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Kostick-Quenet KM, Lang B, Dorfman N, Estep J, Mehra MR, Bhimaraj A, Civitello A, Jorde U, Trachtenberg B, Uriel N, Kaplan H, Gilmore-Szott E, Volk R, Kassi M, Blumenthal-Barby JS. Patients' and physicians' beliefs and attitudes towards integrating personalized risk estimates into patient education about left ventricular assist device therapy. Patient Educ Couns 2024; 122:108157. [PMID: 38290171 DOI: 10.1016/j.pec.2024.108157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 01/06/2024] [Accepted: 01/14/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Personalized risk (PR) estimates may enhance clinical decision making and risk communication by providing individualized estimates of patient outcomes. We explored stakeholder attitudes toward the utility, acceptability, usefulness and best-practices for integrating PR estimates into patient education and decision making about Left Ventricular Assist Device (LVAD). METHODS AND RESULTS As part of a 5-year multi-institutional AHRQ project, we conducted 40 interviews with stakeholders (physicians, nurse coordinators, patients, and caregivers), analyzed using Thematic Content Analysis. All stakeholder groups voiced positive views towards integrating PR in decision making. Patients, caregivers and coordinators emphasized that PR can help to better understand a patient's condition and risks, prepare mentally and logistically for likely outcomes, and meaningfully engage in decision making. Physicians felt it can improve their decision making by enhancing insight into outcomes, enhance tailored pre-emptive care, increase confidence in decisions, and reduce bias and subjectivity. All stakeholder groups also raised concerns about accuracy, representativeness and relevance of algorithms; predictive uncertainty; utility in relation to physician's expertise; potential negative reactions among patients; and overreliance. CONCLUSION Stakeholders are optimistic about integrating PR into clinical decision making, but acceptability depends on prospectively demonstrating accuracy, relevance and evidence that benefits of PR outweigh potential negative impacts on decision making quality.
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Affiliation(s)
| | - Benjamin Lang
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Natalie Dorfman
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | | | | | | | | | | | | | - Nir Uriel
- Columbia University Irving Medical Center, New York, NY, USA
| | - Holland Kaplan
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Eleanor Gilmore-Szott
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Robert Volk
- University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | | | - J S Blumenthal-Barby
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
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2
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Kassi M, Avenatti E, Hoang KD, Zook S, Yousafzai R, Guha A, Bhimaraj A, Chou LCP, Suarez EE. Repeat left ventricular-assisted device exchange and upgrade from second- to third-generation devices in a high-volume single center. Artif Organs 2024; 48:536-542. [PMID: 38189564 DOI: 10.1111/aor.14710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/09/2023] [Accepted: 12/26/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Pump exchange is an established strategy to treat LVAD-related complications such as thrombosis, infection, and driveline failure. Pump upgrades with an exchange to newer generation devices are being performed to the advantage of the patient on long-term support. The safety and efficacy of a repeat LVAD exchange with a concomitant upgrade to a third-generation pump have not been reported. METHODS We performed a retrospective analysis of all consecutive patients who underwent a repeat LVAD device exchange and upgrade to HeartMate III (HMIII) at Houston Methodist Hospital between December 2018 and December 2020. RESULTS Five patients underwent exchange and upgrade to HMIII within the specified timeframe. Four patients had already had two prior exchanges (all HMII to HMII), and one patient had one prior exchange (HVAD to HVAD). In all cases, implantation was performed as destination therapy. The surgical exchange was performed via redo median sternotomy on full cardiopulmonary bypass. No unplanned redo surgery of the device component was required. In-hospital mortality was 20% in this very high-risk population. At 1-, 3-, and 6-month follow-up, all discharged patients were on HMIII support, with no major LVAD-related adverse events reported. CONCLUSION We report the feasibility and safety of a repeat pump exchange with an upgrade to HMIII in a high-volume center. The decision for medical therapy versus surgical exchange has to be tailored to individual cases based on risk factors and clinical stability but in expert hands, even a re-redo surgical approach grants options for good medium-term outcomes.
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Affiliation(s)
- Mahwash Kassi
- Department of Cardiology, Houston Methodist Hospital - DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Eleonora Avenatti
- Department of Cardiology, Houston Methodist Hospital - DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Khanh-Doan Hoang
- Department of Cardiology, University of Kansas, Wichita, Kansas, USA
| | - Salma Zook
- Department of Cardiology, Houston Methodist Hospital - DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Rayan Yousafzai
- Department of Cardiology, Houston Methodist Hospital - DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Ashrith Guha
- Department of Cardiology, Houston Methodist Hospital - DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Arvind Bhimaraj
- Department of Cardiology, Houston Methodist Hospital - DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Lin-Chiang Philip Chou
- Department of Cardiology, Houston Methodist Hospital - DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Erik E Suarez
- Department of Cardiology, Houston Methodist Hospital - DeBakey Heart and Vascular Center, Houston, Texas, USA
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3
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Zambrano BA, Wilson SI, Zook S, Vekaria B, Moreno MR, Kassi M. Computational investigation of outflow graft variation impact on hemocompatibility profile in LVADs. Artif Organs 2024; 48:375-385. [PMID: 37962282 DOI: 10.1111/aor.14679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/17/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Hemocompatibility-related adverse events (HRAE) occur commonly in patients with left ventricular assist devices (LVADs) and add to morbidity and mortality. It is unclear whether the outflow graft orientation can impact flow conditions leading to HRAE. This study presents a simulation-based approach using exact patient anatomy from medical images to investigate the influence of outflow cannula orientation in modulating flow conditions leading to HRAEs. METHODS A 3D model of a proximal aorta and outflow graft was reconstructed from a computed tomography (CT) scan of an LVAD patient and virtually modified to model multiple cannula orientations (n = 10) by varying polar (cranio-caudal) (n = 5) and off-set (anterior-posterior) (n = 2) angles. Time-dependent computational flow simulations were then performed for each anatomical orientation. Qualitative and quantitative hemodynamics metrics of thrombogenicity including time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), endothelial cell platelet activation potential (ECAP), particle residence time (PRT), and platelet activation potential (PLAP) were analyzed. RESULTS Within the simulations performed, endothelial cell activation potential (ECAP) and particle residence time (PRT) were found to be lowest with a polar angle of 85°, regardless of offset angle. However, polar angles that produced parameters at levels least associated with thrombosis varied when the offset angle was changed from 0° to 12°. For offset angles of 0° and 12° respectively, flow shear was lowest at 65° and 75°, time averaged wall shear stress (TAWSS) was highest at 85° and 35°, and platelet activation potential (PLAP) was lowest at 65° and 45°. CONCLUSION This study suggests that computational fluid dynamic modeling based on patient-specific anatomy can be a powerful analytical tool when identifying optimal positioning of an LVAD. Contrary to previous work, our findings suggest that there may be an "ideal" outflow cannula for each individual patient based on a CFD-based hemocompatibility profile.
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Affiliation(s)
- Byron A Zambrano
- J. Mike Walker '66 Department of Mechanical Engineering, Texas A&M University, College Station, Texas, USA
| | - Shannon I Wilson
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas, USA
| | - Salma Zook
- Houston Methodist, Department of Cardiology, Houston Methodist Research Hospital, Houston, Texas, USA
| | - Bansi Vekaria
- Houston Methodist, Department of Cardiology, Houston Methodist Research Hospital, Houston, Texas, USA
| | - Michael R Moreno
- J. Mike Walker '66 Department of Mechanical Engineering, Texas A&M University, College Station, Texas, USA
| | - Mahwash Kassi
- Houston Methodist, Department of Cardiology, Houston Methodist Research Hospital, Houston, Texas, USA
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4
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Dreucean D, Donahue KR, Morton C, Succar L, Krisl J, Agrawal T, Perez K, Jaramillo T, Kim J, Fida N, Guha A, Kassi M, Yousefzai R, Hussain I, Grimes K, Bhimaraj A. Bloodstream infections in prolonged use of axillary-placed, intra-aortic balloon-pump support: A single-center study. Infect Control Hosp Epidemiol 2024; 45:374-376. [PMID: 37946375 DOI: 10.1017/ice.2023.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Infections from prolonged use of axillary intra-aortic balloon pumps (IABPs) have not been well studied. Bloodstream infection (BSI) occurred in 13% of our patients; however, no difference in outcome was noted between those with BSI and those without. Further studies regarding protocol developments that minimize BSI risk are needed.
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Affiliation(s)
- Diane Dreucean
- Department of Pharmacy, Houston Methodist Hospital, Houston, Texas
| | - Kevin R Donahue
- Department of Pharmacy, Houston Methodist Hospital, Houston, Texas
| | - Celia Morton
- Department of Pharmacy, Houston Methodist Hospital, Houston, Texas
| | - Luma Succar
- Department of Pharmacy, Houston Methodist Hospital, Houston, Texas
| | - Jill Krisl
- Department of Pharmacy, Houston Methodist Hospital, Houston, Texas
| | - Tanushree Agrawal
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Katherine Perez
- Department of Pharmacy, Houston Methodist Hospital, Houston, Texas
| | | | - Ju Kim
- Methodist DeBakey Cardiology Associates, Houston Methodist Hospital, Houston, Texas
| | - Nadia Fida
- Methodist DeBakey Cardiology Associates, Houston Methodist Hospital, Houston, Texas
| | - Ashrith Guha
- Methodist DeBakey Cardiology Associates, Houston Methodist Hospital, Houston, Texas
| | - Mahwash Kassi
- Methodist DeBakey Cardiology Associates, Houston Methodist Hospital, Houston, Texas
| | - Rayan Yousefzai
- Methodist DeBakey Cardiology Associates, Houston Methodist Hospital, Houston, Texas
| | - Imad Hussain
- Methodist DeBakey Cardiology Associates, Houston Methodist Hospital, Houston, Texas
| | - Kevin Grimes
- Infectious Diseases, Houston Methodist Academic Medicine Associates, Houston Methodist Hospital, Houston, Texas
| | - Arvind Bhimaraj
- Methodist DeBakey Cardiology Associates, Houston Methodist Hospital, Houston, Texas
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5
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Fida N, Eagar TN, Yun AN, Rogers AW, Nguyen DT, Graviss EA, Ishaq F, DiPaola NR, Kim J, Janardhana G, Kassi M, Yousefzai R, Suarez EE, Bhimaraj A, Krisl JC, Guha A. Effectiveness of combined plasma cell therapy and costimulation blockade based desensitization regimen in heart transplant candidates. Clin Transplant 2024; 38:e15249. [PMID: 38369810 DOI: 10.1111/ctr.15249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 12/22/2023] [Accepted: 01/17/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Desensitization is one of the strategies to reduce antibodies and facilitate heart transplantation in highly sensitized patients. We describe our center's desensitization experience with combination of plasma cell (PC) depletion therapy (with proteasome inhibitor or daratumumab) and costimulation blockade (with belatacept). METHODS We reviewed five highly sensitized patients who underwent desensitization therapy with plasma cell depletion and costimulation blockade. We evaluated the response to therapy by measuring the changes in cPRA, average MFI, and number of positive beads > 5000MFI. RESULTS Five patients, mean age of 56 (37-66) years with average cPRA of 98% at 5000 MFI underwent desensitization therapy. After desensitization, mean cPRA decreased from 98% to 70% (p = .09), average number of beads > 5000 MFI decreased from 59 to 37 (p = .15), and average MFI of beads > 5000 MFI decreased from 16713 to 13074 (p = .26). CONCLUSION Combined PC depletion and CoB could be a reasonable strategy for sustained reduction in antibodies in highly sensitized patients being listed for heart transplantation.
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Affiliation(s)
- Nadia Fida
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Todd N Eagar
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Allison N Yun
- Department of Pharmacy, Houston Methodist Hospital, Houston, Texas, USA
| | - Alex W Rogers
- Department of Pharmacy, Houston Methodist Hospital, Houston, Texas, USA
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Institute for Academic Medicine, Houston Methodist Research Institute, Houston, Texas, USA
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Institute for Academic Medicine, Houston Methodist Research Institute, Houston, Texas, USA
| | - Farhan Ishaq
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Nicholas R DiPaola
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Ju Kim
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Gorthi Janardhana
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Mahwash Kassi
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Rayan Yousefzai
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Eric E Suarez
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Arvind Bhimaraj
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Jill C Krisl
- Department of Pharmacy, Houston Methodist Hospital, Houston, Texas, USA
| | - Ashrith Guha
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
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6
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Lamba HK, Kherallah R, Nair AP, Shafii AE, Loor G, Kassi M, Chatterjee S, Rogers JG, Civitello AB, Liao KK. Sex Disparities in Left Ventricular Assist Device Implantation: Delayed Presentation and Worse Right Heart Failure. ASAIO J 2024:00002480-990000000-00384. [PMID: 38181411 DOI: 10.1097/mat.0000000000002134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Abstract
We explored whether women undergo continuous-flow left ventricular assist device (CF-LVAD) implantation in later stages of heart failure (HF) than men, evidenced by worse preoperative right HF (RHF). We also compared two propensity models with and without preoperative RHF to assess its effect on outcomes. INTERMACS was queried from July 2008 to December 2017. Propensity model 1 matched men and women on age ≥50 years, HF etiology, body surface area, INTERMACS class, comorbidities, device strategy, temporary mechanical circulatory support, and device type. Model 2 included these variables plus LV end-diastolic diameter, right atrial pressure/pulmonary capillary wedge pressure, pulmonary artery pulsatility index, and right ventricular ejection fraction. The primary outcome was all-cause mortality. Secondary outcomes comprise RHF, rehospitalization, renal dysfunction, stroke, and device malfunction. In model 1, characteristics were comparable between 3,195 women and 3,195 men, except women more often had preoperative RHF and postoperative right VAD support and had worse 1 year and overall survival. In model 2, after propensity matching for additional risk factors for preoperative RHF, 1,119 women and 1,119 men had comparable post-LVAD implant RVAD use and survival. These findings suggest that women present more often with biventricular failure and after implantation have higher RHF and mortality rates.
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Affiliation(s)
- Harveen K Lamba
- From the Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Riyad Kherallah
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ajith P Nair
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Department of Cardiology, The Texas Heart Institute, Houston, Texas
| | - Alexis E Shafii
- From the Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, Texas
| | - Gabriel Loor
- From the Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, Texas
| | | | - Subhasis Chatterjee
- From the Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, Texas
| | - Joseph G Rogers
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Department of Cardiology, The Texas Heart Institute, Houston, Texas
| | - Andrew B Civitello
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Department of Cardiology, The Texas Heart Institute, Houston, Texas
| | - Kenneth K Liao
- From the Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, Texas
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7
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Dhorepatil A, Modi V, Kassi M, Chamsi-Pasha MAR, Ewton A, Allen D, Mallah MHA. Insidious Mass Within a Sinus. Methodist Debakey Cardiovasc J 2023; 19:92-95. [PMID: 38161506 PMCID: PMC10756152 DOI: 10.14797/mdcvj.1316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 01/03/2024] Open
Abstract
A 75-year-old patient was incidentally found to have an intracardiac mass by echocardiography. Subsequent cardiac magnetic resonance imaging and cardiac positron emission tomography confirmed a large and possibly malignant mass extending from the right atrium into the coronary sinus. The patient underwent an intracardiac echocardiography guided biopsy, which revealed diffuse B-cell lymphoma, and is currently undergoing rituximab, etoposide, vincristine, cyclophosphamide, and doxorubicin (R-EPOCH)-based chemotherapy.
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Affiliation(s)
- Aneesh Dhorepatil
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
| | - Vivek Modi
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
| | - Mahwash Kassi
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
| | | | - April Ewton
- Houston Methodist Hospital, Houston, Texas, US
| | - Dyron Allen
- Houston Methodist Hospital, Houston, Texas, US
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8
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Wilson SI, Ingram KE, Oh A, Moreno MR, Kassi M. The role of innovative modeling and imaging techniques in improving outcomes in patients with LVAD. Front Cardiovasc Med 2023; 10:1248300. [PMID: 37692033 PMCID: PMC10484111 DOI: 10.3389/fcvm.2023.1248300] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Heart failure remains a significant cause of mortality in the United States and around the world. While organ transplantation is acknowledged as the gold standard treatment for end stage heart failure, supply is limited, and many patients are treated with left ventricular assist devices (LVADs). LVADs extend and improve patients' lives, but they are not without their own complications, particularly the hemocompatibility related adverse events (HRAE) including stroke, bleeding and pump thrombosis. Mainstream imaging techniques currently in use to assess appropriate device function and troubleshoot complications, such as echocardiography and cardiac computed tomography, provide some insight but do not provide a holistic understanding of pump induced flow alterations that leads to HRAEs. In contrast, there are technologies restricted to the benchtop-such as computational fluid dynamics and mock circulatory loops paired with methods like particle image velocimetry-that can assess flow metrics but have not been optimized for clinical care. In this review, we outline the potential role and current limitations of converging available technologies to produce novel imaging techniques, and the potential utility in evaluating hemodynamic flow to determine whether LVAD patients may be at higher risk of HRAEs. This addition to diagnostic and monitoring capabilities could improve prevention and treatment of LVAD-induced complications in heart failure patients.
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Affiliation(s)
- Shannon I. Wilson
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, United States
| | - Katelyn E. Ingram
- DeBakey Heart and Vascular- Heart Center Research, Houston Methodist Research Institute, Houston, TX, United States
| | - Albert Oh
- School of Engineering Medicine, Texas A&M University, Houston, TX, United States
| | - Michael R. Moreno
- J. Mike Walker ‘66 Department of Mechanical Engineering, Texas A&M University, College Station, TX, United States
| | - Mahwash Kassi
- Cardiology, DeBakey Heart and Vascular, Houston Methodist Hospital, Houston, TX, United States
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9
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Zook S, Ingram S, Guha A, Bhimaraj A, Fida N, Kim J, Yousefzai R, Ahsan S, Legha S, Martin C, Hussain I, Gorthi J, Graviss E, Nguyen D, Moreno M, Suarez E, Chou P, Kassi M. Is There a Relationship Between Cannula Position and Right Ventricular Failure Outcome in Patients with Centrifugal Flow Left Ventricular Assist Devices? J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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10
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Lamba H, Kherallah R, Kassi M, Delgado R, Mattar A, Nair A, Chatterjee S, Shafii A, Loor G, Rogers J, Civitello A, Liao K. Greater Burden of Biventricular Dysfunction in Female Recipients of Continuous-Flow Left Ventricular Devices. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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11
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Patel K, Nguyen D, Graviss E, Bhimaraj A, Kassi M, Kim J, Guha A. The Impact of Donation after Circulatory Death Heart Transplants on Waitlist Time: A UNOS Analysis. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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12
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Kumar S, Nguyen D, Graviss E, Patil S, Kim J, Suarez E, Hussain I, Yousefzai R, Ahsan S, Gorthi J, Kassi M, Bhimaraj A, Martin C, Guha A. Donor-Derived Cell-Free DNA in Heart Multiorgan Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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13
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Kumar S, Nguyen D, Graviss E, Patil S, Kim J, Suarez E, Hussain I, Yousefzai R, Ahsan S, Gorthi J, Kassi M, Bhimaraj A, Martin C, Guha A. A Novel Simultaneous Heart-Kidney (sHK) Transplantation Risk Calculator Predicts Chronic Dialysis or Death at 1-Year: A UNOS Analysis. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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14
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Kassi M, Agrawal T, Xu J, Marcos-Abdala HG, Araujo-Gutierrez R, Macgillivray T, Suarez EE, Yousefzai R, Fida N, Kim JH, Hussain I, Guha A, Trachtenberg B, Bhimaraj A, Chang SM, Estep J. Outflow cannula alignment in continuous flow left ventricular devices is associated with stroke. Int J Artif Organs 2023; 46:226-234. [PMID: 36895175 DOI: 10.1177/03913988231154284] [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] [Indexed: 03/11/2023]
Abstract
We sought to evaluate whether differences in left ventricular assist device (LVAD) canula alignment are associated with stroke. There is a paucity of clinical data on contribution of LVAD canulae alignment to strokes. We conducted a retrospective analysis of patients who underwent LVAD implantation at Houston Methodist hospital from 2011 to 2016 and included those who had undergone cardiac computed tomography (CT) with contrast. LVAD graft alignment using X-ray, echocardiography, and cardiac CT was evaluated. The primary outcome was stroke within 1 year of LVAD implantation. Of the 101 patients that underwent LVAD Implantation and cardiac CT scan during the study period, 78 met inclusion criteria. The primary outcome occurred in 12 (15.4%) patients with a median time to stroke of 77 days (interquartile range: 42-132 days). Of these, 10 patients had an ischemic and two had hemorrhagic strokes. The predominant device type was Heart Mate II (94.8%). Patients with LVAD outflow cannula to aortic angle lesser than 37.5° and those with outflow graft diameter of anastomosis less than 1.5 cm (assessed by cardiac CT) had significantly higher stroke risk (p < 0.001 and p = 0.01 respectively). In HMII patients, a lower LVAD speed at the time of CT scan was associated with stroke. Further studies are needed to identify optimal outflow graft configuration to mitigate stroke risk.
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Affiliation(s)
| | - Tanushree Agrawal
- Houston Methodist Hospital DeBakey Cardiology Associates, Houston, TX, USA
| | - Jiaqiong Xu
- Houston Methodist Research Institute, Houston, TX, USA
| | | | | | | | - Erik E Suarez
- Houston Methodist Research Institute, Houston, TX, USA
| | | | - Nadia Fida
- Houston Methodist Hospital, Houston, TX, USA
| | - Ju H Kim
- Houston Methodist Hospital, Houston, TX, USA
| | - Imad Hussain
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Ashrith Guha
- Houston Methodist Hospital DeBakey Cardiology Associates, Houston, TX, USA
| | - Barry Trachtenberg
- Houston Methodist Hospital DeBakey Cardiology Associates, Houston, TX, USA
| | - Arvind Bhimaraj
- Houston Methodist Hospital DeBakey Cardiology Associates, Houston, TX, USA
| | - Su Min Chang
- Houston Methodist Hospital DeBakey Cardiology Associates, Houston, TX, USA
| | - Jerry Estep
- Cleveland Clinic Foundation, Cleveland, OH, USA
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15
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Saad JM, Ahmed AI, Alahdab F, Rifai MA, Han Y, Alfawara MS, Kassi M, Trachtenberg B, Al-Mallah MH. CARDIAC SCINTIGRAPHY ATRIAL UPTAKE AND HEART FAILURE ADMISSIONS IN ATTR-CARDIAC AMYLOIDOSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01912-5] [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: 03/06/2023]
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16
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Saad JM, Ahmed AI, Alahdab F, Rifai MA, Han Y, Alfawara MS, Kassi M, Trachtenberg B, Al-Mallah MH. PROGNOSTIC VALUE OF LOW QRS VOLTAGE IN PATIENTS WITH TRANSTHYRETIN CARDIAC AMYLOIDOSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01176-2] [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: 03/06/2023]
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17
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Kassi M, Filippini S, Avenatti E, Xu S, El-Tallawi KC, Angulo CI, Vukicevic M, Little SH. Patient-specific, echocardiography compatible flow loop model of aortic valve regurgitation in the setting of a mechanical assist device. Front Cardiovasc Med 2023; 10:994431. [PMID: 36844719 PMCID: PMC9945256 DOI: 10.3389/fcvm.2023.994431] [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: 07/14/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023] Open
Abstract
Background Aortic regurgitation (AR) occurs commonly in patients with continuous-flow left ventricular assist devices (LVAD). No gold standard is available to assess AR severity in this setting. Aim of this study was to create a patient-specific model of AR-LVAD with tailored AR flow assessed by Doppler echocardiography. Methods An echo-compatible flow loop incorporating a 3D printed left heart of a Heart Mate II (HMII) recipient with known significant AR was created. Forward flow and LVAD flow at different LVAD speed were directly measured and AR regurgitant volume (RegVol) obtained by subtraction. Doppler parameters of AR were simultaneously measured at each LVAD speed. Results We reproduced hemodynamics in a LVAD recipient with AR. AR in the model replicated accurately the AR in the index patient by comparable Color Doppler assessment. Forward flow increased from 4.09 to 5.61 L/min with LVAD speed increasing from 8,800 to 11,000 RPM while RegVol increased by 0.5 L/min (2.01 to 2.5 L/min). Conclusions Our circulatory flow loop was able to accurately replicate AR severity and flow hemodynamics in an LVAD recipient. This model can be reliably used to study echo parameters and aid clinical management of patients with LVAD.
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Affiliation(s)
- Mahwash Kassi
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, United States,*Correspondence: Mahwash Kassi ✉
| | - Stefano Filippini
- Department of Cardiology, Houston Methodist Research Institute, Houston, TX, United States
| | - Eleonora Avenatti
- Department of Internal Medicine, Houston Methodist Hospital, Houston, TX, United States
| | - Susan Xu
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, United States,Department of Cardiology, Houston Methodist Research Institute, Houston, TX, United States
| | - Kinan Carlos El-Tallawi
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, United States
| | - Clara I. Angulo
- Department of Cardiology, Houston Methodist Research Institute, Houston, TX, United States
| | - Marija Vukicevic
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, United States,Department of Cardiology, Houston Methodist Research Institute, Houston, TX, United States
| | - Stephen H. Little
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, United States
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18
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Dreucean D, Donahue KR, Donahue KR, Morton C, Succar L, Krisl J, Agrawal T, Perez KK, Jaramillo T, Kassi M, Yousefzai R, Hussain I, Guha A, Kim J, Bhimaraj A. 2013. Bloodstream Infections in Advanced Heart Failure Patients Requiring Prolonged Use of Axillary Intra-Aortic Balloon Pumps - A Single Center Study. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Bloodstream infections (BSI) impact outcomes in critically ill patients. Institutions and quality and performance improvement efforts to minimize catheter associated infections are valued to optimize outcomes. While intra-aortic balloon pumps (IABP) implanted through the axillary route have been recently used in cardiogenic shock patients for prolonged support, the incidence and associated significance of BSI remains unknown in this cohort. The aim of this study was to assess the incidence of BSI in patients with axillary-placed IABP and evaluate its impact on patient outcomes.
Methods
We retrospectively reviewed 141 patients that underwent axillary IABP placement from May 2016 through August 2020. The primary endpoint was the incidence of BSI during axillary IABP, reported as the proportion of patients who developed a BSI and BSI per 1000-device days.
Results
BSI occurred in 13% of patients and accounted for 4.3 infections per 1000-device days. Prior femoral device use and longer duration of axillary IABP support occurred more frequently in the BSI cohort. Presence of traditional BSI risk factors including central line days, use of parenteral nutrition, and prior positive cultures did not differ between those who developed BSI and those who did not. The rate of end-outcome attainment (transplant, LVAD, recovery) was not statistically different in those that developed BSI vs not (72% vs 88% p=0.08). A total of 41% of BSI were caused by Staphylococcus epidermidis. Use of peri-procedural antimicrobials was associated with lower risk of BSI development (24% vs 8%; p=0.01)
Conclusion
Patients in cardiogenic shock requiring use of life-saving temporary mechanical support pose a challenge to maintain free of BSI during prolonged support with an indwelling catheter that allows for ambulation and movement. Mitigation of modifiable BSI risk factors, such as the use of peri-procedural antimicrobial prophylaxis, accompanied by a low threshold for screening and treatment are reasonable strategies to improve patient outcomes. Future research is needed to further evaluate BSI risk in this patient population and its subsequent impact on patient outcomes.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
| | | | | | | | | | - Jill Krisl
- Houston Methodist Hospital , Houston, Texas
| | - Tanushree Agrawal
- Houston Methodist Hospital, Methodist DeBakey Heart and Vascular Center , Houston, Texas
| | | | | | - Mahwash Kassi
- Houston Methodist Hospital, Advanced Heart Failure and Transplant, Methodist DeBakey Cardiology Associates , Houston, Texas
| | - Rayan Yousefzai
- Houston Methodist Hospital, Advanced Heart Failure and Transplant, Methodist DeBakey Cardiology Associates , Houston, Texas
| | - Imad Hussain
- Houston Methodist Hospital, Advanced Heart Failure and Transplant, Methodist DeBakey Cardiology Associates , Houston, Texas
| | - Ashrith Guha
- Houston Methodist Hospital, Advanced Heart Failure and Transplant, Methodist DeBakey Cardiology Associates , Houston, Texas
| | - Ju Kim
- Houston Methodist Hospital, Advanced Heart Failure and Transplant, Methodist DeBakey Cardiology Associates , Houston, Texas
| | - Arvind Bhimaraj
- Houston Methodist Hospital, Advanced Heart Failure and Transplant, Methodist DeBakey Cardiology Associates , Houston, Texas
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19
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Ojukwu O, Zook S, Kleiman N, Lawrie G, Kassi M. Giant Coronary Sinus Complicated by Spontaneous Thrombosis. Methodist Debakey Cardiovasc J 2022; 18:89-93. [PMID: 36188096 PMCID: PMC9479748 DOI: 10.14797/mdcvj.1159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 11/12/2022] Open
Abstract
Spontaneous coronary sinus thrombosis (CST) is an extremely rare occurrence. Most cases are iatrogenic and related to right heart instrumentation, due to either central line placement or electrophysiology procedures such as pacemaker insertion that causes direct damage to the endothelial lining. The course can be insidious and may result in a fatal outcome. Diagnosis of CST is challenging, and the syndrome often goes unrecognized. However, in the current era of multimodality imaging, it is possible that this condition will be recognized in more patients. Herein, we present a patient with spontaneous coronary sinus thrombosis that was diagnosed using multimodality imaging and thereafter successfully managed.
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Affiliation(s)
- Otito Ojukwu
- Texas A&M School of Medicine, College Station, Texas, US
| | - Salma Zook
- Texas A&M School of Medicine, College Station, Texas, US.,Houston Methodist DeBakey Heart & Vascular Center, Methodist J.C. Walter Jr Transplant Center, Houston Methodist Hospital, Houston, Texas, US
| | - Neal Kleiman
- Texas A&M School of Medicine, College Station, Texas, US
| | - Gerald Lawrie
- Texas A&M School of Medicine, College Station, Texas, US
| | - Mahwash Kassi
- Texas A&M School of Medicine, College Station, Texas, US
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20
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Saad JM, Ahmed AI, Alahdab F, Han Y, Alfawara M, Kassi M, Al-Mallah MH. Comparative prognostic utility of visual grade and heart-to-contralateral lung ratio in patients undergoing 99mTc-pyrophosphate radiotracer cardiac scintigraphy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Transthyretin (ATTR) cardiac amyloidosis (CA) is an underdiagnosed form of restrictive cardiomyopathy leading to a rapid progression into heart failure. 99mTc-labeled radiotracer cardiac scintigraphy is crucial for the evaluation of CA. Semiquantitative (Perugini visual grade) and quantitative (heart-to-contralateral lung ratio, H/CL) parameters are used to assessing CA via cardiac scintigraphy.
Purpose
We aimed to assess the comparative prognostic utility of the Perugini visual grade and heart to contralateral lung ratio.
Methods
The study population was identified based on an institutional registry of consecutive patients undergoing 99mTc-PYP radiotracer cardiac scintigraphy for suspected CA between January 2020-October 2021. The H/CL is calculated by the fraction of heart region of interest (ROI) mean uptake counts to the contralateral chest ROI. The visual scoring system compares uptake between bone (rib) and heart where 0 = absent cardiac uptake, 1 = uptake less than bone, 2 = uptake equal to bone, and 3 = is uptake greater than bone. Ejection fraction (EF) was obtained from echocardiographic studies done around the time of cardiac scintigraphy. MACE was defined as a composite of inclusive of all-cause death, myocardial infarction, admission for heart failure and late revascularization – percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) >90 days after imaging.
Results
A total of 330 patients (mean age 70.9±12.2 years, 62.2% male) were included in the analysis. Risk factors were prevalent (59.7% hypertension, Heart Failure 68.3%, 26.5% dyslipidemia, 26.2% diabetes) (Table 1). In total, 32.6% of the cohort had studies suggestive of ATTR CA. Median time between echocardiography and cardiac scintigraphy was 7 days (IQR 5–42 days). A higher frequency of MACE was reported in patients with a 2+ visual grade (30% vs 42%, p=0.03). A H/CL >1.5 was associated with borderline significance (43% vs 35% p=0.07).
Conclusion
Our analysis showed that the Perugini visual grading of transthyretin cardiac amyloidosis conferred the best prognostic utility contrary to heart to contralateral lung ratio in 99mTc-PYP radiotracer cardiac scintigraphy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J M Saad
- Houston Methodist Hospital , Houston , United States of America
| | - A I Ahmed
- Houston Methodist Hospital , Houston , United States of America
| | - F Alahdab
- Houston Methodist Hospital , Houston , United States of America
| | - Y Han
- Houston Methodist Hospital , Houston , United States of America
| | - M Alfawara
- Houston Methodist Hospital , Houston , United States of America
| | - M Kassi
- Houston Methodist Hospital , Houston , United States of America
| | - M H Al-Mallah
- Houston Methodist Hospital , Houston , United States of America
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21
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Ariss RW, Minhas AMK, Lang J, Ramanathan PK, Khan SU, Kassi M, Warraich HJ, Kolte D, Alkhouli M, Nazir S. Demographic and Regional Trends in Stroke-Related Mortality in Young Adults in the United States, 1999 to 2019. J Am Heart Assoc 2022; 11:e025903. [PMID: 36073626 DOI: 10.1161/jaha.122.025903] [Citation(s) in RCA: 4] [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] [Indexed: 11/16/2022]
Abstract
Background Despite improvements in the management and prevention of stroke, increasing hospitalizations for stroke and stagnant mortality rates have been described in young adults. However, there is a paucity of contemporary national mortality estimates in young adults. Methods and Results Trends in mortality related to stroke in young adults (aged 25-64 years) were assessed using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Age-adjusted mortality rates per 100 000 people with associated annual percentage change were calculated. Joinpoint regression was used to assess the trends in the overall sample and different demographic (sex, race and ethnicity, and age) and geographical (state, urban-rural, and regional) subgroups. Between 1999 and 2019, a total of 566 916 stroke-related deaths occurred among young adults. After the initial decline in mortality in the overall population, age-adjusted mortality rate increased from 2013 to 2019 with an associated annual percentage change of 1.5 (95% CI, 1.1-2.0). Mortality rates were higher in men versus women and in non-Hispanic Black people versus individuals of other races and ethnicities. Non-Hispanic American Indian or Alaskan Native people had a marked increase in stroke-related mortality (annual percentage change 2010-2019: 3.3). Furthermore, rural (nonmetropolitan) counties experienced the greatest increase in mortality (annual percentage change 2012-2019: 3.1) compared with urban (metropolitan) counties. Conclusions Following the initial decline in stroke-related mortality, young adults have experienced increasing mortality rates from 2013 to 2019, with considerable differences across demographic groups and regions.
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Affiliation(s)
- Robert W Ariss
- Division of Cardiovascular Medicine University of Toledo Medical Center Toledo OH.,ProMedica Heart and Vascular Institute, ProMedica Toledo Hospital Toledo OH.,Department of Medicine Brigham and Women's Hospital, Harvard Medical School Boston MA
| | | | - Jacob Lang
- Division of Cardiovascular Medicine University of Toledo Medical Center Toledo OH
| | - P Kasi Ramanathan
- ProMedica Heart and Vascular Institute, ProMedica Toledo Hospital Toledo OH
| | - Safi U Khan
- Department of Cardiology Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Mahwash Kassi
- Department of Cardiology Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Haider J Warraich
- Division of Cardiovascular Medicine Brigham and Women's Hospital Boston MA.,Cardiology Section, Department of Medicine VA Boston Healthcare System Boston MA
| | - Dhaval Kolte
- Cardiology Division Massachusetts General Hospital and Harvard Medical School Boston MA
| | | | - Salik Nazir
- Division of Cardiovascular Medicine University of Toledo Medical Center Toledo OH.,ProMedica Heart and Vascular Institute, ProMedica Toledo Hospital Toledo OH.,Section of Cardiology Baylor College of Medicine Houston TX
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22
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Kenneth Sims R, Srour N, El Nihum LI, Hannawi B, Araujo-Gutierrez R, Cruz-Solbes AS, Trachtenberg BH, Hussain I, Kim JH, Kassi M, Graviss EA, Nguyen DT, Estep J, Bhimaraj A, Guha A. Tissue plasminogen activator in left ventricular assist device-related intravascular hemolysis after failed augmented anticoagulation. Int J Artif Organs 2022; 45:911-918. [PMID: 35941752 DOI: 10.1177/03913988221115445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We sought to examine the efficacy and safety of adding fibrinogen-guided low-dose multi-day Alteplase™ tissue plasminogen activator (tPA) in the management of intravascular hemolysis (IVH) in patients with the HeartMate II (HM-II) continuous flow (CF) left ventricular assist device (LVAD) who failed to achieve IVH resolution with conventional augmented anticoagulation (AAC). BACKGROUND IVH in patients with LVAD is often treated with AAC, failing which pump exchange is considered. We hypothesized that a trial of low-dose tPA after failed AAC therapy could resolve IVH and prevent pump exchange in some patients. METHODS We performed a retrospective study of 31 HM-II CF LVAD patients admitted to our center from January 2015 to January 2020 for IVH management who received tPA following failed AAC. Primary 6-month outcomes included successful IVH resolution, unsuccessful IVH resolution requiring pump exchange, gastrointestinal bleeding, ischemic and hemorrhagic cerebrovascular accident (CVA), and death. RESULTS Thirty-one patients with IVH were treated with tPA following failed AAC. Successful resolution of IVH occurred in 22/31 (71%) patients. Pump exchange occurred in 9/31 (29%) patients. Gastrointestinal bleeding occurred in 7/31 (22.6%) patients. Ischemic CVA occurred in 6/31 (19.4%) patients. CONCLUSIONS Management of IVH with administration of low-dose tPA after failed AAC is feasible and may prevent pump exchange in some patients.
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Affiliation(s)
- Robert Kenneth Sims
- Texas A&M College of Medicine, Bryan, TX, USA
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Nina Srour
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Lamees I El Nihum
- Texas A&M College of Medicine, Bryan, TX, USA
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | | | | | | | | | - Imad Hussain
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Ju H Kim
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Mahwash Kassi
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Edward A Graviss
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Duc T Nguyen
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | | | - Arvind Bhimaraj
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Ashrith Guha
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
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23
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Ariss RW, Minhas AMK, Lang J, Ramanathan PK, Khan SU, Kassi M, Warraich HJ, Kolte D, Alkhouli M, Nazir S. Urban-Rural Trends in Young Stroke-Related Mortality in the United States, 1999-2019. J Am Coll Cardiol 2022; 80:466-468. [PMID: 35863854 DOI: 10.1016/j.jacc.2022.05.018] [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] [Received: 12/06/2021] [Revised: 04/28/2022] [Accepted: 05/13/2022] [Indexed: 10/17/2022]
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24
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Ebong IA, DeFilippis EM, Hamad EA, Hsich EM, Randhawa VK, Billia F, Kassi M, Bhardwaj A, Byku M, Munagala MR, Rao RA, Hackmann AE, Gidea CG, DeMarco T, Hall SA. Special Considerations in the Care of Women With Advanced Heart Failure. Front Cardiovasc Med 2022; 9:890108. [PMID: 35898277 PMCID: PMC9309391 DOI: 10.3389/fcvm.2022.890108] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/22/2022] [Indexed: 01/17/2023] Open
Abstract
Advanced heart failure (AHF) is associated with increased morbidity and mortality, and greater healthcare utilization. Recognition requires a thorough clinical assessment and appropriate risk stratification. There are persisting inequities in the allocation of AHF therapies. Women are less likely to be referred for evaluation of candidacy for heart transplantation or left ventricular assist device despite facing a higher risk of AHF-related mortality. Sex-specific risk factors influence progression to advanced disease and should be considered when evaluating women for advanced therapies. The purpose of this review is to discuss the role of sex hormones on the pathophysiology of AHF, describe the clinical presentation, diagnostic evaluation and definitive therapies of AHF in women with special attention to pregnancy, lactation, contraception and menopause. Future studies are needed to address areas of equipoise in the care of women with AHF.
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Affiliation(s)
- Imo A. Ebong
- Division of Cardiovascular Medicine, University of California, Davis, Sacramento, CA, United States
- *Correspondence: Imo A. Ebong
| | - Ersilia M. DeFilippis
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Eman A. Hamad
- Division of Cardiovascular Medicine, Temple University Hospital, Philadelphia, PA, United States
| | - Eileen M. Hsich
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH, United States
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Varinder K. Randhawa
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Filio Billia
- Department of Cardiology, Toronto General Hospital, Toronto, ON, Canada
| | - Mahwash Kassi
- Houston Methodist Debakey Heart & Vascular Center, Houston, TX, United States
| | - Anju Bhardwaj
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas-Houston, Houston, TX, United States
| | - Mirnela Byku
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mrudala R. Munagala
- Department of Cardiology, Miami Transplant Institute, University of Miami Miller School of Medicine/Jackson Memorial Hospital, University of Miami, Miami, FL, United States
| | - Roopa A. Rao
- Division of Cardiology, Krannert Institute of Cardiology at Indiana University School of Medicine, Indianapolis, IN, United States
| | - Amy E. Hackmann
- Department of Cardiovascular and Thoracic Surgery, University of Texas SouthWestern Medical Center, Dallas, TX, United States
| | - Claudia G. Gidea
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Health, New York, NY, United States
| | - Teresa DeMarco
- Division of Cardiology, University of California, San Francisco, San Francisco, CA, United States
| | - Shelley A. Hall
- Division of Cardiology, Baylor University Medical Center, Dallas, TX, United States
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25
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Ali HJR, Kassi M, Agrawal T, Shah DJ, Alnabelsi T, El-Tallawi C, Al-Mallah M, Bhimaraj A. Inflammatory Cardiomyopathies. JACC Case Rep 2022; 4:632-638. [PMID: 35615210 PMCID: PMC9125516 DOI: 10.1016/j.jaccas.2022.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 12/05/2022]
Abstract
We present 3 cases of inflammatory cardiomyopathies illustrating the need for a multimodality imaging and multidisciplinary approach for diagnosis and treatment. (Level of Difficulty: Intermediate.)
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26
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Shah A, Thaker R, Kassi M. Acute Circulatory Collapse and Advanced Therapies in Patients with COVID-19 Infection. J Heart Lung Transplant 2022. [PMCID: PMC8988832 DOI: 10.1016/j.healun.2022.01.698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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27
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Yousefzai R, Ahsan S, Chavez M, Castro M, Bakare O, Graviss E, Nguyen D, Suarez E, MacGillivray T, Kassi M, Kim J, Hussain I, Bhimaraj A, Guha A. Right Ventricular Failure and Left Ventricular Transmural Pressure as Predictors of Successful Left Ventricular Unloading in Patients with HM 3 CF-LVAD. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1172] [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: 11/26/2022] Open
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28
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Kassi M. Cardiogenic Shock with an Unsuspecting Etiology. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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29
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Kassi M, Minhas A, Khan S, Shah A, Yousafzai R, Guha A, Bhimaraj A. Sex-Based Differences in Clinical Outcomes of Stroke Related to LVAD. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.379] [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] Open
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30
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Ali HJ, Kassi M, Shah D, Alnabelsi T, El-Tallawi C, Al-Mallah M, Bhimaraj A. Inflammatory Cardiomyopathy: A Multi-modality Imaging Approach For A Timely Diagnosis. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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31
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Halawi H, Harris J, Putney D, Nguyen D, Graviss E, Kassi M. Impact of Statins on the Incidence of Gastrointestinal Bleeding Events Among Patients with Continuous Flow Left Ventricular Assist Devices. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1168] [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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32
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Khan M, Alnabelsi T, Ahmed AI, Thaker R, Bhimaraj A, Trachtenberg B, Al-Mallah M, Kassi M. Combination Therapy With Mycophenolate Mofetil And Prednisone In The Treatment Of Cardiac Sarcoidosis. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.272] [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: 11/29/2022]
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Kassi M, Shah A. Utility of Intracardiac Echocardiography to Biopsy Cardiac Tumors. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1156] [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: 11/16/2022] Open
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Trachtenberg B, Kassi M. Insights on Infiltrative and Restrictive Cardiomyopathies. Methodist Debakey Cardiovasc J 2022; 18:1-3. [PMID: 35414859 PMCID: PMC8932373 DOI: 10.14797/mdcvj.1098] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Barry Trachtenberg
- Houston Methodist DeBakey Heart & Vascular Center, Methodist J.C. Walter Jr Transplant Center, Houston Methodist, Houston, Texas, US
| | - Mahwash Kassi
- Houston Methodist DeBakey Heart & Vascular Center, Methodist J.C. Walter Jr Transplant Center, Houston Methodist, Houston, Texas, US
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35
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Saad JM, Ahmed AI, Han Y, Malahfji M, Trachtenberg B, Kassi M, Al-Mallah MH. CARDIAC AMYLOIDOSIS: ARE WE DIAGNOSING PATIENTS LATE? J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01400-0] [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: 11/29/2022]
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Thaker R, Shah A, Kim J, Kassi M. Acute Circulatory Collapse and Advanced Therapies in Patients with COVID-19 Infection. Methodist Debakey Cardiovasc J 2022; 17:43-52. [PMID: 34992722 PMCID: PMC8680078 DOI: 10.14797/mdcvj.1048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/18/2021] [Indexed: 12/22/2022] Open
Abstract
In the current era of the COVID-19 pandemic, intensive care patients with COVID-19 often develop respiratory failure and acute respiratory distress syndrome. While less frequent, acute circulatory collapse, with or without respiratory failure, has its own management challenges and nuances. Early identification of acute circulatory collapse requires appropriate imaging, particularly echocardiography, and precise diagnosis of cardiogenic shock using a Swan-Ganz catheter. Escalation to mechanical circulatory support (MCS), such as an intra-aortic balloon pump, Impella, and extracorporeal membrane oxygenation, has been useful in patients with acute circulatory collapse from COVID-19. This condition is associated with high morbidity and mortality, but early recognition of appropriate candidates for specific treatment strategies and escalation to MCS might improve outcomes.
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Affiliation(s)
- Rishi Thaker
- New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, NY
| | - Aayush Shah
- Houston Methodist DeBakey Cardiology Associates, Houston, TX
| | - Ju Kim
- Houston Methodist DeBakey Cardiology Associates, Houston, TX
| | - Mahwash Kassi
- Houston Methodist DeBakey Cardiology Associates, Houston, TX
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Hoang J, Krisl J, Moaddab M, Nguyen DT, Graviss EA, Hussain I, Kassi M, Yousefzai R, Kim J, Trachtenberg B, Bhimaraj A, Guha A. Intravenous Immunoglobulin in Heart Transplant Recipients with Mild to Moderate Hypogammaglobulinemia and Infection. Clin Transplant 2021; 36:e14571. [DOI: 10.1111/ctr.14571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Johnny Hoang
- Department of Pharmacy Houston Methodist Hospital Houston Texas
| | - Jill Krisl
- Department of Pharmacy Houston Methodist Hospital Houston Texas
| | - Mozhgon Moaddab
- Department of Pharmacy Houston Methodist Hospital Houston Texas
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine Houston Methodist Hospital Houston Texas
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine Houston Methodist Hospital Houston Texas
- Department of Surgery Houston Methodist Hospital Houston Texas
| | - Imad Hussain
- Houston Methodist DeBakey Heart and Vascular Center Houston Methodist Hospital Houston Texas
| | - Mahwash Kassi
- Houston Methodist DeBakey Heart and Vascular Center Houston Methodist Hospital Houston Texas
| | - Rayan Yousefzai
- Houston Methodist DeBakey Heart and Vascular Center Houston Methodist Hospital Houston Texas
| | - Ju Kim
- Houston Methodist DeBakey Heart and Vascular Center Houston Methodist Hospital Houston Texas
| | - Barry Trachtenberg
- Houston Methodist DeBakey Heart and Vascular Center Houston Methodist Hospital Houston Texas
| | - Arvind Bhimaraj
- Houston Methodist DeBakey Heart and Vascular Center Houston Methodist Hospital Houston Texas
| | - Ashrith Guha
- Houston Methodist DeBakey Heart and Vascular Center Houston Methodist Hospital Houston Texas
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Shenoy C, Grizzard JD, Shah DJ, Kassi M, Reardon MJ, Zagurovskaya M, Kim HW, Parker MA, Kim RJ. Cardiovascular magnetic resonance imaging in suspected cardiac tumour: a multicentre outcomes study. Eur Heart J 2021; 43:71-80. [PMID: 34545397 PMCID: PMC8720142 DOI: 10.1093/eurheartj/ehab635] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/25/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022] Open
Abstract
AIMS Cardiovascular magnetic resonance (CMR) imaging is a key diagnostic tool for the evaluation of patients with suspected cardiac tumours. Patient management is guided by the CMR diagnosis, including no further testing if a mass is excluded or if only a pseudomass is found. However, there are no outcomes studies validating this approach. METHODS AND RESULTS In this multicentre study of patients undergoing clinical CMR for suspected cardiac tumour, CMR diagnoses were assigned as no mass, pseudomass, thrombus, benign tumour, or malignant tumour. A final diagnosis was determined after follow-up using all available data. The primary endpoint was all-cause mortality. Among 903 patients, the CMR diagnosis was no mass in 25%, pseudomass in 16%, thrombus in 16%, benign tumour in 17%, and malignant tumour in 23%. Over a median of 4.9 years, 376 patients died. Compared with the final diagnosis, the CMR diagnosis was accurate in 98.4% of patients. Patients with CMR diagnoses of pseudomass and benign tumour had similar mortality to those with no mass, whereas those with malignant tumour [hazard ratio (HR) 3.31 (2.40-4.57)] and thrombus [HR 1.46 (1.00-2.11)] had greater mortality. The CMR diagnosis provided incremental prognostic value over clinical factors including left ventricular ejection fraction, coronary artery disease, and history of extracardiac malignancy (P < 0.001). CONCLUSION In patients with suspected cardiac tumour, CMR has high diagnostic accuracy. Patients with CMR diagnoses of no mass, pseudomass, and benign tumour have similar long-term mortality. The CMR diagnosis is a powerful independent predictor of mortality incremental to clinical risk factors.
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Affiliation(s)
- Chetan Shenoy
- University of Minnesota Medical Center, Cardiovascular Division, Department of Medicine, 420 Delaware St MMC 508, Minneapolis, MN, USA
| | - John D Grizzard
- Virginia Commonwealth University Medical Center, 1250 E. Marshall Street, Richmond, VA, USA
| | - Dipan J Shah
- Houston Methodist Hospital, 6550 Fannin St Suite 1901, Houston, TX, USA
| | - Mahwash Kassi
- Houston Methodist Hospital, 6550 Fannin St Suite 1901, Houston, TX, USA
| | - Michael J Reardon
- Houston Methodist Hospital, 6550 Fannin St Suite 1901, Houston, TX, USA
| | - Marianna Zagurovskaya
- Virginia Commonwealth University Medical Center, 1250 E. Marshall Street, Richmond, VA, USA
| | - Han W Kim
- Duke University Medical Center, Duke Medical Pavilion, 10 Medicine Circle, Rm IE-58 Durham, NC 27710, USA
| | - Michele A Parker
- Duke University Medical Center, Duke Medical Pavilion, 10 Medicine Circle, Rm IE-58 Durham, NC 27710, USA
| | - Raymond J Kim
- Duke University Medical Center, Duke Medical Pavilion, 10 Medicine Circle, Rm IE-58 Durham, NC 27710, USA
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39
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Affiliation(s)
- Mahwash Kassi
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
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40
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Kassi M, Rosenbaum AN, El Sabbagh A, Boilson B, Behfar A. Hemodynamic Assessment of Dual Obstructive Left Ventricular Assist Device Lesions. Cureus 2021; 13:e17180. [PMID: 34548982 PMCID: PMC8437207 DOI: 10.7759/cureus.17180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/14/2021] [Indexed: 11/05/2022] Open
Abstract
Obstructive left ventricular assist device (LVAD) lesions are uncommon but are being increasingly recognized, particularly with the increased use of advanced imaging modalities. While heart failure symptoms and LVAD power fluctuations have a broad differential, obstructive lesions in the LVAD circuit should be considered. We present a unique case of a patient supported on HeartWare HVAD (Medtronic Inc., Dublin, Ireland) therapy, who experienced postural dizziness with objective orthostatic hypotension and occasional ventricular tachycardia. With fluctuations in LVAD flow and power, a CT scan with three-dimensional reconstruction was obtained showing outflow graft kinking. The patient was brought to the cardiac catheterization laboratory for investigation and consideration of outflow graft intervention. However, intracardiac echocardiography revealed the presence of an inflow cannula obstruction with position changes and catheter interrogation involving the outflow cannula suggestive of a gradient across the kinked area as an unlikely cause for the presentation. This case highlights the importance of a thorough interrogation for obstructive lesions in the setting of heart failure symptoms, particularly postural symptoms, in a patient on LVAD therapy, even when not identified on routine echocardiography.
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Affiliation(s)
- Mahwash Kassi
- Department of Cardiology, Houston Methodist, Houston, USA
| | | | | | - Barry Boilson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, USA
| | - Atta Behfar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, USA
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41
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Ahmed AI, Abebe AT, Han Y, Alnabelsi T, Agrawal T, Kassi M, Aljizeeri A, Taylor A, Tleyjeh IM, Al-Mallah MH. The prognostic role of cardiac positron emission tomography imaging in patients with sarcoidosis: A systematic review. J Nucl Cardiol 2021; 28:1545-1552. [PMID: 34228337 DOI: 10.1007/s12350-021-02681-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Sarcoidosis is a multi-systemic inflammatory disease of unknown etiology. Cardiac sarcoidosis (CS) has been reported in as much as 25% of patients with systemic involvement. 18Fluorodeoxyglucose (FDG) positron emission tomography (PET) has a high diagnostic sensitivity/specificity in the diagnosis of CS. The aim of this review is to summarize evidence on the prognostic role of FDG PET. METHODS Studies were identified by searching MEDLINE from inception to October 2020. Medical subject headings (MeSH) terms for sarcoidosis; cardiac and FDG PET imaging were used. Studies of any design assessing the prognostic role of FDG PET in patients with either suspected or confirmed cardiac sarcoidosis imaging done at baseline were included. Abnormal PET was defined as abnormal metabolism (presence of focal or focal-on-diffuse uptake of FDG) OR abnormal metabolism and a perfusion defect. Studies reporting any outcome measure were included. Pooled risk ratio for the composite outcome of MACE was done. RESULTS A total of 6 studies were selected for final inclusion (515 patients, 53.4% women, 19.8% racial minorities.) Studies were institution based, retrospective in design and enrolled consecutive patients. All were observational in nature and published in English. All studies used a qualitative assessment of PET scans (abnormal FDG uptake with or without abnormal perfusion). Two studies assessed quantitative metrics (summed stress score in segments with abnormal FDG uptake, standardized uptake value and cardiac metabolic activity.) All studies reported major adverse cardiovascular events (MACE) as a composite outcome. After a mean follow up ranging from 1.4 to 4.1 years, there were a total of 105 MACE. All studies included death (either all-cause death or sudden cardiac death) and ventricular arrhythmia (ventricular tachycardia or ventricular fibrillation) as a component of MACE. Four of the six studies adjusted for several characteristics in their analysis. All four studies used left ventricular ejection fraction (LVEF). However, other adjustment variables were not consistent across studies. Five studies found a positive prognostic association with the primary outcome, two of which assessing right ventricular uptake. CONCLUSION Although available evidence indicates FDG PET can be used in the risk stratification of patients with CS, our findings show further studies are needed to quantify the effect in this patient group.
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Affiliation(s)
- Ahmed Ibrahim Ahmed
- Houston Methodist Debakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Abel Tsehay Abebe
- Department of Radiology, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19146, USA
| | - Yushui Han
- Houston Methodist Debakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Talal Alnabelsi
- Houston Methodist Debakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Tanushree Agrawal
- Houston Methodist Debakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Mahwash Kassi
- Houston Methodist Debakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Ahmed Aljizeeri
- King Abdulaziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Amy Taylor
- Houston Methodist Debakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | | | - Mouaz H Al-Mallah
- Houston Methodist Debakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA.
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42
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Khalaf S, Khan N, Al-Mallah M, Kassi M, Shah D. A positive PYP scan: Thinking beyond amyloid. J Nucl Cardiol 2021; 28:1796-1797. [PMID: 32385833 DOI: 10.1007/s12350-020-02149-6] [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] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Shaden Khalaf
- Houston Methodist Hospital, 6565 Fannin St., Houston, TX, 77030, USA
| | - Najah Khan
- Houston Methodist Hospital, 6565 Fannin St., Houston, TX, 77030, USA.
| | - Mouaz Al-Mallah
- Houston Methodist Hospital, 6565 Fannin St., Houston, TX, 77030, USA
| | - Mahwash Kassi
- Houston Methodist Hospital, 6565 Fannin St., Houston, TX, 77030, USA
| | - Dipan Shah
- Houston Methodist Hospital, 6565 Fannin St., Houston, TX, 77030, USA
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43
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Ahmed AI, Tsehay A, Han Y, Alnabelsi T, Agrawal T, Kassi M, Aljizeeri A, Taylor A, Tleyjeh I, Al-Mallah MH. The prognostic role of PET myocardial perfusion imaging in patients with cardiac sarcoidosis: a systematic review. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab111.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Sarcoidosis is a multi-systemic inflammatory disease of unknown etiology. Cardiac Sarcoidosis (CS) has been reported in as much as 25% of patients with systemic involvement. 18Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) has a high diagnostic sensitivity/specificity in the diagnosis of CS.
Purpose
The aim of this review is to summarize evidence on the prognostic role of FDG PET.
Methods
Studies were identified by searching MEDLINE from inception to October 2020. Medical Subject Headings (MeSH) terms for sarcoidosis; cardiac and FDG PET imaging were used. Studies of any design assessing the prognostic role of FDG PET in patients with either suspected or confirmed cardiac sarcoidosis imaging done at baseline were included. Abnormal PET was defined as abnormal metabolism (presence of focal or focal-on-diffuse uptake of FDG) OR abnormal metabolism and a perfusion defect. Studies reporting any outcome measure were included. Pooled risk ratio for the composite outcome of MACE was done.
Results
A total of 6 studies were selected for final inclusion (515 patients, 53.4% women, 19.8% racial minorities.) Studies were institution based, retrospective in design and enrolled consecutive patients. All were observational in nature and published in English. All studies used a qualitative assessment of PET scans (abnormal FDG uptake with or without abnormal perfusion). Two studies assessed quantitative metrics (summed stress score in segments with abnormal FDG uptake, standardized uptake value and cardiac metabolic activity.) All studies reported Major Adverse Cardiovascular Events (MACE) as a composite outcome. After a mean follow up ranging from 1.4 to 4.1 years, there were a total of 105 MACE. All studies included death (either all-cause death or sudden cardiac death) and ventricular arrhythmia (ventricular tachycardia or ventricular fibrillation) as a component of MACE. Four of the six studies adjusted for several characteristics in their analysis. All four studies used Left Ventricular Ejection Fraction (LVEF). However, other adjustment variables were not consistent across studies. Five studies found a positive prognostic association with the primary outcome, two of which assessing right ventricular uptake.
Conclusion
Although available evidence indicates FDG PET can be used in the risk stratification of patients with CS, our findings show further studies are needed to quantify the effect in this patient group.
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Affiliation(s)
- AI Ahmed
- Houston Methodist Hospital, Houston, United States of America
| | - A Tsehay
- Wolaita Sodo University, College of Health Sciences and Medicine, Wolaita Sodo, Ethiopia
| | - Y Han
- Houston Methodist Hospital, Houston, United States of America
| | - T Alnabelsi
- Houston Methodist Hospital, Houston, United States of America
| | - T Agrawal
- Houston Methodist Hospital, Houston, United States of America
| | - M Kassi
- Houston Methodist Hospital, Houston, United States of America
| | - A Aljizeeri
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - A Taylor
- Houston Methodist Hospital, Houston, United States of America
| | - I Tleyjeh
- Mayo Clinic, Rochester, United States of America
| | - MH Al-Mallah
- Houston Methodist Hospital, Houston, United States of America
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Kim J, DeOliveira M, Kassi M, Yousefzai R, Hussain I, Fida N, Trachtenberg B, Bhimaraj A, Guha A. Low AlloSure® Despite Discordance with High AlloMap® Associated with Low Risk of Moderate to Severe Cardiac Allograft Rejection. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.388] [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: 11/30/2022] Open
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Araujo-Gutierrez R, Chitturi KR, Xu J, Wang Y, Kinder E, Senapati A, Chebrolu LB, Kassi M, Trachtenberg BH. Baseline global longitudinal strain predictive of anthracycline-induced cardiotoxicity. Cardiooncology 2021; 7:4. [PMID: 33517910 PMCID: PMC7849080 DOI: 10.1186/s40959-021-00090-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 09/27/2020] [Accepted: 01/19/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cancer therapy-related cardiac dysfunction (CTRD) is a major source of morbidity and mortality in long-term cancer survivors. Decreased GLS predicts decreased left ventricular ejection fraction (LVEF) in patients receiving anthracyclines, but knowledge regarding the clinical utility of baseline GLS in patients at low-risk of (CTRD) is limited. OBJECTIVES The purpose of this study was to investigate whether baseline echocardiographic assessment of global longitudinal strain (GLS) before treatment with anthracyclines is predictive of (CTRD) in a broad cohort of patients with normal baseline LVEF. METHODS Study participants comprised 188 patients at a single institution who underwent baseline 2-dimensional (2D) speckle-tracking echocardiography before treatment with anthracyclines and at least one follow-up echocardiogram 3 months after chemotherapy initiation. Patients with a baseline LVEF <55% were excluded from the analysis. The primary endpoint, (CTRD), was defined as an absolute decline in LVEF > 10% from baseline and an overall reduced LVEF <50%. Potential and known risk factors were evaluated using univariable and multivariable Cox proportional hazards regression analysis. RESULTS Twenty-three patients (12.23%) developed (CTRD). Among patients with (CTRD), the mean GLS was -17.51% ± 2.77%. The optimal cutoff point for (CTRD) was -18.05%. The sensitivity was 0.70 and specificity was 0.70. The area under ROC curve was 0.70. After adjustment for cardiovascular and cancer therapy related risk factors, GLS or decreased baseline GLS ≥-18% was predictive of (CTRD) (adjusted hazards ratio 1.17, 95% confidence interval 1.00, 1.36; p = 0.044 for GLS, or hazards ratio 3.54; 95% confidence interval 1.34, 9.35; p = 0.011 for decreased GLS), along with history of tobacco use, pre-chemotherapy systolic blood pressure, and cumulative anthracycline dose. CONCLUSIONS Baseline GLS or decreased baseline GLS was predictive of (CTRD) before anthracycline treatment in a cohort of cancer patients with a normal baseline LVEF. This data supports the implementation of strain-protocol echocardiography in cardio-oncology practice for identifying and monitoring patients who are at elevated risk of (CTRD).
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Affiliation(s)
- Raquel Araujo-Gutierrez
- Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St., Suite 1901, Houston, Texas 77030 USA
| | - Kalyan R. Chitturi
- Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St., Suite 1901, Houston, Texas 77030 USA
- Department of Medicine, Division of Cardiovascular Medicine, University of Missouri-Columbia, Columbia, Missouri USA
| | - Jiaqiong Xu
- Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St., Suite 1901, Houston, Texas 77030 USA
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas USA
| | - Yuanchen Wang
- Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St., Suite 1901, Houston, Texas 77030 USA
| | - Elizabeth Kinder
- Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St., Suite 1901, Houston, Texas 77030 USA
| | - Alpana Senapati
- Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St., Suite 1901, Houston, Texas 77030 USA
| | - L. Bindu Chebrolu
- Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St., Suite 1901, Houston, Texas 77030 USA
| | - Mahwash Kassi
- Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St., Suite 1901, Houston, Texas 77030 USA
| | - Barry H. Trachtenberg
- Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St., Suite 1901, Houston, Texas 77030 USA
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Senapati A, Rojas SF, Kurrelmeyer K, Kassi M, Valderrábano M, Shah DJ, Al-Mallah MH. Incessant PVCs and Cardiomyopathy: Think Outside the Box. Methodist Debakey Cardiovasc J 2020; 16:e1. [PMID: 32904706 DOI: 10.14797/mdcj-16-2-e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Alpana Senapati
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Stephanie Fuentes Rojas
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Karla Kurrelmeyer
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Mahwash Kassi
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Miguel Valderrábano
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Dipan J Shah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
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Chitturi KR, Thacker S, Al-Saadi MA, Kassi M. Successful treatment of acute heart failure in COVID-19-induced cytokine storm with tocilizumab: a case report. Eur Heart J Case Rep 2020; 4:1-6. [PMID: 33089052 PMCID: PMC7454490 DOI: 10.1093/ehjcr/ytaa188] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Received: 04/22/2020] [Revised: 04/27/2020] [Accepted: 06/02/2020] [Indexed: 02/07/2023]
Abstract
Background SARS-CoV-2 is known to induce a cytokine storm, a hyperinflammatory state driven by up-regulation of interleukin 6 (IL-6) and immunomodulatory chemokines that may result in acute heart failure. Case summary A 65-year-old woman with confirmed SARS-CoV-2 developed shock with multiorgan system failure, including acute biventricular heart failure, 2 weeks after the initial onset of fever, cough, and shortness of breath. The patient experienced myocardial recovery within 48 h after administration of tocilizumab, a humanized monoclonal anti-IL-6 receptor antibody, and multiple supportive vasoactive medications. Discussion The differential diagnosis of acute heart failure in critically ill patients with COVID-19 infection is broad, including sepsis-induced cardiomyopathy, Takotsubo syndrome, viral lymphocytic myocarditis, and acute coronary syndrome. Immunomodulatory treatment with tocilizumab may benefit patients who develop cardiogenic shock associated with SARS-CoV-2-induced cytokine storm.
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Affiliation(s)
- Kalyan R Chitturi
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Sameer Thacker
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | | | - Mahwash Kassi
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
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Araujo-Gutierrez R, Bhimaraj A, Guha A, Hussain I, Kassi M, Kim J, Trachtenberg B. No Increase in Infections or Readmissions in Al Amyloid Patients Who Undergo Heart Transplant. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.629] [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: 11/29/2022] Open
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Bhimaraj A, Agrawal T, Duran A, Tamimi O, Amione-Guerra J, Trachtenberg B, Guha A, Hussain I, Kim J, Kassi M, Xu J, Suarez E, Ngo UQ, Torre-Amione G, Estep JD. Percutaneous Left Axillary Artery Placement of Intra-Aortic Balloon Pump in Advanced Heart Failure Patients. JACC: Heart Failure 2020; 8:313-323. [PMID: 32241538 DOI: 10.1016/j.jchf.2020.01.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 11/15/2022]
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Chitturi KR, Xu J, Araujo-Gutierrez R, Bhimaraj A, Guha A, Hussain I, Kassi M, Bernicker EH, Trachtenberg BH. Immune Checkpoint Inhibitor-Related Adverse Cardiovascular Events in Patients With Lung Cancer. JACC CardioOncol 2019; 1:182-192. [PMID: 34396181 PMCID: PMC8352266 DOI: 10.1016/j.jaccao.2019.11.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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: 08/26/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate whether immune checkpoint inhibitors (ICIs) are associated with an increased risk of major adverse cardiovascular events (MACE) compared with non-ICI therapies in patients with lung cancer. BACKGROUND ICIs activate the host immune system to target cancer cells. Though uncommon, cardiovascular immune-related adverse events can be life-threatening. METHODS A retrospective single-institution cohort study of 252 patients with pathologically confirmed lung cancer who received ICI or non-ICI therapy was analyzed. The primary endpoint was MACE, defined as a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and hospitalization for heart failure. RESULTS During a median follow-up of 6 months, MACE occurred in 13.3% of ICI-treated patients, with a median time to event of 51 days, compared with 10.3% and 64 days in non-ICI patients. ICIs were not associated with MACE (hazard ratio [HR]: 1.18; 95% confidence interval [CI]: 0.57 to 2.43; p = 0.66) in a univariable Fine-Gray regression analysis incorporating noncardiovascular death as a competing risk. Multivariable regression analyses determined that patients treated with ICIs with elevated serum troponin I >0.01 ng/ml (HR: 7.27; 95% CI: 2.72 to 19.43; p < 0.001) and B-type natriuretic peptide (BNP) >100 pg/ml (HR: 2.65; 95% CI: 1.01 to 6.92; p = 0.047) had an increased risk of MACE. Patients pre-treated or receiving combined immunotherapy with ICIs and vascular endothelial growth factor inhibitors (VEGFIs) or tyrosine kinase inhibitors (TKIs) had an increased risk of MACE (HR: 2.15; 95% CI: 1.05 to 4.37; p = 0.04). CONCLUSIONS ICIs were not independently associated with an increased risk of MACE in patients with lung cancer, although power is an important limitation in these analyses. ICI-associated cardiotoxicity was associated with elevations in serum troponin and BNP, and combined immunotherapy with VEGFIs or TKIs. Future studies are needed to further define the role of cardiac biomarkers as a monitoring strategy with ICI therapy.
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Key Words
- BNP
- BNP, B-type natriuretic peptide
- CI, confidence interval
- HR, hazard ratio
- ICI, immune checkpoint inhibitor
- IQR, interquartile range
- LVEF, left ventricular ejection fraction
- MACE
- MACE, major adverse cardiovascular events
- PD, programmed cell death protein
- PD-L1, programmed cell death-ligand 1
- TKI, tyrosine kinase inhibitor
- TnI, troponin I
- VEGFI, vascular endothelial growth factor inhibitor
- cardiotoxicity
- immune checkpoint inhibitors
- lung cancer
- troponin
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Affiliation(s)
| | - Jiaqiong Xu
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA
| | | | - Arvind Bhimaraj
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Ashrith Guha
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Imad Hussain
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Mahwash Kassi
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Eric H. Bernicker
- Department of Medical Oncology, Houston Methodist Cancer Center, Houston, Texas, USA
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