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Roehl K, Suppah M, Geske J, Newman D, Giudicessi J, Ackerman M, Ommen S, Alsidawi S. Effect of Mavacamten on Hypertrophic Cardiomyopathy Patients With Left Ventricular Outflow Tract Obstruction Provoked Only Postexercise or With Amyl Nitrite. J Am Soc Echocardiogr 2024; 37:566-568. [PMID: 38266966 DOI: 10.1016/j.echo.2024.01.009] [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: 12/04/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/26/2024]
Affiliation(s)
- Kaitlin Roehl
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona
| | - Mustafa Suppah
- Department of Internal Medicine, Creighton University, Phoenix, Arizona
| | - Jeffrey Geske
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Darrell Newman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - John Giudicessi
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Michael Ackerman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Steve Ommen
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Said Alsidawi
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona
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2
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Masson R, Vuyisile NT, Holmes DR, Pislaru SV, Arsanjani R, Chao CJ, Klanderman M, Abraham B, Morsy M, Fortuin FD, Sweeney JP, Sell-Dotten K, Alsidawi S. Disproportionately High Aortic Valve Calcium Scores in Atrial Fibrillation: Implications for Transcatheter Aortic Valve Replacement. Eur Heart J Cardiovasc Imaging 2024:jeae113. [PMID: 38669204 DOI: 10.1093/ehjci/jeae113] [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: 01/30/2024] [Revised: 03/23/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
AIMS Doppler mean gradient (MG) can underestimate aortic stenosis (AS) severity in patients with atrial fibrillation (AF) compared to patients in sinus rhythm (SR), potentially delaying intervention in AF. This study compared outcomes in patients with AF and SR following transcatheter aortic valve replacement (TAVR) and investigated delay in TAVR based on computed tomography aortic valve calcium score (AVCS). METHODS AND RESULTS Patients who underwent TAVR from 2013 to 2017 for native valve severe AS were identified from an institutional database. Baseline characteristics and overall survival were compared between those in SR and AF. There were 820 patients (mean age 81 years; 41.6% female) included. AF was present in 356 patients. Patients in AF were older (82.2 vs. 80.5, p = 0.003), had lower MG compared to SR patients (42.0 vs. 44.9, p = 0.002) with similar indexed aortic valve area (0.4 vs. 0.4, p = 0.17). Median AVCS was higher in AF (males: AF 2850.0 vs. SR 2561.0, p = 0.044; females: AF 1942.0 vs. SR 1610.5, p = 0.025). Projected AVCS assuming same age of diagnosis was similar between AF and SR. Median survival post-TAVR was worse in AF compared to SR (3.2 vs 5.4 years, log rank p < 0.001). AF, lower MG, higher RVSP, dialysis, diabetes, and significant TR were associated with higher mortality (p < 0.05 for all). CONCLUSION Older age and higher AVCS in patients with AF compared to SR suggests that AS was both underestimated and more advanced at TAVR referral.
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Affiliation(s)
- Rajeev Masson
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Nkomo T Vuyisile
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Molly Klanderman
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Bishoy Abraham
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Mahmoud Morsy
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - F David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - John P Sweeney
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Kristen Sell-Dotten
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Said Alsidawi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
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3
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Castrichini M, Alsidawi S, Geske JB, Newman DB, Arruda-Olson AM, Bos JM, Ommen SR, Siontis KC, Ackerman MJ, Giudicessi JR. Incidence of newly recognized atrial fibrillation in patients with obstructive hypertrophic cardiomyopathy treated with Mavacamten. Heart Rhythm 2024:S1547-5271(24)02382-8. [PMID: 38621499 DOI: 10.1016/j.hrthm.2024.04.055] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Affiliation(s)
- Matteo Castrichini
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Department of Molecular Pharmacology and Experimental Therapeutics Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Said Alsidawi
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona
| | - Jeffrey B Geske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Darrell B Newman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - J Martijn Bos
- Department of Molecular Pharmacology and Experimental Therapeutics Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Steve R Ommen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Michael J Ackerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Department of Molecular Pharmacology and Experimental Therapeutics Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota; Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - John R Giudicessi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Department of Molecular Pharmacology and Experimental Therapeutics Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota.
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Roehl K, Alsidawi S. Myosin Inhibitors Can Reduce Primary Mitral Regurgitation by Improving Systolic Anterior Motion of the Mitral Leaflets. Korean Circ J 2024; 54:108-109. [PMID: 38346698 PMCID: PMC10864247 DOI: 10.4070/kcj.2023.0290] [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] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 02/17/2024] Open
Affiliation(s)
- Kaitlin Roehl
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA
| | - Said Alsidawi
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA.
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5
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Giudicessi JR, Alsidawi S, Geske JB, Newman DB, Arruda-Olson AM, Bos JM, Ommen SR, Ackerman MJ. Genotype Influences Mavacamten Responsiveness in Obstructive Hypertrophic Cardiomyopathy. Mayo Clin Proc 2024; 99:341-343. [PMID: 38309941 DOI: 10.1016/j.mayocp.2023.11.019] [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: 11/11/2023] [Accepted: 11/27/2023] [Indexed: 02/05/2024]
Affiliation(s)
- John R Giudicessi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN.
| | - Said Alsidawi
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ
| | - Jeffrey B Geske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Darrell B Newman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - J Martijn Bos
- Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN; Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Steve R Ommen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Michael J Ackerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN; Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
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Stepanek J, Farina JM, Mahmoud AK, Chao CJ, Alsidawi S, Ayoub C, Barry T, Pereyra M, Scalia IG, Abbas MT, Wraith RE, Brown LS, Radavich MS, Curtisi PJ, Hartzendorf PC, Lasota EM, Umetsu KN, Peterson JM, Karlson KE, Breznak K, Fortuin DF, Lester SJ, Arsanjani R. Identifying the Causes of Unexplained Dyspnea at High Altitude Using Normobaric Hypoxia with Echocardiography. J Imaging 2024; 10:38. [PMID: 38392086 PMCID: PMC10889907 DOI: 10.3390/jimaging10020038] [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: 12/24/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
Exposure to high altitude results in hypobaric hypoxia, leading to physiological changes in the cardiovascular system that may result in limiting symptoms, including dyspnea, fatigue, and exercise intolerance. However, it is still unclear why some patients are more susceptible to high-altitude symptoms than others. Hypoxic simulation testing (HST) simulates changes in physiology that occur at a specific altitude by asking the patients to breathe a mixture of gases with decreased oxygen content. This study aimed to determine whether the use of transthoracic echocardiography (TTE) during HST can detect the rise in right-sided pressures and the impact of hypoxia on right ventricle (RV) hemodynamics and right to left shunts, thus revealing the underlying causes of high-altitude signs and symptoms. A retrospective study was performed including consecutive patients with unexplained dyspnea at high altitude. HSTs were performed by administrating reduced FiO2 to simulate altitude levels specific to patients' history. Echocardiography images were obtained at baseline and during hypoxia. The study included 27 patients, with a mean age of 65 years, 14 patients (51.9%) were female. RV systolic pressure increased at peak hypoxia, while RV systolic function declined as shown by a significant decrease in the tricuspid annular plane systolic excursion (TAPSE), the maximum velocity achieved by the lateral tricuspid annulus during systole (S' wave), and the RV free wall longitudinal strain. Additionally, right-to-left shunt was present in 19 (70.4%) patients as identified by bubble contrast injections. Among these, the severity of the shunt increased at peak hypoxia in eight cases (42.1%), and the shunt was only evident during hypoxia in seven patients (36.8%). In conclusion, the use of TTE during HST provides valuable information by revealing the presence of symptomatic, sustained shunts and confirming the decline in RV hemodynamics, thus potentially explaining dyspnea at high altitude. Further studies are needed to establish the optimal clinical role of this physiologic method.
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Affiliation(s)
- Jan Stepanek
- Aerospace Medicine Program, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
| | - Juan M Farina
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
| | - Ahmed K Mahmoud
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
| | - Chieh-Ju Chao
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Said Alsidawi
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
| | - Chadi Ayoub
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
| | - Timothy Barry
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
| | - Milagros Pereyra
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
| | - Isabel G Scalia
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
| | | | - Rachel E Wraith
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
| | - Lisa S Brown
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
| | - Michael S Radavich
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
| | - Pamela J Curtisi
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
| | | | - Elizabeth M Lasota
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
| | - Kyley N Umetsu
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
| | - Jill M Peterson
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
| | - Kristin E Karlson
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
| | - Karen Breznak
- Aerospace Medicine Program, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
| | - David F Fortuin
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
| | - Steven J Lester
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
| | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
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7
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Farina JM, Chao CJ, Pereyra M, Roarke M, Said EF, Barry T, Alsidawi S, Sell-Dottin K, Sweeney JP, Fortuin DF, Ayoub C, Lester SJ, Oh JK, Arsanjani R, Marcotte F. Role of lipoprotein(a) concentrations in bioprosthetic aortic valve degeneration. Heart 2024; 110:299-305. [PMID: 37643771 DOI: 10.1136/heartjnl-2023-322987] [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: 05/18/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES Lipoprotein(a) (Lp(a)) is associated with an increased incidence of native aortic stenosis, which shares similar pathological mechanisms with bioprosthetic aortic valve (bAV) degeneration. However, evidence regarding the role of Lp(a) concentrations in bAV degeneration is lacking. This study aims to evaluate the association between Lp(a) concentrations and bAV degeneration. METHODS In this retrospective multicentre study, patients who underwent a bAV replacement between 1 January 2010 and 31 December 2020 and had a Lp(a) measurement were included. Echocardiography follow-up was performed to determine the presence of bioprosthetic valve degeneration, which was defined as an increase >10 mm Hg in mean gradient from baseline with concomitant decrease in effective orifice area and Doppler Velocity Index, or new moderate/severe prosthetic regurgitation. Levels of Lp(a) were compared between patients with and without degeneration and Cox regression analysis was performed to investigate the association between Lp(a) levels and bioprosthetic valve degeneration. RESULTS In total, 210 cases were included (mean age 74.1±9.4 years, 72.4% males). Median time between baseline and follow-up echocardiography was 4.4 (IQR 3.7) years. Bioprostheses degeneration was observed in 33 (15.7%) patients at follow-up. Median serum levels of Lp(a) were significantly higher in patients affected by degeneration versus non-affected cases: 50.0 (IQR 72.0) vs 15.6 (IQR 48.6) mg/dL, p=0.002. In the regression analysis, high Lp(a) levels (≥30 mg/dL) were associated with degeneration both in a univariable analysis (HR 3.6, 95% CI 1.7 to 7.6, p=0.001) and multivariable analysis adjusted by other risk factors for bioprostheses degeneration (HR 4.4, 95% CI 1.9 to 10.4, p=0.001). CONCLUSIONS High serum Lp(a) is associated with bAV degeneration. Prospective studies are needed to confirm these findings and to investigate whether lowering Lp(a) levels could slow bioprostheses degradation.
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Affiliation(s)
- Juan M Farina
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Chieh-Ju Chao
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Milagros Pereyra
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Michael Roarke
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Ebram F Said
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Timothy Barry
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Said Alsidawi
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Kristen Sell-Dottin
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - John P Sweeney
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - David F Fortuin
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Chadi Ayoub
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Steven J Lester
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Francois Marcotte
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
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Shipman J, Srivathsan K, Alsidawi S. Bad to worse: mitral regurgitation increases from moderate-severe to torrential following cardioversion to sinus rhythm. Eur Heart J Cardiovasc Imaging 2023; 25:e63. [PMID: 37804530 DOI: 10.1093/ehjci/jead253] [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: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/09/2023] Open
Affiliation(s)
- Justin Shipman
- Division of Cardiovascular Diseases, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
| | - Komandoor Srivathsan
- Division of Cardiovascular Diseases, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
| | - Said Alsidawi
- Division of Cardiovascular Diseases, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
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9
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Killian M, Barry T, Larsen C, Alsidawi S. Case series: cardiac sarcoma. Eur Heart J Case Rep 2023; 7:ytad546. [PMID: 38046649 PMCID: PMC10691649 DOI: 10.1093/ehjcr/ytad546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/22/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023]
Abstract
Background Cardiac masses encompass a wide differential including primary and secondary malignancies and can present with a variety of symptoms, many of which are non-specific. Early identification and classification are important, particularly for cardiac malignancies such as sarcomas as these are aggressive tumours with exceptionally poor prognoses when metastases are present at diagnosis. Case summary We report two cases of patients who presented with dyspnoea and were diagnosed with cardiac sarcomas; the former a primary sarcoma (undifferentiated pleomorphic subtype) and the latter a secondary sarcoma (round cell myxoid liposarcoma) that serve as comparisons for presentation and management of different types of this disease. Computed Tomography (CT) and echocardiography imaging findings are demonstrated showing the typical location and morphology of each subtype. Discussion Cardiac sarcomas are the most common primary cardiac malignancy, of which undifferentiated pleomorphic sarcoma is a common subtype. Undifferentiated pleomorphic sarcomas are aggressive, have a tendency to arise in the left atrium, and can appear similar to benign cardiac masses. Round cell myxoid liposarcomas by contrast are rare causes of secondary cardiac malignancies, metastasizing to the heart from soft tissues. Both diagnoses carry poor prognoses and although rare, are important to recognize as timely intervention with surgery, radiotherapy, and consideration of chemotherapy is key to maximizing survival.
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Affiliation(s)
- Michael Killian
- Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA
| | - Timothy Barry
- Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA
| | - Carolyn Larsen
- Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA
| | - Said Alsidawi
- Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA
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Suppah M, Kamal A, Saadoun R, Baradeiya AMA, Abraham B, Alsidawi S, Sorajja D, Fortuin FD, Arsanjani R. An Evidence-Based Approach to Anticoagulation Therapy Comparing Direct Oral Anticoagulants and Vitamin K Antagonists in Patients With Atrial Fibrillation and Bioprosthetic Valves: A Systematic Review, Meta-Analysis, and Network Meta-Analysis. Am J Cardiol 2023; 206:132-150. [PMID: 37703679 DOI: 10.1016/j.amjcard.2023.07.141] [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: 05/03/2023] [Revised: 07/21/2023] [Accepted: 07/30/2023] [Indexed: 09/15/2023]
Abstract
Direct oral anticoagulants (DOACs) are a newer class of anticoagulants that inhibit factor Xa or factor IIa and include drugs such as rivaroxaban, apixaban, edoxaban, betrixaban, and dabigatran. Although vitamin K antagonists (VKAs) have been traditionally used to prevent thromboembolic events, DOACs have gained popularity because of their faster onset and offset of action and reduced need for monitoring. This study aimed to provide more data for anticoagulants in patients with atrial fibrillation with bioprosthetic heart valves by incorporating all available trials to date. A search was performed across 5 electronic databases to identify relevant studies. We analyzed the data using a pooled risk ratio for categorical outcomes and used the I2 test to determine heterogeneity. The quality of randomized controlled trials was assessed using the Cochrane risk of bias assessment tool, and the National Institutes of Health tool was used for observational studies. Our study included a frequentist network meta-analysis (MA) of the aggregate data to obtain the network estimates for the outcomes of interest. We retrieved 28 studies with a total of 74,660 patients with bioprosthetic heart valves. Our MA significantly showed that DOACs decrease the risk of all-cause bleeding (risk ratio [RR] 0.80, 95% confidence interval [CI] 0.75 to 0.85, p >0.00001), stroke and systemic embolization (RR 0.89, 95% CI 0.80 to 0.99, p = 0.03), and intracranial bleeding outcomes (RR 0.62, 95% CI 0.45 to 0.86, p = 0.004) compared with VKA. In contrast, there was no significant difference between the compared groups in major bleeding (RR = 0.92, 95% CI 0.84 to 1.02, p = 0.10) and all-cause mortality outcomes (RR = 0.96, 95% CI 0.85 to 1.07, p = 0.43), respectively. In addition, the network MA results did not favor any of the studied interventions over each other (p <0.05) regarding all-cause bleeding, mortality, stroke and systemic embolization, and major bleeding outcomes. In conclusion, our study found that DOACs are more effective in reducing the risk of bleeding, stroke, systemic embolism, and intracranial bleeding than VKAs. However, no significant difference was observed in the incidence of gastrointestinal bleeding, major bleeding, thromboembolic events, and all-cause mortality. In addition, our network MA did not identify any specific DOAC treatment as more favorable than others.
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Affiliation(s)
- Mustafa Suppah
- Department of Cardiology, Mayo Clinic Arizona, Phoenix, Arizona.
| | - Abdallah Kamal
- Department of Cardiology, University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Rakan Saadoun
- Department of Cardiology, University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, Pennsylvania
| | | | - Bishoy Abraham
- Department of Cardiology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Said Alsidawi
- Department of Cardiology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Dan Sorajja
- Department of Cardiology, Mayo Clinic Arizona, Phoenix, Arizona
| | - F David Fortuin
- Department of Cardiology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Reza Arsanjani
- Department of Cardiology, Mayo Clinic Arizona, Phoenix, Arizona
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11
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Chao CJ, Agasthi P, Girardo M, Barry T, Seri AR, Brown L, Wraith RE, Shanbhag A, Wang Y, Chen YC, Lester SJ, Alsidawi S, Freeman WK, Naqvi TZ, Eleid M, Fortuin D, Pollak P, El Sabbagh A, Sell-Dottin K, Majdalany D, Larsen C, Holmes DR, Oh JK, Appleton CP, Arsanjani R. Using Augmented Mean Arterial Pressure to Identify High Mortality Risk Patients With Moderate Aortic Stenosis. Mayo Clin Proc 2023; 98:1501-1514. [PMID: 37793726 DOI: 10.1016/j.mayocp.2023.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/07/2023] [Accepted: 02/17/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE To study the usefulness of a novel echocardiographic marker, augmented mean arterial pressure (AugMAP = [(mean aortic valve gradient + systolic blood pressure) + (2 × diastolic blood pressure)] / 3), in identifying high-risk patients with moderate aortic stenosis (AS). PATIENTS AND METHODS Adults with moderate AS (aortic valve area, 1.0-1.5 cm2) at Mayo Clinic sites from January 1, 2010, through December 31, 2020, were identified. Baseline demographic, echocardiographic, and all-cause mortality data were retrieved. Patients were grouped into higher and lower AugMAP groups using a cutoff value of 80 mm Hg for analysis. Kaplan-Meier and Cox regression models were used to assess the performance of AugMAP. RESULTS A total of 4563 patients with moderate AS were included (mean ± SD age, 73.7±12.5 years; 60.5% men). Median follow-up was 2.5 years; 36.0% of patients died. The mean ± SD left ventricular ejection fraction (LVEF) was 60.1%±11.4%, and the mean ± SD AugMAP was 99.1±13.1 mm Hg. Patients in the lower AugMAP group, with either preserved or reduced LVEF, had significantly worse survival performance (all P<.001). Multivariate Cox regression showed that AugMAP (hazard ratio, 0.962; 95% CI, 0.942 to 0.981 per 5-mm Hg increase; P<.001) and AugMAP less than 80 mm Hg (hazard ratio, 1.477; 95% CI, 1.241 to 1.756; P<.001) were independently associated with all-cause mortality. CONCLUSION AugMAP is a simple and effective echocardiographic marker to identify high-risk patients with moderate AS independent of LVEF. It can potentially be used in the candidate selection process if moderate AS becomes indicated for aortic valve intervention in the future.
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Affiliation(s)
- Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ; Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN.
| | - Pradyumma Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ; Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN
| | - Marlene Girardo
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Timothy Barry
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Amith R Seri
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Lisa Brown
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Rachel E Wraith
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Anusha Shanbhag
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Yuxiang Wang
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Yi-Chieh Chen
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ; Department of Pharmacy, Mayo Clinic Health System, Austin, MN
| | - Steven J Lester
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Said Alsidawi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - William K Freeman
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Tasneem Z Naqvi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Mackram Eleid
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN
| | - David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Peter Pollak
- Department of Cardiovascular Diseases, Mayo Clinic Florida, Jacksonville, FL
| | - Abdallah El Sabbagh
- Department of Cardiovascular Diseases, Mayo Clinic Florida, Jacksonville, FL
| | | | - David Majdalany
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Carolyn Larsen
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN
| | - Jae K Oh
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN
| | | | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
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12
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Chao CJ, Agasthi P, Barry T, Chiang CC, Wang P, Ashraf H, Mookadam F, Seri AR, Venepally N, Allam M, Pujari SH, Sriramoju A, Sleem M, Alsidawi S, Eleid M, Beohar N, Fortuin FD, Yang EH, Rihal CS, Holmes DR, Arsanjani R. Using Artificial Intelligence in Predicting Ischemic Stroke Events After Percutaneous Coronary Intervention. J Invasive Cardiol 2023; 35:E297-E311. [PMID: 37410747] [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] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
BACKGROUND Ischemic stroke (IS) is an uncommon but severe complication in patients undergoing percutaneous coronary intervention (PCI). Despite significant morbidity and economic cost associated with post PCI IS, a validated risk prediction model is not currently available. AIMS We aim to develop a machine learning model that predicts IS after PCI. METHODS We analyzed data from Mayo Clinic CathPCI registry from 2003 to 2018. Baseline clinical and demographic data, electrocardiography (ECG), intra/post-procedural data, and echocardiographic variables were abstracted. A random forest (RF) machine learning model and a logistic regression (LR) model were developed. The receiver operator characteristic (ROC) analysis was used to assess model performance in predicting IS at 6-month, 1-, 2-, and 5-years post-PCI. RESULTS A total of 17,356 patients were included in the final analysis. The mean age of this cohort was 66.9 ± 12.5 years, and 70.7% were male. Post-PCI IS was noted in 109 patients (.6%) at 6 months, 132 patients (.8%) at 1 year, 175 patients (1%) at 2 years, and 264 patients (1.5%) at 5 years. The area under the curve of the RF model was superior to the LR model in predicting ischemic stroke at 6 months, 1-, 2-, and 5-years. Periprocedural stroke was the strongest predictor of IS post discharge. CONCLUSIONS The RF model accurately predicts short- and long-term risk of IS and outperforms logistic regression analysis in patients undergoing PCI. Patients with periprocedural stroke may benefit from aggressive management to reduce the future risk of IS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Reza Arsanjani
- Associate Professor of Medicine, Director, Echocardiography Lab, Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona.
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13
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Abraham B, Farina JM, Fath A, Abdou M, Elbanna M, Suppah M, Sleem M, Eldaly A, Aly M, Megaly M, Agasthi P, Chao CJ, Fortuin D, Alsidawi S, Ayoub C, Alkhouli M, El Sabbagh A, Holmes D, Brilakis ES, Arsanjani R. The impact of moderate aortic stenosis in acute myocardial infarction: A multicenter retrospective study. Catheter Cardiovasc Interv 2023. [PMID: 37146200 DOI: 10.1002/ccd.30676] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/31/2023] [Accepted: 04/22/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Aortic stenosis (AS) is associated with myocardial ischemia through different mechanisms and may impair coronary arterial flow. However, data on the impact of moderate AS in patients with acute myocardial infarction (MI) is limited. AIMS This study aimed to investigate the impact of moderate AS in patients presenting with acute myocardial infarction (MI). METHODS We conducted a retrospective analysis of all patients who presented with acute MI to all Mayo Clinic hospitals, using the Enterprise Mayo PCI Database from 2005 to 2016. Patients were stratified into two groups: moderate AS and mild/no AS. The primary outcome was all cause mortality. RESULTS The moderate AS group included 183 (13.3%) patients, and the mild/no AS group included 1190 (86.7%) patients. During hospitalization, there was no difference between both groups in mortality. Patients with moderate AS had higher in-hospital congestive heart failure (CHF) (8.2% vs. 4.4%, p = 0.025) compared with mild/no AS patients. At 1-year follow-up, patients with moderate AS had higher mortality (23.9% vs. 8.1%, p < 0.001) and higher CHF hospitalization (8.3% vs. 3.7%, p = 0.028). In multivariate analysis, moderate AS was associated with higher mortality at 1-year (odds ratio 2.4, 95% confidence interval [1.4-4.1], p = 0.002). In subgroup analyses, moderate AS increased all-cause mortality in STEMI and NSTEMI patients. CONCLUSION The presence of moderate AS in acute MI patients was associated with worse clinical outcomes during hospitalization and at 1-year follow-up. These unfavorable outcomes highlight the need for a close follow-up of these patients and for timely therapeutic strategies to best manage these coexisting conditions.
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Affiliation(s)
- Bishoy Abraham
- Department of Cardiology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Juan M Farina
- Department of Cardiology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Ayman Fath
- Department of Cardiology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Merna Abdou
- Department of Cardiology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Mostafa Elbanna
- Department of Cardiology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Mustafa Suppah
- Department of Cardiology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Mohamed Sleem
- Department of Cardiology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Abdullah Eldaly
- Department of Cardiology, Mayo Clinic Hospital, Jacksonville, Florida, USA
| | - Mohamed Aly
- Department of Cardiology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Michael Megaly
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Pradyumna Agasthi
- Department of Cardiology, Mayo Clinic Hospital, Rochester, Minnesota, USA
| | - Chieh-Ju Chao
- Department of Cardiology, Mayo Clinic Hospital, Rochester, Minnesota, USA
| | - David Fortuin
- Department of Cardiology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Said Alsidawi
- Department of Cardiology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Chadi Ayoub
- Department of Cardiology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Mohamad Alkhouli
- Department of Cardiology, Mayo Clinic Hospital, Rochester, Minnesota, USA
| | | | - David Holmes
- Department of Cardiology, Mayo Clinic Hospital, Rochester, Minnesota, USA
| | - Emmanouil S Brilakis
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Reza Arsanjani
- Department of Cardiology, Mayo Clinic Hospital, Phoenix, Arizona, USA
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14
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Abraham B, Fath A, Megaly M, Chao CJ, Arsanjani R, Fortuin FD, Sweeney J, Pellikka P, Nkomo V, Alkhouli M, Holmes D, Alsidawi S. TCT-476 Tricuspid Regurgitation Is Associated With Increased One-Year Mortality After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.562] [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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15
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Abraham B, Fath A, Megaly M, Chao CJ, Arsanjani R, Fortuin FD, Sweeney J, Alkhouli M, Pellikka P, Nkomo V, Holmes D, Alsidawi S. TCT-475 Moderate to Severe Mitral Regurgitation’s Impact on One-Year Mortality After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.560] [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: 10/14/2022]
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16
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Alhasan F, Arsanjani R, Alsidawi S. The Use of New Emerging Technology in Echocardiography-Glass View. Korean Circ J 2022; 52:87-88. [PMID: 34989196 PMCID: PMC8738711 DOI: 10.4070/kcj.2021.0341] [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] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/27/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Faysal Alhasan
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Scottsdale, AZ, USA
| | - Said Alsidawi
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Scottsdale, AZ, USA.
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17
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Alsidawi S, Khan S, Pislaru SV, Thaden JJ, El-Am EA, Scott CG, Morant K, Oguz D, Luis SA, Padang R, Lane CE, McCully RB, Pellikka PA, Oh JK, Nkomo VT. High Prevalence of Severe Aortic Stenosis in Low-Flow State Associated With Atrial Fibrillation. Circ Cardiovasc Imaging 2021; 14:e012453. [PMID: 34250815 DOI: 10.1161/circimaging.120.012453] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is a low-flow state and may underestimate aortic stenosis (AS) severity. Single-high Doppler signals (HS) consistent with severe AS (peak velocity ≥4 m/s or mean gradient ≥40 mm Hg) are averaged down in current practice. The objective for the study was to determine the significance of HS in AF low-gradient AS (LGAS). METHODS One thousand five hundred forty-one patients with aortic valve area ≤1 cm2 and left ventricular ejection fraction ≥50% were identified and classified as high-gradient AS (HGAS) (≥40 mm Hg) and LGAS (<40 mm Hg), and AF versus sinus rhythm (SR). Available computed tomography aortic valve calcium scores (AVCS) were retrieved from the medical record. Outcomes were assessed. RESULTS Mean age was 76±11 years, female 47%. Mean gradient was 51±12 in SR-HGAS, 48±10 in AF-HGAS, 31±5 in SR-LGAS, and 29±7 mm Hg in AF-LGAS, all P≤0.001 versus SR-HGAS; HS were present in 33% of AF-LGAS. AVCS were available in 34%. Compared with SR-HGAS (2409 arbitrary units; interquartile range, 1581-3462) AVCS were higher in AF-HGAS (2991 arbitrary units; IQR1978-4229, P=0.001), not different in AF-LGAS (2399 arbitrary units; IQR1817-2810, P=0.47), and lower in SR-LGAS (1593 arbitrary units; IQR945-1832, P<0.001); AVCS in AF-LGAS were higher when HS were present (P=0.048). Compared with SR-HGAS, the age-, sex-, comorbidity index-, and time-dependent aortic valve replacement-adjusted mortality risk was higher in AF-HGAS (hazard ratio=1.82 [1.40-2.36], P<0.001) and AF-LGAS with HS (hazard ratio=1.54 [1.04-2.26], P=0.03) but not different in AF-LGAS without HS or SR-LGAS (both P=not significant). CONCLUSIONS Severe AS was common in AF-LGAS. AVCS in AF-LGAS were not different from SR-HGAS. AVCS were higher and mortality worse in AF-LGAS when HS were present.
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Affiliation(s)
- Said Alsidawi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A., S.K., S.V.P., J.J.T., E.A.E.-A., K.M., D.O., S.A.L., R.P., C.E.L., R.B.M., P.A.P., J.K.O., V.T.N.).,Minneapolis Heart Institute, Minneapolis, MN (S.A.)
| | - Sana Khan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A., S.K., S.V.P., J.J.T., E.A.E.-A., K.M., D.O., S.A.L., R.P., C.E.L., R.B.M., P.A.P., J.K.O., V.T.N.).,University of Minnesota, Minneapolis, MN (S.K.)
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A., S.K., S.V.P., J.J.T., E.A.E.-A., K.M., D.O., S.A.L., R.P., C.E.L., R.B.M., P.A.P., J.K.O., V.T.N.)
| | - Jeremy J Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A., S.K., S.V.P., J.J.T., E.A.E.-A., K.M., D.O., S.A.L., R.P., C.E.L., R.B.M., P.A.P., J.K.O., V.T.N.)
| | - Edward A El-Am
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A., S.K., S.V.P., J.J.T., E.A.E.-A., K.M., D.O., S.A.L., R.P., C.E.L., R.B.M., P.A.P., J.K.O., V.T.N.).,Department of Medicine, Indiana University School of Medicine, Indianapolis (E.A.E.-A.)
| | | | - Kareem Morant
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A., S.K., S.V.P., J.J.T., E.A.E.-A., K.M., D.O., S.A.L., R.P., C.E.L., R.B.M., P.A.P., J.K.O., V.T.N.).,North York General Hospital, Toronto, ON, Canada (K.M.)
| | - Didem Oguz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A., S.K., S.V.P., J.J.T., E.A.E.-A., K.M., D.O., S.A.L., R.P., C.E.L., R.B.M., P.A.P., J.K.O., V.T.N.)
| | - Sushil A Luis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A., S.K., S.V.P., J.J.T., E.A.E.-A., K.M., D.O., S.A.L., R.P., C.E.L., R.B.M., P.A.P., J.K.O., V.T.N.)
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A., S.K., S.V.P., J.J.T., E.A.E.-A., K.M., D.O., S.A.L., R.P., C.E.L., R.B.M., P.A.P., J.K.O., V.T.N.)
| | - Colleen E Lane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A., S.K., S.V.P., J.J.T., E.A.E.-A., K.M., D.O., S.A.L., R.P., C.E.L., R.B.M., P.A.P., J.K.O., V.T.N.)
| | - Robert B McCully
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A., S.K., S.V.P., J.J.T., E.A.E.-A., K.M., D.O., S.A.L., R.P., C.E.L., R.B.M., P.A.P., J.K.O., V.T.N.)
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A., S.K., S.V.P., J.J.T., E.A.E.-A., K.M., D.O., S.A.L., R.P., C.E.L., R.B.M., P.A.P., J.K.O., V.T.N.)
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A., S.K., S.V.P., J.J.T., E.A.E.-A., K.M., D.O., S.A.L., R.P., C.E.L., R.B.M., P.A.P., J.K.O., V.T.N.)
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A., S.K., S.V.P., J.J.T., E.A.E.-A., K.M., D.O., S.A.L., R.P., C.E.L., R.B.M., P.A.P., J.K.O., V.T.N.)
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18
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Alsidawi S. Avaliação da Insuficiência Valvar Aórtica por Ecocardiografia: Conceitos Básicos e Novos. Arq Bras Cardiol 2020; 115:261-262. [PMID: 32876193 PMCID: PMC8384290 DOI: 10.36660/abc.20200559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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19
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Alsidawi S, Campbell A, Tamene A, Garcia S. Ventricular Septal Rupture Complicating Delayed Acute Myocardial Infarction Presentation During the COVID-19 Pandemic. JACC Case Rep 2020; 2:1595-1598. [PMID: 32835258 PMCID: PMC7290201 DOI: 10.1016/j.jaccas.2020.05.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 04/27/2020] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 01/27/2023]
Abstract
The rate of mechanical complications of acute myocardial infarction has declined. Recent publications raised concerns over the reduction in cardiac catheterization laboratory activation for ST-segment myocardial infarction (STEMI) during the coronavirus disease-2019 (COVID-19) pandemic. We present 2 recent cases of ventricular septal rupture in patients who presented to our institution with delayed STEMI. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Said Alsidawi
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Alex Campbell
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Ashenafi Tamene
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Santiago Garcia
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota
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20
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Garcia S, Alsidawi S, Bae R, Cavalcante J, Eckman P, Gössl M, Steffen R, Sun B, Schmidt CW, Sorajja P. Percutaneous Mitral Valve Repair With MitraClip in Inoperable Patients With Severe Mitral Regurgitation Complicated by Cardiogenic Shock. J Invasive Cardiol 2020; 32:228-231. [PMID: 32385191] [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: 06/11/2023]
Abstract
BACKGROUND Severe mitral regurgitation (MR) complicated by cardiogenic shock has high operative mortality. Percutaneous leaflet repair with MitraClip (Abbott Vascular) is a less invasive alternative to surgery. The effectiveness and safety of this approach is unknown. METHODS We retrospectively analyzed procedural characteristics of shock patients with severe MR treated with MitraClip in a tertiary, high-volume program (Abbott Northwestern Hospital, Minneapolis, Minnesota) during 2010-2019. The primary outcome of the study was 30-day survival free of significant MR (grade ≤2). One-year mortality was a secondary outcome. RESULTS Among 322 patients who underwent MitraClip implantation during the study period, 11 inoperable patients with severe MR and cardiogenic shock were included in this analysis. Mean patient age was 74 ± 11 years and 54% were male. The mechanism of MR was degenerative in 7 patients (63.6%) and functional in 4 patients (36.4%), including 1 post myocardial infarction, 1 with chronic ischemic heart disease, and 2 with end-stage non-ischemic cardiomyopathy. Hemodynamic support with intra-aortic balloon pump was used in 5 patients (45%). The A2-P2 scallop was the more common location for MitraClip insertion, and 27% of patients had >1 clip implanted. Median fluoroscopy time was 18.5 minutes (interquartile range [IQR], 10-22 minutes) and mean postprocedure gradient was 4.5 mm Hg (IQR, 3-5 mm Hg). At 30 days, eight patients (72.7%) were alive with MR grade ≤2. At 1 year, mortality was 66%, and was driven mainly by non-cardiac causes. CONCLUSIONS Among inoperable patients with severe MR and cardiogenic shock, percutaneous leaflet repair with MitraClip is associated with acceptable short-term effectiveness.
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Affiliation(s)
- Santiago Garcia
- Minneapolis Heart Institute at Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN 55407 USA.
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21
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Ahmed A, Alsidawi S, Bae R, Cavalcante J, Fukui M, Gössl M, Sorajja P, Garcia S. Changes in quality of life in patients with low‐flow aortic stenosis undergoing transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2020; 96:972-978. [DOI: 10.1002/ccd.28805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/21/2019] [Revised: 01/23/2020] [Accepted: 02/10/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Aisha Ahmed
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital Minneapolis Minnesota
| | - Said Alsidawi
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital Minneapolis Minnesota
| | - Richard Bae
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital Minneapolis Minnesota
| | - Joao Cavalcante
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital Minneapolis Minnesota
| | - Miho Fukui
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital Minneapolis Minnesota
| | - Mario Gössl
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital Minneapolis Minnesota
| | - Paul Sorajja
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital Minneapolis Minnesota
| | - Santiago Garcia
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital Minneapolis Minnesota
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22
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El-Am E, Alsidawi S, Oguz D, Scott C, Thaden J, Pislaru S, Morant K, Pellikka P, Oh J, Nkomo V. 1049 High single-beat Doppler signals in low-gradient aortic stenosis are associated with higher aortic valve calcium. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.641] [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
Funding Acknowledgements
Mayo Clinic
Background
Variability in Doppler signals is common in patients with atrial fibrillation (AF) and AF is common in low-gradient AS (LGAS). Presence of high single beat Doppler signals (peak velocity ≥4m/s or mean gradient ≥40mmHg) is not factored into decision-making in low-gradient aortic stenosis (LGAS).
Objective
Determine prevalence of at least one high Doppler signal in AF LGAS and its relationship to computed tomography aortic valve calcium score (AVCS) versus sinus rhythm (SR) high-gradient aortic stenosis (HGAS).
Methods
Consecutive patients with aortic valve area ≤1cm2 and left ventricular ejection fraction ≥50% during echo were identified (January 1, 2012-December 31, 2016). At least three consecutive Doppler signals were averaged in sinus rhythm (SR) and five in atrial fibrillation (AF).
Results
Of 1,854 patients, age 76± 11 years, male 52%, 301/1,854 (16%) were in AF and LGAS was present in 122/301 (41%). At least one high Doppler signal in AF LGAS was present in 43/122 (35%). AVCS within 1 year of echo was available for 36% of patient with SR HGAS and 34% of AS LGAS. Median AVCS was not different in SR HGAS 2424 (IQR 1623, 3445) vs AF LGAS with at least one high Doppler signal 2509 [IQR1547, 3119], p =0.10 AVCS threshold for severe AS (men >2000 women >1200) was met in 80% SR HGAS vs 86% AF LGAS with high signals.
Conclusions
High Doppler signals in AF LGAS are associated with high AVCS more frequently exceeding thresholds for severe AS. Single-beat high Doppler signals instead of the average correlate better with AVCS and classic HGAS.
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Affiliation(s)
- E El-Am
- Mayo Clinic, Cardiovascular diseases, Rochester, United States of America
| | - S Alsidawi
- Mayo Clinic, Cardiovascular diseases, Rochester, United States of America
| | - D Oguz
- Mayo Clinic, Cardiovascular diseases, Rochester, United States of America
| | - C Scott
- Mayo Clinic, Cardiovascular diseases, Rochester, United States of America
| | - J Thaden
- Mayo Clinic, Cardiovascular diseases, Rochester, United States of America
| | - S Pislaru
- Mayo Clinic, Cardiovascular diseases, Rochester, United States of America
| | - K Morant
- Mayo Clinic, Cardiovascular diseases, Rochester, United States of America
| | - P Pellikka
- Mayo Clinic, Cardiovascular diseases, Rochester, United States of America
| | - J Oh
- Mayo Clinic, Cardiovascular diseases, Rochester, United States of America
| | - V Nkomo
- Mayo Clinic, Cardiovascular diseases, Rochester, United States of America
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23
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Wang Z, Ayoub C, Thaden JJ, Alsidawi S, Miller FA, Sinak LJ, Rihal CS, Melduni RM. Echocardiographic mimicker of thrombus on a mechanical aortic valve prosthesis due to cavitation: A paradoxical phenomenon of pressure recovery. Echocardiography 2019; 36:1397-1400. [DOI: 10.1111/echo.14403] [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: 05/07/2019] [Accepted: 05/19/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Zhenzhen Wang
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester Minnesota
| | - Chadi Ayoub
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester Minnesota
| | - Jeremy J. Thaden
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester Minnesota
| | - Said Alsidawi
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester Minnesota
| | | | - Lawrence J. Sinak
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester Minnesota
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Alsidawi S, Khan S, Pislaru SV, Nkomo VT. Aortic valve hemodynamics in atrial fibrillation: Should the highest Doppler signal be used to estimate severity of aortic stenosis? Echocardiography 2018; 35:869-871. [DOI: 10.1111/echo.14020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Said Alsidawi
- Minneapolis Heart Institute at Abbott Northwestern Hospital; Minneapolis MN USA
| | - Sana Khan
- Department of Cardiology; Mayo Clinic School of Medicine; Rochester MN USA
| | - Sorin V. Pislaru
- Department of Cardiology; Mayo Clinic School of Medicine; Rochester MN USA
| | - Vuyisile T. Nkomo
- Department of Cardiology; Mayo Clinic School of Medicine; Rochester MN USA
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Alsidawi S, Price K, Foote R, Garcia J, Westin G, Moore E, Chintakuntlawar A. Adjuvant Chemotherapy Utilization According to Treatment Facility Type in Resected Head and Neck Cancer With Negative Surgical Margins and No Extracapsular Nodal Extension. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2017.12.041] [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: 11/15/2022]
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Huntley GD, Thaden JJ, Alsidawi S, Michelena HI, Maleszewski JJ, Edwards WD, Scott CG, Pislaru SV, Pellikka PA, Greason KL, Ammash NM, Malouf JF, Enriquez-Sarano M, Nkomo VT. Comparative study of bicuspid vs. tricuspid aortic valve stenosis. Eur Heart J Cardiovasc Imaging 2017; 19:3-8. [DOI: 10.1093/ehjci/jex211] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/14/2017] [Indexed: 11/12/2022] Open
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Huntley G, Thaden J, Alsidawi S, Michelena H, Maleszewski J, Edwards W, Pislaru S, Pellikka P, Ammash N, Greason K, Maalouf Y, Enriquez-Sarano M, Nkomo V. BICUSPID VERSUS TRICUSPID AORTIC VALVE STENOSIS: COMPARATIVE STUDY OF CLINICAL CHARACTERISTICS AND OUTCOMES FOLLOWING AORTIC VALVE REPLACEMENT IN AN AGE-MATCHED COHORT. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35373-1] [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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Alsidawi S, Greason KL, Sandhu GS, Malouf JF, Chandrasekaran K. Percutaneous valve-in-homograft for management of a failed homograft. Eur Heart J Cardiovasc Imaging 2016; 17:1190. [DOI: 10.1093/ehjci/jew138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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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Abo-Salem E, Alsidawi S, Jamali H, Effat M, Helmy T. Optimal Duration of Dual Antiplatelet Therapy after Drug-Eluting Stents: Meta-Analysis of Randomized Trials. Cardiovasc Ther 2016; 33:253-63. [PMID: 26010419 DOI: 10.1111/1755-5922.12137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent implantation (DES) is not certain. The AHA/ACC guidelines recommend 12 months of DAPT based on observational trials. Recently, several large randomized controlled trials (RCT) suggested a noninferiority of shorter duration of DAPT and other trials showed a benefit from extended duration of DAPT after 12 months of DES implantation. METHODS PubMed databases were searched for RCTs comparing the continued use of DAPT to shorter duration of DAPT (aspirin alone) for variable durations beyond 3 months of DES implantation. Our analysis was limited to trials with clinical outcomes. Odds ratio (OR) and 95% confidence intervals (CI) were calculated using fixed and random-effects models. Subgroup analyses were performed for second generation DES and for trials comparing 12 months of DAPT vs. earlier interruption or longer duration of DAPT. RESULTS We identified 10 RCTs including 32,136 subjects randomized to continued use of DAPT vs. aspirin alone for variable durations after 3 months of DES implantation. There was no significant heterogeneity among studies (Q test P > 0.1). Compared to shorter DAPT, longer DAPT resulted in a significant reduction in stent thrombosis (0.3% vs. 0.7%, P < 0.01) and myocardial infarction (1.3% vs. 2%, P < 0.01), and a significant increase in major bleeding (0.8% vs. 0.4%, P < 0.01). There was no difference in cardiac deaths or stroke. All-cause deaths were slightly lower with shorter DAPT compared to longer DAPT (OR 0.8, 95% CI 0.7 to 0.99, P = 0.04). A small number of subjects were included between 3 and 6 months after DES implantation. CONCLUSION DAPT continued beyond 6 months after second generation DES implantation decreases stent thrombosis and myocardial infarction, but increases major bleeding and all-causes mortality compared to shorter DAPT (aspirin alone). There was no difference in cardiac mortality or stroke.
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Affiliation(s)
- Elsayed Abo-Salem
- Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, OH, USA
| | - Said Alsidawi
- Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, OH, USA
| | - Hina Jamali
- Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, OH, USA
| | - Mohamed Effat
- Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, OH, USA
| | - Tarek Helmy
- Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, OH, USA
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Abstract
A 62-year-old female with severe symptomatic rheumatic mitral stenosis was referred for mitral valve replacement. A 27-mm Carbomedics mechanical mitral valve was placed using everting sutures. As the patient was weaned off cardiopulmonary bypass, she became hemodynamically unstable. Intraoperative transesophageal echocardiogram revealed a significant drop in left ventricular function along with severe LVOT obstruction. The Carbomedics prosthesis was replaced by a 27-mm St. Jude mechanical valve using noneverting sutures which relieved the LVOT obstruction. doi: 10.1111/jocs.12749 (J Card Surg 2016;31:376-379).
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Affiliation(s)
- Said Alsidawi
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - David L Joyce
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph F Malouf
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Vuyisile T Nkomo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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Alsidawi S, Effat M, Rahman S, Abdallah M, Leesar M. The Role of Vascular Imaging in Guiding Routine Percutaneous Coronary Interventions: A Meta-Analysis of Bare Metal Stent and Drug-Eluting Stent Trials. Cardiovasc Ther 2015; 33:360-6. [DOI: 10.1111/1755-5922.12160] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 11/28/2022] Open
Affiliation(s)
- Said Alsidawi
- Division of Cardiovascular Health and Diseases; University of Cincinnati College of Medicine; Cincinnati OH USA
| | - Mohamed Effat
- Division of Cardiovascular Health and Diseases; University of Cincinnati College of Medicine; Cincinnati OH USA
| | - Shahid Rahman
- Division of Cardiovascular Health and Diseases; University of Cincinnati College of Medicine; Cincinnati OH USA
| | - Mouhamad Abdallah
- Division of Cardiovascular Health and Diseases; University of Cincinnati College of Medicine; Cincinnati OH USA
| | - Massoud Leesar
- Division of Cardiovascular Diseases; University of Alabama; Birmingham AL USA
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Alsaied T, Alsidawi S, Allen CC, Faircloth J, Palumbo JS, Veldtman GR. Strategies for thromboprophylaxis in Fontan circulation: a meta-analysis. Heart 2015; 101:1731-7. [PMID: 26319122 DOI: 10.1136/heartjnl-2015-307930] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [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: 04/02/2015] [Accepted: 08/06/2015] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The Fontan circulation is associated with an increased risk of thromboembolic events (TEs). As many as 25% of these thrombotic events result in fatality. More subtle adverse effects on the pulmonary circulation from embolic thrombi may further impair adequate functioning of the circuit. Despite these well-documented phenomena, the most optimal approaches to thromboprophylaxis are still not clearly defined. OBJECTIVE A meta-analysis of published trials in English on PubMed and Cochrane libraries that evaluated the role of using TE prophylaxis in patients who underwent the Fontan procedure was conducted. METHODS 10 studies with a total number of 1200 patients with an average follow-up time of 7.1 years were identified. A random effect model was used. RESULTS The incidence of TE was significantly less in patients who received TE prophylaxis (using either aspirin or warfarin) compared with patients who did not receive TE prophylaxis (OR 0.425, 95% CI 0.194 to 0.929, p<0.01, I(2)=37%). The incidence of TE was significantly lower in patients who received aspirin compared with no TE prophylaxis (OR 0.363, 95% CI 0.177 to 0.744, p<0.01, I(2)=0%) and who received warfarin compared with no TE prophylaxis (OR 0.327, 95% CI 0.168 to 0.634, p<0.01, I(2)=2.5%). There was no significant difference in incidence of TE between warfarin and aspirin (OR 0.936, 95% CI 0.609 to 1.438, p=0.54, I(2)=0%). Furthermore, there was no significant difference in incidence of early TE (within 6 months of the operation) or late TE (>6 months) between patients receiving warfarin and aspirin (OR 0.784, 95% CI 0.310 to 1.982, p=0.37, I(2)=8%) and (OR 0.776, 95% CI 0.249 to 2.42, p=0.3, I(2)=45%), respectively. When only total cavopulmonary connection patients were included, there was again no difference between warfarin and aspirin in the incidence of TE (OR 0.813, 95% CI 0.471 to 1.401, p=0.34, I(2)=11%). CONCLUSIONS This study shows a significantly lower incidence of TE after Fontan procedure if either aspirin or warfarin is used. This meta-analysis suggests no significant difference in incidence of early or late TE in patients receiving aspirin compared with warfarin.
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Affiliation(s)
- Tarek Alsaied
- Pediatric Cardiology Fellowship Training Program, Children's Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Said Alsidawi
- Division of Cardiovascular Health and Disease, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Catherine C Allen
- Pediatric Cardiology Fellowship Training Program, Children's Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jenna Faircloth
- Division of Pharmacy, Children's Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Joseph S Palumbo
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Gruschen R Veldtman
- Adolescent and Adult Congenital Program, Children's Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Alsidawi S, Nkomo VT, Dearani JA, Freeman WK. Rapid pannus formation: a rare cause of mitral stenosis following successful mitral valve repair. Eur Heart J Cardiovasc Imaging 2015; 17:8. [PMID: 26453543 DOI: 10.1093/ehjci/jev245] [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)
- Said Alsidawi
- Division of Cardiovascular Diseases, Mayo Clinic School of Medicine, 200 First Street SW, Rochester 55905, MN, USA
| | - Vuyisile T Nkomo
- Division of Cardiovascular Diseases, Mayo Clinic School of Medicine, 200 First Street SW, Rochester 55905, MN, USA
| | - Joseph A Dearani
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - William K Freeman
- Division of Cardiovascular Diseases, Mayo Clinic School of Medicine, 200 First Street SW, Rochester 55905, MN, USA
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Affiliation(s)
- Said Alsidawi
- Division of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Mackram F Eleid
- Division of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Charanjit S Rihal
- Division of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Vuyisile T Nkomo
- Division of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Sorin Pislaru
- Division of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, MN, USA
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Alsidawi S, Couto M, López-Candales A. Acquired Von Willebrand Syndrome In Aortic Stenosis: Case Report And Review. Bol Asoc Med P R 2015; 107:86-88. [PMID: 26434092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We present a case of a 61 year old man who presented with a 3 week history of easy bruising and ecchymoses in both thighs and right arm without significant trauma. Physical exam was remarkable for oozing gums, diminished second heart sound, a systolic ejection murmur at the aortic position with radiation to carotids, and delayed pulses. Laboratories were remarkable for iron deficiency anemia. Echocardiogram was consistent with severe aortic stenosis. Colonoscopy revealed several arteriovenous malformations throughout the colon. There is an association between severe aortic stenosis and gastrointestinal bleeding. The pathogenesis of Heyde's Syndrome involves iron deficiency anemia due to acquired von Willebrand factor (vWF) deficiency and ultimately gastrointestinal angiodysplasia. Correct diagnosis and management warrants a multidisciplinary approach.
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Alsidawi S, Alsaied T, Veldtman G. THROMBOEMBOLISM PROPHYLAXIS IN FONTAN PATIENTS. WHAT SHOULD WE USE? A META-ANALYSIS OF PUBLISHED TRIALS. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60509-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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37
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Alsidawi S, Effat M. Peri-procedural management of anti-platelets and anticoagulation in patients undergoing MitraClip procedure. J Thromb Thrombolysis 2014; 38:416-9. [DOI: 10.1007/s11239-014-1092-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abd-Elsayed AA, Lisco SJ, Alsidawi S, Bonomo J. Simultaneous antiphospholipid syndrome and heparin-induced thrombocytopenia in a single patient. A A Case Rep 2014; 2:9-10. [PMID: 25612260 DOI: 10.1097/acc.0b013e3182a1afc9] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Antiphospholipid syndrome and heparin-induced thrombocytopenia are immune-mediated thrombotic conditions initiated by 2 distinct antibodies each targeting a discrete protein-antigen complex. Although produced by 2 different types of antibodies, they are similar in their autoimmune and pathophysiologic mechanisms. We present a case with simultaneous antiphospholipid syndrome and heparin-induced thrombocytopenia syndromes that sheds light on the correlation between these 2 syndromes.
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Affiliation(s)
- Alaa A Abd-Elsayed
- From the *Department of Anesthesiology, University of Cincinnati, Cincinnati, Ohio; †Department of Anesthesiology, University of Nebraska, Omaha, Nebraska; and Departments of ‡Internal Medicine and §Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
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Alsidawi S, Khan F. Anomalous left main coronary artery originating from the pulmonary artery. J Thromb Thrombolysis 2013; 38:223-5. [PMID: 24352974 DOI: 10.1007/s11239-013-1038-1] [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: 10/25/2022]
Affiliation(s)
- Said Alsidawi
- Division of Cardiovascular Health and Disease, University of Cincinnati College of Medicine, Cincinnati, OH, USA,
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Yang FH, Zhang B, Zhou DJ, Bie L, Tom MW, Drummond DC, Nicolaides T, Mueller S, Banerjee A, Park JW, Prados MD, James DC, Gupta N, Hashizume R, Strohbehn GW, Zhou J, Fu M, Patel TR, Piepmeier JM, Saltzman WM, Xie Q, Johnson J, Bradley R, Ascierto ML, Kang L, Koeman J, Marincola FM, Briggs M, Tanner K, Vande Woude GF, Tanaka S, Klofas LK, Wakimoto H, Borger DR, Iafrate AJ, Batchelor TT, Chi AS, Madhankumar AB, Slagle-Webb B, Rizk E, Harbaugh K, Connor JR, Sarkar G, Curran GL, Jenkins RB, Kurozumi K, Ichikawa T, Onishi M, Fujii K, Ishida J, Shimazu Y, Date I, Ebsworth K, Walters MJ, Ertl LS, Wang Y, Berahovich RD, Zhang P, Powers JP, Liu SC, Al Omran R, Sullivan TJ, Jaen JC, Brown M, Schall TJ, Yusuke N, Shimizu S, Shishido-Hara Y, Shiokawa Y, Nagane M, Wang J, Sai K, Chen FR, Chen ZP, Shi Z, Zhang J, Zhang K, Han L, Chen L, Qian X, Zhang A, Wang G, Jia Z, Pu P, Kang C, Kong LY, Doucette TA, Ferguson SD, Hachem J, Yang Y, Wei J, Priebe W, Fuller GN, Qiao W, Rao G, Heimberger AB, Chen PY, Ozawa T, Drummond D, Santos R, Torre JD, Ng C, Lepe EL, Butowski N, Prados M, Bankiewicz K, James CD, Cheng Z, Gong Y, Ma Y, Muller-Knapp S, Knapp S, Wang J, Fujii K, Kurozumi K, Ichikawa T, Onishi M, Shimazu Y, Ishida J, Antonio Chiocca E, Kaur B, Date I, Yu JS, Judkowski V, Bunying A, Ji J, Li Z, Bender J, Pinilla C, Srinivasan V, Dombovy-Johnson M, Carson-Walter E, Walter K, Xu Z, Popp B, Schlesinger D, Gray L, Sheehan J, Keir ST, Friedman HS, Bigner DD, Kut C, Tyler B, McVeigh E, Li X, Herzka D, Grossman S, Lasky JL, Wang Y, Panosyan E, Meisen WH, Hardcastle J, Wojton J, Wohleb E, Alvarez-Breckenridge C, Nowicki M, Godbout J, Kaur B, Lee SY, Slagle-Webb B, Sheehan JM, Connor JR, Yin S, Kaluz S, Devi SN, de Noronha R, Nicolaou KC, Van Meir EG, Lachowicz JE, Demeule M, Che C, Tripathy S, Jarvis S, Currie JC, Regina A, Nguyen T, Castaigne JP, Zielinska-Chomej K, Mohanty C, Viktorsson K, Lewensohn R, Driscoll JJ, Alsidawi S, Warnick RE, Rixe O, deCarvalho AC, Irtenkauf S, Hasselbach L, Xin H, Mikkelsen T, Sherman JH, Siu A, Volotskova O, Keidar M, Gibo DM, Dickinson P, Robertson J, Rossmeisl J, Debinski W, Nair S, Schmittling R, Boczkowski D, Archer G, Bigner DD, Sampson JH, Mitchell DA, Miller IS, Didier S, Murray DW, Issaivanan M, Coniglio SJ, Segall JE, Al-Abed Y, Symons M, Fotovati A, Hu K, Wakimoto H, Triscott J, Bacha J, Brown DM, Dunn SE, Daniels DJ, Peterson TE, Dietz AB, Knutson GJ, Parney IF, Diaz RJ, Golbourn B, Picard D, Smith C, Huang A, Rutka J, Saito N, Fu J, Yao J, Wang S, Koul D, Yung WKA, Fu J, Koul D, Yao J, Wang S, Yuan Y, Sulman EP, Colman H, Lang FF, Yung WKA, Slat EA, Herzog ED, Rubin JB, Brown M, Carminucci AS, Amendolara B, Leung R, Lei L, Canoll P, Bruce JN, Wojton JA, Chu Z, Kwon CH, Chow LM, Palascak M, Franco R, Bourdeau T, Thornton S, Qi X, Kaur B, Kitange GJ, Mladek AC, Su D, Carlson BL, Schroeder MA, Pokorny JL, Bakken KK, Gupta SK, Decker PA, Wu W, Sarkaria JN, Colman H, Oddou MP, Mollard A, Call LT, Vakayalapati H, Warner SL, Sharma S, Bearss DJ, Chen TC, Cho H, Wang W, Hofman FM, Flores CT, Snyder D, Sanchez-Perez L, Pham C, Friedman H, Bigner DD, Sampson JH, Mitchell DA, Woolf E, Abdelwahab MG, Turner G, Preul MC, Lynch A, Rho JM, Scheck AC, Salphati L, Heffron TP, Alicke B, Barck K, Carano RA, Cheong J, Greve J, Lee LB, Nishimura M, Pang J, Plise EG, Reslan HB, Zhang X, GOuld SG, Olivero AG, Phillips HS, Zadeh G, Jalali S, Voce D, Wei Z, Shijun K, Nikolai K, Josh W, Clayton C, Bakhtiar Y, Alkins R, Burgess A, Ganguly M, Wels W, Hynynen K, Li YM, Jun H, Daniel V, Walter HA, Nakashima H, Nguyen TT, Shalkh I, Goins WF, Chiocca EA, Pyko IV, Nakada M, Furuyama N, Lei T, Hayashi Y, Kawakami K, Minamoto T, Fedulau AS, Hamada JI. LAB-EXPERIMENTAL (PRE-CLINICAL) THERAPEUTICS AND PHARMACOLOGY. Neuro Oncol 2012; 14:vi25-vi37. [PMCID: PMC3488776 DOI: 10.1093/neuonc/nos222] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
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Alsidawi S, Muth J, Wilkin J. Adderall induced inverted-Takotsubo cardiomyopathy. Catheter Cardiovasc Interv 2011; 78:910-3. [DOI: 10.1002/ccd.23036] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 01/29/2011] [Indexed: 11/08/2022]
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