Publications by authors named "Fnu Zafrullah"

11 Publications

  • Page 1 of 1

Comparison of left atrial appendage parameters using computed tomography vs. transesophageal echocardiography for watchman device implantation: a systematic review & meta-analysis.

Expert Rev Cardiovasc Ther 2022 Feb 4;20(2):151-160. Epub 2022 Mar 4.

Detroit Medical Center, Wayne State University, Detroit, MI, USA.

Background: Inaccurate sizing of left atrial appendage (LAA) occlusion devices is associated with increased stroke risk. We compared the LAA size to implant the Watchman device assessed by computed tomography (CT) to transesophageal echocardiography (TEE).

Methods: Databases were searched to identify studies comparing LAA anatomical measurements and procedural outcomes across imaging modalities for the Watchman device implantation.

Results: Seven studies were included in the analysis (242 patients on TEE, and 232 on CT). The LAA orifice was larger when sized with CT compared to TEE (CT mean vs TEE SMD 0.30 mm, 95%CI 0.09-0.51 mm, P < 0.01; and CT max vs TEE SMD 0.69 mm, 95%CI 0.51-0.87 mm, P < 0.001). Additionally, CT, including CT-based 3-dimensional models, had higher odds of predicting correct device size compared to TEE (OR 1.64; 95%CI 1.05-2.56; P = 0.03). CT resulted in a lower fluoroscopy time vs TEE (SMD -0.78 min, 95% CI -1.39 to -0.18, P = 0.012). No significant differences were found in device clinical outcomes.

Conclusion: Compared to TEE, CT resulted in larger LAA orifice measurements, improved odds of predicting correct device size, and reduced fluoroscopy time in patients undergoing LAA occlusion with the Watchman device. There were no significant differences in other procedural outcomes.
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http://dx.doi.org/10.1080/14779072.2022.2043745DOI Listing
February 2022

Contemporary trends and in-hospital outcomes of catheter and stand-alone surgical ablation of atrial fibrillation.

Europace 2022 02;24(2):218-225

Division of Cardiovascular Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH 43614, USA.

Aims: The contemporary trends in catheter ablation (CA) and surgical ablation (SA) utilization and surgical techniques [open vs. thoracoscopic, with or without left atrial appendage closure (LAAC)] are unclear. In addition, the in-hospital outcomes of stand-alone SA compared with CA are not well-described.

Methods And Results: The National Inpatient Sample 2010-18 was queried for atrial fibrillation (AF) hospitalizations with CA or stand-alone SA. Complex samples multivariable logistic and linear regression models were used to compare the association between stand-alone SA vs. CA and the primary outcomes of in-hospital mortality and stroke. Of 180 243 hospitalizations included within the study, 167 242 were for CA and 13 000 were for stand-alone SA. Catheter ablation and stand-alone SA hospitalizations decreased throughout the study period (Ptrend < 0.001). Surgical ablation had higher rates of in-hospital mortality [adjusted odds ratio (aOR) 2.26; 95% confidence interval (CI) 1.41-3.61; P = 0.001] and stroke (aOR 4.64; 95% CI 3.25-6.64; P < 0.001) compared with CA. When examining different surgical approaches, thoracoscopic SA was associated with similar in-hospital mortality (aOR 1.53; 95% CI 0.60-3.89; P = 0.369) and similar risk of stroke (aOR 1.75; 95% CI 1.00-3.07; P = 0.051) compared with CA.

Conclusion: Stand-alone SA comprises a minority of AF ablation procedures and is associated with increased risk of mortality, stroke, and other in-hospital complications compared to CA. However, when a thoracoscopic approach was utilized, the risks of mortality and stroke appear to be reduced.
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http://dx.doi.org/10.1093/europace/euab198DOI Listing
February 2022

Predictors and risk factors of short-term readmission of acute pericarditis.

Expert Rev Cardiovasc Ther 2021 Mar 26;19(3):261-268. Epub 2021 Jan 26.

Cardiology Department, Wayne State University/Detroit Medical Center, Detroit, Michigan, USA.

: The 30-day readmission risk factors for acute pericarditis are not well known. We investigated the risk factors and predictors of pericarditis from a national cohort.: Readmission data from the National Readmission Database (NRD) from the year 2016 were used to analyze the prevalence of risk factors and predictors of pericarditis 30-day readmission.: From the year 2016, 16,475 acute pericarditis hospitalizations were recorded. The rate of readmission from the year 2016 is similar to 2012 reported data (18%). A total of 13,844 patients (mean age 55.2 years, 40% of women) were found for acute pericarditis readmissions. The incidence rate of 30-day readmission of acute pericarditis patients in our study was 17.8% with the major cause of readmission was related to cardiovascular (pericarditis, endocarditis, and myocarditis) during 30-day follow-up. The median cost of the index and 30 days pericarditis admission $10,048 and $9,932, respectively.: Chronic comorbidities, prolonged hospitalization, and admission to a short-term hospital/left against medical advice admission to metropolitan teaching hospital were associated with a higher risk of 30-day readmission.
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http://dx.doi.org/10.1080/14779072.2021.1876564DOI Listing
March 2021

Meta-Analysis of Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement.

Am J Cardiol 2021 01 24;139:138-139. Epub 2020 Oct 24.

Division of Cardiology, Reading Hospital-Tower Health System, West Reading, Pennsylvania.

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http://dx.doi.org/10.1016/j.amjcard.2020.10.038DOI Listing
January 2021

Diagnosis and Management of Lemierre's Syndrome Presented with Multifocal Pneumonia and Cerebral Venous Sinus Thrombosis.

Case Rep Infect Dis 2020 22;2020:6396274. Epub 2020 Mar 22.

Department of Internal Medicine, Steward Carney Hospital, Tufts Medical Center, Boston, MA, USA.

A 27-year-old female patient initially presented with fever, myalgia, sore throat that progressed to multifocal pneumonia, and cerebral sinus venous thrombosis. A combination of upper respiratory symptoms with tooth infection, positive blood culture for , computed tomography (CT) chest finding of multifocal pneumonia, and magnetic resonance imaging (MRI) finding of internal jugular vein thrombosis (IJVT) and cerebral venous sinus thrombosis (CVST) suggested Lemierre syndrome. The patient was managed with fluids, antibiotics, and anticoagulants. The patient survived and discharged from the hospital. The patient's symptoms improved at 2 months of follow-up.
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http://dx.doi.org/10.1155/2020/6396274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7085867PMC
March 2020

Hydrocortisone Reduces 28-day Mortality in Septic Patients: A Systemic Review and Meta-analysis.

Cureus 2019 Jun 17;11(6):e4914. Epub 2019 Jun 17.

Nephrology, Drexel University, Philadelphia, USA.

The goal of this study was to determine the utility of hydrocortisone in septic shock and its effect on mortality. We performed a systematic search from inception until March 01, 2018, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines comparing hydrocortisone to placebo in septic shock patients and selected studies according to our pre-defined inclusion and exclusion criteria. Four reviewers extracted data into the predefined tables in the Microsoft Excel (Microsoft Corp., New Mexico, US) sheet. We used RevMan software to perform a meta-analysis and draw Forest plots. We used a random effects model to estimate risk ratios. A two-sided p-value of ≤ 0.05 was considered statistically significant. A total of five randomized control trials (RCTs) with 5,838 patients were included in our analysis. The primary outcome was mortality at 28 days. Secondary outcomes were intensive care unit (ICU) and in-hospital mortality, mortality at 90 days and one year, reversal of shock, intensive care unit (ICU) and hospital length of stay, incidence of superinfections, and incidence of limb and/or cerebral ischemia. The 28-day mortality was significantly reduced with hydrocortisone, 808 vs. 880 with placebo, Risk Ratio (RR)=0.92, confidence interval (CI) =0.85-0.99, p=0.04, I=0%. There was no difference in ICU mortality (RR=0.93, CI=0.81-1.08), in-hospital mortality (RR=0.95, CI=0.84-1.08), 90-day mortality (RR=0.93, CI=0.84-1.02, p=0.10), and one-year mortality (RR=0.97, CI=0.84-1.12). Superinfections were significantly common with hydrocortisone, RR=1.16, CI=1.05-1.28, p=0.003. In conclusion, the use of hydrocortisone showed a significant reduction in mortality at 28 days and a trend toward reduced ICU mortality. This mortality reduction was observed at the cost of significantly higher superinfections.
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http://dx.doi.org/10.7759/cureus.4914DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6692095PMC
June 2019

Use of Plasmapheresis and Immunosuppressants to Treat Diffuse Alveolar Hemorrhage in a Patient with Granulomatosis with Polyangiitis.

Medicina (Kaunas) 2019 Jul 16;55(7). Epub 2019 Jul 16.

Steward Carney Hospital, Tufts Medical Center, Boston, MA 02111, USA.

Granulomatosis with polyangiitis (GPA) is a systemic granulomatous inflammatory disease characterized by small-to-medium vessel vasculitis due to Central Anti-Neutrophil Cytoplasmic Antibody (C-ANCA). GPA commonly involves the lungs and the kidneys. Among the pulmonary manifestations, diffuse alveolar hemorrhage (DHA) is a rare presentation of GPA that can present with hemoptysis leading to acute onset of anemia and hemodynamic instability. An active diagnostic workup including serologic titer of C-ANCA, imaging, intensive care, and aggressive immunosuppression is the key to DAH management. We report a case of DAH secondary to GPA that presented with hemoptysis leading to severe anemia, initially resuscitated symptomatically and started on plasmapheresis with pulse steroids and cyclophosphamide. Timely diagnosis and management led to a remarkable recovery of the pulmonary symptoms and imaging findings of DAH.
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http://dx.doi.org/10.3390/medicina55070378DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681500PMC
July 2019

Ivabradine in Congestive Heart Failure: Patient Selection and Perspectives.

Cureus 2019 Apr 13;11(4):e4448. Epub 2019 Apr 13.

Internal Medicine, Lasante Health, Jersey City, USA.

Heart failure (HF) is the fourth-most frequent cause of death and remains a challenge for public health. Therapy goals for HF with reduced ejection fraction (HFrEF) are the improvement in the quality of life, prolonged survival, a reduction of signs and symptoms, and the prevention of hospitalization. Angiotensin-converting enzyme inhibitors, beta-blockers, and mineralocorticoid receptor antagonists are the treatments of choice for HFrEF. Although ivabradine is not available in all countries, it is likely a new promising approach to improve outcomes in patients with HFrEF, either alone or with beta-blockers. Here, we review the current knowledge about ivabradine in HFrEF and assess its effect on outcomes in HF.
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http://dx.doi.org/10.7759/cureus.4448DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561528PMC
April 2019

The Use of Fractional Flow Reserve for Physiological Assessment of Indeterminate Lesions in Peripheral Artery Disease.

Cureus 2019 Apr 12;11(4):e4445. Epub 2019 Apr 12.

Cardiology, University of Toledo Medical Center, Toledo, USA.

Peripheral artery disease (PAD) is a prevalent disorder in the United States, associated with significant morbidity and mortality. Fractional Flow Reserve (FFR) is a physiological test used to assess the hemodynamic significance of intermediate lesions on conventional angiography. It is well studied in coronary artery disease and is as an important tool to guide decisions regarding revascularization in a significant percentage of patients with intermediate lesions. As compared to coronary FFR, the use of FFR in peripheral artery disease (PFFR) is much less prevalent. Overall data regarding the use of the PFFR is sparse. There are limited studies that have shown the correlation of PFFR with non-invasive testing including ankle-brachial index (ABI) and Doppler Imaging. Unlike coronary FFR, the optimal pharmaceutical agents and doses to induce maximal hyperemia in the peripheral vascular bed are also not well established. Moreover, there are no established standardized procedural protocols for measuring PFFR. Various studies have employed varying techniques, hyperemic agents and doses. The aim of this literature review is to summarize the current evidence on PFFR, the correlation with noninvasive studies used in PAD and to increase awareness of the potential role of the PFFR in peripheral interventions.
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http://dx.doi.org/10.7759/cureus.4445DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561523PMC
April 2019

Multivessel Spontaneous Coronary Artery Dissection: Amberen as a Possible Risk Factor.

Cureus 2019 Mar 6;11(3):e4191. Epub 2019 Mar 6.

Cardiology, University of Toledo Medical Center, Toledo, USA.

Spontaneous coronary artery dissection (SCAD) is a rare phenomenon that causes acute, life-threatening myocardial infarction. Most notably occurring in the female population, certain risk factors have been implicated in SCAD including pregnancy, hormone therapy, stimulant drug use, connective tissue disorders and systemic inflammatory disorders. However, the effects of over-the-counter supplements have not been widely studied in SCAD. We have a case of acute multivessel type 2 SCAD involving the obtuse marginal artery and posterior descending artery that may have been secondary to Amberen, an over-the-counter supplement used to relieve symptoms of menopause. This is a rare case of multivessel SCAD possibly caused by an over-the-counter supplement not previously known to trigger this disease process.
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http://dx.doi.org/10.7759/cureus.4191DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6504015PMC
March 2019

Diagnosis and Management of a Cardiac Amyloidosis Case Mimicking Hypertrophic Cardiomyopathy.

Cureus 2018 Dec 18;10(12):e3749. Epub 2018 Dec 18.

Internal Medicine, American University of Integrative Sciences, Tucker, BRB.

Cardiac amyloidosis is an acquired heart disease secondary to the deposition of β-pleated amyloid proteins in heart tissue. Amyloid light chain (AL) amyloidosis is usually secondary to multiple myeloma and can rapidly deteriorate cardiac function, with high mortality. Up to 50% of AL patients have cardiac involvement presenting as heart failure, conduction abnormalities, and cardiomyopathies. One of the rare presentations is the likely simulation of disease with hypertrophic cardiomyopathies like left ventricular outflow tract (LVOT) obstruction due to the systolic anterior motion of the mitral valve and irregular septal hypertrophy secondary to amyloid deposits. We present a case of cardiac amyloidosis secondary to multiple myeloma who presented with dynamic LVOT obstruction resembling hypertrophic obstructive cardiomyopathy and complicated by acute pulmonary edema. These complicated cases can be initially treated for pulmonary edema with an elevation of the head of the bed, furosemide, and nitroglycerin intravenously. For multiple myeloma, chemotherapy was continued. Beta-blockers, calcium channel blockers and angiotensin-converting enzyme inhibitors, and aldosterone receptor blocker were avoided due to poor tolerability. After symptomatic control, the patient can likely be scheduled for septal myotomy and the placement of a pacemaker or implantable cardiac defibrillator to prevent any arrhythmias causing sudden cardiac death in these subsets of patients.
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http://dx.doi.org/10.7759/cureus.3749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388819PMC
December 2018
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