100 results on '"Leya, F"'
Search Results
2. Outcomes of ST-Elevation Myocardial Infarction due to spontaneous coronary artery dissection: a nationwide cohort sample
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Elkaryoni, A, primary, Klappa, A, additional, Doukas, D, additional, Luke, D, additional, John, A, additional, Allen, S, additional, Bakir, M, additional, Leya, F, additional, Lewis, B, additional, Darki, A, additional, Lopez, J, additional, and Steen, L, additional
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- 2021
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3. Treatment of unprotected left main coronary artery stenosis with a drug eluting stent in a heart transplant patient with allograft vasculopathy
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Matos, G, Steen, L, and Leya, F
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- 2005
4. Everolimus-eluting stents or bypass surgery for left main coronary artery disease
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Stone, Gw, Sabik, Jf, Serruys, Pw, Simonton, Ca, Généreux, P, Puskas, J, Kandzari, De, Morice, Mc, Lembo, N, Brown WM 3rd, Taggart, Dp, Banning, A, Merkely, B, Horkay, F, Boonstra, Pw, van Boven AJ, Ungi, I, Bogáts, G, Mansour, S, Noiseux, N, Sabaté, M, Pomar, J, Hickey, M, Gershlick, A, Buszman, P, Bochenek, A, Schampaert, E, Pagé, P, Dressler, O, Kosmidou, I, Mehran, R, Pocock, Sj, Kappetein, Ap, van Es GA, Leon, Mb, Gersh, B, Chaturvedi, S, Kint, Pp, Valgimigli, M, Colombo, A, Costa, M, Di Mario, C, Ellis, S, Fajadet, J, Fearon, W, Kereiakes, D, Makkar, R, Mintz, Gs, Moses, Jw, Teirstein, P, Ruel, M, Sergeant, P, Mack, M, Fontana, G, Mohr, Fw, Nataf, P, Smith, C, Boden, B, Fox, K, Maron, D, Steg, G, Blackstone, E, Juni, P, Parise, H, Wallentin, L, Bertrand, M, Krucoff, M, Turina, M, Ståhle, E, Tijssen, J, Brill, D, Atkins, C, Applegate, B, Argenziano, M, Faly, Rc, Dauerman, H, Davidson, C, Griffith, B, Reisman, M, Rizik, D, Sakwa, M, Shemin, R, Romano, M, Hamm, C, Gummert, J, Tamburino, C, Alfieri, O, Savina, C, de Bruyne, B, Machado, Fp, Uva, S, Moccetti, T, Siclari, F, Hildick Smith, D, Szekely, L, Erglis, A, Stradins, P, Abizaid, A, Bento Sousa LC, Belardi, J, Navia, D, Park, Sj, Lee, Jw, Meredith, I, Smith, J, Yehuda, Ob, Schneijdenberg, R, Ronden, J, Jonk, J, Jonkman, A, van Remortel, E, de Zwart, I, Elshout, L, de Vries, T, Andreae, R, Tol van, J, Teurlings, E, Balachandran, S, Breazna, A, Jenkins, P, Mcandrew, T, Marx, So, Connolly, Mw, Hong, Mk, Weinberger, J, Wong, Sc, Dizon, J, Biviano, A, Morrow, J, Wang, D, Corral, M, Alfonso, M, Sanchez, R, Wright, D, Djurkovic, C, Lustre, M, Jankovic, I, Sanidas, E, Lasalle, L, Maehara, A, Matsumura, M, Sun, E, Iacono, S, Greenberg, T, Jacobson, J, Pullano, A, Gacki, M, Liu, S, Cohen, Dj, Magnuson, E, Baron, Sj, Wang, K, Traylor, K, Worthley, S, Stuklis, R, Barbato, E, Stockman, B, Dubois, C, Meuris, B, Vrolix, M, Dion, R, Bento de Souza LC, Costantini, C, Woitowicz, V, Hueb, W, Stolf, N, Beydoun, H, Baskett, R, Curtis, M, Kieser, T, Doucet, S, Pellerin, M, Hamburger, J, Cook, R, Kutryk, M, Peterson, M, Madan, M, Fremes, S, Mehta, S, Cybulsky, I, Prabhakar, M, Peniston, C, Welsh, R, Macarthur, R, Berland, J, Bessou, Jp, Carrié, D, Glock, Y, Darremont, O, Deville, C, Grimaud, Jp, Soula, P, Lefèvre, T, Maupas, E, Durrleman, N, Silvestri, M, Houel, R, Pratt, A, Francis, J, Van Belle, E, Vicentelli, A, Luchner, A, Hilker, M, Endemann, Dh, Felix, S, Wollert, Hg, Walther, T, Erbel, R, Jacob, H, Kahlert, P, Kupatt, C, Näbauer, M, Schmitz, C, Scholtz, W, Börgermann, J, Schuler, G, Borger, M, Davierwala, P, Fontos, G, Székely, L, Bedogni, F, Panisi, P, Berti, S, Glauber, M, Marzocchi, A, Di Bartolomeo, R, Merlo, M, Guagliumi, G, Fenili, F, Napodano, M, Gerosa, G, Ribichini, F, Faggian, Giuseppe, Saccà, S, Giacomin, A, Mignosa, C, Tumscitz, C, Savini, C, Van Mieghem, N, von Birgelen, C, Grandjean, J, Kubica, J, Anisimowicz, L, Zmudka, K, Sadowski, J, Hernández García, J, Such, M, Macaya, C, Rodríguez Hernández JE, Maroto, L, Serra, A, Padro, J, Tenas, Ms, De Souza, A, Egred, M, Clark, S, Trivedi, U, Jain, A, Uppal, R, Redwood, S, Young, C, Stables, Rh, Pullan, M, Uren, N, Pessotto, R, Abu Fadel, M, Peyton, M, Allaqaband, S, O’Hair, D, Bachinsky, W, Mumtaz, M, Blankenship, J, Casale, A, Brott, B, Davies, J, Brown, D, Cannon, L, Talbott, J, Chang, G, Macheers, S, Choi, J, Henry, C, Cutlip, D, Khabbaz, K, Das, G, Liao, K, Diver, D, Thayer, J, Dobies, D, Fliegner, K, Fischbein, M, Feldman, T, Pearson, P, Foster, M, Briggs, R, Giugliano, G, Engelman, D, Gordon, P, Ehsan, A, Grantham, J, Allen, K, Grodin, J, Jessen, M, Gruberg, L, Taylor JR Jr, Gupta, S, Hermiller J., Jr, Heimansohn, D, Iwaoka, R, Chan, B, Kander, Nh, Duff, S, Brown, W, Karmpaliotis, D, Kini, A, Filsoufi, F, Kong, D, Lin, S, Kutcher, M, Kincaid, E, Leya, F, Bakhos, M, Liberman, H, Halkos, M, Lips, D, Eales, F, Mahoney, P, Rich, J, Barreiro, C, Cheng, W, Metzger, C, Greenfield, T, Moses, J, Palacios, I, Macgillivray, T, Perin, E, Del Prete, J, Pompili, V, Kilic, A, Ragosta, M, Kron, I, Rashid, J, Mueller, D, Riley, R, Reimers, C, Patel, N, Resar, J, Shah, A, Schneider, J, Landvater, L, Reardon, M, Shavelle, D, Baker, C, Singh, J, Maniar, H, Wei, L, Strain, J, Zapolanski, A, Taheri, H, Ad, N, Tannenbaum, M, Prabhakar, G, Waksman, R, Corso, P, Wang, J, Fiocco, M, Wilson, Bh, Steigel, Rm, Chadwick, S, Zidar, F, Oswalt, J., Stone, Gregg W., Sabik, Joseph F., Serruys, Patrick W., Simonton, Charles A., Généreux, Philippe, Puskas, John, Kandzari, David E., Morice, Marie Claude, Lembo, Nichola, Brown, W. Morri, Taggart, David P., Banning, Adrian, Merkely, Béla, Horkay, Ferenc, Boonstra, Piet W., Van Boven, Ad J., Ungi, Imre, Bogáts, Gabor, Mansour, Samer, Noiseux, Nicola, Sabaté, Manel, Pomar, José, Hickey, Mark, Gershlick, Anthony, Buszman, Pawel, Bochenek, Andrzej, Schampaert, Erick, Pagé, Pierre, Dressler, Ovidiu, Kosmidou, Ioanna, Mehran, Roxana, Pocock, Stuart J., Kappetein, A. Pieter, for the EXCEL Trial Investigators:, [. . ., Antonio, Marzocchi, DI BARTOLOMEO, Roberto, ], . ., and Cardiothoracic Surgery
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Coronary Artery Disease ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,law.invention ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Clinical endpoint ,Drug-Eluting Stent ,Humans ,Everolimus ,030212 general & internal medicine ,cardiovascular diseases ,Coronary Artery Bypass ,Aged ,Female ,Middle Aged ,Drug-Eluting Stents ,business.industry ,Coronary Artery Bypa ,Medicine (all) ,Percutaneous coronary intervention ,General Medicine ,medicine.disease ,Surgery ,Cardiac surgery ,Everolimu ,surgical procedures, operative ,Bypass surgery ,Conventional PCI ,Cardiology ,business ,medicine.drug ,Human - Abstract
BACKGROUND: Patients with obstructive left main coronary artery disease are usually treated with coronary-artery bypass grafting (CABG). Randomized trials have suggested that drug-eluting stents may be an acceptable alternative to CABG in selected patients with left main coronary disease. METHODS: We randomly assigned 1905 eligible patients with left main coronary artery disease of low or intermediate anatomical complexity to undergo either percutaneous coronary intervention (PCI) with fluoropolymer-based cobalt-chromium everolimus-eluting stents (PCI group, 948 patients) or CABG (CABG group, 957 patients). Anatomic complexity was assessed at the sites and defined by a Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score of 32 or lower (the SYNTAX score reflects a comprehensive angiographic assessment of the coronary vasculature, with 0 as the lowest score and higher scores [no upper limit] indicating more complex coronary anatomy). The primary end point was the rate of a composite of death from any cause, stroke, or myocardial infarction at 3 years, and the trial was powered for noninferiority testing of the primary end point (noninferiority margin, 4.2 percentage points). Major secondary end points included the rate of a composite of death from any cause, stroke, or myocardial infarction at 30 days and the rate of a composite of death, stroke, myocardial infarction, or ischemia-driven revascularization at 3 years. Event rates were based on Kaplan-Meier estimates in time-to-first-event analyses. RESULTS: At 3 years, a primary end-point event had occurred in 15.4% of the patients in the PCI group and in 14.7% of the patients in the CABG group (difference, 0.7 percentage points; upper 97.5% confidence limit, 4.0 percentage points; P=0.02 for noninferiority; hazard ratio, 1.00; 95% confidence interval, 0.79 to 1.26; P=0.98 for superiority). The secondary end-point event of death, stroke, or myocardial infarction at 30 days occurred in 4.9% of the patients in the PCI group and in 7.9% in the CABG group (P
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- 2017
5. 98: Efficacy of Dobutamine Stress Echocardiography in Cardiac Evaluation for Lung Transplantation
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Lome, S.M., primary, Jeff, F.F., additional, Ling, F., additional, Dilling, D.F., additional, Love, R.B., additional, Wigfield, C.H., additional, Gagermeier, J.P., additional, Alex, C.G., additional, Dieter, R.S., additional, and Leya, F., additional
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- 2009
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6. Plasma procarboxypeptidase U is up-regulated in patients undergoing percutaneous intervention: effects of anticoagulant dosage of low molecular weight heparins
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Florian-Kujawski, M., primary, Hoppensteadt, D. A., additional, Tobu, M., additional, Kereiakes, D. J., additional, Lewis, B., additional, Leya, F., additional, and Fareed, J., additional
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- 2003
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7. Combined Thrombin and Platelet Inhibition Treatment for HIT Patients
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Lewis, B.E., primary, Jeske, W. P., primary, Leya, F., primary, Wallis, Diane, primary, Bakhos, M., primary, Fareed, J., primary, and Walenga, Jeanine, additional
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- 1999
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8. Ergot induced peripheral vascular insufficiency, non-interventional treatment
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McKiernan, T. L., primary, Bock, K., additional, Leya, F., additional, Grassman, E., additional, Lewis, B., additional, Johnson, S. A., additional, and Scanlon, P. J., additional
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- 1994
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9. Intracoronary ultrasound assessment of morphological and functional abnormalities associated with cardiac allograft vasculopathy.
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Heroux, A L, primary, Silverman, P, additional, Costanzo, M R, additional, O'Sullivan, E J, additional, Johnson, M R, additional, Liao, Y, additional, McKiernan, T L, additional, Balhan, J E, additional, Leya, F S, additional, and Mullen, G M, additional
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- 1994
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10. Some Objective Considerations for the Use of Heparins and Recombinant Hirudin in Percutaneous Transluminal Coronary Angioplasty
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Fareed, Jawed, primary, Walenga, Jeanine, additional, Leya, F., additional, Bacher, P., additional, Hoppensteadt, Debra, additional, Messmore, Harry, additional, and Pifarre, Roque, additional
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- 1991
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11. Multicenter patency trial of intravenous anistreplase compared with streptokinase in acute myocardial infarction. The TEAM-2 Study Investigators.
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Anderson, J L, primary, Sorensen, S G, additional, Moreno, F L, additional, Hackworthy, R A, additional, Browne, K F, additional, Dale, H T, additional, Leya, F, additional, Dangoisse, V, additional, Eckerson, H W, additional, and Marder, V J, additional
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- 1991
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12. A comparison of directional atherectomy with coronary angioplasty in patients with coronary artery disease. The CAVEAT Study Group.
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Topol EJ, Leya F, Pinkerton CA, Whitlow PL, Hofling B, Simonton CA, Masden RR, Serruys PW, Leon MB, and Williams DO
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- 1993
13. Combined Thrombin and Platelet Inhibition Treatment for HIT Patients
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Walenga, Jeanine M., Lewis, B.E., Jeske, W. P., Leya, F., Wallis, Diane E., Bakhos, M., and Fareed, J.
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- 1999
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14. A comparison of debulking versus dilatation of bifurcation coronary arterial narrowings (from the CAVEAT I trial)
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Brener, S. J., Leya, F. S., Apperson-Hansen, C., Cowley, M. J., Califf, R. M., and Eric Topol
15. A Comparison of Debulking Versus Dilatation of Bifurcation Coronary Arterial Narrowings (from the CAVEAT I Trial)
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Brener, S. J., Leya, F. S., Apperson-Hansen, C., Cowley, M. J., Califf, R. M., and Topol, E. J.
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- 1996
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16. An unusual case of recurrent loffler endomyocarditis of the aortic valve.
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Gudmundsson GS, Ohr J, Leya F, Jacobs WR, Godwin JE, and Schwartz J
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Idiopathic hypereosinophilic syndrome is a rare systemic disease with an unexplained elevated eosinophil count. Loffler endomyocarditis is hypereosinophilic syndrome with endocardial fibrosis and restrictive cardiomyopathy. The atrioventricular valves are frequently involved, causing valvular regurgitation. Previously, there has been one case report of combined aortic and mitral valve involvement with Loffler endomyocarditis that was treated with bivalvular replacement. We describe a previously healthy 50-year-old man diagnosed with Loffler endomyocarditis complicated by peripheral thromboembolism and severe aortic regurgitation due to valve fibrosis and fibrotic vegetation on the aortic valve. He underwent embolectomy and aortic valve replacement in addition to treatment for his hypereosinophilia. He later presented with cardiomyopathy with severe aortic insufficiency due to the destruction of the aortic valve prosthesis by sterile fibrinous vegetation. To our knowledge, this is the second case in the literature in which Loffler endomyocarditis involves the aortic valve and the first patient in whom only the aortic valve is involved. [ABSTRACT FROM AUTHOR]
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- 2003
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17. Alcohol septal ablation for the treatment of hypertrophic obstructive cardiomyopathy. A multicenter North American registry.
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Nagueh SF, Groves BM, Schwartz L, Smith KM, Wang A, Bach RG, Nielsen C, Leya F, Buergler JM, Rowe SK, Woo A, Maldonado YM, Spencer WH 3rd, Nagueh, Sherif F, Groves, Bertron M, Schwartz, Leonard, Smith, Karen M, Wang, Andrew, Bach, Richard G, and Nielsen, Christopher
- Abstract
Objectives: The purpose of the study is to identify the predictors of clinical outcome (mortality and survival without repeat septal reduction procedures) of alcohol septal ablation for the treatment of patients with hypertrophic obstructive cardiomyopathy.Background: Alcohol septal ablation is used for treatment of medically refractory hypertrophic obstructive cardiomyopathy patients with severe outflow tract obstruction. The existing literature is limited to single-center results, and predictors of clinical outcome after ablation have not been determined. Registry results can add important data.Methods: Hypertrophic obstructive cardiomyopathy patients (N = 874) who underwent alcohol septal ablation were enrolled. The majority (64%) had severe obstruction at rest, and the remaining had provocable obstruction. Before ablation, patients had severe dyspnea (New York Heart Association [NYHA] functional class III or IV: 78%) and/or severe angina (Canadian Cardiovascular Society angina class III or IV: 43%).Results: Significant improvement (p < 0.01) occurred after ablation (~5% in NYHA functional classes III and IV, and 8 patients in Canadian Cardiovascular Society angina class III). There were 81 deaths, and survival estimates at 1, 5, and 9 years were 97%, 86%, and 74%, respectively. Left anterior descending artery dissections occurred in 8 patients and arrhythmias in 133 patients. A lower ejection fraction at baseline, a smaller number of septal arteries injected with ethanol, a larger number of ablation procedures per patient, a higher septal thickness post-ablation, and the use beta-blockers post-ablation predicted mortality.Conclusions: Variables that predict mortality after ablation, include baseline ejection fraction and NYHA functional class, the number of septal arteries injected with ethanol, post-ablation septal thickness, beta-blocker use, and the number of ablation procedures. [ABSTRACT FROM AUTHOR]- Published
- 2011
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18. Comparison of outcomes in catheter-directed versus ultrasound-assisted thrombolysis for management of submassive pulmonary embolism.
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Allen S, Chan L, Masic D, Porcaro K, Morris S, Haines J, Leya F, Bechara CF, Lopez J, Lewis B, Steen L, Fareed J, Darki A, and Brailovsky Y
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- Catheters, Fibrinolytic Agents therapeutic use, Humans, Thrombolytic Therapy, Treatment Outcome, Pulmonary Embolism drug therapy
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- 2021
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19. Bifurcation pulmonary venoplasty and stenting for recalcitrant pulmonary vein stenosis after surgical pulmonary vein reconstruction.
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Belin RJ, Leya MV, Bediako T, Ronan AP, Schwartz J, and Leya F
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Pulmonary vein stenosis (PVS) is a rare, severe, and potentially fatal complication most often arising from pulmonary vein ablation for medication refractory, symptomatic, and permanent atrial fibrillation. At present, the optimal approach for the management of PVS remains to be defined. Here, we describe a unique case of bifurcation pulmonary venoplasty and stenting in a patient with recalcitrant PVS after surgical reconstruction of her pulmonary veins. To our knowledge, this is the first such report of its kind. < Learning objective: The optimal approach to managing complex pulmonary vein stenosis (PVS) is unclear. Our aim is to illustrate our successful approach for treating recalcitrant and complex PVS using dual transseptal access and kissing balloon bifurcation pulmonary venoplasty.>., (© 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)
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- 2020
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20. Impact of Emergency Medical Services Activation of the Cardiac Catheterization Laboratory and a 24-Hour/Day In-Hospital Interventional Cardiology Team on Treatment Times (Door to Balloon and Medical Contact to Balloon) for ST-Elevation Myocardial Infarction.
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Pulia M, Salman T, O'Connell TF, Balasubramanian N, Gaines R, Shah F, Henry M, Leya F, Mathew V, Bufalino D, Steen L, Lewis B, Darki A, Cichon M, Fennessy M, Sielaff A, Haas M, and Lopez JJ
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- Aged, Female, Humans, Male, Middle Aged, Retrospective Studies, ST Elevation Myocardial Infarction diagnosis, Time Factors, Treatment Outcome, Angioplasty, Balloon, Coronary, Cardiac Catheterization, Emergency Medical Services, ST Elevation Myocardial Infarction therapy, Time-to-Treatment
- Abstract
The incremental benefit of emergency medical services (EMS) activation of the cardiac catheterization laboratory (CCL) for ST-elevation myocardial infarction (STEMI) in the setting of an established in-house interventional team (IHIT) is uncertain. We evaluated the impact of EMS activation on door-to-balloon (D2B) time and first medical contact-to-balloon (FMC2B) time for STEMI when coupled with a 24-hour/day IHIT. All patients presenting with STEMI to Loyola University Medical Center had demographic, procedural, and outcome data consecutively entered in a STEMI Data Registry. From 223 consecutive patients presenting between April 2009 and December 2015, a retrospective analysis was performed on 190 patients. Patients were divided into 2 groups depending on CCL activation mode (EMS activation or emergency department activation) and STEMI treatment process times were compared. The primary end point was D2B process times. The secondary end point was FMC2B process times in a subgroup analysis of EMS-transported patients. D2B times were shorter (37 ± 14 minutes vs 57 ± 27 minutes, p < 0.001) with EMS activation. Subgroup analysis of EMS-transported patients demonstrated shorter FMC2B times with EMS activation (52 ± 17 minutes vs 67 ± 32 minutes, p = 0.002). EMS activation was the only predictor of D2B ≤60 minutes in multivariable analysis of EMS-transported patients (odds ratio 9.4; 95% confidence interval 2.1 to 43.0; p = 0.04). In conclusion, EMS activation of the CCL in STEMI was associated with significant improvements in already excellent D2B and FMC2B times even in the setting of a 24-hour/day IHIT., (Copyright © 2019 Elsevier Inc. All rights reserved.)
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- 2019
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21. Meta-Analysis of Studies Comparing Dual- Versus Mono-Antiplatelet Therapy Following Transcatheter Aortic Valve Implantation.
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Al Halabi S, Newman J, Farkouh ME, Fortuin D, Leya F, Sweeney J, Darki A, Lopez J, Steen L, Lewis B, Webb J, Leon MB, and Mathew V
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- Drug Therapy, Combination, Global Health, Humans, Incidence, Postoperative Complications epidemiology, Survival Rate trends, Thrombosis epidemiology, Aortic Valve Stenosis surgery, Platelet Aggregation Inhibitors administration & dosage, Postoperative Complications prevention & control, Thrombosis prevention & control, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
Current guidelines recommend dual-antiplatelet therapy (DAPT) after transcatheter aortic valve implantation (TAVI), although some studies suggest mono-antiplatelet therapy is equally efficacious with an improved safety profile. We performed a meta-analysis of studies comparing DAPT with mono-antiplatelet therapy after TAVI. Study quality and heterogeneity were assessed using Jadad score, Newcastle-Ottawa Scale, and Cochran's Q statistics. Mantel-Haenszel odds ratios (ORs) were calculated using fixed effect models as the primary analysis. Eight studies including 2,439 patients met the inclusion criteria. At 30 days, DAPT was associated with an increased risk of all-cause mortality (OR 2.06, 95% confidence interval [CI] 1.34 to 3.18, p = 0.001), major or life-threatening bleeding (OR 2.04, 95% CI 1.60 to 2.59, p <0.001), and major vascular complications (OR 2.15, 95% CI 1.51 to 3.06, p <0.001). There was no difference in the rate of the combined end point of stroke or transient ischemic attack, or myocardial infarction. Outcome data up to 6 months were available in 5 studies; all-cause mortality and stroke were similar between groups, although major or life-threatening bleeding was more frequent with DAPT. In conclusion, in patients undergoing TAVI, DAPT is associated with increased risk at 30 days of all-cause mortality, major or life-threatening bleeding, and major vascular complications without a decrease in ischemic complications; at 6 months, the excess bleeding risk persisted. These data suggest a safety concern with DAPT and justify further investigation of the optimal antiplatelet therapy regimen after TAVI., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
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22. Abnormal distortion of aortic corevalve bioprosthesis with suicide left ventricle, aortic insufficiency, and severe mitral regurgitation during transcatheter aortic valve replacement.
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Leya F, Tuchek JM, and Coats W
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- Aortic Valve Insufficiency diagnostic imaging, Aortic Valve Insufficiency physiopathology, Aortic Valve Insufficiency therapy, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis physiopathology, Balloon Valvuloplasty, Cardiac Catheterization adverse effects, Cardiac Catheterization methods, Echocardiography, Doppler, Color, Echocardiography, Transesophageal, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation methods, Humans, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency physiopathology, Mitral Valve Insufficiency therapy, Multidetector Computed Tomography, Prosthesis Design, Radiography, Interventional, Recovery of Function, Severity of Illness Index, Stroke Volume, Treatment Outcome, Ventricular Pressure, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Aortic Valve Insufficiency etiology, Aortic Valve Stenosis therapy, Bioprosthesis, Cardiac Catheterization instrumentation, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation instrumentation, Mitral Valve Insufficiency etiology, Ventricular Function, Left
- Abstract
We present a patient with critical degenerative aortic stenosis, mitral annular and aortomitral continuity calcification, and senile sigmoid septal hypertrophy who underwent transcatheter aortic valve replacement using the CoreValve bioprosthesis. Immediately after predilation of the aortic valve (18-mm balloon), the patient developed severe hypotension and dynamic left ventricular outflow tract (LVOT) obstruction with systolic anterior motion of the anterior mitral leaflet, causing severe mitral regurgitation. After deployment of a 26-mm bioprosthesis, a transesophageal echocardiogram and left ventriculogram showed that the frame of the bioprosthesis appeared distorted and underexpanded. On the mitral side of the aorta (side of the aortomitral curtain between 12:00 and 3:00, echo short axis view), we found moderate periprosthetic aortic insufficiency with worse mitral regurgitation. The left ventricle was small and hyperdynamic (ejection fraction >85%). The patient soon developed complete heart block, atrial fibrillation, and ventricular tachycardia. She was resuscitated with aggressive intravenous fluids, vasopressors, and an emergently placed atrioventricular sequential pacemaker. We postdilated the 26-mm bioprosthesis with a 22-mm Z-Med balloon and subsequently with a 25-mm balloon. Each balloon was inflated to its nominal volume and pressure and conformed the nitinol frame of the valve to the net circular shape and expected diameter. However, as soon as each balloon was deflated, the surrounding aortic root anatomy visibly recoiled and the frame returned to its smaller diameter with a distorted shape. A second 26-mm CoreValve bioprosthesis was then deployed in a "valve-in-valve" configuration. Soon after, the patient's hemodynamics improved, her clinical condition stabilized, and she completely recovered. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)
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- 2016
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23. Comparison of primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction during and prior to availability of an in-house STEMI system: early experience and intermediate outcomes of the HARRT program for achieving routine D2B times <60 minutes.
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Nguyen B, Fennessy M, Leya F, Nowak W, Ryan M, Freeberg S, Gill J, Dieter RS, Steen L, Lewis B, Cichon M, Probst B, Jarotkiewicz M, Wilber D, and Lopez JJ
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- After-Hours Care, Aged, Female, Health Resources statistics & numerical data, Humans, Illinois, Length of Stay, Male, Middle Aged, Myocardial Infarction diagnosis, Myocardial Infarction mortality, Patient Care Team, Program Evaluation, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Workflow, Cardiac Catheterization adverse effects, Cardiac Catheterization mortality, Cardiac Catheterization statistics & numerical data, Delivery of Health Care, Myocardial Infarction therapy, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention mortality, Percutaneous Coronary Intervention statistics & numerical data, Process Assessment, Health Care, Time-to-Treatment
- Abstract
Background: Over the last decade, significant advances in ST-elevation myocardial infarction (STEMI) workflow have resulted in most hospitals reporting door-to-balloon (D2B) times within the 90 min standard. Few programs have been enacted to systematically attempt to achieve routine D2B within 60 min. We sought to determine whether 24-hr in-house catheterization laboratory coverage via an In-House Interventional Team Program (IHIT) could achieve D2B times below 60 min for STEMI and to compare the results to the standard primary percutaneous coronary intervention (PCI) approach., Methods: An IHIT program was established consisting of an attending interventional cardiologist, and a catheterization laboratory team present in-hospital 24 hr/day. For all consecutive STEMI patients, we compared the standard primary PCI approach during the two years prior to the program (group A) to the initial 20 months of the IHIT program (group B), and repeated this analysis for only CMS-reportable patients. The D2B process was analyzed by calculating workflow intervals. The primary endpoint was D2B process times, and secondary endpoints included in-hospital and 6-month cardiovascular outcomes and resource utilization., Results: An IHIT program for STEMI resulted in significant reductions across all treatment intervals with an overall 57% reduction in D2B time, and an absolute reduction in mean D2B time of 71 min. There were no differences pre- and post-program implementation in regard to individual or composite components of in-hospital cardiovascular outcomes; however at 6 months, there was a reduction in cardiovascular rehospitalization after program implementation (30 vs. 5%, P < 0.01). The IHIT program resulted in a significant reduction in length-of-stay (LOS) (90 ± 102 vs. 197 ± 303 hr, P = 0.02), and critical care time (54 ± 97 vs. 149 ± 299 hr, P = 0.02)., Conclusions: Availability of an in-house 24-hr STEMI team significantly decreased reperfusion time and led to improved clinical outcomes and a shorter LOS for PCI-treated STEMI patients., (© 2015 Wiley Periodicals, Inc.)
- Published
- 2015
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24. Increase in cardiac myosin binding protein-C plasma levels is a sensitive and cardiac-specific biomarker of myocardial infarction.
- Author
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Govindan S, Kuster DW, Lin B, Kahn DJ, Jeske WP, Walenga JM, Leya F, Hoppensteadt D, Fareed J, and Sadayappan S
- Abstract
Earlier studies have shown that cardiac myosin binding protein-C (cMyBP-C) is easily releasable into the circulation following myocardial infarction (MI) in animal models and patients. However, since its release kinetics has not been clearly demonstrated, no parameters are available to judge its efficacy as a bona fide biomarker of MI in patients with MI. To make this assessment, plasma levels of cMyBP-C and six known biomarkers of MI were determined by sandwich enzyme-linked immunosorbent assay in patients with MI who had before and after Percutaneous Transcoronary Angioplasty (PTCA), as well as healthy controls. Compared to healthy controls (22.3 ± 2.4 ng/mL (n=54)), plasma levels of cMyBP-C were significantly increased in patients with MI (105.1 ± 8.8 ng/mL (n=65), P<0.001). Out of 65 patients, 24 had very high levels of plasma cMyBP-C (116.5 ± 13.3 ng/mL), indicating high probability of MI. Importantly, cMyBP-C levels were significantly decreased in patients (n=40) at 12 hours post-PTCA (41.2 ± 9.3 ng/mL, P<0.001), compared to the patients with MI. Receiver operating characteristic analysis revealed that a plasma cMyBP-C reading of 68.1 ng/mL provided a sensitivity of 66.2% and a specificity of 100%. Also, myoglobin, carbonic anhydrase and creatine kinase-MB levels were significantly increased in MI patients who also had higher cMyBP-C levels. In contrast, levels of cardiac troponin I, glycogen phosphorylase and heart-type fatty acid binding protein were not significantly changed in the samples, indicating the importance of evaluating the differences in release kinetics of these biomarkers in the context of accurate diagnosis. Our findings suggest that circulating cMyBP-C is a sensitive and cardiac-specific biomarker with potential utility for the accurate diagnosis of MI.
- Published
- 2013
25. Long-term outcomes of plaque debulking with rotational atherectomy in side-branch ostial lesions to treat bifurcation coronary disease.
- Author
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Ito H, Piel S, Das P, Chhokar V, Khadim G, Nierzwicki R, Williams A, Dieter RS, and Leya F
- Subjects
- Aged, Angioplasty, Balloon, Coronary mortality, Atherectomy, Coronary mortality, Coronary Angiography, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease mortality, Coronary Vessels, Feasibility Studies, Female, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Treatment Outcome, Angioplasty, Balloon, Coronary methods, Atherectomy, Coronary methods, Coronary Artery Disease therapy, Drug-Eluting Stents
- Abstract
Background: The prognosis after rotational atherectomy of a side-branch ostium to treat bifurcation coronary lesions is unknown., Methods: This was a retrospective case-review study of 40 consecutive patients who underwent rotational atherectomy of the sidebranch ostium to treat symptomatic bifurcation coronary lesions meeting the Medina classification (1,1,1) at our institution between 2003 and 2007., Results: Twenty-two (55.0%) patients underwent rotational atherectomy of the side-branch ostium alone and 18 (45.0%) underwent rotational atherectomy of the both the main vessel and the sidebranch ostium. Most of the patients (n = 37, 92.5%) had a drug-eluting stent placed in the main vessel after rotational atherectomy. Only 8 patients (20.0%) required side-branch stents, and 2 patients (5.0%) underwent a final kissing-balloon technique. No acute closure of the side branch or coronary perforation were observed. Major adverse cardiac events included cardiac death (n = 1; 2.5%), nonfatal myocardial infarction (n = 1; 2.5%), target vessel revascularization (n = 2; 5.0%) and target lesion revascularization (n = 0; 0.0%) during the mean follow-up period of 21.3 +/- 18.5 months., Conclusions: The study demonstrated safety and feasibility of rotational atherectomy and provisional side-branch stenting to treat side-branch ostial lesions of true severe bifurcation coronary artery disease. The study results suggest that rotational atherectomy of a side-branch ostium prior to main-vessel stenting may be an option in selected patients undergoing complex bifurcation lesion angioplasty.
- Published
- 2009
26. Usefulness of wide pulse pressure as a predictor of poor outcome after renal artery angioplasty and stenting.
- Author
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Dieter RS, Darki A, Nanjundappa A, Chhokar VS, Khadim G, Morshedi-Meibodi A, Freihage JH, Steen L, Lewis B, and Leya F
- Subjects
- Aged, Female, Humans, Logistic Models, Male, Middle Aged, Predictive Value of Tests, Retrospective Studies, Sensitivity and Specificity, Stents, Angioplasty, Balloon, Blood Pressure, Renal Artery Obstruction therapy
- Abstract
Renal artery stenosis is a common cause of secondary hypertension and ischemic nephropathy. Percutaneous angioplasty and stent placement has allowed select patients with renal artery stenosis to use fewer antihypertensive agents and improve or stabilize renal function. The associations of baseline systolic, diastolic, and pulse pressures (PPs) with outcomes of blood pressure (BP) and renal function were examined in 243 patients who underwent renal angioplasty and stent placement. The average PP before the procedure in patients with improvements or stabilizations in renal function was 53 +/- 20 mm Hg, compared to 107 +/- 18 mm Hg (p <0.05) in those with poorer outcomes. The average PPs before procedure were 47 +/- 15 mm Hg in those with improvements in BP, 82 +/- 10 mm Hg in those with stabilizations of BP, and 111 +/- 14 mm Hg in those with worsening BP. All findings were statistically significant (p <0.05). In conclusion, wide PP may reflect more advanced vascular stiffness and renal disease distinguishing patients less likely to benefit from revascularization.
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- 2009
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27. Prospective study of cardiac sarcoid mimicking arrhythmogenic right ventricular dysplasia.
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Vasaiwala SC, Finn C, Delpriore J, Leya F, Gagermeier J, Akar JG, Santucci P, Dajani K, Bova D, Picken MM, Basso C, Marcus F, and Wilber DJ
- Subjects
- Adolescent, Adult, Female, Humans, Male, Middle Aged, Prospective Studies, Young Adult, Arrhythmogenic Right Ventricular Dysplasia pathology, Cardiomyopathies pathology, Myocardium pathology, Sarcoidosis pathology
- Abstract
Introduction: Case studies indicate that cardiac sarcoid may mimic the clinical presentation of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C); however, the incidence and clinical predictors to diagnose cardiac sarcoid in patients who meet International Task Force criteria for ARVD/C are unknown., Methods and Results: Patients referred for evaluation of left bundle branch block (LBBB)-type ventricular arrhythmia and suspected ARVD/C were prospectively evaluated by a standardized protocol including right ventricle (RV) cineangiography-guided myocardial biopsy. Sixteen patients had definite ARVD/C and four had probable ARVD/C. Three patients were found to have noncaseating granulomas on biopsy consistent with sarcoid. Age, systemic symptoms, findings on chest X-ray or magnetic resonance imaging (MRI), type of ventricular arrhythmia, RV function, ECG abnormalities, and the presence or duration of late potentials did not discriminate between sarcoid and ARVD/C. Left ventricular dysfunction (ejection fraction <50%) was present in 3/3 patients with cardiac sarcoid, but only 2/17 remaining patients with definite or probable ARVD/C (P = 0.01)., Conclusions: In this prospective study of consecutive patients with suspected ARVD/C evaluated by a standard protocol including biopsy, the incidence of cardiac sarcoid was surprisingly high (15%). Clinical features, with the exception of left ventricular dysfunction and histological findings, did not discriminate between the two entities.
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- 2009
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28. Lipotamous cardiac disorders: two unsual cases and a review of the literature.
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Ramana RK, Darki A, Havens M, Wojcik E, Brylka D, Singh MM, and Leya F
- Subjects
- Aged, Antigens, CD, Antigens, Differentiation, Myelomonocytic, Cardiomyopathy, Hypertrophic diagnostic imaging, Cardiomyopathy, Hypertrophic pathology, Echocardiography, Female, Heart Diseases diagnostic imaging, Heart Diseases pathology, Heart Neoplasms diagnostic imaging, Heart Neoplasms pathology, Humans, Lipomatosis diagnostic imaging, Lipomatosis pathology, Male, Middle Aged, Cardiomyopathy, Hypertrophic diagnosis, Heart Diseases diagnosis, Heart Neoplasms diagnosis, Lipomatosis diagnosis
- Abstract
Tumors involving the heart and surrounding cardiac structures may be benign or malignant and can be classified as primary versus secondary in etiology. Primary cardiac tumors are rare lesions and the vast majority of these are benign neoplasms. More commonly, masses that involve the cardiac structures are secondary in nature. The focus of this manuscript will be those cardiac lesions characterized by a predominance of fatty cells. We present two unusual cases of patients with lipomatous cardiac disorders with extreme imaging and review the current literature on this topic.
- Published
- 2009
29. Outcomes of bare metal versus drug-eluting stents in allograft vasculopathy.
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Reddy PR, Gulati A, Steen L, Sinacore J, Leya F, and Heroux A
- Subjects
- Angioplasty, Balloon, Coronary, Cardiac Catheterization, Coronary Restenosis mortality, Equipment Design, Heart Failure epidemiology, Humans, Postoperative Complications surgery, Transplantation, Homologous, Treatment Outcome, Coronary Restenosis epidemiology, Drug-Eluting Stents, Heart Transplantation adverse effects, Stents
- Abstract
Background: Because of improved outcomes with drug-eluting stents (DES), we examined angiographic and clinical outcomes of bare metal stents (BMS) vs DES for discrete lesions in chronic allograft vasculopathy., Methods: Heart transplant patients who underwent percutaneous coronary intervention were divided into one of two groups: BMS or DES. Baseline clinical characteristics, rejection episodes and procedural details were compared. Distal arteriopathy was qualitatively compared using the Gao score. End-points included angiographic in-stent restenosis, acute coronary syndrome (ACS), ST-elevation myocardial infarction, heart failure admissions and cardiac death at 1 year. Student's t-test, chi-square test and the Mann-Whitney U-test were utilized to assess the results. Correlations were assessed using Pearson's correlation coefficient., Results: Forty-two patients with 80 stents (56 DES, 24 BMS) were identified. Baseline clinical characteristics, immunosuppression regimen, cardiac risk factors, frequency of rejection and procedural details were similar. Distal arteriopathy was similar (p = 0.374), suggesting equally advanced vasculopathy. Twenty-nine patients (69%) and 46 lesions (58%) were available at 1 year for clinical and angiographic follow-up. One-year diameter stenosis (26.1 +/- 21.3% vs 31.7 +/- 38.3%; p = 0.602) and binary restenosis (22.6% vs 22.7%; p = 0.774) rates were similar for DES and BMS, respectively. There were no ST-elevation infarctions; ACS [9 (16%) vs 5 (21%) p = 0.638] and cardiac death (2 in both groups) were similar for DES and BMS, respectively. Heart failure admissions were more frequent in the DES group [18 (32%) vs 5 (21%); p = 0.016]. No clinical predictors were identified., Conclusions: In-stent stenosis, ACS and cardiac death at 1 year were similar for DES and BMS. The milieu of systemic immunosuppression in heart transplant decreases the advantages of DES in allograft vasculopathy.
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- 2008
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30. Late presentation of an anomalous origin of the left coronary artery from the pulmonary artery: case report and review.
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Ramana RK, Varga P, and Leya F
- Subjects
- Adolescent, Coronary Vessel Anomalies surgery, Coronary Vessels surgery, Humans, Male, Pulmonary Artery pathology, Pulmonary Artery surgery, Time Factors, Coronary Vessel Anomalies pathology, Coronary Vessels pathology, Pulmonary Artery abnormalities
- Abstract
Anomalous origin of the left coronary artery (LCA) from the pulmonary artery (ALCAPA) is a rare cause of ischemia, heart failure and/or sudden death. A premortem diagnosis beyond early childhood is exceedingly rare because over 90% of untreated infants die in the first 12 months of life. We present a case of an asymptomatic fourteen-year old male with ALCAPA diagnosed by multidetector computed tomography (MDCT) angiography, who was successfully treated by surgical coronary transfer of the ALCAPA with reimplantation of the LCA to the aortic root.
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- 2008
31. Paradoxical embolism to the central nervous system after sexual intercourse in a young woman with a complex atrial septal abnormality.
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Velicu S, Biller J, Hacein-Bey L, Freihage JH, and Leya F
- Subjects
- Adult, Anticoagulants therapeutic use, Cerebral Angiography, Echocardiography, Female, Fibrinolytic Agents therapeutic use, Heparin therapeutic use, Humans, Infarction, Middle Cerebral Artery drug therapy, Leg blood supply, Physical Exertion, Thrombolytic Therapy methods, Tissue Plasminogen Activator therapeutic use, Treatment Outcome, Foramen Ovale, Patent complications, Heart Aneurysm complications, Heart Septal Defects, Atrial complications, Infarction, Middle Cerebral Artery pathology, Sexual Behavior physiology, Venous Thrombosis complications
- Abstract
Ischemic stroke during sexual intercourse is an unusual occurrence. We report the evaluation and treatment of a young woman on oral contraceptives, with a complex atrial septal abnormality and right lower extremity deep vein thrombus, who had an ischemic stroke during sexual intercourse. Successful treatment was accomplished with administration of intra-arterial tissue plasminogen activator and subsequent transvascular occlusion of the atrial septal abnormality.
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- 2008
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32. Femoral angiogram prior to arteriotomy closure device does not reduce vascular complications in patients undergoing cardiac catheterization.
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Ramana RK, Singh A, Dieter RS, Moran JF, Steen L, Lewis BE, and Leya F
- Subjects
- Adult, Aged, Aged, 80 and over, Angioplasty, Balloon, Coronary instrumentation, Cardiac Catheterization instrumentation, Cardiac Catheterization methods, Female, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Vascular Surgical Procedures, Angioplasty, Balloon, Coronary methods, Coronary Angiography, Coronary Artery Disease therapy, Femoral Artery, Hemostatic Techniques instrumentation
- Abstract
Objectives: To compare the efficacy of achieving hemostasis without vascular access site complications (VCs) in patients who did not undergo femoral angiogram (FA) prior to arteriotomy closure device (ACD) placement., Background: Following coronary angiogram/percutaneous coronary intervention (CA/PCI), VCs increase morbidity and mortality. Previous studies in which an FA was highly recommended but not mandatory suggest that a predictor of VC is ACD use., Methods: We retrospectively identified consecutive patients who underwent CA/PCI and attempted ACD deployment at our institution over a three-year period. These patients' medical and procedural records, angiogram films, and subsequent hospitalization records were reviewed to identify predetermined clinical outcomes., Results: One thousand four hundred and twenty-two patients underwent CA/PCI from the transfemoral approach with ACD deployment. Seven hundred and eight (49.8%) patients did not undergo FA prior to ACD deployment. The use of ACD without FA guidance was not associated with an increased rate of combined measured clinical end-point; immediate ACD failure; retroperitoneal bleed; TIMI minor bleed; infectious complications; need for surgical intervention; or mortality (5.3 vs. 4.9; 2.7% vs. 2.2%; 1.4% vs. 0.9%; 0.5% vs. 0.4%; 0% vs. 0%; 0.1% vs. 0.1%; 0% vs. 0%, respectively, P = NS)., Conclusion: We found no evidence that performing an FA prior to ACD placement as recommended by the manufacturer had any influence on the clinical success rate of ACD placement or rates of VCs. Therefore, ACD use without FA guidance in patients undergoing CA/PCI is an equally safe and effective method in successfully obtaining hemostasis without an increased risk of VCs.
- Published
- 2008
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33. The role of antiphospholipid syndrome in cardiovascular disease.
- Author
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Long BR and Leya F
- Subjects
- Anticoagulants therapeutic use, Antiphospholipid Syndrome drug therapy, Antiphospholipid Syndrome physiopathology, Cardiovascular Diseases drug therapy, Cardiovascular Diseases physiopathology, Consensus Development Conferences as Topic, Humans, Practice Guidelines as Topic, Antiphospholipid Syndrome complications, Cardiovascular Diseases complications
- Abstract
The antiphospholipid syndrome (APS) is associated with various cardiovascular manifestations. These include accelerated atherosclerosis, valvular heart disease, intracardiac thrombi, myocardial and pericardial involvement, cerebral and peripheral vascular disease, and premature restenosis of vein grafts and coronary stents. This article reviews the prevalence and proposed mechanisms of the various cardiovascular diseases associated with APS. It concludes with a discussion of current recommendations for treatment of these conditions.
- Published
- 2008
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34. Regional variation in the reconstitution of flow in the internal mammary artery graft.
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Reddy PR, Bakhos M, and Leya F
- Subjects
- Aged, 80 and over, Coronary Artery Bypass, Coronary Circulation physiology, Graft Occlusion, Vascular diagnostic imaging, Graft Occlusion, Vascular physiopathology, Humans, Male, Mammary Arteries diagnostic imaging, Mammary Arteries transplantation, Radiography, Recurrence, Graft Occlusion, Vascular etiology, Mammary Arteries physiopathology, Vascular Patency
- Abstract
We report an 81-year-old man with coronary artery disease and bypass surgery with a sequential internal mammary artery (IMA) to the diagonal and then the anterior descending, who developed regional variations in the flow through his arterial conduit. Four years after his initial surgery, he developed atresia of the proximal segment of the arterial conduit due to competitive flow. After reoperation, the patient reconstituted flow in his proximal segment, but developed atresia of the distal segment. We describe for the first time, regional variation in arterial conduit patency and discuss factors controlling patency in the sequential arterial conduit.
- Published
- 2008
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35. Stroke and myocardial infarction as late complications of lung transplantation.
- Author
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Johnston SL, Halabi S, Cohoon K, Alex C, Hutchens K, and Leya F
- Subjects
- Anastomosis, Surgical adverse effects, Aspergillosis complications, Aspergillus flavus, Bronchial Fistula diagnosis, Bronchial Fistula microbiology, Bronchial Fistula pathology, Echocardiography, Transesophageal, Electrocardiography, Embolism, Air diagnostic imaging, Embolism, Air etiology, Fatal Outcome, Humans, Male, Middle Aged, Myocardial Infarction diagnosis, Pulmonary Veins pathology, Time Factors, Tissue Adhesions pathology, Tomography, X-Ray Computed, Vascular Diseases diagnosis, Vascular Diseases microbiology, Vascular Diseases pathology, Lung Transplantation adverse effects, Myocardial Infarction etiology, Stroke etiology
- Abstract
A 64-year-old man who had received a lung transplant later presented with an air embolism that caused ST-segment elevation myocardial infarction, multiple strokes, and death. Transesophageal echocardiography was used to document air bubbles crossing from a bronchial fistula to a pulmonary vein and into the left atrium. Spontaneous air was seen entering a pulmonary vein during positive-pressure ventilation and exiting through the left ventricular outflow tract. Autopsy confirmed the presence of a probe-patent bronchial-to-pulmonary vein fistula within a focus of necrosis and infection with Aspergillus flavus, an angioinvasive organism. The potential for intravascular gas arising from the anastomotic site should be considered when transplant recipients who present with myocardial or peripheral arterial infarction are evaluated.
- Published
- 2007
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36. Presence of asymmetric dimethylarginine gradients across high-grade lesions in patients with coronary artery disease.
- Author
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Joyal D, Leya F, Obada Al-Chekakie M, Arab D, Dieter RS, Morshedi-Meibodi A, Lewis B, Steen L, Fareed J, Hoppenstead D, and Akar JG
- Subjects
- Aged, Angioplasty, Balloon, Laser-Assisted, Arginine metabolism, Atherosclerosis pathology, Atherosclerosis physiopathology, Biomarkers metabolism, Coronary Artery Disease pathology, Coronary Artery Disease physiopathology, Coronary Vessels pathology, Endothelium, Vascular pathology, Endothelium, Vascular physiopathology, Female, Humans, Male, Middle Aged, Arginine analogs & derivatives, Atherosclerosis metabolism, Coronary Artery Disease metabolism, Coronary Vessels metabolism
- Abstract
Background: Asymmetric dimethylarginine, an endogenous inhibitor of nitric oxide synthase, is a systemic marker of endothelial dysfunction. Although experimental evidence indicates that asymmetric dimethylarginine may play an important role in atherogenesis, local asymmetric dimethylarginine levels have not been measured in vivo., Objectives: We sought to determine whether: (i) asymmetric dimethylarginine is elevated locally at sites of coronary lesions, (ii) systemic asymmetric dimethylarginine concentrations correlate with local levels, and (iii) percutaneous coronary intervention produces immediate local asymmetric dimethylarginine elevation., Methods: In patients undergoing percutaneous coronary intervention (n=15), blood samples were obtained from a peripheral venous site, the coronary ostium proximal to the lesion and the coronary vessel distal to the lesion, before percutaneous coronary intervention. Samples were also obtained distal to the coronary lesion immediately after percutaneous coronary intervention and from the peripheral venous line 24 h after percutaneous coronary intervention., Results: Asymmetric dimethylarginine gradients were present across the coronary bed: local asymmetric dimethylarginine (micromol/l) was significantly higher distal to coronary lesions compared with proximally (2.39+/-1.27 vs. 1.52+/-0.68, P=0.005), and to systemic venous levels (2.39+/-1.27 vs. 1.17+/-0.72, P=0.001). Local asymmetric dimethylarginine did not increase immediately after percutaneous coronary intervention (1.88+/-0.89 vs. 2.39+/-1.27, P=0.11). Peripheral venous percutaneous coronary intervention levels 24 h after percutaneous coronary intervention were similar to baseline values (1.17+/-1.2 vs. 1.17+/-0.72, P=0.98)., Conclusion: Asymmetric dimethylarginine gradients exist across coronary lesions, suggesting asymmetric dimethylarginine release at the plaque site. Local asymmetric dimethylarginine accumulation may contribute to the endothelial dysfunction associated with high-grade coronary lesions. Peripheral asymmetric dimethylarginine is a marker of generalized endothelial dysfunction, but our findings highlight its limitation in detecting focal injury.
- Published
- 2007
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37. Troponin I levels in patients with preeclampsia.
- Author
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Joyal D, Leya F, Koh M, Besinger R, Ramana R, Kahn S, Jeske W, Lewis B, Steen L, Mestril R, and Arab D
- Subjects
- Adult, Endothelium, Vascular physiopathology, Female, Humans, Pre-Eclampsia physiopathology, Pregnancy, Pregnancy Trimester, Third, Pre-Eclampsia blood, Troponin I blood
- Abstract
Introduction: Preeclampsia involves a diffuse inflammatory state and elevated levels of troponins in patients with preeclampsia have been anecdotally reported. It is, however, unknown whether it is attributable to the preeclampsia., Objective: We sought to determine the troponin I levels at the time of delivery in pregnant women with and without preeclampsia., Methods: Plasma samples were obtained at the time of delivery and serum troponin I was measured by ELISA method., Results: Thirty-nine women were included (20 with preeclampsia and 19 without). Mean troponin I level was 0.008 ng/mL in patients with preeclampsia and 0.01 ng/mL in controls (P =.59). The highest troponin I level was 0.04 ng/mL for both patients with and without preeclampsia., Conclusions: Preeclampsia was not associated with a rise in troponin I levels in our study. Patients with preeclampsia and elevated troponin levels should have further cardiac investigations.
- Published
- 2007
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38. The influence of low (81 mg) versus high (325 mg) doses of ASA on the incidence of sirolimus-eluting stent thrombosis.
- Author
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Joyal D, Freihage JH, Cohoon K, Tempelhof M, Leya F, Dieter RS, Steen L, Lewis B, and Arab D
- Subjects
- Administration, Oral, Aged, Coronary Angiography, Coronary Stenosis diagnostic imaging, Coronary Stenosis therapy, Dose-Response Relationship, Drug, Follow-Up Studies, Humans, Immunosuppressive Agents pharmacology, Incidence, Male, Middle Aged, Postoperative Care methods, Retrospective Studies, Treatment Outcome, Angioplasty, Balloon, Coronary instrumentation, Aspirin administration & dosage, Coated Materials, Biocompatible, Coronary Thrombosis diagnostic imaging, Coronary Thrombosis epidemiology, Coronary Thrombosis prevention & control, Platelet Aggregation Inhibitors administration & dosage, Sirolimus pharmacology, Stents
- Abstract
Background: Conflicting opinion exists regarding the optimal dose of acetyl salicylic acid (ASA) to be given after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). We sought to evaluate the influence of ASA dose on the incidence of unexplained subacute and late stent thrombosis in the era of DES., Methods: We performed a retrospective analysis of the incidence of subacute and late stent thrombosis in our patient population over a 2-year period. The analysis was limited to patients being discharged and maintained on a daily ASA dose of either 81 mg or 325 mg and having received at least 1 sirolimus-eluting stent., Results: During the study period, 1,093 patients (1,807 separate PCI procedures) met the inclusion criteria. The incidence of unexplained subacute and late stent thrombosis was 1.1% in the study population (12 out of 1,093 patients). When considering the total number of individual procedures performed on the study population during the study period (1,807 procedures), the incidence of unexplained subacute or late stent thrombosis was 0.7%. Six were subacute and 6 were late thrombosis. No significant difference was observed in the incidence of stent thrombosis between the 2 ASA dose groups. Seven patients had stent thrombosis in the 81 mg group (1.2% of 583 patients), while 5 had thrombosis in the 325 mg group (1% of 510 patients); p = 0.727., Conclusion: In conclusion, we found no significant difference in the incidence of unexplained subacute or late stent thrombosis with the use of an 81 mg versus 325 mg dose of aspirin post-PCI with sirolimus-eluting stents.
- Published
- 2007
39. Alcohol septal ablation after failed surgical myectomy.
- Author
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Joyal D, Arab D, Chen-Johnston C, and Leya F
- Subjects
- Cardiomyopathy, Hypertrophic diagnostic imaging, Cardiomyopathy, Hypertrophic physiopathology, Electrocardiography, Heart Conduction System physiopathology, Heart Septum surgery, Heart Valve Diseases diagnostic imaging, Heart Valve Diseases physiopathology, Heart Valve Diseases surgery, Humans, Male, Middle Aged, Reoperation, Severity of Illness Index, Treatment Failure, Treatment Outcome, Ultrasonography, Ventricular Function, Left, Ventricular Outflow Obstruction surgery, Cardiac Surgical Procedures, Cardiomyopathy, Hypertrophic surgery, Catheter Ablation methods, Ethanol administration & dosage, Heart Valve Diseases etiology, Mitral Valve diagnostic imaging, Mitral Valve physiopathology, Ventricular Outflow Obstruction etiology
- Abstract
We describe the case of a successful alcohol septal ablation in a patient with persistent gradient and severe symptoms postsurgical myectomy. The alcohol ablation of the thickened septum abolished the left ventricular outflow gradient and the systolic anterior motion (SAM) of the mitral valve. Although the surgical literature advocates for mitral valve replacement in patients who continue to have SAM with significant outflow obstruction postmyectomy, targeted alcohol septal ablation of the remaining septum appears to be an attractive alternative.
- Published
- 2007
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40. Ethanol septal ablation for refractory ventricular tachycardia.
- Author
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Ramana RK, Wilber DJ, and Leya F
- Subjects
- Biopsy, Needle, Cardiac Catheterization, Cardiomyopathy, Dilated complications, Cardiomyopathy, Dilated diagnosis, Coronary Angiography, Electrocardiography, Ethanol administration & dosage, Follow-Up Studies, Heart Septum surgery, Humans, Immunohistochemistry, Male, Middle Aged, Recurrence, Risk Assessment, Severity of Illness Index, Tachycardia, Ventricular etiology, Treatment Outcome, Waiting Lists, Cardiomyopathy, Dilated surgery, Catheter Ablation methods, Heart Transplantation methods, Tachycardia, Ventricular diagnosis, Tachycardia, Ventricular surgery
- Abstract
It is not uncommon for patients with severe ischemic or nonischemic cardiomyopathy to have recurrent ventricular arrhythmias. Many of these arrhythmias remain asymptomatic and can be controlled with beta-blockers or amiodarone. However, for a subset of these patients, the arrhythmia is persistent and requires antitachycardic pacing, internal defibrillation, or radiofrequency ablation therapy. We present a patient with end-stage nonischemic cardiomyopathy and recurrent ventricular tachycardia (VT) who was listed for cardiac transplantation. His VT was not responsive to medical management, and standard endocardial or epicardial VT radiofrequency ablation (VTRFA) procedures. Therefore, this patient underwent successful ethanol septal ablation (ESA) to obliterate the source of arrhythmia. Five days after the ablation procedure, he underwent cardiac transplantation. Therefore, this case presents a rare opportunity to review the use of ESA for refractory VT and an excellent opportunity to review the acute pathologic and histologic changes induced by ESA.
- Published
- 2007
41. Invasive assessment of mitral regurgitation: comparison of hemodynamic parameters.
- Author
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Freihage JH, Joyal D, Arab D, Dieter RS, Loeb HS, Steen L, Lewis B, Liu JC, and Leya F
- Subjects
- Adult, Aged, Aged, 80 and over, Cardiac Catheterization, Coronary Angiography, Female, Humans, Male, Middle Aged, Mitral Valve Insufficiency diagnostic imaging, Pulmonary Wedge Pressure, Severity of Illness Index, Mitral Valve Insufficiency physiopathology
- Abstract
Objectives: We sought to analyze several new hemodynamic characteristics which address the interplay of left atrial (LA) and left ventricular (LV) pressures, as well as to re-analyze several other V wave characteristics employed in the determination of mitral regurgitation (MR) severity in order to determine which, if any, had adequate correlation with grade of MR for clinical utility., Background: Invasive assessment of mitral regurgitation includes analysis of intracardiac pressures and LV angiography. The V wave, when obtained from the pulmonary capillary wedge position (PCWP), and its various characteristics are believed to be of limited value for prediction of MR severity., Method: We analyzed the transeptal pressure tracings of patients with various degrees of MR. Several relationships from the simultaneous pressure-time curves of the LA and LV were defined. Biplane left ventricular angiography was used to grade MR. Correlation between each parameter and MR grade was determined by calculating a Pearson correlation coefficient., Results: The ratio of the area under the V wave to the LV systolic area (V(a)/LV(a)) best correlates with the degree of MR with a Pearson correlation coefficient of 0.60. The V(a)/LV(a) was significantly lower in patients with 0-1+ MR compared to > or =2+ MR (0.14 vs. 0.23 p = 0.002)., Conclusions: Invasive hemodynamic assessment of MR severity could be enhanced by calculating our new ratio, V(a)/LV(a), due to its ability to account for LV work that is lost to the LA with a proportional decrease in forward or useful LV work with progressively increasing severity of MR., ((c) 2006 Wiley-Liss, Inc.)
- Published
- 2007
- Full Text
- View/download PDF
42. Safety and efficacy of the 2.25-mm sirolimus-eluting Bx Velocity stent in the treatment of patients with de novo native coronary artery lesions: the SIRIUS 2.25 trial.
- Author
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Moses JW, Nikolsky E, Mehran R, Cambier PA, Bachinsky WB, Leya F, Kuntz RE, Popma JJ, Schleckser P, Wang H, Cohen SA, and Leon MB
- Subjects
- Angioplasty, Balloon, Coronary, Coronary Restenosis, Diabetes Complications therapy, Female, Humans, Male, Middle Aged, Prospective Studies, Treatment Outcome, Coronary Stenosis therapy, Sirolimus administration & dosage, Stents
- Abstract
Smaller reference vessel diameter is a recognized determinant of in-stent restenosis. The SIRIUS 2.25 trial was a prospective, nonrandomized study including 100 patients (mean age 63.4 years; 64% men, 40% with diabetes mellitus) assessing the safety and efficacy of the 2.25-mm sirolimus-eluting Bx Velocity stent in patients with de novo native coronary lesions. Using propensity score matching for gender, diabetes mellitus, left anterior descending artery target vessel, lesion length, and reference vessel diameter, the outcomes were compared with historical control groups (angioplasty and Palmaz-Schatz stent arms from the STRESS/BENESTENT I/II trials and the Bx Velocity bare metal stent arm from the RAVEL and SIRIUS trials having a reference vessel diameter <3 mm). Use of the 2.25-mm sirolimus-eluting Bx Velocity stent was associated with a high rate of procedural success (97%) and a low rate of in-hospital major adverse cardiac events (2%). The primary end point, 6-month in-lesion binary angiographic restenosis, occurred less frequently in patients treated with the 2.25-mm sirolimus-eluting Bx Velocity stent than in each of 3 historical controls (16.9% vs 30.6%, p = 0.12; 36.5%, p <0.001; 45.9%, p <0.001, respectively). This translated into lower rates of 6-month target lesion revascularization in the 2.25-mm sirolimus-eluting Bx Velocity stent group (4.0% vs 15.0% in each of 3 control groups, p = 0.01 to <0.001). By multivariate analysis, in-lesion binary restenosis was predicted by multiple implanted stents (odds ratio 10.4, p = 0.002). Four of 13 patients who developed restenosis (30.8%) had a diffuse pattern of restenosis. In the long lesion tertile (mean lesion length 19.5 mm), the in-lesion binary restenosis rate was 27.6%. In conclusion, use of the 2.25-mm sirolimus-eluting Bx Velocity stent was safe and provided favorable 6-month clinical outcomes. Use of multiple stents (in longer lesions) was an independent predictor of in-lesion restenosis.
- Published
- 2006
- Full Text
- View/download PDF
43. Clinical experience with rotational atherectomy in patients with severe left ventricular dysfunction.
- Author
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Ramana RK, Joyal D, Arab D, Dieter RS, Steen L, Lewis B, and Leya F
- Subjects
- Aged, Atherectomy, Coronary mortality, Coronary Angiography, Coronary Circulation physiology, Coronary Stenosis diagnostic imaging, Coronary Stenosis mortality, Female, Follow-Up Studies, Humans, Male, Middle Aged, Radiology, Interventional, Retrospective Studies, Risk Assessment, Severity of Illness Index, Stroke Volume, Survival Rate, Treatment Outcome, Ventricular Dysfunction, Left mortality, Ventricular Dysfunction, Left therapy, Atherectomy, Coronary methods, Coronary Stenosis therapy, Ventricular Dysfunction, Left diagnosis
- Abstract
Objective: To evaluate the safety and efficacy of rotational atherectomy (RA) in patients with severe left ventricular (LV) dysfunction., Background: RA, using a rotating diamond-crystal burr, is most commonly used to open lesions with severe calcification or diffuse disease that may prove difficult to cross or dilate. However, RA generates microparticular debris that may attenuate the coronary microcirculation, inducing transient myocardial stunning and LV dysfunction. In fact, the manufacturer does not support RA use in patients with severe LV dysfunction., Methods: We retrospectively identified patients with a LV ejection fraction < 30% who underwent RA in our institution over a 4-year period. The medical records were reviewed and risk factors for cardiac disease were recorded. The procedural reports and subsequent hospitalization records were reviewed to identify predetermined positive and negative outcomes., Results: Twenty-three patients (17 males) who underwent RA with severe LV dysfunction (mean LVEF 21.3%) were identified. The majority of these patients had multivessel coronary artery disease, hypertension, hyperlipidemia and/or tobacco use. Also, a substantial subset had diabetes, renal insufficiency and or in-stent restenosis. RA was 100% successful in opening the lesions without any in-hospital procedure-related mortality. Three patients experienced periprocedural myocardial infarctions. One patient died from malignancy during hospitalization. There were no major adverse cardiac events at 30 days., Conclusion: The transient effect of RA on ventricular function did not adversely affect short-term outcomes in our study population. These results suggest that RA, when performed by experienced operators, is safe and feasible in patients with severe LV dysfunction.
- Published
- 2006
44. Effects of argatroban therapy, demographic variables, and platelet count on thrombotic risks in heparin-induced thrombocytopenia.
- Author
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Lewis BE, Wallis DE, Hursting MJ, Levine RL, and Leya F
- Subjects
- Aged, Amputation, Surgical, Arginine analogs & derivatives, Cohort Studies, Controlled Clinical Trials as Topic, Female, Humans, Male, Middle Aged, Platelet Count, Retrospective Studies, Sulfonamides, Thrombocytopenia blood, Thrombosis surgery, Treatment Outcome, Anticoagulants therapeutic use, Heparin adverse effects, Pipecolic Acids therapeutic use, Thrombocytopenia chemically induced, Thrombocytopenia drug therapy, Thrombosis etiology
- Abstract
Study Objectives: We investigated the effects of the direct thrombin inhibitor argatroban, patient demographics, and the platelet count on thrombotic risks in heparin-induced thrombocytopenia (HIT), a serious thrombotic condition, to determine if argatroban provides effective antithrombotic therapy in patients with HIT without increasing bleeding., Design: We retrospectively analyzed thrombotic outcomes in 882 HIT patients (697 patients receiving mean argatroban doses of 1.7 to 2.0 mug/kg/min for 5 to 7 days, plus 185 historical control subjects) from previously reported prospective studies. Time-to-event analyses of our primary end point-a thrombotic composite of death due to thrombosis, amputation secondary to HIT-associated thrombosis, or new thrombosis within 37 days-and the individual components were conducted, with hazard ratios estimated for treatment with and without adjustments for patient age, gender, race, weight, and baseline platelet count., Measurements and Results: Argatroban, vs control, significantly reduced the thrombotic composite risk (HIT: hazard ratio, 0.33; 95% confidence interval [CI], 0.20 to 0.54, p < 0.001; HIT with thrombosis: hazard ratio, 0.39; 95% CI, 0.25 to 0.62, p < 0.001), regardless of covariate adjustments. More argatroban-treated patients than control subjects remained thrombotic event free during follow-up, regardless of whether baseline thrombosis was absent (91% vs 73%) or present (72% vs 50%). Argatroban significantly reduced new thrombosis (p < 0.001) and death due to thrombosis (p = 0.001). Major bleeding was similar between groups (6 to 7%, p = 0.74). Thrombotic risks were 2 times greater in nonwhite than in white patients, 1.7 times greater in female than male patients with HIT and thrombosis, and increased with decreasing weight or platelet count., Conclusions: Argatroban, vs control, provides effective antithrombotic therapy in patients with HIT, without increasing bleeding. Patients at higher risk for HIT-associated thrombosis include women, nonwhites, and individuals with current HIT-associated thrombosis, lower body weight, or more severe thrombocytopenia.
- Published
- 2006
- Full Text
- View/download PDF
45. Coronary artery perforation during percutaneous coronary intervention: incidence and outcomes in the new interventional era.
- Author
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Ramana RK, Arab D, Joyal D, Steen L, Cho L, Lewis B, Liu J, Loeb H, and Leya F
- Subjects
- Abciximab, Adult, Aged, Aged, 80 and over, Angioplasty, Balloon, Coronary instrumentation, Antibodies, Monoclonal adverse effects, Female, Heart Injuries etiology, Heart Injuries therapy, Humans, Immunoglobulin Fab Fragments adverse effects, Incidence, Male, Middle Aged, Retrospective Studies, Stents adverse effects, Treatment Outcome, Angioplasty, Balloon, Coronary adverse effects, Atherectomy, Coronary adverse effects, Coronary Vessels injuries, Heart Injuries epidemiology, Medical Errors statistics & numerical data, Platelet Glycoprotein GPIIb-IIIa Complex antagonists & inhibitors
- Abstract
Background: Coronary artery perforation (CP) is a serious complication of percutaneous coronary intervention (PCI). We sought to define the incidence and outcome of CP given the advance in interventional techniques, devices and use of glycoprotein inhibitors (GP IIb/IIIa)., Methods: We retrospectively reviewed the records of patients who underwent PCI at our institution over a four-year period. The incidence of CP was derived from patient records and then confirmed by reviewing the angiogram. Perforations were classified as Type 1, 2, or 3, as previously defined., Results: A total of 4,886 patients underwent PCI. Atherectomy devices were used in 329 patients and GP IIb/IIIa in 2,200 patients. Twenty-five CP were identified (0.5% incidence). Six were Type 1 (24%), 10 were Type 2 (40%), and 9 were Type 3 (36%). 13/25 (52%) of the CP were Type C Lesions, and 12/25 (48%) occurred in calcified vessels. All Type 1 perforations were caused by coronary wires and 4/6 CP occurred with the use of hydrophilic and extra stiff wires. Type 2 perforations were caused by coronary wires in 8/10 CP, and by stent deployment in 2/10. Two patients with Type 2 CP sustained a non-ST-elevation myocardial infarction. Type 3 perforations were caused by stent placement in 4/9 CP, 2/9 by atherectomy devices, and 3/9 by coronary wires. Four patients with Type 3 CP underwent pericardial drainage, 5 patients had a myocardial infarction and 2 patients died., Conclusion: Type 1 and 2 perforations are predominately caused by hydrophilic and stiff wires and do not require pericardial drainage or surgical intervention. Type 3 perforations are more often associated with stent and device use. A majority of Type 3 perforations can be initially managed by percutaneous methods.
- Published
- 2005
46. Controlled myocardial infarction induced by intracoronary injection of n-butyl cyanoacrylatein dogs: a feasibility study.
- Author
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Matos GF, Hammadeh R, Francois C, McCarthy R, and Leya F
- Subjects
- Animals, Coronary Angiography, Disease Models, Animal, Dogs, Feasibility Studies, Injections, Myocardial Infarction diagnostic imaging, Bucrylate, Myocardial Infarction chemically induced, Tissue Adhesives
- Abstract
Concentrated ethanol has been used to induce controlled myocardial infarct in patients with hypertrophic obstructive cardiomyopathy. We report the acute and early follow-up results of an alternative agent, n-butyl cyanoacrylate (n-BCA) glue, in a dog model. In 11 mongrel dogs, we injected n-BCA into different branches of the left anterior descending artery. Biplane left ventriculogram and coronary angiogram were performed before and after injection. In the surviving animals, we performed programmed stimulation (PS) to test for inducible ventricular tachycardia (VT) 48 days later. Following euthanasia, the removed hearts were studied with computer tomography (CT) and gross and histologic examination. Three dogs were lost before injection. Four dogs died within 2 hr to 4 days, and four animals survived 48 days. Accidental embolization of n-BCA into nontarget vessels was documented in four subjects. In the n-BCA-injected animals, homogeneous circumscribed scar was demonstrated by CT and histology. The glue was confined strictly to the tributary of the injected vessel, infiltrating arterioles of 14 mum. There was intense granulomatous reaction (GR) in the vessel wall and in the surrounding myocardium. Remote areas were unaffected. Monomorphic VT was not inducible with PS. We report a feasibility study of n-BCA injection to selected coronary arteries of dogs to cause controlled myocardial infarction. We demonstrated that the glue does not escape from the target artery through capillaries or small collateral vessels and thus produces a sharply demarcated and homogeneous scar, which is confined strictly to the supply zone of the injected vessel. Improvement of the delivery system is necessary to eliminate inadvertent embolization. Long-term follow-up is needed to study the GR induced by n-BCA.
- Published
- 2005
- Full Text
- View/download PDF
47. Antiplatelet therapy in anticoagulated patients requiring coronary intervention.
- Author
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Arab D, Lewis B, Cho L, Steen L, Joyal D, and Leya F
- Subjects
- Anticoagulants adverse effects, Aspirin adverse effects, Clopidogrel, Drug Therapy, Combination, Humans, Risk Factors, Stents, Thromboembolism etiology, Ticlopidine adverse effects, Ticlopidine analogs & derivatives, Warfarin adverse effects, Angioplasty, Balloon, Coronary, Hemorrhage chemically induced, Platelet Aggregation Inhibitors adverse effects, Thromboembolism prevention & control
- Abstract
Objective: To define the optimal antiplatelet regime in patients requiring long-term anticoagulation who undergo percutaneous coronary intervention., Background: Antiplatelet therapy following coronary intervention consists of a regime of aspirin and clopidogrel for the prevention of subacute stent thrombosis. The optimal antiplatelet therapy post-coronary intervention in patients on ongoing anticoagulation therapy remains to be defined. Addition of aspirin and clopidogrel to patients already on warfarin increases the risk of bleeding, while withholding antiplatelet therapy increases the risk of stent thrombosis. Discontinuation of warfarin in turn increases the risk of thromboembolism., Methods: We performed a systematic review and synthesis of the English language literature examining the risk of subacute thrombosis with various antiplatelet regimens and the risk for thromboembolism with and without warfarin. The risk of bleeding complications with various drug combinations were reviewed., Conclusions: There are no data from randomized trials to clarify the optimum treatment in these patients; and the feasibility of such studies may be questionable. Hence, treatment decisions continue to be made on an individualized basis and should include assimilation of information on key factors, including the risk of bleeding and the risk of thromboembolism.
- Published
- 2005
48. BlackAorta: a rare finding at aortic valve replacement.
- Author
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Goodfellow RJ, Schwartz J, and Leya F
- Subjects
- Aged, Alkaptonuria complications, Alkaptonuria pathology, Aortic Dissection complications, Aortic Dissection diagnosis, Aortic Dissection pathology, Aortic Dissection surgery, Aortic Aneurysm complications, Aortic Aneurysm diagnosis, Aortic Aneurysm pathology, Aortic Aneurysm surgery, Aortic Valve, Coronary Artery Bypass, Coronary Artery Disease complications, Coronary Artery Disease pathology, Coronary Artery Disease surgery, Cyanosis etiology, Cyanosis pathology, Diagnosis, Differential, Dyspnea etiology, Female, Heart Valve Diseases complications, Heart Valve Diseases pathology, Heart Valve Diseases surgery, Heart Valve Prosthesis, Humans, Ochronosis complications, Ochronosis diagnosis, Ochronosis pathology, Alkaptonuria diagnosis, Coronary Artery Disease diagnosis, Heart Valve Diseases diagnosis
- Published
- 2005
49. Amelioration of hypertrophic cardiomyopathy using nonsurgical septal ablation in a cirrhotic patient prior to liver transplantation.
- Author
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Paramesh AS, Fairchild RB, Quinn TM, Leya F, George M, and Van Thiel DH
- Subjects
- Cardiomyopathy, Hypertrophic epidemiology, Contraindications, Hepatitis C epidemiology, Humans, Liver Cirrhosis epidemiology, Male, Middle Aged, Ventricular Outflow Obstruction surgery, Cardiomyopathy, Hypertrophic surgery, Catheter Ablation, Liver Transplantation
- Abstract
A 53-year-old male with hepatitis C cirrhosis, who had been refused liver transplantation because of hypertrophic cardiomyopathy (HC), underwent nonsurgical septal ablation using alcohol with resolution of his ventricular outflow obstruction. This patient was able to subsequently undergo a successful deceased donor liver transplantation. This is the first reported case of alcohol induced septal ablation being performed in a cirrhotic patient with HC. Such nonsurgical procedures may be attractive in cirrhotic patients who are refused access to liver transplantation because of high surgical risk.
- Published
- 2005
- Full Text
- View/download PDF
50. Biomarker profiling of plasma from acute coronary syndrome patients. Application of ProteinChip Array analysis.
- Author
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Florian-Kujawski M, Hussain W, Chyna B, Kahn S, Hoppensteadt D, Leya F, and Fareed J
- Subjects
- Acute Disease, Case-Control Studies, Humans, Hydroxylation, Mass Spectrometry, Molecular Weight, Peptides metabolism, Proteins metabolism, Serum Albumin metabolism, Syndrome, Biomarkers blood, Coronary Disease blood, Protein Array Analysis
- Abstract
Aim: Acute coronary syndrome (ACS) is one of the leading causes of death in the world and remains a complex pathophysiologic process involving inflammatory, hemostatic and vascular processes. The purpose of this study was to identify unique proteomic biomarkers present in patients with ACS using a newly developed proteomic profiling technique, surface enhanced laser desorption/ionization (SELDI)., Methods: Citrated plasma samples obtained from clinically confirmed cases of ACS (n=100) and age matched controls (n=25) were profiled using SELDI-time of flight (TOF)-mass spectrometry (Ciphergen Biosystems, Freemont, CA, USA). A strong anion exchange (SAX) ProteinChip Array was used to profile these samples. In addition to spectra profiles, protein density plots were be obtained from the generated molecular profile., Results: The SELDI profile in the molecular weight (MW) range of 0-150 kDa revealed a prominent 66.3 kDa albumin peak along with several distinct components at 28 kDa, 13.7 kDa and 6.5 kDa. Additional minor molecular components were also noted in the lower MW range (<6 kDa). There was a cluster of peaks between 10 and 12 kDa that were unique to the patients with ACS; about 1/3 of the ACS patients exhibited these peaks as evident in the ProteinChip Array spectrum. None of the age-matched controls exhibited the peaks in this MW range, nor did the normal human plasma pool that was used as an additional control. The relative intensity of these novel molecular components in the range of 10-12 kDa represent unique proteins/peptides which are generated in specific pathologic states associated with ACS., Conclusions: These observations suggest that patients with ACS have a unique cluster of molecular components that are present in their SELDI profile. It might be possible to use these patterns to identify high-risk patients who may be more susceptible to the development of unstable plaque, which may eventually lead to myocardial infarction. Identification and characterization of these molecular components will also help in the understanding of the pathogenesis of ACS. These unique peaks may represent pathologic proteins, novel inflammatory mediators or protease cleavage products. Further studies need to be done to better characterize and identify these molecular components and their pathologic role in ACS.
- Published
- 2004
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