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Dasa O, Ruzieh M. Editorial commentary: Resting heart rate and outcomes: Risk marker or risk factor? Trends Cardiovasc Med 2023; 33:516-517. [PMID: 35667637 DOI: 10.1016/j.tcm.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Osama Dasa
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida; Division of Cardiovascular Medicine, Department of Medicine, Department of Cardiovascular Medicine, College of Medicine, University of Florida College of Medicine, University of Florida, 1600 SW Archer Rd, PO BOX 100288, Gainesville, Florida
| | - Mohammed Ruzieh
- Division of Cardiovascular Medicine, Department of Medicine, Department of Cardiovascular Medicine, College of Medicine, University of Florida College of Medicine, University of Florida, 1600 SW Archer Rd, PO BOX 100288, Gainesville, Florida.
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Katterle KR, Niedoba MJ, Pasadyn VE, Mann A, Brewster PS, Dasa O, Ruzieh M, Ammari Z, Gupta R. Impact of Baseline Heart Failure on Acute Pulmonary Embolism Risk Stratification and Clinical Outcomes. Am J Cardiol 2023; 200:26-31. [PMID: 37276720 DOI: 10.1016/j.amjcard.2023.05.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/18/2023] [Accepted: 05/07/2023] [Indexed: 06/07/2023]
Abstract
Among patients with acute pulmonary embolism (PE), abnormal cardiac biomarkers and elevated right ventricular to left ventricular (RV/LV) diameter ratio are associated with increased morbidity and mortality. However, subjects with baseline heart failure (HF) have abnormalities in cardiac chamber dimensions and biomarkers. We sought to describe risk stratification variables in a cohort with acute PE and categorized HF status as no HF, HF with reduced ejection fraction (HFrEF), or HF with preserved ejection fraction (HFpEF). In total, 182 subjects were identified for this study, of whom 142 were categorized as having no HF, 16 as having HFrEF, and 24 as having HFpEF. The median age was 65 years [interquartile range 51 to 75 years], and 43% were male. Subjects with HFrEF had significantly greater LV diameters and significantly lower RV/LV diameter ratio (no HF 0.94, HFrEF 0.65, HFpEF 0.89, p = 0.002). Subjects with HFrEF also had significantly higher B-type natriuretic peptide levels (no HF 112 pg/mL, HFrEF 835 pg/mL, HFpEF 241 pg/mL, p <0.001) and higher 90-day mortality rates. Among subjects with acute PE, those with baseline HFrEF had significantly greater LV diameter and lower RV/LV diameter ratio than those of patients with HFpEF or no HF. In addition, subjects with HFrEF had significantly higher B-type natriuretic peptide levels and worse survival at 90 days. In conclusion, these results indicate that PE risk stratification using current guidelines, especially reliance on RV/LV ratio, is inaccurate among subjects with baseline HFrEF.
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Affiliation(s)
- Konrad R Katterle
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Matthew J Niedoba
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Vanessa E Pasadyn
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Alexandria Mann
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Pamela S Brewster
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Osama Dasa
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida
| | - Mohammed Ruzieh
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida
| | - Zaid Ammari
- Division of Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California
| | - Rajesh Gupta
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio; Division of Cardiovascular Medicine, Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio.
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Hamburger RF, Clugston J, Handberg EM, Pepine CJ, Dasa O, Ruzieh M, Martinez MW, Edenfield KM. THE IMPACT OF TRAINING ON CARDIAC REMODELING IN COLLEGIATE FOOTBALL PLAYERS AS ASSESSED BY ECHOCARDIOGRAPHY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02775-4] [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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Altman J, Rambarat CA, Hamburger R, Dasa O, Dimza M, Kelling M, Clugston JR, Handberg EM, Pepine CJ, Edenfield KM. Relationship between arm span to height ratio, aortic root diameter, and systolic blood pressure in collegiate athletes. Am Heart J Plus 2023; 25:100242. [PMID: 38510494 PMCID: PMC10946030 DOI: 10.1016/j.ahjo.2022.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/12/2022] [Indexed: 03/22/2024]
Abstract
Study objective Sudden cardiac death is the most common cause of non-traumatic death in collegiate athletes. Marfan syndrome poses a risk for sudden cardiac death secondary to aortic root dilation leading to aortic dissection or rupture. Arm span to height ratio (ASHR) > 1.05 has been proposed as a screening tool for Marfan syndrome in pre-participation examinations (PPE) for collegiate athletes but limited data exists on the association between ASHR and aortic root diameter (ARD). This study examines the relationship between ASHR and ARD and assesses for predictors of ARD. Design Retrospective chart review. Setting National Collegiate Athletic Association Division I University. Participants 793 athletes across thirteen sports between 2012 and 2022 evaluated with PPE and screening echocardiogram. Interventions Not applicable. Main outcome measures (1) Relationships between ASHR, SBP, BSA, and ARD amongst all athletes as well as stratified by ASHR >1.05 or ≤1.05 using univariate analysis. (2) Predictors of ARD using multivariate analysis using linear regression. Results 143 athletes (18 %) had ASHRs > 1.05. Athletes with ASHR > 1.05 had higher ARD (2.99 cm) than athletes with ASHR ≤ 1.05 (2.85 cm). Weak correlations were noted between ASHR, ARD, and SBP. Multivariate analysis showed that BSA, male sex, and participation in swimming were predictors of ARD. ASHR was not predictive of ARD in regression analysis. Conclusions These findings showed a tendency towards higher ARD in athletes with ASHR >1.05 but this observation was not statistically significant in multivariate analysis.
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Affiliation(s)
- Joshua Altman
- University of Florida College of Medicine, Department of Emergency Medicine, Department of Orthopaedic Surgery and Sports Medicine, Gainesville, FL, United States of America
| | - Cecil A. Rambarat
- University of Florida College of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Gainesville, FL, United States of America
| | - Robert Hamburger
- University of Florida College of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Gainesville, FL, United States of America
| | - Osama Dasa
- University of Florida, College of Public Health and Health Professions, Gainesville, FL, United States of America
| | - Michelle Dimza
- University of Florida College of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Gainesville, FL, United States of America
| | - Matthew Kelling
- University of Florida College of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Gainesville, FL, United States of America
| | - James R. Clugston
- University of Florida College of Medicine, Department of Community Health and Family Medicine, Gainesville, FL, United States of America
| | - Eileen M. Handberg
- University of Florida College of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Gainesville, FL, United States of America
| | - Carl J. Pepine
- University of Florida College of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Gainesville, FL, United States of America
| | - Katherine M. Edenfield
- University of Florida College of Medicine, Department of Community Health and Family Medicine, Gainesville, FL, United States of America
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Sajdeya R, Wijayabahu AT, Stetten NE, Sajdeya O, Dasa O. What's Up Your Sleeve? A Scoping Review of White Coat Contamination and Horizontal Microbial Transmission. South Med J 2022; 115:360-365. [PMID: 35649520 DOI: 10.14423/smj.0000000000001405] [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: 01/20/2023]
Abstract
OBJECTIVES White coats have been suggested to serve as fomites carrying and transmitting pathogenic organisms and potentially increasing the risk of healthcare-associated infections (HAIs). We aimed to examine the current evidence regarding white coat contamination and its role in horizontal transmission and HAIs risk. We also examined handling practices and policies associated with white coat contamination in the reviewed literature. METHODS We conducted a literature search through PubMed and Web of Science Core Collection/Cited Reference Search, and manually searched the bibliographies of the articles identified in electronic searches. Studies published up to March 3, 2021 that were accessible in English-language full-text format were included. RESULTS Among 18 included studies, 15 (83%) had ≥100 participants, 16 (89%) were cross-sectional studies, and 13 (72%) originated outside of the United States. All of the studies showed evidence of microbial colonization. Colonization with Staphylococcus aureus and Escherichia coli was reported in 100% and 44% of the studies, respectively. Antibacterial-resistant strains, including methicillin-resistant Staphylococcus aureus and multidrug-resistant organisms were reported in 8 (44%) studies. There was a lack of studies assessing the link between white coat contamination and HAIs. The data regarding white coat handling and laundering practices showed inconsistencies between healthcare facilities and a lack of clear policies. CONCLUSIONS There is robust evidence that white coats serve as fomites, carrying dangerous pathogens, including multidrug-resistant organisms. A knowledge gap exists, however, regarding the role of contaminated white coats in HAI risk that warrants further research to generate the evidence necessary to guide the current attire policies for healthcare workers.
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Affiliation(s)
- Ruba Sajdeya
- From the Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, and the Department of Occupational Therapy, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, and the Department of Internal Medicine, University of Toledo Medical Centre, Toledo, Ohio
| | - Akemi T Wijayabahu
- From the Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, and the Department of Occupational Therapy, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, and the Department of Internal Medicine, University of Toledo Medical Centre, Toledo, Ohio
| | - Nichole E Stetten
- From the Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, and the Department of Occupational Therapy, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, and the Department of Internal Medicine, University of Toledo Medical Centre, Toledo, Ohio
| | - Omar Sajdeya
- From the Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, and the Department of Occupational Therapy, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, and the Department of Internal Medicine, University of Toledo Medical Centre, Toledo, Ohio
| | - Osama Dasa
- From the Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, and the Department of Occupational Therapy, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, and the Department of Internal Medicine, University of Toledo Medical Centre, Toledo, Ohio
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Dasa O, Mahmoud AN, Kaufmann PG, Ketterer M, Light KC, Raczynski J, Sheps DS, Stone PH, Handberg E, Pepine CJ. Relationship of Psychological Characteristics to Daily Life Ischemia: An Analysis From the National Heart, Lung, and Blood Institute Psychophysiological Investigations in Myocardial Ischemia. Psychosom Med 2022; 84:359-367. [PMID: 35067655 PMCID: PMC8976783 DOI: 10.1097/psy.0000000000001044] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Cardiac ischemia during daily life is associated with an increased risk of adverse outcomes. Mental stress is known to provoke cardiac ischemia and is related to psychological variables. In this multicenter cohort study, we assessed whether psychological characteristics were associated with ischemia in daily life. METHODS This study examined patients with clinically stable coronary artery disease (CAD) with documented cardiac ischemia during treadmill exercise (n = 196, mean [standard deviation] age = 62.64 [8.31] years; 13% women). Daily life ischemia (DLI) was assessed by 48-hour ambulatory electrocardiophic monitoring. Psychological characteristics were assessed using validated instruments to identify characteristics associated with ischemia occurring in daily life stress. RESULTS High scores on anger and hostility were common in this sample of patients with CAD, and DLI was documented in 83 (42%) patients. However, the presence of DLI was associated with lower anger scores (odds ratio [OR] = 2.03; 95% confidence interval [CI] = 1.12-3.69), reduced anger expressiveness (OR = 2.04; 95% CI = 1.10-3.75), and increased ratio of anger control to total anger (OR = 2.33; 95% CI = 1.27-4.17). Increased risk of DLI was also associated with lower hostile attribution (OR = 2.22; 95% CI = 1.21-4.09), hostile affect (OR = 1.92; 95% CI = 1.03-3.58), and aggressive responding (OR = 2.26; 95% CI = 1.25-4.08). We observed weak inverse correlations between DLI episode frequency and anger expressiveness, total anger, and hostility scores. DLI was not associated with depression or anxiety measures. The combination of the constructs low anger expressiveness and low hostile attribution was independently associated with DLI (OR = = 2.59; 95% CI = 1.42-4.72). CONCLUSIONS In clinically stable patients with CAD, the tendency to suppress angry and hostile feelings, particularly openly aggressive behavior, was associated with DLI. These findings warrant a study in larger cohorts, and intervention studies are needed to ascertain whether management strategies that modify these psychological characteristics improve outcomes.
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Affiliation(s)
- Osama Dasa
- Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Ahmed N. Mahmoud
- Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | | | - Mark Ketterer
- Department of Behavioral Health, Henry Ford Hospital and Wayne State University, Detroit, Michigan
| | - Kathleen C. Light
- Departments of Anesthesiology and Psychology, University of Utah School of Medicine, Salt Lake City, Utah
| | - James Raczynski
- University of Arkansas for Medical Sciences Fay W. Boozman College of Public Health, Little Rock, Arkansas
| | - David S. Sheps
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Peter H. Stone
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eileen Handberg
- Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Carl J. Pepine
- Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
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Dasa O, Bai C, Mardini M, Smith SM, Handberg EM, Pepine CJ. MACHINE LEARNING PREDICTION MODEL OF BLOOD PRESSURE VARIABILITY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02572-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dasa O, Bai C, Mardini M, Pearson TA. USING MACHINE LEARNING TO ASSESS RACIAL DISPARITIES IN COVID-19 MORBIDITY AND MORTALITY. J Am Coll Cardiol 2022. [PMID: 35331852 PMCID: PMC8972567 DOI: 10.1016/s0735-1097(22)02837-6] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Taha YK, Rambarat CA, Reifsteck F, Hamburger R, Clugston JR, Handberg EM, Street JM, Asken B, Dasa O, Kelling M, Dimza M, Pepine CJ, Martinez MW, Edenfield KM. Blood pressure characteristics of collegiate female athletes: A call for more focused attention on young women's health. Am Heart J Plus 2022; 13:100085. [PMID: 38560086 PMCID: PMC10978186 DOI: 10.1016/j.ahjo.2022.100085] [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] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/17/2021] [Accepted: 01/02/2022] [Indexed: 04/04/2024]
Abstract
Background There is a paucity of data describing the association between blood pressure (BP) and cardiac remodeling in female collegiate athletes. Methods This retrospective cohort review describes the BP characteristics and echocardiographic features of female collegiate athletes during preparticipation evaluation. We evaluated data from 329 female athletes at two National Collegiate Athletic Association (NCAA) Division I universities who underwent preparticipation evaluation that included medical history, physical examination, 12-lead electrocardiography, and 2-dimensional transthoracic echocardiography. BP values were divided into categories of normal, elevated, stage 1 and stage 2 hypertension based on 2017 ACC/AHA Guidelines. Left ventricular mass index was calculated and indexed to body surface area and further classified into concentric remodeling, concentric hypertrophy, and eccentric hypertrophy. Results Normal BP values were noted in 184 (56%) female athletes, 88 (26.7%) had elevated BP and 57 (17.3%) had BP values indicating stage 1 or 2 hypertension. The majority of participants were white (n = 136, 73.9%). There was significantly higher body surface area in female athletes with higher BP values: 1.85 ± 0.18 in the stage 1 and 2 hypertension range, 1.82 ± 0.18 in the elevated BP range versus 1.73 ± 0.16 in the normal BP range (p < 0.001). Conclusions There was a trend toward higher incidence of concentric and eccentric hypertrophy in athletes with higher than normal BP, however no statistical significance was noted. Elevated BP values were frequent among female collegiate athletes, and there is evidence of cardiac remodeling associated with higher BP values.
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Affiliation(s)
- Yasmeen K. Taha
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - Cecil A. Rambarat
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - Fred Reifsteck
- Student Health Center, University of Georgia, Athens, GA, USA
| | - Robert Hamburger
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - James R. Clugston
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, USA
| | - Eileen M. Handberg
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - Joan M. Street
- Student Health Care Center, University of Florida, Gainesville, FL, USA
| | - Breton Asken
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Osama Dasa
- Division of General Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Matthew Kelling
- Division of General Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Michelle Dimza
- Division of General Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Carl J. Pepine
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | | | - Katherine M. Edenfield
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, USA
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Taha YK, Rambart CA, Reifsteck F, Hamburger R, Clugston JR, Handberg EM, Street J, Dasa O, Pepine CJ, Martinez M, Edenfield KM. Abnormal left ventricular geometry in female collegiate swimmers. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2784] [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
There is a paucity of data describing left ventricular geometry changes in female athletes. While some studies suggest that female athletes participating in dynamic sports exhibit higher prevalence of eccentric left ventricular hypertrophy (LVH) when compared to men, a recent study suggested more concentric geometry changes in female basketball athletes. We were unable to identify studies describing the left ventricular geometry of female collegiate swimmers.
Objectives
To describe LV geometry changes in a cohort of female collegiate swimmers.
Methods
We analyzed a cohort of female collegiate swimmers who had a pre-participation cardiac evaluation by 12-lead ECG and 2-dimensional echocardiography. Left ventricular (LV) geometry was assessed based on relative wall thickness (RWT) (defined as: 2 x posterior wall thickness (PWT) divided by LV end-diastolic diameter (LVEDD)) and LV mass (LVM) (Devereux's formula: LVM = [0.8 x 1.04 [(LVEDD + interventricular septum + posterior wall thickness)3 − (LVEDD)3]] + 0.6g) and was indexed to body surface area (BSA).LVH was defined as LV mass index >95 g and was defined as concentric when associated with a relative wall thickness (RWT) >0.42 and as eccentric when RWT was ≤0.42. Concentric remodeling was defined as normal LVM index and increased RWT.
Results
A total of 83 female collegiate swimmers were included. Their age was 18.5±0.5 years (mean ± standard deviation, SD), 74 (89.2%) were White, BSA was 1.78±0.11 m2, height 173±6.3 cm, weight 66.2±7.2 K. Their interventricular septum diameter was 0.89±0.14 cm, PWT 0.92±0.15 cm, LVEDD 4.9±0.5 cm and LV end-systolic diameter (LVESD) 3.2±0.4 cm. Left atrium diameter ranged from 2.6 to 4.3 cm (mean 3.4 cm ± 0.4 cm). Aortic root diameter ranged from 1.9 to 3.5 cm (mean 2.7±0.3 cm) (Figure 1). LVH was present in 27 swimmers (32.5%). Eccentric LVH was present in 17 athletes (20.5%), concentric hypertrophy in 10 athletes (12%), and concentric remodeling in 12 (14.5%) (Figure 2). No athletes with LVH or concentric remodeling had borderline or abnormal ECG findings based on international criteria. Only two women with normal LV geometry had abnormal ECG findings: prolonged QT interval and abnormal T wave inversion. There was a linear correlation between BSA with LVEDD, LVESD and LV mass (r=0.40, 0.35, and 0.48 with P<0.001,0.002 and <0.001, respectively). However, there was no statistically significant difference between LV geometry groups based on BSA or blood pressure.
Conclusion
Our data document a high incidence of eccentric hypertrophy among female collegiate swimmers. Concentric remodeling and hypertrophy were also relatively high. Differentiating physiologic from pathologic cardiac remodeling in these athletes is critical to prevent potential complications such as sudden cardiac death, arrhythmias, and other adverse outcomes.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): This work was supported in part by the American Medical Society for Sports Medicine (AMSSM) Foundation Research Grant 2016 awarded to KE, and the University of Florida REDCap uses the NIH National Center for Advancing Translational Sciences (NCATS) grant UL1 TR001427. Figure 1Figure 2. LV geometry in female swimmers
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Affiliation(s)
- Y K Taha
- University of Florida, Cardiology, Gainesville, United States of America
| | - C A Rambart
- University of Florida, Cardiology, Gainesville, United States of America
| | - F Reifsteck
- University of Georgia, Student Health Center, Athens, United States of America
| | - R Hamburger
- University of Florida, Cardiology, Gainesville, United States of America
| | - J R Clugston
- University of Florida, Community Health and Family Medicine, Gainesville, United States of America
| | - E M Handberg
- University of Florida, Cardiology, Gainesville, United States of America
| | - J Street
- University of Florida, Student Health Care Center, Gainesville, United States of America
| | - O Dasa
- University of Florida, Department of Internal Medicine, Gainesville, United States of America
| | - C J Pepine
- University of Florida, Cardiology, Gainesville, United States of America
| | - M Martinez
- Morristown Medical Center, Morristown, United States of America
| | - K M Edenfield
- University of Florida, Community Health and Family Medicine, Gainesville, United States of America
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Affiliation(s)
- Osama Dasa
- College of Public Health and Health Professions and the College of Medicine, University of Florida, Gainesville, Florida
| | - Thomas A Pearson
- College of Public Health and Health Professions and the College of Medicine, University of Florida, Gainesville, Florida
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Qi Y, Dasa O, Maden M, Vohra R, Batra A, Walter G, Yarrow JF, Aranda JM, Raizada MK, Pepine CJ. Functional heart recovery in an adult mammal, the spiny mouse. Int J Cardiol 2021; 338:196-203. [PMID: 34126132 DOI: 10.1016/j.ijcard.2021.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/27/2021] [Accepted: 06/09/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Ischemic heart disease and the resulting heart failure continue to carry high morbidity and mortality, and a breakthrough in our understanding of this disorder is needed. The adult spiny mouse (Acomys cahirinus) has evolved the remarkable capacity to regenerate full-thickness skin tissue, including microvasculature and cartilage, without fibrosis or scarring. We hypothesized that lack of scarring and resulting functional regeneration also applies to the adult Acomys heart. METHODS AND RESULTS We compared responses of the Acomys heart to CD1 outbred Mus heart following acute left anterior descending coronary artery ligation to induce myocardial infarction. Both Acomys and Mus hearts showed decreased ejection fraction (EF) after ligation. However, Acomys hearts showed significant EF recovery to pre-ligation values over four weeks. Histological analysis showed comparable infarct area 24-h after ligation with a similar collateral flow in both species' hearts, but subsequently, Acomys displayed reduced infarct size, regenerated microvasculature, and increased cell proliferative activity in the infarcted area. CONCLUSIONS These observations suggest that adult Acomys displays remarkable cardiac recovery properties after acute coronary artery occlusion and may be a useful model to understand functional recovery better. TRANSLATIONAL PERSPECTIVE Adult Acomys provides a novel mammalian model to further investigate the cardioprotective and regenerative signaling mechanisms in adult mammals. This opens the door to breakthrough treatment strategies for the injured myocardium and help millions of patients with heart failure secondary to tissue injury with irreversible damage.
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Affiliation(s)
- Yanfei Qi
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Osama Dasa
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Malcolm Maden
- UF Genetics Institute and Department of Biology, University of Florida, Gainesville, FL, USA
| | - Ravneet Vohra
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Abhinandan Batra
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Glenn Walter
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Juan M Aranda
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Mohan K Raizada
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Carl J Pepine
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.
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Dasa O, Cohen SA, Zheng Y, sajdeya R, Taha MB, Hu H, Pearson TA. Abstract 042: Do Disparities In Cardiovascular Comorbidities Account For Excess Covid-19 Morbidity And Mortality In African Americans? Circulation 2021. [DOI: 10.1161/circ.143.suppl_1.042] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
COVID-19 incidence, severity, and death in African Americans (AA) has been reported to markedly exceed those of White Americans (WA), but the epidemiologic basis for this is unclear.
Hypothesis:
We hypothesize that AA have an excess of comorbid conditions compared to WA accounting for the disparity in COVID-19 infection and death.
Methods:
We examined 67,094 COVID-19 cases with laboratory-confirmed COVID-19 and compared them to 135,188 controls (2:1 match by age, sex, and zip code) representing a state-wide sample of healthcare recipients from the ‘OneFlorida’ research consortium through August 3, 2020. We assessed the prevalence of preexisting comorbid conditions (e.g. cardiovascular disease, cancer), behavioral risk factors, and health outcomes in the electronic health records of COVID-19 cases compared to controls.
Results:
Cases included 25,443 (37.9%) WA, 11,709 (17.5%) AA, and 16,119 (24%) Hispanic Americans (HA). Among cases, there was a significant increase in the prevalence of several cardiovascular comorbidities in AA vs. WA, such as hypertension, diabetes, heart failure, and stroke, but not for common cancers, liver disease, and COPD (Table 1). Likewise, smoking and BMI were higher in AA. Similar disparities were also appreciated in matched controls. Compared to WA, AA and HA had higher odds of becoming infected with COVID-19 (Unadjusted OR, 1.08; CI [1.05-1.11] and OR, 1.17; [1.15-1.2]) respectively. The prevalence of severe COVID-19 outcomes (intubation and death) was higher in AA (3.6 and 2.7%) than WA (2.5% and 2.3%) or HA (1.3 and 1.4%), respectively.
Conclusions:
Excess comorbidities for cardiometabolic diseases are present in this population-based sample of COVID-19 cases and controls. Careful mediation analyses will determine whether these differences in cardiovascular comorbidities alone account for disparities in COVID-19 in AA patients. Such data would be important to identify high-risk subgroups benefitting from enhanced preventive and early therapeutic interventions.
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Affiliation(s)
| | | | - Yi Zheng
- Univ of Florida, GAINESVILLE, FL
| | | | | | - Hui Hu
- Univ of Florida, Gainesville, FL
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Dasa O, Smith S, Cooper-DeHoff R, Handberg E, Pepine C. ASSOCIATION BETWEEN SHORT-TERM VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY AND LONG-TERM MORTALITY AMONG PATIENTS WITH CORONARY ARTERY DISEASE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03002-3] [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: 11/28/2022]
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Taha MB, Sayaideh MA, Sajdeya O, Dasa O, Ruzieh M. THE RATE OF ADVERSE EVENTS OF SODIUM-GLUCOSE COTRANSPORTER 2 INHIBITORS: A META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02019-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ammari Z, Hasnie AA, Ruzieh M, Dasa O, Al-Sarie M, Shastri P, Ashcherkin N, Brewster PS, Cooper CJ, Gupta R. Prognostic Value of Computed Tomography Versus Echocardiography Derived Right to Left Ventricular Diameter Ratio in Acute Pulmonary Embolism. Am J Med Sci 2021; 361:445-450. [DOI: 10.1016/j.amjms.2020.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/02/2020] [Accepted: 07/07/2020] [Indexed: 01/14/2023]
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Massoomi MR, Anderson RD, Ahmed MM, Dasa O, George P, Miles WM, Aranda JM, Pepine CJ. Erratum to "Cardiovascular Considerations for the Internist and Hospitalist in the COVID-19 Era" AmJMed, 133(11); 1254-1261. Am J Med 2021; 134:555. [PMID: 33461734 PMCID: PMC8445265 DOI: 10.1016/j.amjmed.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Michael R Massoomi
- Division of Cardiovascular Medicine, UF Health, University of Florida, Gainesville
| | - R David Anderson
- Division of Cardiovascular Medicine, UF Health, University of Florida, Gainesville.
| | - Mustafa M Ahmed
- Division of Cardiovascular Medicine, UF Health, University of Florida, Gainesville
| | - Osama Dasa
- Department of Internal Medicine, UF Health, University of Florida, Gainesville
| | - Philip George
- Division of Cardiovascular Medicine, UF Health, University of Florida, Gainesville
| | - William M Miles
- Division of Cardiovascular Medicine, UF Health, University of Florida, Gainesville
| | - Juan M Aranda
- Division of Cardiovascular Medicine, UF Health, University of Florida, Gainesville
| | - Carl J Pepine
- Division of Cardiovascular Medicine, UF Health, University of Florida, Gainesville
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Dasa O, Smith SM, Howard G, Cooper-DeHoff RM, Gong Y, Handberg E, Pepine CJ. Association of 1-Year Blood Pressure Variability With Long-term Mortality Among Adults With Coronary Artery Disease: A Post Hoc Analysis of a Randomized Clinical Trial. JAMA Netw Open 2021; 4:e218418. [PMID: 33914047 PMCID: PMC8085725 DOI: 10.1001/jamanetworkopen.2021.8418] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/11/2021] [Indexed: 12/11/2022] Open
Abstract
Importance Accumulating evidence indicates that higher blood pressure (BP) variability from one physician office visit to the next (hereafter referred to as visit-to-visit BP variability) is associated with poor outcomes. Short-term measurement (throughout 1 year) of visit-to-visit BP variability in high-risk older patients may help identify patients at increased risk of death. Objective To evaluate whether short-term visit-to-visit BP variability is associated with increased long-term mortality risk. Design, Setting, and Participants The US cohort of the International Verapamil SR-Trandolapril Study (INVEST), a randomized clinical trial of 16 688 patients aged 50 years or older with hypertension and coronary artery disease, was conducted between September 2, 1997, and December 15, 2000, with in-trial follow-up through February 14, 2003. The study evaluated a calcium antagonist (sustained-release verapamil plus trandolapril) vs β-blocker (atenolol plus hydrochlorothiazide) treatment strategy. Blood pressure measurement visits were scheduled every 6 weeks for the first 6 months and biannually thereafter. Statistical analysis was performed from September 2, 1997, to May 1, 2014. Exposures Visit-to-visit systolic BP (SBP) and diastolic BP variability during the first year of enrollment using 4 different BP variability measures: standard deviation, coefficient of variation, average real variability, and variability independent of the mean. Main Outcomes and Measures All-cause death, assessed via the US National Death Index, beginning after the exposure assessment period through May 1, 2014. Results For the present post hoc analysis, long-term mortality data were available on 16 688 patients (9001 women [54%]; mean [SD] age, 66.5 [9.9] years; 45% White patients, 16% Black patients, and 37% Hispanic patients). During a mean (SD) follow-up of 10.9 (4.2) years, 5058 patients (30%) died. All 4 variability measures for SBP were significantly associated with long-term mortality after adjustment for baseline demographic characteristics and comorbidities. After comparison of lowest vs highest variability measure quintiles, the magnitude of the association with death remained statistically significant even after adjustment for baseline demographic characteristics and comorbidities (average real variability: adjusted hazard ratio [aHR], 1.18; 95% CI, 1.08-1.30; standard deviation: aHR, 1.14; 95% CI, 1.04-1.24; coefficient of variation: aHR, 1.15; 95% CI, 1.06-1.26; variability independent of the mean: aHR, 1.15; 95% CI, 1.05-1.25). The signal was stronger in women compared with men. Associations of diastolic BP variability measures with death were weaker than for SBP and were not significant after adjustment. Conclusions and Relevance This study suggests that, in a large population of older patients with hypertension and coronary artery disease, short-term visit-to-visit SBP variability was associated with excess long-term mortality, especially for women. Efforts to identify and minimize visit-to-visit SBP variability may be important in reducing excess mortality later in life. Trial Registration ClinicalTrials.gov Identifier: NCT00133692.
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Affiliation(s)
- Osama Dasa
- Department of Internal Medicine and Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville
| | - Steven M. Smith
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham
| | - Rhonda M. Cooper-DeHoff
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville
| | - Eileen Handberg
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville
| | - Carl J. Pepine
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville
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Rambarat CA, Reifsteck F, Clugston JR, Handberg EM, Martinez MW, Hamburger R, Street JM, Asken B, Taha Y, Kelling M, Dimza M, Dasa O, Pepine CJ, Edenfield KM. Preparticipation Cardiac Evaluation Findings in a Cohort of Collegiate Female Athletes. Am J Cardiol 2021; 140:134-139. [PMID: 33144161 DOI: 10.1016/j.amjcard.2020.10.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 11/24/2022]
Abstract
Knowledge of cardiovascular adaptations in athletes has predominantly focused on males, with limited data available on females who compromise a substantial percentage of all collegiate athletes. A multicenter retrospective cohort review of preparticipation cardiovascular screening data of 329 National Collegiate Athletic Association Division I female athletes was performed. This included physical exams, electrocardiograms, and echocardiograms. Female athletes in class IB sports had elevated systolic blood pressure (p = 0.01). For electrocardiograms, 7 (2%) had abnormal findings: 100% were white; 6 of 7 (86%) participated in IIC sports. Black athletes had longer PR intervals (p ≤ 0.001), whereas white athletes had longer QTc and QRS durations (p = 0.02 and 0.01, respectively). Athletes in IC and IIC sports had longer QTc intervals (p = 0.01). For echocardiographic parameters, no differences were noted based on race. However, significant differences were noted based on classification of sport: athletes in class IC sports had higher left-atrial volume indexes and E/A ratios. Athletes in class IB and IIC had increased left-ventricular wall thicknesses and aortic root dimensions. In conclusion, among one of the largest cohorts of collegiate female athlete preparticipation cardiac screening data to date, significant differences in various parameters based on classification of sport and race were observed. These categorizations should be considered when interpreting cardiovascular screening in female collegiate athletes to improve screening and guide future research.
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Taha MB, Taha AB, Dasa O, Alom M, Abdelgadir YH, Winchester DE. Chronic elevation of cardiac troponin I predicts the extent of coronary disease in hemodialysis patients presenting with acute enzyme elevation. Am Heart J Plus 2021; 2:100012. [PMID: 38560585 PMCID: PMC10978145 DOI: 10.1016/j.ahjo.2021.100012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 04/04/2024]
Abstract
Introduction Elevation of cardiac troponin I (cTn-I) is associated with coronary artery disease (CAD) in asymptomatic patients with end-stage renal disease (ESRD) receiving hemodialysis. We aim to investigate the diagnostic value of chronically elevated cTn-I in ESRD patients presenting with an acute rise in serum cTn-I levels. Methods We performed a retrospective analysis of 364 patients. Using coronary angiography, we correlated baseline elevation of cTn-I with the severity of CAD when hemodialysis patients present with acute symptomatic elevation in serum cTn-I. Results In hemodialysis patients presenting with a rise in serum cTn-I above baseline levels, 59% had severe CAD, and 17% had no angiographic evidence of CAD. Hemodialysis patients with severe CAD had significantly higher baseline cTn-I levels compared to patients with non-severe CAD or normal coronaries (p < 0.0001). Baseline elevation of cTn-I in the severe CAD group was correlated with the degree of CAD occlusion (r2 0.56, p < 0.0001), fitting a positive linear model. Furthermore, baseline cTn-I differentiates between patients with and without severe CAD with a test accuracy of 0.72 (95% CI, 0.69-0.75, p < 0.001). At a value of ≥0.2 ng/mL (cutoff for myocardial necrosis), the specificity of baseline cTn-I for underlying severe CAD was 0.95. Conclusions Elevated baseline cTn-I has good accuracy for anticipating more advanced angiographic CAD when hemodialysis patients present with a symptomatic rise in serum cTn-I above baseline levels. Baseline elevation of cTn-I can be used for cardiac disease risk management in hemodialysis patients presenting with symptoms suggestive of CAD.
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Affiliation(s)
- Mohamad B. Taha
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, United States
- Department of Internal Medicine, Detroit Medical Center (Sinai-Grace Hospital), Wayne State University School of Medicine, Detroit, MI, United States
| | - Ahmad B. Taha
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Osama Dasa
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, United States
| | - Modar Alom
- Department of Internal Medicine, Detroit Medical Center (Sinai-Grace Hospital), Wayne State University School of Medicine, Detroit, MI, United States
- Department of Medicine, University of Toledo, Toledo, OH, United States
| | - Yasir H. Abdelgadir
- Department of Internal Medicine, Detroit Medical Center (Sinai-Grace Hospital), Wayne State University School of Medicine, Detroit, MI, United States
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - David E. Winchester
- Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, FL, United States
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Dasa O, Pepine CJ. Sex Differences, Aspirin, and Primary Prevention. Am J Med 2021; 134:9-10. [PMID: 32941847 DOI: 10.1016/j.amjmed.2020.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Osama Dasa
- Department of Internal Medicine and Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville
| | - Carl J Pepine
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville.
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Taha MB, Dasa O, Al-Ani M, Taha OB, Radhakrishnan NS, Ahmed MM. Acute right ventricular failure: a novel presentation of methadone-induced cardiotoxicity. BMJ Case Rep 2020; 13:13/11/e237168. [DOI: 10.1136/bcr-2020-237168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
As methadone use increases, the potential for methadone-induced cardiotoxicity (MIC) may rise. We describe a case of acute right ventricular (RV) failure leading to cardiogenic shock after methadone overdose. This presentation was followed by full RV recovery. This previously undescribed presentation highlights the challenges involved with MIC, its diagnosis and its management.
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Affiliation(s)
- Osama Dasa
- Department of Internal Medicine and Epidemiology, University of Florida College of Public Health and Health Professions, College of Medicine, Gainesville, FL 32610-0238, USA.
| | - Mohammed Ruzieh
- Department of Cardiovascular Medicine, College of Medicine, Penn State Heart and Vascular Institute, Hershey, PA, USA
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Gupta R, Ammari Z, Dasa O, Ruzieh M, Burlen JJ, Shunnar KM, Nguyen HT, Xie Y, Brewster P, Chen T, Aronow HD, Cooper CJ. Long-term mortality after massive, submassive, and low-risk pulmonary embolism. Vasc Med 2019; 25:141-149. [PMID: 31845835 DOI: 10.1177/1358863x19886374] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Guidelines for management of normotensive patients with acute pulmonary embolism (PE) emphasize further risk stratification on the basis of right ventricular (RV) size and biomarkers of RV injury or strain; however, the prognostic importance of these factors on long-term mortality is not known. We performed a retrospective cohort study of subjects diagnosed with acute PE from 2010 to 2015 at a tertiary care academic medical center. The severity of initial PE presentation was categorized into three groups: massive, submassive, and low-risk PE. The primary endpoint of all-cause mortality was ascertained using the Centers for Disease Control National Death Index (CDC NDI). A total of 183 subjects were studied and their median follow-up was 4.1 years. The median age was 65 years. The 30-day mortality rate was 7.7% and the overall mortality rate through the end of follow-up was 40.4%. The overall mortality rates for massive, submassive, and low-risk PE were 71.4%, 44.5%, and 28.1%, respectively (p < 0.001). Landmark analysis using a 30-day cutpoint demonstrated that subjects presenting with submassive PE compared with low-risk PE had increased mortality during both the short- and the long-term periods. The most frequent causes of death were malignancy, cardiac disease, respiratory disease, and PE. Independent predictors of all-cause mortality were cancer at baseline, age, white blood cell count, diabetes mellitus, liver disease, female sex, and initial presentation with massive PE. In conclusion, the diagnosis of acute PE was associated with substantial long-term mortality. The severity of initial PE presentation was associated with both short- and long-term mortality.
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Affiliation(s)
- Rajesh Gupta
- Division of Cardiovascular Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA.,Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Zaid Ammari
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Osama Dasa
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Mohammed Ruzieh
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Jordan J Burlen
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Khaled M Shunnar
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Hanh T Nguyen
- Department of Mathematics and Statistics, University of Toledo, Toledo, OH, USA
| | - Yanmei Xie
- Department of Mathematics and Statistics, University of Toledo, Toledo, OH, USA
| | - Pamela Brewster
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Tian Chen
- Department of Mathematics and Statistics, University of Toledo, Toledo, OH, USA
| | - Herbert D Aronow
- Warren Alpert Medical School at Brown University, Lifespan Cardiovascular Institute, Providence, RI, USA
| | - Christopher J Cooper
- Division of Cardiovascular Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA.,Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
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Affiliation(s)
- Osama Dasa
- Division of Hospital Medicine, University of Florida, Gainesville, Florida
| | | | - Mohammed Ruzieh
- Penn State Heart and Vascular Institute, Hershey, Pennsylvania
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Dasa O, Ruzieh M, Ammari Z, Syed MA, Brickman KR, Gupta R. Response to Letter to the Editor. J Emerg Med 2019; 56:718. [PMID: 31229260 DOI: 10.1016/j.jemermed.2019.02.001] [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: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Osama Dasa
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
| | - Mohammed Ruzieh
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
| | - Zaid Ammari
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
| | - Mubbasher A Syed
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio
| | - Kris R Brickman
- Department of Emergency Medicine, University of Toledo Medical Center, Toledo, Ohio
| | - Rajesh Gupta
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio
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Ammari Z, Pak SC, Ruzieh M, Dasa O, Tiwari A, Jaume JC, Alfonso-Jaume MA. Posttransplant Tacrolimus-Induced Diabetic Ketoacidosis: Review of the Literature. Case Rep Endocrinol 2018; 2018:4606491. [PMID: 29854487 PMCID: PMC5966672 DOI: 10.1155/2018/4606491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 04/02/2018] [Indexed: 11/25/2022] Open
Abstract
Diabetic ketoacidosis (DKA) in patients receiving tacrolimus as part of their immunosuppressive regimen is a rarely reported adverse event. We report a patient with autosomal dominant polycystic kidney disease (ADPKD) and no known history of diabetes mellitus who presented with DKA, 3 months after kidney transplantation.
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Affiliation(s)
- Zaid Ammari
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Stella C. Pak
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Mohammed Ruzieh
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Osama Dasa
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Abhinav Tiwari
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Juan C. Jaume
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
- Division of Endocrinology, Diabetes and Metabolism, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
- Center for Diabetes and Endocrine Research (CeDER), College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Maria A. Alfonso-Jaume
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
- Center for Diabetes and Endocrine Research (CeDER), College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
- Division of Nephrology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
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Ammari Z, Ruzieh M, Dasa O, Cooper C, Gupta R. IS CT ANGIOGRAPHY-DERIVED RIGHT TO LEFT VENTRICULAR DIAMETER RATIO ADEQUATE FOR PULMONARY EMBOLISM RISK STRATIFICATION? J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32470-7] [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: 11/25/2022]
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Dasa O, Shafiq Q, Ruzieh M, Alhazmi L, Al-Dabbas M, Ammari Z, Khouri S, Moukarbel G. Patient Factors But Not the Use of Novel Anticoagulants or Warfarin Are Associated With Internal Jugular Vein Access-Site Hematoma After Right Heart Catheterization. J Invasive Cardiol 2017; 29:401-403. [PMID: 29207361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Right heart catheterization (RHC) is routinely performed to assess hemodynamics. Generally, anticoagulants are held prior to the procedure. At our center, anticoagulants are continued and ultrasound guidance is always used for internal jugular vein access. A micropuncture access kit is used to place a 5 or 6 Fr sheath using the modified Seldinger technique. Manual compression is applied for 10-15 min and the patient is observed for at least 2 hours after the procedure. In a retrospective analysis, we investigated the risk of bleeding complications associated with RHC via the internal jugular vein in patients with and without full anticoagulation. METHODS AND RESULTS Our catheterization laboratory database was searched for adult patients who underwent RHC by a single operator between January 2012 and December 2015. A total of 571 patients were included in the analysis. Baseline characteristics, labs, relevant invasive hemodynamics, co-morbid conditions, and incidence of access-site hematoma are presented. Multivariable binary logistic regression was performed using IBM SPSS v. 23.0 software. Statistically significant associations with access-site hematoma were observed with body mass index (P=.02; 95% confidence interval [CI], 1.0-1.1), right atrial pressure (P=.03; 95% CI, 0.7-0.9), and dialysis dependence (P<.01; 95% CI, 0.1-0.6). There was no association of access-site hematoma with the use of anticoagulants (P>.99). CONCLUSION The incidence of internal jugular vein access-site hematoma is small when using careful access techniques for RHC even with the continued use of novel oral anticoagulants and warfarin. Patient characteristics and co-morbid conditions are related to bleeding complications.
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Affiliation(s)
| | | | | | | | | | | | | | - George Moukarbel
- Division of Cardiovascular Medicine, The University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH 43614 USA.
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Ruzieh M, Ammari Z, Dasa O, Karim S, Grubb B. Role of closed loop stimulation pacing (CLS) in vasovagal syncope. Pacing Clin Electrophysiol 2017; 40:1302-1307. [DOI: 10.1111/pace.13194] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/17/2017] [Accepted: 08/28/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Mohammed Ruzieh
- Department of Internal Medicine; University of Toledo; Toledo OH USA
| | - Zaid Ammari
- Department of Internal Medicine; University of Toledo; Toledo OH USA
| | - Osama Dasa
- Department of Internal Medicine; University of Toledo; Toledo OH USA
| | - Saima Karim
- Department of Internal Medicine; University of Toledo; Toledo OH USA
| | - Blair Grubb
- Department of Internal Medicine; University of Toledo; Toledo OH USA
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Ruzieh M, Sirianni N, Ammari Z, Dasa O, Alhazmi L, Karabin B, Grubb B. Ivabradine in the treatment of postural tachycardia syndrome (POTS), a single center experience. Pacing Clin Electrophysiol 2017; 40:1242-1245. [DOI: 10.1111/pace.13182] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/10/2017] [Accepted: 07/30/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Mohammed Ruzieh
- Department of Internal Medicine; University of Toledo; Toledo OH USA
| | | | - Zaid Ammari
- Department of Internal Medicine; University of Toledo; Toledo OH USA
| | - Osama Dasa
- Department of Internal Medicine; University of Toledo; Toledo OH USA
| | - Luai Alhazmi
- Department of Internal Medicine; University of Toledo; Toledo OH USA
| | - Beverly Karabin
- Cardiovascular Department, Syncope and Autonomic Dysfunction Clinic; University of Toledo; Toledo OH USA
| | - Blair Grubb
- Cardiovascular Department, Syncope and Autonomic Dysfunction Clinic; University of Toledo; Toledo OH USA
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Alhazmi L, Qaiser S, Ammari Z, Ruzieh M, Dasa O, Moukarbel G. In Dialysis Dependent Renal Failure Patients Plasma BNP is Associated with Mean Pulmonary Artery Pressure but Not Left Ventricular Filling Pressure. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- Mohammed Ruzieh
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Lillian Batizy
- College of Medicine, University of Toledo, Toledo, OH, USA
| | - Osama Dasa
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Carson Oostra
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Blair Grubb
- Department of Cardiovascular Medicine, Syncope and Autonomic Dysfunction Center, University of Toledo, Toledo, OH, USA
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Luni FK, Malik SA, Khan AR, Riaz H, Singh H, Federman D, Kanjwal Y, Dasa O, Khuder S, Kabour A. Risk of Ischemic Heart Disease in Patients With Sjögren's Syndrome. Am J Med Sci 2017; 354:395-398. [PMID: 29078844 DOI: 10.1016/j.amjms.2017.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 04/28/2017] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Ischemic heart disease (IHD) has emerged as a major cause of morbidity and mortality in patients with autoimmune conditions such as systemic lupus erythematosus and rheumatoid arthritis, but the risk of IHD in Sjögren's syndrome (SjS) is unknown. To fill this knowledge gap, we estimated the prevalence and risk of IHD with SjS compared to controls from the general population using the Healthcare Cost and Utilization Project National Inpatient Sample 2011 database. MATERIALS AND METHODS The Healthcare Cost and Utilization Project administrative longitudinal database contains encounter-level information on inpatient stays, emergency department visits and ambulatory surgery in all U.S. hospitals. We conducted a cross-sectional study among the inpatient population diagnosed with SjS and matched 1:4 with controls for age, sex and hospital region. Odds ratio for IHD was calculated as cases compared to controls. The contribution of various risk factors to IHD was also evaluated by logistic regression. RESULTS Analysis demonstrated that 7,154 of 13,086 cases (54.7%) of SjS had IHD compared to 27,367 of 52,448 controls (52.2%). The adjusted odds ratio for IHD in those with SjS was 0.898 (95% CI: 0.844-0.955). Patients with SjS were significantly more likely to have hypertension, diabetes, apnea and lipid disorders. CONCLUSIONS To our knowledge, this is the largest population-based study investigating the risk of IHD in patients with SjS. We found a modest, though statistically significant, decrease in the risk of IHD in SjS compared to controls.
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Affiliation(s)
- Faraz Khan Luni
- Department of Cardiovascular Diseases, Mercy Saint Vincent Medical Center, Toledo, Ohio.
| | - Sonia Ali Malik
- Department of Family Medicine, Mercy Saint Vincent Medical Center, Toledo, Ohio
| | - Abdur Rahman Khan
- Department of Cardiovascular Diseases, University of Louisville, Louisville, Kentucky
| | - Haris Riaz
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Hemindermeet Singh
- Department of Cardiovascular Diseases, Mercy Saint Vincent Medical Center, Toledo, Ohio
| | - Douglas Federman
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
| | | | - Osama Dasa
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
| | - Sadik Khuder
- School of Population Health, University of Toledo Medical Center, Toledo, Ohio
| | - Ameer Kabour
- Department of Cardiovascular Diseases, Mercy Saint Vincent Medical Center, Toledo, Ohio
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Ruzieh M, Baugh A, Dasa O, Parker RL, Perrault JT, Renno A, Karabin BL, Grubb B. Effects of intermittent intravenous saline infusions in patients with medication—refractory postural tachycardia syndrome. J Interv Card Electrophysiol 2017; 48:255-260. [DOI: 10.1007/s10840-017-0225-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
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Ruzieh M, Dasa O, Meziane-Tani A, Renno A, Alkully T, Darr U, Grubb B, Murphy L. Clinical Efficacy of Cardiac Resynchronization Therapy in Patients with Ischemic and Non-ischemic Cardiomyopathy. J Innov Card Rhythm Manag 2016. [DOI: 10.19102/icrm.2016.070704] [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: 11/06/2022] Open
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Luni FK, Dasa O, Khan AR, Riaz H, Federman D, Kanjwal Y, Khuder S. DECREASED RISK OF ISCHEMIC HEART DISEASE IN PATIENTS WITH SJGREN’S SYNDROME: AN ANALYSIS OF UNITED STATES NATIONAL DATABASE. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)32152-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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