Publications by authors named "Uzoma N Ibebuogu"

61 Publications

Ventricular Arrhythmias in Seniors with Heart Failure: Present Dilemmas and Therapeutic Considerations: A Systematic Review.

Curr Cardiol Rev 2022 ;18(2):78-90

Department of Internal Medicine (Cardiology), University of Tennessee Health Sciences Center, Memphis, Tennessee, USA.

Background: Heart Failure (HF) is a global public health problem, which affects over 23 million people worldwide. The prevalence of HF is higher among seniors in the USA and other developed countries. Ventricular Arrhythmias (VAs) account for 50% of deaths among patients with HF. We aim to elucidate the factors associated with VAs among seniors with HF, as well as therapies that may improve the outcomes.

Methods: PubMed, Web of Science, Scopus, Cochrane Library databases, Science Direct, and Google Scholar were searched using specific keywords. The reference lists of relevant articles were searched for additional studies related to HF and VAs among seniors as well as associated outcomes.

Results: The prevalence of VAs increases with worsening HF. A 24-hour Holter electrocardiogram may be useful in risk stratifying patients for device therapy if they do not meet the criterion of low ventricular ejection fraction. Implantable Cardiac Defibrillators (ICDs) are superior to anti-arrhythmic drugs in reducing mortality in patients with HF. Guideline-Directed Medical Therapy (GDMT) together with device therapy may be required to reduce symptoms. In general, the proportion of seniors on GDMT is low. A combination of ICDs and cardiac resynchronization therapy may improve outcomes in selected patients.

Conclusion: Seniors with HF and VAs have high mortality even with the use of device therapy and GDMT. The holistic effect of device therapy on outcomes among seniors with HF is equivocal. More studies focused on seniors with advanced HF as well as therapeutic options are, therefore, required.
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http://dx.doi.org/10.2174/1573403X17666211018095324DOI Listing
April 2022

Aortic stenosis and Heyde's syndrome: A comprehensive review.

World J Clin Cases 2021 Sep;9(25):7319-7329

Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN 38163, United States.

Heyde's syndrome is an under reported systemic disease of gastrointestinal and cardiac manifestation in older adults. It is characterized by a triad of aortic stenosis, angiodysplasia with bleeding and acquired von Willebrand syndrome. It is characterized by proteolysis of high molecular weight multimers of von Willebrand Factor and loss of platelet mediated homeostasis. Heyde's syndrome is a treatable condition in most cases, especially in the current era of evolution in interventional cardiology and gastroenterology. There are currently no established guidelines in the management of this condition due to paucity of high quality studies, which warrant future trials. High index of suspicion and increasing the awareness of the syndrome among the general practitioners and sub-specialists will improve the diagnostic potential of Heyde's syndrome. Future studies may change the management aspect of Heyde's syndrome and pave a path for drawing specific guidelines and algorithms. The aim of our review article is to summarize the basic pathophysiology, diagnostics and management of Heyde's syndrome with a special attention to Transcatheter aortic valve replacement.
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http://dx.doi.org/10.12998/wjcc.v9.i25.7319DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8464459PMC
September 2021

A Unique Case of STEMI STEALing the Flow.

JACC Case Rep 2020 Dec 4;2(15):2419-2423. Epub 2020 Nov 4.

Section of Cardiology, University of Tennessee School of Medicine, Memphis, Tennessee, USA.

We report a case of a 55-year-old woman with previous coronary artery bypass grafting. She presented with acute ST-segment elevation myocardial infarction secondary to occlusion of the proximal left subclavian artery causing reduced flow in the left internal mammary artery to left anterior descending artery graft. ().
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http://dx.doi.org/10.1016/j.jaccas.2020.09.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8304535PMC
December 2020

Transcatheter Aortic Valve Replacement in Rheumatic Aortic Stenosis: A Comprehensive Review.

Curr Probl Cardiol 2021 Dec 19;46(12):100843. Epub 2021 Mar 19.

Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN.

Rheumatic heart disease (RHD) mainly affects people in developing, low-income countries. However, due to globalization and migration, developed countries are now seeing more cases of RHD. In RHD patients who develop severe symptomatic aortic stenosis, surgical aortic valve replacement remains the treatment of choice. In the past decade, there has been an extension of transcatheter aortic valve replacement (TAVR) to intermediate-risk and lower-risk patients with aortic stenosis. This review suggests the possible utility of TAVR for the treatment of rheumatic aortic stenosis. Rheumatic aortic stenosis has been excluded from major TAVR studies due to the predominantly noncalcific pathology of the rheumatic aortic valve. However, there have been case reports and case series showing successful implantation of the valve even in patients with and without significant leaflet calcification. In this review article, we summarize the latest evidence of severe rheumatic aortic stenosis treated with TAVR and discuss the procedure's impact on patient care, safety, and efficacy.
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http://dx.doi.org/10.1016/j.cpcardiol.2021.100843DOI Listing
December 2021

Meta-Analysis of Outcomes in Ultrasound Guided Versus Traditional Guided Vascular Access for Interventional Cardiac and Peripheral Vascular Procedures.

Am J Cardiol 2021 06 6;148:176-178. Epub 2021 Mar 6.

Division of Cardiology, University of Tennessee Health Sciences Center, Memphis, Tennessee.

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http://dx.doi.org/10.1016/j.amjcard.2021.03.002DOI Listing
June 2021

Review of Hypothermia Protocol and Timing of the Echocardiogram.

Curr Probl Cardiol 2021 Apr 7;46(4):100786. Epub 2021 Jan 7.

Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN.

Targeted temperature management, also known as therapeutic hypothermia (TH), is recommended for out-of-hospital cardiac arrest (OHCA). Both internal or external methods of cooling can be applied. Individuals resuscitated from OHCA frequently develop postarrest myocardial dysfunction resulting in decreased cardiac output and left ventricular systolic function. This dysfunction is usually transient and improves with spontaneous recovery over time. Echocardiogram (ECHO) can be a vital tool for the assessment and management of these patients. This manuscript reviewed methods available for TH after OHCA and reviews role of ECHO in the diagnosis and prognosis in this setting.
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http://dx.doi.org/10.1016/j.cpcardiol.2021.100786DOI Listing
April 2021

Invasive Strategies for the Treatment of Pulmonary Embolism. Where Are We in 2020?

Curr Probl Cardiol 2021 Mar 22;46(3):100650. Epub 2020 Jul 22.

Pulmonary Embolism (PE) is the third most common cause of cardiovascular mortality in the United States, with 60,000-100,000 deaths per year following myocardial infarction and stroke. During the past 5 years, there has been an introduction of novel interventions as a result of a renewed interest in optimizing PE management, particularly among those individuals with more severe disease of hemodynamic significance. The cornerstone treatment for PE is anticoagulation. More aggressive alternatives have been considered for patients with intermediate and high-risk PE. In general, these options can be grouped into 3 different categories: systemic thrombolysis, catheter-directed interventions, and surgical embolectomy. Systemic thrombolysis has shown statistical benefit in several randomized trials for intermediate- and high-risk PE, however, this benefit has been offset by an elevated risk of major bleeding and intracerebral hemorrhage, limiting their use in clinical practice. Catheter-directed thrombolysis refers to catheter-directed injection of a thrombolytic drug directly into the pulmonary artery. Three interventional devices (EKOSonic endovascular system, FlowTriever embolectomy device and the Indigo thrombectomy system) have recently been cleared by the US Food and Drug Administration for marketing, and several others are in various stages of development. As of today, catheter-based interventions are limited to small randomized trials and single arm-prospective studies focused on short-term surrogate endpoints. Although single arm studies carry some value establishing the preliminary safety and effectiveness of these devices, they are not sufficient to stratify risk and guide clinical practice. Furthermore, no trials have been performed with enough power to assess potential mortality benefit with the use of catheter-directed thrombolysis or catheter-based embolectomy devices, hence treatment decisions continue to be influenced by individual risk of bleeding, the location of thrombus and operator expertise until additional evidence becomes available.
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http://dx.doi.org/10.1016/j.cpcardiol.2020.100650DOI Listing
March 2021

Renal Sympathetic Denervation: A Comprehensive Review.

Curr Probl Cardiol 2021 Mar 3;46(3):100598. Epub 2020 May 3.

In 2017, the American College of Cardiology and American Heart Association released its updated blood pressure guidelines, redefining hypertension to be any systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥80 mm Hg. Among United States adults, these new parameters increased the prevalence of hypertension from 72.2 million (31.9%) to 103.3 million (45.6%) adults and decreased the rate of medication-controlled hypertension from 53.4% to 39% with the prevalence of resistant hypertension ranging from 12% to 18%. Results of the pivotal SPRINT trial showed that more intensive blood pressure control in diabetic patients decreased both cardiovascular events and all-cause mortality. However, even with ideal goals in mind, compliance remains an issue due to multiple causes, and approximately half of study participants had stopped taking their antihypertensive drug within a year. Renal sympathetic denervation is a process in which catheter-based techniques are used to ablate specific portions of the renal artery nerves with the goal of decreasing sympathetic nerve activity and reducing blood pressure. Several studies using renal artery denervation have already shown benefit in patients with resistant hypertension, and now newer trials are beginning to focus on those with stage II hypertension as an additional potential treatment population. This review will seek to summarize the current evidence surrounding renal artery denervation and discuss some of its future trials, current issues, and potential roles both in hypertension and other comorbidities.
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http://dx.doi.org/10.1016/j.cpcardiol.2020.100598DOI Listing
March 2021

The Predictors of Peri-Procedural and Sub-Acute Cerebrovascular Events Following TAVR.

Authors:
Uzoma N Ibebuogu

Cardiovasc Revasc Med 2020 06 4;21(6):739-740. Epub 2020 Apr 4.

956 Court Avenue, Suite A312, Memphis, Tennessee 38163, United States of America. Electronic address:

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http://dx.doi.org/10.1016/j.carrev.2020.04.002DOI Listing
June 2020

Outcomes of Early Versus Delayed Transcatheter Closure of Post-Myocardial Infarction Ventricular Septal Defect.

Cardiovasc Revasc Med 2020 09 13;21(9):1093-1096. Epub 2020 Feb 13.

Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States of America. Electronic address:

Background: Post myocardial infarction ventricular septal defect (VSD) is a rare, but devastating complication which carries a poor prognosis if left untreated. Optimal therapy remains unclear and surgical repair is associated with high mortality.

Objective: The aim of our study is to compare 30-day survival in patients with early versus late primary transcatheter repair of post myocardial infarction ventricular septal defect.

Methods: We performed a comprehensive search of published data through SCOPUS and identified published reports of primary transcatheter closure of post myocardial infarction VSD. We included case reports and series that reported timing of VSD closure and 30-day survival and excluded those with prior surgical repair. Early repair was defined as transcatheter closure within 14 days of diagnosis of VSD while late repair was defined as transcatheter closure after 14 days of diagnosis of VSD.

Results: A total 27 publications describing 193 patients were identified in the SCOPUS search. We excluded 8 publications with no reported timing of VSD repair or 30-day outcome. Of the 193 patients initially included, a total of 126 patients fulfilled all the criteria and were included in the final analysis. The overall 30-day survival rate was found to be 62.7% (79 patients). In the early repair group, only 36.2% of the patients were still alive at 30 days compared to 85.3% in the delayed repair group, P < .01. No significant difference in age, gender, presence of shock, VSD size, presence of significant residual shunt, location of VSD or infarction was observed. The early repair group was found to have a significantly larger Qp: Qs ratio as well as larger occluder size and lower rate of successful repair.

Conclusion: Compared to the late repair group, the early transcatheter VSD repair group had a larger pre-procedure Qp:Qs and worse 30-day survival. Further studies are needed to determine the optimal timing of transcatheter repair of a post myocardial infarction VSD.
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http://dx.doi.org/10.1016/j.carrev.2020.02.011DOI Listing
September 2020

Efficacy and Safety of Transcarotid Transcatheter Aortic Valve Replacement: A Systematic Review.

Cardiovasc Revasc Med 2020 07 10;21(7):917-926. Epub 2019 Dec 10.

Division of Cardiology, University of Tennessee Health Science Center, Memphis, TN, USA. Electronic address:

Background: In patients who are not suitable for traditional access routes for transcatheter aortic valve replacement (TAVR) due to severe peripheral vascular disease (PVD) or prohibitive surgical risk, carotid artery (CA) access is an emerging route for TAVR. This study represents the most up to date on outcomes of carotid access TAVR.

Methods: A systematic review was conducted as per the Preferred Reporting Instructions for Systematic Reviews and Meta-analysis (PRISMA). We performed a thorough electronic search through Pubmed, SCOPUS and Embase databases. Statistical analyses were performed using SPSS version 24 (IBM Corporation, Armonk, New York, USA).

Results: A total of 15 non-randomized studies were included in this systematic review comprising of patients that received TAVR via 4 vascular access sites, transcarotid (TC) (N = 1035), transfemoral (TF) (N = 1116), transapical (TAP) (N = 307), transaortic (TAO) (N = 176) and transaxillary (TAX) (N = 90). In the Transcarotid cases, device success was achieved in 95.6% of patients (n = 748). The 30-day and 1-yr mortality was 4.2% and 10.5% respectively. 15.3% of patients required new pacemaker implantation. In-hospital stroke or TIA occurred in 4% of cases. 30-day stroke or TIA occurred in 5% of cases. There were no hemorrhagic strokes. 30-day Mortality was significantly higher in the Transaortic group (12.1%) compared to the Transcarotid group (2.6%) [RR = 2.93 95% CI = 1.15-7.58; p = 0.027]. There were no differences in outcomes between the Transcarotid group and the Transapical or Transaxillary groups.

Conclusion: The most contemporary data on Carotid access TAVR shows impressive device success, low rates of stroke and pacemaker implantation and an acceptable 30-day and 1-year mortality. 30-day mortality was significantly lower in TC compared to TAO patients.
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http://dx.doi.org/10.1016/j.carrev.2019.12.012DOI Listing
July 2020

Useful indices of thrombogenesis in the exclusion of intra-cardiac thrombus.

Echocardiography 2020 01 19;37(1):86-95. Epub 2019 Dec 19.

Division of Cardiology, Department of Medicine, Augusta University Medical Center, Augusta, GA, USA.

Background: Cardioversion in patients with atrial fibrillation (AF) can cause cardioembolic stroke, and effective clinical management is necessary to reduce morbidity and mortality. Currently, transesophageal echocardiography (TEE) is the accepted standard to diagnose cardiogenic thromboemboli; however, a negative TEE does not eliminate the possibility of left atrial thrombus. The objective of this study was to evaluate the diagnostic value of supplementing the TEE with additional noninvasive markers to ensure thrombus absence.

Methods: A prospective study was conducted on 59 patients who underwent TEE for suspected intra-cardiac thrombi. The TEE indications included acute ischemic stroke (45.7%) and AF or flutter (59.3%). D-dimer level and white blood cell counts were assessed.

Results: A negative D-dimer level (<200 ng/mL) excluded the presence of intra-cardiac thrombi. Groups with either negative (n = 14) or positive (n = 45) D-dimer levels had comparable clinical characteristics. Comparing positive D-dimer-level patients with thrombus (n = 7) and without thrombus (n = 33), patients with thrombus had reduced left atrial appendage (LAA) velocity (P = .0024), reduced left ventricular ejection fraction (LVEF) (P = .0263), increased neutrophil percent (P = .0261), decreased lymphocyte percent (P = .0216), and increased monocyte counts (P = .0220). The area under the receiver operating characteristic (ROC) curve for thrombus diagnostics was larger for combinations of clinical and biochemical data than for each parameter individually.

Conclusions: Supplementing the gold standard TEE with the analysis of LAA velocity, noninvasive LVEF, D-dimer, and hemostatic markers provided additional useful diagnostic information. Larger studies are needed to further validate the efficacy of supplementing the TEE to better assess patients for intra-cardiac thrombi.
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http://dx.doi.org/10.1111/echo.14562DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027915PMC
January 2020

What is causing this patient's cyclical fever?

JAAPA 2019 11;32(11):53-55

Pooja S. Jagadish practices in the Department of Internal Medicine, University of Tennessee Health Science Center in Memphis, Tenn. Tamunoinemi Bob-Manuel practices in the Heart & Vascular Institute at Ochsner Clinic Foundation in New Orleans, La. Taylor Simmons is a student in the PA program at Mississippi College in Clinton, Miss. Hemnishil K. Marella and Jayna Kelly practice at the University of Tennessee Health Science Center. Uzoma N. Ibebuogu practices in the Division of Cardiology at the University of Tennessee Health Science Center. The authors have disclosed no potential conflicts of interest, financial or otherwise.

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http://dx.doi.org/10.1097/01.JAA.0000586352.50114.09DOI Listing
November 2019

Accuracy of non-invasive and minimally invasive hemodynamic monitoring: where do we stand?

Ann Transl Med 2019 Sep;7(17):421

Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA.

One of the most important variables in assessing hemodynamic status in the intensive care unit (ICU) is the cardiac function and blood pressure. Invasive methods such as pulmonary artery catheter and arterial line allow monitoring of blood pressure and cardiac function accurately and reliably. However, their use is not without drawbacks, especially when the invasive nature of these procedures and complications associated with them are considered. There are several newer methods of noninvasive and minimally invasive hemodynamic monitoring available. In this manuscript, we will review these different methods of minimally invasive and non-invasive hemodynamic monitoring and will discuss their advantages, drawbacks and limitations.
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http://dx.doi.org/10.21037/atm.2019.07.06DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6787372PMC
September 2019

Transcatheter aortic valve replacement with a focus on transcarotid: a review of the current literature.

Ann Transl Med 2019 Sep;7(17):420

Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.

Valve replacement in high-risk patients with severe aortic stenosis has undergone a huge paradigm shift in the recent years in terms of procedural details and vascular access site for patients who have poor peripheral access. Carotid artery is one of the more promising access sites which has been proven to provide a good alternative site with comparable outcomes to transfemoral approach. In this manuscript, we will provide a review of the current literature on transaortic, transapical, transaxillary and transcarotid approaches to transcatheter aortic valve replacement (TAVR) while focusing on the transcarotid approach.
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http://dx.doi.org/10.21037/atm.2019.07.11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6787377PMC
September 2019

Is there an optimal "door to cath time" in the treatment of acute pulmonary embolism with catheter-directed thrombolysis?

Ann Transl Med 2019 Sep;7(17):419

Division of Cardiovascular Diseases, Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.

Ultrasound assisted catheter-directed thrombolysis (UACT) is a relatively novel approach to treating acute pulmonary embolism (PE). It is an alternative to systemic thrombolysis with good success rates and low reported in-hospital mortality, and low rates of procedure-related major and minor bleeding. Since UACT received FDA approval for the treatment of PE in 2014, there is paucity of data regarding the optimal timing of initiation of the procedure after the initial diagnosis is made. We reviewed the available literature regarding UACT for acute PE and found six studies that included time to procedure. Based on our review, patients may benefit from early (<24-48 h after presentation) rather than delayed (>48 h) initiation. Early initiation of therapy has shown to improve pulmonary arterial pressures, right ventricular (RV) to left ventricular (LV) ratios, with low rates of bleeding and low post procedural and in hospital mortality. However, further studies are required to confirm these findings and establish the appropriate timeline for initiation of UACT.
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http://dx.doi.org/10.21037/atm.2019.07.89DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6787388PMC
September 2019

CardioMEMS: where we are and where can we go?

Ann Transl Med 2019 Sep;7(17):418

Division of Cardiovascular Diseases, Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.

The prevalence of heart failure (HF) has been on the rise with associated increase in hospitalizations, morbidity and mortality. These hospitalizations have led to increasingly more cost on and decreased quality of life for patients. CardioMEMS is one of the newer devices designed to help tackle this issue by allowing for better monitoring of HF patients. This device also allows for accurate recording of pulmonary artery pressures (PAPs) and has also been applied in various other areas, such as aneurysmal tears, for monitoring pressures. In this manuscript we will review the current state of CardioMEMS HF system and investigate some of the other areas for its promising use in the field.
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http://dx.doi.org/10.21037/atm.2019.07.53DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6787393PMC
September 2019

Action plan for improving cardiac rehabilitation-related outcomes in a university hospital based on a review of previous interventions.

Ann Transl Med 2019 Sep;7(17):415

Division of Cardiovascular Diseases, Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.

Although referral to cardiac rehabilitation (CR) is considered the standard of care and demonstrably reduces both mortality rates and hospital admissions after cardiac events, rates of referral continue to be suboptimal. In fact, national reports reveal rates ranging from approximately 60% to 85% depending on the type of cardiac event. At an urban teaching hospital in Tennessee, efforts to increase referral rates were launched during the first quarter of 2018 as part of the Define, Measure, Analyze, Improve, Control (DMAIC) Project: Acute Myocardial Infarction (AMI) Transition of Care. The goal of this Action Plan is to review the interventions taken and the outcomes data from this project in order to propose future deliverables that can address areas of improvement within the DMAIC project. A list of the DMAIC project's interventions, which were varied and multidisciplinary, were obtained from the university hospital as well as the project's data. Data from the National Cardiovascular Data Registry (NCDR)-ACTION Registry show that referral rates at this hospital have been on the rise since the initiation of the DMAIC project. Peak referral rates in the year before the interventions were implemented were approximately 39%; whereas, the peak referral rate in the year these interventions were launched rose to 86.4%. While the interventions of the DMAIC project are hypothesized to have contributed to this increase in referral rates, based on their collaborative nature and the types of referral strategies employed, there are still opportunities for improvement and growth. Thus, this Action Plan proposes future projects to increase inclusivity of CR referral pathways, improve physician education, and establish support for outpatient CR programs.
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http://dx.doi.org/10.21037/atm.2019.08.09DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6787375PMC
September 2019

Targeting ticagrelor: a novel therapy for emergency reversal.

Ann Transl Med 2019 Sep;7(17):410

Division of Cardiovascular Diseases, Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.

Newer P2Y12 inhibitors are prescribed in place of clopidogrel for patients with acute coronary syndrome (ACS) and are associated with significant bleeding risks. Currently, limited options exist for the management of life-threatening bleeding or acute reversal for patients on P2Y12 inhibitor therapy, specifically ticagrelor. Various interventions, including platelet transfusion and desmopressin, have been studied for ticagrelor reversal demonstrating limited success. PB2452 is a novel monoclonal antibody which binds to both ticagrelor and its active metabolite resulting in a rapid return of platelet aggregation. PB2452 has been studied in animal models and, most recently, in a Phase I trial in healthy volunteers. In animal models, PB2452 displayed rapid reversal of ticagrelor and its metabolites and return to near normal levels of platelet aggregation within 60 min. In healthy human volunteers, cohorts that received higher dose bolus and infusions of PB2452 over 12-16 h resulted in maximal and sustained reversal of ticagrelor inhibition of platelet aggregation. While it is currently not US Food and Drug Administration approved, future Phase 2 and 3 studies are currently underway that may lead to new directions for patients on ticagrelor therapy who require urgent reversal.
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http://dx.doi.org/10.21037/atm.2019.08.08DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6787384PMC
September 2019

The death of aspirin for primary prevention-should aspirin be changed to a prescription only medication?

Ann Transl Med 2019 Sep;7(17):402

Division of Cardiovascular Diseases, Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.

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http://dx.doi.org/10.21037/atm.2019.07.05DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6787387PMC
September 2019

Interaction Between Type 2 Diabetes Prevention Strategies and Genetic Determinants of Coronary Artery Disease on Cardiometabolic Risk Factors.

Diabetes 2020 01 21;69(1):112-120. Epub 2019 Oct 21.

Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ.

Coronary artery disease (CAD) is more frequent among individuals with dysglycemia. Preventive interventions for diabetes can improve cardiometabolic risk factors (CRFs), but it is unclear whether the benefits on CRFs are similar for individuals at different genetic risk for CAD. We built a 201-variant polygenic risk score (PRS) for CAD and tested for interaction with diabetes prevention strategies on 1-year changes in CRFs in 2,658 Diabetes Prevention Program (DPP) participants. We also examined whether separate lifestyle behaviors interact with PRS and affect changes in CRFs in each intervention group. Participants in both the lifestyle and metformin interventions had greater improvement in the majority of recognized CRFs compared with placebo ( < 0.001) irrespective of CAD genetic risk ( > 0.05). We detected nominal significant interactions between PRS and dietary quality and physical activity on 1-year change in BMI, fasting glucose, triglycerides, and HDL cholesterol in individuals randomized to metformin or placebo, but none of them achieved the multiple-testing correction for significance. This study confirms that diabetes preventive interventions improve CRFs regardless of CAD genetic risk and delivers hypothesis-generating data on the varying benefit of increasing physical activity and improving diet on intermediate cardiovascular risk factors depending on individual CAD genetic risk profile.
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http://dx.doi.org/10.2337/db19-0097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6925585PMC
January 2020

Heart Failure and Cognitive Impairment: Clinical Relevance and Therapeutic Considerations.

Curr Cardiol Rev 2019 ;15(4):291-303

Division of Cardiology, New York Medical College, Metropolitan Hospital Center, New York NY, United States.

Heart failure (HF) is a devastating condition characterized by poor quality of life, numerous complications, high rate of readmission and increased mortality. HF is the most common cause of hospitalization in the United States especially among people over the age of 64 years. The number of people grappling with the ill effects of HF is on the rise as the number of people living to an old age is also on the increase. Several factors have been attributed to these high readmission and mortality rates among which are; poor adherence with therapy, inability to keep up with clinic appointments and even failure to recognize early symptoms of HF deterioration which may be a result of cognitive impairment. Therefore, this review seeks to compile the most recent information about the links between HF and dementia or cognitive impairment. We also assessed the prognostic consequences of cognitive impairment complicating HF, therapeutic strategies among patients with HF and focus on future areas of research that would reduce the prevalence of cognitive impairment, reduce its severity and also ameliorate the effect of cognitive impairment coexisting with HF.
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http://dx.doi.org/10.2174/1573403X15666190313112841DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8142355PMC
November 2019

Outcomes of transcatheter aortic valve replacement in bicuspid aortic valve stenosis.

Ann Transl Med 2019 Mar;7(5):102

Division of Cardiovascular Diseases, Ochsner Clinic Foundation, New Orleans, USA.

Background: Due to abnormal valve geometry, patients with bicuspid aortic valve (BAV) have been excluded in many transcatheter aortic valve replacement (TAVR) trials resulting in very limited data with regards to its safety and efficacy.

Methods: We searched electronic databases including Cochrane Database of Systematic Reviews, MEDLINE and EMBASE for all studies including case series, and original reports published before December 2018 that assessed outcomes following TAVR in BAV stenosis. We also included studies that had patients with TAV for comparison. Pooled effect size was calculated with a random-effect model and weighted for the inverse of variance, to compare outcomes post-TAVR between BAV and TAV. The heterogeneity of effect estimates across the studies was assessed using I2. Publication bias was assessed with funnel plots. Statistical analysis was performed using SPSS version 24 (IBM Corp., SPSS Statistics for Windows, Version 24.0. Armonk, NY.).

Results: A total of 19 studies describing 1,332 patients with BAV and 3,610 with TAV. There was no significant difference in the30-day mortality between patients with BAV and TAV [odds ratio (OR): 1.18, 95% confidence interval (CI): 0.7-1.7, P=0.41, I=0]. One-year mortality rate in the BAV population was 13.1% compared to 15.4% in the TAV patients (P=0.75). Patients with BAV had significantly more moderate to severe paravalvular leak (PVL) post TAVR (PVL ≥3) 8.8% 4.2% in TAV patients (OR: 1.478, 95% CI: 1.000-2.184, P=0.050, I=0. Device success was significantly higher in TAV patients compared to BAV patients 93.5% 87% (OR: 0.63, 95% CI: 0.49-0.86, P=0.003).

Conclusions: TAVR in patients with BAV is associated with a high incidence of paravalvular regurgitation with a comparable 30-day mortality rate to TAV patients. The use of newer generation valve prosthesis improved outcomes.
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http://dx.doi.org/10.21037/atm.2019.02.04DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6462665PMC
March 2019

Correlation Between Aortic Angulation and Outcomes of Transcatheter Aortic Valve Replacement With New-Generation Valves.

Curr Probl Cardiol 2021 Feb 14;46(2):100415. Epub 2019 Mar 14.

The aim of this study was to assess the correlation of aortic angulation (AA) on immediate postprocedural and long-term outcomes following transcatheter aortic valve replacement (TAVR) with new-generation valves. There is limited and conflicting data on the impact of AA on short- and long-term outcomes in patients undergoing TAVR. Available studies to date were done with first-generation valves. We assessed 179 patients who underwent TAVR with either a balloon-expandable or self-expandable valve at our institute from May 2014 to June 2017 and had multislice computed tomography scans available for AA evaluation. All included patients received a second- or third-generation valve. TAVR endpoints, device success, and adverse events were defined according to the Valve Academic Research Consortium-2 criteria. The mean AA of the study population was 49.05 ± 10.07. Patients were divided into 2 groups: AA <49 and AA ≥49, and then further subdivided by valve type. There were no difference in mean age, The Society for Thoracic Surgery (STS) score, or race distribution between the AA <49 and AA ≥49 groups. The preimplantation balloon valvuloplasty rate was higher in patients with AA ≥ 49 compared to patients with AA <49, (70% vs 55.1%, P = 0.04). There was no difference in re-hospitalization, pacemaker implantation, postprocedural aortic regurgitation or mortality between patients with AA <49 and AA ≥49 irrespective of valve type (P < 0.05). AA does not significantly affect short- or long-term outcomes in patients who undergo TAVR with new-generation balloon-expandable or self-expandable valves.
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http://dx.doi.org/10.1016/j.cpcardiol.2019.03.004DOI Listing
February 2021

Cocaine Positivity in ST-Elevation Myocardial Infarction: A True or False Association.

Perm J 2019 ;23

University of Tennessee Health Science Center College of Medicine, Memphis, TN.

Introduction: Every year, more than 500,000 US Emergency Department visits are associated with cocaine use. People who use cocaine tend to have a lower incidence of true ST-elevation myocardial infarction (STEMI).

Objective: To identify the factors associated with true STEMI in patients with cocaine-positive (CPos) findings.

Methods: We retrospectively analyzed 1144 consecutive patients with STEMI between 2008 and 2013. True STEMI was defined as having a culprit lesion on coronary angiogram. Multivariate and univariate analyses were used to identify risk factors and create a predictive model.

Results: A total of 64 patients with suspected STEMI were CPos (mean age 53.1 ± 11.2 years; male = 80%). True STEMI was diagnosed in 34 patients. Patients with CPos true STEMI were more likely to be uninsured than those with false STEMI (61.8% vs 34.5%, p = 0.03) and have higher peak troponin levels (21.1 ng/mL vs 2.12 ng/mL, p = < 0.01) with no difference in mean age between the 2 groups (p = 0.24). In multivariate analyses, independent predictors of true STEMI in patients with CPos findings included age older than 65 years (odds ratio [OR] = 19.3, 95% confidence iterval [CI] = 1.2-318.3), lack of health insurance (OR = 4.9, 95% CI = 1.2-19.6), and troponin level higher than 0.05 (OR = 24.0, 95% CI = 2.6-216.8) (all p < 0.05). A multivariate risk score created with a C-statistic of 82% (95% CI = 71-93) significantly improved the identification of patients with true STEMI.

Conclusion: Among those with suspected STEMI, patients with CPos findings had a higher incidence of false STEMI. Older age, lack of health insurance, and troponin levels outside of defined limits were associated with true STEMI in this group.
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http://dx.doi.org/10.7812/TPP/18-048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6443362PMC
September 2019

Aortic Stenosis in African Americans: Focus On Disparities in Treatment and Outcomes.

J Natl Med Assoc 2019 Jun 24;111(3):328-333. Epub 2018 Dec 24.

University of Tennessee Health Science Center, Memphis, TN, USA.

Aortic stenosis (AS) is the third most common type of cardiovascular disease after hypertension and coronary artery disease, and it carries a high mortality rate when left untreated. Risk factors include male sex, hypertension, tobacco use, advanced age, elevated LDL cholesterol, and coronary atherosclerosis. Definitive treatment for AS includes valve repair, either percutaneously or surgically; however, in aging populations corrective surgery carries increased risk. While research suggests that patients of some non-White ethnic groups, including African-Americans, are less likely than their Caucasian counterparts to have AS, these minority patients may experience may experience differences in the way they receive and accept care. This paper seeks to explicate the mechanisms of racial disparities among the African-Americans affected by aortic stenosis as they pertain to healthcare utilization, referral for valve replacement, acceptance of therapy, and overall treatment outcomes.
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http://dx.doi.org/10.1016/j.jnma.2018.11.004DOI Listing
June 2019

Post-Myocardial Infarction Ventricular Septal Defect: A Comprehensive Review.

Cardiovasc Revasc Med 2020 11 20;21(11):1444-1449. Epub 2018 Nov 20.

Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Sciences Center, Memphis, TN, United States of America. Electronic address:

Post-myocardial infarction (MI) ventricular septal defect (VSD) is a rare but potentially catastrophic mechanical complication that occurs in <1% of patients following a myocardial infarction and it is associated with a high morbidity and mortality despite improvements in medical and surgical therapies. Post-MI VSD is a medical emergency and outcome is very poor in medically treated patients. Treatment of choice remains surgical closure of defect and transcatheter defect closure less so. We performed a comprehensive review of the clinical presentation and management options of post-MI VSD.
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http://dx.doi.org/10.1016/j.carrev.2018.11.017DOI Listing
November 2020

Spontaneous Rupture of Sinus of Valsalva Aneurysm Presenting as Perivalvular Hematoma.

J Cardiovasc Echogr 2018 Jul-Sep;28(3):201-203

Department of Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA.

Acute rupture of sinus of Valsalva often presents as an acute emergency with significant hemodynamic compromise whereas contained rupture of sinus of Valsalva with a perivalvular hematoma formation is rarely seen. We describe the case of a 63-year-old male who presented with acute shortness of breath and was found to have rupture of sinus of Valsalva aneurysm (SVA) with a perivalvular hematoma and severe aortic regurgitation. We also review the presentation, diagnosis, and management of SVAs.
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http://dx.doi.org/10.4103/jcecho.jcecho_6_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6172882PMC
October 2018
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