255 results on '"Puri, R"'
Search Results
2. Absent Contractility in Esophagus on high resolution esophageal manometry (HREM) should trigger search for Systemic Autoimmune Disorders
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Zubin, S., additional and Puri, R., additional
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- 2024
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3. Contribution Of Mitral Valve Atrioventricular Plane Displacement To The Stroke Volume In Patients With Severe Mitral Regurgitation
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Kassab, J., primary, Layoun, H., additional, El Dahdah, J., additional, Chedid El Helou, M., additional, Kapadia, S., additional, Harb, S., additional, and Puri, R., additional
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- 2023
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4. New HREM based proposed classification for Hypercontractile Esophagus with Clinical Correlation- ?Learning from Achlasia
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Zubin, S., additional, Puri, R., additional, Sahu, B., additional, and Kathuria, A., additional
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- 2023
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5. Single Balloon Enteroscope(SBE) Directed ERCP, Direct Cholangioscopy, intrahepatic stone extraction using standard accessories in post jejunostomy and hepatico-jejunostomy stricture and hepaticoliths- A Video Case Report
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Zubin, S., additional, Puri, R., additional, Bhagat, S., additional, and Kathuria, A., additional
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- 2023
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6. Biliary RFA for recanalization of blocked SEMS (2 stents in stent) in a case of peri-ampullary malignancy- A video case report
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Zubin, S., additional, Puri, R., additional, Sahu, B., additional, and Kathuria, A., additional
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- 2023
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7. Lemmel's syndrome as a Rare cause of prolonged right hypochondrial pain and obstructive jaundice
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Panchal, H., additional, Zubin, S., additional, and Puri, R., additional
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- 2023
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8. An unusual case of Pancreatic Mass in a young male
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Lanjekar, S., additional, Sharma, Z., additional, and Puri, R., additional
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- 2023
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9. Effects of Meconopsis aculeata Royle Extracts on Leukocytosis and Eosinophilia Induced by Milk in Albino Mice: Anti-asthmatic Property.
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Boora, P., Puri, R., Rani, S., and Mehta, M.
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LEUCOCYTOSIS , *DENATURATION of proteins , *PLANT extracts , *PLANT identification , *LEUKOCYTE count , *EOSINOPHILIA - Abstract
Meconopsis aculeata Royle is a herb with medicinal value, traditionally used by the local people of the Himalayan range for its anti-asthmatic potential. The present work aims to determine the effects of the methanolic whole plant extract of M. aculeata for the management of allergy (asthma) in mice as less work has been done on this potential of the plant. We also determined the in vitro antioxidant and anti-inflammatory potential and identification of the plant's active phytoconstituents through GC-MS. It was found that M. aculeata extracts inhibited (89.68 %) free radicals in a better way when compared with standard ascorbic acid (73.47 %) at a higher concentration of 250 μg/mL. Plant extract inhibited (85.52 %) denaturation of protein when compared with standard aspirin (76.47 %) at a higher concentration of 250 μg/mL. Methanolic extracts (at 100-200 mg/kg, intraperitoneally) significantly decreased elevated leukocyte and eosinophil count in mice that were induced by milk. The anti-asthmatic potential of this plant may be due to identified phytoconstituents like Stigmast-5-en-3-ol; Protopine; 9,12-Octadecadienoic acid; and 9,12-Octadecadienoic acid (Z, Z), methyl ester as these possesses anti-asthmatic and antihistaminic properties. Thus, M. aculeata can be used to treat allergies like asthma, and inflammation and reduce oxidative stress. [ABSTRACT FROM AUTHOR]
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- 2023
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10. In vitro Micropropagation of Bergenia ligulata (Hook. f. & Thomson) Engl. through Leaf Explant
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Rani, S., primary, Puri, R., additional, Qasim, A., additional, Boora, P., additional, and Angmo, D., additional
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- 2023
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11. Impact of Induction Chemotherapy Antecedent to Long Course Neoadjuvant Concurrent Chemo-Radiotherapy on Clinical Outcomes of Patients with Carcinoma Rectum: Retrospective Audit from a Tertiary Cancer Center
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Puri, R., primary, Gandhi, A.K., additional, Rastogi, M., additional, Khurana, R., additional, Hadi, R., additional, Srivastava, A.K., additional, Bharati, A., additional, and Mishra, S.P., additional
- Published
- 2022
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12. Incidence and predictors of transthyretin cardiac amyloidosis in patients with degenerative aortic stenosis
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Abadie, B, primary, Held, M, additional, Puri, R, additional, Krishnaswamy, A, additional, Yun, J, additional, Hanna, M, additional, Reed, G, additional, Kapadia, S, additional, and Jaber, W, additional
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- 2022
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13. Impact of Intensive Lipid Lowering Therapy With Evolocumab on Plaque Phenotype Changes in Acute Coronary Syndrome Patients With Elevated Lp(a) Levels: A HUYGENS Sub Study
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Di Giovanni, G., Fujino, M., Kataoka, Y., Butters, J., Hucko, T., Puri, R., Psaltis, P., and Nicholls, S.
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- 2024
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14. Hunting for homozygous FH - lessons learnt
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Iyengar, S., Lai, Puri, R., Gupta, P., Melinkeri, R., Narasingan, S., Pradhan, A., Jain, P., Mehta, A., Chag, M., Basavanagowda, H., Prabhakar, D., and Dileep, A.
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- 2022
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15. OSARI, an Open-Source Anticipated Response Inhibition Task.
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He, JL, Hirst, RJ, Puri, R, Coxon, J, Byblow, W, Hinder, M, Skippen, P, Matzke, D, Heathcote, A, Wadsley, CG, Silk, T, Hyde, C, Parmar, D, Pedapati, E, Gilbert, DL, Huddleston, DA, Mostofsky, S, Leunissen, I, MacDonald, HJ, Chowdhury, NS, Gretton, M, Nikitenko, T, Zandbelt, B, Strickland, L, Puts, NAJ, He, JL, Hirst, RJ, Puri, R, Coxon, J, Byblow, W, Hinder, M, Skippen, P, Matzke, D, Heathcote, A, Wadsley, CG, Silk, T, Hyde, C, Parmar, D, Pedapati, E, Gilbert, DL, Huddleston, DA, Mostofsky, S, Leunissen, I, MacDonald, HJ, Chowdhury, NS, Gretton, M, Nikitenko, T, Zandbelt, B, Strickland, L, and Puts, NAJ
- Abstract
The stop-signal paradigm has become ubiquitous in investigations of inhibitory control. Tasks inspired by the paradigm, referred to as stop-signal tasks, require participants to make responses on go trials and to inhibit those responses when presented with a stop-signal on stop trials. Currently, the most popular version of the stop-signal task is the 'choice-reaction' variant, where participants make choice responses, but must inhibit those responses when presented with a stop-signal. An alternative to the choice-reaction variant of the stop-signal task is the 'anticipated response inhibition' task. In anticipated response inhibition tasks, participants are required to make a planned response that coincides with a predictably timed event (such as lifting a finger from a computer key to stop a filling bar at a predefined target). Anticipated response inhibition tasks have some advantages over the more traditional choice-reaction stop-signal tasks and are becoming increasingly popular. However, currently, there are no openly available versions of the anticipated response inhibition task, limiting potential uptake. Here, we present an open-source, free, and ready-to-use version of the anticipated response inhibition task, which we refer to as the OSARI (the Open-Source Anticipated Response Inhibition) task.
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- 2022
16. Influence of tDCS over right inferior frontal gyrus and pre-supplementary motor area on perceptual decision-making and response inhibition: A healthy ageing perspective
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Fujiyama, H., Tan, J., Puri, R., Hinder, M.R., Fujiyama, H., Tan, J., Puri, R., and Hinder, M.R.
- Abstract
A wide body of literature suggests that transcranial direct current stimulation (tDCS) administered over the prefrontal cortex can improve executive function – including decision-making and inhibitory control – in healthy young adults. However, the effects of tDCS in older adults are largely unknown. Here, using a double-blind, sham-controlled approach, changes in a combined perceptual decision-making and inhibitory control task were assessed before and after the application of tDCS (1 mA, 20 minute) targeting the right inferior frontal gyrus (rIFG) or pre-supplementary motor area (preSMA) in 42 young (18–34 years) and 41 older (60–80 years) healthy adults. Compared to sham stimulation, anodal tDCS over the preSMA improved decision-making speed for both age groups. Furthermore, the inhibitory control performance of older and younger adults was improved by preSMA and rIFG stimulation, respectively. This study provides evidence that tDCS can improve both perceptual decision-making and inhibitory control in healthy older adults, with the causal role of the preSMA and rIFG regions in cognitive control appearing to vary as a function of healthy ageing.
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- 2022
17. Emerging drug delivery in the treatment of hyperpituitarism and hypopituitarism
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Arora, V, Kabra, A, Puri, R, Vyas, G, Dua, K, Dureja, H, Arora, V, Kabra, A, Puri, R, Vyas, G, Dua, K, and Dureja, H
- Abstract
Hypopituitarism (failure to produce or underproduction of hormones released by the pituitary) and hyperpituitarism (excess production of hormones by the pituitary gland) are chronic endocrine disorders that arise as an outcome of diseases that affect brain tissue, namely metastatic deposits, primary tumors, trauma, surgery, radiotherapy, and vascular accidents. Hypopituitarism is correlated more with excessive incidences of mortality, as compared to hyperpituitarism. The common treatment for the management of hypopituitarism is hormone replacement therapy, but the continuous administration of certain hormones and their synthetic analogs may show substantially unexpected outcomes. Whereas in the case of tumor-associated compression and tissue damage leading to hypopituitarism the conventional approach of radiotherapy may be utilized to lower the tumor size and hence the revival of normal pituitary functions. On the other hand, the treatment of hyperpituitarism varies based upon the disease-causing factor and hormones impacted, which includes the use of competitive receptor antagonists for that specific hormone. For example, in patients with excessive secretion of growth hormone the analogs of somatostatin have been used effectively. Various literature revealed that the brain tissue differs from the other tissues of the body due to its restrictive blood-brain barrier which is the major limitation for designing alternative treatments for the diseased state associated with the pituitary. In such cases, nanotechnological approaches can be a promising alternative, especially during postsurgical treatment. This chapter seeks to provide an overview of research breakthroughs, drug therapy development trends, and delivery system applications in the treatment of hypopituitarism and hyperpituitarism.
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- 2022
18. IDF21-0595 Association of Diabetic Retinopathy and Dyslipidemia: Systematic Review of the Published Evidence During Last Decade
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Wangnoo, S., Siddiqui, A., and Puri, R.
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- 2022
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19. Impact of changes in tricuspid regurgitation on clinical outcomes following mitral valve teer compared to guideline-directed medical therapy: a sub-analysis of the COAPT trial
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Lehenbauer, K, primary, Asch, F, additional, Weissman, NJ, additional, Grayburn, P, additional, Kar, S, additional, Lim, S, additional, Li, D, additional, Puri, R, additional, Kapadia, S, additional, Sannino, A, additional, Lindenfeld, J, additional, Abraham, W, additional, Mack, MJ, additional, Stone, GW, additional, and Hahn, R, additional
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- 2022
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20. 6-Month Outcomes of the TricValve System in Patients With Tricuspid Regurgitation The TRICUS EURO Study
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Estevez-Loureiro, R, Sanchez-Recalde, A, Amat-Santos, IJ, Cruz-Gonzalez, I, Baz, JA, Pascual, I, Mascherbauer, J, Altisent, OAJ, Nombela-Franco, L, Pan, M, Trillo, R, Moreno, R, Delle Karth, G, Salido-Tahoces, L, Santos-Martinez, S, Nunez, JC, Moris, C, Goliasch, G, Jimenez-Quevedo, P, Ojeda, S, Cid-Alvarez, B, Santiago-Vacas, E, Jimenez-Valero, S, Serrador, A, Martin-Moreiras, J, Strouhal, A, Hengstenberg, C, Zamorano, JL, Puri, R, and Iniguez-Romo, A
- Subjects
right heart failure ,CAVI ,tricuspid regurgitation - Abstract
BACKGROUND Severe tricuspid regurgitation (TR) is frequently associated with significant morbidity and mortality; such patients are often deemed to be at high surgical risk. Heterotopic bicaval stenting is an emerging, attractive transcatheter solution for these patients. OBJECTIVES The aim of this study was to evaluate the 30-day safety and 6-month efficacy outcomes of specifically designed bioprosthetic valves for the superior and inferior vena cava. METHODS TRICUS EURO (Safety and Efficacy of the TricValve (R) Transcatheter Bicaval Valves System in the Superior and Inferior Vena Cava in Patients With Severe Tricuspid Regurgitation) is a nonblinded, nonrandomized, single-arm, multicenter, prospective trial that enrolled patients from 12 European centers between December 2019 and February 2021. High-risk individuals with severe symptomatic TR despite optimal medical therapy were included. The primary endpoint was quality-of-life (QOL) improvement measured by Kansas City Cardiomyopathy Questionnaire score and New York Heart Association (NYHA) functional dass improvement at 6-month follow-up. RESULTS Thirty-five patients (mean age 76 +/- 6.8 years, 83% women) were treated using the TricValve system. All patients at baseline were in NYHA functional class III or IV. At 30 days, procedural success was 94%, with no procedural deaths or conversions to surgery. A significant increase in QOL at 6 months follow-up was observed (baseline and 6-month Kansas City Cardiomyopathy Questionnaire scores 42.01 +/- 22.3 and 59.7 +/- 23.6, respectively; P = 0.004), correlating with a significant improvement in NYHA functional class, with 79.4% of patients noted to be in functional class I or II at 6 months (P = 0.0006). The rates of 6-month all-cause mortality and heart failure hospitalization were 8.5% and 20%, respectively. CONCLUSIONS The dedicated bicaval system for treating severe symptomatic TR was associated with a high procedural success rate and significant improvements in both QOL and functional classification at 6 months follow-up. (C) 2022 by the American College of Cardiology Foundation.
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- 2022
21. 800.01 Redo-TAVR with the Supra-Annular, Self-Expanding Evolut Platform: Insights from a Multi-Center Real-World Registry
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Rogers, T., Bapat, V., Chetcuti, S., Dauerman, H., Forrest, J., Grubb, K., Htun, W., Puri, R., Reardon, M., Tang, G., Vora, A., Yakubov, S., Eisenberg, R., and Attizzani, G.
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- 2024
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22. Effect of Evolocumab on Changes in Coronary Plaque Phenotype in Statin-Treated Patients Following Myocardial Infarction: The HUYGENS Randomised Clinical Trial
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Nicholls, S., primary, Kataoka, Y., additional, Nissen, S., additional, Prati, F., additional, Windecker, S., additional, Puri, R., additional, Hucko, T., additional, Aradi, D., additional, Herrman, J., additional, Hermanides, R., additional, Wang, B., additional, Wang, H., additional, Butters, J., additional, Di Giovanni, G., additional, Jones, S., additional, Pompili, G., additional, and Psaltis, P., additional
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- 2022
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23. Impact of pacing-related differences on clinical and echocardiographic outcomes after TAVR with SAPIEN-3 valve
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Lak, H, primary, Sammour, Y, additional, Chawla, S, additional, Gajulapalli, R D, additional, Kumar, A, additional, Parikh, P, additional, Svensson, L G, additional, Harb, S, additional, Tarakji, K, additional, Wazni, O, additional, Reed, G W, additional, Puri, R, additional, Krishnaswamy, A, additional, and Kapadia, S, additional
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- 2021
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24. Impact of doppler velocity index after transcatheter aortic valve replacement using Sapien-3 valve – a single centre experience
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Lak, H, primary, Sammour, Y, additional, Chawla, S, additional, Svensson, L G, additional, Yun, J, additional, Harb, S, additional, Reed, G W, additional, Puri, R, additional, Jaber, W, additional, Krishnaswamy, A, additional, and Kapadia, S, additional
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- 2021
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25. Impact of new-onset left bundle branch block on clinical and echocardiographic outcomes after TAVR with SAPIEN-3 valve
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Lak, H, primary, Sammour, Y, additional, Chahine, J, additional, Chawla, S, additional, Kadri, A, additional, Popovic, Z, additional, Tarakji, K, additional, Svensson, L G, additional, Reed, G, additional, Puri, R, additional, Krishnaswamy, A, additional, and Kapadia, S, additional
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- 2021
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26. Evidence in crisis: a closer look into the quality of published systematic reviews in the cardiology literature
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Abushouk, A, primary, Yunusa, I, additional, Elmehrath, A O, additional, Elmatboly, A M, additional, Saad, A, additional, Fayek, S H, additional, Abdelfattah, O, additional, Ghanem, E, additional, Isogai, T, additional, Shekhar, S, additional, Reed, G W, additional, Puri, R, additional, Kalra, A, additional, and Kapadia, S R, additional
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- 2021
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27. HbA1c, coronary atheroma progression and cardiovascular events
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Dykun, I, primary, Bayturan, O, additional, Carlo, J, additional, Nissen, S E, additional, Nicholls, S J, additional, and Puri, R, additional
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- 2021
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28. Late Clinical and Hemodynamic Outcomes in patients with degenerated bioprosthetic aortic valves undergoing transcatheter valve-in-valve implantation
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Abushouk, A I, primary, Abdelfattah, O, additional, Saad, A, additional, Gad, M M, additional, Reed, G W, additional, Puri, R, additional, Yun, J, additional, Vargo, P R, additional, Weiss, A, additional, Burns, D, additional, Popovic, Z, additional, Harb, S C, additional, Krishnaswamy, A, additional, Svensson, L G, additional, and Kapadia, S R, additional
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- 2021
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29. Longitudinal high-sensitivity C-reactive protein and long-term cardiovascular outcomes in optimally-treated patients with high-risk vascular disease
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Dykun, I, primary, Clark, D, additional, Carlo, J, additional, Lincoff, A M, additional, Menon, V, additional, Nissen, S E, additional, Nicholls, S J, additional, and Puri, R, additional
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- 2021
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30. Outcomes of transfemoral-transcatheter aortic valve replacement with Sapien-3 valve in liver cirrhosis patients
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Lak, H, primary, Chawla, S, additional, Verma, B, additional, Vural, A, additional, Gad, M, additional, Shekhar, S, additional, Nair, R, additional, Yun, J, additional, Burns, D, additional, Puri, R, additional, Reed, G, additional, Harb, S, additional, Krishnaswamy, A, additional, and Kapadia, S, additional
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- 2021
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31. SOLAR ENERGY IN SMART TEXTILES.
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Toshniwal, V. R. and Puri, R. S.
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- 2023
32. Chronic Kidney Disease Predisposes to Acute Congestive Heart Failure, Cardiogenic Shock, and Mortality in Patients Undergoing Percutaneous Coronary Intervention.
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Iyer M, Ziada K, Cho L, Tamis-Holland J, Khot U, Krishnaswamy A, Puri R, Kapadia S, and Reed GW
- Abstract
The relationships between degrees of chronic kidney disease (CKD) and congestive heart failure (CHF) events after percutaneous coronary intervention (PCI) are not well characterized. We sought to determine the relationship between different stages of CKD and acute CHF events, including heart failure (HF) and cardiogenic shock (CS), and the impact of CKD stages on all-cause mortality after PCI. Patients who underwent PCI from 2009-2017 were identified from our institution's National Cardiovascular Disease Registry (NCDR) CathPCI Database. Patients were stratified by CKD stage 1 (eGFR≥90 ml/min/1.73 m
2 ), 2 (60-89), 3a (45-59), 3b (30-44), 4 (16-29), 5 (≤15), and current dialysis. The primary endpoint was composite HF events defined as acute HF or CS within 30 days after PCI, or in-hospital mortality, stratified by CKD and analyzed by multivariable regression after screening with univariate analysis (P<0.05 entry criteria). Patients with CKD stage 3a or worse had more composite HF events, with an increase in all components, compared to patients with CKD stages 1-2 (P<0.0001 for all comparisons). After multivariable adjustment, CKD stages 3a-5 remained independent predictors of composite HF or in-hospital mortality events. eGFR remained a strong predictor of acute HF events after multivariable adjustment, with a model including eGFR and baseline and procedural characteristics achieving excellent discriminatory ability with AUC 0.92. In conclusion, baseline eGFR is a strong, independent predictor of acute HF events post-PCI. CKD stages 3a-5 independently predict HF events including HF decompensation and CS, and are predictors of in-hospital mortality post-PCI. Patients with baseline CKD may benefit from targeted interventions to limit acute HF events after PCI., (Copyright © 2024. Published by Elsevier Inc.)- Published
- 2024
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33. Real-World Patient Eligibility and Feasibility of Transcatheter Edge-to-Edge Repair or Replacement Interventions for Tricuspid Regurgitation.
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Abushouk A, Layoun H, Harb SC, Miyasaka R, Albert C, Starling RC, Reed GW, Krishnaswamy A, Yun JJ, Kapadia SR, and Puri R
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- Humans, Female, Male, Aged, Retrospective Studies, Eligibility Determination methods, Patient Selection, Aged, 80 and over, Treatment Outcome, Tricuspid Valve surgery, Tricuspid Valve diagnostic imaging, Middle Aged, Follow-Up Studies, Tricuspid Valve Insufficiency surgery, Cardiac Catheterization methods, Feasibility Studies, Heart Valve Prosthesis Implantation methods
- Abstract
Novel transcatheter therapies for tricuspid regurgitation (TR) appear promising, yet their applicability to an all-comer TR population remains unclear. We aimed to assess the feasibility of emerging transcatheter tricuspid therapies in a real-world population with greater than or equal to moderate symptomatic TR. A total of 178 patients were referred to our center between January 2019 and December 2021 for greater than or equal to moderate symptomatic TR and were classified into 4 groups: Investigative (patients eligible for enrollment in the Triluminate, Clasp TR, and TRISCEND trials), off-label clipping, surgery, and medical treatment. A total of 10.7% of the population were deemed eligible for investigative therapies, 20.2% and 19.7% of patients were offered off-label clipping and surgery, respectively, and 49.4% received medical treatment. Common reasons for investigative therapy-related ineligibility were unsuitable anatomy (large tricuspid annulus or wide leaflet coaptation gap) and the presence of significant comorbidities. Compared with the other groups, the investigative group was less likely to harbor concomitant ≥moderate mitral regurgitation, greater than or equal to moderate right ventricular dysfunction or severe pulmonary hypertension (P < .05). At 1 year, there remained a significant reduction in TR severity in the investigative group (P < .001) in comparison with the medical treatment group. However, the results were comparable to off-label clipping (P = .60) and inferior to surgery (P =.04). Exploratory analyses failed to show evidence of differences in the rates of all-cause mortality (P =.40) and heart failure hospitalizations (P = .94) between all groups. Current real-world eligibility of TR patients for emerging transcatheter therapies remains limited, underscoring the need for continued innovative efforts to offer device therapies to a broader TR cohort., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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34. Does Adopting Western Low-density Lipoprotein Cholesterol Targets Expose Indians to a Higher Risk of Cardiovascular Events? Expert Opinion From the Lipid Association of India.
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Puri R, Mehta V, Bansal M, Duell PB, Iyengar SS, Shetty S, Graham I, Mohan JC, Kaul U, Rao D, Agarwala R, Wander GS, Hazra P, Kumar S, Wangnoo SK, Zargar AH, Saboo B, Yusuf J, Vijan VM, Aggarwal P, Chandra S, Kasliwal RR, Manoria PC, Rabbani MU, Chag MC, Prabhakar D, Khan A, Bordoloi N, Palanippan S, Mahajan K, Pradhan A, Jain D, Murugnathan A, Dabla PK, Desai N, Tiwaskar MH, Nair DR, Singh C, Panda J, Gupta V, Sahoo P, and Wong ND
- Subjects
- Humans, India epidemiology, Practice Guidelines as Topic, Risk Factors, Heart Disease Risk Factors, Cholesterol, LDL blood, Cardiovascular Diseases epidemiology, Cardiovascular Diseases prevention & control, Dyslipidemias epidemiology
- Abstract
Adverse cardiovascular (CV) events have declined in Western countries due at least in part to aggressive risk factor control, including dyslipidemia management. The American and European (Western) dyslipidemia treatment guidelines have contributed significantly to the reduction in atherosclerotic cardiovascular disease (ASCVD) incidence in the respective populations. However, their direct extrapolation to Indian patients does not seem appropriate for the reasons described below. In the US, mean low-density lipoprotein cholesterol (LDL-C) levels have markedly declined over the last 2 decades, correlating with a proportional reduction in CV events. Conversely, poor risk factor control and dyslipidemia management have led to increased CV and coronary artery disease (CAD) mortality rates in India. The population-attributable risk of dyslipidemia is about 50% for myocardial infarction, signifying its major role in CV events. In addition, the pattern of dyslipidemia in Indians differs considerably from that in Western populations, requiring unique strategies for lipid management in Indians and modified treatment targets. The Lipid Association of India (LAI) recognized the need for tailored LDL-C targets for Indians and recommended lower targets compared to Western guidelines. For individuals with established ASCVD or diabetes with additional risk factors, an LDL-C target of <50 mg/dL was recommended, with an optional target of ≤30 mg/dL for individuals at extremely high risk. There are several reasons that necessitate these lower targets. In Indian subjects, CAD develops 10 years earlier than in Western populations and is more malignant. Additionally, Indians experience higher CAD mortality despite having lower basal LDL-C levels, requiring greater LDL-C reduction to achieve a comparable CV event reduction. The Indian Council for Medical Research-India Diabetes study described a high prevalence of dyslipidemia among Indians, characterized by relatively lower LDL-C levels, higher triglyceride levels, and lower high-density lipoprotein cholesterol (HDL-C) levels compared to Western populations. About 30% of Indians have hypertriglyceridemia, aggravating ASCVD risk and complicating dyslipidemia management. The levels of atherogenic triglyceride-rich lipoproteins, including remnant lipoproteins, are increased in hypertriglyceridemia and are predictive of CV events. Hypertriglyceridemia is also associated with higher levels of small, dense LDL particles, which are more atherogenic, and higher levels of apolipoprotein B (Apo B), reflecting a higher burden of circulating atherogenic lipoprotein particles. A high prevalence of low HDL-C, which is often dysfunctional, and elevated lipoprotein(a) [Lp(a)] levels further contribute to the heightened atherogenicity and premature CAD in Indians. Considering the unique characteristics of atherogenic dyslipidemia in Indians, lower LDL-C, non-HDL-C, and Apo B goals compared to Western guidelines are required for effective control of ASCVD risk in Indians. South Asian ancestry is identified as a risk enhancer in the American lipid management guidelines, highlighting the elevated ASCVD risk of Indian and other South Asian individuals, suggesting a need for more aggressive LDL-C lowering in such individuals. Hence, the LDL-C goals recommended by the Western guidelines may be excessively high for Indians and could result in significant residual ASCVD risk attributable to inadequate LDL-C lowering. Further, the results of Mendelian randomization studies have shown that lowering LDL-C by 5-10 mg/dL reduces CV risk by 8-18%. The lower LDL-C targets proposed by LAI can yield these incremental benefits. In conclusion, Western LDL-C targets may not be suitable for Indian subjects, given the earlier presentation of ASCVD at lower LDL-C levels. They may result in greater CV events that could otherwise be prevented with lower LDL-C targets. The atherogenic dyslipidemia in Indian individuals necessitates more aggressive LDL-C and non-HDL-C lowering, as recommended by the LAI, in order to stem the epidemic of ASCVD in India., (© Journal of the Association of Physicians of India 2024.)
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- 2024
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35. Interplay of Age and Risk Factor Control Upon Coronary Atheroma Progression.
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Dykun I, Carlo J, Nissen SE, Kapadia SR, Nicholls SJ, and Puri R
- Abstract
Background & Aim: The extent and composition of coronary plaque, and its progression differ with patients' age. The interplay of patient's age with respect to risk factor control, upon atheroma progression has not been evaluated. We tested the hypothesis that risk factor control modulates the association between age and coronary atheroma progression., Method: We performed a posthoc pooled analysis of data from 10 prospective, randomised trials involving serial coronary intravascular ultrasonography (IVUS) (n=5,823). The percent atheroma volume (PAV) was calculated as the proportion of the entire vessel wall occupied by atherosclerotic plaque., Results: Mean overall age was 58±9 years (28% women). In a fully adjusted multivariable analysis (following adjustment of sex, body mass index, systolic blood pressure [SBP], smoking, high-density lipoprotein and low-density lipoprotein [LDL]-cholesterol, triglyceride levels, peripheral vascular disease, diabetes mellitus, trial, region, and baseline PAV), an increase in age by one standard deviation was linked with PAV progression (β-estimate 0.097; 95% confidence interval 0.048-0.15; p<0.001). In patients with good risk factor control (LDL-cholesterol <1.8 mmol/L and SBP <130 mmHg), increasing age remained associated with PAV progression (0.123; 0.014-0.23; p=0.027). Lower effect sizes for the association of age with PAV progression were observed for patients with partial control of LDL-cholesterol and SBP and were not significantly associated with PAV progression when both LDL-cholesterol and SBP were not controlled (0.099; 0.032-0.167; p=0.004 and 0.042; -0.056 to 0.14; p=0.40, respectively)., Conclusions: Patient age is directly associated with coronary atheroma progression independently of traditional cardiovascular risk factors. In the setting of poor risk factor control, the influence of age on coronary artery disease progression is attenuated., Competing Interests: Conflicts of Interest S.E.N. reported receiving grants from AstraZeneca, Novartis, AbbVie, Silence Therapeutics, Medtronic, MyoKardia, Esperion, Eli Lilly, Amgen, Novo Nordisk, Pfizer, Cerenis, and The Medicines Company. S.J.N. reported receiving grants from AstraZeneca, Amgen, Anthera, Eli Lilly, Esperion, Novartis, Cerenis, The Medicines Company, Resverlogix, InfraReDx, Roche, Sanofi-Regeneron, and LipoScience and receiving personal fees from AstraZeneca, Eli Lilly, Anthera, Omthera, Merck, Takeda, Resverlogix, Sanofi-Regeneron, CSL Behring, Esperion, and Boehringer Ingelheim. All other authors report no conflict of interest with regard to this work., (Copyright © 2024. Published by Elsevier B.V.)
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- 2024
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36. Efficacy and safety of per-oral endoscopic myotomy in non-achalasia esophageal motility disorders: a systematic review and meta-analysis.
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Puri R, Giri S, Panigrahi SC, Mallick B, Nath P, Sharma ZD, and Sahu BK
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- Humans, Treatment Outcome, Male, Female, Middle Aged, Esophagoscopy methods, Esophagoscopy adverse effects, Adult, Esophageal Spasm, Diffuse surgery, Esophageal Spasm, Diffuse complications, Natural Orifice Endoscopic Surgery methods, Natural Orifice Endoscopic Surgery adverse effects, Aged, Esophagogastric Junction surgery, Esophageal Motility Disorders surgery, Esophageal Motility Disorders complications, Myotomy methods, Myotomy adverse effects
- Abstract
Per‑oral endoscopic myotomy (POEM) is the preferred endoscopic modality for managing achalasia cardia. However, there are no recommendations on the role of POEM in non‑achalasia esophageal dysmotility disorders (NAEMD), including esophagogastric junction outflow obstruction (EGJOO), distal esophageal spasm (DES), and hypercontractile esophagus (HE). The present systematic review and meta-analysis aimed to assess the safety and efficacy of POEM in the treatment of NAEMD. MEDLINE, Embase, and Scopus were searched from inception to August 2023 for studies analyzing the outcome of POEM in NAEMD. Clinical success and adverse events were the main outcomes assessed. The event rates and their 95% confidence interval were calculated using a random effects model. A total of 11 studies with 271 patients were included in the final analysis. The pooled clinical success rate with POEM in NAEMD was 86.9% (82.9-90.9). On subgroup analysis, the pooled clinical success rates of POEM in DES and EGJOO were 97.8% (90.9-100.0) and 92.7% (86.3-95.1), which were significantly higher than in HE 81.2% (73.5-88.8). Data from limited studies showed that the pooled rate of improvement in dysphagia and chest pain was 88.5% (83.0-93.9) and 87.4% (80.5-94.4). The pooled incidence of overall AEs and serious AEs was 12.6% (5.7-19.5) and 0.3% (0.0-1.9), respectively. On follow-up, the pooled incidence of new-onset heartburn was 18.7% (11.1-26.2). POEM is a safe and efficacious treatment modality for the management of NAEMD with a lower clinical success in patients with HE. Further large-scale studies are required to validate the findings of the present analysis., (© 2024. The Author(s) under exclusive licence to The Japan Esophageal Society.)
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- 2024
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37. Age-related differences in how the shape of alpha and beta oscillations change during reaction time tasks.
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Opie GM, Hughes JM, and Puri R
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- Humans, Female, Male, Adult, Young Adult, Middle Aged, Aged, Principal Component Analysis, Aging physiology, Reaction Time physiology, Beta Rhythm physiology, Alpha Rhythm physiology
- Abstract
While the shape of cortical oscillations is increasingly recognised to be physiologically and functionally informative, its relevance to the aging motor system has not been established. We therefore examined the shape of alpha and beta band oscillations recorded at rest, as well as during performance of simple and go/no-go reaction time tasks, in 33 young (23.3 ± 2.9 years, 27 females) and 27 older (60.0 ± 5.2 years, 23 females) adults. The shape of individual oscillatory cycles was characterised using a recently developed pipeline involving empirical mode decomposition, before being decomposed into waveform motifs using principal component analysis. This revealed four principal components that were uniquely influenced by task and/or age. These described specific dimensions of shape and tended to be modulated during the reaction phase of each task. Our results suggest that although oscillation shape is task-dependent, the nature of this effect is altered by advancing age, possibly reflecting alterations in cortical activity. These outcomes demonstrate the utility of this approach for understanding the neurophysiological effects of ageing., Competing Interests: Declaration of Competing Interest None, (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2024
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38. Sarcopenia and frailty in patients undergoing transcatheter aortic valve replacement.
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Persits I, Mirzai S, Sarnaik KS, Volk MC, Yun J, Harb S, Puri R, Kapadia S, Krishnaswamy A, Chen PH, Reed G, and Tang WHW
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- Humans, Male, Female, Aged, 80 and over, Risk Assessment methods, Aged, Postoperative Complications epidemiology, Postoperative Complications etiology, Hand Strength, Walking Speed, Risk Factors, Muscle, Skeletal, Sarcopenia epidemiology, Sarcopenia complications, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement methods, Frailty complications, Frailty epidemiology, Aortic Valve Stenosis surgery, Aortic Valve Stenosis complications
- Abstract
Background: Skeletal muscle mass (SMM) plays a crucial role in risk assessment in transcatheter aortic valve replacement (TAVR) candidates, yet it remains underutilized. Traditional methods focus on weakness or performance but omit SMM. This study compared traditional and novel markers of sarcopenia and frailty in terms of their ability to predict adverse outcomes post-TAVR., Methods: Three risk models were evaluated for the composite outcome of perioperative complications, 1-year rehospitalization, or 1-year mortality: (1) sarcopenia by combining low muscle mass (LMM) and weakness/performance assessed by hand grip strength or gait speed; (2) frailty by an Adapted Green score; and (3) frailty by the Green-SMI score incorporating LMM by multilevel opportunistic pre-TAVR thoracic CT segmentation., Results: In this study we included 184 eligible patients from January to December of 2018, (96.7%) of which were balloon expandable valves. The three risk models identified 22.8% patients as sarcopenic, 63.6% as frail by the Adapted Green score, and 53.8% as frail by the Green-SMI score. There were higher rates of the composite outcome in patients with sarcopenia (54.8%) and frailty (41.9% with the Adapted Green and 50.5% with the Green-SMI score) compared to their nonsarcopenic (30.3%) and nonfrail counterparts (25.4% with the Adapted Green and 18.8% with the Green-SMI score). Sarcopenia and frailty by Green-SMI, but not by the Adapted Green, were associated with higher risks of the composite outcome on multivariable adjustment (HR 2.2 [95% CI: 1.25-4.02], P = .007 and HR 3.4 [95% CI: 1.75-6.65], P < .001, respectively)., Conclusions: The integration of preoperative CT-based SMM to a frailty score significantly improves the prediction of adverse outcomes in patients undergoing TAVR., Competing Interests: Declaration of competimng interest Dr. Tang served as a consultant for Sequana Medical, Cardiol Therapeutics, Genomics plc, Zehna Therapeutics, Renovacor, WhiteSwell, Boston Scientific, CardiaTec Biosciences, Intellia Therapeutics, Alleviant Medical, Alexion Pharmaceuticals, Salubris Biotherapeutics, BioCardia Inc, and has received an honorarium from Springer, Belvoir Publishing, and American Board of Internal Medicine – all unrelated to this manuscript. All other authors have no relationships to disclose., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
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- 2024
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39. Satellite observations indicate that chia uses less water than other crops in warm climates.
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Kirsch B, Fisher JB, Piechota T, Hassani M, Suardiaz DC, Puri R, Cahill J, and Atamian HS
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- Droughts, Salvia physiology, Climate, Agriculture methods, Satellite Imagery, Medicago sativa, Crops, Agricultural growth & development, Water
- Abstract
Many parts of the world face severe and prolonged drought conditions, stressing the sustainability of water resources and agriculture. Transitioning to water-efficient crops is one strategy that can help adapt to water scarcity. An emerging drought-tolerant crop of interest is chia (Salvia hispanica). Yet, no study has compared its large-scale water use dynamics to those of widely established crops across the globe. Here, we use satellite data over multiple years to assess the water use efficiency of chia, alfalfa, corn, and soybean globally. Results show that chia consumed 13-38% less water than alfalfa, corn, and soy and assimilated 14-20% more carbon per amount of water used. Substituting 10% of Southwest United States alfalfa cultivation with chia would save 184 million liters of water per growing season, equivalent to the annual water consumption of 1,300 households. Future research shall explore the economic, societal, and environmental ramifications of substituting alfalfa with chia in dry areas worldwide. These insights can guide decision-makers in promoting sustainable agriculture and water resource management., (© 2024. The Author(s).)
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- 2024
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40. A Mitochondria-Targeting SIRT3 Inhibitor with Activity against Diffuse Large B Cell Lymphoma.
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Jana S, Shang J, Hong JY, Fenwick MK, Puri R, Lu X, Melnick AM, Li M, and Lin H
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- Humans, Animals, Cell Line, Tumor, Mice, Xenograft Model Antitumor Assays, Cell Proliferation drug effects, Structure-Activity Relationship, Sirtuin 3 antagonists & inhibitors, Sirtuin 3 metabolism, Lymphoma, Large B-Cell, Diffuse drug therapy, Lymphoma, Large B-Cell, Diffuse pathology, Lymphoma, Large B-Cell, Diffuse metabolism, Mitochondria drug effects, Mitochondria metabolism, Antineoplastic Agents pharmacology, Antineoplastic Agents chemistry, Antineoplastic Agents chemical synthesis
- Abstract
Diffuse large B-cell lymphomas (DLBCLs) are heterogeneous cancers that still require better and less toxic treatments. SIRT3, a member of the sirtuin family of NAD
+ -dependent protein deacylase, is critical for DLBCL growth and survival. A mitochondria-targeted SIRT3 small-molecule inhibitor, YC8-02, exhibits promising activity against DLBCL. However, YC8-02 has several limitations including poor solubility. Here, we report our medicinal chemistry efforts that led to an improved mitochondria-targeted SIRT3 inhibitor, SJ-106C, achieved by using a triethylammonium group, which helps to increase both solubility and SIRT3 inhibition potency. SJ-106C, while still inhibiting SIRT1 and SIRT2, is enriched in the mitochondria to help with SIRT3 inhibition. It is more active against DLBCL than other solid tumor cells and effectively inhibits DLBCL xenograft tumor growth. The findings provide useful insights for the development of SIRT3 inhibitors and mitochondrial targeting agents and further support the notion that SIRT3 is a promising druggable target for DLBCL.- Published
- 2024
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41. Trends in Complications Among Patients Undergoing Aortic Valve Replacement in the United States.
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Harvey JE 3rd, Kapadia SR, Cohen DJ, Kalra A, Irish W, Gunnarsson C, Ryan M, Chikermane SG, Thompson C, and Puri R
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- Humans, Female, Male, Aged, United States epidemiology, Retrospective Studies, Aged, 80 and over, Risk Factors, Medicare, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation trends, Risk Assessment, Treatment Outcome, Aortic Valve surgery, Time Factors, Aortic Valve Stenosis surgery, Aortic Valve Stenosis epidemiology, Postoperative Complications epidemiology, Postoperative Complications etiology, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement trends
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Background: The treatment of severe aortic stenosis has evolved considerably since the introduction of transcatheter aortic valve replacement (TAVR), yet trends in complications for patients undergoing TAVR or surgical aortic valve replacement (SAVR) at a national level have yet to be evaluated., Methods and Results: We performed a retrospective cohort study using Medicare data to evaluate temporal trends in complications among beneficiaries, aged ≥65 years, treated with elective isolated transfemoral TAVR or SAVR between 2012 and 2019. The study end point was the occurrence of a major complication (composite outcome) during index and up to 30 days after. Multivariable logistic regression was used to assess odds of complications for TAVR and SAVR, individually over time, and for TAVR versus SAVR, over time. The cohort included 211 212 patients (mean±SD age, 78.6±7.3 years; 45.0% women). Complication rates during index following elective isolated aortic valve replacement decreased from 49% in 2012 to 22% in 2019. These reductions were more pronounced for TAVR (41% to >19%, Δ=22%) than SAVR (51% to >47%, Δ=4%). After risk adjustment, the risk of any complication with TAVR was 47% ( P <0.0001) lower compared with SAVR in 2012, and 78% ( P <0.0001) lower in 2019. TAVR was independently associated with reduced odds of complications each year compared with 2012, with the magnitude of benefit increasing over time (2013 versus 2012: odds ratio [OR], 0.89 [95% CI, 0.81-0.97]; 2019 versus 2012: OR, 0.35 [95% CI, 0.33-0.38]). These findings are consistent for complications up to 30 days from index., Conclusions: Between 2012 and 2019, the risk of complications after aortic valve replacement among Medicare beneficiaries decreased significantly, with larger absolute and relative changes among patients treated with TAVR than SAVR.
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- 2024
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42. Outcomes and treatment strategy of transcatheter aortic valve replacement with balloon-expandable valve in borderline-size annulus.
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Isogai T, Spilias N, Bakhtadze B, Sabbak N, Denby KJ, Layoun H, Agrawal A, Shekhar S, Yun JJ, Puri R, Harb SC, Reed GW, Krishnaswamy A, and Kapadia SR
- Subjects
- Humans, Female, Male, Retrospective Studies, Aged, 80 and over, Treatment Outcome, Aged, Risk Factors, Time Factors, Postoperative Complications etiology, Risk Assessment, Recovery of Function, Hemodynamics, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement instrumentation, Transcatheter Aortic Valve Replacement mortality, Heart Valve Prosthesis, Prosthesis Design, Aortic Valve diagnostic imaging, Aortic Valve surgery, Aortic Valve physiopathology, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Aortic Valve Stenosis mortality, Aortic Valve Stenosis physiopathology, Balloon Valvuloplasty adverse effects
- Abstract
Background: Candidates for transcatheter aortic valve replacement (TAVR) occasionally have a "borderline-size" aortic annulus between 2 transcatheter heart valve sizes, based on the manufacturer's sizing chart. Data on TAVR outcomes in such patients are limited., Methods: We retrospectively reviewed 1816 patients who underwent transfemoral-TAVR with balloon-expandable valve (BEV) at our institution between 2016 and 2020. We divided patients into borderline and non-borderline groups based on computed tomography-derived annular measurements and compared outcomes. Furthermore, we analyzed procedural characteristics and compared outcomes between the smaller- and larger-valve strategies in patients with borderline-size annulus., Results: During a median follow-up of 23.3 months, there was no significant difference between the borderline (n = 310, 17.0 %) and non-borderline (n = 1506) groups in mortality (17.3 % vs. 19.5 %; hazard ratio [HR] = 0.86 [95% CI = 0.62-1.20], p = 0.39), major adverse cardiac/cerebrovascular events (MACCE: death/myocardial infarction/stroke, 21.2 % vs. 21.5 %; HR = 0.97 [0.71-1.32], p = 0.85), paravalvular leak (PVL: mild 21.8 % vs. 20.6 %, p = 0.81; moderate 0 % vs. 1.2 %; p = 0.37), or mean gradient (12.9 ± 5.8 vs. 12.6 ± 5.2 mmHg, p = 0.69) at 1 year. There was no significant difference between the larger-(n = 113) and smaller-valve(n = 197) subgroups in mortality (23.7 % vs. 15.2 %; HR = 1.57 [0.89-2.77], p = 0.12), MACCE (28.1 % vs. 18.4 %; HR = 1.52 [0.91-2.54], p = 0.11), mild PVL (13.3 % vs. 25.9 %; p = 0.12), or mean gradient (12.3 ± 4.5 vs. 13.6 ± 5.3 mmHg, p = 0.16); however, the rate of permanent pacemaker implantation (PPI) was higher in the larger-valve subgroup (15.9 % vs. 2.6 %, p < 0.001)., Conclusion: Borderline-size annulus is not associated with higher risk of adverse outcomes after BEV-TAVR. However, the larger-valve strategy for borderline-size annulus is associated with higher PPI risk, suggesting a greater risk of injury to the conduction system., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2024
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43. Outcomes and Predictors of Stroke After Transcatheter Aortic Valve Replacement in the Cerebral Protection Device Era.
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Shekhar S, Isogai T, Agrawal A, Kaw R, Mahalwar G, Krishnaswamy A, Puri R, Reed G, Mentias A, and Kapadia S
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- Humans, Male, Female, Aged, 80 and over, Aged, Risk Factors, Aortic Valve Stenosis surgery, Aortic Valve Stenosis mortality, United States epidemiology, Embolic Protection Devices, Risk Assessment methods, Postoperative Complications epidemiology, Postoperative Complications prevention & control, Treatment Outcome, Patient Readmission statistics & numerical data, Retrospective Studies, Databases, Factual, Incidence, Time Factors, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement instrumentation, Stroke prevention & control, Stroke epidemiology, Stroke etiology
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Background: Studies have shown inconclusive results on the effectiveness of cerebral protection devices (CPDs) with transcatheter aortic valve replacement. We aimed to analyze the national statistics on stroke and other outcomes with CPD use., Methods and Results: The Nationwide Readmissions Database (2017-2020) was queried to obtain data on patients undergoing transcatheter aortic valve replacement. Outcomes were compared between patients with a CPD and patients without a CPD. Of 271 804 patients undergoing transcatheter aortic valve replacement, CPD was used in 7.3% of patients. In a multivariable logistic regression analysis, CPD use was not associated with lower overall stroke rates (1.6% versus 1.9% without CPD; odds ratio, 0.95 [95% CI, 0.84-1.07]; P =0.364), but it was significantly associated with lower major stroke rates (1.2% versus 1.5% without CPD; odds ratio, 0.85 [95% CI, 0.74-0.98]; P =0.02). Patients with a CPD also had a shorter length of stay, higher routine discharges to home/self-care (74.9% versus 70.6%), and lower mortality rates (0.7% versus 1.3%). The 30-day (9.6% versus 11.7%) and 180-day (24.6% versus 28.2%) readmission rates were significantly lower in the CPD cohort. Among patients who developed stroke, patients with a CPD had more frequent routine discharges. Prior valve surgery was associated with the highest risk of overall and major stroke., Conclusions: CPD use during transcatheter aortic valve replacement was not independently associated with a lower risk of overall stroke but was associated with a lower risk of major stroke in a multivariable model. Data from future randomized trials that may offset any potential confounders in our study are required to help identify patients who would benefit from the use of these devices.
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- 2024
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44. A-Flux: a novel self-expanding coronary sinus reducer for refractory angina.
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Farjat-Pasos JI, Puri R, Altisent OA, Giannini F, Albert G, Del Portillo J, Rodés-Cabau J, Nguyen CM, and Paradis JM
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- Humans, Treatment Outcome, Male, Aged, Middle Aged, Coronary Angiography, Coronary Sinus diagnostic imaging, Coronary Sinus surgery, Angina Pectoris therapy, Angina Pectoris etiology, Angina Pectoris surgery
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- 2024
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45. COVID-19-Associated Sepsis: Potential Role of Phytochemicals as Functional Foods and Nutraceuticals.
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de Souza Goncalves B, Sangani D, Nayyar A, Puri R, Irtiza M, Nayyar A, Khalyfa A, Sodhi K, and Pillai SS
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- Humans, COVID-19 Drug Treatment, Resveratrol therapeutic use, Resveratrol pharmacology, Dietary Supplements, COVID-19 complications, COVID-19 virology, Sepsis drug therapy, Sepsis complications, Phytochemicals therapeutic use, Phytochemicals pharmacology, Functional Food, SARS-CoV-2 drug effects
- Abstract
The acute manifestations of coronavirus disease 2019 (COVID-19) exhibit the hallmarks of sepsis-associated complications that reflect multiple organ failure. The inflammatory cytokine storm accompanied by an imbalance in the pro-inflammatory and anti-inflammatory host response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection leads to severe and critical septic shock. The sepsis signature in severely afflicted COVID-19 patients includes cellular reprogramming and organ dysfunction that leads to high mortality rates, emphasizing the importance of improved clinical care and advanced therapeutic interventions for sepsis associated with COVID-19. Phytochemicals of functional foods and nutraceutical importance have an incredible impact on the healthcare system, which includes the prevention and/or treatment of chronic diseases. Hence, in the present review, we aim to explore the pathogenesis of sepsis associated with COVID-19 that disrupts the physiological homeostasis of the body, resulting in severe organ damage. Furthermore, we have summarized the diverse pharmacological properties of some potent phytochemicals, which can be used as functional foods as well as nutraceuticals against sepsis-associated complications of SARS-CoV-2 infection. The phytochemicals explored in this article include quercetin, curcumin, luteolin, apigenin, resveratrol, and naringenin, which are the major phytoconstituents of our daily food intake. We have compiled the findings from various studies, including clinical trials in humans, to explore more into the therapeutic potential of each phytochemical against sepsis and COVID-19, which highlights their possible importance in sepsis-associated COVID-19 pathogenesis. We conclude that our review will open a new research avenue for exploring phytochemical-derived therapeutic agents for preventing or treating the life-threatening complications of sepsis associated with COVID-19.
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- 2024
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46. Navigating Cardiovascular Risk and Lipid Management in Indian Patients: Key Messages from the Lipid Association of India 2024 Consensus Statement IV.
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Puri R, Mehta V, Bansal M, Shetty S, Yusuf J, Agarwala R, Vijan VM, Muruganathan A, Tiwaskar M, Narasingan SN, and Iyengar SS
- Subjects
- Humans, India epidemiology, Risk Assessment methods, Algorithms, Consensus, Risk Factors, Practice Guidelines as Topic, Cardiovascular Diseases prevention & control, Cardiovascular Diseases epidemiology, Cholesterol, LDL blood, Heart Disease Risk Factors
- Abstract
Effective lipid management is crucial for preventing atherosclerotic cardiovascular disease (ASCVD). The Western lipid guidelines may not apply to Indian subjects because of the vast differences in cardiovascular (CV) disease epidemiology. To overcome this challenge, the Lipid Association of India (LAI) in 2016 proposed an ASCVD risk stratification algorithm. The appropriate low-density lipoprotein cholesterol (LDL-C) goals for various risk groups were proposed, with an LDL-C target of <50 mg/dL recommended for the first time globally for patients in the very high-risk group. Subsequently, in 2020, an extreme risk group was added because of observations that patients with more severe or extensive ASCVD, along with multiple risk factors and comorbidities, had increased rates of adverse CV events and could benefit from more intensive LDL-C lowering. The extreme risk group was subdivided into categories A and B, with LDL-C targets as low as 30 mg/dL or lower. The availability of further evidence regarding the significance of novel risk factors and the availability of new LDL-C lowering therapies necessitated refining the ASCVD risk assessment algorithm, defining LDL-C targets for subjects with these risk factors, and incorporating recommendations for attaining very low LDL-C levels in a defined, select group of patients. Accordingly, the LAI expert group recently published the Consensus Statement IV, which is a comprehensive document addressing several key issues about risk stratification and dyslipidemia management in Indian subjects. LDL-C and nonhigh-density lipoprotein cholesterol (non-HDL-C) are not only primary and co-primary targets for lipid-lowering therapy but also risk factors for ASCVD risk stratification. Apolipoprotein B is a secondary target. The risk assessment algorithm has been updated to incorporate several nonconventional yet relevant CV risk factors. Additionally, the role of subclinical atherosclerosis has been highlighted. The CV risk due to subclinical atherosclerosis has been considered equivalent to that of established ASCVD, and hence, similar LDL-C targets have been recommended. Furthermore, a new risk category-extreme risk group category C has been added for the small subgroup of patients who continue to experience ASCVD sequelae despite achieving LDL-C levels of 30 mg/dL or lower. An ultralow LDL-C target (10-15 mg/dL) has been recommended along with optimal control of risk factors and guideline-directed management of comorbidities. Dyslipidemia management should be effective with sustained LDL-C lowering. In high-risk situations (e.g., acute coronary syndrome), the LDL-C target should be achieved as early as possible, preferably within the first 2 weeks. The present document summarizes the key messages from the LAI Consensus Statement IV., (© Journal of the Association of Physicians of India 2024.)
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- 2024
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47. Mechanistic and data-driven modeling of carbon respiration with bio-electrochemical sensors.
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Puri R, Emaminejad SA, and Cusick RD
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- Electrochemical Techniques methods, Machine Learning, Wastewater chemistry, Carbon metabolism, Biosensing Techniques methods
- Abstract
Bioelectrochemical sensor (BES) technologies have been developed to measure soluble carbon concentrations in wastewater. However, architectures and analytical methods developed in controlled laboratory environments fail to predict BES behavior during field deployments at water resource recovery facilities (WRRFs). Here, we examine the possibilities and obstacles associated with integrating BESs into environmental sensing networks and machine learning algorithms to monitor the biodegradable carbon dynamics and microbial metabolism at WRRFs. This approach highlights the potential of BESs to provide real-time insights into full-scale biodegradable carbon consumption across WRRFs., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest related to the manuscript submission., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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48. Efficacy of Drug-Coated Balloon Angioplasty in Pulmonary Vein Stenosis or Total Occlusion.
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Denby KJ, Tereshchenko LG, Kanj M, Taigen T, Callahan T, Dresing T, Tanaka Esposito C, Santangeli P, Hussein A, Hargrave J, Wakefield B, Skubas NJ, Tovar Camargo O, Krishnaswamy A, Nanjundappa A, Puri R, Khatri J, Kapadia S, Suntharos P, Prieto L, and Ghobrial J
- Subjects
- Humans, Male, Female, Retrospective Studies, Middle Aged, Treatment Outcome, Adult, Aged, Pulmonary Veins surgery, Pulmonary Veno-Occlusive Disease, Angioplasty, Balloon methods, Angioplasty, Balloon instrumentation, Stenosis, Pulmonary Vein
- Abstract
Background: Current therapies for pulmonary vein stenosis (PVS) or pulmonary vein total occlusion (PVTO) involving angioplasty and stenting are hindered by high rates of restenosis., Objectives: This study compares a novel approach of drug-coated balloon (DCB) angioplasty and stenting with the current standard of care in PVS or PVTO due to pulmonary vein isolation (PVI)., Methods: A retrospective single-center study analyzed patients with PVS or PVTO due to PVI who underwent either angioplasty and stenting (NoDCB group; December 2012-December 2016) or DCB angioplasty and stenting (DCB group; January 2018-January 2021). Multivariable Andersen-Gill regression analysis assessed the risk of restenosis and target lesion revascularization (TLR)., Results: The NoDCB group comprised 58 patients and 89 veins, with a longer median follow-up of 35 months, whereas the DCB group included 26 patients and 33 veins, with a median follow-up of 11 months. The DCB group exhibited more PVTO (NoDCB: 12.3%; DCB: 42.4%; P = 0.0001), with a smaller reference vessel size (NoDCB: 10.2 mm; DCB: 8.4 mm; P = 0.0004). Follow-up computed tomography was performed in 82% of NoDCB and 85% of DCB, revealing lower unadjusted rates of restenosis (NoDCB: 26%; DCB: 14.3%) and TLR (NoDCB: 34.2%; DCB: 10.7%) in the DCB group. DCB use was associated with a significantly lower risk of restenosis and TLR (HR: 0.003: CI: 0.00009-0.118; P = 0.002)., Conclusions: The novel approach of DCB angioplasty followed by stenting is effective and safe and significantly reduces the risk of restenosis and reintervention compared with the standard of care in PVS or PVTO due to PVI., Competing Interests: Funding Support and Author Disclosures Dr Ghobrial is a consultant for congenital therapies for Edwards LifeSciences, Medtronic, and Gore. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2024
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49. Inversion of Left Ventricular Axial Shortening: In Silico Proof of Concept for Treatment of HFpEF.
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Goetz WA, Yao J, Brener M, Puri R, Swaans M, Schopka S, Wiesner S, Creutzenberg M, Sievert H, and Kassab GS
- Abstract
Left ventricular (LV) longitudinal function is mechanically coupled to the elasticity of the ascending aorta (AA). The pathophysiologic link between a stiff AA and reduced longitudinal strain and the subsequent deterioration in longitudinal LV systolic function is likely relevant in heart failure with preserved ejection fraction (HFpEF). The proposed therapeutic effect of freeing the LV apex and allowing for LV inverse longitudinal shortening was studied in silico utilizing the Living Left Heart Human Model (Dassault Systémes Simulia Corporation). LV function was evaluated in a model with (A) an elastic AA, (B) a stiff AA, and (C) a stiff AA with a free LV apex. The cardiac model simulation demonstrated that freeing the apex caused inverse LV longitudinal shortening that could abolish the deleterious mechanical effect of a stiff AA on LV function. A stiff AA and impairment of the LV longitudinal strain are common in patients with HFpEF. The hypothesis-generating model strongly suggests that freeing the apex and inverse longitudinal shortening may improve LV function in HFpEF patients with a stiff AA.
- Published
- 2024
- Full Text
- View/download PDF
50. Tackling Tricuspid Regurgitation: A "Horses for Courses" and Earlier Approach Is the Future.
- Author
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Puri R, Harb SC, and Cohen J
- Subjects
- Humans, Treatment Outcome, Recovery of Function, Time-to-Treatment, Risk Factors, Cardiac Catheterization instrumentation, Heart Valve Prosthesis, Hemodynamics, Tricuspid Valve Insufficiency physiopathology, Tricuspid Valve Insufficiency surgery, Tricuspid Valve Insufficiency diagnostic imaging, Heart Valve Prosthesis Implantation instrumentation, Heart Valve Prosthesis Implantation adverse effects, Tricuspid Valve physiopathology, Tricuspid Valve diagnostic imaging, Tricuspid Valve surgery
- Abstract
Competing Interests: Funding Support and Author Disclosures Dr Puri serves as a consultant to P&F; is the global co–principal investigator for the TRICAV 1 and TRICAV 2 trials; and serves on the Data and Safety Monitoring Board for VDyne EFS. All other authors have reported that they have no relationship relevant to the contents of this paper to disclose.
- Published
- 2024
- Full Text
- View/download PDF
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