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Xu R, Xu H, Zhang K, Xu H, Liu H, Fu H, Xie L, Xu K, Fu C, Li X, Zhou X, Ananthakrishna R, Selvanayagam JB, Yu L, Cai X, Guo Y. Prevalence and associated factors of myocardial involvement in Duchenne muscular dystrophy patients in the first decade of life. Chin Med J (Engl) 2023; 136:1132-1134. [PMID: 37027393 PMCID: PMC10228473 DOI: 10.1097/cm9.0000000000002385] [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: 12/21/2022] [Indexed: 04/08/2023] Open
Affiliation(s)
- Rong Xu
- Department of Radiology, West China Second University Hospital, Sichuan University, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Chengdu, Sichuan 610041, China
| | - Huayan Xu
- Department of Radiology, West China Second University Hospital, Sichuan University, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Chengdu, Sichuan 610041, China
| | - Kun Zhang
- Department of Radiology, West China Second University Hospital, Sichuan University, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Chengdu, Sichuan 610041, China
| | - Hong Xu
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Hui Liu
- Department of Radiology, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 510040, China
| | - Hang Fu
- Department of Radiology, West China Second University Hospital, Sichuan University, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Chengdu, Sichuan 610041, China
| | - Linjun Xie
- Department of Radiology, West China Second University Hospital, Sichuan University, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Chengdu, Sichuan 610041, China
| | - Ke Xu
- Department of Radiology, West China Second University Hospital, Sichuan University, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Chengdu, Sichuan 610041, China
| | - Chuan Fu
- Department of Radiology, West China Second University Hospital, Sichuan University, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Chengdu, Sichuan 610041, China
| | - Xuesheng Li
- Department of Radiology, West China Second University Hospital, Sichuan University, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Chengdu, Sichuan 610041, China
| | - Xiaoyue Zhou
- MR Collabration, Siemens Healthineers Ltd., Shanghai 210001, China
| | - Rajiv Ananthakrishna
- Department of Cardiovascular Medicine, Flinders Medical Centre, South Australian Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Joseph B. Selvanayagam
- Department of Cardiovascular Medicine, Flinders Medical Centre, South Australian Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Li Yu
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiaotang Cai
- Department of Pediatrics Neurology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yingkun Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Chengdu, Sichuan 610041, China
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2
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Ananthakrishna R, Rajvi BP, Hancock DE, Kholmurodova F, Woodman RJ, Patil S, Horsfall M, Chew DP, Daril NDM, Selvanayagam JB. Utility of cardiovascular magnetic resonance in patients with stable troponin elevation. Eur Heart J Cardiovasc Imaging 2023; 24:192-201. [PMID: 36336838 DOI: 10.1093/ehjci/jeac215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 11/09/2022] Open
Abstract
AIMS Cardiovascular magnetic resonance (CMR) imaging has a potential role in the evaluation of symptomatic patients with stable troponin elevation; however, its utility remains unexplored. We sought to determine the incremental diagnostic value of CMR in this unique cohort and assess the long-term clinical outcomes. METHODS AND RESULTS Two hundred twenty-five consecutive patients presenting with cardiac chest pain/dyspnoea, stable troponin elevation, and undergoing CMR assessment were identified retrospectively from registry database. The study cohort was prospectively followed for major adverse cardiac events (MACEs) (defined as composite of all-cause mortality and cardiovascular readmissions). The primary outcome measure was the diagnostic utility of CMR, i.e. percentage of patients for whom CMR identified the cause of stable troponin elevation. Secondary outcome measures included the incremental value of CMR and occurrence of MACE. CMR was able to identify the cause for stable troponin elevation in 160 (71%) patients. A normal CMR was identified in 17% and an inconclusive CMR in 12% of the patients. CMR changed the referral diagnosis in 59 (26%) patients. Utilizing a baseline prediction model (pre-CMR referral diagnosis), the net reclassification index was 0.11 and integrated discriminatory improvement index measured 0.33 following CMR. Over a median follow-up of 4.3 years (interquartile range 2.8-6.3), 72 (32%) patients experienced MACE. CONCLUSION CMR identified a cause for stable troponin elevation in 7 of 10 cases, and a new diagnosis was evident in 1 of 4 cases. CMR improved the net reclassification of patients with stable troponin elevation.
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Affiliation(s)
- Rajiv Ananthakrishna
- College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, Adelaide, South Australia 5042, Australia.,South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia 5000, Australia.,Department of Cardiovascular Medicine, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia 5042, Australia
| | - Benita P Rajvi
- College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, Adelaide, South Australia 5042, Australia.,South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia 5000, Australia
| | - Diana E Hancock
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia 5000, Australia
| | - Feruza Kholmurodova
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Sturt Road, Bedford Park, Adelaide, South Australia 5042, Australia
| | - Richard J Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Sturt Road, Bedford Park, Adelaide, South Australia 5042, Australia
| | - Sanjana Patil
- College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, Adelaide, South Australia 5042, Australia.,South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia 5000, Australia
| | - Matthew Horsfall
- Department of Cardiovascular Medicine, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia 5042, Australia
| | - Derek P Chew
- College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, Adelaide, South Australia 5042, Australia.,South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia 5000, Australia.,Department of Cardiovascular Medicine, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia 5042, Australia
| | - Noor Darinah Mohd Daril
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia 5000, Australia
| | - Joseph B Selvanayagam
- College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, Adelaide, South Australia 5042, Australia.,South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia 5000, Australia.,Department of Cardiovascular Medicine, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia 5042, Australia
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Liang Z, Ananthakrishna R, Selvanayagam JB. Regression of Left Ventricular Hypertrophy in a Case of Adult Hypertrophic Cardiomyopathy: Importance of Clinical Context at Initial Diagnosis. Heart Lung Circ 2022; 31:e151-e152. [PMID: 35981934 DOI: 10.1016/j.hlc.2022.06.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 06/06/2022] [Accepted: 06/16/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Zach Liang
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Flinders Medical Centre, Adelaide, SA, Australia
| | - Rajiv Ananthakrishna
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Flinders Medical Centre, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Joseph B Selvanayagam
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Flinders Medical Centre, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
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4
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Ananthakrishna R, Sree Raman K, Shah R, Woodman RJ, Walls A, Bradbrook C, Grover S, Selvanayagam JB. Myocardial Oxygenation in Hibernating Myocardium. JACC Cardiovasc Imaging 2022; 15:1351-1353. [DOI: 10.1016/j.jcmg.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/03/2022] [Accepted: 02/09/2022] [Indexed: 11/26/2022]
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5
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Ananthakrishna R, Liang Z, Raman B, Moran JL, Rajvi B, Patil S, Grover S, Bridgman C, Selvanayagam JB. Long-term clinical outcomes in patients with a working diagnosis of myocardial infarction with non-obstructed coronary arteries (MINOCA) assessed by cardiovascular magnetic resonance imaging. Int J Cardiol 2021; 349:12-17. [PMID: 34864074 DOI: 10.1016/j.ijcard.2021.11.088] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 05/10/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Myocardial infarction with non-obstructed coronary arteries (MINOCA) is a distinct entity among patients presenting with troponin-positive acute chest pain. We have previously reported on the incremental diagnostic capability of cardiovascular magnetic resonance (CMR) in this cohort. There is paucity of evidence on the long-term (> 5 years) clinical outcomes of these patients as graded by their acute CMR diagnosis. METHODS AND RESULTS A total of 229 patients with a working diagnosis of MINOCA who underwent CMR assessment during the acute admission (2010-2017) were prospectively studied. The primary endpoint was major adverse cardiac events (MACE) defined as a composite of all-cause mortality and cardiovascular readmissions, identified from hospital and primary care records. CMR performed at a median of 6 days (IQR 2, 8) from presentation provided a diagnosis in 85% of the patients (38% myocarditis, 28% acute myocardial infarction and 19% Takotsubo cardiomyopathy). Over a median follow-up of 7.1 years (IQR 3.7, 8.2), 56 (24%) patients experienced a MACE. We found a strong association between CMR diagnosis and MACE (log rank 30.47, p < 0.001). In multivariate analysis, age (hazard ratio = 1.07; 95% confidence interval = 1.05, 1.10; p < 0.001) and CMR diagnosis of acute myocardial infarction (hazard ratio = 8.87; 95% confidence interval = 2.58, 30.4; p = 0.001) were independent predictors of MACE. CONCLUSIONS In a large cohort of patients with a working diagnosis of MINOCA, one in four suffer a MACE during long-term clinical follow-up. CMR diagnosis of acute myocardial infarction and age were significant predictors of MACE even in the absence of significant coronary artery obstruction.
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Affiliation(s)
- Rajiv Ananthakrishna
- College of Medicine and Public Health, Flinders University, Adelaide, Australia; Flinders Medical Centre, Adelaide, Australia; South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Zach Liang
- College of Medicine and Public Health, Flinders University, Adelaide, Australia; Flinders Medical Centre, Adelaide, Australia
| | - Betty Raman
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - John L Moran
- The Queen Elizabeth Hospital, Adelaide, Australia
| | - Benita Rajvi
- College of Medicine and Public Health, Flinders University, Adelaide, Australia; South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Sanjana Patil
- College of Medicine and Public Health, Flinders University, Adelaide, Australia; South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | | | - Joseph B Selvanayagam
- College of Medicine and Public Health, Flinders University, Adelaide, Australia; Flinders Medical Centre, Adelaide, Australia; South Australian Health and Medical Research Institute, Adelaide, Australia.
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6
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Ananthakrishna R, Lee SL, Foote J, Sallustio BC, Binda G, Mangoni AA, Woodman R, Semsarian C, Horowitz JD, Selvanayagam JB. Randomized controlled trial of perhexiline on regression of left ventricular hypertrophy in patients with symptomatic hypertrophic cardiomyopathy (RESOLVE-HCM trial). Am Heart J 2021; 240:101-113. [PMID: 34175315 DOI: 10.1016/j.ahj.2021.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 06/20/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The presence and extent of left ventricular hypertrophy (LVH) is a major determinant of symptoms in patients with hypertrophic cardiomyopathy (HCM). There is increasing evidence to suggest that myocardial energetic impairment represents a central mechanism leading to LVH in HCM. There is currently a significant unmet need for disease-modifying therapy that regresses LVH in HCM patients. Perhexiline, a potent carnitine palmitoyl transferase-1 (CPT-1) inhibitor, improves myocardial energetics in HCM, and has the potential to reduce LVH in HCM. OBJECTIVE The primary objective is to evaluate the effects of perhexiline treatment on the extent of LVH, in symptomatic HCM patients with at least moderate LVH. METHODS/DESIGN RESOLVE-HCM is a prospective, multicenter double-blind placebo-controlled randomized trial enrolling symptomatic HCM patients with at least moderate LVH. Sixty patients will be randomized to receive either perhexiline or matching placebo. The primary endpoint is change in LVH, assessed utilizing cardiovascular magnetic resonance (CMR) imaging, after 12-months treatment with perhexiline. SUMMARY RESOLVE-HCM will provide novel information on the utility of perhexiline in regression of LVH in symptomatic HCM patients. A positive result would lead to the design of a Phase 3 clinical trial addressing long-term effects of perhexiline on risk of heart failure and mortality in HCM patients.
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Affiliation(s)
- Rajiv Ananthakrishna
- College of Medicine and Public Health, Flinders University, Adelaide, Australia; South Australian Health and Medical Research Institute, Adelaide, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Sau L Lee
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Jonathon Foote
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Benedetta C Sallustio
- Department of Clinical Pharmacology, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, Australia; Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Australia
| | - Giulia Binda
- South Australian Health and Medical Research Institute, Adelaide, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Arduino A Mangoni
- Department of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Adelaide, Australia
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute and Sydney Medical School, University of Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - John D Horowitz
- The Queen Elizabeth Hospital, Basil Hetzel Institute for Translational Research, University of Adelaide, Adelaide, Australia
| | - Joseph B Selvanayagam
- College of Medicine and Public Health, Flinders University, Adelaide, Australia; South Australian Health and Medical Research Institute, Adelaide, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia.
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Rajvi B, Ananthakrishna R, Hancock D, Kholmurodova F, Patil S, Horsfall M, Chew D, Mohd Daril N, Selvanayagam J. Utility of Cardiovascular Magnetic Resonance in pAtieNts with CHronic myOcaRdial injury (CMR-ANCHOR). Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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Snaith K, Gieve M, Bridgman C, Ananthakrishna R, De Pasquale C. Diagnosis of Löffler Endocarditis Secondary to Chronic Eosinophilic Leukaemia With FIP1L1-PDGFRA Rearrangement. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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9
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Ananthakrishna R, Woodman R, Grover S, Bridgman C, Selvanayagam J. Long-term clinical outcomes of troponin-positive chest pain and unobstructed coronary arteries assessed by cardiovascular magnetic resonance imaging. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1805] [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: 11/14/2022] Open
Abstract
Abstract
Background and introduction
Troponin-positive chest pain with unobstructed coronary arteries is a distinct entity with different pathophysiological causes. We have previously reported on the incremental diagnostic capability of cardiovascular magnetic resonance (CMR) in this cohort. However, there is paucity of literature on the long-term clinical outcomes of these patients assessed with CMR.
Objectives
Using the unique cohort of patients previously studied, we sought to assess the long-term clinical outcomes in patients with troponin-positive chest pain and unobstructed coronary arteries, as graded by their acute CMR presentation.
Methods
A total of 122 consecutive patients with troponin-positive chest pain and unobstructed coronary arteries undergoing CMR assessment during the acute admission (2010–2014) were studied. The primary endpoint was major adverse cardiac event (MACE), defined as a composite of all-cause mortality and cardiovascular readmissions (heart failure, acute myocardial infarction [AMI], atrial or ventricular arrhythmia and stroke). Patients were grouped into 4 categories based on their initial CMR findings: AMI, acute myocarditis, Takotsubo cardiomyopathy and normal CMR.
Results
The mean age of the study cohort was 55.6±16.5 years and 56.5% were women. CMR (performed at a median of 6 days from presentation) provided a diagnosis in 87% of the patients (38% myocarditis, 28% Takotsubo cardiomyopathy and 21% AMI). Patients with a diagnosis of AMI were prescribed guideline recommended medical therapy. Over a median follow-up of 2524 days (6.9 years), 32 (26.2%) patients experienced a MACE. The all-cause mortality was 2.5%. The most common indication for cardiovascular readmissions in this cohort was heart failure (12.3%) and AMI (9%). In multivariate analysis, a CMR diagnosis of AMI (hazard ratio = 2.6; 95% confidence interval = 1.2, 5.7; p=0.019) and peak troponin (hazard ratio = 1.0003; 95% confidence interval = 1.00003, 1.0006; p=0.028) were significantly associated with MACE after adjusting for age and gender. In addition, CMR diagnosis of AMI was significantly associated with a lower event-free survival rate compared with a diagnosis of non-AMI (adjusted hazard ratio = 2.57, p=0.019) (Figure).
Conclusions
The long-term prognosis of patients with troponin-positive chest pain and unobstructed coronary arteries is not benign. CMR diagnosis of AMI is a significant predictor of MACE even in the absence of significant coronary artery obstruction and despite guideline recommended post AMI therapy.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - R Woodman
- Flinders University, Adelaide, Australia
| | - S Grover
- Flinders Medical Centre, Adelaide, Australia
| | - C Bridgman
- Flinders Medical Centre, Adelaide, Australia
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10
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Sree Raman K, Shah R, Stokes M, Walls A, Woodman RJ, Ananthakrishna R, Walker JG, Proudman S, Steele PM, De Pasquale CG, Celermajer DS, Selvanayagam JB. Left ventricular ischemia in pre-capillary pulmonary hypertension: a cardiovascular magnetic resonance study. Cardiovasc Diagn Ther 2020; 10:1280-1292. [PMID: 33224752 DOI: 10.21037/cdt-20-698] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Prognosis in pulmonary arterial hypertension (PAH) is largely dependent on right ventricular (RV) function. However, recent studies have suggested the presence of left ventricular (LV) dysfunction in PAH patients. The potential role of LV ischemia, as a contributor to progressive LV dysfunction, has not been systematically studied in PAH. We aim to assess the presence and extent of LV myocardial ischemia in patients with known PH and without obstructive coronary artery disease (CAD), using oxygen-sensitive (OS) cardiovascular magnetic resonance (CMR) and stress/rest CMR T1 mapping. Methods We prospectively recruited 28 patients with right heart catheter-proven PH and no significant CAD, 8 patients with known CAD and 11 normal age-matched controls (NC). OS-CMR images were acquired using a T2* sequence and T1 maps were acquired using Shortened Modified Look-Locker Inversion recovery (ShMOLLI) at rest and adenosine-induced stress vasodilatation; ΔOS-CMR signal intensity (SI) index (stress/rest SI) and ΔT1 reactivity (stress-rest/rest T1 mapping) were calculated. Results Global LV ΔOS SI index was significantly lower in PH patients compared with controls (11.1%±6.7% vs. 20.5%±10.5%, P=0.016), as was ΔT1 reactivity (5.2%±4.5% vs. 8.0%±2.9%, P=0.047). The ischemic segments of CAD patients had comparable ΔOS SI (10.3%±6.4% vs. 11.1%±6.7%, P=0.773) to PH patients, but lower ΔT1 reactivity (1.1%±4.2% vs. 5.2%±4.5%, P=0.036). Conclusions Decreased OS-CMR SI and T1 reactivity signify the presence of impaired myocardial oxygenation and vasodilatory response in PH patients. Given their unobstructed epicardial coronary arteries, this is likely secondary to coronary microvascular dysfunction (CMD).
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Affiliation(s)
- Karthigesh Sree Raman
- College of Medicine and Public Health, Flinders University, Flinders, Australia.,Flinders Medical Centre, Flinders, Australia.,Cardiac Imaging Research, South Australian Health & Medical Research Institute, Australia.,Whangarei Hospital, Northland District Health Board, Whangarei, New Zealand.,Department of Medicine (Northland Campus), Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ranjit Shah
- College of Medicine and Public Health, Flinders University, Flinders, Australia.,Flinders Medical Centre, Flinders, Australia.,Cardiac Imaging Research, South Australian Health & Medical Research Institute, Australia
| | - Michael Stokes
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Angela Walls
- Clinical Research and Imaging Centre, South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia
| | - Richard J Woodman
- Flinders Centre of Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, Flinders, Australia
| | - Rajiv Ananthakrishna
- College of Medicine and Public Health, Flinders University, Flinders, Australia.,Flinders Medical Centre, Flinders, Australia.,Cardiac Imaging Research, South Australian Health & Medical Research Institute, Australia
| | | | - Susanna Proudman
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Peter M Steele
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Carmine G De Pasquale
- College of Medicine and Public Health, Flinders University, Flinders, Australia.,Flinders Medical Centre, Flinders, Australia
| | - David S Celermajer
- Sydney Medical School, University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Joseph B Selvanayagam
- College of Medicine and Public Health, Flinders University, Flinders, Australia.,Flinders Medical Centre, Flinders, Australia.,Cardiac Imaging Research, South Australian Health & Medical Research Institute, Australia
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Selvanayagam JB, Ananthakrishna R, Shirodaria C, Channon K. Timing of cardiovascular magnetic resonance in clinical trials evaluating cardioprotective therapies to reduce infarct size. Int J Cardiol 2020; 323:272-274. [PMID: 32931858 DOI: 10.1016/j.ijcard.2020.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/04/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Joseph B Selvanayagam
- College of Medicine and Public Health, Flinders University, Adelaide, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia; South Australian Health and Medical Research Institute, Adelaide, Australia.
| | - Rajiv Ananthakrishna
- College of Medicine and Public Health, Flinders University, Adelaide, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia; South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Cheerag Shirodaria
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK; Caristo Diagnostics Ltd, Whichford House, Parkway Court, John Smith Dr, Oxford, UK
| | - Keith Channon
- National Institute for Health (NIHR) Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford John Radcliffe Hospital, Oxford, United Kingdom
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12
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Krishnegowda C, Puttegowda B, Krishnappa S, Ananthakrishna R, Mahadevappa NC, Siddegowda SK, Ramegowda RT, Manjunath CN. "Incidence, clinical and angiographic characteristics, management and outcomes of coronary artery perforation at a high volume cardiac care center during percutaneous coronary intervention". Indian Heart J 2020; 72:232-238. [PMID: 32861375 PMCID: PMC7474113 DOI: 10.1016/j.ihj.2020.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/21/2020] [Accepted: 07/07/2020] [Indexed: 01/31/2023] Open
Abstract
AIMS To study the incidence, clinical and angiographic characteristics, management and outcomes of coronary artery perforation (CAP) during percutaneous coronary intervention (PCI) at a high volume center in South-east Asia. METHODS Data from patients who had CAP during PCI from January 2016 to December 2019 at our center were collected. Clinical features, angiographic and procedural characteristics, their management and outcomes were analyzed retrospectively. RESULTS A total of 40,696 patients underwent PCI during the study period and the incidence of CAP was 0.13% (n = 51). Mean age was 60.0 ± 10.8 years and 69% were males. CAP cases involved complex type B2/C lesions in 73%, calcified lesions in 58%, and chronic total occlusions in 25%. Majority of patients presented as acute coronary syndrome (65%) and STEMI was the most frequent indication for PCI (33%). Most of the CAPs were Ellis type II (33%) and III (55%). CAP most frequently occurred during post dilation (n = 20) and wire manipulation (n = 17). Majority were treated by prolonged balloon inflation (53%) and covered stents (33%). Pericardiocentesis was required in 19 patients to alleviate tamponade. In one patient coil embolisation was done and two patients required bail-out emergency cardiac surgery. Periprocedural myocardial infarction occurred in 6% and in-hospital mortality was 10%. All-cause mortality accrued to 14% at 30 days and 16% at 6 months. CONCLUSION Although incidence of CAP in contemporary interventional practice remains low, the morbidity and mortality are considerable. Early recognition and management strategies tailored to the severity of perforation play a key role in achieving better outcomes.
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Affiliation(s)
- Chetana Krishnegowda
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore Branch, India.
| | - Beeresha Puttegowda
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Santhosh Krishnappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore Branch, India
| | - Rajiv Ananthakrishna
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Nagesh C Mahadevappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Sadananda K Siddegowda
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore Branch, India
| | - Raghu T Ramegowda
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Cholenahally N Manjunath
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
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Agstam S, Panneerselvam A, Manjunath SC, Ananthakrishna R. Down the Memory Lane of Tamponade During Balloon Mitral Valvotomy. J Invasive Cardiol 2020; 32:E133-E134. [PMID: 32357134] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Sourabh Agstam
- Department of Cardiology, VMMC and Safdarjung Hospital, New Delhi, India 110029.
| | - Arunkumar Panneerselvam
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Jaya Nagar 9th Block, BG Road, Bangalore, India 560069
| | - Satvic C Manjunath
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Jaya Nagar 9th Block, BG Road, Bangalore, India 560069.
| | - Rajiv Ananthakrishna
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Jaya Nagar 9th Block, BG Road, Bangalore, India 560069
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14
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Ananthakrishna R, Lloyd R, Kuss BJ, Selvanayagam JB. Cardiac Amyloidosis: The Importance of Surveillance in a Patient With an Initial Negative Cardiac Biopsy. JACC Case Rep 2020; 2:282-285. [PMID: 34317223 PMCID: PMC8298295 DOI: 10.1016/j.jaccas.2019.11.041] [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: 10/01/2019] [Revised: 10/31/2019] [Accepted: 11/02/2019] [Indexed: 11/06/2022]
Abstract
Cardiac amyloidosis is a progressive disorder and is sometimes difficult to diagnose even when suspected in the appropriate clinical setting. We present an interesting case of rapidly progressive light-chain cardiac amyloidosis and highlights the importance of close monitoring even when the initial biopsy and imaging findings are not pathognomonic for amyloidosis. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Rajiv Ananthakrishna
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Rachael Lloyd
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Bryone J. Kuss
- Department of Molecular Medicine (Haematology and Molecular Genetics), Flinders University, Adelaide, Australia
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15
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Panneerselvam A, Ananthakrishna R, Srinivas BC, Hemanna Setty SK, Manjunath SC, Basavanna D, Nanjappa MC. Hemopericardium Following Transseptal Puncture During Balloon Mitral Valvotomy: Management Strategies and Outcomes. J Invasive Cardiol 2020; 32:70-75. [PMID: 31611427] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Hemopericardium is a major complication of balloon mitral valvotomy (BMV). Only a few studies are available to address this issue following transseptal access. In addition, the management strategy regarding completion of BMV is uncertain. OBJECTIVE We sought to determine the incidence of hemopericardium complicating transseptal puncture during BMV. In addition, the management strategy adopted and outcomes are highlighted. METHODS This prospective study included 29 consecutive patients who developed hemopericardium following transseptal access during BMV. RESULTS Out of 1424 patients who underwent BMV, hemopericardium developed in 29 patients following transseptal access (2.0%). The mean age of the study cohort was 36.9 ± 13.7 years and 82.8% were women. A second transseptal puncture was done and BMV was completed in 26 patients (89.6%). An acceptable hemodynamic result was obtained in 22 patients (84.6%). Six patients (20.7%) underwent emergency surgery for hemopericardium. The sites of perforation were inferior vena cava-right atrial junction in 4 cases, left atrial posterior wall in 1 case, and left atrial appendage in 1 case. In addition to repair of the perforation, a total of 2 patients underwent mitral valve replacement and 1 patient underwent open mitral commissurotomy. The in-hospital mortality rate was 6.9%. CONCLUSIONS The incidence of hemopericardium complicating transseptal access during BMV was 2.0%, and was associated with a mortality rate of 6.9%. BMV can be safely performed in the same sitting with a second transseptal puncture, in patients with a favorable valve morphology. Surgical intervention can be reserved for a subset of patients with persistent pericardial collection.
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Affiliation(s)
| | | | | | | | - Satvic C Manjunath
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Jaya Nagar 9th Block, BG Road, Bangalore, India 560069.
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16
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Manjunath SC, Doddaiah B, Ananthakrishna R, Sastry SL, Patil VS, Devegowda L, Veervhadraiah SB, Bhat P, Nanjappa Manjunath C. Observational study of left ventricular global longitudinal strain in ST-segment elevation myocardial infarction patients with extended pharmaco-invasive strategy: A six months follow-up study. Echocardiography 2020; 37:283-292. [PMID: 31955468 DOI: 10.1111/echo.14588] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 11/27/2022] Open
Abstract
AIMS AND OBJECTIVES To evaluate left ventricular (LV) function by assessment of LV global longitudinal strain (GLS) in ST-segment elevation myocardial infarction (STEMI) patients who underwent delayed fibrinolysis and coronary intervention (extended pharmaco-invasive strategy), since LV function is one of the determinants of both immediate and long-term outcomes. METHODS Prospective study of consecutive STEMI patients who underwent extended pharmaco-invasive strategy. The LV function was estimated using LV GLS at baseline and at 6 months. RESULTS The study included eighty-seven STEMI patients who received delayed pharmaco-invasive therapy and coronary intervention. The primary aim of the study was to evaluate a change in LV function by assessment of GLS at 6 months as compared to baseline. Prior to PCI, LV ejection fraction was 48.08 ± 6.23% and GLS was -11.11 ± 2.99%. Procedural success was achieved in all patients. LV ejection fraction after 6 months of follow-up increased to 53.12 ± 5.61% and the GLS improved to -13.03 ± 3.06% In comparison to baseline, there was a significant improvement in both LV ejection fraction and GLS at 6 months of follow-up (P < .001).The cardiac mortality was 1.1% at 6 months. CONCLUSION There is a significant improvement of LV function as assessed by GLS and ejection fraction at short-term follow-up. In a stable cohort of STEMI patients, extended pharmaco-invasive strategy is also a reasonable option if PCI cannot be performed within the first 24 hours, due to logistic and infrastructural constraints.
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Affiliation(s)
- Satvic C Manjunath
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, India
| | - Balaraju Doddaiah
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, India
| | - Rajiv Ananthakrishna
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, India
| | - Sridhar Lakshmana Sastry
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, India
| | - Vikram S Patil
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, India
| | - Lachikrathman Devegowda
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, India
| | - Sumangala B Veervhadraiah
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, India
| | - Prabhavathi Bhat
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, India
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17
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Ananthakrishna R, Low AF. Bioresorbable vascular scaffold implantation in a lesion with a coronary artery aneurysm: long-term optical coherence tomography follow-up. AsiaIntervention 2019; 5:128-129. [PMID: 36483531 PMCID: PMC9706742 DOI: 10.4244/aij-d-19-00003] [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] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 05/02/2019] [Indexed: 06/17/2023]
Affiliation(s)
- Rajiv Ananthakrishna
- Department of Cardiology, National University Heart Centre, Singapore
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Adrian F Low
- Department of Cardiology, National University Heart Centre, Singapore
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18
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Ananthakrishna R, Srinivas BC, Reddy B, Shankar S, Moorthy N. Giant syphilitic aortic pseudoaneurysm with extrinsic compression of the left atrium, right pulmonary artery, and oesophagus. Eur Heart J Cardiovasc Imaging 2019; 19:1431. [PMID: 30281098 DOI: 10.1093/ehjci/jey144] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rajiv Ananthakrishna
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Jaya Nagar 9th Block, BG Road, Bangalore, Karnataka, India
| | - Budanur Chikkaswamy Srinivas
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Jaya Nagar 9th Block, BG Road, Bangalore, Karnataka, India
| | - Babu Reddy
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Jaya Nagar 9th Block, BG Road, Bangalore, Karnataka, India
| | - Sandeep Shankar
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Jaya Nagar 9th Block, BG Road, Bangalore, Karnataka, India
| | - Nagaraja Moorthy
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Jaya Nagar 9th Block, BG Road, Bangalore, Karnataka, India
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19
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Moorthy N, Ananthakrishna R. Chronic postrheumatic fever arthropathy. Eur J Rheumatol 2019; 6:163-164. [PMID: 30978163 DOI: 10.5152/eurjrheum.2019.19010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/21/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
- Nagaraja Moorthy
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Rajiv Ananthakrishna
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
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20
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Krishnegowda C, Chikkaswamy SB, Barthur A, Ananthakrishna R. Intracardiac mass in chronic myeloid leukemia. Echocardiography 2019; 36:794-796. [PMID: 30735269 DOI: 10.1111/echo.14279] [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: 12/16/2018] [Revised: 01/13/2019] [Accepted: 01/15/2019] [Indexed: 10/27/2022] Open
Abstract
Chronic myeloid leukaemia (CML) is a neoplastic disorder of myeloid cell lines and is a less aggressive disease compared to acute myeloid leukemia (AML). Although cardiovascular complications are not uncommon, intracardiac thrombosis in CML is rarely reported. Herein, we report a case of CML presenting with an intracardiac thrombus attached to the posterior mitral leaflet, and subsequently resulting in peripheral embolization.
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Affiliation(s)
- Chetana Krishnegowda
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, India
| | | | - Ashita Barthur
- Department of Radiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, India
| | - Rajiv Ananthakrishna
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, India
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21
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Sree Raman K, Grover S, Woodman R, Ananthakrishna R, Sinhal A, Bradbrook C, Selvanayagam J. Myocardial Oxygenation in Hibernating Myocardium: Insights from Oxygen-Sensitive (OS) Cardiac Magnetic Resonance Imaging (CMR). Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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22
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Ananthakrishna R, Loh JP, Shen L, Low AF, Lee CH, Tan HC. Selective use of drug-eluting stents in high-risk versus bare metal stents in low-risk patients according to predefined criteria confers similar four-year long-term clinical outcomes. AsiaIntervention 2018; 4:87-91. [PMID: 36484004 PMCID: PMC9706730 DOI: 10.4244/aij-d-17-00039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 05/18/2018] [Indexed: 06/17/2023]
Abstract
AIMS The aim of the study was to evaluate the long-term outcomes following selective implantation of drug-eluting stents (DES) in patients at high risk of restenosis versus bare metal stents (BMS) in low-risk patients, according to predefined criteria. METHODS AND RESULTS Patients who underwent elective percutaneous coronary intervention (PCI) between May 2002 and April 2004 were enrolled in this retrospective, single-centre study. All patients received a BMS while undergoing PCI, unless they fulfilled at least two entry criteria that warranted DES usage. The study endpoints were major adverse cardiac events (MACE), comprising death, myocardial infarction, stent thrombosis (ST), and target vessel revascularisation (TVR), at four years between the DES and BMS groups. A total of 1,250 patients were enrolled in the study, among whom 1,095 (88%) received BMS and the rest received DES. At four years, there was no difference in the cumulative incidence of MACE: death (4.5% in DES vs. 5.8% in BMS, p=0.531), myocardial infarction (2.6% in DES vs. 3.1% in BMS, p=0.722), TVR (9.7% in DES vs. 7.9% in BMS, p=0.461), and ST (1.9% in DES vs. 0.8% in BMS, p=0.183). The event-free survival rate at four years was similar in the two groups (87.1% in DES vs. 86.1% in BMS; p=0.741). CONCLUSIONS In elective PCI, a strategy of selective use of DES in patients at high risk of restenosis based on predefined criteria confers the same favourable long-term clinical outcomes as BMS in low-risk patients.
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23
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Sim HW, Ananthakrishna R, Chan SP, Low AF, Lee CH, Chan MY, Tay EL, Loh PH, Chan KH, Tan HC, Loh JP. Treatment of Very Small De Novo Coronary Artery Disease With 2.0 mm Drug-Coated Balloons Showed 1-Year Clinical Outcome Comparable With 2.0 mm Drug-Eluting Stents. J Invasive Cardiol 2018; 30:256-261. [PMID: 29656281] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the 1-year clinical outcomes of patients treated with 2.0 mm drug-coated balloon (DCB) vs 2.0 mm drug-eluting stent (DES) implantation in small-caliber vessel de novo coronary artery disease (CAD). METHODS All patients treated with 2.0 mm DCB or 2.0 mm DES for very small vessel de novo CAD from July 2014 to June 2016 were included in this study. The primary endpoint was the occurrence of target-lesion failure (TLF) and time to TLF, defined as a combination of cardiac mortality, target-vessel myocardial infarction, and target-lesion revascularization (TLR). RESULTS A total of 87 patients (96 lesions) were implanted with 2.0 mm DCBs and 200 patients (223 lesions) were implanted with 2.0 mm DESs during the study period. Mean reference vessel diameter was similar between the DCB and DES groups (1.88 ± 0.38 mm vs 1.95 ± 0.21 mm, respectively; P=.11). The 1-year TLF rates were 7.0% in the DCB group and 8.2% in the DES group (P=.73). TLF was driven by TLR in both groups. Bailout stenting was performed in 7 patients (8 lesions) who received a DCB. Stent thrombosis was seen in 4 patients (2.0%) who underwent DES implantation. There was no vessel thrombosis noted in the DCB group. Cardiogenic shock was identified as a direct and significant predictor for both the occurrence of TLF and time to TLF. CONCLUSIONS In this first report, treatment of very small vessel CAD with 2.0 mm DCB vs 2.0 mm DES was associated with similar 1-year TLF rates.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Joshua P Loh
- Department of Cardiology, National University Heart Centre, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore 119228.
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24
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Teng M, Zhao YJ, Khoo AL, Ananthakrishna R, Yeo TC, Lim BP, Chan MY, Loh JP. Cost-effectiveness analysis of biodegradable polymer versus durable polymer drug-eluting stents incorporating real-world evidence. Cardiovasc Ther 2018; 36:e12442. [PMID: 29873191 DOI: 10.1111/1755-5922.12442] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/28/2018] [Accepted: 05/31/2018] [Indexed: 11/29/2022] Open
Abstract
AIM Compared with second-generation durable polymer drug-eluting stents (DP-DES), the cost-effectiveness of biodegradable polymer drug-eluting stents (BP-DES) remains unclear in the real-world setting. We assessed the cost-effectiveness of BP-DES in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI). METHODS We developed a decision-analytic model to compare the cost-effectiveness of BP-DES to DP-DES over 1 year and 5 years from healthcare payer perspective. Relative treatment effects during the first year post-PCI were obtained from a real-world population analysis while clinical event risks in the subsequent 4 years were derived from a meta-analysis of published studies. RESULTS At 1 year, based on the clinical data analysis of 497 propensity-score matched pairs of patients, BP-DES were associated with an incremental cost-effectiveness ratio (ICER) of USD20 503 per quality-adjusted life-year (QALY) gained. At 5 years, BP-DES yielded an ICER of USD4062 per QALY gained. At the willingness-to-pay threshold of USD50 400 (one gross domestic product per capita in Singapore in 2015), BP-DES were cost-effective. Sensitivity analysis showed that the cost of stents had a significant impact on the cost-effectiveness of BP-DES. Threshold analysis demonstrated that if the cost difference between BP-DES and DP-DES exceeded USD493, BP-DES would not be cost-effective in patients with 1 year of follow-up. CONCLUSIONS Biodegradable polymer drug-eluting stents were cost-effective compared with DP-DES in patients with coronary artery disease at 1 year and 5 years after PCI. It is worth noting that the cost of stents had a significant impact on the findings.
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Affiliation(s)
- Monica Teng
- Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, Singapore, Singapore
| | - Ying Jiao Zhao
- Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, Singapore, Singapore
| | - Ai Leng Khoo
- Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, Singapore, Singapore
| | - Rajiv Ananthakrishna
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Tiong Cheng Yeo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Boon Peng Lim
- Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, Singapore, Singapore
| | - Mark Y Chan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joshua P Loh
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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25
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Ananthakrishna R, Kristanto W, Liu L, Chan SP, Loh PH, Tay EL, Chan KH, Chan MY, Lee CH, Low AF, Tan HC, Loh JP. Incidence and predictors of target lesion failure in a multiethnic Asian population receiving the SYNERGY coronary stent: A prospective all-comers registry. Catheter Cardiovasc Interv 2018. [PMID: 29513378 DOI: 10.1002/ccd.27577] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To evaluate the target lesion failure (TLF) rate of the SYNERGY stent in all-comers, multiethnic Asian population. BACKGROUND Currently, most drug eluting stents deliver anti-proliferative drugs from a durable polymer which is associated with a risk of late stent thrombosis. The novel everolimus-eluting, platinum chromium SYNERGY stent is coated with a bioabsorbable abluminal polymer that resolves within 4 months. METHODS This was a prospective, single center registry of consecutive patients treated with the SYNERGY stent between December 2012 and April 2015. The primary outcome was the incidence of TLF, defined as the combination of cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization (TLR) at 1 year. RESULTS A total of 807 patients received the SYNERGY stent during the study period. One-year clinical outcome data was available for 765 patients (94.8%) and were considered for statistical analysis. The mean age was 60.7 ± 10.8 years, and 83.4% were males. Patients with acute myocardial infarction consisted of 50.3% (ST-segment elevation myocardial infarction: 23.0%, Non-ST-segment elevation myocardial infarction: 27.3%) of the study population. The treated lesions were complex (ACC/AHA type B2/C: 72.7%). The primary end point of TLF at 1 year was 5.8%. Rates of cardiac mortality, target vessel myocardial infarction, and TLR were 4.2, 1.0, and 1.3%, respectively, at 1 year. Predictors of the incidence and time to early TLF were female gender, Malay ethnicity, diabetes mellitus, acute myocardial infarction at presentation, a prior history of coronary artery bypass surgery and the presence of lesion calcification. The incidence of definite stent thrombosis was 0.4% at 1 year. CONCLUSIONS In this registry, the use of the SYNERGY stent was associated with low rates of TLF at 1 year.
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Affiliation(s)
| | - William Kristanto
- Department of Cardiology, National University Heart Centre, Singapore
| | - Li Liu
- Department of Cardiology, National University Heart Centre, Singapore
| | - Siew-Pang Chan
- Department of Cardiology, National University Heart Centre, Singapore
| | - Poay Huan Loh
- Department of Cardiology, National University Heart Centre, Singapore
| | - Edgar L Tay
- Department of Cardiology, National University Heart Centre, Singapore
| | - Koo Hui Chan
- Department of Cardiology, National University Heart Centre, Singapore
| | - Mark Y Chan
- Department of Cardiology, National University Heart Centre, Singapore
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre, Singapore
| | - Adrian F Low
- Department of Cardiology, National University Heart Centre, Singapore
| | - Huay Cheem Tan
- Department of Cardiology, National University Heart Centre, Singapore
| | - Joshua P Loh
- Department of Cardiology, National University Heart Centre, Singapore
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26
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Moorthy N, Ananthakrishna R, Rao DPV, Manjunath SC, Nanjappa MC. Prosthetic mitral valve thrombosis, malfunction, and paroxysmal mitral regurgitation. Echocardiography 2018; 35:388-390. [PMID: 29457259 DOI: 10.1111/echo.13831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Intermittent dysfunction of mechanical mitral valve prosthesis is an uncommon condition. It carries serious clinical implications if unrecognized. Here, we present a case of a 28-year-old female with a history of rheumatic multivalvular disease, for which she had undergone double valve replacement and tricuspid annuloplasty. Six months later, she presented with heart failure. Clinical examination revealed intermittent loss of closing clicks followed by a pansystolic murmur at the apex, suggestive of mitral prosthetic valve dysfunction. We highlight the echocardiographic findings of paroxysmal mitral valvular regurgitation secondary to prosthetic valve malfunction secondary to prosthetic valve thrombosis.
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Affiliation(s)
- Nagaraja Moorthy
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Rajiv Ananthakrishna
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Dattatreya P V Rao
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Satvic C Manjunath
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Manjunath C Nanjappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
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Zhao YJ, Teng M, Khoo AL, Ananthakrishna R, Yeo TC, Lim BP, Loh JP, Chan MY. A propensity score-matched comparison of biodegradable polymer vs second-generation durable polymer drug-eluting stents in a real-world population. Cardiovasc Ther 2018; 36. [PMID: 29316284 DOI: 10.1111/1755-5922.12319] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/13/2017] [Accepted: 01/04/2018] [Indexed: 11/28/2022] Open
Abstract
AIMS The safety and efficacy of BP-DES compared to second-generation DP-DES remain unclear in the real-world setting. We compared the clinical outcomes of biodegradable polymer drug-eluting stents (BP-DES) with second-generation durable polymer drug-eluting stents (DP-DES) in an all-comer percutaneous coronary intervention (PCI) registry. METHODS/RESULTS The study included a cohort of 1065 patients treated with either BP-DES or DP-DES from January 2009 through October 2015. Propensity score matching was performed to account for potential confounders and produced 497 matched pairs of patients. The primary endpoint was target lesion failure (TLF) at one-year follow-up. The rates of TLF were comparable between BP-DES and DP-DES (8.7% vs 9.1%, P = .823) at 1 year. The rates of stent thrombosis at 30 days (0.4% vs 0.4%, P = 1.00) and 1 year (0.8% vs 0.8%, P = 1.00) did not differ between BP-DES and DP-DES. There were no significant differences in other clinical outcomes including target vessel failure (8.9% vs 9.5%, P = .741), in-stent restenosis (1.8% vs 1.0%, P = .282), and cardiac death (6.4% vs 7.4%, P = .533) at 1 year. Multivariate cox regression analysis showed that the risk of TLF at one-year did not differ significantly between BP-DES and DP-DES (hazard ratio 0.94, P = .763). CONCLUSIONS Efficacy and safety of BP-DES were not better than DP-DES at one-year follow-up.
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Affiliation(s)
- Ying Jiao Zhao
- Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore City, Singapore
| | - Monica Teng
- Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore City, Singapore
| | - Ai Leng Khoo
- Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore City, Singapore
| | - Rajiv Ananthakrishna
- Department of Cardiology, National University Heart Centre, Singapore City, Singapore
| | - Tiong Cheng Yeo
- Department of Cardiology, National University Heart Centre, Singapore City, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Boon Peng Lim
- Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore City, Singapore
| | - Joshua P Loh
- Department of Cardiology, National University Heart Centre, Singapore City, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Mark Y Chan
- Department of Cardiology, National University Heart Centre, Singapore City, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
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28
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Affiliation(s)
- Nagaraja Moorthy
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Rajiv Ananthakrishna
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
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29
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Moorthy N, Ananthakrishna R, Rao DPV, Manjunath SC, Nanjappa MC. Percutaneous Balloon Dilation of Discrete Subaortic Stenosis: A Futile Exercise. J Invasive Cardiol 2017; 29:E107-E108. [PMID: 28878105] [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
Discrete subaortic stenosis (DSS) is a progressive obstruction of left ventricular outflow tract (LVOT) resulting in the development of aortic regurgitation in its natural course. Hence, early intervention is recommended. Percutaneous balloon dilation of DSS has been reported and can substantially reduce LVOT pressure gradient. The response to balloon dilation of DSS is transient and may complicate with chordal or papillary muscle rupture. Hence, balloon dilation of DSS should be discouraged.
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Affiliation(s)
- Nagaraja Moorthy
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India 560069.
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30
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Sim H, Ananthakrishna R, Djohan A, Chan S, Tay E, Loh P, Chan K, Chan M, Lee C, Low A, Tan H, Loh J. P1391Impact of aspiration thrombectomy on stroke and mortality in an all-comers ST elevation myocardial infarction population undergoing primary percutaneous coronary intervention. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1391] [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: 11/12/2022] Open
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31
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Moorthy N, Ananthakrishna R, Rao DPV, Hegde M, Nanjappa MC. Right Aortic Arch With Left-Sided Arteria Lusoria: A Challenge for Radial Interventionalists. JACC Cardiovasc Interv 2017; 10:e85-e86. [PMID: 28412259 DOI: 10.1016/j.jcin.2017.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/06/2017] [Accepted: 02/09/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Nagaraja Moorthy
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.
| | - Rajiv Ananthakrishna
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Dattatreya P V Rao
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Madhav Hegde
- Department of Radiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Manjunath C Nanjappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
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Affiliation(s)
| | - Li-Jun Wang
- Department of Cardiology, National University Heart Centre, Singapore
| | - Liang Ping Zhao
- Department of Cardiology, National University Heart Centre, Singapore
| | - Huay Cheem Tan
- Department of Cardiology, National University Heart Centre, Singapore
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33
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Moorthy N, Ananthakrishna R, PV D, Ramalingam R, Manjunath C. TCTAP A-171 Crossover from Radial to Ipsilateral Ulnar Artery: A Safe and Feasible Alternative in Complex Radial Artery Anatomy. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.03.219] [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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34
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Sim HW, Ananthakrishna R, Loh PH, Lik-Wui Tay E, Chan KH, Chan M, Lee RCH, Low A, Tan HC, Loh JP. TCTAP A-148 Drug Eluting Stents Versus Drug Eluting Balloons in the Treatment of Very Small De Novo Coronary Artery Disease. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.03.194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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35
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Moorthy N, Ananthakrishna R, PV D, Kalpana S, Manjunath C. TCTAP C-203 Post Bentall's Periconduit Aneurysm, Severe Paraconduit Leak, Aorta to Periconduit Fistula Periconduit to RA Fistula- a Challenging Successful Multiple Device Closures: Clinical-imaging-autopsy Correlation. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.03.439] [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: 11/30/2022]
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36
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Loh JPY, Ananthakrishna R, Kristanto W, Li L, Chan SP, Loh PH, Tay E, Chan M, Chan K, Lee RC, Low A, Tan HC. INCIDENCE AND PREDICTORS OF TARGET LESION FAILURE IN A MULTI-ETHNIC ASIAN POPULATION RECEIVING THE SYNERGY CORONARY STENT: A PROSPECTIVE ALL-COMERS REGISTRY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34766-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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37
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Loh JPY, Ananthakrishna R, Sim HW, Loh PH, Tay E, Chan K, Chan M, Lee RC, Low A, Tan HC. SAFETY AND EFFICACY OF SMALL VESSEL STENTING WITH 2 MM DRUG ELUTING STENTS IN REAL WORLD CLINICAL PRACTICE. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34639-9] [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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38
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Basavanna D, Manjunath C, Panneerselvam A, Ananthakrishna R, Honnayanayak M, Bhat P. Spontaneous coronary artery dissection: A retrospective analysis of 19,676 coronary angiograms. J Clin Prev Cardiol 2017. [DOI: 10.4103/jcpc.jcpc_15_17] [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: 11/04/2022] Open
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Abstract
In the field of percutaneous coronary intervention, the evolution of coronary metal stents has been well established for the past three decades, but research on bioresorbable scaffolds has only gained momentum in the recent past. Although second-generation drug-eluting metal stents are the gold standard for the treatment of obstructive coronary artery disease, a few drawbacks exist. The development of bioresorbable scaffolds is an attempt to overcome the limitations of metal stents. This review highlights the rationale for the bioresorbable scaffold, its properties and potential applications. It also focuses on the current evidence and concerns regarding the application of the bioresorbable scaffold in day-to-day practice.
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Affiliation(s)
- Huay Cheem Tan
- Department of Cardiology, National University Heart Centre, Singapore
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40
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Abstract
Myocardial calcification is rare and occurs in previous myocardial infarction, endomyocardial fibrosis, and infections such as tuberculosis, chronic renal failure, or hyperparathyroidism. We present an interesting case of massive myocardial calcification of the left ventricle following prior extensive myocardial infarction, presenting as progressive heart failure.
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Affiliation(s)
- Rajiv Ananthakrishna
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, India.
| | - Nagaraja Moorthy
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, India
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41
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Ananthakrishna R, Rao DP, Moorthy N, Nanjappa MC. Balloon valvotomy for rheumatic valvar stenosis in a patient with complex congenital heart disease. Ann Pediatr Cardiol 2016; 9:265-8. [PMID: 27625529 PMCID: PMC5007940 DOI: 10.4103/0974-2069.189114] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Rajiv Ananthakrishna
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India. E-mail:
| | - Dattatreya Pv Rao
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India. E-mail:
| | - Nagaraja Moorthy
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India. E-mail:
| | - Manjunath C Nanjappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India. E-mail:
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43
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Abstract
A 22-year-old male patient presented with progressive effort intolerance of 2-years duration. Clinical findings and investigations were suggestive of Tetralogy of Fallot (TOF). In addition, there was a conspicuous difference in the pulmonary vascularity with oligemia on the left side and relative hypervascularity on the right side. The right pulmonary artery was arising from the proximal ascending aorta and the main pulmonary artery was continuing as the left pulmonary artery. The anomalous origin of a branch pulmonary artery from the aorta (AOPA) is a rare cardiac anomaly. We report this condition in association with TOF, highlighting the differential pulmonary vascularity.
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Affiliation(s)
- Rajiv Ananthakrishna
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Nagaraja Moorthy
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Dattatreya Pv Rao
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Manjunath C Nanjappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
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44
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Gupta A, Ananthakrishna R, Rao DPV, Bhat P, Nanjappa MC. Hematological dyspnea: A rare cause with gratifying recovery. J Cardiol Cases 2015; 12:83-86. [PMID: 30671146 DOI: 10.1016/j.jccase.2015.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 05/15/2015] [Accepted: 05/19/2015] [Indexed: 11/25/2022] Open
Abstract
A 17-year-old female was referred for evaluation of fever of two-month duration with acute onset of dyspnea since 1 week. Clinical examination revealed tachycardia, tachypnea, elevated jugular venous pressure, bilateral basal crepitations with normal heart sounds, and no murmur. Chest X-ray showed infiltrates in bilateral lung fields. Echocardiography revealed obliteration of biventricular apices along with layered thrombus over the left ventricular endocardium. Doppler studies elicited restrictive physiology with mild mitral and tricuspid regurgitation. Complete hemogram revealed hypereosinophilia with eosinophilic count of 7.4 × 109/L. All secondary causes of elevated eosinophil count were excluded. The patient was started on steroids and anticoagulation. Serial echocardiograms showed clearing of the thrombus with marked symptomatic improvement. We highlight a case of idiopathic hypereosinophilic syndrome with classic cardiac (Loeffler endocarditis) and pulmonary manifestations and prompt recovery with steroids and anticoagulation. <Learning objective: Idiopathic hypereosinophilic syndrome is a rare entity leading to multi-organ involvement. Cardiac involvement is one of the most common causes of morbidity and mortality. On the basis of this case report, we discuss Loeffler endocarditis in idiopathic hypereosinophilic syndrome; demonstrate classic echocardiographic findings in the intermediate stage, and remarkable symptomatic and echocardiographic recovery after appropriate treatment.>.
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Affiliation(s)
- Ashish Gupta
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, India
| | - Rajiv Ananthakrishna
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, India
| | - Dattatreya P V Rao
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, India
| | - Prabhavathi Bhat
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, India
| | - Manjunath C Nanjappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, India
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45
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Moorthy N, Ananthakrishna R, Nanjappa MC. Percutaneous stenting of interrupted aortic arch to treat compressive myelopathy. Catheter Cardiovasc Interv 2014; 84:815-9. [PMID: 24458503 DOI: 10.1002/ccd.25408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 01/05/2014] [Accepted: 01/20/2014] [Indexed: 11/12/2022]
Abstract
Neurological complications of coarctation of aorta include spontaneous SAH, intracerebral hemorrhage, and cerebral abscess. Interrupted aortic arch (IAA) present as compressive myelopathy is not known. We describe an adult male presenting to neurology department with progressive paraparesis and was detected to have IAA with intraspinal collaterals causing compressive myelopathy. He was successfully treated with percutaneous stenting of IAA with dramatic improvement in paraparesis. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Nagaraja Moorthy
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India, 560069
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46
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Abstract
Familial homozygous hypercholesterolemia is one of the high risk factors that can result in premature coronary arterial disease leading to severe morbidity and premature death in children and young adults. We describe a rare example of extensive xanthoma tuberosum in a case of familial homozygous hypercholesterolemia.
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Affiliation(s)
- Nagaraja Moorthy
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Rajiv Ananthakrishna
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Prabhavathi Bhat
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Manjunath C Nanjappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
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47
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Theodore J, Ananthakrishna R, Bhat P, Rao DP, Nanjappa MC. Electrogenic Cardioversion. Cardiol Res 2014; 5:80-82. [PMID: 28392880 PMCID: PMC5358179 DOI: 10.14740/cr334w] [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] [Accepted: 04/25/2014] [Indexed: 11/17/2022] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. Cardioversion for AF may be performed by either using direct current (DC) shock (electrical cardioversion) or using drugs (chemical cardioversion). Here we report a case of a patient with heart failure and AF, who reverted to the normal sinus rhythm on correction of hyperkalemia (electrogenic cardioversion). The patient maintained sinus rhythm during follow-up. We highlight the importance of serum potassium in patients with AF.
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Affiliation(s)
- Joseph Theodore
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar 9th Block, Bannerghatta Road, Bangalore, 560069, India
| | - Rajiv Ananthakrishna
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar 9th Block, Bannerghatta Road, Bangalore, 560069, India
| | - Prabhavathi Bhat
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar 9th Block, Bannerghatta Road, Bangalore, 560069, India
| | - Dattatreya Pv Rao
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar 9th Block, Bannerghatta Road, Bangalore, 560069, India
| | - Manjunath Cholenhally Nanjappa
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar 9th Block, Bannerghatta Road, Bangalore, 560069, India
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48
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Ananthakrishna R, Moorthy N, Bhat P, Nanjappa MC. A vanishing left ventricular outflow tract mass: an uncommon manifestation of systemic lupus erythematosus. Echocardiography 2014; 31:E222-3. [PMID: 24666028 DOI: 10.1111/echo.12598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Rajiv Ananthakrishna
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, India
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49
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Manjunath CN, Agarwal A, Bhat P, Ravindranath KS, Ananthakrishna R, Ravindran R, Agarwal N. Coronary artery disease in patients undergoing cardiac surgery for non-coronary lesions in a tertiary care centre. Indian Heart J 2014; 66:52-6. [PMID: 24581096 PMCID: PMC3946445 DOI: 10.1016/j.ihj.2013.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 07/26/2013] [Accepted: 12/04/2013] [Indexed: 11/29/2022] Open
Abstract
Background The objective of the present study was to determine the prevalence of coronary artery disease (CAD) in patients undergoing surgery for various valvular as well as non-valvular cardiac pathologies. Methods Patients with various valvular and non-valvular pathologies were selected. All patients with age ≥40 years and an indication for open heart surgery underwent pre-operative coronary angiogram and were included in the study. Results The mean age was 51.5 ± 9.02 years. 178 (59.3%) patients were males and 122 (40.7%) patients were females. Out of 300 patients, 270 (90%) patients had valvular heart disease (VHD) and 30 (10%) patients had non-valvular heart disease. Rheumatic heart disease (RHD), mitral valve prolapse (MVP), degenerative aortic valve disease (DAVD) and bicuspid aortic valve (BAV) was present in 161 (53.7%), 17 (5.7%), 60 (20%) and 32 (10.7%) patients respectively. Overall, 26 (8.7%) patients were found to have significant CAD. CAD was significantly more common in patients with VHD as compared to patients with other etiologies (1 patient, 3.3%, p < 0.05). In the valvular group, DAVD patients had maximum prevalence of CAD (14 patients, 23.4%, p < 0.05). In the group with CAD, the presence of variables such as age >60 years, male sex, typical angina, HT, dyslipidemia and smoking were significantly greater as compared to those with normal coronaries. Conclusion The overall prevalence of CAD among patients undergoing non-coronary cardiac surgery is 8.7%. Coronary artery disease is relatively uncommon in patients with rheumatic VHD (4.9%), while its prevalence is highest in DAVD (23.4%).
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Affiliation(s)
| | - Ashish Agarwal
- Resident, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.
| | - Prabhavathi Bhat
- Professor, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | | | - Rajiv Ananthakrishna
- Assistant Professor, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - R Ravindran
- Resident, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Neena Agarwal
- Assistant Professor, Department of Emergency Medicine, Kempe Gowda Institute of Medical Sciences, Bangalore, India
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50
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Rajendran R, Ananthakrishna R, Rao DP, Bhat P, Nanjappa MC. Mobile subpulmonary membrane in a patient with hypertrophic cardiomyopathy and right ventricular mid-cavitary obstruction. Eur Heart J Cardiovasc Imaging 2013; 14:1121. [DOI: 10.1093/ehjci/jet073] [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: 11/14/2022] Open
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