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Teodorovich N, Gandelman G, Jonas M, Fabrikant Y, Swissa MS, Shimoni S, George J, Swissa M. The CHA 2DS 2-VAS C Score Predicts Mortality in Patients Undergoing Coronary Angiography. Life (Basel) 2023; 13:2026. [PMID: 37895408 PMCID: PMC10608546 DOI: 10.3390/life13102026] [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: 09/01/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The CHA2DS2-VASC score is used to predict the risk of thromboembolic complications in patients with atrial fibrillation (AF). We hypothesized that the CHA2DS2-VASC score can be used to predict mortality in patients undergoing coronary angiography. METHODS AND RESULTS This was a prospective study of 990 patients undergoing coronary angiography. The median follow-up was 2294 days. The patients were categorized into two groups according to their CHA2DS2-VASC score: group I had scores <4 and group II had scores ≥4 (527 (53.2%) and 463 (46.8%), respectively). A Kaplan-Meier analysis demonstrated a significant association between the CHA2DS2-VASC score and mortality (69/527 (13.1%) vs. 179/463 (38.7%) for group I vs. group II, respectively, p < 0.0001). The association remained significant in patients with and without AF, reduced and preserved LVEF, normal and reduced kidney function, and with and without ACS (p < 0.009 to p < 0.0001 for all). In the Cox regression model, which combined the CHA2DS2-VASC score, the presence of AF, LVEF, anemia, and renal insufficiency, an elevated CHA2DS2-VASC score of ≥4 was independently associated with higher mortality (HR 2.12, CI 1.29-3.25, p = 0.001). CONCLUSIONS The CHA2DS2VASC score is a simple and reliable mortality predictor in patients undergoing coronary angiography and should be used for the initial screening for such patients.
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Affiliation(s)
- Nicholay Teodorovich
- Kaplan Medical Center, Rehovot and the Hebrew University, Jerusalem 7661041, Israel; (G.G.); (M.J.); (Y.F.); (S.S.); (J.G.); (M.S.)
| | - Gera Gandelman
- Kaplan Medical Center, Rehovot and the Hebrew University, Jerusalem 7661041, Israel; (G.G.); (M.J.); (Y.F.); (S.S.); (J.G.); (M.S.)
| | - Michael Jonas
- Kaplan Medical Center, Rehovot and the Hebrew University, Jerusalem 7661041, Israel; (G.G.); (M.J.); (Y.F.); (S.S.); (J.G.); (M.S.)
| | - Yakov Fabrikant
- Kaplan Medical Center, Rehovot and the Hebrew University, Jerusalem 7661041, Israel; (G.G.); (M.J.); (Y.F.); (S.S.); (J.G.); (M.S.)
| | - Michael Sraia Swissa
- Shari-Zedek Medical Center, and the Hebrew University, Jerusalem 9103102, Israel;
| | - Sara Shimoni
- Kaplan Medical Center, Rehovot and the Hebrew University, Jerusalem 7661041, Israel; (G.G.); (M.J.); (Y.F.); (S.S.); (J.G.); (M.S.)
| | - Jacob George
- Kaplan Medical Center, Rehovot and the Hebrew University, Jerusalem 7661041, Israel; (G.G.); (M.J.); (Y.F.); (S.S.); (J.G.); (M.S.)
| | - Moshe Swissa
- Kaplan Medical Center, Rehovot and the Hebrew University, Jerusalem 7661041, Israel; (G.G.); (M.J.); (Y.F.); (S.S.); (J.G.); (M.S.)
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Teodorovich N, Fabrikant Y, Gandelman G, Swissa M, Jonas M, George J, Shimoni S. The Additive Effect of Left Ventricular Filling Pressure and Renal Function on Long-Term Prognosis of High-Risk Patients Undergoing Coronary Angiography. Cardiorenal Med 2023; 13:271-281. [PMID: 37604117 PMCID: PMC10664344 DOI: 10.1159/000533589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 06/27/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION Impaired relaxation is the earliest manifestation of ischemic cascade. Risk factors and renal function abnormalities are associated with coronary disease and diastolic dysfunction as well. We aimed to study the association of noninvasive assessment of left ventricular filling pressures and renal function with mortality in high-risk patients undergoing coronary angiography. PATIENTS AND METHODS An observational prospective study of 564 consecutive patients undergoing coronary angiography was conducted. The median follow-up was 2,293 days. Patients were categorized into 2 groups according to presence of significant diastolic dysfunction: group 1, 382 patients, with normal and group 2, 182 patients, with elevated filling pressure. Renal insufficiency was determined as calculated glomerular filtration rate <60 mL/min. Patients demographic, clinical, echocardiography, laboratory, and angiographic data were prospectively collected. RESULTS Fifty-three percent of patients underwent angiography due to acute coronary syndrome (ACS), 85.5% had coronary artery disease, 53.4% had reduced (<50%) left ventricular ejection fraction (LVEF), and 47.4% had abnormal renal function. The mortality during the follow-up period was 30.0%. Patients with elevated filling pressure had significantly higher mortality (50.5% vs. 20.2%, p < 0.0001). Impaired renal failure as well, was associated with higher mortality (48% vs. 15%, p < 0.001). The association remained significant in subgroups of patients with and without ACS and reduced and preserved LVEF. In Cox regression model which combined elevated filling pressure, renal insufficiency, age, diabetes mellitus, hypertension, presence of atrial fibrillation, LVEF, and anemia, elevated filling pressure and renal function impairment were independently associated with higher mortality (HR: 3.717, CI: 1.623-8.475, p < 0.0001 and HR: 0.972, CI: 0.958-0.985, p = 0.0001, respectively). There was an incremental prognostic value of elevated filling pressures and renal function impairment on mortality. CONCLUSIONS Advanced diastolic dysfunction and impaired renal function are signals toward worse outcomes and are associated with mortality in high-risk patients undergoing coronary angiography.
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Affiliation(s)
- Nicholay Teodorovich
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Yakov Fabrikant
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Gera Gandelman
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Moshe Swissa
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Michael Jonas
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Jacob George
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Sara Shimoni
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
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Țica O, Teodorovich N, Champsi A, Swissa M. Are the Four Pillars the Ideal Treatment for the Elderly? Cardiology 2023; 148:296-299. [PMID: 37290402 PMCID: PMC10614260 DOI: 10.1159/000531467] [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: 04/26/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Affiliation(s)
- Otilia Țica
- Institute of Cardiovascular Sciences, University of Birmingham, Medical School Birmingham, Birmingham, UK
| | - Nicholay Teodorovich
- Heart Institute, Kaplan Medical Center, Rehovot and the Hebrew University, Jerusalem, Israel
| | - Asgher Champsi
- Institute of Cardiovascular Sciences, University of Birmingham, Medical School Birmingham, Birmingham, UK
| | - Moshe Swissa
- Heart Institute, Kaplan Medical Center, Rehovot and the Hebrew University, Jerusalem, Israel
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Abstract
Sudden cardiac death (SCD) in the young person, although rare, is a dramatic and devastating event. The annual incidence of SCD in young persons (up to 35 years old) was reported to be 1.3 to 2.28 per 100,000. When older (up to 49 years old) SCD victims were included, the annual incidence was reported to be as high as 8.8 per 100,000, because of the much higher incidence (38.5 per 100,000) in the 40-49 age group.
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Affiliation(s)
- Nicholay Teodorovich
- Cardiology, Kaplan Medical Center, Rehovot and the Hebrew University, Jerusalem, Israel
| | - Evgeny N Mikhaylov
- Department of Pathology, Institute of Heart and Vessels, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation
| | - Lubov B Mitrofanova
- Department of Pathology, Institute of Heart and Vessels, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation
| | - Moshe Swissa
- Cardiology, Kaplan Medical Center, Rehovot and the Hebrew University, Jerusalem, Israel
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Sella G, Gandelman G, Teodorovich N, Tuvali O, Ayyad O, Abu Khadija H, Haberman D, Poles L, Jonas M, Volodarsky I, George J, Blatt A. Mid-Term Clinical Outcomes Following Drug-Coated Balloons in Coronary Artery Disease. J Clin Med 2022; 11:jcm11071859. [PMID: 35407467 PMCID: PMC9000207 DOI: 10.3390/jcm11071859] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 12/22/2022] Open
Abstract
Objective: The aim of this study was to evaluate the mid-term efficacy of drug-coated balloons (DCB) in percutaneous coronary intervention (PCI) in two different pathophysiologic scenarios. Background: There are different underlying pathological processes in coronary artery disease. Mid-term safety and efficacy of DCB approach is still limited. Methods: Medical records of all consecutive patients undergoing DCB were evaluated. The primary endpoint was the rate of clinically driven target lesion revascularization (TLR) after 24 months. Results: Between January 2011 and December 2017, 442 patients were included, representing 4.4% of all PCIs in our institution. A total of 460 DCB lesions were treated, of which 328 (71.3%) were de novo and 132 (28.7%) were combined bare metal or drug-eluting stents with in-stent restenosis (ISR). The patients’ mean age was 66.2 ± 11.7 years with a diabetes prevalence of 45.3%. The TLR rate was lower in the de novo group (5.3%) compared to the ISR group (9.4%) (p = 0.04). No differences were observed in major adverse cardiovascular events (MACE) between the de novo group (38.9%) and ISR group (42.5%) (p = 0.47). No significant differences were detected in the TLR occurrence in the subgroup analysis. Conclusion: Our extended experience demonstrates that the mid-term DCB approach in these two pathophysiologic settings represent a reasonable option, with low TLR rate.
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Teodorovich N, Jonas M, Haberman D, Abu Khadija H, Ayyad O, Gandelman G, Poles L, George J, Blatt A. Natural Anti-Endothelial Cell Antibodies in Patients Undergoing Coronary Angiography. Isr Med Assoc J 2021; 23:657-661. [PMID: 34672449] [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: 06/13/2023]
Abstract
BACKGROUND Anti-endothelial cell antibodies (AECA) are a known biomarker of endothelial dysfunction and damage in clinical practice, especially in autoimmune disease. OBJECTIVES To determine the relation between natural AECA levels and prognosis related to coronary artery disease. METHODS Candidates for coronary angiography were prospectively enrolled. AECA levels were determined by ELISA assay. Mortality was evaluated after more than 5 years follow-up. RESULTS Of a total 857 patients, 445 had high AECA levels (group 1) and 412 had low levels (< 1 OD unit, group 2). Both groups did not differ in age, sex, or presence of diabetes. The median follow up was 2293 days (76 months). Patients with high AECA levels were more likely to have normal coronary arteries on angiography (21.6% vs. 16.9%, P = 0.047) and less likely to have calcified lesions (19.0% vs. 26.6%, P = 0.028) and lower prevalence of abnormal renal functions (71.1 mg/dl vs. 66.5 mg/dl, P = 0.033). Patients with higher AECA levels had lower mortality levels (20.1% vs. 27.6%, P = 0.006). A logistic regression model demonstrated independent association between lower AECA levels and the presence of coronary atherosclerosis based on angiogram. CONCLUSIONS After a median of more than 6 years, higher natural AECA levels were associated with less coronary artery disease and lower mortality rates in patients undergoing coronary angiography.
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Affiliation(s)
- Nicholay Teodorovich
- Kaplan Heart Center, Kaplan Medical Center, Rehovot, affiliated with Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Michael Jonas
- Kaplan Heart Center, Kaplan Medical Center, Rehovot, affiliated with Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Dan Haberman
- Kaplan Heart Center, Kaplan Medical Center, Rehovot, affiliated with Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Haitham Abu Khadija
- Kaplan Heart Center, Kaplan Medical Center, Rehovot, affiliated with Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Omar Ayyad
- Kaplan Heart Center, Kaplan Medical Center, Rehovot, affiliated with Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Gera Gandelman
- Kaplan Heart Center, Kaplan Medical Center, Rehovot, affiliated with Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Lion Poles
- Kaplan Heart Center, Kaplan Medical Center, Rehovot, affiliated with Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Jacob George
- Kaplan Heart Center, Kaplan Medical Center, Rehovot, affiliated with Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Alex Blatt
- Kaplan Heart Center, Kaplan Medical Center, Rehovot, affiliated with Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
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Teodorovich N, Goldenberg I, Kogan E, Swissa M. ATRIAL FIBRILLATION IS AN INDEPENDENT PREDICTOR OF MORTALITY IN ICD RECIPIENTS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31169-4] [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: 10/24/2022]
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Teodorovich N, Gandelman G, Jonas M, Shimoni S, George J, Swissa M. P4494Renal insufficiency mitigates the protective effects of elevated anti endothelial cell antibodies on survival in patients undergoing coronary angiography. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
We previously demonstrated that elevated levels of antiendothelial cell antibodies are associated with improved survival of patients undergoing coronary angiography. However, renal insufficiency, which is associated with decreased survival, leads to increased level of the antiendothelial cell antibodies. The purpose of this study was to evaluate the correlation of the levels of these antibodies with survival in patients with normal versus reduced renal function.
Patients and methods
This was a single center prospective study. Eight hundred thirty eight consecutive patients undergoing coronary angiography with detectable antibody levels were enrolled. The levels of antiendothelial antibodies were determined by ELISA and measured in optical density units. Renal insufficiency was defined as adjusted GFR<60 ml/min. The mean follow up was 30 months.
Results
Of total 838 patients, 481 (57%) had normal and 357 (42.6%) had reduced renal function. Total mortality was 13.6%, being significantly higher in patients with reduced (23.2%) versus normal (6.4%) renal function (p<0.0001). Antiendothelial cell antibody levels were higher in patients with normal versus reduced renal function (4.76±7.05 versus 3.84±6.09 OD units, p=0.042). Antiendothelial cell antibody levels were significantly higher in survived versus deceased patients (4.56±6.82 versus 3.14±5.50 OD units, p=0.014). This association with survival was even more pronounced in patients with normal renal function (4.98±7.19 versus 11.69±3.29 OD units, p<0.0001). In patients with reduced renal function, there was no significant difference between survived and deceased patients (3.89±6.12 versus 3.68±6.05 OD units, p=0.788).
Conclusions
Renal insufficiency leads to mild decrease in the antiendothelial cell antibodies' levels. Higher levels of antiendothelial cell antibodies are associated with improved survival in patients undergoing coronary angiography. This association is significant in patients with normal but not reduced renal function. Thus, the effect of the higher levels of these antibodies on survival cannot be explained by its association with renal dysfunction.
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Affiliation(s)
| | - G Gandelman
- Kaplan Medical Center, Cardiology, Rehovot, Israel
| | - M Jonas
- Kaplan Medical Center, Cardiology, Rehovot, Israel
| | - S Shimoni
- Kaplan Medical Center, Cardiology, Rehovot, Israel
| | - J George
- Kaplan Medical Center, Cardiology, Rehovot, Israel
| | - M Swissa
- Kaplan Medical Center, Cardiology, Rehovot, Israel
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9
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Teodorovich N, Fabrikant Y, Jonas M, Gandelman G, George J, Swissa M, Shimoni S. P1487The additive effect of diastolic dysfunction and renal insufficiency on mortality in patients undergoing coronary angiography. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Coronary artery disease (CAD) is the leading cause of diastolic dysfunction. Diastolic dysfunction is associated with adverse outcomes. Renal insufficiency is also associated with adverse outcomes in CAD patients. The interaction between diastolic dysfunction and renal insufficiency is not completely elucidated.
Aims
We evaluated the prognostic value of diastolic function assessed by echocardiography in patients with and without renal failure undergoing coronary angiography.
Patients and methods
An observational prospective study of 547 consecutive patients undergoing coronary angiography. The median follow up was 30 months. Significant diastolic dysfunction was defined as elevated LV filling pressure with e/e'>12. Renal insufficiency was defined as adjusted GFR<60 ml/min. One hundred seventy-nine patients (32.7%) had significant diastolic dysfunction and 259 (47.3%) had renal insufficiency. Patients were categorized into 4 groups according to the presence of both significant diastolic dysfunction and renal insufficiency (Table 1).
Results
Significant diastolic dysfunction and renal insufficiency had additive effect on mortality (Table 1). A significant association was observed between diastolic dysfunction and mortality in patients with and without renal insufficiency (p<0.0001 & p=0.005, respectively). The presence of either diastolic dysfunction or renal insufficiency was associated with mortality (Figure 1), with the combination of both leading to the highest mortality (p<0.0001). In Cox regression model which combined diastolic dysfunction, presence of AF, LVEF, obstructive coronary disease on angiography, presence of acute coronary syndrome and renal insufficiency, both elevated filling pressure and renal insufficiency were independently associated with higher mortality (HR 2.65, CI 1.65–4.24, p<0.001 and HR 2.92, CI 1.72–4.98, p<0.0001, respectively).
Table 1. Patients divided into 4 groups according to the presence of the significant diastolic dysfunction and renal insufficiency Patients' group N (%) Mortality Normal LV filling pressure / Normal renal function 230 (42.0%) 4.8% Elevated LV filling pressure / Normal renal function 58 (10.6%) 15.5% Normal LV filling pressure / Renal insufficiency 138 (25.2%) 15.9% Elevated LV filling pressure / Renal insufficiency 121 (22.1%) 38.8% P<0.0001 in Pearson Chi-Square.
Fugure 1
Conclusions
In patients undergoing coronary angiography, significant diastolic dysfunction with elevated filling pressure is associated with mortality in patients both with and without renal insufficiency. Both significant diastolic dysfunction and renal insufficiency are independent predictors of mortality.
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Affiliation(s)
| | - Y Fabrikant
- Kaplan Medical Center, Cardiology, Rehovot, Israel
| | - M Jonas
- Kaplan Medical Center, Cardiology, Rehovot, Israel
| | - G Gandelman
- Kaplan Medical Center, Cardiology, Rehovot, Israel
| | - J George
- Kaplan Medical Center, Cardiology, Rehovot, Israel
| | - M Swissa
- Kaplan Medical Center, Cardiology, Rehovot, Israel
| | - S Shimoni
- Kaplan Medical Center, Cardiology, Rehovot, Israel
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Teodorovich N, Jonas M, Gandelman G, Fabrikant Y, George J, Swissa M, Shimoni S. P867Diastolic dysfunction is an independent predictor of mortality in patients undergoing coronary angiography. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - M Jonas
- Kaplan Medical Center, Cardiology, Rehovot, Israel
| | - G Gandelman
- Kaplan Medical Center, Cardiology, Rehovot, Israel
| | - Y Fabrikant
- Kaplan Medical Center, Cardiology, Rehovot, Israel
| | - J George
- Kaplan Medical Center, Cardiology, Rehovot, Israel
| | - M Swissa
- Kaplan Medical Center, Cardiology, Rehovot, Israel
| | - S Shimoni
- Kaplan Medical Center, Cardiology, Rehovot, Israel
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Teodorovich N, Swissa MS, Kogan Y, Gandelman G, Jonas M, George J, Swissa M. Atrial fibrillation and CHADS 2 score as mortality predictors in young versus elderly patients undergoing coronary angiography. J Geriatr Cardiol 2017; 14:582-586. [PMID: 29056957 PMCID: PMC5641646 DOI: 10.11909/j.issn.1671-5411.2017.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Affiliation(s)
- Nicholay Teodorovich
- Kaplan Medical Center, Rehovot and the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Sraia Swissa
- Kaplan Medical Center, Rehovot and the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yonatan Kogan
- Kaplan Medical Center, Rehovot and the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gera Gandelman
- Kaplan Medical Center, Rehovot and the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Jonas
- Kaplan Medical Center, Rehovot and the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jacob George
- Kaplan Medical Center, Rehovot and the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Moshe Swissa
- Kaplan Medical Center, Rehovot and the Hebrew University of Jerusalem, Jerusalem, Israel
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Teodorovich N, Jonas M, Gandelman G, Kogan Y, George J, Swissa M. P1789Elevated antiendothelial cell antibodies are associated with higher likelihood of normal coronary angiograms. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1789] [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: 11/14/2022] Open
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Teodorovich N, Kogan Y, Jonas M, Gandelman G, George J, Swissa M. P844Atrial fibrillation is an Independent predictor of mortality in patients undergoing coronary angiography. Europace 2017. [DOI: 10.1093/ehjci/eux151.026] [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: 11/13/2022] Open
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Affiliation(s)
- Nicholay Teodorovich
- Department of Cardiology, Kaplan Medical Center, Rehovot, Israel.,Hebrew University Hadassah School of Medicine, Jerusalem, Israel
| | - Yonatan Kogan
- Department of Cardiology, Kaplan Medical Center, Rehovot, Israel.,Hebrew University Hadassah School of Medicine, Jerusalem, Israel
| | - Offir Paz
- Department of Cardiology, Kaplan Medical Center, Rehovot, Israel.,Hebrew University Hadassah School of Medicine, Jerusalem, Israel
| | - Moshe Swissa
- Department of Cardiology, Kaplan Medical Center, Rehovot, Israel.,Hebrew University Hadassah School of Medicine, Jerusalem, Israel
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Abstract
A tilt table test (TTT) is an inexpensive, noninvasive tool for the differential diagnosis of syncope and orthostatic intolerance and has good diagnostic yield. The autonomic system malfunction which underlines the reflex syncope is manifested as either hypotension or bradycardia, while an orthostatic challenge is applied. The timing of the response to the orthostatic challenge, as well as the predominant component of the response help to differentiate between various forms of neurocardiogenic syncope, orthostatic hypotension and non-cardiovascular conditions (e.g., pseudosyncope). Medications, such as isoproterenol and nitrates, may increase TTT sensitivity. Sublingual nitrates are easiest to administer without the need of venous access. TTT can be combined with carotid sinus massage to evaluate carotid sinus hypersensitivity, which may not be present in supine position. TTT is not useful to access the response to treatment. Recently, implantable loop recorders (ILR) have been used to document cardioinhibitory reflex syncope, because pacemakers are beneficial in many of these patients, especially those over 45 years of age. The stepwise use of both TTT and ILR is a promising approach in these patients. Recently, TTT has been used for indications other than syncope, such as assessment of autonomic function in Parkinson’s disease and its differentiation from multiple system atrophy.
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Abstract
Adenosine can produce arrhythmias, which are generally short living. It may induce PACs and PVCs, sinus bradycardia, and atrial fibrillation. There have been reports of transient polymorphic VT (torsades de pointes) in patients with LQTS and others in people with normal QT interval. We report a case of a long episode of polymorphic VT induced by adenosine. A 27 year old woman received 6 mg adenosine for PSVT, which terminated and torsades de pointes developed, persisting for 17 seconds and terminated spontaneously. This is the longest described duration of the torsades after adenosine administration in patients with normal QT interval.
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Affiliation(s)
- Nicholay Teodorovich
- Department of Cardiology, Kaplan Medical Center, Rehovot, Israel; The Hebrew University, Jerusalem, Israel.
| | - Elena Margolin
- Department of Cardiology, Kaplan Medical Center, Rehovot, Israel; The Hebrew University, Jerusalem, Israel
| | - Yonatan Kogan
- Department of Cardiology, Kaplan Medical Center, Rehovot, Israel; The Hebrew University, Jerusalem, Israel
| | - Ofir Paz
- Department of Cardiology, Kaplan Medical Center, Rehovot, Israel; The Hebrew University, Jerusalem, Israel
| | - Moshe Swissa
- Department of Cardiology, Kaplan Medical Center, Rehovot, Israel; The Hebrew University, Jerusalem, Israel
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