Publications by authors named "Mohammed Osman"

178 Publications

Meta-analysis of Pacemaker Therapy in Patients With Neurocardiogenic Syncope.

Am J Cardiol 2021 Jun;149:159-160

Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon. Electronic address:

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http://dx.doi.org/10.1016/j.amjcard.2021.03.015DOI Listing
June 2021

Impact of catheter ablation in patients with atrial flutter and concurrent heart failure.

Heart Rhythm O2 2021 Feb 22;2(1):53-63. Epub 2020 Nov 22.

Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio.

Background: No studies assessed impact of atrial flutter (AFL) ablation on outcomes in patients with AFL and concurrent heart failure (HF).

Objectives: To assess the effect of AFL ablation on mortality and HF readmissions in patients with AFL and HF.

Methods: This retrospective cohort study identified 15,952 patients with AFL and HF from the 2016-17 Nationwide Readmissions Database. The primary outcome was a composite of all-cause mortality and/or HF readmission at 1 year. Secondary outcomes included HF readmission, all-cause mortality, and atrial fibrillation (AF) readmission at 1 year. Propensity score match (1:2) algorithm was used to adjust for confounders. Cox proportional hazard regression was used to generate hazard ratios.

Results: Of the 15,952 patients, 9889 had heart failure with reduced ejection fraction (HFrEF) and 6063 had heart failure with preserved ejection fraction (HFpEF). In the matched HFrEF cohort (n = 5421), the primary outcome was significantly lower in patients undergoing ablation (HR 0.72, 95% CI 0.61-0.85, < .001). HF readmission (HR 0.73, 95% CI 0.61-0.89, = .001), all-cause mortality (HR 0.62, 95% CI 0.46-0.85, = .003), and AF readmission (HR 0.63, 95% CI 0.48-0.82, = .001) were also significantly reduced. In the matched HFpEF cohort (n = 2439), the primary outcome was lower in the group receiving ablation but was not statistically significant (HR 0.80, 95% CI 0.63-1.01, = .065).

Conclusion: In patients with AFL and HFrEF, AFL ablation was associated with lower mortality and HF readmissions at 1 year. Patients with AFL and HFpEF did not show a similar significant reduction in the primary outcome.
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http://dx.doi.org/10.1016/j.hroo.2020.11.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8183960PMC
February 2021

Familial hypercholesterolemia related admission for acute coronary syndrome in the United States: Incidence, predictors, and outcomes.

J Clin Lipidol 2021 May-Jun;15(3):460-465. Epub 2021 Apr 29.

Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA. Electronic address:

Background: Individuals with Familial Hypercholesterolemia (FH) are at high risk for atherosclerotic cardiovascular disease (ASCVD) events.

Objectives: The purpose of this study was to evaluate the incidence, predictors, and outcomes of admissions for acute coronary syndromes (ACS) in this high-risk group.

Methods: Utilizing the National Readmission Databases, we identified individuals with or without FH admitted to participating hospitals for ACS. The primary outcome was admission for recurrent ACS at 11 month follow-up.

Results: There were a total of 1,697,513 ACS admissions from 10/2016 to 12/2017 (non-FH=1,696,979 and FH=534). Individuals with FH admitted for ACS were younger (median age 57 vs 69 y), had fewer comorbidities (hypertension 74.7% vs 79.6%; diabetes mellitus 30.5% vs 39.0%;p<0.01), were more likely to present with ST-elevation-myocardial infarction (32.8% vs 22.6%;p<0.01) and more likely to undergo multivessel percutaneous coronary intervention (11.4% vs 7.6%;p<0.01) than patients without FH. After propensity-score matching, FH patients more commonly experienced in-hospital VT arrest (11.8% vs 8.0%;p<0.01) and required more mechanical circulatory support (8.6% vs 3.3%; p<0.01). The 30-day readmission in those with FH was more frequently for cardiovascular disease (81.5% vs 46.5%; =p<0.01). At 11-month follow-up, FH patients were more likely to be readmitted with recurrent ACS compared to those without FH (hazard ratio=2.34; 95% confidence interval=1.30-4.23; p<0.01).

Conclusions: Individuals with FH admitted for ACS are younger, have fewer comorbidities, and more frequently present with STEMIs compared to those without FH. FH patients were more likely to suffer in-hospital cardiac complications and have a higher incidence of recurrent ACS.
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http://dx.doi.org/10.1016/j.jacl.2021.04.005DOI Listing
April 2021

Phase II study of apatinib in combination with oral vinorelbine in heavily pretreated HER2-negative metastatic breast cancer and clinical implications of monitoring ctDNA.

Cancer Biol Med 2021 May 26. Epub 2021 May 26.

Unit of Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma 00176, Italy.

Objective: Apatinib is an oral TKI targeting VEGFR-2. Single-agent apatinib treatment has been shown to produce an objective response in patients with pretreated mBC. Oral vinorelbine also holds promise as a treatment of choice in patients with mBC. This study aimed to investigate the efficacy and safety of the oral vinorelbine-apatinib combination in patients with pretreated mBC. In addition, we detected gene variants in ctDNA to explore the therapeutic implications.

Methods: This study enrolled patients with HER2-negative mBC who were pretreated with anthracycline/taxanes. Patients were treated with apatinib at 500 mg/425 mg daily plus oral vinorelbine 60 mg/m on days 1, 8, and 15 of every cycle (3 weeks). The primary endpoint was PFS. The secondary endpoints were ORR, CBR, OS, and safety. Patients eligible for ctDNA detection were evaluated before and during treatment.

Results: Forty patients were enrolled. The median PFS was 5.2 months (95% CI, 3.4-7.0 months), and the median OS was 17.4 months (95% CI, 8.0-27.0 months). The ORR was 17.1% (6/35), and the CBR was 45.7% (16/35). The most common AEs included gastrointestinal reaction, myelosuppression, and hypertension. In 20 patients, ctDNA was detected at baseline and during treatment. A significant difference was found in PFS for undetected detected baseline ctDNA (13.9 months 3.6 months, = 0.018).

Conclusions: All-oral therapy with apatinib plus vinorelbine displayed objective efficacy in patients with heavily pretreated HER2-negative mBC, with acceptable and manageable toxicity profiles. Patients with no gene variant detected and lower variant allele frequencies in ctDNA at baseline showed longer PFS.
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http://dx.doi.org/10.20892/j.issn.2095-3941.2020.0418DOI Listing
May 2021

Avacopan for the treatment of ANCA-associated vasculitis.

Expert Rev Clin Immunol 2021 May 28:1-10. Epub 2021 May 28.

Vasculitis Clinic, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.

: Anti-neutrophil cytoplasm autoantibodies (ANCA)-associated vasculitides (AAVs) are a group of rare heterogeneous diseases characterized by blood vessel inflammation resulting in organ destruction and death. Although various treatment strategies have resulted in marked improvement in vasculitis-specific outcomes, many patients with AAV continue to suffer from complications related to the prolonged use of glucocorticoids (GC) such as infections, metabolic abnormalities, and increased cardiovascular morbidity. Recently, activation of the alternative complement pathway has been implicated in the augmentation of the damage caused by AAV via the complement C5a receptor (C5aR1, CD88). Specifically targeting this pathway may lead to improved outcomes in patients with AAV.: In this article, we have summarized the rationale for targeting the complement pathway in AAV. The relevant pre-clinical, phase I, II and III findings with emphasis on the efficacy, and safety of avacopan, a new oral competitive inhibitor that interferes with the binding of C5a to C5aR1 (CD88), are reviewed.: These results are encouraging, may led to major changes in the treatment approach for AAV, and give rise to future studies utilizing complement inhibitors in AAV patients, and potentially in other immune mediated diseases.
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http://dx.doi.org/10.1080/1744666X.2021.1932466DOI Listing
May 2021

Gender-based outcomes of coronary bifurcation stenting: A report from the National Readmission Database.

Catheter Cardiovasc Interv 2021 May 15. Epub 2021 May 15.

Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA.

Background: There is a paucity of data focusing on women's outcomes after percutaneous coronary interventions (PCI) for coronary bifurcation lesions (CBLs).

Methods: Patients who received PCI for CBLs in the context of acute coronary syndrome (ACS) during the period of 01 October 2015- 31 December 2017, were identified from the United States National Readmission Database. The primary endpoint of this study was in-hospital major adverse events (MAEs). The secondary endpoints were in-hospital mortality, vascular complications, major bleeding, post-procedural bleeding, need for blood transfusion, severe disability surrogates (non-home discharge and need for mechanical ventilation), resources utilization surrogates (length of stay and cost of hospitalization), and 30-day readmission rate. A 1:1 propensity score matching was used to compare the outcomes between women and men.

Results: A total of 25,050 (women = 7,480; men = 17,570) patients were included in the current analysis. After propensity score matching, women had higher in-hospital MAEs (7 vs 5.2%, p < .01), major bleeding (1.8 vs 0.8%, p < .01), post-procedural bleeding (6.1 vs 3.4%, p < .01), need for blood transfusion (6.4 vs 4.2%, p < .01), non-home discharges (10.2 vs 7.1%; p < .01), longer length of hospital stay (3 days [IQR 2-6] vs. 3 days [IQR 2-5], p < .01) and higher 30-day readmission rate compared to men (14.2 vs. 11.5%, p < .01).

Conclusions: Among all-comers who received PCI for CBLs in the context of ACS, women suffered higher MAEs and 30-day readmission rates compared to their men' counterparts. The higher MAEs in the women were mainly driven by higher postprocedural bleeding rates and the need for blood transfusion.
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http://dx.doi.org/10.1002/ccd.29704DOI Listing
May 2021

Erythroid precursors and progenitors suppress adaptive immunity and get invaded by SARS-CoV-2.

Stem Cell Reports 2021 05;16(5):1165-1181

School of Dentistry, Division of Foundational Sciences, University of Alberta, Edmonton, T6G2E1, AB, Canada; Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, T6G2E1, AB, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, T6G2E1, AB, Canada; Department of Medical Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, T6G2E1, AB, Canada. Electronic address:

SARS-CoV-2 infection is associated with lower blood oxygen levels, even in patients without hypoxia requiring hospitalization. This discordance illustrates the need for a more unifying explanation as to whether SARS-CoV-2 directly or indirectly affects erythropoiesis. Here, we show significantly enriched CD71 erythroid precursors/progenitors in the blood circulation of COVID-19 patients. We found that these cells have distinctive immunosuppressive properties. In agreement, we observed a strong negative correlation between the frequency of these cells with T and B cell proportions in COVID-19 patients. The expansion of these CD71 erythroid precursors/progenitors was negatively correlated with the hemoglobin levels. A subpopulation of abundant erythroid cells, CD45 CD71 cells, co-express ACE2, TMPRSS2, CD147, and CD26, and these can be infected with SARS-CoV-2. In turn, pre-treatment of erythroid cells with dexamethasone significantly diminished ACE2/TMPRSS2 expression and subsequently reduced their infectivity with SARS-CoV-2. This provides a novel insight into the impact of SARS-CoV-2 on erythropoiesis and hypoxia seen in COVID-19 patients.
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http://dx.doi.org/10.1016/j.stemcr.2021.04.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111797PMC
May 2021

Reviving Invasive Hemodynamic Monitoring in Cardiogenic Shock. Invasive Hemodynamic Monitoring in Cardiogenic Shock.

Am J Cardiol 2021 Jul 8;150:128-129. Epub 2021 May 8.

Division of Cardiology, Department of Medicine, Henry Ford Health System, Detroit, Michigan.

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http://dx.doi.org/10.1016/j.amjcard.2021.03.033DOI Listing
July 2021

Meta-analysis of restrictive versus liberal blood transfusion among patients with coronary artery disease.

J Thromb Thrombolysis 2021 May 6. Epub 2021 May 6.

Division of Cardiology, West Virginia University School of Medicine, WVU Heart & Vascular Institute, 1 Medical Center Drive, Box 8003, Morgantown, WV, 26506, USA.

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http://dx.doi.org/10.1007/s11239-021-02469-5DOI Listing
May 2021

Galectin-9, a Player in Cytokine Release Syndrome and a Surrogate Diagnostic Biomarker in SARS-CoV-2 Infection.

mBio 2021 05 4;12(3). Epub 2021 May 4.

School of Dentistry, Division of Foundational Sciences, University of Alberta, Edmonton, Alberta, Canada

The outbreak of SARS-CoV-2 infection has enormously impacted our lives. Clinical evidence has implicated the emergence of cytokine release syndrome as the prominent cause of mortality in COVID-19 patients. In this study, we observed massive elevation of plasma Galectin-9 (Gal-9) in COVID-19 patients compared to healthy controls (HCs). By using the receiver operating characteristic (ROC) curve, we found that a baseline of 2,042 pg/ml plasma Gal-9 can differentiate SARS-CoV-2-infected from noninfected individuals with high specificity/sensitivity (95%). Analysis of 30 cytokines and chemokines detected a positive correlation of the plasma Gal-9 with C-reactive protein (CRP) and proinflammatory cytokines/chemokines such as interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), IP-10, MIP-1α, and MCP-1 but an inverse correlation with transforming growth factor β (TGF-β) in COVID-19 patients. In agreement, we found enhanced production of IL-6 and TNF-α by monocytes and NK cells of COVID-19 patients once treated with the recombinant human Gal-9 Also, we observed that although the cell-membrane expression of Gal-9 on monocytes does not change in COVID-19 patients, those with higher Gal-9 expression exhibit an activated phenotype. Furthermore, we noted significant downregulation of surface Gal-9 in neutrophils from COVID-19 patients compared to HCs. Our further investigations indicated that immune activation following SARS-CoV-2 infection results in Gal-9 shedding from neutrophils. The strong correlation of Gal-9 with proinflammatory mediators suggests that inhibition of Gal-9 may severe as a therapeutic approach in COVID-19 infection. Besides, the plasma Gal-9 measurement may be used as a surrogate diagnostic biomarker in COVID-19 patients. The outbreak of SARS-CoV-2 infection has enormously impacted our lives. Clinical evidence has implicated the emergence of cytokine release syndrome as the prominent cause of mortality in COVID-19 patients. We observed substantial elevation of the plasma Galectin-9 (Gal-9) in COVID-19 patients compared to healthy controls. Gal-9 is an abundant protein in many immune and nonimmune cells. We found that Gal-9 detection assay can differentiate SARS-CoV-2-infected from noninfected individuals with a specificity/sensitivity of 95%. Importantly, we found a positive correlation of the plasma Gal-9 with a wide range of proinflammatory biomarkers in COVID-19 patients. In agreement, we found enhanced expression and production of such proinflammatory molecules by immune cells of COVID-19 patients once treated with Gal-9 Our results propose Gal-9 as an important contributing factor in cytokine release syndrome; therefore, Gal-9 inhibition may serve as a beneficial therapeutic approach by suppressing the hyperimmune activation in COVID-19 patients.
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http://dx.doi.org/10.1128/mBio.00384-21DOI Listing
May 2021

Index admission and thirty-day readmission outcomes of patients with cancer presenting with STEMI.

Cardiovasc Revasc Med 2021 Apr 16. Epub 2021 Apr 16.

Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA. Electronic address:

Background: National-level data of cancer patients' readmissions after ST-segment elevation myocardial infarction (STEMI) are lacking.

Objectives: The primary aim of this study was to compare the rates and causes of 30-day readmissions in patients with and without cancer.

Methods: Among patients admitted with STEMI in the United States National Readmission Database (NRD) from October 2015-December 2017, we identified patients with the diagnosis of active breast, colorectal, lung, or prostate cancer. The primary endpoint was the 30-day unplanned readmission rate. Secondary endpoints included in-hospital outcomes during the index admission and causes of readmissions. A propensity score model was used to compare the outcomes of patients with and without cancer.

Results: A total of 385,522 patients were included in the analysis: 5956 with cancer and 379,566 without cancer. After propensity score matching, 23,880 patients were compared (Cancer = 5949, No Cancer = 17,931). Patients with cancer had higher 30-day readmission rates (19% vs. 14%, p < 0.01). The most common causes for readmission among patients with cancer were cardiac (31%), infectious (21%), oncologic (17%), respiratory (4%), stroke (4%), and renal (3%). During the first readmission, patients with cancer had higher adjusted rates of in-hospital mortality (15% vs. 7%; p < 0.01) and bleeding complications (31% vs. 21%; p < 0.01), compared to the non-cancer group. In addition, cancer (OR 1.5, 95% CI 1.2-1.6, p < 0.01) was an independent predictor for 30-day readmission.

Conclusions: About one in five cancer patients presenting with STEMI will be readmitted within 30 days. Cardiac causes predominated the reason for 30-day readmissions in patients with cancer.
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http://dx.doi.org/10.1016/j.carrev.2021.04.015DOI Listing
April 2021

Association Between Breast Arterial Calcification on Mammography and Coronary Artery Disease: A Systematic Review and Meta-Analysis.

J Womens Health (Larchmt) 2021 Apr 7. Epub 2021 Apr 7.

Department of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA.

Breast arterial calcification (BAC), which may be detected during screening mammography, is hypothesized to be a noninvasive imaging marker that may enhance cardiovascular risk assessment. In this systematic review and meta-analysis, we sought to assess the association between BAC and coronary artery disease (CAD) by conducting a meta-analysis. We conducted a literature search of PubMed, Scopus, Cochrane library, ClinicalTrials.gov, and conference proceedings, from inception through December 24, 2019. The outcome of interest was the presence of CAD in patients with BAC. This was reported as crude and adjusted odds ratio (OR). A total of 18 studies comprising 33,494 women (mean age of 60.8 ± 3.7 years, 25% with diabetes, 57% with hypertension, and 21% with history of tobacco smoking) were included in the current meta-analysis. The prevalence of BAC among study participants was 10%. There was a statistically significant association between BAC and CAD (unadjusted OR 2.14; 95% confidence interval [CI] 1.63-2.81,  < 0.001,  = 76.5%). Moreover, adjusted estimates were available from 10 studies and BAC was an independent predictor of CAD (OR 2.39; 95% CI 1.68-3.41,  < 0.001,  = 61.7%). In the meta-regression analysis, covariates included year of publication, age, hypertension, diabetes mellitus, and history of tobacco smoking. None of these study covariates explained the heterogeneity across studies. BAC detected as part of screening mammography is a promising noninvasive imaging marker that may enhance CAD risk prediction in women. The clinical value of BAC for cardiovascular risk stratification merits further evaluation in large prospective studies.
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http://dx.doi.org/10.1089/jwh.2020.8733DOI Listing
April 2021

Do COVID-19 Infections Result in a Different Form of Secondary Hemophagocytic Lymphohistiocytosis.

Int J Mol Sci 2021 Mar 15;22(6). Epub 2021 Mar 15.

Division of Rheumatology, Department of Medicine, University of Alberta Hospital, University of Alberta, Edmonton, AB T6G 2R3, Canada.

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in significant morbidity and mortality across the world, with no current effective treatments available. Recent studies suggest the possibility of a cytokine storm associated with severe COVID-19, similar to the biochemical profile seen in hemophagocytic lymphohistiocytosis (HLH), raising the question of possible benefits that could be derived from targeted immunosuppression in severe COVID-19 patients. We reviewed the literature regarding the diagnosis and features of HLH, particularly secondary HLH, and aimed to identify gaps in the literature to truly clarify the existence of a COVID-19 associated HLH. Diagnostic criteria such as HScore or HLH-2004 may have suboptimal performance in identifying COVID-19 HLH-like presentations, and criteria such as soluble CD163, NK cell activity, or other novel biomarkers may be more useful in identifying this entity.
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http://dx.doi.org/10.3390/ijms22062967DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001312PMC
March 2021

Meta-analysis of device related thrombosis after left atrial appendage occlusion in women versus men.

Cardiovasc Revasc Med 2020 Nov 20. Epub 2020 Nov 20.

West Virginia University Heart & Vascular Institute, Morgantown, WV, USA.

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http://dx.doi.org/10.1016/j.carrev.2020.11.020DOI Listing
November 2020

Invasive Approaches in the Management of Cocaine-Associated Non-ST-Segment Elevation Myocardial Infarction.

JACC Cardiovasc Interv 2021 Mar;14(6):623-636

Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA. Electronic address:

Objectives: The aim of this study was to determine the impact of invasive approaches and revascularization in patients with cocaine-associated non-ST-segment elevation myocardial infarction (NSTEMI).

Background: The role of invasive approaches in cocaine-associated NSTEMI is uncertain.

Methods: This retrospective cohort study identified 3,735 patients with NSTEMI and history of cocaine use from the Nationwide Readmissions Database from 2016 to 2017. Invasive approaches were defined as coronary angiography, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). Revascularization was defined as PCI and CABG. The primary efficacy outcome was major adverse cardiac events (MACE), and the primary safety outcome was emergent revascularization. Nonadherence was identified using appropriate International Classification of Diseases-Tenth Revision codes. Two propensity-matched cohorts were generated (noninvasive vs. invasive and noninvasive vs. revascularization) through multivariate logistic regression.

Results: In the propensity score-matched cohorts, an invasive approach (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.56 to 0.92; p = 0.008) and revascularization (HR: 0.54; 95% CI: 0.40 to 0.73; p < 0.001) (compared with a noninvasive approach) were associated with a lower rate of MACE, without an increase in emergent revascularization. On stratification, PCI and CABG individually were associated with a lower rate of MACE. Emergent revascularization was increased with PCI (HR: 1.78; 95% CI: 1.12 to 2.81; p = 0.014) but not with CABG. Nonadherent patients after PCI and CABG did not have significant difference in rate of MACE. PCI in nonadherent patients was associated with an increase in emergent revascularization (HR: 4.45; 95% CI: 2.07 to 9.57; p < 0.001).

Conclusions: Invasive approaches and revascularization for cocaine-associated NSTEMI are associated with lower morbidity. A history of medical nonadherence was not associated with a difference in morbidity but was associated with an increased risk for emergent revascularization with PCI.
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http://dx.doi.org/10.1016/j.jcin.2021.01.005DOI Listing
March 2021

Baseline characteristics and outcomes of end-stage renal disease patients after in-hospital sudden cardiac arrest: a national perspective.

J Interv Card Electrophysiol 2021 Mar 16. Epub 2021 Mar 16.

Section of Electrophysiology, Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California San Diego, 9452 Medical Center Dr., MC 7411, La Jolla, CA, 92037, USA.

Purpose: End-stage renal disease (ESRD) is a well-recognized risk factor for the development of sudden cardiac arrest (SCA). There is limited data on baseline characteristics and outcomes after an in-hospital SCA event in ESRD patients.

Methods: For the purpose of this study, data were obtained from the National Inpatient Sample from January 2007 to December 2017. In-hospital SCA was identified using the International Classification of Disease, 9th Revision, Clinical Modification and International Classification of Disease, 10th Revision, Clinical Modification codes of 99.60, 99.63, and 5A12012. ESRD patients were subsequently identified using codes of 585.6 and N18.6. Baseline characteristics and outcomes were compared among ESRD and non-ESRD patients in crude and propensity score (PS)-matched cohorts. Predictors of mortality in ESRD patients after an in-hospital SCA event were analyzed using a multivariate logistic regression model.

Results: A total of 1,412,985 patients sustained in-hospital SCA during our study period. ESRD patients with in-hospital SCA were younger and had a higher burden of key co-morbidities. Mortality was similar in ESRD and non-ESRD patients in PS-matched cohort (70.4% vs. 70.7%, p = 0.45) with an overall downward trend over our study years. Advanced age, Black race, and key co-morbidities independently predicted increased mortality while prior implantable defibrillator was associated with decreased mortality in ESRD patients after an in-hospital SCA event.

Conclusions: In the context of in-hospital SCA, mortality is similar in ESRD and non-ESRD patients in adjusted analysis. Adequate risk factor modification could further mitigate the risk of in-hospital SCA among ESRD patients.
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http://dx.doi.org/10.1007/s10840-021-00977-1DOI Listing
March 2021

Meta-Analysis of Sodium-Glucose Cotransporter 2 Inhibitors in Heart Failure Patients Without Diabetes.

Am J Cardiol 2021 Jun 6;148:175-176. Epub 2021 Mar 6.

Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA. Electronic address:

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http://dx.doi.org/10.1016/j.amjcard.2021.03.001DOI Listing
June 2021

Regional Variation in the Adoption of Invasive Hemodynamic Monitoring for Cardiogenic Shock in the United States.

Am J Cardiol 2021 Jun 3;148:174-175. Epub 2021 Mar 3.

Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia.

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http://dx.doi.org/10.1016/j.amjcard.2021.02.028DOI Listing
June 2021

National Trends in Mechanical and Bioprosthetic Valve Replacement Among Women of Childbearing Age.

Am J Cardiol 2021 05 5;146:137-138. Epub 2021 Feb 5.

Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota. Electronic address:

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http://dx.doi.org/10.1016/j.amjcard.2021.01.009DOI Listing
May 2021

Disease recurrence after gut transplantation.

Curr Opin Organ Transplant 2021 Apr;26(2):207-219

Cleveland Clinic, Center for Gut Rehabilitation and Transplantation, Cleveland, Ohio, USA.

Purpose Of Review: Despite three decades of clinical experience, this article is the first to comprehensively address disease recurrence after gut transplantation. Pertinent scientific literature is reviewed and management strategies are discussed with new insights into advances in gut pathobiology and human genetics.

Recent Findings: With growing experience and new perspectives in the field of gut transplantation, the topic of disease recurrence continues to evolve. The clinicopathologic spectrum and diagnostic criteria are better defined in milieu of the nature of the primary disease. In addition to neoplastic disorders, disease recurrence is suspected in patients with pretransplant Crohn's disease, gut dysmotility, hypercoagulability and metabolic syndrome. There has also been an increased awareness of the potential de-novo development of various disorders in the transplanted organs. For conventionally unresectable gastrointestinal and abdominal malignancies, ex-vivo excision and autotransplantation are advocated, particularly for the nonallotransplant candidates.

Summary: Similar to other solid organ and cell transplantations, disease recurrence has been suspected following gut transplantation. Despite current lack of conclusive diagnostic criteria, recurrence of certain mucosal and neuromuscular disorders has been recently described in a large single-centre series with an overall incidence of 7%. Disease recurrence was also observed in recipients with pretransplant hypercoagulability and morbid obesity with respective incidences of 4 and 24%. As expected, tumour recurrence is largely determined by type, extent and biologic behaviour of the primary neoplasm. With the exception of high-grade aggressive malignancy, disease recurrence is still of academic interest with no significant impact on overall short and long-term outcome.
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http://dx.doi.org/10.1097/MOT.0000000000000856DOI Listing
April 2021

Venous Thromboembolism Has a Variable Time of Occurrence in the Course of COVID-19: A Case Series.

Cureus 2020 Dec 26;12(12):e12295. Epub 2020 Dec 26.

Internal Medicine, Yale New Haven Health System/Bridgeport Hospital, Bridgeport, USA.

The novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) which results in coronavirus disease 2019 (COVID-19) has had a devastating impact globally. Not much is fully understood about this disease. Acute respiratory distress syndrome (ARDS) appears to be the commonest complication among patients with COVID-19. However, venous thromboembolism (VTE) appears to be a common complication among patients with COVID-19 even with adequate anticoagulation during hospitalization. VTE may confer a poor outcome on its own or may exacerbate other common complications such as ARDS or cardiac injury. There are several diagnostic dilemmas with regards confirming VTE among patients with COVID-19 as there is a move to reduce the transfer of patients for angiographic studies or even venous Doppler ultrasonography because of the high transmissibility SARS-CoV-2. There is also the risk of worsening ARDS following fluid administration to prevent contrast nephropathy after angiographic studies.  It is, therefore, crucial to understand the timing of VTE occurrence in the setting of COVID-19, identify strategies for early diagnosis of VTE, therapeutic options as well as prognostic implications of VTE in the setting of COVID-19.
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http://dx.doi.org/10.7759/cureus.12295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834583PMC
December 2020

Association of chronic kidney disease with in-hospital outcomes of endovascular stroke interventions.

Cardiovasc Revasc Med 2021 Jan 22. Epub 2021 Jan 22.

Department of Cardiology, Mayo Clinic School of Medicine, Rochester, MN, United States of America. Electronic address:

Background: Data on the differential impact of chronic kidney disease (CKD) on the outcomes of endovascular stroke interventions (ESI) for acute ischemic stroke (AIS) are limited.

Methods: Adult patients who underwent ESI for AIS between October 1st, 2015 and September 30th, 2019, were identified in a national multicenter database. The primary endpoints were in-hospital mortality and poor functional outcomes. Secondary endpoints included intracranial hemorrhage, mechanical ventilation, pneumonia, myocardial infarction, blood transfusion, length of stay, and cost. A multilevel mixed-effects regression model was used to derive adjusted outcomes.

Results: A total of 22,193 AIS patients who underwent ESI at 99 centers were included. Among those, 18,881 (85%) had no CKD, and 3312 (15%) had CKD. Patients with CKD were older and had a higher prevalence of key comorbidities. After multivariable risk adjustment, patients with CKD had significantly higher in-hospital mortality (Odds Ratio [OR] 1.55 [95% Confidence Interval] [CI] 1.40-1.73, p < 0.01), and poor functional outcomes (OR 1.38, 95%CI 1.26-1.50, p < 0.01). Major complications, including mechanical ventilation, pneumonia, blood transfusion, and myocardial infarction, were more common among CKD patients, who also had longer hospitalizations and accrued higher cost.

Conclusion: The presence of CKD in patients with AIS treated with ESI is an independent predictor of in-hospital mortality and poor functional outcomes at discharge.
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http://dx.doi.org/10.1016/j.carrev.2021.01.021DOI Listing
January 2021

Meta-Analysis of Drug-Coated Balloons Versus Drug-Eluting Stents for Small Vessel De-Novo Coronary Artery Disease.

Am J Cardiol 2021 03 6;142:157-158. Epub 2021 Jan 6.

Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia. Electronic address:

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http://dx.doi.org/10.1016/j.amjcard.2020.12.071DOI Listing
March 2021

COVID-19, rheumatic diseases and immune dysregulation-a perspective.

Clin Rheumatol 2021 Feb 7;40(2):433-442. Epub 2021 Jan 7.

Division of Rheumatology, Department of Medicine, University of Alberta, 8-130 Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada.

The COVID-19 pandemic has resulted in widespread hospitalisations and deaths around the world. As patients with rheumatic diseases generally have increased risk of infections and complications, understandably, there is significant concern of the impact of SARS-CoV-2 on these patients. However, there is a paucity of data in rheumatic patients. We review mechanisms through which SARS-CoV-2 results in infection, including ACE2 receptor, and complications (including immune dysregulation, thrombosis and complement activation). We assess these pathways in patients with rheumatic disease and those on immune modulating therapy. Although data thus far does not appear to show worse outcomes in rheumatic patients as a whole, given alterations in the underlying immune pathways in certain diseases (such as systemic lupus erythematosus), we posit that the risk is not equal in all rheumatic patients. We also discuss the benefit of underlying disease control with respect to COVID-19 risk reduction and potential increased risk of disease flares following viral infection from an immune standpoint.
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http://dx.doi.org/10.1007/s10067-020-05529-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788381PMC
February 2021

Insertion technique for the Impella 5.0 heart pump in the COVID-19 era.

Multimed Man Cardiothorac Surg 2020 Dec 23;2020. Epub 2020 Dec 23.

Department of Transplantation Royal Papworth Hospital NHS Foundation Trust Cambridge, United Kingdom.

We describe the insertion of the Impella 5.0, a peripherally placed mechanical cardiovascular microaxial pump, in a patient with ischemic left ventricular dysfunction. The Impella is a 7 Fr device capable of achieving a flow of 4.0-5.0 L/min; its use necessitates an open arterial cut-down. A subclavicular incision is used to access the right or left axillary artery. A 10-mm tube graft is anastomosed to the artery through which the Impella 5.0 is inserted. The device traverses the tube graft and is advanced via the aorta, across the aortic valve, to its final position (inflow toward the ventricular apex and outflow above the aorta). The device may remain in situ for 10 days until recovery or until further supports are instituted. Our goal is to demonstrate the insertion of the Impella 5.0 device in a patient with cardiogenic shock whose situation was further complicated by coronavirus disease 2019.
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http://dx.doi.org/10.1510/mmcts.2020.078DOI Listing
December 2020

CT assessment of the left atrial appendage post-transcatheter occlusion - A systematic review and meta analysis.

J Cardiovasc Comput Tomogr 2020 Dec 15. Epub 2020 Dec 15.

Heart and Vascular Institute, West Virginia University School of Medicine, Morgantown, WV, USA. Electronic address:

Background: Transesophageal echocardiography (TEE) is the standard imaging modality used to assess the left atrial appendage (LAA) after transcatheter device occlusion. Cardiac computed tomography angiography (CCTA) offers an alternative non-invasive modality in these patients. We aimed to conduct a comparison of the two modalities.

Methods: We performed a comprehensive systematic review of the current literature pertaining to CCTA to establish its usefulness during follow-up for patients undergoing LAA device closure. Studies that reported the prevalence of inadequate LAA closure on both CCTA and TEE were further evaluated in a meta-analysis. 19 studies were used in the systematic review, and six studies were used in the meta-analysis.

Results: The use of CCTA was associated with a higher likelihood of detecting LAA patency than the use of TEE (OR, 2.79, 95% CI 1.34-5.80, p ​= ​0.006, I ​= ​70.4%). There was no significant difference in the prevalence of peridevice gap ≥5 ​mm (OR, 3.04, 95% CI 0.70-13.17, p ​= ​0.13, I ​= ​0%) between the two modalities. Studies that reported LAA assessment in early and delayed phase techniques detected a 25%-50% higher prevalence of LAA patency on the delayed imaging.

Conclusion: CCTA can be used as an alternative to TEE for LAA assessment post occlusion. Standardized CCTA acquisition and interpretation protocols should be developed for clinical practice.
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http://dx.doi.org/10.1016/j.jcct.2020.12.003DOI Listing
December 2020

Meta-Analysis Comparing Ticagrelor or Prasugrel Versus Clopidogrel in Patients Undergoing Elective Percutaneous Coronary Intervention.

Am J Cardiol 2021 03 28;143:160-162. Epub 2020 Dec 28.

Division of Cardiovascular Health and Disease, University of Cincinnati College of Medicine, Cincinnati, Ohio. Electronic address:

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http://dx.doi.org/10.1016/j.amjcard.2020.12.054DOI Listing
March 2021

Utility of Single-Photon Emission Computed Tomography/Computed Tomography in Suspected Unilateral Condylar Hyperplasia: A Histopathologic Validation Study.

J Oral Maxillofac Surg 2021 May 28;79(5):1083.e1-1083.e10. Epub 2020 Nov 28.

Assistant Professor and Consultant of Nuclear Medicine, Nuclear Medicine Unit, South Egypt Cancer Institute, Assiut University, Assiut, Egypt and Postdoctoral Scholar, Department of Radiology, University of California Davis, Sacramento, CA. Electronic address:

Purpose: The purpose of this study is to evaluate the utility of hybrid single-photon emission computed tomography (SPECT) and computed tomography (CT) with technetium-99m methylene diphosphonate in patients with suspected active unilateral condylar hyperplasia (UCH) using histopathology as the reference standard.

Methods: Twenty-four patients with suspected active UCH prospectively underwent technetium-99m methylene diphosphonate planar bone scintigraphy with SPECT/CT of the mandible. Qualitative and quantitative readings for growth activity were performed by 3 nuclear medicine physicians and the final diagnosis was derived from postoperative histopathological examination. Readings were reported as positive, equivocal, or negative. Total, maximum, and mean counts were recorded for each condyle on SPECT/CT images. The uptake of the index (suspected) condyle was expressed as a count ratio (R, R, R), a percentage uptake (P, P, P), background-corrected counts (B, B, B), as well as CT-based condylar diameters (R,P) relative to the contralateral condyle.

Results: Interobserver agreement was 0.79 and 0.83 for planar bone scintigraphy and SPECT/CT, respectively, with a total of 5 and 1 equivocal readings from the respective modalities. Surgery was performed in 22 patients; all of them had pathologically proven UCH. SPECT/CT was slightly more sensitive than planar bone scintigraphy (91 vs 78%) with identical specificity (96%). R, R P, and P demonstrated area under the curve between 84% and 86%. Metrics based on CT diameters and background-corrected counts were not associated with UCH diagnosis.

Conclusions: Quantitative approaches based on total or mean count ratio or relative count percentage were equally predictive for UCH diagnosis; however, they were slightly less sensitive compared with qualitative technetium-99m methylene diphosphonate SPECT/CT evaluation. SPECT/CT evaluation has the potential to decrease the equivocal readings.
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http://dx.doi.org/10.1016/j.joms.2020.11.020DOI Listing
May 2021

Meta-analysis of Direct Oral Anticoagulants in Patients With Atrial Fibrillation and Bioprosthetic Valves.

Am J Cardiol 2021 03 4;142:140-141. Epub 2020 Dec 4.

Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon. Electronic address:

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http://dx.doi.org/10.1016/j.amjcard.2020.12.006DOI Listing
March 2021

Transcatheter Aortic Valve Replacement vs Surgical Replacement in Patients With Pure Aortic Insufficiency.

Mayo Clin Proc 2020 12;95(12):2655-2664

Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV.

Objective: To compare the outcomes of transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) in patients with pure aortic insufficiency (PAI).

Background: The treatment of choice for patients with severe symptomatic PAI is SAVR. However, not all patients are candidates for surgery because of comorbidities or are deemed high risk for surgery. As a result, TAVR is being used as an off-label procedure in some patients with PAI.

Patients And Methods: We analyzed the National Inpatient Sample database from January 1, 2016, to December 31, 2017, using the International Classification of Diseases, 10th Revision. Inclusion criteria were patients with aortic valve insufficiency undergoing either TAVR or SAVR. Patients with concomitant aortic stenosis, or history of infective endocarditis, and those below the age of 18 years were excluded.

Results: A total of 14,720 patients with PAI underwent valve replacement. Of those, 6.2% underwent TAVR. The TAVR group was significantly older (median age 78 years vs 64 years; P <.001). There was no evidence of a difference in in-hospital mortality between the 2 groups. However, after adjustment, patients in the TAVR group were associated with favorable outcomes in terms of acute kidney injury, cardiogenic shock, postoperative respiratory complications, and length of stay. On the other hand, those in the SAVR group were less likely to need permanent pacemakers.

Conclusion: There was no evidence of a significant statistical difference in in-hospital mortality between patients with PAI treated by either SAVR or TAVR, both in unmatched and propensity-matched cohorts. TAVR could be considered for patients with PAI who are not candidates for surgery.
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http://dx.doi.org/10.1016/j.mayocp.2020.07.030DOI Listing
December 2020