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Mughal MS, Mirza HM, Bansal A, Weiyi X, Mughal WA, Ahmed S, Yarkoni A, Waqar F, Wasty N, Waxman S, Usman H, Alam M, Rehman A. Spontaneous coronary artery dissection (SCAD) and takotsubo cardiomyopathy (TCM) - A potential association. Am Heart J Plus 2024; 37:100347. [PMID: 38510510 PMCID: PMC10945967 DOI: 10.1016/j.ahjo.2023.100347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 03/22/2024]
Abstract
Background Spontaneous coronary artery dissection and takotsubo cardiomyopathy are increasingly recognized in the last two decades. Case reports have shown both entities can present concomitantly - however, little is known about their association. Methods In this retrospective study we aimed to explore a potential association between SCAD and TCM using the Nationwide Inpatient Sample. The odds of having TCM among patients with SCAD compared with those who did not have SCAD were calculated as an odds ratio. Conversely, the odds of having SCAD among patients with TCM compared with those who did not have TCM were also calculated. The primary outcome was the odds of TCM among patients with a primary diagnosis of SCAD and vice versa. The secondary endpoint was the odds of in-hospital mortality among patients with SCAD, and/or TCM. Results Hospitalized patients who had SCAD were 7.12 (95 % CI: 6.28-8.08) times more likely to also have TCM than those who did not have SCAD (p < 0.0001).), while patients with TCM were 6.91 (95 % CI: 6.07-7.85) times more likely to have SCAD compared to those who didn't have TCM adjusted for age, gender, race, hypertension, hyperlipidemia, and diabetes mellitus (p < 0.0001). Conclusion This data indicate that patients with either SCAD or TCM are seven times more likely to be diagnosed concomitantly with both, compared to the patients without either diagnosis [after adjusting for age, gender, race, hypertension, hyperlipidemia, and diabetes mellitus]. Our data are consistent with the growing body of evidence supporting an association between SCAD and TCM and raise the question of a common pathophysiologic mechanism.
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Affiliation(s)
| | - Hasan M. Mirza
- University of Massachuset - Berkshire Medical Center, Pittsfield, MA, USA
| | | | - Xia Weiyi
- Biostatistics and Epidemiology Services Center, Rutgers School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Waqar Arshad Mughal
- United Health Services Heart and Vascular Institute, New York, USA
- University of Gujrat, Pakistan
| | - Saba Ahmed
- United Health Services Heart and Vascular Institute, New York, USA
| | - Alon Yarkoni
- United Health Services Heart and Vascular Institute, New York, USA
| | | | | | | | | | | | - Afzal Rehman
- United Health Services Heart and Vascular Institute, New York, USA
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2
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Sohal S, Khakwani MZ, Sandhu Z, El-Sayed D, Tayal R, Waxman S, Wasty N. Coronary Catheter Course Via the Left Radial Approach Is Diametrically Opposed to the Course Via the Femoral Approach: A Stroke Paradox. CJC Open 2023; 5:164-166. [PMID: 36880072 PMCID: PMC9984880 DOI: 10.1016/j.cjco.2022.11.017] [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] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Sumit Sohal
- Division of Cardiology, Department of Internal Medicine, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| | - Muhammad Zain Khakwani
- Division of Cardiology, Department of Internal Medicine, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| | - Zainab Sandhu
- Division of Cardiology, Department of Internal Medicine, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| | - Dina El-Sayed
- Division of Cardiology, Department of Internal Medicine, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| | - Rajiv Tayal
- Division of Cardiology, Department of Internal Medicine, The Valley Hospital, Ridgewood, New Jersey, USA
| | - Sergio Waxman
- Division of Cardiology, Department of Internal Medicine, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| | - Najam Wasty
- Division of Cardiology, Department of Internal Medicine, Newark Beth Israel Medical Center, Newark, New Jersey, USA
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3
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Sohal S, Tanko FA, Vucic E, Waxman S, Gupta S, Fyfe-Kirschner B. Pathological Correlation of a Cardiac Mass with Multimodality Imaging. Case Rep Med 2023; 2023:7352934. [PMID: 37113318 PMCID: PMC10129422 DOI: 10.1155/2023/7352934] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/02/2023] [Accepted: 03/16/2023] [Indexed: 04/29/2023] Open
Abstract
Cardiac masses are rarely encountered in clinical practice and can lead to severe hemodynamic consequences. In addition to clinical cues, noninvasive modalities can play an important role in characterization of these masses and therefore their diagnosis and management planning. Here in this case report, we describe the use of various forms of noninvasive imaging techniques to narrow the differential diagnosis and form an operative plan for a cardiac mass later identified as a benign myxoma originating from the right ventricle on histological examination.
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Affiliation(s)
- Sumit Sohal
- Division of Cardiology, Department of Internal Medicine, RWJBH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, USA
| | - Farida A. Tanko
- Department of Pathology, Robert Wood Johnson University Hospital, 125 Paterson St, New Brunswick, NJ 08901, USA
| | - Esad Vucic
- Division of Cardiology, Department of Internal Medicine, RWJBH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, USA
| | - Sergio Waxman
- Division of Cardiology, Department of Internal Medicine, RWJBH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, USA
| | - Suresh Gupta
- Department of Pathology, RWJBH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, USA
| | - Billie Fyfe-Kirschner
- Department of Pathology, RWJBH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, USA
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4
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Brankovic M, Ansari J, Karanam R, Waxman S. Transcatheter Aortic Valve Replacement as a Rescue Treatment for Prosthetic Valve Endocarditis. JACC Case Rep 2022; 4:1306-1310. [PMID: 36406906 PMCID: PMC9666743 DOI: 10.1016/j.jaccas.2022.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 05/02/2023]
Abstract
A 74-year-old man with a history of bioprosthetic aortic valve replacement presented with acute severe aortic insufficiency and cardiogenic shock secondary to Diphtheroides and Enterococcus endocarditis. The patient was deemed to be not a surgical candidate by the multidisciplinary team and underwent rescue transcatheter aortic valve-in-valve replacement, resulting in complete recovery. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Milos Brankovic
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Transatlantic Cardiovascular Study Group, Bloomfield, New Jersey, USA
- Address for correspondence: Dr. Milos Brankovic, Department of Medicine, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, New Jersey 07103, USA.
| | - Julia Ansari
- Department of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| | - Ravindra Karanam
- Department of Cardiothoracic Surgery, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| | - Sergio Waxman
- Department of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey, USA
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5
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Sohal S, Aroke D, Cohen M, Visveswaran G, Waxman S. TCT-423 Effect of Low Versus High Mitral Valve Gradients on Outcomes of Functional and Degenerative Mitral Valve Disease Post Transcatheter Edge to Edge Repair. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.498] [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: 10/14/2022]
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6
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Sohal S, Mathai SV, Lipat K, Kaur A, Visveswaran G, Cohen M, Waxman S, Tiwari N, Vucic E. Multimodality Imaging of Constrictive Pericarditis: Pathophysiology and New Concepts. Curr Cardiol Rep 2022; 24:1439-1453. [PMID: 35917048 PMCID: PMC9344806 DOI: 10.1007/s11886-022-01758-6] [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] [Accepted: 07/26/2022] [Indexed: 11/15/2022]
Abstract
Purpose of Review The unique pathophysiological changes of constrictive pericarditis (CP) can now be identified with better imaging modalities, thereby helping in its early diagnosis. Through this review, we outline the pathophysiology of CP and its translation into symptomology and various imaging findings which then are used for both diagnosis and guiding treatment options for CP. Recent Findings Multimodality imaging has provided us with the capability to recognize early stages of the disease and identify patients with a potential for reversibility and can be treated with medical management. Additionally, peri-procedural planning and prediction of post-operative complications has been made possible with the use of advanced imaging techniques. Summary Advanced imaging has the potential to play a greater role in identification of patients with reversible disease process and provide peri-procedural risk stratification, thereby improving outcomes for patients with CP.
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Affiliation(s)
- Sumit Sohal
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA.
| | - Sheetal Vasundara Mathai
- Division of Cardiovascular Diseases, Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Kevin Lipat
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Arpanjeet Kaur
- Department of Medicine, Mount Sinai West, 1000 Tenth Avenue, New York, NY, 10019, USA
| | - Gautam Visveswaran
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Marc Cohen
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Sergio Waxman
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Nidhish Tiwari
- Division of Cardiovascular Diseases, Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Esad Vucic
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
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Garg A, Rout A, Farhan S, Waxman S, Giustino G, Tayal R, Abbott JD, Huber K, Angiolillo DJ, Rao SV. Dual antiplatelet therapy duration after percutaneous coronary intervention using drug eluting stents in high bleeding risk patients: A systematic review and meta-analysis. Am Heart J 2022; 250:1-10. [PMID: 35436504 DOI: 10.1016/j.ahj.2022.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 11/28/2021] [Revised: 03/11/2022] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Optimal dual antiplatelet therapy (DAPT) duration in patients at high bleeding risk (HBR) is not fully defined. We aimed to compare the safety and effectiveness of short-term DAPT (S-DAPT) with longer duration DAPT (L-DAPT) after percutaneous coronary intervention (PCI) with drug eluting stents (DES) in patients at HBR. METHODS We searched for studies comparing S-DAPT (≤3 months) followed by aspirin or P2Y 12 inhibitor monotherapy against L-DAPT (6-12 months) after PCI in HBR patients. Primary end points of interest were major bleeding and myocardial infarction (MI). Random-effects meta-analyses were performed to calculate odds ratios with 95% CIs. RESULTS Six randomized trials and 3 propensity-matched studies (n = 16,848) were included in the primary analysis. Compared with L-DAPT (n = 8,422), major bleeding was lower with S-DAPT (n = 8,426) [OR 0.68; 95% CI 0.51-0.89] whereas MI did not differ significantly between the 2 groups [1.16; 0.94-1.44]. There were no significant differences in risks of death, stroke or stent thrombosis (ST) between S-DAPT and L-DAPT groups. These findings were consistent when propensity-matched studies were analysed separately. Finally, there was a numerically higher, albeit statistically non-significant, ST in the S-DAPT arm of patients without an indication for OAC [1.98; 0.86-4.58]. CONCLUSIONS Among HBR patients undergoing current generation DES implantation, S-DAPT reduces bleeding without an increased risk of death or MI compared with L-DAPT. More research is needed to (1) evaluate risks of late ST after 1 to 3 months DAPT among patients with high ischemic and bleeding risks, (2) defining the SAPT of choice after 1 to 3 months DAPT.
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Affiliation(s)
- Aakash Garg
- Division of Cardiology, Brown University, Providence, RI.
| | - Amit Rout
- Division of Cardiology, University of Louisville, Louisville, KY
| | - Serdar Farhan
- Division of Cardiology, Icahn school of Medicine at Mount Sinai, New York, NY
| | - Sergio Waxman
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ
| | - Gennaro Giustino
- Division of Cardiology, University of Louisville, Louisville, KY
| | - Raj Tayal
- Division of Cardiology, Valley Hospital, Ridgewood, NJ
| | | | - Kurt Huber
- Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
| | - Sunil V Rao
- Division of Cardiology, Duke Clinical Research Institute, Durham, NC
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8
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Heaton JN, Okoh AK, Suh S, Ozturk E, Salemi A, Waxman S, Tayal R. Safety and Efficacy of the Amplatzer Septal Occluder: A Systematic Review and Meta-Analysis. Cardiovasc Revasc Med 2022; 37:52-60. [PMID: 34183276 PMCID: PMC10909392 DOI: 10.1016/j.carrev.2021.06.002] [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: 03/19/2021] [Revised: 05/12/2021] [Accepted: 06/01/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess the safety and efficacy of the Amplatzer Septal Occluder in the closure of secundum type atrial septal defects. BACKGROUND The Amplatzer Septal Occluder (ASO; Abbott, St. Paul, MN) is an FDA-approved device for percutaneous closure of secundum type atrial septal defects (ASD). Previous small cohort trials have shown a favorable safety and technical efficacy profile. METHODS We conducted a systemic review and meta-analysis of all prospective case series and controlled trials that evaluated the ASO's safety and implant efficacy. The primary endpoint was the technical success rate of implantations. Secondary outcomes included proportions of arrhythmias and embolism specific-adverse events. RESULTS We included a total of 12 studies with 2972 patients. The ratio of device implantation was 2:1 by sex [female: male]. Pooled technical success rate of implantation was 98% (95% CI: 0.968-0.990, P < 0.01). The cumulative adverse event rate was 5.1% (95% CI: 0.035-0.068, P < 0.01), which included arrhythmia and embolism specific adverse event rates of 1.8% (95% CI: 0.007-0.032, P < 0.01) and 0.7% (95% CI: 0.002-0.013, P < 0.01), respectively. Sensitivity analysis did not significantly affect pooled outcomes for success rate and adverse events; both forest plot and Begg's and Egger's regression tests supported symmetricity. CONCLUSION A high likelihood of technical success can be expected when implanting the ASO in secundum type ASDs. Adverse event rates are expected for one in twenty patients, and thus, our results support the safe use of ASO in secundum type ASDs closure. CONDENSED ABSTRACT The AMPLATZER Septal Occluder is an FDA-approved device for percutaneous closure of secundum type atrial septal defects (ASD). We conducted a systemic review and meta-analysis of all prospective case series and controlled trials that evaluated the ASO's safety and implant efficacy. We included a total of 12 studies with 2972 patients. Pooled technical success rate of implantation was 98% (P < 0.01). The cumulative adverse event rate was 5.1% (P < 0.01), 1.8% (P < 0.01) rate of arrhythmias, and 0.7% (P < 0.01) rate of embolisms. A high likelihood of technical success can be expected with a low rate of adverse events.
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Affiliation(s)
- Joseph N Heaton
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, NY, United States of America; Cardiovascular Research Unit, RWJ Barnabas Health. NBIMC, Newark, NJ, United States of America.
| | - Alexis K Okoh
- Cardiovascular Research Unit, RWJ Barnabas Health. NBIMC, Newark, NJ, United States of America
| | - Seungmo Suh
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, NY, United States of America
| | - Ebru Ozturk
- Cardiovascular Research Unit, RWJ Barnabas Health. NBIMC, Newark, NJ, United States of America
| | - Arash Salemi
- Cardiovascular Research Unit, RWJ Barnabas Health. NBIMC, Newark, NJ, United States of America
| | - Sergio Waxman
- Cardiovascular Research Unit, RWJ Barnabas Health. NBIMC, Newark, NJ, United States of America
| | - Rajiv Tayal
- Cardiovascular Research Unit, RWJ Barnabas Health. NBIMC, Newark, NJ, United States of America
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Mughal M, Xia W, Mirza H, Jagdey HS, Ghani A, Khakwani M, Akbar H, Hafeez H, Raza MZA, Levitt HL, Waqar F, Wasty N, Usman MH, Alam M, Waxman S. INPATIENT HOSPITAL MORTALITY IN TAKOTSUBO CARDIOMYOPATHY (TCM): INSIGHTS FROM THE NATIONAL INPATIENT SAMPLE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02144-1] [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: 10/18/2022]
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10
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Sohal S, Mehta H, Kurpad KP, Tayal R, Visveswaran GK, Wasty N, Waxman S, Cohen M. DECLINING TREND OF TRANSAPICAL ACCESS FOR TRANSCATHETER AORTIC VALVE REPLACEMENT IN PATIENTS WITH AORTIC STENOSIS: AN ANALYSIS OF NATIONAL INPATIENT SAMPLE FROM 2011-2017. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01783-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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]
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11
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Khakwani M, Sohal S, Barvalia M, Samreen I, Tayal R, Waxman S, Wasty N. “IS THE COVERAGE AREA OF THE SECOND GENERATION TRANSCATHETER AORTIC VALVE REPLACEMENT EMBOLIC PROTECTION DEVICES TOO GENEROUS”? J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01678-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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Mughal M, Ghani A, Kumar S, Mirza H, Levitt HL, Waxman S, Khakwani M, Grewal J, Raza MZA, Usman MHU, Nasir A, Alam M, Mikhalkova D. PREMATURE MORTALITY IN MALES DUE TO HEART FAILURE IN THE UNITED STATES FROM 2010-2018. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01454-1] [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: 11/16/2022]
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13
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Mughal M, Kaur I, Waxman S, Gandhi H, Kakadia M, Khakwani Z, Okoh A, Shah K, Obaid A, Sirpal V, Azad S, Jaffery A, Jagdey H, Tawfik I, Alam M. Clinical outcomes in COVID-19 patients with in-hospital cardiac arrest – an insight from multi-centre data. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1546] [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
In general, rates of in-hospital cardiac arrest are reportedly 9 to 10 arrests per 1000 admissions, with survival rates of approximately 20–25%. Data regarding clinical characteristics and outcomes in patients with COVID-19 who received in-hospital CPR (cardiopulmonary resuscitation) are limited. This information can help guide end-of-life care conversations between families and health care workers based on real-world experience.
Purpose
To observe the outcomes (survival to discharged alive from the hospital) in critically sick COVID-19 patients who experienced in-hospital cardiac arrest.
Methods
This is a multi-centre institutional review board (IRB) approved retrospective study. The RT-PCR confirmed adult COVID-19 patients consecutively admitted from March 1st to April 30, 2020, were included. Data were extracted manually using the hospital's electronic medical record. The final date of follow-up to monitor clinical outcomes was January 2021.
Results
A total of 721 patients were admitted to the hospital. Of these, only 64 (8.87%) patients had “no CPR” orders.Cardiac arrest occurred in 141 (19.5%) patients. The mean duration of beginning of resuscitation was less than a minute and the mean duration of CPR was 19 minutes. The median age was 65 years; 62.4% were male. The most common co-morbidities were hypertension (66%) and diabetes mellitus (56%). The initial rhythm was non-shockable in 93.7% of patients [asystole in 48.4% and Pulseless Electrical Activity (PEA) in 45.3% of patients]. Only six (4.2%) patients had pulseless ventricular tachycardia and three (2.1%) patients had ventricular fibrillation. A total of eight patients (5.6%) survived and were discharged from the hospital; six (4.25%) had non-shockable and two (0.82%) had shockable initial rhythms. The median age of those who survived was 60 years (Figure 1).
Conclusions
Our study showed that critically sick patients with COVID-19 have a high rate of cardiac arrest and poor outcomes in those who received CPR. A non-shockable initial rhythm indicates that non-cardiac reasons might be playing a major role. These include acute respiratory insufficiency, severe sepsis, or multiorgan failure. These data should inform end-of-life care discussions between providers and patients' families.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Mughal
- Monmouth Medical Center, Long Branch, United States of America
| | - I Kaur
- Monmouth Medical Center, Long Branch, United States of America
| | - S Waxman
- Newark Beth Israel Medical Center, The Department of Medicine, Section of Cardiology, Newark, United States of America
| | - H Gandhi
- Monmouth Medical Center, Long Branch, United States of America
| | - M Kakadia
- Monmouth Medical Center, Long Branch, United States of America
| | - Z Khakwani
- Newark Beth Israel Medical Center, The Department of Medicine, Section of Cardiology, Newark, United States of America
| | - A Okoh
- Newark Beth Israel Medical Center, The Department of Medicine, Section of Cardiology, Newark, United States of America
| | - K Shah
- St. Luke's University Hospital, Bethlehem, United States of America
| | - A Obaid
- Monmouth Medical Center, Long Branch, United States of America
| | - V Sirpal
- Monmouth Medical Center, Long Branch, United States of America
| | - S Azad
- Monmouth Medical Center, Long Branch, United States of America
| | - A Jaffery
- Monmouth Medical Center, Long Branch, United States of America
| | - H Jagdey
- Bronx-Lebanon Hospital Center, Bronx NY, United States of America
| | - I Tawfik
- Monmouth Medical Center, Long Branch, United States of America
| | - M Alam
- Baylor College of Medicine, The Department of Medicine, Section of Cardiology, Houston, United States of America
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14
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Heaton JN, Dhaduk N, Okoh AK, Dang-Ho KP, Tayal R, Salemi A, Waxman S. Author's reply: Characteristics, management, and outcomes among admissions for primary cardiac tumors: Results from The National Inpatient Sample. J Card Surg 2021; 36:4827. [PMID: 34585436 DOI: 10.1111/jocs.16037] [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] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Joseph N Heaton
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, New York, USA.,Cardiovascular Research Unit, NBIMC, RWJ Barnabas Health, Newark, New Jersey, USA
| | - Nehal Dhaduk
- Cardiovascular Research Unit, NBIMC, RWJ Barnabas Health, Newark, New Jersey, USA
| | - Alexis K Okoh
- Cardiovascular Research Unit, NBIMC, RWJ Barnabas Health, Newark, New Jersey, USA
| | - Khoi P Dang-Ho
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Rajiv Tayal
- Cardiovascular Research Unit, NBIMC, RWJ Barnabas Health, Newark, New Jersey, USA
| | - Arash Salemi
- Cardiovascular Research Unit, NBIMC, RWJ Barnabas Health, Newark, New Jersey, USA
| | - Sergio Waxman
- Cardiovascular Research Unit, NBIMC, RWJ Barnabas Health, Newark, New Jersey, USA
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15
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Heaton JN, Dhaduk N, Okoh AK, Dang-Ho KP, Tayal R, Salemi A, Waxman S. Characteristics, management, and outcomes among admissions for primary cardiac tumors: Results from the National Inpatient Sample. J Card Surg 2021; 36:3586-3592. [PMID: 34314042 DOI: 10.1111/jocs.15862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/29/2021] [Accepted: 07/07/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Primary cardiac tumors (PCT) are rare, and their contemporary outcomes are not well characterized in the literature. We assessed temporal trends in patient characteristics and management of admissions for PCT in US hospitals. METHODS Admissions with the principal diagnoses of a PCT (benign neoplasm of heart: ICD-9 212.7, ICD-10 D15.1; malignant neoplasm of heart: ICD-9 164.1, ICD-10 C38.0) between 2006 and 2017 were extracted from the National Inpatient Sample. Trends in demographics and clinical profiles were evaluated. We conducted descriptive analyses on the cohort and compared outcomes between those managed medically and surgically. RESULTS Between 2006 and 2017, 19,111 admissions had the primary diagnosis of a PCT. Of these, 91.1% were benign. Admissions were mostly female (65.0%), caucasian (72.0%), and aged more than 50 years (76.0%). The annual admission rate for PCT was similar from 2006 to 2017 (p trend > .05) and associated with congestive heart failure, diabetes, renal failure, and valvular lesions. PCTs were managed surgically in 12,811 (67.0%) of overall cases, 70.8% for benign and 28.3% for malignant tumors. Overall, the in-hospital mortality rate was 2.3%. Medically managed cases reported a 2.5% higher mortality (p < .001) than those surgically managed. Admissions with malignant tumors were more likely to expire during hospitalization than those with benign tumors (odds ratio, 9.75; 95% confidence interval 6.34-14.99; p < .001). CONCLUSION Admissions for primary cardiac tumors were primarily women or in their fifth or sixth decade of life. Surgical intervention is more commonly practiced and is associated with better in-hospital survival.
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Affiliation(s)
- Joseph N Heaton
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, New York, USA.,Division of Cardiology, Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, New Jersey, USA
| | - Nehal Dhaduk
- Division of Cardiology, Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, New Jersey, USA
| | - Alexis K Okoh
- Division of Cardiology, Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, New Jersey, USA
| | - Khoi P Dang-Ho
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Rajiv Tayal
- Division of Cardiology, Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, New Jersey, USA
| | - Arash Salemi
- Division of Cardiology, Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, New Jersey, USA
| | - Sergio Waxman
- Division of Cardiology, Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, New Jersey, USA
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Garg A, Hakeem H, Chennu G, Saeed Q, Vucic E, Kats Y, Waxman S. Left ventricular mural thrombi with multisystem thrombosis in patients with COVID-19 and myocardial injury: a case series. Eur Heart J Case Rep 2021; 5:ytab239. [PMID: 34263128 PMCID: PMC8276321 DOI: 10.1093/ehjcr/ytab239] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/18/2021] [Accepted: 05/27/2021] [Indexed: 01/02/2023]
Abstract
Background Cardiovascular and thromboembolic complications have been reported in patients with Coronavirus disease-2019 (COVID-19)-related severe respiratory distress syndrome. Although myocarditis associated with COVID-19 pneumonia has been described, evidence of left ventricular (LV) mural thrombi with other multisystem events has not been reported. Case summary We report two cases with severe COVID-19 pneumonia and myocardial injury with large LV thrombi and other multisystem thrombotic events. The first patient represents an unusual case of large LV apical thrombus without concordant regional wall motion abnormality and mildly reduced LV function. A subsequent inferior ST-elevation myocardial infarction (STEMI) was likely related to either an embolic event or in situ coronary thrombosis. We could not ascertain whether the acute right ventricular dysfunction was due to in situ pulmonary thrombosis or inferior STEMI. The catastrophic cerebrovascular accident was likely an embolic phenomenon. Similarly, the second patient demonstrated multiple large pedunculated thrombi occupying one-third of the LV cavity with moderately reduced LV function. A segmental pulmonary embolism was diagnosed on computed tomography chest, confirming multiple territories of in situ thrombosis. Discussion COVID-19-related inflammatory cytokine release has been linked to activation of coagulation pathways. Marked elevation of ferritin and C-reactive protein levels in both patients were consistent with evidence of a hyperinflammatory state with ‘cytokine storm’. Furthermore, the finding of elevated D-dimer levels lends support to the altered coagulation cascade that plausibly explains the multisystem thrombosis observed in our patients. The direct viral endothelial involvement and subsequent endothelial dysfunction may play an important role in the development of thrombosis in different vascular beds, as seen in our patients.
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Affiliation(s)
- Aakash Garg
- Division of Cardiology, Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, USA
| | - Hisham Hakeem
- Division of Cardiology, Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, USA
| | - Gouthami Chennu
- Division of Cardiology, Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, USA
| | - Qaisra Saeed
- Division of Cardiology, Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, USA
| | - Esad Vucic
- Division of Cardiology, Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, USA
| | - Yuliya Kats
- Division of Cardiology, Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, USA
| | - Sergio Waxman
- Division of Cardiology, Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, USA
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Gerbaud E, Weisz G, Tanaka A, Luu R, Osman HASH, Baldwin G, Coste P, Cognet L, Waxman S, Zheng H, Moses JW, Mintz GS, Akasaka T, Maehara A, Tearney GJ. Plaque burden can be assessed using intravascular optical coherence tomography and a dedicated automated processing algorithm: a comparison study with intravascular ultrasound. Eur Heart J Cardiovasc Imaging 2021; 21:640-652. [PMID: 31326995 DOI: 10.1093/ehjci/jez185] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 04/07/2019] [Revised: 05/22/2019] [Accepted: 07/10/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS Plaque burden (PB) measurement using intravascular optical coherence tomography (IVOCT) is currently thought to be inferior to intravascular ultrasound (IVUS). We developed an automated IVOCT image processing algorithm to enhance the external elastic lamina (EEL) contour. Thus, we investigated the accuracies of standard IVOCT and an IVOCT enhancement algorithm for measuring PB using IVUS as the reference standard. METHODS AND RESULTS The EEL-enhancement algorithm combined adaptive attenuation compensation, exponentiation, angular registration, and image averaging using three sequential frames. In two different laboratories with intravascular imaging expertise, PB was quantified on 200 randomized, matched IVOCT and IVUS images by four independent observers. Fibroatheroma, fibrocalcific plaque, fibrous plaque, pathological intimal thickening (PIT), and mixed plaque were included in each set. Pearson's correlation coefficients between IVUS and standard IVOCT measurements of PB were 0.61, 0.67, 0.76, 0.78, and 0.87 for fibroatheromas, mixed plaques, fibrocalcific plaques, fibrous plaques, and PIT plaques, respectively. Pearson's correlation coefficients increased to 0.81, 0.83, 0.83, 0.84, and 0.90 when using the EEL-enhanced images (P = 0.003, P = 0.004, P = 0.08, P = 0.12, and P = 0.23, respectively). EEL-enhanced IVOCT analysis was associated with a lower EEL-area measurement absolute error for fibroatheromas, mixed plaques, and all pooled plaques (P = 0.006, P = 0.02, and P < 0.001, respectively). Compared with standard IVOCT, the EEL-enhanced IVOCT images had a higher sensitivity (79% vs. 28%, P < 0.001) and specificity (98% vs. 85%, P = 0.03) for plaques with an IVUS PB ≥70%. CONCLUSION EEL-enhanced IVOCT can be used to reliably measure PB in all types of coronary atherosclerotic lesions, including fibroatheromas and mixed plaques.
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Affiliation(s)
- Edouard Gerbaud
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, 40 Blossom Street, BHX-604A, Boston, MA 02114, USA.,Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, 5 Avenue Magellan, Pessac 33600, France.,Bordeaux Cardio-Thoracic Research Centre, Bordeaux University, U1045, Hôpital Xavier Arnozan, Avenue du Haut Lévêque, Pessac 33600, France
| | - Giora Weisz
- Columbia University Medical Center, New York, NY, USA.,Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA.,Montefiore-Einstein Center for Heart and Vascular, The University Hospital for the Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Atsushi Tanaka
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, 40 Blossom Street, BHX-604A, Boston, MA 02114, USA.,Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama Prefecture 641-8509, Japan
| | - Romain Luu
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, 40 Blossom Street, BHX-604A, Boston, MA 02114, USA.,Institut d'Optique Graduate School, CNRS-UMR 5298, Bordeaux University, Rue François Miterrand, Talence 33400, France
| | - Hany Ahmed Salaheldin Hussein Osman
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, 40 Blossom Street, BHX-604A, Boston, MA 02114, USA
| | - Grace Baldwin
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, 40 Blossom Street, BHX-604A, Boston, MA 02114, USA
| | - Pierre Coste
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, 5 Avenue Magellan, Pessac 33600, France.,Bordeaux Cardio-Thoracic Research Centre, Bordeaux University, U1045, Hôpital Xavier Arnozan, Avenue du Haut Lévêque, Pessac 33600, France
| | - Laurent Cognet
- Institut d'Optique Graduate School, CNRS-UMR 5298, Bordeaux University, Rue François Miterrand, Talence 33400, France
| | - Sergio Waxman
- Department of Cardiology, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA 01805, USA
| | - Hui Zheng
- Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jeffrey W Moses
- Columbia University Medical Center, New York, NY, USA.,Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA
| | - Gary S Mintz
- Columbia University Medical Center, New York, NY, USA.,Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama Prefecture 641-8509, Japan
| | - Akiko Maehara
- Columbia University Medical Center, New York, NY, USA.,Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA
| | - Guillermo J Tearney
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, 40 Blossom Street, BHX-604A, Boston, MA 02114, USA.,Department of Pathology, Massachusetts General Hospital and Harvard Medical School, 40 Blossom Street, Boston, MA 02114, USA.,Harvard-MIT Health Sciences and Technology, Boston, MA, USA
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18
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Affiliation(s)
- Esad Vucic
- Division of Cardiology, Department of Medicine, RWJBH Newark Beth Israel Medical Center, Newark, NJ (E.V., E.Y.C., S.S., S.W.)
| | - Elie Y Chakhtoura
- Division of Cardiology, Department of Medicine, RWJBH Newark Beth Israel Medical Center, Newark, NJ (E.V., E.Y.C., S.S., S.W.).,Department of Cardiology, RWJBH Clara Maass Medical Center, Belleville, NJ (E.Y.C.)
| | - Sumit Sohal
- Division of Cardiology, Department of Medicine, RWJBH Newark Beth Israel Medical Center, Newark, NJ (E.V., E.Y.C., S.S., S.W.)
| | - Sergio Waxman
- Division of Cardiology, Department of Medicine, RWJBH Newark Beth Israel Medical Center, Newark, NJ (E.V., E.Y.C., S.S., S.W.)
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19
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Ramey D, Mudge M, Rudolphi O, Waxman S. Use of an absorbable haemostatic gauze product to control bleeding in 20 horses. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13267] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- D. Ramey
- Ramey Equine Chatsworth CaliforniaUSA
| | - M. Mudge
- Department of Veterinary Clinical Sciences The Ohio State University Columbus OhioUSA
| | - O. Rudolphi
- Rudolphi Veterinary Services, Ltd. Noble IllinoisUSA
| | - S. Waxman
- Department of Veterinary Clinical Sciences Purdue University College of Veterinary Medicine West Lafayette Indiana USA
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20
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Heaton J, Okoh A, Dhaduk N, Dang-Ho KP, Tayal R, Salemi A, Waxman S. TEMPORAL TRENDS IN PATIENT CHARACTERISTICS, MANAGEMENT, AND OUTCOMES AMONG PATIENTS ADMITTED FOR PRIMARY CARDIAC TUMORS: RESULTS FROM THE NATIONAL INPATIENT SAMPLE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)04637-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Shah AM, Siddiqui E, Cuenca C, Drotar P, Okoh AK, Salemi A, Waxman S, Sambol J. Trends in the utilization and reimbursement of coronary revascularization in the United States Medicare population from 2010 to 2018. Catheter Cardiovasc Interv 2021; 98:E205-E212. [PMID: 33759362 DOI: 10.1002/ccd.29649] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/05/2021] [Accepted: 03/12/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To determine utilization and reimbursement trends of coronary revascularization procedures in the US Medicare population from 2000 to 2018. BACKGROUND US Medicare population is increasing, and coronary revascularization decreased in the 2000s. METHODS This is a population-based, cross sectional study of US Medicare beneficiaries from 2010 to 2018. The Centers for Medicare and Medicaid Services' database was queried for revascularization procedures using the coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) current procedural terminology (CPT) codes. Trends in Medicare enrollees, PCIs, CABGs, and physician reimbursements were analyzed. RESULTS Total utilization and reimbursement decreased for both revascularization procedures. The national CABG and PCI utilization per enrollee has decreased by 40.7% (best fit line: b coefficient, 95% CI; -0.297, -0.358 to -0.235) and 26.4% (best fit line: -0.229, -0.373 to -0.0858), respectively. For CABG, annual Medicare payout per enrollee and physician compensation per procedure has decreased by 49.3% (best fit line: -0.250, -0.315 to -0.185) and 14.5% (best fit line: -11.54, -15.62 to -7.452), respectively, and for PCI, decreased by 53.3% (best fit line: -0.373, -0.560 to -0.186) and 36.6% (best fit line: -34.15, -49.35 to -18.95), respectively. Amongst the states, there was significant variability in procedure utilization, and CABG reimbursement rates but minimal variability in PCI reimbursement rates. CONCLUSION Even though the US population has aged, revascularization utilization and reimbursement continue to decline. Advancement in medical intervention strategies, particularly non-surgical management, may account for these trends. Further understanding of these trends will allow health systems to tailor resources to the aging population.
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Affiliation(s)
- Aakash M Shah
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Emaad Siddiqui
- Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Carlos Cuenca
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Persida Drotar
- Department of Cardiothoracic Surgery, RWJ Barnabas Health-NBIMC, Newark, New Jersey, USA
| | - Alexis K Okoh
- Department of Cardiothoracic Surgery, RWJ Barnabas Health-NBIMC, Newark, New Jersey, USA
| | - Arash Salemi
- Department of Cardiothoracic Surgery, RWJ Barnabas Health-NBIMC, Newark, New Jersey, USA
| | - Sergio Waxman
- Department of Medicine, RWJ Barnabas Health-NBIMC, Newark, New Jersey, USA
| | - Justin Sambol
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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22
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Siddiqui E, Shah A, Dhaduk N, Okoh A, Waxman S. TCT CONNECT-225 Understanding Trends in Medicare Reimbursement for Cardiovascular Procedures. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.240] [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: 10/23/2022]
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23
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Heaton J, Okoh AK, Sossou C, Singh S, Sandhu M, Chakrabarti R, Rao R, Waxman S, Tayal R, Wasty N. Adverse Events After Left Atrial Appendage Closure: Lessons Learned From the Manufacturer and User Facility Device Experience (MAUDE) Database. J Invasive Cardiol 2020; 32:E216-E218. [PMID: 32737269] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Left atrial appendage (LAA) closure devices are alternative treatments recently approved for patients with atrial fibrillation. Due to the novelty of these devices, limited postapproval surveillance data on LAA closure devices have been published. Thus, we analyzed the United States Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database to report these findings. The primary endpoint was final event outcome, and secondary endpoints included management strategies of reported events.
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Affiliation(s)
| | - Alexis K Okoh
- Cardiovascular Research Unit, RWJ Barnabas Health Heart Centers, Newark Beth Israel Medical Center, 201 Lyons Avenue, Suite G5, Newark, NJ 07112 USA.
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24
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Waxman S, Garg A, Torre S, Wasty N, Roelke M, Cohen M, Salemi A. Prioritizing elective cardiovascular procedures during the COVID-19 pandemic: The cardiovascular medically necessary, time-sensitive procedure scorecard. Catheter Cardiovasc Interv 2020; 96:E602-E607. [PMID: 32588955 PMCID: PMC7361381 DOI: 10.1002/ccd.29093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Following the surge of the coronavirus disease 2019 (COVID-19) pandemic, government regulations, and recommendations from professional societies have conditioned the resumption of elective surgical and cardiovascular (CV) procedures on having strategies to prioritize cases because of concerns regarding the availability of sufficient resources and the risk of COVID-19 transmission. OBJECTIVES We evaluated the use of a scoring system for standardized triage of elective CV procedures. METHODS We retrospectively reviewed records of patients scheduled for elective CV procedures that were prioritized ad hoc to be either performed or deferred when New Jersey state orders limited the performance of elective procedures due to the COVID-19 pandemic. Patients in both groups were scored using our proposed CV medically necessary, time-sensitive (MeNTS) procedure scorecard, designed to stratify procedures based on a composite measure of hospital resource utilization, risk of COVID-19 exposure, and time sensitivity. RESULTS A total of 109 scheduled elective procedures were either deferred (n = 58) or performed (n = 51). The median and mean cumulative CV MeNTS scores for the group of performed cases were significantly lower than for the deferred group (26 (interquartile range (IQR) 22-31) vs. 33 (IQR 28-39), p < .001, and 26.4 (SE 0.34) vs. 32.9 (SE 0.35), p < .001, respectively). CONCLUSIONS The CV MeNTS procedure score was able to stratify elective cases that were either performed or deferred using an ad hoc strategy. Our findings suggest that the CV MeNTS procedure scorecard may be useful for the fair triage of elective CV cases during the time when available capacity may be limited due to the COVID-19 pandemic.
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Affiliation(s)
- Sergio Waxman
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| | - Aakash Garg
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| | - Sabino Torre
- Division of Cardiology, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Najam Wasty
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| | - Marc Roelke
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey, USA.,Division of Cardiology, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Marc Cohen
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| | - Arash Salemi
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey, USA.,Division of Cardiology, Saint Barnabas Medical Center, Livingston, New Jersey, USA.,Department of Cardiothoracic Surgery, Northern Region, Robert Wood Johnson Barnabas Health, West Orange, New Jersey, USA
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25
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Carioli G, Malvezzi M, Bertuccio P, Hashim D, Waxman S, Negri E, Boffetta P, La Vecchia C. Cancer mortality in the elderly in 11 countries worldwide, 1970-2015. Ann Oncol 2020; 30:1344-1355. [PMID: 31147682 DOI: 10.1093/annonc/mdz178] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 02/06/2023] Open
Abstract
BACKGROUND Population ageing results in an increasing cancer burden in the elderly. We aimed to evaluate time-trends in cancer mortality for adults aged 65 and over for 17 major cancer types and all cancers combined in 11 countries worldwide over the period 1970-2015. MATERIALS AND METHODS We obtained cancer death certification and population figures from the WHO and PAHO databases. We computed age-standardised (world standard population) rates for individuals aged 65 and over, and applied joinpoint regression models. RESULTS Age-standardised mortality rates for all cancers combined showed a heterogeneous, but widespread decline. Lung cancer mortality rates have been decreasing among men, and increasing among women. Pancreatic cancer had unfavourable trends in all countries for both sexes. Despite variability across countries, other tobacco-related cancers (except kidney) showed overall favourable trends, except in Poland and Russia. Age-standardised mortality rates from stomach cancer have been declining in all countries for both sexes. Colorectal mortality has been declining, except in Poland and Russia. Liver cancer mortality increased in all countries, except in Japan, France and Italy, which had the highest rates in the past. Breast cancer mortality decreased for most countries, except for Japan, Poland and Russia. Trends for age-standardised uterine cancer rates in the USA, Canada and the UK were increasing over the last decade. Ovarian cancer rates showed declines in most countries. With the exception of Russia, prostate cancer rates showed overall declines. Lymphoid neoplasms rates have been declining in both sexes, except in Poland and Russia. CONCLUSION Over the last decades, age-standardised cancer mortality in the elderly has been decreasing in major countries worldwide and for major cancer sites, with the major exception of lung and uterine cancer in women and liver, pancreatic and kidney cancers in both sexes. Cancer mortality for the elderly in central and eastern Europe remains comparatively high.
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Affiliation(s)
- G Carioli
- Departments of Clinical Sciences and Community Health, Universitá degli Studi di Milano, Milan, Italy
| | - M Malvezzi
- Departments of Clinical Sciences and Community Health, Universitá degli Studi di Milano, Milan, Italy
| | - P Bertuccio
- Departments of Biomedical and Clinical Sciences, Universitá degli Studi di Milano, Milan, Italy
| | - D Hashim
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - S Waxman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - E Negri
- Departments of Biomedical and Clinical Sciences, Universitá degli Studi di Milano, Milan, Italy
| | - P Boffetta
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - C La Vecchia
- Departments of Clinical Sciences and Community Health, Universitá degli Studi di Milano, Milan, Italy.
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26
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Shehata A, Patel I, Samreen I, Singh S, Waxman S, Cohen M, patel S. Abstract 363: Impact of Health Questionnaires as a Behavioral Modifier in Obese Patients: A Prospective Analysis. Circ Cardiovasc Qual Outcomes 2020. [DOI: 10.1161/hcq.13.suppl_1.363] [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: 11/16/2022]
Abstract
Introduction:
The morbidity and mortality associated with obesity (BMI >30 kg/m2) has been known to medical science for more than 2000 years.
1
Obesity is increasing in prevalence in adults, adolescents, and children and is considered a global epidemic. The age-adjusted overall prevalence of obesity in the United States increased progressively from 22.9 to 30.5 to 39.6 percent from the year 2007 to 2016.
2
Purpose:
To Assess if filling out a survey on obesity has any impact on a patient’s behavior and self-awareness in an outpatient setting.
Methods:
In an urban outpatient setting, 350 individuals aged 18 and above, suffering from obesity (defined as BMI >30/m2) were asked to fill-out a survey. The survey included basic demographic information, weight, employment status, exercise frequency, eating habits, and questions about self-perception. Patients filled out an identical follow-up survey 2-3 months later. We measured the changes in responses between the pre- and the post- survey.
Results:
Of the 350 original respondents, 103 patients followed up with the post-survey. 68.9% were women, 73.2% were African-American, and 62.3% were unemployed. 46.4% of patients felt neutral, or content about their current weight. 37.7% of patients reported never exercising in the pre-survey vs. 16.8% in the post-survey (20.9% improvement), while 25.3% of patients reported exercising 2-3 times per week in the pre-survey vs. 36.4% in the post-survey (11.1% improvement). 61% of patients had lost weight (average weight loss of 6.75lbs), 19% of patients had gained weight (average weight gain 4.55 lbs.) and 20% had maintained the same weight. We recorded a net weight loss of 2.2 lbs.
Conclusion:
In our pilot study, we found that the act of filling out a survey on obesity may have a positive impact on the behavior and self-awareness of patients with BMI > 30kg/m2. Larger sample sizes would be beneficial in order to further establish the impact of such intervention.
1. Bray GA. The Battle of the Bulge: A History of Obesity Research, Dorrance, Pittsburgh 2007. 2. Hales CM, Fryar CD, Carroll MD, Freedman DS, Ogden CL. Trends in Obesity and Severe Obesity Prevalence in US Youth and Adults by Sex and Age, 2007-2008 to 2015-2016. JAMA. 2018;319(16):1723.
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Singh S, Okoh AK, Khakwani Z, Hakeem H, Pilani H, Grewal J, Visveswaran G, Michael D, Agarwal S, Waxman S, Cohen M. CRT-200.17 Impact of Race on Clinical Outcomes After Stent Revascularization for High-Grade Renal Artery Stenosis: A Single-Center Experience. JACC Cardiovasc Interv 2020. [DOI: 10.1016/j.jcin.2020.01.105] [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: 11/30/2022]
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Okoh AK, Singh S, Obaidi N, Haik B, Chen C, Cohen M, Waxman S, Agarwal S, Russo M. CRT-600.10 Renin-Angiotensin-Aldosterone System Inhibitors Are Associated With Reno-Protective Effects in Aging Patients Undergoing Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2020. [DOI: 10.1016/j.jcin.2020.01.156] [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: 10/25/2022]
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Singh S, Okoh A, Sossou C, Heaton J, Sandhu M, Chakrabarti R, Rao R, Tayal R, Wasty N, Waxman S. TCT-113 Adverse Events After Left Atrial Appendage Closure: Lessons Learned From the Manufacturer and User Facility Device Experience (MAUDE) Database. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.160] [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: 10/25/2022]
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Okoh A, Thawabi M, Al Obaidi N, Fugar S, Singh S, Gold J, Waxman S, Tayal R, Wasty N. TCT-336 Use of a Percutaneous Temporary Mechanical Circulatory Support as a Bridge to Decision in Advanced Heart Failure Patients Listed for Heart Transplantation. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.417] [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: 10/25/2022]
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Batra S, Ramamurthi A, Waxman S, Shah S. ACUTE MASSIVE PULMONARY EMBOLUS COMPLICATED BY REFRACTORY CARIOGENIC SHOCK: WHAT IS THE OPTIMAL RIGHT VENTRICULAR SUPPORT DEVICE? J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32779-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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32
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Yager N, Waxman S. Impella removal with access site salvage. Catheter Cardiovasc Interv 2018; 92:58-60. [PMID: 29481717 DOI: 10.1002/ccd.27542] [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: 11/06/2017] [Revised: 01/09/2018] [Accepted: 01/29/2018] [Indexed: 11/12/2022]
Abstract
Removal of the percutaneous Impella CP assist device while maintaining femoral artery access site is not always possible. This case highlights a technique of Impella removal with access site salvage.
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Affiliation(s)
- Neil Yager
- Albany Medical College, Albany, New York
| | - Sergio Waxman
- Lahey Hospital and Medical Center, Burlington, Massachusetts
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33
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Affiliation(s)
- Sergio Waxman
- From Lahey Hospital & Medical Center, Burlington, Massachusetts
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34
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Yager N, Majithia A, Waxman S. Multivessel stent thrombosis with optical coherence tomography (OCT) utilization for therapeutic guidance. Cardiovascular Revascularization Medicine 2017; 18:445-446. [DOI: 10.1016/j.carrev.2017.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/22/2017] [Accepted: 03/29/2017] [Indexed: 11/30/2022]
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Abstract
In patients with left ventricular (LV) dysfunction, a large atrial septal defect (ASD) provides an alternate pathway for left atrial emptying and prevents abnormal elevation of left atrial and LV filling pressures. In such patients, closure of the ASD can cause an increase in LV diastolic pressure with pulmonary venous hypertension and congestion. The protective effect of an ASD is attenuated or abolished in the presence of right ventricular (RV) dysfunction. Thus, an elevated LV diastolic pressure in the presence of an ASD indicates dysfunction or failure of both ventricles. In this situation, pharmacologic or mechanical unloading of the left ventricle may result in right to left shunting with arterial hypoxemia. In the absence of RV failure, creation of an ASD can reduce LV filling pressures. Management of patients with heart failure and an ASD requires accurate assessment of atrial pressures and shunt flows as well as consideration of the functional state of both ventricles.
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Abstract
Revolutionizing treatment strategies is an urgent clinical need in the fight against cancer. Recently the scientific community has recognized chromatin-associated proteins as promising therapeutic candidates. However, there is a need to develop more targeted epigenetic inhibitors with less toxicity. Sin3 family is one such target which consists of evolutionary conserved proteins with two paralogues Sin3A and Sin3B. Sin3A/B are global transcription regulators that provide a versatile platform for diverse chromatin-modifying activities. Sin3 proteins regulate key cellular functions that include cell cycle, proliferation, and differentiation, and have recently been implicated in cancer pathogenesis. In this chapter, we summarize the key concepts of Sin3 biology and elaborate the recent advancements in the role of Sin3 proteins in cancer with specific examples in multiple endocrine neoplasia type 2, pancreatic ductal adenocarcinoma, and triple negative breast cancer. Finally, a program to create an integrative approach for screening antitumor agents that target chromatin-associated factors like Sin3 is presented.
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Affiliation(s)
- N Bansal
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - G David
- New York University School of Medicine, New York, NY, United States
| | - E Farias
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - S Waxman
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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37
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Gerbaud E, Weisz G, Tanaka A, Kashiwagi M, Shimizu T, Wang L, Souza C, Bouma BE, Suter MJ, Shishkov M, Ughi GJ, Halpern EF, Rosenberg M, Waxman S, Moses JW, Mintz GS, Maehara A, Tearney GJ. Multi-laboratory inter-institute reproducibility study of IVOCT and IVUS assessments using published consensus document definitions. Eur Heart J Cardiovasc Imaging 2015; 17:756-64. [PMID: 26377904 DOI: 10.1093/ehjci/jev229] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 08/26/2015] [Indexed: 10/23/2022] Open
Abstract
AIMS The aim of this study was to investigate the reproducibility of intravascular optical coherence tomography (IVOCT) assessments, including a comparison to intravascular ultrasound (IVUS). Intra-observer and inter-observer variabilities of IVOCT have been previously described, whereas inter-institute reliability in multiple laboratories has never been systematically studied. METHODS AND RESULTS In 2 independent laboratories with intravascular imaging expertise, 100 randomized matched data sets of IVOCT and IVUS images were analysed by 4 independent observers according to published consensus document definitions. Intra-observer, inter-observer, and inter-institute variabilities of IVOCT qualitative and quantitative measurements vs. IVUS measurements were assessed. Minor inter- and intra-observer variability of both imaging techniques was observed for detailed qualitative and geometric analysis, except for inter-observer mixed plaque identification on IVUS (κ = 0.70) and for inter-observer fibrous cap thickness measurement reproducibility on IVOCT (ICC = 0.48). The magnitude of inter-institute measurement differences for IVOCT was statistically significantly less than that for IVUS concerning lumen cross-sectional area (CSA), maximum and minimum lumen diameters, stent CSA, and maximum and minimum stent diameters (P < 0.001, P < 0.001, P < 0.001, P = 0.02, P < 0.001, and P = 0.01, respectively). Minor inter-institute measurement variabilities using both techniques were also found for plaque identification. CONCLUSION In the measurement of lumen CSA, maximum and minimum lumen diameters, stent CSA, and maximum and minimum stent diameters by analysts from two different laboratories, reproducibility of IVOCT was more consistent than that of IVUS.
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Affiliation(s)
- Edouard Gerbaud
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, BHX604A, Boston, MA 02114, USA
| | - Giora Weisz
- Columbia University Medical Center, New York, NY, USA Cardiovascular Research Foundation, New York, NY, USA
| | - Atsushi Tanaka
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, BHX604A, Boston, MA 02114, USA
| | - Manabu Kashiwagi
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, BHX604A, Boston, MA 02114, USA
| | - Takehisa Shimizu
- Columbia University Medical Center, New York, NY, USA Cardiovascular Research Foundation, New York, NY, USA
| | - Lin Wang
- Columbia University Medical Center, New York, NY, USA Cardiovascular Research Foundation, New York, NY, USA
| | - Christiano Souza
- Columbia University Medical Center, New York, NY, USA Cardiovascular Research Foundation, New York, NY, USA
| | - Brett E Bouma
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, BHX604A, Boston, MA 02114, USA
| | - Melissa J Suter
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, BHX604A, Boston, MA 02114, USA
| | - Milen Shishkov
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, BHX604A, Boston, MA 02114, USA
| | - Giovanni J Ughi
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, BHX604A, Boston, MA 02114, USA
| | - Elkan F Halpern
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA
| | - Mireille Rosenberg
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, BHX604A, Boston, MA 02114, USA
| | - Sergio Waxman
- Department of Cardiology, Lahey Clinic Medical Center, Burlington, MA, USA
| | - Jeffrey W Moses
- Columbia University Medical Center, New York, NY, USA Cardiovascular Research Foundation, New York, NY, USA
| | - Gary S Mintz
- Columbia University Medical Center, New York, NY, USA Cardiovascular Research Foundation, New York, NY, USA
| | - Akiko Maehara
- Columbia University Medical Center, New York, NY, USA Cardiovascular Research Foundation, New York, NY, USA
| | - Guillermo J Tearney
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, BHX604A, Boston, MA 02114, USA Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, USA Department of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
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38
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Waksman R, Kirtane AJ, Torguson R, Cohen DJ, Ryan T, Räber L, Applegate R, Waxman S, Gordon P, Kaneshige K, Leon MB. Correlates and outcomes of late and very late drug-eluting stent thrombosis: results from DESERT (International Drug-Eluting Stent Event Registry of Thrombosis). JACC Cardiovasc Interv 2014; 7:1093-102. [PMID: 25240540 DOI: 10.1016/j.jcin.2014.04.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [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: 03/17/2014] [Accepted: 04/24/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aim of this study was to identify clinical, procedural, and angiographic correlates of late/very late drug-eluting stent (DES) thrombosis as well as to determine the clinical outcomes of these events. BACKGROUND Late/very late DES thromboses are a poorly studied phenomenon, partly due to the relative infrequency of these events, even in large cohort studies. METHODS In the DESERT (International Drug-Eluting Stent Event Registry of Thrombosis), a retrospective, case-control registry, 492 cases of late/very late definite DES thrombosis from 21 international sites were matched in a 1:1 fashion with controls without stent thrombosis (ST). Controls were matched according to 2 criteria: same enrolling institution and date of initial DES implantation. Baseline and procedural variables were collected, and clinical follow-up was obtained for patients with ST as long as 1 year after the event. Offline quantitative coronary angiography was performed for a subset of 378 case-control pairs. RESULTS The majority of ST events occurred after 1 year (75%) and continued to occur for as long as 7.3 years. The clinical presentation of late/very late ST events was mainly myocardial infarction (66.7% ST-segment elevation myocardial infarction and 22.0% non-ST-segment elevation myocardial infarction); in-hospital mortality was 3.8%. A minority of patients (30%) with ST were receiving dual-antiplatelet therapy at the time of the event. Independent clinical correlates of late/very late ST were younger age, African-American race, current smoking, multivessel disease, longer stented length, overlapping stents, and percutaneous coronary intervention of vein graft lesions. Independent angiographic correlates for late/very late ST were lesions within the left anterior descending artery or a bypass graft, thrombus, and a larger residual diameter stenosis after the initial DES implantation. Despite the large sample of ST cases, all identified correlates of late/very late ST had weak associations with subsequent ST (all odds ratios <2.5). CONCLUSIONS Despite a large sample of ST cases and use of limited matching to maximize the identification of predictive factors associated with late/very late ST, the variables associated with the development of late/very late ST were only weakly predictive of subsequent events. Additionally, a relatively low observed mortality rate of ST in this series may reflect a different pathophysiology of these late/very late events compared with acute/subacute ST. (Drug Eluting Stent Registry of Thrombosis [DESERT]; NCT00812552).
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Affiliation(s)
- Ron Waksman
- MedStar Washington Hospital Center, Washington, DC.
| | - Ajay J Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital/Cardiovascular Research Foundation, New York, New York
| | | | - David J Cohen
- Saint Luke's Mid America Heart Institute, Kansas City, Kansas
| | | | - Lorenz Räber
- Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
| | | | - Sergio Waxman
- Lahey Clinic Medical Center, Burlington, Massachusetts
| | - Paul Gordon
- The Miriam Hospital, Providence, Rhode Island
| | | | - Martin B Leon
- Columbia University Medical Center/New York-Presbyterian Hospital/Cardiovascular Research Foundation, New York, New York
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Pyne CT, Gadey G, Jeon C, Piemonte T, Waxman S, Resnic F. Effect of Reduction of the Pulse Rates of Fluoroscopy and CINE-Acquisition on X-Ray Dose and Angiographic Image Quality During Invasive Cardiovascular Procedures. Circ Cardiovasc Interv 2014; 7:441-6. [DOI: 10.1161/circinterventions.114.001479] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Christopher T. Pyne
- From the Department of Cardiology, Lahey Clinic Medical Center, Burlington, MA
| | - Gautam Gadey
- From the Department of Cardiology, Lahey Clinic Medical Center, Burlington, MA
| | - Cathy Jeon
- From the Department of Cardiology, Lahey Clinic Medical Center, Burlington, MA
| | - Thomas Piemonte
- From the Department of Cardiology, Lahey Clinic Medical Center, Burlington, MA
| | - Sergio Waxman
- From the Department of Cardiology, Lahey Clinic Medical Center, Burlington, MA
| | - Frederic Resnic
- From the Department of Cardiology, Lahey Clinic Medical Center, Burlington, MA
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40
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Shah S, Boyd G, Pyne CT, Bilazarian SD, Piemonte TC, Jeon C, Waxman S. Right heart catheterization using antecubital venous access: Feasibility, safety and adoption rate in a tertiary center. Catheter Cardiovasc Interv 2013; 84:70-4. [DOI: 10.1002/ccd.25249] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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: 06/30/2013] [Revised: 09/17/2013] [Accepted: 10/10/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Sachin Shah
- Lahey Clinic41 Burlington Mall Road, 5 East, Cardiovascular MedicineBurlington Massachusetts
| | - Graham Boyd
- Lahey Clinic41 Burlington Mall Road, 5 East, Cardiovascular MedicineBurlington Massachusetts
| | - Christopher T. Pyne
- Lahey Clinic41 Burlington Mall Road, 5 East, Cardiovascular MedicineBurlington Massachusetts
| | - Seth D. Bilazarian
- Lahey Clinic41 Burlington Mall Road, 5 East, Cardiovascular MedicineBurlington Massachusetts
| | - Thomas C. Piemonte
- Lahey Clinic41 Burlington Mall Road, 5 East, Cardiovascular MedicineBurlington Massachusetts
| | - Cathy Jeon
- Lahey Clinic41 Burlington Mall Road, 5 East, Cardiovascular MedicineBurlington Massachusetts
| | - Sergio Waxman
- Lahey Clinic41 Burlington Mall Road, 5 East, Cardiovascular MedicineBurlington Massachusetts
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41
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Waksman R, Torguson R, Kaneshige K, Kirtane A, Ryan T, Applegate R, Waxman S, Cohen D, Gordon P. Who is at risk to develop late drug-eluting stent thrombosis while on dual antiplatelet therapy? A subset analysis from the Drug Eluting Stent Event Registry of Thrombosis (DESERT). Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3047] [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: 11/13/2022] Open
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42
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Shah SP, Waxman S. Two cases of Bezold-Jarisch reflex induced by intra-arterial nitroglycerin in critical left main coronary artery stenosis. Tex Heart Inst J 2013; 40:484-486. [PMID: 24082386 PMCID: PMC3783151] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The Bezold-Jarisch reflex, a well-described phenomenon, occurs upon the stimulation of intracardiac mechanoreceptors and is mediated by vagal afferent nerve fibers. Several factors can sensitize the cardiovascular system to develop this reflex, including acute myocardial ischemia, natriuretic peptides, and, rarely, nitroglycerin administration in the setting of acute myocardial infarction. The development of the Bezold-Jarisch reflex in the presence of severe coronary artery stenosis, specifically left main coronary artery stenosis, has not been described. We report 2 cases of patients who underwent elective coronary angiography and were given intra-arterial nitroglycerin during radial sheath insertion to reduce radial artery spasm. In both patients, bradycardia and hypotension developed along with diaphoresis, consistent with the Bezold-Jarisch reflex. Coronary angiography revealed critical (>90%) left main coronary artery stenosis in both patients. Critical left main coronary artery stenosis might sensitize mechanoreceptors or vagal afferents to the development of the Bezold-Jarisch reflex after intra-arterial nitroglycerin use; however, the mechanism of this possible relationship is unclear. In addition to discussing our patients' cases, we review the medical literature relevant to the Bezold-Jarisch reflex.
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Affiliation(s)
- Sachin P Shah
- Department of Cardiovascular Medicine (Drs. Shah and Waxman), Lahey Clinic, Burlington, Massachusetts 01805; and Tufts University School of Medicine (Dr. Waxman), Boston, Massachusetts 02111
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43
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Waksman R, Torguson R, Kaneshige K, Kirtane A, Ryan T, Räber L, Applegate R, Waxman S, Cohen D, Gordon P. TCT-621 Drug-Eluting Stent Event Registry of Thrombosis (DESERT): The International Drug-Eluting Stent Thrombosis Registry, Angiographic Assessment. J Am Coll Cardiol 2012. [DOI: 10.1016/j.jacc.2012.08.658] [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: 10/27/2022]
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44
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Fleg JL, Stone GW, Fayad ZA, Granada JF, Hatsukami TS, Kolodgie FD, Ohayon J, Pettigrew R, Sabatine MS, Tearney G, Waxman S, Domanski MJ, Srinivas PR, Narula J. Detection of high-risk atherosclerotic plaque: report of the NHLBI Working Group on current status and future directions. JACC Cardiovasc Imaging 2012; 5:941-55. [PMID: 22974808 PMCID: PMC3646061 DOI: 10.1016/j.jcmg.2012.07.007] [Citation(s) in RCA: 165] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 07/18/2012] [Accepted: 07/19/2012] [Indexed: 12/27/2022]
Abstract
The leading cause of major morbidity and mortality in most countries around the world is atherosclerotic cardiovascular disease, most commonly caused by thrombotic occlusion of a high-risk coronary plaque resulting in myocardial infarction or cardiac death, or embolization from a high-risk carotid plaque resulting in stroke. The lesions prone to result in such clinical events are termed vulnerable or high-risk plaques, and their identification may lead to the development of pharmacological and mechanical intervention strategies to prevent such events. Autopsy studies from patients dying of acute myocardial infarction or sudden death have shown that such events typically arise from specific types of atherosclerotic plaques, most commonly the thin-cap fibroatheroma. However, the search in human beings for vulnerable plaques before their becoming symptomatic has been elusive. Recently, the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study demonstrated that coronary plaques that are likely to cause future cardiac events, regardless of angiographic severity, are characterized by large plaque burden and small lumen area and/or are thin-cap fibroatheromas verified by radiofrequency intravascular ultrasound imaging. This study opened the door to identifying additional invasive and noninvasive imaging modalities that may improve detection of high-risk atherosclerotic lesions and patients. Beyond classic risk factors, novel biomarkers and genetic profiling may identify those patients in whom noninvasive imaging for vulnerable plaque screening, followed by invasive imaging for risk confirmation is warranted, and in whom future pharmacological and/or device-based focal or regional therapies may be applied to improve long-term prognosis.
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Affiliation(s)
- Jerome L. Fleg
- National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Gregg W. Stone
- Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
| | | | - Juan F. Granada
- Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
| | | | | | - Jacques Ohayon
- National Institute of Diabetes, Digestive, and Kidney Diseases, Bethesda, Maryland
| | - Roderic Pettigrew
- National Institute of Diabetes, Digestive, and Kidney Diseases, Bethesda, Maryland
| | - Marc S. Sabatine
- Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Guillermo Tearney
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Jagat Narula
- Mount Sinai School of Medicine, New York, New York
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45
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Wang R, Xia L, Gabrilove J, Waxman S, Jing Y. Downregulation of Mcl-1 through GSK-3β activation contributes to arsenic trioxide-induced apoptosis in acute myeloid leukemia cells. Leukemia 2012; 27:315-24. [PMID: 22751450 PMCID: PMC3478411 DOI: 10.1038/leu.2012.180] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [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] [Indexed: 12/26/2022]
Abstract
Arsenic trioxide (ATO) induces disease remission in acute promyelocytic leukemia (APL) patients, but not in non-APL acute myeloid leukemia (AML) patients. ATO at therapeutic concentrations (1-2 μM) induce APL NB4, but not non-APL HL-60, cells to undergo apoptosis through the mitochondrial pathway. The role of antiapoptotic protein Mcl-1 in ATO-induced apoptosis was determined. The levels of Mcl-1 were decreased in NB4, but not in HL-60, cells after ATO treatment through proteasomal degradation. Both GSK3β inhibitor SB216763 and siRNA blocked ATO-induced Mcl-1 reduction as well as attenuated ATO-induced apoptosis in NB4 cells. Silencing Mcl-1 sensitized HL-60 cells to ATO-induced apoptosis. Both ERK and AKT inhibitors decreased Mcl-1 levels and enhanced ATO-induced apoptosis in HL-60 cells. Sorafenib, a Raf inhibitor, activated GSK3β by inhibiting its phosphorylation, decreased Mcl-1 levels, and decreased intracellular glutathione levels in HL-60 cells. Sorafenib plus ATO augmented ROS production and apoptosis induction in HL-60 cells and in primary AML cells. These results indicate that ATO induces Mcl-1 degradation through activation of GSK3β in APL cells and provide a rationale for utilizing ATO in combination with sorafenib for the treatment of non-APL AML patients.
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Affiliation(s)
- R Wang
- The Division of Hematology/Oncology, Department of Medicine, Mount Sinai School of Medicine, The Tisch Cancer Institute, New York, NY, USA
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Tearney GJ, Regar E, Akasaka T, Adriaenssens T, Barlis P, Bezerra HG, Bouma B, Bruining N, Cho JM, Chowdhary S, Costa MA, de Silva R, Dijkstra J, Di Mario C, Dudek D, Dudeck D, Falk E, Falk E, Feldman MD, Fitzgerald P, Garcia-Garcia HM, Garcia H, Gonzalo N, Granada JF, Guagliumi G, Holm NR, Honda Y, Ikeno F, Kawasaki M, Kochman J, Koltowski L, Kubo T, Kume T, Kyono H, Lam CCS, Lamouche G, Lee DP, Leon MB, Maehara A, Manfrini O, Mintz GS, Mizuno K, Morel MA, Nadkarni S, Okura H, Otake H, Pietrasik A, Prati F, Räber L, Radu MD, Rieber J, Riga M, Rollins A, Rosenberg M, Sirbu V, Serruys PWJC, Shimada K, Shinke T, Shite J, Siegel E, Sonoda S, Sonada S, Suter M, Takarada S, Tanaka A, Terashima M, Thim T, Troels T, Uemura S, Ughi GJ, van Beusekom HMM, van der Steen AFW, van Es GA, van Es GA, van Soest G, Virmani R, Waxman S, Weissman NJ, Weisz G. Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation. J Am Coll Cardiol 2012; 59:1058-72. [PMID: 22421299 DOI: 10.1016/j.jacc.2011.09.079] [Citation(s) in RCA: 1289] [Impact Index Per Article: 107.4] [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] [Received: 02/28/2011] [Revised: 08/09/2011] [Accepted: 09/27/2011] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The purpose of this document is to make the output of the International Working Group for Intravascular Optical Coherence Tomography (IWG-IVOCT) Standardization and Validation available to medical and scientific communities, through a peer-reviewed publication, in the interest of improving the diagnosis and treatment of patients with atherosclerosis, including coronary artery disease. BACKGROUND Intravascular optical coherence tomography (IVOCT) is a catheter-based modality that acquires images at a resolution of ~10 μm, enabling visualization of blood vessel wall microstructure in vivo at an unprecedented level of detail. IVOCT devices are now commercially available worldwide, there is an active user base, and the interest in using this technology is growing. Incorporation of IVOCT in research and daily clinical practice can be facilitated by the development of uniform terminology and consensus-based standards on use of the technology, interpretation of the images, and reporting of IVOCT results. METHODS The IWG-IVOCT, comprising more than 260 academic and industry members from Asia, Europe, and the United States, formed in 2008 and convened on the topic of IVOCT standardization through a series of 9 national and international meetings. RESULTS Knowledge and recommendations from this group on key areas within the IVOCT field were assembled to generate this consensus document, authored by the Writing Committee, composed of academicians who have participated in meetings and/or writing of the text. CONCLUSIONS This document may be broadly used as a standard reference regarding the current state of the IVOCT imaging modality, intended for researchers and clinicians who use IVOCT and analyze IVOCT data.
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Affiliation(s)
- Guillermo J Tearney
- The Massachusetts General Hospital and the Wellman Center for Photomedicine, Boston, Massachusetts 02114, USA.
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Pettersson F, Miller WH, Nervi C, Gronemeyer HJ, Licht J, Tallman MS, Waxman S. The 12th international conference on differentiation therapy: targeting the aberrant growth, differentiation and cell death programs of cancer cells. Cell Death Differ 2011; 18:1231-3. [PMID: 21212795 DOI: 10.1038/cdd.2010.173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Larsen P, Shah S, Waxman S, Freilich M, Riskalla N, Piemonte T, Jeon C, Pyne C. Comparison of procedural times, success rates, and safety between left versus right radial arterial access in primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction. Catheter Cardiovasc Interv 2010; 78:38-44. [DOI: 10.1002/ccd.22843] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 09/20/2010] [Indexed: 01/28/2023]
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Saltzman AJ, Choi SW, Dabreo A, Baur WE, Weiss E, Nguyen K, Ishibashi F, Celestin FF, Karia DH, Pandian NG, Karas RH, Waxman S. Endothelial progenitor cells delivered into the pericardial space incorporate into areas of ischemic myocardium. Cardiovascular Revascularization Medicine 2010; 11:241-8. [DOI: 10.1016/j.carrev.2009.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 05/28/2009] [Accepted: 06/04/2009] [Indexed: 11/29/2022]
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Waxman S, Freilich MI, Suter MJ, Shishkov M, Bilazarian S, Virmani R, Bouma BE, Tearney GJ. A case of lipid core plaque progression and rupture at the edge of a coronary stent: elucidating the mechanisms of drug-eluting stent failure. Circ Cardiovasc Interv 2010; 3:193-6. [PMID: 20407116 DOI: 10.1161/circinterventions.109.917955] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sergio Waxman
- Tufts University School of Medicine, Boston, MA, USA
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