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Ellis SG, Alencherry B, Ziada K. Prestent Hyperemic, Not Resting, Coronary Flow Indexes Correlate With Improvement in Left Ventricular Systolic Function. JACC Cardiovasc Interv 2024; 17:955-957. [PMID: 38599705 DOI: 10.1016/j.jcin.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 04/12/2024]
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Kafil TS, Wang TKM, Agrawal A, Majid M, Syed AB, Hutt E, Alencherry B, Cohen JA, Kumar S, Bansal A, Griffin BP, Klein AL. Advances in multi-modality imaging for constrictive pericarditis and pericardial inflammation: role of imaging-guided therapy. Expert Rev Cardiovasc Ther 2023; 21:269-279. [PMID: 37070761 DOI: 10.1080/14779072.2023.2187377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
INTRODUCTION Constrictive pericarditis (CP) can result from uncontrolled inflammation of the pericardium. This can be due to various etiologies. CP can lead to both left- and right-sided heart failure with associated poor quality of life, so early recognition is key. The evolving role of multimodality cardiac imaging allows for earlier diagnosis and facilitates management to help mitigate this adverse outcome. AREAS COVERED This review discusses the pathophysiology of constrictive pericarditis, chronic inflammation and autoimmune etiologies, clinical presentation of CP, and advances in multimodality cardiac imaging for diagnosis and management. Echocardiography and cardiac magnetic resonance (CMR) imaging remain cornerstone modalities to evaluate this condition, whereas additional imaging modalities such as computed tomography and FDG-positron emission tomography can provide complementary information. EXPERT OPINION Advances in multimodality imaging allow for a more precision diagnosis of constrictive pericarditis. There has been a paradigm shift in pericardial disease management with advances in multimodality imaging, especially CMR, to detect subacute and chronic inflammation. This has enabled imaging-guided therapy (IGT) to both help prevent and potentially reverse established constrictive pericarditis.
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Affiliation(s)
- Tahir S Kafil
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tom Kai Ming Wang
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ankit Agrawal
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Muhammad Majid
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alveena B Syed
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Erika Hutt
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ben Alencherry
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joshua A Cohen
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sachin Kumar
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Agam Bansal
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian P Griffin
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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Mutagaywa RK, Cramer MJ, Chillo P, Barongo A, Kifai E, Chamuleau S, Eze-Nliam C, Vera NB, Nkya D, Loth A, Alencherry B, Mongella S, Mayala H, Kisenge P, Mwinchete S, Joseph AB, Kwesigabo G, Kamuhabwa A, Albaghdadi M, Ghobrial J, Janabi M. Characteristics and immediate outcomes of patients who underwent percutaneous balloon mitral valvuloplasty at the Jakaya Kikwete Cardiac Institute, Tanzania. Cardiovasc J Afr 2023; 34:1-11. [PMID: 36745007 DOI: 10.5830/cvja-2022-068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/06/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND For rheumatic mitral stenosis (MS), a multidisciplinary evaluation is mandatory to determine the optimal treatment: medical, percutaneous balloon mitral valvuloplasty (PBMV) or valve surgery. Clinical and imaging evaluations are essential for procedural risk assessment and outcomes. PBMV interventions are increasingly available in Africa and are feasible options for selected candidates. Enhancing PBMV training/skills transfer across most of African countries is possible. OBJECTIVES The aim of this study was to provide insight into the clinical practice of patients with rheumatic MS evaluated for PBMV in a Tanzanian teaching hospital and to define the role of imaging, and evaluate the heart team and training/skills transfer in PBMV interventions. METHODS From August 2019 to May 2022, 290 patients with rheumatic MS were recruited consecutively in the Tanzania Mitral Stenosis study. In total, 43 (14.8%) patients were initially evaluated for eligibility for PBMV by a heart team. We carried out the clinical assessment, laboratory investigations, transthoracic/oesophageal echocardiography (TTE/TEE) and electrocardiography. RESULTS The median age was 31 years (range 11-68), and two-thirds of the patients were female (four diagnosed during pregnancy). Two patients had symptomatic MS at six and eight years. Nine patients had atrial fibrillation with left atrial thrombus in three, and two were detected by TEE. Nine patients in normal sinus rhythm had spontaneous echo contrast. The mean Wilkins score was 8.6 (range 8-12). With re-evaluation by the local and visiting team, 17 patients were found to have unfavourable characteristics: Bi-commissural calcification (four), ≥ grade 2/4 mitral regurgitation (six), high scores and left atrial thrombus (three), left atrial thrombus (two), and severe pulmonary hypertension (two). Three patients died before the planned PBMV. Eleven patients were on a waiting list. We performed PBMV in 12 patients, with success in 10 of these, and good short-term outcomes [mean pre-PBMV (16.03 ± 5.52 mmHg) and post-PBMV gradients (3.08 ± 0.44 mmHg, p < 0.001)]. There were no complications. CONCLUSIONS PBMV had good outcomes for selected candidates. TEE is mandatory in pre-PBMV screening and for procedural guidance. In our cohort, patients with Wilkins score of up to 11 underwent successful PBMV. We encourage PBMV skills expansion in low- and middle-income countries, concentrating on expertise centres.
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Affiliation(s)
- Reuben K Mutagaywa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania; Department of Cardiology, Division of Heart and Lung, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Maarten J Cramer
- Department of Cardiology, Division of Heart and Lung, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Pilly Chillo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Aileen Barongo
- Department of Paediatric and Child Health, Mwananyamala Regional Hospital, Dar es Salaam, Tanzania
| | | | - Steven Chamuleau
- Amsterdam Heart Centre, Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Chete Eze-Nliam
- Department of Clinical and Interventional Cardiology, Cleveland Clinic; Heart, Vascular, and Thoracic Institute, Cleveland, USA
| | - Nelson B Vera
- Department of Clinical and Interventional Cardiology, Cleveland Clinic; Heart, Vascular, and Thoracic Institute, Cleveland, USA
| | - Deogratias Nkya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Alex Loth
- Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Ben Alencherry
- Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania; Department of Clinical and Interventional Cardiology, Cleveland Clinic; Heart, Vascular, and Thoracic Institute, Cleveland, USA
| | | | - Henry Mayala
- Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Peter Kisenge
- Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | | | - Alex B Joseph
- Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Gideon Kwesigabo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | | | - Joanna Ghobrial
- Department of Clinical and Interventional Cardiology, Cleveland Clinic; Heart, Vascular, and Thoracic Institute, Cleveland, USA
| | - Mohamed Janabi
- Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
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Dong T, Alencherry B, Ospina S, Desai MY. Review of Mavacamten for Obstructive Hypertrophic Cardiomyopathy and Future Directions. Drug Des Devel Ther 2023; 17:1097-1106. [PMID: 37064432 PMCID: PMC10094472 DOI: 10.2147/dddt.s368590] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 03/16/2023] [Indexed: 04/18/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a condition with abnormal hypertrophy of the left ventricle in the absence of common causes. The most common form involves the basal septum and can lead to obstruction of the left ventricular outflow tract. Patients can experience exertional symptoms such as chest pain, dyspnea and syncope. Traditional treatment has included beta blockers and nondihydropyridine calcium channel blockers with second-line therapy being disopyramide. Recently, mavacamten, a cardiac myosin inhibitor, has demonstrated improvement in quantitative measures of obstruction and symptom relief to such a degree that patients were able to defer invasive management of the disease. This review focuses on the pharmacology of mavacamten, its clinical trial data and guidance on how to incorporate this drug into clinical practice. Furthermore, it discusses emerging therapies currently being investigated for HCM.
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Affiliation(s)
- Tiffany Dong
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ben Alencherry
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Susan Ospina
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Milind Y Desai
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
- Correspondence: Milind Y Desai, Department of Cardiovascular Medicine, Miller Family Heart and Vascular Institute, Cleveland Clinic Main Campus J1-5, 9500 Euclid Avenue, Cleveland, OH, 44195, USA, Tel +1 216 445 5250, Fax +1 216 445 6155, Email
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Alencherry B, Bruemmer D. Quality of Diabetes Care in the USA. Curr Cardiol Rep 2021; 23:73. [PMID: 34081207 DOI: 10.1007/s11886-021-01503-5] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an overview of the current quality of diabetes care in the USA, discuss barriers to guideline-recommended treatment adherence, and outline strategies for the improvement in care. RECENT FINDINGS Current treatment guidelines highlight the importance of glycemic control, use of novel medications with proven cardiovascular efficacy, and multifactorial cardiovascular risk factor intervention for the treatment of diabetes and associated complications. Albeit proven evidence for these guidelines, the vast majority of patients with diabetes remain insufficiently treated. Interventions to improve outcomes require focus on care delivery systems, physician behavior, and patient-centered approaches. De-fragmenting care systems to form collaborative, multi-specialty teams, use of standardized and comprehensive treatment algorithms, development of quality assessment tools, avoiding physician therapeutic inertia, and addressing patient barriers, including lack of perceived benefit, insufficient diabetes education and access to care, and medication costs, represent key objectives to improve diabetes care and outcomes. Clinical research in standardized trials has proven the feasibility to reduce morbidity and mortality associated with diabetes. Implementing models of care to disseminate these encouraging research findings to the wider population and to overcome barriers to achieving guideline-recommended treatment goals should be the objective to improve our current quality of diabetes care in the USA.
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Affiliation(s)
- Ben Alencherry
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Dennis Bruemmer
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA. .,Center for Cardiometabolic Health, Section of Preventive Cardiology and Rehabilitation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue JB-815, Cleveland, OH, 44195, USA.
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Alkharabsheh S, Khayata M, Alencherry B, Hussain M, Cameron S, Gomes M, Collier P. SYSTEMIC REVIEW AND META-ANALYSIS OF VITAMIN K ANTAGONIST VS DIRECT ORAL ANTICOAGULANTS FOR TREATMENT OF LEFT VENTRICULAR THROMBUS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03154-5] [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: 10/21/2022]
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Abstract
PURPOSE OF REVIEW Blood pressure guidelines worldwide have changed their recommended blood pressure goals multiple times over the past decade due to an evolving understanding of the treatment of hypertension in patients with diabetes mellitus. While it is evident through randomized trials that treatment of hypertension in diabetes mellitus prevents complications, the optimal blood pressure goal is not clear. RECENT FINDINGS Post hoc analyses of the Action to Control Cardiovascular Risk in Diabetes-Blood Pressure (ACCORD-BP) trial, its long-term follow along study ACCORDION, and Systolic Blood Pressure Intervention Trial (SPRINT) suggest that patients with diabetes have a reduced risk of adverse cardiovascular events when aiming for more intensive blood pressure targets. High-quality data support guideline recommendations for more aggressive blood pressure targets in patients with diabetes mellitus. Reasoning for a return to more aggressive blood pressure goals in this at-risk population is discussed, and treatment strategies encompassing contemporary therapeutic options are recommended.
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Affiliation(s)
- Ben Alencherry
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Luke J Laffin
- Section of Preventive Cardiology and Rehabilitation, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mail Code JB-1, Cleveland, OH, 44195, USA.
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DeWyer A, Scheel A, Otim IO, Longenecker CT, Okello E, Ssinabulya I, Morris S, Okwir M, Oyang W, Joyce E, Nabongo B, Sable C, Alencherry B, Tompsett A, Aliku T, Beaton A. Improving the accuracy of heart failure diagnosis in low-resource settings through task sharing and decentralization. Glob Health Action 2020; 12:1684070. [PMID: 31694487 PMCID: PMC6844369 DOI: 10.1080/16549716.2019.1684070] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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] [Indexed: 12/17/2022] Open
Abstract
Background: Task sharing of TTE may improve capacity for heart failure diagnosis and management in patients in remote, low-resource settings but the impact on diagnostic accuracy and patient outcomes has not been studied. Objectives: Determine feasibility and impact of non-expert training in transthoracic echocardiography (TTE) to improve the diagnosis and outcomes of patients with suspected heart failure in Uganda. Methods: This two-part study examined an innovative training program to develop TTE competency among non-experts and used a pre-post design to determine the impact of decentralized TTE. Four of 8 non-experts (50%) passed a three-part training course. The training comprised of distance learning through a web-based curriculum, a 2-day hands-on workshop with cardiologists, and independent practice with remote mentorship. Continuous measures were compared (pre- vs. post-TTE) using t-tests or Wilcoxon rank-sum tests as distributionally appropriate and categorical variables assessed through chi-square testing. Sensitivity and specificity were calculated according to standard methodology comparing diagnosis pre- and post-TTE during phase 2. Results: Performance in the post-training phase showed good agreement with expert categorization (κ = 0.80) with diagnostic concordance in 421 of 454 studies (92.7%). TTE changed the preliminary diagnosis in 81% of patients, showing low specificity of clinical decision-making alone (14.2%; 95% CI 10.1–19.2%). Dilated cardiomyopathy, hypertensive heart disease with preserved systolic function, and right heart failure were the most underdiagnosed conditions prior to TTE while hypertensive heart disease with decreased systolic function was the most over-diagnosed condition. Conclusions: In conclusion, non-expert providers can achieve a high level of proficiency for the categorization of heart failure using handheld TTE in low-resource settings and use of telemedicine and remote mentorship may improve performance and feasibility. The addition of TTE resulted in substantial improvement in etiological specificity. Further study is needed to understand implications of this strategy on healthcare utilization, long-term patient outcomes, and cost.
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Affiliation(s)
- Alyssa DeWyer
- Department of Cardiology, Children's National Health System, Washington, DC, USA
| | - Amy Scheel
- Department of Cardiology, Children's National Health System, Washington, DC, USA.,School of Medicine, Emory University, Atlanta, GA, USA
| | - Isaac Omara Otim
- Department of Medicine, Lira Regional Referral Hospital, Cardiac Clinic, Lira, Uganda
| | - Christopher T Longenecker
- Department of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University, Cleveland, OH, USA
| | - Emmy Okello
- Department of Cardiology, Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Isaac Ssinabulya
- Department of Cardiology, Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Stephen Morris
- Department of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University, Cleveland, OH, USA
| | - Mark Okwir
- Department of Medicine, Lira Regional Referral Hospital, Cardiac Clinic, Lira, Uganda
| | - William Oyang
- Department of Medicine, Lira Regional Referral Hospital, Cardiac Clinic, Lira, Uganda
| | - Erine Joyce
- Department of Medicine, Lira Regional Referral Hospital, Cardiac Clinic, Lira, Uganda
| | - Betty Nabongo
- Department of Medicine, Lira Regional Referral Hospital, Cardiac Clinic, Lira, Uganda
| | - Craig Sable
- Department of Cardiology, Children's National Health System, Washington, DC, USA
| | - Ben Alencherry
- Department of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University, Cleveland, OH, USA
| | - Alison Tompsett
- Department of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University, Cleveland, OH, USA
| | - Twalib Aliku
- Department of Cardiology, Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Andrea Beaton
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Alencherry B, Erem G, Mirembe G, Ssinabulya I, Yun CH, Hung CL, Siedner MJ, Bittencourt M, Kityo C, McComsey GA, Longenecker CT. Coronary artery calcium, HIV and inflammation in Uganda compared with the USA. Open Heart 2019; 6:e001046. [PMID: 31218009 PMCID: PMC6546194 DOI: 10.1136/openhrt-2019-001046] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/11/2019] [Accepted: 04/26/2019] [Indexed: 12/22/2022] Open
Abstract
Objectives To compare the prevalence of detectable coronary artery calcium (CAC) among higher risk, older people living with HIV (PLWH) and uninfected persons in Uganda versus the USA, and second to explore associations of CAC with HIV-specific variables and biomarkers of inflammation. Methods This cross-sectional study of 430 total subjects compared 100 PLWH on antiretroviral therapy and 100 age-matched and sex-matched HIV-uninfected controls in Uganda with 167 PLWH on antiretroviral therapy and 63 uninfected controls in the USA. Multivariable logistic regression was used to examine associations with detectable CAC (CAC >0). Results Compared with US subjects, Ugandans were older (mean age 56 vs 52 years) and were more likely to have diabetes (36% vs 3%) and hypertension (85% vs 36%), but were less likely to be male (38% vs 74%) or smokers (4% vs 56%). After adjustment for HIV serostatus, age, sex and traditional risk factors, Ugandans had substantially lower odds of CAC >0 (adjusted OR 0.07 (95% CI 0.03 to 0.17), p<0.001). HIV was not associated with CAC >0 in either country (p>0.1). Among all PLWH, nadir CD4 count was associated with the presence of CAC, and among Ugandans soluble intercellular adhesion molecule (p=0.044), soluble CD163 (p=0.004) and oxidised low-density lipoprotein (p=0.043) were all associated with the presence of CAC. Conclusions Ugandans had a dramatically lower prevalence of any coronary calcification compared with US subjects. The role of HIV infection and inflammation as risk factors for subclinical coronary disease in sub-Saharan Africa merits further investigation.
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Affiliation(s)
- Ben Alencherry
- Medicine and Pediatrics, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Geoffrey Erem
- Radiology, St Francis Hospital Nsambya, Kampala, Uganda.,Radiology and Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grace Mirembe
- HIV Medicine, Joint Clinical Research Centre, Kampala, Uganda
| | - Isaac Ssinabulya
- Radiology and Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Chun-Ho Yun
- Radiology, Mackay Memorial Hospital, Taipei, Taiwan
| | | | - Mark J Siedner
- Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA.,Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Cissy Kityo
- HIV Medicine, Joint Clinical Research Centre, Kampala, Uganda
| | - Grace A McComsey
- Medicine and Pediatrics, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Pediatric Infectious Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Chris T Longenecker
- Cardiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Scheel A, Aliku T, Otim I, DeWyer A, Longenecker C, Ssinabulya I, Morris S, Alencherry B, Sable C, Okello E, Beaton A. PO050 Improving the Accuracy of Heart Failure Diagnosis In Low-Resource Settings: The Impact of Decentralization And Task Sharing. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Dousa KM, Khan K, Alencherry B, Deng L, Salata RA. Renal infarction in vascular Ehlers-Danlos syndrome masquerading as pyelonephritis. Clin Case Rep 2018; 6:1478-1480. [PMID: 30147886 PMCID: PMC6099022 DOI: 10.1002/ccr3.1639] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/31/2018] [Accepted: 05/17/2018] [Indexed: 12/02/2022] Open
Abstract
Symptoms associated with numerous diseases can be indistinguishable from those of the urinary system disorders because receptors of many visceral organs as well as the body wall transmit sensation through pain fibers shared with the kidneys. Disregarding important family background of genetic disorder can be detrimental for some patients.
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Affiliation(s)
- Khalid M. Dousa
- University Hospitals Cleveland Medical CenterCase Western Reserve UniversityClevelandOHUSA
- Division of Infectious Diseases and HIV MedicineUniversity Hospitals Cleveland Medical CenterClevelandOHUSA
| | - Kashif Khan
- University Hospitals Cleveland Medical CenterCase Western Reserve UniversityClevelandOHUSA
| | - Ben Alencherry
- University Hospitals Cleveland Medical CenterCase Western Reserve UniversityClevelandOHUSA
| | - Lin Deng
- University Hospitals Cleveland Medical CenterCase Western Reserve UniversityClevelandOHUSA
| | - Robert A. Salata
- University Hospitals Cleveland Medical CenterCase Western Reserve UniversityClevelandOHUSA
- Division of Infectious Diseases and HIV MedicineUniversity Hospitals Cleveland Medical CenterClevelandOHUSA
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Chami T, Kim CH, Tefera L, Alencherry B, Darmoch F, Al-Kindi SG, Oliveira GH. Spironolactone and Incidence of Atrial Fibrillation in Heart Failure with Reduced Ejection Fraction. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.201] [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: 10/19/2022]
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Kim C, Tefera L, Alencherry B, Chami AT, Al-Kindi S, Longenecker C. RISK OF ATRIAL FIBRILLATION IN HUMAN IMMUNODEFICIENCY VIRUS INFECTION IN THE ERA OF ANTIRETROVIRAL THERAPY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33868-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kim CH, Morrison J, Alencherry B, Nadeem F, Al-Kindi SG, Oliveira GH. Heart Failure in Granulomatosis with Polyangiitis. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.242] [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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Kim CH, Morrison J, Alencherry B, Al-Kindi SG, Oliveira GH. Heart Failure and Cardiovascular Risk in Polymyositis and Dermatomyositis. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.066] [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]
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