1
|
Al-Sadawi M, Tao M, Dhaliwal S, Goldschmit M, Tam E, Mann N. Safety and Efficacy of Anti-Hypertensive Medications in Patients with Heart Failure with Preserved Ejection Fraction: A Systematic Review and Meta-analysis. High Blood Press Cardiovasc Prev 2024:10.1007/s40292-024-00646-0. [PMID: 38740725 DOI: 10.1007/s40292-024-00646-0] [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: 02/08/2024] [Accepted: 04/17/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Hypertension (HTN) is a co-morbidity that is commonly associated with heart failure with preserved ejection fraction (HFpEF). However, it remains unclear whether treatment of hypertension in HFpEF patients is associated with improved cardiovascular outcomes. AIM The purpose of this meta-analysis is to evaluate the association of anti-hypertensive medical therapy with cardiovascular outcomes in patients with HFpEF. METHODS We performed a database search for studies reporting on the association of anti-hypertensive medications with cardiovascular outcomes and safety endpoints in patients with HFpEF. The databases searched include OVID Medline, Web of Science, and Embase. The primary endpoint was all-cause mortality. Secondary endpoints include cardiovascular (CV) mortality, worsening heart failure (HF), CV hospitalization, composite major adverse cardiovascular events (MACE), hyperkalemia, worsening renal function, and hypotension. RESULTS A total of 12 studies with 14062 HFpEF participants (7010 treated with medical therapy versus 7052 treated with placebo) met inclusion criteria. Use of anti-hypertensive medications was not associated with lower all-cause mortality, CV mortality or CV hospitalization compared to treatment with placebo (OR 1.02, 95% CI 0.77-1.35; p = 0.9, OR 0.88, 95% CI 0.73-1.06; p = 0.19, OR 0.99, 95% CI 0.87-1.12; p = 0.83, OR 0.90, 95% CI 0.79-1.03; p = 0.11). Anti-hypertensive medications were not associated with lower risk of subsequent acute myocardial infarction (AMI) (OR 0.53, 95% CI 0.07-3.73; p = 0.5). Use of anti-hypertensive medications was associated with a statistically significant lower risk of MACE (OR 0.90, 95% CI 0.83-0.98; p = 0.02). CONCLUSIONS While treatment with anti-hypertensive medications was not associated with lower risk of all-cause mortality, their use may be associated with reduce risk of adverse cardiovascular outcomes in patients with HFpEF regardless of whether they have HTN. Additional high quality studies are required to clarify this association and determine the effect based on specific classes of medications.
Collapse
Affiliation(s)
- Mohammed Al-Sadawi
- University of Michigan Hospital, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
| | - Michael Tao
- Stony Brook University Hospital, 101 Nicolls Rd, Stony Brook, NY, 11794, USA
| | - Simrat Dhaliwal
- Stony Brook University Hospital, 101 Nicolls Rd, Stony Brook, NY, 11794, USA
| | - Mark Goldschmit
- Stony Brook University Hospital, 101 Nicolls Rd, Stony Brook, NY, 11794, USA
| | - Edlira Tam
- Stony Brook University Hospital, 101 Nicolls Rd, Stony Brook, NY, 11794, USA
| | - Noel Mann
- Stony Brook University Hospital, 101 Nicolls Rd, Stony Brook, NY, 11794, USA
| |
Collapse
|
2
|
Al-Sadawi M, Tao M, Dhaliwal S, Masson R, Bhagat AA, Parikh PB, Lawson WE, Reilly JP. Association of antiplatelet therapy with clinical outcomes in patients with peripheral artery disease. Cardiovasc Revasc Med 2024; 62:66-72. [PMID: 38176961 DOI: 10.1016/j.carrev.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND The beneficial role of dual anti-platelet therapy (DAPT) in coronary artery disease is well established. However, there is limited data describing the effects of DAPT in patients with atherosclerotic peripheral artery disease (PAD). The aim of this meta-analysis is to compare clinical outcomes associated with DAPT versus single anti-platelet therapy (SAPT) in patients with symptomatic PAD. METHODS We performed a literature search for studies assessing the risk of adverse cardiovascular and limb events in cohorts receiving either DAPT or SAPT. The primary endpoint was all cause mortality. The secondary endpoints included graft failure, amputation, total bleeding, severe bleeding and fatal bleeding. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. RESULTS A total of 11 studies with 54,331 participants (24,449 on SAPT and 29,882 on DAPT) were included. Patients with PAD treated with SAPT had higher all-cause mortality compared to patients treated with DAPT (OR 1.37, 95 % CI 1.09-1.74; p < 0.01). There was no difference in risk of graft failure or amputation between patients treated with SAPT or DAPT (OR 0.9, 95 % CI 0.77-1.06; p = 0.19; OR 1.11, 95 % CI 0.88-1.41; p = 0.37). Patients treated with SAPT had lower total bleeds compared to patients treated with DAPT (OR 0.53, 95 % CI 0.36-0.77; p < 0.01). However, For SAPT plus AC vs SAPT, a total of 8 studies with 17,100 participants (3447 with SAPT plus AC and 8619 with only SAPT) were included. Patients on SAPT plus AC did not have a statistically significant difference in risk for all-cause mortality, (OR 0.91, 95 % CI 0.67-1.24; p = 0.56). SAPT plus AC had significantly lower risk of MI (OR 0.82, 95 % CI 0.69-0.97; p = 0.02), amputation (OR 0.72, 95 % CI 0.53-0.97; p = 0.03), and graft failure (OR 0.66, 95 % CI 0.48-0.93; p = 0.02). There was no significant different in risk of fatal bleeding be-tween the two groups (OR 1.60, 95 % CI 0.76-3.35; p = 0.22). CONCLUSIONS In patients with symptomatic PAD, a strategy of DAPT may confer a mortality benefit when compared to SAPT without significantly increasing the risk of serious bleeding events.
Collapse
Affiliation(s)
- Mohammed Al-Sadawi
- Division of Cardiology, University of Michigan Hospital, Ann Arbor, MI, USA.
| | - Michael Tao
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Simrat Dhaliwal
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Ravi Masson
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Aditi A Bhagat
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Puja B Parikh
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - William E Lawson
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - John P Reilly
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
| |
Collapse
|
3
|
Al-Sadawi M, Tao M, Dhaliwal S, Radakrishnan A, Liu Y, Gier C, Masson R, Rahman T, Tam E, Mann N. Utility of coronary revascularization in patients with ischemic left ventricular dysfunction. Cardiovasc Revasc Med 2024:S1553-8389(24)00074-5. [PMID: 38503643 DOI: 10.1016/j.carrev.2024.02.021] [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: 01/03/2024] [Revised: 02/09/2024] [Accepted: 02/27/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Revascularization in patients with left ventricular (LV) dysfunction has been a subject of ongoing uncertainty and conflicting results. This is further complicated by factors including viability, severity of LV dysfunction, and method of revascularization using percutaneous coronary intervention (PCI) versus coronary-artery bypass grafting (CABG). OBJECTIVES The purpose of this meta-analysis is to evaluate the association of coronary revascularization with outcomes in patients with ischemic LV dysfunction. METHODS A literature search was conducted for studies reporting on cardiovascular outcomes after revascularization compared to optimal medical therapy (OMT) in patients with ischemic LV dysfunction. RESULTS A total of 23 studies with 10,110 participants met inclusion criteria. Revascularization was significantly associated with lower all-cause mortality and CV mortality compared to OMT. The association was statistically significant regardless of severity of LV dysfunction or method of revascularization. Subgroup analysis demonstrated that revascularization was significantly associated with lower all-cause and CV mortality compared to OMT for patients with viable myocardium and mixed cohorts with variable viability, but not patients without viable myocardium. Revascularization was not associated with a significant difference in risk of heart failure (HF) hospitalization or acute myocardial infarction (AMI) compared to OMT. CONCLUSIONS Revascularization in patients with ischemic LV dysfunction is associated with lower risk of all-cause and CV mortality independent of severity of LV dysfunction or method of revascularization. Revascularization is not associated with lower risk of mortality in patients without evidence of viable myocardium and is not associated with lower risk of AMI or HF hospitalization.
Collapse
Affiliation(s)
- Mohammed Al-Sadawi
- Division of Cardiology, University of Michigan Hospital, Ann Arbor, MI, USA.
| | - Michael Tao
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Simrat Dhaliwal
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Archanna Radakrishnan
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Yang Liu
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Chad Gier
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Ravi Masson
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Tahmid Rahman
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Edlira Tam
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Noelle Mann
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
| |
Collapse
|
4
|
Gupte T, Al-Sadawi M, Luke T, Smith EK, Mehta N, Liang JJ, Chugh A, Morady F, Romano MA, Oral H, Ghannam M. Clinical outcomes of patients referred for left atrial appendage exclusion who did and did not undergo the procedure. Heart Rhythm 2024:S1547-5271(24)00216-9. [PMID: 38403234 DOI: 10.1016/j.hrthm.2024.02.044] [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: 11/02/2023] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Left atrial appendage exclusion (LAAE) is an effective alternative to long-term anticoagulation in patients with atrial fibrillation. Not all patients considered for LAAE undergo the procedure because of ineligibility, anatomic or medical constraints, and preference of the patient. OBJECTIVE The objective of this study was to report on the management strategies and long-term clinical outcomes of patients referred to a dedicated multidisciplinary LAAE clinic, including all who subsequently did and did not undergo LAAE. METHODS This was a retrospective analysis of prospectively acquired data from all patients referred to the comprehensive multidisciplinary LAAE clinic at the University of Michigan between 2016 and 2022. A consecutive 301 patients (age, 75 ± 8 years; 106 women) with atrial fibrillation were evaluated. LAAE was performed in 168 patients (56%) with use of the Watchman device in 146 (49%) and surgically in 22 (7%). LAAE was not performed in 133 patients (44%, no-LAAE group) because of ineligibility in 62 (21%), anatomic constraints in 23 (7%), and preference of the patient in 48 (36%). The CHA2DS2-VASc score (4.7 ± 1.5 vs 4.1 ± 1.6; P = .002) and HAS-BLED score (3.4 ± 1.0 vs 2.8 ± 1.1; P < .001) were higher in the LAAE groups. RESULTS Anticoagulant therapy was discontinued in 137 of 146 (94%) and 61 of 133 (61%) in the Watchman and no-LAAE groups, respectively (P < .001). During a median follow-up of 2.2 years (interquartile range, 1.2-4.0 years), in the LAAE (n = 168) and no-LAAE (n = 133) groups, respectively, 39 (23%) vs 29 (22%) deaths, 13 (8%) vs 5 (4%) thromboembolic events, and 24 (14%) vs 23 (17%) bleeding complications occurred. Continued long-term anticoagulation was not a predictor of clinical outcomes. CONCLUSION After a comprehensive evaluation in a multidisciplinary clinic, ∼50% of the patients referred for LAAE did not proceed with LAAE and resumed anticoagulation.
Collapse
Affiliation(s)
- Trisha Gupte
- Section of Electrophysiology, Division of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Mohammed Al-Sadawi
- Section of Electrophysiology, Division of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Tiffany Luke
- Section of Electrophysiology, Division of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Eryn K Smith
- Section of Electrophysiology, Division of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Nimita Mehta
- Section of Electrophysiology, Division of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Jackson J Liang
- Section of Electrophysiology, Division of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Aman Chugh
- Section of Electrophysiology, Division of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Fred Morady
- Section of Electrophysiology, Division of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Matthew A Romano
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Hakan Oral
- Section of Electrophysiology, Division of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Michael Ghannam
- Section of Electrophysiology, Division of Cardiology, University of Michigan, Ann Arbor, Michigan.
| |
Collapse
|
5
|
Al-Sadawi M, Gier C, Tao M, Henriques M, Kim P, Aslam F, Almasry I, Singh A, Fan R, Rashba E. Risk of Appropriate Implantable Cardioverter-Defibrillator Therapies and Sudden Cardiac Death in Patients With Heart Failure With Improved Left Ventricular Ejection Fraction. Am J Cardiol 2024; 213:55-62. [PMID: 38183873 DOI: 10.1016/j.amjcard.2023.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND The benefit of implantable cardioverter-defibrillator (ICD) therapy is controversial in patients who have heart failure with improved left ventricular ejection fraction (EF) to >35% after implantation (HFimpEF). METHODS Databases (Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar) were queried for studies in patients with ICD that reported the association between HFimpEF and arrhythmic events (AEs), defined as the combined incidence of ventricular arrhythmias, appropriate ICD intervention, and sudden cardiac death (primary composite end point). RESULTS A total of 41 studies and 38,572 patients (11,135 with HFimpEF, 27,437 with persistent EF ≤35%) were included; mean follow-up was 43 months. HFimpEF was associated with decreased AEs (odds ratio [OR] 0.39, 95% confidence interval [CI] 0.32 to 0.47; annual rate [AR] 4.1% vs 8%, p <0.01). Super-responders (EF ≥50%) had less risk of AEs than did patients with more modest reverse remodeling (EF >35% and <50%, OR 0.25, 95% CI 0.14 to 0.46, AR 2.7% vs 6.2%, p <0.01). Patients with HFimpEF who had an initial primary-prevention indication had less risk of AEs (OR 0.43, 95% CI 0.3 to 0.61, AR 5.1% vs 10.3%, p <0.01). Among patients with primary prevention who had never received appropriate ICD therapy at the time of generator change, HFimpEF was associated with decreased subsequent AEs (OR 0.26, 95% CI 0.12 to 0.59, AR 1.6% vs 4.8%, p <0.01). In conclusion, HFimpEF is associated with reduced, but not eliminated, risk for AEs in patients with ICDs. The decision to replace an ICD in subgroups at less risk should incorporate shared decision making based on risks for subsequent AEs and procedural complications.
Collapse
Affiliation(s)
- Mohammed Al-Sadawi
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Chad Gier
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Michael Tao
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Matthew Henriques
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Paul Kim
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Faisal Aslam
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Ibrahim Almasry
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Abhijeet Singh
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Roger Fan
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Eric Rashba
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York.
| |
Collapse
|
6
|
Tao M, Gier C, Al-Sadawi M, Dhaliwal S, Masson R, Rahman T, Gavalas M, Tam E, Mann N. Utility of Fractional Flow Reserve Computed Tomography Angiography in Patients With Stable Coronary Artery Disease. Am J Cardiol 2023; 208:31-36. [PMID: 37812863 DOI: 10.1016/j.amjcard.2023.07.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 10/11/2023]
Abstract
Coronary computed tomography angiography is a modality with high negative predictive value for evaluation of coronary artery disease (CAD). However, its diagnostic accuracy for obstructive CAD is limited by multiple factors. Fractional flow reserve (FFR) computed tomography (FFRCT) is an emerging analysis tool for identifying flow-limiting disease; nonetheless, the prognostic value of FFRCT is not well established. This meta-analysis aims to evaluate the association of FFRCT with clinical outcomes in patients with stable CAD. A literature search was conducted for studies reporting the association between FFRCT measurements and all-cause mortality, major adverse cardiovascular events (MACEs), acute myocardial infarction (AMI), and any need for coronary revascularization. Obstructive disease was defined as a FFR value ≤0.80; nonobstructive disease was defined as an FFR value >0.80. Ten studies were identified to meet the inclusion criteria; mean follow-up was 17 months (range, 3 to 56 months). There was no difference in risk of all-cause mortality between patients with obstructive and those with nonobstructive CAD on FFRCT. However, obstructive lesions were associated with increased risk of MACE, AMI, and any need for revascularization. FFRCT is a useful adjunctive modality for further risk stratification of patients with stable CAD. Obstructive lesions identified by FFRCT are associated with increased risk of MACE, AMI, and any need for revascularization.
Collapse
Affiliation(s)
- Michael Tao
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Chad Gier
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Mohammed Al-Sadawi
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Simrat Dhaliwal
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Ravi Masson
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Tahmid Rahman
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Michael Gavalas
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Edlira Tam
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Noelle Mann
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York..
| |
Collapse
|
7
|
Al-Sadawi M, Tao M, Frye J, Dianati-Maleki N, Mann N. The Use of Quality Improvement Interventions in Reducing Rarely Appropriate Cardiac Imaging. Am J Cardiol 2023; 207:349-355. [PMID: 37774477 DOI: 10.1016/j.amjcard.2023.08.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 10/01/2023]
Abstract
The use of cardiac imaging has become increasingly prevalent over the last decade. Approximately 10% to 15% of noninvasive cardiac imaging is ordered for rarely appropriate indications. The appropriate use criteria (AUC) for cardiac imaging were issued to decrease unnecessary testing and reduce health care costs. However, it remains unclear whether these efforts have been successful. This meta-analysis evaluates whether AUC quality improvement (QI) interventions effectively reduce inappropriate cardiac imaging. Databases were searched for studies reporting QI intervention effect aiming to reduce rarely appropriate noninvasive cardiac imaging based on AUC. Imaging modalities assessed include transthoracic echocardiography, stress echocardiography, and myocardial perfusion imaging. We searched Ovid MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar, and EBSCO CINAHL. The primary end point was a decrease of rarely appropriate testing. The search was not restricted to time or publication status. The literature search identified 2,391 possible studies, 13 studies and 26,557 patients were included. Mean follow-up was 12 months (1 to 60 months). QI interventions were statistically significant in reducing rarely appropriate tests after the intervention compared with the control group (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.41 to 0.64, p <0.01). The QI interventions were also assessed for persistence based on short-term (<3 months) and long-term (>3 months) efficacy. Both the short-term effect and long-term effect were persistent (OR 0.6, 95% CI 0.47 to 0.77, p <0.01 and OR 0.47, 95% CI 0.37 to 0.61, p <0.01, respectively). AUC QI interventions are associated with the successful decrease of inappropriate noninvasive cardiac testing with these effects persisting over time.
Collapse
Affiliation(s)
- Mohammed Al-Sadawi
- Department of Cardiovascular Medicine, University of Michigan Hospital, Ann Arbor, Michigan.
| | - Michael Tao
- Department of Cardiology, Stony Brook University Hospital, Stony Brook, New York
| | - Jesse Frye
- Department of Cardiology, Stony Brook University Hospital, Stony Brook, New York
| | - Neda Dianati-Maleki
- Department of Cardiology, Stony Brook University Hospital, Stony Brook, New York
| | - Noelle Mann
- Department of Cardiology, Stony Brook University Hospital, Stony Brook, New York
| |
Collapse
|
8
|
Tao M, Al-Sadawi M, Dhaliwal S, Gier C, Masson R, Miller A, Price J, Dianati-Maleki N, Rahman T, Bench T, Mann N. Outcomes and Medical Therapy in Myocardial Infarction With Nonobstructive Coronary Arteries: A Systematic Review and Meta-Analysis. Am J Cardiol 2023; 207:456-464. [PMID: 37802006 DOI: 10.1016/j.amjcard.2023.08.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 10/08/2023]
Abstract
Myocardial infarction with nonobstructive coronary arteries (MINOCAs) is a disease that has been poorly characterized with unclear clinical and therapeutic outcomes. The association of medical therapy with cardiovascular outcomes in patients with MINOCA has been inadequately assessed. The purpose of this meta-analysis is to evaluate the association of MINOCA at risk of adverse cardiovascular outcomes as compared with myocardial infarction with coronary artery disease (MICAD) and the efficacy of medical therapy in reducing the risk of adverse outcomes. A literature search was conducted for studies reporting on the association of MINOCA at risk of adverse outcomes as compared with MICAD. A literature search was also conducted for studies reporting on the association of medical therapy at risk of adverse outcomes in patients with MINOCA. A total of 29 studies with 893,134 participants met inclusion criteria comparing MINOCA to MICAD. Patients with MINOCA had a significantly lower risk of adverse outcomes as compared with MICAD. Nine studies with 27,731 MINOCA patients met inclusion criteria for evaluating the utility of medical therapy. Medical therapy did not significantly reduce risk of MACE; however, there was a trend toward lower risk in patients treated with β blockers. In conclusion, our results suggest that MINOCA is associated with a lower risk of in-hospital and long-term adverse outcomes compared with MICAD. Standard medical therapy is not associated with a lower risk of adverse cardiovascular outcomes in patients with MINOCA. Additional high-quality studies are required to evaluate the utility of specific medication classes for the treatment of specific etiologies of MINOCA.
Collapse
Affiliation(s)
- Michael Tao
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York.
| | - Mohammed Al-Sadawi
- Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Simrat Dhaliwal
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Chad Gier
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Ravi Masson
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Alec Miller
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Jordan Price
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Neda Dianati-Maleki
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Tahmid Rahman
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Travis Bench
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| | - Noelle Mann
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York
| |
Collapse
|
9
|
Tao M, Al-Sadawi M, Ahmed N, Dianati-Maleki N, Mann N, Kort S. The use of quality improvement interventions in reducing rarely appropriate echocardiograms: A systematic review and meta-analysis. Echocardiography 2023; 40:916-924. [PMID: 37464949 DOI: 10.1111/echo.15653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/18/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The volume of cardiac imaging continues to increase, with many tests performed for rarely appropriate indications. Appropriate use criteria (AUC) documents were published by the American Society of Echocardiography and American College of Cardiology, with quality improvement (QI) interventions developed in various institutions. However, the effectiveness of these interventions has not been assessed in a systematic fashion. METHODS We searched Ovid MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar, and EBSCO CINAHL for studies reporting association between cardiac imaging, AUC and QI. The search was not restricted to time or publication status. We selected studies assessing the effect of QI interventions on performance of rarely appropriate echocardiograms. The primary endpoint was reduction of rarely appropriate testing. RESULTS Nine studies with 22,070 patients met inclusion criteria. Mean follow up was 15 months (1-60 months). QI interventions resulted in statistically significant reduction in rarely appropriate tests (OR 0.52, 95% CI: .41-.66; p < .01). The effects of QI interventions were analyzed over both the short (<3 months) and long-term (>3 months) post intervention (OR 0.62, 95% CI: .49-.79; p < .01 in the short term, and OR 0.47, 95% CI: .35-.62; p < .01 in the long term). Subgroup analysis of the type of intervention, classified as education tools or decision support tools showed both significantly reduced rarely appropriate testing (OR 0.54, 95% CI: .41-.73; p < .01; OR .47, 95% CI: .36-.61; p < .01). Adding a feedback tool did not change the effect compared to not using a feedback tool (OR 0.49 vs. 0.57, 95% CI: .36-.68 vs. 39-.84; p > .05). CONCLUSION QI interventions are associated with a significant reduction in performance of rarely appropriate echocardiography testing, the effects of which persist over time. Both education and decision support tools were effective, while adding feedback tools did not result in further reduction of ordering rarely appropriate studies.
Collapse
Affiliation(s)
- Michael Tao
- Stony Brook University Hospital, 101 Nicolls Rd., Stony Brook, New York, USA
| | - Mohammed Al-Sadawi
- Stony Brook University Hospital, 101 Nicolls Rd., Stony Brook, New York, USA
| | - Navid Ahmed
- Stony Brook University Hospital, 101 Nicolls Rd., Stony Brook, New York, USA
| | - Neda Dianati-Maleki
- Stony Brook University Hospital, 101 Nicolls Rd., Stony Brook, New York, USA
| | - Noelle Mann
- Stony Brook University Hospital, 101 Nicolls Rd., Stony Brook, New York, USA
| | - Smadar Kort
- Stony Brook University Hospital, 101 Nicolls Rd., Stony Brook, New York, USA
| |
Collapse
|
10
|
Al-Sadawi M, Henriques M, Tao M, Gier C, Kim P, Aslam F, Almasry I, Singh A, Fan R, Rashba E. Prognostic value of late-gadolinium enhancement on cardiac magnetic resonance in patients with cardiac sarcoidosis. Pacing Clin Electrophysiol 2023. [PMID: 37216284 DOI: 10.1111/pace.14722] [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: 03/06/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Late-gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is a predictor of adverse events in patients with cardiac sarcoidosis (CS), but available studies had small sample sizes and did not consider all relevant endpoints. OBJECTIVE To evaluate the association between LGE on CMR in patients with CS and mortality, ventricular arrhythmias (VA) and sudden cardiac death (SCD), and heart failure (HF) hospitalization. METHODS A literature search was conducted for studies reporting the association between LGE in CS and the study endpoints. The endpoints were mortality, VA and SCD, and HF hospitalization. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. The minimum follow-up duration was 1 year. RESULTS A total of 17 studies and 1915 CS patients (595 with LGE vs. 1320 without LGE) were included; mean follow-up was 3.3 years (ranging between 17 and 84 months). LGE was associated with increased all-cause mortality (OR 6.05, 95% CI 3.16-11.58; p < .01), cardiovascular mortality (OR 5.83, 95% CI 2.89-11.77; p < .01), and VA and SCD (OR 16.48, 95% CI 8.29-32.73; p < .01). Biventricular LGE was associated with increased VA and SCD (OR 6.11, 95% CI 1.14-32.68; p = .035). LGE was associated with an increased HF hospitalization (OR 17.47, 95% CI 5.54-55.03; p < .01). Heterogeneity was low: df = 7 (p = .43), I2 = 0%. CONCLUSIONS LGE in CS patients is associated with increased mortality, VA and SCD, and HF hospitalization. Biventricular LGE is associated with an increased risk of VA and SCD.
Collapse
Affiliation(s)
- Mohammed Al-Sadawi
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Matthew Henriques
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Michael Tao
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Chad Gier
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Paul Kim
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Faisal Aslam
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Ibrahim Almasry
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Abhijeet Singh
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Roger Fan
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Eric Rashba
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| |
Collapse
|
11
|
Ijaz H, Al-Sadawi M, Aslam F, Singh A. RARE ATRIAL ISCHEMIA FROM AN ANOMALOUS RIGHT CORONARY ARTERY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03435-6] [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: 03/06/2023]
|
12
|
Al-Sadawi M, Aslam F, Tao M, Salam S, Alsaiqali M, Singh A, Fan R, Rashba EJ. Is CRT-D superior to CRT-P in patients with nonischemic cardiomyopathy? Int J Arrhythm 2023. [DOI: 10.1186/s42444-023-00085-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Abstract
Background
Recent studies have questioned the role of implanted cardiac defibrillators (ICDs) in nonischemic cardiomyopathy (NICM). Cardiac resynchronization therapy (CRT) can be delivered by a pacemaker (CRT-P) or an ICD (CRT-D). This meta-analysis assessed the effect of CRT-P versus CRT-D on mortality in patients with NICM.
Methods
Databases were searched for studies reporting the effect of CRT on all-cause mortality in patients with nonischemic cardiomyopathy (Ovid MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar, and EBSCO CINAHL). The primary endpoint was all-cause mortality. The minimum duration of follow-up required for inclusion was one year. The search was not restricted to time or publication status.
Results
The literature search identified 955 candidate studies, 15 studies and 22,763 patients were included. Mean follow-up was 53 months (17–100 months). CRT-D in NICM was associated with lower all-cause mortality (log HR − 0.169, SE 0.055; p = 0.002) compared to CRT-P. Heterogeneity: df = 15 (P 0.03), I2 = 43; test for overall effect: Z = − 3.043 (P = 0.002).
Conclusion
CRT-D in NICM was associated with lower all-cause mortality than CRT-P.
Collapse
|
13
|
Al-Sadawi M, Aslam F, Gier C, Aleem S, Ijaz H, Jacobs R, Cao K, Alsaiqali M, Singh A. The effect of gender on atrial fibrillation ablation outcomes using a propensity score matched analysis. Heart Rhythm O2 2023. [DOI: 10.1016/j.hroo.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
|
14
|
Haseltine JM, Apte A, Jackson A, Yorke E, Yu AF, Plodkowski A, Wu A, Peleg A, Al-Sadawi M, Iocolano M, Gelblum D, Shaverdian N, Simone CB, Rimner A, Gomez DR, Shepherd AF, Thor M. Association of cardiac calcium burden with overall survival after radiotherapy for non-small cell lung cancer. Phys Imaging Radiat Oncol 2023; 25:100410. [PMID: 36687507 PMCID: PMC9852638 DOI: 10.1016/j.phro.2023.01.001] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/05/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023] Open
Abstract
Background and purpose Coronary calcifications are associated with coronary artery disease in patients undergoing radiotherapy (RT) for non-small cell lung cancer (NSCLC). We quantified calcifications in the coronary arteries and aorta and investigated their relationship with overall survival (OS) in patients treated with definitive RT (Def-RT) or post-operative RT (PORT). Materials and methods We analyzed 263 NSCLC patients treated from 2004 to 2017. Calcium burden was ascertained with a Hounsfield unit (HU) cutoff of > 130 in addition to a deep learning (DL) plaque estimator. The HU cutoff volumes were defined for coronary arteries (PlaqueCoro) and coronary arteries and aorta combined (PlaqueCoro+Ao), while the DL estimator ranged from 0 (no plaque) to 3 (high plaque). Patient and treatment characteristics were explored for association with OS. Results The median PlaqueCoro and PlaqueCoro+Ao was 0.75 cm3 and 0.87 cm3 in the Def-RT group and 0.03 cm3 and 0.52 cm3 in the PORT group. The median DL estimator was 2 in both cohorts. In Def-RT, large PlaqueCoro (HR:1.11 (95%CI:1.04-1.19); p = 0.008), and PlaqueCoro+Ao (HR:1.06 (95%CI:1.02-1.11); p = 0.03), and poor Karnofsky Performance Status (HR: 0.97 (95%CI: 0.94-0.99); p = 0.03) were associated with worse OS. No relationship was identified between the plaque volumes and OS in PORT, or between the DL plaque estimator and OS in either Def-RT or PORT. Conclusions Coronary artery calcification assessed from RT planning CT scans was significantly associated with OS in patients who underwent Def-RT for NSCLC. This HU thresholding method can be straightforwardly implemented such that the role of calcifications can be further explored.
Collapse
Affiliation(s)
- Justin M. Haseltine
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Aditya Apte
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Andrew Jackson
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Anthony F. Yu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Andrew Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Abraham Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ariel Peleg
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Mohammed Al-Sadawi
- Department of Medicine, Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Michelle Iocolano
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Daphna Gelblum
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Narek Shaverdian
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Charles B. Simone
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Daniel R. Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Annemarie F. Shepherd
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Corresponding authors.
| | - Maria Thor
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Corresponding authors.
| |
Collapse
|
15
|
Al-Sadawi M, Aslam F, Tao M, Fan R, Singh A, Rashba E. Association of Late-Gadolinium Enhancement in Cardiac Magnetic Resonance with Mortality, Ventricular Arrhythmias, and Heart Failure in Patients with Non-Ischemic Cardiomyopathy: A Systematic Review and Meta-Analysis. Heart Rhythm O2 2023; 4:241-250. [PMID: 37124560 PMCID: PMC10134398 DOI: 10.1016/j.hroo.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Late gadolinium enhancement (LGE) on cardiac magnetic resonance is a predictor of adverse events in patients with nonischemic cardiomyopathy (NICM). Objective This meta-analysis evaluated the correlation between LGE and mortality, ventricular arrhythmias (VAs) and sudden cardiac death (SCD), and heart failure (HF) outcomes. Methods A literature search was conducted for studies reporting the association between LGE in NICM and the study endpoints. The primary endpoint was mortality. Secondary endpoints included VA and SCD, HF hospitalization, improvement in left ventricular ejection fraction (LVEF) to >35%, and heart transplantation referral. The search was not restricted to time or publication status. The minimum follow-up duration was 1 year. Results A total of 46 studies and 10,548 NICM patients (4610 with LGE, 5938 without LGE) were included; mean follow-up was 3 years (range 13-71 months). LGE was associated with increased mortality (odds ratio [OR] 2.9; 95% confidence interval [CI] 2.3-3.8; P < .01) and VA and SCD (OR 4.6; 95% CI 3.5-6.0; P < .01). LGE was associated with an increased risk of HF hospitalization (OR 3.4; 95% CI 2.3-5.0; P < .01), referral for transplantation (OR 5.1; 95% CI 2.5-10.4; P < .01), and decreased incidence of LVEF improvement to >35% (OR 0.2; 95% CI 0.03-0.85; P = .03). Conclusion LGE in NICM patients is associated with increased mortality, VA and SCD, and HF hospitalization and heart transplantation referral during long-term follow up. Given these competing risks of mortality and HF progression, prospective randomized controlled trials are required to determine if LGE is useful for guiding prophylactic implantable cardioverter-defibrillator placement in NICM patients.
Collapse
Affiliation(s)
| | | | | | | | | | - Eric Rashba
- Address reprint requests and correspondence: Dr Eric Rashba, Stony Brook Heart Rhythm Center, Stony Brook Medicine, 101 Nicolls Road, Stony Brook, NY 11794.
| |
Collapse
|
16
|
Tao M, Al-Sadawi M, Aslam F, Mann N, Goldschmidt M, Tam E. Association of late gadolinium enhancement in cardiac magnetic resonance with heart failure outcomes in patients with non-ischemic cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Late-gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) has been found to be associated with increased mortality in patients with non-ischemic cardiomyopathy (NICM). The correlation between LGE and heart failure (HF) hospitalization, referral for heart transplant, and ejection fraction (EF) improvement have not been well established.
Purpose
This meta-analysis assessed the relationship between LGE in CMR with HF hospitalization, referral for heart transplant and EF improvement in patients with NICM.
Methods
We searched the databases for studies reporting the association between LGE in CMR for NICM and HF outcomes including Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar for all studies. The search was not restricted to time or publication status. The minimal follow up duration is one year.
Results
A total of 216 studies resulted from the literature search. A total of 25 studies and 3,039 patients (1,265 with LGE vs 1,774 without LGE) were included; mean follow up is around 33 months (ranging between 13 to 71 months). Our analysis demonstrated that LGE in NICM was associated with increased risk of HF hospitalization (odds ratio 3.38, 95% confidence interval 2.27–5.04; P<0.01), referral for transplant (odds ratio 5.08, 95% confidence interval 2.49–10.35; P<0.01), and lower chance for EF improvement (odds ratio 0.16, 95% confidence interval 0.03–0.85; P 0.03). Heterogeneity is moderate: χ2=49.5, df=21 (P=0.001), I2=57%. (Figures 1 and 2)
Conclusions
Our results suggest that LGE is associated with increased risk of HF hospitalization and referral for heart transplant and lower chance for EF improvement in long-term follow up.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- M Tao
- Stony Brook University Hospital , Stony Brook , United States of America
| | - M Al-Sadawi
- Stony Brook University Hospital , Stony Brook , United States of America
| | - F Aslam
- Stony Brook University Hospital , Stony Brook , United States of America
| | - N Mann
- Stony Brook University Hospital , Stony Brook , United States of America
| | - M Goldschmidt
- Stony Brook University Hospital , Stony Brook , United States of America
| | - E Tam
- Stony Brook University Hospital , Stony Brook , United States of America
| |
Collapse
|
17
|
Ijaz H, Al-Sadawi M, Aslam F, Aleem S, Jacob R, Cao K, Santore L, Almasry I, Singh A, Fan R, Rashba E. Safety of same day discharge after atrial fibrillation ablation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) ablation is an outpatient procedure with traditionally an overnight hospital observation (OHO). Recently, there has been a trend towards same day discharge (SDD).
Purpose
Compare AF ablation procedure safety outcomes with SDD vs. OHO.
Methods
We reviewed consecutive AF procedures performed from January 2013 to June 2021 at a single academic center. Patients underwent OHO until June 2020, after which patients had SDD whenever feasible. Adverse events were assessed at three months, which included pericardial effusion, pericarditis, post-procedure hypotension, embolic events, and vascular complications. We also assessed emergency department (ED) visits and procedure-related hospital admissions.
Results
There were 1254 patients who underwent 1575 AF ablations. 1440 patients underwent OHO and 135 had SDD. Mean age was 62.2 years, BMI 33 kg/m2, 65% were male, and 27.6% had persistent AF, without significant differences in baseline characteristics between OHO and SDD. We found that SDD was not associated with increased complications (OHO 0.20% v. SDD 0.49%; p>0.05), ED visits, or hospital admissions (2% v. 5%; p>0.05) (Figure 1, 2). There were no gender or age-related disparities in all outcomes (p>0.05).
Conclusion
SDD protocol after AF ablation is feasible and not associated with higher incidence of complications, ED visits, and procedure-related hospitalizations.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- H Ijaz
- Stony Brook University Hospital , Stony Brook , United States of America
| | - M Al-Sadawi
- Stony Brook University Hospital , Stony Brook , United States of America
| | - F Aslam
- Stony Brook University Hospital , Stony Brook , United States of America
| | - S Aleem
- Stony Brook University Hospital , Stony Brook , United States of America
| | - R Jacob
- Stony Brook University Hospital , Stony Brook , United States of America
| | - K Cao
- Stony Brook University Hospital , Stony Brook , United States of America
| | - L Santore
- Stony Brook University Hospital , Stony Brook , United States of America
| | - I Almasry
- Stony Brook University Hospital , Stony Brook , United States of America
| | - A Singh
- Stony Brook University Hospital , Stony Brook , United States of America
| | - R Fan
- Stony Brook University Hospital , Stony Brook , United States of America
| | - E Rashba
- Stony Brook University Hospital , Stony Brook , United States of America
| |
Collapse
|
18
|
Aslam F, Al-Sadawi M, Gore A, Ijaz H, Dhar K, Dhaliwal A, Singh A. Race disparities in atrial fibrillation detection using implantable loop recorder for cryptogenic stroke. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cryptogenic stroke represents about 25–30% of all ischemic strokes. Continuous electrocardiographic monitoring using implantable loop recorder (ILR) can detect asymptomatic and undiagnosed atrial fibrillation (AF).
Purpose
To assess patient-specific factors in ILR implantation and AF detection in patients with cryptogenic strokes.
Methods
We retrospectively reviewed 379 patients with cryptogenic stroke indicated for ILR implantation, from January 2017 to June 2021 at our university hospital. We evaluated patient demographic and clinical characteristics to assess the risk factors associated with higher incidence of AF detection, using logistic regression models.
Results
Of the 379 ILRs implanted, 60.4% were males with 71.2% Caucasian, mean age 67.6 years, and mean BMI 28.5. The mean CHADSVASC score of 3.9 at the time of ischemic stroke. These patients had prior diagnosis of diabetes mellitus (27.4%), hypertension (65.7%), chronic kidney disease (19.5%), coronary artery disease (20%) and congestive heart failure (2%). Of the entire cohort, AF was diagnosed in 16% of patients with 14 months mean follow up. There were more females diagnosed with AF on ILR (20% v. 18.7%, p>0.05). Caucasians were more likely to have AF detected compared to non-Caucasians (OR 2.3, 95% CI, p<0.02). There were 52 patients with mobile cardiac outpatient telemetry (MCOT) before having ILR implantation. AF was not detected on MCOT, but 15% were diagnosed with AF with ILR monitoring. In univariate analysis, increasing age is strongly associated with the detection of AF (p=0.03).
Conclusions
There continues to exist race disparities in ILR implantation and eventual AF detection, leading to further socioeconomic health disparities. ILR should be considered especially in elderly with cryptogenic stroke given the higher incidence of AF detection.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- F Aslam
- Stony Brook University Hospital , Stony Brook , United States of America
| | - M Al-Sadawi
- Stony Brook University Hospital , Stony Brook , United States of America
| | - A Gore
- Stony Brook University Hospital , Stony Brook , United States of America
| | - H Ijaz
- Stony Brook University Hospital , Stony Brook , United States of America
| | - K Dhar
- Stony Brook University Hospital , Stony Brook , United States of America
| | - A Dhaliwal
- Stony Brook University Hospital , Stony Brook , United States of America
| | - A Singh
- Stony Brook University Hospital , Stony Brook , United States of America
| |
Collapse
|
19
|
Aslam F, Al-Sadawi M, Aleem S, Alsaiqali M, Almasry I, Singh A, Rashba E, Fan R. Effect of defibrillator on long term all-cause mortality in patients with chronic kidney disease: an updated meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The beneficial role of implantable defibrillator (ICD) in patients with chronic kidney disease (CKD) is less understood as this population is often not well represented in clinical trials.
Purpose
Evaluate the effect of ICD use in patients with CKD on long term outcomes.
Methods
Literature search was conducted for studies reporting the effect of ICD on all-cause mortality in patients with CKD, which is defined as glomerular filtration rate (GFR) <60 mL/min. The search was not restricted to time or publication status. The search included the following databases: Ovid MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar, and EBSCO CINAHL. The minimum duration of follow-up required for inclusion was one year.
Results
The literature search identified 834 studies, of which 14 studies with 70,661 patients were included. Mean follow up was 39 months (12–81 months). For all patients with CKD, ICD was associated with lower all-cause mortality (log HR −0.247, SE 0.101, p=0.015); Heterogeneity: df=13 (P<0.01), I2=97.057; Test for overall effect: Z=−2.431 (Figure 1). When further stratified based on dialysis, CKD patients without the need for dialysis had favorable outcome (log HR −0.211, SE 0.095, p=0.026); Heterogeneity: df=6 (P<0.01), I2=70.146; Test for overall effect: Z=−2.225, whereas ICD implantation in CKD patients requiring dialysis was not associated with mortality benefit (log HR −0.262, SE 0.134, p=0.051) (Figure 2A, B).
Conclusion
ICD implantation is associated with mortality benefit in patients with CKD, but this association is not present for patients requiring dialysis.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- F Aslam
- Stony Brook University Hospital , Stony Brook , United States of America
| | - M Al-Sadawi
- Stony Brook University Hospital , Stony Brook , United States of America
| | - S Aleem
- Stony Brook University Hospital , Stony Brook , United States of America
| | - M Alsaiqali
- Suny Downstate Medical Center , Brooklyn , United States of America
| | - I Almasry
- Stony Brook University Hospital , Stony Brook , United States of America
| | - A Singh
- Stony Brook University Hospital , Stony Brook , United States of America
| | - E Rashba
- Stony Brook University Hospital , Stony Brook , United States of America
| | - R Fan
- Stony Brook University Hospital , Stony Brook , United States of America
| |
Collapse
|
20
|
Aslam F, Al-Sadawi M, Tao M, Aleem S, Almasry I, Singh A, Rashba E, Fan R. Association of late-gadolinium enhancement in cardiac magnetic resonance with ventricular arrhythmias and mortality in patients with non-ischemic cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Late-gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) is a predictor of adverse events such as cardiovascular mortality, cardiovascular related hospitalization and defibrillation shocks in patients with non-ischemic cardiomyopathy (NICM). The correlation between LGE and ventricular arrhythmia and mortality has not been completely established.
Purpose
This meta-analysis assessed the relationship between LGE in CMR with ventricular arrhythmias: sustained, non-sustained and ICD therapy; and mortality in patients with NICM.
Methods
Databases were queried for studies reporting the association between LGE in CMR in NICM and ventricular arrhythmias and mortality, including Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. The minimal follow up duration was one year.
Results
A total of 46 studies and 10,548 patients (4,610 with LGE vs 5,938 without LGE) were included; mean follow up was 3 years (ranging between 13 to 71 months) and mean left ventricular ejection fraction 33%. LGE in NICM was associated with increased risk of ventricular arrhythmias and sudden cardiac death (odds ratio 4.595, 95% confidence interval 3.54–5.97; P<0.01) and mortality (odds ratio 2.949, 95% confidence interval 2.285–3.806; P<0.01). Heterogeneity is low to moderate: χ2=82.2, df =45 (P=0.001), I2=45% (Figures 1, 2).
Conclusions
Our results suggest that LGE is associated with increased risk of ventricular arrhythmias, sudden cardiac death and mortality in long-term follow up. These results further substantiate the need for larger prospective randomized trials using LGE to decide ICD indication regardless of EF. There are two ongoing trials testing this indication: CMR-ICD and CMR-GUIDE.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- F Aslam
- Stony Brook University Hospital , Stony Brook , United States of America
| | - M Al-Sadawi
- Stony Brook University Hospital , Stony Brook , United States of America
| | - M Tao
- Stony Brook University Hospital , Stony Brook , United States of America
| | - S Aleem
- Stony Brook University Hospital , Stony Brook , United States of America
| | - I Almasry
- Stony Brook University Hospital , Stony Brook , United States of America
| | - A Singh
- Stony Brook University Hospital , Stony Brook , United States of America
| | - E Rashba
- Stony Brook University Hospital , Stony Brook , United States of America
| | - R Fan
- Stony Brook University Hospital , Stony Brook , United States of America
| |
Collapse
|
21
|
Aleem S, Al-Sadawi M, Aslam F, Ijaz H, Cao K, Jacob R, Santore L, Almasry I, Fan R, Rashba E, Singh A. Does body mass index affect atrial fibrillation ablation outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There are conflicting reports in the literature regarding whether body-mass index (BMI) influences the success and procedural complication rates of atrial fibrillation (AF) ablation.
Purpose
To determine if differences in BMI affect AF ablation outcomes
Methods
At a single academic center, AF ablation procedures were reviewed from 2013 to 2021. Primary outcomes were AF recurrence (after a 90 day blanking period), procedure-related complications, emergency department visits or hospital admission (ED/HOSP). Patients had a minimum of 6 months follow-up
Results
We analyzed 1569 AF ablation consecutive procedures (1093 de novo, 476 repeat ablation) using either radiofrequency or cryoablation. The study population was 65% male with a mean age 62 years, with 28% persistent AF. BMI was separated into three cohorts: <25 kg/m2 (N=218), 25–30 kg/m2 (N=547), and >30 kg/m2 (N=804). There were no significant differences in the type of AF, left atrial diameter, or left ventricular ejection fraction in the BMI subgroups. There was a direct relationship between the prevalence of co-morbid conditions and increasing BMI: hypertension (49.1%, 59.9%, 60.2%; p 0.04), diabetes (6.4%, 13.5%, 21.3%; p 0.01), and obstructive sleep apnea (5.5%, 10.8%, 26.7%; p<0.01). There were no significant differences in AF recurrence, procedural complications or ED/HOSP among the BMI cohorts (p>0.05) (Figure 1). No gender related disparities were noted in outcomes (p>0.05).
Conclusion
Higher BMI was not associated with AF recurrence, complications, or ED/HOSP after AF ablation despite a higher prevalence of comorbid medical conditions
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- S Aleem
- Stony Brook University Hospital , Stony Brook , United States of America
| | - M Al-Sadawi
- Stony Brook University Hospital , Stony Brook , United States of America
| | - F Aslam
- Stony Brook University Hospital , Stony Brook , United States of America
| | - H Ijaz
- Stony Brook University Hospital , Stony Brook , United States of America
| | - K Cao
- Stony Brook University Hospital , Stony Brook , United States of America
| | - R Jacob
- Stony Brook University Hospital , Stony Brook , United States of America
| | - L Santore
- Stony Brook University Hospital , Stony Brook , United States of America
| | - I Almasry
- Stony Brook University Hospital , Stony Brook , United States of America
| | - R Fan
- Stony Brook University Hospital , Stony Brook , United States of America
| | - E Rashba
- Stony Brook University Hospital , Stony Brook , United States of America
| | - A Singh
- Stony Brook University Hospital , Stony Brook , United States of America
| |
Collapse
|
22
|
Al-Sadawi M, Theodoropoulos K, Saeidifard F, Kiladejo A, Al-Ajam M, Salciccioli L, Budzikowski AS. Sleep Apnea as a Risk Factor for Diastolic Dysfunction: A Systematic Review and Meta-Analysis. Respiration 2022; 101:1051-1068. [PMID: 36041415 DOI: 10.1159/000525782] [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: 01/08/2022] [Accepted: 06/20/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This meta-analysis assessed the relationship between obstructive sleep apnea (OSA) and echocardiographic parameters of diastolic dysfunction (DD), which are used in the assessment of heart failure with preserved ejection fraction. METHODS We searched the databases including Ovid MEDLINE, Ovid Embase, Scopus, Web of Science, Google Scholar, and EBSCO CINAHL from inception up to December 26, 2020. The search was not restricted to time, publication status, or language. Two independent investigators screened the identified studies and extracted the data in duplicate. We conducted a meta-analysis using RevMan v.5. The risk of bias was assessed using Cochrane collaboration tools. Comparisons were made between patients with OSA, diagnosed in-laboratory polysomnography or home sleep apnea testing, and patients without OSA in relation to established markers of DD. RESULTS Primary search identified 2,512 studies. A total of 18 studies including 2,509 participants were included. The two groups were free of conventional cardiovascular risk factors. Significant structural changes were observed between the two groups. Patients with OSA exhibited greater left atrial volume index (LAVI) (3.94 95% CI [0.8, 7.07]; p = 0.000) and left ventricular mass index (11.10 95% CI [2.56, 19.65]; p = 0.000) as compared to control group. The presence of OSA was also associated with more prolonged deceleration time (10.44 ms 95% CI [0.71, 20.16]; p = 0.04), isovolumic relaxation time (IVRT) (7.85 ms 95% CI [4.48, 11.22]; p = 0.000), and a lower ratio of early to late mitral inflow velocities (E/A) ratio (-0.62 95% CI [-1, -0.24]; p = 0.001) suggestive of early DD. The early mitral inflow velocity to mitral annular early diastolic velocity (E/e') ratio (0.94 95% CI [0.44, 1.45]; p = 0.000) was increased. Linear correlation between severity of OSA and LAVI and IVRT parameters was observed but this association did not sustain for the E/A and E/e'. The ejection fraction was not significantly different between patients with OSA and healthy controls (-0.48 95% CI [-1.18, 0.23]; p = 0.18). CONCLUSION An association between OSA and echocardiographic parameters of DD was detected that was independent of conventional cardiovascular risk factors. OSA may be independently associated with DD perhaps due to higher LV mass. Investigating the role of continuous positive airway pressure therapy in reversing or ameliorating DD is recommended.
Collapse
Affiliation(s)
- Mohammed Al-Sadawi
- Department of Cardiovascular Medicine, Stony Brook Medicine, Stony Brook, New York, USA
| | - Kleanthis Theodoropoulos
- Division of Cardiovascular Medicine, Department of Medicine, SUNY Downstate, Brooklyn, New York, USA
| | - Farzane Saeidifard
- Department of Internal Medicine, Lenox Hill Hospital, Northwell Health, Zucker School of Medicine, New York, New York, USA.,Division of Pulmonary and Critical Care Medicine, Department of Veterans Administration NY Harbor Healthcare System, Brooklyn Campus, Brooklyn, New York, USA
| | - Adekunle Kiladejo
- Division of Cardiovascular Medicine, Department of Medicine, SUNY Downstate, Brooklyn, New York, USA
| | - Mohammad Al-Ajam
- Division of Pulmonary and Critical Care Medicine, Department of Veterans Administration NY Harbor Healthcare System, Brooklyn Campus, Brooklyn, New York, USA
| | - Louis Salciccioli
- Division of Cardiovascular Medicine, Department of Medicine, SUNY Downstate, Brooklyn, New York, USA
| | - Adam S Budzikowski
- Division of Cardiovascular Medicine, Department of Medicine, SUNY Downstate, Brooklyn, New York, USA
| |
Collapse
|
23
|
Polok K, Fronczek J, Artigas A, Flaatten H, Guidet B, De Lange DW, Fjølner J, Leaver S, Beil M, Sviri S, Bruno RR, Wernly B, Bollen Pinto B, Schefold JC, Studzińska D, Joannidis M, Oeyen S, Marsh B, Andersen FH, Moreno R, Cecconi M, Jung C, Szczeklik W, Joannidis M, Mesotten D, Reper P, Oeyen S, Swinnen W, Brix H, Brushoej J, Villefrance M, Nedergaard HK, Bjerregaard AT, Balleby IR, Andersen K, Hansen MA, Uhrenholt S, Bundgaard H, Fjølner J, Hussein AARM, Salah R, Ali YKNM, Wassim K, Elgazzar YA, Tharwat S, Azzam AY, habib AA, Abosheaishaa HM, Azab MA, Leaver S, Galbois A, Guidet B, Charron C, Guerot E, Besch G, Rigaud JP, Maizel J, Djibré M, Burtin P, Garcon P, Nseir S, Valette X, Alexandru N, Marin N, Vaissiere M, Plantefeve G, Vanderlinden T, Jurcisin I, Megarbane B, Caillard A, Valent A, Garnier M, Besset S, Oziel J, RAPHALEN JH, Dauger S, Dumas G, Goncalves B, Piton G, Barth E, Goebel U, Barth E, Kunstein A, Schuster M, Welte M, Lutz M, Meybohm P, Steiner S, Poerner T, Haake H, Schaller S, Schaller S, Schaller S, Kindgen-Milles D, Meyer C, Kurt M, Kuhn KF, Randerath W, Wollborn J, Dindane Z, Kabitz HJ, Voigt I, Shala G, Faltlhauser A, Rovina N, Aidoni Z, Chrisanthopoulou E, Papadogoulas A, Gurjar M, Mahmoodpoor A, Ahmed AK, Marsh B, Elsaka A, Sviri S, Comellini V, Rabha A, Ahmed H, Namendys-Silva SA, Ghannam A, Groenendijk M, Zegers M, de Lange D, Cornet A, Evers M, Haas L, Dormans T, Dieperink W, Romundstad L, Sjøbø B, Andersen FH, Strietzel HF, Olasveengen T, Hahn M, Czuczwar M, Gawda R, Klimkiewicz J, de Lurdes Campos Santos M, Gordinho A, Santos H, Assis R, Oliveira AIP, Badawy MR, Perez-Torres D, Gomà G, Villamayor MI, Mira AP, Cubero PJ, Rivera SA, Tomasa T, Iglesias D, Vázquez EM, Aldecoa C, Ferreira AF, Zalba-Etayo B, Canas-Perez I, Tamayo-Lomas L, Diaz-Rodriguez C, Sancho S, Priego J, Abualqumboz EMY, Hilles MMY, Saleh M, Ben-HAmouda N, Roberti A, Dullenkopf A, Fleury Y, Bollen Pinto B, Schefold JC, Al-Sadawi M. Noninvasive ventilation in COVID-19 patients aged ≥ 70 years-a prospective multicentre cohort study. Crit Care 2022; 26:224. [PMID: 35869557 PMCID: PMC9305028 DOI: 10.1186/s13054-022-04082-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/27/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Noninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV. METHODS This is a substudy of COVIP study-an international prospective observational study enrolling patients aged ≥ 70 years with confirmed COVID-19 treated in ICU. We enrolled patients in 156 ICUs across 15 European countries between March 2020 and April 2021.The primary endpoint was 30-day mortality. RESULTS Cohort included 3074 patients, most of whom were male (2197/3074, 71.4%) at the mean age of 75.7 years (SD 4.6). NIV frequency was 25.7% and varied from 1.1 to 62.0% between participating countries. Primary NIV failure, defined as need for endotracheal intubation or death within 30 days since ICU admission, occurred in 470/629 (74.7%) of patients. Factors associated with increased NIV failure risk were higher Sequential Organ Failure Assessment (SOFA) score (OR 3.73, 95% CI 2.36-5.90) and Clinical Frailty Scale (CFS) on admission (OR 1.46, 95% CI 1.06-2.00). Patients initially treated with NIV (n = 630) lived for 1.36 fewer days (95% CI - 2.27 to - 0.46 days) compared to primary IMV group (n = 1876). CONCLUSIONS Frequency of NIV use varies across European countries. Higher severity of illness and more severe frailty were associated with a risk of NIV failure among critically ill older adults with COVID-19. Primary IMV was associated with better outcomes than primary NIV. Clinical Trial Registration NCT04321265 , registered 19 March 2020, https://clinicaltrials.gov .
Collapse
Affiliation(s)
- Kamil Polok
- grid.5522.00000 0001 2162 9631Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30 – 901 Kraków, Poland ,grid.5522.00000 0001 2162 9631Department of Pulmonology, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Fronczek
- grid.5522.00000 0001 2162 9631Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30 – 901 Kraków, Poland
| | - Antonio Artigas
- grid.7080.f0000 0001 2296 0625Critical Care Department, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Sabadell, Spain
| | - Hans Flaatten
- grid.412008.f0000 0000 9753 1393Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bertrand Guidet
- grid.462844.80000 0001 2308 1657INSERM, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Equipe: Epidémiologie Hospitalière Qualité et Organisation des Soins, Sorbonne Universités, UPMC Univ Paris 06, 75012 Paris, France ,grid.50550.350000 0001 2175 4109Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Dylan W. De Lange
- grid.5477.10000000120346234Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Jesper Fjølner
- grid.416838.00000 0004 0646 9184Department of Anaesthesia and Intensive Care, Viborg Regional Hospital, Viborg, Denmark
| | - Susannah Leaver
- grid.464688.00000 0001 2300 7844Department of Critical Care Medicine, St George’s Hospital, London, UK
| | - Michael Beil
- grid.17788.310000 0001 2221 2926Medical Intensive Care Unit, Hadassah Medical Center, Jerusalem, Israel
| | - Sigal Sviri
- grid.9619.70000 0004 1937 0538Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raphael Romano Bruno
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Bernhard Wernly
- grid.21604.310000 0004 0523 5263Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria ,grid.21604.310000 0004 0523 5263Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Bernardo Bollen Pinto
- grid.150338.c0000 0001 0721 9812Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Joerg C. Schefold
- grid.5734.50000 0001 0726 5157Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dorota Studzińska
- grid.5522.00000 0001 2162 9631Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30 – 901 Kraków, Poland
| | - Michael Joannidis
- grid.5361.10000 0000 8853 2677Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- grid.410566.00000 0004 0626 3303Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Brian Marsh
- grid.411596.e0000 0004 0488 8430Department of Critical Care Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H. Andersen
- grid.459807.7Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway ,grid.5947.f0000 0001 1516 2393Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rui Moreno
- grid.414551.00000 0000 9715 2430Faculdade de Ciências Médicas de Lisboa - Nova Médical School, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal ,grid.7427.60000 0001 2220 7094Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Maurizio Cecconi
- grid.417728.f0000 0004 1756 8807Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center – IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Rozzano, MI Italy
| | - Christian Jung
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Wojciech Szczeklik
- grid.5522.00000 0001 2162 9631Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30 – 901 Kraków, Poland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Al-Sadawi M, Aleem S, Aslam F, Jacobs R, Stevens G, Almasry I, Singh A, Fan R, Rashba E. Rhythm versus rate control for atrial fibrillation in heart failure with preserved ejection fraction. Heart Rhythm O2 2022; 3:520-525. [DOI: 10.1016/j.hroo.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
25
|
Alsaiqali M, Al-Sadawi M. CONTRAST ASSOCIATED NEPHROPATHY(CAN) IN PATIENTS WITH RENAL TRANSPLANT. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01611-4] [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]
|
26
|
Al-Sadawi M, Aslam F, Alsadaoee M, Ijaz H, Dhar K, Singh A. THE EFFECT OF ONCE-WEEKLY OF HIGH DOSE SEMAGLUTIDE ON BODY WEIGHT AND PHYSICAL ACTIVITY: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02537-2] [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: 11/17/2022]
|
27
|
Al-Sadawi M, Aslam F, Aleem S, Alsadaoee M, Alexander SG, Singh A, Almasry IO, Fan R, Rashba EJ. THE EFFECT OF GLP-1 AGONISTS IN PATIENTS WITH TYPE 2 DIABETES ON ALL-CAUSE MORTALITY AND CARDIOVASCULAR MORTALITY: AN UPDATED META-ANALYSIS OF 44 RANDOMIZED CONTROLLED TRIALS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02533-5] [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: 12/01/2022]
|
28
|
Al-Sadawi M, Saeidifard F, Kort S, Cao K, Capric V, Salciccioli L, Al-Ajam M, Budzikowski AS. Treatment of Sleep Apnea with Positive Airway Pressure and Its Association with Diastolic Dysfunction: A Systematic Review and Meta-Analysis. Respiration 2021; 101:334-344. [PMID: 34872099 DOI: 10.1159/000519406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This meta-analysis assessed the effect of long-term (>6 weeks) noninvasive positive airway pressure (PAP) on diastolic function in patients with obstructive sleep apnea (OSA). METHODS We searched the databases for randomized clinical trials including Ovid MEDLINE, Ovid Embase Scopus, Web of Science, Google Scholar, and EBSCO CINAHL from inception up to December 20, 2019. The search was not restricted to time, publication status, or language. Two independent investigators screened the studies and extracted the data, in duplicate. Risk of bias was assessed using Cochrane collaboration tools. RESULTS A total of 2,753 abstracts were resulted from literature search. A total of 9 randomized clinical trials assessing the effect of long-term (>6 weeks) PAP on diastolic function in patients with OSA including 833 participants were included. The following echo parameters were found in treated patients: a decrease in deceleration time (-39.49 ms CI [-57.24, -21.74]; p = 0.000), isovolumic relaxation time (-9.32 ms CI [-17.08, -1.57]; p = 0.02), and the ratio of early mitral inflow velocity to mitral annular early diastolic velocity (-1.38 CI [-2.6, -0.16]; p = 0.03). However, changes in left-atrial volume index and the ratio of early to late mitral inflow velocities were not statistically different. The risk of bias was mild to moderate among the studies. CONCLUSION Our results suggest that chronic treatment of moderate to severe OSA with noninvasive PAP is associated with improvement in echocardiographic findings of diastolic dysfunction.
Collapse
Affiliation(s)
- Mohammed Al-Sadawi
- Cardiovascular Department, Stony Brook Medicine, Stony Brook, New York, USA
| | - Farzane Saeidifard
- Internal Medicine Department, Lenox Hill Hospital, New York, New York, USA
| | - Smadar Kort
- Cardiovascular Department, Stony Brook Medicine, Stony Brook, New York, USA
| | - Kerry Cao
- Internal Medicine Department, Stony Brook Medicine, Stony Brook, New York, USA
| | - Violeta Capric
- Internal Medicine Department, SUNY Downstate, Brooklyn, New York, USA
| | | | - Mohammad Al-Ajam
- Pulmonary and Critical Care Department, Harbor VA, Brooklyn, New York, USA
| | | |
Collapse
|
29
|
Al-Sadawi M, Kane J, Stevens GA, Parikh P. Sex-related differences in long-term mortality after coronary artery bypass graft surgery: a systematic review and meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
This meta-analysis assessed the sex-related differences in long-term mortality (>7 years) after Coronary Artery Bypass Graft (CABG) Surgery.
Purpose
Women has higher incidence of short-term cardiovascular mortality after CABG compared to men. However, data about long-term differences are controversial.
Methods
We searched the databases for studies reporting sex-specific mortality following CABG including Ovid MEDLINE, Ovid, Embase, Scopus, Web of Science, Google Scholar, and EBSCO CINAHL from inception up to December 31st, 2020. The search was not restricted to time or publication status. Outcomes included rates of long-term mortality (>7 year or longer).
Results
A total of 518 studies were resulted from literature search. A total of 14 studies and 204,223 patients; 158,663 men and 45,556 women, with a mean age of the men 60.2 years and 63.2 years for women, were included in our systematic review and meta-analysis. Our analysis suggested sex-related differences in long-term mortality (>7 years) following CABG (odds ratio (1), 1.15; 95% confidence interval (2), 1.017–1.30; P<.02).
Conclusions
Our results suggest that women had higher long-term mortality following CABG compared with men. It is the largest study to date of sex-specific differences in long-term mortality (>7 years).
Funding Acknowledgement
Type of funding sources: None. Meta-analysisDemographics
Collapse
Affiliation(s)
- M Al-Sadawi
- Stony Brook University Medical Center, Cardiovascular Medicine, Stony Brook, United States of America
| | - J Kane
- Stony Brook University Medical Center, Cardiovascular Medicine, Stony Brook, United States of America
| | - G A Stevens
- Stony Brook University Medical Center, Cardiovascular Medicine, Stony Brook, United States of America
| | - P Parikh
- Stony Brook University Medical Center, Cardiovascular Medicine, Stony Brook, United States of America
| |
Collapse
|
30
|
Haseltine J, Apte A, Jackson A, Yorke E, Yu A, Wu A, Peleg A, Al-Sadawi M, Iocolano M, Gelblum D, Shaverdian N, Simone, Ii C, Rimner A, Gomez D, Shepherd A. P27.02 Associating Cardiac Plaque Accumulation With Cardiac Toxicity and Overall Survival In Locally Advanced Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
31
|
Al-Sadawi M, Saad M, Ayyadurai P, Shah NN, Bhandari M, Vittorio TJ. Biomarkers in Acute Heart Failure Syndromes: An Update. Curr Cardiol Rev 2021; 18:e090921196330. [PMID: 34503430 DOI: 10.2174/1573403x17666210909170415] [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: 04/26/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 11/22/2022] Open
Abstract
Heart failure is one of the leading healthcare problems in the world. Clinical data lacks sensitivity and specificity in the diagnosis of heart failure. Laboratory biomarkers are a non-invasive method of assessing suspected decompensated heart failure. Biomarkers such as natriuretic peptides have shown promising results in the management of heart failure. The literature does not provide comprehensive guidance in the utilization of biomarkers in the setting of acute heart failure syndrome. Many conditions that manifest with similar pathophysiology as acute heart failure syndrome may demonstrate positive biomarkers. The following is a review of biomarkers in heart failure, enlightening their role in diagnosis, prognosis and management of heart failure.
Collapse
Affiliation(s)
- Mohammed Al-Sadawi
- Cardiovascular Medicine Department, SUNY Stony Brook Medicine, Stony Brook, NY. United States
| | - Muhammad Saad
- Division of Internal Medicine, BronxCare Hospital Center, Bronx, NY. United States
| | | | - Niel N Shah
- Division of Internal Medicine, BronxCare Hospital Center, Bronx, NY. United States
| | - Manoj Bhandari
- Division of Cardiology, BronxCare Hospital Center, Bronx, NY. United States
| | - Timothy J Vittorio
- Division of Cardiology, BronxCare Hospital Center, Bronx, NY. United States
| |
Collapse
|
32
|
Chera HH, Al-Sadawi M, Michelakis N, Spinelli M. Optimizer Smart System for the treatment of chronic heart failure: Overview of its safety and efficacy. Expert Rev Med Devices 2021; 18:505-512. [PMID: 34323128 DOI: 10.1080/17434440.2021.1923478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Heart failure (HF) is a major cause of morbidity and mortality throughout the world. Despite the significant progress in the prevention and treatment of HF, mortality rates still remain high. Device therapy for HF includes cardiac resynchronization therapy (CRT) and the use of an implantable cardioverter-defibrillator (ICD). Recently, a new device therapy for the treatment of HF became available, called cardiac contractility modulation (CCM). CCM is a new device therapy for patients with HF who do not qualify for CRT. It is implanted in a minimally invasive manner to improve the patient's morbidity. Optimizer Smart System is a new device that delivers CCM therapy.Areas covered: We review the function of the Optimizer Smart System, the data from the recent clinical trials, and discuss its efficacy and future projections in the treatment for HF.Expert opinion: CCM therapy provided with the Optimizer® Smart System is safe, feasible, and applicable to a wide range of patients with HF. To demonstrate the effectiveness of the Optimizer Smart System's use merits further large multicenter randomized controlled trials.
Collapse
|
33
|
Battisha A, Altibi AM, Madoukh B, Sheikh O, Sawalha K, Shaikh S, Al-Sadawi M. Spontaneous Biliary Pericardial Tamponade: A Case Report and Literature Review. Curr Cardiol Rev 2021; 17:204-208. [PMID: 32525780 PMCID: PMC8226206 DOI: 10.2174/1573403x16666200611132045] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Biliary pericardial tamponade (BPT) is a rare form of pericardial tamponade, characterized by yellowish-greenish pericardial fluid upon pericardiocentesis. Historically, BPT reported to occur in the setting of an associated pericardiobiliary fistula. However, BPT in the absence of a detectable fistula is extremely rare. LEARNING OBJECTIVE A biliary pericardial tamponade is a rare form of tamponade warranting a prompt workup (e.g., MRCP or HIDA scan) for a potential fistula between the biliary system and the pericardial space. A pericardio-biliary fistula can be iatrogenic or traumatic. People with a history of chest wall trauma, abdominal surgery, or chest surgery are at increased risk. The use of HIDA scanning plays a salient role in effectively surveilling for the presence of a fistula - especially when MRCP is contraindicated. CASE PRESENTATION A 75-year-old Hispanic male presenting with dyspnea and diagnosed with cardiac tamponade is the subject of the study. Subsequent pericardiocentesis revealed biliary pericardial fluid (bilirubin of 7.6 mg/dl). The patient underwent extensive workup to identify a potential fistula between the hepatobiliary system and the pericardial space, which was non-revealing. The mechanism of bile entry into the pericardial space remains to be unidentified. LITERATURE REVIEW A total of six previously published BPT were identified: all were males, with a mean age of 53.3 years (range: 31-73). Mortality was reported in two out of the six cases. The underlying etiology for pericardial tamponade varied across the cases: incidental pericardio-biliary fistula, traumatic pericardial injury, and presence of associated malignancy. - Conclusion: Biliary pericardial tamponade is a rare form of tamponade that warrants a prompt workup (e.g., Hepatobiliary Iminodiacetic Acid - HIDA scan) for an iatrogenic vs. traumatic pericardio- biliary fistula. As a first case in the literature, our case exhibits a biliary tamponade in the absence of an identifiable fistula.
Collapse
Affiliation(s)
- Ayman Battisha
- University of Massachusetts Medical School, Baystate, Springfield, MA 01107, United States
| | - Ahmed M Altibi
- Henry Ford Allegiance Health Hospital, Jackson, MA 49201, United States
| | - Bader Madoukh
- Overland Park Regional Medical Center, Overland Park, KS 66215, United States
| | - Omar Sheikh
- University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Khalid Sawalha
- University of Massachusetts Medical School, Baystate, Springfield, MA 01107, United States
| | - Shakil Shaikh
- State University of New York: Downstate Medical Center, Brooklyn, NY 11202, United States
| | - Mohammed Al-Sadawi
- State University of New York: Downstate Medical Center, Brooklyn, NY 11202, United States
| |
Collapse
|
34
|
Al-Sadawi M, Hussain Y, Copeland-Halperin RS, Tobin JN, Moskowitz CS, Dang CT, Liu JE, Steingart RM, Johnson MN, Yu AF. Racial and Socioeconomic Disparities in Cardiotoxicity Among Women With HER2-Positive Breast Cancer. Am J Cardiol 2021; 147:116-121. [PMID: 33617819 DOI: 10.1016/j.amjcard.2021.02.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 01/23/2023]
Abstract
Breast cancer and cardiovascular-specific mortality are higher among blacks compared with whites, but disparities in cancer therapy-related adverse cardiovascular outcomes have not been well studied. We assessed for the contribution of race and socioeconomic status on cardiotoxicity among women with HER2-positive breast cancer. This retrospective cohort analysis studied women diagnosed with stage I-III HER2-positive breast cancer from 2004-2013. All underwent left ventricular ejection fraction assessment at baseline and at least one follow-up after beginning trastuzumab. Multivariable logistic regression was used to assess the association between race and socioeconomic status (SES) on cardiotoxicity, defined by clinical heart failure (New York Heart Association class III or IV) or asymptomatic left ventricular ejection fraction decline (absolute decrease ≥ 10% to < 53%, or ≥ 16%). Blacks had the highest prevalence of hypertension, diabetes, and increased BMI. Neighborhood-level SES measures including household income and educational attainment were lower for blacks compared with whites and others. The unadjusted cardiotoxicity risk was significantly higher in black compared with white women (OR, 2.10; 95% CI, 1.42 to 3.10). In a multivariable analysis, this disparity persisted after controlling for relevant cardiovascular risk factors (adjusted OR, 1.88; 95% CI, 1.25 to 2.84). Additional models adjusting for SES factors of income, educational attainment, and insurance status did not significantly alter the association between race and cardiotoxicity. In conclusion, black women are at increased risk of cardiotoxicity during HER2-targeted breast cancer therapy. Future etiologic analyses, particularly studies exploring biologic or genetic mechanisms, are needed to further elucidate and reduce racial disparities in cardiotoxicity.
Collapse
|
35
|
Aleem S, Al-Sadawi M, Fan R. DIGOXIN TOXICITY WITH NEGATIVE SERUM DIGOXIN LEVELS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03475-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
36
|
Al-Sadawi M, Aleem S, Pyo R. RESOLUTION OF A PROXIMAL LAD THROMBUS IN A YOUNG MALE WITHOUT PERCUTANEOUS INTERVENTION. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03937-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
37
|
Shepherd A, Yu A, Al-Sadawi M, Peleg A, Iocolano M, Leeman J, Imber B, Wild A, Offin M, Chaft J, Huang J, Rimner A, Wu A, Gelblum D, Shaverdian N, Gomez D, Simone Ii C, Yorke E, Jackson A. FP04.01 Heart Dose is a Dosimetric Predictor of Overall Survival in Patients with NSCLC Undergoing Post-Operative Radiation Therapy. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
38
|
Doughem K, Battisha A, Sheikh O, Konduru L, Madoukh B, Al-Sadawi M, Shaikh S. Hydralazine-Induced ANCA Associated Vasculitis (AAV) Presenting with Pulmonary-Renal Syndrome (PRS): A Case Report with Literature Review. Curr Cardiol Rev 2021; 17:182-187. [PMID: 32418528 PMCID: PMC8226194 DOI: 10.2174/1573403x16666200518092814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/29/2020] [Accepted: 03/23/2020] [Indexed: 01/26/2023] Open
Abstract
Hydralazine, an arterial vasodilator, is a widely used medication for the management of hypertension and heart failure, especially for patients who cannot tolerate the use of ACEIs or ARBs. It is generally well-tolerated and has a safe profile in pregnancy. However, hydralazine can induce immune-mediated side effects, such as hydralazine-induced lupus and less commonly hydralazine- induced ANCA vasculitis. The latter most commonly affects the kidneys with or without other organ involvement. There are several cases reported in the literature of hydralazine-induced ANCA associated vasculitis (AAV) that have pulmonary manifestations, also known as hydralazine- induced pulmonary-renal syndrome (PRS), a condition with a high risk of mortality. We are reporting a case of Hydralazine-induced ANCA associated glomerulonephritis with severe diffuse alveolar hemorrhage (DAH). In addition, we will review the current literature and discuss the importance of prompt diagnosis and early management to decrease mortality and morbidity associated with this serious condition.
Collapse
Affiliation(s)
- Karim Doughem
- Address correspondence to this author at University of Texas Health Science Center at Houston, Houston, TX 77030, United States; E-mail:
| | | | | | | | | | | | | |
Collapse
|
39
|
Al-Sadawi M, Ortega RR, Ariyaratnam J, Battisha A, Madoukh B, Bukharovich I. State-of-the-Art Review of Current Therapies for HFpEF: An Overview of Interatrial Septal Device Therapy in Heart Failure. Curr Cardiol Rev 2020; 17:e230421189012. [PMID: 33305708 PMCID: PMC8950450 DOI: 10.2174/1573403x16999201210195455] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/17/2020] [Accepted: 08/03/2020] [Indexed: 11/24/2022] Open
Abstract
Heart failure (HF) affects an increasing number of geriatric patients. The condition is classified according to whether the left ventricular ejection fraction (EF) is reduced or preserved. Many patients have heart failure with preserved ejection fraction (HFpEF) and face a shortage of effective therapeutic strategies. However, an emerging mechanical strategy for treatment is gaining momentum. Interatrial septal connection devices, i.e. V-wave device and Interatrial septal device, are new devices for patients with heart failure with preserved ejection fraction. We review the function of these systems and the data from the recent clinical trials. Interatrial septal connection device therapy provided favorable efficacy and safety profile applicable to a wide range of patients with HFpEF. However, the long-term effects of these devices on morbidity and mortality merits longitudinal studies and large multicenter randomized controlled trials.
Collapse
Affiliation(s)
- Mohammed Al-Sadawi
- Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY 11720, United States
| | - Romy R Ortega
- Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, United States
| | - Jonathan Ariyaratnam
- Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, United States
| | - Ayman Battisha
- Department of Internal Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA 01199, United States
| | - Bader Madoukh
- Department of Internal Medicine, Overland Park Regional Medical Center-HCA Midwest Health, Overland Park, KS 66215, United States
| | - Inna Bukharovich
- Department of Cardiovascular Medicine, Kings County Medical Center, Brooklyn, NY 11203, United States
| |
Collapse
|
40
|
Copeland-Halperin RS, Al-Sadawi M, Patil S, Liu JE, Steingart RM, Dang CT, Yu AF. Early Trastuzumab Interruption and Recurrence-Free Survival in ERBB2-Positive Breast Cancer. JAMA Oncol 2020; 6:1971-1972. [PMID: 33057570 PMCID: PMC7563661 DOI: 10.1001/jamaoncol.2020.4749] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/28/2020] [Indexed: 01/27/2023]
Affiliation(s)
| | | | - Sujata Patil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer, New York, New York
- Weill Cornell Medical College, New York, New York
| | - Jennifer E. Liu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | - Richard M. Steingart
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | - Chau T. Dang
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | - Anthony F. Yu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| |
Collapse
|
41
|
Al-Sadawi M, Francois J, Rodriguez Ortega R, Capric V, Budzikowski AS. Novel oral anticoagulants in intracardiac thrombosis resolution: a case series. Eur Heart J Case Rep 2020; 4:1-6. [PMID: 33204959 PMCID: PMC7649461 DOI: 10.1093/ehjcr/ytaa181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 01/05/2020] [Revised: 01/28/2020] [Accepted: 05/29/2020] [Indexed: 11/13/2022]
Abstract
Background Vitamin K antagonists (VKAs) have been regarded as the therapy of choice for intracardiac thrombosis for decades based mostly on observational data. The advent of direct oral anticoagulants (DOACs) has displaced VKAs as the first-line therapy for multiple thrombotic disorders but not for intracardiac thrombosis. Although limited, there is growing evidence that DOACs are effective for intracardiac thrombosis and some data suggest that thrombus resolution might be superior to that with warfarin. Case summary Here, we present a series of six patients with left atrial appendage thrombi were treated with a venous thromboembolic dose of DOACs with resolution within 2–6 months with no reported complications. Discussion This case series adds to the accumulating evidence supporting the efficacy of DOACs in the treatment of intracardiac thrombi.
Collapse
Affiliation(s)
- Mohammed Al-Sadawi
- Department of Internal Medicine, SUNY Downstate, 450 Clarkson Ave Box 1199, Brooklyn, NY 11203, USA
| | - Jonathan Francois
- Department of Internal Medicine, SUNY Downstate, 450 Clarkson Ave Box 1199, Brooklyn, NY 11203, USA
| | - Romy Rodriguez Ortega
- Department of Internal Medicine, SUNY Downstate, 450 Clarkson Ave Box 1199, Brooklyn, NY 11203, USA
| | - Violeta Capric
- Department of Internal Medicine, SUNY Downstate, 450 Clarkson Ave Box 1199, Brooklyn, NY 11203, USA
| | - Adam S Budzikowski
- Division of Cardiovascular Medicine, Electrophysiology Section, Department of Medicine, SUNY Downstate, 450 Clarkson Ave Box 1199, Brooklyn, NY 11203, USA
| |
Collapse
|
42
|
Hossain N, Hossain N, Al-Sadawi M, Haq S. Bezold–Jarisch reflex-mediated asystole during dobutamine stress testing: a case report. Eur Heart J Case Rep 2020; 4:1-6. [PMID: 33532694 PMCID: PMC7837248 DOI: 10.1093/ehjcr/ytaa348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/21/2020] [Accepted: 09/03/2020] [Indexed: 11/17/2022]
Abstract
Background The Bezold–Jarisch reflex (BJR) is a cardioinhibitory parasympathetic response to activation of ventricular mechanoreceptors, which can result in bradycardia, atrioventricular block, or asystole. This phenomenon has been triggered by acute myocardial ischaemia, intra-arterial nitroglycerine use, natriuretic peptides, and with exceptional rarity, in middle-aged women only, by dobutamine infusion during stress echocardiography. Case summary We present the case of a 61-year-old woman who suffered a 5.1-s sinus pause during her 20 μg/kg/min infusion of dobutamine. Recovery was immediate following termination of dobutamine infusion. Concurrent echocardiography was normal, and subsequent cardiac catheterization and electrophysiologic study were normal. Discussion This is the fifth documented case of a severe BJR causing asystole during dobutamine infusion, which adds to the accumulating evidence supporting the benign nature of the condition.
Collapse
Affiliation(s)
- Nimrah Hossain
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, NY 11215, USA
| | - Naseem Hossain
- Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, USA
| | - Mohammed Al-Sadawi
- Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, USA
| | - Salman Haq
- Division of Cardiology, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, NY 11215, USA
| |
Collapse
|
43
|
Al-Sadawi M, Budzikowski A, Lee J, Jallad A, Sidiqi B, Ibtida I, Qaiser Y, Chandrakumar HP, Tadayoni A, Madaj P. TCT CONNECT-217 Hydroxychloroquine and Azithromycin Usage in African American Patients With Coronavirus Disease 2019 (COVID-19) and Their Effects on QT Interval. J Am Coll Cardiol 2020. [PMCID: PMC7581319 DOI: 10.1016/j.jacc.2020.09.232] [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: 11/24/2022]
|
44
|
Battisha A, Madoukh B, Sheikh O, Altibi A, Sheikh S, Al-Sadawi M. Coronary Fistula Between Left Anterior Descending Artery (LAD) and Pulmonary Artery (PA) Leading to Sudden Cardiac Death: Case Report with Literature Review. Curr Cardiol Rev 2020; 16:98-102. [PMID: 31593531 PMCID: PMC7460707 DOI: 10.2174/1573403x15666191008100848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/14/2019] [Accepted: 08/27/2019] [Indexed: 11/22/2022] Open
Abstract
Coronary Artery Fistulas (CAF) are inappropriate connections between a coronary artery and a major vessel or a cardiac chamber. These fistulas may or may not present with symptoms, but they need to be detected as early as possible in order to decide the most appropriate treatment methodology (i.e. surgery vs. conservative management). We report the case of a 67-year-old female with no modifiable cardiovascular risk factors who had an unwitnessed sudden death at home during her ongoing evaluation of a fistula detected incidentally between the Left Anterior Descending Artery (LAD) and the Pulmonary Artery (PA). This case highlights that early diagnosis and treatment of symptomatic CAF are crucial to minimize the risk of sudden cardiac death. Although the symptomatic fistula of LAD to PA has been reported in the literature multiple times, it has been rarely reported that this fistula can result in sudden cardiac death.
Collapse
Affiliation(s)
- Ayman Battisha
- Department of Internal Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, MA 01003, United States
| | - Bader Madoukh
- Department of Internal Medicine, Overland Park Regional Medical Center-HCA Midwest Health, Overland Park, Kansas, KS, United States
| | - Omar Sheikh
- Department of Internal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 77030, United States
| | - Ahmed Altibi
- Department of Internal Medicine, Henry Ford Allegiance Health, Jackson, MI, United States
| | - Shakil Sheikh
- Department of Cardiology, State University of New York, Downstate Medical Center, Brooklyn, New York, NY 12222, United States
| | - Mohammed Al-Sadawi
- Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, NY 12222, United States
| |
Collapse
|
45
|
Battisha A, Sawalha K, Madoukh B, Sheikh O, Doughem K, Al-Akchar M, Al-Sadawi M, Shaikh S. Acute Myocardial Infarction in Systemic Mastocytosis: Case Report With Literature Review on the Role of Inflammatory Process in Acute Coronary Syndrome. Curr Cardiol Rev 2020; 16:333-337. [PMID: 32228426 PMCID: PMC7903504 DOI: 10.2174/1573403x16666200331123242] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/03/2020] [Accepted: 03/16/2020] [Indexed: 12/18/2022] Open
Abstract
Background Systemic Mastocytosis (SM) is a disorder of excessive mast cell infiltration in multiple organ tissues. Atherosclerosis is a major risk factor for developing acute coronary syndrome. In addition to lipid accumulation in the arterial wall, inflammation plays an important role in the pathogenesis of plaque rupture and activating the thrombosis cascade. The Mast cells contribution to plaque destabilization has been well established in multiple animal and human studies. In a recent study, SM has been proven to be associated with a higher incidence of acute coronary syndrome even with lower plasma lipids levels. The study showed that 20% of patients with SM had cardiovascular events compared to only 6% in the control group with adjustment to all cardiac risk factors. Case We presented a patient with no risk factors for heart disease other than old age and history of SM who developed acute myocardial infarction. Conclusion SM can be life-threatening and can result in ACS, anaphylactic reaction, syncope, or cardiac arrest. Clinicians should have a high index of suspicion of acute coronary syndrome (ACS) occurrence in the setting of inflammatory conditions, such as SM and KS, and vice versa, where SM should be considered or ruled out in patients who suffer from anaphylaxis and cardiac arrest or myocardial infarction.
Collapse
Affiliation(s)
- Ayman Battisha
- University of Massachusetts Medical School-Baystate, Springfield, MA 01107, United States
| | - Khalid Sawalha
- University of Massachusetts Medical School-Baystate, Springfield, MA 01107, United States
| | - Bader Madoukh
- Overland Park Regional Medical Center-HCA Midwest Health, Kansas, KS 66215, United States
| | - Omar Sheikh
- University of Texas Health Science Center at San Antonio, San Antonio, TX78229, United States
| | - Karim Doughem
- University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Mohammad Al-Akchar
- Southern Illinois University School of Medicine, Springfield, IL 62701, United States
| | - Mohammed Al-Sadawi
- Department of Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, United States
| | - Shakil Shaikh
- Department of Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, United States
| |
Collapse
|
46
|
Theodoropoulos K, Ihsan M, Al-Sadawi M, Marmur J, Feit A. SPONTANEOUS RESOLUTION OF PROXIMAL LAD THROMBUS AND DISTAL EMBOLI WITH ORAL ANTICOAGULATION AND ANTIPLATELET THERAPY: A CASE OF ENDOGENOUS FIBRINOLYSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33390-8] [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]
|
47
|
Saeidifard F, Al-Sadawi M, Kiladejo A, Erwin P, Salciccioli LF, Budzikowski A. THE ASSOCIATION OF SEVERITY OF SLEEP APNEA WITH ECHOCARDIOGRAPHIC MEASURES OF DIASTOLIC DYSFUNCTION: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31484-4] [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: 10/24/2022]
|
48
|
Al-Sadawi M, Saeidifard F, Kiladejo A, Almasri M, Erwin P, Budzikowski AS. SLEEP APNEA AS A RISK FACTOR FOR DIASTOLIC DYSFUNCTION: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32292-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
49
|
Al-Sadawi M, Singh K, Capric V, Mohiuddin A, Haddadin M, Nunez A, Shaikh S, Bukharovich I, McFarlane SI. Incidence and Associated Risk Factors of Chemotherapy-Induced Cardiomyopathy in the African American and Afro-Caribbean Populations. Int J Clin Res Trials 2020; 5:154. [PMID: 33511317 PMCID: PMC7839991 DOI: 10.15344/2456-8007/2020/154] [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] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Chemotherapy-induced cardiomyopathy (CICM) and heart failure are major complications of cancer therapeutics and can result in significant morbidity and mortality. There is limited data on the incidence and risk factors of CICM in African American and Afro-Caribbean patients. METHODS We performed a retrospective chart review to evaluate the baseline characteristics that may predispose to CICM. Patients were African American and Afro-Caribbean ethnicity. Data was collected between 2014 to 2018. Patients had transthoracic echocardiogram (TTE) or multigated acquisition scan (MUGA) prior to cancer therapy and every 3 months thereafter, until the end of the regimen. CICM was defined as a ≥16% reduction in LVEF or ≥10% reduction in LVEF to a value <50%. RESULTS A total of 230 patients were studied, with a mean age of 54±12 years with 91% were females, BMI 30±4, 81% were taking anthracyclines, 87% were on Trastuzumab while 5% were receiving both medications. The prevalence of comorbidities was as follows: hypertension 8%, diabetes mellitus 8%, ESRD 8%, dyslipidemia 8%, CAD 7%. The incidence of CICM was 7% overall, while it was 6% and 8% for patients taking Anthracyclines and Trastuzumab, respectively. CICM was associated with dyslipidemia (r= .22, p= .001), hypertension (r= .12, p= .05), baseline ejection fraction (r= -.21, p= .001) and concomitant use of radiation therapy (r= .147, p= .02), but not with age, gender, beta blocker use, angiotensin converting enzyme inhibitor use, number of chemotherapy cycles or stage of the malignancy. On multivariate analysis CICM was independently associated with baseline ejection fraction (β= -.193, P= .003) and dyslipidemia (β= -.20, P= .003). CONCLUSION The incidence of CICM in African Americans and Afro-Caribbean is higher than reported in the general population. Dyslipidemia and baseline ejection fraction were seen as the major risk factors associated with the higher incidence of CICM.
Collapse
Affiliation(s)
- Mohammed Al-Sadawi
- Department of Internal Medicine, State University of New York: Downstate Medical Center, Brooklyn, NY 11203, United States
| | - Kurnvir Singh
- Department of Internal Medicine, State University of New York: Downstate Medical Center, Brooklyn, NY 11203, United States
| | - Violeta Capric
- Department of Internal Medicine, State University of New York: Downstate Medical Center, Brooklyn, NY 11203, United States
| | - Amena Mohiuddin
- Department of Internal Medicine, State University of New York: Downstate Medical Center, Brooklyn, NY 11203, United States
| | - Michael Haddadin
- Department of Internal Medicine, State University of New York: Downstate Medical Center, Brooklyn, NY 11203, United States
| | - Arismendy Nunez
- Department of Cardiovascular Medicine, State University of New York: Downstate Medical Center, Brooklyn, NY 11203, United States
| | - Shakil Shaikh
- Department of Cardiovascular Medicine, State University of New York: Downstate Medical Center, Brooklyn, NY 11203, United States
| | - Inna Bukharovich
- Department of Cardiovascular Medicine, Kings County Hospital Center, Brooklyn, NY 11203, United States
| | - Samy I. McFarlane
- Department of Internal Medicine, State University of New York: Downstate Medical Center, Brooklyn, NY 11203, United States,Corresponding Author: Prof. Samy I. McFarlane, College of Medicine, Department of Medicine, Division of Endocrinology, Internal Medicine Residency Program Director, State University of New York, Downstate Medical Center, 450 Clarkson Ave, Box 50, Brooklyn, New York, 11203-2098, USA. Phone 718-270-6707, Fax 718-270-4488;
| |
Collapse
|
50
|
Francois J, Al-Sadawi M, Casillas J, Botti E, Soni L, Ponse D, Decamps SM, McFarlane SI. Hypothyroidism and Heart Failure: Epidemiology, Pathogenetic Mechanisms & Therapeutic Rationale. Int J Clin Res Trials 2020; 5:146. [PMID: 32617437 PMCID: PMC7331968 DOI: 10.15344/2456-8007/2020/146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Heart Failure (HF) is a major public health problem and a major cause of morbidity and mortality worldwide. Thyroid hormones (TH) have multiple effects on the heart and cardiovascular system. In recent years, studies have shown that hypothyroidism, including subclinical hypothyroidism, is associated with an increased risk for developing and worsening of HF. This review addresses the relationship between HF and hypothyroidism by highlighting the epidemiology, pathophysiology and management.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Samy I. McFarlane
- Corresponding Author: Prof. Samy I. McFarlane, College of Medicine, Department of Medicine, Division of Endocrinology, Internal Medicine Residency Program Director, State University of New York, Downstate Medical Center, 450 Clarkson Ave, Box 50, Brooklyn, New York, USA, Tel 718-270-6707, Fax 718-270-4488;
| |
Collapse
|