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Katamreddy A, Kokkinidis DG, Miles J, Siasos G, Giannakoulas G, Faillace RT. Elevated red cell distribution width and cardiovascular mortality in ASCVD risk cohorts: National Health and Nutrition Examination Survey (NHANES III). Rev Cardiovasc Med 2022; 23:51. [DOI: 10.31083/j.rcm2302051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/19/2021] [Accepted: 09/06/2021] [Indexed: 11/06/2022] Open
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Palaiodimos L, Ali R, Teo HO, Parthasarathy S, Karamanis D, Chamorro-Pareja N, Kokkinidis DG, Kaur S, Kladas M, Sperling J, Chang M, Hupart K, Cha-Fong C, Srinivasan S, Kishore P, Davis N, Faillace RT. Obesity, Inflammation, and Mortality in COVID-19: An Observational Study from the Public Health Care System of New York City. J Clin Med 2022; 11:jcm11030622. [PMID: 35160073 PMCID: PMC8836690 DOI: 10.3390/jcm11030622] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/09/2022] [Accepted: 01/24/2022] [Indexed: 01/08/2023] Open
Abstract
Severe obesity increases the risk for negative outcomes in patients with coronavirus disease 2019 (COVID-19). Our objectives were to investigate the effect of BMI on in-hospital outcomes in our New York City Health and Hospitals’ ethnically diverse population, further explore this effect by age, sex, race/ethnicity, and timing of admission, and, given the relationship between COVID-19 and hyperinflammation, assess the concentrations of markers of systemic inflammation in different BMI groups. A retrospective study was conducted in hospitalized patients with COVID-19 in the public health care system of New York City from 1 March 2020 to 31 October 2020. A total of 8833 patients were included in this analysis (women: 3593, median age: 62 years). The median body mass index (BMI) was 27.9 kg/m2. Both overweight and obesity were independently associated with in-hospital death. The association of overweight and obesity with death appeared to be stronger in men, younger patients, and individuals of Hispanic ethnicity. We did not observe higher concentrations of inflammatory markers in patients with obesity as compared to those without obesity. In conclusion, overweight and obesity were independently associated with in-hospital death. Obesity was not associated with higher concentrations of inflammatory markers.
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Koslowsky J, Kakkar A, Faillace RT, Sokol SI. Pulmonary Embolism Response Team (PERT) - A New Paradigm for the Treatment of Pulmonary Embolism. Curr Pharm Des 2021; 28:535-549. [PMID: 34781864 DOI: 10.2174/1381612827666211115153910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 10/06/2021] [Indexed: 11/22/2022]
Abstract
Pulmonary embolism (PE) is the third leading cause of cardiovascular mortality. Patients with PE can present with a wide array of symptoms, ranging from mild to life threatening. The mainstay of PE treatment is anticoagulation; however, there are many advanced options available for more severe patients, including catheter-directed interventions, surgical treatments, and hemodynamic support. Although different risk scores and clinical guidelines exist, the primary treating teams are frequently left uncertain on the most suitable treatment for a specific complex patient. Pulmonary Embolism Response Teams (PERT), composed of multidisciplinary experts, have emerged and been implemented in many centers and are available 24 hours a day to help guide the primary team. PERTs have changed the way complex PE patients are managed. In centers with a PERT, teams are called upon very frequently and there is a significant increase in the use of advanced treatments for PE, although there are differences between centers based upon the center's specific PERT protocol and available capabilities. As PE is an evolving area, and more studies are necessary, PERTs around the world can help advance the field and improve the treatment offered to PE patients.
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Gurin MI, Lin YJ, Bernard S, Goldberg RI, Narula N, Faillace RT, Alviar CL, Bangalore S, Keller NM. Cardiogenic shock complicating multisystem inflammatory syndrome following COVID-19 infection: a case report. BMC Cardiovasc Disord 2021; 21:522. [PMID: 34715788 PMCID: PMC8555861 DOI: 10.1186/s12872-021-02304-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/05/2021] [Indexed: 12/31/2022] Open
Abstract
Background With the high prevalence of COVID-19 infections worldwide, the multisystem inflammatory syndrome in adults (MIS-A) is becoming an increasingly recognized entity. This syndrome presents in patients several weeks after infection with COVID-19 and is associated with thrombosis, elevated inflammatory markers, hemodynamic compromise and cardiac dysfunction. Treatment is often with steroids and intravenous immunoglobulin (IVIg). The pathologic basis of myocardial injury in MIS-A, however, is not well characterized. In our case report, we obtained endomyocardial biopsy that revealed a pattern of myocardial injury similar to that found in COVID-19 cardiac specimens. Case presentation A 26-year-old male presented with fevers, chills, headache, nausea, vomiting, and diarrhea 5 weeks after his COVID-19 infection. His SARS-CoV-2 PCR was negative and IgG was positive, consistent with prior infection. He was found to be in cardiogenic shock with biventricular failure, requiring inotropes and diuretics. Given concern for acute fulminant myocarditis, an endomyocardial biopsy (EMB) was performed, showing an inflammatory infiltrate consisting predominantly of interstitial macrophages with scant T lymphocytes. The histologic pattern was similar to that of cardiac specimens from COVID-19 patients, helping rule out myocarditis as the prevailing diagnosis. His case was complicated by persistent hypoxemia, and a computed tomography scan revealed pulmonary emboli. He received IVIg, steroids, and anticoagulation with rapid recovery of biventricular function. Conclusions MIS-A should be considered as the diagnosis in patients presenting several weeks after COVID-19 infection with severe inflammation and multi-organ involvement. In our case, EMB facilitated identification of MIS-A and guided therapy. The patient’s biventricular function recovered with IVIg and steroids. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02304-y.
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Varrias D, Palaiodimos L, Balasubramanian P, Barrera CA, Nauka P, Melainis AA, Zamora C, Zavras P, Napolitano M, Gulani P, Ntaios G, Faillace RT, Galen B. The Use of Point-of-Care Ultrasound (POCUS) in the Diagnosis of Deep Vein Thrombosis. J Clin Med 2021; 10:3903. [PMID: 34501350 PMCID: PMC8432124 DOI: 10.3390/jcm10173903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/24/2022] Open
Abstract
Acute lower extremity proximal deep venous thrombosis (DVT) requires accurate diagnosis and treatment in order to prevent embolization and other complications. Point-of-care ultrasound (POCUS), a clinician performed, and clinician interpreted bedside ultrasound examination has been increasingly used for DVT evaluation mainly in the urgent and critical care setting, but also in the ambulatory clinics and the medical wards. Studies have demonstrated that POCUS has excellent diagnostic accuracy for acute proximal DVT when performed by well-trained users. However, there is significant heterogeneity among studies on the necessary extent of training and universally acceptable standardized education protocols are needed. In this review, we summarize the evidence that supports the use of POCUS to diagnose acute proximal DVT and focus on methodology and current technology, sensitivity and specificity, pre-test probability and the role of D-dimer, time and resources, education, limitations, and future directions.
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Hanumanthu BKJ, Nair AS, Katamreddy A, Gilbert JS, You JY, Offor OL, Kushwaha A, Krishnan A, Napolitano M, Palaidimos L, Morante J, Tekwani S, Mehta S, Gupta A, Goraya H, Sun M, Faillace RT, Gulani P. Sepsis-induced cardiomyopathy is associated with higher mortality rates in patients with sepsis. Acute Crit Care 2021; 36:215-222. [PMID: 34311515 PMCID: PMC8435447 DOI: 10.4266/acc.2021.00234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/18/2021] [Indexed: 12/04/2022] Open
Abstract
Background Patients with sepsis are at risk for developing sepsis-induced cardiomyopathy (SIC). Previous studies offer inconsistent results regarding the association of SIC and mortality. This study sought to assess whether SIC is linked to mortality in patients with sepsis and to evaluate predictors of the development of SIC. Methods In this retrospective study, patients admitted to the medical intensive care unit with a diagnosis of sepsis in the absence of acute coronary syndrome were included. SIC was identified using transthoracic echo and was defined by a new onset decline in left ventricular ejection fraction (LVEF) ≤50%, or ≥10% decline in LVEF compared to baseline in patients with a history of heart failure with reduced ejection fraction. Multivariable logistic regression analysis was performed using the R software program. Results Of the 359 patients in the final analysis, 19 (5.3%) had SIC. Eight (42.1%) of the 19 patients in the SIC group and 60 (17.6%) of the 340 patients in the non-SIC group died during hospitalization. SIC was associated with an increased risk for all-cause in-hospital mortality (odds ratio [OR], 4.46; 95% confidence interval [CI], 1.15–18.69; P=0.03). Independent predictors for the development of SIC were albumin level (OR, 0.47; 95% CI, 0.23–0.93; P=0.03) and culture positivity (OR, 8.47; 95% CI, 2.24–55.61; P=0.006). Concomitant right ventricular hypokinesis was noted in 13 (68.4%) of the 19 SIC patients. Conclusions SIC was associated with an increased risk for all-cause in-hospital mortality. Low albumin level and culture positivity were independent predictors of SIC.
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Tzoumas A, Giannopoulos S, Kakargias F, Kokkinidis DG, Giannakoulas G, Faillace RT, Bakoyiannis C, Doulamis IP, Avgerinos DV. Repeat Coronary Artery Bypass Grafting: A Meta-Analysis of Off-Pump versus On-Pump Techniques in a Large Cohort of Patients. Heart Lung Circ 2021; 30:1281-1291. [PMID: 33810970 DOI: 10.1016/j.hlc.2021.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 02/03/2021] [Accepted: 02/08/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Redo coronary artery bypass grafting (CABG) can be performed with either the off-pump (OPCAB) or the on-pump (ONCAB) technique. METHOD Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), this meta-analysis compared the safety and efficacy of OPCAB versus ONCAB redo CABG. RESULTS Twenty-three (23) eligible studies were included (OPCAB, n=2,085; ONCAB, n=3,245). Off-pump CABG significantly reduced the risk of perioperative death (defined as in-hospital or 30-day death rate), myocardial infarction, atrial fibrillation, and acute kidney injury. The two treatment approaches were comparable regarding 30-day stroke and late all-cause mortality. CONCLUSIONS Off-pump redo CABG resulted in lower perioperative death and periprocedural complication rates. No difference was observed in perioperative stroke rates and long-term survival between the two techniques.
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Friedman A, Miles J, Liebelt J, Christia P, Engstrom K, Thachil R, Grushko M, Faillace RT. QT Dispersion and Drug-Induced Torsade de Pointes. Cureus 2021; 13:e12895. [PMID: 33643739 PMCID: PMC7903857 DOI: 10.7759/cureus.12895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Amiodarone causes less drug-induced torsade de pointes (TdP) compared to other class III antiarrhythmics. Two theories proposed for this finding include that amiodarone has less repolarization heterogeneity, and/or decreases early after depolarization (EADs). Corrected QT (QTc) dispersion as measured on a surface electrocardiogram (ECG) represents spatial heterogeneity of ventricular repolarization. Objective The purpose of this study was to analyze the difference in QT dispersion between amiodarone and other class III antiarrhythmics and to determine the etiology of TdP. Methods This was a retrospective, observational study at Montefiore Medical Center between January 2005 and January 2015. Inclusion criteria were adults >18 years on amiodarone, dofetilide, or sotalol with prolonged QT interval on 12-lead ECG. ECGs were reviewed by three blinded observers. QTc was calculated using the Bazett and Framingham formulas. QTc dispersion was calculated by subtracting the shortest from the longest QTc. Analysis of variance (ANOVA) was applied for comparison between antiarrhythmic groups with Bonferroni correction for multiple comparisons. Results A total of 447 ECGs were reviewed and 77 ECGs met inclusion criteria. The average QT dispersion for amiodarone, dofetilide, and sotalol was 0.050, 0.037, and 0.034, respectively (p=0.006) and the average QTc dispersion by Bazett was 0.053, 0.038, and 0.037 (p=0.008) and by Framingham was 0.049, 0.036, and 0.035 (p=0.009), respectively. Conclusion Our results show that given the increase in QT dispersion seen with amiodarone, heterogeneous ventricular repolarization as measured by QTc dispersion likely does not account for the lower incidence of drug-induced TdP seen with amiodarone. The ability of amiodarone to decrease EADs via sodium-channel blockade is more likely the explanation for its lower incidence of drug-induced TdP.
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Aoi S, Kakkar AM, Golowa Y, Grushko M, Coyle CM, Elrafei T, Langston MD, Faillace RT, Bangalore S, Sokol SI. Saddle pulmonary embolism and clot in transit in COVID-19 infection: a case report of catastrophic venous thromboembolism. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-6. [PMID: 33628997 PMCID: PMC7891250 DOI: 10.1093/ehjcr/ytaa437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/21/2020] [Accepted: 10/28/2020] [Indexed: 12/23/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) is associated with a coagulopathy favouring thrombosis over bleeding that imparts a poor prognosis. Clot in transit (CIT) is considered a rare entity and the most severe form of venous thromboembolism (VTE), carrying a higher mortality than isolated pulmonary embolism (PE). The incidence of this phenomenon in patients with COVID-19 infection is unknown and likely under-recognized. Case summary During the peak of the COVID-19 pandemic in New York City, a 70-year-old Hispanic female presented with syncope due to a saddle PE further complicated by a highly mobile CIT. Polymerase chain reaction was positive for COVID-19 infection, however, there was no evidence of lung parenchymal involvement or hyper-inflammation. Based on consensus from a multidisciplinary team, aspiration thrombectomy was attempted to treat this extreme case of VTE, however, the patient died during the procedure. Discussion This case raises awareness to the most catastrophic form of VTE, presenting in an early phase of COVID-19 infection without the typical hyper-inflammation and severe lung injury associated with development of COVID-related coagulopathy. It also serves to inform on the critical role echocardiography has in the comprehensive evaluation and re-evaluation of hospitalized patients with COVID-19, and the importance of a multidisciplinary organized approach in clinical decision-making for this complex and poorly understood disease and its sequelae.
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Katamreddy A, Kokkinidis DG, Miles JA, Faillace RT. Elevated red cell distribution width is associated with negative P wave amplitude in lead V1: national health and nutrition examination survey (NHANES III). AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2020; 10:356-361. [PMID: 33224583 PMCID: PMC7675171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Red cell distribution (RDW) is associated with atrial fibrillation (AF) incidence. However, its relationship with precursors of AF has not been established. We aim to investigate if association exists between RDW and negative P wave amplitude in V1, a marker of left atrial abnormality. METHODS NHANES III is a complex, multistage, clustered design survey of noninstitutionalized United States population between 1988-94. A Sample of 6403 individuals was extracted after excluding missing demographic, laboratory, anthropometric and ECG data and major ECG abnormalities. Variables were selected and univariate analysis was done first with a level of significance at P<0.01 (99% confidence). All the significant variables were included in a multivariate linear regression model. RESULTS 53.58% of subjects were female. Racial distribution was caucasian 50.2%, hispanic 23.9% and african american 21.7%. Age, PR interval, heart rate, systolic blood pressure, red cell distribution width, glycated hemoglobin, serum cholesterol, serum ferritin, and body mass index showed a significant correlation with negative P wave amplitude in V1 (P<0.001). After including all these variables in a multivariate regression model, only age, body mass index, systolic blood pressure, PR interval, heart rate and red cell distribution width had a P≤0.001. CONCLUSIONS Increased RDW is independently associated with negative P wave amplitude in V1 after correcting for other cardiovascular risk factors. Further studies are required to analyze the reason for this correlation.
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Miles JA, Mejia M, Rios S, Sokol SI, Langston M, Hahn S, Leiderman E, Salgunan R, Soghier I, Gulani P, Joshi K, Chung V, Morante J, Maggiore D, Uppal D, Friedman A, Katamreddy A, Abittan N, Ramani G, Irfan W, Liaqat W, Grushko M, Krouss M, Cho HJ, Bradley SM, Faillace RT. Characteristics and Outcomes of In-Hospital Cardiac Arrest Events During the COVID-19 Pandemic: A Single-Center Experience From a New York City Public Hospital. Circ Cardiovasc Qual Outcomes 2020; 13:e007303. [PMID: 32975134 PMCID: PMC7673640 DOI: 10.1161/circoutcomes.120.007303] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Patients hospitalized for severe coronavirus disease 2019 (COVID-19) infection are at risk for in-hospital cardiac arrest (IHCA). It is unknown whether certain characteristics of cardiac arrest care and outcomes of IHCAs during the COVID-19 pandemic differed compared with a pre-COVID-19 period. Methods: All patients who experienced an IHCA at our hospital from March 1, 2020 through May 15, 2020, during the peak of the COVID-19 pandemic, and those who had an IHCA from January 1, 2019 to December 31, 2019 were identified. All patient data were extracted from our hospital’s Get With The Guidelines–Resuscitation registry, a prospective hospital-based archive of IHCA data. Baseline characteristics of patients, interventions, and overall outcomes of IHCAs during the COVID-19 pandemic were compared with IHCAs in 2019, before the COVID-19 pandemic. Results: There were 125 IHCAs during a 2.5-month period at our hospital during the peak of the COVID-19 pandemic compared with 117 IHCAs in all of 2019. IHCAs during the COVID-19 pandemic occurred more often on general medicine wards than in intensive care units (46% versus 33%; 19% versus 60% in 2019; P<0.001), were overall shorter in duration (median time of 11 minutes [8.5–26.5] versus 15 minutes [7.0–20.0], P=0.001), led to fewer endotracheal intubations (52% versus 85%, P<0.001), and had overall worse survival rates (3% versus 13%; P=0.007) compared with IHCAs before the COVID-19 pandemic. Conclusions: Patients who experienced an IHCA during the COVID-19 pandemic had overall worse survival compared with those who had an IHCA before the COVID-19 pandemic. Our findings highlight important differences between these 2 time periods. Further study is needed on cardiac arrest care in patients with COVID-19.
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Israilov S, Krouss M, Zaurova M, Jalon HS, Conley G, Shulman P, Ivanyuk M, Jalkut E, Saladini-Aponte C, Sharma-Cooper H, Smeltz R, Faillace RT, Wei EK, Cho HJ. National Outreach of Telepalliative Medicine Volunteers for a New York City Safety Net System COVID-19 Pandemic Response. J Pain Symptom Manage 2020; 60:e14-e17. [PMID: 32479861 PMCID: PMC7258838 DOI: 10.1016/j.jpainsymman.2020.05.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 11/26/2022]
Abstract
The coronavirus disease 2019 surge in New York City created an increased demand for palliative care (PC) services. In staff-limited settings such as safety net systems, and amid growing reports of health care worker illness, leveraging help from less-affected areas around the country may provide an untapped source of support. A national social media outreach effort recruited 413 telepalliative medicine volunteers (TPMVs). After expedited credentialing and onboarding of 67 TPMVs, a two-week pilot was initiated in partnership with five public health hospitals without any previous existing telehealth structure. The volunteers completed 109 PC consults in the pilot period. Survey feedback from TPMVs and on-site PC providers was largely positive, with areas of improvement identified around electronic health record navigation and continuity of care. This was a successful, proof of concept, and quality improvement initiative leveraging TPMVs from across the nation for a PC pandemic response in a safety net system.
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Chugh Y, Bavishi C, Mojadidi MK, Elgendy IY, Faillace RT, Brilakis ES, Tamis‐Holland J, Mamas M, Chugh SK. Safety of transradial access compared to transfemoral access with hemostatic devices (vessel plugs and suture devices) after percutaneous coronary interventions: A systematic review and
meta‐analysis. Catheter Cardiovasc Interv 2020; 96:285-295. [DOI: 10.1002/ccd.29061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/28/2020] [Accepted: 05/24/2020] [Indexed: 12/16/2022]
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Pinsino A, Mondellini GM, Royzman EA, Hoffman KL, D'Angelo D, Mabasa M, Gaudig A, Zuver AM, Masoumi A, Garan AR, Mohan S, Husain SA, Toma K, Faillace RT, Giles JT, Takeda K, Takayama H, Naka Y, Topkara VK, Demmer RT, Radhakrishnan J, Colombo PC, Yuzefpolskaya M. Cystatin C- Versus Creatinine-Based Assessment of Renal Function and Prediction of Early Outcomes Among Patients With a Left Ventricular Assist Device. Circ Heart Fail 2020; 13:e006326. [PMID: 31959016 DOI: 10.1161/circheartfailure.119.006326] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Estimated glomerular filtration rate (eGFR) based on serum creatinine (sCr) improves early after left ventricular assist device (LVAD) implantation but subsequently declines. Although sCr is a commonly accepted clinical standard, cystatin C (CysC) has shown superiority in assessment of renal function in disease states characterized by muscle wasting. Among patients with an LVAD, we aimed to (1) longitudinally compare CysC-eGFR and sCr-eGFR, (2) assess their predictive value for early postoperative outcomes, and (3) investigate mechanisms which might explain potential discrepancies. METHODS A prospective cohort (n=116) with CysC and sCr concurrently measured at serial time points, and a retrospective cohort (n=91) with chest computed tomography performed within 40 days post-LVAD were studied. In the prospective cohort, the primary end point was a composite of in-hospital mortality, renal replacement therapy, or severe right ventricular failure. In the retrospective cohort, muscle mass was estimated using pectoralis muscle area indexed to body surface area (pectoralis muscle index). RESULTS In the prospective cohort, sCr-eGFR significantly improved early post-LVAD and subsequently declined, whereas CysC-eGFR remained stable. CysC-eGFR but not sCr-eGFR predicted the primary end point: odds ratio per 5 mL/(min·1.73 m2) decrease 1.16 (1.02-1.31) versus 0.99 (0.94-1.05). In retrospective cohort, for every 5 days post-LVAD, a 6% decrease in pectoralis muscle index was observed (95% CI, 2%-9%, P=0.003). After adjusting for time on LVAD, for every 1 cm2/m2 decrease in pectoralis muscle index, there was a 4% decrease in 30-day post-LVAD sCr (95% CI, 1%-6%, P=0.004). CONCLUSIONS Initial improvement in sCr-eGFR is likely due to muscle wasting following LVAD surgery. CysC may improve assessment of renal function and prediction of early postoperative outcomes in patients with an LVAD.
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Hanumanthu BKJ, Chugh Y, Grushko M, Faillace RT. Hyperkalemia Presenting as Sinus Bradycardia, Junctional Rhythm and Atrial Bigeminy. Cureus 2019; 11:e6439. [PMID: 31998568 PMCID: PMC6973538 DOI: 10.7759/cureus.6439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The spectrum of electrocardiographic changes seen with hyperkalemia is known to progress gradually with increasing serum levels of potassium. Initial changes are limited to peaked T waves and QT shortening, which subsequently progress to prolonged QRS/QT intervals, and finally sinus arrest, sinus bradycardia and asystole. We report a unique case of severe sinus bradycardia with atrial bigeminy and junctional rhythm in the setting of moderate hyperkalemia, a rarely reported electrocardiographic finding.
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Buhari O, Dayyab FM, Igbinoba O, Atanda A, Medhane F, Faillace RT. The association between heavy metal and serum cholesterol levels in the US population: National Health and Nutrition Examination Survey 2009-2012. Hum Exp Toxicol 2019; 39:355-364. [PMID: 31797685 DOI: 10.1177/0960327119889654] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Few studies have examined the relationship between heavy metal and serum cholesterol levels, and no recent study has examined this relationship in the US population. METHODS AND RESULTS A total of 19,591 individuals aged 0-80 years were included in the National Health and Nutrition Examination Survey 2009-2012; the current study was composed of survey participants for whom some or all low-density lipoprotein cholesterol (LDL-C), serum triglyceride, high-density lipoprotein cholesterol, total cholesterol, blood lead (Pb), total blood mercury (Hg), and blood cadmium (Cd) levels had been measured. Three tertiles (T1-T3) of heavy metals were used to explore dose-response association between heavy metal exposure and serum cholesterol level. Logistic regression was used to explore the relationship between tertiles of blood heavy metal levels and serum cholesterol levels after adjusting for age, sex, and socioeconomic status. We have shown that the groups with the highest levels of Pb, Hg, and Cd had a 56%, 73%, and 41% chance, respectively, of having a high total cholesterol level. In study subjects with the highest Pb levels, there was also a 22% chance of being in the group with the highest LDL-C level. An increase in total cholesterol and LDL-C levels was observed from the first to the third tertiles of the heavy metals studied. CONCLUSION Increasing blood Pb, Hg, and Cd levels were associated with significantly increased odds of high total cholesterol after adjusting for age, sex, and socioeconomic status.
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Miles JA, Quispe R, Mehlman Y, Patel K, Lama Von Buchwald C, You JY, Sokol S, Faillace RT. Racial differences and mortality risk in patients with heart failure and hyponatremia. PLoS One 2019; 14:e0218504. [PMID: 31216316 PMCID: PMC6583993 DOI: 10.1371/journal.pone.0218504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/04/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hyponatremia is a well-established poor prognostic marker in patients with heart failure. Whether the mortality risk is comparable among different races of patients with heart failure and hyponatremia is unknown. MATERIALS AND METHODS Consecutive patients admitted with acute decompensated heart failure and an admission sodium level<135 mEq/L from 1/1/2001 through 12/31/10 were identified. Patients were divided into four groups based on self-reported race: white, African American, Hispanic and other. African Americans were used as the reference group for statistical analysis. The primary outcome was all-cause mortality. RESULTS We included 4,343 patients, from which 1,356 (31%) identified as white, 1,248 (29%) as African American, 780 (18%) as Hispanic and 959 (22%) as other. During a median follow-up of 23 months, a total of 2,384 patients died: 678 were African American, 820 were white, 298 were Hispanic and 588 were other. After adjusting for baseline demographics, comorbidities and medication use, Hispanic patients had a 45% less risk of death as compared to African Americans (HR .55, CI .48-.64, p<0.05). There was no difference in mortality between white and African American patients (HR 1.04, CI .92-1.2, p = 0.79). CONCLUSION Hispanic patients admitted for heart failure and who were hyponatremic on admission had an independent lower risk of mortality compared to other groups. These findings may be due to the disparate activity of the renin-angiotensin-aldosterone system among various racial groups. This observational study is hypothesis generating and suggests that treatment of patients with heart failure and hyponatremia should perhaps be focused more on renin-angiotensin-aldosterone system reduction in certain racial groups, yet less in others.
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Li DL, Quispe R, Onyekwelu C, Faillace RT, Taub CC. Racial differences of heart failure with midrange ejection fraction (HFmrEF): a large urban centre-based retrospective cohort study in the USA. BMJ Open 2019; 9:e026479. [PMID: 31048442 PMCID: PMC6501992 DOI: 10.1136/bmjopen-2018-026479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES We aimed to study the racial differences in clinical presentations, survival outcomes and outcome predictors among patients with heart failure (HF) with midrange ejection fraction (HFmrEF, EF 40%-49%). DESIGN This is a retrospective study. SETTING Adults with HF diagnosis at Montefiore Medical Center, Bronx, New York between 2008 and 2012, with an inpatient echocardiogram showing left ventricular ejection fraction of 40%-49% were included as HFmrEF population. PARTICIPANTS 1,852 HFmrEF patients are included in the study (56% male, mean age 67 years). There were 493 (26.5%) non-Hispanic whites, 541 (29.2%) non-Hispanic black, 489 (26.4%) Hispanics and 329 (17.8%) other racial populations. OUTCOME MEASURES Cumulative probabilities of all-cause mortality among different racial groups were estimated and multivariable adjusted Cox proportional regressions were performed to assess predictors of mortality. RESULTS Among the HFmrEF patients, white patients were older and were less likely to be on guideline-directed medications. Blacks had a lower prevalence of prior myocardial infarction comparing to other groups. Hispanics had more chronic diseases and yet better survival comparing to whites and blacks after adjustment for age, sex and comorbidities. Distinct sets of survival predictors were revealed in individual racial groups. Baseline use of mineralocorticoid receptor antagonist (MRA) was associated with lower mortality among HFmrEF patients in general (HR 0.61, 95% CI 0.37 to 0.99). CONCLUSIONS There are significant racial/ethnic differences in clinical phenotypes, survival outcomes and mortality predictors of HFmrEF. Furthermore, the use of MRA predicted a reduced mortality in HFmrEF patients.
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Mastoris I, Kokkinidis DG, Bikakis I, Archontakis-Barakakis P, Papanastasiou CA, Jonnalagadda AK, Schizas D, Bakoyiannis C, Palaiodimos L, Faillace RT. Catheter-directed thrombolysis vs. anticoagulation for the prevention and treatment of post-thrombotic syndrome in deep vein thrombosis: An updated systematic review and meta-analysis of randomized trials. Phlebology 2019; 34:675-682. [DOI: 10.1177/0268355519835618] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Oral anticoagulation therapy was the mainstay of deep vein thrombosis treatment but recently, catheter-directed thrombolysis has emerged as an alternative. Objective To compare the efficacy and safety of the two strategies. Methods Medline, Embase and Cochrane CENTRAL were reviewed. Outcomes of interest included post-thrombotic syndrome, thromboembolic events, mortality, bleeding risk and iliofemoral patency. A random effects model meta-analysis was performed. Heterogeneity was assessed with I square. Results Four randomized controlled trials (RCTs) including 1005 patients met the inclusion criteria. Catheter-directed thrombolysis was more likely to prevent overall post-thrombotic syndrome compared to anticoagulation only (OR: 0.32; 95% CI: 0.12–0.85; I2=87.2%), and to lead to iliofemoral vein patency (OR: 2.7; 95% CI: 1.08–6.75; I2=55.3%) but no difference was noted in thromboembolic events (OR = 0.5; 95% CI: 0.08–3.02, I2=55.1%), bleeding and mortality rates. Conclusions Catheter-directed thrombolysis can decrease post-thrombotic syndrome rates and improve iliofemoral vein patency compared to anticoagulation when used for the treatment of deep vein thrombosis.
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Waqas M, Bizzocchi LL, Menegus MA, Faillace RT. Coronary Artery Ectasia: An Insight into Intraprocedural and Postprocedural Management Strategies. Cureus 2019; 11:e3928. [PMID: 30931196 PMCID: PMC6430305 DOI: 10.7759/cureus.3928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Coronary artery ectasia (CAE) can present as an acute coronary syndrome (ACS) with a high clot burden in ectatic coronary arteries. Thrombectomy with intracoronary thrombolysis often does not ensure immediate blood flow. Also, there have not been clear guidelines regarding long-term management in such cases. A 40-year-old male presented with anginal chest discomfort and a working diagnosis of non-ST elevation myocardial infarction (NSTEMI) was made. The initial angiography showed thrombotic occlusion of several large and ectatic coronary arteries with visibly swirling blood flow. The culprit lesions were treated with balloon angioplasty and multiple rounds of thrombectomy yielding red thrombi. Interestingly, the post-intervention antegrade flow decreased in both vessels (Thrombolysis in Myocardial Infarction (TIMI) score: 0), possibly because of the distal migration of the clots. Peri-procedure, the patient received two boluses of eptifibatide, 180 mcg/kg each, followed by a continuous infusion of 2 mcg/kg/minute for 18 hours. Afterward, the patient was started on ticagrelor and continued on daily aspirin, high-intensity statin, beta blocker, and Coumadin® with heparin bridge. During the one year follow-up period, the Coumadin was switched to rivaroxaban, ticagrelor was stopped after six months, and the patient was continued on guideline-directed medical therapy (GDMT) for coronary artery disease (CAD) with favorable outcomes. The presented case gives us an insight into not only the intra-procedural but also the post-procedural management of ACS in the setting of CAE, and that is thrombectomy alone followed by longer duration oral anticoagulation in addition to GDMT for CAD. However, it will be interesting to see future studies aimed toward defining the duration as well as the choice of anticoagulation, i.e., dual antiplatelet therapy (DAPT) alone or in combination with warfarin/novel oral anticoagulants (NOACs).
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Kokkinidis DG, Palaiodimos L, Mastoris I, Karamanis D, Faillace RT. The best DEFENSE for high-risk patent foramen ovale: An updated meta-analysis of six randomized trials. Arch Cardiovasc Dis 2018; 112:150-152. [PMID: 30594572 DOI: 10.1016/j.acvd.2018.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 06/12/2018] [Accepted: 06/18/2018] [Indexed: 01/16/2023]
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Kokkinidis DG, Papanastasiou CA, Jonnalagadda AK, Oikonomou EK, Theochari CA, Palaiodimos L, Karvounis HI, Armstrong EJ, Faillace RT, Giannakoulas G. The predictive value of baseline pulmonary hypertension in early and long term cardiac and all-cause mortality after transcatheter aortic valve implantation for patients with severe aortic valve stenosis: A systematic review and meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:859-867. [DOI: 10.1016/j.carrev.2018.03.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/17/2018] [Accepted: 03/14/2018] [Indexed: 11/28/2022]
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Lama von Buchwald C, Faillace RT. Water-bottle heart. Eur Heart J 2018; 39:2431-2432. [DOI: 10.1093/eurheartj/ehy225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Madan N, Christia P, Faillace RT. Cardiac Allograft Vasculopathy: Pathogenesis and Role of Coronary Computed Tomography Angiography in the Diagnosis and Surveillance. ACTA ACUST UNITED AC 2018. [DOI: 10.12970/2311-052x.2018.06.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Palaiodimos L, Kokkinidis DG, Faillace RT, Foley TR, Dangas GD, Price MJ, Mastoris I. Percutaneous closure of patent foramen ovale vs. medical treatment for patients with history of cryptogenic stroke: A systematic review and meta-analysis of randomized controlled trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:852-858. [PMID: 29576519 DOI: 10.1016/j.carrev.2018.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/04/2018] [Accepted: 02/23/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with history of cryptogenic stroke are more likely to have a patent foramen ovale (PFO) and should be managed with antithrombotic agents, while the alternative option is percutaneous closure of PFOs. Our aim was to perform a meta-analysis of randomized controlled trials (RCTs) comparing percutaneous closure vs. medical treatment for patients with PFO and prior cryptogenic stroke. METHODS Medline, Scopus and Cochrane databases were reviewed. A random-effect model meta-analysis was used and I-square was utilized to assess the heterogeneity. New ischemic stroke was defined as the primary endpoint. A sensitivity analysis was performed for Amplatzer device. Subgroup analyses were performed for different patient and PFO characteristics for the composite endpoints as defined by the included RCTs. RESULTS In total of 3440 patients were included in this meta-analysis. Closure devices were superior to medical therapy for prevention of recurrent ischemic strokes (HR = 0.29; CI: 0.02-0.56), but were associated with increased risk of new onset of atrial fibrillation (AF) and atrial flutter (RR = 4.67; CI: 2.22-9.81). However, in the sensitivity analysis for Amplatzer device, there was no difference between the two groups in new onset of atrial arrhythmias. Closure devices were superior across all different subgroups when compared to medical treatment with the exception of patients with a small shunt. CONCLUSION This meta-analysis shows that closure devices for patients with PFO and history of cryptogenic stroke can significantly decrease the risk of a new ischemic stroke. The use of Amplatzer device was not associated with increased risk of newly diagnosed atrial arrhythmias.
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