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Markovitch N, Rispler S, Feld Y, Solomonica A, Yalonetsky S, Musallamis A, Kerner A, Roguin A, Landesberg A. The adverse effects of the respiratory effort on the pulmonary circulation are independent of the ejection fraction and heart failure etiology. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Heart failure (HF) is associated with hemodynamic lung congestion that leads to dyspnea and excessive respiratory effort.
Purpose
We hypothesized that this HF induced excessive respiratory effort adversely affects both ventricles loading conditions, leading to a vicious cardiopulmonary cycle and progressive cardiac deterioration, and that this vicious cardiopulmonary cycle is independent of HF etiology.
Methods
The hemodynamic and respiratory indices were simultaneously measured in patients undergoing right heart catheterization for the diagnosis of dyspnea. The pulmonary wedge pressure (PCWP) is modulated by the changes in the intrathoracic pressure. The latter is determined by the respiratory effort. To quantify the respiratory effort, the PCWP was decomposed into cardiac and respiratory waves. The respiratory effort (Presp) was defined as the peak to peak amplitude of the respiratory wave that modulated the PCWP. The immediate effects of the respiratory effort on the pulmonary capillary wedge pressures (PCWP) were scrutinized by asking the patients to perform intentional vigorous breathing and short apneic events.
Results
The HF patients (N=50) exhibited a high Presp of 9.3±5.0 mmHg, ∼3.5-fold higher than the normal respiratory effort. The baseline end-expiratory PCWP (PCWPee) and end-expiratory pulmonary artery pressure of the HF patients have linear relationship with the baseline Presp with slops of 0.78±0.05 and 1.42±0.09 respectively. The changes in PCWPee appeared immediately, within a single breathing-cycle (t =1.65±0.39 sec) in all patients, when each patient intentionally changed the respiratory effort from apnea to his maximum Presp of 19.8±8.6 mmHg. The PCWP during apnea underestimated the HF severity and yielded lower PCWPee while severe respiratory effort markedly increased the PCWPee. Interestingly, similar slope of the instantaneous relationship between the varying Presp and observed PCWPee was obtained for all the patients, independently of the baseline PCWPee-. The PCWPee rose immediately by 0.43±0.15 for every 1 mmHg of Presp. Similar slope was observed in HF patients with ischemic (N=24) and non-ischemic (N=26, p=0.36) HF diseases (p=0.26), and in those with preserved (N=35) or reduced (N=15) ejection fractions (p=0.91).
Conclusions
The respiratory effort has immediate effects on the hemodynamic congestion and the workloads of the heart, and this adverse effects are independent of HF etiology. The observations support the existence of a vicious cardiopulmonary cycle that can lead to decompensation, where the respiratory effort plays a pivotal role. It may explain the similar prognosis of patients with various ejection fractions and etiologies, but with similar dyspnea severity and clinical symptoms.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Markovitch
- Technion, Israel Institute of Technology , Haifa , Israel
| | - S Rispler
- Rambam Health Care Campus, Cardiology , Haifa , Israel
| | - Y Feld
- Rambam Health Care Campus, Cardiology , Haifa , Israel
| | - A Solomonica
- Rambam Health Care Campus, Cardiology , Haifa , Israel
| | - S Yalonetsky
- Rambam Health Care Campus, Cardiology , Haifa , Israel
| | - A Musallamis
- Rambam Health Care Campus, Cardiology , Haifa , Israel
| | - A Kerner
- Rambam Health Care Campus, Cardiology , Haifa , Israel
| | - A Roguin
- Hillel Yaffe Hospital, Cardiology , Hadera , Israel
| | - A Landesberg
- Technion, Israel Institute of Technology , Haifa , Israel
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Marcusohn E, Qasum M, Epstein D, Solomonica A, Orbach A, Musallam A, Kerner A, Feld Y. Vascular Complications Among Patients Undergoing Trans-femoral Transcatheter Aortic Valve Implantation: Prostar vs ProGlide Parallel Technique. Angiology 2022; 73:635-642. [PMID: 35147041 DOI: 10.1177/00033197211058498] [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] [Indexed: 12/17/2022]
Abstract
Reliable femoral artery closure devices are essential for the success of trans-femoral Transcatheter Aortic Valve Implantation (TAVI) procedures. Accordingly, device choice might affect vascular complications and bleeding rates. This was a retrospective analysis, comparing vascular complication rates among patients who underwent trans-femoral TAVI with vascular access closure using either the ProGlide parallel suture or Prostar closure devices. We included 191 patients: 106 were treated with Prostar and 85 with ProGlide. The ProGlide group had higher rate of diabetes, chronic kidney disease, peripheral arterial disease, and significantly smaller femoral arteries that were treated via larger sheaths. Valve Academic Research Consortium (VARC)-2 major complications were similar between the groups. (4.7% for ProGlide vs 3.8% for Prostar, P=1), with similar incidence of closure device failure (2 vs 3, P=1). No differences were found after univariant analysis and propensity-score matching in the incidence of major and minor bleeding nor in the rate of in-hospital mortality between ProGlide and Prostar (4.7 vs 2.8%, P=.7, 1.2 vs 2.8%, P=.63, and 1.2 vs .0%, P=.45, respectively). Parallel suture technique using two ProGlide sutures showed comparable rates of vascular complications to the Prostar closure device in higher risk population of TAVI patients.
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Affiliation(s)
- Erez Marcusohn
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
| | - Majd Qasum
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
| | - Danny Epstein
- Critical Care Division, Rambam Health Care Campus, Haifa, Israel
| | - Amir Solomonica
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.,Rappaport - Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ady Orbach
- Schulich Heart Center - Sunnybrook Health Science Center, Toronto, ON, Canada
| | - Anees Musallam
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
| | - Arthur Kerner
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.,Rappaport - Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Yair Feld
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.,Rappaport - Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Bagur R, Ybarra LF, Israeli Z, Solomonica A, Taleb H, Savvoulidis P, Sanjoy SS, Lavi S. Postprocedural Radial Artery Compression Time In Chronic AnticoaguLated patients using StatSeal: The PRACTICAL-SEAL study. Int J Cardiol 2022; 346:14-17. [PMID: 34774642 DOI: 10.1016/j.ijcard.2021.11.011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/20/2021] [Accepted: 11/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients on uniterrupted chronic oral anticoagulation (OAC) therapy are at high-risk of bleeding during cardiac catheterization. We aimed to investigate the safety and efficacy of the StatSeal® disc for adjunct hemostasis in patients undergoing transradial coronary angiography under uninterrupted OAC therapy. METHODS Patients who underwent transradial cardiac catheterization without interrupted OAC therapy were included in this study. RESULTS Among 180 patients, 85 (47.2%) patients were on warfarin and 95 (52.8%) patients on novel oral anticoagulants (NOACs). Patients on NOACs were older (72.9 ± 9.6 versus 69.7 ± 10.8 years, P < 0.001) and had more atrial fibrillation/flutter (94.7% versus 62.4%, P < 0.001), whereas patients on Warfarin were more often women (43.5% versus 26.3%, P = 0.02) and had mechanical heart valves (27.1% versus 0%, P < 0.001). Intravenous unfractioned heparin (UFH) was administered in 96.5% of patients on warfarin (3799 ± 1342 units) and 93.7% patients on NOACs (4028 ± 1362 units), P = 0.27. There were no differences in terms of type and sheath size and the need for ad hoc coronary intervention. Time-to-first release of the hemostatic wristband was 56.2 ± 12.6 min and complete hemostasis was achieved in 71.1 ± 13.0 min, with shorter times among patients on NOACs (54.1 ± 11.7 and 58.5 ± 13.2 min, 68.9 ± 11.7 versus 73.6 ± 14.0 min, P = 0.02, for both). There were no significant differences in terms of bleeding. There was no radial artery occlusion among 112 participants who underwent color Doppler ultrasound. CONCLUSION The present study shows that in patients undergoing transradial coronary angiogram under contemporary uninterrupted OAC therapy and periprocedural administration of UFH, the use of StatSeal® disc for adjunctive hemostasis was associated with short times to complete hemostasis.
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Affiliation(s)
- Rodrigo Bagur
- London Health Sciences Centre, London, Ontario, Canada.
| | - Luiz F Ybarra
- London Health Sciences Centre, London, Ontario, Canada
| | - Zeev Israeli
- Division of Cardiology, Ziv Medical Center, Safed, Israel
| | - Amir Solomonica
- Interventional Cardiology Unit, Rambam Healthcare Campus, Haifa, Israel
| | - Hussein Taleb
- London Health Sciences Centre, London, Ontario, Canada
| | | | - Shubrandu S Sanjoy
- Research Department, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Shahar Lavi
- London Health Sciences Centre, London, Ontario, Canada
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Solomonica A, Kerner A, Feld Y, Yalonetsky S. Novel Technique for the Treatment of Coronary Artery Perforation. Can J Cardiol 2020; 36:1326.e1-1326.e3. [PMID: 32634393 DOI: 10.1016/j.cjca.2020.03.017] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/15/2020] [Accepted: 03/15/2020] [Indexed: 11/19/2022] Open
Abstract
Coronary artery perforation is a rare complication of percutaneous coronary intervention (PCI); its rate is estimated at 0.4- 0.7% of all PCIs. Fast recognition and response are imperative for the treatment of this potentially life-threatening complication. Available techniques for the treatment of perforations have moderate success rates and often necessitate dedicated equipment and expertise. In the case report presented, we describe a novel technique used to treat coronary perforations with readily available equipment.
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Affiliation(s)
- Amir Solomonica
- Interventional Cardiology Unit, Rambam Healthcare Campus, Haifa, Israel.
| | - Arthur Kerner
- Interventional Cardiology Unit, Rambam Healthcare Campus, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Yair Feld
- Interventional Cardiology Unit, Rambam Healthcare Campus, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Sergey Yalonetsky
- Interventional Cardiology Unit, Rambam Healthcare Campus, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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Solomonica A, Wagner C, Lavi S. Endothelial Dysfunction Is Not Associated With Spontaneous Coronary Artery Dissection. Cardiovasc Revasc Med 2020; 21:1539-1541. [PMID: 32473907 DOI: 10.1016/j.carrev.2020.05.029] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/25/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome, yet its pathophysiology is only partially understood. We sought to assess the association between endothelial dysfunction (ED) and SCAD. METHODS We prospectively assessed patients presenting with acute coronary syndrome who were diagnosed with SCAD. The control arm had established coronary artery atherosclerotic disease (AD) according to previous coronary angiography. ED was assessed using the EndoPAT 2000 while patients returned to their steady state condition. A total of 16 patients with SCAD and 66 patients with AD were included. RESULTS Microvascular reactivity as assessed with the EndoPAT was significantly worse in the AD group compared to the SCAD group. The median RHI in the AD group was 1.76 (IQR 1.52, 2.2) vs. a median RHI of 2.08 (IQR 1.73, 2.79) in the SCAD group (p < 0.05). While the RHI values in half of the AD group (33 patients; 50%) were below the cut-off of 1.67 only one patient had an RHI below this cut-off in the SCAD group. CONCLUSIONS Patients with SCAD were not found to have ED and it is therefore unlikely that ED takes part in SCAD formation.
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Affiliation(s)
- Amir Solomonica
- Rambam Medical Center, Department of Cardiology, Haifa, Israel
| | - Cassandra Wagner
- Western University, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Shahar Lavi
- Western University, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.
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Lavi S, Mehta SR, Bajwa R, Taleb H, Bakar SN, Sachedina A, Wagner C, Solomonica A, Awan K, Puka K, Garg P, Diamantouros P, Bagur R. Short Durations of Radial Hemostatic Device After Diagnostic Transradial Cardiac Catheterization: The PRACTICAL-2 Randomized Trial. Can J Cardiol 2020; 37:276-283. [PMID: 32335132 DOI: 10.1016/j.cjca.2020.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 03/30/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Radial artery occlusion (RAO) is the most common complication following transradial approach (TRA) for cardiac catheterisation. Our aim was to assess if decreasing radial hemostatic device (RHD) time reduces the risk of RAO among individuals receiving small sheath sizes with no adjunctive heparin. METHODS We randomised 450 individuals undergoing diagnostic cardiac catheterization via TRA to 3 durations of RHD time: 10, 20, or 30 minutes. After these time periods, the RHD was gradually released over 20 minutes. The primary efficacy end point was forearm hematoma grade ≥ 2 (5-10 cm) and the primary safety end point was RAO (as determined by Doppler ultrasound) 1 hour after RHD removal (before discharge). RESULTS The mean age was 66 years and 64% were male. Five-French sheaths were used in all patients. Hematoma grade ≥ 2 occurred in only 1 patient, who was in the 20-minute group (P = 0.39). RAO occurred in 6.7% of patients in the 10-minute group, 10.7% in the 20-minute group and 6% in the 30-minute group (P = 0.26). CONCLUSIONS Among patients receiving small-caliber sheaths without adjunctive heparin, the incidence of forearm hematoma and RAO are low. Shorter durations of RHD time did not further reduce the risk of these complications.
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Affiliation(s)
- Shahar Lavi
- London Health Sciences Centre, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada.
| | - Shamir R Mehta
- Population Health Research Institute and Department of Medicine, McMaster University and Hamilton Health Sciences, Ontario, Canada
| | - Rehana Bajwa
- London Health Sciences Centre, London, Ontario, Canada
| | - Hussein Taleb
- London Health Sciences Centre, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada
| | - Shahrukh N Bakar
- London Health Sciences Centre, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada
| | - Ayaaz Sachedina
- London Health Sciences Centre, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada
| | | | - Amir Solomonica
- London Health Sciences Centre, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada
| | - Kokab Awan
- London Health Sciences Centre, London, Ontario, Canada
| | - Klajdi Puka
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Pallav Garg
- London Health Sciences Centre, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada
| | - Pantelis Diamantouros
- London Health Sciences Centre, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada
| | - Rodrigo Bagur
- London Health Sciences Centre, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada; Population Health Research Institute and Department of Medicine, McMaster University and Hamilton Health Sciences, Ontario, Canada
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Lavi S, Mehta SR, Bajwa R, Taleb H, Bakar SN, Sachedina A, Wagner C, Solomonica A, Awan K, Garg P, Diamantouros P, Bagur R. SHORT DURATIONS OF COMPRESSION HEMOSTATIC DEVICE APPLICATION POST TRANS-RADIAL CARDIAC CATHETERIZATION: THE PRACTICAL-2 TRIAL. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31757-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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8
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Bagur R, Solomonica A, Taleb H, Sanjoy S, Israeli Z, Lavi S. POSTPROCEDURAL RADIAL ARTERY COMPRESSION TIME IN CHRONIC ANTICOAGULATED PATIENTS USING STATSEAL. THE PRACTICAL-SEAL FEASIBILITY STUDY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32152-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Levi Y, Lavi S, Solomonica A, Israeli Z, Bagur R. Small-Size vs Large-Size Burr for Rotational Atherectomy. J Invasive Cardiol 2019; 31:183-186. [PMID: 31158807] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Rotational atherectomy (RA) has been traditionally performed via the transfemoral approach, mostly utilizing large guide catheters (≥7 Fr), which can accommodate the passage of large burrs (≥1.75 mm). However, contemporary data show that using smaller sheath and catheter sizes reduces the risk of procedural access-site related complications. Therefore, the aim of this study was to assess the feasibility of performing RA using smaller burrs and subsequently smaller-sized sheath catheters. METHODS A total of 220 patients underwent RA procedures between January 2011 and July 2017. We compared 162 patients who underwent RA using a maximal burr size of 1.5 mm (small-burr group) with 58 patients who underwent RA using burrs >1.5 mm in diameter (large-burr group). Clinical, procedural, safety, and feasibility data were evaluated and compared between the two groups. RESULTS Baseline characteristics of the two groups were quite similar other than a higher prevalence of smoking (21.0% vs 5.2%; P<.01) and a lower body weight (80.9 ± 17.5 kg vs 86.8 ± 17.2 kg; P=.03) in the small-burr group vs the large-burr group. The indications for the procedure for the small-burr group vs large-burr group were stable angina in 53% vs 62%, unstable angina in 16% vs 17%, non-ST elevation myocardial infarction (MI) in 26% vs 17%, and ST-elevation MI in 3.7% vs 3.4%, respectively (P=NS for all). The target-vessel (TV) diameter was significantly larger in the large-burr group vs the small-burr group (3.5 ± 0.3 mm vs 3.2 ± 0.5 mm, respectively; P<.01). Importantly, a sheath size >6 Fr was used in 56.0% of the small-burr group vs 89.5% of the large-burr group (P<.01). Moreover, in 53% of the small-burr group, a guide catheter >6 Fr was used. Radial access was used in 33% of the small-burr group and 17% of the large-burr group (P=.03). Procedural success was achieved in 93% of the small-burr group and 100% of the large-burr group (P=.07). CONCLUSION In the majority of cases, RA can be successfully performed using smaller-sized burrs while achieving a high procedural success rate. Notably, our study also highlights the overuse of large sheaths and catheters to deliver small burrs. These results further support the contemporary strategy of using 6 Fr guide catheters, thereby increasing the possibility of using the radial approach for more complex interventional procedures.
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Affiliation(s)
| | | | | | | | - Rodrigo Bagur
- University Hospital, London Health Sciences Centre, 339 Windermere Road, London, ON, Canada N6A 5A5.
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Abstract
INTRODUCTION Transcatheter aortic valves have evolved over the last 15 years. Second- and third- generation devices have considerably improved, and a range of newer devices have also been introduced with the aim of decreasing the incidence of paravalvular leak, reducing the need for permanent pacemaker implantation and minimizing procedure- and device-related complications. Areas covered: In this review, we highlight the special features of the latest generation of self-expanding Evolut PRO (Medtronic, Minneapolis, Minnesota) transcatheter aortic valve system. A detailed literature search on the Medtronic Evolut R and Evolut PRO transcatheter aortic valves was undertaken using Ovid, PubMed and Web of Science. Expert commentary: In a single, small study, the Evolut PRO has shown significant improvement over the Evolut R in terms of reduced paravalvular leak and pacemaker implantation. Larger scaled studies are needed to ascertain the performance of the Evolut PRO.
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Affiliation(s)
| | | | - Rodrigo Bagur
- a London Health Sciences Centre , London , Ontario , Canada.,b Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences , University of Keele , Stoke-on-Trent , UK
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Solomonica A, Choudhury T, Bagur R. Newer-generation of Edwards transcatheter aortic valve systems: SAPIEN 3, Centera, and SAPIEN 3 Ultra. Expert Rev Med Devices 2018; 16:81-87. [DOI: 10.1080/17434440.2019.1555465] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | - Rodrigo Bagur
- London Health Sciences Centre, London, Canada
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
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Choudhury T, Solomonica A, Bagur R, Lavi S. Intravascular imaging for cardiac arrest with “normal” coronary arteriography. Cardiovascular Revascularization Medicine 2018; 19:53-55. [DOI: 10.1016/j.carrev.2018.04.016] [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] [Received: 03/05/2018] [Revised: 04/13/2018] [Accepted: 04/13/2018] [Indexed: 10/17/2022]
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Solomonica A, Choudhury T, Bagur R. The mechanically expandable LOTUS Valve and LOTUS Edge transcatheter aortic valve systems. Expert Rev Med Devices 2018; 15:763-769. [DOI: 10.1080/17434440.2018.1536543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Amir Solomonica
- Cardiology Division, London Health Sciences Centre, London, Ontario, Canada
| | - Tawfiq Choudhury
- Cardiology Division, London Health Sciences Centre, London, Ontario, Canada
| | - Rodrigo Bagur
- Cardiology Division, London Health Sciences Centre, London, Ontario, Canada
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
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Affiliation(s)
| | | | - Rodrigo Bagur
- London Health Sciences Centre, London, Canada
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
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Solomonica A, Lavi S, Choudhury T, Bagur R. An atypical presentation of acute coronary syndrome. J Thorac Dis 2018; 10:E616-E619. [PMID: 30233897 DOI: 10.21037/jtd.2018.07.55] [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] [Indexed: 11/06/2022]
Affiliation(s)
| | - Shahar Lavi
- London Health Sciences Centre, London, Ontario, Canada
| | | | - Rodrigo Bagur
- London Health Sciences Centre, London, Ontario, Canada.,Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
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Choudhury T, Hayman S, McLellan A, Bagur R, Lavi S, Solomonica A, Zeev Israeli, Yadegari A, McPherson T, Teefy P, Garg P. TCT-247 Reducing Radiation Exposure to Operators During Invasive Cardiac Procedures with a Novel Lead-Based Arm-Board (RADAR). J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Roguin A, Solomonica A, von Birgelen C. Is the proximal left anterior descending coronary artery segment justifiably considered as the last frontier for stenting? EUROINTERVENTION 2018; 14:729-731. [DOI: 10.4244/eijv14i7a127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Affiliation(s)
- Amir Solomonica
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Shahar Lavi
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Tawfiq Choudhury
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Rodrigo Bagur
- London Health Sciences Centre, Western University, London, Ontario, Canada.,Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
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Solomonica A. [THE EFFECT OF AIR POLLUTION ON CARDIOVASCULAR DISEASES]. Harefuah 2017; 156:586-588. [PMID: 28971658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The effect of air pollution on lung diseases has been recognized for many years. During the past few years a growing body of evidence suggests a connection between air pollution and cardiovascular diseases. Amongst the different air pollutants, much attention has been focused on particulate matter which is defined as a large group of different compounds suspended in the air in the form of minute solid particles or liquid droplets. Particulate matter is broadly categorized according to aerodynamic size. Thus PM2.5 consists of fine particles, smaller than 2.5 micron and PM10 comprises fine particles and coarser particles between 2.5 and 10 micron. Bigger particles cannot usually enter airways and lungs due to their size and so their direct medical effect is minimal. In this review we will elaborate on the effect of air pollution on cardiovascular diseases, the different mechanisms by which particle exposure elicits cardiovascular morbidity and mortality, the way air pollution is currently perceived and its future role as a risk factor.
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Eden S, Solomonica A, Musallam A, Mishra S, Eitan A, Nikolsky E, Kerner A, Yalonetsky S, Roguin A. 3126Drug coated balloon efficacy for the treatment of instent restenosis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.3126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Affiliation(s)
- Amir Solomonica
- Interventional Cardiology, Rambam Medical Center, B. Rappaport - Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 31096, Israel
| | - Ariel Roguin
- Interventional Cardiology, Rambam Medical Center, B. Rappaport - Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 31096, Israel
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Darawsha W, Chirmicci S, Solomonica A, Wattad M, Kaplan M, Makhoul BF, Abassi ZA, Azzam ZS, Aronson D. Discordance Between Hemoconcentration and Clinical Assessment of Decongestion in Acute Heart Failure. J Card Fail 2016; 22:680-8. [PMID: 27079674 DOI: 10.1016/j.cardfail.2016.04.005] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 03/09/2016] [Accepted: 04/08/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Hemoconcentration has been proposed as a surrogate for successful decongestion in acute heart failure (AHF). The aim of the present study was to evaluate the relationship between hemoconcentration and clinical measures of congestion. METHODS AND RESULTS We studied 704 patients with AHF and volume overload. A composite congestion score was calculated at admission and discharge, with a score >1 denoting persistent congestion. Hemoconcentration was defined as any increase in hematocrit and hemoglobin levels between baseline and discharge. Of 276 patient with hemoconcentration, 66 (23.9%) had persistent congestion. Conversely, of 428 patients without hemoconcentration, 304 (71.0%) had no clinical evidence of congestion. Mean hematocrit changes were similar with and without persistent congestion (0.18 ± 3.4% and -0.19 ± 3.6%, respectively; P = .17). There was no correlation between the decline in congestion score and the change in hematocrit (P = .93). Hemoconcentration predicted lower mortality (hazard ratio 0.70, 95% confidence interval 0.54-0.90; P = .006). Persistent congestion was associated with increased mortality independent of hemoconcentration (Ptrend = .0003 for increasing levels of congestion score). CONCLUSIONS Hemoconcentration is weakly related to congestion as assessed clinically. Persistent congestion at discharge is associated with increased mortality regardless of hemoconcentration. Hemoconcentration is associated with better outcome but cannot substitute for clinically derived estimates of congestion to determine whether decongestion has been achieved.
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Affiliation(s)
- Wisam Darawsha
- Department of Cardiology, Rambam Medical Center, Haifa, Israel
| | - Stefan Chirmicci
- Department of Internal Medicine D, Rambam Medical Center, Haifa, Israel
| | - Amir Solomonica
- Department of Cardiology, Rambam Medical Center, Haifa, Israel
| | - Malak Wattad
- Department of Cardiology, Rambam Medical Center, Haifa, Israel
| | - Marielle Kaplan
- Laboratory of Clinical Biochemistry, Department of Physiology and Biophysics, Rambam Medical Center, Haifa, Israel
| | - Badira F Makhoul
- Department of Internal Medicine B, Rambam Medical Center, Haifa, Israel
| | - Zaid A Abassi
- Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Zaher S Azzam
- Laboratory of Clinical Biochemistry, Department of Physiology and Biophysics, Rambam Medical Center, Haifa, Israel
| | - Doron Aronson
- Department of Cardiology, Rambam Medical Center, Haifa, Israel.
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Solomonica A, Musallam A, Roguin A. Coronary artery aneurysm following drug-coated balloon treatment. Cardiovasc Revasc Med 2015; 16:505-7. [PMID: 26349442 DOI: 10.1016/j.carrev.2015.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 05/08/2015] [Revised: 07/19/2015] [Accepted: 08/03/2015] [Indexed: 11/27/2022]
Abstract
Drug-coated balloons are an effective treatment option for stent restenosis. Because of their potential benefits, the use of drug-coated balloons is predicted to increase in the future and expand further for the treatment of de novo lesions as well. We hereby present a case in which a patient developed a coronary artery aneurysm following the treatment of a de novo native coronary narrowing with a drug-coated balloon.
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Affiliation(s)
- Amir Solomonica
- Cardiology, Rambam Medical Center, Rappaport - Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, 31096, Israel
| | - Anees Musallam
- Cardiology, Rambam Medical Center, Rappaport - Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, 31096, Israel
| | - Ariel Roguin
- Cardiology, Rambam Medical Center, Rappaport - Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, 31096, Israel.
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Solomonica A, Roguin A. [Successful termination of ventricular fibrillation using the precordial thump]. Harefuah 2015; 154:426-470. [PMID: 26380460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 75 year old female underwent angiography which revealed diffuse restenosis in a bare metal stent implanted in the right coronary artery, three month earlier. A wire was used to cross the lesion; balloon angioplasty was performed followed by drug eluting stent implantation. Inflation times were short. As the balloon of the stent was retrieved, the patient went into ventricular fibrillation (VF). An order to charge the defibrillator for DC shock was given. The operating physician immediately delivered a quick strong blow to the patient's thorax (precordial thump) which stopped the VF rhythm and converted it into atrial fibrillation. The patient regained consciousness and had no recollection of what had happened. No DC shock was needed.
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Wattad M, Darawsha W, Solomonica A, Hijazi M, Kaplan M, Makhoul BF, Abassi ZA, Azzam ZS, Aronson D. Interaction between worsening renal function and persistent congestion in acute decompensated heart failure. Am J Cardiol 2015; 115:932-7. [PMID: 25700802 DOI: 10.1016/j.amjcard.2015.01.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 01/03/2015] [Accepted: 01/03/2015] [Indexed: 01/07/2023]
Abstract
Worsening renal function (WRF) and congestion are inextricably related pathophysiologically, suggesting that WRF occurring in conjunction with persistent congestion would be associated with worse clinical outcome. We studied the interdependence between WRF and persistent congestion in 762 patients with acute decompensated heart failure (HF). WRF was defined as ≥0.3 mg/dl increase in serum creatinine above baseline at any time during hospitalization and persistent congestion as ≥1 sign of congestion at discharge. The primary end point was all-cause mortality with mean follow-up of 15 ± 9 months. Readmission for HF was a secondary end point. Persistent congestion was more common in patients with WRF than in patients with stable renal function (51.0% vs 26.6%, p <0.0001). Both persistent congestion and persistent WRF were significantly associated with mortality (both p <0.0001). There was a strong interaction (p = 0.003) between persistent WRF and congestion, such that the increased risk for mortality occurred predominantly with both WRF and persistent congestion. The adjusted hazard ratio for mortality in patients with persistent congestion as compared with those without was 4.16 (95% confidence interval [CI] 2.20 to 7.86) in patients with WRF and 1.50 (95% CI 1.16 to 1.93) in patients without WRF. In conclusion, persisted congestion is frequently associated with WRF. We have identified a substantial interaction between persistent congestion and WRF such that congestion portends increased mortality particularly when associated with WRF.
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Kerner A, Abadi S, Abergel E, Solomonica A, Aronson D, Roguin A, Lessick J. Direct comparison between coronary computed tomography and invasive angiography for calculation of SYNTAX score. EUROINTERVENTION 2013; 8:1428-34. [DOI: 10.4244/eijv8i12a216] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
BACKGROUND Dyspnea relief constitutes a major treatment goal and a key measure of treatment efficacy in decompensated heart failure. However, there are no data with regard to the relationship between hemodynamic measurements during treatment and dyspnea improvement. METHODS AND RESULTS We studied 233 patients assigned to right heart catheterization in the Vasodilation in the Management of Acute Congestive Heart Failure trial. Dyspnea (assessed using a 7-point Likert scale) and hemodynamic parameters were measured simultaneously at 15 and 30 minutes and 1, 2, 3, 6, and 24 hours. Dyspnea relief was defined as moderate or marked improvement. There was a time-dependent association between the reductions in pulmonary capillary wedge pressure (PCWP; 25.4, 24.6, 24.0, 23.5, 23.4, 21.5, and 19.9 mm Hg) and the percentage of patients achieving dyspnea relief (17.7%, 24.6%, 32.2%, 36.2%, 37.8%, 47.4%, and 66.1%, in the respective time points). Multivariable logistic generalized estimating equations modeling demonstrated that reductions of both PCWP and mean pulmonary artery pressure were independently associated with dyspnea relief. Compared with the highest PCWP quartile, the adjusted odds ratios for dyspnea relief were 0.92 (95% confidence interval [CI], 0.67-1.29), 1.07 (95% CI, 0.75-1.55), and 1.80 (95% CI, 1.22-2.65) in the third, second, and first PCWP quartiles, respectively (P(trend)=0.003). Compared with the highest mean pulmonary artery pressure quartile, the adjusted odds ratios for dyspnea relief were 2.0 (95% CI, 1.41-2.82), 2.23 (95% CI, 1.52-3.27), and 2.98 (95% CI, 1.91-4.66) in the third, second, and first mean pulmonary artery pressure quartiles, respectively (P(trend)<0.0001). CONCLUSIONS A clinically significant improvement in dyspnea is associated with a reduction in both PCWP and mean pulmonary artery pressure.
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Affiliation(s)
- Amir Solomonica
- Department of Cardiology, Rambam Medical Center, Haifa, Israel
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