1
|
Luni FK, Daniels J, Link MS, Joglar JA, Zungsontiporn N, Wu R, Kaplish N, Malik SA. Meta-analysis of Usefulness of Phrenic Nerve Stimulation in Central Sleep Apnea. Am J Cardiol 2020; 125:1738-1744. [PMID: 32295701 DOI: 10.1016/j.amjcard.2020.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/16/2020] [Accepted: 02/18/2020] [Indexed: 11/25/2022]
Abstract
Transvenous neurostimulation of the phrenic nerve (PNS) is a potentially improved and unique approach to the treatment of central sleep apnea (CSA). There have been multiple studies with limited individuals evaluating the efficacy of PNS. Our aim was to review and pool those studies to better understand whether phrenic nerve stimulation is efficacious in the treatment of CSA. The initial search on Pubmed retrieved a total of 97 articles and after screening all articles, only 5 could be included in our quantitative analysis. Pooling of data from 5 studies with a total of 204 patients demonstrated a reduction of mean apnea hypopnea index with PNS compared to controls by -26.7 events/hour with 95% confidence interval and P value of [CI (-31.99, -21.46), I2 85, p 0.00]. The mean difference in central apnea index was -22.47 [CI (-25.19, -19.76), I2 0, p 0.00]. The mean reduction in the oxygen desaturation index of 4% or more demonstrated a decrease in PNS group by -24.16 events/hour [(CI -26.20, -22.12), I2 0, p 0.00] compared with controls. PNS resulted in mean reduction in arousal index of -13.77 [CI (-16.15, -11.40), I2 0, p 0.00]. The mean change in percent of time spent in rapid eye movement sleep demonstrated a nonsignificant increase in PNS group by 1.01 % [CI (-5.67, 7.86), I293, p 0.75]. In conclusion, PNS therapy for treating CSA demonstrated positive outcomes but larger randomized studies are needed to evaluate the safety and clinical outcomes.
Collapse
Affiliation(s)
- Faraz Khan Luni
- Department of Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, Texas
| | - James Daniels
- Department of Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, Texas
| | - Mark S Link
- Department of Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, Texas
| | - Jose A Joglar
- Department of Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, Texas
| | - Nath Zungsontiporn
- Department of Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, Texas
| | - Richard Wu
- Department of Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, Texas
| | - Neeraj Kaplish
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Sonia Ali Malik
- Department of Neurology and Family Medicine, UT Southwestern Medical Center, Dallas, Texas.
| |
Collapse
|
2
|
Luni FK, Zungsontiporn N, Link MS, Joglar JA. Response to the Editor: Percutaneous left ventricular assist device support during ablation of ventricular tachycardia: A meta-analysis of current evidence. J Cardiovasc Electrophysiol 2019; 30:2185-2186. [PMID: 31310404 DOI: 10.1111/jce.14046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Mark S Link
- UT Southwestern Medical Center, Dallas, Texas
| | | |
Collapse
|
3
|
Malik SA, Luni FK, Link M, Dunn A, Kaplish N. 1052 Hypertrophic Cardiomyopathy and Sleep Apnea- The Central Plot. Sleep 2019. [DOI: 10.1093/sleep/zsz069.1049] [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: 11/13/2022] Open
Affiliation(s)
- Sonia Ali Malik
- Sleep Medicine Fellow, Department of Neurology, University of Michigan; Ann Arbor, Michigan
| | - Faraz Khan Luni
- Electrophysiology Fellow, Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mark Link
- Professor, Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Abbey Dunn
- Clinical Instructor, Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Neeraj Kaplish
- Assistant Professor, Department of Neurology, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
4
|
Luni FK, Zungsontiporn N, Farid T, Malik SA, Khan S, Daniels J, Wu R, Link MS, Joglar JA. Percutaneous left ventricular assist device support during ablation of ventricular tachycardia: A meta-analysis of current evidence. J Cardiovasc Electrophysiol 2019; 30:886-895. [PMID: 30847997 DOI: 10.1111/jce.13907] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/26/2019] [Accepted: 03/03/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Catheter ablation of ventricular tachycardia (VT) can be an effective therapy to reduce VT burden, but often it is limited by the potential for hemodynamic instability. Percutaneous left ventricular assist devices (pLVADs) have been used to maintain hemodynamic support during VT ablation but the evidence regarding its clinical impact has been inconclusive. METHODS AND RESULTS We sought to assess the clinical impact of pLVAD when used in VT ablation by conducting a meta-analysis of the current evidence. We searched Pubmed and found nine observational studies that compared clinical outcomes of VT ablation in patients with pLVAD support to controls with no pLVAD support. The pooled data did not show a significant difference in mortality between both groups, nor a difference in acute procedural success or in recurrence of VT. There was also no difference in the number of patients receiving a cardiac transplant or being enrolled in the transplant list. Although there was no difference in the ablation time between the groups, patients in the pLVAD group had a longer total procedural time and more procedure-related adverse effects. CONCLUSION This meta-analysis did not show clinical benefits from using pLVAD support during VT ablation, whereas it was associated with longer procedure times and more complications. This study was, however, limited by the observational nature of the data. In view of these data, the risk and benefit of pLVAD support during VT ablation should be considered on an individual basis.
Collapse
Affiliation(s)
- Faraz Khan Luni
- Department of Cardiology, UT Southwestern Medical Center, Dallas, Texas
| | | | - Talha Farid
- Department of Cardiology, University of Louisville, Louisville, Kentucky
| | - Sonia Ali Malik
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Sobia Khan
- Department of Cardiology, University of Louisville, Louisville, Kentucky
| | - James Daniels
- Department of Cardiology, UT Southwestern Medical Center, Dallas, Texas
| | - Richard Wu
- Department of Cardiology, UT Southwestern Medical Center, Dallas, Texas
| | - Mark S Link
- Department of Cardiology, UT Southwestern Medical Center, Dallas, Texas
| | - Jose A Joglar
- Department of Cardiology, UT Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
5
|
Nazir S, Lohani S, Tachamo N, Khan MS, Timilsina B, Luni FK, Donato A. Outcomes following transcatheter transseptal versus transapical mitral valve-in-valve and valve-in-ring procedures. J Cardiovasc Thorac Res 2019; 10:182-186. [PMID: 30680074 PMCID: PMC6335986 DOI: 10.15171/jcvtr.2018.31] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 07/07/2018] [Accepted: 11/15/2018] [Indexed: 02/02/2023] Open
Abstract
Introduction: Transcatheter mitral valve-in-valve (ViV) & valve-in-ring (ViR) are relatively novel therapeutic alternatives for patients with degenerated bioprostheses or failed annuloplasty rings whose reoperative risk is too high. The predominant procedural access for both procedures is transapical or transseptal. However, whether there are differences in outcomes of this procedure using transseptal versus transapical access has not yet been defined. Methods: We conducted a systematic review of all published articles from MEDLINE and EMBASE to explore the outcomes of these two procedural approaches. Results:total of 55 studies including 183 patients (154 ViV and 29 ViR) were included. Patients that underwent ViV (101 transapical and 53 transseptal) using the transseptal approach required more iatrogenic atrial septal defect (ASD) closure (19% versus 0.0 %; P < 0.001) and hence had a lower device success rate (68% versus 89%; P = 0.001). However, there was no significant difference between the two groups in procedural success and all-cause mortality at 30 days. Overall severe bleeding complications (major or life threatening) were not different the two groups (3.7% versus 7.9%; P = 0.321). In the ViR group (19 transapical and 10 transseptal), no difference in procedural success, device success or 30-day outcomes were identified between transseptal and transapical groups, although sample size was small. Conclusion: In conclusion, mitral ViV and ViR using the two different procedural approaches appear to confer equal and reasonable 30-day outcomes.
Collapse
Affiliation(s)
- Salik Nazir
- Department of Medicine, Reading Hospital-Tower Health System, West Reading, Pennsylvania, USA
| | - Saroj Lohani
- Department of Medicine, Reading Hospital-Tower Health System, West Reading, Pennsylvania, USA
| | - Niranjan Tachamo
- Department of Medicine, Reading Hospital-Tower Health System, West Reading, Pennsylvania, USA
| | - Muhammad Sohail Khan
- Department of Medicine, Reading Hospital-Tower Health System, West Reading, Pennsylvania, USA
| | - Bidhya Timilsina
- Department of Medicine, Reading Hospital-Tower Health System, West Reading, Pennsylvania, USA
| | - Faraz Khan Luni
- Division of Cardiology, Mercy Saint Vincent Medical Center, Toledo, Ohio, USA
| | - Anthony Donato
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
6
|
Nazir S, Elmariah S, Lohani S, Tachamo N, Khan MS, Timilsina B, Luni FK, Donato A. OUTCOMES FOLLOWING TRANSCATHETER TRANSSEPTAL VERSUS TRANSAPICAL MITRAL VALVE-IN-VALVE AND VALVE-IN-RING PROCEDURES. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31797-2] [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: 10/17/2022]
|
7
|
Khan MI, Adeel FA, Luni FK, Khan AR, Malhotra D, Duggan J. Secondary Peritonitis in Peritoneal Dialysis: A Case Report and Review of Literature. J Med Cases 2018. [DOI: 10.14740/jmc3116w] [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: 11/11/2022] Open
|
8
|
Luni FK, Khan AR, Singh H, Riaz H, Malik SA, Khawaja O, Farid T, Cummings J, Taleb M. Identification and Ablation of Dormant Conduction in Atrial Fibrillation Using Adenosine. Am J Med Sci 2017; 355:27-36. [PMID: 29289258 DOI: 10.1016/j.amjms.2017.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 09/05/2017] [Accepted: 09/18/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Ablation is used for treatment of atrial fibrillation (AF) but recurrence is common. Dormant conduction is hypothesized to be responsible for these recurrences, and the role of adenosine in identification and ablation of these pathways is controversial with conflicting results on AF recurrence. MATERIALS AND METHODS We conducted a meta-analysis for studies evaluating AF ablation and adenosine use. Included in the meta-analysis were human studies that compared ablation using adenosine or adenosine triphosphate (ATP) and reported freedom from AF in patients beyond a minimum follow-up of 6 months. RESULTS Our analysis suggests that the use of adenosine leads to a decrease in recurrence of AF compared to the cohort which did not utilize adenosine. Subgroup analysis showed no difference in the recurrence of AF with the modality used for ablation (cryoablation vs. radiofrequency ablation) or with the preparation of adenosine used (ATP vs. adenosine). There was a significant benefit in delayed administration of ATP over early administration. Pooling results of only randomized control trials did not show any significant difference in AF recurrence. CONCLUSIONS Adenosine-guided identification and ablation of dormant pathways may lead to a decrease in recurrence of AF.
Collapse
Affiliation(s)
- Faraz Khan Luni
- Department of Cardiovascular Diseases and Department of Family Medicine, Mercy Saint Vincent Medical Center, Toledo, Ohio.
| | - Abdur Rahman Khan
- Department of Cardiovascular Diseases, University of Louisville, Louisville, Kentucky
| | - Hemindermeet Singh
- Department of Cardiovascular Diseases and Department of Family Medicine, Mercy Saint Vincent Medical Center, Toledo, Ohio
| | - Haris Riaz
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Sonia Ali Malik
- Department of Cardiovascular Diseases and Department of Family Medicine, Mercy Saint Vincent Medical Center, Toledo, Ohio
| | - Owais Khawaja
- Department of Cardiovascular Diseases and Department of Family Medicine, Mercy Saint Vincent Medical Center, Toledo, Ohio
| | - Talha Farid
- Department of Cardiovascular Diseases, University of Louisville, Louisville, Kentucky
| | - Jennifer Cummings
- Department of Cardiovascular Diseases, Northeastern Ohio Medical University, Canton, Ohio
| | - Mohammed Taleb
- Department of Cardiovascular Diseases and Department of Family Medicine, Mercy Saint Vincent Medical Center, Toledo, Ohio
| |
Collapse
|
9
|
Riaz H, Khan AR, Khan MS, Rehman KA, Alansari SAR, Gheyath B, Raza S, Barakat A, Luni FK, Ahmed H, Krasuski RA. Meta-analysis of Placebo-Controlled Randomized Controlled Trials on the Prevalence of Statin Intolerance. Am J Cardiol 2017; 120:774-781. [PMID: 28779871 DOI: 10.1016/j.amjcard.2017.05.046] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 02/22/2017] [Revised: 05/15/2017] [Accepted: 05/30/2017] [Indexed: 11/16/2022]
Abstract
The prevalence of intolerance varies widely. Stopping statin therapy is associated with worse outcomes in patients with cardiovascular disease. Despite extensive studies, the benefits and risks of statins continue to be debated by clinicians and the lay public. We searched the PubMed, Medline, and Cochrane Central Register of Controlled Trials (CENTRAL) databases for all randomized controlled trials of statins compared with placebo. Studies were included if they had ≥1,000 participants, had patients who were followed up for ≥1 year, and reported rates of drug discontinuation. Studies were pooled as per the random effects model. A total of 22 studies (statins = 66,024, placebo = 63,656) met the inclusion criteria. The pooled analysis showed that, over a mean follow-up of 4.1 years, the rates of discontinuation were 13.3% (8,872 patients) for statin-treated patients and 13.9% (8,898 patients) for placebo-treated patients. The random effects model showed no significant difference between the placebo and statin arms (odds ratio [OR] = 0.99, 95% confidence interval [CI] = 0.93 to 1.06). The results were similar for both primary prevention (OR = 0.98, 95% CI = 0.92 to 1.05, p = 0.39) and secondary prevention (OR = 0.92, 95% CI = 0.83 to 1.05, p = 0.43) studies. The pooled analysis suggested that the rates of myopathy were also similar between the statins and placebos (OR = 1.2, 95% CI = 0.88 to 1.62, p = 0.25). In conclusion, this meta-analysis of >125,000 patients suggests that the rate of drug discontinuation and myopathy does not significantly differ between statin- and placebo-treated patients in randomized controlled trials. These findings are limited by the heterogeneity of results, the variable duration of follow-up, and the lower doses of statins compared with contemporary clinical practice.
Collapse
Affiliation(s)
- Haris Riaz
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Abdur Rahman Khan
- Department of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky
| | - Muhammad Shahzeb Khan
- Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | | | | | - Bashaer Gheyath
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sajjad Raza
- Department of Cardiac Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amr Barakat
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Faraz Khan Luni
- Department of Cardiovascular Medicine, Mercy Saint Vincent Medical Center, Toledo, Ohio
| | - Haitham Ahmed
- Section of Preventive Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Richard A Krasuski
- Department of Cardiovascular Medicine, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
10
|
Luni FK, Malik SA, Khan AR, Riaz H, Singh H, Federman D, Kanjwal Y, Dasa O, Khuder S, Kabour A. Risk of Ischemic Heart Disease in Patients With Sjögren's Syndrome. Am J Med Sci 2017; 354:395-398. [PMID: 29078844 DOI: 10.1016/j.amjms.2017.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 12/08/2016] [Revised: 04/28/2017] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Ischemic heart disease (IHD) has emerged as a major cause of morbidity and mortality in patients with autoimmune conditions such as systemic lupus erythematosus and rheumatoid arthritis, but the risk of IHD in Sjögren's syndrome (SjS) is unknown. To fill this knowledge gap, we estimated the prevalence and risk of IHD with SjS compared to controls from the general population using the Healthcare Cost and Utilization Project National Inpatient Sample 2011 database. MATERIALS AND METHODS The Healthcare Cost and Utilization Project administrative longitudinal database contains encounter-level information on inpatient stays, emergency department visits and ambulatory surgery in all U.S. hospitals. We conducted a cross-sectional study among the inpatient population diagnosed with SjS and matched 1:4 with controls for age, sex and hospital region. Odds ratio for IHD was calculated as cases compared to controls. The contribution of various risk factors to IHD was also evaluated by logistic regression. RESULTS Analysis demonstrated that 7,154 of 13,086 cases (54.7%) of SjS had IHD compared to 27,367 of 52,448 controls (52.2%). The adjusted odds ratio for IHD in those with SjS was 0.898 (95% CI: 0.844-0.955). Patients with SjS were significantly more likely to have hypertension, diabetes, apnea and lipid disorders. CONCLUSIONS To our knowledge, this is the largest population-based study investigating the risk of IHD in patients with SjS. We found a modest, though statistically significant, decrease in the risk of IHD in SjS compared to controls.
Collapse
Affiliation(s)
- Faraz Khan Luni
- Department of Cardiovascular Diseases, Mercy Saint Vincent Medical Center, Toledo, Ohio.
| | - Sonia Ali Malik
- Department of Family Medicine, Mercy Saint Vincent Medical Center, Toledo, Ohio
| | - Abdur Rahman Khan
- Department of Cardiovascular Diseases, University of Louisville, Louisville, Kentucky
| | - Haris Riaz
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Hemindermeet Singh
- Department of Cardiovascular Diseases, Mercy Saint Vincent Medical Center, Toledo, Ohio
| | - Douglas Federman
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
| | | | - Osama Dasa
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
| | - Sadik Khuder
- School of Population Health, University of Toledo Medical Center, Toledo, Ohio
| | - Ameer Kabour
- Department of Cardiovascular Diseases, Mercy Saint Vincent Medical Center, Toledo, Ohio
| |
Collapse
|
11
|
Singh H, Ali S, Luni FK, Hashmi F, Taleb M. Isolated rupture of bicuspid aortic valve following blunt chest trauma: a case report and systematic review of literature. Cardiovasc Diagn Ther 2017; 7:89-91. [PMID: 28164016 DOI: 10.21037/cdt.2016.05.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Blunt trauma to chest cause injury to various cardiac structures. Isolated rupture of aortic valve without aortic dissection is rare complication of blunt chest trauma and can be caused by a tear or avulsion of the valve. We report a case of a 35-year-old male who presented with severe aortic insufficiency due to rupture of a non-infected congenital bicuspid aortic valve following non-penetrating chest trauma. The diagnosis was suggested by echocardiography and was confirmed by intra-operative and histological findings. The patient was successfully treated with surgical valve replacement with uneventful postoperative course and recovery. We describe patho-physiology, clinical manifestations, management and the literature review of traumatic rupture of bicuspid aortic valve.
Collapse
Affiliation(s)
- Hemindermeet Singh
- 1 Department of Cardiovascular Fellowship, 2 Department of Cardiothoracic Surgery, Mercy St Vincent Medical Center and Hospital, Toledo, OH, USA
| | - Sajid Ali
- 1 Department of Cardiovascular Fellowship, 2 Department of Cardiothoracic Surgery, Mercy St Vincent Medical Center and Hospital, Toledo, OH, USA
| | - Faraz Khan Luni
- 1 Department of Cardiovascular Fellowship, 2 Department of Cardiothoracic Surgery, Mercy St Vincent Medical Center and Hospital, Toledo, OH, USA
| | - Fayyaz Hashmi
- 1 Department of Cardiovascular Fellowship, 2 Department of Cardiothoracic Surgery, Mercy St Vincent Medical Center and Hospital, Toledo, OH, USA
| | - Mohammed Taleb
- 1 Department of Cardiovascular Fellowship, 2 Department of Cardiothoracic Surgery, Mercy St Vincent Medical Center and Hospital, Toledo, OH, USA
| |
Collapse
|
12
|
Luni FK, Riaz H, Khan AR, Riaz T, Husnain M, Riaz IB, Khan MS, Taleb M, Kanjwal Y, Cooper CJ, Khuder SA. Clinical outcomes associated with per-operative discontinuation of aspirin in patients with coronary artery disease: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2016; 89:1168-1175. [PMID: 27663179 DOI: 10.1002/ccd.26807] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 10/27/2016] [Revised: 08/07/2016] [Accepted: 09/05/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Postoperative state is characterized by increased thrombotic risk by virtue of platelet activation. Whether aspirin ameliorates this risk in patients with established coronary artery disease undergoing cardiac or noncardiac surgery is unknown. We conducted a systematic review and meta-analysis to compare the risk of major adverse cardiac events (MACE) and the risk of bleeding in patients with early (3-5 or more days before surgery) vs. late discontinuation(<3-5 days)/no discontinuation of aspirin. METHODS Multiple databases were searched from inception of these databases until March 2015 to identify studies that reported discontinuation of aspirin in patients undergoing surgery. The outcomes measured were all cause mortality, nonfatal myocardial infarction and other relevant thrombotic events (MACE) which also may include, fatal and nonfatal MI, stent thrombosis and restenosis, stroke, perioperative cardiovascular complications (heart failure, MI, VTE, acute stroke) and perioperative bleeding during the perioperative period to up to 30 days after surgery. RESULTS A total of 1,018 titles were screened, after which six observational studies met the inclusion criteria. Our analysis suggests that there is no difference in MACE with planned discontinuation of aspirin (OR = 1.17, 95% CI = 0.76-1.81; P = 0.05; I2 = 55%). Early discontinuation of aspirin showed a decreased risk of peri-operative bleeding (OR 0.82, 95% CI = 0.67-0.99; P = 0.04; I2 = 42%). CONCLUSION Our analysis suggests that planned short-term discontinuation in the appropriate clinical setting appears to be safe in the correct clinical setting with no increased risk of thrombotic events and with a decreased risk of bleeding. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
| | | | | | - Talha Riaz
- Bronx Lebanon Hospital, New York, New York
| | | | | | | | | | | | | | | |
Collapse
|
13
|
|
14
|
Singh H, Luni FK, Marwaha B, Ali SS, Alo M. Transient Complete Heart Block Secondary to Bed Bug Insecticide: A Case of Pyrethroid Cardiac Toxicity. Cardiology 2016; 135:160-163. [DOI: 10.1159/000446574] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 04/30/2016] [Indexed: 11/19/2022]
Abstract
Pyrethroids are the major components of various commercially used insect repellants. These are less toxic to humans due to their slow absorption and rapid metabolism. However, cases of suicidal and accidental poisoning with household insecticides are not uncommon. We report a case of a 59-year-old female who presented with syncope after an accidental exposure to bed bug repellant spray at home. She was found to be in complete heart block and was treated conservatively. There was complete resolution of symptoms and atrioventricular conduction abnormality on day 2 of hospitalization. She was discharged in a stable condition with an uneventful follow-up course. Cardiac involvement in pyrethroid toxicity is rare. We describe various clinical manifestations and the pathophysiology of toxicity caused by pyrethroid-containing insecticides.
Collapse
|
15
|
Riaz H, Alansari SAR, Khan MS, Riaz T, Raza S, Luni FK, Khan AR, Riaz IB, Krasuski RA. Safety and Use of Anticoagulation After Aortic Valve Replacement With Bioprostheses: A Meta-Analysis. Circ Cardiovasc Qual Outcomes 2016; 9:294-302. [PMID: 27166205 DOI: 10.1161/circoutcomes.115.002696] [Citation(s) in RCA: 16] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/29/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The American College of Cardiology guidelines recommend 3 months of anticoagulation after replacement of the aortic valve with a bioprosthesis. However, there remains great variability in the current clinical practice and conflicting results from clinical studies. To assist clinical decision making, we pooled the existing evidence to assess whether anticoagulation in the setting of a new bioprosthesis was associated with improved outcomes or greater risk of bleeding. METHODS AND RESULTS We searched the PubMed database from the inception of these databases until April 2015 to identify original studies (observational studies or clinical trials) that assessed anticoagulation with warfarin in comparison with either aspirin or no antiplatelet or anticoagulant therapy. We included the studies if their outcomes included thromboembolism or stroke/transient ischemic attacks and bleeding events. Quality assessment was performed in accordance with the Newland Ottawa Scale, and random effects analysis was used to pool the data from the available studies. I(2) testing was done to assess the heterogeneity of the included studies. After screening through 170 articles, a total of 13 studies (cases=6431; controls=18210) were included in the final analyses. The use of warfarin was associated with a significantly increased risk of overall bleeding (odds ratio, 1.96; 95% confidence interval, 1.25-3.08; P<0.0001) or bleeding risk at 3 months (odds ratio, 1.92; 95% confidence interval, 1.10-3.34; P<0.0001) compared with aspirin or placebo. With regard to composite primary outcome variables (risk of venous thromboembolism, stroke, or transient ischemic attack) at 3 months, no significant difference was seen with warfarin (odds ratio, 1.13; 95% confidence interval, 0.82-1.56; P=0.67). Moreover, anticoagulation was also not shown to improve outcomes at time interval >3 months (odds ratio, 1.12; 95% confidence interval, 0.80-1.58; P=0.79). CONCLUSIONS Contrary to the current guidelines, a meta-analysis of previous studies suggests that anticoagulation in the setting of an aortic bioprosthesis significantly increases bleeding risk without a favorable effect on thromboembolic events. Larger, randomized controlled studies should be performed to further guide this clinical practice.
Collapse
Affiliation(s)
- Haris Riaz
- From the Department of Internal Medicine, Cleveland Clinic, OH (H.R., S.A.R.A.); Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, OH (S.A.R.A., S.R.); Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (M.S.K.); Department of Internal Medicine, Bronx Lebanon Hospital, New York, NY (T.R.); Department of Cardiovascular Medicine, Mercy Saint Vincent Medical Center, Toledo, OH (F.K.L.); Department of Cardiovascular Medicine, University of Louisville, KY (A.R.K.); Department of Internal Medicine, University of Arizona, Tucson (I.B.R.); and Department of Cardiovascular Medicine, Duke University, Durham, NC (R.A.K.).
| | - Shehab Ahmad Redha Alansari
- From the Department of Internal Medicine, Cleveland Clinic, OH (H.R., S.A.R.A.); Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, OH (S.A.R.A., S.R.); Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (M.S.K.); Department of Internal Medicine, Bronx Lebanon Hospital, New York, NY (T.R.); Department of Cardiovascular Medicine, Mercy Saint Vincent Medical Center, Toledo, OH (F.K.L.); Department of Cardiovascular Medicine, University of Louisville, KY (A.R.K.); Department of Internal Medicine, University of Arizona, Tucson (I.B.R.); and Department of Cardiovascular Medicine, Duke University, Durham, NC (R.A.K.)
| | - Muhammad Shahzeb Khan
- From the Department of Internal Medicine, Cleveland Clinic, OH (H.R., S.A.R.A.); Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, OH (S.A.R.A., S.R.); Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (M.S.K.); Department of Internal Medicine, Bronx Lebanon Hospital, New York, NY (T.R.); Department of Cardiovascular Medicine, Mercy Saint Vincent Medical Center, Toledo, OH (F.K.L.); Department of Cardiovascular Medicine, University of Louisville, KY (A.R.K.); Department of Internal Medicine, University of Arizona, Tucson (I.B.R.); and Department of Cardiovascular Medicine, Duke University, Durham, NC (R.A.K.)
| | - Talha Riaz
- From the Department of Internal Medicine, Cleveland Clinic, OH (H.R., S.A.R.A.); Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, OH (S.A.R.A., S.R.); Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (M.S.K.); Department of Internal Medicine, Bronx Lebanon Hospital, New York, NY (T.R.); Department of Cardiovascular Medicine, Mercy Saint Vincent Medical Center, Toledo, OH (F.K.L.); Department of Cardiovascular Medicine, University of Louisville, KY (A.R.K.); Department of Internal Medicine, University of Arizona, Tucson (I.B.R.); and Department of Cardiovascular Medicine, Duke University, Durham, NC (R.A.K.)
| | - Sajjad Raza
- From the Department of Internal Medicine, Cleveland Clinic, OH (H.R., S.A.R.A.); Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, OH (S.A.R.A., S.R.); Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (M.S.K.); Department of Internal Medicine, Bronx Lebanon Hospital, New York, NY (T.R.); Department of Cardiovascular Medicine, Mercy Saint Vincent Medical Center, Toledo, OH (F.K.L.); Department of Cardiovascular Medicine, University of Louisville, KY (A.R.K.); Department of Internal Medicine, University of Arizona, Tucson (I.B.R.); and Department of Cardiovascular Medicine, Duke University, Durham, NC (R.A.K.)
| | - Faraz Khan Luni
- From the Department of Internal Medicine, Cleveland Clinic, OH (H.R., S.A.R.A.); Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, OH (S.A.R.A., S.R.); Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (M.S.K.); Department of Internal Medicine, Bronx Lebanon Hospital, New York, NY (T.R.); Department of Cardiovascular Medicine, Mercy Saint Vincent Medical Center, Toledo, OH (F.K.L.); Department of Cardiovascular Medicine, University of Louisville, KY (A.R.K.); Department of Internal Medicine, University of Arizona, Tucson (I.B.R.); and Department of Cardiovascular Medicine, Duke University, Durham, NC (R.A.K.)
| | - Abdur Rahman Khan
- From the Department of Internal Medicine, Cleveland Clinic, OH (H.R., S.A.R.A.); Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, OH (S.A.R.A., S.R.); Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (M.S.K.); Department of Internal Medicine, Bronx Lebanon Hospital, New York, NY (T.R.); Department of Cardiovascular Medicine, Mercy Saint Vincent Medical Center, Toledo, OH (F.K.L.); Department of Cardiovascular Medicine, University of Louisville, KY (A.R.K.); Department of Internal Medicine, University of Arizona, Tucson (I.B.R.); and Department of Cardiovascular Medicine, Duke University, Durham, NC (R.A.K.)
| | - Irbaz Bin Riaz
- From the Department of Internal Medicine, Cleveland Clinic, OH (H.R., S.A.R.A.); Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, OH (S.A.R.A., S.R.); Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (M.S.K.); Department of Internal Medicine, Bronx Lebanon Hospital, New York, NY (T.R.); Department of Cardiovascular Medicine, Mercy Saint Vincent Medical Center, Toledo, OH (F.K.L.); Department of Cardiovascular Medicine, University of Louisville, KY (A.R.K.); Department of Internal Medicine, University of Arizona, Tucson (I.B.R.); and Department of Cardiovascular Medicine, Duke University, Durham, NC (R.A.K.)
| | - Richard A Krasuski
- From the Department of Internal Medicine, Cleveland Clinic, OH (H.R., S.A.R.A.); Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, OH (S.A.R.A., S.R.); Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (M.S.K.); Department of Internal Medicine, Bronx Lebanon Hospital, New York, NY (T.R.); Department of Cardiovascular Medicine, Mercy Saint Vincent Medical Center, Toledo, OH (F.K.L.); Department of Cardiovascular Medicine, University of Louisville, KY (A.R.K.); Department of Internal Medicine, University of Arizona, Tucson (I.B.R.); and Department of Cardiovascular Medicine, Duke University, Durham, NC (R.A.K.)
| |
Collapse
|
16
|
Luni FK, Dasa O, Khan AR, Riaz H, Federman D, Kanjwal Y, Khuder S. DECREASED RISK OF ISCHEMIC HEART DISEASE IN PATIENTS WITH SJGREN’S SYNDROME: AN ANALYSIS OF UNITED STATES NATIONAL DATABASE. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)32152-0] [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: 11/26/2022]
|
17
|
Khan AR, Khan S, Riaz H, Luni FK, Simo H, Bin Abdulhak A, Bavishi C, Flaherty M. Efficacy and safety of transcatheter aortic valve replacement in intermediate surgical risk patients: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2016; 88:934-944. [PMID: 26946091 DOI: 10.1002/ccd.26465] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 07/12/2015] [Revised: 11/28/2015] [Accepted: 01/22/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND The efficacy of transcatheter aortic valve replacement (TAVR) in aortic stenosis patients at high surgical risk has been established. The data on patients with intermediate risk is not conclusive. We performed a meta-analysis of studies which compared TAVR with surgical aortic valve replacement (SAVR) in patients at intermediate surgical risk. METHODS Several databases searched from inception to February 2015 yielded 7 eligible studies with 2,173 participants. The measured outcome of efficacy was all-cause mortality. Data on safety included stroke, permanent pacemaker implantation (PPI), aortic regurgitation (AR), vascular access complications, and major bleeding. Outcomes were pooled and relative risk (RR) was calculated with the Mantel-Haenszel method. RESULTS There was no difference in either short-term (RR, 1.02; 95% CI: 0.63-1.63; P = 0.94; I2 = 0%) or medium to long-term all-cause mortality (RR, 0.99; 95% CI: 0.81-1.21; P = 0.91; I2 = 0%). There was increased incidence of stroke (RR, 2.96; 95% CI: 0.87-10.09; P = 0.08; I2 = 0%), AR (RR, 3.59; 95% CI: 2.13-7.19; P < 0.00001; I2 = 2%), PPI (RR, 6.53; 95% CI: 1.91-22.32; P < 0.003; I2 = 0%) and vascular access complications (RR, 3.84; 95% CI: 0.65-22.76; P < 0.14; I2 = 48%) in patients with TAVR. There was a small, albeit increased risk of major or life threatening bleeding with SAVR as compared to TAVR (RR, 1.36; 95% CI: 1.04-1.80; P < 0.03; I2 = 0%). CONCLUSIONS In this meta-analysis we found that TAVR may be an acceptable alternative to SAVR in patients with intermediate risk for surgery. However, we must await evidence from the current large randomized trials before widespread adoption of this procedure is undertaken. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Abdur Rahman Khan
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Louisville, Louisville, Kentucky
| | - Sobia Khan
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
| | - Haris Riaz
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Faraz Khan Luni
- Division of Cardiovascular Medicine, Department of Internal Medicine, Saint Vincent Mercy Hospital, Toledo, Ohio
| | - Herman Simo
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
| | - Aref Bin Abdulhak
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Chirag Bavishi
- Division of Cardiovascular Medicine, Department of Internal Medicine, St Lukes Roosevelt Hospital, New York
| | - Michael Flaherty
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Louisville, Louisville, Kentucky
| |
Collapse
|
18
|
Khan AR, Khan Luni F, Bavishi C, Khan S, Eltahawy EA. Left dominant circulation increases mortality in acute coronary syndrome: A systematic review and meta-analysis of observational studies involving 255,718 patients. Catheter Cardiovasc Interv 2015; 88:201-8. [PMID: 26524998 DOI: 10.1002/ccd.26281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 04/16/2015] [Revised: 08/31/2015] [Accepted: 10/03/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND The effect of coronary dominance on mortality in patients with acute coronary syndrome (ACS) remains unclear. We performed a meta-analysis to evaluate the effect of coronary dominance in patients with ACS. METHODS Several data sources were searched for studies which compared studies that compared outcomes between right and left dominant coronary circulation in patients with ACS. The measured outcomes were in-hospital, 30-day or long-term mortality as reported in individual studies. The Generic inverse variance method was used in a random-effects model to pool mortality as an outcome. Odds ratio (OR) was calculated for mortality in the left dominant circulation relative to a right dominant one. Sub-group analysis was performed after stratification of mortality by duration. RESULTS A total of 5 studies with 8 comparisons and 255,718 participants revealed an increased risk mortality (OR = 1.27 (95% CI: 1.13 - 1.42; P < 0.0001; I(2) = 34%). Sub-group analysis revealed that the increased risk was evident at all time periods after the ACS; in-hospital (OR = 1.37; 95% CI: 1.07 - 1.76; P = 0.01; I(2) = 50%), at 30 days (OR = 1.69; 95% CI: 1.14 - 2.52; P = 0.009; I(2) = 18%) and long-term (OR = 1.15; 95% CI: 1.03 - 1.28; P = 0.01; I(2) = 0%). CONCLUSIONS In this meta-analysis we found that there is an increased risk of mortality with LD coronary circulation in patients with ACS. The knowledge of coronary dominance may not only be helpful as an incremental prognostic factor beyond pre-procedural risk scores in all patients with ACS, but may also aid in clinical decision making in a subset of these patients. © 2015 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Abdur R Khan
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Louisville, Kentucky
| | - Faraz Khan Luni
- Division of Cardiovascular Medicine, Mercy St Vincent Medical Center, Toledo, Ohio
| | - Chirag Bavishi
- Department of Cardiology, Mount Sinai St. Luke's & Roosevelt Hospitals, New York, New York
| | - Sobia Khan
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
| | - Ehab A Eltahawy
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
| |
Collapse
|
19
|
Khan AR, Siddiqui NS, Thotakura R, Hasan SS, Luni FK, Sodeman T, Hinch B, Kaw D, Hariri I, Khuder S, Assaly R. Evaluation and enhancement of medical knowledge competency by monthly tests: a single institution experience. Adv Med Educ Pract 2015; 6:571-575. [PMID: 26491378 PMCID: PMC4598237 DOI: 10.2147/amep.s89951] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND In-training examination (ITE) has been used as a predictor of performance at the American Board of Internal Medicine (ABIM) certifying examination. ITE however may not be an ideal modality as it is held once a year and represents snapshots of performance as compared with a trend. We instituted monthly tests (MTs) to continually assess the performance of trainees throughout their residency. OBJECTIVE To determine the predictors of ABIM performance and to assess whether the MTs can be used as a tool to predict passing the ABIM examination. METHODS The MTs, core competencies, and ITE scores were analyzed for a cohort of graduates who appeared for the ABIM examination from 2010 to 2013. Logistic regression was performed to identify the predictors of a successful performance at the ABIM examination. RESULTS Fifty-one residents appeared for the ABIM examination between 2010 and 2013 with a pass rate of 84%. The MT score for the first year (odds ratio [OR] =1.302, CI =1.004-1.687, P=0.04) and second year (OR =1.125, CI =1.004-1.261, P=0.04) were independent predictors of ABIM performance along with the second-year ITE scores (OR =1.248, CI =1.096-1.420, P=0.001). CONCLUSION The MT is a valuable tool to predict the performance at the ABIM examination. Not only it helps in the assessment of likelihood of passing the certification examination, it also helps to identify those residents who may require more assistance earlier during their residency. It may also highlight the areas of weakness in program curriculum and guide curriculum development.
Collapse
Affiliation(s)
- Abdur Rahman Khan
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | | | - Raja Thotakura
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Syed Shafae Hasan
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Faraz Khan Luni
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Thomas Sodeman
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Bryan Hinch
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Dinkar Kaw
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Imad Hariri
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Sadik Khuder
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Ragheb Assaly
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| |
Collapse
|
20
|
Khan AR, Bin Abdulhak AA, Luni FK, Assaly R. Platelet activation and myocardial infarction in patients with pneumonia: are statins the answer? J Am Coll Cardiol 2015; 65:1488-9. [PMID: 25857918 DOI: 10.1016/j.jacc.2014.11.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 11/25/2014] [Indexed: 10/23/2022]
|
21
|
Suryanarayana P, Kollampare S, Riaz IB, Lee J, Husnain M, Luni FK, Movahed MR. Presence of anomalous coronary seen on angiogram is not associated with increased risk of significant coronary artery disease. Int J Angiol 2014; 23:243-6. [PMID: 25484555 DOI: 10.1055/s-0034-1384839] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 10/24/2022] Open
Abstract
It is unclear if anomalous coronary arteries are at higher risk for atherosclerosis. The link between anomalous coronary artery and early coronary artery disease has been suggested. The aim of this study is to determine whether the coronary artery anomaly predisposes to development of significant coronary disease. Using retrospective chart review, patients with documented anomalous coronary arteries recognized during coronary angiography between years 2000 to 2007 were analyzed. Prevalence of significant atherosclerotic coronary artery disease (defined as more than 50% luminal narrowing) was compared between normal and anomalous coronaries. A total of 147 patients with anomalous coronary arteries were found. Right coronary artery was the most common anomalous artery 128 of 148 (86.5%) in our dataset. There was no difference in the occurrence of atherosclerosis between anomalous and nonanomalous coronaries. Significant atherosclerosis was present in 59 of the 148 anomalous coronary arteries (37.8%), and 112 of the 293 nonanomalous coronary arteries (38.2%, p = 0.9). On the basis of our study, there is no evidence that anomalous coronary arteries predispose to significant coronary artery disease in comparison to normal coronary arteries.
Collapse
Affiliation(s)
- Prakash Suryanarayana
- Department of Internal Medicine, Division of Cardiology, University of Arizona, Tucson, Arizona
| | - Shubha Kollampare
- Department of Internal Medicine, Division of Cardiology, University of Arizona, Tucson, Arizona
| | - Irbaz Bin Riaz
- Department of Internal Medicine, Division of Cardiology, University of Arizona, Tucson, Arizona
| | - Justin Lee
- Department of Internal Medicine, Division of Cardiology, University of Arizona, Tucson, Arizona
| | - Muhammad Husnain
- Department of Internal Medicine, Division of Cardiology, University of Arizona, Tucson, Arizona
| | - Faraz Khan Luni
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
| | - Mohammad Reza Movahed
- Department of Internal Medicine, Division of Cardiology, University of Arizona, Tucson, Arizona ; CareMore Healthcare, Tucson, Arizona
| |
Collapse
|
22
|
Kakroo MA, Chowdhury MA, Luni FK, Moza A, Bhat PK. Reverse Takotsubo Cardiomyopathy: A Story of a Critically Ill Man with Transient Cardiac Dysfunction. Cardiology 2014; 129:213-5. [DOI: 10.1159/000365963] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 07/16/2014] [Indexed: 11/19/2022]
|
23
|
Luni FK, Moza A, Khan AR, Kakroo M, Grubb B. EKG quiz. Pacer talk. J Electrocardiol 2014; 47:750-1. [PMID: 25295339 DOI: 10.1016/j.jelectrocard.2014.05.004] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
24
|
Young K, Luni FK, Yoon Y. Toxic Shock Syndrome: An Unrecognized Organism. Chest 2014. [DOI: 10.1378/chest.1989463] [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: 11/01/2022] Open
|
25
|
Luni FK, Khan MA, De Las Casas L, Alastal Y, Alwardi A, Yoon Y. Small Cell Carcinoma of Lung Presenting With Acute Pancreatitis: Case Report and Review of Literature. Chest 2014. [DOI: 10.1378/chest.1992075] [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: 11/01/2022] Open
|
26
|
Khan AR, Binabdulhak AA, Alastal Y, Khan S, Faricy-Beredo BM, Luni FK, Lee WM, Khuder S, Tinkel J. Cardioprotective role of ischemic postconditioning in acute myocardial infarction: a systematic review and meta-analysis. Am Heart J 2014; 168:512-521.e4. [PMID: 25262261 DOI: 10.1016/j.ahj.2014.06.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [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: 01/22/2014] [Accepted: 06/15/2014] [Indexed: 12/24/2022]
Abstract
BACKGROUND Evidence suggests that ischemic postconditioning (IPoC) may reduce the extent of reperfusion injury. We performed a meta-analysis of randomized controlled trials, which compared the role of IPoC during primary percutaneous coronary intervention (PCI) to PCI alone (control group) in ST-segment elevation myocardial infarction. METHODS Several databases were searched, which yielded 19 studies. The outcomes of interest were measures of myocardial damage (serum cardiac enzymes and infarct size by imaging) and left ventricular function (left ventricular ejection fraction and wall motion score index). Mean difference (MD) and standardized mean difference (SMD) were used to assess the treatment effect. An inverse variance method was used to pool data into a random-effects model. RESULTS Ischemic postconditioning demonstrated a decrease in serum cardiac enzymes (SMD -0.48, 95% CI -0.92 to -0.05, I(2) = 92%), reduction in infarct size by imaging (SMD -0.30, 95% CI -0.58 to -0.01, I(2) = 80%), wall motion score index (MD -0.19, 95% CI -0.29 to -0.09, I(2) = 44%), and showed improvement in left ventricular ejection fraction (IPoC 52 ± 0.4, control 49.7 ± 0.4) (MD 2.78, 95% CI 0.66-4.91, I(2) = 69%). All included studies were limited by high risk of performance and publication bias. CONCLUSIONS Ischemic postconditioning during PCI in ST-segment elevation myocardial infarction appears to be superior to PCI alone in reduction of both myocardial injury or damage and improvement in global and regional left ventricular function. The effect seems to be more pronounced when a greater myocardial area is at risk. Given the limitations of the current available evidence, additional data from large randomized controlled trials are warranted.
Collapse
Affiliation(s)
- Abdur Rahman Khan
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH
| | - Aref A Binabdulhak
- Department of Internal Medicine, University of Missouri - Kansas City, Kansas, MO
| | - Yaseen Alastal
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH
| | - Sobia Khan
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH
| | | | - Faraz Khan Luni
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH
| | - Wade M Lee
- Mulford Health Science Library - University of Toledo, Toledo, OH
| | - Sadik Khuder
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH
| | - Jodi Tinkel
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH.
| |
Collapse
|
27
|
Khan AR, Luni FK, Moukarbel GV. Clinical practice guidelines: still miles to go.. Mayo Clin Proc 2014; 89:859-60. [PMID: 24943700 DOI: 10.1016/j.mayocp.2014.03.007] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
|
28
|
Khan AR, Alreefi F, Shah SR, Luni FK, Sheikh MA, Moukarbel GV. CRT-102 Non ST Segment Elevation Myocardial Infarction Due to Complete Coronary Occlusion: Clinical Characteristics. JACC Cardiovasc Interv 2014. [DOI: 10.1016/j.jcin.2013.12.020] [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: 12/01/2022]
|
29
|
Khan MA, Luni FK, Kamal S, Alastal Y, Alwardia A, Bieszczad J, Casas LDL, Yoon Y. Acute Pancreatitis: First and Sole Manifestation of Small Cell Carcinoma of Lung. J Med Cases 2014. [DOI: 10.14740/jmc1896w] [Citation(s) in RCA: 2] [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: 11/11/2022] Open
|
30
|
Luni FK, Moza A, Sheikh M, Coker MF, Chaganti SK, Lewis TJ, Kanjwal Y. Nonobstructive hypertrophic cardiomyopathy with left ventricular aneurysm: the role of cardiac magnetic resonance. Tex Heart Inst J 2013; 40:465-467. [PMID: 24082381 PMCID: PMC3783143] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Hypertrophic cardiomyopathy with concomitant left ventricular aneurysm is rare and has important clinical implications, including an increased risk of sudden cardiac death. Most patients with this rare combination have obstructive hypertrophic cardiomyopathy, but we treated a 26-year-old woman who had nonobstructive hypertrophic cardiomyopathy and a family history of probable sudden cardiac death. In our patient, coronary angiograms showed distal occlusion of the left anterior descending coronary artery. Late gadolinium-enhanced cardiac magnetic resonance images showed scattered fibrosis within and beyond the left ventricular aneurysm. Precautionary therapy with an implantable cardioverter-defibrillator yielded an uneventful outcome. Cardiac magnetic resonance has emerged as a promising method for diagnosing these aneurysms and detecting associated myocardial fibrosis, thereby enabling patient risk stratification and the determination of appropriate therapeutic options. We discuss the role of cardiac magnetic resonance imaging in the management of this rare clinical entity.
Collapse
Affiliation(s)
- Faraz Khan Luni
- Departments of Internal Medicine (Drs. Luni and Moza), Cardiovascular Medicine (Drs. Chaganti, Kanjwal, and Sheikh), and Radiology (Drs. Coker and Lewis), University of Toledo Medical Center, Toledo, Ohio 43614
| | | | | | | | | | | | | |
Collapse
|
31
|
Luni FK, Hamid SA, Mamji S, Baig SM. Ischaemic stroke management by emergency care physicians at public sector hospitals of Karachi, Pakistan. J PAK MED ASSOC 2011; 61:375-380. [PMID: 21465977] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To assess the clinicians management of patients presenting with acute ischaemic stroke in the emergency departments of two large state run hospitals in Karachi, Pakistan. METHODS A questionnaire was filled by 59 registered medical practitioners working at these two government hospitals who would be managing stroke patients presenting in the emergency. It was a descriptive cross sectional study designed to assess the methods used by the doctors for diagnosing and treating stroke patients. The data was collected from October to November 2007 and entered using Epi Data Entry and analyzed by SPSS 13.0. RESULTS The preferred overall investigation for a suspected stroke patient in an emergency ward was an ECG (98%). 51% of the respondents would prescribe aspirin to most patients (300 mg by 40% respondents). Intravenous tissue plasminogen activator was thought to be beneficial by 43% of doctors, low molecular weight heparin by 91%, subcutaneous heparin by 86.5%, intravenous Vitamin B complex by 20% and steroids by 39% of respondents. Regarding elevated blood pressure, 60% answered that they would manage the blood pressure according to the type of stroke and 73% responded that they would lower blood pressure when it reached greater than 150/80. 88% of the doctors answered that they would use cholesterol lowering drugs in the management of stroke patients in an emergency. 97% of the doctors recommended rehabilitation and 88% of the respondents believed that there should be separate stroke units. CONCLUSION The development of a standardized protocol and stroke team is recommended which should speed the clinical assessment, decisions for early management and also increase the performance of diagnostic studies.
Collapse
|
32
|
Luni FK, Ansari B, Jawad A, Dawson A, Baig SM. Prevalence of depression and anxiety in a village in Sindh. J Ayub Med Coll Abbottabad 2009; 21:68-72. [PMID: 20524473] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To study the prevalence of Anxiety and Depression and its association in a rural area of Sindh, Pakistan. METHODS A cross-sectional study was conducted at Ansari Para, in Tehsil Hala, Sindh province in Pakistan, using the Aga Khan University Anxiety and Depression Scale Urdu Version. RESULTS Out of a total of 260 people interviewed, 112 people (43.1%) were screened to have anxiety and depression. Depression and anxiety were strongly associated with female gender, family dynamics, child environment, unsuccessful love affairs and among those with medical chronic disorders. A gradual decreasing incidence of depression and anxiety was noted with increasing level of education. A significantly strong association was noted between child mortality and maternal depression while no such association was found in males. There is a significant difference in the age of depressed and normal individuals. There was significant correlation between unhappy childhood and unsatisfying family relationships. However, no relationships were found between depression & anxiety and martial status, presence or number of children, absence of male offspring, living in joint family system, financial problems and any deficiencies that the respondents felt that he might have. CONCLUSION This study suggests that anxiety and depression is a common psychiatric disorder even in remote village areas and contradicts the common belief that people those who live in the remote rural areas lead stress-free lives or have low rates of psychiatric morbidity.
Collapse
|