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4. Cardiac Magnetic Resonance Assessment of Response to Cardiac Resynchronization Therapy and Programming Strategies

Author

Mohamad Abdi, Frederick H. Epstein, Christopher Schumann, Michael Salerno, Sarah Ratcliffe, Christopher M. Kramer, Xu Gao, Christopher A Hanson, Sula Mazimba, Pamela K. Mason, Pim J.A. Oomen, Rohit Malhotra, Austin A. Robinson, J. Michael Mangrum, Andrew E. Darby, Oliver J. Monfredi, Changyu Sun, Kenneth C. Bilchick, Daniel A. Auger, and Jeffrey W. Holmes

Subjects
Male, medicine.medical_specialty, Magnetic Resonance Spectroscopy, Scar assessment, medicine.medical_treatment, Cardiac resynchronization therapy, Ventricular Function, Left, Cardiac Resynchronization Therapy, Predictive Value of Tests, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, PR interval, Aged, Heart Failure, Ejection fraction, Atrial pacing, business.industry, Stroke Volume, medicine.disease, Implantable cardioverter-defibrillator, Treatment Outcome, Heart failure, cardiovascular system, Cardiology, Female, Cardiology and Cardiovascular Medicine, Cardiac magnetic resonance, business, circulatory and respiratory physiology
Abstract

The objective was to determine the feasibility and effectiveness of cardiac magnetic resonance (CMR) cine and strain imaging before and after cardiac resynchronization therapy (CRT) for assessment of response and the optimal resynchronization pacing strategy.CMR with cardiac implantable electronic devices can safely provide high-quality right ventricular/left ventricular (LV) ejection fraction (RVEF/LVEF) assessments and strain.CMR with cine imaging, displacement encoding with stimulated echoes for the circumferential uniformity ratio estimate with singular value decomposition (CURE-SVD) dyssynchrony parameter, and scar assessment was performed before and after CRT. Whereas the pre-CRT scan constituted a single "imaging set" with complete volumetric, strain, and scar imaging, multiple imaging sets with complete strain and volumetric data were obtained during the post-CRT scan for biventricular pacing (BIVP), LV pacing (LVP), and asynchronous atrial pacing modes by reprogramming the device outside the scanner between imaging sets.100 CMRs with a total of 162 imaging sets were performed in 50 patients (median age 70 years [IQR: 50-86 years]; 48% female). Reduction in LV end-diastolic volumes (P = 0.002) independent of CRT pacing were more prominent than corresponding reductions in right ventricular end-diastolic volumes (P = 0.16). A clear dependence of the optimal CRT pacing mode (BIVP vs LVP) on the PR interval (P = 0.0006) was demonstrated. The LVEF and RVEF improved more with BIVP than LVP with PR intervals ≥240 milliseconds (P = 0.025 and P = 0.002, respectively); the optimal mode (BIVP vs LVP) was variable with PR intervals 240 milliseconds. A lower pre-CRT displacement encoding with stimulated echoes (DENSE) CURE-SVD was associated with greater improvements in the post-CRT CURE-SVD (r = -0.69; P 0.001), LV end-systolic volume (r = -0.58; P 0.001), and LVEF (r = -0.52; P 0.001).CMR evaluation with assessment of multiple pacing modes during a single scan after CRT is feasible and provides useful information for patient care with respect to response and the optimal pacing strategy.

Published
2021

5. Evaluation of ECG-gated and Fast Low-Angle Shot (FLASH) Dual Source Computed Tomography Scanning Protocols for Transcatheter Aortic Valve Replacement

Author

Amartya Kundu, Waqas Qureshi, Mohamed Ahmed, Nikolaos Kakouros, Rohit Malhotra, Abdul Moiz Hafiz, Eric J. Schmidlin, and Jennifer D. Walker

Subjects
Male, Transcatheter aortic, Computed Tomography Angiography, Image quality, medicine.medical_treatment, 030218 nuclear medicine & medical imaging, Cohort Studies, Transcatheter Aortic Valve Replacement, Perimeter, Electrocardiography, 03 medical and health sciences, Flash (photography), 0302 clinical medicine, Valve replacement, medicine.artery, Multidetector Computed Tomography, medicine, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Cardiac skeleton, Aged, Aged, 80 and over, Aorta, business.industry, Aortic Valve Stenosis, Peripheral, Aortic Valve, Heart Valve Prosthesis, 030220 oncology & carcinogenesis, cardiovascular system, Female, business, Nuclear medicine
Abstract

Background Transcatheter aortic valve replacement (TAVR) procedural success relies heavily on volumetric reconstruction imaging, particularly ECG-gated multi-detector row computed tomography. We postulated that single examination using fast low-angle shot (FLASH) dual source CT scanning (DS-CTA) could provide lower dose than ECG-gated CTA while maintaining the image quality. Methods In this single-centre cohort study, all patients who underwent ECG-gated and FLASH DS-CTA were evaluated. Volumetric reconstructions were performed for both ECG-gated and FLASH DS-CTA to obtain nonsagittal views of the structures. ECG-gated cardiac CT was obtained to evaluate the aortic annular size while FLASH DS-CTA was obtained to examine the aortic and iliac vasculature as part of TAVR imaging protocol. We evaluated measures of aortic annulus, coronaries and sinus of Valsalva using ECG-gated and FLASH DS-CTA scanning protocols. Image quality assessments were performed using aortic root region-of-interest signal-to-noise ratio. Results A total of 130 patients (mean age 81.5 ± 9.2 years, 46.2% female, and 99.2% white) underwent both ECG-gated CT and FLASH DS-CTA. There were excellent correlations between aortic annular area (R2 = 0.934) and aortic annular perimeter (R2 = 0.923) measured by the two protocols. Only 2 (1.5%) patients had >10% difference between aortic annular measurements by ECG-gated and FLASH DS-CTA, while none of the patients had a >10% difference between aortic annular perimeter measured by ECG-gated and FLASH DS-CT scans. There was no significant difference in signal-to-noise ratio between the two methods (mean difference 13.4; 95% CI −2.1–28.8, p = 0.09). There was significantly lower radiation dose for FLASH DS-CTA than ECG-gated CT scan (mean dose-length product difference 404.38; 95% CI 328.9–479.87, p Conclusion Overall, FLASH DS-CTA and ECG-gated CT scans provided comparable image quality and aortic annular dimensions for pre-TAVR evaluation. DS-CTA additionally provided the necessary angiographic imaging of the aorta and peripheral access vessels while still maintaining a lower radiation dose. We propose that a single non-ECG gated FLASH DS-CTA could be utilized to provide all the necessary pre-TAVR imaging information without a gated CT scan.

Published
2021

6. Meta-Analysis of Anticoagulation Therapy for the Prevention of Cardiovascular Events in Patients With Peripheral Arterial Disease

Author

Aakash Garg, Rami O. Tadros, Usman Baber, Haroon Kamran, Reza Masoomi, Daniel Han, Arthur Tarricone, Prakash Krishnan, Rheoneil A. Lascano, Amit Hooda, Roxana Mehran, Serdar Farhan, Kurt Huber, and Rohit Malhotra

Subjects
medicine.medical_specialty, Myocardial Infarction, MEDLINE, Hemorrhage, Disease, 030204 cardiovascular system & hematology, Cochrane Library, Amputation, Surgical, law.invention, Peripheral Arterial Disease, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, medicine, Humans, 030212 general & internal medicine, Randomized Controlled Trials as Topic, business.industry, Absolute risk reduction, Anticoagulants, Confidence interval, Stroke, Cardiovascular Diseases, Meta-analysis, Cardiology, Cardiology and Cardiovascular Medicine, business, Vascular Surgical Procedures, Platelet Aggregation Inhibitors, Mace
Abstract

Peripheral artery disease (PAD) remains a major cause of morbidity and future cardiovascular events despite advancement in the surgical interventions and optimal medical therapy. The aim of our study is to evaluate the efficacy and safety of anticoagulation (AC) therapy for reducing cardiovascular and limb events in patients with PAD. PUBMED, Medline, and Cochrane Library were searched through 2020 for randomized clinical trials comparing major adverse cardiovascular events (MACE) and risk of major bleeding (MB), between AC and standard of care (SOC) therapy, among patients with PAD. Meta-analysis was performed using weighted pooled absolute risk difference (RD) with 95% confidence interval (CI) and fixed effects model for overall and sub-groups of full dose (FD) and low dose (LD) AC therapies. Amongst 17,684 patients from 7 different studies, the addition of AC to SOC therapy was associated with MACE reduction (RD -0.022, 95% CI -0.033 to -0.012, p0.001) and increased MB (RD 0.02, 95% CI 0.014 to 0.025, p0.001). For FD, MACE reduction was (RD -0.021, 95% CI -0.042 to 0.001, p = 0.061) and MB (RD 0.036, 95% CI 0.025 to 0.047, p0.001). For LD, MACE reduction was (RD -0.023, 95% CI -0.035 to -0.011, p0.001) and MB (RD 0.011, 95% CI 0.005 to 0.017, p0.001). In conclusion, addition of AC to the current SOC therapy can mitigate future MACE events in patients with PAD albeit at risk of increased bleeding. LD AC is associated with an efficacy/safety net benefit compared to FD AC therapy.

Published
2021

7. CMR DENSE and the Seattle Heart Failure Model Inform Survival and Arrhythmia Risk After CRT

Author

Kenneth C. Bilchick, John D. Ferguson, Nishaki Mehta, J. Michael Mangrum, Rohit Malhotra, Andrew E. Darby, Mohammad Abdishektaei, Aditya Narayan, Frederick H. Epstein, Sula Mazimba, Wayne C. Levy, Xiaoying Cai, Christopher M. Kramer, Pamela K. Mason, Changyu Sun, Roshin C. Mathew, Min-Woong Sohn, and Daniel A. Auger

Subjects
Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Electric Countershock, Cardiac resynchronization therapy, Magnetic Resonance Imaging, Cine, Risk Assessment, Article, Decision Support Techniques, Cardiac Resynchronization Therapy, Predictive Value of Tests, Risk Factors, Interquartile range, Internal medicine, medicine, Clinical endpoint, Humans, Radiology, Nuclear Medicine and imaging, Cardiac Resynchronization Therapy Devices, Aged, Heart Failure, business.industry, Hazard ratio, Arrhythmias, Cardiac, Middle Aged, medicine.disease, Implantable cardioverter-defibrillator, Confidence interval, Defibrillators, Implantable, Treatment Outcome, Heart failure, Ventricular assist device, Cardiology, Female, Cardiology and Cardiovascular Medicine, business
Abstract

This study sought to determine if combining the Seattle Heart Failure Model (SHFM-D) and cardiac magnetic resonance (CMR) provides complementary prognostic data for patients with cardiac resynchronization therapy (CRT) defibrillators.The SHFM-D is among the most widely used risk stratification models for overall survival in patients with heart failure and implantable cardioverter-defibrillators (ICDs), and CMR provides highly detailed information regarding cardiac structure and function.CMR Displacement Encoding with Stimulated Echoes (DENSE) strain imaging was used to generate the circumferential uniformity ratio estimate with singular value decomposition (CURE-SVD) circumferential strain dyssynchrony parameter, and the SHFM-D was determined from clinical parameters. Multivariable Cox proportional hazards regression was used to determine adjusted hazard ratios and time-dependent areas under the curve for the primary endpoint of death, heart transplantation, left ventricular assist device, or appropriate ICD therapies.The cohort consisted of 100 patients (65.5 [interquartile range 57.7 to 72.7] years; 29% female), of whom 47% had the primary clinical endpoint and 18% had appropriate ICD therapies during a median follow-up of 5.3 years. CURE-SVD and the SHFM-D were independently associated with the primary endpoint (SHFM-D: hazard ratio: 1.47/SD; 95% confidence interval: 1.06 to 2.03; p = 0.02) (CURE-SVD: hazard ratio: 1.54/SD; 95% confidence interval: 1.12 to 2.11; p = 0.009). Furthermore, a favorable prognostic group (Group A, with CURE-SVD 0.60 and SHFM-D 0.70) comprising approximately one-third of the patients had a very low rate of appropriate ICD therapies (1.5% per year) and a greater (90%) 4-year survival compared with Group B (CURE-SVD ≥0.60 or SHFM-D ≥0.70) patients (p = 0.02). CURE-SVD with DENSE had a stronger correlation with CRT response (r = -0.57; p 0.0001) than CURE-SVD with feature tracking (r = -0.28; p = 0.004).A combined approach to risk stratification using CMR DENSE strain imaging and a widely used clinical risk model, the SHFM-D, proved to be effective in this cohort of patients referred for CRT defibrillators. The combined use of CMR and clinical risk models represents a promising and novel paradigm to inform prognosis and device selection in the future.

Published
2020

11. The use of non-invasive mapping in persistent AF to predict acute procedural outcome

Author

Kenneth C. Bilchick, Rohit Malhotra, Pamela K. Mason, Anna G. Lam, Nishaki Mehta, Andrew E. Darby, Xu Gao, and J. Michael Mangrum

Subjects
medicine.medical_specialty, medicine.medical_treatment, Catheter ablation, 030204 cardiovascular system & hematology, Pulmonary vein, Electrocardiography, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Atrial Fibrillation, medicine, Humans, 030212 general & internal medicine, medicine.diagnostic_test, Atrium (architecture), business.industry, Non invasive, Atrial fibrillation, medicine.disease, Ablation, Treatment Outcome, medicine.anatomical_structure, Pulmonary Veins, Catheter Ablation, Cardiology, Cardiology and Cardiovascular Medicine, business, Interatrial septum
Abstract

Background ECG imaging (ECGI) with phase mapping has been used to identify rotational activity non-invasively that can be targeted during atrial fibrillation (AF) ablation. Acute termination of AF using this method has shown improved clinical outcomes. In this study we sought to evaluate whether patterns of rotational density are associated with acute procedural outcomes when using a step-wise ablation strategy. Methods 50 patients with persistent or long-standing persistent AF underwent non-invasive 3D mapping with CardioInsight™ prior to AF ablation. Composite maps of rotational activity were created and prioritized based on the density of rotations on a biatrial model. Stepwise ablation of pulmonary vein isolation (PVI) ± rotations ± linear lesions was done with AF termination as the procedural endpoint. Results Acute termination of AF was achieved in 34 patients (68%). Median number of rotations in the left atrium (LA), interatrial septum and right atrium (RA) were 22.2 (9.4 to 29.3), 12.0 (4.3 to 13.4), 25.0 (14.5 to 31.3), respectively. In patients with acute AF termination, a higher number of rotations in the LA was observed, 20.3 (10.0 to 37.1) compared to 10.6 (7.7 to 17.2) in the RA (p = 0.02). Additionally, high density of rotations in the posterior inferior right atrium (segment 2B on the biatrial model) was observed in patients without acute AF termination (p = 0.02). Conclusion Acute termination of persistent and long-standing persistent AF using rotational ablation guided by ECGI phase mapping can be achieved in a high percentage of both index and re-do cases. The distribution and pattern of these rotations may be associated with procedural outcomes and could potentially be used to stratify patients.

Published
2019

12. B-PO03-194 PRECISION MEDICINE APPROACH TO CARDIAC RESYNCHRONIZATION THERAPY VIA NONINVASIVE ULTRASONIC STIMULATION

Author

Andrew E. Darby, Xu Gao, Mike Mangrum, Robert W. Stadler, Pamela K. Mason, David Kim, Rohit Malhotra, Oliver Monfredi, Ekaterina M. Ippolito, Joy A. Aso, Kenneth C Bilchick, and Peter M. Franzen

Subjects
Ultrasonic stimulation, medicine.medical_specialty, business.industry, Physiology (medical), medicine.medical_treatment, Internal medicine, Cardiac resynchronization therapy, Cardiology, Medicine, Cardiology and Cardiovascular Medicine, Precision medicine, business
Published
2021

13. The Changing Landscape for Stroke Prevention in AF

Author

Mercedes Samson, Siegfried Frickel, Hirosi Meno, Niels Gadsbøll, Sébastien Prévôt, Sorin Alexandru Antonescu, Xiaodong Li, Tetsuya Haruna, Zicheng Li, Catarina Fonseca, Ralf Zahn, Shahid Aziz, Takashi Tsutsui, Galal Kerfes, Elisabeth Louise Zeuthen, Lluís Mont, Angelika Tamm, Bogdan Minescu, Eric Lo, Gerardo Ansalone, Malcolm Foster, Tristan Mirault, Nabil Andrawis, Apostolos Katsivas, Imad Kreidieh, Juliano Novaes Cardoso, Margaret Ikpoh, Dimitar Raev, Said Chaaban, Dan Tesloianu, Philippe Loiselet, Joachim Gmehling, Joseph Hakas, Steven Forman, Ernst Günter Vester, Bettina Schmitz, Hassan El-Sayed, Hiroshi Tsutsui, Salvatore Pirelli, Jens Taggeselle, Arnljot Tveit, David Smith, Manuel De Los Rios Ibarra, Rafael Salguero, Jindrich Spinar, Vanja Bašić Kes, Jose Walter Cabrera Honorio, Adrien Salem, Gavino Casu, Jean Michel Quedillac, Ana Fruntelata, Peter Siostrzonek, Dmitry Napalkov, Luthando Adams, Valeria Calvi, Jeff S. Healey, Magnus Forsgren, Larisa Kalinina, Ratika Parkash, P. F.M.M. Bergen van, Carmen Manuela Muresan, H. Gorka, Andreas Mügge, Gustavo Maid, Serge Yvorra, Alexander Paraschos, Bernhard Witzenbichler, Viktor Peršić, Jeong Su Kim, Dong Jin Oh, Yutaka Furukawa, Steve Compton, Ravikiran Korabathina, Tammam Al-Joundi, Muzahir H. Tayebjee, Robert Betzu, David J. Cislowski, Alon Steinberg, Carisi Anne Polanczyk, Sanjiv Petkar, Andy Lam, Mingsheng Wang, Galina Ivanchura, Ruediger Seebass, Thomas Guarnieri, Seth H. Baker, Paula Carvalho, Brian First, Konstantinos Makaritsis, Alex C. Spyropoulos, Mohiburrahman Sirajuddin, Richard Bala, David Goldscher, G. Larsen Kneller, Ki Seok Kim, Sherman Tang, Venkat Iyer, Payman Sattar, Yamile Porro, Gregory Y.H. Lip, Christa Raters, Olivier Gartenlaub, Elizaveta Panchenko, Niccolo' Marcionni, Ole Nyvad, Sibel Zehra Aydin, Kenji Kawajiri, Dipankar Dutta, Gabriel Contreras Buenostro, Shaival Kapadia, Harry J.G.M. Crijns, Miroslav Rubacek, Myriam Brunehaut, Igor Diemberger, Kyle Rickner, Katsumi Tanaka, Moon Hyoung Lee, Pamela Nerheim, Jose Carlos Moura Jorge, Michael Gumbley, Katie Randall, Francesco Melandri, Sunil Chand, Harukazu Iseki, Thalie Traissac, Ningfu Wang, Ghiath Mikdadi, Peter D. Schellinger, Andrew M. Rubin, Conrad Genz, Karl Heinz Seidl, Maurice Pye, Giorgio Annoni, Adalberto Menezes Lorga Filho, William H. Pentz, Lisa Schmitz, Gary Miller, Didier Smadja, Elena Khludeeva, David Hargroves, Hans-Christoph Diener, Tiziano Moccetti, Azlisham Mohd Nor, Kai Koenig, F. A. Rooyer, Kiyoo Mori, Carlos Gonzalez Juanatey, Jan Beyer-Westendorf, Charles Landau, Steven B Eisenberg, Hugh F. McIntyre, Emilio Gonzalez Cocina, Erik May, Gyo-Seung Hwang, Alberto Giniger, Karl-Heinz Kuck, Yan Carlos Duarte Vera, Vladimir Gorbunov, Priya Nair, Shih Ann Chen, Beat J. Meyer, Donghui Zhang, Feng Wang, Richard J.H. Smith, Michele Massimo Gulizia, Darko Pocanic, Abul Azim, Jose Maria Lobos, Patrick Leprince, Peter Vanacker, Marica Bracic Kalan, James Crenshaw, Ewa Nowalany-Kozielska, Ayham Al-Zoebi, Eiji Hishida, Louis Essandoh, Younghoon Kim, Yanmin Yang, Dhiraj Gupta, Fausto J. Pinto, Arnold Pinter, Stanley Koch, Luis Felipe Pezo, Dzifa Wosornu Abban, Martin S. Green, Chrystalenia Kafkala, Zhitao Liu, Jose Luis Llisterri, Su Mei Angela Koh, Lin Chih-Chan, Ruth Davies, Ursula Rauch-Kroehnert, Julio Tallet, Juan Benezet-Mazuecos, Andreas Kastrup, Rohit Malhotra, Serge Timsit, Thierry Frappé, Kostas Oikonomou, Ameer Kabour, Kishor Vora, Douglas Roberts, Carlos Scherr, Pedro Dionísio, Nicoleta Violeta Miu, Eve Gillespie, Petr Povolny, F.R. Grondin, Philippe Lyrer, Raymond Fisher, Philip O'Donnell, Nima Amjadi, Juan Vazquez, Lynn Corbett, Patrick Peters, Jing Zhou, Thomas Kümler, Danny H.K. Wong, Evaldas Giedrimas, William McGarity, Frank L. Silver, Emmanuel Touzé, Ana Leitão, Suk keun Hong, Marwan Salfity, Constantin Militaru, S T Matskeplishvili, Johannes A. Kragten, Sam Henein, Anthony D'Souza, B. J. Krenning, Francesco Chiarella, Rene Casanova, Stephan Willems, Yong Keun Cho, Tae Joon Cha, Stewart Pollock, Rajendra Moodley, Rosa Ysabel Cotrina Pereyra, Volker Laske, Zhanquan Li, Kenneth B. Harris, Johnny Dy, Gabriele Guardigli, Hisham Kashou, Norberto Matadamas Hernandez, Zdravka Poljaković, E. Decoulx, Paul Wakefield, Sung Ho Her, Fatma Qaddoura, Giuseppe Boriani, Younus Ismail, Franz Goss, Shigeru Fujii, J. R. Groot de, Ming Shien Wen, Rui Candeias, Thomas Rebane, Juan Carlos Arias, Robert Jobe, Nicolas Ley, Taishi Sasaoka, Luigi Ria, Jonathan Banayan, Paul McLaughlin, Sergei Zenin, Luis E. Martinez, Thuraia Nageh, Fabrizio Ammirati, M. E.W. Hemels, Yutaka Shimizu, Elina Trendafilova, Maxime Fayard, Randeep Suneja, Attilia Maria Pizzini, Mark B. Abelson, Rabih R. Azar, Jian Zhou, Valerie Bockisch, Martin Koschutnik, James Hitchcock, Vlad Ciobotaru, Didier Irles, Patrik Michel, Witold Streb, John F. Corrigan, Ajit Singh Khaira, Marco Antônio Mota Gomes, Richard Tytus, Christian Hall, Antonius Ziekenhuis, Catherine Mallecourt, David J. Williams, Doo Il Kim, Brian Gordon, Salvatore Novo, Soufian Al Mahameed, Anil Shah, N. Joseph Deumite, Brent T. McLaurin, Ruth H. Strasser, Somnath Kumar, Genshan Ma, Aurel Cracan, Rajiv Mallik, Anthony Vlastaris, Francesco Perticone, Julio Alberto Aguilar Linares, Angel Moya, William Ashcraft, Steven Lupovitch, Renate Weinrich, Ralph F. Bosch, Gerald Ukrainski, Jon Arne Sparby, Norbert Schön, Pierre Jean Scala, Steven E. Hearne, Mark Roman, Ramin Farsad, Werner Rieker, Guillaume Cayla, Ramon Freixa, Hidemitsu Nakagawa, Kunihiro Nishida, Thomas J. Mulhearn, Tak W. Kwan, Jeffrey Shanes, Tiziana Tassinari, Ka Sing Lawrence Wong, Kneale Metcalf, Dominique Lejay, Daniel Savard, Pierre Chevallereau, Gilles O'Hara, Milan Mikus, Hiroshi Fukunaga, Olga Korennova, Xavier Ducrocq, Edvard Berngard, Mario Bo, Hoi Fan Chow, E. Ronner, Yuriy Grinshstein, Amparo Mena, Sidiqullah Rahimi, Axel Brandes, Shigenobu Bando, Freddy Del-Carpio Munoz, Jonathan L. Halperin, Ronald D. Jenkins, Carlos Rodríguez Pascual, Alain Lacroix, Sergio Agosti, Franklin Handel, Aylmer Tang, Nan Jiang, Diana A. Gorog, Dimitrios Stakos, Gerald Greer, Dudley Goulden, Martin Grond, Oran Corey, Stellan Bandh, Efrain Gonzalez, Alexander Klein, Jacques Scemama, Amelie Elsaesser, Nathan Foster, Francesco Fedele, Dinesh Mistry, Alberto Caccavo, Bjørn Bratland, Jean Marc Davy, D. J. Boswijk, Abdullah Al Ali, Muhammad Khalid, Terry McCormack, Clare Seamark, Enrico Passamonti, Zoran Olivari, Simon W Dubrey, Wlodzimierz Musial, Antonio Martín Santana, Jianqiu Liang, Manuel de Mora, Dmitry Dupljakov, Nicholas Jones, Mohamed Alshehri, Paul Charbel, John Bullinga, Petr Polasek, Hossein Almassi, Reza Mehzad, Gamal Hussein, Marcus Wiemer, Ali Sharareh, Alexandra Finsen, David Huckins, Denis Angoulvant, Matthias Leschke, Craig Vogel, Stefan Schuster, Juan E. Mesa, Yong Seog Oh, Axel De La Briolle, Jacek Kowalczyk, Louise Shaw, Eduardo de Teresa, Stefan Naydenov, Hubert Vial, Ian I Joffe, Christoph Kleinschnitz, Takeshi Yamashita, A. Salvioni, Aman M. Shah, Michael Renzi, Claude Brunschwig, Ioannis Styliadis, Ravi Bhagwat, Julian Coronel, Asok Venkataraman, Zayd Eldadah, Dinesh Singal, Byung Chun Jung, Michael Lillestol, Mirza S. Baig, Jose Polo, Ira Dauber, Olga Barbarash, Kristina Zint, Pavel Galin, P. J. A. M. Brouwers, Ki Byeong Nam, Andrey Ezhov, Kevin F. Browne, Iveta Sime, Tetsuo Sakai, Jean Louis Georges, Manish Jain, Alexey Nizov, Jean Dillinger, Arif Elvan, John Barton, Rainer Zimmermann, Junji Kanda, Clare Holmes, Werner Jung, Aurélien Miralles, Tatiana Novikova, Steven Georgeson, Yorihiko Higashino, Akira Yamada, David Sprigings, Haroon Rashid, J. W.M. Eck van, Bernard Erickson, Barry Seidman, Koji Kajiwara, Kannappan Krishnaswamy, Daniel Ferreira, Sébastien Armero, Brian Wong, Dong Gu Shin, Ludovic Chartier, Priit Kampus, Francisco Marín, Rickey Manning, Martin Köhrmann, Edward J. Kosinski, Bengt Johansson, Y. S. Tuininga, Simon Cattan, Sergio Dubner, Imran Dotani, Wenchi Kevin Tsai, Gregorio Sanchez, Edwin Blumberg, Charles Crump, Frank Jäger, Christoforos Olympios, Matthew Hoghton, Xinwen Zhao, Derek Muse, Alexandre Guignier, Toby Black, Yuichiro Takagi, Phil Keeling, Richard A. Bernstein, Omar Elhag, Jean Ernst Poulard, Fernando Gabriel Manzur Jattin, James Hampsey, Shahid Mahmood, Steffen Behrens, Tianlun Yang, Elena Dotcheva, Krishnan Challappa, Nam Ho Kim, Claudio Cavallini, Eric Espaliat, Martin James, June Soo Kim, Marc Roelke, Harold Thomas, Charles A. Shoultz, Rami El Mahmoud, José Francisco Kerr Saraiva, Jürgen vom Dahl, Xuebo Liu, Dong Ju Choi, Sergio Mondillo, Ian Parker, Kazuya Yamamoto, Rafael Martin Suarez, Karla M. Kurrelmeyer, Akber Mohammed, Nikitas Moschos, Benoit Coutu, Georgios Hananis, Hamed M. Zuhairy, Giovanni Baula, Suchdeep Bains, Menno V. Huisman, Heng Jiang, Jaroslaw Sek, Yoto Yotov, Malik Ali, Dalmo Antonio Ribeiro Moreira, Torben Larsen, Raed Osman, Marie Paule Houppe Nousse, Shulin Wu, Arturo Raisaro, Efrain Alonso Gomez Lopez, Violeta Cindea Nica, Eduardo Julián José Roberto Chuquiure Valenzuela, Wladmir Faustino Saporito, Changsheng Ma, Francesco Romeo, Jorge Martínez, M. Shakil Aslam, Kenneth J. Rothman, Kamal Al Ghalayini, Magdy Mikhail, Charles Augenbraun, Andreas Wilke, Peter Goethals, John D. McClure, Humberto Rodriguez Reyes, Peter Schoeniger, Nabil Jarmukli, Elizabeth S. Kaufman, Nathalie Duvilla, Jens Wicke, Kausik Chatterjee, Philippe Audouin, Dragan Kovacic, Xingwei Zhang, Brad Frandsen, Alberto Conti, Francisco Aguilar, Sasalu Deepak, Geir Heggelund, David S. Rosenbaum, Sergey P. Golitsyn, Alessandro Capucci, Rodolfo Sotolongo, Begoña Sevilla, François Poulain, Thomas Ronzière, Naseem Jaffrani, Dominik Michalski, Jose Lopez-Sendon, Silvia Di Legge, Bernard Jouve, Chang Sheng Ma, Robert Parris, Sumeet K. Mainigi, Jing Yao, Lars Udo Krause, Ulrich Tebbe, Quansan Zhang, Mathieu Amelot, Peter Crean, Benzy J. Padanilam, Nicolas Breton, Fernando Tomas Lanas Zanetti, Subhash Banerjee, Andrew I. Cohen, Michel Galinier, Jacek Miarka, Gerian Grönefeld, Vicente Bertomeu, Mariusz Gierba, Danny, Anna Ferrier, Luciano Marcelo Backes, Lianqun Cui, Eun-Seok Shin, Andreas Meinel, Jay Koons, Jen Yuan Kuo, Brett Graham, Antonio Garcia Quintana, Michael Hill, Sylvain Destrac, Janko Szavits-Nossan, Shanglang Cai, Joaquín Osca, Luis Aguinaga, Hemal M. Nayak, Chander Arora, Shinji Tayama, Diana Delić Brkljačić, Tiemin Jiang, Miguel Agustin Reyes Rocha, Ronan Collins, Davide Imberti, Kwang Soo Cha, Matthias Gabelmann, Alfredo Astesiano, Christian Weimar, William Eaves, Tatiana Ionova, Khalid Almuti, Thierry Schaupp, Bernhard Paul Lodde, Darlene Elias, Yuichiro Nakamura, Raed Al-Dallow, Eric Parrens, Weihua Li, Alan Bell, Noah Israel, Nadezda Rozkova, Nediljko Pivac, Nooshin Bazargani, Armando Pineda-Velez, Hyung Wook Park, Amin Karim, Clemens Steinwender, Davor Milicic, Gonzalo Barón, Robert Topkis, Mehrdad Ariani, Craig S. Barr, Paulo Bettencourt, Roberto Zanini, Andrew Moriarty, Pascal Goube, Fausto Rigo, Irene Madariaga, Atsushi Sueyoshi, Małgorzata Lelonek, Kevin R. Wheelan, Richard Huntley, Donald Brautigam, Jacek Gniot, Ido Lori, Dragos Vinereanu, Daniel Lee, Kouki Watanabe, Michael Vargas, Natalya Koziolova, James S. Zebrack, Basel Hanbali, Cesare Greco, José Luis Zamorano, Rajesh Patel, Fernando Carvalho Neuenschwander, Sergio Luiz Zimmermann, Shuiping Zhao, Pedro Adragão, Karl Heinz Schmitz, Abdelfatah Alasfar, Olga Ferreira de Souza, David N. Pham, Mark Dayer, Thomas Davee, Yoshiki Hata, Mika Skeppholm, Martin O'Donnell, David Molony, Joe Hargrove, Hani Sabbour, Pascal Defaye, Jochen Bott, Dora Ines Molina de Salazar, Anthony Clay, Giancarlo Landini, Michael McGuire, Dae Kyeong Kim, A. Shekhar Pandey, Bouziane Benhalima, Serge Cohen, Aamir Cheema, Matthias Claus, Marcus L. Williams, Qiangsun Zheng, Karim Bakhtiar, Hailong Lin, Sergio Berti, David Hartley, Libor Nechvatal, Rami Mihail Chreih, Domingo Pozzer, James Capo, John Floyd, Bhola Rama, Harald Darius, Ioannis Mantas, Pareed Aliyar, Carlos Barrera, Galina Ketova, Mark Chang, Alan J. Bank, José Ferreira Santos, Samir Turk, Lakshmanan Sekaran, Adam Ellery, Aurélie Buhl, Naomasa Miyamoto, Kuo Ho Yeh, Nicolas Mousallem, Hassan Soda, Dimitrios J. Richter, Zhaohui Wu, Tim Edwards, Kai Sukles, Koji Maeno, Huanyi Zhang, Paolo Verdecchia, Alexandros Gkotsis, Joe Pouzar, Philippe Berdagué, Edoardo Gronda, Olesya Rubanenko, Cristian Podoleanu, Mariano Ruiz Borret, Guillermo Llamas Esperon, Iveta Mintale, Hideki Shimomura, Dadong Zhang, Angelo Amato Vicenzo de Paola, Kenneth Butcher, Pascal Tessier, Minang Turakhia, Peter Svensson, Shabbir Reza, Herbert Pardell, Wilfried Lang, Holger Poppert, Alan Ackermann, Olivier Citerne, Emil Hayek, Yang Zheng, Jin bae Kim, Lorenzo Fácila, Tetsuo Hisadome, Li Sun, Panagiotis Vardas, Angel Grande, Piers Clifford, C. Zwaan van der, Nicki Law, Ilsbe Salecker, Steven Isserman, Shozo Tanaka, Dorothee B. Bartels, Yann Hemery, Susanna Cary, Mehiar El-Hamdani, Indira Natarajan, Miney Paquette, C. Wilson Sofley, Charles C. Gornick, Fu-Tien Chiang, Ellen Bøhmer, Hiroki Yamanoue, Toru Nakayama, Chakri Yarlagadda, Ciro Indolfi, Narendra Singh, Juan Carlos Nunez Fragoso, Eisho Kyo, Laurent Deluche, Andreas Götte, Stephen Phlaum, Jong Sung Park, Paresh Mehta, Terrence C. Hack, Fred Cucher, Olivier Dibon, Chia Theng Daniel Oh, Shannon Twiddy, Sean Connors, Edo Bottacchi, Beata Wożakowska-Kapłon, Ronald B. Goldberg, Jordi Bruguera, James J. Kmetzo, Jeanne Wei, John Kazmierski, Pilar Mazón, M Frais, Kazuya Kawai, Dimitrios Alexopoulos, Abayomi Osunkoya, Wanda Sudnik, Ramon Horacio Limon Rodriguez, William J. French, Ira Lieber, Rajesh Aggarwal, Stuart W. Zarich, John A. Puleo, David Cudmore, Jost Henner Wirtz, Ute Altmann, Kyung Tae Jung, Jennifer Litchfield, Jei Keon Chae, Rainer Dziewas, James Neiman, Karin Rybak, Galina Chumakova, Riccardo Pini, Richard Oliver, Benoit Lequeux, Athanasios J. Manolis, Luisa Fonseca, César A. Jardim, Katsuhiro Matsuda, Paul Hermany, Ming Luo, Ronnie Garcia, Oscar Pereira Dutra, John Culp, Amrit Pal Singh Takhar, Victor Howard, Oyidie Igbokidi, Kuo Yang Wang, Britta Goldmann, Thomas Walter, Mohamed K. Al-Obaidi, Antonio Pose, Christine Teutsch, Arthur J. Labovitz, Thomas Folk, Nell Wyatt, A. Huizenga, Benhur Henz, Konstantin Protasov, Petra Maskova, Ioannis Goudevenos, Kier Huehnergarth, Elena Kinova, Georgios Stergiou, Guohai Su, Hüseyin Ince, Chi Hung Huang, Winfried Haerer, Saad Al Ismail, Michael Gabris, Brian Carlson, Feng Liu, Yansheng Li, Luis Gustavo Gomes Ferreira, Radosław Lenarczyk, Ruben Omar Iza Villanueva, Nandkishore Ranadive, Yong Xu, Oscar Saenz Morales, Wayne Turner, Aleksey Khripun, Paul G. Grena, Yusuke Fujino, Abraham Salacata, Aleksandar Knezevic, Fouad Elghelbazouri, Hamid Bayeh, Mikhail Torosoff, Martin Cooper, Alenka Mavri, Marina Freydlin, Vassilios Vassilikos, Naresh Ranjith, Laurent Prunier, E. Hoffer, George Mitchell, Javier León Jiménez, S.S. Kabbani, Waldemar Krysiak, Emmanuel Nsah, John Ip, Charles B. Eaton, Jérome Thevenin, Dimitrios Chrysos, Asaad Bakbak, L. Steven Zukerman, Maria Grazia Bongiorni, Matthias von Mering, Lisa Alderson, Jean Joseph Muller, Yann Jamon, Roger Moore, Harinath Chandrashekar, Athanasios Pras, Venkatesh Nadar, B. J. Berg van den, Tomas Ripoll, Eric Van De Graaff, Patrick Dary, Peter L. Schwimmbeck, James Poock, Robert Schnitzler, Rohit Arora, Vuong DuThinh, Uwe Gremmler, Nuno Raposo, Chirag Sandesara, Ping Yen Bryan Yan, Junya Shite, Andrea Berz, Isabel Egocheaga, Karine Lavandier, Jose M. Teixeira, Ewart Jackson-Voyzey, Mayar Jundi, Ignacio Iglesias, Stephen Bloom, Hans Rickli, Rudolph Evonich, Giulio Molon, Vinay Shah, Salvador Bruno Valdovinos Chavez, Walter Ageno, Mauro Esteves Hernandes, Ali Ghanbasha, Stefan Regner, Luc De Wolf, Abdel El Hallak, Mohammad Shoukfeh, Francesco Musumeci, Pablo Andres Sepulveda Varela, Gershan Davis, Xianyan Jiang, Matthew Ebinger, Xiangdong Xu, Andreas Winkler, T. A. Simmers, Olivier Dascotte, Dominique Magnin, Karen Mahood, Carolina Guevara Caiedo, Zulu Wang, Hung-Fat Tse, John Camm, Didier Cadinot, Javier Aguila Marin, Juan Jose Olalla, Tamara Everington, Sherryn Roth, Feliz Alvaro Medina Palomino, Gregg Coodley, Wenhui Liu, G. Y. H. Lip, Ricky Ganim, Paul Ainsworth, Luiz Eduardo Fonteles Ritt, Yalin Liu, Sung Won Jang, Percy Berrospi, Dhananjai Menzies, Julien Pineau, Robert J. Jeanfreau, Hervé Buathier, John D. Osborne, Ted S. N. Lo, Li Fern Hsu, Xi Su, Beate Wild, Alvaro Rabelo Alves, Tomas Cieza-Lara, Neeraj Prasad, Yoshinori Seko, Jaydutt Patel, Malte Kuniss, Guy Chouinard, Jacek Morka, Frank Rubalcava, Fran Adams, Ignacio Rodriguez Briones, Vivek Sharma, Xinhua Wang, Amir Malik, Walid Amara, Adnan El Jabali, José Arturo Maldonado Villalon, Frederic Georger, Hong Ma, Steffen Schnupp, Nolan Mayer, Adam Sokal, Nasser Abdul, Gérald Phan Cao Phai, Jorge Hugo Blanco Ibaceta, Ramakrishnan Iyer, Yves Cottin, Barry Troyan, Achim Küppers, Anastas Stoikov, Jasjit Walia, Bruce Iteld, Abdul Alawwa, Christos Milonas, Frank Mibach, Mahfouz El Shahawy, H.William Stites, Neerav Shah, Clifford Ehrlich, Zia Ahmad, Furio Colivicchi, and Laszlo Karolyi

Subjects
medicine.medical_specialty, business.industry, Atrial fibrillation, 030204 cardiovascular system & hematology, medicine.disease, Dabigatran, 03 medical and health sciences, 0302 clinical medicine, Stroke prevention, Antithrombotic, Emergency medicine, medicine, In patient, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, Intensive care medicine, Prospective cohort study, business, Stroke, Fibrinolytic agent, medicine.drug
Abstract

Background: GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic t...

Published
2017

14. THE USE OF NON-INVASIVE MAPPING IN REPEAT ABLATIONS OF PERSISTENT AF

Author

Xu Gao, Rohit Malhotra, Oliver Monfredi, Pamela K. Mason, Andrew E. Darby, Kenneth C Bilchick, James M Mangrum, and Matt Schneck

Subjects
medicine.medical_specialty, business.industry, Non invasive, medicine, Radiology, Cardiology and Cardiovascular Medicine, business
Published
2021

15. Usefulness of Pharmacologic Conversion of Atrial Fibrillation During Dofetilide Loading Without the Need for Electrical Cardioversion to Predict Durable Response to Therapy

Author

John P. DiMarco, Kenneth C. Bilchick, and Rohit Malhotra

Subjects
Male, medicine.medical_specialty, Electric Countershock, Dofetilide, Article, Electrocardiography, Heart Rate, Recurrence, Interquartile range, Internal medicine, Atrial Fibrillation, Phenethylamines, Heart rate, medicine, Humans, Sinus rhythm, Retrospective Studies, Sulfonamides, medicine.diagnostic_test, business.industry, Proportional hazards model, Atrial fibrillation, Retrospective cohort study, Middle Aged, medicine.disease, Treatment Outcome, Anesthesia, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Anti-Arrhythmia Agents, Follow-Up Studies, medicine.drug
Abstract

Conversion of persistent atrial fibrillation (AF) to sinus rhythm is frequently seen during the 3-day in-hospital loading period required during dofetilide initiation, but it is not known whether pharmacologic conversion (PC) without the need for electrical cardioversion (EC) is a predictor of long-term maintenance of sinus rhythm during continued therapy with dofetilide. We sought to test the hypothesis that PC predicts durable maintenance of sinus rhythm and determine additional predictors of long-term maintenance of sinus rhythm on dofetilide. We retrospectively reviewed all elective inpatient admissions for dofetilide loading from 2003 to 2011 at the University of Virginia. A multivariate Cox proportional hazards model was used to assess predictors of maintenance of sinus rhythm after in-hospital dofetilide loading. In all, 101 patients with a current duration of AF lasting for a median of 1.86 months (interquartile range 0.47 to 6.03) were included in the analysis. Forty-seven patients were in the PC group, whereas 54 patients were in the EC group. Patients in the PC group remained longer in sinus rhythm compared with the patients in the EC group (log-rank p = 0.032). The seventy-fifth percentile for the current episode duration in the PC group was 5.77 months, indicating that even long-standing persistent AF frequently converted pharmacologically. Hypertension and a longer duration of the current AF episode were also predictors of recurrence in the multivariate model. In conclusion, PC during in-hospital dofetilide loading is an important predictor of durable response even in long-standing persistent patients, which has important public health implications for choice of therapy.

Published
2014

16. TCT-125 Evaluation of EKG-gated and Dual Source Accelerated Computed Tomography Imaging Protocols for Transcatheter Aortic Valve Sizing

Author

Mohamed Ahmed, Rohit Malhotra, Amartya Kundu, Nikolaos Kakouros, and Abdul Moiz Hafiz

Subjects
medicine.diagnostic_test, Transcatheter aortic, business.industry, medicine.medical_treatment, Computed tomography, Sizing, Volumetric reconstruction, Radiation exposure, Valve replacement, cardiovascular system, medicine, Dual source, Cardiology and Cardiovascular Medicine, business, Nuclear medicine
Abstract

Procedure success for Transcatheter aortic valve replacement (TAVR) relies heavily on volumetric reconstruction imaging, particularly of EKG-gated multi-detector computed tomography (MDCT). With emerging data supporting TAVR in younger and lower-risk patients, radiation exposure becomes a valid

Published
2018

17. TCT-537 Electrophysiological Complications With Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients: Evidence From a Meta-Analysis of Randomized Controlled Trials

Author

Partha Sardar, Amartya Kundu, Waqas Qureshi, Nikolaos Kakouros, and Rohit Malhotra

Subjects
medicine.medical_specialty, Randomized controlled trial, Aortic valve replacement, law, business.industry, Meta-analysis, medicine, Cardiology and Cardiovascular Medicine, business, medicine.disease, law.invention, Surgery
Published
2019

18. TCT-729 Short-Term Outcomes with Transcatheter vs. Surgical Aortic Valve Replacement in Low-Risk Patients: A Meta-Analysis of Randomized Controlled Trials

Author

Waqas Qureshi, Amartya Kundu, Nikolaos Kakouros, Partha Sardar, and Rohit Malhotra

Subjects
medicine.medical_specialty, Transcatheter aortic, business.industry, medicine.medical_treatment, Treatment options, medicine.disease, Surgery, law.invention, Valve replacement, Aortic valve replacement, Randomized controlled trial, law, Aortic valve stenosis, Meta-analysis, medicine, Cardiology and Cardiovascular Medicine, business
Abstract

Transcatheter aortic valve replacement (TAVR) is an established treatment option in high- and intermediate-risk patients with severe aortic valve stenosis (AS). There are fewer data regarding the efficacy of TAVR in low-risk patients. We performed a meta-analysis to evaluate the short-term efficacy

Published
2019

20. OUTCOMES OF ISCHEMIC TESTING PRIOR TO ABLATION FOR SUSTAINED MONOMORPHIC VENTRICULAR TACHYCARDIA

Author

Andrew E. Darby, John D. Ferguson, Kenneth C Bilchick, Christopher Schumann, James M Mangrum, John P. DiMarco, Pamela K. Mason, Evan Harmon, Nishaki Mehta, and Rohit Malhotra

Subjects
medicine.medical_specialty, Monomorphic Ventricular Tachycardia, business.industry, Internal medicine, medicine.medical_treatment, Cardiology, Medicine, Cardiology and Cardiovascular Medicine, business, Ablation
Published
2019

21. A RARE CASE OF ST ELEVATION MYOCARDIAL INFARCTION (STEMI) SECONDARY TO EXTENSIVE THROMBOEMBOLISM

Author

Matthew E McGuiness, Bryan Dolan, Adedotun Ogunsua, Jorge Escobar, and Rohit Malhotra

Subjects
medicine.medical_specialty, business.industry, Chest pain, Embolic event, surgical procedures, operative, St elevation myocardial infarction, Internal medicine, Rare case, medicine, Cocaine use, Cardiology, Treatment strategy, In patient, cardiovascular diseases, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract

While management of STEMI is well-defined, there are no clear guidelines regarding treatment strategies in patients found to have a STEMI secondary to an embolic event. A 43-year-old man with recent cocaine use presented with chest pain and dyspnea. The initial electrocardiogram (EKG) showed

Published
2019

22. LONG-TERM MORTALITY WITH MULTIVESSEL VERSUS CULPRIT-LESION-ONLY PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AND CARDIOGENIC SHOCK: INSIGHTS FROM AN UPDATED META-ANALYSIS

Author

Amartya Kundu, Partha Sardar, Nikolaos Kakouros, Rohit Malhotra, and Daniel Z. Fisher

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Cardiogenic shock, Percutaneous coronary intervention, medicine.disease, Meta-analysis, Culprit lesion, Internal medicine, Cardiology, Medicine, Long term mortality, In patient, Myocardial infarction, Cardiology and Cardiovascular Medicine, business
Published
2019

23. MYOPERICARDITIS IN THE SETTING OF CLASSIC ACUTE GRAFT VERSUS HOST DISEASE (GVHD): A RARE COMPLICATION

Author

Rohit Malhotra, Summer Aldrugh, and Seth T. Dahlberg

Subjects
medicine.medical_specialty, Vincristine, Cyclophosphamide, business.industry, medicine.disease, Gastroenterology, surgical procedures, operative, Graft-versus-host disease, immune system diseases, hemic and lymphatic diseases, Internal medicine, Acute graft versus host disease, medicine, Stem cell, Cardiology and Cardiovascular Medicine, business, Complication, Dexamethasone, medicine.drug, Myopericarditis
Abstract

Graft versus Host Disease (GvHD) is a serious complication of allogenic stem cell transplant (SCT). Although cardiac involvement is rare, outcomes are poor with mortality as high as 43%. A 25 yo male with ALL status post Hyper-CVAD (cyclophosphamide, Vincristine, Adriamycin, Dexamethasone) and SCT

Published
2019

24. Cost of a Recall of a Single-Center Experience Managing the Riata Defibrillator Lead

Author

Kenneth C. Bilchick, Liza P. Moorman, John D. Ferguson, J. Michael Mangrum, John P. DiMarco, Rohit Malhotra, J. Randall Moorman, Andrew E. Darby, Pamela K. Mason, and Sarah K. Hussain

Subjects
Male, Medical Device Recalls, medicine.medical_specialty, Single Center, Article, Internal medicine, medicine, Lead failure, Humans, Defibrillator lead, Lead (electronics), Retrospective Studies, Recall, United States Food and Drug Administration, business.industry, Mechanical failure, Retrospective cohort study, Equipment Design, United States, Defibrillators, Implantable, Surgery, Increased risk, Emergency medicine, Costs and Cost Analysis, Cardiology, Equipment Failure, Female, Cardiology and Cardiovascular Medicine, business
Abstract

Riata and Riata ST defibrillator leads (St. Jude Medical, Sylmar, California) were recalled in 2011 due to increased risk of insulation failure leading to externalized cables. Fluoroscopic screening can identify insulation failure, although the relation between mechanical failure and electrical failure is unclear. At the time of the recall, the University of Virginia developed a screening program, including fluoroscopic evaluation, education sessions, device interrogation, and remote monitoring for patients with this defibrillator lead. The aim of this study was to review the outcomes of the screening program, including costs, which were absorbed by our institution. Costs were calculated using Medicare reimbursement estimates. Forty-eight patients participated in the screening program. At initial screening, 31% were found to have evidence of insulation failure but electrical function was normal in all leads. The cost of this program was $35,358.72. The cost per diagnosis of mechanical lead failure was $2,357.25. During 2 years of follow-up, 1 patient experienced Riata lead electrical failure without fluoroscopic evidence of insulation failure. Patients were more likely to have a lead revision if there was evidence of insulation failure. Lead revisions occurred at the time of generator change in 88% of patients with insulation failure but in only 14% of patients with a fluoroscopically normal lead (p = 0.04). The cost of recall-related defibrillator lead revisions was $81,704.55. In conclusion, our Riata screening program added expense without clear benefit to patients. In fact, patients may have been put at more risk by undergoing defibrillator lead revisions based solely on the results of the fluoroscopic screening.

Published
2015

25. Cardiovascular Screening and the Elite Athlete: Advances, Concepts, Controversies, and a View of the Future

Author

Robert W. Battle, John M. MacKnight, Dilaawar J. Mistry, Rohit Malhotra, Ethan N. Saliba, and Srijoy Mahapatra

Subjects
medicine.medical_specialty, Medical education, biology, Athletes, business.industry, education, Alternative medicine, Physical Therapy, Sports Therapy and Rehabilitation, Cardiomyopathy, Hypertrophic, biology.organism_classification, Electrocardiography, Death, Sudden, Cardiac, Elite, medicine, Physical therapy, Humans, Mass Screening, Recreational sports, Orthopedics and Sports Medicine, Elite athletes, Sports activity, business, human activities
Abstract

This article addresses programmatic cardiovascular screening and evaluation of the elite athlete at the intercollegiate, national team, professional, and Olympic levels. Although much of this content may apply to high-school and recreational sports at large, it is not specifically designed to address athletes participating in all sports activities.

Published
2011

26. Cost and yield of adding electrocardiography to history and physical in screening Division I intercollegiate athletes: A 5-year experience

Author

Rohit Malhotra, Robert W. Battle, J. Jason West, John P. DiMarco, Dilaawar J. Mistry, Christopher M. Kramer, Max Luna, John M. Dent, J. Paul Mounsey, Ethan N. Saliba, Srijoy Mahapatra, John M. MacKnight, and Benjamin Rose

Subjects
Adult, Male, medicine.medical_specialty, Heart Diseases, Ventricular tachycardia, Electrocardiography, Bicuspid aortic valve, Physiology (medical), Internal medicine, medicine, Humans, Mass Screening, cardiovascular diseases, Medical History Taking, Physical Examination, Ejection fraction, biology, medicine.diagnostic_test, Athletes, business.industry, Hypertrophic cardiomyopathy, Atrial fibrillation, medicine.disease, biology.organism_classification, Cardiology, Female, Supraventricular tachycardia, Cardiology and Cardiovascular Medicine, business
Abstract

Background Electrocardiographic screening of intercollegiate athletes is controversial because the costs and yield are not well defined. Both the American Heart Association (AHA) and the European Society of Cardiology (ESC) have different criteria for screening, partly because the populations being screened are different. Objective The purpose of this study was to determine the cost and yield of a 5-year ECG screening program at a United States Division I college. Methods At the University of Virginia, all 1,473 competitive athletes over the course of 5 years were screened with history and physical and with ECGs using ESC guidelines with follow-up testing as dictated by clinical symptoms and ECG findings. Results History and physical alone uncovered five significant cardiac abnormalities. ECGs were abnormal in 275 (19%), resulting in 359 additional tests. Additional testing confirmed eight significant cardiac abnormalities that were not found by history and physical: 1 bicuspid aortic valve, 4 rapidly conducting accessory pathways, 1 long QT patient, 1 with frequent premature ventricular contractions and low ejection fraction, and 1 with frequent premature ventricular contractions but normal ejection fraction. No cases of hypertrophic cardiomyopathy were found. Total cost of the program was US $894,870. Cost of history and physical screening alone was $343,725 or $68,745 per finding. The marginal cost of adding ECG screening, including resulting tests and procedures. was US$551,145 or US$68,893 per additional finding. Conclusion ECG screening of U.S. college athletes can uncover significant cardiac pathology not discovered by history and physical alone. Although ECG screening also results in many false positives resulting in additional tests, the overall cost per diagnosis of adding ECG screening is similar to that of history and physical screening alone.

Published
2011

27. RENAL ARTERY STENOSIS CAUSING RENAL DYSFUNCTION AND HEART FAILURE, CONFOUNDED BY SEVERE AORTIC STENOSIS

Author

Rohit Malhotra and Alvaro Alonso

Subjects
medicine.medical_specialty, animal structures, Ejection fraction, business.industry, medicine.disease, Renal artery stenosis, body regions, Stenosis, Pedal Edema, Heart failure, Internal medicine, cardiovascular system, Cardiology, Medicine, cardiovascular diseases, Cardiology and Cardiovascular Medicine, business, Kidney disease
Abstract

An 82 year old female with uncontrolled hypertension and chronic kidney disease presented with symptoms of heart failure (HF). Examination was significant for an aortic stenosis (AS) murmur, distended jugular veins and pedal edema. Echocardiography showed preserved ejection fraction and severe AS (

Published
2018

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