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Rodenas-Alesina E, Luk A, Gajasan J, Alhussaini A, Martel G, Serrick C, McRae K, Overgaard C, Cypel M, Singer L, Tikkanen J, Keshavjee S, Del Sorbo L. Implications of High Sensitivity Troponin Levels After Lung Transplantation. Transpl Int 2024; 37:12724. [PMID: 38665474 PMCID: PMC11043535 DOI: 10.3389/ti.2024.12724] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024]
Abstract
Trends in high-sensitivity cardiac troponin I (hs-cTnI) after lung transplant (LT) and its clinical value are not well stablished. This study aimed to determine kinetics of hs-cTnI after LT, factors impacting hs-cTnI and clinical outcomes. LT recipients from 2015 to 2017 at Toronto General Hospital were included. Hs-cTnI levels were collected at 0-24 h, 24-48 h and 48-72 h after LT. The primary outcome was invasive mechanical ventilation (IMV) >3 days. 206 patients received a LT (median age 58, 35.4% women; 79.6% double LT). All patients but one fulfilled the criteria for postoperative myocardial infarction (median peak hs-cTnI = 4,820 ng/mL). Peak hs-cTnI correlated with right ventricular dysfunction, >1 red blood cell transfusions, bilateral LT, use of EVLP, kidney function at admission and time on CPB or VA-ECMO. IMV>3 days occurred in 91 (44.2%) patients, and peak hs-cTnI was higher in these patients (3,823 vs. 6,429 ng/mL, p < 0.001 after adjustment). Peak hs-cTnI was higher among patients with had atrial arrhythmias or died during admission. No patients underwent revascularization. In summary, peak hs-TnI is determined by recipient comorbidities and perioperative factors, and not by coronary artery disease. Hs-cTnI captures patients at higher risk for prolonged IMV, atrial arrhythmias and in-hospital death.
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Affiliation(s)
- Eduard Rodenas-Alesina
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Adriana Luk
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - John Gajasan
- Interdepartmental Division of Critical Care Medicine, University Health Network, Toronto, ON, Canada
| | - Anhar Alhussaini
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Genevieve Martel
- Perfusion Services, University Health Network, Toronto, ON, Canada
| | - Cyril Serrick
- Perfusion Services, University Health Network, Toronto, ON, Canada
| | - Karen McRae
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | | | - Marcelo Cypel
- Division of Thoracic Surgery, Faculty of Surgery, University of Toronto, Toronto, ON, Canada
- Toronto Lung Transplant Program, Ajmera Transplant Center, University Health Network, Toronto, ON, Canada
| | - Lianne Singer
- Toronto Lung Transplant Program, Ajmera Transplant Center, University Health Network, Toronto, ON, Canada
- Division of Respirology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jussi Tikkanen
- Toronto Lung Transplant Program, Ajmera Transplant Center, University Health Network, Toronto, ON, Canada
- Division of Respirology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Shaf Keshavjee
- Division of Thoracic Surgery, Faculty of Surgery, University of Toronto, Toronto, ON, Canada
- Toronto Lung Transplant Program, Ajmera Transplant Center, University Health Network, Toronto, ON, Canada
| | - Lorenzo Del Sorbo
- Interdepartmental Division of Critical Care Medicine, University Health Network, Toronto, ON, Canada
- Toronto Lung Transplant Program, Ajmera Transplant Center, University Health Network, Toronto, ON, Canada
- Division of Respirology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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2
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Williams S, Kalakoutas A, Olusanya S, Schrage B, Tavazzi G, Carnicelli AP, Montero S, Vandenbriele C, Luk A, Lim HS, Bhagra S, Ott SC, Farrero M, Samsky MD, Kennedy JLW, Sen S, Agrawal R, Rampersad P, Coniglio A, Pappalardo F, Barnett C, Proudfoot AG. The management of heart failure cardiogenic shock: an international RAND appropriateness panel. Crit Care 2024; 28:105. [PMID: 38566212 PMCID: PMC10988801 DOI: 10.1186/s13054-024-04884-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Observational data suggest that the subset of patients with heart failure related CS (HF-CS) now predominate critical care admissions for CS. There are no dedicated HF-CS randomised control trials completed to date which reliably inform clinical practice or clinical guidelines. We sought to identify aspects of HF-CS care where both consensus and uncertainty may exist to guide clinical practice and future clinical trial design, with a specific focus on HF-CS due to acute decompensated chronic HF. METHODS A 16-person multi-disciplinary panel comprising of international experts was assembled. A modified RAND/University of California, Los Angeles, appropriateness methodology was used. A survey comprising of 34 statements was completed. Participants anonymously rated the appropriateness of each statement on a scale of 1 to 9 (1-3 as inappropriate, 4-6 as uncertain and as 7-9 appropriate). RESULTS Of the 34 statements, 20 were rated as appropriate and 14 were rated as inappropriate. Uncertainty existed across all three domains: the initial assessment and management of HF-CS; escalation to temporary Mechanical Circulatory Support (tMCS); and weaning from tMCS in HF-CS. Significant disagreement between experts (deemed present when the disagreement index exceeded 1) was only identified when deliberating the utility of thoracic ultrasound in the immediate management of HF-CS. CONCLUSION This study has highlighted several areas of practice where large-scale prospective registries and clinical trials in the HF-CS population are urgently needed to reliably inform clinical practice and the synthesis of future societal HF-CS guidelines.
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Affiliation(s)
- Stefan Williams
- Perioperative Medicine Department, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Antonis Kalakoutas
- Perioperative Medicine Department, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Segun Olusanya
- Perioperative Medicine Department, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Benedict Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy
| | - Anthony P Carnicelli
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Santiago Montero
- Acute Cardiovascular Care Unit, Cardiology, Hospital Germans Trias i Pujol, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Adriana Luk
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Hoong Sern Lim
- Department of Cardiology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Sai Bhagra
- Advanced Heart Failure and Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Sascha C Ott
- Department of Cardiac Anesthesiology and Intensive Care Medicine, German Heart Center Berlin, Berlin, Germany
| | | | - Marc D Samsky
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jamie L W Kennedy
- Heart Failure / Transplant Program, Inova Heart and Vascular Institute, Falls Church, VA, USA
| | - Sounok Sen
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Richa Agrawal
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | | | - Amanda Coniglio
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Federico Pappalardo
- Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Christopher Barnett
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Alastair G Proudfoot
- Perioperative Medicine Department, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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Réa ABBAC, Mihajlovic V, Vishram-Nielsen JKK, Brahmbhatt DH, Scolari FL, Wang VN, Nisar M, Fung NL, Otsuki M, Billia F, Overgaard CB, Luk A. Pulmonary Artery Catheter Usage and Impact on Mortality in Patients With Cardiogenic Shock: Results From a Canadian Single-Centre Registry. Can J Cardiol 2024; 40:664-673. [PMID: 38092192 DOI: 10.1016/j.cjca.2023.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Hemodynamic assessment for cardiogenic shock (CS) phenotyping in patients has led to renewed interest in the use of pulmonary artery catheters (PACs). METHODS We included patients admitted with CS from January 2014 to December 2020 and compared clinical outcomes among patients who received PACs and those who did not. The primary outcome was the rate of in-hospital mortality. Secondary outcomes included use of advanced heart failure therapies and coronary intensive care unit (CICU) and hospital lengths of stay. RESULTS A total of 1043 patients were analysed and 47% received PACs. Patients selected for PAC-guided management were younger and had lower left ventricular function. They also had higher use of vasopressor and inotropes, and 15.2% of them were already supported with temporary mechanical circulatory support (MCS). In-hospital mortality was lower in patients who received PACs (29.3% vs 36.2%; P = 0.02), mainly driven by a reduction in mortality among those in Society for Cardiovascular Angiography and Interventions (SCAI) stages D and E CS. Patients who received PACs were more likely to receive temporary MCS with Impella, durable ventricular assist devices (VADs), or orthotopic heart transplantation (OHT) (P < 0.001 for all analyses). CICU and hospital lengths of stay were longer in patients who used PACs. CONCLUSIONS Among patients with CS, the use of PACs was associated with lower in-hospital mortality, especially among those in SCAI stages D and E. Patients who received PACs were also more frequently rescued with temporary MCS or received advanced heart failure therapies, such as durable VADs or OHT.
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Affiliation(s)
- Ana Beatriz B A C Réa
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vesna Mihajlovic
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Darshan H Brahmbhatt
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fernando Luis Scolari
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vicki N Wang
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mahrukh Nisar
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Nicole L Fung
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Madison Otsuki
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Filio Billia
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christopher B Overgaard
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Adriana Luk
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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4
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van Diepen S, Le May MR, Alfaro P, Goldfarb MJ, Luk A, Mathew R, Peretz-Larochelle M, Rayner-Hartley E, Russo JJ, Senaratne JM, Ainsworth C, Belley-Côté E, Fordyce CB, Kromm J, Overgaard CB, Schnell G, Wong GC. Canadian Cardiovascular Society/Canadian Cardiovascular Critical Care Society/Canadian Association of Interventional Cardiology Clinical Practice Update on Optimal Post Cardiac Arrest and Refractory Cardiac Arrest Patient Care. Can J Cardiol 2024; 40:524-539. [PMID: 38604702 DOI: 10.1016/j.cjca.2024.01.012] [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] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 04/13/2024] Open
Abstract
Survival to hospital discharge among patients with out-of-hospital cardiac arrest (OHCA) is low and important regional differences in treatment practices and survival have been described. Since the 2017 publication of the Canadian Cardiovascular Society's position statement on OHCA care, multiple randomized controlled trials have helped to better define optimal post cardiac arrest care. This working group provides updated guidance on the timing of cardiac catheterization in patients with ST-elevation and without ST-segment elevation, on a revised temperature control strategy targeting normothermia instead of hypothermia, blood pressure, oxygenation, and ventilation parameters, and on the treatment of rhythmic and periodic electroencephalography patterns in patients with a resuscitated OHCA. In addition, prehospital trials have helped craft new expert opinions on antiarrhythmic strategies (amiodarone or lidocaine) and outline the potential role for double sequential defibrillation in patients with refractory cardiac arrest when equipment and training is available. Finally, we advocate for regionalized OHCA care systems with admissions to a hospital capable of integrating their post OHCA care with comprehensive on-site cardiovascular services and provide guidance on the potential role of extracorporeal cardiopulmonary resuscitation in patients with refractory cardiac arrest. We believe that knowledge translation through national harmonization and adoption of contemporary best practices has the potential to improve survival and functional outcomes in the OHCA population.
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Affiliation(s)
- Sean van Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Michel R Le May
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Patricia Alfaro
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Michael J Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Adriana Luk
- Division of Cardiology, Department of Medicine, University of Toronto and the Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Rebecca Mathew
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Maude Peretz-Larochelle
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Erin Rayner-Hartley
- Royal Columbian Hospital, Division of Cardiology, University of British Columbia, New Westminster, British Columbia, Canada
| | - Juan J Russo
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Janek M Senaratne
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Craig Ainsworth
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Emilie Belley-Côté
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Christopher B Fordyce
- Division of Cardiology, Department of Medicine, Vancouver General Hospital and the Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julie Kromm
- Department of Critical Care, Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Christopher B Overgaard
- Division of Cardiology, Department of Medicine, University of Toronto and the Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Gregory Schnell
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Graham C Wong
- Division of Cardiology, Department of Medicine, Vancouver General Hospital and the Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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5
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Rodenas-Alesina E, Brahmbhatt DH, Mak S, Ross HJ, Luk A, Rao V, Billia F. Value of Invasive Hemodynamic Assessments in Patients Supported by Continuous-Flow Left Ventricular Assist Devices. JACC Heart Fail 2024; 12:16-27. [PMID: 37804313 DOI: 10.1016/j.jchf.2023.08.019] [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] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/14/2023] [Accepted: 08/22/2023] [Indexed: 10/09/2023]
Abstract
Left ventricular assist devices (LVADs) are increasingly used in patients with end-stage heart failure (HF). There is a significant risk of HF admissions and hemocompatibility-related adverse events that can be minimized by optimizing the LVAD support. Invasive hemodynamic assessment, which is currently underutilized, allows personalization of care for patients with LVAD, and may decrease the need for recurrent hospitalizations. It also aids in triaging patients with persistent low-flow alarms, evaluating reversal of pulmonary vasculature remodeling, and assessing right ventricular function. In addition, it can assist in determining the precipitant for residual HF symptoms and physical limitation during exercise and is the cornerstone of the assessment of myocardial recovery. This review provides a comprehensive approach to the use of invasive hemodynamic assessments in patients supported with LVADs.
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Affiliation(s)
- Eduard Rodenas-Alesina
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Darshan H Brahmbhatt
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Mount Sinai Hospital, Toronto Ontario, Canada
| | - Susanna Mak
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Mount Sinai Hospital, Toronto Ontario, Canada
| | - Heather J Ross
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Adriana Luk
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vivek Rao
- Division of Cardiac Surgery, Peter Munk Cardiac Center, University Health Network, Toronto, Ontario, Canada
| | - Filio Billia
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Florica IT, Santi ND, Nguyen ET, Luk A. Chronic Ventricular Septal Defect and Retained Bullet After Gunshot: Best Not to Reopen Old Wounds. JACC Case Rep 2023; 18:101924. [PMID: 37545675 PMCID: PMC10401112 DOI: 10.1016/j.jaccas.2023.101924] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/25/2023] [Indexed: 08/08/2023]
Abstract
Penetrating cardiac trauma from gunshots is usually fatal. We describe the case of a 62-year-old male presenting with ST-segment elevation myocardial infarction. A retained bullet embedded into the left ventricle was identified incidentally along with a ventricular septal defect from a gunshot wound decades prior. The ventricular septal defect and retained bullet were managed conservatively. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Ioana Tereza Florica
- Department of Internal Medicine, Kingston Health Sciences Center, Queen’s University, Kingston, Ontario, Canada
| | - Nicolas D. Santi
- Division of Cardiology, Toronto General Hospital/University Health Network, Toronto, Ontario, Canada
| | - Elsie T. Nguyen
- Department of Medical Imaging, Peter Munk Cardiac Center, Toronto General Hospital, Toronto, Ontario, Canada
| | - Adriana Luk
- Division of Cardiology, Toronto General Hospital/University Health Network, Toronto, Ontario, Canada
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7
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Rodenas-Alesina E, Luis Scolari F, Wang VN, Brahmbhatt DH, Mihajlovic V, Fung NL, Otsuki M, Billia F, Overgaard CB, Luk A. Improved mortality and haemodynamics with milrinone in cardiogenic shock due to acute decompensated heart failure. ESC Heart Fail 2023. [PMID: 37322827 PMCID: PMC10375068 DOI: 10.1002/ehf2.14379] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 01/09/2023] [Accepted: 03/30/2023] [Indexed: 06/17/2023] Open
Abstract
AIMS Studies in cardiogenic shock (CS) often have a heterogeneous population of patients, including those with acute myocardial infarction and acute decompensated heart failure (ADHF-CS). The therapeutic profile of milrinone may benefit patients with ADHF-CS. We compared the outcomes and haemodynamic trends in ADHF-CS receiving either milrinone or dobutamine. METHODS AND RESULTS Patients presenting with ADHF-CS (from 2014 to 2020) treated with a single inodilator (milrinone or dobutamine) were included in this study. Clinical characteristics, outcomes, and haemodynamic parameters were collected. The primary endpoint was 30 day mortality, with censoring at the time of transplant or left ventricular assist device implantation. A total of 573 patients were included, of which 366 (63.9%) received milrinone and 207 (36.1%) received dobutamine. Patients receiving milrinone were younger, had better kidney function, and lower lactate at admission. In addition, patients receiving milrinone received mechanical ventilation or vasopressors less frequently, whereas a pulmonary artery catheter was more frequently used. Milrinone use was associated with a lower adjusted risk of 30 day mortality (hazard ratio = 0.52, 95% confidence interval 0.35-0.77). After propensity-matching, the use of milrinone remained associated with a lower mortality (hazard ratio = 0.51, 95% confidence interval 0.27-0.96). These findings were associated with improved pulmonary artery compliance, stroke volume, and right ventricular stroke work index. CONCLUSIONS The use of milrinone compared with dobutamine in patients with ADHF-CS is associated with lower 30 day mortality and improved haemodynamics. These findings warrant further study in future randomized controlled trials.
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Affiliation(s)
- Eduard Rodenas-Alesina
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Fernando Luis Scolari
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Vicki N Wang
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Darshan H Brahmbhatt
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Vesna Mihajlovic
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Nicole L Fung
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Madison Otsuki
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Filio Billia
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Christopher B Overgaard
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Adriana Luk
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
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Réa ABBAC, Luk A. Incident Myocarditis in Patients Recovered From COVID-19: Is There a Cause for Concern? Can J Cardiol 2023; 39:845-848. [PMID: 36731606 PMCID: PMC9886388 DOI: 10.1016/j.cjca.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 12/29/2022] [Accepted: 01/01/2023] [Indexed: 02/01/2023] Open
Affiliation(s)
- Ana Beatriz B A C Réa
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Adriana Luk
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
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9
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Fordyce CB, Kramer AH, Ainsworth C, Christenson J, Hunter G, Kromm J, Lopez Soto C, Scales DC, Sekhon M, van Diepen S, Dragoi L, Josephson C, Kutsogiannis J, Le May MR, Overgaard CB, Savard M, Schnell G, Wong GC, Belley-Côté E, Fantaneanu TA, Granger CB, Luk A, Mathew R, McCredie V, Murphy L, Teitelbaum J. Neuroprognostication in the Post Cardiac Arrest Patient: A Canadian Cardiovascular Society Position Statement. Can J Cardiol 2023; 39:366-380. [PMID: 37028905 DOI: 10.1016/j.cjca.2022.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 04/08/2023] Open
Abstract
Cardiac arrest (CA) is associated with a low rate of survival with favourable neurologic recovery. The most common mechanism of death after successful resuscitation from CA is withdrawal of life-sustaining measures on the basis of perceived poor neurologic prognosis due to underlying hypoxic-ischemic brain injury. Neuroprognostication is an important component of the care pathway for CA patients admitted to hospital but is complex, challenging, and often guided by limited evidence. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to evaluate the evidence underlying factors or diagnostic modalities available to determine prognosis, recommendations were generated in the following domains: (1) circumstances immediately after CA; (2) focused neurologic exam; (3) myoclonus and seizures; (4) serum biomarkers; (5) neuroimaging; (6) neurophysiologic testing; and (7) multimodal neuroprognostication. This position statement aims to serve as a practical guide to enhance in-hospital care of CA patients and emphasizes the adoption of a systematic, multimodal approach to neuroprognostication. It also highlights evidence gaps.
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Affiliation(s)
- Christopher B Fordyce
- Division of Cardiology, Department of Medicine, Vancouver General Hospital, and the Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia.
| | - Andreas H Kramer
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta; Department of Critical Care, University of Calgary, Alberta
| | - Craig Ainsworth
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jim Christenson
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia
| | - Gary Hunter
- Division of Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Julie Kromm
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta; Department of Critical Care, University of Calgary, Alberta
| | - Carmen Lopez Soto
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Damon C Scales
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mypinder Sekhon
- Division of Critical Care, Department of Medicine, Vancouver General Hospital, Djavad Mowafaghian Centre for Brain Health, International Centre for Repair Discoveries, University of British Columbia, Vancouver, British Columbia
| | - Sean van Diepen
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta; Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Laura Dragoi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Colin Josephson
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta; Department of Critical Care, University of Calgary, Alberta
| | - Jim Kutsogiannis
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta
| | - Michel R Le May
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Christopher B Overgaard
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Martin Savard
- Department of Neurological Sciences CHU de Québec - Hôpital de l'Enfant-Jésus Quebec City, Quebec, Canada
| | - Gregory Schnell
- Division of Cardiology, Department of Medicine, University of Calgary, Calgary, Alberta
| | - Graham C Wong
- Division of Cardiology, Department of Medicine, Vancouver General Hospital, and the Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia
| | - Emilie Belley-Côté
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Tadeu A Fantaneanu
- Division of Neurology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Adriana Luk
- Division of Cardiology, Department of Medicine, University of Toronto and the Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, and the Faculty of Medicine, Division of Critical Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Victoria McCredie
- Interdepartmental Division of Critical Care Medicine, University of Toronto, the Krembil Research Institute, Toronto Western Hospital, University Health Network, and Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Laurel Murphy
- Departments of Emergency Medicine and Critical Care, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeanne Teitelbaum
- Neurological Intensive Care Unit, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
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Rodenas-Alesina E, Luk A, Gajasan J, Alhussaini A, Overgaard C, Martel G, Serrick C, McRae K, Cypel M, Singer L, Tikkanen J, Keshavjee S, Sorbo LD. Prognostic Significance of Serial Troponin Measurement after Lung Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.731] [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: 04/05/2023] Open
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11
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Roston TM, So DY, Liu S, Fordyce CB, Grunau B, Jentzer JC, Bagai A, Luk A, Goodman SG, van Diepen S. Leveraging Existing STEMI Networks to Regionalize Cardiogenic Shock Systems of Care: Efforts to Expand the Scope Could Improve Shock Outcomes. Can J Cardiol 2022; 39:427-431. [PMID: 36402241 DOI: 10.1016/j.cjca.2022.11.005] [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] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Thomas M Roston
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Derek Y So
- University of Ottawa Heart Institute, Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Shuangbo Liu
- Section of Cardiology, St Boniface Hospital, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christopher B Fordyce
- Division of Cardiology and Centre for Cardiovascular Innovation, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Grunau
- Departments of Emergency Medicine, University of British Columbia and the Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Akshay Bagai
- Division of Cardiology, St Michaels Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Adriana Luk
- Division of Cardiology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Shaun G Goodman
- Division of Cardiology, St Michaels Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian VIGOUR Centre, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sean van Diepen
- Canadian VIGOUR Centre, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada.
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12
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Szekely Y, Luk A, Lawler PR. Emerging biomarkers for risk stratification in cardiogenic shock: steps closer to precision? Eur Heart J Acute Cardiovasc Care 2022; 11:739-741. [PMID: 36166348 DOI: 10.1093/ehjacc/zuac112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Yishay Szekely
- Peter Munk Cardiac Centre and Ted Rogers Centre for Heart Research, University Health Network, 585 University Ave, Toronto, ON M5G 2N2, Canada
- Division of Cardiology, Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, Toronto, ON, M5S 3H2, Canada
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, 6 Weizmann St, Tel Aviv, 6423906, Israel
| | - Adriana Luk
- Peter Munk Cardiac Centre and Ted Rogers Centre for Heart Research, University Health Network, 585 University Ave, Toronto, ON M5G 2N2, Canada
- Division of Cardiology, Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, Toronto, ON, M5S 3H2, Canada
| | - Patrick R Lawler
- Peter Munk Cardiac Centre and Ted Rogers Centre for Heart Research, University Health Network, 585 University Ave, Toronto, ON M5G 2N2, Canada
- Division of Cardiology, Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, Toronto, ON, M5S 3H2, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, 6 Queen's Park Crescent West, Toronto, ON, M5S 3H2, Canada
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So DYF, Bagai A, van Diepen S, Fordyce CB, Liu S, Avram R, Russo J, Shah AH, Tanguay JF, Goodman SG, Luk A. A Pan-Canadian Survey of Cardiogenic Shock Management: A Report From the Canadian Cardiovascular Research Collaboratory (C3) Cardiogenic Shock Working Group. Can J Cardiol 2022; 38:1732-1735. [PMID: 35940456 DOI: 10.1016/j.cjca.2022.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Derek Y F So
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Akshay Bagai
- Division of Cardiology, St Michaels Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sean van Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Centre, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Christopher B Fordyce
- Division of Cardiology and Centre for Cardiovascular Innovation, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shuangbo Liu
- Section of Cardiology, St Boniface Hospital, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert Avram
- Montreal Heart Institute, Division of Cardiology, Université de Montreal, Montreal, Quebec, Canada
| | - Juan Russo
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ashish H Shah
- Section of Cardiology, St Boniface Hospital, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jean-Francois Tanguay
- Montreal Heart Institute, Division of Cardiology, Université de Montreal, Montreal, Quebec, Canada
| | - Shaun G Goodman
- Division of Cardiology, St Michaels Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian VIGOUR Centre, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Adriana Luk
- Division of Cardiology, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Elfassy M, Gewarges M, Bagga A, Basuita M, Bennett S, Janusonis I, McLean B, Nadarajah S, Osei-Yeboah C, Rosh J, Sklar J, Tanaka D, Teitelbaum D, Scales D, Luk A, Dorian P. ARE BEST PRACTICE GUIDELINES INFORMING WITHDRAWAL OF LIFE SUSTAINING THERAPY FOLLOWED AFTER CARDIAC ARREST? Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.011] [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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Tehrani BN, Drakos SG, Billia F, Batchelor WB, Luk A, Stelling K, Tonna J, Rosner C, Hanff T, Rao V, Brozzi NA, Baran DA. The Multicenter Collaborative to Enhance Biologic Understanding, Quality, and Outcomes in Cardiogenic Shock (VANQUISH Shock): Rationale and Design. Can J Cardiol 2022; 38:1286-1295. [PMID: 35288292 PMCID: PMC10625804 DOI: 10.1016/j.cjca.2022.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/27/2022] [Accepted: 03/07/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Despite efforts to advance therapies in cardiogenic shock (CS), outcomes remain poor. This is likely due to several factors, including major gaps in our understanding of the pathophysiology, phenotyping of patients, and challenges with conducting adequately powered clinical studies. An unmet need exists for a comprehensive multicentre "all-comers" prospective registry to facilitate characterising contemporary presentation, treatment (in a device-agnostic fashion), and short- and intermediate-term outcomes and quality of life (QOL) of CS patients. METHODS The Multicenter Collaborative to Enhance Biological Understanding, Quality and Outcomes in Cardiogenic Shock (VANQUISH Shock) registry is a prospective observational registry that will study unrestricted adult patients with a primary diagnosis of CS at 4 North American centres with multidisciplinary shock programs. Both acute myocardial infarction (AMI-CS) and acute heart failure (HF-CS) etiologies will be included, and the registry will be device agnostic and widely inclusive. The primary end point will be survival at 30 days after hospital discharge. Secondary outcomes will include in-hospital adverse events and survival to 6 and 12 months. Patients will also undergo neurologic and health-related QOL assessments with the Cerebral Performance Category (CPC) and Short-Form 36 (SF-36) health survey tools before discharge and during follow-up. Serial biospecimens will facilitate biomarker studies. CONCLUSIONS The VANQUISH Shock registry provides a unique opportunity to study the pathophysiology, contemporary management, clinical course, and outcomes of CS. By capturing detailed and high-quality longitudinal data, the registry will address existing knowledge gaps and serve as a springboard for future mechanistic clinical studies to advance the field.
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Affiliation(s)
| | | | - Filio Billia
- Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada.
| | | | - Adriana Luk
- Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kelly Stelling
- Sentara Norfolk General Hospital, Norfolk, Virginia, USA
| | | | | | | | - Vivek Rao
- Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nicolas A Brozzi
- Cleveland Clinic Heart, Vascular, and Thoracic Institute, Weston, Florida, USA
| | - David A Baran
- Cleveland Clinic Heart, Vascular, and Thoracic Institute, Weston, Florida, USA.
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16
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Manshadi SD, Eisenberg N, Montbriand J, Luk A, Roche-Nagle G. Vascular Complications with Intra-Aortic Balloon Pump (IABP) – Experience from a large Canadian metropolitan centre. CJC Open 2022; 4:989-993. [DOI: 10.1016/j.cjco.2022.08.008] [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] [Received: 01/31/2022] [Accepted: 08/02/2022] [Indexed: 10/15/2022] Open
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17
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Aleksova N, Fan CPS, Foroutan F, Moayedi Y, Posada JD, Guinty CM, Luk A, Stehlik J, Ross HJ, Alba AC. Predicted heart mass for size matching in obese heart transplant donors and recipients. Clin Transplant 2022; 36:e14744. [PMID: 35770834 DOI: 10.1111/ctr.14744] [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: 05/24/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Predicted heart mass (PHM) was neither derived nor evaluated in an obese population. Our objective was to evaluate size mismatch using actual body weight or IBW-adjusted PHM on mortality and risk assessment. METHODS We conducted a retrospective cohort study of adult recipients with BMI ≥30 kg/m2 or recipients of donors with BMI≥30 kg/m2 from the ISHLT registry. We used multivariable Cox proportional hazard models to evaluate 30 day and 1-year mortality. The 2 models were compared using net reclassification index. RESULTS 10,817 HT recipients, age 55 (IQR 46-62) years, 23% female, BMI 31 kg/m2 (IQR 28-33) were included. Donors were age 34 (IQR 24-44) years, 31% female, and BMI 31 kg/m2 (IQR 26-34). There was a significant non-linear association between mortality and actual PHM but not IBW-adjusted PHM. Undersizing using actual PHM was associated with higher 30-day and 1-year mortality (p<0.01), not seen with IBW-adjusted PHM. Actual PHM better risk classified 0.6% (95% CI 0.3-0.8%) patients compared to IBW-adjusted PHM. CONCLUSION Actual PHM can be used for size matching when assessing mortality risk in obese recipients or recipients of obese donors. There is no advantage to re-calculating PHM using IBW to define candidate risk at the time of organ allocation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Natasha Aleksova
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Chun-Po S Fan
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Canada
| | - Farid Foroutan
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Canada
| | - Yas Moayedi
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Juan Duero Posada
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Canada
| | | | - Adriana Luk
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Josef Stehlik
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, USA
| | - Heather J Ross
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Ana C Alba
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Canada
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Malik A, Gewarges M, Pezzutti O, Allan KS, Samman A, Akioyamen LE, Ruiz M, Brijmohan A, Basuita M, Tanaka D, Scales D, Luk A, Lawler P, Kalra S, Dorian P. Association between sex and survival after non-traumatic out of hospital cardiac arrest: A systematic review and meta-analysis. Resuscitation 2022; 179:172-182. [PMID: 35728744 DOI: 10.1016/j.resuscitation.2022.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Existing studies have shown conflicting results regarding the relationship of sex with survival after out of hospital cardiac arrest (OHCA). This systematic review evaluates the association of female sex with survival to discharge and survival to 30 days after non-traumatic OHCA. METHODS We searched Medline, Embase, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews from inception through June 2021 for studies evaluating female sex as a predictor of survival in adult patients with non-traumatic cardiac arrest. Random-effects inverse variance meta-analyses were performed to calculate pooled odds ratios (ORs) with 95% confidence intervals (CI). The GRADE approach was used to assess evidence quality. RESULTS Thirty studies including 1,068,788 patients had female proportion of 41%. There was no association for female sex with survival to discharge (OR 1.03, 95% CI 0.95-1.12; I2=89%). Subgroup analysis of low risk of bias studies demonstrated increased survival to discharge for female sex (OR 1.20, 95% CI 1.18-1.23; I2=0%) and with high certainty, the absolute increase in survival was 2.2% (95% CI 0.1%-3.6%). Female sex was not associated with survival to 30 days post-OHCA (OR 1.02, 95% CI 0.92-1.14; I2=79%). CONCLUSIONS In adult patients experiencing OHCA, with high certainty in the evidence from studies with low risk of bias, female sex had a small absolute difference for the outcome survival to discharge and no difference in survival at 30 days. Future models that aim to stratify risk of survival post-OHCA should focus on sex-specific factors as opposed to sex as an isolated prognostic factor.
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Affiliation(s)
- Abdullah Malik
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mena Gewarges
- Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada
| | - Olivia Pezzutti
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Anas Samman
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Leo E Akioyamen
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael Ruiz
- Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada
| | - Angela Brijmohan
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Manpreet Basuita
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dustin Tanaka
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Damon Scales
- Division of Critical Care, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Adriana Luk
- Division of Cardiology, Toronto General Hospital, Toronto, ON, Canada
| | - Patrick Lawler
- Division of Cardiology, Toronto General Hospital, Toronto, ON, Canada
| | - Sanjog Kalra
- Division of Cardiology, Toronto General Hospital, Toronto, ON, Canada
| | - Paul Dorian
- Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada.
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Rodenas-Alesina E, Wang VN, Brahmbhatt DH, Scolari FL, Mihajlovic V, Fung NL, Otsuki M, Billia F, Overgaard CB, Luk A. CALL-K score: predicting the need for renal replacement therapy in cardiogenic shock. Eur Heart J Acute Cardiovasc Care 2022; 11:377-385. [PMID: 35303055 DOI: 10.1093/ehjacc/zuac024] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/07/2022] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
AIMS The clinical predictors and outcomes of patients with cardiogenic shock (CS) requiring renal replacement therapy (RRT) have not been studied previously. This study assesses the impact of RRT on mortality in patients with CS and aims to identify clinical factors that contribute to the need of RRT. METHODS AND RESULTS Consecutive patients presenting with CS were included from a prospective registry of cardiac intensive care unit admissions at a single institution between 2014 and 2020. Of the 1030 patients admitted with CS, 123 (11.9%) received RRT. RRT was associated with higher 1-year mortality [adjusted hazard ratio = 1.62, 95% confidence interval (CI) 1.02-2.14], and a higher in-hospital incidence of sepsis [risk ratio = 2.76, P < 0.001], and pneumonia (risk ratio = 2.9, P = 0.001). Those who received RRT were less likely to receive guideline-directed medical treatment at time of discharge, undergo heart transplantation (2.4% vs. 11.5%, P = 0.002) or receive a durable left ventricular assist device (0.0% vs. 11.6%, P < 0.001). Five variables at admission best predicted the need for RRT (age, lactate, haemoglobin, use of pre-admission loop diuretics, and admission estimated glomerular filtration rate) and were used to generate the CALL-K 9-point risk score, with better discrimination than creatinine alone (P = 0.008). The score was internally validated (area under the curve = 0.815, 95% CI 0.739-0.835) with good calibration (Hosmer-Lemeshow P = 0.827). CONCLUSIONS RRT is associated with worse outcomes, including a lower likelihood to receive advanced heart failure therapies in patients with CS. A risk score comprising five variables routinely collected at admission can accurately estimate the risk of needing RRT.
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Affiliation(s)
- Eduard Rodenas-Alesina
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Avenue, 4N 478, Toronto, ON M5G 2N2, Canada
- Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Vicki N Wang
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Avenue, 4N 478, Toronto, ON M5G 2N2, Canada
- Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Darshan H Brahmbhatt
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Avenue, 4N 478, Toronto, ON M5G 2N2, Canada
- Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, ON M5G 1X8, Canada
- National Heart & Lung Institute, Imperial College London, Royal Brompton Campus, Dovehouse Street, London, SW3 6LY, UK
| | - Fernando Luis Scolari
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Avenue, 4N 478, Toronto, ON M5G 2N2, Canada
- Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Vesna Mihajlovic
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Avenue, 4N 478, Toronto, ON M5G 2N2, Canada
- Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Nicole L Fung
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Avenue, 4N 478, Toronto, ON M5G 2N2, Canada
| | - Madison Otsuki
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Avenue, 4N 478, Toronto, ON M5G 2N2, Canada
| | - Filio Billia
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Avenue, 4N 478, Toronto, ON M5G 2N2, Canada
- Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Christopher B Overgaard
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Avenue, 4N 478, Toronto, ON M5G 2N2, Canada
- Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, ON M5G 1X8, Canada
- Southlake Regional Health Centre, 596 Davis Dr, Newmarket, ON L3Y 2P9, Canada
| | - Adriana Luk
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Avenue, 4N 478, Toronto, ON M5G 2N2, Canada
- Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, ON M5G 1X8, Canada
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Gewarges M, Amad H, Luk A. From Bedside to Balloon: The Challenges of In-Hospital ST-Elevation Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2022; 15:e008688. [PMID: 35698972 DOI: 10.1161/circoutcomes.121.008688] [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)
- Mena Gewarges
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada. Department of Medicine, University of Toronto, Toronto ON, Canada
| | - Hani Amad
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada. Department of Medicine, University of Toronto, Toronto ON, Canada
| | - Adriana Luk
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada. Department of Medicine, University of Toronto, Toronto ON, Canada
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21
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Broda CR, Alonso-Gonzalez R, Ghanekar A, Gulamhusein A, McDonald M, Luk A, Kobulnik J, Billia F, Heggie J, Jariani M, Honjo O, Barron D, Hickey E, Roche SL. Fate of the liver in the survivors of adult heart transplant for a failing Fontan circulation. J Heart Lung Transplant 2021; 41:283-286. [PMID: 34953719 DOI: 10.1016/j.healun.2021.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/02/2021] [Revised: 09/23/2021] [Accepted: 10/31/2021] [Indexed: 02/07/2023] Open
Abstract
The Fontan circulation has inherent long-term vulnerabilities such that adult Fontan patients now comprise the largest, most rapidly growing subgroup of adult congenital heart disease referred for transplant assessment. Almost all have Fontan Associated Liver Disease (FALD). There is an absence of mid to late hepatic outcome data after heart transplant alone. Therefore, we analyzed outcomes of survivors of heart only transplant in patients with failing Fontan circulation. Including all 10 of our adult Fontan patients surviving >1 year after isolated heart transplant, we report evolution of their clinical features, bloodwork, hemodynamic data, and liver ultrasound findings over a median of 4.7 years. Nonprogression of FALD, resolution of ascites and freedom from hepatocellular carcinoma in the mid-term highlight the outcomes in this selected group once normal cardiac output and venous pressures are established by heart transplant.
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Affiliation(s)
- Christopher R Broda
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Pediatric and Adult Congenital Heart Disease, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Rafael Alonso-Gonzalez
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anand Ghanekar
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Aliya Gulamhusein
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto Centre for Liver Disease, Francis Family Liver Clinic, University Health Network, Toronto, Ontario, Canada
| | - Michael McDonald
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Adriana Luk
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jeremy Kobulnik
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Filio Billia
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jane Heggie
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marjan Jariani
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Osami Honjo
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David Barron
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Edward Hickey
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Pediatric and Adult Congenital Heart Disease, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Susan L Roche
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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22
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Luk A, Clarke B, Dahdah N, Ducharme A, Krahn A, McCrindle B, Mizzi T, Naus M, Udell JA, Virani S, Zieroth S, McDonald M. Myocarditis and Pericarditis following COVID-19 mRNA Vaccination: Practical Considerations for Care Providers. Can J Cardiol 2021; 37:1629-1634. [PMID: 34375696 PMCID: PMC8349442 DOI: 10.1016/j.cjca.2021.08.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/01/2021] [Accepted: 08/01/2021] [Indexed: 01/06/2023] Open
Abstract
The mRNA vaccines against COVID-19 infection have been effective in reducing the number of symptomatic cases worldwide. With widespread uptake, case series of vaccine-related myocarditis/pericarditis have been reported, particularly in adolescents and young adults. Men tend to be affected with greater frequency, and symptom onset is usually within 1 week after vaccination. Clinical course appears to be mild in most cases. On the basis of the available evidence, we highlight a clinical framework to guide providers on how to assess, investigate, diagnose, and report suspected and confirmed cases. In any patient with highly suggestive symptoms temporally related to COVID-19 mRNA vaccination, standardized workup includes serum troponin measurement and polymerase chain reaction testing for COVID-19 infection, routine additional lab work, and a 12-lead electrocardiogram. Echocardiography is recommended as the imaging modality of choice for patients with unexplained troponin elevation and/or pathologic electrocardiogram changes. Cardiovascular specialist consultation and hospitalization should be considered on the basis of the results of standard investigations. Treatment is largely supportive, and myocarditis/pericarditis that is diagnosed according to defined clinical criteria should be reported to public health authorities in every jurisdiction. Finally, we recommend COVID-19 vaccination in all individuals in accordance with the Health Canada and National Advisory Committee on Immunization guidelines. In patients with suspected myocarditis/pericarditis after the first dose of an mRNA vaccine, deferral of a second dose is recommended until additional reports become available.
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Affiliation(s)
- Adriana Luk
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Brian Clarke
- Libin Cardiovascular Institute, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, Department of Pediatrics, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada
| | - Anique Ducharme
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Andrew Krahn
- Center for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian McCrindle
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Trent Mizzi
- Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Monika Naus
- Communicable Diseases and Immunization Service, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacob A Udell
- Division of Cardiology, Women's College Hospital and Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Sean Virani
- Center for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Michael McDonald
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
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23
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Lee S, Luk A, Kailash Y, Chaplin B. 541 Investigation of Suspected Prostate Cancer In UK; Evaluation of Local Practice and Feasibility of Moving Towards MRI As First Line Investigation – Re-Audit Following Change of Radiology Staffing. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.449] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
NICE recommends MRI as first-line investigation for suspected clinically localised prostate cancer (PCa); previous local audit findings suggest this to be safe and feasible to implement. Recent retirement of radiology staffing however had resulted in MRIs being reported by teleconsultation radiology service. There were concerns on whether this may lead to more missed significant PCa. We performed a re-audit on our prostate MRI and biopsy to assess if this is indeed the case.
Method
All patients with suspected PCa who have had prostate MRI and biopsy simultaneously from April-August 2019 were retrospectively analysed.
Results
222 men were included. 36% of patients with negative MRI had positive biopsies; within this group 25% had significant disease (Gleason grade group ≥2). Compared with our previous audit, specificity for significant PCa has increased (from 34% to 46%), but with a reduced negative predictive value (from 97% to 91%).
Conclusions
If we are to implement MRI as first-line triage for potential subsequent biopsy, it would result in more men not going for a biopsy (from 18% to 25%), a reduction in diagnosis of non-significant PCa (from 21% to 36%), but at an expense of increase in missed significant PCa (from 3% to 9%).
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Affiliation(s)
- S Lee
- South Tees Hospital NHS Foundation Trust, Middlesbrough, United Kingdom
| | - A Luk
- South Tees Hospital NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Y Kailash
- South Tees Hospital NHS Foundation Trust, Middlesbrough, United Kingdom
| | - B Chaplin
- South Tees Hospital NHS Foundation Trust, Middlesbrough, United Kingdom
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24
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Wang V, Brahmbhatt D, Overgaard C, Luk A. Outcomes for Cardiogenic Shock: Comparison of Patients Transferred from Outside Hospitals with Those Directly Admitted to an Advanced Heart Failure Centre. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.405] [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: 10/21/2022] Open
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25
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Aleksova N, Fan C, Foroutan F, Moayedi Y, Duero Posada J, McGuinty C, Luk A, Stehlik J, Ross H, Alba A. Predicted Heart Mass in Obese Heart Transplant Donors and Recipients: An Analysis of the ISHLT Registry. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.359] [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: 10/21/2022] Open
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26
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Almazroa L, Mihajlovic V, Lawler PR, Luk A. Crossing the chasm: caution for use of angiotensin receptor-neprilysin inhibition in patients with cardiogenic shock- a case report. Eur Heart J Case Rep 2021; 4:1-4. [PMID: 33442637 PMCID: PMC7793177 DOI: 10.1093/ehjcr/ytaa233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/03/2020] [Accepted: 06/30/2020] [Indexed: 12/11/2022]
Abstract
Background Vasoplegia has been reported in patients receiving angiotensin receptor-neprilysin inhibitors (ARNI) with heart failure with reduced ejection fraction (HFrEF). We present a case of vasoplegic shock after initiation of ARNI in a hospitalized 65-year-old man recovering from cardiogenic shock (CS) and acute kidney injury (AKI). Case summary A 65-year-old man with HFrEF presented to a community hospital with CS with evidence of poor perfusion with a lactate of 5.6 mmol/L and creatinine (Cr) 125 µmol/L. He was treated with intravenous furosemide infusion. Subsequently, his lactate normalized but he developed an AKI with a Cr of 176 µmol/L. He was then started on ARNI and beta blockers. Over the next 24 h, he developed a vasoplegic shock necessitating multiple vasopressors and a transfer to a tertiary academic centre. With supportive therapy, his vasoplegic shock improved and he was discharged home. Discussion PARADIGM-HF found that the introduction of an ARNI in patients with ambulatory symptomatic HFrEF reduces the risk of death and heart failure hospitalization. Most recently, PIONEER-HF showed that ARNI reduced N-terminal pro-B-type natriuretic peptide levels at 4 and 8 weeks, without significantly different rates of medication-related adverse effects. However, thus far, no clinical trials have examined the role of ARNI in CS. Our case report highlights the risk of vasoplegic shock caused by initiation of ARNI in patients hospitalized with CS especially in whom renal and hepatic impairment is present.
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Affiliation(s)
- Loai Almazroa
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, 18-365 600 University Avenue, Toronto, ON M5G 1X5, Canada
| | - Vesna Mihajlovic
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, 18-365 600 University Avenue, Toronto, ON M5G 1X5, Canada
| | - Patrick R Lawler
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, 18-365 600 University Avenue, Toronto, ON M5G 1X5, Canada
| | - Adriana Luk
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, 18-365 600 University Avenue, Toronto, ON M5G 1X5, Canada.,Division of Cardiology, Sinai Health System/University Health Network, 18-365 600 University Avenue, Toronto, ON M5G 1X5, Canada
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27
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Zhu X, Ding Y, Yu Y, Wang M, Zhou W, Wang J, Zhu X, Zhang H, Wang M, Chai K, Zhang X, Luk A, Jiang W, Liu S, Zhang Q. A Phase 1 randomized study compare the pharmacokinetics, safety and immunogenicity of HLX02 to reference CN- and EU-sourced trastuzumab in healthy subjects. Cancer Chemother Pharmacol 2020; 87:349-359. [PMID: 33169186 DOI: 10.1007/s00280-020-04196-9] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/26/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE This study evaluated the bioequivalence of China-manufactured biosimilar, HLX02, to reference China (CN)- and European Union (EU)-sourced trastuzumab. METHODS This was a two-part Phase 1 study conducted in healthy Chinese males. Part 1 evaluated the safety of different doses of HLX02 (2, 4, 6 or 8 mg/kg; intravenous infusion over 90 min, n = 3 per group). Part 2, a randomized, double-blind study, investigated the pharmacokinetics (PK), safety and immunogenicity of study drugs (HLX02 [n = 37], CN-trastuzumab [n = 35] or EU-trastuzumab [n = 37] at the dose suggested by Part 1 results). The primary PK endpoint was the area under the serum concentration-time curve from time 0 to infinity (AUCinf). Equivalence was concluded if the 90% confidence interval (CI) for the geometric least squares mean ratio (GLSMR) fell in the equivalence criteria of 0.80-1.25. RESULTS In Part 1, all doses of HLX02 were well tolerated and 6 mg/kg was suggested for Part 2. The GLSMRs and 90% CIs for AUCinf were: 0.950 (0.891-1.013), 0.914 (0.858-0.973) and 0.962 (0.902-1.025) for HLX02 versus CN-trastuzumab, HLX02 versus EU-trastuzumab and CN-trastuzumab versus EU-trastuzumab, respectively. Secondary endpoints comparisons also fell in the equivalence criteria. Treatment-emergent adverse events were reported in 75.7, 86.5 and 70.3% of the subjects in HLX02, CN-trastuzumab, and EU-trastuzumab groups, respectively. No serious adverse events or deaths occurred. No treatment-related anti-drug antibodies were detected. CONCLUSION This study demonstrated comparable safety profiles and PK bioequivalence among HLX02, CN-trastuzumab and EU-trastuzumab in healthy Chinese male subjects. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT02581748, registered at October 19, 2015.
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Affiliation(s)
- X Zhu
- Phase 1 Clinical Trial Laboratory, The First Hospital of Jilin University, Changchun, China
| | - Y Ding
- Phase 1 Clinical Trial Laboratory, The First Hospital of Jilin University, Changchun, China
| | - Y Yu
- Phase 1 Clinical Trial Laboratory, The Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Gusu District, Suzhou, 215004, China
| | - M Wang
- Phase 1 Clinical Trial Laboratory, The Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Gusu District, Suzhou, 215004, China
| | - W Zhou
- Phase 1 Clinical Trial Laboratory, The Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Gusu District, Suzhou, 215004, China
| | - J Wang
- Internal Medicine Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - X Zhu
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - H Zhang
- Phase 1 Clinical Trial Laboratory, The First Hospital of Jilin University, Changchun, China
| | - M Wang
- Phase 1 Clinical Trial Laboratory, The First Hospital of Jilin University, Changchun, China
| | - K Chai
- Shanghai Henlius Biotech, Inc., Shanghai, China
| | - X Zhang
- Shanghai Henlius Biotech, Inc., Shanghai, China
| | - A Luk
- Shanghai Henlius Biotech, Inc., Shanghai, China
| | - W Jiang
- Shanghai Henlius Biotech, Inc., Shanghai, China
| | - S Liu
- Shanghai Henlius Biotech, Inc., Shanghai, China
| | - Q Zhang
- Phase 1 Clinical Trial Laboratory, The Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Gusu District, Suzhou, 215004, China.
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28
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Xu B, Zhang Q, Sun T, Li W, Teng Y, Hu X, Bondarenko I, Adamchuk H, Li Y, Shan B, Cheng J, Wang X, Chen Y, Jiang W, Liu S, Zhang X, Liu E, Luk A, Wang Q, Chai K. HLX02, a China-manufactured trastuzumab biosimilar versus EU-sourced trastuzumab: Results of a global phase 3, randomized, double-blind efficacy and safety comparative study in metastatic breast cancer. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30708-5] [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: 11/25/2022]
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29
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Abstract
(IgG4-RD) is a systemic fibro-inflammatory immune-mediated disease, which has been defined in the past few years. IgG4-RD affects various organs and leads to a variety of clinical manifestations. As it is a relatively newly defined entity, new manifestations are now being recognised and reported. We describe a case involving the cardiovascular system.
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Affiliation(s)
- Marina Pourafkari
- Cardiothoracic Imaging Clinical Fellow, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Prodipto Pal
- Assistant Professor of Pathology, Department of Laboratory Medicine & Pathobiology, University Health Network, Toronto, ON, Canada
| | - Adriana Luk
- Associate Professor of Cardiology, Division of Cardiology, University Health Network, Toronto, ON, Canada
| | - Daniel Ennis
- Rheumatology Clinical Fellow, Department of Rheumatology, University Health Network, Toronto, ON, Canada
| | - Mini Pakkal
- Assistant Professor of Radiology, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Patrik Rogalla
- Professor of Radiology, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
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30
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Zhang Q, Xu B, Sun T, Li W, Teng Y, Hu X, Bondarenko I, Adamchuk H, Li Y, Shan B, Liu S, Jiang W, Zhang X, Luk A, Chai K. 287P Efficacy, safety and pharmacokinetics of a proposed trastuzumab biosimilar HLX02 compared with trastuzumab in metastatic breast cancer: A global phase III study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.389] [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: 10/23/2022] Open
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31
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Kiamanesh O, Luk A, Nesbitt GC, Badiwala M, Mak S. Pericardial waffle for effusive-constrictive pericarditis. ESC Heart Fail 2020; 7:3213-3214. [PMID: 32762001 PMCID: PMC7524110 DOI: 10.1002/ehf2.12926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/13/2020] [Indexed: 11/30/2022] Open
Abstract
We present the case of a 55‐year‐old female marathon runner who presented with progressive exercise intolerance and was diagnosed with effusive‐constrictive pericarditis. Stereotypical findings of this challenging diagnosis are shown by transthoracic echocardiographic and right heart catheterization. We treated the patient with a parietal pericardiectomy and pericardial waffle procedure to relieve a thick and constrictive epicardium.
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Affiliation(s)
- Omid Kiamanesh
- Division of Cardiology, University of Toronto, Toronto, Ontario, Canada.,Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Adriana Luk
- Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Gillian C Nesbitt
- Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Mitesh Badiwala
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Susanna Mak
- Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
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32
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Frankfurter C, Buchan TA, Kobulnik J, Lee DS, Luk A, McDonald M, Ross HJ, Alba AC. Reduced Rate of Hospital Presentations for Heart Failure During the COVID-19 Pandemic in Toronto, Canada. Can J Cardiol 2020; 36:1680-1684. [PMID: 32682855 PMCID: PMC7366087 DOI: 10.1016/j.cjca.2020.07.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 01/25/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has resulted in public health measures and health care reconfigurations likely to have impact on chronic disease care. We aimed to assess the volume and characteristics of patients presenting to hospitals with acute decompensated heart failure (ADHF) during the 2020 COVID-19 pandemic compared with a time-matched 2019 cohort. Patients presenting to hospitals with ADHF from March 1, to April 19, 2020 and 2019 in an urban hospital were examined. Multivariable logistic-regression models were used to evaluate the difference in probability of ADHF-related hospitalization between the 2 years. During the COVID-19 pandemic, a total of 1106 emergency department (ED) visits for dyspnea or peripheral edema were recorded, compared with 800 ED visits in 2019. A decrease in ADHF-related ED visits of 43.5% (14.8%-79.4%, P = 0.002) and ADHF-related admissions of 39.3% (8.6%-78.5%, P = 0.009) was observed compared with 2019. Patients with ADHF presenting to hospitals (n = 128) were similar in age, sex, and comorbidities compared with the 2019 cohort (n = 186); however, a higher proportion had recent diagnoses of heart failure. Upon ED presentation, the relative probability of hospitalization or admission to intensive care was not statistically different. There was a trend toward higher in-hospital mortality in 2020. The decline in ADHF-related hospitalizations raises the timely question of how patients with heart failure are managing beyond the acute-care setting and reinforces the need for public education on the availability and safety of emergency services throughout the COVID-19 pandemic.
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Affiliation(s)
- Claudia Frankfurter
- Peter Munk Cardiac Centre University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tayler A Buchan
- Peter Munk Cardiac Centre University Health Network, Toronto, Ontario, Canada
| | - Jeremy Kobulnik
- Peter Munk Cardiac Centre University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Douglas S Lee
- Peter Munk Cardiac Centre University Health Network, Toronto, Ontario, Canada
| | - Adriana Luk
- Peter Munk Cardiac Centre University Health Network, Toronto, Ontario, Canada
| | - Michael McDonald
- Peter Munk Cardiac Centre University Health Network, Toronto, Ontario, Canada
| | - Heather J Ross
- Peter Munk Cardiac Centre University Health Network, Toronto, Ontario, Canada
| | - Ana C Alba
- Peter Munk Cardiac Centre University Health Network, Toronto, Ontario, Canada.
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33
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Luk A, Wang VN, Almazroa L, Foroutan F, Huebener N, Hillyer AG, Billia F, Ross H, Overgaard CB. Management of Acute Decompensated Heart Failure in the Cardiac Intensive Care Unit: The Importance of Co-management With a Heart Failure Specialist. CJC Open 2020; 2:229-235. [PMID: 32695973 PMCID: PMC7365826 DOI: 10.1016/j.cjco.2020.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Heart failure (HF) is a common reason for admission to the cardiac intensive care unit. We sought to identify the role of an HF consultation service in improving the management of this patient population. Methods We identified all adult patients admitted to the cardiac intensive care unit (2014-2015) at the University Health Network with a diagnosis of acute decompensated HF ± cardiogenic shock (CS). Clinical characteristics and course were recorded. We calculated a propensity score–adjusted association between HF consultation and in-hospital mortality. Results A total of 285 unique patients were identified in our cohort. Of these, 82 (28.7%) died. A total of 150 patients (52.6%) were co-managed by an HF service, and 135 patients (47.3%) were not. Patients who were managed by an HF team were younger (52.5 vs 68.0 years, P < 0.0001), were more likely to be admitted with CS (61.3 vs 41.5%, P < 0.0009), and had higher rates of vasoactive medications during their admission (69.3% vs 52.6%, P < 0.005). At discharge, there were higher rates of discharge to a HF clinic (52.0% vs 27.5%, P < 0.0001) and prescription of guideline-directed medical therapy. In-hospital mortality was lower in those co-managed by a HF team (16.7% vs 42.2%, P < 0.0001). HF consultation reduced the odds of readmission by 76% (odds ratio, 0.24; 95% confidence interval, 0.13-0.47). Conclusions Patients managed by a HF team were more likely to be in CS at admission, to survive to discharge from hospital, and to be initiated on guideline-directed medical therapy with HF follow-up.
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34
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Chow J, Alhussaini A, Calvillo-Argüelles O, Billia F, Luk A. Cardiovascular Collapse in COVID-19 Infection: The Role of Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO). CJC Open 2020; 2:273-277. [PMID: 32363334 PMCID: PMC7194983 DOI: 10.1016/j.cjco.2020.04.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 04/04/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus Disease 2019 (COVID-19) has been associated with cardiovascular complications, including acute cardiac injury, heart failure, and cardiogenic shock (CS). The role of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the event of COVID-19–associated cardiovascular collapse has not been established. We reviewed the existing literature surrounding the role of VA-ECMO in the treatment of coronavirus-related cardiovascular collapse. COVID-19 is associated with a higher incidence of cardiovascular complications compared with previous coronavirus outbreaks (Severe Acute Respiratory Syndrome Coronavirus and Middle East Respiratory Syndrome Coronavirus). We found only 1 case report from China in which COVID-19–associated fulminant myocarditis and CS were successfully rescued using VA-ECMO as a bridge to recovery. We identified potential clinical scenarios (cardiac injury, myocardial infarction with and without obstructive coronary artery disease, viral myocarditis, and decompensated heart failure) leading to CS and risk factors for poor/uncertain benefit (age, sepsis, mixed/predominantly vasodilatory shock, prothrombotic state or coagulopathy, severe acute respiratory distress syndrome, multiorgan failure, or high-risk prognostic scores) specific to using VA-ECMO as a bridge to recovery in COVID-19 infection. Additional considerations and proposed recommendations specific to the COVID-19 pandemic were formulated with guidance from published data and expert consensus. A small subset of patients with cardiovascular complications from COVID-19 infection may progress to refractory CS. While accepting that resource scarcity may be the overwhelming concern for healthcare systems during this pandemic, VA-ECMO can be considered in highly selected cases of refractory CS and echocardiographic evidence of biventricular failure. The decision to initiate this therapy should take into consideration the availability of resources, perceived benefit, and risks of transmitting disease.
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Affiliation(s)
- Justin Chow
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anhar Alhussaini
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Oscar Calvillo-Argüelles
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, Ted Rogers Center for Heart Research, University Health Network, Toronto, Ontario, Canada
| | - Filio Billia
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, Ted Rogers Center for Heart Research, University Health Network, Toronto, Ontario, Canada
- Medical Director, Mechanical Circulatory Support Program, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Adriana Luk
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, Ted Rogers Center for Heart Research, University Health Network, Toronto, Ontario, Canada
- Corresponding author: Dr Adriana Luk, Toronto General Hopsital, 585 University Avenue, Toronto ON M5G 1V7. Tel.: 416-340-4800; fax: 416-340-4134.
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Xu B, Zhang Q, Sun T, Li W, Teng Y, Hu X, Bondarenko I, Adamchuk H, Li Y, Shan B, Cheng J, Peng T, Wang X, Chen Y, Jiang W, Liu S, Zhang X, Liu E, Luk A, Wang Q. First China-manufactured trastuzumab biosimilar HLX02 global phase III trial met primary endpoint in breast cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz446.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hou M, Ho C, Lin H, Jiang W, Liu S, Hong Y, Luk A, Lin S, Hsieh T, Liu E. A novel anti-EGFR antibody HLX07 for potential treatment of squamous cell carcinoma of the head and neck. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz420.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Shi Y, Qin Y, Zhao S, Hu P, Zeng X, Zhang X, Jiang W, Liu S, Liu E, Chai K, Luk A, Yao D. A population pharmacokinetic model: Assessment of pharmacokinetic similarity of HLX01 and rituximab in diffuse large B-cell lymphoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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Chao T, Ho C, Cheng W, Chang C, Hsieh Y, Jiang W, Liu S, Luk A, Lin S, Hsieh T, Liu E. A novel anti-PD-1 antibody HLX10 study led to the initiation of combination immunotherapy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz438.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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39
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Shi Y, Dan Y, Hong Y, Guo J, Zhao S, Zeng X, Hu P, Jiang W, Liu S, Zhang X, Luk A, Chai K, Liu E. A new population model validated pharmacokinetic similarity of HLX01 and rituximab in B-cell lymphoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz251.015] [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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Lau E, Salem A, Chan JCN, So WY, Kong A, Lamotte M, Luk A. Insulin glargine compared to neutral protamine Hagedorn (NPH) insulin in patients with type-2 diabetes uncontrolled with oral anti-diabetic agents alone in Hong Kong: a cost-effectiveness analysis. Cost Eff Resour Alloc 2019; 17:13. [PMID: 31303866 PMCID: PMC6604305 DOI: 10.1186/s12962-019-0180-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 06/21/2019] [Indexed: 12/20/2022] Open
Abstract
Background International guidelines recommend using basal insulin in patients with type-2 diabetes mellitus if glycaemic target cannot be attained on non-insulin anti-diabetic drugs. Available choices of basal insulin include intermediate-acting neutral protamine Hagedorn (NPH) insulin and long-acting insulin analogues like insulin glargine U100. Despite clear advantages of glargine U100, the existing practice in Hong Kong still favours NPH insulin due to lower immediate drug costs. Objectives The objective of this study was to assess the cost-effectiveness of insulin glargine U100 compared to NPH insulin in patients with type-2 diabetes uncontrolled with non-insulin anti-diabetic agents alone in Hong Kong. Methods The IQVIA™ Core Diabetes Model (CDM) v9.0 was used to conduct the cost-effectiveness analysis of glargine U100 versus NPH. Baseline characteristics were collected from the Hong Kong Diabetes Registry. Efficacy rates were extracted from a published study comparing glargine U100 and NPH in Asia, utilities from published literature, and costs constructed using the Hong Kong Hospital Authority (HA) Gazette (public healthcare setting). The primary outcome was an incremental cost-effectiveness ratio (ICER). Results Insulin glargine U100 resulted in an ICER of HKD 98,663 per Quality Adjusted Life Year (QALY) gained. The incremental gains in QALY and costs were 0.217 years and HKD 21,360 respectively. Results from scenario and probabilistic sensitivity analyses were consistent with that from base case analysis. Conclusion Insulin glargine U100 is a cost-effective treatment for patients with type 2 diabetes compared to NPH insulin in setting in Hong Kong. This was mainly driven by the significantly lower rates of hypoglycaemia of insulin glargine U100 than NPH insulin. Electronic supplementary material The online version of this article (10.1186/s12962-019-0180-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR China
| | - A Salem
- IQVIA, Real World Evidence, Zaventem, Belgium
| | - J C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR China
| | - W Y So
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR China
| | - A Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR China
| | - M Lamotte
- IQVIA, Real World Evidence, Zaventem, Belgium
| | - A Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR China
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Bibas L, Peretz-Larochelle M, Adhikari NK, Goldfarb MJ, Luk A, Englesakis M, Detsky ME, Lawler PR. Association of Surrogate Decision-making Interventions for Critically Ill Adults With Patient, Family, and Resource Use Outcomes: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e197229. [PMID: 31322688 PMCID: PMC6646989 DOI: 10.1001/jamanetworkopen.2019.7229] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE Physicians often rely on surrogate decision-makers (SDMs) to make important decisions on behalf of critically ill patients during times of incapacity. It is uncertain whether targeted interventions to improve surrogate decision-making in the intensive care unit (ICU) reduce nonbeneficial treatment and improve SDM comprehension, satisfaction, and psychological morbidity. OBJECTIVE To perform a systematic review and meta-analysis of randomized clinical trials (RCTs) to determine the association of such interventions with patient- and family-centered outcomes and resource use. DATA SOURCES A search was conducted of MEDLINE, Embase, and other relevant databases for potentially relevant studies from inception through May 30, 2018. STUDY SELECTION Randomized clinical trials studying interventions that were targeted at SDMs or family members of critically ill adults in the ICU were included. Key search terms included surrogate or substitute decision-maker, critically ill, randomized controlled trials, and their respective related terms. DATA EXTRACTION AND SYNTHESIS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Two independent, blinded reviewers independently screened citations and extracted data. Random effects models with inverse variance weighting were used to pool outcomes data when possible and otherwise present findings qualitatively. MAIN OUTCOMES AND MEASURES Outcomes of interest were divided into 3 categories: (1) patient-related clinical outcomes (mortality, length of stay [LOS], duration of life-sustaining therapies), (2) SDM and family-related outcomes (comprehension, major change in goals of care, incident psychological comorbidities [posttraumatic stress disorder, anxiety, depression], and satisfaction with care), and (3) use of resources (cost of care and health care resource use). RESULTS Of 3735 studies screened, 13 RCTs were included, comprising a total of 10 453 patients. Interventions were categorized as health care professional led (n = 6), ethics consultation (n = 3), palliative care consultation (n = 2), and media (n = 1 pamphlet and 1 video). No association with mortality was observed (risk ratio, 1.03; 95% CI, 0.98-1.08; P = .22). Intensive care unit LOS was significantly shorter among patients who died (mean difference, -2.11 days; 95% CI, -4.16 to -0.07; P = .04), but not in the overall population (mean difference, -0.79 days; 95% CI, -2.33 to 0.76 days; P = .32). There was no consistent difference in SDM-related outcomes, including satisfaction with care or perceived quality of care (n = 6 studies) and incident psychological comorbidities (depression: ratio of means, -0.11; 95% CI, -0.29 to 0.08; P = .26; anxiety: ratio of means, -0.08; 95% CI, -0.25 to 0.08; P = .31; or posttraumatic stress disorder: ratio of means: -0.04; 95% CI, -0.21 to 0.13; P = .65). Among 6 trials reporting effects on health care resource use, only 1 nurse-led intervention observed a significant reduction in costs ($75 850 control vs $51 060 intervention; P = .04). CONCLUSIONS AND RELEVANCE Systematic interventions aimed at improving surrogate decision-making for critically ill adults may reduce ICU LOS among patients who die in the ICU, without influencing overall mortality. Better understanding of the complex processes related to surrogate decision-making is needed.
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Affiliation(s)
- Lior Bibas
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Maude Peretz-Larochelle
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Neill K. Adhikari
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michael J. Goldfarb
- Division of Cardiology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Adriana Luk
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Marina Englesakis
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Michael E. Detsky
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
| | - Patrick R. Lawler
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Heart and Stroke/Richard Lewar Centre of Excellence, University of Toronto, Toronto, Ontario, Canada
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Tabesh M, Magliano DJ, Tanamas SK, Surmont F, Bahendeka S, Chiang C, Elgart JF, Gagliardino JJ, Kalra S, Krishnamoorthy S, Luk A, Maegawa H, Motala AA, Pirie F, Ramachandran A, Tayeb K, Vikulova O, Wong J, Shaw JE. Cardiovascular disease management in people with diabetes outside North America and Western Europe in 2006 and 2015. Diabet Med 2019; 36:878-887. [PMID: 30402961 PMCID: PMC6618273 DOI: 10.1111/dme.13858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2018] [Indexed: 01/07/2023]
Abstract
AIM Optimal treatment of cardiovascular disease is essential to decrease mortality among people with diabetes, but information is limited on how actual treatment relates to guidelines. We analysed changes in therapeutic approaches to anti-hypertensive and lipid-lowering medications in people with Type 2 diabetes from 2006 and 2015. METHODS Summary data from clinical services in seven countries outside North America and Western Europe were collected for 39 684 people. Each site summarized individual-level data from outpatient medical records for 2006 and 2015. Data included: demographic information, blood pressure (BP), total cholesterol levels and percentage of people taking statins, anti-hypertensive medication (angiotensin-converting enzyme inhibitors, calcium channel blockers, angiotensin II receptor blockers, thiazide diuretics) and antiplatelet drugs. RESULTS From 2006 to 2015, mean cholesterol levels decreased in six of eight sites (range: -0.5 to -0.2), whereas the proportion with BP levels > 140/90 mmHg increased in seven of eight sites. Decreases in cholesterol paralleled increases in statin use (range: 3.1 to 47.0 percentage points). Overall, utilization of anti-hypertensive medication did not change. However, there was an increase in the use of angiotensin II receptor blockers and a decrease in angiotensin-converting enzyme inhibitors. The percentage of individuals receiving calcium channel blockers and aspirin remained unchanged. CONCLUSIONS Our findings indicate that control of cholesterol levels improved and coincided with increased use of statins. The percentage of people with BP > 140/90 mmHg was higher in 2015 than in 2006. Hypertension treatment shifted from using angiotensin-converting enzyme inhibitors to angiotensin II receptor blockers. Despite the potentially greater tolerability of angiotensin II receptor blockers, there was no associated improvement in BP levels.
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Affiliation(s)
- M. Tabesh
- Baker Heart and Diabetes InstituteMelbourneAustralia
- Department of Epidemiology and Preventive MedicineSchool of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - D. J. Magliano
- Baker Heart and Diabetes InstituteMelbourneAustralia
- Department of Epidemiology and Preventive MedicineSchool of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - S. K. Tanamas
- Baker Heart and Diabetes InstituteMelbourneAustralia
| | | | - S. Bahendeka
- MKPGMS‐Uganda Martyrs University & St. Francis Hospital NsambyaKampalaUganda
| | - C.‐E. Chiang
- General Clinical Research CenterTaipei Veterans General HospitalTaipeiTaiwan
| | - J. F. Elgart
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP‐CONICET)La PlataArgentina
| | - J. J. Gagliardino
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP‐CONICET)La PlataArgentina
| | - S. Kalra
- Bharti Research Institute of Diabetes & EndocrinologyBharti HospitalKarnalHaryanaIndia
| | | | - A. Luk
- Department of Medicine and TherapeuticsPrince of Wales HospitalHong Kong SARChina
| | - H. Maegawa
- Shiga University of Medical ScienceShigaJapan
| | - A. A. Motala
- Department of Diabetes and EndocrinologyUniversity of KwaZulu NatalDurbanSouth Africa
| | - F. Pirie
- Department of Diabetes and EndocrinologyUniversity of KwaZulu NatalDurbanSouth Africa
| | | | - K. Tayeb
- Diabetes Center at AlNoor Specialist HospitalMakkahSaudi Arabia
| | - O. Vikulova
- FGBU ‘Endocrinology Research Center’Ministry of HealthMoscowRussia
| | - J. Wong
- Royal Prince Alfred Hospital Diabetes Centre and the University of SydneySydneyAustralia
| | - J. E. Shaw
- Baker Heart and Diabetes InstituteMelbourneAustralia
- Department of Epidemiology and Preventive MedicineSchool of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
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Ding Y, Yu T, Sun J, Wu M, Chen Q, Qian H, Xie L, Zhang X, Liu E, Jiang W, Liu S, Luk A. A China-manufactured bevacizumab biosimilar, HLX04, matches bevacizumab sourced from China, USA and the European Union. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy431.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Zhang Q, Xu B, Zhang Q, Sun T, Li W, Teng Y, Hu X, Bondarenko I, Adamchuk H, Zhang L, Trukhin D, Wang S, Zheng H, Tong Z, Zhang X, Liu E, Jiang W, Liu S, Luk A. Global clinical trials validating bioequivalence with China-manufactured trastuzumab biosimilar, HLX02, and trastuzumab. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy428.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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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45
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Shi Y, Zhang Q, Han X, Song Y, Qin Y, Hong X, Ke X, Feng J, Wang D, Li W, Su H, Zhang Y, Zhang H, Yang J, Liu L, Zhang X, Liu E, Jiang W, Liu S, Luk A. First china-manufactured proposed rituximab biosimilar met primary efficacy and safety endpoints in CD20-positive diffuse large B-cell lymphoma (generics). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy437.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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46
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Luk A, Groarke JD, Desai AS, Mahmood SS, Gopal DM, Joyce E, Shah SP, Lindenfeld J, Stevenson L, Lakdawala NK. First spot urine sodium after initial diuretic identifies patients at high risk for adverse outcome after heart failure hospitalization. Am Heart J 2018; 203:95-100. [PMID: 29907406 DOI: 10.1016/j.ahj.2018.01.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 05/18/2017] [Accepted: 01/28/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Relief of congestion is the primary goal of initial therapy for acute decompensated heart failure (ADHF). Early measurement of urine sodium concentration (UNa) may be useful to identify patients with diminished response to diuretics. The aim of this study was to determine if the first spot UNa after diuretic initiation could select patients likely to require more intensive therapy during hospitalization. METHODS At the time of admission, 103 patients with ADHF were identified prospectively, and UNa was measured after the first dose of intravenous diuretic. Clinical outcomes were compared for patients with UNa >60 mmol/L and UNa of ≤60 mmol/L, with the primary outcome of a composite of death at 90 days, mechanical circulatory support during admission, and requirement of inotropic support at discharge. RESULTS Patients with UNa ≤60 had lower admission blood pressure, had less chronic neurohormonal antagonist prior to admission, and were more than twice as likely to experience the primary end point (hazard ratio 2.40, 95% CI 1.02-5.66, P = .045), which was marginally significant after adjusting for renal function and baseline home loop diuretic. Worsening renal function was significantly more common in patients with UNa <60 (23.6% vs 6.5%, P = .05). Although the initial assessment of congestion was similar at admission, patients with low early UNa had a longer length of stay (11 vs 6 days, P < .006) than patients with UNa >60. CONCLUSIONS Assessment of spot UNa after initial intravenous loop diuretic administration may facilitate identification and triage of a population of HF patients at increased risk for adverse events and prolonged hospitalization.
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Affiliation(s)
- Adriana Luk
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - John D Groarke
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Akshay S Desai
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Syed Saad Mahmood
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | | | | | - Sachin P Shah
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Lahey Hospital and Medical Center, Burlington, MA
| | | | - Lynne Stevenson
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Vanderbilt University Medical Center, Nashville, TN
| | - Neal K Lakdawala
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
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Abstract
Schistosoma haematobium is the species primarily responsible for the manifestation of schistosomiasis in the genitourinary tract. It is a parasitic disease caused by flukes (trematodes) of the genus Schistosoma, which can result in acute and chronic manifestation. We report a case of urinary schistosomiasis that initially presented as advanced bladder cancer with pulmonary metastasis on initial computed tomography scan. Further investigations revealed no cancer and pulmonary changes resolved with treatment. The involvement of bladder is the hallmark of S. haematobium infection and it is unusual to have pulmonary manifestation without concurrent hepatosplenic disease. Within the lungs, deposition of Schistosoma eggs causes a granulomatous reaction, typically producing miliary nodules on chest radiographs. In our case, this was interpreted initially as lung metastases. However, given the cystoscopic findings and subsequent resolution with praziquantel, this was proved otherwise. This case highlights the importance of urinary cytology in the initial investigation of haematuria. Clinicians should be aware of such a potential differential diagnosis, especially in patients with prior travel history to endemic areas.
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Affiliation(s)
- K Hosny
- Urology Department, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust , Blackburn , UK
| | - A Luk
- Urology Department, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust , Blackburn , UK
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Luk A, Almazroa L, Billia F, Ross H, Overgaard C. MANAGEMENT OF ACUTE DECOMPENSATED HEART FAILURE IN THE CORONARY INTENSIVE CARE UNIT: THE IMPORTANCE OF CO-MANAGEMENT WITH A DEDICATED HEART FAILURE SERVICE. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.321] [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: 10/18/2022] Open
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Barghash MH, De Castro RRT, Motiwala SR, Nayor M, Gopal D, Luk A, Brinkley DM, Joyce E, Chaudhry S, Groarke JD, Lakdawala N, Givertz MM, Desai A, Nohria A, Stevenson LW. Most Admissions to HF Service are Preceded by a Provider Interaction That Did Not Prevent Hospitalization. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.314] [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: 11/15/2022]
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Nouizi F, Erkol H, Luk A, Marks M, Unlu MB, Gulsen G. An accelerated photo-magnetic imaging reconstruction algorithm based on an analytical forward solution and a fast Jacobian assembly method. Phys Med Biol 2016; 61:7448-7465. [PMID: 27694717 DOI: 10.1088/0031-9155/61/20/7448] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We previously introduced photo-magnetic imaging (PMI), an imaging technique that illuminates the medium under investigation with near-infrared light and measures the induced temperature increase using magnetic resonance thermometry (MRT). Using a multiphysics solver combining photon migration and heat diffusion, PMI models the spatiotemporal distribution of temperature variation and recovers high resolution optical absorption images using these temperature maps. In this paper, we present a new fast non-iterative reconstruction algorithm for PMI. This new algorithm uses analytic methods during the resolution of the forward problem and the assembly of the sensitivity matrix. We validate our new analytic-based algorithm with the first generation finite element method (FEM) based reconstruction algorithm previously developed by our team. The validation is performed using, first synthetic data and afterwards, real MRT measured temperature maps. Our new method accelerates the reconstruction process 30-fold when compared to a single iteration of the FEM-based algorithm.
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Affiliation(s)
- F Nouizi
- Department of Radiological Sciences, Tu and Yuen Center for Functional Onco-Imaging, University of California, Irvine, CA, USA
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