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Publications (130)
Background
Mitral regurgitation (MR) is the most common valvular disease in the United States and increases the risk of death and hospitalization. The economic burden of MR in the United States is not known.
Methods and Results
We analyzed inpatient hospitalization data from the 1 221 173 Maryland residents who had any in‐state admissions from Oct...
Background
While there is evidence that patients with low-flow, low-gradient aortic stenosis (AS) benefit from transcatheter aortic valve replacement (TAVR), data are lacking regarding outcomes of patients with a very low gradient (VLG).
Methods
In this retrospective, single-center study of patients with severe AS who underwent TAVR, three groups...
Background:
Frailty and cognitive impairment (CI) are geriatric conditions that lead to poor health outcomes among older adults with cardiovascular disease. The association between their temporal patterns of development and cardiovascular risk is unknown.
Objectives:
This study aims to examine the 5-year cardiovascular outcomes by the pattern of...
Background:
Transcatheter aortic valve replacement (TAVR) is an increasingly used but relatively expensive procedure with substantial associated readmission rates. It is unknown how cost-constrictive payment reform measures, such as Maryland's All Payer Model, impact TAVR utilization given its relative expense. This study investigated the impact o...
Structural heart disease is common in the elderly, and in past decades the definitive treatment of many structural heart diseases required cardiac surgery. Because surgical morbidity and mortality increase with age and comorbidity burden, many elderly patients are at high surgical risk or inoperable. The last decade has seen an explosion in effecti...
Background
The Evolut Low Risk Trial (Medtronic Evolut Transcatheter Aortic Valve Replacement in Low Risk Patients) showed that transcatheter aortic valve replacement (TAVR) with a supra-annular, self-expanding valve was noninferior to surgery for the primary endpoint of all-cause mortality or disabling stroke at 2 years. This finding was based on...
With the aging of the world’s population, a large proportion of patients seen in cardiovascular practice are older adults, but many patients also exhibit signs of physical frailty. Cardiovascular disease and frailty are interdependent and have the same physiological underpinning that predisposes to the progression of both disease processes. Frailty...
Objectives
We aimed to evaluate the risk of procedural complications after TAVR using secondary radial access (RA) versus femoral access (FA) through a systematic review and meta-analysis of the published literature.
Background
Transcatheter aortic valve replacement (TAVR) entails both large-bore arterial access for device delivery and secondary a...
Aims:
Physical frailty is a commonly encountered geriatric syndrome among older adults without coronary heart disease (CHD). The impact of frailty on the incidence of long-term cardiovascular outcomes is not known. We aimed to evaluate the long-term association of frailty, measured by the Fried frailty phenotype, with all-cause-mortality and MACE...
The use of transcatheter aortic valve implantation (TAVI) has greatly increased over the past 2 decades and now has overtaken surgical aortic valve replacement. We have limited data regarding the long-term durability of TAVI and the predictors of survival. Calcification, inflammation, fibrous tissue deposition, and mechanical stress are important i...
[This corrects the article DOI: 10.1055/s-0040-1716328.].
Introduction: Frailty, a clinical state of vulnerability, is associated with subsequent adverse geriatric syndromes in the general population.
Hypothesis: We hypothesized that frailty influence health outcomes among older patients with coronary heart disease (CHD).
Methods: We used the National Health and Aging Trends Study, a prospective cohort st...
Background: Knowledge gaps remain in the epidemiology and clinical implications of myocardial injury in COVID-19. Our goal was to determine the prevalence and outcomes of myocardial injury in severe COVID-19 compared to acute respiratory distress syndrome (ARDS) unrelated to COVID-19.
Methods: We included intubated COVID-19 patients from 5 hospital...
Background
Frailty, a clinical state of vulnerability, is associated with subsequent adverse geriatric syndromes in the general population. We examined the long-term impact of frailty on geriatric outcomes among older patients with coronary heart disease.
Methods
We used the National Health and Aging Trends Study, a prospective cohort study linked...
Coronary computed tomography angiography (CCTA) offers high-resolution anatomic characterization of the coronary vasculature but may be suboptimal for lesions dependent on real-time visualization of flow including chronic total occlusion (CTO). In CTOs, heavy calcification and distal vessel opacification from collateralization may confound luminal...
Background
Restricting transcatheter aortic valve replacement (TAVR) to centers based on volume thresholds alone can potentially create unintended disparities in healthcare access. We aimed to compare the influence of population density in state of Florida in regard to access to TAVR, TAVR utilization rates, and in-hospital mortality.
Methods and...
Background
Racial and ethnic inequities exist in surgical aortic valve replacement for aortic stenosis (AS), and early studies have suggested similar inequities in transcatheter aortic valve replacement.
Methods and Results
We performed a retrospective analysis of the Maryland Health Services Cost Review Commission inpatient data set from 2016 to...
Background
Skeletal muscle wasting, or sarcopenia, affects a significant proportion of patients undergoing TAVR. However, its influence on post-TAVR recovery and one-year health-related quality of life (HR-QOL) remains unknown. We examined the relationship between skeletal muscle index (SMI), post TAVR length of hospital stay (LOS), and one-year QO...
Purpose:
To evaluate the relationship between CT findings of diffuse lung disease and post-transcatheter aortic valve replacement (TAVR) outcomes.
Materials and methods:
Retrospective review of pre-TAVR CT scans obtained during 2012-2017 was conducted. Emphysema, reticulation, and honeycombing were separately scored using a five-point scale and...
Objectives:
The aim of this study was to report the 2-year results of the SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial and confirm the interim Bayesian analysis.
Background:
Transcatheter aortic valve replacement (TAVR) with a self-expanding valve was noninferior to surgery in patients with severe aortic steno...
Background
Frailty is a predictor of adverse outcomes after acute myocardial infarction ( AMI ).
Methods and Results
We estimated the prevalence of frailty among adults age ≥75 years admitted with AMI and examined the relationship between frailty, interventions, and mortality. We used the Premier Healthcare Database to identify older adults with p...
Objective:
In this secondary analysis of the PACIFY randomized trial, we assessed whether dose and timing of fentanyl have implications for the pharmacokinetics and pharmacodynamics of ticagrelor loading during percutaneous coronary intervention (PCI).
Methods:
Among 212 patients undergoing clinically indicated coronary angiography, a total of 7...
Background:
Older adults ≥75 years of age carry an increased risk of mortality after ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock.
Objectives:
The purpose of this study was to examine the use of percutaneous coronary intervention (PCI) in older adults with STEMI and shock and its influence on in-hospital mo...
Background
Transcatheter aortic-valve replacement (TAVR) is an alternative to surgery in patients with severe aortic stenosis who are at increased risk for death from surgery; less is known about TAVR in low-risk patients.
Methods
We performed a randomized noninferiority trial in which TAVR with a self-expanding supraannular bioprosthesis was comp...
Introduction:
Frailty is an important component of risk prognostication in transcatheter aortic valve replacement (TAVR). Objective markers of frailty, including sarcopenia, the modified Frailty Index (mFI), and albumin levels, have emerged, but little is known how such markers compare to each other in predicting outcomes after TAVR. We sought to...
Objectives
The Multi‐center Prospective Study to Evaluate Outcomes of Moderate to Severely Calcified Coronary Lesions (MACE—Trial) was designed to provide further insight on the impact of calcification on procedural and long‐term percutaneous coronary intervention outcomes.
Background
Prior studies evaluating the impact of lesion calcification on...
Objectives:
The authors sought to compare clinical and hemodynamic outcomes in patients receiving transcatheter aortic valve replacement (TAVR) for low-gradient (LG) aortic stenosis in the CoreValve EUS (Expanded Use Study) versus those with high-gradient (HG) aortic stenosis from the CoreValve U.S. Pivotal Extreme Risk Trial and CAS (Continued Ac...
Morphine delays oral P2Y12 platelet inhibitor absorption and is associated with adverse outcomes after myocardial infarction. Consequently, many physicians and first responders are now considering fentanyl as an alternative. We conducted a single-centre trial randomizing cardiac patients undergoing coronary angiography to intravenous fentanyl or no...
Received: April 26, 2018
Accepted: April 26, 2018
Published online: July 02, 2018
Issue release date: July 2018
Background
We examined the outcomes of older adults undergoing nontrans‐femoral (non‐TF) transcatheter aortic valve replacement (TAVR) procedures including trans‐apical (TA), trans‐aortic (TAo), trans‐subclavian (TSub), and trans‐carotid (TCa) techniques.
Methods and Results
This is an observational study of all consecutive older patients who unde...
Introduction:
Morphine reduces and delays the absorption of oral P2Y12 platelet inhibitors. Fentanyl is another opiate often administered during percutaneous coronary interventions (PCI). The PACIFY study will test whether intravenous fentanyl also impairs the absorption and action of oral P2Y12 inhibitors.
Methods:
PACIFY is a single-center tri...
Fentanyl is a potent opiate commonly administered during cardiac catheterization procedures in North America. The question of whether fentanyl could have adverse consequences in patients undergoing percutaneous coronary intervention (PCI) is raised by recent research demonstrating that intravenous morphine significantly delays the absorption of ora...
Objectives
Procedural complications following transcatheter (TAVR) or surgical aortic valve replacement (SAVR) are usually reported as retrospective analyses. We report the first comparison of complications following SAVR or self-expanding TAVR from a prospectively randomized study of high risk SAVR patients.
Methods
A total of 395 TAVR and 402 SA...
Importance:
Transcatheter aortic valve replacement (TAVR) is now a well-accepted alternative to surgical AVR (SAVR) for patients with symptomatic aortic stenosis at increased operative risk. There is interest in whether TAVR would benefit patients at lower risk.
Objective:
The Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM) h...
Background:
Multidetector computed tomography is useful for determining the appropriate transcatheter heart valve (THV) size in patients with severe aortic stenosis who are suboptimal surgical candidates. The relationship between adherence to the recommended CoreValve sizing algorithm and clinical outcomes is not known.
Methods and results:
We e...
The objective of this study is based on the phase of care mortality analysis (POCMA), an effective tool to evaluate the root cause of in-hospital mortality in cardiac surgery patients. POCMA has not been used to compare operative mortalities among transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) populations...
Background:
In patients with severe aortic stenosis at increased risk for surgery, self-expanding transcatheter aortic valve replacement (TAVR) is associated with improved 2-year survival compared with surgery.
Objective:
We sought to determine whether this clinical benefit was sustained over time.
Methods:
Patients with severe aortic stenosis...
Background:
Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are treatment options for aortic stenosis in patients with prior coronary artery bypass graft surgery. We assessed the major clinical outcomes of such patients enrolled in the CoreValve High Risk (CHR) study.
Methods:
Of the 795 CHR study patie...
The patient is a 74-year-old woman with a history of paroxysmal atrial fibrillation, hypertension, and dyslipidemia, who initially presented to an outside hospital in 2009 with a transient ischemic attack. Evaluation identified a patent foramen ovale; a percutaneous closure of the patent foramen ovale was performed using a StarFLEX atrial septal oc...
Mediastinal fibrosis is an uncommon disease involving the esophagus, respiratory tract, and great vessels. We report a man who presented with dyspnea on exertion. Computed tomography of the chest demonstrated granulomatous disease with dense calcifications leading to severe stenosis of the main pulmonary artery (PA) and narrowing of the superior ve...
The U.S. pivotal trial for the self-expanding valve found that among patients with severe aortic stenosis at increased risk for surgery, the 1-year survival rate was 4.9 percentage points higher in patients treated with a self-expanding transcatheter aortic valve bioprosthesis than in those treated with a surgical bioprosthesis.
Longer-term clinica...
Introduction: Stroke is a leading cause of death in adults with sickle cell disease (SCD), although little is known about the underlying pathophysiology or associated risk factors. A patent foramen ovale (PFO) or other intracardiac shunts are associated with ischemic stroke in children with SCD and young adults without SCD. PFOs are relatively comm...
Valvular aortic stenosis (AS) is a progressive disease that affects 2% of the population aged 65 years or older. The major cause of valvular AS in adults is calcification and fibrosis of a previously normal tricuspid valve or a congenital bicuspid valve, with rheumatic AS being rare in the United States. Once established, the rate of progression of...
Ischemic stroke occurring during intercourse in the young patient is exceedingly rare. We present two cases of young women taking oral contraceptives, each presenting with an ischemic stroke. Transthoracic echocardiography revealed a patent foramen ovale (PFO) in one patient, and an atrial septal defect (ASD) in the other. The most likely etiology...
Objectives:
The CoreValve Extreme Risk US Pivotal Trial enrolled patients with symptomatic severe aortic stenosis deemed unsuitable for surgical aortic valve replacement. Implants were attempted using transfemoral access (n = 489) or an alternative access (n = 150). In present analysis, we sought to examine the safety and efficacy of CoreValve tra...
Severe aortic stenosis (AS) results in considerable morbidity and mortality without aortic valve replacement and is expected to increase in prevalence with the aging population. Since AS primarily affects the elderly, many patients with co-morbidities are poor candidates for surgical aortic valve replacement (SAVR) and may not be referred. Trans-ca...
Although individuals with sickle cell disease (SCD) are at increased risk for stroke, the underlying pathophysiology is incompletely understood. Intracardiac shunting via a patent foramen ovale (PFO) is associated with cryptogenic stroke in individuals without SCD. Recent evidence suggests that PFOs are associated with stroke in children with SCD,...
What's known on the subject? and What does the study add?
Withdrawal of dual antiplatelet therapy before the recommended, 12 months for drug-eluting stents and 1 month for bare-metal stents increases the rate of major adverse coronary events and mortality. However, in those undergoing surgery the risk of bleeding is increased substantially for thos...
The interventricular septum constitutes approximately one-third of the mass of the left ventricle, and the bulk of the anterior septum is supplied by septal branches of the left anterior descending coronary artery. Ischemia of the interventricular septum results in angina, infarction, biventricular failure and ventricular arrhythmias. While the maj...
Patients with diabetes mellitus have an increased prevalence of vascular disease. Pathologic thrombosis associated with atherosclerotic plaque rupture is a major cause of morbidity and mortality. Platelets are intimately involved in the initiation and propagation of thrombosis. Evidence suggests that platelets from patients with type 2 diabetes hav...
Bronchopulmonary fistula, a communication between the bronchial airway and the pleural space, is associated with increased morbidity and mortality often requiring surgical therapy. A successful closure of a fistula from the posterior trachea to the right apical pleural space in a 60-year-old man with a history of Barrett's esophagus, esophagectomy,...
Perfusion assessed in the cardiac catheterization laboratory predicts outcomes after myocardial infarction. The aim of this study was to investigate a novel method of assessing perfusion using digital subtraction angiography to generate a time-density curve (TDC) of myocardial blush, incorporating epicardial and myocardial perfusion. Seven pigs und...
Several treatment strategies, including lowering low-density lipoprotein cholesterol with intensive statin therapy, reducing triglycerides with fibrates, and raising high-density lipoprotein cholesterol with nicotinic acid, have the potential to induce atherosclerosis regression. Atherosclerosis imaging techniques including intravascular ultrasound...
A 58-yr-old woman with a known patent foramen ovale (PFO), which was diagnosed 3 yr ago by trans- esophageal echocardiogram (TEE) after a transient ischemic attack, presented with chest pain, and was referred for cardiac catheterization with possible in- tervention. Up to this point, the PFO was being medically managed with warfarin; however, becau...
The incidence of probe-patent foramen ovale (PFO) at autopsy is approximately 27% with slit widths ranging from 1 mm to 19 mm (mean 4.9 mm) in diameter. In patients with end-stage heart failure requiring mechanical support, implantation of a left ventricular assist device (LVAD) abruptly decreases diastolic filling pressures and can cause right-to-...
Patients with metabolic syndrome are at increased risk for cardiovascular complications. We sought to determine whether peroxisome proliferator-activated receptor gamma agonists had any beneficial effect on patients with metabolic syndrome undergoing percutaneous coronary intervention (PCI).
A total of 200 patients with metabolic syndrome undergoin...
Optimization of coronary images for percutaneous coronary intervention (PCI) remains difficult due to cardiac motion throughout the respiratory and cardiac cycles. We tested a novel system to stabilize angiographic images at the region of interest in order to assist during PCI.
Patients undergoing PCI to the right coronary artery (RCA) (group 1, n...
Coronary air embolism is a complication in the catheterization laboratory that can be associated with high morbidity and even mortality. A case report of air embolism and methods to prevent this complication from occurring are presented along with various management techniques.
Guide catheter-induced dissection of the coronary arteries is an uncommon but potentially catastrophic complication of diagnostic and interventional cardiac catheterization. Several factors placing the individual at higher risk of this complication have been identified. We discuss these risk factors and utilize them to propose methods to prevent di...
This paper presents measurements of three-dimensional (3-D) displacements and velocities of the coronary arteries due to the myocardial beating motion and due to breathing. Data were acquired by reconstructing the coronary arteries and their motion from biplane angiograms in 10 patients. A parametric motion model was used to separate the cardiac an...
The purpose of this prospective, multicenter trial was to evaluate the safety and effectiveness of the TRAP Vascular Filtration System (VFS) to reduce embolic complications during stenting of diseased saphenous vein grafts (SVGs). Patients with SVG lesions were randomly assigned to undergo stenting with or without the TRAP device. The trial was des...
Marked variability exists in coronary artery collaterals in patients with ischemic heart disease. Although multiple factors are thought to play a role in collateral development, the contribution of genetic factors is largely unknown. Hypoxia inducible factor 1 (HIF-1), a transcriptional activator that functions as a master regulator of oxygen homeo...
Chronic kidney disease is associated with an increased risk of ischemic and bleeding complications after percutaneous coronary intervention (PCI). Bivalirudin, a direct thrombin inhibitor, has been shown to reduce adverse bleeding events compared to unfractionated heparin in patients undergoing PCI. However, the effect of diminished renal function...
Background:
Magnetocardiography (MCG) is a noninvasive technology that measures the magnetic field of the heart by superconducting quantum interference devices (SQUID) sensors. The novelty of the present system is that the sensors can be operated without electromagnetic shielding of the examination room, thus allowing the system to be easily insta...
A method for prospective motion correction of X-ray imaging of the heart is presented. A 3D + t coronary model is reconstructed from a biplane coronary angiogram obtained during free breathing. The deformation field is parameterized by cardiac and respiratory phase, which enables the estimation of the state of the arteries at any phase of the cardi...
Drug-eluting stents have rapidly come to dominate the field of coronary intervention, constituting 85% of the US market just one year after introduction. The current utilization of bare metal stents in coronary intervention in the US is quite limited. This article will review technological advances in third-generation bare metal stents, which optim...
A 52-year-old asymptomatic man, with cardiac risk factors of hypertension, Type II diabetes, hypertriglyceridemia, low HDL, obesity, and positive family history for early coronary artery disease (CAD), was referred to nuclear stress test. He exercised for 14 minutes, achieved his target heart rate, without any symptoms or ECG changes. Nuclear image...
Magnetic resonance (MR) and computed tomography coronary imaging is susceptible to artifacts caused by motion of the heart. The presence of rest periods during the cardiac and respiratory cycles suggests that images free of motion artifacts could be acquired. In this paper, we studied the rest period (RP) duration of the coronary arteries during a...
Respiratory motion compensation for cardiac imaging requires knowledge of the heart's motion and deformation during breathing. This paper presents a method for measuring the natural tidal respiratory motion of the heart from free breathing coronary angiograms. A three-dimensional (3-D) deformation field describing the cardiac and respiratory motion...
Introduction: Motion during MR imaging causes blurring and ghosting artifacts. The long scan times used for 3D MR coronary angiography introduce the possibility of respiratory motion artifacts. Imaging during quiescent phases of the respiratory cycle is a method for eliminating these artifacts. Additionally, translational motion correction using na...
Respiratory motion compensation for cardiac imaging requires knowledge
of the heart's motion and deformation during breathing. We propose a
method for measuring the natural tidal respiratory motion of the heart
using free breathing coronary angiograms. A 3D deformation field
describing the cardiac and respiratory motion of the coronary arteries
is...
A nitric oxide (NO)-related defect may contribute to abnormal coronary sympathetic responses that can cause ischemia in patients with endothelial dysfunction. Because L-arginine, the NO synthase (NOS) precursor, augments NO bioactivity, we hypothesized that L-arginine would improve dysfunctional coronary sympathetic responses. Eleven patients with...