Publications by authors named "Debabrata Mukherjee"

400 Publications

Sodium-Glucose Cotransporter Inhibitors in Non- Diabetic Heart Failure: A Narrative Review.

Cardiovasc Hematol Disord Drug Targets 2020 Dec 31. Epub 2020 Dec 31.

Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, EL Paso, Texas;. United States.

Background: Heart failure (HF) is one of the leading public health problems with a substantial burden in the global healthcare system. Although significant efforts are based on prevention, early recognition, and proper management of HF, the worldwide surge of risk factors like hypertension, diabetes, obesity has further complicated the existing problem.

Objective: To define the role of the sodium-glucose cotransporter 2 (SGLT2) inhibitors in non-diabetic HF.

Methods: We performed a comprehensive literature review to examine the available evidence in the clinical implications of SGLT2 inhibitors in non-diabetic HF using the online databases (PubMed and Embase).

Results: We identified two RCTs - DAPA-HF and DEFINE-HF, which were conducted to analyze the net clinical benefit of dapagliflozin in non-diabetic HF patients. Although we could not study the composite effects of these studies due to the difference in outcome measures, the individual outcomes look promising. The number needed to treat (NNT) to prevent one primary event was 21 (95% CI: 15 to 38) in the DAPA study. In, DEFINE HF study, responder analysis showed a significant proportion of patients in the treatment arm experienced improvements in functional status with clinically meaningful improvement in KCCQ-OS by 3.7 points and KCCQ-CS by 4.6 points with NNT of 10 and 7 respectively, at 12 weeks. Both studies also showed low safety concerns in patients without T2D.

Conclusions: The outcomes of the two RCTs, DAPA-HF and DEFINE-HF, that studied the effects of SGLT2 inhibitors in non-diabetic HF showed promising clinical outcomes. Although we are waiting for other prospective RCTs to reflect similar results and safety profiles, it seems the SGLT2 inhibitors can have broader clinical implications in managing non-diabetic HF with improved cardiovascular outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2174/1871529X20999201231205504DOI Listing
December 2020

Outcomes of rotational atherectomy versus orbital atherectomy for the treatment of heavily calcified coronary stenosis: A systematic review and meta-analysis.

Catheter Cardiovasc Interv 2020 Dec 16. Epub 2020 Dec 16.

Division of Cardiovascular Medicine, East Tennessee State University, Johnson City, Tennessee, USA.

Introduction: The optimal approach to deal with severe coronary artery calcification (CAC) during percutaneous coronary intervention (PCI) remains ill-defined.

Methods: We conducted an electronic database search of all published studies comparing Orbital versus Rotational Atherectomy in patients undergoing PCI.

Results: Eight observational studies were included in the analysis. Overall, there were no significant differences in Major-adverse-cardiac-events/MACE (OR: 0.81, CI: 0.63-1.05, p = .11), myocardial-infarction/MI (OR: 0.75, CI: 0.56-1.00, p = .05), all-cause mortality (OR: 0.82, CI: 0.25-2.64, p = .73) or Target-vessel-revascularization/TVR (OR: 0.72, CI: 0.38-1.36, p = .31). However, OA was associated with lower long-term MACE (1-year), (OR: 0.66, CI: 0.44-0.99, p = .04), long-term TVR (OR: 0.40, CI: 0.18-0.89, p = .03), and short-term MI (in-hospital and 30-day) (OR: 0.64, CI: 0.44-0.94, p = .02). OA was associated with more coronary artery dissections (OR: 2.61, CI: 1.38-4.92, p = .003) and device-related coronary perforations (OR: 2.79, CI: 1.08-7.19, p = .03). There were no differences in cardiac tamponade (OR: 1.78, CI: 0.37-8.69, p = .47). OA was noted to have significantly lower fluoroscopy time (MD: -3.96 min, CI: -7.67, -0.25; p = .04) compared to RA. No significant difference was noted in terms of contrast volume between the two groups (OR: -4.35 ml, CI: -14.52, 23.22; p = .65).

Conclusion: Although there was no difference in overall MACE, MI, all-cause mortality and TVR, OA was associated with lower long-term MACE and short-term MI. OA is associated with lower fluoroscopy time but higher rates of coronary artery dissection and coronary perforation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ccd.29430DOI Listing
December 2020

Perioperative Acute Pulmonary Embolism: A Concise Review with Emphasis on Multidisciplinary Approach.

Int J Angiol 2020 Sep 14;29(3):183-188. Epub 2020 May 14.

Division of Cardiovascular Diseases, Texas Tech University Health Sciences Center, El Paso, Texas.

Perioperative acute pulmonary embolism represents a relatively rare complication; however, it could be very serious and devastating in some cases. Its diagnosis could be particularly challenging, especially in the intraoperative period. Herein, we emphasize some key concepts with the aim to perform an early and appropriate risk stratification, diagnostic and therapeutic approach in a multidisciplinary fashion, a brief overview on thromboprophylaxis, with the main objective to improve outcomes and survival in these challenging patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0040-1709501DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599112PMC
September 2020

Gamut of cardiac manifestations and complications of COVID-19: a contemporary review.

J Investig Med 2020 12 19;68(8):1334-1340. Epub 2020 Oct 19.

Cardiovascular Disease, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA.

COVID-19 has posed an extraordinary burden on health and the economy worldwide. Patients with cardiovascular diseases are more likely to have severe illness due to COVID-19 and are at increased risk for complications and mortality. We performed a narrative literature review to assess the burden of COVID-19 and cardiovascular morbidity and mortality. Myocardial injury has been reported in 20%-30% of patients hospitalized due to COVID-19 and is associated with a worse prognosis and high mortality (~50%-60%). Proposed mechanisms of myocardial injury include inflammation within the myocardium (due to direct viral infection or cytokine storm), endotheliitis, coronary vasculitis, myocarditis, demand ischemia, plaque destabilization and right ventricular failure. The right ventricle is particularly vulnerable to injury and failure in COVID-19-infected patients, given the hypoxic pulmonary vasoconstriction, pulmonary microthrombi or pulmonary embolism. Echocardiography is an effective and accessible tool to evaluate left and right ventricular functions and risk stratify patients with COVID-19 infection. Cardiac MRI has detected and characterized myocardial injury, with changes compatible with other inflammatory cardiomyopathies. The long-term consequences of these inflammatory changes are unknown, but accumulating data will provide insight regarding the longitudinal impact of COVID-19 infection on cardiovascular morbidity and mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/jim-2020-001592DOI Listing
December 2020

Outcomes of Percutaneous Coronary Intervention Versus Optimal Medical Treatment for Chronic Total Occlusion: A Comprehensive Meta-analysis.

Curr Probl Cardiol 2021 Mar 28;46(3):100695. Epub 2020 Aug 28.

The presence of concurrent chronic total occlusion (CTO) is a strong predictor for both short-term and long-term mortality. Successful percutaneous coronary intervention (PCI) of CTO has been associated with clinical benefit. We sought to perform a meta-analysis comparing CTO-PCI versus optimal medical therapy. PubMed, ClinicalTrials.gov, Google scholar and the Cochrane Central Register of Controlled Trials were searched for studies published from 2006 to 2019. A total of 16 studies, with 11,314 patients were included. We analyzed data on mortality, cardiac deaths, myocardial re-infarction, major adverse cardiac events, stroke, and repeat CTO-PCI using random-effects models. The odds ratios (OR) with 95% confidence interval (CI) were computed and P < 0.05 was considered as a level of significance. Compared with medical therapy alone, CTO-PCI was associated with lower mortality (OR: 0.45, CI: 0.32-0.63, P < 0.00001) and cardiac deaths (OR: 0.58, CI: 0.38-0.89, P = 0.01). These results were primarily driven by observational studies with no difference observed in randomized controlled trials. There was no significant difference in the incidence of major adverse cardiac events (OR: 0.71, CI: 0.48-1.05, P = 0.54), myocardial re-infarction (OR: 0.71, CI: 0.48-1.05, P = 0.54), stroke (OR: 0.61, CI: 0.32-1.17, P = 0.14, and repeat PCI (OR: 1.28, CI: 0.91-1.78, P = 0.16). This meta-analysis shows lower long-term mortality and cardiac deaths in CTO-PCI group as compared to OMT driven by observational studies with no difference observed in randomized controlled trials. Further randomized trials are needed to confirm these findings and evaluate long term results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cpcardiol.2020.100695DOI Listing
March 2021

Association between tumor mutation profile and clinical outcomes among Hispanic Latina women with triple-negative breast cancer.

PLoS One 2020 4;15(9):e0238262. Epub 2020 Sep 4.

Division of Hematology-Oncology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, United States of America.

Triple-negative breast cancer (TNBC) represents 15%-20% of all breast cancer types. It is more common among African American (AA) and Hispanic-Latina (HL) women. The biology of TNBC in HL women has been poorly characterized, but some data suggest that the molecular drivers of breast cancer might differ. There are no clinical tools to aid medical oncologists with decisions regarding appropriate individualized therapy, and no way to predict long-term outcomes. The aim of this study was to characterize individual patient gene mutation profiles and to identify the relationship with clinical outcomes. We collected formalin-fixed paraffin-embedded tumors (FFPE) from women with TNBC. We analyzed the gene mutation profiles of the collected tumors and compared the results with individual patient's clinical histories and outcomes. Of 25 patients with TNBC, 24 (96%) identified as HL. Twenty-one (84%) had stage III-IV disease. The most commonly mutated genes were TP53, NOTCH1, NOTCH2, NOTCH3, AKT, MEP3K, PIK3CA, and EGFR. Compared with other international cancer databases, our study demonstrated statistically significant higher frequencies of these genes among HL women. Additionally, a worse clinical course was observed among patients whose tumors had mutations in NOTCH genes and PIK3CA. This study is the first to identify the most common genetic alterations among HL women with TNBC. Our data strongly support the notion that molecular drivers of breast cancer could differ in HL women compared with other ethnic backgrounds. Therefore, a deeper understanding of the biological mechanisms behind NOTCH gene and PIK3CA mutations may lead to a new treatment approach.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238262PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473586PMC
October 2020

Updates in Anti-anginal and Anti-ischemic Therapies for Acute Coronary Syndromes.

Curr Cardiol Rep 2020 Aug 21;22(10):126. Epub 2020 Aug 21.

Department of Internal Medicine, Texas Tech University Health Sciences Center at El Paso, 4800 Alberta Avenue, El Paso, TX, 79905, USA.

Purpose Of Review: Acute coronary syndrome is a major health problem affecting ~ 1.5 million individuals a year in the USA. We review the contemporary role of anti-anginal and anti-ischemic therapies in the management of an individual presenting with an acute coronary syndrome.

Recent Findings: Early diagnosis and appropriate evidence-based therapies significantly improve clinical outcomes in acute coronary syndrome patients. Typically, acute coronary syndrome is associated with rupture of an atherosclerotic plaque and either partial or complete thrombotic occlusion of a coronary artery. Management of an acute coronary syndrome is targeted towards this underlying pathophysiology. The last few years have seen significant advances in anti-anginal and anti-ischemic therapies in the management of patients with acute coronary syndrome. It is important to have a team effort to target risk reduction measures and to emphasize medication and dietary compliance. Long-term pharmacotherapy should include aspirin, beta-blocker, DAPT (for at least 1 year), statins, and ACE inhibitors and PCSK9 inhibitors if indicated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11886-020-01370-6DOI Listing
August 2020

After revascularization for PAD, rivaroxaban reduced vascular events with a small increase in major bleeding.

Ann Intern Med 2020 08;173(4):JC22

Texas Tech University Health Sciences Center at El Paso, El Paso, Texas, USA (D.M.).

Source Citation: Bonaca MP, Bauersachs RM, Anand SS, et al. N Engl J Med. 2020;382:1994-2004. 32222135.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7326/ACPJ202008180-022DOI Listing
August 2020

Coronary Angiography Challenges After Transcatheter Aortic Valve Replacement-in-Transcatheter Aortic Valve Replacement.

J Am Heart Assoc 2020 07 24;9(13):e017409. Epub 2020 Jun 24.

Division of Cardiovascular Medicine Texas Tech University Health Sciences Center El Paso TX.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/JAHA.120.017409DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670524PMC
July 2020

Early Post-Percutaneous Coronary Intervention Chest Pain: A Nationwide Survey on Interventional Cardiologists' Perspective.

Cardiovasc Revasc Med 2020 Dec 16;21(12):1517-1522. Epub 2020 May 16.

Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA. Electronic address:

Background: Early post-percutaneous coronary intervention chest pain (EPPCP) appears to be a common clinical phenomenon. EPPCP has not been fully explained or studied in the literature despite the abundance of clinical trials on percutaneous coronary intervention (PCI). The objective of this questionnaire-based survey is to assess the current perception of EPPCP among practicing interventional cardiologists nationwide.

Methods: A survey questionnaire was designed utilizing the Survey Monkey tool to address the perceptions and current practices regarding key aspects of EPPCP among interventional cardiologists. The survey was sent to the interventional cardiologists via email.

Results: The survey questionnaire regarding EPPCP was provided to 2615 practicing interventional cardiologists and resulted in 623 total survey responses, with 503 of those respondents completing all eight survey questions. A total of 50.2% of the interventional cardiologists perceive that the incidence of EPPCP is 5-10%, and 57.5% consider that repeat angiography or PCI is rarely needed (1 in 1000 cases). A total of 47.1% of the participants think that EPPCP is due to transient microvascular dysfunction, while 39% perceive it as a different entity requiring a different approach. When asked about developing a standardized labeling for the phenomenon of EPPCP, 34.8% of responders indicated that they believe EPPCP should be labeled as a benign form of chest pain/angina, and 28% preferred to describe EPPCP in non-standardized terms. Among interventional cardiologists, 80% thought that the treatment of this entity is a combination of reassurance and vasodilators and, without ischemic ECG changes, medical management is appropriate.

Conclusion: A total of 72% of interventional cardiologists in our survey preferred to label EPPCP as standard nomenclature to facilitate communication between healthcare providers, patients and families in a consistent way. There is a diversity of opinion regarding EPPCP, no standard nomenclature, and no guideline to standardize practice. Further large-scale prospective studies are needed to better understand the pathophysiological mechanisms, optimal management strategies, prognostic implications, and clinical reporting of EPPCP.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.carrev.2020.05.011DOI Listing
December 2020

Pulmonary embolism response teams in the challenging era of venous thromboembolism associated with COVID-19.

J Vasc Surg Venous Lymphat Disord 2020 09 1;8(5):898-899. Epub 2020 Jun 1.

Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jvsv.2020.04.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7262498PMC
September 2020

Cardiovascular and Hematological Medicine in 2020 - Advances and Insights.

Cardiovasc Hematol Agents Med Chem 2020 ;18(1)

Department of Internal Medicine Texas Tech University El Paso, TX, United States.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2174/187152571801200317101055DOI Listing
January 2020

Outcomes Following Percutaneous Coronary Intervention Before, During, and After Transition to a Default Transradial Approach at a Veterans Affairs Medical Center.

Angiology 2020 08 22;71(7):602-608. Epub 2020 Apr 22.

Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA.

Transradial coronary intervention (TRI) lowers bleeding and mortality compared with transfemoral coronary intervention (TFI). There are limited data on outcomes as TFI operators transition to a default TRI practice. The aim of this study was to assess TFI and TRI outcomes before, during, and after the year TRI was first learned by femoral operators. Patients undergoing percutaneous coronary intervention (PCI) at a Veterans Affairs Medical Center from 2006 to 2012 were included. In 2009, TRI was learned by all operators and then used as the default PCI approach from 2010 to 2012. Baseline characteristics and outcomes were collected. Predictors of major bleeding, major adverse cardiovascular events (MACE), and mortality were determined by multivariable analysis; 1192 veterans were included. TRI rates were 9% (2006-2008), 65% (2009), and 90% (2010-2012). Incidence of 1-year MACE and mortality was 5.4% and 3.9%, respectively, in 2009, and 5.6% and 3%, respectively, during 2010 to 2012. Major bleeding remained at <1%. Age, glycoprotein IIb/IIIa inhibitors, and ST-elevation myocardial infarction were independently associated with major bleeding, whereas TRI was protective. Transition to default TRI is feasible over a short time period and associated with low rates of MACE and mortality and very low rate of major bleeding.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0003319720920159DOI Listing
August 2020

Clinical characteristics and outcomes of patients requiring prolonged inotropes after left ventricular assist device implantation.

Artif Organs 2020 Oct 22;44(10):E382-E393. Epub 2020 Apr 22.

Division of Cardiovascular Diseases, University of Arizona, Tucson, AZ, USA.

Limited data exist regarding patients with continuous-flow left ventricular assist device (LVAD) support who require long-term inotropes. Our primary objective was to evaluate the clinical characteristics and all-cause mortality of LVAD recipients with prolonged inotrope use (PIU). Secondary endpoints were to compare predictors of PIU, mortality, risk of late re-initiation of inotropes, time to gastrointestinal bleed (GIB), infection, and arrhythmias. Retrospective cohort study was conducted on adult patients with primary continuous-flow LVADs implanted from January 2008 to February 2017 and the patients were followed up through February 2018. We defined PIU as ≥14 days of inotrope support. Kaplan-Meier method, competing risk models and Cox proportional hazard models were used. Final analytic sample was 203 patients, 58% required PIU, and 10% were discharged on inotropes. There was no difference in preimplant characteristics. One-year survival rate was 87% if no PIU required, 74% if PIU required, and 72% if discharged on inotropes. PIU was associated with longer length of stay and higher incidence of GIB. We found no association between PIU and late re-initiation of inotropes, infection or arrhythmias. Adjusted hazard risk of death was increased in patients with PIU (HR = 1.66, P = .046), older age (HR = 1.28, P = .031), and higher creatinine levels (HR = 1.60, P = .007). Prolonged inotrope use is frequently encountered following LVAD implantation and is associated with adverse prognosis but remains a therapeutic option. Inability to wean inotropes prior to hospital discharge is a marker of patients at particularly higher risk of mortality following LVAD implantation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/aor.13692DOI Listing
October 2020

Coronary Calcium Risk Score and Cardiovascular Risk.

Curr Vasc Pharmacol 2021 ;19(3):280-284

Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas 79905, United States.

The association between the presence of coronary artery calcium (CAC) and the risk of coronary artery disease (CAD) has been appreciated for decades. In this review, we critically appraise the role of CAC based on computerized tomography in contemporary risk stratification. Available evidence suggests that the measurement of CAC is a useful modality in many patients for more precise risk stratification and prognostic determination. Whether newer CAC score incorporating extra coronary calcification will add incremental value, especially for stroke and other non-coronary vascular outcomes, needs a prospective study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2174/1570161118666200403143518DOI Listing
January 2021

An Updated Review on Myocardial Bridging.

Cardiovasc Revasc Med 2020 Sep 18;21(9):1169-1179. Epub 2020 Feb 18.

Department of Internal Medicine, Division of Cardiology, East Tennessee State University, Johnson City, TN, USA. Electronic address:

Myocardial bridging is a congenital coronary anomaly with normal epicardial coronary artery taking an intra-myocardial course also described as tunneled artery. The majority of patients with this coronary anomaly are asymptomatic and generally it is a benign condition. However, it is an important cause of myocardial ischemia, which may lead to anginal symptoms, acute coronary syndrome, cardiac arrhythmias and rarely sudden cardiac death. There are numerous studies published in the recent past on understanding the pathophysiology, diagnostic and management strategies of myocardial bridging. This review highlights some of the recent updates in the diagnosis and management of patients with myocardial bridging. We discuss the role of various non-invasive and invasive diagnostic methods to evaluate functional significance of bridging. In addition, role of medical therapy such as beta-blockers, percutaneous coronary intervention with stents/bioresorbable scaffolds and surgical unroofing in patients unresponsive to medical therapy is highlighted as well.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.carrev.2020.02.014DOI Listing
September 2020

SCAI publications committee manual of standard operating procedures.

Catheter Cardiovasc Interv 2020 07 14;96(1):145-155. Epub 2020 Feb 14.

Cardiovascular Associates of Alabama, Birmingham, Alabama.

Evidence-based recommendations for clinical practice are intended to help health care providers and patients make decisions, minimize inappropriate practice variation, promote effective resource use, improve clinical outcomes, and direct future research. The Society for Cardiovascular Angiography and Interventions (SCAI) has been engaged in the creation and dissemination of clinical guidance documents since the 1990s. These documents are a cornerstone of the society's education, advocacy, and quality improvement initiatives. The publications committee is charged with oversight of SCAI's clinical documents program and has created this manual of standard operating procedures to ensure consistency, methodological rigor, and transparency in the development and endorsement of the society's documents. The manual is intended for use by the publications committee, document writing groups, external collaborators, SCAI representatives, peer reviewers, and anyone seeking information about the SCAI documents program.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ccd.28754DOI Listing
July 2020

Coronary Revascularization in the United States-Patient Characteristics and Outcomes in 2020.

JAMA Netw Open 2020 02 5;3(2):e1921322. Epub 2020 Feb 5.

Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center, El Paso.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamanetworkopen.2019.21322DOI Listing
February 2020

Cadaveric renal transplantation: Our experience at a tertiary care centre in India.

Med J Armed Forces India 2020 Jan 22;76(1):58-62. Epub 2018 Nov 22.

Senior Resident (Nephrology), Army Hospital (Research & Referral), Delhi, India.

Background: Renal transplantation in developing countries like India is largely live donor transplantation. Cadaveric transplantation comprises <2% of all transplants in India.

Methods: Ninety-two cadaveric renal transplantations were included. Various donor and recipient characteristics were analysed along with graft and patient survival, using Kaplan-Meier method.

Results: The mean age of the recipients was 35.5 ± 10.9 years while that of cadaver was 43.9 ± 17.0 years. Proportion of females among recipients was 47.8% while that of donors was 34.8%. The most common underlying pathology was chronic glomerulonephritis (44.6%). Antithymocyte globulin was used as induction in 84.8% of cases. Tacrolimus-based triple-drug regimen was most commonly used as maintenance (80.4%). The mean follow-up time was 39.02 ± 28.24 months. The most common cause of death was sepsis (47%). More than 50% deaths (9/17) occurred within first 3 years, while 61.5% of graft loss occurred 5 years after transplantation. The mean graft survival time was 81.6 months (95% confidence interval [CI]: 72.8-90.4). Cumulative proportion of graft survival was 91.6% at 3 years and 77.1% at 5 years. Although females have better mean graft survival time (91.6 vs 73.5 months), it was not a significant difference as shown by log-rank test (p value = 0.062). Pretransplant haemodialysis has no significant effect on graft loss, but patients on peritoneal dialysis have significantly higher odds of graft loss (odds: 4.86, p value < 0.05 [0.018]). The mean patient survival time was 99.5 months (95% CI: 84.0-114.9). Cumulative proportion of patient survival was 83.3% at 3 years and 70.8% at 5 years.

Conclusion: Graft and patient survival rate of cadaveric transplant at our centre was satisfactory. There is need to sensitise and augment the rate of cadaveric transplantation to increase the donor pool.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.mjafi.2018.08.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6994763PMC
January 2020

Patent Foramen Ovale, the Role of Antiplatelet Therapy Alone or Anticoagulant Therapy Alone Versus Device Closure for Cryptogenic Stroke: A Review of the Literature and Current Recommendations.

Cardiovasc Hematol Agents Med Chem 2020 ;18(2):135-150

Department of Medicine, Texas Tech University of Health Sciences, El Paso, TX, United States.

Cryptogenic stroke and its relation to the Patent Foramen Ovale (PFO) is a long-debated topic. Recent clinical trials have unequivocally established the relationship between cryptogenic strokes and paradoxical embolism across the PFO. This slit-like communication exists in everyone before birth, but most often closes shortly after birth. PFO may persist as a narrow channel of communication between the right and left atria in approximately 25-27% of adults. In this review, we examine the clinical relevance of the PFO with analysis of the latest trials evaluating catheter-based closure of PFO's for cryptogenic stroke. We also review the current evidence examining the use of antiplatelet medications versus anticoagulants for stroke prevention in those patients with PFO who do not qualify for closure per current guidelines.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2174/1871525718666200203111641DOI Listing
January 2020

Underutilization of Cardiac Therapies in Patients with Acute Ischemic Stroke and Elevated Troponin.

Cardiovasc Hematol Agents Med Chem 2019 ;17(2):144-151

Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center, El Paso, TX, United States.

Introduction: Recent findings have shown that in Acute Ischemic Stroke (AIS) patients, elevated troponin is associated with increased mortality. However, due to concerns of cerebral hypoperfusion and hemorrhagic transformation, current practice has been slow to apply proven cardiac therapies to these patients. This study aims to determine this rate of utilization.

Materials And Methods: A single-center review of 83 patients with AIS and measured troponin was conducted. Patients were stratified based on elevated and non-elevated troponin. Between groups, we measured the utilization of evidence-based cardiac therapies and used a univariate logistic regression to compare outcomes of mortality, re-hospitalization, recurrent acute ischemic stroke, recurrent acute myocardial infarction, and a composite of these outcomes.

Results: Of 83 patients, 25 had elevated troponin and 58 had non-elevated troponin. There was no statistical difference in the use of cardiac therapies between the two groups. Adenosine diphosphate P2Y12 antagonists were infrequently used in both elevated and non-elevated troponin groups at 32% vs. 24% (p = 0.64), as were Angiotensin-Converting Enzyme Inhibitors (ACE-I) and angiotensin II receptor blockers (ARB) at 56% vs. 69% (p = 0.38). Those in the elevated troponin group encountered a statistically significant increase in composite endpoint 64% vs. 33% (Odds Ratio [OR] 7.28, 95% Confidence interval [CI] 2.19-28.88, p<0.01).

Conclusion: Cardiac therapies are underutilized in patients with acute ischemic stroke and elevated troponin levels. In turn, this low usage may explain the increase in morbidity and mortality seen in these patients and the use of such therapies should be considered when treating this subset of patients as the cardio protective nature of these therapies may outweigh the risks associated with them in AIS patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2174/1871525717666191019115338DOI Listing
January 2020

Pulmonary embolism response teams: Purpose, evidence for efficacy, and future research directions.

Res Pract Thromb Haemost 2019 Oct 9;3(4):769. Epub 2019 Aug 9.

Division of Cardiovascular Diseases Texas Tech University Health Sciences Center El Paso TX USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/rth2.12249DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6781912PMC
October 2019

Pulmonary Embolism Response Teams: Pursuing Excellence in the Care for Venous Thromboembolism.

Arch Med Res 2019 07 5;50(5):257-258. Epub 2019 Oct 5.

Division of Cardiovascular Diseases, Texas Tech University Health Sciences Center El Paso, Texas, USA.

Acute pulmonary embolism remains a catastrophic acute cardiovascular event, and it is the leading cause of preventable mortality among hospitalized patients. Pulmonary embolism response teams have been designed to facilitate efficiency, streamline and improve quality of care in a timely manner for complex pulmonary embolism case scenarios with a multidisciplinary approach. Herein, we briefly describe and delineate the main goals and strategies on how to leverage the strengths from such pulmonary embolism response teams, with the aim to be adopted worldwide, improve survival, and change the paradigm in the care of a potentially deadly disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arcmed.2019.08.011DOI Listing
July 2019

Cardiovascular and Hematological Medicine in 2019 - Advances and Insights.

Cardiovasc Hematol Agents Med Chem 2019 ;17(1)

Department of Internal Medicine Texas Tech University El Paso, TX, United States.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2174/187152571701190722113042DOI Listing
November 2019

Tailoring strategies to optimize ischaemic benefit vs. bleeding risk in individuals post-myocardial infarction.

Eur Heart J 2020 02;41(7):844-846

Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/eurheartj/ehz642DOI Listing
February 2020

Epidemiology and Adverse Consequences of Hookah/Waterpipe Use: A Systematic Review.

Cardiovasc Hematol Agents Med Chem 2019 ;17(2):82-93

Texas Tech University Health Science Center, Department of Internal Medicine, El Paso, TX 79905, United States.

Hookah smoking is becoming a popular trend globally. Waterpipe smoking is the second most prevalent form of alternate tobacco products. The rapid increase in hookah use is because of the misconception prevalent in society that hookah smoking is less harmful than cigarette smoking. Smoking ban policies had given impetus of switching from cigarette smoking to alternate tobacco products like waterpipe. Hookah users regard hookah to be more socially acceptable, less stigmatizing with flavors and to alleviate cigarette craving symptoms. Newer basic science research on animal models and human cells has shown consistently mutagenic, oxidative, and inflammatory changes that could cause possible health effects of premalignant oral lesion and chronic diseases like atherosclerosis and chronic obstructive pulmonary disease. Studies on the chemistry of waterpipe smoke had shown alarming results with the smoke containing seven carcinogens, 39 central nervous system depressants, and 31 respiratory irritants. Enormous data exist showing waterpipe smoking causing various health effects. Hookah smoking effects on cardiovascular disease is additive with hookah containing a significant amount of nicotine, tar, and heavy metals causing both acute and chronic effects on the cardiovascular system. These effects include increased heart rate, blood pressure, prevalence of coronary heart disease, heart failure, ST-segment elevation myocardial ischemia, recurrent ischemia, and worse outcomes including mortality related to these diseases. The objectives of the review are to assess the factor associated with the increasing use of hookah, its health effects, options for hookah smoking cessation, and public health policy initiatives to mitigate waterpipe use.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2174/1871525717666190904151856DOI Listing
January 2020

In AF with recent ACS or PCI, apixaban reduced bleeding vs VKAs; aspirin increased bleeding vs placebo.

Ann Intern Med 2019 07;171(2):JC7

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7326/ACPJ201907160-007DOI Listing
July 2019

Myocardial Infarction With Nonobstructive Coronary Arteries: A Call for Individualized Treatment.

J Am Heart Assoc 2019 07 9;8(14):e013361. Epub 2019 Jul 9.

1 Division of Cardiovascular Medicine Texas Tech University Health Sciences Center El Paso TX.

See Article Choo et al.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/JAHA.119.013361DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6662152PMC
July 2019