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251. TEMPORAL TRENDS IN ALL-CAUSE MORTALITY OF SMOKERS VERSUS NON-SMOKERS HOSPITALIZED WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION IN A REAL WORLD SETTING DECADE-LONG OUTCOMES FROM THE ACUTE CORONARY SYNDROME ISRAELI SURVEY (ACSIS) 2000-2010

Author

Arbel, Yaron, primary, Matetzky, Shlomi, additional, Gavrielov-Yusim, Natalie, additional, Keren, Gad, additional, Roth, Arie, additional, Kopel, Eran, additional, Finkelstein, Ariel, additional, Banai, Shmuel, additional, Klempfner, Robert, additional, and Goldenberg, Ilan, additional

Published
2014
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252. CRT-155 Forced Diuresis with Matched Hydration Using the Renalguard ® System for the Prevention of Contrast Induced Acute Kidney Injury - A Single Center Experience

Author

Ben-Assa, Eyal, primary, Arbel, Yaron, additional, Rofe, Meital, additional, Shacham, Yacov, additional, Konigstein, Maayan, additional, Havakuk, Ofer, additional, Leshem-Rubinow, Eran, additional, Halkin, Amir, additional, Finkelstein, Ariel, additional, Keren, Gad, additional, and Banai, Shmuel, additional

Published
2014
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254. Dynamics of functional mitral regurgitation during dobutamine therapy in patients with severe congestive heart failure: a Doppler echocardiographic study

Author

Keren, Gad, Laniado, Shlomo, Sonnenblick, Edmund H., and Lejemtel, Thierry H.

Subjects
Doppler ultrasonography -- Usage, Echocardiography -- Usage, Congestive heart failure -- Physiological aspects, Mitral valve insufficiency -- Measurement, Dobutamine -- Physiological aspects, Dobutamine -- Health aspects, Health
Abstract

Mitral regurgitation is the backwards flow of blood into the left atrium during the contraction of the ventricles. It is obvious that the more effective heartbeat is one with less blood regurgitating and more being forced into the arterial system. Indeed, investigators have shown that a significant portion of the effectiveness of vasodilating drugs in the treatment of congestive heart failure comes from the reduction of mitral regurgitation. From a physiological standpoint, the amount of regurgitated blood should depend upon the duration of the regurgitation, the area of opening through which the regurgitation occurs, and the pressure difference between the ventricle and the atrium. Since inotropic drugs, which are used to potentiate the contraction of the heart muscle in patients with congestive heart failure, actually increase the pressure difference between the chambers, the mitral regurgitation could actually increase, at least in principle. To examine what happens to mitral regurgitation in patients with congestive heart failure when treated with an inotropic drug, dobutamine, Doppler and echocardiography were used to measure the blood flow through the heart, including mitral regurgitation. As anticipated, an increase in the pressure difference between the atrium and the ventricle was observed. However, the volume of blood regurgitated through the mitral valve dropped from 20 to 10 milliliters per beat. The drop in the regurgitation was accounted for by a halving of the effective area of the mitral valve opening through which the blood flowed, from 0.25 to 0.12 square centimeters. The results indicate an overall improvement in the circulation resulting from the treatment with dobutamine. (Consumer Summary produced by Reliance Medical Information, Inc.)

Published
1989

255. Effect of isometric exercise on cardiac performance and mitral regurgitation in patients with severe congestive heart failure

Author

Keren, Gad, Katz, Stuart, Gage, Joseph, Strom, Joel, Sonnenblick, Edmund H., and LeJemtel, Thierry

Subjects
Heart failure -- Research, Mitral valve -- Abnormalities, Isometric exercise -- Physiological aspects, Congestive heart failure, Health
Abstract

Congestive heart failure (CHF) results from inability of the heart to pump blood effectively; this loss of function may develop following a heart attack or with other cardiac conditions. CHF may be temporary or chronic, and symptoms include weakness, shortness of breath, and edema. Cardiac performance, or heart function, was evaluated in 17 patients with severe, chronic CHF. The effect of an isometric hand-grip exercise on cardiac indices was measured. Results showed that during exercise, blood pressure in the arteries rose but the heart was unable to increase the amount of blood pumped (cardiac output) as a normal heart would. Cardiac output actually decreased, apparently because the heart muscle could not contract sufficiently to match the increased resistance in the arteries. While these CHF patients exercised, mitral regurgitation (the backflow of blood from the left ventricle to the left atrium) became significantly worse. The mitral valve in the heart is a small flap that alternately covers and uncovers the passageway between the two left chambers of the heart and affects blood flow. Abnormal blood flow is usually related to improper closure of the mitral valve. These findings suggest that MR is variable in patients with severe CHF; it is exacerbated by isometric exercise and improves with rest. Treatments that can match cardiac output to arterial pressure, thereby reducing 'cardiac afterload', may help minimize mitral regurgitation in CHF patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Published
1989

256. Relation of subclinical serum creatinine elevation to adverse in-hospital outcomes among myocardial infarction patients

Author

Margolis, Gilad, Gal-Oz, Amir, Khoury, Shafik, Keren, Gad, and Shacham, Yacov

Abstract

Background: Acute kidney injury is associated with adverse outcomes after acute ST elevation myocardial infarction (STEMI). It remains unclear, however, whether subclinical increase in serum creatinine that does not reach the consensus criteria for acute kidney injury is also related to adverse outcomes in STEMI patients undergoing primary percutaneous coronary intervention.Methods: We conducted a retrospective study of 1897 consecutive STEMI patients between January 2008 and May 2016 who underwent primary percutaneous coronary intervention, and in whom acute kidney injury was not diagnosed throughout hospitalization. We investigated the incidence of subclinical acute kidney injury (defined as serum creatinine increase of ≥ 0.1 and < 0.3 mg/dl) and its relation to a composite end point of adverse in hospital outcomes.Results: Subclinical acute kidney injury was detected in 321 patients (17%). Patients with subclinical acute kidney injury had increased rate of the composite end point of adverse in-hospital events (20.3% vs. 9.7%, p<0.001), a finding which was independent of baseline renal function. Individual components of this end point (occurrence of heart failure, atrial fibrillation, need for mechanical ventilation and in-hospital mortality) were all significantly higher among patients with subclinical acute kidney injury (p< 0.05 for all). In a multivariable regression model subclinical acute kidney injury was independently associated with higher risk for adverse in-hospital events (odds ratio 1.92.6, 95% confidence interval: 1.23–2.97, p=0.004).Conclusions: Among STEMI patients treated with primary percutaneous coronary intervention, small, subclinical elevations of serum creatinine, while not fulfilling the consensus criteria for acute kidney injury, may serve as a significant biomarker for adverse outcomes.

Published
2018
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257. Aortic Stenosis with Severe Tricuspid Regurgitation: Comparative Study between Conservative Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement Combined With Tricuspid Repair

Author

Rozenbaum, Zach, Granot, Yoav, Steinvil, Arie, Banai, Shmuel, Finkelstein, Ariel, Ben-Gal, Yanai, Keren, Gad, and Topilsky, Yan

Abstract

Severe aortic stenosis (AS) and severe tricuspid regurgitation (TR) may coexist. The aim of this study was to determine the change in right ventricular (RV) function and TR after surgical aortic valve replacement combined with tricuspid valve repair (SAVR+TVr), transcatheter aortic valve replacement (TAVR), or conservative management and compare outcomes dependent on RV functional parameters and treatment allocation.

Published
2018
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259. Acute kidney injury based on the KDIGO criteria among ST elevation myocardial infarction patients treated by primary percutaneous intervention

Author

Margolis, Gilad, Gal-Oz, Amir, Letourneau-Shesaf, Sevan, Khoury, Shafik, Keren, Gad, and Shacham, Yacov

Abstract

Acute kidney injury (AKI) following acute ST elevation myocardial infarction (STEMI) is associated with adverse outcomes. The recently proposed KDIGO criteria suggested modifications to the consensus classification system for AKI, namely lowering the threshold of increase in absolute serum creatinine and extending the time frame for AKI detection to 7 days. We evaluated the incidence, risk factors, and long-term mortality associated with AKI as classified by the KDIGO definition in a large single center cohort of consecutive STEMI patients. We retrospectively studied 2122 consecutive STEMI patients undergoing primary percutaneous coronary intervention (PCI). Recruited patients were admitted between January 2008 and May 2016 to the cardiac intensive care unit with the diagnosis of acute STEMI. We compared the utilization of the KDIGO and consensus criteria for the diagnosis of AKI and its relation to long term mortality. The KDIGO criteria allowed the identification of more patients as having AKI (10.6 vs. 5.6%, p < 0.001) compared to the consensus criteria. Even mild elevation of serum creatinine (≥ 0.3 mg/dL) was associated with a marked increase in all-cause mortality (HR 4.7, 95% CI 3.1–6.43, p < 0.001). Patients with AKI whose renal function resolved prior to hospital discharge still had significantly higher mortality compared to patients with no AKI (23 vs. 8%, HR 3.1, 95% CI 2.09–4.90, p < 0.001). KDIGO criteria is more sensitive than the consensus criteria in defining AKI in STEMI patients and identifying populations at risk for long term adverse outcomes.

Published
2018
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260. Clinical Outcome of Isolated Tricuspid Regurgitation in Patients with Preserved Left Ventricular Ejection Fraction and Pulmonary Hypertension

Author

Bar, Nir, Schwartz, Lorin Arie, Biner, Simon, Aviram, Galit, Ingbir, Meirav, Nachmany, Ido, Margolis, Gilad, Sadeh, Ben, Barashi, Rami, Keren, Gad, and Topilsky, Yan

Abstract

The outcome of tricuspid regurgitation (TR) remains unclear because of heterogeneity of etiology and the contradictory results of outcome studies. The aim of this study was to evaluate the clinical outcomes of TR in patients with pulmonary hypertension (PH) and normal left systolic function, stratified to patients with post- or precapillary PH.

Published
2018
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263. Usefulness of Updated Valve Academic Research Consortium–2 Criteria for Acute Kidney Injury Following Transcatheter Aortic Valve Implantation

Author

Konigstein, Maayan, primary, Ben-Assa, Eyal, additional, Abramowitz, Yigal, additional, Steinvil, Arie, additional, Leshem Rubinow, Eran, additional, Havakuk, Ofer, additional, Arbel, Yaron, additional, Halkin, Amir, additional, Keren, Gad, additional, Banai, Shmuel, additional, and Finkelstein, Ariel, additional

Published
2013
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264. Abstract 18354: Chronic Pressure-Dependent Cardiac Unloading With a Novel Intra-Atrial Shunt (V-Wave Device) in an Ovine Model of Ischemic Heart Failure: Evidence for Shunt-mediated Improvements in Function and Survivability

Author

del Rio, Carlos L, primary, McConnell, Patrick I, additional, Nitzan, Yaacov, additional, Ueyama, Yukie, additional, Kloepfer, Pamela, additional, Youngblood, Bradley L, additional, George, Robert, additional, Jacoby, Meni, additional, Hamlin, Robert L, additional, Oz, Orna, additional, Keren, Gad, additional, Verheye, Stefan, additional, and Abraham, William T, additional

Published
2013
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271. Radiation dose of patients undergoing transcatheter aortic valve implantation: A comparison between edwards SAPIEN XT and medtronic corevalve aortic valve prostheses

Author

Steinvil, Arie, primary, Aviram, Galit, additional, Konigstein, Maayan, additional, Abramowitz, Yigal, additional, Halkin, Amir, additional, Arbel, Yaron, additional, Ben‐Gal, Yanai, additional, Keren, Gad, additional, Banai, Shmuel, additional, and Finkelstein, Ariel, additional

Published
2013
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272. Platelet Inhibitory Effect of Clopidogrel in Patients Treated With Omeprazole, Pantoprazole, and Famotidine: A Prospective, Randomized, Crossover Study

Author

Arbel, Yaron, primary, Birati, Edo Y., additional, Finkelstein, Ariel, additional, Halkin, Amir, additional, Kletzel, Hanna, additional, Abramowitz, Yigal, additional, Berliner, Shlomo, additional, Deutsch, Varda, additional, Herz, Itzhak, additional, Keren, Gad, additional, and Banai, Shmuel, additional

Published
2013
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275. ACUTE KIDNEY INJURY FOLLOWING TRANSCATHETER AORTIC VALVE IMPLANTATION USING BOTH EDWARDS SAPIEN XT AND COREVALVE BIOPROSTHESIS: IMPLEMENTATION OF THE UPDATED VARC–2 CRITERIA

Author

Havakuk, Ofer, primary, Ben–Assa, Eyal, additional, Konigstein, Maayan, additional, Abramowitz, Yigal, additional, Steinvil, Arie, additional, Leshem–Rubinow, Eran, additional, Halkin, Amir, additional, Keren, Gad, additional, Banai, Shmuel, additional, and Finkelstein, Ariel, additional

Published
2013
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281. Erythrocyte aggregation portends worse outcomes in unstable angina patients undergoing percutaneous coronary interventions

Author

Steinvil, Arie, primary, Arbel, Yaron, additional, Leshem-Rubinow, Eran, additional, Halkin, Amir, additional, Keren, Gad, additional, Revivo, Miri, additional, Finkelstein, Ariel, additional, Cohen, Merav, additional, Tal, Ruth, additional, Aviram, Galit, additional, Berliner, Shlomo, additional, and Banai, Shmuel, additional

Published
2013
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282. Left atrial appendage and pulmonary artery anatomic relationship by cardiac-gated computed tomography: Implications for late pulmonary artery perforation by left atrial appendage closure devices.

Author

Halkin, Amir, Cohen, Clara, Rosso, Raphael, Chorin, Ehud, Schnapper, Michael, Biner, Simon, Topilsky, Yan, Shiran, Avinoam, Shmilovich, Haim, Cohen, Dotan, Keren, Gad, Banai, Shmuel, and Aviram, Galit

Abstract

Background: Delayed pulmonary artery (PA) perforation and tamponade caused by implantable left atrial appendage (LAA) closure devices has been reported in patients with close proximity between these structures. The LAA and PA anatomic relationship (LAA-PAar) has not been analyzed systematically.Objective: The purpose of this study was to identify LAA-PAar variants potentially susceptible to this complication using cardiac-gated computed tomography angiography.Methods: We studied 100 consecutive patients with atrial fibrillation undergoing cardiac-gated computed tomography angiography of the left atrium. The LAA-PAar was classified into 3 types on the basis of the location, length, and thickness of the segment of contact between the PA and/or its branches and the LAA: type 1, no contact; type 2, contact involving the proximal LAA (defined as the proximal 15 mm extending into the LAA from its ostium, or the LAA proximal to the first major bend arising <15 mm from the ostium); and type 3, contact limited to the distal LAA.Results: LAA-PAar types 1, 2, and 3 were present in 7 (7%), 28 (28%), and 65 (65%) patients, respectively. For LAA-PAar type 2, the mean contact segment thickness and length were 0.6 ± 0.3 and 18.1 ± 10.6 mm, respectively. For LAA-PAar type 3, the distance between the LAA orifice and the segment of contact was <30 mm in 52 patients (80%).Conclusion: In this series, the LAA came in direct contact with the main PA in the majority of patients. Contact involved the proximal LAA (where the fixation components of most LAA closure devices are positioned) in 28% of patients, posing potential vulnerability to PA perforation. [ABSTRACT FROM AUTHOR]

Published
2016
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284. HbA1c Levels and Long-Term Mortality in Patients Undergoing Coronary Angiography.

Author

Havakuk, Ofer, Banai, Shmuel, Halkin, amir, Konigstein, Maayan, Ben assa, Eyal, Berliner, Shlomo, Ziv-Baran, Tomer, Elbaz, Meital, Revivo, Miri, Keren, Gad, Finkelstein, ariel, and arbel, Yaron

Subjects
CORONARY angiography, BIOMARKERS, INFLAMMATION, CARDIOVASCULAR diseases risk factors, ANEMIA
Abstract

Objectives: Previous studies investigating the prognostic value of HbA1c in patients undergoing coronary angiography reported a mixed pattern of results. Therefore, we aimed to better define the prognostic power of HbA1c among coronary catheterized patients. Methods: Patients undergoing coronary angiography (n = 3,749) were divided into four groups according to HbA1c levels (<5,5-6,6-7 and >7%). Cox regression models assessed long-term mortality after adjusting for multiple covariates. Results: Baseline clinical profiles differed in HbA1c groups, with a higher prevalence of comor-bidities in the groups with higher HbA1c levels. Median follow-up was 1,745 days (interquartile range 1,007-2,171). A J-shaped association curve was observed between HbA1c levels and all-cause mortality rates, with patients in the lowest and highest HbA1c groups suffering from significantly higher mortality rates compared to in-between groups (hazard ratio 1.9, 95% CI 1.32-2.74, p = 0.001, and hazard ratio 1.58,95% CI 1.29-1.95, p < 0.001, for the lowest and highest HbA1c groups, respectively). This association persisted after adjustmentforanemia, nutritional status, renal function, cardiovascular risk factors and inflammatory biomarkers. Conclusions: HbA1c levels <5 or >7% are predictors of all-cause mortality in patients undergoing coronary angiography. [ABSTRACT FROM AUTHOR]

Published
2016
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286. High red blood cell distribution width is associated with the metabolic syndrome.

Author

Perl, Michal Laufer, Havakuk, Ofer, Finkelstein, Ariel, Halkin, Amir, Revivo, Miri, Elbaz, Meital, Herz, Itzhak, Keren, Gad, Banai, Shmuel, and Arbel, Yaron

Subjects
ERYTHROCYTES, METABOLIC syndrome, INFLAMMATION, CARDIOVASCULAR diseases, DEATH
Abstract

OBJECTIVES: High values of Red Blood Cell Distribution Width (RDW) have been associated with adverse outcome in various clinical settings. The mechanism behind this association is not clear. The Metabolic Syndrome (MetS) is a chronic inflammatory disorder that increases the risk for cardiovascular disease and death. The aim of our study was to evaluate the association between high RDW and the MetS in a relatively large cohort of patients. METHODS: A cohort of 3,529 consecutive patients undergoing coronary angiography was used to evaluate the association between RDWand the MetS. The association was assessed by using a logistic regression. Cox's regression analysis was used to evaluate the impact of RDW on long term mortality. RESULTS: The mean age was 65 years (range 24-97), with 27% women. Overall, 30% were diagnosed with metabolic syndrome. The prevalence of MetS was 29% in patients with RDW<14% and 34% in patients with RDW≥14% (P = 0.003). Using multivariate analysis, RDW values above 14% were independently associated with MetS (odds ratio 1.2 [95% CI 1.0-1.4], P = 0.043). Among all the criteria of the metabolic syndrome, hypertension, elevated glucose levels and abdominal obesity were associated with high RDW, with hypertension being the strongest criteria, with an increased risk of 1.8 fold ([95% CI 1.5-2.1]; P = 0.001). During follow up (1614±709 days, 2-2763 days), long term mortality was 8% in the low RDW group and 28% in the high RDW group (p < 0.001). CONCLUSION: RDW≥14% is independently associated with higher rates of metabolic syndrome and long-term all-cause mortality. [ABSTRACT FROM AUTHOR]

Published
2016
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287. Differential Effects of Colchicine on Cardiac Cell Viability in an in vitro Model Simulating Myocardial Infarction.

Author

Margolis, Gilad, Hertzberg-Bigelman, Einat, Levy, Ran, Ben-Shoshan, Jeremy, Keren, Gad, and Entin-Meer, Michal

Subjects
MYOCARDIAL infarction, CORONARY disease, HEART cells, COLCHICINE, APOPTOSIS
Abstract

Objectives: We aimed to examine the effects of colchicine, currently in clinical trials for acute myocardial infarction (AMI), on the viability of cardiac cells using a cell line model of AMI. Methods: HL-1, a murine cardiomyocyte cell line, and H9C2, a rat cardiomyoblast cell line, were incubated with TNFa or sera derived from rats that underwent AMI or sham operation followed by addition of colchicine. In another experiment, HL-1/H9C2 cells were exposed to anoxia with or without subsequent addition of colchicine. Cell morphology and viability were assessed by light microscopy, flow cytometry and Western blot analyses for apoptotic markers. Results: Cellular viability was similar in both sera; however, exposing both cell lines to anoxia reduced their viability. Adding colchicine to anoxic H9C2, but not to anoxic HL-1, further increased their mortality, at least in part via enhanced apoptosis. Under any condition, colchicine induced detachment of H9C2 cells from their culture plates. This phenomenon did not apply to HL-1 cells. Conclusions: Colchicine enhanced cardiomyoblast mortality under in vitro conditions mimicking AMI and reduced their adherence capability. HL-1 was not affected by colchicine; nevertheless, no salvage effect was observed. We thus conclude that colchicine may not inhibit myocardial apoptosis following AMI. [ABSTRACT FROM AUTHOR]

Published
2016
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292. Islet-1 gene delivery improves myocardial performance after experimental infarction

Author

Barzelay, Aya, primary, Hochhauser, Edith, additional, Entin-Meer, Michal, additional, Chepurko, Yelena, additional, Birk, Einat, additional, Afek, Arnon, additional, Barshack, Iris, additional, Pinhas, Lidya, additional, Rivo, Yulia, additional, Ben-Shoshan, Jeremy, additional, Maysel-Auslender, Sofia, additional, Keren, Gad, additional, and George, Jacob, additional

Published
2012
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