Publications by authors named "J David Burkhardt"

686 Publications

Incidence of Device-Related Thrombosis in Watchman Patients Undergoing a Genotype-Guided Antithrombotic Strategy.

JACC Clin Electrophysiol 2021 Jun 23. Epub 2021 Jun 23.

Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Interventional Electrophysiology, Scripps Clinic, La Jolla, California, USA; Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.

Objectives: This study sought to report the incidence of device-related thrombosis (DRT) and thromboembolic (TE) events when an alternative to clopidogrel is prescribed in loss-of-function (LOF) allele carriers of the cytochrome P450 2C19 (CYP2C19) gene.

Background: LOF polymorphisms of the CYP2C19 gene are associated with reduced hepatic bioactivation of clopidogrel.

Methods: One thousand two Watchman patients were included. Six hundred forty-five patients underwent CYP2C19 genetic testing; among patients with clopidogrel resistance, clopidogrel was replaced by either prasugrel (pilot cohort) or half dose direct oral anticoagulant ((DOAC)/Group 1), both in combination with aspirin. We compared the incidence of DRT/TE events among genotyped patients and a control group which received standard dual antiplatelet therapy (DAPT) (Group 2; n = 357). All reported events occurred during a timeframe between 45- and 180-day follow-up transesophageal echocardiograms, when the 2 different antithrombotic strategies (genotype-guided vs standard DAPT) were adopted.

Results: In the pilot cohort (n = 244), bleeding events occurred in 10.2% of patients who received aspirin plus prasugrel, leading to early discontinuation of the prasugrel-based protocol. DOAC Group 1 patients (n = 401), 25.7% were reduced metabolizers, and clopidogrel was replaced by half dose direct oral anticoagulant. DRT was documented in 1 (0.2%) patient of Group 1 and 7 (1.96%) patients of Group 2 (log-rank P value = 0.021). The composite endpoint of DRT/TE events was significantly lower among patients receiving a genotype-guided antithrombotic strategy (0.75% vs 3.1%; log-rank P value = 0.017).

Conclusions: In Watchman patients, a genotype-based antithrombotic strategy with aspirin plus half dose DOAC in reduced clopidogrel metabolizers was superior to standard DAPT with respect to DRT/TE events.
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http://dx.doi.org/10.1016/j.jacep.2021.04.012DOI Listing
June 2021

Amplatzer PFO Occluder for treatment of incomplete LAA closure with AtriClip.

J Cardiovasc Electrophysiol 2021 Jun 29. Epub 2021 Jun 29.

Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.

Herein, we describe the use of an Amplatzer PFO Occluder to treat incomplete LAA closure due to a malpositioned AtriClip.
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http://dx.doi.org/10.1111/jce.15137DOI Listing
June 2021

Exploring the Association Between USMLE Scores and ACGME Milestone Ratings: A Validity Study Using National Data From Emergency Medicine.

Acad Med 2021 Jun 15. Epub 2021 Jun 15.

S.J. Hamstra is research consultant, Milestones Research and Evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois, and professor, Department of Surgery, University of Toronto, Toronto, Ontario, Canada, and adjunct professor, Department of Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-0680-366X. M.M. Cuddy is measurement scientist, National Board of Medical Examiners, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0002-5756-9113. D. Jurich is manager, Psychometrics, National Board of Medical Examiners, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0002-1870-2436. K. Yamazaki is senior analyst, Milestones Research and Evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-7039-4717. J. Burkhardt is assistant professor, Emergency Medicine and Learning Health Sciences, University of Michigan, Ann Arbor, Michigan. E.S. Holmboe is chief, Research, Milestones Development and Evaluation Officer, Accreditation Council for Graduate Medical Education, Chicago, Illinois. M.A. Barone is vice president, Licensure Programs, National Board of Medical Examiners, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0002-4724-784X. S.A. Santen is senior associate dean, and Professor of Emergency Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia; ORCID: https://orcid.org/0000-0002-8327-8002.

Purpose: The United States Medical Licensing Examination (USMLE) sequence and the Accreditation Council for Graduate Medical Education (ACGME) milestones represent 2 major components along the continuum of assessment from undergraduate through graduate medical education. This study examines associations between USMLE Step 1 and Step 2 Clinical Knowledge (CK) scores and ACGME emergency medicine (EM) milestone ratings.

Method: In February 2019, subject matter experts (SMEs) provided judgments of expected associations for each combination of Step examination and EM subcompetency. The resulting sets of subcompetencies with expected strong and weak associations were selected for convergent and discriminant validity analysis, respectively. National-level data for 2013-2018 were provided; the final sample included 6,618 EM residents from 158 training programs. Empirical bivariate correlations between milestone ratings and Step scores were calculated, then those correlations were compared with the SMEs' judgments. Multilevel regression analyses were conducted on the selected subcompetencies, in which milestone ratings were the dependent variable, and Step 1 score, Step 2 CK score, and cohort year were independent variables.

Results: Regression results showed small but statistically significant positive relationships between Step 2 CK score and the subcompetencies (regression coefficients ranged from 0.02 [95% confidence interval (CI): 0.01-0.03] to 0.12 [95% CI: 0.11-0.13]; all P < .05), with the degree of association matching the SMEs' judgments for 7 of the 9 selected subcompetencies. For example, a 1 standard deviation increase in Step 2 CK score predicted a 0.12 increase in MK-01 milestone rating, when controlling for Step 1. Step 1 score showed a small statistically significant effect with only the MK-01 subcompetency (regression coefficient = 0.06 [95% CI: 0.05-0.07], P < .05).

Conclusions: These results provide incremental validity evidence in support of Step 1 and Step 2 CK score and EM milestone rating uses.
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http://dx.doi.org/10.1097/ACM.0000000000004207DOI Listing
June 2021

Remodeling of the Posterior Cerebral Artery P1-Segment after Pipeline Flow Diverter Treatment of Posterior Communicating Artery Aneurysms.

Neurol Int 2021 May 7;13(2):195-201. Epub 2021 May 7.

Department of Radiology, Section of Interventional Neuroradiology, NYU Langone Medical Center, New York, NY 10016, USA.

Introduction: Flow diverters such as the pipeline embolization device (PED) cause hemodynamic changes of the treated vessel segment. In posterior communicating artery (PcomA), aneurysms' unique anatomic consideration have to be taken in account due to the connection between the anterior and posterior circulation. We hypothesize that in conjunction with PcomA remodeling, there will also be remodeling of the ipsilateral P1 segment of the posterior cerebral artery (PCA) after PED treatment for PcomA aneurysms.

Methods: We retrospectively collected radiological as well as clinical data of PcomA aneurysm patients treated with PED including PcomA and P1 vessel diameters before and after treatment as well as patient and aneurysm characteristics.

Results: Overall, 14 PcomA aneurysm patients were included for analysis and PED treatment was performed without complications in all patients. In 10 out of 14 patients (71%), a decrease in PcomA diameter was observed and there was a significant mean decrease of 0.78 mm in PcomA diameter on angiographic last follow-up (LFU) ( = 0.003). In the same patient population (10 out of 14 patients), there was meanwhile a significant mean increase of 0.43 mm in the ipsilateral P1 segment diameter observed ( = 0.015). These vessel remodeling effects were in direct correlation with aneurysm occlusion since all of these patients showed aneurysm occlusion at LFU while 29% showed only partial occlusion without vessel remodeling effects. A decrease in PcomA diameter was directly associated with aneurysm occlusion ( = 0.042). There were no neurologic complications on LFU.

Conclusion: In the treatment of PcomA aneurysms with PED, the P1 segment of the PCA increases in diameter while the PcomA diameter decreases. Our results suggest that this remodeling effect is associated with aneurysm occlusion and decrease of PcomA is hemodynamically compensated for by an increase in the ipsilateral P1 diameter.
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http://dx.doi.org/10.3390/neurolint13020020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8162531PMC
May 2021

Comparison of Simultaneous Bilateral Internal Carotid Artery (ICA) 3-Dimensional Rotational Venography (3D-RV) versus Separate Bilateral ICA 3D-RV and Postprocessing 3D-3D Fusion.

World Neurosurg 2021 May 27. Epub 2021 May 27.

Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Background: Preoperative venogram of the superior sagittal sinus (SSS) is helpful to plan the surgical resection strategy in patients with parasagittal meningiomas invading the SSS.

Methods: Catheter 3-dimensional rotational venography (3D-RV) allows for SSS patency assessment and detection of alternative venous cortical drainage routes in patients with contraindication for magnet resonance venography. It is unknown if separate bilateral internal carotid artery 3D-RV followed by postprocessing 3D-3D fusion (technique 1) achieves the same imaging results as simultaneous bilateral internal carotid artery 3D-RV without postprocessing fusion (technique 2) needed.

Results: In this report we were able to confirm in 2 patients that both techniques achieve comparable imaging quality with similar amount of contrast use.

Conclusions: Although technique 2 requires less radiation, technique 1 is favored due to the need for only 1 vessel access site and catheter with reduced risk for access site and ischemic complications.
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http://dx.doi.org/10.1016/j.wneu.2021.05.063DOI Listing
May 2021
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