW, P = 0.024) and patients with aortic stenosis (14.3 ± 8.2 mW, P < 0.001) compared with healthy volunteers (2.3 ± 0.9 mW). The same pattern of significant differences was seen in the ascending aorta, where viscous energy losses in patients with dilated aortas (2.2 ± 1.1 mW, P = 0.021) and patients with aortic stenosis (10.9 ± 6.8 mW, P < 0.001) were elevated compared with healthy volunteers (1.2 ± 0.6 mW). CONCLUSION This technique provides a capability to quantify the contribution of abnormal laminar blood flow to increased ventricular afterload. In this pilot study, viscous energy loss in patient cohorts was significantly elevated and indicates that cardiac afterload is increased due to abnormal flow.
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Affiliation(s)
- Alex J Barker
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
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Gheorghiade M, Albaghdadi M, Zannad F, Fonarow GC, Böhm M, Gimpelewicz C, Botha J, Moores S, Lewis EF, Rattunde H, Maggioni A. Rationale and design of the multicentre, randomized, double-blind, placebo-controlled Aliskiren Trial on Acute Heart Failure Outcomes (ASTRONAUT). Eur J Heart Fail 2014; 13:100-6. [DOI: 10.1093/eurjhf/hfq209] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mihai Gheorghiade
- Center for Cardiovascular Innovation; Northwestern University Feinberg School of Medicine; 645 N. Michigan Avenue, Suite 1006 Chicago IL 60611 USA
| | - Mazen Albaghdadi
- Center for Cardiovascular Innovation; Northwestern University Feinberg School of Medicine; 645 N. Michigan Avenue, Suite 1006 Chicago IL 60611 USA
| | - Faiez Zannad
- Clinical Investigation Center INSERM-CHU de Nancy Hôpital Jeanne d'Arc; Dommartin-les Toul Cedex France
| | - Gregg C. Fonarow
- Ahmanson-UCLA Cardiomyopathy Center; University of California Los Angeles; Los Angeles CA USA
| | - Michael Böhm
- Klinik für Innere Medizin III; Universitätsklinikum des Saarlandes; Homburg Germany
| | | | | | | | - Eldrin F. Lewis
- Cardiovascular Division; Brigham and Women's Hospital; Boston MA USA
| | | | - Aldo Maggioni
- Associazione Nazionale Medici Cardiologi Ospedalieri Research Center; Florence Italy
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