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Chami T, Janus S, Mahowald MK, Brilakis ES. An Interventional Odyssey: The Importance of Planning and Prompt Recognition and Treatment of Complications During a Complex Chronic Total Occlusion Intervention. Cardiovasc Revasc Med 2023; 53S:S298-S301. [PMID: 35595608 DOI: 10.1016/j.carrev.2022.04.018] [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: 03/14/2022] [Revised: 04/16/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022]
Abstract
Despite significant progress, chronic total occlusion (CTO) percutaneous coronary interventions (PCI) are often challenging and carry increased risk of complications. We present a highly complex CTO PCI case that was successfully completed despite numerous complications (perforation, donor vessel closure, stent loss, guide extension tip fracture, access site bleeding and cardiac arrest) to highlight the importance of appropriate patient selection, pre-procedural planning, comprehensive patient-centered risk/benefit discussion, and prompt recognition and treatment of intra-procedural complications.
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Affiliation(s)
- Tarek Chami
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Scott Janus
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Madeline K Mahowald
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
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Dong T, Harris K, Freedman D, Janus S, Griggs S, Iyer Y, Nasir K, Neeland IJ, Rajagopalan S, Al-Kindi SG. Food insecurity and atherosclerotic cardiovascular disease risk in adults with diabetes. Nutrition 2023; 106:111865. [PMID: 36473415 PMCID: PMC9851285 DOI: 10.1016/j.nut.2022.111865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Adults with diabetes are at an increased risk of atherosclerotic cardiovascular disease (ASCVD), and food insecurity may be a major and underappreciated risk compounder in this population. We sought to analyze the prevalence of food insecurity and its association with ASCVD in adults with diabetes. METHODS A total of 6424 participants with diabetes were included from the 2019 and 2020 National Health Interview Survey. Food insecurity was determined with a 10-question U.S. Adult Food Security Survey Module, and classified as high, marginal, low, and very low. ASCVD was defined as a self-reported history of coronary artery disease, myocardial infarction, or stroke. RESULTS Of the 6424 included participants (weighted: n = 21 690 217), 5 405 543 (24.4%) reported a history of ASCVD and 2 946 061 (13.3%) were identified as food insecure (low or very low food security). Adults with food insecurity were more likely to have ASCVD than adults who were food secure (28.9% vs 23.7%; P = 0.008). In the multivariate analyses adjusted for traditional cardiovascular risk factors, all levels of food insecurity were associated with ASCVD compared with food-secure adults (marginal security: odds ratio [OR]: 1.60; 95% confidence interval [CI], 1.18-2.18]; P = 0.003; low security: OR: 2.09; 95% CI, 1.58-2.74]; P < 0.001; very low security: OR: 1.69; 95% CI, 1.22-2.34]; P = 0.001). The association persisted when adjusted for income, location, education, and insurance status. In adults with diabetes and ASCVD, income was a negative factor for food insecurity (OR: 0.71; 95% CI, 0.62-0.80; P < 0.001), but female sex and smoking were positive factors (OR: 1.90; 95% CI, 1.29-2.80; P = 0.001; and OR: 1.97; 95% CI, 1.23-3.18; P = 0.005; respectively). At younger ages, the prevalence of food insecurity increased, especially in adults with ASCVD. CONCLUSIONS We showed that 13% of U.S. adults with diabetes are food insecure, which was associated with ASCVD independent of traditional and socioeconomic risk factors. Our findings emphasize the importance of recognizing food insecurity as a driver of ASCVD in adults with diabetes, and encourage future efforts at reducing this disparity.
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Affiliation(s)
- Tony Dong
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Kristen Harris
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Darcy Freedman
- Mary Ann Swetland Center for Environmental Health, Case Western Reserve University, Cleveland, Ohio, USA; School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Scott Janus
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
| | - Stephanie Griggs
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yasaswini Iyer
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Khurram Nasir
- Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas, USA
| | - Ian J Neeland
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA; Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA; Center for Integrated and Novel Approaches in Vascular-Metabolic Disease, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
| | - Sanjay Rajagopalan
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA; Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA; Center for Integrated and Novel Approaches in Vascular-Metabolic Disease, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
| | - Sadeer G Al-Kindi
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA; Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA; Center for Integrated and Novel Approaches in Vascular-Metabolic Disease, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA.
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Dallan LAP, Reed J, Yoon SH, Janus S, Rajagopalan S, Rashid I, Al-Kindi S, Filby SJ. Novel cardiac magnetic resonance imaging-based sizing for left atrial appendage closure. J Cardiovasc Electrophysiol 2022; 33:2649-2650. [PMID: 36300704 DOI: 10.1111/jce.15720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/10/2022] [Accepted: 10/06/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Luis Augusto Palma Dallan
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Joseph Reed
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sung-Han Yoon
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Scott Janus
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sanjay Rajagopalan
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Imran Rashid
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sadeer Al-Kindi
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Steven J Filby
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Al-Kindi S, Motairek I, Janus S, Deo S, Rahman M, Neeland IJ, Rajagopalan S. Time-Varying Cardiovascular Effects of Finerenone in Diabetic Kidney Disease. J Am Coll Cardiol 2022; 80:1855-1856. [DOI: 10.1016/j.jacc.2022.08.791] [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] [Received: 06/03/2022] [Revised: 08/18/2022] [Accepted: 08/25/2022] [Indexed: 01/07/2023]
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Motairek I, Lee EK, Janus S, Farkouh M, Freedman D, Wright J, Nasir K, Rajagopalan S, Al-Kindi S. Historical Neighborhood Redlining and Contemporary Cardiometabolic Risk. J Am Coll Cardiol 2022; 80:171-175. [PMID: 35798451 PMCID: PMC10411483 DOI: 10.1016/j.jacc.2022.05.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/26/2022] [Accepted: 05/02/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Issam Motairek
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Eun Kyung Lee
- Mary Ann Swetland Center for Environmental Health and Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA; Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Scott Janus
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Michael Farkouh
- Peter Munk Cardiac Centre and the Heart and Stroke, Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada
| | - Darcy Freedman
- Mary Ann Swetland Center for Environmental Health and Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Jackson Wright
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | | | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
| | - Sadeer Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
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Khawaja T, Janus S, Al-Kindi SG. Role of Coronary CT Angiography in the Evaluation of Acute Chest Pain and Suspected or Confirmed Acute Coronary Syndrome. US Cardiology Review 2022. [DOI: 10.15420/usc.2021.30] [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: 11/04/2022] Open
Abstract
Advances in CT technology have resulted in improved imaging of the coronary anatomy in patients with stable coronary artery disease, using coronary CT angiography (CCTA). Recent data suggest that CCTA may play a role in higher risk patients, such as those evaluated in the emergency room with acute chest pain. Data thus far support the use of CCTA in low-risk patients with acute chest pain. Recent literature suggests that CCTA may play a role in the risk stratification of selected intermediate-risk patients. In this review, the authors discuss the emerging role of CCTA in higher risk patients, such as those with suspected or confirmed acute coronary syndrome (ACS). The excellent accuracy of CCTA in detecting obstructive coronary artery disease in patients with ACS is detailed, along with a highlighting of the safety of using CCTA in this setting. The authors also discuss the role for CCTA atheromatous plaque characterization, which is being increasingly recognized as an important predictor of clinical outcomes.
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Affiliation(s)
- Tasveer Khawaja
- Department of Medicine, Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH
| | - Scott Janus
- Department of Medicine, Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH
| | - Sadeer G Al-Kindi
- Department of Medicine, Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH
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Khan MZ, Janus S, Franklin S, Figueredo V, Baqi A, Alvarez R. COVID-19 Vaccination-Induced Cardiomyopathy Requiring Permanent Left Ventricular Assist Device. Cureus 2022; 14:e24477. [PMID: 35651464 PMCID: PMC9132740 DOI: 10.7759/cureus.24477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2022] [Indexed: 11/13/2022] Open
Abstract
Myocarditis was identified as a rare but serious adverse event that can occur after mRNA-based coronavirus disease 2019 (COVID-19) vaccination, particularly in young males. During the COVID-19 pandemic, we report a case of a young obese male without multiple comorbidities who presented with abdominal pain and was found to have severe myocarditis/cardiomyopathy, which was likely due to mRNA-based COVID-19 vaccination. The patient had left ventricular assist device (LVAD) implantation during hospitalization. Myocarditis/cardiomyopathy may be a rare complication of the mRNA-based COVID vaccine; however, one should maintain a high index of suspicion that these vaccines may cause irreversible cardiomyopathy if the patient had prior COVID-19 infection.
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Janus S, Chami T, Mously H, Hajjari J, Karnib M, Al-Juhaishi T, Al-Kindi S, Al-Kindi S. PROPORTIONATE AND ABSOLUTE PULMONARY EMBOLISM MORTALITY IN ONCOLOGY IN THE UNITED STATES FROM 1999-2019. JACC CardioOncol 2022. [DOI: 10.1016/j.jaccao.2022.01.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Dong T, Chami T, Janus S, Hajjari J, Fernandez AS, Josephson R. Diaphragmatic pacemaker-induced ventricular tachycardia leading to cardiac arrest: a case report. Eur Heart J Case Rep 2021; 5:ytab352. [PMID: 34532640 PMCID: PMC8440889 DOI: 10.1093/ehjcr/ytab352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/25/2021] [Accepted: 08/23/2021] [Indexed: 11/19/2022]
Abstract
Background Diaphragmatic pacemakers are used to assist respiration in ventilator-dependent patients. Electromagnetic interference with intrinsic cardiac electrical activity is a theoretical risk but has never been reported in the literature. This case highlights a serious complication of cardiac arrest as a result of diaphragmatic pacing. Case summary We report a quadriplegic patient with recent diaphragmatic pacemaker implantation who presented with ventricular tachycardia leading to cardiac arrest. Extensive workup was negative for other aetiologies for ventricular arrhythmias. Reduction of the left-sided diaphragmatic pacemaker voltage resulted in cessation of ventricular ectopy. Discussion Diaphragmatic pacing at high voltages can cause unwanted transmission of impulses to the cardiac myocytes as a rare complication. This should be noted as a possible complication of intramuscular diaphragmatic pacing, and efforts should be taken to circumvent this risk in the future.
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Affiliation(s)
- Tony Dong
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Tarek Chami
- Harrington Heart and Vascular Institute, University Hospital Cleveland Medical Center, 11100 Euclid Ave Cleveland 44106, OH, USA
| | - Scott Janus
- Harrington Heart and Vascular Institute, University Hospital Cleveland Medical Center, 11100 Euclid Ave Cleveland 44106, OH, USA
| | - Jamal Hajjari
- Harrington Heart and Vascular Institute, University Hospital Cleveland Medical Center, 11100 Euclid Ave Cleveland 44106, OH, USA
| | - Antonio Sotolongo Fernandez
- Harrington Heart and Vascular Institute, University Hospital Cleveland Medical Center, 11100 Euclid Ave Cleveland 44106, OH, USA
| | - Richard Josephson
- Harrington Heart and Vascular Institute, University Hospital Cleveland Medical Center, 11100 Euclid Ave Cleveland 44106, OH, USA
- Case Western Reserve University, 10900 Euclid Ave Cleveland 44106, OH, USA
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Abstract
There is virtually nothing in the literature about patients' perceptions and misconceptions regarding sonography. From January to June, 1979, 204 patients at the Mount Sinai Hospital in New York City were asked to fill out questionnaires before and after their sonographic examinations. The results showed that many of the first-time patients did not know what to expect, had never heard of ultrasound, and were incorrectly prepared for the examination. Education of both patients and physicians is needed to prevent unnecessary patient anxiety and to encourage the use of this safe and accurate diagnostic modality.
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Janus S, Bess B. Drug abuse, sexual attitudes, political radicalization, and religious practices of college seniors and public school teachers. Am J Psychiatry 1973; 130:187-91. [PMID: 4685240 DOI: 10.1176/ajp.130.2.187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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