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Lin YH, Azraai M, Miura D, Rodrigues T, Nadurata V. Incidence of Radiotherapy Induced Cardiac Implantable Electronic Devices Malfunction: Australian-Based Observation Study. Int J Radiat Oncol Biol Phys 2023; 117:e408. [PMID: 37785356 DOI: 10.1016/j.ijrobp.2023.06.1550] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To assess the incidence rate of cardiac implantable electronic devices (CIED) malfunction with radiotherapy (RT) and identify factors resulting in CIED malfunction. The working hypothesis is that CIED malfunction is associated with higher photon beam energy, treatment anatomical location, device type and dose to device. MATERIALS/METHODS This retrospective review involved 441 patients with CIED treated with RT. Clinical information, RT (prescription, dose to device, beam energy, anatomical regions treated etc.) and CIED details (type, manufacturer, and device malfunction) were collected from electronic medical records. RESULTS A total of 344 patients (78%) had a permanent pacemaker (PPM), 44 patients (10%) had implantable cardioverter defibrillator (ICD), 44 patients (10%) had CRT-defibrillator (CRT-D) and 9 (2%) had cardiac resynchronization therapy-pacing (CRT-P). The median prescribed dose was 36 Gy (IQR 1.8-80 Gy). 17 out of 441 patients (3.9%) experienced an CIED malfunction event. This group had a higher prescribed median dose of 42.5 Gy (IQR 20-77 Gy) and beam energy of 14 MV (12-18 MV). None of the malfunctions resulted in clinical symptoms. Median dose to CIED was 0.28 Gy (IQR 0-3.3). No patents received dose to device ≥2 Gy. Using logistic regression, the predictors of CIED malfunction were photon beam energy use ≥10 MV (OR 5.73; 95% CI, 1.58-10.76), anatomical location of RT above the diaphragm (OR 5.2, 95% CI, 1.82-15.2), and having an ICD (OR 4.6, 95% CI, 0.75-10.2). CONCLUSION We have demonstrated that photon beam energies ≥10 MV, RT to above the diaphragm and ICD devices are significantly associated with CIED malfunction. The recorded CIED malfunctions in this study were minor malfunctions which did not result in any clinical symptoms. Stringent adherence to the local institution's CIED treatment guidelines, utilization of safety measures and careful choice of beam energy are recommended to minimize risk of symptomatic CIED malfunctions.
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Affiliation(s)
- Y H Lin
- Alfred Health, Melbourne, VIC, Australia; Peter McCallum Cancer Centre, Melbourne, VIC, Australia
| | - M Azraai
- Bendigo Health, Bendigo, VIC, Australia
| | - D Miura
- Bendigo Health, Bendigo, VIC, Australia
| | - T Rodrigues
- Monash University, Melbourne, VIC, Australia
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Azraai M, Miura D, Lin YH, Rodrigues TS, Nadurata V. Incidence and Predictors of Cardiac Implantable Electronic Devices Malfunction with Radiotherapy Treatment. J Clin Med 2022; 11:jcm11216329. [PMID: 36362559 PMCID: PMC9654752 DOI: 10.3390/jcm11216329] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 12/01/2022] Open
Abstract
Aims: To investigate the incidence of cardiac implantable electronic devices (CIED) malfunction with radiotherapy (RT) treatment and assess predictors of CIED malfunction. Methods: A 6-year retrospective analysis of patients who underwent RT with CIED identified through the radiation oncology electronic database. Clinical, RT (cumulative dose, dose per fraction, beam energy, beam energy dose, and anatomical area of RT) and CIED details (type, manufacturer, and device malfunction) were collected from electronic medical records. Results: We identified 441 patients with CIED who underwent RT. CIED encountered a permanent pacemaker (PPM) (78%), cardiac resynchronization therapy—pacing (CRT-P) (2%), an implantable cardioverter defibrillator (ICD) (10%), and a CRT-defibrillator (CRT-D) (10%). The mean cumulative dose of RT was 36 gray (Gy) (IQR 1.8–80 Gy) and the most common beam energy used was photon ≥10 megavolt (MV) with a median dose of 7 MV (IQR 5–18 MV). We further identified 17 patients who had CIED malfunction with RT. This group had a higher cumulative RT dose of 42.5 Gy (20–77 Gy) and a photon dose of 14 MV (12–18 MV). None of the malfunctions resulted in clinical symptoms. Using logistic regression, the predictors of CIED malfunction were photon beam energy use ≥10 MV (OR 5.73; 95% CI, 1.58–10.76), anatomical location of RT above the diaphragm (OR 5.2, 95% CI, 1.82–15.2), and having a CIED from the ICD group (OR 4.6, 95% CI, 0.75–10.2). Conclusion: Clinicians should be aware of predictors of CIED malfunction with RT to ensure the safety of patients.
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Affiliation(s)
- Meor Azraai
- Department of Cardiology, Bendigo Health, Bendigo, VIC 3550, Australia
- Faculty of Medicine, Nursing and Health Sciences, School of Rural Health, Monash University, Melbourne, VIC 3550, Australia
- Correspondence: or ; Tel.: +613-5454-6000
| | - Daisuke Miura
- Department of Cardiology, Bendigo Health, Bendigo, VIC 3550, Australia
| | - Yuan-Hong Lin
- Department of Radiation Oncology, Peter McCallum, Bendigo Health, Bendigo, VIC 3550, Australia
| | - Thalys Sampaio Rodrigues
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Voltaire Nadurata
- Department of Cardiology, Bendigo Health, Bendigo, VIC 3550, Australia
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Azraai M, Tan S, Narayan O. Answer: A broken and blocked heart-Takotsubo cardiomyopathy with dynamic left ventricular outflow tract obstruction. Eur Heart J Acute Cardiovasc Care 2022; 11:e5-e6. [PMID: 35672027 DOI: 10.1093/ehjacc/zuac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Meor Azraai
- Department of Cardiology, Bendigo Health, 100 Barnard Street, Bendigo, VIC 3550, Australia
| | - Sean Tan
- Department of Cardiology, Bendigo Health, 100 Barnard Street, Bendigo, VIC 3550, Australia
- Department of Cardiology, Victorian Heart Institute, Monash University, Melbourne, VIC, Australia
| | - Om Narayan
- Department of Cardiology, Bendigo Health, 100 Barnard Street, Bendigo, VIC 3550, Australia
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Azraai M, Tan S, Narayan O. Question: A broken and blocked heart-Takotsubo cardiomyopathy with dynamic left ventricular outflow tract obstruction. Eur Heart J Acute Cardiovasc Care 2022; 11:e3-e4. [PMID: 35641245 DOI: 10.1093/ehjacc/zuac015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Meor Azraai
- Department of Cardiology, Bendigo Health, 100 Barnard Street, Bendigo, VIC 3550, Australia
| | - Sean Tan
- Department of Cardiology, Bendigo Health, 100 Barnard Street, Bendigo, VIC 3550, Australia
- Department of Cardiology, Victorian Heart Institute, Monash University, VIC, Australia
| | - Om Narayan
- Department of Cardiology, Bendigo Health, 100 Barnard Street, Bendigo, VIC 3550, Australia
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Azraai M, D'Souza D, Nadurata V. Current Clinical Practice in Patients With Cardiac Implantable Electronic Devices (CIED) Undergoing Radiotherapy (RT). Heart Lung Circ 2021; 31:327-340. [PMID: 34844904 DOI: 10.1016/j.hlc.2021.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/05/2021] [Accepted: 10/25/2021] [Indexed: 11/26/2022]
Abstract
Patients with cardiac implantable electronic devices (CIED) undergoing radiotherapy (RT) are more common due to ageing of the population. With newer CIEDs implementing the complementary metal-oxide semiconductor (CMOS) technology which allows the miniaturisation of CIED, it is also more susceptible to RT. Effects of RT on CIED ranges from device interference, device operational/memory errors of permanent damage. These malfunctions can cause life threatening clinical effects. Cumulative dose is not the only component of RT that causes CIED malfunction, as neutron use and dose rate effect also affects CIEDs. The management of this patient cohort in clinical practice is inconsistent due to lack of a consistent guideline from manufacturers and physician specialty societies. Our review will focus on the current clinical practice and the recent updated guidelines of managing patients with CIED undergoing RT. We aim to simplify the evidence and provide a simple and easy to use guide based on the recent guidelines.
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Affiliation(s)
- Meor Azraai
- Department of Cardiology, Bendigo Health, Bendigo, Vic, Australia.
| | - Daniel D'Souza
- Department of Cardiology, Bendigo Health, Bendigo, Vic, Australia
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Hamilton G, Patel SK, Azraai M, Burrell LM. No dynamic changes in plasma ACE2 activity in patients with acute coronary syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3280] [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
Background
Angiotensin converting enzyme 2 (ACE2) is expressed in the human myocardium and blood vessels and degrades the vasoconstrictor peptide angiotensin (Ang) II. Plasma ACE2 activity is elevated in patients with cardiovascular disease (CVD) and is a predictor of major adverse cardiovascular events (MACE) in obstructive coronary artery disease. However, it is unknown whether acute coronary syndrome (ACS) causes dynamic changes in plasma ACE2 activity.
Purpose
We investigated dynamic changes in serial troponin-T and plasma ACE2 activity in patients presenting with ACS who underwent invasive coronary angiography (ICA).
Methods
Consecutive patients admitted with ACS from October-November 2019 were screened. Those meeting the Fourth Universal Definition of Myocardial Infarction who had both ICA and serial troponin-T testing were included. The study was approved by the hospitals Human Research Ethics Committee. All patients had routine plasma samples taken over 3 time-points for measurement of troponin-T; the same sample was used to measure plasma ACE2 activity. Catalytic ACE2 activity was measured using a validated, sensitive quenched fluorescent substrate-based assay. Serial median troponin and ACE2 activity levels were analysed using the Friedman test for repeated measures.
Results
Forty-nine patients were included. The mean age of participants was 63.9±11.0 years, and 36 (74%) patients were male. Overall, 16 (36%) patients presented with ST-elevation myocardial infarction (STEMI) and 29 (74%) with non-ST-elevation myocardial infarction (NSTEMI). Twenty-nine (59%) patients had a history of hypertension and 14 (29%) a history of ischaemic heart disease; 13 (27%) with priorMI, 11 (22%) had previous PCI and 2 (4%) had prior coronary artery bypass grafting. Over the 3 time points, there was a clear rise in median troponin-T levels representing myocardial injury (p<0.001), with no change in median plasma ACE2 activity (p=0.23, table 1). There was no difference in median ACE2 activity in those presenting with STEMI vs. NSTEMI (6.9 [2.1–9.5] vs. 6.0 [1.8–12.1], p=0.87), nor in those who underwent PCI to a culprit lesion compared to those who did not have a culprit lesion stented (5.8 [0.9–10.5] vs. 7.3 [2.8–14.9], p=0.37).
Conclusions
Patients with ACS had higher plasma ACE2 levels compared to levels previously reported in healthy controls. There were no dynamic changes in ACE2 activity in the setting of ACS, despite a significant rise in troponin-T. These results suggest that plasma ACE2 levels reflect underlying endothelial dysfunction rather than acute myocardial injury or infarction. Studies are now underway to assess if plasma ACE2 activity in ACS predicts MACE.
Funding Acknowledgement
Type of funding sources: None. Table 1
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Affiliation(s)
- G Hamilton
- Austin Health, Department of Cardiology, Melbourne, Australia
| | - S K Patel
- University of Melbourne, Department of Medicine, Melbourne, Australia
| | - M Azraai
- University of Melbourne, Department of Medicine, Melbourne, Australia
| | - L M Burrell
- Austin Hospital, Department of Medicine, Melbourne, Australia
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Azraai M, Pham JH, Looi WF, Wirth D, Ng ASL, Babu U, Saluja B, Lim AKH. Observational cohort study of the triggers, diagnoses and outcomes of the medical emergency team (MET) response in adult psychiatry inpatients colocated with acute medical services in Australia. BMJ Open 2021; 11:e046110. [PMID: 34620654 PMCID: PMC8499333 DOI: 10.1136/bmjopen-2020-046110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Medical emergencies in psychiatric inpatients are challenging due to the model of care and limited medical resources. The study aims were to determine the triggers and outcomes of a medical emergency team (MET) call in psychiatric wards, and the risk factors for MET activation and mortality. DESIGN Retrospective multisite cohort study. SETTING Psychiatry units colocated with acute medical services at three major metropolitan hospitals in Melbourne, Australia. PARTICIPANTS We studied 487 adult inpatients who experienced a total of 721 MET calls between January 2015 and January 2020. Patients were relatively young (mean age, 45 years) and had few medical comorbidities, but a high prevalence of smoking, excessive alcohol intake and illicit drug use. OUTCOME MEASURES We performed a descriptive analysis of the triggers and outcomes (transfer rates, investigations, final diagnosis) of MET calls. We used logistic regression to determine the factors associated with the primary outcome of inpatient mortality, and the secondary outcome of the need for specific medical treatment compared with simple observation. RESULTS The most common MET triggers were a reduced Glasgow Coma Scale, tachycardia and hypotension, and 49% of patients required transfer. The most frequent diagnosis was a drug adverse effect or toxidrome, followed by infection and dehydration. There was a strong association between a leave of absence and MET calls, tachycardia and the final diagnosis of drug adverse effects. Mortality occurred in 3% after MET calls. Several baseline and MET clinical variables were associated with mortality but a model with age (per 10 years, OR 1.61, 95% CI 1.29 to 2.01) and hypoxia (OR 3.59, 95% CI 1.43 to 9.04) independently predicted mortality. CONCLUSION Vigilance is required in patients returning from day leave, and drug adverse effects remain a challenging problem in psychiatric units. Hypoxic older patients with cardiovascular comorbidity have a higher risk of death.
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Affiliation(s)
- Meor Azraai
- Department of General Medicine, Monash Health, Clayton, Victoria, Australia
| | - Jeanette H Pham
- Department of General Medicine, Monash Health, Clayton, Victoria, Australia
| | - Wenye F Looi
- Department of General Medicine, Monash Health, Clayton, Victoria, Australia
| | - Daniel Wirth
- Department of General Medicine, Monash Health, Clayton, Victoria, Australia
| | - Ashley S L Ng
- Department of General Medicine, Monash Health, Clayton, Victoria, Australia
| | - Umesh Babu
- Department of Psychiatry, Monash Health, Clayton, Victoria, Australia
| | - Bharat Saluja
- Department of Psychiatry, Monash Health, Clayton, Victoria, Australia
| | - Andy K H Lim
- Department of General Medicine, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia
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Azraai M, D'Souza D, Lin YH, Nadurata V. Current clinical practice in patients with cardiac implantable electronic devices undergoing radiotherapy: a literature review. Europace 2021; 24:362-374. [PMID: 34516616 DOI: 10.1093/europace/euab241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/25/2021] [Indexed: 12/25/2022] Open
Abstract
Patients with cardiac implantable electronic devices (CIED) undergoing radiotherapy (RT) are more common due to the ageing of the population. With newer CIEDs' implementing the complementary metal-oxide semiconductor (CMOS) technology which allows the miniaturization of CIED, it is also more susceptible to RT. Effects of RT on CIED ranges from device interference, device operational/memory errors of permanent damage. These malfunctions can cause life-threatening clinical effects. Cumulative dose is not the only component of RT that causes CIED malfunction, as neutron use and dose rate effect also affects CIEDs. The management of this patient cohort in clinical practice is inconsistent due to the lack of a consistent guideline from manufacturers and physician specialty societies. Our review will focus on the current clinical practice and the recently updated guidelines of managing patients with CIED undergoing RT. We aim to simplify the evidence and provide a simple and easy to use guide based on the recent guidelines.
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Affiliation(s)
- Meor Azraai
- Department of Cardiology, Bendigo Health, 100 Barnard Street, Bendigo, Victoria 3550, Australia
| | - Daniel D'Souza
- Department of Cardiology, Bendigo Health, 100 Barnard Street, Bendigo, Victoria 3550, Australia
| | - Yuan-Hong Lin
- Department of Cardiology, Bendigo Health, 100 Barnard Street, Bendigo, Victoria 3550, Australia
| | - Voltaire Nadurata
- Department of Cardiology, Bendigo Health, 100 Barnard Street, Bendigo, Victoria 3550, Australia
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Azraai M, McMahon M, Dick R. Case report of amiodarone-associated allergic pneumonitis amidst the COVID-19 pandemic. Rev Cardiovasc Med 2021; 22:181-184. [PMID: 33792260 DOI: 10.31083/j.rcm.2021.01.267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 11/06/2022] Open
Abstract
Amiodarone is a common antiarrhythmic drug that is utilised in clinical practice and is associated with pulmonary toxicity. The most common form of pulmonary complication is interstitial pneumonitis which is treated with discontinuation of amiodarone and initiation of corticosteroids. Amiodarone-induced pulmonary eosinophilia is a rare complication of amiodarone therapy, with blood and pulmonary eosinophilia the predominant features. During the COVID-19 era, the incidence of delay in treatment of pulmonary pathology is also delayed due to the effort of excluding COVID-19 infection. Here we report a case of a 64-year-old man who developed eosinophilic pneumonia after initiation of amiodarone therapy, and the investigations required to exclude other forms of pulmonary toxicity. We also reviewed the effect of COVID-19 testing in the management of patients presenting with respiratory distress.
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Affiliation(s)
- Meor Azraai
- Department of Cardiology, Epworth Healthcare, Melbourne, 3121 Victoria, Australia
| | - Marcus McMahon
- Department of Respiratory Medicine, Epworth Healthcare, Melbourne, 3121 Victoria, Australia
| | - Ronald Dick
- Department of Cardiology, Epworth Healthcare, Melbourne, 3121 Victoria, Australia
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Lim AKH, Azraai M, Pham JH, Looi WF, Wirth D, Ng ASL, Babu U, Saluja B. Severe Tachycardia Associated with Psychotropic Medications in Psychiatric Inpatients: A Study of Hospital Medical Emergency Team Activation. J Clin Med 2021; 10:jcm10071534. [PMID: 33917515 PMCID: PMC8038822 DOI: 10.3390/jcm10071534] [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: 01/05/2021] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 11/29/2022] Open
Abstract
The use of antipsychotic medications is associated with side effects, but the occurrence of severe tachycardia (heart rate ≥ 130 per minute) is not well described. The aim of this study was to determine the frequency and strength of the association between antipsychotic use and severe tachycardia in an inpatient population of patients with mental illness, while considering factors which may contribute to tachycardia. We retrospectively analyzed data from 636 Medical Emergency Team (MET) calls occurring in 449 psychiatry inpatients in three metropolitan hospitals co-located with acute medical services, and used mixed-effects logistic regression to model the association between severe tachycardia and antipsychotic use. The median age of patients was 42 years and 39% had a diagnosis of schizophrenia or psychotic disorder. Among patients who experienced MET calls, the use of second-generation (atypical) antipsychotics was commonly encountered (70%), but the use of first-generation (conventional) antipsychotics was less prevalent (10%). Severe tachycardia was noted in 22% of all MET calls, and sinus tachycardia was the commonest cardiac rhythm. After adjusting for age, anticholinergic medication use, temperature >38 °C and hypoglycemia, and excluding patients with infection and venous thromboembolism, the odds ratio for severe tachycardia with antipsychotic medication use was 4.09 (95% CI: 1.64 to 10.2).
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Affiliation(s)
- Andy K. H. Lim
- Department of General Medicine, Monash Health, Clayton, VIC 3168, Australia; (M.A.); (J.H.P.); (W.F.L.); (D.W.); (A.S.L.N.)
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia
- Correspondence:
| | - Meor Azraai
- Department of General Medicine, Monash Health, Clayton, VIC 3168, Australia; (M.A.); (J.H.P.); (W.F.L.); (D.W.); (A.S.L.N.)
| | - Jeanette H. Pham
- Department of General Medicine, Monash Health, Clayton, VIC 3168, Australia; (M.A.); (J.H.P.); (W.F.L.); (D.W.); (A.S.L.N.)
| | - Wenye F. Looi
- Department of General Medicine, Monash Health, Clayton, VIC 3168, Australia; (M.A.); (J.H.P.); (W.F.L.); (D.W.); (A.S.L.N.)
| | - Daniel Wirth
- Department of General Medicine, Monash Health, Clayton, VIC 3168, Australia; (M.A.); (J.H.P.); (W.F.L.); (D.W.); (A.S.L.N.)
| | - Ashley S. L. Ng
- Department of General Medicine, Monash Health, Clayton, VIC 3168, Australia; (M.A.); (J.H.P.); (W.F.L.); (D.W.); (A.S.L.N.)
| | - Umesh Babu
- Department of Psychiatry, Monash Health, Clayton, VIC 3168, Australia; (U.B.); (B.S.)
| | - Bharat Saluja
- Department of Psychiatry, Monash Health, Clayton, VIC 3168, Australia; (U.B.); (B.S.)
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Lim AKH, Azraai M, Pham JH, Looi WF, Bennett C. The Association Between Illicit Drug Use and the Duration of Renal Replacement Therapy in Patients With Acute Kidney Injury From Severe Rhabdomyolysis. Front Med (Lausanne) 2020; 7:588114. [PMID: 33240909 PMCID: PMC7680872 DOI: 10.3389/fmed.2020.588114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/21/2020] [Indexed: 11/25/2022] Open
Abstract
Background and Aims: Acute kidney injury is a known complication of severe rhabdomyolysis. In patients who present to hospital with rhabdomyolysis, illicit drug use is associated with a higher risk of acute kidney injury needing renal replacement therapy (RRT), independent of the peak serum creatine kinase level. The aim of this study was to assess if RRT duration and renal outcomes were also worse in illicit drug use-associated rhabdomyolysis. Methods: We conducted a cohort study of adult patients who presented to Monash Health (Jan 2011–June 2020) with rhabdomyolysis and required RRT. Patients with isolated myocardial injury and cardiac arrest were excluded. We used survival analysis to examine the time to RRT independence, utilizing the Fine-Gray competing risks regression and death as the competing event. A subdistribution hazard ratio (SHR) < 1.0 represents a relatively greater duration of RRT and a worse outcome. Results: We included 101 patients with a mean age of 58 years, of which 17% were cases associated with illicit drug use. The median peak creatine kinase level was 5,473 U/L (interquartile range, 1,795–17,051 U/L). Most patients (79%) initiated RRT within 72 h of admission, at a median serum creatinine of 537 μmol/L (interquartile range, 332–749 μmol/L). In the competing risks analysis, the estimated SHR was 1.48 (95% CI: 0.78–2.84, P = 0.23) for illicit drug use, 0.87 (95% CI: 0.76–0.99, P = 0.041) for the log-transformed peak creatine kinase, and 0.41 (95% CI: 0.25–0.67, P < 0.001) for sepsis. A 50% cumulative incidence of RRT independence occurred at 11 days (95% CI: 8–16 days). Only 5% of patients remained on RRT at 3 months. Conclusion: In rhabdomyolysis-associated acute kidney injury, it is unlikely that patients with illicit drug use-associated rhabdomyolysis require a longer duration of RRT compared to patients with rhabdomyolysis from other causes.
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Affiliation(s)
- Andy K. H. Lim
- Department of General Medicine, Monash Health, Clayton, VIC, Australia
- Department of Nephrology, Monash Health, Clayton, VIC, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
- *Correspondence: Andy K. H. Lim
| | - Meor Azraai
- Department of General Medicine, Monash Health, Clayton, VIC, Australia
| | - Jeanette H. Pham
- Department of General Medicine, Monash Health, Clayton, VIC, Australia
| | - Wenye F. Looi
- Department of General Medicine, Monash Health, Clayton, VIC, Australia
| | - Caitriona Bennett
- Department of General Medicine, Monash Health, Clayton, VIC, Australia
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Azraai M, Gao L, Ajani AE. Cost-Effectiveness of Transcatheter Aortic Valve Intervention (TAVI) Compared to Surgical Aortic Valve Replacement (SAVR) in Low- to Intermediate-Surgical-Risk Patients. Cardiovascular Revascularization Medicine 2020; 21:1164-1168. [DOI: 10.1016/j.carrev.2020.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 01/05/2020] [Accepted: 01/09/2020] [Indexed: 12/01/2022]
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Azraai M, Ajani AE. Late Post- Infarction Left Ventricular Pseudoaneurysm: A Case Report. Cardiovasc Revasc Med 2019; 21:145-146. [PMID: 31270024 DOI: 10.1016/j.carrev.2019.05.030] [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] [Received: 05/24/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
We present a case of a 90 year-old-patient who presented with syncope. She had previous inferior acute myocardial infarction 10 years ago. Coronary angiography revealed left ventricular pseudoaneurysm, which was confirmed on cardiac computed tomography. The patient refused surgical repair and implantable cardioverter defibrillator insertion and was discharged from the hospital alive. This case demonstrates the possibility of long-term survival with left ventricular pseudoaneurysm and the increasing detection of 'incidental' left ventricular pseudoaneurysm with more frequent use of imaging.
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Affiliation(s)
- Meor Azraai
- Royal Melbourne Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew E Ajani
- Royal Melbourne Hospital, Melbourne, Australia; NHMRC Centre of Clinical Research Excellence in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; University of Melbourne, Melbourne, Victoria, Australia.
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Gayed D, Azraai M, Liu B, McMaster C, O’Donavan R, Patel S, Liew D, Burrell L. An Audit Of Glucose Lowering Therapies in Patients With Type 2 Diabetes and Hospitalisation for Heart Failure. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.524] [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]
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Rodrigues TS, Azraai M, Crosthwaite A, Patel S, Farouque O, Ramchand J, Lim R, Roberts M, Ierino F, Burrell L. The Peguero-Lo Presti Criteria Improve the Sensitivity of the Electrocardiogram to Diagnose Left Ventricular Hypertrophy in Patients with End-Stage Kidney Disease. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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