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Cremer PC, Geske JB, Owens A, Jaber WA, Harb SC, Saberi S, Wang A, Sherrid M, Naidu SS, Schaff HV, Smedira NG, Wang Q, Wolski K, Lampl KL, Sehnert AJ, Nissen SE, Desai MY. Mitral Regurgitation in Obstructive Hypertrophic Cardiomyopathy: Insight from the VALOR-HCM Study. JACC Cardiovasc Imaging 2024:S1936-878X(24)00109-8. [PMID: 38639695 DOI: 10.1016/j.jcmg.2024.02.014] [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: 11/12/2023] [Revised: 02/01/2024] [Accepted: 02/28/2024] [Indexed: 04/20/2024]
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Hanson ID, Rusia A, Palomo A, Tawney A, Pow T, Dixon SR, Meraj P, Sievers E, Johnson M, Wohns D, Ali O, Kapur NK, Grines C, Burkhoff D, Anderson M, Lansky A, Naidu SS, Basir MB, O'Neill W. Treatment of Acute Myocardial Infarction and Cardiogenic Shock: Outcomes of the RECOVER III Postapproval Study by Society of Cardiovascular Angiography and Interventions Shock Stage. J Am Heart Assoc 2024; 13:e031803. [PMID: 38293995 PMCID: PMC11056148 DOI: 10.1161/jaha.123.031803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND The Society for Cardiovascular Angiography and Interventions proposed a staging system (A-E) to predict prognosis in cardiogenic shock. Herein, we report clinical outcomes of the RECOVER III study for the first time, according to Society for Cardiovascular Angiography and Interventions shock classification. METHODS AND RESULTS The RECOVER III study is an observational, prospective, multicenter, single-arm, postapproval study of patients with acute myocardial infarction with cardiogenic shock undergoing percutaneous coronary intervention with Impella support. Patients enrolled in the RECOVER III study were assigned a baseline Society for Cardiovascular Angiography and Interventions shock stage. Staging was then repeated within 24 hours after initiation of Impella. Kaplan-Meier survival curve analyses were conducted to assess survival across Society for Cardiovascular Angiography and Interventions shock stages at both time points. At baseline assessment, 16.5%, 11.4%, and 72.2% were classified as stage C, D, and E, respectively. At ≤24-hour assessment, 26.4%, 33.2%, and 40.0% were classified as stage C, D, and E, respectively. Thirty-day survival among patients with stage C, D, and E shock at baseline was 59.7%, 56.5%, and 42.9%, respectively (P=0.003). Survival among patients with stage C, D, and E shock at ≤24 hours was 65.7%, 52.1%, and 29.5%, respectively (P<0.001). After multivariable analysis of impact of shock stage classifications at baseline and ≤24 hours, only stage E classification at ≤24 hours was a significant predictor of mortality (odds ratio, 4.8; P<0.001). CONCLUSIONS In a real-world cohort of patients with acute myocardial infarction with cardiogenic shock undergoing percutaneous coronary intervention with Impella support, only stage E classification at ≤24 hours was significantly predictive of mortality, suggesting that response to therapy may be more important than clinical severity of shock at presentation.
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Affiliation(s)
- Ivan D. Hanson
- Department of Cardiovascular MedicineWilliam Beaumont University HospitalRoyal OakMI
| | - Akash Rusia
- Department of Advanced Heart Failure, Baylor Scott & White Health–The Heart HospitalPlanoTX
| | - Andres Palomo
- Department of Cardiovascular MedicineWilliam Beaumont University HospitalRoyal OakMI
| | - Adam Tawney
- Department of Cardiovascular MedicineWilliam Beaumont University HospitalRoyal OakMI
| | - Timothy Pow
- Department of Cardiovascular MedicineWilliam Beaumont University HospitalRoyal OakMI
| | - Simon R. Dixon
- Department of Cardiovascular MedicineWilliam Beaumont University HospitalRoyal OakMI
| | | | - Eric Sievers
- Department of Cardiovascular SurgeryJackson‐Madison County HospitalJacksonTN
| | | | - David Wohns
- Division of CardiologySpectrum HealthGrand RapidsMI
| | - Omar Ali
- Department of CardiologyDetroit Medical CenterDetroitMI
| | - Navin K. Kapur
- Department of CardiologyTufts University School of MedicineBostonMA
| | - Cindy Grines
- Northside Hospital Cardiovascular InstituteAtlantaGA
| | | | - Mark Anderson
- Department of Cardiac SurgeryHackensack University Medical CenterHackensackNJ
| | | | - Srihari S. Naidu
- Department of CardiologyWestchester Medical Center and New York Medical CollegeValhallaNY
| | - Mir B. Basir
- Division of CardiologyHenry Ford HospitalDetroitMI
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3
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Bali AD, Malik A, Naidu SS. Treatment Strategies for Hypertrophic Cardiomyopathy: Alcohol Septal Ablation and Procedural Step-by-Step Technique. Am J Cardiol 2024; 212S:S42-S52. [PMID: 38368036 DOI: 10.1016/j.amjcard.2023.10.064] [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: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 02/19/2024]
Abstract
Alcohol septal ablation (ASA) is a well-established procedure for septal reduction therapy in patients with obstructive hypertrophic cardiomyopathy, significant at rest or provocable outflow tract gradients, and medically refractory symptoms. This percutaneous approach to relief of obstruction and eventual cardiac remodeling involves the infusion of a small quantity of ethanol into an appropriately targeted septal artery that is feeding the basal septum to create an iatrogenic and controlled focal infarction. Early akinesia is followed by subsequent thinning and remodeling, which widens the outflow tract, reducing or eliminating the obstruction. Historically, the use of ASA was reserved primarily for high-risk surgical candidates; however, more contemporary data suggest similar outcomes in the short-term and long-term safety of the procedure and overall effectiveness in relieving obstructive symptoms when it is performed in broader populations at experienced centers. Therefore, the current guidelines published in 2020 support ASA as a class 1 indication, similar to its open-heart surgical counterpart, surgical myectomy, when no concomitant significant coronary or valve surgical indication exists. This article summarizes contemporary management of patients with hypertrophic cardiomyopathy who were selected for ASA and details procedural methods and outcomes.
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Affiliation(s)
- Atul D Bali
- Westchester Medical Center, New York Medical College, Valhalla, New York.
| | - Aaqib Malik
- Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Srihari S Naidu
- Westchester Medical Center, New York Medical College, Valhalla, New York
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Verghese D, Bhat AG, Patlolla SH, Naidu SS, Basir MB, Cubeddu RJ, Navas V, Zhao DX, Vallabhajosyula S. Outcomes in non-ST-segment elevation myocardial infarction complicated by in-hospital cardiac arrest based on management strategy. Indian Heart J 2023; 75:443-450. [PMID: 37863393 PMCID: PMC10774581 DOI: 10.1016/j.ihj.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/19/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND There are limited data on in-hospital cardiac arrest (IHCA) complicating non-ST-segment-elevation myocardial infarction (NSTEMI) based on management strategy. METHODS We used National Inpatient Sample (2000-2017) to identify adults with NSTEMI (not undergoing coronary artery bypass grafting) and concomitant IHCA. The cohort was stratified based on use of early (hospital day 0) or delayed (≥hospital day 1) coronary angiography (CAG), percutaneous coronary intervention (PCI), and medical management. Outcomes included incidence of IHCA, in-hospital mortality, adverse events, length of stay, and hospitalization costs. RESULTS Of 6,583,662 NSTEMI admissions, 375,873 (5.7 %) underwent early CAG, 1,133,143 (17.2 %) received delayed CAG, 2,326,391 (35.3 %) underwent PCI, and 2,748,255 (41.7 %) admissions were managed medically. The medical management cohort was older, predominantly female, and with higher comorbidities. Overall, 63,085 (1.0 %) admissions had IHCA, and incidence of IHCA was highest in the medical management group (1.4 % vs 1.1 % vs 0.7 % vs 0.6 %, p < 0.001) compared to early CAG, delayed CAG and PCI groups, respectively. In adjusted analysis, early CAG (adjusted OR [aOR] 0.67 [95 % confidence interval {CI} 0.65-0.69]; p < 0.001), delayed CAG (aOR 0.49 [95 % CI 0.48-0.50]; p < 0.001), and PCI (aOR 0.42 [95 % CI 0.41-0.43]; p < 0.001) were associated with lower incidence of IHCA compared to medical management. Compared to medical management, early CAG (adjusted OR 0.53, CI: 0.49-0.58), delayed CAG (adjusted OR 0.34, CI: 0.32-0.36) and PCI (adjusted OR 0.19, CI: 0.18-0.20) were associated with lower in-hospital mortality (all p < 0.001). CONCLUSION Early CAG and PCI in NSTEMI was associated with lower incidence of IHCA and lower mortality among NSTEMI-IHCA admissions.
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Affiliation(s)
- Dhiran Verghese
- Division of Cardiovascular Medicine, Department of Medicine, Naples Heart Institute, Naples, FL, USA
| | - Anusha G Bhat
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland, Baltimore, MD, USA
| | | | - Srihari S Naidu
- Division of Cardiovascular Medicine, Westchester Medical Center/New York Medical College, Valhalla, NY, USA
| | - Mir B Basir
- Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Robert J Cubeddu
- Division of Cardiovascular Medicine, Department of Medicine, Naples Heart Institute, Naples, FL, USA
| | - Viviana Navas
- Division of Cardiovascular Medicine, Department of Medicine, Naples Heart Institute, Naples, FL, USA
| | - David X Zhao
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
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Fishkin T, Isath A, Virk HUH, Bandyopadhyay D, Wang Z, Naidu SS, Jneid H, Krittanawong C. Ultrasound Guidance for Vascular Access for Coronary Angiogram: A Meta-Analysis of Randomized Controlled Trials. Am J Cardiol 2023; 206:70-72. [PMID: 37683581 DOI: 10.1016/j.amjcard.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/29/2023] [Accepted: 08/05/2023] [Indexed: 09/10/2023]
Abstract
Obtaining vascular access during percutaneous coronary intervention is necessary to facilitate the procedure but carries procedural risks that impact patient outcomes. Historically, vascular access has been accomplished using anatomic landmarks, pulsation, and/or fluoroscopic guidance. Ultrasound (US) guidance has emerged as a modality for achieving vascular access in a multitude of interventional procedures including those in the cardiac catheterization laboratory. US use has been demonstrated in randomized controlled trials and meta-analyses to be associated with an increased success rate for vascular access with fewer complications, although the data are mixed. We aimed to re-evaluate the totality of evidence in an updated meta-analysis to compare the ease of access and complications rates between US-guided and manual vascular access. A meta-analysis of 8 randomized controlled trials including 5,170 patients was performed. The primary outcome evaluated was the rate of access failure, and the secondary outcomes included hematomas and access site bleeding. US-guided arterial access was associated with a significantly higher rate of first-attempt success and a decreased risk of venipuncture. US use had a trend toward a lower total number of attempts, but the results were not significant. This updated meta-analysis further supports the use of US for vascular access for coronary angiography because of higher rates of first-attempt success and reduced venipuncture. However, there was no significant difference in vascular complications such as hematoma, pseudoaneurysm, and bleeding complications. Because of the high morbidity of bleeding complications associated with coronary angiography, further research should be done to reduce these complications.
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Affiliation(s)
- Tzvi Fishkin
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Ameesh Isath
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Hafeez Ul Hassan Virk
- Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Hani Jneid
- Division of Cardiology, University of Texas Medical Branch, Houston, Texas
| | - Chayakrit Krittanawong
- Cardiology Division, New York University Langone Health and New York University School of Medicine, New York, New York.
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6
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Desai MY, Owens A, Wolski K, Geske JB, Saberi S, Wang A, Sherrid M, Cremer PC, Lakdawala NK, Tower-Rader A, Fermin D, Naidu SS, Smedira NG, Schaff H, McErlean E, Sewell C, Mudarris L, Gong Z, Lampl K, Sehnert AJ, Nissen SE. Mavacamten in Patients With Hypertrophic Cardiomyopathy Referred for Septal Reduction: Week 56 Results From the VALOR-HCM Randomized Clinical Trial. JAMA Cardiol 2023; 8:968-977. [PMID: 37639243 PMCID: PMC10463171 DOI: 10.1001/jamacardio.2023.3342] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Received: 07/19/2023] [Accepted: 08/07/2023] [Indexed: 08/29/2023]
Abstract
Importance There is an unmet need for novel medical therapies before recommending invasive therapies for patients with severely symptomatic obstructive hypertrophic cardiomyopathy (HCM). Mavacamten has been shown to improve left ventricular outflow tract (LVOT) gradient and symptoms and may thus reduce the short-term need for septal reduction therapy (SRT). Objective To examine the cumulative longer-term effect of mavacamten on the need for SRT through week 56. Design, Setting, and Participants This was a double-blind, placebo-controlled, multicenter, randomized clinical trial with placebo crossover at 16 weeks, conducted from July 2020 to November 2022. Participants were recruited from 19 US HCM centers. Included in the trial were patients with obstructive HCM (New York Heart Association class III/IV) referred for SRT. Study data were analyzed April to August 2023. Interventions Patients initially assigned to mavacamten at baseline continued the drug for 56 weeks, and patients taking placebo crossed over to mavacamten from week 16 to week 56 (40-week exposure). Dose titrations were performed using echocardiographic LVOT gradient and LV ejection fraction (LVEF) measurements. Main Outcome and Measure Proportion of patients undergoing SRT, remaining guideline eligible or unevaluable SRT status at week 56. Results Of 112 patients with highly symptomatic obstructive HCM, 108 (mean [SD] age, 60.3 [12.5] years; 54 male [50.0%]) qualified for the week 56 evaluation. At week 56, 5 of 56 patients (8.9%) in the original mavacamten group (3 underwent SRT, 1 was SRT eligible, and 1 was not SRT evaluable) and 10 of 52 patients (19.2%) in the placebo crossover group (3 underwent SRT, 4 were SRT eligible, and 3 were not SRT evaluable) met the composite end point. A total of 96 of 108 patients (89%) continued mavacamten long term. Between the mavacamten and placebo-to-mavacamten groups, respectively, after 56 weeks, there was a sustained reduction in resting (mean difference, -34.0 mm Hg; 95% CI, -43.5 to -24.5 mm Hg and -33.2 mm Hg; 95% CI, -41.9 to -24.5 mm Hg) and Valsalva (mean difference, -45.6 mm Hg; 95% CI, -56.5 to -34.6 mm Hg and -54.6 mm Hg; 95% CI, -66.0 to -43.3 mm Hg) LVOT gradients. Similarly, there was an improvement in NYHA class of 1 or higher in 51 of 55 patients (93%) in the original mavacamten group and in 37 of 51 patients (73%) in the placebo crossover group. Overall, 12 of 108 patients (11.1%; 95% CI, 5.87%-18.60%), which represents 7 of 56 patients (12.5%) in the original mavacamten group and 5 of 52 patients (9.6%) in the placebo crossover group, had an LVEF less than 50% (2 with LVEF ≤30%, one of whom died), and 9 of 12 patients (75%) continued treatment. Conclusions and Relevance Results of this randomized clinical trial showed that in patients with symptomatic obstructive HCM, mavacamten reduced the need for SRT at week 56, with sustained improvements in LVOT gradients and symptoms. Although this represents a useful therapeutic option, given the potential risk of LV systolic dysfunction, there is a continued need for close monitoring. Trial Registration ClinicalTrials.gov Identifier: NCT04349072.
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Affiliation(s)
- Milind Y. Desai
- The Hypertrophic Cardiomyopathy Center, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
- Coordinating Center for Clinical Research Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Anjali Owens
- Division of Cardiology, University of Pennsylvania, Philadelphia
| | - Kathy Wolski
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
- Coordinating Center for Clinical Research Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jeffrey B. Geske
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Sara Saberi
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Andrew Wang
- Department of Cardiology, Duke University, Durham, North Carolina
| | - Mark Sherrid
- Department of Cardiology, New York University, New York
| | - Paul C. Cremer
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
- Coordinating Center for Clinical Research Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Neal K. Lakdawala
- Division of Cardiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - David Fermin
- Department of Cardiology, Corewell Health, Grand Rapids, Michigan
| | - Srihari S. Naidu
- Department of Cardiology, Westchester Medical Center, Valhalla, New York
| | - Nicholas G. Smedira
- The Hypertrophic Cardiomyopathy Center, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Cardiothoracic Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hartzell Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Ellen McErlean
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
- Coordinating Center for Clinical Research Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Christina Sewell
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
- Coordinating Center for Clinical Research Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | | | | | | | | | - Steven E. Nissen
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
- Coordinating Center for Clinical Research Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
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Isath A, Naami E, Fried JA, Bellumkonda L, Naidu SS, Tang WHW, Sharma S, Jneid H, Krittanawong C. Intra-Aortic Balloon Pump: Uncovering Myths and Misconceptions. Curr Probl Cardiol 2023; 48:101806. [PMID: 37209795 DOI: 10.1016/j.cpcardiol.2023.101806] [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: 05/09/2023] [Accepted: 05/13/2023] [Indexed: 05/22/2023]
Affiliation(s)
- Ameesh Isath
- Department of Cardiology, Westchester Medical Centre, New York Medical College, Valhalla, NY
| | - Edmund Naami
- Department of Cardiology, Westchester Medical Centre, New York Medical College, Valhalla, NY
| | - Justin A Fried
- Division of Cardiology, Cardiac Care Unit, Department of Medicine, Columbia University Medical Center, New York, NY
| | - Lavanya Bellumkonda
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Centre, New York Medical College, Valhalla, NY
| | - W H Wilson Tang
- Department of Cardiology, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Samin Sharma
- Department of Cardiology, Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Hospital, New York, NY
| | - Hani Jneid
- Division of Cardiology, Chief of the Division of Cardiology at UTMB, Houston, TX
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8
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Ismayl M, Hussain Y, Aboeata A, Walters RW, Naidu SS, Messenger JC, Basir MB, Rao SV, Goldsweig AM, Altin SE. Pulmonary Artery Catheter Use and Outcomes in Patients With ST-Elevation Myocardial Infarction and Cardiogenic Shock Treated With Impella (a Nationwide Analysis from the United States). Am J Cardiol 2023; 203:304-314. [PMID: 37517125 DOI: 10.1016/j.amjcard.2023.06.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 04/15/2023] [Revised: 05/24/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023]
Abstract
The role of continuous hemodynamic assessment with pulmonary artery (PA) catheter placement in cardiogenic shock (CS) remains debated. We aimed to assess the association between PA catheter placement and clinical outcomes in patients with CS secondary to ST-elevation myocardial infarction (STEMI) treated with an intravascular microaxial flow pump. We identified patients hospitalized with STEMI complicated by CS on mechanical circulatory support with an intravascular microaxial flow pump (Impella, Abiomed, Danvers, Massachusetts) using the National Inpatient Sample database and compared the outcomes in those treated with and without PA catheters. The primary outcome was in-hospital mortality. The secondary outcomes included in-hospital complications, hospital length of stay, inpatient costs, and temporal trends. The total cohort included 14,635 hospitalizations for STEMI complicated by CS treated with Impella between 2016 and 2020, of whom 5,505 (37.6%) received PA catheters. Over the study period, the use of PA catheters increased significantly from 25.9% to 41.8% (ptrend <0.01). Similarly, the use of Impella increased from 9.9% to 18.9% (ptrend <0.01). After adjustment for baseline characteristics using a multivariate logistic regression analysis, PA catheter use was associated with lower in-hospital mortality (adjusted odds ratio 0.80, 95% confidence interval 0.67 to 0.96, p = 0.01) and similar cardiovascular, neurologic, renal, and hematologic complications; length of stay; and inpatient costs compared with no PA catheter use. In conclusion, PA catheter use in patients with STEMI complicated by CS treated with Impella is associated with reduced in-hospital mortality and similar complication rates. Given the mortality benefit, further research is necessary to optimize PA catheter use in patients with STEMI with CS.
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Affiliation(s)
- Mahmoud Ismayl
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota.
| | - Yasin Hussain
- Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Ahmed Aboeata
- Department of Cardiovascular Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Ryan W Walters
- Clinical Research and Evaluative Sciences, Creighton University School of Medicine, Omaha, Nebraska
| | - Srihari S Naidu
- Department of Cardiovascular Medicine, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - John C Messenger
- Department of Cardiovascular Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Mir B Basir
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Sunil V Rao
- Department of Cardiovascular Medicine, NYU Langone Health System, New York, New York
| | - Andrew M Goldsweig
- Department of Cardiovascular Medicine, Baystate Medical Center and University of Massachusetts-Baystate, Springfield, Massachusetts
| | - S Elissa Altin
- Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
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9
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Isath A, Koziol KJ, Martinez MW, Garber CE, Martinez MN, Emery MS, Baggish AL, Naidu SS, Lavie CJ, Arena R, Krittanawong C. Exercise and cardiovascular health: A state-of-the-art review. Prog Cardiovasc Dis 2023; 79:44-52. [PMID: 37120119 DOI: 10.1016/j.pcad.2023.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Abstract
Cardiovascular (CV) disease (CVD) is the leading cause of global morbidity and mortality, and low levels of physical activity (PA) is a leading independent predictor of poor CV health and associated with an increased prevalence of risk factors that predispose to CVD development. In this review, we evaluate the benefits of exercise on CV health. We discuss the CV adaptations to exercise, focusing on the physiological changes in the heart and vasculature. We review the impact and benefits of exercise on specific CV prevention, including type II diabetes, hypertension, hyperlipidemia, coronary artery disease, and heart failure, in addition to CVD-related and all-cause mortality. Lastly, we evaluate the current PA guidelines and various modes of exercise, assessing the current literature for the effective regimens of PA that improve CVD outcomes.
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Affiliation(s)
- Ameesh Isath
- Department of Cardiology, Westchester Medical Centre and New York Medical College, Valhalla, NY, United States of America
| | - Klaudia J Koziol
- New York Medical College, School of Medicine, Valhalla, NY, United States of America
| | - Matthew W Martinez
- Department of Cardiovascular Medicine, Sports Cardiology and Hypertrophic Cardiomyopathy, Atlantic Health, Morristown Medical Center, Morristown, NJ, United States of America
| | - Carol Ewing Garber
- Department of Biobehavioral Sciences, Program in Applied Physiology, Teachers College, Columbia University, United States of America
| | - Matthew N Martinez
- Department of Pediatric Cardiology, NYU Grossman School of Medicine and Langone Medical Center, NYU Langone Health, New York, NY, United States of America
| | - Michael S Emery
- Vascular and Thoracic Institute, Section of Clinical Cardiology, Cleveland Clinic, Cleveland, OH, United States of America
| | - Aaron L Baggish
- Cardiovascular Performance Program, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States of America
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Centre and New York Medical College, Valhalla, NY, United States of America
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, United States of America
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, United States of America
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10
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Isath A, Malik A, Bandyopadhyay D, Goel A, Hajra A, Gupta R, Naidu SS, Bhatt DL. Effect of COVID-19 Infection in Patients Who Present With Acute Myocardial Infarction and Cardiogenic Shock. Can J Cardiol 2023; 39:826-828. [PMID: 36907377 PMCID: PMC10007719 DOI: 10.1016/j.cjca.2023.03.005] [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: 12/02/2022] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023] Open
Affiliation(s)
- Ameesh Isath
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Aaqib Malik
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Dhrubajyoti Bandyopadhyay
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Akshay Goel
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Adrija Hajra
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Rahul Gupta
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA.
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11
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Parwani P, Kang N, Safaeipour M, Mamas MA, Wei J, Gulati M, Naidu SS, Merz NB. Contemporary Diagnosis and Management of Patients with MINOCA. Curr Cardiol Rep 2023; 25:561-570. [PMID: 37067753 DOI: 10.1007/s11886-023-01874-x] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE OF REVIEW Myocardial infarction with nonobstructive coronary arteries (MINOCA) is defined as acute myocardial infarction (MI) with angiographically no obstructive coronary artery disease or stenosis ≤ 50%. MINOCA is diagnostically challenging and complex, making it difficult to manage effectively. This condition accounts for 6-8% of all MI and poses an increased risk of morbidity and mortality after diagnosis. Prompt recognition and targeted management are essential to improve outcomes and our understanding of this condition, but this process is not yet standardized. This article offers a comprehensive review of MINOCA, delving deep into its unique clinical profile, invasive and noninvasive diagnostic strategies for evaluating MINOCA in light of the lack of widespread availability for comprehensive testing, and current evidence surrounding targeted therapies for patients with MINOCA. RECENT FINDINGS MINOCA is not uncommon and requires comprehensive assessment using various imaging modalities to evaluate it further. MINOCA is a heterogenous working diagnosis that requires thoughtful approach to diagnose the underlying disease responsible for MINOCA further.
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Affiliation(s)
- Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA.
- Loma Linda University School of Medicine, Loma Linda, CA, USA.
| | - Nicolas Kang
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Mary Safaeipour
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Institute for Prognosis Research, University of Keele, Keele, UK
| | - Janet Wei
- Barbara Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Martha Gulati
- Barbara Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
| | - Noel Bairey Merz
- Barbara Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
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12
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Goel A, Malik AH, Bandyopadhyay D, Isath A, Gupta R, Hajra A, Shrivastav R, Virani SS, Fonarow GC, Lavie CJ, Naidu SS. Impact of COVID-19 on Outcomes of Patients Hospitalized With STEMI: A Nationwide Propensity-matched Analysis. Curr Probl Cardiol 2023; 48:101547. [PMID: 36528206 PMCID: PMC9749390 DOI: 10.1016/j.cpcardiol.2022.101547] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Patients with ST-segment elevation myocardial infarction (STEMI) and concurrent coronavirus disease 2019 (COVID-19) have been reported to have poor outcomes. However, previous studies are small and limited. The National Inpatient Sample database for the year 2020 was queried to identify all adult hospitalizations with a primary diagnosis of STEMI, with and without concurrent COVID-19. A 1:1 propensity score matching was performed. A total of 159,890 hospitalizations with a primary diagnosis of STEMI were identified. Of these, 2210 (1.38%) had concurrent COVID-19. After propensity matching, STEMI patients with concurrent COVID-19 had a significantly higher mortality (17.8% vs 9.1%, OR 1.96, P< 0.001), lower likelihood to receive same-day percutaneous coronary intervention (PCI) (63.6% vs 70.6%, P = 0.019), with a trend towards lower overall PCI (74.9% vs 80.2%, P = 0.057) and significantly lower coronary artery bypass grafting) (3.0% vs 6.8%, P = 0.008) prior to discharge, compared with STEMI patients without COVID-19. The prevalence of cardiogenic shock, need for mechanical circulatory support, extracorporeal membrane oxygenation, cardiac arrest, acute kidney injury (AKI), dialysis, major bleeding and stroke were not significantly different between the groups. COVID-19-positive STEMI patients who received same-day PCI had significantly lower odds of in-hospital mortality (adjusted OR 0.42, 95% CI 0.20-0.85, P = 0.017). STEMI patients with concurrent COVID-19 infection had a significantly higher (almost 2 times) in-hospital mortality, and lower likelihood of receiving same-day PCI, overall (any-day) PCI, and CABG during their admission, compared with STEMI patients without COVID-19.
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Affiliation(s)
- Akshay Goel
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY.
| | - Aaqib H. Malik
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY
| | | | - Ameesh Isath
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Rahul Gupta
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA
| | - Adrija Hajra
- Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | | | | | | | - Carl J. Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Srihari S. Naidu
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY
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13
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Desai NR, Sutton MB, Xie J, Fine JT, Gao W, Owens AT, Naidu SS. Clinical Outcomes, Resource Utilization, and Treatment Over the Disease Course of Symptomatic Obstructive Hypertrophic Cardiomyopathy in the United States. Am J Cardiol 2023; 192:16-23. [PMID: 36709525 DOI: 10.1016/j.amjcard.2022.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/21/2022] [Accepted: 12/26/2022] [Indexed: 01/28/2023]
Abstract
We sought to describe the clinical outcomes, resource utilization, and treatment options for patients with symptomatic obstructive hypertrophic cardiomyopathy (HCM) over the course of their disease. Adults with obstructive HCM who were symptomatic were identified from the IBM MarketScan Commercial and Medicare supplemental database (January 2009 to March 2019). The index date was the initial obstructive HCM diagnosis date. Patients were required to have ≥12-month continuous eligibility before and after the index date. Incidence rates (IRs) and cumulative risk of cardiovascular events, healthcare resource utilization, and pharmacotherapy were assessed after index and compared with matched controls. Among 4,617 eligible patients with obstructive HCM, 2,917 (63.2%, mean age 60, 47.2% women) were symptomatic at index date. The most common cardiovascular events were atrial fibrillation/flutter (IR:1.421 per person-year [PPY], heart failure (IR: 0.895 PPY), and dyspnea (IR:0.797 PPY). Patients incurred higher resource use with frequent tests and monitoring, hospitalizations (0.454 PPY), and emergency room visits (0.611 PPY). The use of pharmacotherapy increased from 61.2% in the 6-month preindex period to 83.9% in the 6-month postindex period and remained stable after diagnosis. These events ranged from 3 to over 60-fold higher compared with controls, with the largest difference observed in arrhythmic events. The majority of patients were symptomatic at the time of obstructive HCM diagnosis, resulting in significantly increased cardiovascular complications and frequent disease monitoring after diagnosis versus controls. In conclusion, healthcare resource utilization was substantial, and these findings suggest a higher clinical and economic burden over the disease course among patients with symptomatic obstructive HCM, despite current treatment.
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Affiliation(s)
- Nihar R Desai
- Yale University School of Medicine, New Haven, Connecticut.
| | - Megan B Sutton
- MyoKardia, Inc., a wholly owned subsidiary of Bristol-Myers Squibb, Brisbane, Brisbane, California
| | - Jipan Xie
- Analysis Group, Inc., Los Angeles, California
| | - Jennifer T Fine
- MyoKardia, Inc., a wholly owned subsidiary of Bristol-Myers Squibb, Brisbane, Brisbane, California
| | - Wei Gao
- Analysis Group, Inc., Boston, Massachusetts
| | - Anjali T Owens
- Heart and Vascular Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Srihari S Naidu
- Westchester Medical Center, Westchester Medical Center Health Network, Valhalla, New York; New York Medical College, Valhalla, New York
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14
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Desai MY, Owens A, Geske JB, Wolski K, Saberi S, Wang A, Sherrid M, Cremer PC, Naidu SS, Smedira NG, Schaff H, McErlean E, Sewell C, Balasubramanyam A, Lampl K, Sehnert AJ, Nissen SE. Dose-Blinded Myosin Inhibition in Patients With Obstructive Hypertrophic Cardiomyopathy Referred for Septal Reduction Therapy: Outcomes Through 32 Weeks. Circulation 2023; 147:850-863. [PMID: 36335531 DOI: 10.1161/circulationaha.122.062534] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [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: 11/07/2022]
Abstract
BACKGROUND Septal reduction therapy (SRT) in patients with intractable symptoms from obstructive hypertrophic cardiomyopathy (oHCM) is associated with variable morbidity and mortality. The VALOR-HCM trial (A Study to Evaluate Mavacamten in Adults with Symptomatic Obstructive Hypertrophic Cardiomyopathy Who Are Eligible for Septal Reduction Therapy) examined the effect of mavacamten on the need for SRT through week 32 in oHCM. METHODS A double-blind randomized placebo-controlled multicenter trial at 19 US sites included patients with oHCM on maximal tolerated medical therapy referred for SRT with left ventricular outflow tract gradient ≥50 mm Hg at rest or provocation (enrollment, July 2020-October 2021). The group initially randomized to mavacamten continued the drug for 32 weeks, and the placebo group crossed over to dose-blinded mavacamten from week 16 to week 32. Dose titrations were based on investigator-blinded echocardiographic assessment of left ventricular outflow tract gradient and left ventricular ejection fraction. The principal end point was the proportion of patients proceeding with SRT or remaining guideline eligible at 32 weeks in both treatment groups. RESULTS From the 112 randomized patients with oHCM, 108 (mean age, 60.3 years; 50% men; 94% in New York Heart Association class III/IV) qualified for week 32 evaluation (56 in the original mavacamten group and 52 in the placebo cross-over group). After 32 weeks, 6 of 56 patients (10.7%) in the original mavacamten group and 7 of 52 patients (13.5%) in the placebo cross-over group met SRT guideline criteria or elected to undergo SRT. After 32 weeks, a sustained reduction in resting left ventricular outflow tract gradient (-33.0 mm Hg [95% CI, -41.1 to -24.9]) and Valsalva left ventricular outflow tract gradient (-43.0 mm Hg [95% CI, -52.1 to -33.9]) was observed in the original mavacamten group. A similar reduction in resting (-33.7 mm Hg [95% CI, -42.2 to -25.2]) and Valsalva (-52.9 mm Hg [95% CI, -63.2 to -42.6]) gradients was quantified in the cross-over group after 16 weeks of mavacamten. After 32 weeks, improvement by ≥1 New York Heart Association class was observed in 48 of 53 patients (90.6%) in the original mavacamten group and 35 of 50 patients (70%) after 16 weeks in the cross-over group. CONCLUSIONS In severely symptomatic patients with oHCM, 32 weeks of mavacamten treatment showed sustained reduction in the proportion proceeding to SRT or remaining guideline eligible, with similar effects observed in patients who crossed over from placebo after 16 weeks. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT04349072.
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Affiliation(s)
- Milind Y Desai
- From the Hypertrophic Cardiomyopathy Center (M.Y.D., N.G.S.), Heart Vascular and Thoracic Institute, Cleveland Clinic, OH.,Department of Cardiovascular Medicine (M.Y.D., K.W., P.C.C., E.M., C.S., S.E.N.), Heart Vascular and Thoracic Institute, Cleveland Clinic, OH.,Cleveland Clinic Coordinating Center for Clinical Research (M.Y.D., K.W., P.C.C., E.M., C.S., S.E.N.), Heart Vascular and Thoracic Institute, Cleveland Clinic, OH
| | - Anjali Owens
- Division of Cardiology, University of Pennsylvania, Philadelphia (A.O.)
| | - Jeffrey B Geske
- Departments of Cardiovascular Diseases (J.B.G.), Mayo Clinic, Rochester, MN
| | - Kathy Wolski
- Department of Cardiovascular Medicine (M.Y.D., K.W., P.C.C., E.M., C.S., S.E.N.), Heart Vascular and Thoracic Institute, Cleveland Clinic, OH.,Cleveland Clinic Coordinating Center for Clinical Research (M.Y.D., K.W., P.C.C., E.M., C.S., S.E.N.), Heart Vascular and Thoracic Institute, Cleveland Clinic, OH
| | - Sara Saberi
- Department of Internal Medicine, University of Michigan, Ann Arbor (S.S.)
| | - Andrew Wang
- Department of Cardiology, Duke University, Durham, NC (A.W.)
| | - Mark Sherrid
- Department of Cardiology, New York University, NY (M.S.)
| | - Paul C Cremer
- Department of Cardiovascular Medicine (M.Y.D., K.W., P.C.C., E.M., C.S., S.E.N.), Heart Vascular and Thoracic Institute, Cleveland Clinic, OH.,Cleveland Clinic Coordinating Center for Clinical Research (M.Y.D., K.W., P.C.C., E.M., C.S., S.E.N.), Heart Vascular and Thoracic Institute, Cleveland Clinic, OH
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Center, Valhalla, NY (S.S.N.)
| | - Nicholas G Smedira
- From the Hypertrophic Cardiomyopathy Center (M.Y.D., N.G.S.), Heart Vascular and Thoracic Institute, Cleveland Clinic, OH.,Department of Cardiothoracic Surgery (N.G.S.), Heart Vascular and Thoracic Institute, Cleveland Clinic, OH
| | | | - Ellen McErlean
- Department of Cardiovascular Medicine (M.Y.D., K.W., P.C.C., E.M., C.S., S.E.N.), Heart Vascular and Thoracic Institute, Cleveland Clinic, OH.,Cleveland Clinic Coordinating Center for Clinical Research (M.Y.D., K.W., P.C.C., E.M., C.S., S.E.N.), Heart Vascular and Thoracic Institute, Cleveland Clinic, OH
| | - Christina Sewell
- Department of Cardiovascular Medicine (M.Y.D., K.W., P.C.C., E.M., C.S., S.E.N.), Heart Vascular and Thoracic Institute, Cleveland Clinic, OH.,Cleveland Clinic Coordinating Center for Clinical Research (M.Y.D., K.W., P.C.C., E.M., C.S., S.E.N.), Heart Vascular and Thoracic Institute, Cleveland Clinic, OH
| | - Aarthi Balasubramanyam
- MyoKardia, Inc, a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, CA (A.B., K.L., A.J.S.)
| | - Kathy Lampl
- MyoKardia, Inc, a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, CA (A.B., K.L., A.J.S.)
| | - Amy J Sehnert
- MyoKardia, Inc, a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, CA (A.B., K.L., A.J.S.)
| | - Steven E Nissen
- Department of Cardiovascular Medicine (M.Y.D., K.W., P.C.C., E.M., C.S., S.E.N.), Heart Vascular and Thoracic Institute, Cleveland Clinic, OH.,Cleveland Clinic Coordinating Center for Clinical Research (M.Y.D., K.W., P.C.C., E.M., C.S., S.E.N.), Heart Vascular and Thoracic Institute, Cleveland Clinic, OH
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15
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Bandyopadhyay D, Krishnan S, Malik A, Goel A, Gupta R, Naidu SS. FEASIBILITY OF TRANSCATHETER EDGE TO EDGE REPAIR IN HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01532-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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16
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Isath A, Lanier GM, Spielvogel D, Malekan R, Steinmetz C, Fishkin T, Semaan R, Panza JA, Naidu SS. OUTCOMES OF PATIENTS WITH OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY AND PULMONARY HYPERTENSION UNDERGOING SEPTAL REDUCTION THERAPY STRATIFIED BY TREATMENT MODALITY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00994-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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17
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Isath A, Malik A, Koziol KJ, Shrivastav R, Sherif AA, Ahmad HA, Naidu SS. META-ANALYSIS OF PATENT FORAMEN OVALE CLOSURE FOR CRYPTOGENIC STROKE IN OLDER VERSUS YOUNGER PATIENTS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01260-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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18
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Isath A, Lanier GM, Spielvogel D, Malekan R, Steinmetz C, Semaan R, Fishkin T, Panza JA, Naidu SS. IMPACT OF PULMONARY HYPERTENSION ON SEPTAL REDUCTION THERAPY OUTCOMES FOR HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00993-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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19
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Rao SJ, Iqbal SB, Kanwal AS, Aronow WS, Naidu SS. Multi-modality management of hypertrophic cardiomyopathy. Hosp Pract (1995) 2023; 51:2-11. [PMID: 36598161 DOI: 10.1080/21548331.2022.2162297] [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] [Indexed: 01/05/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is an autosomal dominant inherited condition defined by left ventricular wall thickness greater than 15 mm in the absence of other conditions that could explain that degree of hypertrophy. Obstructive HCM associated with left ventricular outflow tract obstruction is defined by an intraventricular systolic pressure gradient greater than or equal to 30 mm Hg. Over the past couple of decades, there has been an expansion of both invasive and pharmacotherapeutic options for patients with HCM, with recent guidelines calling for a melody of invasive and non-invasive treatment strategies. There are several invasive therapies including proven therapies such as alcohol septal ablation and septal myectomy. Novel invasive therapies such as MitraClip, radiofrequency septal ablation and SESAME procedure have more recently been promoted. Pharmacological therapy has also dramatically evolved and includes conventional medications such as beta-blockers, calcium channel blockers, and disopyramide. Mavacamten, a novel cardiac myosin inhibitor, may significantly change management. Other myosin inhibitors and modulators are also being developed and tested in large clinical trials. Given significant phenotypical variability in patients with HCM, clinical management can be challenging, and often requires an individualized approach with a combination of invasive and non-invasive options.
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Affiliation(s)
- Shiavax J Rao
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, USA
| | - Shaikh B Iqbal
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, USA
| | - Arjun S Kanwal
- Department of Cardiology, Westchester Medical Center, Valhalla, USA
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center and Department of Medicine, New York Medical College, Valhalla, USA
| | - Srihari S Naidu
- Hypertrophic Cardiomyopathy Center, Cardiac Catheterization Laboratory, Department of Cardiology, Westchester Medical Center and Department of Medicine, New York Medical College, Valhalla, USA
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20
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Isath A, Kanwal A, Virk HUH, Bandyopadhyay D, Wang Z, Kumar A, Kalra A, Naidu SS, Lavie CJ, Virani SS, Krittanawong C. The Effect of Yoga on Cardiovascular Disease Risk Factors: A Meta-Analysis. Curr Probl Cardiol 2023; 48:101593. [PMID: 36681213 DOI: 10.1016/j.cpcardiol.2023.101593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/12/2023] [Indexed: 01/20/2023]
Abstract
Yoga has been increasingly popular yet has shown inconsistent benefits on cardiovascular disease (CVD) risk factors. We aimed to systematically analyze the effect of yoga on modifiable CVD risk factors. We systematically searched Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception in 1966 through June 2022 for studies evaluating the association between yoga and blood pressure, lipid profile, HbA1c and body mass index (BMI). Two investigators independently reviewed data. Conflicts were resolved through consensus. Random-effects meta-analyses were used. 64 RCTs including a total of 16,797 participants were eligible for inclusion in the meta-analysis. Yoga therapy improved both systolic as well as diastolic blood pressure (weight mean difference [WMD] (95% Confidence interval [CI]) of -4.56 [-6.37, -2.75] mm Hg, WMD [95% CI] - 3.39 [-5.01, -1.76] mm Hg respectively). There was also an improvement in BMI as well as hemoglobin A1c (HbA1c) (WMD [95% CI] of -0.57 [-1.05, -0.10] kg/m2, WMD [95% CI] of -0.14 [-0.24, -0.030] mmol/L respectively) . In addition, all parameters of the lipid profile, including low-density lipoprotein cholesterol (LDL-C) showed a significant improvement with yoga therapy (WMD [95% CI] -7.59 [-12.23, -2.95] mg/dL for LDL-C). Yoga has a modest yet positive effect on blood pressure, BMI, lipid profile and HbA1c and, therefore, may play an ancillary role in primary prevention of CVD.
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Affiliation(s)
- Ameesh Isath
- Department of Cardiology, Westchester Medical Centre, New York Medical College, Valhalla, NY
| | - Arjun Kanwal
- Department of Cardiology, Westchester Medical Centre, New York Medical College, Valhalla, NY
| | - Hafeez Ul Hassan Virk
- Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH
| | | | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH
| | - Ankur Kalra
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center Indiana University School of Medicine, Indianapolis, IN
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Centre, New York Medical College, Valhalla, NY
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Salim S Virani
- Section of Cardiology, Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Medical Center Houston, TX
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21
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Paul TK, Naidu SS. Revascularization of Left Main Coronary Artery in Patients With Diabetes: Is the Pendulum Swinging to PCI? Cardiovasc Revasc Med 2023; 46:62-63. [PMID: 36371310 DOI: 10.1016/j.carrev.2022.10.012] [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: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Timir K Paul
- University of Tennessee Health Sciences Center at Nashville, Ascension St. Thomas Hospital, Nashville, TN, USA; Westchester Medical Center and WMC Health Network, New York Medical College, USA.
| | - Srihari S Naidu
- University of Tennessee Health Sciences Center at Nashville, Ascension St. Thomas Hospital, Nashville, TN, USA; Westchester Medical Center and WMC Health Network, New York Medical College, USA
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22
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Rao SJ, Forst B, Kanwal AK, Kanwal A, Aronow WS, Naidu SS. Cardiac myosin inhibitors for hypertrophic cardiomyopathy: shedding light on their clinical potential. Expert Opin Investig Drugs 2023; 32:1-4. [PMID: 36625220 DOI: 10.1080/13543784.2023.2166825] [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] [Indexed: 01/11/2023]
Affiliation(s)
- Shiavax J Rao
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Beani Forst
- Department of Medicine, Creighton University Arizona Health Education Alliance, Phoenix, Az, USA
| | | | - Arjun Kanwal
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center and Department of Medicine, New York Medical College, Valhalla, NY, USA
| | - Srihari S Naidu
- Hypertrophic Cardiomyopathy Center, Cardiac Catheterization Laboratory, Department of Cardiology, Westchester Medical Center and Department of Medicine, New York Medical College, Valhalla, NY, USA
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23
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Naidu SS, Sutton MB, Gao W, Fine JT, Xie J, Desai NR, Owens AT. Frequency and clinicoeconomic impact of delays to definitive diagnosis of obstructive hypertrophic cardiomyopathy in the United States. J Med Econ 2023; 26:682-690. [PMID: 37170479 DOI: 10.1080/13696998.2023.2208966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
AIMS The diagnostic history in the years leading up to the definitive diagnosis of patients with obstructive hypertrophic cardiomyopathy (HCM) has not been studied. METHODS Patients with a delay in the definitive diagnosis of obstructive HCM from January 2009 to March 2019 were identified in the US IBM MarketScan Commercial and Medicare Supplemental Databases if they had an alternative diagnosis indicating a misdiagnosis during the 24 months before the definitive obstructive HCM diagnosis. Resource use and costs associated with the delay were estimated during the same period. RESULTS Of 3,888 eligible patients with obstructive HCM, 59.5% had a delay in definitive diagnosis. Patients received a mean of 4.0 misdiagnoses before the definitive obstructive HCM diagnosis, most of which were other cardiovascular conditions. Consequently, 15.7% of patients may have received inappropriate treatment. Approximately 78.4% of patients visited a cardiologist (mean 4.7 visits) before the definitive obstructive HCM diagnosis. Additionally, 26.8% and 32.1% of patients had an inpatient and emergency room visit, respectively. Annualized healthcare costs associated with the delay were $4,379 per patient. LIMITATIONS The current study used administrative claims data for a commercially insured population. Therefore, the results may not be generalizable to other populations (e.g. those insured by Medicare or Medicaid and the uninsured). Like other database studies, the current study may have suffered from miscoding or undercoding, which may have caused misclassification of patients. Owing to insufficient data, the study could not evaluate all potential consequences of a delay in definitive diagnosis. CONCLUSIONS Most patients with obstructive HCM had a delay of ≤ 2 years before receiving the definitive diagnosis. The diagnostic journey involved multiple potential misdiagnoses, predominantly cardiovascular, as well as a substantial clinical and economic burden on patients and the healthcare system.
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Affiliation(s)
- Srihari S Naidu
- Westchester Medical Center, Westchester Medical Center Health Network, Valhalla, NY, USA
- New York Medical College, Valhalla, NY, USA
| | - Megan B Sutton
- MyoKardia, Inc., a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, CA, USA
| | - Wei Gao
- Analysis Group, Inc., Boston, MA, USA
| | - Jennifer T Fine
- MyoKardia, Inc., a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, CA, USA
| | - Jipan Xie
- Analysis Group, Inc., Los Angeles, CA, USA
| | - Nihar R Desai
- Yale University School of Medicine, New Haven, CT, USA
| | - Anjali T Owens
- Center for Inherited Cardiovascular Disease, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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24
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Isath A, Elson D, Kayani W, Wang Z, Sharma S, Naidu SS, Jneid H, Krittanawong C. A Meta-Analysis of Traditional Radial Access and Distal Radial Access in Transradial Access for Percutaneous Coronary Procedures. Cardiovasc Revasc Med 2023; 46:21-26. [PMID: 36182561 DOI: 10.1016/j.carrev.2022.09.006] [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: 08/10/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Radial approaches are classified into traditional radial access (TRA) and more contemporary distal radial access (DRA), with recently published comparative studies reporting inconsistent outcomes. As there have been several recent randomized control trials (RCT), we assessed the totality of evidence in an updated meta-analysis to compare outcomes of DRA and TRA. METHODS We searched PubMed, CENTRAL, Web of Science, EMBASE, and Cochrane Database of Systematic Reviews from inception to August 2022 for studies comparing DRA and TRA for coronary angiography. Primary outcomes were the rate of radial artery occlusion (RAO) and access failure. Secondary outcomes included hematomas and puncture site bleeding. The pooled risk ratio (RR) with 95 % confidence interval (95 % CI) was calculated for each outcome. RESULTS A total of 14,071 patients undergoing coronary angiography from 23 studies, including 5488 patients from 10 RCTs. The mean age of the study population was 59.8 ± 5.9 years with 66.2 % men. Outcomes for a total of 6796 (48.3 %) patients undergoing DRA and 7166 (50.9 %) patients undergoing TRA were compared. DRA was associated with a lower rate of RAO (RR = 0.36, 95CI [0.27, 0.48], I2 = 0 %) but an increased risk of vascular access failure (RR = 2.38, 95CI [1.46, 3.87], I2 = 82.7 %). There was no significant difference in the rate of bleeding or hematoma formation. CONCLUSION In an updated metanalysis, DRA is associated with lower rates of RAO but with higher rates of access failure.
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Affiliation(s)
- Ameesh Isath
- Department of Cardiology, Westchester Medical Centre, New York Medical College, Valhalla, NY, USA
| | - David Elson
- Department of Cardiology, Westchester Medical Centre, New York Medical College, Valhalla, NY, USA
| | - Waleed Kayani
- Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Samin Sharma
- Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Hospital, New York, NY, USA
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Centre, New York Medical College, Valhalla, NY, USA
| | - Hani Jneid
- Chief of the Division of Cardiology at UTMB, Houston, TX, USA
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25
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Cremer PC, Geske JB, Owens A, Jaber WA, Harb SC, Saberi S, Wang A, Sherrid M, Naidu SS, Schaff H, Smedira NG, Wang Q, Wolski K, Lampl KL, Sehnert AJ, Nissen SE, Desai MY. Myosin Inhibition and Left Ventricular Diastolic Function in Patients With Obstructive Hypertrophic Cardiomyopathy Referred for Septal Reduction Therapy: Insights From the VALOR-HCM Study. Circ Cardiovasc Imaging 2022; 15:e014986. [PMID: 36335645 DOI: 10.1161/circimaging.122.014986] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 11/07/2022]
Abstract
BACKGROUND In the randomized phase 3 VALOR-HCM study (A Study to Evaluate Mavacamten in Adults With Symptomatic Obstructive Hypertrophic Cardiomyopathy Who Are Eligible for Septal Reduction Therapy) of patients with obstructive hypertrophic cardiomyopathy, mavacamten reduced the need for septal reduction therapy. Because mavacamten improves ventricular compliance, this sub-study examined the effects of treatment with this cardiac myosin inhibitor on diastolic function. METHODS Symptomatic obstructive hypertrophic cardiomyopathy patients on maximally tolerated medical therapy referred for septal reduction therapy were randomized 1:1 to mavacamten or placebo. At baseline and week 16, a resting and stress echocardiogram was performed with interpretation by a core laboratory. In this exploratory substudy, the principal end point was the change in parameters used to define the grade of diastolic function in patients treated with mavacamten and placebo. A related objective was to assess the proportion of patients with an improvement in diastolic function grade. A secondary aim was to assess for correlation between diastolic function parameters and the secondary end points from VALOR-HCM: New York Heart Association class, quality of life, and cardiac biomarkers. RESULTS Diastolic dysfunction grade was evaluable in 98 patients at baseline and week 16. Among patients treated with mavacamten, 29.4% (15 of 51) demonstrated improvement in diastolic function grade compared with 12.8% (6 of 47) patients with placebo (P=0.05). Average E/e' ratio decreased significantly in patients treated with mavacamten (-3.4±5.3) compared with placebo (0.57±3.5; P<0.001). Indexed left atrial volumes (mL/m2) also decreased significantly in patients who received mavacamten (-5.2±7.8) compared with placebo (-0.51±8.1; P=0.005). After adjustment for change in left ventricular outflow tract gradient and mitral regurgitation, mavacamten was significantly associated with a decrease in average E/e' ratio and indexed left atrial volumes. Change in average E/e' ratio was significantly correlated with the secondary end points from VALOR-HCM. CONCLUSIONS In this exploratory substudy, after 16 weeks of therapy, mavacamten improved diastolic function, and this change correlated with improvement in clinical and biomarker end points. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT04349072.
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Affiliation(s)
- Paul C Cremer
- Department of Cardiovascular Medicine (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH.,Cleveland Clinic Coordinating Center for Clinical Research Heart Vascular and Thoracic Institute (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH
| | - Jeffrey B Geske
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (J.B.G.)
| | - Anjali Owens
- Division of Cardiology, University of Pennsylvania (A.O.)
| | - Wael A Jaber
- Department of Cardiovascular Medicine (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH.,Cleveland Clinic Coordinating Center for Clinical Research Heart Vascular and Thoracic Institute (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH
| | - Serge C Harb
- Department of Cardiovascular Medicine (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH.,Cleveland Clinic Coordinating Center for Clinical Research Heart Vascular and Thoracic Institute (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH
| | - Sara Saberi
- Department of Internal Medicine, University of Michigan, Ann Arbor (S.S.)
| | - Andrew Wang
- Department of Cardiology, Duke University, Durham, NC (A.W.)
| | - Mark Sherrid
- Department of Cardiology, New York University (M.S.)
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Center, NY (S.S.N.)
| | - Hartzell Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN (H.S.)
| | - Nicholas G Smedira
- Department of Cardiothoracic Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, OH (N.G.S.).,Hypertrophic Cardiomyopathy Center, Cleveland Clinic, OH (N.G.S., M.Y.D.)
| | - Qiuqing Wang
- Department of Cardiovascular Medicine (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH.,Cleveland Clinic Coordinating Center for Clinical Research Heart Vascular and Thoracic Institute (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH
| | - Kathy Wolski
- Department of Cardiovascular Medicine (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH.,Cleveland Clinic Coordinating Center for Clinical Research Heart Vascular and Thoracic Institute (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH
| | - Kathy L Lampl
- MyoKardia, Inc, a wholly-owned subsidiary of Bristol Myers Squibb, Brisbane, CA (K.L.L., A.J.S.)
| | - Amy J Sehnert
- MyoKardia, Inc, a wholly-owned subsidiary of Bristol Myers Squibb, Brisbane, CA (K.L.L., A.J.S.)
| | - Steven E Nissen
- Department of Cardiovascular Medicine (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH.,Cleveland Clinic Coordinating Center for Clinical Research Heart Vascular and Thoracic Institute (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH
| | - Milind Y Desai
- Department of Cardiovascular Medicine (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH.,Cleveland Clinic Coordinating Center for Clinical Research Heart Vascular and Thoracic Institute (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH.,Hypertrophic Cardiomyopathy Center, Cleveland Clinic, OH (N.G.S., M.Y.D.)
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26
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Kern MJ, Cox D, Fearon W, Johnson N, Klein L, Krucoff M, Moses J, Naidu SS, Pinto D, Ramee S, Teirstein P, Yeung A. Is FFR dead? A conversation in cardiology. Catheter Cardiovasc Interv 2022; 100:1045-1050. [DOI: 10.1002/ccd.30422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Morton J. Kern
- Long Beach Healthcare Center Charlotte North Carolina USA
| | - David Cox
- Long Beach Healthcare Center Charlotte North Carolina USA
| | | | | | - Lloyd Klein
- University of California SF Sonoma California USA
| | | | | | | | | | | | | | - Alan Yeung
- Stanford University Palo Alto California USA
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27
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Isath A, Virani SS, Wang Z, Lavie CJ, Naidu SS, Messerli FH, Krittanawong C. Meta-analysis of Per-Day Step Count and All-Cause Mortality. Am J Cardiol 2022; 180:166-168. [PMID: 35961790 DOI: 10.1016/j.amjcard.2022.06.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Ameesh Isath
- Department of Cardiology, Westchester Medical Centre, New York Medical College, Valhalla, New York
| | - Salim S Virani
- The Michael E. DeBakey VA Medical Center, Houston, Texas; Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Zhen Wang
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic Rochester, Minnesota
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, the University of Queensland School of Medicine, New Orleans, Louisiana
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Centre, New York Medical College, Valhalla, New York
| | - Franz H Messerli
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New York, New York; University of Bern, Switzerland; Jagiellonian University Krakow, Poland
| | - Chayakrit Krittanawong
- The Michael E. DeBakey VA Medical Center, Houston, Texas; Section of Cardiology, Baylor College of Medicine, Houston, Texas
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28
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Krittanawong C, Rivera MR, Shaikh P, Kumar A, May A, Mahtta D, Jentzer J, Civitello A, Katz J, Naidu SS, Cohen MG, Menon V. SKey Concepts Surrounding Cardiogenic Shock. Curr Probl Cardiol 2022; 47:101303. [PMID: 35787427 DOI: 10.1016/j.cpcardiol.2022.101303] [Citation(s) in RCA: 2] [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] [Received: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 11/03/2022]
Abstract
Cardiogenic shock (CS) is the final common pathway of impaired cardiovascular performance that results in ineffective forward cardiac output producing clinical and biochemical signs of organ hypoperfusion. CS represents the most common cause of shock in the cardiac intensive care unit (CICU) and accounts for a substantial proportion of CICU patient deaths. Despite significant advances in revascularization techniques, pharmacologic therapeutics and mechanical support devices, CS remains associated with a high mortality rate. Indeed, the prevalence of CS within the CICU appears to be increasing. CS can be differentiated as phenotypes reflecting different metabolic, inflammatory, and hemodynamic profiles, depending also on anatomic substrate and congestion profile. Future prospective studies and clinical trials may further characterize these phenotypes and apply targeted intervention for each phenotype and SCAI SHOCK stage rather than a one-size-fits-all approach. Overall, there are 8 key concepts of CS; 1) the mortality associated with CS; 2) Shock attributed to AMI may be declining in both incidence and associated mortality; 3) providers should think about hemodynamic, metabolic, inflammation and cardiac function in totality to assess CS; 4) CS is a dynamic process; 5) no randomized trials evaluating use of the PAC in patients with CS; 6) most data supporting neosynephrine as first line agent in CS; 7) most registries suggest that almost half of CS patients do not have any mechanical support, and the vast majority of the remainder utilize the IABP; and 8) patients with AMI CS should receive emergent PCI of the culprit vessel.
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Affiliation(s)
- Chayakrit Krittanawong
- Section of Cardiology, Baylor College of Medicine, Baylor St. Luke's Medical Center, Texas Heart Institute, Houston, TX.
| | - Mario Rodriguez Rivera
- John T. Milliken Department of Medicine, Division of Cardiovascular Disease. Barnes-Jewish Hospital/Washington University in St.Louis School of Medicine
| | - Preet Shaikh
- John T. Milliken Department of Medicine, Barnes-Jewish Hospital/Washington University in St.Louis School of Medicine
| | - Anirudh Kumar
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Adam May
- John T. Milliken Department of Medicine, Division of Cardiovascular Disease, Section of Critical Care Cardiology. Barnes-Jewish Hospital/Washington University in St.Louis School of Medicine
| | - Dhruv Mahtta
- Section of Cardiology, Baylor College of Medicine, Baylor St. Luke's Medical Center, Texas Heart Institute, Houston, TX
| | - Jacob Jentzer
- Department of Cardiovascular Medicine; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Andrew Civitello
- Section of Cardiology, Baylor College of Medicine, Baylor St. Luke's Medical Center, Texas Heart Institute, Houston, TX
| | - Jason Katz
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Centre, New York Medical College, Valhalla, NY
| | - Mauricio G Cohen
- Cardiovascular Division, University of Miami Miller School of Medicine, FL, USA
| | - Venu Menon
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
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29
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Reaney M, Allen V, Sehnert AJ, Fang L, Hagège AA, Naidu SS, Olivotto I. Development of the Hypertrophic Cardiomyopathy Symptom Questionnaire (HCMSQ): A New Patient-Reported Outcome (PRO) Instrument. Pharmacoecon Open 2022; 6:563-574. [PMID: 35653062 PMCID: PMC9283619 DOI: 10.1007/s41669-022-00335-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 05/22/2023]
Abstract
BACKGROUND Currently, there is no patient-reported outcome (PRO) instrument specifically designed to evaluate hypertrophic cardiomyopathy (HCM). OBJECTIVE We present the development and psychometric validation of a novel PRO measure, the HCM Symptom Questionnaire version 1.0 (HCMSQv1.0). METHODS Cognitive debriefing interviews and a card-sorting task were conducted in 33 patients with HCM to support development of the HCMSQv1.0, showing the scale to be interpretable and relevant to patients' experiences. Baseline blinded data from two trials (EXPLORER-HCM and MAVERICK-HCM) were pooled (N = 299) to develop the scoring algorithm of HCMSQv1.0. Measurement properties were examined, followed by a meaningful-change analysis to interpret scores. Rasch modeling, mixed-model repeated measures, exploratory factor analysis, confirmatory factor analysis, and missing-data simulation analysis informed the number of domains and the items in each domain. RESULTS The scoring algorithm for HCMSQv1.0 consists of four domains: shortness of breath, tiredness, cardiovascular symptoms, and syncope; plus a total score, with higher scores indicating more severe symptoms. Item characteristics, internal consistency, test-retest reliability, construct validity, and responsiveness were acceptable. A clinically meaningful responder definition of 1-2 points on the HCMSQv1.0 score for shortness of breath and total score, and approximately 1 point on the tiredness and cardiovascular symptom scores, was calculated based on distribution- and anchor-based methods. CONCLUSION Our findings support the HCMSQv1.0 as a fit-for-purpose PRO instrument for assessing treatment benefit in patients with HCM. Studies in larger patient populations are ongoing to confirm responder definition and scoring approaches encompassing key HCM symptoms.
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Affiliation(s)
- Matthew Reaney
- IQVIA, 3 Forbury Place, 23 Forbury Road, Reading, RG1 3JH, UK.
| | | | - Amy J Sehnert
- MyoKardia, Inc. (a wholly owned subsidiary of Bristol Myers Squibb), Brisbane, CA, USA
| | - Liang Fang
- MyoKardia, Inc. (a wholly owned subsidiary of Bristol Myers Squibb), Brisbane, CA, USA
| | - Albert A Hagège
- Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Srihari S Naidu
- Westchester Medical Center, WMC Health Network, New York Medical College, Valhalla, NY, USA
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, University of Florence, Florence, Italy
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30
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Desai MY, Owens A, Geske JB, Wolski K, Naidu SS, Smedira NG, Cremer PC, Schaff H, McErlean E, Sewell C, Li W, Sterling L, Lampl K, Edelberg JM, Sehnert AJ, Nissen SE. Myosin Inhibition in Patients With Obstructive Hypertrophic Cardiomyopathy Referred for Septal Reduction Therapy. J Am Coll Cardiol 2022; 80:95-108. [PMID: 35798455 DOI: 10.1016/j.jacc.2022.04.048] [Citation(s) in RCA: 109] [Impact Index Per Article: 54.5] [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: 04/01/2022] [Accepted: 04/08/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Septal reduction therapy (SRT), surgical myectomy or alcohol ablation, is recommended for obstructive hypertrophic cardiomyopathy (oHCM) patients with intractable symptoms despite maximal medical therapy, but is associated with morbidity and mortality. OBJECTIVES This study sought to determine whether the oral myosin inhibitor mavacamten enables patients to improve sufficiently to no longer meet guideline criteria or choose to not undergo SRT. METHODS Patients with left ventricular (LV) outflow tract (LVOT) gradient ≥50 mm Hg at rest/provocation who met guideline criteria for SRT were randomized, double blind, to mavacamten, 5 mg daily, or placebo, titrated up to 15 mg based on LVOT gradient and LV ejection fraction. The primary endpoint was the composite of the proportion of patients proceeding with SRT or who remained guideline-eligible after 16 weeks' treatment. RESULTS One hundred and twelve oHCM patients were enrolled, mean age 60 ± 12 years, 51% men, 93% New York Heart Association (NYHA) functional class III/IV, with a mean post-exercise LVOT gradient of 84 ± 35.8 mm Hg. After 16 weeks, 43 of 56 placebo patients (76.8%) and 10 of 56 mavacamten patients (17.9%) met guideline criteria or underwent SRT, difference (58.9%; 95% CI: 44.0%-73.9%; P < 0.001). Hierarchical testing of secondary outcomes showed significant differences (P < 0.001) favoring mavacamten, mean differences in post-exercise peak LVOT gradient -37.2 mm Hg; ≥1 NYHA functional class improvement 41.1%; improvement in patient-reported outcome 9.4 points; and NT-proBNP and cardiac troponin I between-groups geometric mean ratio 0.33 and 0.53. CONCLUSIONS In oHCM patients with intractable symptoms, mavacamten significantly reduced the fraction of patients meeting guideline criteria for SRT after 16 weeks. Long-term freedom from SRT remains to be determined. (A Study to Evaluate Mavacamten in Adults With Symptomatic Obstructive HCM Who Are Eligible for Septal Reduction Therapy [VALOR-HCM]; NCT04349072).
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Affiliation(s)
- Milind Y Desai
- Hypertrophic Cardiomyopathy Center, Cleveland Clinic, Cleveland, Ohio, USA; Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA; Cleveland Clinic Coordinating Center for Clinical Research, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anjali Owens
- Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey B Geske
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathy Wolski
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA; Cleveland Clinic Coordinating Center for Clinical Research, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Nicholas G Smedira
- Hypertrophic Cardiomyopathy Center, Cleveland Clinic, Cleveland, Ohio, USA; Department of Cardiothoracic Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Paul C Cremer
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA; Cleveland Clinic Coordinating Center for Clinical Research, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hartzell Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ellen McErlean
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA; Cleveland Clinic Coordinating Center for Clinical Research, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christina Sewell
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA; Cleveland Clinic Coordinating Center for Clinical Research, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Wanying Li
- MyoKardia, Inc, a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, California, USA
| | - Lulu Sterling
- MyoKardia, Inc, a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, California, USA
| | - Kathy Lampl
- MyoKardia, Inc, a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, California, USA
| | - Jay M Edelberg
- MyoKardia, Inc, a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, California, USA
| | - Amy J Sehnert
- MyoKardia, Inc, a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, California, USA
| | - Steven E Nissen
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA; Cleveland Clinic Coordinating Center for Clinical Research, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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31
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Krittanawong C, Virk HUH, Isath A, Wang Z, Naidu SS, Mehran R, Birnbaum Y, Levine GN, Jneid H. Meta-Analysis of Brief Dual-Antiplatelet Therapy Duration After Percutaneous Coronary Intervention. Am J Cardiol 2022; 174:182-184. [PMID: 35504744 DOI: 10.1016/j.amjcard.2022.03.045] [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: 03/14/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Chayakrit Krittanawong
- The Michael E. DeBakey Veterans Affairs Medical Center, Section of Cardiology, Baylor College of Medicine, Houston, Texas.
| | - Hafeez Ul Hassan Virk
- Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Ameesh Isath
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Zhen Wang
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Roxana Mehran
- Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Hospital, New York, New York
| | - Yochai Birnbaum
- The Michael E. DeBakey Veterans Affairs Medical Center, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Glenn N Levine
- The Michael E. DeBakey Veterans Affairs Medical Center, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Hani Jneid
- The Michael E. DeBakey Veterans Affairs Medical Center, Section of Cardiology, Baylor College of Medicine, Houston, Texas
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Owens AT, Sutton MB, Gao W, Fine JT, Xie J, Naidu SS, Desai NR. Treatment Changes, Healthcare Resource Utilization, and Costs Among Patients with Symptomatic Obstructive Hypertrophic Cardiomyopathy: A Claims Database Study. Cardiol Ther 2022; 11:249-267. [PMID: 35230625 PMCID: PMC9135924 DOI: 10.1007/s40119-022-00257-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/04/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION There is limited evidence on therapies for obstructive hypertrophic cardiomyopathy (HCM), and data regarding treatment patterns and cost are scarce. This study assessed treatment patterns and economic outcomes in patients with symptomatic obstructive HCM. METHODS Adults with symptomatic obstructive HCM as per study design and treated with pharmacotherapies [beta blockers (BBs), calcium channel blockers (CCBs), BB + CCB, or disopyramide] or procedures (septal reduction therapy, heart transplantation, implantable cardioverter-defibrillator, and pacemaker implantation) were identified from the IBM® MarketScan® Commercial and Medicare Supplemental database (January 2009-March 2019). Patients had 12-month continuous eligibility before and after (study period) treatment initiation (index treatment). Healthcare resource utilization (HRU), costs, and treatment changes were assessed. RESULTS Of the 4883 patients included in the analysis, 85% received pharmacotherapies (BB 52.5%; CCB 11.7%; BB + CCB 17.7%; disopyramide 2.4%) and 15.7% underwent procedures. During the study period, 38, 34, and 100% of all patients had ≥ 1 inpatient stay, emergency room (ER) visit, and outpatient visit, respectively; mean total healthcare costs were US$53,053. Patients undergoing procedures had the highest HRU and costs across groups. Among patients receiving pharmacotherapies, HRU was lowest with BBs and highest with disopyramide. Treatment changes were observed in 43.8% of patients receiving pharmacotherapies. CONCLUSIONS Patients experienced high rates of treatment changes, and the economic burden associated with symptomatic obstructive HCM increased as therapy escalated. More effective therapies are needed to stabilize or decrease the economic burden of obstructive HCM.
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Affiliation(s)
- Anjali T Owens
- Center for Inherited Cardiovascular Disease, Perelman Center for Advanced Medicine, University of Pennsylvania Perelman School of Medicine, 11th Floor South Tower, 3400 Civic Center Blvd, Philadelphia, PA, 19014, USA.
| | - Megan B Sutton
- Myokardia, Inc., a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, CA, USA
| | - Wei Gao
- Analysis Group, Inc., Boston, MA, USA
| | - Jennifer T Fine
- Myokardia, Inc., a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, CA, USA
| | - Jipan Xie
- Analysis Group, Inc., Los Angeles, CA, USA
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Center, Westchester Medical Center Health Network, New York Medical College, Valhalla, NY, USA
| | - Nihar R Desai
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
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Kern MJ, Applegate B, Bittl J, Block P, Butman S, Dehmer G, Garratt KN, Henry T, Hirshfeld J, Holmes DR, Kaplan A, King S, Klein LW, Krucoff MW, Kutcher MA, Naidu SS, Pichard A, Ruiz CE, Skelding KA, Tobis JM, Tommaso C, Weiner BH, White C. Conversations in cardiology: Late career transitions-Retool, retire, refocus. Catheter Cardiovasc Interv 2022; 99:2136-2144. [PMID: 35446473 DOI: 10.1002/ccd.30210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Morton J Kern
- Department of Cardiology, Veterans Administration Long Beach Health Care System, Long Beach, California, USA.,University of California Irvine, Orange, California, USA
| | - Bob Applegate
- Professor of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Peter Block
- Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Gregory Dehmer
- Quality and Outcomes, Carilion Clinic and Cardiovascular Institute, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | | | - Tim Henry
- The Carl and Edyth Lindner Center for Research and Education, Cincinnati, Ohio, USA
| | - John Hirshfeld
- Professor Emeritus of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David R Holmes
- Scripps Professor of Cardiovascular Medicine, Mayo Graduate School of Medicine, Rochester, Minnesota, USA
| | - Aaron Kaplan
- Dartmouth Device Development Symposium, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center/Geisel School of Medicine, Lebanon, Dartmouth, New Hampshire, USA
| | - Spencer King
- Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Mitchell W Krucoff
- Medicine/Cardiology, Duke University Medical Center, Cardiovascular Devices Unit, eECG Core Laboratories Duke Clinical Research Institute, Raleigh, North Carolina, USA
| | - Michael A Kutcher
- Professor of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Srihari S Naidu
- Cardiac Cath Labs, Westchester Medical Center, Winthrop, New York, USA
| | - Augusto Pichard
- Medstar Washington Hospital Center, Georgetown University, Washington, District of Columbia, USA
| | | | | | - Jonathan M Tobis
- David Geffen Shool of Medicine at UCLA, Santa Barbara, California, USA
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Patel N, Bandyopadhyay D, Agarwal G, Chakraborty S, Kumar A, Hajra A, Amgai B, Krittanawong C, Martin L, Abbott JD, Mamas MA, Naidu SS. Outcomes of rotational atherectomy followed by cutting balloon versus plain balloon before drug-eluting stent implantation for calcified coronary lesions: A meta-analysis. Catheter Cardiovasc Interv 2022; 99:1741-1749. [PMID: 35366389 DOI: 10.1002/ccd.30159] [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: 09/13/2020] [Revised: 02/11/2022] [Accepted: 03/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study is to compare outcomes of rotational atherectomy and cutting balloon (RACB) versus rotational atherectomy and plain balloon (RAPB) before drug-eluting stent (DES) implantation in calcified coronary lesions. METHODS Randomized controlled trials (RCT) and observational studies comparing RACB with RAPB were identified through a systematic search of published literature across multiple databases. Random effect meta-analysis was performed to compare the outcome between the two groups. RESULTS Four studies were included in the meta-analysis (three observational and one RCT) involving a total of 315 patients. 166 patients had RACB, and 149 patients had RAPB before DES placement with a median follow-up of 11.5 months. Compared with patients who had RAPB there was no difference in MACE (composite of death, myocardial infarction, and target vessel revascularization) (odds ratio [OR]: 0.74; 95% confidence interval [CI]: 0.25-2.18], slow flow/no reflow (OR: 0.71; 95% CI: 0.23-2.16), all-cause mortality (OR: 2.02; 95% CI: 0.28-14.60), and device success rate (OR: 1.79; 95% CI: 0.28-11.18) in the RACB approach. There was a benefit towards less target lesion revascularization in the RACB group; however, this outcome was reported in two studies (OR: 0.29; 95% CI: 0.08-0.99). On meta-regression there was no association between age, sex, diabetes, or lesion location with MACE and all-cause mortality. The studies were homogenous across all outcomes. CONCLUSION RACB, as compared with RAPB, had a similar risk of MACE, all-cause mortality, device success, and complication, but a lower risk of target lesion revascularization.
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Affiliation(s)
- Neelkumar Patel
- Department of Cardiology, University of Kansas, Lawrence, Kansas, USA
| | - Dhrubajyoti Bandyopadhyay
- Department of Cardiology, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Gaurav Agarwal
- Jersey City Medical Center, Jersey City, New Jersey, USA
| | | | - Ashish Kumar
- Crozer-Chester Medical Center, Philadelphia, Pennsylvania, USA
| | - Adrija Hajra
- Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Chayakrit Krittanawong
- Department of Cardiology, The Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas, USA
| | - Lily Martin
- Levy Library, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - J Dawn Abbott
- Department of Cardiology, Lifespan Cardiovascular Institute, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mamas A Mamas
- Department of Cardiology, Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
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Lemor A, Hosseini Dehkordi SH, Alrayes H, Cowger J, Naidu SS, Villablanca PA, Basir MB, O'Neill W. Outcomes, Temporal Trends, and Resource Utilization in Ischemic versus Nonischemic Cardiogenic Shock. Crit Pathw Cardiol 2022; 21:11-17. [PMID: 34907938 DOI: 10.1097/hpc.0000000000000272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Cardiogenic shock (CS) is associated with significant morbidity and mortality. Differentiating the etiologic factors driving CS has epidemiological significance and aids in optimization of therapeutic strategies, prognostication, and resource utilization. The aim herein is to investigate the epidemiology and clinical outcomes of CS in those with ischemic and nonischemic CS etiologies. Using International Classification of Diseases codes, we queried the national inpatient sample for CS hospitalization from 2007 to 2018 and divided the study sample into cohorts of ischemic (I-CS) and nonischemic cardiogenic shock (NI-CS). We then compared the primary outcome of in-hospital mortality between these 2 cohorts. Two groups of secondary outcomes (clinical and procedural) were also assessed between the 2 cohorts. CS was present in 557,860 hospitalizations; 84% of these were I-CS and 15.8% NI-CS. Patients with I-CS were older, more commonly males, with more risk factors for coronary artery disease (P < 0.05). NI-CS had higher prevalence of preexisting systolic heart failure and atrial fibrillation. The in-hospital mortality was significantly higher in patients with I-CS (32.2% vs. 29.5%, adjusted odds ratio 1.10, P < 0.001). Frequencies of acute ischemic stroke, mechanical ventilation, ventricular arrhythmias, and vascular complications were higher in I-CS versus NI-CS, while acute kidney injury and acute liver failure were more common in NI-CS (P < 0.05). The use of mechanical circulatory support devices was higher in the I-CS group. In conclusion, patients with I-CS comprise the vast majority of CS and are associated with higher mortality and higher resource utilization. Conversely, patients with NI-CS appear to have higher survival but with a higher prevalence of end-organ dysfunction.
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Affiliation(s)
- Alejandro Lemor
- From the Department of Cardiology, Henry Ford Health System, Detroit, MI
| | | | - Hussayn Alrayes
- From the Department of Cardiology, Henry Ford Health System, Detroit, MI
| | - Jennifer Cowger
- From the Department of Cardiology, Henry Ford Health System, Detroit, MI
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | | | - Mir B Basir
- From the Department of Cardiology, Henry Ford Health System, Detroit, MI
| | - William O'Neill
- From the Department of Cardiology, Henry Ford Health System, Detroit, MI
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Feldstein E, Dominguez JF, Kaur G, Patel SD, Dicpinigaitis AJ, Semaan R, Fuentes LE, Ogulnick J, Ng C, Rawanduzy C, Kamal H, Pisapia J, Hanft S, Amuluru K, Naidu SS, Cooper HA, Prabhakaran K, Mayer SA, Gandhi CD, Al-Mufti F. Cardiac arrest in spontaneous subarachnoid hemorrhage and associated outcomes. Neurosurg Focus 2022; 52:E6. [DOI: 10.3171/2021.12.focus21650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The authors sought to analyze a large, publicly available, nationwide hospital database to further elucidate the impact of cardiopulmonary arrest (CA) in association with subarachnoid hemorrhage (SAH) on short-term outcomes of mortality and discharge disposition.
METHODS
This retrospective cohort study was conducted by analyzing de-identified data from the National (Nationwide) Inpatient Sample (NIS). The publicly available NIS database represents a 20% stratified sample of all discharges and is powered to estimate 95% of all inpatient care delivered across hospitals in the US. A total of 170,869 patients were identified as having been hospitalized due to nontraumatic SAH from 2008 to 2014.
RESULTS
A total of 5415 patients (3.2%) were hospitalized with an admission diagnosis of CA in association with SAH. Independent risk factors for CA included a higher Charlson Comorbidity Index score, hospitalization in a small or nonteaching hospital, and a Medicaid or self-pay payor status. Compared with patients with SAH and not CA, patients with CA-SAH had a higher mean NIS Subarachnoid Severity Score (SSS) ± SD (1.67 ± 0.03 vs 1.13 ± 0.01, p < 0.0001) and a vastly higher mortality rate (82.1% vs 18.4%, p < 0.0001). In a multivariable model, age, NIS-SSS, and CA all remained significant independent predictors of mortality. Approximately 18% of patients with CA-SAH survived and were discharged to a rehabilitation facility or home with health services, outcomes that were most predicted by chronic disease processes and large teaching hospital status.
CONCLUSIONS
In the largest study of its kind, CA at onset was found to complicate roughly 3% of spontaneous SAH cases and was associated with extremely high mortality. Despite this, survival can still be expected in approximately 18% of patients.
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Affiliation(s)
- Eric Feldstein
- Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine
| | - Jose F. Dominguez
- Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine
| | - Gurkamal Kaur
- Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine
| | - Smit D. Patel
- Department of Neurosurgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California; and
| | - Alis J. Dicpinigaitis
- Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine
| | - Rosa Semaan
- Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine
| | - Leanne E. Fuentes
- Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine
| | - Jonathan Ogulnick
- Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine
| | - Christina Ng
- Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine
| | - Cameron Rawanduzy
- Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine
| | - Haris Kamal
- Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine
| | - Jared Pisapia
- Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine
| | - Simon Hanft
- Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine
| | - Krishna Amuluru
- Department of Neurointerventional Radiology, Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Srihari S. Naidu
- Department of Medicine, Westchester Medical Center, New York Medical College of Medicine
| | - Howard A. Cooper
- Department of Cardiology, Westchester Medical Center, New York Medical College of Medicine
| | - Kartik Prabhakaran
- Department of Surgery, Westchester Medical Center, New York Medical College of Medicine, Valhalla, New York
| | - Stephan A. Mayer
- Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine
| | - Chirag D. Gandhi
- Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine
| | - Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine
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Hassanin A, Bendary A, Abushouk A, Govil N, Al-Seykal I, Jin C, Naidu SS. QUALITY AND OUTCOMES OF STEMI CARE IN MIDDLE INCOME COUNTRIES COMPARED TO HIGH INCOME COUTNRIES A META-ANALYSIS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02865-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jin C, Yandrapalli S, Yang Y, Liu B, Aronow WS, Naidu SS. A Comparison of In-Hospital Outcomes Between the Use of Impella and IABP in Acute Myocardial Infarction Cardiogenic Shock Undergoing Percutaneous Coronary Intervention. J Invasive Cardiol 2022; 34:E98-E103. [PMID: 35100554] [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: 06/14/2023]
Abstract
BACKGROUND The use of Impella ventricular support systems and intra-aortic balloon pump (IABP) in acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) has increased in recent years and expanded treatment options, although the comparative clinical outcomes and device safety remain unclear. METHODS We used the Nationwide Inpatient Sample database (2012-2017) to identify adults who were admitted for AMI complicated by CS and received percutaneous coronary intervention (PCI). The study sample was divided into Impella and IABP groups. Patient characteristics, hospital characteristics, and comorbidities were balanced between groups using propensity-score matching. Regression analysis was utilized to study outcome differences between groups. RESULTS We identified 51,150 patients, of whom 44,265 (86.54%) received IABP and 6885 (13.46%) received Impella. After propensity matching, compared with the Impella group (n = 1592), the IABP group (n = 8638) had lower rates of sepsis (6.44% vs 12.69%; P=.01), blood transfusion (8.92% vs 14.28%; P=.01), mortality (28.95% vs 49.59%; P<.01), and hospitalization costs ($49,420 vs $68,087; P<.001). The IABP group had similar rates of cardiac arrest (20.32% vs 22.22%; P=.32), in-hospital stroke (1.46% vs 1.59%; P=.37), and length-of-stay (8.56 days vs 8.64 days; P=.26) compared with the Impella group. CONCLUSION In patients with CS complicating AMI who underwent PCI, Impella use compared with IABP was associated with higher mortality with no differences in in-hospital stroke and cardiac arrest rates, although study interpretation is limited by retrospective observational design and the potential for remaining confounders. Further prospective research is warranted to elucidate the optimal mechanical circulatory support device in these patients.
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Affiliation(s)
| | | | | | | | | | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Center, Valhalla, New York. 100 Woods Road, Valhalla, NY 10595 USA.
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Yandrapalli S, Harikrishnan P, Andries G, Aronow WS, Panza JA, Naidu SS. Differences in Short-Term Outcomes and Hospital-Based Resource Utilization Between Septal Reduction Strategies for Hypertrophic Obstructive Cardiomyopathy. J Invasive Cardiol 2022; 34:E8-E13. [PMID: 34919530] [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: 06/14/2023]
Abstract
BACKGROUND Given clinical equipoise in a subset of obstructive hypertrophic cardiomyopathy (OHCM) patients who are candidates for both alcohol septal ablation (ASA) or septal myectomy (SM), other considerations such as cost, readmissions, and hospital length of stay (LOS) may be important to optimize healthcare resource utilization and inform shared decision making. METHODS In this retrospective observational analysis of the United States Nationwide Readmissions Database years 2012-2014, we identified adults who underwent isolated septal reduction (SR) for OHCM. We studied the differences in short-term outcomes (inpatient mortality and 90-day readmission rate) and in-hospital resource utilization (LOS and costs) between the SR strategies. RESULTS Of the 2250 patients in this study, ASA was performed in 1113 (49.5%) and SM in 1137 (50.5%). Inpatient mortality occurred in 21 patients (0.9%), with similar rates between strategies (10 SM patients [0.9%] vs 11 ASA patients [1.0%]; P=.30). Of the 2229 patients who survived to discharge, 298 (13.4%) were readmitted 386 times within 90 days with a similar readmission rate between SM (14.9%) and ASA (11.8%; P=.16). During the index admission, average LOS and cost were significantly lower for ASA (3.9 days, United States [US] $20,322) compared with SM (7.6 days, US $39,470; P<.001). Average LOS and cost during 90-day readmissions were similar between ASA and SM. Combining index admissions and readmissions, patients undergoing ASA had significantly lower LOS and hospitalization costs. CONCLUSIONS In this non-randomized observational study of OHCM patients undergoing isolated septal reduction, ASA was associated with similar short-term outcomes, including mortality, but substantially lower hospitalization costs and LOS compared with SM.
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Affiliation(s)
- Srikanth Yandrapalli
- Department of Cardiology, Westchester Medical Center and New York Medical College, 100 Woods Rd, Macy Pavilion, Valhalla, NY 10595 USA.
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Naidu SS, Baran DA, Jentzer JC, Hollenberg SM, van Diepen S, Basir MB, Grines CL, Diercks DB, Hall S, Kapur NK, Kent W, Rao SV, Samsky MD, Thiele H, Truesdell AG, Henry TD. SCAI SHOCK Stage Classification Expert Consensus Update: A Review and Incorporation of Validation Studies. J Am Coll Cardiol 2022; 79:933-946. [DOI: 10.1016/j.jacc.2022.01.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 12/30/2022]
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Beygui N, Bahl D, Mansour C, Michos ED, Velagapudi P, Grapsa J, Choi A, Naidu SS, Parwani P. Social Media as a Tool to Advance Women in Cardiology: Paving the Way for Gender Equality and Diversity. CJC Open 2021; 3:S130-S136. [PMID: 34993442 PMCID: PMC8712539 DOI: 10.1016/j.cjco.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/22/2021] [Indexed: 11/28/2022] Open
Abstract
Although the number of women in the field of medicine continues to rise, the discrimination against women and the gender inequity in both leadership roles and salary remains persistent. The gender divide is particularly prominent in male-dominated specialties, such as cardiology. Social media help foster global connections and disseminate information quickly and worldwide. The rise of social media has influenced how female physicians communicate and has shown its benefits particularly within the field of cardiology. Virtual platforms are important avenues where female physicians have united for greater representation of gender issues and advocacy efforts. Social media further amplify gender-equality activism by facilitating the conversations surrounding gender equity and proposing solutions to self-identified issues by the virtual community of female physicians and their allies. In this review, we discuss the role of social media as tools for advancing women in the field of cardiology and fostering gender equality and diversity.
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Affiliation(s)
- Matthew J Daniels
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, United Kingdom (M.J.D.).,Division of Cardiovascular Sciences, Manchester Academic Health Sciences Center (M.J.D.), University of Manchester, Manchester, United Kingdom.,Division of Cell Matrix Biology and Regenerative Medicine (M.J.D.), University of Manchester, Manchester, United Kingdom
| | - Luca Fusi
- Randall Center for Cell and Molecular Biophysics and BHF Center for Research Excellence, King's College London, United Kingdom (L.F.)
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Australia (C.S.)
| | - Srihari S Naidu
- Hypertrophic Cardiomyopathy Center, Department of Cardiology, Westchester Medical Center, Valhalla, NY (S.S.N.)
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Hassanin A, Rzechorzek W, Naidu SS, Lanier GM. A haemodynamic conundrum: a case report of a patient with concurrent pulmonary arterial hypertension and hypertrophic obstructive cardiomyopathy. Eur Heart J Case Rep 2021; 5:ytab354. [PMID: 34557642 PMCID: PMC8453412 DOI: 10.1093/ehjcr/ytab354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/19/2021] [Accepted: 08/23/2021] [Indexed: 12/04/2022]
Abstract
Background The co-existence of hypertrophic obstructive cardiomyopathy (HOCM) and pulmonary arterial hypertension (PAH) is extremely rare and poses a management conundrum. This is the first case report in the published literature to describe the diagnosis and management of a patient with both conditions. Case summary A 49-year-old female with a history of HOCM and recently diagnosed scleroderma presented to the clinic with progressive dyspnoea. Transthoracic echocardiogram demonstrated left ventricular outflow tract (LVOT) obstruction at rest, and elevated pulmonary artery (PA) pressure. Cardiac catheterization (CC) demonstrated an LVOT gradient of 150 mmHg, PA pressure of 88/32 mmHg, pulmonary capillary wedge pressure (PCWP) 12 mmHg, pulmonary vascular resistance 14.8 Wu, and a cardiac index of 1.6 L/min/m2. The differential diagnosis for the dyspnoea included combined pre- and post-capillary pulmonary hypertension from longstanding HOCM vs. scleroderma associated PAH. Tadalafil was added to the patient’s medical regimen of metoprolol but it was stopped because the patient developed pulmonary oedema. Alcohol septal ablation was undertaken with improvement in the LVOT gradient, but only a modest improvement in her dyspnoea. Repeat CC demonstrated worsening PAH. Vasodilatory testing with nitric oxide led to an improvement in the PA pressure with minimal increase of the PCWP. Hence, she was started on treprostinil and macitentan, with significant improvement in her dyspnoea on follow-up. Conclusion In patients with concurrent HOCM and advanced PAH, a multidisciplinary treatment approach is needed to rapidly and safely optimize the background of HOCM in order to permit the use of PAH-specific medications.
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Affiliation(s)
- Ahmed Hassanin
- Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA
| | - Wojciech Rzechorzek
- Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA
| | - Srihari S Naidu
- Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA
| | - Gregg M Lanier
- Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA
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Naidu SS, Baron SJ, Eng MH, Sathanandam SK, Zidar DA, Feldman DN, Ing FF, Latif F, Lim MJ, Henry TD, Rao SV, Dangas GD, Hermiller JB, Daggubati R, Shah B, Ang L, Aronow HD, Banerjee S, Box LC, Caputo RP, Cohen MG, Coylewright M, Duffy PL, Goldsweig AM, Hagler DJ, Hawkins BM, Hijazi ZM, Jayasuriya S, Justino H, Klein AJ, Kliger C, Li J, Mahmud E, Messenger JC, Morray BH, Parikh SA, Reilly J, Secemsky E, Shishehbor MH, Szerlip M, Yakubov SJ, Grines CL, Alvarez-Breckenridge J, Baird C, Baker D, Berry C, Bhattacharya M, Bilazarian S, Bowen R, Brounstein K, Cameron C, Cavalcante R, Culbertson C, Diaz P, Emanuele S, Evans E, Fletcher R, Fortune T, Gaiha P, Govender D, Gutfinger D, Haggstrom K, Herzog A, Hite D, Kalich B, Kirkland A, Kohler T, Laurisden H, Livolsi K, Lombardi L, Lowe S, Marhenke K, Meikle J, Moat N, Mueller M, Patarca R, Popma J, Rangwala N, Simonton C, Stokes J, Taber M, Tieche C, Venditto J, West NEJ, Zinn L. Hot topics in interventional cardiology: Proceedings from the society for cardiovascular angiography and interventions (SCAI) 2021 think tank. Catheter Cardiovasc Interv 2021; 98:904-913. [PMID: 34398509 DOI: 10.1002/ccd.29898] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 01/07/2023]
Abstract
The Society for Cardiovascular Angiography and Interventions (SCAI) Think Tank is a collaborative venture that brings together interventional cardiologists, administrative partners, and select members of the cardiovascular industry community annually for high-level field-wide discussions. The 2021 Think Tank was organized into four parallel sessions reflective of the field of interventional cardiology: (a) coronary intervention, (b) endovascular medicine, (c) structural heart disease, and (d) congenital heart disease. Each session was moderated by a senior content expert and co-moderated by a member of SCAI's Emerging Leader Mentorship program. This document presents the proceedings to the wider cardiovascular community in order to enhance participation in this discussion, create additional dialog from a broader base, and thereby aid SCAI, the industry community and external stakeholders in developing specific action items to move these areas forward.
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Affiliation(s)
- Srihari S Naidu
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Suzanne J Baron
- Division of Cardiology, Department of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Marvin H Eng
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Shyam K Sathanandam
- Department of Cardiology, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - David A Zidar
- Department of Cardiology, UH Harrington Heart & Vascular Institute, Cleveland, Ohio, USA
| | - Dmitriy N Feldman
- Department of Cardiology, Weill Cornell Medical Center, New York, USA
| | - Frank F Ing
- Department of Cardiology, UC Davis Medical Center, Sacramento, California, USA
| | - Faisal Latif
- Department of Cardiology, The University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | - Michael J Lim
- Department of Cardiology, St. Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Timothy D Henry
- Department of Cardiology, The Christ Hospital Health Network, Cincinnati, Ohio, USA
| | - Sunil V Rao
- Department of Cardiology, Duke University Health System, Durham, North Carolina, USA
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, USA
| | - James B Hermiller
- Department of Cardiology, Ascension St. Vincent Cardiovascular Research Institute, Carmel, Indiana, USA
| | - Ramesh Daggubati
- Department of Cardiology, The West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Binita Shah
- Department of Cardiology, NYU Grossman School of Medicine, New York, USA
| | - Lawrence Ang
- Division of Cardiovascular Medicine, The University of California, San Diego, California, USA
| | - Herbert D Aronow
- Department of Cardiology, Lifespan Cardiovascular Institute/Brown Medical School, Providence, Rhode Island, USA
| | - Subhash Banerjee
- Department of Cardiology, Dallas Veterans Affairs Medical Center, Dallas, Texas, USA
| | - Lyndon C Box
- Department of Cardiology, West Valley Medical Center, Caldwell, Idaho, USA
| | - Ronald P Caputo
- Department of Cardiology, Levine Heart and Wellness, Naples, Florida, USA
| | - Mauricio G Cohen
- Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Megan Coylewright
- Department of Cardiology, Erlanger Health System, Chattanooga, Tennessee, USA
| | - Peter L Duffy
- Department of Cardiology, West Florida Hospital, Pensacola, Florida, USA
| | - Andrew M Goldsweig
- Division of Cardiovascular Medicine, The University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Donald J Hagler
- Division of Pediatric Cardiology and Department of Cardiovascular Diseases, Mayo Clinic Health System, Rochester, Minnesota, USA
| | - Beau M Hawkins
- Department of Cardiology, The University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | - Ziyad M Hijazi
- Cardiology, Weill Cornell Medical College, New York, USA.,Sidra Medicine, Doha, Qatar
| | - Sasanka Jayasuriya
- Cardiology, Ascension Columbia St. Mary's Hospital Milwaukee, Milwaukee, Wisconsin, USA
| | - Henri Justino
- Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Andrew J Klein
- Department of Cardiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Chad Kliger
- Department of Medicine, Division of Cardiovascular Medicine, Northwell Health Lenox Hill Hospital, New York, USA
| | - Jun Li
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ehtisham Mahmud
- Coronary Care Unit, University of California, San Diego, California, USA
| | - John C Messenger
- Department of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Brian H Morray
- Department of Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Sahil A Parikh
- Division of Cardiology and Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, USA
| | - John Reilly
- Division of Cardiovascular Medicine, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Eric Secemsky
- Department of Internal Medicine, Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mehdi H Shishehbor
- Harrington Heart & Vascular Institute, UH Harrington Heart & Vascular Institute, Cleveland, Ohio, USA
| | - Molly Szerlip
- Division of Cardiology, Baylor Scott & White The Heart Hospital - Plano, Plano, Texas, USA
| | - Steven J Yakubov
- Department of Cardiology, OhioHealth Heart & Vascular Physicians, Columbus, Ohio, USA
| | - Cindy L Grines
- Department of Cardiology, Northside Hospital Cardiovascular Institute, Atlanta, Georgia, USA
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- TandemLife, LivaNova, Pittsburgh, Pennsylvania, USA
| | | | | | - David Baker
- Philips Healthcare, Cambridge, Massachusetts, USA
| | | | | | | | | | | | | | | | | | | | | | - Erin Evans
- TandemLife, LivaNova, Pittsburgh, Pennsylvania, USA
| | | | | | - Priya Gaiha
- Siemens Medical Solutions USA, Malvern, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Neil Moat
- Abbott, Santa Clara, California, USA
| | | | | | | | | | | | - Jerry Stokes
- TandemLife, LivaNova, Pittsburgh, Pennsylvania, USA
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Darmoch F, Ullah W, Al-Khadra Y, Sattar Y, Pacha HM, Zghouzi M, Soud M, Bagur R, Naidu SS, Goldsweig AM, Mamas M, Brilakis ES, Alraies MC. Characteristics and hospital outcomes of coronary atherectomy within the United States: a multivariate and propensity-score matched analysis. Expert Rev Cardiovasc Ther 2021; 19:865-870. [PMID: 34330193 DOI: 10.1080/14779072.2021.1963233] [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] [Indexed: 10/20/2022]
Abstract
BACKGROUND Suboptimal stent delivery and deployment in calcified coronary lesions are associated with a poor clinical outcome. METHODS Using the National Inpatient Sample database, we identified patients undergoing percutaneous coronary intervention (PCI). Comparison between procedural and hospital outcomes between patients who underwent atherectomy and those who did not. RESULTS A total of 2,035,039 patients underwent PCI, of which 50,095 (2.4%) underwent lesion modification using atherectomy. After adjustment for baseline differences, patients who underwent atherectomy were found to have higher rates of in-hospital mortality (3.3% vs 2.2% adjusted Odds Ratio, aOR, 1.39; 95% confidence interval [CI], 1.31-1.46, P < 0.001), coronary artery dissection (1.7% vs 1.1%, aOR, 1.56; 95%, 1.45-1.67, P < 0.001) vascular complications (1.6% vs 1.0%, aOR, 1.52; 95%, 1.42-1.64, P < 0.001), major bleeding (6.3% vs 4.7%, aOR, 1.24; 95%, 1.18-1.28, P < 0.001), and acute kidney injury (AKI) (10.9%vs 9.1%, aOR, 1.07; 95%, 1.04-1.11, P < 0.001) when compared with non-atherectomy patients. Concomitant intravascular ultrasound (IVUS) imaging improved mortality, while other complication rates were not affected by imaging. CONCLUSION Coronary atherectomy was performed in patients with multiple comorbidities and was associated with higher in-hospital mortality and complications than the non-atherectomy group.
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Affiliation(s)
- Fahed Darmoch
- Department of Cardiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Waqas Ullah
- Department of Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Yasser Al-Khadra
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Yasar Sattar
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Elmhurst Hospital New York, USA
| | - Homam Moussa Pacha
- Department ofCardiology, University of Texas Health Science Center, Houston, Texas, USA
| | - Mohamed Zghouzi
- Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA
| | - Mohamad Soud
- Department of Cardiology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Rodrigo Bagur
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry Western University, London, Ontario, Canada
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
| | - Andrew M Goldsweig
- Department of Cardiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mamas Mamas
- Department of Cardiology, Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
| | - Emmanouil S Brilakis
- Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Chadi Alraies
- Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA
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Patel N, Narasimhan B, Bandyopadhyay D, Amreia M, Chakraborty S, Hajra A, Amgai B, Rai D, Luo Y, Krittanawong C, Dey AK, Ghosh RK, Fonarow GC, Lanier GM, De Marco T, Naidu SS. Impact of Pulmonary Hypertension on In-Hospital Outcomes and 30-Day Readmissions Following Percutaneous Coronary Interventions. Mayo Clin Proc 2021; 96:2058-2066. [PMID: 34353467 DOI: 10.1016/j.mayocp.2021.03.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/25/2020] [Revised: 02/27/2021] [Accepted: 03/08/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the impact of pulmonary hypertension (PH) on percutaneous coronary intervention (PCI) outcomes and 30-day all-cause readmissions by analyzing a national database. METHODS We queried the 2014 National Readmissions Database to identify patients undergoing PCI using International Classification of Diseases, Ninth Revision, Clinical Modification codes. These patients were then subcategorized based on the coded presence or absence of PH and further analyzed to determine the impact of PH on clinical outcomes, health care use, and 30-day readmissions. RESULTS Among 599,490 patients hospitalized for a PCI in 2014, 19,348 (3.2%) had concomitant PH. At baseline, these patients were older with a higher burden of comorbidities. Patients with PH had longer initial hospitalizations and higher 30-day readmission rates and mortality than their non-PH counterparts. This was largely driven by cardiac causes, most commonly heart failure (20.3% vs 9.0%, P<.001) and non-ST-segment elevation myocardial infarction. Recurrent coronary events (17.5% vs 9.5%, P<.05) including ST-segment elevation myocardial infarction predominated in the non-PH group. CONCLUSION Patients with PH undergoing PCI are a high-risk group in terms of mortality and 30-day readmission rates. Percutaneous coronary intervention in patients with PH is associated with higher rates of recurrent heart failure and non-ST-segment elevation myocardial infarction, rather than recurrent coronary events or ST-segment elevation myocardial infarction. This perhaps indicates a predominance of demand ischemia and heart failure syndromes rather than overt atherothrombosis in the etiology of chest pain in these patients.
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Affiliation(s)
| | - Bharat Narasimhan
- Icahn School of Medicine at Mount Sinai, St Luke's-Roosevelt-Mount Sinai, New York, NY
| | | | | | | | - Adrija Hajra
- Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | | | - Devesh Rai
- Rochester General Hospital, Rochester, NY
| | - Yiming Luo
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | | | | | | | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA
| | - Gregg M Lanier
- Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Teresa De Marco
- Advanced Heart Failure and Pulmonary Hypertension Program, University of California-San Francisco, San Francisco, CA
| | - Srihari S Naidu
- Westchester Medical Center, New York Medical College, Valhalla, NY.
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Malik AH, Yandrapalli S, Shetty SS, Zaid S, Athar A, Aronow WS, Timmermans RJ, Ahmad H, Cooper HA, Naidu SS, Panza JA. Radial vs. Femoral Access for Percutaneous Coronary Artery Intervention in Patients With ST-Elevation Myocardial Infarction. Cardiovasc Revasc Med 2021; 28:57-64. [PMID: 32981856 DOI: 10.1016/j.carrev.2020.06.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/27/2020] [Accepted: 06/15/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND We aimed to compare the safety and efficacy of transradial vs transfemoral access for coronary angiography and intervention in patients presenting with ST-segment elevation myocardial infarction (STEMI) without cardiogenic shock. METHODS PubMed, Embase and Cochrane Central were searched for randomized controlled trials (RCTs) comparing outcomes of STEMI patients who underwent transradial angiography (TRA) compared to transfemoral angiography (TFA). Our outcomes of interest were major adverse cardiac events (MACE), all-cause mortality, severe bleeding, access site bleeding, myocardial infarction, stroke, and major vascular complications. Summary statistics are reported as odds ratios (OR) with 95% confidence intervals (CI). RESULTS In a pooled analysis of 17 RCTs with 12,118 randomized patients, the use of transradial compared to transfemoral approach in STEMI patients without cardiogenic shock was associated with a significant reduction in MACE [OR 0.85 (95% CI 0.73-0.99; p = 0.04; NNT = 111; I2 = 0%)] and all-cause mortality [OR 0.71 (95% CI 0.57-0.88; p < 0.01; NNT = 111; I2 = 0%)]. Severe bleeding [OR 0.57 (95% CI 0.44-0.74; p < 0.01; NNT = 77; I2 = 0%)], access-site bleeding [OR 0.39 (95% CI 0.26-0.59; p < 0.01; NNT = 67; I2 = 24%)], and major vascular complications [OR of 0.31 (95% CI 0.17-0.55; p < 0.01; NNT = 125; I2 = 0%)] were lower in TRA compared to TFA. There was no difference in stroke (0.6% vs 0.5%) or recurrent myocardial infarction (2.01% vs 2.02%) between the two approaches. CONCLUSIONS For coronary intervention in STEMI patients without cardiogenic shock, there is a clear mortality benefit with the TRA over TFA. Further studies are needed to see if this mortality benefit persists over the long-term.
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Affiliation(s)
- Aaqib H Malik
- Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA.
| | - Srikanth Yandrapalli
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Suchith S Shetty
- Division of Cardiology, Department of Internal Medicine, University of Iowa Health Care, Carver College of Medicine, Iowa City, USA
| | - Syed Zaid
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Ammar Athar
- Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Robert J Timmermans
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Hasan Ahmad
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Howard A Cooper
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Julio A Panza
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
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Sreenivasan J, Kaul R, Khan MS, Ranka S, Demmer RT, Yuzefpolskaya M, Aronow WS, Warraich HJ, Pan S, Panza JA, Cooper HA, Naidu SS, Colombo PC. Left Ventricular Assist Device Implantation in Hypertrophic and Restrictive Cardiomyopathy: A Systematic Review. ASAIO J 2021; 67:239-244. [PMID: 33627595 DOI: 10.1097/mat.0000000000001238] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Left ventricular assist device (LVAD) implantation in patients with advanced heart failure due to hypertrophic or restrictive cardiomyopathy (HCM/RCM) presents technical and physiologic challenges. We conducted a systematic review of observational studies to evaluate the utilization and clinical outcomes associated with LVAD implantation in patients with HCM/RCM and compared these to patients with dilated or ischemic cardiomyopathy (DCM/ICM). We searched MEDLINE, EMBASE, and Scopus from inception through May 2019 and included appropriate studies describing the use of an LVAD in patients with HCM/RCM. We identified six studies with a total of 2,766 patients with HCM/RCM and advanced heart failure, among whom 338 patients (12.2%) underwent LVAD implantation. In patients listed for transplant, the rate of LVAD implantation was significantly lower in patients with HCM/RCM compared to that in patients with DCM/ICM (4.4% vs. 18.2%, p < 0.001). Adverse clinical outcomes were significantly higher in HCM/RCM than in DCM/ICM, including operative/short-term mortality (14.0% vs. 9.0%), right ventricular failure (50.0% vs. 21.0%), infection (15.5% vs. 11.2%), bleeding (40.2% vs. 12.5%), renal failure (15.0% vs. 5.1%), stroke (5.0% vs. 2.4%), and arrhythmias (18.0% vs. 7.7%) (all p values <0.001).
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Affiliation(s)
- Jayakumar Sreenivasan
- From the Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Risheek Kaul
- From the Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Muhammad Shahzeb Khan
- Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Sagar Ranka
- Division of Cardiovascular Medicine, Kansas University Medical Center, Kansas City, KS
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Wilbert S Aronow
- From the Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Haider J Warraich
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Medicine, Cardiology Section, VA Boston Healthcare System, Boston, MA
| | - Stephen Pan
- From the Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Julio A Panza
- From the Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Howard A Cooper
- From the Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Srihari S Naidu
- From the Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Paolo C Colombo
- From the Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
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Naidu SS, Abbott JD, Bagai J, Blankenship J, Garcia S, Iqbal SN, Kaul P, Khuddus MA, Kirkwood L, Manoukian SV, Patel MR, Skelding K, Slotwiner D, Swaminathan RV, Welt FG, Kolansky DM. SCAI expert consensus update on best practices in the cardiac catheterization laboratory: This statement was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), and the Heart Rhythm Society (HRS) in April 2021. Catheter Cardiovasc Interv 2021; 98:255-276. [PMID: 33909349 DOI: 10.1002/ccd.29744] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 12/28/2022]
Abstract
The current document commissioned by the Society for Cardiovascular Angiography and Interventions (SCAI) and endorsed by the American College of Cardiology, the American Heart Association, and Heart Rhythm Society represents a comprehensive update to the 2012 and 2016 consensus documents on patient-centered best practices in the cardiac catheterization laboratory. Comprising updates to staffing and credentialing, as well as evidence-based updates to the pre-, intra-, and post-procedural logistics, clinical standards and patient flow, the document also includes an expanded section on CCL governance, administration, and approach to quality metrics. This update also acknowledges the collaboration with various specialties, including discussion of the heart team approach to management, and working with electrophysiology colleagues in particular. It is hoped that this document will be utilized by hospitals, health systems, as well as regulatory bodies involved in assuring and maintaining quality, safety, efficiency, and cost-effectiveness of patient throughput in this high volume area.
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Affiliation(s)
- Srihari S Naidu
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - J Dawn Abbott
- Cardiovascular Institute of Lifespan, Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jayant Bagai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James Blankenship
- Cardiology Division, The University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Sohah N Iqbal
- Mass General Brigham Salem Hospital, Salem, Massachusetts, USA
| | | | - Matheen A Khuddus
- The Cardiac and Vascular Institute and North Florida Regional Medical Center, Gainesville, Florida, USA
| | - Lorrena Kirkwood
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | | | - Manesh R Patel
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - David Slotwiner
- Division of Cardiology, New York Presbyterian, Weill Cornell Medicine Population Health Sciences, Queens, New York, USA
| | - Rajesh V Swaminathan
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Frederick G Welt
- Division of Cardiovascular Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Daniel M Kolansky
- Division of Cardiovascular Medicine, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Chakraborty S, Patel N, Bandyopadhyay D, Hajra A, Amgai B, Zaid S, Sharedalal P, Ahmad H, Cohen MB, Abbott JD, Naidu SS. Readmission following urgent transcatheter aortic valve implantation versus urgent balloon aortic valvuloplasty in patients with decompensated heart failure or cardiogenic shock. Catheter Cardiovasc Interv 2021; 98:607-612. [PMID: 33817969 DOI: 10.1002/ccd.29690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 02/10/2021] [Accepted: 03/14/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Urgent transcatheter aortic valve implantation (TAVI) is a feasible option for aortic stenosis (AS) patients with decompensated heart failure (HF) and cardiogenic shock (CS) as compared to the more traditional urgent balloon aortic valvuloplasty (BAV). OBJECTIVES We conducted a retrospective analysis to compare risk and cause of readmission in these two high-risk groups. METHODS Nationwide Readmission Database (NRD) 2011-2014 was retrospectively analyzed to identify patients with AS having either urgent TAVI or urgent BAV using appropriate ICD-9 codes. Propensity scores were used to match patients with urgent TAVI as compared to patients with urgent BAV. Statistical analysis was performed using the Stata 15.1 software. RESULTS We identified a weighted sample of 6,670 patients with urgent BAV and 6,964 patients with urgent TAVI. The all-cause 30- and 90-day readmission was lower in the urgent TAVI group compared to urgent BAV (15.4 vs. 22.5%, (aHR): 0.92 [0.90-0.95] p < .001). 30-day readmission due to CV cause and HF was also lower in the urgent TAVI group (aHR, 0.93: p < .001 and aHR, 0.98: p = .040, respectively). The 30-day gastrointestinal (GI) bleed readmission rate was three times higher in urgent TAVI group (aHR, 3.00:95% CI (1.23-7.33), p = .016), but was not statistically significant at 90-days. Cardiac causes of readmission were the predominant cause of readmission in both groups, but more pronounced in urgent BAV group (60.3 vs. 40.5%, p < .001). CONCLUSION Urgent TAVI appears beneficial in patients with AS and decompensated HF or CS driven by roughly 10 and 25% reductions in overall readmissions at 30 and 90 days, and marked reductions in reintervention, although offset partially by higher risk of readmission due to GI bleeding at 30 days.
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Affiliation(s)
- Sandipan Chakraborty
- Division of Cardiology, Department of Medicine, Miami Valley Hospital, Dayton, Ohio, USA
| | - Neelkumar Patel
- Division of Cardiology, Department of Medicine, Interfaith Medical Center, New York, New York, USA
| | - Dhrubajyoti Bandyopadhyay
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai/Mount Sinai St Luke's Roosevelt Hospital, New York, New York, USA
| | - Adrija Hajra
- Division of Cardiology, Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, New York, New York, USA
| | - Birendra Amgai
- Division of Cardiology, Department of Medicine, Interfaith Medical Center, New York, New York, USA
| | - Syed Zaid
- Division of Cardiology, Department of Medicine, Westchester Medical Center, New York, New York, USA
| | - Parija Sharedalal
- Division of Cardiology, Department of Medicine, Westchester Medical Center, New York, New York, USA
| | - Hasan Ahmad
- Division of Cardiology, Department of Medicine, Westchester Medical Center, New York, New York, USA
| | - Martin B Cohen
- Division of Cardiology, Department of Medicine, Westchester Medical Center, New York, New York, USA
| | - J Dawn Abbott
- Division of Cardiology, Department of Medicine, Brown University, Providence, Rhode Island, USA
| | - Srihari S Naidu
- Division of Cardiology, Department of Medicine, Westchester Medical Center, New York, New York, USA
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