870 results on '"Murat Tuzcu"'
Search Results
2. High prevalence of cardiometabolic risk factors amongst young adults in the United Arab Emirates: the UAE Healthy Future Study
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Fatima Mezhal, Abderrahim Oulhaj, Abdishakur Abdulle, Abdulla AlJunaibi, Abdulla Alnaeemi, Amar Ahmad, Andrea Leinberger-Jabari, Ayesha S. Al Dhaheri, Eiman AlZaabi, Fatma Al-Maskari, Fatme Alanouti, Fayza Alameri, Habiba Alsafar, Hamad Alblooshi, Juma Alkaabi, Laila Abdel Wareth, Mai Aljaber, Marina Kazim, Michael Weitzman, Mohammad Al-Houqani, Mohammad Hag Ali, E. Murat Tuzcu, Naima Oumeziane, Omar El-Shahawy, Rami H. Al-Rifai, Scott Sherman, Syed M. Shah, Thekra Alzaabi, Tom Loney, Wael Almahmeed, Youssef Idaghdour, Luai A. Ahmed, and Raghib Ali
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Non-communicable disease ,Cardiovascular disease ,Cardiometabolic risk factors ,Obesity ,Dysglycemia ,Dyslipidemia ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Cardiovascular disease (CVD) is the leading cause of death in the world. In the United Arab Emirates (UAE), it accounts for 40% of mortality. CVD is caused by multiple cardiometabolic risk factors (CRFs) including obesity, dysglycemia, dyslipidemia, hypertension and central obesity. However, there are limited studies focusing on the CVD risk burden among young Emirati adults. This study investigates the burden of CRFs in a sample of young Emiratis, and estimates the distribution in relation to sociodemographic and behavioral determinants. Methods Data was used from the baseline data of the UAE Healthy Future Study volunteers. The study participants were aged 18 to 40 years. The study analysis was based on self-reported questionnaires, anthropometric and blood pressure measurements, as well as blood analysis. Results A total of 5167 participants were included in the analysis; 62% were males and the mean age of the sample was 25.7 years. The age-adjusted prevalence was 26.5% for obesity, 11.7% for dysglycemia, 62.7% for dyslipidemia, 22.4% for hypertension and 22.5% for central obesity. The CRFs were distributed differently when compared within social and behavioral groups. For example, obesity, dyslipidemia and central obesity in men were found higher among smokers than non-smokers (p
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- 2023
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3. The interrelationship and accumulation of cardiometabolic risk factors amongst young adults in the United Arab Emirates: The UAE Healthy Future Study
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Fatima Mezhal, Abderrahim Oulhaj, Abdishakur Abdulle, Abdulla AlJunaibi, Abdulla Alnaeemi, Amar Ahmad, Andrea Leinberger-Jabari, Ayesha S. Al Dhaheri, E. Murat Tuzcu, Eiman AlZaabi, Fatma Al-Maskari, Fatme Alanouti, Fayza Alameri, Habiba Alsafar, Hamad Alblooshi, Juma Alkaabi, Laila Abdel Wareth, Mai Aljaber, Marina Kazim, Micheal Weitzman, Mohammad Al-Houqani, Mohammad Hag Ali, Naima Oumeziane, Omar El-Shahawy, Rami H. Al-Rifai, Scott Scherman, Syed M. Shah, Tom Loney, Wael Almahmeed, Youssef Idaghdour, Luai A. Ahmed, and Raghib Ali
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Cardiovascular disease ,Cardiometabolic risk factors ,Obesity ,Dysglycemia ,Dyslipidemia ,Hypertension ,Nutritional diseases. Deficiency diseases ,RC620-627 - Abstract
Abstract Introduction Similar to other non-communicable diseases (NCDs), people who develop cardiovascular disease (CVD) typically have more than one risk factor. The clustering of cardiovascular risk factors begins in youth, early adulthood, and middle age. The presence of multiple risk factors simultaneously has been shown to increase the risk for atherosclerosis development in young and middle-aged adults and risk of CVD in middle age. Objective This study aimed to address the interrelationship of CVD risk factors and their accumulation in a large sample of young adults in the United Arab Emirates (UAE). Methods Baseline data was drawn from the UAE Healthy Future Study (UAEHFS), a volunteer-based multicenter study that recruits Emirati nationals. Data of participants aged 18 to 40 years was used for cross-sectional analysis. Demographic and health information was collected through self-reported questionnaires. Anthropometric data and blood pressure were measured, and blood samples were collected. Results A total of 5126 participants were included in the analysis. Comorbidity analyses showed that dyslipidemia and obesity co-existed with other cardiometabolic risk factors (CRFs) more than 70% and 50% of the time, respectively. Multivariate logistic regression analysis of the risk factors with age and gender showed that all risk factors were highly associated with each other. The strongest relationship was found with obesity; it was associated with four-fold increase in the odds of having central obesity [adjusted OR 4.70 (95% CI (4.04–5.46)], and almost three-fold increase odds of having abnormal glycemic status [AOR 2.98 (95% (CI 2.49–3.55))], hypertension (AOR 3.03 (95% CI (2.61–3.52))] and dyslipidemia [AOR 2.71 (95% CI (2.32–3.15)]. Forty percent of the population accumulated more than 2 risk factors, and the burden increased with age. Conclusion In this young population, cardiometabolic risk factors are highly prevalent and are associated with each other, therefore creating a heavy burden of risk factors. This forecasts an increase in the burden of CVD in the UAE. The robust longitudinal design of the UAEHFS will enable researchers to understand how risk factors cluster before disease develops. This knowledge will offer a novel approach to design group-specific preventive measures for CVD development.
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- 2021
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4. Transcatheter Aortic Valve Replacement–Associated Infective Endocarditis: Comparison of Early, Intermediate, and Late-Onset Cases
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Simrat Kaur, MD, Gursharan Singh Samra, MD, Manpreet Kaur, MD, Nabin K. Shrestha, MD, Steven Gordon, MD, E. Murat Tuzcu, MD, Samir Kapadia, MD, Amar Krishnaswamy, MD, Grant W. Reed, MD, MSc, Rishi Puri, MD, PhD, Lars G. Svensson, MD, PhD, Wael A. Jaber, MD, Brian P. Griffin, MD, and Bo Xu, MD
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Echocardiography ,Infective endocarditis ,PET/CT imaging ,TAVR ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Transcatheter aortic valve replacement–associated infective endocarditis (TAVR-IE) is a relatively rare complication of TAVR. Little is known about the characteristics of early, intermediate, and late-onset TAVR-IE. Methods: We studied the risk factors, microbiological patterns, and diagnostic and treatment strategies in patients with early (1 year) TAVR-IE. Results: Ten out of 494 definite cases of prosthetic valve IE between 2007 and 2019 were confirmed to have TAVR-IE from the IE registry at our center. The mean age was 78.1 ± 13.7 years, with 50% being female. The mean Society of Thoracic Surgeons risk score was 7.8 ± 5.7. Most (60%) TAVR-IE cases had an intermediate onset, with Staphylococcus aureus being the most common organism (66.6%). 18-fluorodeoxyglucose positron emission tomography aided in diagnosis of TAVR-IE in 20% of cases. Mortality due to IE was observed in 40% of cases. Most of the patients underwent conservative management, and 37.5% survived over a mean follow-up of 709 ± 453 days. Two patients underwent surgery, of whom one died on day 30 postoperatively from sepsis. Mortality due to IE occurred in 25% of cases in the early and intermediate-onset groups, while there was 100% mortality in the late-onset group. Conclusions: In a single-center cohort, most TAVR-IE cases had an intermediate onset, with Staphylococcus aureus being the most common organism. Understanding timing of TAVR-IE may have important prognostic implications.
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- 2022
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5. A Review on the Implementation of System Modelling Techniques in Lean Healthcare Applications.
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Maitha AlKaabi, Mecit Can Emre Simsekler, Raja Jayaraman, Kudret Demirli, and Murat Tuzcu
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- 2019
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6. HbA1c, Coronary atheroma progression and cardiovascular outcomes
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Iryna Dykun, Ozgur Bayturan, Julie Carlo, Steven E. Nissen, Samir R. Kapadia, E. Murat Tuzcu, Stephen J. Nicholls, and Rishi Puri
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HbA1c ,Diabetes mellitus ,Coronary atheroma progression ,IVUS ,MACE ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Public aspects of medicine ,RA1-1270 - Abstract
Background and aims: We tested the hypothesis that on-treatment HbA1c levels independently associate with coronary atheroma progression and major adverse cardiovascular events (MACE: death, myocardial infarction, cerebrovascular accident, coronary revascularization, or hospitalization for unstable angina) rates. Methods: We performed a post-hoc pooled analysis of data from seven prospective, randomized trials involving serial coronary intravascular ultrasonography (IVUS). The percent atheroma volume (PAV) was calculated as the proportion of the entire vessel wall occupied by atherosclerotic plaque. Using multivariable mixed modeling, we determined the association of on-treatment HbA1c with annualized change in PAV. Cox proportional hazard models were used to assess the association of HbA1c with incidence of MACE. Results: Among 3,312 patients (mean age 58.6±9years, 28.4%women) average on-treatment HbA1c was 6.2±1.1%. Overall, there was no net significant annualized change in PAV (0.12±0.19%, p = 0.52). In a fully adjusted multivariable analysis (following adjustment of age, sex, body mass index, systolic blood pressure, smoking, low- and high-density lipoprotein cholesterol, triglyceride levels, peripheral vascular disease, trial, region, and baseline PAV), higher on-treatment HbA1c levels were independently associated with annualized changes in PAV [beta-estimate (95% confidence interval): 0.13(0.08, 0.19), p
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- 2022
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7. The implications and requirements of transcatheter aortic valve replacement in low-risk patients
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Emin Murat Tuzcu and Ahmad Edris
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transcatheter aortic valve replacement ,surgical aortic valve replacement ,aortic valve stenosis ,risk factors ,postoperative complications ,treatment outcome. ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Transcatheter aortic valve replacement (TAVR) is a transformative technology that has changed the management of patients with severe, symptomatic aortic stenosis. The use of TAVR in intermediate- to high-risk patients has been validated in several rigorously performed, randomized clinical trials. Recent studies using newer generation devices have demonstrated the noninferiority of TAVR as compared with surgical aortic valve replacement in low-risk patients, supporting the increased utilization and expansion of TAVR. The use of TAVR in low-risk patients has important implications and requires a multifaceted approach that includes a highly functional multidisciplinary heart team for careful patient selection; a need to understand and help mitigate certain key complications, such as stroke, paravalvular regurgitation, and conduction disturbances; careful data collection for continual outcome assessment and improvement; and the necessary expertize and procedural volume to maintain excellent outcomes and ensure optimal clinical care pathways.
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- 2019
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8. An alarming trend: Change in the risk profile of patients with ST elevation myocardial infarction over the last two decades
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Mentias, Amgad, Hill, Elizabeth, Barakat, Amr F., Raza, Mohammad Q., Youssef, Dalia, Banerjee, Kinjal, Sawant, Abhishek C., Ellis, Stephen, Murat Tuzcu, E., and Kapadia, Samir R.
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- 2017
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9. Impact of tricuspid regurgitation on postoperative outcomes after non-cardiac surgeries
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Brian Griffin, Samir Kapadia, Venu Menon, Parth Parikh, Kinjal Banerjee, Ambreen Ali, Anil Anumandla, Aditi Patel, Yash Jobanputra, and E Murat Tuzcu
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
ObjectiveTricuspid regurgitation (TR) severity has known adverse implications, its impact on patients undergoing non-cardiac surgery (NCS) remains unclear. We sought to determine the impact of TR on patient outcomes after NCS.MethodsWe performed a retrospective cohort study in patients undergoing NCS. Outcomes in patients with moderate or severe TR were compared with no/trivial TR after adjusting for baseline characteristics and revised cardiac risk index (RCRI). The primary outcome was defined as 30-day mortality and heart failure (HF), while the secondary outcome was long-term mortality.ResultsOf the 7064 patients included, 312 and 80 patients had moderate and severe TR, respectively. Thirty-day mortality was higher in moderate TR (adjusted OR 2.44, 95% CI 1.25 to 4.76) and severe TR (OR 2.85, 95% CI 1.04 to 7.79) compared with no/trivial TR. There was no difference in 30-day HF in patients with moderate TR (OR 1.48, 95% CI 0.90 to 2.44) or severe TR (OR 1.42, 95% CI 0.60 to 3.39). The adjusted HR for long-term mortality in moderate TR was 1.55 (95% CI 1.31 to 1.82) and 1.87 (95% CI 1.40 to 2.50) for severe TR compared with no/trivial TR.ConclusionIncreasing TR severity has higher postoperative 30-day mortality in patients undergoing NCS, independent of RCRI risk factors, ejection fraction or mitral regurgitation. Severity of TR should be considered in risk stratification for patients undergoing NCS.
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- 2020
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10. A critical review of implementing lean and simulation to improve resource utilization and patient experience in outpatient clinics
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Abdulqader Al-Kaf, Raja Jayaraman, Kudret Demirli, Mecit Can Emre Simsekler, Hussam Ghalib, Dima Quraini, and Murat Tuzcu
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Strategy and Management ,General Decision Sciences ,Business and International Management ,General Business, Management and Accounting - Abstract
PurposeThe purpose of this paper is to explore and critically review the existing literature on applications of Lean Methodology (LM) and Discrete-Event Simulation (DES) to improve resource utilization and patient experience in outpatient clinics. In doing, it is aimed to identify how to implement LM in outpatient clinics and discuss the advantages of integrating both lean and simulation tools towards achieving the desired outpatient clinics outcomes.Design/methodology/approachA theoretical background of LM and DES to define a proper implementation approach is developed. The search strategy of available literature on LM and DES used to improve outpatient clinic operations is discussed. Bibliometric analysis to identify patterns in the literature including trends, associated frameworks, DES software used, and objective and solutions implemented are presented. Next, an analysis of the identified work offering critical insights to improve the implementation of LM and DES in outpatient clinics is presented.FindingsCritical analysis of the literature on LM and DES reveals three main obstacles hindering the successful implementation of LM and DES. To address the obstacles, a framework that integrates DES with LM has been recommended and proposed. The paper provides an example of such a framework and identifies the role of LM and DES towards improving the performance of their implementation in outpatient clinics.Originality/valueThis study provides a critical review and analysis of the existing implementation of LM and DES. The current roadblocks hindering LM and DES from achieving their expected potential has been identified. In addition, this study demonstrates how LM with DES combined to achieve the desired outpatient clinic objectives.
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- 2022
11. Impact of lean six sigma process improvement methodology on cardiac catheterization laboratory efficiency
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Agarwal, Shikhar, Gallo, Justin J., Parashar, Akhil, Agarwal, Kanika K., Ellis, Stephen G., Khot, Umesh N., Spooner, Robin, Murat Tuzcu, Emin, and Kapadia, Samir R.
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- 2016
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12. Plaque microstructures in patients with coronary artery disease who achieved very low low-density lipoprotein cholesterol levels
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Kataoka, Yu, Hammadah, Muhammad, Puri, Rishi, Duggal, Bhanu, Uno, Kiyoko, Kapadia, Samir R., Murat Tuzcu, E., Nissen, Steven E., and Nicholls, Stephen J.
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- 2015
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13. Coronary Heart Disease in the Middle East and North Africa: Current Status and Future Goals
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Traina, Mahmoud I., Almahmeed, Wael, Edris, Ahmad, and Murat Tuzcu, E.
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- 2017
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14. Left ventricular remodelling and changes in functional measurements in patients undergoing transcatheter vs surgical aortic valve replacement: a head-to-head comparison
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Yosef, Manla, Amani, Khalouf, Ahmad, Edris, Khwaja, Hasan, Shahrukh, Hashmani, Anas, El Zouhbi, Terrence, Lee-St John, Nour, Dababo, E Murat, Tuzcu, and Firas, Al Badarin
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Research Correspondence - Published
- 2022
15. Impact of left ventricular diastolic function and survival in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement.
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Kimi Sato, Serge Harb, Arnav Kumar, Samir R Kapadia, Stephanie Mick, Amar Krishnaswamy, Milind Y Desai, Brian P Griffin, L Leonardo Rodriguez, E Murat Tuzcu, Lars G Svensson, and Zoran B Popović
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Medicine ,Science - Abstract
In year 2016, the American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI) updated Recommendations for the assessment and grading of diastolic dysfunction (DD). We aimed to assess the applicability of this DD grading method and its association with prognosis in patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI). We retrospectively identified 237 consecutive patients with severe AS who underwent trans-femoral TAVI. Baseline transthoracic echocardiography was evaluated to assess pre- and post-TAVI diastolic function according to the current ASE/EACVI Recommendations. Prior to TAVI, 41 (17%) patients were diagnosed as having grade I DD, 111 (47%) patients had grade II DD, 80 (34%) had grade III DD. DD grade after TAVI decreased (p < 0.001) with 75 patients (32%) reclassified to a lower DD grade. During the median follow-up of 1,320 days, 136 (57%) patients died. In univariable Cox proportional hazards model analysis, neither pre- nor post-TAVI DD grade were associated with prognosis. However, patients with grade III DD detected before TAVI and AR≥ 2 after TAVI had poorer survival (p
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- 2018
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16. Safety and Efficacy of Balloon Aortic Valvuloplasty Stratified by Acuity of Patient Illness
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Anirudh Kumar, Zoran B. Popović, Venu Menon, Divyang Patel, E. Murat Tuzcu, Amar Krishnaswamy, Agam Bansal, Rohan Shah, Laura Young, Samir R. Kapadia, Rishi Puri, Grant W. Reed, Jonathon White, and Ankur Kalra
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medicine.medical_specialty ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,Cardiogenic shock ,medicine.disease ,Balloon ,Aortic valvuloplasty ,Stenosis ,Valve replacement ,Internal medicine ,Concomitant ,cardiovascular system ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Balloon aortic valvuloplasty (BAV) is often performed for patients with aortic stenosis who are not candidates for transcatheter aortic valve replacement (TAVR) due to concomitant medical issues. H...
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- 2021
17. Using lean techniques and discrete-event simulation for performance improvement in an outpatient clinic
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E. Murat Tuzcu, Mumtaz Jamshed Khan, Raja Jayaraman, Kudret Demirli, Abdulqader Al Kaf, and Mecit Can Emre Simsekler
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Flexibility (engineering) ,Data collection ,Resource (project management) ,Process (engineering) ,Computer science ,Outpatient clinic ,Operations management ,Performance improvement ,Discrete event simulation ,Resource utilization - Abstract
Purpose Increased demand and the pressure to reduce health-care costs have led to longer waiting time for patients to make appointments and during the day of hospital visits. The purpose of this study is to identify opportunities to reduce waiting time using lean techniques and discrete-event simulation (DES). Design/methodology/approach A five-step procedure is proposed to facilitate the effective utilization of lean and DES to improve the performance of the Otolaryngology Head and Neck Surgery Outpatient Clinic at Cleveland Clinic Abu Dhabi. While lean techniques were applied to reduce the potential sources of waste by aligning processes, a DES model was developed to validate the proposed solutions and plan patient arrivals under dynamic conditions and different scenarios. Findings Aligning processes resulted in an efficient patient flow reducing both waiting times. DES played a complementary role in verifying lean solutions under dynamic conditions, helping to plan the patient arrivals and striking a balance between the waiting times. The proposed solutions offered flexibility to improve the clinic capacity from the current 176 patients up to 479 (without violating the 30 min waiting time policy) or to reduce the patient waiting time during the visit from the current 33 min to 4.5 min (without violating the capacity goal of 333 patients). Research limitations/implications Proposing and validating lean solutions require reliable data to be collected from the clinic and such a process could be laborious as data collection require patient and resource tracing without interfering with the regular functions of the clinic. Practical implications The work enables health-care managers to conveniently conduct a trade-off analysis and choose a suitable inter-arrival time – for every physician – that would satisfy their objectives between resource utilization (clinic capacity) and average patient waiting time. Social implications Successful implementation of lean requires a supportive and cooperative culture from all stakeholders involved. Originality/value This study presents an original and detailed application of lean techniques with DES to reduce patient waiting times. The adopted approach in this study could be generalized to other health-care settings with similar objectives.
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- 2021
18. Donor-transmitted Anterior Myocardial Ischaemia in a Teenager: How to Proceed?
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Maurice Hogan, Feras Bader, Laszlo Göbölös, Gopal Bhatnagar, Mosaad El-Banna, and Emin Murat Tuzcu
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medicine.medical_specialty ,Myocardial ischaemia ,business.industry ,Internal medicine ,Cardiology ,medicine ,General Medicine ,business - Abstract
Background: Heart transplantation remains the treatment of choice for end-stage heart failure patients, owing to the associated dual improvements in quality of life, and prognosis. The discrepancy between higher demand and supply of donor organs is the limiting factor, and is established universally. Increasing consideration of donor populations up to 65 years of age and marginal donor hearts has helped to facilitate the availability of potential grafts. However, grafts from older donors carry the mid-term increased risk of coronary allograft vasculopathy, including donor-transmitted coronary disease. Case report: A 15-year-old female underwent orthotopic heart transplantation for non-ischaemic cardiomyopathy, the donor was a 44-year-old male. The recipient developed anterior wall ischaemia within a year requiring coronary angioplasty and stent implantation to treat the severe obstruction in the left anterior descending coronary artery. However, two months later, the patient was readmitted with in-stent restenosis. Therefore, to optimally revascularise the left anterior descending coronary artery, and minimise risks associated with re-sternotomy, a minimally invasive direct coronary artery by pass grafting of the left internal mammary artery to the left anterior descending artery was performed. Conclusion: Surgical revascularisation in generalised coronary allograft vasculopathy is an inadequate option; repeat heart transplantation is the treatment of choice, albeit given its morbidity, should be reserved for a highly selected patient population. In localised coronary lesions, conventional coronary bypass surgery may be a feasible choice in selected patients with left anterior descending artery lesions. Minimal invasive techniques, such as minimally invasive direct coronary artery bypass grafting rather than robotic techniques, would be preferable for ease of approach and to limit the surgical re-do trauma.
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- 2021
19. Incidence and Prevention of Strokes in TAVI
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Brandon M. Jones, E. Murat Tuzcu, Amar Krishnaswamy, and Samir R. Kapadia
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TAVI ,TAVR ,transcatheter aortic valve implantation ,stroke ,embolic protection device ,anti-platelet ,anti-coagulation ,Medicine (General) ,R5-920 - Abstract
Transcatheter aortic valve implantation (TAVI) is now a widely adopted option for many inoperable and high risk patients with severe aortic valve stenosis, and clinical trials continue to show great benefit with regards to mortality and major cardiovascular endpoints. As the technology continues to expand and possibly grow to include intermediate and low risk populations, investigators have remained focused on efforts to reduce the risk of peri-procedural complications, of which neurologic events remain some of the most feared. Fortunately, contemporary studies have shown a significant decline in the risk of stroke with TAVI as compared to early clinical trials, and no difference when compared to surgical aortic valve replacement in the most recent trials. This review will focus on current methods for diagnosing, defining, and quantifying the effect of stroke after TAVI, explore the evidence with regards to stroke risk in various populations undergoing these procedures, discuss possible mechanisms for both early and late neurologic events after TAVI, and discuss strategies for both pharmacologic and device based embolic protection during these procedures.
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- 2015
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20. Adverse Cardiac Effects of SARS-CoV-2 Infection
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Göbölös, Laszlo, primary, Manla, Yosef, additional, Rácz, István, additional, Hogan, Maurice, additional, Remsey-Semmelweis, Ernő, additional, Atallah, Bassam, additional, AlJabery, Yazan, additional, AlMahmeed, Wael, additional, AlSindi, Fahad, additional, Bader, Feras, additional, Bhatnagar, Gopal, additional, Aleinati, Tareq, additional, and Murat Tuzcu, Emin, additional
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- 2022
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21. The role of renin-angiotensin system activated phagocytes in the SARS-CoV-2 coronavirus infection
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Maurice Hogan, Gopal Bhatnagar, F. Alsindi, Bassam Atallah, Rakesh M. Suri, Laszlo Göbölös, Wael Almahmeed, Emin Murat Tuzcu, István Rácz, and Ernő Remsey-Semmelweis
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Systemic disease ,ARDS ,Phagocyte ,Disease ,030204 cardiovascular system & hematology ,medicine.disease_cause ,Article ,Renin-Angiotensin System ,Pathogenesis ,03 medical and health sciences ,0302 clinical medicine ,Immune system ,medicine ,Humans ,030212 general & internal medicine ,Coronavirus ,free radical ,Phagocytes ,SARS-CoV-2 ,business.industry ,COVID-19 ,medicine.disease ,microvascular disease ,activated phagocytes ,Respiratory burst ,medicine.anatomical_structure ,Immunology ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective Management of the pandemic caused by the novel coronavirus SARS-CoV-2 challenges both scientists and physicians to rapidly develop, and urgently assess, effective diagnostic tests and therapeutic interventions. The initial presentation of the disease in symptomatic patients is invariably respiratory, with dry cough being the main symptom, but an increasing number of reports reveal multiple-organ involvement. The aim of this review is to summarize the potential role of the renin-angiotensin system activated phagocytes in the pathogenesis of COVID-19 disease. Methods Data for this review were identified by searches of PubMed and references from relevant articles using the search terms “SARS,” “COVID-19,” “renin-angiotensin-system,” “phagocyte,” “reactive free radical,” “antioxidant,” “ARDS,” “thrombosis,” “myocardial,” “ischaemia,” “reperfusion,” “microvascular,” and “ACE2.” Abstracts and reports from meetings were not included in this work. Only articles published in English between 1976 and 2020 were reviewed. Results The cellular target of SARS viruses is the angiotensin-converting enzyme 2, a critical regulating protein in the renin-angiotensin system. The elimination of this enzyme by the viral spike protein results in excessive activation of phagocytes, migration into the tissues via the high endothelial venules, and an oxidative burst. In the case of an overstimulated host immune response, not only devastating respiratory symptoms but even systemic or multiorgan involvement may be observed. Conclusions Early-stage medical interventions may assist in returning the exaggerated immune response to a normal range; however, some therapeutic delay might result in excessive tissue damages, occasionally mimicking a systemic disease with a detrimental outcome.
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- 2021
22. Prediabetic Patient Outcomes 8 to 15 Years After Drug-Eluting Coronary Stenting
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Samir R. Kapadia, Murat Tuzcu, Stephen G. Ellis, Conrad Simpfendorfer, A. Michael Lincoff, Russell E. Raymond, Christopher Bajzer, Ravi Nair, and Leslie Cho
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Male ,medicine.medical_specialty ,Heart Diseases ,medicine.medical_treatment ,Myocardial Infarction ,Comorbidity ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Revascularization ,Prediabetic State ,Coronary artery disease ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Internal medicine ,Diabetes Mellitus ,Myocardial Revascularization ,medicine ,Humans ,030212 general & internal medicine ,Mortality ,Lost to follow-up ,Aged ,Glycated Hemoglobin ,business.industry ,Mortality rate ,Coronary Stenosis ,Percutaneous coronary intervention ,Stent ,Drug-Eluting Stents ,Middle Aged ,medicine.disease ,Case-Control Studies ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Mace ,Follow-Up Studies - Abstract
Guidelines suggest differential management of diabetics and nondiabetics with coronary artery disease (CAD) referred for revascularization, but pre-diabetics, who now comprise up to 20% to 30% of CAD patients, have been excluded from the diabetic group. To address this, we studied long-term cardiac outcomes in 1,323 consecutively drug-eluting stent (DES)-stented patients from prespecified local zip codes, dividing patients into normal-glycemic patients, prediabetics and diabetics, based upon conventional definitions. Patient age was 63±11 years, 65.5% male, mean baseline SYNTAX score of 10.2±6.8 and residual SYNTAX score=3.0±4.6. Only 2.9% of patients were lost to follow up at 10 years. Duration of follow up for alive patients was 124±33 mos. Major adverse cardiac events (MACE) by Kaplan Meier (KM) was similar for normal glycemics and prediabetics (42.9±2.5% vs 38.6±3.1% at 10 years, p=0.35), whereas that for diabetics was worse (56.7±2.6% at 10 years, p
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- 2021
23. Hypertrophic cardiomyopathy
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Agarwal, Shikhar, primary, Kapadia, Samir R., additional, and Murat Tuzcu, E., additional
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- 2017
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24. Percutaneous therapies for mitral valve disease
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Parashar, Akhil, primary, Murat Tuzcu, E., additional, and Kapadia, Samir R., additional
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- 2017
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25. How Symptomatic Should a Hypertrophic Obstructive Cardiomyopathy Patient Be to Consider Alcohol Septal Ablation?
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Brandon M. Jones, Amar Krishnaswamy, Nicholas G. Smedira, Milind Y. Desai, E. Murat Tuzcu, and Samir R. Kapadia
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Editorials ,hypertrophic cardiomyopathy ,septal ablation ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2017
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26. Paravalvular Aortic Regurgitation After Transcatheter Aortic Valve Replacement
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Barış Buğan and Emin Murat Tuzcu
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aortic valve/abnormalities ,aortic valve insufficiency/ etiology ,echocardiography ,transesophageal ,cardiac catheterization ,heart valve prosthesis. ,Medicine ,Internal medicine ,RC31-1245 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Transcatheter aortic valve replacement (TAVR) is a rapidly evolving technology that has been accepted as a treatment option in patients with severe aortic stenosis who are not suitable for or are at high risk for conventional surgery. Randomized trials have shown that TAVR decreases mortality and improves quality of life in patients who are not suitable for conventional surgery and that TAVR is not inferior to standard surgery in operable but high- risk patients. However, TAVR has several important limitations, the most prominent of which is residual paravalvular aortic regurgitation (PAR). The purpose of this review is to present the mechanism, incidence, assessment, and treatment of PAR after TAVR.
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- 2014
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27. Outcomes of Mild Aortic Regurgitation After Transcatheter Aortic Valve Replacement
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Raunak Nair, Zoran B. Popović, Manpreet Kaur, Wael A. Jaber, E. Murat Tuzcu, Samir R. Kapadia, Beni R Verma, Hassan Mehmood Lak, Grant W. Reed, Oscar Perez, Paul Schoenhagen, Mohamed M. Gad, Amar Krishnaswamy, James Yun, Rama Dilip Gajulapalli, Rishi Puri, Serge C. Harb, Lars G. Svensson, Amer N. Kadri, and Johnny Chahine
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medicine.medical_specialty ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,macromolecular substances ,Regurgitation (circulation) ,eye diseases ,Valve replacement ,Internal medicine ,Cardiology ,Medicine ,sense organs ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: There has been an explosion in the clinical application of transcatheter aortic valve replacement (TAVR) worldwide. While moderate and severe grades of paravalvular regurgitation (PVR) ...
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- 2021
28. Oral Calcium Supplements Associate With Serial Coronary Calcification
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Steven E. Nissen, Mohamed Diab, Julie Carlo, Najdat Bazarbashi, Manpreet Kaur, E. Murat Tuzcu, Samir R. Kapadia, Yasser Sammour, Antonette Karrthik, Keerat Rai Ahuja, Mohamed M. Gad, Stephen J. Nicholls, and Rishi Puri
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medicine.medical_specialty ,chemistry.chemical_element ,030204 cardiovascular system & hematology ,Calcium ,030218 nuclear medicine & medical imaging ,law.invention ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Interquartile range ,Internal medicine ,Intravascular ultrasound ,Medicine ,Radiology, Nuclear Medicine and imaging ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Atheroma ,chemistry ,Concomitant ,Coronary artery calcification ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives This study sought to evaluate and assess the extent of serial coronary artery calcification in response to oral calcium supplementation. Background Oral calcium supplements are frequently used despite their cardiovascular safety remaining controversial. Their effects on serial coronary calcification are not well established. Methods In a post hoc patient-level analysis of 9 prospective randomized trials using serial coronary intravascular ultrasound, changes in serial percentage of atheroma volume (PAV) and calcium indices (CaI) were compared in matched segments of patients coronary artery disease who were receiving concomitant calcium supplements (n = 447) and in those who did not receive supplements (n = 4,700) during an 18- to 24-month trial period. Results Patients (mean age 58 ± 9 years; 73% were men; 43% received concomitant high-intensity statins) demonstrated overall annualized changes in PAV and CaI with a mean of −0.02 ± 1.9% (p = 0.44) and a median of 0.02 (interquartile range: 0.00 to 0.06) (p Conclusions Oral calcium supplementation may increase calcium deposition in the coronary vasculature independent of changes in atheroma volume. The impact of these changes on plaque stability and cardiovascular outcomes requires further investigation.
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- 2021
29. Residency training in the time of COVID-19: A framework for academic medical centers dealing with the pandemic
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Sawsan Abdel-Razig, Mahdi A. Shkoukani, Antonio Ramirez, Ahmad Nusair, Waqaas Ahmad, E. Murat Tuzcu, Yasir Akmal, Kashif Siddiqi, and Ziyana Al Khusaibi
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Process management ,020205 medical informatics ,Computer science ,Graduate medical education ,Psychological intervention ,United Arab Emirates ,Context (language use) ,02 engineering and technology ,Education ,03 medical and health sciences ,0302 clinical medicine ,Stakeholder Participation ,0202 electrical engineering, electronic engineering, information engineering ,Humans ,030212 general & internal medicine ,Human resources ,Academic Medical Centers ,Service system ,Pandemic ,SARS-CoV-2 ,business.industry ,COVID-19 ,Internship and Residency ,Academic health center ,Academic medical center ,Coronavirus ,Intervention (law) ,Workflow ,Education, Medical, Graduate ,Scale (social sciences) ,International medical education ,Show and Tell ,business - Abstract
Background As cases of COVID-19 climb worldwide, academic medical centers (AMCs) are scrambling to balance the increasing demand for medical services while maintaining safe learning environments. The scale and nature of the current pandemic, limitations on key resources, risks of transmission, and the impact on trainee wellbeing pose additional challenges to AMCs. We propose a framework for AMCs to utilize in facilitating health system, organization and program-level adjustments to meet the needs of medical trainees during the pandemic. Approach In February 2020, we developed a three-level approach to the pandemic response of training programs at our AMC. The first level involved AMC alignment and engagement with regulatory stakeholders. The second level utilized the graduate medical education committee and leveraged organizational functions such as human resources, finance, and clinical departments. The third level of intervention focused on common approaches used by programs to ensure continuity of learning in the context of dynamic changes in workflows and service operations. Evaluation Outcomes at each level are reported. These include the co-development of a national framework on medical trainee responses to COVID-19, the composition of an operational guidance document, organizational protocols to accommodate novel challenges posed by the pandemic, and multiple program-level interventions. Reflection This methodical approach, employed during a global crisis, was critical in facilitating interventions required to fulfill the mission of AMCs. Future steps include assessing the impact of these changes on trainee performance and the applicability of the approach in diverse settings. Electronic supplementary material The online version of this article (10.1007/s40037-020-00622-z) contains supplementary material, which is available to authorized users.
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- 2020
30. Temporal Trends in the Utilization and Outcomes of Balloon Aortic Valvuloplasty in the Pre-Transcatheter Aortic Valve Implantation (TAVI) and TAVI Eras
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Agam Bansal, Anirudh Kumar, Ankur Kalra, Venu Menon, Amar Krishnaswamy, Rishi Puri, E. Murat Tuzcu, Samir R. Kapadia, and Grant W. Reed
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Balloon Valvuloplasty ,Stroke ,Transcatheter Aortic Valve Replacement ,Treatment Outcome ,Aortic Valve ,Humans ,Aortic Valve Stenosis ,Cardiology and Cardiovascular Medicine - Abstract
We used a nationwide cohort to (1) compare characteristics and outcomes of patients who underwent balloon aortic valvuloplasty (BAV) in pre-transcatheter aortic valve transplantation (TAVI) and TAVI eras, (2) examine trends in utilization and outcomes of BAV from 2005 to 2017, (3) assess the association of BAV procedural volume with hospital-based TAVI volume, and (4) understand trends and outcomes of BAV in TAVI and non-TAVI centers in the TAVI era. Pre-TAVI era included hospitalizations from 2005 to 2011, and TAVI era included hospitalizations from 2012 to 2017. In the TAVI era, hospitals were classified into quartiles based on the number of TAVI procedures performed. Trends in volume of BAV procedures from 2012 to 2017 were assessed in non-TAVI and TAVI centers (based on TAVI volume). Between 2005 and 2017, a total of 6,962 hospitalizations for BAV were identified. There were no significant differences in in-hospital mortality or stroke between pre-TAVI and TAVI eras (mortality: pre-TAVI, 8.5% vs TAVI era, 9.3%, p = 0.354; stroke: pre-TAVI, 1.9% vs TAVI era, 1.3%, p = 0.083). However, acute kidney injury was more prevalent in the TAVI era and blood transfusion in the pre-TAVI era. Importantly, patients who underwent BAV in the TAVI era were more likely to have a greater number of co-morbidities and to undergo nonelective procedures. From 2005 to 2017, there was 10-fold increase in utilization of BAV. In the TAVI era, the maximum increase in number of BAV procedures was seen in hospitals with highest TAVI volume. In conclusion, although BAV procedural volume increased approximately 10-fold between 2005 and 2017, with concomitant expansion of TAVI, rates of mortality and stroke have remained stable. Despite this, the rate of BAV utilization continues to increase, thereby indicating a significant opportunity to improve outcomes in this patient population.
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- 2022
31. Bleeding complications of triple antithrombotic therapy after percutaneous coronary interventions
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Faza, Nadeen N., Mentias, Amgad, Parashar, Akhil, Chaudhury, Pulkit, Barakat, Amr F., Agarwal, Shikhar, Wayangankar, Siddharth, Ellis, Stephen G., Murat Tuzcu, E., and Kapadia, Samir R.
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- 2017
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32. Comparison of multicenter registries and randomized control trials for transcatheter aortic valve replacement (TAVR)
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Shikhar Agarwal, E. Murat Tuzcu, William Stewart, Navkaranbir Singh Bajaj, Lars G. Svensson, and Samir R. Kapadia
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Transcatheter aortic valve replacement ,Randomized control trials ,Multicenter registries ,Meta-analysis ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: TAVR has emerged as an attractive alternative for treatment of severe aortic stenosis in high risk surgical patients. Despite several large multicenter registries, only one randomized trial (PARTNER) has been published. Objective: We aimed to compare the outcomes obtained using multicenter registries and the PARTNER trial. Methods: Standard MEDLINE search strategy was used to find multicenter registries, reporting clinical outcomes following TAVR. Meta-analytic techniques were utilized to calculate pooled outcomes across multicenter registries and compare them to outcomes in PARTNER trial. Results: Pooled 30-day mortality rate from the registries was 9.2%, which was significantly higher than that in the PARTNER trial (3.8%). Medium-term mortality rates were similar between the PARTNER trial and the multicenter registries. Pooled 30-day and 1-year stroke rates in multicenter registries were 2.6% and 3.8%, respectively. On the other hand, the corresponding rates in PARTNER trial were 5.2% and 7.6%, respectively. In the registry-related cohorts, pooled 30-day and 1-year mortality rates were 6.8% and 20.8% in the transfemoral group and 12.2% and 32.2% in the transapical group. In the PARTNER trial, the pooled incidence of 30-day and 1-year mortality rates were 3.9% and 26.2% in the transfemoral group and 3.8% and 29.0% in the transapical group. Conclusions: Short-term results in PARTNER were better than those reported in the registries, which may be due to better patient selection and aggressive bailout techniques. Similarity of medium-term outcomes between registries and PARTNER highlights that patient selection for TAVR is critical due to considerable risk of mortality in the first year even after the successful procedure.
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- 2013
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33. Impact of Prosthesis‐Patient Mismatch on Left Ventricular Myocardial Mechanics After Transcatheter Aortic Valve Replacement
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Frédéric Poulin, Teerapat Yingchoncharoen, William M. Wilson, Eric M. Horlick, Philippe Généreux, E. Murat Tuzcu, William Stewart, Mark D. Osten, Anna Woo, and Paaladinesh Thavendiranathan
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aortic stenosis ,effective orifice area ,prosthesis‐patient mismatch ,speckle‐tracking echocardiography ,strain ,transcatheter aortic valve replacement ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundThe aim of this study was to compare left ventricular (LV) remodeling using myocardial strain between patients with severe aortic stenosis (AS) treated with transcatheter aortic valve replacement (TAVR) with and without prosthesis‐patient mismatch (PPM). Methods and ResultsIn a retrospective study, speckle‐tracking echocardiography was used to measure global longitudinal strain (GLS) and strain rate (GLSR), circumferential strain, and rotation before and at mid‐term follow‐up post‐TAVR. Moderate and severe PPM were defined as an effective orifice area ≤0.85 and
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- 2016
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34. End‐stage renal disease as an independent risk factor for in‐hospital mortality after coronary drug‐eluting stenting: Understanding and modeling the risk
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Stephen G. Ellis, Conrad Simpfendorfer, Chetan Huded, Aaron N. Dunn, Russell E. Raymond, Samir R. Kapadia, and E. Murat Tuzcu
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medicine.medical_specialty ,Population ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Prosthesis Design ,urologic and male genital diseases ,End stage renal disease ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Clinical endpoint ,Humans ,Radiology, Nuclear Medicine and imaging ,Hospital Mortality ,030212 general & internal medicine ,Myocardial infarction ,Risk factor ,education ,education.field_of_study ,business.industry ,Drug-Eluting Stents ,General Medicine ,Odds ratio ,medicine.disease ,Treatment Outcome ,Pharmaceutical Preparations ,Conventional PCI ,Kidney Failure, Chronic ,Cardiology and Cardiovascular Medicine ,business ,Mace - Abstract
OBJECTIVES We sought to compare in-hospital outcomes between patients with and without end-stage renal disease (ESRD) undergoing coronary drug-eluting stent (DES) placement and to model risk of in-hospital adverse postpercutaneous coronary intervention (PCI) events in ESRD patients. BACKGROUND The effect of ESRD on the risk of in-hospital complications after DES PCI is relatively unclear, as is the ability to prospectively stratify risk in this population. METHODS Consecutive patients undergoing first-time DES between April 1, 2003 and June 30, 2018 at a single tertiary care hospital were included in a prospective registry. Outcomes in those with ESRD were compared to those without ESRD. The primary endpoint was in-hospital all-cause mortality; secondary endpoints included in-hospital major adverse cardiac events (MACE)-defined as cardiac death, myocardial infarction, or unplanned revascularization-and major bleeding. Multivariate logistic regression modeling was used to identify factors associated with each outcome and to generate risk scores. RESULTS Among 18,134 patients in the study population, 382 (2.1%) had ESRD. ESRD was associated with increased risk of in-hospital mortality (7.1 vs. 2.9%, p
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- 2020
35. Readmissions in ST-Elevation Myocardial Infarction and Cardiogenic Shock (from Nationwide Readmission Database)
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E. Murat Tuzcu, Dhrubajyoti Bandyopadhyay, Stephen G. Ellis, Faris Haddadin, Karan Sud, Akhil Parashar, Rayji S. Tsutsui, and Samir R. Kapadia
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Adult ,Male ,Databases, Factual ,Shock, Cardiogenic ,Comorbidity ,030204 cardiovascular system & hematology ,computer.software_genre ,Patient Readmission ,Risk Assessment ,Severity of Illness Index ,03 medical and health sciences ,Percutaneous Coronary Intervention ,Sex Factors ,0302 clinical medicine ,Cause of Death ,Severity of illness ,medicine ,Humans ,Hospital Mortality ,030212 general & internal medicine ,Myocardial infarction ,Aged ,Retrospective Studies ,Cause of death ,Heart Failure ,Database ,business.industry ,Cardiogenic shock ,Age Factors ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Survival Analysis ,United States ,Logistic Models ,Heart failure ,Multivariate Analysis ,Etiology ,ST Elevation Myocardial Infarction ,Female ,Cardiology and Cardiovascular Medicine ,business ,computer - Abstract
Management of ST-elevation myocardial infarction complicated by cardiogenic shock (STEMI-CS) has evolved in the last decade. There is paucity of data on readmissions in this study population. We aimed to assess the burden, major etiologies, and resource utilization for 30-day readmissions among patients with STEMI and CS. The Nationwide Readmission Database was queried from 2010 to 2014. All adult patients with an index admission for STEMI-CS were identified using International Classification of Diseases, ninth edition codes. Patient with mortality on index admission and transfers to other hospitals were excluded. A total of 18,659 admissions were identified with primary diagnosis of STEMI-CS for the study duration. Percutaneous coronary interventions was performed in 78.1% and mechanical circulatory devices were utilized in 53.9% with a mean length of stay of 10.6 (±0.2) days and mean cost of hospitalization of $47,744 (±327). Among these, 2,404 (12.9%) patients were readmitted within 30 days. Major etiologies for readmission include congestive heart failure (25.7%), acute myocardial infarction (9.4%), arrhythmias (4.5%), and sepsis (4.2%). The mean length of stay and cost of hospitalization for 30-day readmission were 5.9 (±0.3) days and $17,043 (±590), respectively. Older age, female gender, lower socioeconomic status, and discharge to home health care were significant predictors for readmission. In conclusion, there is a significant burden of 30-day readmission among patients with STEMI-CS. Percutaneous coronary interventions and mechanical circulatory devices were utilized in a majority of index admissions. Congestive heart failure was the single most common reason for 30-day readmission. Patients discharged to skilled nursing facility, patients with private insurance and higher socioeconomic status were less likely to be readmitted. Moreover, readmissions among STEMI-CS patients contribute to significant resource utilization.
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- 2019
36. Comparison of Long-Term Clinical Outcomes After Drug-Eluting Stenting in Blacks-vs-Whites
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Stephen G. Ellis, Conrad Simpfendorfer, Russell E. Raymond, Samir R. Kapadia, Murat Tuzcu, Christopher Bajzer, Ravi Nair, Leslie Cho, and A M Lincoff
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Black People ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Revascularization ,Risk Assessment ,White People ,03 medical and health sciences ,Percutaneous Coronary Intervention ,Postoperative Complications ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Socioeconomic status ,business.industry ,Incidence ,Incidence (epidemiology) ,Percutaneous coronary intervention ,Drug-Eluting Stents ,Middle Aged ,United States ,Survival Rate ,Blood pressure ,Socioeconomic Factors ,Cohort ,Conventional PCI ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,Forecasting - Abstract
Patients of different racial backgrounds may have socioeconomic, cultural, or genetic differences that impact outcomes after percutaneous coronary intervention (PCI). There are limited data beyond 2 to 3 years for Blacks to inform discussions and perhaps improve outcomes. We studied consecutive limus-stent treated patients, having their first PCI at our institution January 2003 to March 2010 in 2 cohorts; Cohort 1: standard 3-year follow-up (n = 3,782, 12.4% Blacks) and Cohort 2: from nearby zip codes with intended detailed follow-up through 8 to 13 years (n = 616, 31.8% Blacks). The primary outcomes of interest were mortality and death/MI/revascularization (DMIR) (Cohort 1) or major adverse cardiac events (cardiac DMIR) (Cohort 2). In all cohorts, Blacks had a higher prevalence of many risk factors. In Cohort 1, 3-year mortalities were 14.6% and 9.6% (p = 0.001) and DMIR were 32.1% and 25.0% (p = 0.001), for Blacks and Whites, respectively. In Cohort 2, over 9.5 ± 2.0 years, treatment intensity was as high or higher for Blacks, but they continued to have higher low-density lipoprotein-cholesterol and blood pressure values. Major adverse cardiac events and mortality at 10 years were higher for Blacks (59.0% vs 48.1%, p = 0.024 and 44.3% vs 23.0%, p0.001). Differences in outcomes, except 10 year mortality, were not significantly different after adjustment for baseline characteristics. Blacks have a higher risk profile at the time of PCI and worse long-term outcomes after drug-eluting stent, most of which is explained by baseline differences.
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- 2019
37. The interrelationship and accumulation of cardiometabolic risk factors amongst young adults in the United Arab Emirates: The UAE Healthy Future Study
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Mai Aljaber, Fatma Al-Maskari, Rami H. Al-Rifai, Eiman AlZaabi, Naima Oumeziane, Mohammad Hag Ali, Raghib Ali, Abdulla Aljunaibi, Andrea Leinberger-Jabari, Abdulla Alnaeemi, Wael Almahmeed, Laila Abdel Wareth, Syed M. Shah, Abderrahim Oulhaj, Marina Kazim, Fatme Al-Anouti, Tom Loney, Hamad Alblooshi, Omar El-Shahawy, Abdishakur M. Abdulle, Amar Ahmad, Scott Scherman, Habiba Alsafar, Mohammad Al-Houqani, Ayesha S Al Dhaheri, Fayza Alameri, Youssef Idaghdour, Juma Alkaabi, Micheal Weitzman, Luai A. Ahmed, Fatima Mezhal, E. Murat Tuzcu, and Apollo - University of Cambridge Repository
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RC620-627 ,Endocrinology, Diabetes and Metabolism ,Population ,Environmental health ,Internal Medicine ,Medicine ,Obesity ,Young adult ,Risk factor ,Nutritional diseases. Deficiency diseases ,education ,Glycemic ,Metabolic Syndrome ,education.field_of_study ,business.industry ,Research ,Dysglycemia ,medicine.disease ,Cardiometabolic risk factors ,Cardiovascular disease ,Comorbidity ,Middle age ,Dyslipidemia ,Central obesity ,Hypertension ,Metabolic syndrome ,business - Abstract
Introduction Similar to other non-communicable diseases (NCDs), people who develop cardiovascular disease (CVD) typically have more than one risk factor. The clustering of cardiovascular risk factors begins in youth, early adulthood, and middle age. The presence of multiple risk factors simultaneously has been shown to increase the risk for atherosclerosis development in young and middle-aged adults and risk of CVD in middle age. Objective This study aimed to address the interrelationship of CVD risk factors and their accumulation in a large sample of young adults in the United Arab Emirates (UAE). Methods Baseline data was drawn from the UAE Healthy Future Study (UAEHFS), a volunteer-based multicenter study that recruits Emirati nationals. Data of participants aged 18 to 40 years was used for cross-sectional analysis. Demographic and health information was collected through self-reported questionnaires. Anthropometric data and blood pressure were measured, and blood samples were collected. Results A total of 5126 participants were included in the analysis. Comorbidity analyses showed that dyslipidemia and obesity co-existed with other cardiometabolic risk factors (CRFs) more than 70% and 50% of the time, respectively. Multivariate logistic regression analysis of the risk factors with age and gender showed that all risk factors were highly associated with each other. The strongest relationship was found with obesity; it was associated with four-fold increase in the odds of having central obesity [adjusted OR 4.70 (95% CI (4.04–5.46)], and almost three-fold increase odds of having abnormal glycemic status [AOR 2.98 (95% (CI 2.49–3.55))], hypertension (AOR 3.03 (95% CI (2.61–3.52))] and dyslipidemia [AOR 2.71 (95% CI (2.32–3.15)]. Forty percent of the population accumulated more than 2 risk factors, and the burden increased with age. Conclusion In this young population, cardiometabolic risk factors are highly prevalent and are associated with each other, therefore creating a heavy burden of risk factors. This forecasts an increase in the burden of CVD in the UAE. The robust longitudinal design of the UAEHFS will enable researchers to understand how risk factors cluster before disease develops. This knowledge will offer a novel approach to design group-specific preventive measures for CVD development.
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- 2021
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38. HbA1c, Coronary atheroma progression and cardiovascular outcomes
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Iryna Dykun, Ozgur Bayturan, Julie Carlo, Steven E. Nissen, Samir R. Kapadia, E. Murat Tuzcu, Stephen J. Nicholls, and Rishi Puri
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HbA1c ,NORMALISE, Norvasc for Regression of Manifest Atherosclerotic Lesions by Intravascular Sonographic Evaluation ,BMI, body mass index ,SATURN, The Study of Coronary Atheroma by Intravascular Ultrasound: Effect of Rosuvastatin Versus Atorvastatin ,PAV, percent atheroma volume ,MACE ,CVD, cardiovascular disease ,LDL-C, lipoprotein cholesterol ,AQUARIUS, Aliskiren Quantative Atherosclerosis Regression Intravascular Ultrasound Study ,IVUS, intravascular ultrasonography ,HDL-C, high-density lipoprotein cholesterol ,PVD, peripheral vascular disease ,Original Research Contribution ,Diabetes mellitus ,GLAGOV, Global Assessment of Plaque Regression With a PCSK9 Antibody as Measured by Intravascular Ultrasound ,IBIS 2, The Integrated Biomarkers and Imaging Study-2 ,Coronary atheroma progression ,Diseases of the circulatory (Cardiovascular) system ,STRADIVARIUS, Strategy to Reduce Atherosclerosis Development Involving Administration of Rimonabont – The Intravascular Ultrasound Study ,cardiovascular diseases ,PERISCOPE, Pioglitazone Effect on Regression of Intravascular Sonographic Coronary Obstruction Prospective Evaluation ,IVUS ,HbA1c, hemoglobin A1c ,General Medicine ,hsCRP, high-sensitivity-CRP ,REVERSAL, Reversal of Atherosclerosis With Aggressive Lipid Lowering ,TG, triglycerides ,RC666-701 ,MACE, major adverse cardiovascular events ,ACS, acute coronary syndrome ,ASCVD, atherosclerotic cardiovascular disease ,Public aspects of medicine ,RA1-1270 ,UKPDS, UK Prospective Diabetes Study - Abstract
Background and aims: We tested the hypothesis that on-treatment HbA1c levels independently associate with coronary atheroma progression and major adverse cardiovascular events (MACE: death, myocardial infarction, cerebrovascular accident, coronary revascularization, or hospitalization for unstable angina) rates. Methods: We performed a post-hoc pooled analysis of data from seven prospective, randomized trials involving serial coronary intravascular ultrasonography (IVUS). The percent atheroma volume (PAV) was calculated as the proportion of the entire vessel wall occupied by atherosclerotic plaque. Using multivariable mixed modeling, we determined the association of on-treatment HbA1c with annualized change in PAV. Cox proportional hazard models were used to assess the association of HbA1c with incidence of MACE. Results: Among 3,312 patients (mean age 58.6±9years, 28.4%women) average on-treatment HbA1c was 6.2±1.1%. Overall, there was no net significant annualized change in PAV (0.12±0.19%, p = 0.52). In a fully adjusted multivariable analysis (following adjustment of age, sex, body mass index, systolic blood pressure, smoking, low- and high-density lipoprotein cholesterol, triglyceride levels, peripheral vascular disease, trial, region, and baseline PAV), higher on-treatment HbA1c levels were independently associated with annualized changes in PAV [beta-estimate (95% confidence interval): 0.13(0.08, 0.19), p
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- 2021
39. Métodos por imagem da aterosclerose em estudos de progressão/regressão: marcador substituto ou janela direta para o processo patológico da aterosclerose? Atherosclerosis imaging in progression/regression trials: surrogate marker or direct window into the atherosclerotic disease process?
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Paul Schoenhagen and E. Murat Tuzcu
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Aterosclerose ,diagnóstico por imagem ,doença das coronárias ,avanço da doença ,Atherosclerosis ,diagnostic imaging ,coronary diseases ,disease progression ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
A DAC continua sendo uma das principais causas globais de morbimortalidade. Programas amplos de desenvolvimento de drogas para novas estratégias de tratamento medicamentoso freqüentemente utilizam estudos com desfechos de mortalidade/morbidade tradicionais e outros com desfechos substitutos. Essa abordagem paralela permite uma avaliação da eficácia vários anos antes dos dados de estudos com desfechos clínicos estarem disponíveis. Vários marcadores imagenológicos de aterosclerose foram introduzidos nessas estratégias de desenvolvimento de drogas, incluindo angiografia, ultrassonografia de carótida, USIV, RM e TC. Esta revisão discutirá a situação atual dos métodos por imagem da aterosclerose como um desfecho em estudos de progressão/regressão, com ênfase em dados baseados em evidências. Além de uma discussão sobre os resultados das modalidades de métodos por imagem individuais, serão apresentados os dados que têm surgido comparando as diferentes modalidades e abordagens.CAD remains a major global cause of morbidity and mortality. Comprehensive drug development programs of novel pharmacological treatment strategies frequently utilize traditional mortality/morbidity endpoints studies and additional surrogate endpoints trials. This parallel approach allows an assessment of efficacy several years in advance of the availability of data from clinical endpoint trials. Several atherosclerosis imaging markers have been introduced into these drug-development strategies, including angiography, carotid ultrasound, IVUS, MRI, and CT. This review will discuss the current status of atherosclerosis imaging as an endpoint in progression/regression trials, with an emphasis on evidence-based data. In addition to a discussion of the results of individual imaging modalities, the emerging data comparing different modalities and approaches are presented.
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- 2008
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40. Percutaneous mitral valve repair and replacement: a new landmark for structural heart interventions
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Murat Tuzcu, E. and Kapadia, Samir R.
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- 2016
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41. Incidence, treatment, and outcomes of acute myocardial infarction following transcatheter or surgical aortic valve replacement
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Omar M Abdelfattah, Amar Krishnaswamy, Stephen G. Ellis, Samir R. Kapadia, E. Murat Tuzcu, Anas M. Saad, Toshiaki Isogai, Rishi Puri, Grant W. Reed, Shashank Shekhar, Mohamed M. Gad, Keerat Rai Ahuja, and Lars G. Svensson
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medicine.medical_specialty ,medicine.medical_treatment ,Revascularization ,Coronary artery disease ,Transcatheter Aortic Valve Replacement ,Aortic valve replacement ,Risk Factors ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Myocardial infarction ,Hospital Mortality ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,business.industry ,Incidence (epidemiology) ,Incidence ,Significant difference ,Percutaneous coronary intervention ,General Medicine ,Aortic Valve Stenosis ,medicine.disease ,Treatment Outcome ,Aortic Valve ,Cardiology ,ST Elevation Myocardial Infarction ,Cardiology and Cardiovascular Medicine ,business ,Lower mortality - Abstract
OBJECTIVES This study aimed to evaluate the incidence, treatment, and outcomes of acute myocardial infarction (AMI) following transcatheter or surgical aortic valve replacement (TAVR or SAVR). BACKGROUND Coronary artery disease is common in patients who undergo aortic valve replacement. However, little is known about differences in clinical features of post-TAVR or post-SAVR AMI. METHODS We retrospectively identified post-TAVR or post-SAVR (including isolated and complex SAVR) patients admitted with AMI using the Nationwide Readmissions Database 2012-2017. Incidence, invasive strategy (coronary angiography or revascularization), and in-hospital outcomes were compared between post-TAVR and post-SAVR AMIs. RESULTS The incidence of 180-day AMI was higher post-TAVR than post-SAVR (1.59% vs. 0.72%; p
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- 2021
42. Plaque microstructures during metformin therapy in type 2 diabetic subjects with coronary artery disease: optical coherence tomography analysis
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Yu Kataoka, Samir R. Kapadia, E. Murat Tuzcu, Stephen J. Nicholls, Steven E. Nissen, Jordan Andrews, Rishi Puri, and Kiyoko Uno
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Metformin ,Coronary artery disease ,Optical coherence tomography ,Internal medicine ,Cardiology ,Medicine ,Original Article ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
BACKGROUND: While metformin is recommended as a first-line cardioprotective therapy for type 2 diabetic patients, whether it exerts direct effects on atherosclerotic plaque remains uncertain. The current study characterized coronary plaque microstructures in type 2 diabetic patients who received metformin. METHODS: We retrospectively analyzed 409 non-culprit lipid plaques in 313 type 2 diabetic patients with coronary artery disease (CAD) by using frequency-domain optical coherence tomography (FD-OCT) imaging. FD-OCT derived plaque microstructures were compared in patients stratified according to metformin use. RESULTS: A proportion of 38.6% of study subjects received metformin. Patients receiving metformin more likely exhibited a history of hypertension (79.3% vs. 67.1%, P=0.03) and metabolic syndrome (52.8% vs. 36.4%, P=0.01). On FD-OCT imaging, the prevalence of lipid plaque was lower in the metformin group (66.2% vs. 77.9%, P=0.03). Furthermore, the metformin group demonstrated plaques with a smaller lipid arc (median: 168.7° vs. 208.5°, P=0.008), shorter longitudinal length (media: 5.1 vs. 9.1 mm, P=0.04), and a lower frequency of cholesterol crystal (3.9% vs. 18.2%, P=0.01) and spotty calcification (3.9% vs. 34.8%, P=0.008). These differences remained significant after adjusting for clinical characteristics and glycemic control. However, in patients who received insulin, the favourable effect of metformin on lipid arc was not observed (insulin user: P=0.87; insulin non-user: P=0.009; P value for interaction between two groups, P=0.02). CONCLUSIONS: Metformin use was associated with a lower prevalence of vulnerable plaque features in type 2 diabetic patients with CAD, especially insulin non-user. These findings suggest the potential of metformin to exert direct plaque stabilization effects in type 2 diabetic subjects.
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- 2021
43. Successful Bail-Out Stenting for Iatrogenic Right Coronary Artery Dissection in a Young Male
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Faisal Hasan, Emin Murat Tuzcu, and Shahrukh Hashmani
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IVUS, intravascular ultrasound ,OCT, optical tomography ,medicine.medical_specialty ,Percutaneous ,BMW, balance middle weight ,medicine.medical_treatment ,Lumen (anatomy) ,Mini-Focus Issue: Interventional Complications and Their Management ,CICAD, catheter-induced coronary artery dissection ,intravascular ultrasound ,iatrogenic coronary artery dissection ,medicine.artery ,Intravascular ultrasound ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Young male ,FL, false lumen ,PCI, percutaneous coronary intervention ,medicine.diagnostic_test ,business.industry ,digestive, oral, and skin physiology ,percutaneous coronary intervention ,Percutaneous coronary intervention ,Surgery ,TL, true lumen ,Dissection ,Right coronary artery ,RC666-701 ,Case Report: Clinical Case ,Cardiology and Cardiovascular Medicine ,business ,Complication ,human activities ,RCA, right coronary artery - Abstract
A 44-year-old man presented with symptoms of shortness of breath on exertion. The shortness of breath started after walking for 10 min and made him…, Catheter-induced coronary artery dissection is a serious complication of coronary angiography. Percutaneous intervention is usually indicated in case of large spiral dissections, however, wiring into the true lumen can be challenging. This case reports the novel use of intravascular ultrasound-guided rescue percutaneous coronary intervention for stenting an iatrogenic spiral dissection of the right coronary artery. (Level of Difficulty: Intermediate.), Graphical abstract
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- 2019
44. Transcatheter Aortic Valve Replacement in Patients With End-Stage Renal Disease
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Alan Zajarias, Eric D. Peterson, E. Murat Tuzcu, Dadi Dai, Ralph G. Brindis, John D. Carroll, Frederick L. Grover, Fred H. Edwards, Michael J. Mack, Mohanad Hamandi, Brian R. Lindman, Molly Szerlip, Sean M. O'Brien, Vinod H. Thourani, Sreekanth Vemalapalli, Matthew Brennan, Dave Shahian, Hersh S. Maniar, John S. Rumsfeld, and David R. Holmes
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Male ,Risk ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Comorbidity ,Disease ,030204 cardiovascular system & hematology ,End stage renal disease ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Aortic valve replacement ,Reference Values ,Renal Dialysis ,Humans ,Medicine ,In patient ,Hospital Mortality ,Registries ,030212 general & internal medicine ,education ,Dialysis ,Aged ,Aged, 80 and over ,education.field_of_study ,business.industry ,Aortic Valve Stenosis ,medicine.disease ,Surgery ,Stenosis ,Treatment Outcome ,Kidney Failure, Chronic ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
In patients with end-stage renal disease (ESRD), surgical aortic valve replacement is associated with higher early and late mortality, and adverse outcomes compared with patients without renal disease. Transcatheter aortic valve replacement (TAVR) offers another alternative, but there are limited reported outcomes.The purpose of this study was to determine the outcomes of TAVR in patients with ESRD.Among the first 72,631 patients with severe aortic stenosis (AS) treated with TAVR enrolled in the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) TVT (Transcatheter Valve Therapies) registry, 3,053 (4.2%) patients had ESRD and were compared with patients who were not on dialysis for demographics, risk factors, and outcomes.Compared with the nondialysis patients, ESRD patients were younger (76 years vs. 83 years; p 0.01) and had higher rates of comorbidities leading to a higher STS predicted risk of mortality (median 13.5% vs. 6.2%; p 0.01). ESRD patients had a higher in-hospital mortality (5.1% vs. 3.4%; p 0.01), although the observed to expected ratio was lower (0.32 vs. 0.44; p 0.01). ESRD patients also had a similar rate of major vascular complications (4.5% vs. 4.6%; p = 0.86), but a higher rate of major bleeding (1.4% vs. 1.0%; p = 0.03). The 1-year mortality was significantly higher in dialysis patients (36.8% vs. 18.7%; p 0.01).Patients undergoing TAVR with ESRD are at higher risk and had higher in-hospital mortality and bleeding, but similar vascular complications, when compared with those who are not dialysis dependent. The 1-year survival raises concerns regarding diminished benefit in this population. TAVR should be used judiciously after full discussion of the risk-benefit ratio in patients on dialysis.
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- 2019
45. Outcomes of Patients with Significant Obesity Undergoing TAVR or SAVR in the Randomized PARTNER 2A Trial
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Shmuel Chen, Vinod H. Thourani, John G. Webb, Martin B. Leon, Sung-Han Yoon, Tamim Nazif, Susheel Kodali, Raj Makkar, Danny Dvir, Aaron Crowley, Bjorn Redfors, Maria Alu, Rebecca T. Hahn, Ori Ben-Yehuda, Michael J. Mack, Wael A. Jaber, E. Murat Tuzcu, Philippe Pibarot, and Isaac George
- Subjects
medicine.medical_specialty ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,medicine.disease ,Obesity ,Surgical risk ,03 medical and health sciences ,Stenosis ,0302 clinical medicine ,Aortic valve replacement ,Valve replacement ,Internal medicine ,cardiovascular system ,Cardiology ,Medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Body mass index ,Cardiovascular mortality - Abstract
Background: Patients with severe aortic stenosis (AS) at intermediate surgical risk, treated with transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) have simi...
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- 2018
46. Hemodynamic durability of transcatheter aortic valves using the updated Valve Academic Research Consortium‐2 criteria
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Zoran B. Popović, Eugene H. Blackstone, Abhishek C. Sawant, Kimi Sato, Arnav Kumar, Samir R. Kapadia, Amar Krishnaswamy, Jyoti Narayanswami, Wael A. Jaber, E. Murat Tuzcu, Divyanshu Mohananey, Lars G. Svensson, Stephanie Mick, Kinjal Banerjee, Anil Kumar Anumandla, Vivek Menon, and Jorge Betancor
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Male ,Aortic valve ,medicine.medical_specialty ,Time Factors ,Transcatheter aortic ,Hemodynamics ,030204 cardiovascular system & hematology ,Prosthesis Design ,Risk Assessment ,Severity of Illness Index ,Ventricular Function, Left ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Risk Factors ,Median follow-up ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,Bioprosthesis ,Ejection fraction ,Proportional hazards model ,business.industry ,Age Factors ,Valve stenosis ,Aortic Valve Stenosis ,General Medicine ,medicine.disease ,Prosthesis Failure ,Stenosis ,Treatment Outcome ,medicine.anatomical_structure ,Aortic Valve ,Heart Valve Prosthesis ,Cardiology ,Female ,Stress, Mechanical ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors - Abstract
OBJECTIVES We investigated the hemodynamic durability of the transcatheter aortic valves (TAVs) using the updated Valve Academic Research Consortium-2 (VARC-2) criteria. BACKGROUND The updated VARC-2 consensus criteria combine flow-dependent and flow-independent echocardiographic parameters for hemodynamic assessment of TAVR. Data on the hemodynamic durability of TAV and clinical risk factors associated with valve hemodynamic deterioration (VHD) are lacking. METHODS All patients (n = 276) who received TAV between 2006 and 2012 and had ≥2 follow-up echocardiograms were studied. RESULTS During a median follow up period of 3.3 (1.8-4.4) years, 8 patients (3%) developed moderate to severe valve stenosis per the VARC-2 criteria, while 20 had mild stenosis. In a Cox proportional hazards model analysis, moderate to severe stenosis by VARC-2 criteria was associated with younger age (P = 0.03, HR 0.94), absence of dual antiplatelet therapy (DAPT) (P = 0.026, HR 0.18), and lower baseline left ventricular ejection fraction (LVEF) (P = 0.006, HR 0.94). Longitudinal analysis using a mixed effect model showed that presence of stenosis by VARC-2 criteria was associated with an increase in aortic valve mean gradient (P
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- 2018
47. Safety and efficacy of cerebral protection devices in transcatheter aortic valve replacement: A clinical end-points meta-analysis
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Amar Krishnaswamy, Pedro A. Villablanca, Stephanie Mick, E. Murat Tuzcu, Divyanshu Mohananey, Kesavan Sankaramangalam, Samir R. Kapadia, Yash Jobanputra, Lars G. Svensson, and Arnav Kumar
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medicine.medical_specialty ,Transcatheter aortic ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Risk Assessment ,Embolic Protection Devices ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,Humans ,Medicine ,030212 general & internal medicine ,Adverse effect ,Stroke ,business.industry ,Incidence ,Incidence (epidemiology) ,Aortic Valve Stenosis ,General Medicine ,Protective Factors ,medicine.disease ,Confidence interval ,Diffusion Magnetic Resonance Imaging ,Treatment Outcome ,Intracranial Embolism ,Meta-analysis ,Relative risk ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Stroke after transcatheter aortic valve replacement (TAVR) occurs with an incidence of 4–11% and is a particularly devastating adverse event associated with the procedure. Several cerebral protection devices (CPD) have been developed to prevent cerebrovascular events during TAVR. While most studies have shown CPD to be associated with decreased number and volume of lesions on diffusion weighted magnetic resonance imaging , the clinical benefit of these devices remains uncertain. Methods We aimed to use meta-analysis techniques to study the clinical safety and efficacy of these CPD in prospective randomized and non-randomized studies. Data was summarized as Mantel-Haenszel relative risk (RR) and 95% confidence intervals (CI). We used the Higgins' I2 statistic to evaluate heterogeneity. Results We found no evidence of difference between patients with and without CPD [RR 0.70 (95% CI 0.40–1.21)] for the primary composite outcome of stroke and mortality at 30 days. The two groups were also comparable in peri-procedural strokes [RR 0.53 (95% CI 0.27–1.07)], stroke at 30 days [RR 0.69(95% CI 0.38–1.26)], mortality [RR 0.59 (95% CI 0.22–1.59) at 30 days, AKI [RR 0.68(95% CI 0.28–1.62)], major bleeding [RR 0.56 (95% CI 0.26–1.18)], life threating bleeding [0.54 (95% CI 0.19–1.53)] and major vascular complications [RR 0.80 (95% CI 0.52–1.24)]. The risk of strokes within the first week of TAVR was significantly lower in the CPD group [0.56(95% CI 0.33–0.96)]. Conclusion CPD are associated with a decreased incidence of strokes within 1 week of follow-up without showing any evidence of increased risk of other peri-procedural adverse events.
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- 2018
48. Systematic Approach to High Implantation of SAPIEN-3 Valve Achieves a Lower Rate of Conduction Abnormalities Including Pacemaker Implantation
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Hassan Mehmood Lak, Manpreet Kaur, Omar M Abdelfattah, Amar Krishnaswamy, Arnav Kumar, Yasser Sammour, Samir R. Kapadia, Jay Patel, Sanchit Chawla, E. Murat Tuzcu, Grant W. Reed, Lars G. Svensson, James Yun, Cameron Incognito, Kinjal Banerjee, and Rishi Puri
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medicine.medical_specialty ,Aorta ,Pacemaker, Artificial ,Conduction abnormalities ,business.industry ,Hemodynamics ,Aortic Valve Stenosis ,medicine.disease ,Prosthesis Design ,Pacemaker implantation ,Transcatheter Aortic Valve Replacement ,Treatment Outcome ,medicine.artery ,Internal medicine ,Aortic Valve ,Heart Valve Prosthesis ,Cardiology ,Medicine ,Ventricular outflow tract ,Humans ,Cardiology and Cardiovascular Medicine ,business ,Atrioventricular block - Abstract
Background: The conventional method of implanting balloon-expandable SAPIEN-3 (S3) valve results in a final 70:30 or 80:20 ratio of the valve in the aorta:left ventricular outflow tract with published rates of permanent pacemaker around 10%. We sought to evaluate whether higher implantation of S3 reduces conduction abnormalities including the need for permanent pacemaker. Methods: We included consecutive patients who underwent transfemoral transcatheter aortic valve replacement using S3 between April 2015 and December 2018 and compared outcomes with typical valve deployment strategy to our more contemporary high deployment technique (HDT). We excluded patients with nontransfemoral access or valve-in-valve. Results: Among 1028 patients, HDT was performed in 406 patients (39.5%). Mean implantation depth under the noncoronary cusp was significantly smaller with HDT compared with conventional technique (1.5±1.6 versus 3.2±1.9 mm; P P =0.216). Thirty-day permanent pacemaker rates were lower with HDT (5.5% versus 13.1%; P P P P =0.804), or moderate-to-severe aortic regurgitation (1% versus 2.7%; P =0.081) at 1 year. HDT was associated with slightly higher 1-year mean gradients (13.1±6.2 versus 11.8±4.9 mm Hg; P =0.042) and peak gradients (25±11.9 versus 22.5±9 mm Hg; P =0.026). However, Doppler velocity index was similar (0.47±0.15 versus 0.48±0.13; P =0.772). Conclusions: Our novel technique for balloon-expandable S3 valve positioning consistently achieves higher implantation resulting in substantial reduction in conduction abnormalities and permanent pacemaker requirement after transcatheter aortic valve replacement without compromising procedural safety or valve hemodynamics. Operators should consider this as an important technique to improve patient outcomes.
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- 2021
49. Evaluation of System Modelling Techniques for Waste Identification in Lean Healthcare Applications
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Dima Quraini, Mecit Can Emre Simsekler, Abdulqader Al Kaf, E. Murat Tuzcu, Samer Ellahham, Raja Jayaraman, Hussam Ghalib, Kudret Demirli, and Maitha Alkaabi
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Process management ,Computer science ,Communication diagram ,lean healthcare ,kaizen ,03 medical and health sciences ,0302 clinical medicine ,value stream map ,Health care ,system approaches ,Outpatient clinic ,030212 general & internal medicine ,Original Research ,waste identification ,Risk Management and Healthcare Policy ,Kaizen ,business.industry ,030503 health policy & services ,Health Policy ,Public Health, Environmental and Occupational Health ,Usability ,Value stream mapping ,Data flow diagram ,Identification (information) ,system modelling techniques ,healthcare operations ,0305 other medical science ,business - Abstract
Maitha Alkaabi,1 Mecit Can Emre Simsekler,1 Raja Jayaraman,1 Abdulqader Al Kaf,1 Hussam Ghalib,2 Dima Quraini,2 Samer Ellahham,2 E Murat Tuzcu,2 Kudret Demirli3 1Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates; 2Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; 3Department of Mechanical, Industrial and Aerospace Engineering, Concordia University, Montreal, CanadaCorrespondence: Mecit Can Emre SimseklerDepartment of Industrial and Systems Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, United Arab EmiratesTel +9712 501 8410Fax +971 2 447 2442Email emre.simsekler@ku.ac.aePurpose: Waste identification plays a vital role in lean healthcare applications. While the value stream map (VSM) is among the most commonly used tools for waste identification, it may be limited to visualize the behaviour of dynamic and complex healthcare systems. To address this limitation, system modelling techniques (SMTs) can be used to provide a comprehensive picture of various system-wide wastes. However, there is a lack of evidence in the current literature about the potential contribution of SMTs for waste identification in healthcare processes.Methods: This study evaluates the usability and utility of six types of SMTs along with the VSM. For the evaluation, interview-based questionnaires were conducted with twelve stakeholders from the outpatient clinic at the Heart and Vascular Institute at Cleveland Clinic Abu Dhabi.Results: VSM was found to be the most useful diagram in waste identification in general. However, some SMTs that represent the system behaviour outperformed the VSM in identifying particular waste types, e.g., communication diagram in identifying over-processing waste and flow diagram in identifying transportation waste.Conclusion: As behavioural SMTs and VSM have unique strengths in identifying particular waste types, the use of multiple diagrams is recommended for a comprehensive waste identification in lean. However, limited resources and time, as well as limited experience of stakeholders with SMTs, may still present obstacles for their potential contribution in lean healthcare applications.Keywords: lean healthcare, value stream map, system modelling techniques, waste identification, kaizen, system approaches, healthcare operations
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- 2021
50. Outcomes of Mild Aortic Regurgitation After Transcatheter Aortic Valve Replacement
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Chahine, Johnny, Kadri, Amer N., Gajulapalli, Rama Dilip, Lak, Hassan, Krishnaswamy, Amar, Reed, Grant, Perez, Oscar, Rishi Puri, Popovic, Zoran, Verma, Beni Rai, Manpreet Kaur, Gad, Mohamed M., Raunak M. Nair, Jaber, Wael, Yun, James, Schoenhagen, Paul, Harb, Serge C., E. Murat Tuzcu, Svensson, Lars G., and Kapadia, Samir R.
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eye diseases - Abstract
Background: There has been an explosion in the clinical application of transcatheter aortic valve replacement (TAVR) worldwide. While moderate and severe grades of paravalvular regurgitation (PVR) are established as poor prognostic indicators, the impact of mild PVR is unclear. We therefore aimed to compare outcomes after TAVR between those who develop mild PVR versus none or trivial PVR. Methods: We identified 1,098 consecutive patients who underwent TAVR from January 2014 to December 2017. The primary outcome was all-cause mortality using Kaplan Meier curves. The secondary outcomes included heart failure readmissions and the composite endpoints of early safety and clinical efficacy according to VARC-2 definitions. Results: The median age was 82 years, 43% were females, and 94% were Caucasian. The procedure was done through a transfemoral approach, the indication for TAVR was severe AS in 97% of cases, and 72% had an Edwards SAPIEN 3 Transcatheter Heart Valve implanted. Mild PVR was seen in 191 (17.4%) patients, and the rest (82.6%) had no or trivial post-TAVR PVR. Mortality at 30-days and 1 year was similar between none/trivial and mild PVR groups (1.6% vs 1.7%, p = 0.93 & 6.3% vs 8.8%, p = 0.31). HF-related hospitalizations were the same at 30 days as well as 1 year in both groups (1.9% vs 0.8%, p = 0.209 and 4.5% vs 6.3%, p = 0.461). Conclusion: Although mild PVR is seen in approximately one-fifth of patients after TAVR, patients with mild PVR have similar outcomes compared to those with none or trivial PVR. Abbreviations: AR: Aortic Regurgitation; AV: Aortic Valve; HF: Heart Failure; VARC: Valve Academic Research Consortium; LVOT: Left Ventricular Outflow Tract; LVEF: Left Ventricular Ejection Fraction; PVR: Paravalvular Aortic Regurgitation; TAVR: Transcatheter Aortic Valve Replacement; TF: Transfemoral
- Published
- 2021
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