Publications by authors named "Steven C Ajluni"

5 Publications

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Non-Invasive Imaging in the Evaluation of Cardiac Allograft Vasculopathy in Heart Transplantation: A Systematic Review.

Curr Probl Cardiol 2022 Jan 8:101103. Epub 2022 Jan 8.

Department of Medicine, University Hospitals, Cleveland, Ohio; Harrington Heart and Vascular Institute, University Hospitals and School of Medicine, Case Western Reserve University, Cleveland, Ohio. Electronic address:

Cardiac allograft vasculopathy (CAV) is the leading cause of long-term graft dysfunction in patients with heart transplantation and is linked with significant morbidity and mortality. Currently, the gold standard for diagnosing CAV is coronary imaging with intravascular ultrasound (IVUS) during traditional invasive coronary angiography (ICA). Invasive imaging, however, carries increased procedural risk and expense to patients in addition to requiring an experienced interventionalist. With the improvements in non-invasive cardiac imaging modalities such as transthoracic echocardiography (TTE), computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET), an alternative non-invasive imaging approach for the early detection of CAV may be feasible. In this systematic review, we explored the literature to investigate the utility of non-invasive imaging in diagnosis of CAV in >3000 patients across 49 studies. We also discuss the strengths and weaknesses for each imaging modality. Overall, all four imaging modalities show good to excellent accuracy for identifying CAV with significant variations across studies. Majority of the studies compared non-invasive imaging with ICA without intravascular imaging. In summary, non-invasive imaging modalities offer an alternative approach to invasive coronary imaging for CAV. Future studies should investigate longitudinal non-invasive protocols in low-risk patients after heart transplantation.
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http://dx.doi.org/10.1016/j.cpcardiol.2022.101103DOI Listing
January 2022

The use of a sentinel cerebral protection system during Impella CP removal in a patient with left ventricular thrombus.

Catheter Cardiovasc Interv 2020 08 8;96(2):504-506. Epub 2020 May 8.

Center for Advanced Heart Failure, University of Texas Health Science Center of Houston, Houston, Texas, USA.

Percutaneous mechanical circulatory support (pMCS) devices are commonly being utilized for hemodynamic support in patients undergoing high-risk percutaneous coronary interventions or stabilization for those in cardiogenic shock. Left ventricular (LV) to ascending aorta (Ao) rotodynamic pumps such as the Impella devices allow for rapid hemodynamic stabilization or support in such instances. The use of such devices is contraindicated in patients with known LV thrombus. However, it remains unclear on how to manage patients who develop an LV thrombus while on prolonged Impella support. While there are currently no cerebral embolic protection devices (CEPDs) approved for use in conjunction with LV to Ao pMCS devices or other short-term mechanical support devices, there is a theoretical benefit for the use of such technology in the right circumstances. We present a case describing the use of the sentinel cerebral protection system (SCPS) in a patient who developed LV thrombus while on Impella CP support. The use of the SCPS in this patient suggests a potential role for CEPD in prevention of thromboembolism while on Impella support.
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http://dx.doi.org/10.1002/ccd.28956DOI Listing
August 2020

Cardiorespiratory fitness and sleep-related breathing disorders.

Expert Rev Cardiovasc Ther 2008 Jun;6(5):745-58

Division of Cardiology, Department of Internal Medicine, William Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI 48073, USA.

Obstructive sleep apnea and central sleep apnea are burgeoning sleep-related breathing disorders within the general population. Most of the associated comorbidities and causes of these sleep disorders are known to negatively impact cardiorespiratory fitness; however, little is known about the direct relationships between cardiorespiratory fitness, obstructive sleep apnea and central sleep apnea. This article provides a systematic analysis of existing peer reviewed, published clinical studies pertaining to the relationship between cardiorespiratory fitness and sleep-related breathing disorders in adults. A brief description of each sleep disorder, the pathophysiology, its epidemiology and its implications for cardiorespiratory fitness are provided. Finally, we discuss therapy for each disorder and its effect on the cardiovascular system.
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http://dx.doi.org/10.1586/14779072.6.5.745DOI Listing
June 2008

Coronary artery stent thrombosis associated with heparin-induced thrombocytopenia: case report and review of the literature.

J Interv Cardiol 2005 Apr;18(2):131-7

Department of Medicine, Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.

The diagnosis of an acute coronary syndrome associated with heparin-induced thrombocytopenia is an increasingly recognized complication of heparin exposure. We describe a case of an acute myocardial infarction 2 weeks after elective aortobifemoral bypass surgery, subsequent subacute coronary artery stent thrombosis, and the treatment strategies available.
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http://dx.doi.org/10.1111/j.1540-8183.2005.04053.xDOI Listing
April 2005

Optimal glycemic control is associated with a lower rate of target vessel revascularization in treated type II diabetic patients undergoing elective percutaneous coronary intervention.

J Am Coll Cardiol 2004 Jan;43(1):8-14

Division of Cardiology and Biostatistics, Mid America Heart Institute, St. Luke's Hospital, Kansas City, Missouri, USA.

Objectives: We examined the association between glycemic control determined by preprocedural hemoglobin A1c (A1c) and the incidence of target vessel revascularization (TVR) in diabetic patients undergoing elective percutaneous coronary intervention (PCI).

Background: Patients with diabetes mellitus (DM) have increased rates of restenosis and a worse clinical outcome after PCI than patients without DM.

Methods: A total of 239 patients (60 without DM and 179 with DM) were enrolled in this study. Optimal glycemic control was defined as A1c < or =7%, and suboptimal control was defined as A1c >7%. Follow-up was performed at six and 12 months after the index intervention.

Results: Diabetic patients with optimal glycemic control had a rate of 12-month TVR similar to that of nondiabetic patients (15% vs. 18%, p = NS). Diabetic patients with A1c >7% had a significantly higher rate of TVR than those with A1c <7% (34% vs. 15%, p = 0.02). In a multiple logistic regression analysis, A1c >7% was a significant independent predictor of TVR (odds ratio 2.87, 95% confidence interval 1.13 to 7.24; p = 0.03). Optimal glycemic control was associated with a lower rate of cardiac rehospitalization (15% vs. 31%, p = 0.03) and recurrent angina (13% vs. 37%, p = 0.002) at 12-month follow-up.

Conclusions: In diabetic patients undergoing elective PCI, optimal glycemic control (A1c < or =7%) is associated with a lower rate of TVR, cardiac rehospitalization, and recurrent angina. These data suggest that aggressive treatment of DM to achieve A1c < or =7% is beneficial in improving the clinical outcome after PCI.
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http://dx.doi.org/10.1016/j.jacc.2003.06.019DOI Listing
January 2004
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