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Shah MU, Muhammad A, Davison B, Naqvi SY. Invasive management of non-ST elevation myocardial infarction (NSTEMI) in a patient with severe thrombocytopenia secondary to adult-onset immune thrombocytopenic purpura. BMJ Case Rep 2022; 15:15/12/e253140. [PMID: 36549758 PMCID: PMC9791383 DOI: 10.1136/bcr-2022-253140] [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: 12/24/2022] Open
Abstract
Managing patients with immune thrombocytopenic purpura (ITP) and thrombocytopenia is challenging when they present with acute coronary syndrome (ACS). They are at high risk of thrombotic events; however, antiplatelet medications may further lower the platelet count and predispose them to significant bleeding events, especially if undergoing percutaneous coronary intervention (PCI). We present a case of a man in his 70s, previously diagnosed with adult-onset ITP, admitted with ACS and severe thrombocytopenia. He was treated with a single antiplatelet and commenced on high-dose steroids. Once platelet levels had improved, he was started on second antiplatelet and underwent successful PCI with drug-eluting stent. He was safely discharged with dual antiplatelets for 1 month and then lifelong clopidogrel without any immediate complications. Our case shows that such patients, if stable, can be safely and successfully treated with steroids to improve platelet count before proceeding to invasive management and dual antiplatelet medications.
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Affiliation(s)
| | - Asif Muhammad
- Department of Cardiology, Castle Hill Hospital, Cottingham, UK
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Haider SA, Jawaid A, Stuver T, Naqvi SY. Aortic plaque dehiscence caused by rotational atherectomy with Kokeshi phenomenon in a patient with aortic stenosis successfully treated with transcatheter aortic valve replacement. BMJ Case Rep 2022; 15:e248598. [PMID: 35504670 PMCID: PMC9066486 DOI: 10.1136/bcr-2021-248598] [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] [Accepted: 04/11/2022] [Indexed: 11/03/2022] Open
Abstract
Rotational atherectomy (RA) is an important interventional technique to facilitate effective percutaneous coronary intervention of severely calcified lesions. Despite the improved probability of better procedural outcomes during angioplasty, the use of RA is associated with an inherent risk of complications. Here, we present a case of a woman in her mid-90s with severe aortic stenosis (AS) who underwent RA facilitated angioplasty of the right coronary artery (RCA), with the procedure complicated by the Kokeshi phenomenon. Manual traction to retrieve the burr resulted in dehiscence of an aortic plaque near the ostium of the RCA. Unfortunately, the patient's risk profile precluded surgery. After a multidisciplinary discussion, a self-expanding Core Valve Evolut R prosthesis (Medtronic, Minneapolis, Minnesota, USA) was successfully implanted, with improvement in the AS and stabilisation of the aortic plaque. This is the first reported case of successful non-operative management of a mobile-aortic plaque caused by RA with a transcatheter prosthesis.
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Affiliation(s)
- Syedah Aleena Haider
- Cardiology, Hywel Dda University Health Board, Llanelli, UK
- Department of Preventive Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Anas Jawaid
- Cardiology, Strong Memorial Hospital, Rochester, New York, USA
| | - Thomas Stuver
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
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Naqvi SY, Haider SA, Jawaid A, Stuver TP. TRANSCATHETER AORTIC VALVE IMPLANTATION IN AN EXTREMELY TORTUOUS S-SHAPED AORTA. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03791-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Naqvi SY, Jawaid A, Prasad S, Knight P, Ling F, Narins CR. USING THE “SNORKEL TECHNIQUE” TO PROTECT THE LEFT MAIN CORONARY ARTERY DURING VALVE-IN-VALVE TRANSCATHETER AORTIC VALVE IMPLANTATION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03880-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jawaid A, Naqvi SY, O'Connor R, Ling F, Storozynsky E. AN UNCONVENTIONAL APPROACH TO CARCINOID HEART DISEASE. JACC CardioOncol 2022. [DOI: 10.1016/j.jaccao.2022.01.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Naqvi SY, Joynt M, Prasad S, Ling F. Severe baffle leak after Takeuchi repair successfully treated with coronary bypass and percutaneous baffle closure: a case report. Eur Heart J Case Rep 2021; 5:ytab074. [PMID: 34113764 PMCID: PMC8186911 DOI: 10.1093/ehjcr/ytab074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/02/2020] [Accepted: 02/10/2021] [Indexed: 11/12/2022]
Abstract
Background Anomalous left coronary artery from the pulmonary artery is a rare congenital abnormality that requires surgical correction. Case summary We describe the case of a 33-year-old female with a history of anomalous left coronary artery of the pulmonary artery who presents with exertional angina. She underwent a Takeuchi repair that was complicated by a baffle leak. She was successfully treated with left internal mammary artery-left anterior descending (LAD) bypass grafting and percutaneous baffle leak closure. Discussion The Takeuchi procedure involves the creation of an aortopulmonary window and an intrapulmonary tunnel that 'baffles' the aorta to the ostium of the anomalous left coronary artery. The most common late complication of the Takeuchi procedure is the presence of a baffle leak. Percutaneous baffle leak occlusion via vascular plug and coronary bypass of the LAD can successfully treat a baffle leak with excellent short-term follow-up.
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Affiliation(s)
- Syed Yaseen Naqvi
- Division of Interventional Cardiology, Department of Cardiology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - Michael Joynt
- Division of Adult Congenital Cardiology, University of Rochester Medical Center, Rochester, NY, USA
| | - Sunil Prasad
- Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Frederick Ling
- Division of Interventional Cardiology, Department of Cardiology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA
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Elbadawi A, Naqvi SY, Saad M, Elgendy IY, Mahmoud AA, Zainal A, Megaly M, Almahmoud MF, Altaweel A, Kleiman N, Abbott JD. In-Hospital Outcomes with Transfemoral Versus Transapical Access for Transcatheter Aortic Valve Replacement in Patients with Peripheral Arterial Disease. Cardiovascular Revascularization Medicine 2020; 21:604-609. [DOI: 10.1016/j.carrev.2019.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/01/2019] [Accepted: 09/06/2019] [Indexed: 01/19/2023]
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Elbadawi A, Elgendy IY, Naqvi SY, Mohamed AH, Ogunbayo GO, Omer MA, Mentias A, Saad M, Abbott JD, Jneid H, Bhatt DL. Temporal Trends and Outcomes of Hospitalizations With Prinzmetal Angina: Perspectives From a National Database. Am J Med 2019; 132:1053-1061.e1. [PMID: 31047867 DOI: 10.1016/j.amjmed.2019.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 03/10/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Contemporary data regarding the temporal changes in prevalence and outcomes of hospitalizations with Prinzmetal angina are limited. METHODS We queried the National Inpatient Sample Database for the years 2002-2015 to identify hospitalizations with Prinzmetal angina. We described the temporal trends and outcomes in patients with Prinzmetal angina. RESULTS A total of 97,280 hospitalizations with Prinzmetal angina were identified. There was a significant increase in the number of hospitalizations with Prinzmetal angina (3678 in 2002 vs 8633 in 2015, Ptrend <.001) as well as the proportion of hospitalizations with Prinzmetal angina among those with chest pain (Ptrend <.001). There was an increase in the rates of in-hospital mortality (0.24% in 2002 vs 0.85% in 2015, Ptrend = .02), which corresponded to a progressive increase in the burden of comorbidities among patients with Prinzmetal angina. Age >65 years, history of heart failure, chronic kidney disease, chronic liver disease, and acute myocardial infarction upon presentation were independent predictors of in-hospital mortality. Compared with patients with acute myocardial infarction without Prinzmetal angina, those with Prinzmetal angina presenting with acute myocardial infarction had a lower incidence of in-hospital mortality (odds ratio 0.24, 95% confidence interval 0.14-0.41). CONCLUSIONS In this large national analysis, there has been an increase in the prevalence of hospitalizations with Prinzmetal angina. Older age, heart failure, chronic kidney disease, chronic liver disease, and acute myocardial infarction were predictors of higher mortality among patients with Prinzmetal angina. Patients with Prinzmetal angina who developed acute myocardial infarction had more favorable outcomes compared with myocardial infarction without Prinzmetal angina.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, University of Florida, Gainesville
| | - Syed Yaseen Naqvi
- Division of Cardiovascular Medicine, University of Rochester, Rochester, N.Y
| | - Ahmed H Mohamed
- Department of Internal Medicine, Rochester General Hospital, Rochester, N.Y
| | | | - Mohamed A Omer
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City
| | - Amgad Mentias
- Division of Cardiovascular Medicine, University of Iowa, Iowa City
| | - Marwan Saad
- Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - J Dawn Abbott
- Division of Cardiovascular Medicine, Warren Alpert School of Medicine at Brown University, Providence, R.I
| | - Hani Jneid
- Division of Cardiovascular Medicine, Baylor School of Medicine, Houston, Tex
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Mass.
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Elbadawi A, Naqvi SY, Elgendy IY, Almahmoud MF, Hamed M, Abowali H, Ogunbayo GO, Jneid H, Ziada KM. Ethnic and Gender Disparities in the Uptake of Transcatheter Aortic Valve Replacement in the United States. Cardiol Ther 2019; 8:151-155. [PMID: 31240615 PMCID: PMC6828867 DOI: 10.1007/s40119-019-0138-1] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Little is known about ethnic and gender disparities for transcatheter aortic valve replacement (TAVR) procedures in the United States. METHODS We queried the Nationwide Inpatient Sample (NIS) database (2011-2014) to identify patients who underwent TAVR. We described the temporal trends in the uptake of TAVR procedures among various ethnicities and genders. RESULTS Our analysis identified 39,253 records; 20,497 (52.2%) were men and 18,756 (47.8%) were women. Among all TAVRs, 87.2% were Caucasians, 3.9% were African Americans (AA), 3.7% were Hispanics, and 5.2% were of other ethnicities. We found a significant rise in the trend of TAVRs in all groups: in Caucasian men (coefficient = 0.946, p < 0.001), Caucasian women (coefficient = 0.985, p < 0.001), AA men (coefficient = 0.940, p < 0.001), AA women (coefficient = 0.864, p < 0.001), Hispanic men (coefficient = 0.812, p = 0.001), Hispanic women (coefficient = 0.845, p < 0.001). Hence, the uptrend was most significant among Caucasian women, and relatively least significant among Hispanic men. Multivariate regression analysis was conducted to evaluate in-hospital mortality among different groups after adjusting for demographics and baseline characteristics. After multivariable regression for baseline characteristics overall, the in-hospital mortality per 100 TAVRs was highest among Hispanic men 5.5%, followed by Caucasian women 5.0%, Hispanic women 4.6%, AA women 3.7%, AA men 3.4%, and Caucasian men 3.38% (adjusted p value = 0.004). CONCLUSIONS In this observational study, we demonstrated that there is evidence of ethnic and gender differences in the overall uptake and adjusted mortality of TAVRs in the United States.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | - Syed Yaseen Naqvi
- Department of Cardiology, University of Rochester Medical Center, Rochester, NY, USA
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - Mohamed F Almahmoud
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Mohamed Hamed
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Hesham Abowali
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Gbolahan O Ogunbayo
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Hani Jneid
- Division of Cardiovascular Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Khaled M Ziada
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
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Abstract
PURPOSE OF REVIEW Cardiac resynchronization therapy (CRT) is an effective treatment option for therapy-refractory mild to severe heart failure (HF) patients with reduced ejection fraction and left ventricular (LV) conduction delay. Multiple clinical trials have shown that CRT improves cardiac function and overall quality of life, as well as reduces HF hospitalizations, health care costs, and mortality. RECENT FINDINGS Despite its effectiveness, the "non-response" rate to CRT is around 30%, remaining a major challenge that faces electrophysiologists and researchers. It has been recently suggested that the etiology of CRT non-response is multifactorial, and it requires a multifaceted approach to address it. In this focused review, we will summarize the definitions of CRT non-response, identify key factors for CRT non-response, and offer a simplified framework to address CRT non-response with the main goal of improving CRT outcomes.
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Affiliation(s)
- Syed Yaseen Naqvi
- Heart Research Follow-Up Program, Cardiology Division, University of Rochester Medical Center, 265 Crittenden Blvd., Box 653, Rochester, NY, 14642, USA
| | - Anas Jawaid
- Heart Research Follow-Up Program, Cardiology Division, University of Rochester Medical Center, 265 Crittenden Blvd., Box 653, Rochester, NY, 14642, USA
| | - Ilan Goldenberg
- Heart Research Follow-Up Program, Cardiology Division, University of Rochester Medical Center, 265 Crittenden Blvd., Box 653, Rochester, NY, 14642, USA
| | - Valentina Kutyifa
- Heart Research Follow-Up Program, Cardiology Division, University of Rochester Medical Center, 265 Crittenden Blvd., Box 653, Rochester, NY, 14642, USA.
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Naqvi SY, Howell E, Bruckel J, Stuver T. IATROGENIC AORTIC PLAQUE DEHISCENCE CAUSED BY ROTATIONAL ATHERECTOMY IN A PATIENT WITH SEVERE AORTIC STENOSIS SUCCESSFULLY TREATED WITH TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)33034-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Naqvi SY, Morris J, Falvey J, Gosev I, Barrus B, Vidula H. MANAGEMENT OF TYPE 2 HEPARIN-INDUCED THROMBOCYTOPENIA PRIOR TO HEARTMATE 3 LEFT VENTRICULAR ASSIST DEVICE IMPLANTATION: A CASE SERIES. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32823-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
A 48-year-old man presented with acute onset of left facial numbness, ataxic gait and double vision. He also complained of chronic right lower leg pain with acute onset a year prior to presentation. His vital signs were within normal limits. Physical exam was notable for right-sided intranuclear opthalmoplegia, decreased sensation to light touch on the left side of his body, left-sided dysmetria and ataxic gait. Neuroimaging showed evidence of acute stroke in the cerebellum and brainstem, for which he was treated with thrombolytics. An echocardiogram revealed a 5×3 cm left atrial myxoma, which was surgically resected. Subsequent imaging of his lower extremity revealed a chronic common iliac artery occlusion for which he underwent angioplasty. His claudication symptoms resolved, and he was without any neurological deficits at a 2-year follow-up visit.
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Affiliation(s)
- Anas Jawaid
- Internal Medicine Department, Strong Memorial Hospital, Rochester, New York, USA
| | - Syed Yaseen Naqvi
- Cardiology Division, Strong Memorial Hospital, Rochester, New York, USA
| | - Roy Wiener
- Cardiology Division, Strong Memorial Hospital, Rochester, New York, USA
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Tafreshi S, Naqvi SY, Thomas S. Extra-adrenal pheochromocytoma presenting as inverse takotsubo-pattern cardiomyopathy treated with surgical resection. BMJ Case Rep 2018; 11:11/1/e226384. [PMID: 30567218 DOI: 10.1136/bcr-2018-226384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pheochromocytoma is a rare catecholamine-secreting tumour that is typically located in the adrenal medulla or along the sympathetic ganglia. The typical symptoms are episodic in nature and include tachycardia, sweating and headache. These tumours can present as transient, reversible cardiomyopathy similar to takotsubo cardiomyopathy (TCM). TCM is characterised by transient hypokinesis of the left ventricular apex and is typically induced by emotional stress. We describe the case of a 26-year-old woman with a medical history significant for headaches who presented initially to her family physician with nausea, vomiting, headache and hypertension. She was started on lisinopril 10 mg daily. One week later, she presented to the emergency department with substernal severe chest pressure. Her troponin level was elevated. Coronary angiogram showed normal coronary arteries and left ventriculogram showed inverse TCM pattern. Serum catecholamines were very elevated confirming pheochromocytoma. She was successfully treated with alpha-blockers followed by surgical resection.
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Affiliation(s)
- Shima Tafreshi
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Syed Yaseen Naqvi
- Department of Cardiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Sabu Thomas
- Department of Cardiology, University of Rochester Medical Center, Rochester, New York, USA
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Naqvi SY, Salama IG, Narins C, Stuver T. Corynebacterium striatum prosthetic valve endocarditis with severe aortic regurgitation successfully treated with transcatheter aortic valve replacement. BMJ Case Rep 2018; 11:11/1/e226881. [PMID: 30567113 DOI: 10.1136/bcr-2018-226881] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe the case of a 69-year-old man with a history of bioprosthetic aortic valve replacement who presented with Corynebacterium striatum prosthetic valve endocarditis (PVE) complicated by severe aortic insufficiency with refractory cardiogenic shock despite antibiotic therapy. He was considered a prohibitive-risk surgical candidate due to co-morbid conditions and off-label valve-in-valve transcatheter aortic valve replacement (TAVR) was performed after detailed multidisciplinary evaluation. He recovered well without recurrent infection following completion of antibiotics and transthoracic echocardiogram at 12 months showed a normal functioning prosthetic valve. To our knowledge, this is the first reported case of native or PVE treated with TAVR.
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Affiliation(s)
- Syed Yaseen Naqvi
- Department of Medicine, Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Ibrahim G Salama
- Department of Internal Medicine, Unity Hospital, Rochester, New York, USA
| | - Craig Narins
- Department of Medicine, Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Thomas Stuver
- Department of Medicine, Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA
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Kutyifa V, Naqvi SY, Brown M, McNitt S, Goldenberg I, Klein H, Moss AJ. Comparison of Long-Term Survival Benefits With Cardiac Resynchronization Therapy in Patients With Mild Heart Failure With Versus Without Diabetes Mellitus (from the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy [MADIT-CRT]). Am J Cardiol 2018; 121:1567-1574. [PMID: 29625702 DOI: 10.1016/j.amjcard.2018.02.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 02/22/2018] [Accepted: 02/27/2018] [Indexed: 01/09/2023]
Abstract
We have previously shown a reduction in HF events with cardiac resynchronization therapy with defibrillator (CRT-D) in patients with mild heart failure (HF) and diabetes mellitus (DM). It remains unknown whether HF remission in DM patients with CRT-D translates into reduced mortality. The effects of CRT-D versus an implantable cardioverter-defibrillator (ICD) alone to reduce long-term mortality were assessed in patients with left bundle branch block with DM (n = 386) and without DM (n = 982), enrolled in the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT). We further subdivided DM patients by insulin and noninsulin therapy. Kaplan-Meier survival analyses and multivariate cox proportional hazards regression models were utilized. At the 7-year follow-up, CRT-D was associated with a lower mortality in DM patients compared with ICD alone (21% vs 42%, p = 0.02), similar to non-DM patients (16 vs 24%, p = 0.014). CRT-D was associated with a 41% reduction in the risk of long-term all-cause mortality in DM patients (hazard ratio [HR] 0.59, 95% confidence interval 0.36 to 0.96, p = 0.033) and a similar reduction in non-DM patients (HR 0.69, 95% confidence interval 0.48 to 0.99, p = 0.045, treatment-diabetes interaction p = 0.611). Among DM patients, mortality benefit was evident in insulin-treated patients only (HR 0.40, p = 0.030). Reductions in HF events were present in all groups. In the MADIT-CRT, patients with mild HF with DM derive significant long-term survival benefit from CRT-D, similar to those without DM. The mortality benefit from CRT-D within the DM subgroup seems to be confined to patients with insulin treated diabetes.
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Affiliation(s)
- Valentina Kutyifa
- Cardiology Division, Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, New York.
| | - Syed Yaseen Naqvi
- Cardiology Division, Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, New York
| | - Mary Brown
- Cardiology Division, Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, New York
| | - Scott McNitt
- Cardiology Division, Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, New York
| | - Ilan Goldenberg
- Cardiology Division, Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, New York
| | - Helmut Klein
- Cardiology Division, Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, New York
| | - Arthur J Moss
- Cardiology Division, Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, New York
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Naqvi SY, Bruckel J, Welch T, Pacos J, Nelson R, Moalem J, Thomas S. EXTRA-ADRENAL PHEOCHROMOCYTOMA PRESENTING WITH INVERSE TAKOTSUBO-PATTERN CARDIOMYOPATHY SUCCESSFULLY TREATED WITH SURGICAL RESECTION. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32958-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Naqvi SY, Yoruk A, Pressman E, Olson-Chen C, Prasad S, Barrus B, Gosev I, Alexis J, Thomas S. CARDIOMYOPATHY BRIDGED TO HEART TRANSPLANT WITH AMBULATORY EXTRACORPOREAL MEMBRANE OXYGENATION IN A PERIPARTUM PATIENT. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32959-0] [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: 10/17/2022]
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Naqvi SY, Howell E, Narins C, Stuver T. CORYNEBACTERIUM PROSTHETIC AORTIC VALVE ENDOCARDITIS SUCCESSFULLY TREATED WITH EDWARDS SAPIEN 3 TRANSCATHETER VALVE REPLACEMENT. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32756-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
Cardiac transplantation is the gold standard treatment for patients with advanced congestive heart failure that is refractory to maximal medical therapy. However, donor heart availability remains the major limiting factor, resulting in a large number of patients waiting long periods of time before transplantation. As a result, mechanical circulatory support devices have been increasingly used as a 'bridge' in order to sustain organ function and stabilise haemodynamics while patients remain on the transplant waiting list or undergo left ventricular assist device surgery. Intra aortic balloon pumps (IABP) are commonly used for temporary circulatory support in patients with advanced heart failure. IABP is traditionally placed percutaneously through the transfemoral artery approach. The major limitation with this approach is ambulatory restriction that can promote deconditioning, particularly in situations of prolonged circulatory support. A subclavian/axillary artery approach IABP insertion allows patients to be ambulatory during the pre-transplant period. In this review, we aim to summarise the physiology of IABP, the evidence for its use in advanced CHF and the efficacy and safety of subclavian artery IABP insertion.
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Affiliation(s)
- Syed Yaseen Naqvi
- Department of Cardiology, Advanced Heart Transplant Program, University of Rochester Medical Center Rochester, USA
| | | | - Ayhan Yoruk
- Department of Cardiology, Advanced Heart Transplant Program, University of Rochester Medical Center Rochester, USA
| | - Leway Chen
- Department of Cardiology, Advanced Heart Transplant Program, University of Rochester Medical Center Rochester, USA
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21
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Abstract
The diagnosis of brachiocephalic disease is often overlooked. Symptoms include arm claudication and vertebrobasilar insufficiency. In patients who have had the use of the internal mammary artery for coronary bypass surgery, the development of symptoms of myocardial ischemia should alert the clinician to the possibility of subclavian artery stenosis. Also, in patients who have had axillofemoral bypass, lower-extremity claudication may occur. Recognition involves physical examination and accurate noninvasive testing. Endovascular therapy has proven to be effective in alleviating symptoms in properly selected patients.
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Affiliation(s)
- Tisa Saha
- Department of Internal Medicine, Pennsylvania Hospital of the University of Pennsylvania, Philadelphia.
| | - Syed Yaseen Naqvi
- Department of Internal Medicine, Pennsylvania Hospital of the University of Pennsylvania, Philadelphia
| | - Omar Abine Ayah
- Department of Internal Medicine, Pennsylvania Hospital of the University of Pennsylvania, Philadelphia
| | - Daniel McCormick
- Department of Internal Medicine, Pennsylvania Hospital of the University of Pennsylvania, Philadelphia
| | - Sheldon Goldberg
- Department of Internal Medicine, Pennsylvania Hospital of the University of Pennsylvania, Philadelphia
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22
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Abstract
The incidence of aortic stenosis increases with age, affecting up to 10% of the population by the eighth decade. Once symptoms develop, aortic stenosis is rapidly fatal. Proper management requires an understanding of the physiology and criteria used to define disease severity. There is no effective pharmacologic treatment. Surgical aortic valve replacement has been the gold standard treatment for decades. However, over the last 10 years transcatheter aortic valve replacement has emerged as an attractive, less-invasive option for appropriately selected patients. Refinements in valve design and delivery systems have led to widespread use of this breakthrough technology in selected patients. We review the pathophysiology, criteria for valve replacement, and the results of the trials comparing transcatheter aortic valve replacement with surgical aortic valve replacement.
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Affiliation(s)
- Jessica Joseph
- Pennsylvania Hospital of the University of Pennsylvania, Philadelphia
| | - Syed Yaseen Naqvi
- Pennsylvania Hospital of the University of Pennsylvania, Philadelphia
| | - Jay Giri
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Division, University of Pennsylvania, Philadelphia
| | - Sheldon Goldberg
- Pennsylvania Hospital of the University of Pennsylvania, Philadelphia.
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Naqvi SY, Klein J, Saha T, McCormick DJ, Goldberg S. Comparison of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Disease. Am J Cardiol 2017; 119:520-527. [PMID: 28012553 DOI: 10.1016/j.amjcard.2016.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 11/26/2022]
Abstract
Coronary artery bypass grafting (CABG) decreases mortality in patients with significant left main (LM) coronary artery disease and for years remained the therapy of choice for patients with this ominous lesion. Advances in percutaneous coronary intervention (PCI) have enabled it to become an alternative to CABG. The results of observational registries and randomized comparisons have shown the safety and efficacy of PCI in appropriately selected patients with low or intermediate angiographic risk scores. Furthermore, the use of physiological measures of flow limitation and the use of intracoronary imaging techniques has added benefit and improved outcomes. The use of fractional flow reserve to more accurately evaluate the significance of intermediate lesions and guide the extent of revascularization has been an important refinement. Intravascular ultrasound and optical coherence tomography assessment of optimal stent deployment has led to reductions in restenosis. Newer generation stents, combined with improvements in specific techniques, especially at the LM bifurcation have extended PCI to more complex anatomic scenarios. The availability of left ventricular support devices in patients with complex coronary anatomy and severely depressed left ventricular function has added a margin of safety to LM and multivessel intervention. Randomized comparisons of CABG with PCI in carefully selected patients, using contemporaneous surgical and interventional techniques and optimal medical therapy, will further aid heart teams in the decision-making process. In conclusion, this review will give a concise overview of the management of unprotected LM disease.
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Naqvi SY, Zainal A, Flood SP, Kinniry P. Harlequin syndrome with contralateral anhidrosis after an upper chest gunshot wound. BMJ Case Rep 2016; 2016:bcr-2016-216931. [PMID: 27535737 DOI: 10.1136/bcr-2016-216931] [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: 11/04/2022] Open
Affiliation(s)
- Syed Yaseen Naqvi
- Department of Internal Medicine, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Abir Zainal
- Department of Internal Medicine, Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
| | - Shane Patrick Flood
- Department of Medicine, Sligo General Hospital, Sligo, County Sligo, Ireland
| | - Paul Kinniry
- Department of Pulmonary and Critical Care Medicine, Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
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25
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Zainal A, Hamad MN, Naqvi SY. Dilated aortic root and severe aortic regurgitation causing dilated cardiomyopathy in classic Ehlers-Danlos syndrome. BMJ Case Rep 2016; 2016:bcr-2016-215943. [PMID: 27413024 DOI: 10.1136/bcr-2016-215943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Ehlers-Danlos syndrome (EDS) is a group of heritable disorders characterised by vast clinical heterogeneity ranging from the classic constellation of symptoms including skin hyperextensibility, joint hypermobility and skin fragility to the exceedingly critical consequences of arterial rupture and visceral perforation. We describe the case of a 65-year-old male with a history of classic EDS who reported of dyspnoea on exertion, orthopnoea, fatigue and palpitations. He was found to have dilated cardiomyopathy with an ejection fraction of 35%, aortic root dilation and severe aortic valve regurgitation. The authors intend to draw attention to the rare cardiac manifestations of this condition and the therapeutic challenges involved in managing such patients.
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Affiliation(s)
- Abir Zainal
- Department of Medicine, Galway University Hospital, Galway, Ireland
| | | | - Syed Yaseen Naqvi
- Department of Internal Medicine, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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26
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Wilkinson J, Zainal A, Naqvi SY. Penicillin-induced liver injury during treatment for ocular neurosyphilis. BMJ Case Rep 2016; 2016:bcr-2016-215821. [DOI: 10.1136/bcr-2016-215821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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27
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Affiliation(s)
- Syed Yaseen Naqvi
- From Division of Cardiology, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia (S.Y.N., S.G.); and Internal Medicine Resident, Hahnemann University Hospital, Philadelphia, PA (A.S.)
| | - Awail Sadiq
- From Division of Cardiology, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia (S.Y.N., S.G.); and Internal Medicine Resident, Hahnemann University Hospital, Philadelphia, PA (A.S.)
| | - Sheldon Goldberg
- From Division of Cardiology, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia (S.Y.N., S.G.); and Internal Medicine Resident, Hahnemann University Hospital, Philadelphia, PA (A.S.).
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28
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Picardo SL, Teo M, Abdul Jalil KI, Naqvi SY, Morris PG, Breathnach OS, Grogan W, Leonard GD, Hennessy B. Correlation between platelet/lymphocyte ratio, neutrophil/lymphocyte ratio and response to neoadjuvant chemoradiation therapy in rectal cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e15140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - MinYuen Teo
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - William Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | | | - Bryan Hennessy
- Royal College of Surgeons in Ireland, Centre for Systems Medicine, Department of Medical Oncology, Dublin, Ireland
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Naqvi SY, Henry D, Furukawa S, Haber H. Primary neuroendocrine tumour of the right ventricle presenting with heart failure and cyanosis. BMJ Case Rep 2016; 2016:bcr-2016-214810. [PMID: 26969366 DOI: 10.1136/bcr-2016-214810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 68-year-old woman presented to the emergency department owing to exertional dyspnoea and bilateral leg oedema for 3 weeks. Her vital signs included the following: heart rate of 95 bpm, respiratory rate of 24 breaths/min, oxygen saturation of 73% on room air and a blood pressure of 184/108 mm Hg. Physical examination revealed tachypnoea with clear lungs to auscultation, elevated jugular veins, cyanosis and bilateral pitting oedema. A chest X-ray demonstrated cardiomegaly without obvious pulmonary oedema. A CT of the chest was negative for pulmonary embolus; however, the scan did reveal a large right ventricular (RV) mass. An echocardiogram with bubble study confirmed a patent foramen ovale with significant right-to-left shunting and a large RV mass that significantly obstructed the pulmonary outflow tract. A cardiac biopsy revealed a low-grade neuroendocrine tumour. The patient underwent successful debridement and adjuvant chemotherapy. She improved greatly and was asymptomatic at a 9-month follow-up visit.
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Affiliation(s)
- Syed Yaseen Naqvi
- Department of Internal Medicine, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Henry
- Haematology-Oncology Department, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Satoshi Furukawa
- Cardiovascular Surgery Department, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Howard Haber
- Cardiovascular Medicine Department, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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30
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Abstract
A 44-year-old woman with no medical history presented to the emergency department with a 2 h history of sudden onset chest pressure, palpitations, diaphoresis and shortness of breath. She reported a 90-pound unintentional weight loss, increased appetite, irritability, night sweats and palpitations for 2 months. Physical examination revealed a heart rate (HR) of 269 bpm and a blood pressure of 116/94 mm Hg. Her ECG revealed a wide-complex tachycardia with right bundle branch morphology and an HR of 265 bpm. Intravenous adenosine was administered with resolution of the arrhythmia and symptoms. Her subsequent ECG revealed sinus tachycardia with δ waves, which was consistent with Wolff-Parkinson-White (WPW) syndrome. Laboratory findings confirmed thyroid storm and treatment began with intravenous hydrocortisone, methimazole, metoprolol, amiodarone and iodine drops. Graves' disease was confirmed based on the presence of serum thyroid-stimulating hormone receptor antibody. The patient underwent successful WPW accessory tract ablation 6 weeks after initial presentation.
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Affiliation(s)
- Syed Yaseen Naqvi
- Department of Internal Medicine, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey J Luebbert
- Department of Cardiology, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephen G Rosen
- Department of Endocrinology, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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31
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Abstract
A 43-year-old woman developed a sudden-onset severe chest pain and breathlessness at home. She collapsed within minutes and received bystander cardiopulmonary resuscitation from her husband. On arrival, the paramedics identified ventricular fibrillation requiring defibrillation. She was admitted to the intensive care unit for observation. A coronary angiogram performed at our hospital demonstrated non-obstructive disease of the right coronary artery. Her antidepressant medications were discontinued and she was discharged. No specific cause was found for the arrhythmia and collapse. One week later, she developed similar chest pain. An ECG showed transient ST-elevation in the inferior leads. Symptoms and ECG changes resolved with sublingual nitroglycerin. During the course of a repeat coronary angiogram the patient developed severe spasm of the right coronary artery associated with typical chest pain and ST-elevation in the inferior leads. She was treated with insertion of a drug-eluting stent and a cardiac defibrillator.
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