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Chao CJ, Agasthi P, Girardo M, Barry T, Seri AR, Brown L, Wraith RE, Shanbhag A, Wang Y, Chen YC, Lester SJ, Alsidawi S, Freeman WK, Naqvi TZ, Eleid M, Fortuin D, Pollak P, El Sabbagh A, Sell-Dottin K, Majdalany D, Larsen C, Holmes DR, Oh JK, Appleton CP, Arsanjani R. Using Augmented Mean Arterial Pressure to Identify High Mortality Risk Patients With Moderate Aortic Stenosis. Mayo Clin Proc 2023; 98:1501-1514. [PMID: 37793726 DOI: 10.1016/j.mayocp.2023.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/07/2023] [Accepted: 02/17/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE To study the usefulness of a novel echocardiographic marker, augmented mean arterial pressure (AugMAP = [(mean aortic valve gradient + systolic blood pressure) + (2 × diastolic blood pressure)] / 3), in identifying high-risk patients with moderate aortic stenosis (AS). PATIENTS AND METHODS Adults with moderate AS (aortic valve area, 1.0-1.5 cm2) at Mayo Clinic sites from January 1, 2010, through December 31, 2020, were identified. Baseline demographic, echocardiographic, and all-cause mortality data were retrieved. Patients were grouped into higher and lower AugMAP groups using a cutoff value of 80 mm Hg for analysis. Kaplan-Meier and Cox regression models were used to assess the performance of AugMAP. RESULTS A total of 4563 patients with moderate AS were included (mean ± SD age, 73.7±12.5 years; 60.5% men). Median follow-up was 2.5 years; 36.0% of patients died. The mean ± SD left ventricular ejection fraction (LVEF) was 60.1%±11.4%, and the mean ± SD AugMAP was 99.1±13.1 mm Hg. Patients in the lower AugMAP group, with either preserved or reduced LVEF, had significantly worse survival performance (all P<.001). Multivariate Cox regression showed that AugMAP (hazard ratio, 0.962; 95% CI, 0.942 to 0.981 per 5-mm Hg increase; P<.001) and AugMAP less than 80 mm Hg (hazard ratio, 1.477; 95% CI, 1.241 to 1.756; P<.001) were independently associated with all-cause mortality. CONCLUSION AugMAP is a simple and effective echocardiographic marker to identify high-risk patients with moderate AS independent of LVEF. It can potentially be used in the candidate selection process if moderate AS becomes indicated for aortic valve intervention in the future.
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Affiliation(s)
- Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ; Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN.
| | - Pradyumma Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ; Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN
| | - Marlene Girardo
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Timothy Barry
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Amith R Seri
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Lisa Brown
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Rachel E Wraith
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Anusha Shanbhag
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Yuxiang Wang
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Yi-Chieh Chen
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ; Department of Pharmacy, Mayo Clinic Health System, Austin, MN
| | - Steven J Lester
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Said Alsidawi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - William K Freeman
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Tasneem Z Naqvi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Mackram Eleid
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN
| | - David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Peter Pollak
- Department of Cardiovascular Diseases, Mayo Clinic Florida, Jacksonville, FL
| | - Abdallah El Sabbagh
- Department of Cardiovascular Diseases, Mayo Clinic Florida, Jacksonville, FL
| | | | - David Majdalany
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Carolyn Larsen
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN
| | - Jae K Oh
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN
| | | | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
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Chao CJ, Agasthi P, Seri AR, Barry T, Shanbhag A, Wang Y, Eleid MF, Fortuin D, Sweeney JP, Pollak P, El Sabbagh A, Lester SJ, Freeman WK, Naqvi TZ, Holmes DR, Appleton CP, Arsanjani R. Transcatheter Aortic Valve Replacement Prognostication with Augmented Mean Arterial Pressure. J Cardiovasc Dev Dis 2023; 10:jcdd10050192. [PMID: 37233159 DOI: 10.3390/jcdd10050192] [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: 03/29/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Post-transcatheter aortic valve replacement (TAVR) patient outcome is an important research topic. To accurately assess post-TAVR mortality, we examined a family of new echo parameters (augmented systolic blood pressure (AugSBP) and arterial mean pressure (AugMAP)) derived from blood pressure and aortic valve gradients. METHODS Patients in the Mayo Clinic National Cardiovascular Diseases Registry-TAVR database who underwent TAVR between 1 January 2012 and 30 June 2017 were identified to retrieve baseline clinical, echocardiographic and mortality data. AugSBP, AugMAP and valvulo-arterial impedance (Zva) (Zva) were evaluated using Cox regression. Receiver operating characteristic curve analysis and the c-index were used to assess the model performance against the Society of Thoracic Surgeons (STS) risk score. RESULTS The final cohort contained 974 patients with a mean age of 81.4 ± 8.3 years old, and 56.6% were male. The mean STS risk score was 8.2 ± 5.2. The median follow-up duration was 354 days, and the one-year all-cause mortality rate was 14.2%. Both univariate and multivariate Cox regression showed that AugSBP and AugMAP parameters were independent predictors for intermediate-term post-TAVR mortality (all p < 0.0001). AugMAP1 < 102.5 mmHg was associated with a 3-fold-increased risk of all-cause mortality 1-year post-TAVR (hazard ratio 3.0, 95%confidence interval 2.0-4.5, p < 0.0001). A univariate model of AugMAP1 surpassed the STS score model in predicting intermediate-term post-TAVR mortality (area under the curve: 0.700 vs. 0.587, p = 0.005; c-index: 0.681 vs. 0.585, p = 0.001). CONCLUSIONS Augmented mean arterial pressure provides clinicians with a simple but effective approach to quickly identify patients at risk and potentially improve post-TAVR prognosis.
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Affiliation(s)
- Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN 55905, USA
| | - Pradyumna Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN 55905, USA
| | - Amith R Seri
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Timothy Barry
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Anusha Shanbhag
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Yuxiang Wang
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN 55905, USA
| | - David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - John P Sweeney
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Peter Pollak
- Department of Cardiovascular Diseases, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Abdallah El Sabbagh
- Department of Cardiovascular Diseases, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Steven J Lester
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - William K Freeman
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Tasneem Z Naqvi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN 55905, USA
| | | | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
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Rattanawong P, Chao CJ, Sriramoju A, Tagle-Cornell MCA, Farina J, Beirne E, Fatunde OA, Koepke LM, Ko NLK, Shanbhag A, Barry T, Shen WK. SYNCOPE AND ALL-CAUSE MORTALITY IN HEART FAILURE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01046-x] [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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4
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Rattanawong P, Kanitsoraphan C, Kewcharoen J, Sriramoju A, Shanbhag A, Ko Ko NL, Barry T, Vutthikraivit W, Shen WK. Surgical versus catheter ablation in atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials. J Cardiovasc Electrophysiol 2022; 33:2152-2163. [PMID: 35771487 DOI: 10.1111/jce.15617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 06/15/2022] [Accepted: 06/27/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common cardiac arrhythmia with a high stroke and mortality rate. The video-assisted thoracoscopic radiofrequency pulmonary vein ablation is a treatment option for patients who fail catheter ablation. Randomized data comparing surgical versus catheter ablation are limited. We performed a meta-analysis of randomized control trials to explore the outcome efficacy between surgical and catheter radiofrequency pulmonary vein ablation in patients with AF. METHODS We comprehensively searched the databases of MEDLINE and EMBASE from inception to December 2020. Included studies were published randomized control trials that compared video-assisted thoracoscopic and catheter radiofrequency pulmonary vein ablation. Data from each study were combined using the fixed-effects, generic inverse variance method of DerSimonian and Laird to calculate odds ratios and 95% confidence intervals. RESULTS Six studies from November 2013 to 2020 were included in this meta-analysis involving 511 AF patients (79% paroxysmal) with 263 catheter ablation (mean age 56±3 years) and 248 surgical ablations (mean age 52 ±4 years). Catheter ablation was associated with increased atrial arrhythmias recurrence when compared to surgical ablation (pooled relative risk=1.85, 95 % confidence interval: 1.44-2.39, p<0.001, I2 =0.0%) but associated with less total major adverse events (pooled relative risk=0.29, 95 % confidence interval: 0.16-0.53, p<0.001, I2 =0.0%). In subgroup analysis, catheter ablation was associated with increased AF recurrence in refractory paroxysmal AF when compared to surgical ablation (pooled relative risk=2.47, 95 % confidence interval: 1.31-4.65, p=0.005, I2 =0.0%) but not in persistent AF (relative risk=1.09, 95 % confidence interval: 0.60-2.0, p=0.773). CONCLUSION Catheter ablation was associated with higher atrial arrhythmia recurrence when compared with surgical ablation. However, our study suggests that the benefit of surgical ablation in patients with persistent AF is unclear. More studies and alternative ablation strategies investigation in persistent AF are warranted. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Pattara Rattanawong
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA.,Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Jakrin Kewcharoen
- Department of Medicine, Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Anil Sriramoju
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Anusha Shanbhag
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Nway L Ko Ko
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Timothy Barry
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Wasawat Vutthikraivit
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Win-Kuang Shen
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
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Pieszko K, Shanbhag A, Killekar A, Lemley M, Otaki Y, Kriekinge SV, Kavanagh P, Miller RJ, Miller EJ, Bateman T, Dey D, Berman D, Slomka P. Calcium scoring in low-dose ungated chest CT scans using convolutional long-short term memory networks. Proc SPIE Int Soc Opt Eng 2022; 12032:120323A. [PMID: 36277935 PMCID: PMC9585987 DOI: 10.1117/12.2613147] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
We aimed to develop a novel deep-learning based method for automatic coronary artery calcium (CAC) quantification in low-dose ungated computed tomography attenuation correction maps (CTAC). In this study, we used convolutional long-short -term memory deep neural network (conv-LSTM) to automatically derive coronary artery calcium score (CAC) from both standard CAC scans and low-dose ungated scans (CT-attenuation correction maps). We trained convLSTM to segment CAC using 9543 scans. A U-Net model was trained as a reference method. Both models were validated in the OrCaCs dataset (n=32) and in the held-out cohort (n=507) without prior coronary interventions who had CTAC standard CAC scan acquired contemporarily. Cohen's kappa coefficients and concordance matrices were used to assess agreement in four CAC score categories (very low: <10, low:10-100; moderate:101-400 and high >400). The median time to derive results on a central processing unit (CPU) was significantly shorter for the conv-LSTM model- 6.18s (inter quartile range [IQR]: 5.99, 6.3) than for UNet (10.1s, IQR: 9.82, 15.9s, p<0.0001). The memory consumption during training was much lower for our model (13.11Gb) in comparison with UNet (22.31 Gb). Conv-LSTM performed comparably to UNet in terms of agreement with expert annotations, but with significantly shorter inference times and lower memory consumption.
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Affiliation(s)
- K Pieszko
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - A Shanbhag
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - A Killekar
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - M Lemley
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Y Otaki
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Serge Van Kriekinge
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Paul Kavanagh
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert Jh Miller
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Cardiac Sciences, University of Calgary, Calgary AB, Canada
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Tim Bateman
- Cardiovascular Imaging Technologies LLC, Kansas City, MO, USA
| | - D Dey
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - D Berman
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - P Slomka
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Ashraf H, Agasthi P, Shanbhag A, Mehta RA, Rattanawong P, Allam M, Pujari SH, Mookadam F, Freeman WK, Srivathsan K, Sorajja D, Shen WK, Noseworthy PA, Yang EH, Masry HZE, Yao X, Mulpuru SK, Beohar N, Holmes DR, Arsanjani R. Long-Term Clinical Outcomes of Underdosed Direct Oral Anticoagulants in Patients with Atrial Fibrillation and Atrial Flutter. Am J Med 2021; 134:788-796. [PMID: 33444586 DOI: 10.1016/j.amjmed.2020.12.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 08/09/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although direct oral anticoagulants (DOACs) have been shown to be effective at reducing the risk of stroke in patients with atrial fibrillation/flutter (AF), they are sometimes underdosed off-label to mitigate their associated higher bleeding risk. We sought to evaluate frequency and clinical outcomes of inappropriate underdosing of DOACS in patients with AF. METHODS We conducted a study of subjects with AF who had a clinical indication for stroke prophylaxis (with a congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65 to 47 years, sex category [CHA2DS2-VASc] of 2 or greater) and were prescribed 1 of the 4 clinically approved DOACs (apixaban, rivaroxaban, dabigatran, or edoxaban). We compared all-cause mortality, composite of stroke and systemic embolism, composite of myocardial infarction (MI), acute coronary syndromes (ACS), and coronary revascularization, and major bleeding between patients appropriately dosed and inappropriately underdosed. RESULTS A total of 8125 patients met inclusion criteria, with a mean follow up of 2.2 ± 2 years. Of those, 1724 patients (21.2%) were inappropriately dosed. After adjusting for baseline variables, there was no difference in all-cause mortality, risk of stroke or systemic embolism, International Society on Thrombosis and Haemostasis (ISTH) major bleeding, or composite of myocardial infarction, acute coronary syndromes, or coronary revascularization between patients appropriately dosed and inappropriately underdosed. In subgroup analysis, only apixaban demonstrated an increased incidence all-cause mortality (hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.03-1.49) with inappropriate underdosing. There was no difference in the remaining clinical outcomes noted on subgroup analysis. CONCLUSION Underdosing of DOACs did not minimize risk of bleeding, systemic embolization or all-cause mortality in patients with AF. Inappropriate underdosing with apixaban in particular was associated with increased all-cause mortality.
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Affiliation(s)
- Hasan Ashraf
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix Ariz.
| | | | - Anusha Shanbhag
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix Ariz
| | - Ramila A Mehta
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minn
| | | | - Mohamed Allam
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix Ariz
| | | | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix Ariz
| | | | | | - Dan Sorajja
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix Ariz
| | - Win-Kuang Shen
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix Ariz
| | | | - Eric H Yang
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix Ariz
| | | | - Xiaoxi Yao
- Department of Health Care Policy and Research, Mayo Clinic, Rochester, Minn
| | - Siva K Mulpuru
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
| | - Nirat Beohar
- Division of Cardiology, Mount Sinai Medical Center, Miami, Fla
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix Ariz
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Rattanawong P, Kewcharoen J, Kanitsoraphan C, Barry T, Shanbhag A, Ko Ko NL, Vutthikraivit W, Home M, Agasthi P, Ashraf H, Shimizu W, Shen WK. Does the Age of Sudden Cardiac Death in Family Members Matter in Brugada Syndrome? J Am Heart Assoc 2021; 10:e019788. [PMID: 34013737 PMCID: PMC8483509 DOI: 10.1161/jaha.120.019788] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Brugada syndrome is an inherited cardiac channelopathy associated with major arrhythmic events (MAEs). The presence of a positive family history of sudden cardiac death (SCD) as a risk predictor of MAE remains controversial. We aimed to examine the association between family history of SCD and MAEs stratified by age of SCD with a systematic review and meta-analysis. Methods and Results We searched the databases of MEDLINE and EMBASE from January 1992 to January 2020. Data from each study were combined using the random-effects model. Fitted metaregression was performed to evaluate the association between the age of SCD in families and the risk of MAE. Twenty-two studies from 2004 to 2019 were included in this meta-analysis involving 3386 patients with Brugada syndrome. The overall family history of SCD was not associated with increased risk of MAE in Brugada syndrome (pooled odds ratio [OR], 1.11; 95% CI, 0.82-1.51; P=0.489, I2=45.0%). However, a history of SCD in family members of age younger than 40 years of age did increase the risk of MAE by ≈2-fold (pooled OR, 2.03; 95% CI, 1.11-3.73; P=0.022, I2=0.0%). When stratified by the age of cut point at 50, 45, 40, and 35 years old, a history of SCD in younger family member was significantly associated with a higher risk of MAE (pooled OR, 0.49, 1.30, 1.51, and 2.97, respectively; P=0.046). Conclusions A history of SCD among family members of age younger than 40 years was associated with a higher risk of MAE.
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Affiliation(s)
- Pattara Rattanawong
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ.,Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - Jakrin Kewcharoen
- University of Hawaii Internal Medicine Residency Program Honolulu HI
| | | | - Timothy Barry
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ
| | - Anusha Shanbhag
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ
| | - Nway L Ko Ko
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ
| | - Wasawat Vutthikraivit
- Division of Cardiovascular Medicine Department of Internal Medicine University of Iowa IA
| | | | | | - Hasan Ashraf
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ
| | - Wataru Shimizu
- Department of Cardiovascular Medicine Graduate School of Medicine Nippon Medical School Tokyo Japan
| | - Win-Kuang Shen
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ
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8
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Chao CJ, Chiang CC, Agasthi P, Girardo M, Buras M, Shanbhag A, Wang G(Y, Seri AR, Sweeney J, Fortuin FD, Holmes D, Arsanjani R. MACHINE LEARNING ALGORITHM ACCURATELY PREDICTS HEART FAILURE HOSPITALIZATION EVENTS IN POST- TRANSCATHETER AORTIC VALVE PLACEMENT PATIENTS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02486-4] [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: 11/25/2022]
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9
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Chao CJ, Shanbhag A, Chiang CC, Girardo ME, Seri AR, Khalid MU, Rayfield C, O'Shea MP, Fatunde O, Fortuin FD. Baseline thrombocytopenia in acute coronary syndrome: The lower, the worse. Int J Cardiol 2021; 332:1-7. [PMID: 33785391 DOI: 10.1016/j.ijcard.2021.03.059] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with baseline thrombocytopenia can have increased mortality and morbidity, but are typically excluded from randomized clinical trials studying acute coronary syndromes (ACS). We sought to better define the effect thrombocytopenia on clinical outcomes in ACS patients. METHODS Patients identified from the NCDR Chest Pain registry at Mayo Clinic Arizona from Oct 2015 to Sep 2018 were retrospectively classified into two groups: TP (platelet <150 × 103 μL) and control (platelet ≥150 × 103 μL). The groups were analyzed for the clinical outcome (all-cause mortality, major adverse cardiac events (MACE), and bleeding events). The TP group was divided into moderate-severe thrombocytopenia (TPmod; platelet 50-100 × 103 μL) and mild thrombocytopenia (TPmild; platelet 100-150 × 103 μL) for further analysis. P-value <0.05 is considered significant. RESULTS Five hundred and thirty-six patients were identified, and 72 patients (13%) had thrombocytopenia. The median follow-up time was 1.1 years. The TP group was older (TP vs. control: mean age 73 ± 13 years vs. 70 ± 13 years; P = 0.026). In patients discharged on dual-antiplatelet therapy, the TP group had higher all-cause mortality (23% vs. 7.3%; P = 0.007) but not major bleeding events (11% vs. 5.0%; P = 0.123). Only all-cause mortality increased with the severity of thrombocytopenia (TPmod vs. TPmild vs. control: 33% vs. 24% vs. 7.3%; P = 0.007). CONCLUSIONS In patients with ACS, baseline thrombocytopenia is associated with increased all-cause mortality and all bleeding events without net MACE benefit. Further study is needed to identify the optimal antiplatelet strategy in this higher risk population.
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Affiliation(s)
- Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, United States of America.
| | - Anusha Shanbhag
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, United States of America.
| | - Chia-Chun Chiang
- Department of Neurology, Mayo Clinic Rochester, Phoenix, AZ, United States of America
| | - Marlene E Girardo
- Department of Research, Division of Biomedical Statistics and Informatics, Mayo Clinic Arizona, Phoenix, AZ, United States of America
| | - Amith R Seri
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, United States of America
| | - Muhammad U Khalid
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, United States of America
| | - Corbin Rayfield
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, United States of America.
| | - Michael P O'Shea
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, United States of America
| | - Olubadewa Fatunde
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, United States of America.
| | - F David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, United States of America.
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10
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Rattanawong P, Kewcharoen J, Vutthikraivit W, Kanitsoraphan C, Ko NLK, Shanbhag A, Shen WK. ELECTROPHYSIOLOGY STUDY AND THE RISK OF MAJOR ARRHYTHMIC EVENTS IN BRUGADA SYNDROME: AN UPDATED SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31088-3] [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: 10/24/2022]
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11
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Rattanawong P, Kewcharoen J, Kanitsoraphan C, Vutthikraivit W, Shanbhag A, Barry T, Ko NLK, Taweesedt P, Shen WK. SURGICAL VERSUS CATHETER ABLATION IN ATRIAL FIBRILLATION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31087-1] [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: 11/24/2022]
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12
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Rattanawong P, Kewcharoen J, Kanitsoraphan C, Barry T, Shanbhag A, Ko NLK, Vutthikraivit W, Shen WK. FAMILY HISTORY OF SUDDEN CARDIAC DEATH IN BRUGADA SYNDROME: A SYSTEMIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31086-x] [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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13
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Shanbhag A, Ananthula A, Reddy Palagiri RD, Parikh R, Purushothaman R, Vallurupalli S. Variation in High-Intensity Statin Use After Hospitalization for Acute Vascular Emergencies. Am J Med Sci 2018; 356:501-502. [DOI: 10.1016/j.amjms.2018.05.006] [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] [Received: 03/07/2018] [Revised: 05/08/2018] [Accepted: 05/11/2018] [Indexed: 10/16/2022]
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14
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Shulman E, Chudow JJ, Essien UR, Shanbhag A, Kargoli F, Romero J, Di Biase L, Fisher J, Krumerman A, Ferrick KJ. Relative contribution of modifiable risk factors for incident atrial fibrillation in Hispanics, African Americans and non-Hispanic Whites. Int J Cardiol 2018; 275:89-94. [PMID: 30340851 DOI: 10.1016/j.ijcard.2018.10.028] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/26/2018] [Accepted: 10/08/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Contribution of modifiable risk factors for the risk of new onset atrial fibrillation (AF) in minority populations is poorly understood. Our objective was to compare the population attributable risk (PAR) of various risk factors for incident AF between Hispanic, African American and non-Hispanic Whites. METHODS An ECG/EMR database was interrogated for individuals free of AF for development of subsequent AF from 2000 to 2013. Cox regression analysis controlled for age > 65, male gender, body mass index > 40 kg/m2, systolic blood pressure > 140 mm Hg, diabetes mellitus, heart failure, socioeconomic status less than the first percentile in New York State, and race/ethnicity. PAR was calculated as (prevalence of X) ∗ (HR - 1)/HR, where HR is the hazard ratio, and X is the risk factor. RESULTS 47,722 persons free of AF (43% Hispanic, 37% Black and 20% White) were followed for subsequent incident AF. Hypertension in African Americans and Hispanics had a 7.93% and 7.66% greater PAR compared with non-Hispanics Whites. Similar findings existed for the presence of heart failure, with a higher PAR in non-Whites compared to Whites. CONCLUSION In conclusion, modifiable risk factors play an important role in the risk of incident AF. Higher PAR estimates in African Americans and Hispanics were observed for elevated systolic blood pressure and heart failure. Identification of these modifiable risk factors for atrial fibrillation in non-White minorities may assist in targeting better prevention therapies and planning from a public health perspective. No funding sources were used for this study.
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Affiliation(s)
- Eric Shulman
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY, United States of America
| | - Jay J Chudow
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY, United States of America
| | - Utibe R Essien
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Anusha Shanbhag
- Division of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Faraj Kargoli
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY, United States of America
| | - Jorge Romero
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY, United States of America
| | - Luigi Di Biase
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY, United States of America
| | - John Fisher
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY, United States of America
| | - Andrew Krumerman
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY, United States of America
| | - Kevin J Ferrick
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY, United States of America.
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15
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Kattoor AJ, Shanbhag A, Abraham A, Vallurupalli S. Clinical Context and Detection of the Murmur of Advanced Aortic Stenosis. South Med J 2018; 111:230-234. [DOI: 10.14423/smj.0000000000000791] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Habash F, Shanbhag A, Siraj A, Campbell P. A “FUNNY” WAY TO TREAT CARDIOGENIC SHOCK: A CASE SERIES. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32929-2] [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: 10/17/2022]
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17
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Shanbhag A, Pritchard ER, Chatterjee K, Hammond DA. Highly Probable Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome Associated With Lenalidomide. Hosp Pharm 2017; 52:408-411. [PMID: 29276264 DOI: 10.1177/0018578717717394] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening hypersensitivity reaction to medications. We report a case of a 75-year-old African American female who presented with generalized rash with desquamation and malodorous secretions. She was febrile and hypotensive, and required vasopressors for hemodynamic instability. Sepsis secondary to skin or soft tissue infection was considered initially. However, she recently was started on lenalidomide for treatment of her multiple myeloma, and her white blood cell count of 17 K/µL with 55% eosinophils along with peripheral smear showing eosinophilia suggested lenalidomide-induced rash. Lenalidomide was discontinued, and methylprednisolone was initiated. Four days after lenalidomide discontinuation, vasopressors were discontinued. Blood cultures did not exhibit any growth. The Niranjo Adverse Drug Reaction Probability Scale score of 9 suggests lenalidomide was a highly probable cause of DRESS syndrome. The temporal relation of lenalidomide administration and development of symptoms plus improvement of rash with the discontinuation of lenalidomide and reappearance on restarting lenalidomide in the follow-up clinic strengthens our suspicion of lenalidomide-induced DRESS syndrome. Cases of lenalidomide-induced DRESS syndrome are sparse; however, DRESS syndrome is fatal in approximately 10% of patients. Providers should be aware and keep a vigilant eye out for this adverse reaction with lenalidomide.
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Affiliation(s)
- Anusha Shanbhag
- University of Arkansas for Medical Sciences, Little Rock, USA
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18
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Fabbian F, Bhatia S, De Giorgi A, Maietti E, Bhatia S, Shanbhag A, Deshmukh A. Circadian Periodicity of Ischemic Heart Disease: A Systematic Review of the Literature. Heart Fail Clin 2017; 13:673-680. [PMID: 28865776 DOI: 10.1016/j.hfc.2017.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 01/16/2023]
Abstract
The authors performed a MEDLINE search to identify reports, published during the last 20 years, focused on circadian variation of acute myocardial infarction (AMI), and prevalence and the ratios between the number of events per hour during the morning and the other hours of the day were calculated. Despite the optimization of interventional and medical therapy of AMI since the first reports of circadian patterns in AMI occurrence, it was found that such a pattern still exists and that AMI happens most frequently in the morning hours.
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Affiliation(s)
- Fabio Fabbian
- Department of Medical Sciences, University of Ferrara, University Hospital St. Anna, Via Aldo Moro 8, I-44124, Cona, Ferrara, Italy.
| | - Subir Bhatia
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Afredo De Giorgi
- Department of Medical Sciences, University of Ferrara, University Hospital St. Anna, Via Aldo Moro 8, I-44124, Cona, Ferrara, Italy
| | - Elisa Maietti
- Department of Medical Sciences, University of Ferrara, Center for Clinical Epidemiology, 44121 Ferrara, Italy
| | - Sravya Bhatia
- School of Medicine, Duke University, 8 Duke University Medical Center Greenspace, Durham, NC 27703, USA
| | - Anusha Shanbhag
- Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205, USA
| | - Abhishek Deshmukh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, 200 First Street Southwest, Rochester, Minnesota 55905, USA
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19
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Chatterjee K, Gupta T, Goyal A, Kolte D, Khera S, Shanbhag A, Patel K, Villablanca P, Agarwal N, Aronow WS, Menegus MA, Fonarow GC, Bhatt DL, Garcia MJ, Meena NK. Association of Obesity With In-Hospital Mortality of Cardiogenic Shock Complicating Acute Myocardial Infarction. Am J Cardiol 2017; 119:1548-1554. [PMID: 28363355 DOI: 10.1016/j.amjcard.2017.02.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/15/2017] [Accepted: 02/15/2017] [Indexed: 01/20/2023]
Abstract
Several previous studies have shown obesity to be counterintuitively associated with more favorable mortality in patients with acute myocardial infarction (AMI); however, the association of obesity with in-hospital mortality of cardiogenic shock complicating AMI has not been previously examined. We queried the 2004 to 2013 National Inpatient Sample databases to identify all patients ≥18 years hospitalized with the principal diagnosis of AMI. Multivariable regression models adjusting for demographics, hospital characteristics, and co-morbidities were used to examine differences in incidence and in-hospital mortality of cardiogenic shock complicating AMI between obese and nonobese patients. Of 6,097,817 patients with AMI, 290,894 (4.8%) had cardiogenic shock. There was no difference in risk-adjusted incidence of cardiogenic shock between obese and nonobese patients (adjusted odds ratio 1.00, 95% CI 0.98 to 1.01; p = 0.46). Of the patients with cardiogenic shock complicating AMI, 8.9% had a documented diagnosis of obesity. Obese patients were on average 6 years younger and had higher prevalence of most cardiovascular co-morbidities. Obese patients were more likely to receive revascularization (73.0% vs 63.4%, p <0.001) and had lower risk-adjusted in-hospital mortality compared with nonobese patients (28.2% vs 36.5%; adjusted odds ratio 0.89, 95% CI 0.86 to 0.92; p <0.001). Similar findings were seen in subgroups of patients with cardiogenic shock complicating ST elevation or non-ST elevation MI. In conclusion, this large retrospective analysis of a nationwide cohort of patients with cardiogenic shock complicating AMI demonstrated that obese patients were younger, more likely to receive revascularization, and had modestly lower risk-adjusted in-hospital mortality compared with nonobese patients.
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20
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Vallurupalli S, Shanbhag A, Mehta JL. Controversies in postoperative atrial fibrillation after noncardiothoracic surgery: clinical and research implications. Clin Cardiol 2017; 40:329-332. [PMID: 28272807 DOI: 10.1002/clc.22652] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 08/22/2016] [Revised: 11/01/2016] [Accepted: 11/05/2016] [Indexed: 12/27/2022] Open
Abstract
Post operative atrial fibrillation after non-cardiothoracic surgery is an increasingly common problem. There is little high quality data to guide clinicians in risk prediction as well as short term and long term management. There appears to be a significant risk of recurrent atrial fibrillation and stroke but effective screening strategies have not been tested. In this commentary, we delineate various controversies in the management of post operative atrial fibrillation and briefly review the available evidence. Prospective studies in this clinically important area of cardiology should be encouraged.
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Affiliation(s)
- Srikanth Vallurupalli
- Division of Cardiology, Central Arkansas Veterans Healthcare System and the University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Anusha Shanbhag
- Division of Cardiology, Central Arkansas Veterans Healthcare System and the University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jawahar L Mehta
- Division of Cardiology, Central Arkansas Veterans Healthcare System and the University of Arkansas for Medical Sciences, Little Rock, Arkansas
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21
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Pothineni NVK, Shanbhag A, Kattoor A, Kovelamudi S, Killu A, Mulpuru S, Kapa S, Deshmukh A. COMPLICATION RATES OF EPICARDIAL VENTRICULAR TACHYCARDIA ABLATION: A POOLED ANALYSIS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33883-4] [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: 11/29/2022]
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22
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Abstract
Abdominal pregnancy is extremely rare, and has been historically defined as an implantation in the peritoneal cavity exclusive of tubal, ovarian and intraligamentary pregnancy. Abdominal pregnancy can be primary or secondary. The presence of abdominal pregnancy is associated with increased maternal and perinatal morbidity and mortality. The reported incidence of abdominal pregnancy ranges from 1 per 2200 to 1 per 10,200 pregnancies1. The early recognition and management of the same is necessary to prevent untoward complications. This case report describes an interesting case of a 16 year primigravida with a live secondary abdominal pregnancy. NJOG 2011 Nov-Dec; 6 (2): 44-46 DOI: http://dx.doi.org/10.3126/njog.v6i2.6756
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Abstract
The effect of biomaterials on the activation of human neutrophils was studied. Human neutrophils were incubated with F-75 cobalt-based alloy or polystyrene microspheres of a nonphagocytosable size with two times total neutrophil plane surface area. Scanning and transmission electron microscope (SEM, TEM), energy dispersive x-ray microanalysis (EDX), and graphite furnace atomic absorption spectroscopy (GFAAS) were used to analyze changes in cellular morphology and metal content. This report presents evidence that human PMNs display morphological changes related to foreign material challenge, including activation on F-75 bead surfaces, pinocytosis of corrosion products, formation of intracellular vacuoles, degranulation, etc. Moreover, when PMNs were present, the corrosion release rate of F-75 increased as much as three times over cell-free controls.
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Affiliation(s)
- J Yang
- Department of Bioengineering, Clemson University, South Carolina 29634
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24
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Shanbhag A, Yang J, Lilien J, Black J. Decreased neutrophil respiratory burst on exposure to cobalt-chrome alloy and polystyrene in vitro. J Biomed Mater Res 1992; 26:185-95. [PMID: 1314837 DOI: 10.1002/jbm.820260205] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The effect of biomaterials on the superoxide-producing ability of neutrophils was studied. Human peripheral blood neutrophils were incubated with cobalt-base alloy (F-75) or polystyrene beads of a nonphagocytosable size. Respiratory burst activity was studied by measuring superoxide dismutase inhibitable reduction of cytochrome C. Neutrophils were found to release no more superoxide anion on incubation for up to 3 h with either material in a protein-free medium than controls without foreign material. However, the ability of neutrophils incubated with either biomaterial to subsequently respond to phorbol myristate acetate challenge was decreased (p less than 0.05). Chemical analysis of supernatants for the F-75 samples showed a high concentration of cobalt in the medium within 1 h of incubation. Minimal chromium and nickel was detected. No correlation could be demonstrated between metal in solution and the respiratory burst defect in neutrophils. Instead it appears that interaction of cells with either surface was the critical event in altering the response to phorbol myristate acetate. This observed functional defect may play an important role in rendering tissue around implanted biomaterials susceptible to infections.
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Affiliation(s)
- A Shanbhag
- Department of Bioengineering, Clemson University, South Carolina 29634
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25
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Abstract
Autogenous rib cartilage and silicone rubber are materials currently used for ear reconstruction. Increased morbidity and operative time with rib cartilage grafts and a high rate of extrusion with silicone implants render them less than ideal for reconstruction of the human ear. The purpose of the current investigation is to determine the efficacy of porous polyethylene as an alternative synthetic material for ear reconstruction. Porous polyethylene and silicone rubber discs of equal sizes in two thicknesses were implanted in lieu of the cartilage in the external ear of eight baboons. Histological evaluation of the sites after nine weeks revealed excellent anchorage of the thin porous polyethylene implants (1.5 mm) in the surrounding tissues. Silicone rubber implants, however, were encapsulated in a thickened granulation tissue capsule. When thicker implants (3.0 mm) were used, exposure or extrusion occurred in all cases. Porous polyethylene implants demonstrated only partial exposure; half of the silicone rubber implants were extruded; and the other two silicone rubber implants were almost completely extruded. Porous polyethylene was thus better incorporated into the soft tissues than silicone rubber as long as the overlying soft tissues were not stressed by an oversized implant or inadequate soft tissue coverage.
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Affiliation(s)
- A Shanbhag
- Department of Bioengineering, Clemson University, SC 29634-0905
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