1
|
Scarpa Matuck BR, Akino N, Bakhshi H, Cox C, Ebrahimihoor E, Ishida M, Lemos PA, Lima JAC, Matheson MB, Orii M, Ostovaneh A, Ostovaneh MR, Schuijf JD, Szarf G, Trost JC, Yoshioka K, Arbab-Zadeh A. Ultra-high-resolution CT vs. invasive angiography for detecting hemodynamically significant coronary artery disease: Rationale and methods of the CORE-PRECISION multicenter study. J Cardiovasc Comput Tomogr 2024:S1934-5925(24)00107-2. [PMID: 38702271 DOI: 10.1016/j.jcct.2024.04.012] [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: 03/12/2024] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Direct coronary arterial evaluation via computed tomography (CT) angiography is the most accurate noninvasive test for the diagnosis of coronary artery disease (CAD). However, diagnostic accuracy is limited in the setting of severe coronary calcification or stents. Ultra-high-resolution CT (UHR-CT) may overcome this limitation, but no rigorous study has tested this hypothesis. METHODS The CORE-PRECISION is an international, multicenter, prospective diagnostic accuracy study testing the non-inferiority of UHR-CT compared to invasive coronary angiography (ICA) for identifying patients with hemodynamically significant CAD. The study will enroll 150 patients with history of CAD, defined as prior documentation of lumen obstruction, stenting, or a calcium score ≥400, who will undergo UHR-CT before clinically prompted ICA. Assessment of hemodynamically significant CAD by UHR-CT and ICA will follow clinical standards. The reference standard will be the quantitative flow ratio (QFR) with <0.8 defined as abnormal. All data will be analyzed in independent core laboratories. RESULTS The primary outcome will be the comparative diagnostic accuracy of UHR-CT vs. ICA for detecting hemodynamically significant CAD on a patient level. Secondary analyses will focus on vessel level diagnostic accuracy, quantitative stenosis analysis, automated contour detection, in-depth plaque analysis, and others. CONCLUSION CORE-PRECISION aims to investigate if UHR-CT is non-inferior to ICA for detecting hemodynamically significant CAD in high-risk patients, including those with severe coronary calcification or stents. We anticipate this study to provide valuable insights into the utility of UHR-CT in this challenging population and for its potential to establish a new standard for CAD assessment.
Collapse
Affiliation(s)
- Bruna R Scarpa Matuck
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Naruomi Akino
- Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Hooman Bakhshi
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher Cox
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Elnaz Ebrahimihoor
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Masaru Ishida
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Yahaba, Japan
| | - Pedro A Lemos
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Joao A C Lima
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew B Matheson
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Makoto Orii
- Department of Radiology, Iwate Medical University, Yahaba, Japan
| | - Aysa Ostovaneh
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohammad R Ostovaneh
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Gilberto Szarf
- Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Jeffrey C Trost
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Armin Arbab-Zadeh
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
2
|
Tehrani BN, Sherwood MW, Damluji AA, Epps KC, Bakhshi H, Cilia L, Dassanayake I, Eltebaney M, Gattani R, Howard E, Kepplinger D, Ofosu‐Somuah A, Batchelor WB. A Randomized Comparison of Radial Artery Intimal Hyperplasia Following Distal Versus Proximal Transradial Access for Coronary Angiography: PRESERVE RADIAL. J Am Heart Assoc 2024; 13:e031504. [PMID: 38353242 PMCID: PMC11010068 DOI: 10.1161/jaha.123.031504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 10/24/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND Distal transradial access (dTRA) is an alternative to conventional forearm transradial access (fTRA) for coronary angiography (CAG). Differences in healing of the radial artery (RA) in the forearm have not been evaluated between these 2 access strategies. We sought to compare the mean difference in forearm RA intimal-medial thickening (IMT) in patients randomized to dTRA versus fTRA. METHODS AND RESULTS In this single-center randomized clinical trial, 64 patients undergoing nonemergent CAG were randomized (1:1) to dTRA versus fTRA. Ultra-high-resolution (55-MHz) vascular ultrasound of the forearm and distal RA was performed pre-CAG and at 90 days. The primary end point was the mean change in forearm RA IMT. Secondary end points included procedural characteristics, vascular injury, RA occlusion, and ipsilateral hand pain and function. Baseline demographics and clinical characteristics, mean forearm RA IMT, and procedural specifics were similar between the dTRA and fTRA cohorts. There was no difference in mean change in forearm RA IMT between the 2 cohorts (0.07 versus 0.07 mm; P=0.37). No RA occlusions or signs of major vascular injury were observed at 90 days. Ipsilateral hand pain and function (Borg pain scale score: 12 versus 11; P=0.24; Disabilities of the Arm, Shoulders, and Hand scale score: 6 versus 8; P=0.46) were comparable. CONCLUSIONS Following CAG, dTRA was associated with no differences in mean change of forearm RA IMT, hand pain, and function versus fTRA for CAG. Further investigation is warranted to elucidate mechanisms and predictors of RA healing and identify effective strategies to preserving RA integrity for repeated procedures. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04801901.
Collapse
Affiliation(s)
| | | | - Abdulla A. Damluji
- Inova Schar Heart and VascularFalls ChurchVAUSA
- Johns Hopkins UniversityBaltimoreMDUSA
| | | | - Hooman Bakhshi
- Inova Schar Heart and VascularFalls ChurchVAUSA
- Johns Hopkins UniversityBaltimoreMDUSA
| | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Bakhshi H, Gibson CM. MINOCA: Myocardial infarction no obstructive coronary artery disease. Am Heart J Plus 2023; 33:100312. [PMID: 38510552 PMCID: PMC10945965 DOI: 10.1016/j.ahjo.2023.100312] [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: 04/19/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 03/22/2024]
Abstract
Myocardial infarction without obstructive coronary artery disease (MINOCA) is defined as myocardial infarction with mild or no obstructive coronary artery disease (CAD) on angiogram. MINOCA has a number of heterogeneous causes, including coronary disruption, coronary vasospasm, coronary embolism, spontaneous coronary artery dissection (SCAD), and coronary microvascular dysfunction (CMD). Even though MINOCA might have a better prognosis than MI with obstructive CAD, it is not benign. A stepwise diagnostic approach is crucial to identifying the underlying cause of MINOCA or conditions mimicking it. A cause-specific treatment approach is the key to managing MINOCA.
Collapse
Affiliation(s)
- Hooman Bakhshi
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - C. Michael Gibson
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
4
|
Tehrani BN, Sherwood MW, Damluji AA, Epps KC, Bakhshi H, Cilia L, Dassanayake I, Eltebaney M, Gattani R, Howard E, Kepplinger D, Ofosu-Somuah A, Batchelor WB. A Randomized Comparison of Radial Artery Intimal Hyperplasia Following Distal vs. Proximal Transradial Access for Coronary Angiography: PRESERVE RADIAL Trial. medRxiv 2023:2023.07.05.23292274. [PMID: 37461583 PMCID: PMC10350125 DOI: 10.1101/2023.07.05.23292274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Background Distal transradial access (dTRA) is an alternative to conventional forearm transradial access (fTRA) for coronary angiography (CAG). Differences in healing of the radial artery in the forearm (FRA) have not been evaluated between these 2 access strategies. We sought to compare FRA intimal-medial thickening (IMT) in patients randomized to dTRA vs. fTRA for CAG. Methods and Results Sixty-four consecutive patients undergoing non-emergent CAG were randomized (1:1) to dTRA vs. fTRA. Ultrahigh resolution (55 MHz) vascular ultrasound) of the FRA and distal RA was performed pre-CAG and at 90 days. Primary endpoint was 90-day FRA IMT. Secondary endpoints included procedural characteristics, vascular injury, RA occlusion and ipsilateral hand pain and function. Baseline demographics and clinical characteristics, mean FRA IMT, time to RA access, procedure time, and radiation exposure were similar between the dTRA and fTRA cohorts. There were no between group differences in 90-day FRA IMT (0.37 mm vs 0.38 mm, respectively; p =0.73). No RA occlusions or signs of major vascular injury were observed at 90 days. Ipsilateral hand pain and function (Borg pain scale:12 vs 11, p =0.24; DASH scores: 6 vs 8, p =0.46) were comparable. Conclusions In this single center randomized clinical trial, similar patterns of FRA vascular healing at 90 days, procedural results as well as hand pain and function were observed following dTRA vs. fTRA for CAG. Further investigation is warranted to better understand the mechanistics and predictors of RA healing and to identify strategies aimed at preserving RA integrity for future procedures. What is New? DTRA has been proposed as an alternative to traditional fTRA in the wrist for CAG and PCI because of ergonomic and post-procedural recovery benefits to the patient, as well as potential reductions in occlusion of the FRA.There are gaps in knowledge, however, regarding potential differences in remodeling of the FRA in patients undergoing dTRA versus fTRA.In this randomized clinical trial, there were no differences in IMT and patterns of vascular injury and healing, using ultrahigh resolution (55 MHz) ultrasound, at 90 days in patients randomized to dTRA or FTRA for elective and non-emergent CAG and PCI. What Are the Clinical Implications Our findings highlight the need for further inquiry through large multicenter randomized clinical trials to better the understand the mechanistics and predictors of IMT and to identify strategies to mitigate the adverse effects of vessel remodeling in patients undergoing TRA across the entire severity spectrum of cardiovascular disease.
Collapse
|
5
|
Oliveros E, Brailovsky Y, Beneduce A, Bakhshi H, Zancanaro E, Sukmawati I, Shetty M, Lundberg G. Impact of Social Media and Multimedia Platforms: View From the JACC: Case Reports SoMe Editors. JACC Case Rep 2023; 15:101859. [PMID: 37288285 PMCID: PMC10240267 DOI: 10.1016/j.jaccas.2023.101859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Estefania Oliveros
- Division of Cardiovascular Disease, Department of Medicine, Temple University Hospital. Philadelphia, Pennsylvania, USA
| | - Yevgeniy Brailovsky
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | - Hooman Bakhshi
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Indah Sukmawati
- Department of Cardiovascular Medicine, Siloam Hospitals Lippo Village –Pelita Harapan University, Tangerang, Indonesia
| | - Mrinali Shetty
- Department of Medicine, Columbia University, New York, New York, USA
| | - Gina Lundberg
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
6
|
Bakhshi H, Roy S, Ostovaneh M, Miller JM. OPTIMIZATION OF STENT SIZE IN A VERY LARGE CORONARY ARTERY: CAROTID BALLOON SAVED THE DAY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03302-8] [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]
|
7
|
Roy S, Bakhshi H, Miller JM. LIVING BY A THREAD: HIGH RISK PCI OF A COMPLEX SAPHENOUS VEIN GRAFT LESION, A FUNCTIONAL LEFT MAIN EQUIVALENT. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03717-8] [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]
|
8
|
Badrish N, Gattani R, Nguyen AH, Nwancha AB, Dewanjee A, Qian X, Bakhshi H, Sinha SS, Psotka M. A SMOKED HEART: CORONARY ARTERY SPASM AND CARDIOGENIC SHOCK DUE TO ACUTE CARBON MONOXIDE POISONING. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03989-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]
|
9
|
Bakhshi H, Michelhaugh SA, Bruce SA, Seliger SL, Qian X, Ambale Venkatesh B, Varadarajan V, Bagchi P, Lima JAC, deFilippi C. Association between proteomic biomarkers and myocardial fibrosis measured by MRI: the multi-ethnic study of atherosclerosis. EBioMedicine 2023; 90:104490. [PMID: 36857966 PMCID: PMC10006438 DOI: 10.1016/j.ebiom.2023.104490] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Cardiac magnetic resonance imaging (CMR) determines the extent of interstitial fibrosis, measured by increased extracellular volume (ECV), and replacement fibrosis with late gadolinium myocardial enhancement (LGE). Despite advances in detection, the pathophysiology of subclinical myocardial fibrosis is incompletely understood. Targeted proteomic discovery technologies enable quantification of low abundance circulating proteins to elucidate cardiac fibrosis mechanisms. METHODS Using a cross-sectional design, we selected 92 LGE+ cases and 92 LGE- demographically matched controls from the Multi-Ethnic Study of Atherosclerosis. Similarly, we selected 156 cases from the highest ECV quartile and matched with 156 cases from the lowest quartile. The plasma serum proteome was analyzed using proximity extension assays to determine differential regulation of 92 proteins previously implicated with cardiovascular disease. Results were analyzed using volcano plots of statistical significance vs. magnitude of change and Bayesian additive regression tree (BART) models to determine importance. FINDINGS After adjusting for false discovery, higher ECV was significantly associated with 17 proteins. Using BART, Plasminogen activator inhibitor 1, Insulin-like growth factor-binding protein 1, and N-terminal pro-B-type natriuretic peptide were associated with higher ECV after accounting for other proteins and traditional cardiovascular risk factors. In contrast, no circulating proteins were associated with replacement fibrosis. INTERPRETATIONS Our results suggest unique circulating proteomic signatures associated with interstitial fibrosis emphasizing its systemic influences. With future validation, protein panels may identify patients who may develop interstitial fibrosis with progression to heart failure. FUNDING This research was supported by contracts and grants from NHLBI, NCATS and the Inova Heart and Vascular Institute.
Collapse
Affiliation(s)
- Hooman Bakhshi
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Scott A Bruce
- Department of Statistics, Texas A&M University, College Station, TX, USA
| | - Stephen L Seliger
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Geriatric Research and Education Clinical Center, VA Maryland Healthcare System, Baltimore, MD, USA
| | - Xiaoxiao Qian
- Inova Heart and Vascular Institute, Falls Church, VA, USA
| | | | | | - Pramita Bagchi
- Department of Statistics, George Mason University, Fairfax, VA, USA
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | | |
Collapse
|
10
|
Shabani M, Ostovaneh MR, Ma X, Ambale Venkatesh B, Wu CO, Chahal H, Bakhshi H, McClelland RL, Liu K, Shea SJ, Burke G, Post WS, Watson KE, Folsom AR, Bluemke DA, Lima JAC. Pre-diagnostic predictors of mortality in patients with heart failure: The multi-ethnic study of atherosclerosis. Front Cardiovasc Med 2022; 9:1024031. [PMID: 36620619 PMCID: PMC9812565 DOI: 10.3389/fcvm.2022.1024031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Background There are multiple predictive factors for cardiovascular (CV) mortality measured at, or after heart failure (HF) diagnosis. However, the predictive role of long-term exposure to these predictors prior to HF diagnosis is unknown. Objectives We aim to identify predictive factors of CV mortality in participants with HF, using cumulative exposure to risk factors before HF development. Methods Participants of Multi-Ethnic Study of Atherosclerosis (MESA) with incident HF were included. We used stepwise Akaike Information Criterion to select CV mortality predictors among clinical, biochemical, and imaging markers collected prior to HF. Using the AUC of B-spline-corrected curves, we estimated cumulative exposure to predictive factors from baseline to the last exam before HF. The prognostic performance for CV mortality after HF was evaluated using competing risk regression with non-CV mortality as the competing risk. Results Overall, 375 participants had new HF events (42.9% female, mean age: 74). Over an average follow-up of 4.7 years, there was no difference in the hazard of CV death for HF with reduced versus preserved ejection fraction (HR = 1.27, p = 0.23). The selected predictors of CV mortality in models with the least prediction error were age, cardiac arrest, myocardial infarction, and diabetes, QRS duration, HDL, cumulative exposure to total cholesterol and glucose, NT-proBNP, left ventricular mass, and statin use. The AUC of the models were 0.72 when including the latest exposure to predictive factors and 0.79 when including cumulative prior exposure to predictive factors (p = 0.20). Conclusion In HF patients, besides age and diagnosed diabetes or CVD, prior lipid profile, NT-proBNP, LV mass, and QRS duration available at the diagnosis time strongly predict CV mortality. Implementing cumulative exposure to cholesterol and glucose, instead of latest measures, improves predictive accuracy for HF mortality, though not reaching statistical significance.
Collapse
Affiliation(s)
- Mahsima Shabani
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Mohammad R. Ostovaneh
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States,Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Xiaoyang Ma
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, United States
| | | | - Colin O. Wu
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Harjit Chahal
- Medstar Heart and Vascular Institute, Washington, DC, United States
| | - Hooman Bakhshi
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States,Inova Heart and Vascular Institute, Falls Church, VA, United States
| | - Robyn L. McClelland
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Steven J. Shea
- Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, United States,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Gregory Burke
- Division of Public Health Sciences, Wake Forest University, Winston-Salem, NC, United States
| | - Wendy S. Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Karol E. Watson
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Aaron R. Folsom
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, United States
| | - David A. Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - João A. C. Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States,Department of Radiology, Johns Hopkins University, Baltimore, MD, United States,*Correspondence: João A. C. Lima,
| |
Collapse
|
11
|
Sheidu M, Qian X, Bakhshi H, Gattani R, Ofosu-Somuah A, Emaminia A(R. Acute Perimyocarditis Unmasking Anomalous Coronary Artery. JACC Case Rep 2022; 4:507-511. [PMID: 35573847 PMCID: PMC9091527 DOI: 10.1016/j.jaccas.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/14/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022]
Abstract
We report the case of a patient with anomalous right coronary artery (RCA) unmasked by acute perimyocarditis who continued to have ischemic symptoms despite total resolution of perimyocarditis and required surgical intervention of the anomalous RCA. This case was further complicated by ventricular arrhythmia after surgical repair. Collaboration among different cardiac specialists was essential in this case. (Level of Difficulty: Advanced.)
Collapse
|
12
|
Gattani R, Shadman S, Bakhshi H, Qian X, Ofosu-Somuah A, Sidhu BS, Emaminia A, Singh R. BRIDGE THE BAD CONNECTION: ROLE OF MULTIMODALITY IMAGING-GUIDED EVALUATION AND MANAGEMENT OF CORONARY ARTERY FISTULA AND GIANT CORONARY ARTERY ANEURYSM. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03240-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
13
|
Qian X, Bakhshi H, Gattani R, Ofosu-Somuah A, Kim DT, Kennedy J. CONCURRENT WALDENSTROM MACROGLOBULINEMIA AND HEREDITARY ATTR AMYLOIDOSIS IN AN ELDERLY MALE: TUMOR IS THE RUMOR, TISSUE IS THE ISSUE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03753-6] [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: 11/28/2022]
|
14
|
Vavilin I, Bakhshi H, Maghsoudi A, Emaminia A. CHEST PAIN DILEMMA IN A PATIENT WITH TWO LEFT TO RIGHT SHUNTS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)04069-4] [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: 11/28/2022]
|
15
|
Qian X, Kim DT, Bakhshi H, Gattani R, Ofosu-Somuah A. SHOCK CAUSES SHOCK? J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03686-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
16
|
Vavilin I, Bakhshi H, Atkins M. CLONAL HYPEREOSINOPHILIC SYNDROME: A CASE OF TREATED LÖEFFLER ENDOCARDITIS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)04086-4] [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: 10/18/2022]
|
17
|
Bakhshi H, Bagchi P, Meyghani Z, Tehrani B, Qian X, Garg PK, Ambale-Venkatesh B, Bhatia HS, Ohyama Y, Wu CO, Budoff M, Allison M, Criqui MH, Bluemke DA, Lima JAC, deFilippi CR. Association of coronary artery calcification and thoracic aortic calcification with incident peripheral arterial disease in the Multi-Ethnic Study of Atherosclerosis (MESA). European Heart Journal Open 2021; 1:oeab042. [PMID: 35005719 PMCID: PMC8717048 DOI: 10.1093/ehjopen/oeab042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/18/2021] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
The association of subclinical atherosclerotic disease in the coronary arteries and thoracic aorta with incident peripheral arterial disease (PAD) is unknown. We investigated the association between coronary artery calcium score (CACs) and thoracic aortic calcium score (TACs) with incident clinical and subclinical PAD.
Methods and results
The Multi-Ethnic Study of Atherosclerosis (MESA) recruited 6814 men and women aged 45–84 from four ethnic groups who were free of clinical cardiovascular disease at enrolment. Coronary artery calcium score and thoracic aortic calcium score were measured from computed tomography scans. Participants with a baseline ankle-brachial index (ABI) ≤0.90 or >1.4 were excluded. Abnormal ABI was defined as ABI ≤0.9 or >1.4 at follow-up exam. Multivariable logistic regression and Cox proportional hazards models were used to test the associations between baseline CACs and TACs with incident abnormal ABI and clinical PAD, respectively. A total of 6409 participants (female: 52.8%) with a mean age of 61 years were analysed. Over a median follow-up of 16.7 years, 91 participants developed clinical PAD. In multivariable analysis, each unit increase in log (CACS + 1) and log (TACs + 1) were associated with 23% and 13% (P < 0.01for both) higher risk of incident clinical PAD, respectively. In 5725 (female: 52.6%) participants with an available follow-up ABI over median 9.2 years, each 1-unit increase in log (CACs + 1) and log (TACs + 1) were independently associated with 1.15-fold and 1.07-fold (P < 0.01for both) higher odds of incident abnormal ABI, respectively.
Conclusion
Higher baseline CACs and TACs predict abnormal ABI and clinical PAD independent of traditional cardiovascular risk factors and baseline ABI.
Collapse
Affiliation(s)
- Hooman Bakhshi
- Inova Heart and Vascular Institute , 3300 Gallows Road, 1st Floor Suite I—1225, Falls Church, VA 22042, USA
| | - Pramita Bagchi
- Department of Statistics, George Mason University , Fairfax, VA, USA
| | - Zahra Meyghani
- Department of Medicine, Inova Fairfax Medical Campus , Falls Church, VA, USA
| | - Behnam Tehrani
- Inova Heart and Vascular Institute , 3300 Gallows Road, 1st Floor Suite I—1225, Falls Church, VA 22042, USA
| | - Xiaoxiao Qian
- Inova Heart and Vascular Institute , 3300 Gallows Road, 1st Floor Suite I—1225, Falls Church, VA 22042, USA
| | - Parveen K Garg
- Division of Cardiology, University of Southern California Keck School of Medicine , Los Angeles, CA, USA
| | | | - Harpreet S Bhatia
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego , La Jolla, CA, USA
| | - Yoshiaki Ohyama
- Clinical Investigation and Research Unit, Gunma University Hospital , Maebashi, Japan
| | - Colin O Wu
- Office of Biostatistics Research, National Heart Lung and Blood Institute , Bethesda, MD, USA
| | - Matthew Budoff
- Lundquist Institute at Harbor UCLA Medical Center , Torrance, CA, USA
| | - Matthew Allison
- Department of Family Medicine and Public Health, University of California, San Diego , La Jolla, CA, USA
| | - Michael H Criqui
- Department of Family Medicine and Public Health, University of California, San Diego , La Jolla, CA, USA
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health , Madison, WI, USA
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University , Baltimore, MD, USA
| | - Christopher R deFilippi
- Inova Heart and Vascular Institute , 3300 Gallows Road, 1st Floor Suite I—1225, Falls Church, VA 22042, USA
| |
Collapse
|
18
|
Bakhshi H, Guo A, Tehrani B, Thompson J, Batchelor W. Left Main Coronary Artery to Superior Vena Cava Fistula Unmasked by Endarteritis. JACC Case Rep 2021; 3:1599-1601. [PMID: 34729509 PMCID: PMC8543127 DOI: 10.1016/j.jaccas.2021.06.025] [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: 06/02/2021] [Accepted: 06/15/2021] [Indexed: 11/15/2022]
Abstract
Coronary artery fistulas are rare vascular malformations that can present with a broad range of symptoms. We present a case of a left main coronary artery to superior vena cava fistula that was discovered during a work-up for sepsis. A multidisciplinary approach is crucial for successful management of these vascular malformations. (Level of Difficulty: Beginner.)
Collapse
Affiliation(s)
- Hooman Bakhshi
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Abra Guo
- Department of Internal Medicine, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Behnam Tehrani
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - James Thompson
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Wayne Batchelor
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| |
Collapse
|
19
|
Gattani R, Bakhshi H, Ofosu-Somuah A, Qian X, Atkins M. Multimodality Imaging Assessment of Ventricular Septal Rupture and Intramyocardial Dissecting Hematoma Post Late-Presenting Acute Myocardial Infarction. Circ Cardiovasc Imaging 2021; 14:e013185. [PMID: 34579549 DOI: 10.1161/circimaging.121.013185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
20
|
Guo A, Bakhshi H, O'Hara J, Genovese L, Fein A, Maghsoudi A, Sandesara C. Hypoplastic Coronary Artery Disease Presenting with Ventricular Fibrillation Cardiac Arrest. Eur J Case Rep Intern Med 2021; 8:002736. [PMID: 34527617 DOI: 10.12890/2021_002736] [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: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 11/05/2022] Open
Abstract
Hypoplastic coronary artery disease is a rare congenital anomaly that may present with ischaemic heart disease, heart failure or sudden cardiac death (SCD). We describe a case of cardiac arrest in a healthy young man. Work-up revealed a hypoplastic left anterior descending artery. The patient underwent cardioverter-defibrillator implantation for secondary prevention. LEARNING POINTS Hypoplastic coronary artery disease (HCAD) is a rare cause of cardiac arrest and should be suspected in cases of sudden cardiac death (SCD) in young adults.The mechanism in HCAD leading to ventricular fibrillation cardiac arrest is not well understood.Implantable cardioverter-defibrillator (ICD) implantation is recommended for secondary prevention of ventricular fibrillation.
Collapse
Affiliation(s)
- Abra Guo
- Department of Internal Medicine, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Hooman Bakhshi
- Inova Heart and Vascular Institute, Falls Church, VA, USA
| | - James O'Hara
- Inova Heart and Vascular Institute, Falls Church, VA, USA.,Virginia Heart, Falls Church, VA, USA
| | | | - Adam Fein
- Inova Heart and Vascular Institute, Falls Church, VA, USA.,Virginia Heart, Falls Church, VA, USA
| | - Alireza Maghsoudi
- Inova Heart and Vascular Institute, Falls Church, VA, USA.,Virginia Heart, Falls Church, VA, USA
| | - Chirag Sandesara
- Inova Heart and Vascular Institute, Falls Church, VA, USA.,Virginia Heart, Falls Church, VA, USA
| |
Collapse
|
21
|
Shabani M, Bakhshi H, Ostovaneh MR, Ma X, Wu CO, Ambale-Venkatesh B, Blaha MJ, Allison MA, Budoff MJ, Cushman M, Tracy RP, Herrington DM, Szklo M, Cox C, Bluemke DA, Lima JAC. Temporal change in inflammatory biomarkers and risk of cardiovascular events: the Multi-ethnic Study of Atherosclerosis. ESC Heart Fail 2021; 8:3769-3782. [PMID: 34240828 PMCID: PMC8497383 DOI: 10.1002/ehf2.13445] [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: 02/24/2021] [Revised: 05/06/2021] [Accepted: 05/16/2021] [Indexed: 11/30/2022] Open
Abstract
Aims Little is known about the association of temporal changes in inflammatory biomarkers and the risk of death and cardiovascular diseases. We aimed to evaluate the association between temporal changes in C‐reactive protein (CRP), fibrinogen, and interleukin‐6 (IL‐6) and risk of heart failure (HF), cardiovascular disease (CVD), and all‐cause mortality in individuals without a history of prior CVD. Methods and results Participants from the Multi‐Ethnic Study of Atherosclerosis (MESA) cohort with repeated measures of inflammatory biomarkers and no CVD event prior to the second measure were included. Quantitative measures, annual change, and biomarker change categories were used as main predictors in Cox proportional hazard models stratified based on sex and statin use. A total of 2258 subjects (50.6% female, mean age of 62 years) were studied over an average of 8.1 years of follow‐up. The median annual decrease in CRP levels was 0.08 mg/L. Fibrinogen and IL‐6 levels increased by a median of 30 mg/dL and 0.24 pg/mL annually. Temporal changes in CRP were positively associated with HF risk among females (HR: 1.18 per each standard deviation increase, P < 0.001) and other CVD in both female (HR: 1.12, P = 0.004) and male participants (HR: 1.24, P = 0.003). The association of CRP change with HF and other CVD was consistently observed in statin users (HR: 1.23 per SD increase, P = 0.001 for HF and HR: 1.19 per SD increase, P < 0.001 for other CVD). There were no significant associations between temporal changes of fibrinogen or IL‐6 with HF or other CVD. Men with sustained high values of IL‐6 had a 2.3‐fold higher risk of all‐cause mortality (P < 0.001) compared with those with sustained low values. Conclusions Temporal change in CRP is associated with HF only in women and statin users, and other CVD in both women and men, and statin users. Annual changes in fibrinogen and IL‐6 were not predictive of cardiovascular outcomes in either sex.
Collapse
Affiliation(s)
- Mahsima Shabani
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, 21287-0409, USA.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Hooman Bakhshi
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, 21287-0409, USA.,Inova Heart and Vascular Institute, Falls Church, VA, USA
| | - Mohammad R Ostovaneh
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, 21287-0409, USA.,Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Xiaoyang Ma
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Colin O Wu
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Michael J Blaha
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, 21287-0409, USA
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - Mary Cushman
- Departments of Medicine and Pathology, University of Vermont, Burlington, VT, USA
| | - Russell P Tracy
- Departments of Pathology & Laboratory Medicine and Biochemistry, Larner College of Medicine at the University of Vermont, Colchester, VT, USA
| | - David M Herrington
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Moyses Szklo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christopher Cox
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - João A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, 21287-0409, USA
| |
Collapse
|
22
|
Rosner CM, Genovese L, Tehrani BN, Atkins M, Bakhshi H, Chaudhri S, Damluji AA, de Lemos JA, Desai SS, Emaminia A, Flanagan MC, Khera A, Maghsoudi A, Mekonnen G, Muthukumar A, Saeed IM, Sherwood MW, Sinha SS, O'Connor CM, deFilippi CR. Myocarditis Temporally Associated With COVID-19 Vaccination. Circulation 2021; 144:502-505. [PMID: 34133885 PMCID: PMC8340723 DOI: 10.1161/circulationaha.121.055891] [Citation(s) in RCA: 153] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Carolyn M Rosner
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| | - Leonard Genovese
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| | - Behnam N Tehrani
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| | - Melany Atkins
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.).,Fairfax Radiology Centers, VA (M.A.)
| | - Hooman Bakhshi
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| | - Saquib Chaudhri
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| | - Abdulla A Damluji
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| | - James A de Lemos
- Departments of Internal Medicine and Pathology, University of Texas Southwestern Medical Center, Dallas, TX (J.A.d.L., A.K., A. Muthukumar)
| | - Shashank S Desai
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| | - Abbas Emaminia
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| | - Michael Casey Flanagan
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| | - Amit Khera
- Departments of Internal Medicine and Pathology, University of Texas Southwestern Medical Center, Dallas, TX (J.A.d.L., A.K., A. Muthukumar)
| | - Alireza Maghsoudi
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.).,Virginia Heart, Falls Church, VA (I.M.S., A. Maghsoudi)
| | - Girum Mekonnen
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| | - Alagarraju Muthukumar
- Departments of Internal Medicine and Pathology, University of Texas Southwestern Medical Center, Dallas, TX (J.A.d.L., A.K., A. Muthukumar)
| | - Ibrahim M Saeed
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.).,Virginia Heart, Falls Church, VA (I.M.S., A. Maghsoudi)
| | - Matthew W Sherwood
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| | - Shashank S Sinha
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| | - Christopher M O'Connor
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.).,Division of Cardiology, Duke University, Durham, NC (C.M.O'C.)
| | - Christopher R deFilippi
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA (C.M.R., L.G., B.N.T., M.A., H.B., S.C., A.A.D., S.S.D., A.E., G.M., A. Maghsoudi, I.M.S., M.C.F., M.W.S., S.S.S., C.M.O'C., C.R.d.F.)
| |
Collapse
|
23
|
Guo A, Bakhshi H, Hara JO, Genovese L, Fein A, Maghsoudi A, Sandesara C. HYPOPLASTIC CORONARY ARTERY DISEASE PRESENTING WITH VENTRICULAR FIBRILLATION CARDIAC ARREST. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03408-2] [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: 10/21/2022]
|
24
|
Gattani R, Bakhshi H, Ekanem E, Desai M, Sinha S, Speir A, Singh R, Sherwood M, Tehrani B, Batchelor W. COMPLICATED VENTRICULAR SEPTAL RUPTURE REQUIRING MECHANICAL CIRCULATORY SUPPORT BRIDGE TO HEART TRANSPLANT: A CONSEQUENCE OF LATE PRESENTING MYOCARDIAL INFARCTION IN THE ERA OF COVID-19. J Am Coll Cardiol 2021. [PMCID: PMC9090505 DOI: 10.1016/s0735-1097(21)03925-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
25
|
Donthi N, Podder S, Ekanem E, Bakhshi H, Vakilzadeh M, Zhao Q, Desai M. REDUCED RV FUNCTION IS ASSOCIATED WITH MORTALITY IN COVID-19 PATIENTS TREATED WITH ECMO. J Am Coll Cardiol 2021. [PMCID: PMC8091255 DOI: 10.1016/s0735-1097(21)04425-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
26
|
Bakhshi H, Bagchi P, Sun J, Seliger S, Diao G, Venkatesh BA, Varadarajan V, Lima J, DeFilippi C. CARDIOVASCULAR PROTEOMICS PROFILES IN REPLACEMENT AND INTERSTITIAL MYOCARDIAL FIBROSIS: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01922-7] [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: 10/21/2022]
|
27
|
Ekanem E, Podder S, Donthi N, Bakhshi H, Stodghill J, Khandhar S, Mahajan A, Desai M. Spontaneous pneumothorax: An emerging complication of COVID-19 pneumonia. Heart Lung 2021; 50:437-440. [PMID: 33631467 PMCID: PMC7846243 DOI: 10.1016/j.hrtlng.2021.01.020] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/21/2020] [Accepted: 01/25/2021] [Indexed: 11/04/2022]
Abstract
Spontaneous Pneumothorax in the setting of coronavirus disease 19 (COVID-19) has been rarely described and is a potentially lethal complication. We report our institutional experience. Patients with confirmed COVID-19 who were admitted at 5 hospitals within the Inova health system between February 21 and May 2020 were included in the study. We identified 1619 patients, 22 patients (1.4%) developed spontaneous pneumothorax during their hospitalization without evidence of traumatic injury.
Collapse
Affiliation(s)
- Emmanuel Ekanem
- Department of Cardiology, Inova Health System, Heart and Vascular Institute, 3300 Gallows Rd., Falls Church, VA 22042, United States.
| | - Shreya Podder
- Department of Cardiology, Inova Health System, Heart and Vascular Institute, 3300 Gallows Rd., Falls Church, VA 22042, United States
| | - Nisha Donthi
- Department of Cardiology, Inova Health System, Heart and Vascular Institute, 3300 Gallows Rd., Falls Church, VA 22042, United States
| | - Hooman Bakhshi
- Department of Cardiology, Inova Health System, Heart and Vascular Institute, 3300 Gallows Rd., Falls Church, VA 22042, United States
| | - Joshua Stodghill
- Inova Health System, Thoracic Surgery, 3300 Gallows Rd., Falls Church, VA 22042, United States
| | - Sandeep Khandhar
- Inova Health System, Thoracic Surgery, 3300 Gallows Rd., Falls Church, VA 22042, United States
| | - Amit Mahajan
- Inova Health System, Interventional Pulmonology, 3300 Gallows Rd., Falls Church, VA 22042, United States
| | - Mehul Desai
- Inova Health System, Critical Care Medicine, 3300 Gallows Rd., Falls Church, VA 22042, United States
| |
Collapse
|
28
|
Bakhshi H, Gattani R, Ekanem E, Singh R, Desai M, Speir AM, Sinha SS, Sherwood MW, Tehrani B, Batchelor W. Ventricular septal rupture and cardiogenic shock complicating STEMI during COVID-19 pandemic: An old foe re-emerges. Heart Lung 2020; 50:292-295. [PMID: 33387761 PMCID: PMC7756170 DOI: 10.1016/j.hrtlng.2020.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 09/21/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 12/13/2022]
Abstract
The COVID 19 pandemic resulted in a total reduction in the number of hospitalizations for acute coronary syndromes. A consequence of the delay in coronary revascularization has been the resurgence of structural complications of myocardial infarctions. Ventricular septal rupture (VSR) complicating late presenting acute myocardial infarction (AMI) is associated with high mortality despite advances in both surgical repair and perioperative management. Current data suggests a declining mortality with delay in VSR repair; however, these patients may develop cardiogenic shock while waiting for surgery. Available options are limited for patients with VSR who develop right ventricular failure and cardiogenic shock. The survival rate is very low in patients with cardiogenic shock undergoing surgical or percutaneous VSR repair. In this study we present two late presenting ST elevation MI patients who were complicated by rapidly declining hemodynamics and impending organ failure. Both patients were bridged with venoarterial extracorporeal membrane oxygenation (ECMO) to cardiac transplant.
Collapse
Affiliation(s)
- Hooman Bakhshi
- Inova Heart and Vascular Institute, 3300 Gallows Rd, Falls Church, VA 22042, United States.
| | - Raghav Gattani
- Inova Heart and Vascular Institute, 3300 Gallows Rd, Falls Church, VA 22042, United States
| | - Emmanuel Ekanem
- Inova Heart and Vascular Institute, 3300 Gallows Rd, Falls Church, VA 22042, United States
| | - Ramesh Singh
- Inova Heart and Vascular Institute, 3300 Gallows Rd, Falls Church, VA 22042, United States
| | - Mehul Desai
- Inova Heart and Vascular Institute, 3300 Gallows Rd, Falls Church, VA 22042, United States
| | - Alan M Speir
- Inova Heart and Vascular Institute, 3300 Gallows Rd, Falls Church, VA 22042, United States
| | - Shashank S Sinha
- Inova Heart and Vascular Institute, 3300 Gallows Rd, Falls Church, VA 22042, United States
| | - Matthew W Sherwood
- Inova Heart and Vascular Institute, 3300 Gallows Rd, Falls Church, VA 22042, United States
| | - Behnam Tehrani
- Inova Heart and Vascular Institute, 3300 Gallows Rd, Falls Church, VA 22042, United States
| | - Wayne Batchelor
- Inova Heart and Vascular Institute, 3300 Gallows Rd, Falls Church, VA 22042, United States
| |
Collapse
|
29
|
Bakhshi H, Donthi N, Ekanem E, Podder S, Sinha S, Sherwood MW, Tehrani B, Batchelor W. The clinical spectrum of myocardial injury associated with COVID-19 infection. J Community Hosp Intern Med Perspect 2020; 10:521-522. [PMID: 33194121 PMCID: PMC7599025 DOI: 10.1080/20009666.2020.1809910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Although respiratory symptoms are the dominant features of COVID-19 infection, myocardial injury has been described in these patients. Reported cardiac manifestations of COVID-19 infection include myocarditis, arrhythmia and acute coronary syndrome including ST elevation myocardial infarction (STEMI). STEMI is a medical emergency and timely intervention is of utmost importance to prevent mortality and long-term morbidities. In this report, we present a wide spectrum of clinical presentations, management, and outcomes for five patients with COVID-19 infection and ST elevation on ECG.
Collapse
Affiliation(s)
- Hooman Bakhshi
- Department of Medicine, Division of Cardiology, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Nisha Donthi
- Department of Medicine, Division of Cardiology, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Emmanuel Ekanem
- Department of Medicine, Division of Cardiology, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Shreya Podder
- Department of Medicine, Division of Cardiology, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Shashank Sinha
- Department of Medicine, Division of Cardiology, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Matthew W Sherwood
- Department of Medicine, Division of Cardiology, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Behnam Tehrani
- Department of Medicine, Division of Cardiology, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Wayne Batchelor
- Department of Medicine, Division of Cardiology, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| |
Collapse
|
30
|
Ekanem E, Gattani R, Bakhshi H, Tehrani B, Batchelor W. Combined Venoarterial ECMO and Impella-CP Circulatory Support for Cardiogenic Shock Due to Papillary Muscle Rupture. JACC Case Rep 2020; 2:2169-2172. [PMID: 34317131 PMCID: PMC8299848 DOI: 10.1016/j.jaccas.2020.08.007] [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: 06/04/2020] [Revised: 07/31/2020] [Accepted: 08/07/2020] [Indexed: 11/13/2022]
Abstract
Papillary muscle rupture (PMR) is a catastrophic complication of acute myocardial infarction (AMI). We report on 3 consecutive patients with AMI cardiogenic shock due to PMR, treated with combined venoarterial extracorporeal membrane oxygenation and Impella-CP axial flow circulatory support as a bridge to definitive surgery. (Level of Difficulty: Intermediate.)
Collapse
Affiliation(s)
- Emmanuel Ekanem
- Department of Medicine, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Raghav Gattani
- Department of Medicine, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Hooman Bakhshi
- Department of Medicine, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Behnam Tehrani
- Department of Medicine, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Wayne Batchelor
- Department of Medicine, Inova Heart and Vascular Institute, Falls Church, Virginia
| |
Collapse
|
31
|
Masson R, Bakhshi H, Haddad TM. Intermittent left bundle branch block and acute heart failure in trastuzumab-induced cardiotoxicity. BMJ Case Rep 2020; 13:13/7/e236009. [PMID: 32723779 DOI: 10.1136/bcr-2020-236009] [Citation(s) in RCA: 2] [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: 01/26/2023] Open
Abstract
A 70-year-old woman with HER2+/ER+ breast cancer on adjuvant trastuzumab therapy without a history of cardiovascular disease presented with respiratory failure from influenza and was found to have intermittent left bundle branch block (LBBB) with new onset systolic heart failure. Her course was complicated by polymorphic ventricular tachycardia and recurrent chest pain. Significant investigations included a normal cardiac MRI and cardiac catheterisation with unobstructed coronaries. It was determined that the aetiology of her heart failure was trastuzumab-induced cardiotoxicity after comprehensive workup. This case highlights an uncommon presentation of LBBB and the steps taken to diagnose a rare cardiomyopathy.
Collapse
Affiliation(s)
- Ravi Masson
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Hooman Bakhshi
- Department of Cardiology, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Tariq M Haddad
- Department of Cardiology, Inova Heart and Vascular Institute, Falls Church, Virginia, USA.,Department of Cardiology, Virginia Heart, Falls Church, Virginia, USA
| |
Collapse
|
32
|
Xie E, Yu R, Ambale-Venkatesh B, Bakhshi H, Heckbert SR, Soliman EZ, Bluemke DA, Kawut SM, Wu CO, Nazarian S, Lima JAC. Association of right atrial structure with incident atrial fibrillation: a longitudinal cohort cardiovascular magnetic resonance study from the Multi-Ethnic Study of Atherosclerosis (MESA). J Cardiovasc Magn Reson 2020; 22:36. [PMID: 32434529 PMCID: PMC7240918 DOI: 10.1186/s12968-020-00631-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 04/22/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND While studies of the left atrium (LA) have demonstrated associations between volumes and emptying fraction with atrial fibrillation (AF), the contribution of right atrial (RA) abnormalities to incident AF remains poorly understood. OBJECTIVES Assess the association between RA structure and function with incident AF using feature-tracking cardiovascular magnetic resonance (CMR). METHODS This is a prospective cohort study of all participants in the Multi-Ethnic Study of Atherosclerosis with baseline CMR, sinus rhythm, and free of clinical cardiovascular disease at study initiation. RA volume, strain, and emptying fraction in participants with incident AF (n = 368) were compared against AF-free (n = 2779). Cox proportional-hazards models assessed association between variables. RESULTS Participants were aged 60 ± 10 yrs., 55% female, and followed an average 11.2 years. Individuals developing AF had higher baseline RA maximum volume index (mean ± standard deviation [SD]: 24 ± 9 vs 22 ± 8 mL/m2, p = 0.002) and minimum volume index (13 ± 7 vs 12 ± 6 mL/m2, p < 0.001), and lower baseline RA emptying fraction (45 ± 15% vs 47 ± 15%, p = 0.02), peak global strain (34 ± 17% vs 36 ± 19%, p < 0.001), and peak free-wall strain (40 ± 23% vs 42 ± 26%, p = 0.049) compared with the AF-free population. After adjusting for traditional cardiovascular risk factors and LA volume and function, we found RA maximum volume index (hazards ratio [HR]: 1.13 per SD, p = 0.041) and minimum volume index (HR: 1.12 per SD, p = 0.037) were independently associated with incident AF. CONCLUSIONS In a large multiethnic population, higher RA volume indices were independently associated with incident AF after adjustment for conventional cardiovascular risk factors and LA parameters. It is unclear if this predictive value persists when additional adjustment is made for ventricular parameters.
Collapse
Affiliation(s)
- Eric Xie
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Blalock 524D, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Ricky Yu
- Heart Service, Department of Medicine, UCLA School of Medicine, Los Angeles, CA, USA
| | | | - Hooman Bakhshi
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Blalock 524D, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Susan R Heckbert
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Elsayed Z Soliman
- Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Medicine, Section of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Steven M Kawut
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Colin O Wu
- Office of Biostatistics Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Saman Nazarian
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Blalock 524D, 600 North Wolfe Street, Baltimore, MD, 21287, USA
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - João A C Lima
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Blalock 524D, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
| |
Collapse
|
33
|
Bakhshi H, Varadarajan V, Ambale-Venkatesh B, Meyghani Z, Ostovaneh MR, Durda P, Wu CO, Tracy RP, Cushman M, Bluemke DA, Lima JAC. Association of soluble interleukin-2 receptor α and tumour necrosis factor receptor 1 with heart failure: The Multi-Ethnic Study of Atherosclerosis. ESC Heart Fail 2020; 7:639-644. [PMID: 32155316 PMCID: PMC7160474 DOI: 10.1002/ehf2.12623] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 11/12/2019] [Revised: 12/19/2019] [Accepted: 01/03/2020] [Indexed: 11/24/2022] Open
Abstract
Aims Soluble tumour necrosis factor‐α receptor 1 (sTNF‐αR1) and interleukin‐2 receptor α (sIL‐2Rα) predict incident heart failure (HF) in the elderly population. However, the association of these biomarkers with HF in a multi‐ethnic asymptomatic population is unclear. We aimed to investigate the association of sTNF‐αR1 and sIL‐2Rα with incident HF in a multi‐ethnic population of middle age and older participants. Methods and results The multi‐ethnic study of atherosclerosis is a prospective population‐based study of 6814 participants aged 45–84 years who were free of clinical cardiovascular disease at enrolment. We included 2869 participants with available sTNF‐αR1 or sIL‐2Rα level measurement at baseline multi‐ethnic study of atherosclerosis exam (2000–2002). We used Cox proportional‐hazards model to investigate the association between sTNF‐αR1 and sIL‐2Rα with incident HF after adjusting for traditional cardiovascular risk factors and coronary artery calcium score measured by cardiac computed tomography. Among the included participants, the mean (standard deviation) age was 61.6 (10.2) years and 46.7% were men. The median (interquartile range) sTNF‐αR1 and sIL‐2Rα were 1293 (1107–1547) and 901 (727–1154) pg/mL. During a median follow‐up of 14.2 (interquartile range: 11.7–14.8) years, 130 participants developed HF. In multivariable analysis, the hazard ratio (95% confidence interval, P value) of incident HF for each standard deviation increment of log‐transformed sTNF‐αR1 and sIL‐2Rα was 1.43 (1.21–1.7, P ≤ 0.001) and 1.26 (1.04–1.53, P = 0.02), respectively. Excluding participants with interim coronary heart disease, we found a statistically significant association between sTNF‐αR1 and HF with hazard ratio of 1.39 (95% confidence interval: 1.11 to 1.74, P = 0.005) and sIL‐2Rα and HF showing a hazard ratio of 1.39 (95% confidence interval: 1.09 to 1.76, P = 0.007). Conclusions sTNF‐αR1 and sIL‐2Rα are associated with a higher risk of incident HF in a multi‐ethnic cohort without a previous history of cardiovascular disease.
Collapse
Affiliation(s)
- Hooman Bakhshi
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Wolfe Street/Blalock 524, Baltimore, MD, 21287, USA.,Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Vinithra Varadarajan
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Wolfe Street/Blalock 524, Baltimore, MD, 21287, USA
| | - Bharath Ambale-Venkatesh
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Wolfe Street/Blalock 524, Baltimore, MD, 21287, USA
| | - Zahra Meyghani
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Wolfe Street/Blalock 524, Baltimore, MD, 21287, USA
| | - Mohammad R Ostovaneh
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Wolfe Street/Blalock 524, Baltimore, MD, 21287, USA
| | - Peter Durda
- Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, 05405, USA
| | - Colin O Wu
- Office of Biostatistics Research, National Heart Lung and Blood Institute, Bethesda, MD, 20892, USA
| | - Russell P Tracy
- Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, 05405, USA
| | - Mary Cushman
- Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, 05405, USA.,Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, 05405, USA
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
| | - João A C Lima
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Wolfe Street/Blalock 524, Baltimore, MD, 21287, USA
| |
Collapse
|
34
|
Ekanem E, Gattani R, Bakhshi H, Tehrani B, Sherwood MW, Epps K, Damluji A, Rosner C, Truesdell AG, DeFilippi CR, Sinha S, Batchelor WB. ECPELLA SUPPORT STRATEGY FOR THE MANAGEMENT OF ACUTE MYOCARDIAL INFARCTION COMPLICATED BY CARDIOGENIC SHOCK DUE TO PAPILLARY MUSCLE RUPTURE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33716-5] [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: 11/16/2022]
|
35
|
Bakhshi H, Diao G, Seliger S, Sun J, Berry JD, Neeland I, Lemos JD, DeFilippi CR. TARGETED DISCOVERY PROTEOMICS IN MALIGNANT LEFT VENTRICULAR HYPERTROPHY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31304-8] [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]
|
36
|
Ostovaneh MR, Ambale-Venkatesh B, Fuji T, Bakhshi H, Shah R, Murthy VL, Tracy RP, Guallar E, Wu CO, Bluemke DA, Lima JAC. Association of Liver Fibrosis With Cardiovascular Diseases in the General Population: The Multi-Ethnic Study of Atherosclerosis (MESA). Circ Cardiovasc Imaging 2018; 11:e007241. [PMID: 29523555 PMCID: PMC5846116 DOI: 10.1161/circimaging.117.007241] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [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: 11/11/2017] [Accepted: 01/05/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The association of cardiovascular diseases (CVD) with liver fibrosis is poorly understood. We aim to assess the association of liver fibrosis by T1-mapping magnetic resonance imaging and CVD in MESA (Multi-Ethnic Study of Atherosclerosis). METHODS AND RESULTS MESA enrolled 6814 participants free of clinical CVD at baseline (2000-2002). A subsample of participants underwent T1-mapping magnetic resonance imaging 10 years after the baseline (Y10 MESA exam, 2010-2012). Liver T1 maps were generated avoiding vessels and biliary ducts from which native T1 (n=2087) and extracellular volume fraction (ECV, n=1234) were determined. Higher ECV and native T1 were indicators of liver fibrosis. Linear regression analysis evaluated the cross-sectional relationship between liver native T1 and ECV at Y10 MESA exam with a history of CVD events (atrial fibrillation, heart failure, and coronary heart disease [CHD]). Of the 2087 participants (68.7±9.1 years; 46% females), 153 had prior CVD events (78 atrial fibrillation, 25 heart failure, and 78 CHD). History of CVD events was associated with 18.5 ms higher liver native T1 (P<0.001) and 1.4% greater ECV (P=0.06). Prior atrial fibrillation was related to higher liver native T1 (β=21.1; P=0.001) and greater ECV (β=2.2; P=0.02), whereas previous heart failure was associated with greater liver ECV (β=4.1; P=0.02). There was also a relationship of prior CHD with liver native T1 (β=13; P=0.05) and ECV (β=1.9; P=0.05), which was attenuated by adjustment for coronary artery calcium score (β=7.1 and 1.6; P=0.37 and 0.13, respectively). CONCLUSIONS Liver fibrosis by T1-mapping magnetic resonance imaging is associated with history of heart failure, atrial fibrillation, and CHD in a multiethnic cohort. The association of liver fibrosis and CHD is at least in part mediated by atherosclerosis.
Collapse
Affiliation(s)
| | - Bharath Ambale-Venkatesh
- From the Depatrment of Cardiology (M.R.O., T.F., H.B., E.G., J.A.C.L.) and the Department of Radiology (B.A.V.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Harvard University, Boston, MA (R.S.); Department of Medicine, University of Michigan, Ann Arbor (V.L.M.); Department of Pathology and Laboratory Medicine, University of Vermont, Colchester (R.P.T.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (C.O.W.); and Department of Radiology, University of Wisconsin, Madison (D.A.B.).
| | | | | | | | | | | | | | - Colin O. Wu
- National Institutes of Health, Bethesda MD, USA
| | | | | |
Collapse
|
37
|
Bakhshi H, Ambale-Venkatesh B, Yang X, Ostovaneh MR, Wu CO, Budoff M, Bahrami H, Wong ND, Bluemke DA, Lima JAC. Progression of Coronary Artery Calcium and Incident Heart Failure: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2017; 6:JAHA.116.005253. [PMID: 28428195 PMCID: PMC5533017 DOI: 10.1161/jaha.116.005253] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 12/02/2022]
Abstract
Background Although the association between coronary artery calcium (CAC) and future heart failure (HF) has been shown previously, the value of CAC progression in the prediction of HF has not been investigated. In this study, we investigated the association of CAC progression with subclinical left ventricular (LV) dysfunction and incident HF in the Multi‐Ethnic Study of Atherosclerosis. Methods and Results The Multi‐Ethnic Study of Atherosclerosis is a population‐based study consisting of 6814 men and women aged 45 to 84, free of overt cardiovascular disease at enrollment, who were recruited from 4 ethnicities. We included 5644 Multi‐Ethnic Study of Atherosclerosis participants who had baseline and follow‐up cardiac computed tomography and were free of HF and coronary heart disease before the second cardiac computed tomography. Mean (±SD) age was 61.7±10.2 years and 47.2% were male. The Cox proportional hazard models and multivariable linear regression models were deployed to determine the association of CAC progression with incident HF and subclinical LV dysfunction, respectively. Over a median follow‐up of 9.6 (interquartile range: 8.8–10.6) years, 182 participants developed incident HF. CAC progression of 10 units per year was associated with 3% of increased risk of HF independent of overt coronary heart disease (P=0.008). In 2818 participants with available cardiac magnetic resonance images, CAC progression was associated with increased LV end diastolic volume (β=0.16; P=0.03) and LV end systolic volume (β=0.12; P=0.006) after excluding participants with any coronary heart disease. Conclusions CAC progression was associated with incident HF and modestly increased LV end diastolic volume and LV end systolic volume at follow‐up exam independent of overt coronary heart disease.
Collapse
Affiliation(s)
- Hooman Bakhshi
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD
| | | | | | - Mohammad R Ostovaneh
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD
| | - Colin O Wu
- Office of Biostatistics Research, National Heart Lung and Blood Institute, Bethesda, MD
| | - Matthew Budoff
- Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA
| | - Hossein Bahrami
- Division of Cardiovascular Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Nathan D Wong
- Division of Cardiology, University of California, Irvine, Irvine, CA
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD
| | - João A C Lima
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD
| |
Collapse
|
38
|
Bakhshi H, Meyghani Z, Shakir Z, Chen A, Kershner D. Thrombus entrapped in patent foramen ovale: a rare form of thrombus in transit. J Community Hosp Intern Med Perspect 2015; 5:28170. [PMID: 26333859 PMCID: PMC4558283 DOI: 10.3402/jchimp.v5.28170] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 05/24/2015] [Accepted: 06/02/2015] [Indexed: 11/30/2022] Open
Abstract
In rare cases, thrombus in transit can be entrapped in a patent foramen ovale (PFO). A patient with this condition is at high risk of embolic stroke and death. Early diagnosis and treatment is essential to help prevent stroke and death in these cases. There is no universal management guideline for this rare condition. The decision between medical versus surgical treatment should be made individually for each patient. We present a case of thrombus in transit entrapped in a PFO that was treated medically by lifelong anticoagulation.
Collapse
Affiliation(s)
- Hooman Bakhshi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA;
| | - Zahra Meyghani
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Zaid Shakir
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Alexander Chen
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Dawn Kershner
- Division of Cardiology, Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| |
Collapse
|
39
|
Aggarwal VK, Bakhshi H, Ecker NU, Parvizi J, Gehrke T, Kendoff D. Organism profile in periprosthetic joint infection: pathogens differ at two arthroplasty infection referral centers in Europe and in the United States. J Knee Surg 2014; 27:399-406. [PMID: 24414388 DOI: 10.1055/s-0033-1364102] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Infecting microorganism is a strong predictor of treatment success for periprosthetic joint infection (PJI). The purpose of this study was to compare the infecting pathogens causing PJI at two large infection referral centers in the United States and in Europe. In this study, 898 consecutive cases of PJI were identified at the HELIOS ENDO-Klinik Hamburg in Europe and 772 cases were identified at the Rothman Institute in the United States. The incidence of organisms at the HELIOS ENDO-Klinik Hamburg versus the Rothman Institute was: coagulase-negative Staphylococcus (39.3 vs. 20.2%), S. aureus (13.0 vs. 31.0%), Streptococcus (6.5 vs. 5.8%), Enterococcus (7.0 vs. 3.9%), anaerobic (9.0 vs. 0.9%), fungal (0.3 vs. 2.3%), mycobacterial (0 vs. 0.6%), polymicrobial (3.4 vs. 7.4%), culture negative (16.1 vs. 15.8%), and other organisms (0.9 vs. 5.4%). The percentage of methicillin-resistant S. aureus was significantly higher at the American center than at the European center (48.1 vs. 12.8%; p < 0.0001). Our findings show higher virulence and resistance organisms are more prevalent at a referral center in the United States compared with one in Europe.
Collapse
Affiliation(s)
- Vinay K Aggarwal
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania
| | - Hooman Bakhshi
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania
| | - Niklas Unter Ecker
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Germany
| | - Javad Parvizi
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Germany
| | - Daniel Kendoff
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Germany
| |
Collapse
|
40
|
Bakhshi H, Bakhshialiabad MH, Hassanshahi G. Students' perceptions of the educational environment in an Iranian Medical School, as measured by The Dundee Ready Education Environment Measure. Bangladesh Med Res Counc Bull 2014; 40:36-41. [PMID: 26118171 DOI: 10.3329/bmrcb.v40i1.20335] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Learning environment is found to be important in determining students' academic success and learning. The goal of this study was to investigate the viewpoints of medical students toward learning environment based on The Dundee Ready Education Environment Measure (DREEM) at Rafsanjan University of Medical Sciences (RUMS). This descriptive study was conducted using the Persian DREEM questionnaire. All medical students in basic and clinical courses except internship students (fifth and sixth year) were approached to participate during the study period, of which 223 provided consent and completed the survey. Data were analyzed by SPSS-17, t-test and ANOVA statistical tests were used. The mean total score was 113.8 ± 17.31 (out of a maximum of 200, 56.9%) indicating relative satisfaction with the perceived environment. There were no individual areas of excellence. Some items scored consistently badly indicating cause for concern. The highest score were related to Academic Self-Perception (64.11%) and learning (57.2%) domains. The lowest score were related to Teachers (55.9%), Social Self-Perceptions (56.6%) and atmosphere (55.8%) domains. Basic science students perceived the environment to be significantly more positive than preclinical students (p < 0.05). Native and married students perceived the environment to be significantly more positive (p < 0.05). Second and fourth year students were significantly higher than the others (P < 0.01). There was significant difference between mean scores of total mean DREEM and sub-domains by year of enrolment (p = 0.001). This tool identified areas of concern within RUMS medical school. Further use of the DREEM as a monitoring tool would be useful to re-evaluate the environment following appropriate intervention. To create an appropriate educational environment and reduce the deficits in order to provide a better learning environment with facilitate and supportive system for students.
Collapse
|
41
|
Bakhshi H, Borhani N, Mohebali M, Khamesipour A, Abai MR, Hajjaran H, Tajedin L, Rassi Y, Akhavan AA, Mohtarami F, Oshaghi MA. Interleukin 4 (IL-4) gene promoter polymorphisms in Rhombomys opimus, the main reservoir of zoonotic cutaneous leishmaniasis. Cytokine 2013; 65:1-3. [PMID: 24209596 DOI: 10.1016/j.cyto.2013.10.001] [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: 04/25/2013] [Revised: 09/28/2013] [Accepted: 10/02/2013] [Indexed: 10/26/2022]
Abstract
Great gerbils (Rhombomys opimus) are the most common gerbils in center to northeast of Iran as well as central Asia and serve as reservoirs for the zoonotic agents, including Leishmania major, the principal etiologic agent of zoonotic cutaneous leishmaniasis (ZCL). The outcome of L. major infection in gerbils is not uniform. Among several immune-related factors including cytokine genes, the polymorphism in interleukin 4 (IL-4) promoter gene showed a great impact on outcome and pathological symptoms of L. major infection at least in mouse model. In this study gerbils' IL-4 promoter gene polymorphism is assessed. Specific primers were designed to develop a PCR-based assay to amplify IL-4 promoter gene to possibly define IL-4 promoter gene polymorphism in great gerbil populations with a range of Leishmania infection and symptoms collected from different foci of the central, north and northeast regions of Iran. The results showed that the designed primers amplify 689bp of the promoter gene. Sequence analysis of the promoter gene revealed five polymorphic sites assembly six haplotypes among the gerbil populations. Further studies are needed to assess whether or not the five polymorphisms cause different outcome phenotypes following infection with L. major in great gerbils. The data might be used to characterize the immune responses of R. opimus against L. major infection.
Collapse
Affiliation(s)
- H Bakhshi
- Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, P.O. Box 14155-6446, Tehran, Iran
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Bakhshi H, Oshaghi M, Abai M, Rassi Y, Akhavan A, Sheikh Z, Mohtarami F, Saidi Z, Mirzajani H, Anjomruz M. Molecular detection of Leishmania infection in sand flies in border line of Iran–Turkmenistan: Restricted and permissive vectors. Exp Parasitol 2013; 135:382-7. [DOI: 10.1016/j.exppara.2013.07.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Revised: 06/14/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
|
43
|
Abstract
BACKGROUND Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) have recently been suggested as diagnostic criteria for periprosthetic joint infection (PJI) diagnosis. Thresholds for these markers should be reexamined since they have been determined arbitrarily. QUESTIONS/PURPOSES Based on recently defined criteria for PJI, we determined (1) whether there is a difference in the threshold value of ESR and CRP between hips and knees, (2) whether the threshold value for ESR and CRP should be different for early-postoperative and late-chronic PJI, and (3) the optimal thresholds for ESR and CRP in PJI diagnosis. METHODS We retrospectively reviewed 1962 patients with revision arthroplasty for aseptic failure (1095 hips, 594 knees) or first onset of PJI (108 hips, 165 knees) between 2000 and 2009. The PJI diagnosis was made independent of ESR and CRP using criteria recently proposed by the Musculoskeletal Infection Society. Patients with comorbidities that confound ESR and CRP were not included. Receiver operating characteristic (ROC) analysis was performed to determine thresholds. RESULTS ESR and CRP levels in late-chronic PJI were higher in knees than in hips. Optimal thresholds for ESR and CRP were 48.5 mm/hour and 13.5 mg/L in hips and 46.5 mm/hour and 23.5 mg/L in knees, respectively. In early-postoperative PJI, ESR and CRP were similar in both joints with common thresholds of 54.5 mm/hour and 23.5 mg/L, respectively. CONCLUSIONS The data suggest a similar threshold for ESR but not for CRP should be implemented for late-chronic hips and knees. Optimal magnitudes are higher than conventional thresholds, indicating the need for refinement of thresholds if ESR and CRP are to be criteria for PJI diagnosis. Early-postoperative and late-chronic PJI might require different thresholds. LEVEL OF EVIDENCE Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Pouya Alijanipour
- Rothman Institute of Orthopedics at Thomas Jefferson Hospital, 925 Chestnut Street, Philadelphia, PA 19107 USA
| | - Hooman Bakhshi
- Rothman Institute of Orthopedics at Thomas Jefferson Hospital, 925 Chestnut Street, Philadelphia, PA 19107 USA
| | - Javad Parvizi
- Rothman Institute of Orthopedics at Thomas Jefferson Hospital, 925 Chestnut Street, Philadelphia, PA 19107 USA
| |
Collapse
|
44
|
Alavi-Moghaddam M, Bakhshi H, Rezaei B, Khashayar P. Pneumonia severity index compared to CURB-65 in predicting the outcome of community acquired pneumonia among patients referred to an Iranian emergency department: a prospective survey. Braz J Infect Dis 2013; 17:179-83. [PMID: 23453945 PMCID: PMC9427418 DOI: 10.1016/j.bjid.2012.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 10/03/2012] [Accepted: 10/03/2012] [Indexed: 01/21/2023] Open
Abstract
Objective To compare the prognostic value of the pneumonia severity index and the severity score for community-acquired pneumonia (CURB-65) in predicting mortality and the need for ICU admission of patients with community-acquired pneumonia referred to our emergency department. Materials and methods This prospective study was performed on patients with community-acquired pneumonia admitted to the emergency department of Imam Hossein Medical Center, Tehran, Iran. A questionnaire with demographic information, clinical signs and symptoms, laboratory and radiographic findings was completed for each patient. The information required for calculating the pneumonia severity index and CURB-65 were extracted from the medical records. The patients’ clinical outcome was also recorded within a month after admission. Results We studied 200 patients with community-acquired pneumonia (122 men, 78 women). The sensitivity and specificity of CURB-65 in predicting mortality were 100% and 82.3%, respectively. As for pneumonia severity index, the rates were 100% and 75%, respectively. The sensitivity and specificity rates of CURB-65 and pneumonia severity index in predicting mortality and need for ICU admission were 96.7% and 89.3%, and 90% and 78.7%, respectively. Conclusion CURB-65 seems to be the preferred method to predict mortality and need for ICU admission in patients with community-acquired pneumonia. Despite their comparable specificity and sensitivity, CURB-65 is much easier to implement.
Collapse
|
45
|
Bakhshi H, Kazemian G, Emami M, Nemati A, Karimi Yarandi H, Safdari F. Local erythropoietin injection in tibiofibular fracture healing. Trauma Mon 2013; 17:386-8. [PMID: 24350133 PMCID: PMC3860668 DOI: 10.5812/traumamon.7099] [Citation(s) in RCA: 26] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 10/28/2012] [Accepted: 11/17/2012] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Erythropoietin (EPO), in addition to its function as an erythropoiesis regulator has a regenerative activity on some nonhematopoietic tissues. Animal studies have suggested a role for erythropoietin in bone healing. OBJECTIVES The present study aimed to evaluate the effects of local EPO injection in healing of tibiofibular fractures. MATERIALS AND METHODS In a prospective double blind study, 60 patients with tibiofibular fracture were divided to equal EPO or placebo groups, randomly. Patients received local injection of either EPO or a placebo to the site of fracture two weeks after surgical fixation. Patients were followed by clinical and radiographic examination to determine the union rate. The period of fracture union and incidence of nonunion were compared between the two groups. RESULTS The demographic data and types of fractures were similar in the both groups. The mean duration of the fracture union was 2.1 weeks shorter in those treated with EPO (P = 0.01). Nonunion was observed in 6 patients of the control group and 2 receiving EPO (P = 0.02). No patient experienced any adverse effect from local EPO injections. CONCLUSIONS EPO injection into the site of tibiofibular fractures may possibly accelerate healing.
Collapse
Affiliation(s)
- Hooman Bakhshi
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Gholamhossein Kazemian
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Emami
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Ali Nemati
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Ali Nemati, Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Madani St, Tehran, IR Iran. Tel/Fax: +98-9133425890, E-mail:
| | - Hossein Karimi Yarandi
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Farshad Safdari
- Orthopedic Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| |
Collapse
|
46
|
Bakhshi H, Alavi-Moghaddam M, Wu KC, Imami M, Banasiri M. D-dimer as an applicable test for detection of posttraumatic deep vein thrombosis in lower limb fracture. Am J Orthop (Belle Mead NJ) 2012; 41:E78-E80. [PMID: 22837995] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Measuring the plasma levels of D-dimer is an accurate and easy modality to detect deep vein thrombosis (DVT) in nontraumatic settings. However, the diagnostic reliability of D-dimer assays in detecting posttraumatic DVT among patients with lower limb fracture undergoing orthopedic surgery is not validated. In this study, 141 patients with lower limb fracture admitted through the emergency department and undergoing orthopedic surgery were enrolled. Postoperative venous blood samples for D-dimer assay were taken on the 1st, 7th, and 28th postoperative days. Color Doppler sonography examination of both lower limbs was performed at the same time as a standard test. Eight out of the 141 patients (6%) had acute DVT based on Color Doppler sonography. Mean D-dimer was 2160 ng/mL in DVT positive patients and 864 in DVT negative patients. D-dimer levels greater than 1000 ng/mL were 100% sensitive and 71% specific for detecting postoperative DVT. D-dimer assay is a useful and sensitive test for detecting posttraumatic DVT.
Collapse
Affiliation(s)
- Hooman Bakhshi
- Department of Orthopaedic Surgery, Iman Hussein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | | | | |
Collapse
|
47
|
Bakhshi H, Rasouli MR, Parvizi J. Can local Erythropoietin administration enhance bone regeneration in osteonecrosis of femoral head? Med Hypotheses 2012; 79:154-6. [PMID: 22617757 DOI: 10.1016/j.mehy.2012.04.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 04/15/2012] [Indexed: 11/27/2022]
Abstract
Osteonecrosis of femoral head (ONFH) is a challenging disease. Regardless of underlying causes, the ultimate result in all cases is disruption of femoral head blood supply. Once the disease starts, it is progressive in 80% of cases. Since the majority of the affected individuals are young, every effort should be focused on preserving the patients own femoral head. These years, the role of angiogenic growth factors has been investigated with promising results in animal models of ONFH. Erythropoietin (EPO) is a well known hormone that has been used in treatment of chronic anemia for many years with few side effects. Considering the angiogenic properties of EPO, we hypothesize that local delivery of recombinant human EPO during core decompression will enhance bone regeneration in ONFH. In this way we also can avoid systemic side effects of EPO.
Collapse
Affiliation(s)
- Hooman Bakhshi
- Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
| | | | | |
Collapse
|
48
|
Abstract
BACKGROUND Rotational malalignment after intramedullary tibial nailing is rarely addressed in clinical studies. Malrotation (especially >10°)of the lower extremity can lead to development and progression of degenerative changes in knee and ankle joints. The purpose of this study is to determine the incidence and severity of tibial malrotation after reamed intramedullary nailing for closed diaphyseal tibial fractures. MATERIALS AND METHODS Sixty patients (53 males and 7 females) with tibial diaphyseal fracture were included in this study. The mean age of the patients was 33.4±13.3 years. All fractures were manually reduced and fixed using reamed intramedullary nailing. A standard method using bilateral limited computerized tomography was used to measure the tibial torsion. A difference greater than 10° between two tibiae was defined as malrotation. RESULTS Eighteen (30%) patients had malrotation of more than 10°. Malrotation was greater than 15° in seven cases. Good or excellent rotational reduction was achieved in 70% of the patients. There was no statistically significant relation between AO tibial fracture classification and fibular fixation and malrotation of greater than 10°. CONCLUSIONS Considering the high incidence rate of tibial malrotation following intramedullary nailing, we need a precise method to evaluate the torsion intraoperatively to prevent the problem.
Collapse
Affiliation(s)
- Adel Ebrahimpour Jafarinejad
- Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Address for correspondence: Dr. A Ebrahimpour Jafarinejad, Orthopaedics Ward, Taleghani Hospital, Evin, Tehran, Iran. E-mail:
| | - Hooman Bakhshi
- Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Haghnegahdar
- Department of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Nima Ghomeishi
- Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
49
|
Azari-Hami S, Abai M, Arzamani K, Bakhshi H, Karami H, Ladonni H, Harbach R. Mosquitoes (Diptera: Culicidae) of North Khorasan Province, Northeastern Iran and the Zoogeographic Affinities of the Iranian and Middle Asian Mosquito Fauna. ACTA ACUST UNITED AC 2011. [DOI: 10.3923/je.2011.204.217] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
50
|
Kazemian GH, Bakhshi H, Lilley M, Emami Tehrani Moghaddam M, Omidian MM, Safdari F, Mohammadpour I. DRUJ instability after distal radius fracture: A comparison between cases with and without ulnar styloid fracture. Int J Surg 2011; 9:648-51. [DOI: 10.1016/j.ijsu.2011.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Revised: 07/08/2011] [Accepted: 08/14/2011] [Indexed: 11/28/2022]
|