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Agrawal A, Kumar A, Majid M, Badwan O, Arockiam AD, El Dahdah J, Syed AB, Schleicher M, Reed GW, Cremer PC, Griffin BP, Menon V, Wang TKM. Optimal antiplatelet strategy following coronary artery bypass grafting: a meta-analysis. Heart 2024; 110:323-330. [PMID: 37648436 DOI: 10.1136/heartjnl-2023-323097] [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: 06/13/2023] [Accepted: 07/18/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVE Coronary artery bypass grafting (CABG) is an established revascularisation strategy for multivessel and left main coronary artery disease. Although aspirin is routinely recommended for patients with CABG, the optimal antiplatelet regimen after CABG remains unclear. We evaluated the efficacies and risks of different antiplatelet regimens (dual (DAPT) versus single (SAPT), and dual with clopidogrel (DAPT-C) versus dual with ticagrelor or prasugrel (DAPT-T/P)) after CABG. METHODS We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and performed a comprehensive literature search using PubMed, Ovid Medline, Ovid Embase and Cochrane Central Register of Controlled Trials. Data were extracted and pooled using random-effects models and Review Manager (V.5.4). RESULTS Among the 2970 article abstracts screened, 215 full-text articles were reviewed and 38 studies totaling 77 447 CABG patients were included for analyses. DAPT compared with SAPT was associated with significantly lower all-cause mortality (OR 0.65 with 95% CI 0.50 to 0.86; p=0.002), cardiovascular mortality (OR 0.53, 95% CI 0.33 to 0.84; p=0.008), and major adverse cardiac and cerebrovascular events (MACCE) (OR 0.68, 95% CI 0.51 to 0.91; p=0.01), but higher rates of major (OR 1.30, 95% CI 1.08 to 1.56; p=0.007) and minor bleeding (OR 1.87, 95% CI 1.28 to 2.74; p=0.001) after CABG. DAPT-T/P compared with DAPT-C was associated with significantly lower all-cause (OR 0.43, 95% CI 0.29 to 0.65; p≤0.0001) and cardiovascular mortality (OR 0.44, 95% CI 0.24 to 0.80; p=0.008), and no differences on other cardiovascular or bleeding outcomes after CABG. CONCLUSION In patients with CABG, DAPT compared with SAPT and DAPT-T/P compared with DAPT-C were associated with reduction in all-cause and cardiovascular mortality, especially in patients with acute coronary syndrome. Additionally, DAPT was associated with reduction in MACCE, but higher rates of major and minor bleeding. An individualised approach to choosing antiplatelet regimen is necessary for patients with CABG based on ischaemic and bleeding risks.
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Affiliation(s)
- Ankit Agrawal
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ashwin Kumar
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Muhammad Majid
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Osamah Badwan
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Joseph El Dahdah
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alveena B Syed
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mary Schleicher
- Floyd D. Loop Alumni Library, Cleveland Clinic, Cleveland, OH, USA
| | - Grant W Reed
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Paul C Cremer
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian P Griffin
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Venu Menon
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tom Kai Ming Wang
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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Majid M, Parker J, Yaker Z, Abdelghaffar B, Agrawal A, Kumar A, Syed AB, Fritchie K, Tornekar V, Klein AL. A Rare Case of Constrictive Pericarditis: Inflammatory Myofibroblastic Tumor. JACC Case Rep 2023; 18:101908. [PMID: 37545674 PMCID: PMC10401052 DOI: 10.1016/j.jaccas.2023.101908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/27/2023] [Accepted: 05/11/2023] [Indexed: 08/08/2023]
Abstract
A previously healthy 15-year-old adolescent female presented with dependent edema, ascites, and dyspnea on exertion. The result of her initial evaluation was consistent with constrictive pericarditis in the setting of local low-grade spindle cell sarcoma. She was unresponsive to traditional medical management and required concurrent mass resection and radical pericardiectomy for definitive treatment. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Muhammad Majid
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joshua Parker
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Zachary Yaker
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bahaa Abdelghaffar
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ashwin Kumar
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alveena B. Syed
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Karen Fritchie
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Vineet Tornekar
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Allan L. Klein
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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Kafil TS, Wang TKM, Agrawal A, Majid M, Syed AB, Hutt E, Alencherry B, Cohen JA, Kumar S, Bansal A, Griffin BP, Klein AL. Advances in multi-modality imaging for constrictive pericarditis and pericardial inflammation: role of imaging-guided therapy. Expert Rev Cardiovasc Ther 2023; 21:269-279. [PMID: 37070761 DOI: 10.1080/14779072.2023.2187377] [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: 04/19/2023]
Abstract
INTRODUCTION Constrictive pericarditis (CP) can result from uncontrolled inflammation of the pericardium. This can be due to various etiologies. CP can lead to both left- and right-sided heart failure with associated poor quality of life, so early recognition is key. The evolving role of multimodality cardiac imaging allows for earlier diagnosis and facilitates management to help mitigate this adverse outcome. AREAS COVERED This review discusses the pathophysiology of constrictive pericarditis, chronic inflammation and autoimmune etiologies, clinical presentation of CP, and advances in multimodality cardiac imaging for diagnosis and management. Echocardiography and cardiac magnetic resonance (CMR) imaging remain cornerstone modalities to evaluate this condition, whereas additional imaging modalities such as computed tomography and FDG-positron emission tomography can provide complementary information. EXPERT OPINION Advances in multimodality imaging allow for a more precision diagnosis of constrictive pericarditis. There has been a paradigm shift in pericardial disease management with advances in multimodality imaging, especially CMR, to detect subacute and chronic inflammation. This has enabled imaging-guided therapy (IGT) to both help prevent and potentially reverse established constrictive pericarditis.
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Affiliation(s)
- Tahir S Kafil
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tom Kai Ming Wang
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ankit Agrawal
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Muhammad Majid
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alveena B Syed
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Erika Hutt
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ben Alencherry
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joshua A Cohen
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sachin Kumar
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Agam Bansal
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian P Griffin
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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Yaker ZS, Majid M, Honnekeri B, Kumar A, Syed AB, Mazumder S, Vipparla NS, Klein AL. A RARE CASE OF CARDIAC SARCOIDOSIS MANIFESTING AS CHRONIC RECURRENT PERICARDITIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03816-0] [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: 03/06/2023]
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Kumar A, Yesilyaprak A, Agrawal A, Akyuz K, Syed AB, Rizk AA, Dey A, Majid M, Singh H, Yaker ZS, Verma B, Mudra S, Mahalwar G, Wang TKM, Cremer P, Klein AL. SEX BASED DIFFERENCES IN DETERMINING OUTCOMES OF RECURRENT PERICARDITIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00834-3] [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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Syed AB, Agrawal A, Alzahrani A, Mazumder S, Yaker ZS, Cremer P, Klein AL. IS IT POSSIBLE FOR AN ATHLETE WITH RECURRENT PERICARDITIS TO EXERCISE VIGOROUSLY ON AN IL-1 BLOCKER? J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02912-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Yaker ZS, Majid M, Honnekeri B, Kumar A, Syed AB, Mazumder S, Vipparla NS, Klein AL. A RARE CASE OF PERICARDITIS CAUSED BY PECTUS EXCAVATUM SURGERY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04057-3] [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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Syed AB, Majid M, Layoun H, Chahine J, Alzahrani A, Agrawal A, Wang TKM, Ramchand J, Klein AL. TRANSIENT CONSTRICTIVE PERICARDITIS: BASELINE CHARACTERISTICS, CAUSES, AND LONG-TERM NATURAL HISTORY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01909-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Honnekeri B, Karmali R, Syed AB, Majid M, Alzahrani A, Braghieri L, Badwan O, Akintoye E, Klein AL. A CLINICAL ROLLER-COASTER: TRAUMATIC MYOPERICARDITIS FOLLOWING AN AMUSEMENT PARK RIDE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04075-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Majid M, Akintoye E, Yaker ZS, Karmali R, Syed AB, Agrawal A, Kumar A, Hanna MA, Moudgil R, Klein AL. INTRA- AND INTER-OBSERVER VARIABILITY IN LEFT ATRIAL STRAIN ANALYSIS IN PATIENTS WITH AMYLOID CARDIOMYOPATHY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01054-9] [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: 03/06/2023]
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Harrigan TP, Hwang BJ, Mathur AK, Mills KA, Pantelyat AY, Bang JA, Syed AB, Vyas P, Martin SD, Jamal A, Ziegelman L, Hernandez ME, Wong DF, Brašić JR. Dataset of quantitative structured office measurements of movements in the extremities. Data Brief 2020; 31:105876. [PMID: 32642510 PMCID: PMC7334383 DOI: 10.1016/j.dib.2020.105876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 12/01/2022] Open
Abstract
A low-cost quantitative structured office measurement of movements in the extremities of people with Parkinson's disease [1,2] was performed on people with Parkinson's disease, multiple system atrophy, and age-matched healthy volunteers. Participants underwent twelve videotaped procedures rated by a trained examiner while connected to four accelerometers [1,2] generating a trace of the three location dimensions expressed as spreadsheets [3,4]. The signals of the five repetitive motion items [1,2] underwent processing to fast Fourier [5] and continuous wavelet transforms [6]. The dataset [7] includes the coding form with scores of the live ratings [1,2], the raw files [3], the converted spreadsheets [4], and the fast Fourier [5] and continuous wavelet transforms [6]. All files are unfiltered. The data also provide findings suitable to compare and contrast with data obtained by investigators applying the same procedure to other populations. Since this is an inexpensive procedure to quantitatively measure motions in Parkinson's disease and other movement disorders, this will be a valuable resource to colleagues, particularly in underdeveloped regions with limited budgets. The dataset will serve as a template for other investigations to develop novel techniques to facilitate the diagnosis, monitoring, and treatment of Parkinson's disease, other movement disorders, and other nervous and mental conditions. The procedure will provide the basis to obtain objective quantitative measurements of participants in clinical trials of new agents.
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Affiliation(s)
- Timothy P. Harrigan
- Research and Exploratory Development, Applied Physics Laboratory, The Johns Hopkins University, Laurel, MD, United States
- Section of High Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Brian J. Hwang
- Section of High Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Anil K. Mathur
- Section of High Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kelly A. Mills
- Neuromodulation and Advanced Therapies Clinic, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Alexander Y. Pantelyat
- Atypical Parkinsonism Center, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jee A. Bang
- Johns Hopkins Huntington Center of Excellence, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Alveena B. Syed
- Section of High Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Pankhuri Vyas
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Samuel D. Martin
- Krieger School of Arts and Sciences, The Johns Hopkins University, Baltimore, MD, United States
| | - Armaan Jamal
- Krieger School of Arts and Sciences, The Johns Hopkins University, Baltimore, MD, United States
| | - Liran Ziegelman
- Neuroscience Program, College of Liberal Arts and Sciences, University of Illinois at Champaign-Urbana, Champaign-Urbana, IL, United States
| | - Manuel E. Hernandez
- Neuroscience Program, College of Liberal Arts and Sciences, University of Illinois at Champaign-Urbana, Champaign-Urbana, IL, United States
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Champaign-Urbana, Champaign-Urbana, IL, United States
| | - Dean F. Wong
- Section of High Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - James Robert Brašić
- Section of High Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Ali MN, Ali MNA, Syed A, Syed AB, Bhandari S, Bhandari SC. Case series: hemolytic uremic syndrome--another cause of transplant dysfunction. Transplant Proc 2014; 45:3284-8. [PMID: 24182801 DOI: 10.1016/j.transproceed.2013.07.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 07/14/2013] [Accepted: 07/17/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Renal transplantation is the optimal treatment for suitable patients with end-stage renal disease (ESRD). However, acute graft dysfunction occurs in 5%-35% of patients. This is commonly due to acute rejection, drug toxicity, ureteric obstruction, or infection. Atypical hemolytic uremic syndrome (aHUS), either recurrent or de novo, is uncommon after transplantation. CASES We highlight three cases of acute transplant dysfunction in which transplant biopsy revealed HUS without associated clinical or hematologic clues to the etiology. Two cases had recurrent HUS and 1 had de novo HUS secondary to tacrolimus therapy. Screenings for ADAMTS-13 and gene mutations of complement regulatory proteins were negative. Thrombocytopenia and red blood cell fragments on blood film appeared some days later. TREATMENT Treatment comprised a combination of plasma exchange with fresh-frozen plasma and switching immunosuppressive therapy, which led to the recovery of the above hematologic features but salvaged graft function in only 1 case. CONCLUSIONS Classical hematologic findings of HUS appeared late in these cases. HUS should be considered in cases of allograft dysfunction where there is no obvious cause, and biopsy should be performed. This enables early initiation of therapy to gain rapid recovery of hematologic parameters and potentially of transplant function.
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Affiliation(s)
| | - M N A Ali
- Department of Renal Medicine, Hull and East Yorkshire Hospitals, NHS Trust, and Hull and York Medical School, Hull, East Yorkshire, United Kingdom
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Affiliation(s)
- R A Armstrong
- Department of Vision Sciences, Aston University, Birmingham, UK
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