87 results on '"Raphael CE"'
Search Results
2. Spectral Water Wave Dissipation by Biomimetic Soft Structure
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Garance Marlier, Frédéric Bouchette, Samuel Meulé, Raphaël Certain, and Jean-Yves Jouvenel
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wave attenuation ,bioinspired structure ,biomimetics ,soft-shoreline engineering ,Naval architecture. Shipbuilding. Marine engineering ,VM1-989 ,Oceanography ,GC1-1581 - Abstract
Coastal protection solutions can be categorised as grey, hybrid or natural. Grey infrastructure includes artificial structures like dykes. Natural habitats like seagrasses are considered natural protection infrastructure. Hybrid solutions combine both natural and grey infrastructure. Evidence suggests that grey solutions can negatively impact the environment, while natural habitats prevent flooding without such adverse effects and provide many ecosystem services. New types of protective solutions, called biomimetic solutions, are inspired by natural habitats and reproduce their features using artificial materials. Few studies have been conducted on these new approaches. This study aims to quantify wave dissipation observed in situ above a biomimetic solution inspired by kelps, known for their wave-dampening properties. The solution was deployed in a full water column near Palavas-les-Flots in southern France. A one-month in situ experiment showed that the biomimetic solution dissipates around 10% of total wave energy on average, whatever the meteo-marine conditions. Wave energy dissipation is frequency-dependent: short waves are dissipated, while low-frequency energy increases. An anti-dissipative effect occurs for forcing conditions with frequencies close to the eigen mode linked to the biomimetic solution’s geometry, suggesting that resonance should be considered in designing future biomimetic protection solutions.
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- 2024
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3. Treatment resistance in schizophrenia: a meta-analysis of prevalence and correlates
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Elton Diniz, Lais Fonseca, Deyvis Rocha, Alisson Trevizol, Raphael Cerqueira, Bruno Ortiz, André R. Brunoni, Rodrigo Bressan, Christoph U. Correll, and Ary Gadelha
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Schizophrenia ,clozapine ,treatment-resistant ,prevalence ,meta-analysis ,Psychiatry ,RC435-571 - Abstract
Objectives: To determine the prevalence and correlates of treatment-resistant schizophrenia (TRS) through a systematic review and meta-analysis. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, an electronic search was performed in PubMed and Embase through May 17, 2022. All study designs that assessed a minimum of 20 schizophrenia-spectrum patients and provided data on TRS prevalence or allowed its calculation were included. Estimates were produced using a random-effects model meta-analysis. Results: The TRS prevalence across 50 studies (n = 29,390) was 36.7% (95%CI 33.1-40.5, p < 0.0001). The prevalence ranged from 22% (95%CI 18.4-25.8) in first-episode to 39.5% (95%CI 32.2-47.0) in multiple-episode samples (Q = 18.27, p < 0.0001). Primary treatment resistance, defined as no response from the first episode, was 23.6% (95%CI 20.5-26.8) vs. 9.3% (95%CI 6.8-12.2) for later-onset/secondary (≥ 6 months after initial treatment response). Longer illness duration and recruitment from long-term hospitals or clozapine clinics were associated with higher prevalence estimates. In meta-regression analyses, older age and poor functioning predicted greater TRS. When including only studies with lower bias risk, the TRS prevalence was 28.4%. Conclusion: Different study designs and recruitment strategies accounted for most of the observed heterogeneity in TRS prevalence rates. The results point to early-onset and later-onset TRS as two separate disease pathways requiring clinical attention. Registration number: PROSPERO CRD42018092033.
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- 2023
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4. Mechanisms of Myocardial Ischemia in Hypertrophic Cardiomyopathy
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Raphael, CE, Cooper, R, Parker, KH, Collinson, J, Vassiliou, V, Pennell, DJ, De Silva, R, Hsu, LY, Greve, AM, Nijjer, S, Broyd, C, Ali, A, Keegan, J, Francis, DP, Davies, JE, Hughes, AD, Arai, A, Frenneaux, M, Stables, RH, Di Mario, C, Prasad, SK, British Heart Foundation, and Medical Research Council (MRC)
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BEW, backward expansion wave ,Male ,Cardiac & Cardiovascular Systems ,HCM, hypertrophic cardiomyopathy ,LVOT, left ventricular outflow tract ,Myocardial Ischemia ,FCWa, additional forward compression wave ,Blood Pressure ,FEW, forward expansion wave ,ABLATION ,CMR ,1102 Cardiorespiratory Medicine and Haematology ,Original Investigation ,CORONARY FLOW RESERVE ,LGE, late gadolinium enhancement ,ABNORMALITIES ,CFR, coronary flow reserve ,Middle Aged ,Coronary Vessels ,Magnetic Resonance Imaging ,cardiovascular system ,Female ,Cardiology and Cardiovascular Medicine ,Life Sciences & Biomedicine ,MPR, myocardial perfusion reserve ,Blood Flow Velocity ,Adult ,MBF, myocardial blood flow ,DIAGNOSIS ,WIA, wave intensity analysis ,VALIDATION ,perfusion ,1117 Public Health and Health Services ,angina ,cardiovascular magnetic resonance ,left ventricular outflow tract obstruction ,Aged ,Cardiac Imaging Techniques ,Cardiomyopathy, Hypertrophic ,Humans ,Young Adult ,Coronary Circulation ,BCWtot, backward compression wave ,SUCTION ,cardiovascular diseases ,FEWa, additional forward expansion wave ,Science & Technology ,FCW, forward compression wave ,BLOOD-FLOW ,DYSFUNCTION ,Cardiovascular System & Hematology ,BCW, backward compression wave ,Cardiovascular System & Cardiology ,VASODILATION - Abstract
BACKGROUND: Angina is common in hypertrophic cardiomyopathy (HCM) and is associated with abnormal myocardial perfusion. Wave intensity analysis improves the understanding of the mechanics of myocardial ischemia. OBJECTIVES: Wave intensity analysis was used to describe the mechanisms underlying perfusion abnormalities in patients with HCM. METHODS: Simultaneous pressure and flow were measured in the proximal left anterior descending artery in 33 patients with HCM and 20 control patients at rest and during hyperemia, allowing calculation of wave intensity. Patients also underwent quantitative first-pass perfusion cardiac magnetic resonance to measure myocardial perfusion reserve. RESULTS: Patients with HCM had a lower coronary flow reserve than control subjects (1.9 ± 0.8 vs. 2.7 ± 0.9; p = 0.01). Coronary hemodynamics in HCM were characterized by a very large backward compression wave during systole (38 ± 11% vs. 21 ± 6%; p < 0.001) and a proportionately smaller backward expansion wave (27% ± 8% vs. 33 ± 6%; p = 0.006) compared with control subjects. Patients with severe left ventricular outflow tract obstruction had a bisferiens pressure waveform resulting in an additional proximally originating deceleration wave during systole. The proportion of waves acting to accelerate coronary flow increased with hyperemia, and the magnitude of change was proportional to the myocardial perfusion reserve (rho = 0.53; p < 0.01). CONCLUSIONS: Coronary flow in patients with HCM is deranged. Distally, compressive deformation of intramyocardial blood vessels during systole results in an abnormally large backward compression wave, whereas proximally, severe left ventricular outflow tract obstruction is associated with an additional deceleration wave. Perfusion abnormalities in HCM are not simply a consequence of supply/demand mismatch or remodeling of the intramyocardial blood vessels; they represent a dynamic interaction with the mechanics of myocardial ischemia that may be amenable to treatment.
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- 2016
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5. The Morphodynamics of a Double-Crescent Bar System under a Mediterranean Wave Climate: Leucate Beach
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Pierre Feyssat, Raphaël Certain, Nicolas Robin, Olivier Raynal, Antoine Lamy, Jean-Paul Barusseau, and Bertil Hebert
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nearshore bars ,double-crescent bar ,morphological coupling ,Mediterranean Sea ,Gulf of Lions ,Naval architecture. Shipbuilding. Marine engineering ,VM1-989 ,Oceanography ,GC1-1581 - Abstract
The morphodynamics of the Leucate double-crescent bar system was studied over twenty years using bathymetric data supplemented by satellite images and video monitoring. Eleven different bar typologies were identified, mostly based on existing beach state classifications (Low-Tide Terrace, Transverse Bar and Rip, Rhythmic Bar and Beach), also including new heterogeneous typologies (TBR/LTT, RBB HP/RBB, TBR/RBB). The inner bar shows greater variability, with 10 different typologies observed, while the outer bar shows only three different typologies. Summer low-energy periods are dominated by TBR/LTT and TBR typologies, while RBB, although common throughout the year, dominates winter periods along with disrupted bar configurations. The return to less energetic periods in spring is associated with the establishment of heterogeneous typologies. The outer bar has a fairly stable position, although breaches at the embayments and slight movements of its horns can occur following particularly energetic episodes. The inner bar, on the other hand, is much more dynamic, with more common breaches at the embayments and significant cross-shore movement of the horns. Seasonal changes in bar typology do not lead to bar renewal through destruction/reconstruction. Overall, the morphological and typological characteristics of the bar system described here seem somewhat unique compared to the existing literature.
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- 2024
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6. Defining the real-world reproducibility of visual grading and visual estimation of left ventricular ejection fraction: impact of image quality, experience and accreditation
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Cole, GD, Dhutia, NM, Shun-Shin, MJ, Willson, K, Harrison, J, Raphael, CE, Zolgharni, M, Mayet, J, Francis, DP, Imperial College Healthcare NHS Trust- BRC Funding, and British Heart Foundation
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Reproducibility of results ,Adult ,Male ,Cardiac & Cardiovascular Systems ,Heart failure ,INTRACARDIAC FILLING PRESSURE ,DECOMPENSATED PATIENTS ,ANGIOGRAPHY ,Severity of Illness Index ,1102 Cardiovascular Medicine And Haematology ,Ventricular Function, Left ,ITERATIVE METHOD ,Accreditation ,Ventricular Dysfunction, Left ,Predictive Value of Tests ,Humans ,ARTICLE ,Ventricular function ,BEHOLDER ,Aged ,Observer Variation ,Science & Technology ,Radiology, Nuclear Medicine & Medical Imaging ,Stroke Volume ,Middle Aged ,Nuclear Medicine & Medical Imaging ,Echocardiography ,Cardiovascular System & Cardiology ,Visual Perception ,CARDIAC RESYNCHRONIZATION THERAPY ,Female ,Clinical Competence ,Life Sciences & Biomedicine ,ATRIOVENTRICULAR OPTIMIZATION ,SYSTOLIC HEART-FAILURE - Abstract
Left ventricular function can be evaluated by qualitative grading and by eyeball estimation of ejection fraction (EF). We sought to define the reproducibility of these techniques, and how they are affected by image quality, experience and accreditation. Twenty apical four-chamber echocardiographic cine loops (Online Resource 1–20) of varying image quality and left ventricular function were anonymized and presented to 35 operators. Operators were asked to provide (1) a one-phrase grading of global systolic function (2) an “eyeball” EF estimate and (3) an image quality rating on a 0–100 visual analogue scale. Each observer viewed every loop twice unknowingly, a total of 1400 viewings. When grading LV function into five categories, an operator’s chance of agreement with another operator was 50 % and with themself on blinded re-presentation was 68 %. Blinded eyeball LVEF re-estimates by the same operator had standard deviation (SD) of difference of 7.6 EF units, with the SD across operators averaging 8.3 EF units. Image quality, defined as the average of all operators’ assessments, correlated with EF estimate variability (r = −0.616, p < 0.01) and visual grading agreement (r = 0.58, p < 0.01). However, operators’ own single quality assessments were not a useful forewarning of their estimate being an outlier, partly because individual quality assessments had poor within-operator reproducibility (SD of difference 17.8). Reproducibility of visual grading of LV function and LVEF estimation is dependent on image quality, but individuals cannot themselves identify when poor image quality is disrupting their LV function estimate. Clinicians should not assume that patients changing in grade or in visually estimated EF have had a genuine clinical change.
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- 2015
7. Statistical process control in the production of Requeijão: a case study in a dairy industry in the south of Minas Gerais state, Brazil
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Gabriel Baldasso, Raphael César de Souza Pimenta, and Eric Batista Ferreira
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gestão da qualidade ,derivados do leite ,índice de capabilidade. ,Dairy processing. Dairy products ,SF250.5-275 - Abstract
Being typically Brazilian and especially useful in the reprocessing of mozzarella, the Requeijão has become a product of high consumption and production in Brazil. Over time, the increased competitiveness among the dairy industries has improved the productivity of Requeijão. However, it is essential to increase the production and productivity of Requeijão without losing quality. It is known that a way to promote high productivity and high quality in a process is by using the Statistical Quality Control (SQC), which aims to help the production process to correct the identifiable errors throughout the process, in order to increase the profitability of production. This paper presents the process of Statistical Process Control (SPC) implementation in a Requeijão production line of a dairy industry in southern Minas Gerais. Control charts were used for variables and capability indexes, to monitor critical variables of the Requeijão production process, in order to meet the specifications of the Technical Regulation on Identity and Quality. After analysis of the results, it was found that the process variables are under statistical control and are capable to meet the specified standards. However, by analyzing the variability of the data, non-randomness patterns were identified, which indicates that the process variability is not under statistical control. The main cause which was pointed out was the poor accuracy of the data collected in the production process, which shows the effectiveness of SPC tools.
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- 2021
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8. Morphodynamic Behaviour of a Mediterranean Intermittent Estuary with Opening Phases Primarily Dominated by Offshore Winds
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Pierre Feyssat, Raphaël Certain, Nicolas Robin, Olivier Raynal, Nicolas Aleman, Bertil Hebert, Antoine Lamy, and Jean-Paul Barusseau
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intermittent estuaries ,microtidal ,wind-driven opening ,coastal lagoon ,Gulf of Lions ,Naval architecture. Shipbuilding. Marine engineering ,VM1-989 ,Oceanography ,GC1-1581 - Abstract
This study focuses on the dynamics of an intermittent estuary in a wave-dominated (microtidal) area, with low fluvial discharges and strong dominant offshore wind regimes. The aims are to understand the effect of these particular environmental factors in the dynamics of such estuaries. The results allow us to propose a synthetic morphodynamic model of evolution whereby opening phases are predominantly controlled by offshore winds, which have a significant influence in the northern Mediterranean. Inputs from rainfall/karst discharge and the overtopping of storm waves cause the lagoon to fill. Closing phases are controlled by the slight easterly swell which forms a berm at the inlet entrance. On occasion, major storms can also contribute to barrier opening. Nevertheless, offshore wind remains the main controlling factor allowing the surge of lagoon waters behind the beach barrier and the lowering of the berm by wind deflation. This leads to opening of the barrier due to the overflow of lagoon waters at the beach megacusp horns, thus connecting the sub-aerial beach with the inner bar system that is developed on topographically low sectors of the barrier. To the best of the authors’ knowledge, this type of estuary is not described in the literature.
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- 2022
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9. The Clinical Utility of Post-Bronchoscopy Sputum Samples in Smear Negative PTB.
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Salmasi, MY, primary, Raphael, CE, additional, Jepson, A, additional, Wickremasinghe, M, additional, and Kon, OM, additional
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- 2009
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10. Growth and longevity of the spider crab Libinia ferreirae (Majoidea, Epialtidae)
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Geslaine Rafaela Lemos Gonçalves, Lizandra Fernandes Miazaki, Eduardo Antonio Bolla Junior, Raphael Cezar Grabowski, Rogério Caetano da Costa, and Antonio Leão Castilho
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Growth ,von Bertalanffy ,puberty moult ,age ,symbiotic relationship ,Science ,Biology (General) ,QH301-705.5 ,Zoology ,QL1-991 - Abstract
Abstract We estimated the growth parameters of the spider crab, Libinia ferreirae (age, asymptotic size and growth rate) using the von Bertalanffy growth equation model. We obtained nine cohorts for female carapace asymptotic width (CW∞) = 64.32 mm, growth coefficient (day-1) (k) = 0.0027 e t0= 0.77 days) and seven for males (CW∞ = 81.93 mm, k= 0.0021 e t0= 0.49 days). The longevity for males was higher than that for females, estimated 2,156 days (5.91 years) and 1,706 days (4.68 years), respectively. The growth curves for males and females differed (F = 34.67 e p < 0.001). Males reached gonadal maturity before morphometric maturity and occurred at 8.8 and 16.6 months of life, respectively. Females reach gonad and morphometric maturity synchronously and this was estimated to occur at about 11.42 months of life. These crabs invest a great amount of energy in growth during a brief period of their development until reaching the terminal moult. This growth strategy would bring less wear to the organism and consequently a greater longevity.
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- 2020
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11. An illustrated approach to Soft Textual Cartography
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Raphaël Ceré and Mattia Egloff
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Textual cartography ,Complex network ,Topic modelling ,Thematic exploration ,Soft clustering ,Text mining ,Applied mathematics. Quantitative methods ,T57-57.97 - Abstract
Abstract We propose and illustrate an approach of Soft Textual Cartography consisting in the clustering of regions by taking into account both their spatial relationships and their textual description within a corpus. We reduce large geo-referenced textual content into topics and merge them with their spatial configuration to reveal spatial patterns. The strategy consists in constructing a complex weighted network, reflecting the geographical layout, and whose nodes are further characterised by their thematic dissimilarity, extracted form topic modelling. A soft k-means procedure, taking into account both aspects through expectation maximisation on Gaussian mixture models and label propagation, converges towards a soft membership, to be further compared with expert knowledge on regions. Application on the Wikipedia pages of Swiss municipalities demonstrate the potential of the approach, revealing textual autocorrelation and associations with official classifications. The synergy of the spatial and textual aspects appears promising in topic interpretation and geographical information retrieval, and able to incorporate expert knowledge through the choice of the initial membership.
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- 2018
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12. Quantifying the paradoxical effect of higher systolic blood pressure on mortality in chronic heart failure.
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Raphael CE, Whinnett ZI, Davies JE, Fontana M, Ferenczi EA, Manisty CH, Mayet J, and Francis DP
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BACKGROUND: Although higher blood pressures are generally recognised to be an adverse prognostic marker in risk assessment of cardiology patients, its relationship to risk in chronic heart failure (CHF) may be different. OBJECTIVE: To examine systematically published reports on the relationship between blood pressure and mortality in CHF. METHODS: Medline and Embase were used to identify studies that gave a hazard or relative risk ratio for systolic blood pressure in a stable population with CHF. Included studies were analysed to obtain a unified hazard ratio and quantify the degree of confidence. RESULTS: 10 studies met the inclusion criteria, giving a total population of 8088, with 29 222 person-years of follow-up. All studies showed that a higher systolic blood pressure (SBP) was a favourable prognostic marker in CHF, in contrast to the general population where it is an indicator of poorer prognosis. The decrease in mortality rates associated with a 10 mm Hg higher SBP was 13.0% (95% CI 10.6% to 15.4%) in the heart failure population. This was not related to aetiology, ACE inhibitor or beta blocker use. CONCLUSION: SBP is an easily measured, continuous variable that has a remarkably consistent relationship with mortality within the CHF population. The potential of this simple variable in outpatient assessment of patients with CHF should not be neglected. One possible application of this information is in the optimisation of cardiac resynchronisation devices. [ABSTRACT FROM AUTHOR]
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- 2009
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13. Uso de vídeo-análise para promover a experimentação dos conceitos de Física com atividades ao ar livre
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Cassio Henrique de Souza Marculino, Vinicius Justino Pimenta, Francielli de Fatima dos Santos David, Ygor Lacerda da Silva, João Victor de Almeida, Amanda Aparecida Borges da Silva, Gabriel Baldasso, Lucas Marques Fagundes, Raphael César de Souza Pimenta, and Samuel Bueno Soltau
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Ensino de Física ,Educação Física ,Experimentos ao ar livre ,Vídeo análise ,Mathematics ,QA1-939 ,Education - Abstract
Apresentamos uma proposta de efetuar experimentos ao ar livre com objetos e situações cotidianas. O trabalho, realizado por um grupo de graduandos em Física, tem o intuito de propor práticas interdisciplinares ao ar livre que proporcionem a possibilidade da interlocução entre as disciplinas de Física e Educação Física, no Ensino Médio. Encenamos situações com o potencial para servir de experimentos que demonstrem conceitos de mecânica clássica, utilizamos a câmera do telefone celular para gravar as cenas e usamos o software Tracker para extrair e analisar os vídeos. Resgatamos o experimento clássico de demonstração da inércia, realizado por Galileu Galilei, com o uso de uma motocicleta e o lançamento vertical de uma bola, além disso, analisamos o lançamento oblíquo por meio do arremesso ao cesto na quadra basquete, também verificamos o movimento superamortecido de uma bola de tênis quicando no solo e conferimos a trajetória representada pela braquistócrona com o uso de uma marca feita no pneu de uma bicicleta em movimento. Todas as cenas selecionadas se mostraram adequadas para utilização na proposta interdisciplinar.
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- 2019
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14. FANCD2 Maintains Fork Stability in BRCA1/2-Deficient Tumors and Promotes Alternative End-Joining DNA Repair
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Zeina Kais, Beatrice Rondinelli, Amie Holmes, Colin O’Leary, David Kozono, Alan D. D’Andrea, and Raphael Ceccaldi
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Biology (General) ,QH301-705.5 - Abstract
BRCA1/2 proteins function in homologous recombination (HR)-mediated DNA repair and cooperate with Fanconi anemia (FA) proteins to maintain genomic integrity through replication fork stabilization. Loss of BRCA1/2 proteins results in DNA repair deficiency and replicative stress, leading to genomic instability and enhanced sensitivity to DNA-damaging agents. Recent studies have shown that BRCA1/2-deficient tumors upregulate Polθ-mediated alternative end-joining (alt-EJ) repair as a survival mechanism. Whether other mechanisms maintain genomic integrity upon loss of BRCA1/2 proteins is currently unknown. Here we show that BRCA1/2-deficient tumors also upregulate FANCD2 activity. FANCD2 is required for fork protection and fork restart in BRCA1/2-deficient tumors. Moreover, FANCD2 promotes Polθ recruitment at sites of damage and alt-EJ repair. Finally, loss of FANCD2 in BRCA1/2-deficient tumors enhances cell death. These results reveal a synthetic lethal relationship between FANCD2 and BRCA1/2, and they identify FANCD2 as a central player orchestrating DNA repair pathway choice at the replication fork.
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- 2016
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15. The Intensification of Hurricane Maria 2017 in the Antilles
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Mark R. Jury, Sen Chiao, and Raphael Cécé
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hurricane intensification ,antilles ,wrf simulations ,Meteorology. Climatology ,QC851-999 - Abstract
Environmental influences on Hurricane Maria in the Antilles Islands are analyzed at the large-scale (1−25 September) and at the meso-scale (17−20 September 2017). The storm intensified rapidly prior to landfall in Dominica, going from category 1 to 5 in 15 h. As the storm progressed toward Puerto Rico (PR), its NE flank entrained air from seas cooled by the earlier passage of two hurricanes, and strengthened on its SW flank. Operational model forecasts tended to delay intensification until west of the Antilles Islands, thus motivating two independent weather research and forecasting (WRF) simulations. These gave minimal track errors at 1- to 3-day lead time. The simulation for landfall at Dominica on 19 September 2017 showed that a static nest with 0.8 km resolution using a Holland-type synthetic vortex and Yonsei University (YSU)/Kain-Fritsch schemes performed better; with a track error of 8 km and intensity error of 10 m/s. Our PR-area simulation of central pressure lagged 30 hPa behind observation; and caught up with reality by landfall in PR. The simulated rainband structure corresponded with Cloudsat observations over PR. Maria’s intensification occurred in an area of thermodynamic gradients included cooler SST in the right side of the track, so operational models with right-track bias were late in predicting intensification. Category-2 forecasts prior to 18 September 2017 left many Antilles islanders unprepared for the disaster that ensued.
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- 2019
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16. Coastal Processes and Influence on Damage to Urban Structures during Hurricane Irma (St-Martin & St-Barthélemy, French West Indies)
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Tony Rey, Frédéric Leone, Thomas Candela, Ali Belmadani, Philippe Palany, Yann Krien, Raphael Cécé, Monique Gherardi, Matthieu Péroche, and Narcisse Zahibo
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Hurricane Irma ,Lesser Antilles ,storm surge ,damage ,coastal change ,Naval architecture. Shipbuilding. Marine engineering ,VM1-989 ,Oceanography ,GC1-1581 - Abstract
This study aims to better understand coastal processes associated with extreme cyclonic events through the study of the coastal changes, flooding and damage that resulted from the passage of a category 5 hurricane (Irma) on 6 September 2017 over the islands of Saint-Martin and Saint-Barthélemy in the Lesser Antilles. Hurricane Irma was contextualized from tropical cyclone track data and local weather observations collected by Météo-France, as well as high-resolution numerical modelling. Field work involved the study of accretion coasts through qualitative observations, topo-morphological and sedimentary surveys, as well as image acquisition with Unmanned Aerial Vehicle (UAV) surveys during two trips that were made 2 and 8 months after the catastrophe. Wave propagation and flood numerical models are presented and compared to field data. Our field analysis also reports on the devastating impacts of storm surges and waves, which reached 4 and 10 meters height, respectively, especially along east-facing shores. The approaches reveal a variety of morpho-sedimentary responses over both natural and highly urbanized coasts. The analysis shows the effects of coastal structures and streets on flow channeling, on the amplification of some erosion types, and on water level increase. Positive spatial correlation is found between damage intensity and marine flood depth. The signatures of ocean-induced damage are clear and tend to validate the relevance of the intensity scale used in this study.
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- 2019
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17. Can We Improve Parametric Cyclonic Wind Fields Using Recent Satellite Remote Sensing Data?
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Yann Krien, Gaël Arnaud, Raphaël Cécé, Chris Ruf, Ali Belmadani, Jamal Khan, Didier Bernard, A.K.M.S. Islam, Fabien Durand, Laurent Testut, Philippe Palany, and Narcisse Zahibo
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CYGNSS ,ASCAT ,cyclones ,hurricanes ,parametric models ,storm surges ,waves ,winds ,remote sensing ,Science - Abstract
Parametric cyclonic wind fields are widely used worldwide for insurance risk underwriting, coastal planning, and storm surge forecasts. They support high-stakes financial, development and emergency decisions. Yet, there is still no consensus on a potentially “best„ parametric approach, nor guidance to choose among the great variety of published models. The aim of this paper is to demonstrate that recent progress in estimating extreme surface wind speeds from satellite remote sensing now makes it possible to assess the performance of existing parametric models, and select a relevant one with greater objectivity. In particular, we show that the Cyclone Global Navigation Satellite System (CYGNSS) mission of NASA, along with the Advanced Scatterometer (ASCAT), are able to capture a substantial part of the tropical cyclone structure, and to aid in characterizing the strengths and weaknesses of a number of parametric models. Our results suggest that none of the traditional empirical approaches are the best option in all cases. Rather, the choice of a parametric model depends on several criteria, such as cyclone intensity and the availability of wind radii information. The benefit of using satellite remote sensing data to select a relevant parametric model for a specific case study is tested here by simulating hurricane Maria (2017). The significant wave heights computed by a wave-current hydrodynamic coupled model are found to be in good agreement with the predictions given by the remote sensing data. The results and approach presented in this study should shed new light on how to handle parametric cyclonic wind models, and help the scientific community conduct better wind, wave, and surge analyses for tropical cyclones.
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- 2018
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18. Une danse autour du vide?
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Raphaël Cervera
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Fragment ,figurability ,collective memory ,loss ,Fine Arts - Abstract
Critique of the notion of collective memory echoes in Pierre Huygue’s work, The Third Memory (2000). We also find this reflection on memory, on its deficiencies and its excesses, in the work of the artist Fabio Mauri. Therefore, while studying those several figures of oblivion, we seek to question the ontological aspect of collective oblivion. The second part intends to analyse Anne and Patrick Poirier's work, L’Oeil de l’Oubli, realized in 1996 and set up in 2010 in Chaumont’s castle gardens. In the wake of an observation by Damien Sausset, one can consider that the artists produce here « incarnations ». L’Oeil de l’Oubli is a paradoxical fragment, a fragment for a fragment, since it only refers to an « almost nothing ». We use the Freudian notion of « consideration of figurability » (Rücksicht auf Darstellbarkeit) a starting point to conduct several analysis of plastic figures of oblivion. In other words, we make a shifting from a psychological figurability to a plastic figurability. Over the course of the analysis, other figures of oblivion are circumscribed in this way.
- Published
- 2015
19. Partial Crosstalk Cancellation for Upstream VDSL
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Raphael Cendrillon, Marc Moonen, Katleen Van Acker, George Ginis, Piet Vandaele, and Tom Bostoen
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DSL ,interference cancellation ,reduced complexity ,partial crosstalk cancellation ,crosstalk selectivity ,hybrid selection/combining. ,Telecommunication ,TK5101-6720 ,Electronics ,TK7800-8360 - Abstract
Crosstalk is a major problem in modern DSL systems such as VDSL. Many crosstalk cancellation techniques have been proposed to help mitigate crosstalk, but whilst they lead to impressive performance gains, their complexity grows with the square of the number of lines within a binder. In binder groups which can carry up to hundreds of lines, this complexity is outside the scope of current implementation. In this paper, we investigate partial crosstalk cancellation for upstream VDSL. The majority of the detrimental effects of crosstalk are typically limited to a small subset of lines and tones. Furthermore, significant crosstalk is often only seen from neighbouring pairs within the binder configuration. We present a number of algorithms which exploit these properties to reduce the complexity of crosstalk cancellation. These algorithms are shown to achieve the majority of the performance gains of full crosstalk cancellation with significantly reduced run-time complexity.
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- 2004
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20. A prospective study of bone marrow hematopoietic and mesenchymal stem cells in type 1 Gaucher disease patients.
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Séverine Lecourt, Enguerran Mouly, Delphine Freida, Audrey Cras, Raphaël Ceccaldi, Djazia Heraoui, Christine Chomienne, Jean-Pierre Marolleau, Bertrand Arnulf, Raphael Porcher, Catherine Caillaud, Valérie Vanneaux, Nadia Belmatoug, and Jérôme Larghero
- Subjects
Medicine ,Science - Abstract
Gaucher disease (GD) is an autosomal recessive disorder characterized by lysosomal glucocerebrosidase (GBA) deficiency leading to hematological and skeletal manifestations. Mechanisms underlying these symptoms have not yet been elucidated. In vivo, bone marrow (BM) mesenchymal stem cells (MSCs) have important role in the regulation of bone mass and in the support of hematopoiesis, thus representing potential candidate that could contribute to the disease. GBA deficiency may also directly impair hematopoietic stem/progenitors cells (HSPCs) intrinsic function and induce hematological defect. In order to evaluate the role of BM stem cells in GD pathophysiology, we prospectively analyzed BM-MSCs and HSPCs properties in a series of 10 patients with type 1 GD. GBA activity was decreased in all tested cell subtypes. GD-MSCs had an impaired growth potential, morphological and cell cycle abnormalities, decreased capacities to differentiate into osteoblasts. Moreover, GD-MSCs secreted soluble factors that stimulated osteoclasts resorbing activities. In vitro and in vivo primitive and mature hematopoiesis were similar between patients and controls. However, GD-MSCs had a lower hematopoietic supportive capacity than those from healthy donors. These data suggest that BM microenvironment is altered in GD and that MSCs are key components of the manifestations observed in GD.
- Published
- 2013
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21. Deactivation of Implantable Cardioverter-Defibrillators in Terminal Illness and End-of-Life Care.
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Raphael CE
- Published
- 2012
22. Oral Abstract session: Demanding measurements: why bother?: Thursday 4 December 2014, 16:30-18:00 * Location: Agora
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Saura Espin, D, Caballero Jimenez, L, Oliva Sandoval, MJ, Gonzalez Carrillo, J, Espinosa Garcia, MD, Garcia Navarro, M, De La Morena, G, Van Dyck, M, Hulin, J, De Kerchove, L, Momeni, M, Watremez, C, Dreyfus, J, Durand-Viel, G, Cimadevilla, C, Brochet, E, Vahanian, A, Messika-Zeitoun, D, Nagy, A I, Apor, AA, Kovacs, A, Manouras, A, Andrassy, P, Merkely, B, Adamyan, KG, Tumasyan, LR, Chilingaryan, AL, Tunyan, LG, Barutcu, A, Bekler, A, Gazi, E, Kirilmaz, B, Temiz, A, Altun, B, Cole, G D, Dhutia, N, Shun-Shin, M, Willson, K, Harrison, J, Raphael, CE, Zolgharni, M, Mayet, J, Francis, DP, Kosior, D A, Szulc, M, Wozakowska-Kaplon, B, and Opolski, G
- Abstract
Background: Current guidelines accept planimetry of anatomic aortic valve stenosis (AVS) area (AVA) by means of three-dimensional transesophageal echocardiography (3D-TEE) as "reasonable when additional information is needed in selected patients", but it is not considered appropriate for direct clinical-decision making. We aimed to test the long-term prognostic value of 3D-TEE planimetered AVS area. Methods: 282 patients with moderate and severe AVS underwent 3D-TEE with planimetry of AVA. Vital status was assessed after 5.58 years of follow-up and analyzed by Kaplan-Meier and Cox methods.
Multivariate Cox analysis for mortality Variable P RR (IC 95%) 3D-TEE AVA <0.001 1.883 (1.377-2.576) EuroScoreII 0.020 1.030 (1.005-1.056) Any symptoms 0.118 1.669 (0.878-3.172) Medical management <0.001 2.895 (1.939-4.322) Results: Survival data of 280 (93.3% patients were available after 5.58 years of FU. 109 patients (39.9%) died. Mean survival was 3.46 years. In multivariate Cox regression analysis, AVA, EuroScoreII value as measure of co-morbidity and absence of aortic valve replacement were independently associated with higher mortality rate (Table). K-M curves showed increased mortality rate in patients with severe aortic stenosis (as defined by AVA≤0.8cm2) assessed by means of 3D-TEE (Figure), Log Rank p=0.022. Conclusion: Anatomic planimetry of AVA by 3D-TEE has good prognostic performance in patients with AVS.Figure K-M curves by 3D-TEE AVS planimetry - Published
- 2014
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23. Agreement of Doppler Flow Velocity Reserve With PET Flow Reserve in Patients With Angina Without Obstructive Coronary Arteries.
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Ismayl M, Raphael CE, Prasad A, Chareonthaitawee P, and Bois JP
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- 2024
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24. Coronary Sinus Reducer Improves Angina, Quality of Life, and Coronary Flow Reserve in Microvascular Dysfunction.
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Tryon D, Corban MT, Alkhouli M, Prasad A, Raphael CE, Rihal CS, Reeder GS, Lewis B, Albers D, Gulati R, and Lerman A
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Background: Coronary microvascular dysfunction (CMD) is a common cause of angina with no obstructive coronary artery disease (ANOCA), and effective treatment options are limited., Objectives: This study aims to assess the safety and efficacy of the coronary sinus (CS) Reducer (Neovasc, Inc/Shockwave Medical) for treatment of angina in patients with CMD., Methods: This Phase II trial enrolled 30 patients with ANOCA, invasively diagnosed CMD, and Canadian Cardiovascular Society (CCS) class 3 to 4 angina despite medical therapy. CMD was defined by coronary flow reserve (CFR) ≤2.5 and/or ≤50% increase in coronary blood flow (CBF) in response to intracoronary infusion of acetylcholine. Invasive coronary microvascular function testing was performed before and at 120 days postimplantation. The primary endpoint was change in microvascular function at 120 days. Secondary endpoints were changes in CCS angina class and Seattle Angina Questionnaire (SAQ) scores., Results: Mean age was 54.8 ± 11.0 years; 67% (20/30) were women. In patients with low baseline CFR (endothelium-independent CMD), CFR increased significantly from 2.1 (1.95-2.30) to 2.7 (2.45-2.95) (n = 19; P = 0.0011). Patients with abnormal CBF response to acetylcholine at baseline (endothelium-dependent CMD) had an increase in CBF response to acetylcholine: -11.0% (-20.15% to 5.85%) to 11.5% (-4.82% to 39.29%) (n = 11; P = 0.042). There was a significant improvement in CCS angina class from 4.0 (3.25-4.0) to 2.0 (2.0-3.0) (P < 0.001) and increase in each domain of the SAQ questionnaire (P < 0.006 for all)., Conclusions: This study demonstrates that the CS Reducer is associated with significant improvement in angina, quality of life, and coronary microvascular function in patients with CMD and may emerge as a novel therapy for patients with ANOCA., Competing Interests: Funding Support and Author Disclosures The study was supported by the Mayo Foundation and unrestricted grants from NeoVasc, Inc/Shockwave Medical, Inc. and Phillips/Volcano. Protocol Number: (IRBe) 20-006386, IDE Number: G200153. The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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25. Developments and Controversies in Invasive Diagnosis of Coronary Microvascular Dysfunction in Angina With Nonobstructive Coronary Arteries.
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Denby KJ, Zmaili M, Datta S, Das T, Ellis S, Ziada K, Lerman A, and Raphael CE
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- Humans, Angina Pectoris physiopathology, Angina Pectoris diagnosis, Angina Pectoris etiology, Thermodilution methods, Coronary Circulation physiology, Coronary Vessels physiopathology, Coronary Vessels diagnostic imaging, Coronary Angiography methods, Vascular Resistance physiology, Coronary Artery Disease physiopathology, Coronary Artery Disease diagnosis, Microcirculation physiology
- Abstract
Approximately half of all coronary angiograms performed for angina do not show obstructive coronary artery disease, and many of these patients have coronary microvascular dysfunction (CMD). Invasive testing for CMD has increased with the advent and wider availability of thermodilution systems. We review CMD pathophysiology and invasive diagnostic testing using the Doppler and thermodilution systems. We report the results of a PubMed search of invasive microvascular testing and discuss limitations of current diagnostic algorithms in the diagnosis of CMD, including controversies regarding the optimal cutoff value for abnormal coronary flow reserve, use of microvascular resistance indices, and options for increasing sensitivity of testing., (Copyright © 2024 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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26. Coronary Artery Tortuosity and Spontaneous Coronary Artery Dissection: Association With Echocardiography and Global Longitudinal Strain, Fibromuscular Dysplasia, and Outcomes.
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Tweet MS, Pellikka PA, Gulati R, Gochanour BR, Barrett-O'Keefe Z, Raphael CE, Best PJM, and Hayes SN
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- Humans, Female, Male, Middle Aged, Prospective Studies, Coronary Angiography methods, Adult, Global Longitudinal Strain, Fibromuscular Dysplasia complications, Fibromuscular Dysplasia diagnosis, Fibromuscular Dysplasia epidemiology, Fibromuscular Dysplasia physiopathology, Coronary Vessel Anomalies epidemiology, Coronary Vessel Anomalies complications, Coronary Vessel Anomalies diagnosis, Coronary Vessel Anomalies physiopathology, Echocardiography methods, Vascular Diseases congenital, Vascular Diseases epidemiology, Vascular Diseases physiopathology, Vascular Diseases diagnosis, Vascular Diseases complications, Coronary Vessels diagnostic imaging
- Abstract
Background: The etiology and significance of coronary artery tortuosity (TCA) among patients with spontaneous coronary artery dissection (SCAD) are unknown. The aim of this prospective imaging cohort study was to report echocardiographic findings and evaluate whether TCA correlates with cardiac anatomy and function among patients with SCAD. Comorbidities including fibromuscular dysplasia (FMD) and outcomes were also assessed., Methods: TCA was determined on coronary angiography performed during the diagnosis of SCAD, and cardiac structure and function were evaluated using prospective comprehensive echocardiography., Results: Among 116 patients with SCAD, the mean age at echocardiography was 50.8 ± 8.8 years, a median of 10.9 months after SCAD. Sixty-two patients (53.4%) had FMD, 41 (35.3%) had histories of hypertension, and 17 (14.8%) were hypertensive during echocardiography. Most patients (n = 78 [69%]) had normal left ventricular geometry with normal median ejection fraction (61%; interquartile range, 56% to 64%) and normal global longitudinal strain (-22.2%; interquartile range, -24.0% to -19.9%). Fifteen patients (13.4%) had diastolic dysfunction that was associated with hypertension at the time of echocardiography. Patients with TCA (n = 96 [82.8%]) were older (mean age, 52.1 ± 8.0 vs 44.7 ± 9.9 years; P < .001) with a higher prevalence of FMD (59.4% vs 25%, P = .007) but a similar prevalence of hypertension (35% vs 35%, P > .99) compared with patients without TCA. Across the age range (31.5 to 66.9 years), each decade of age was associated with an approximately 0.89-unit increase in coronary tortuosity score (P < .0001). Echocardiographic parameters were not significantly different between the two groups. Median follow-up duration was 4.4 years (95% CI, 3.8 to 5.2 years). The Kaplan-Meier 3-year SCAD recurrence rate was 9.4% (95% CI, 3.7% to 14.8%). There were no deaths., Conclusions: The majority of patients with SCAD had normal or near normal echocardiographic results, including global longitudinal strain, with no differences according to TCA. However, patients with SCAD with TCA were older, with a higher prevalence of FMD., Competing Interests: Conflicts of Interest None., (Copyright © 2024 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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27. Coronary Vasomotor Dysfunction Is Associated With Cardiovascular Events in Patients With Nonobstructive Coronary Artery Disease.
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Kanaji Y, Ahmad A, Sara JDS, Ozcan I, Akhiyat N, Prasad A, Raphael CE, Kakuta T, Lerman LO, and Lerman A
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- Humans, Coronary Circulation, Treatment Outcome, Angina Pectoris, Coronary Vessels diagnostic imaging, Acetylcholine, Endothelium, Vascular, Coronary Angiography, Coronary Artery Disease
- Abstract
Background: Coronary vasomotor dysfunction (CVDys) can be comprehensively classified on the basis of anatomy and functional mechanisms., Objectives: The aim of this study was to evaluate the association between different CVDys phenotypes and outcomes in patients with angina and nonobstructive coronary artery disease (ANOCA)., Methods: Patients with ANOCA who underwent coronary reactivity testing using an intracoronary Doppler guidewire to assess microvascular and epicardial coronary endothelium-dependent and endothelium-independent function were enrolled. Endothelium-dependent microvascular and epicardial coronary dysfunction were defined as a <50% change in coronary blood flow in response to intracoronary acetylcholine (Ach) infusion and a <-20% change in coronary artery diameter in response to Ach. Endothelium-independent microvascular and epicardial coronary dysfunction were defined as coronary flow reserve < 2.5 during adenosine-induced hyperemia and change in cross-sectional area in response to intracoronary nitroglycerin administration < 20%. Major adverse cardiac and cerebrovascular events (cardiovascular death, nonfatal MI, heart failure, stroke, and late revascularization) served as clinical outcomes., Results: Among the 1,196 patients with ANOCA, the prevalence of CVDys was 24.5% and 51.8% among those with endothelium-independent and endothelium-dependent microvascular dysfunction, respectively, and 47.4% and 25.4% among those with endothelium-independent and endothelium-dependent epicardial coronary dysfunction, respectively. During 6.3 years (Q1-Q3: 2.5-12.9 years) of follow-up, patients with endothelium-dependent microvascular dysfunction, endothelium-dependent epicardial coronary dysfunction, or endothelium-independent microvascular dysfunction showed significantly higher event rates compared with those without (19.5% vs 12.0% [P < 0.001], 19.7% vs 14.6% [P = 0.038] and 22.2% vs 13.8% [P = 0.001], respectively). Coronary flow reserve (HR: 0.757; 95% CI: 0.604-0.957) and percentage change in coronary blood flow in response to Ach infusion (HR: 0.998; 95% CI: 0.996-0.999) remained significant predictors of major adverse cardiac and cerebrovascular event after adjustment for conventional risk factors., Conclusions: CVDys phenotype is differentially associated with worse outcomes, and endothelium-dependent and endothelium-independent microvascular function provide independent prognostic information in patients with ANOCA., Competing Interests: Funding Support and Author Disclosures Dr Lerman is an advisor to AstraZeneca, CureSpec, and Ribocure Pharmaceuticals. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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28. Incidence and outcomes of high bleeding risk patients with type 1 and type 2 myocardial infarction in a community-based cohort: Application of the Academic Research Consortium High Bleeding Risk Criteria.
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Breen TJ, Raphael CE, Ingraham B, Lane C, Huxley S, Roger VL, Jaffe A, Lewis B, Sandoval YB, Prasad A, Rihal CS, Gulati R, and Singh M
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- Humans, Retrospective Studies, Incidence, Hemorrhage diagnosis, Hemorrhage epidemiology, Hemorrhage chemically induced, Platelet Aggregation Inhibitors adverse effects, Treatment Outcome, Risk Factors, Myocardial Infarction diagnosis, Myocardial Infarction epidemiology, Myocardial Infarction complications, Anterior Wall Myocardial Infarction complications, Stroke diagnosis, Stroke epidemiology, Stroke chemically induced, Percutaneous Coronary Intervention
- Abstract
Background and Aims: The incidence and outcomes of high bleeding risk (HBR) patients in a community cohort according to the Academic Research Consortium (ARC) criteria is not known. We hypothesized that HBR is common and associated with worse outcomes for all-comers with myocardial infarction., Methods: We prospectively collected all patients with cardiac troponin T > 99th percentile upper limit of normal (≥0.01 ng/mL) in Olmsted County between 2003 and 2012. Events were retrospectively classified as type 1 myocardial infarction (T1MI), type 2 myocardial infarction (T2MI), or myocardial injury. Patients were further classified as HBR based on the "ARC-HBR definition." Outcomes included all-cause mortality, cardiovascular mortality, recurrent MI, stroke, and major bleeding., Results: 2419 patients were included in the final study; 1365 were classified as T1MI and 1054 as T2MI. Patients were followed for a median of 5.5 years. ARC-HBR was more common in T2MI than T1MI (73% vs 46%, p < 0.001). Among patients with T1MI, HBR was associated with higher all-cause mortality (HR 3.7, 95% CI 3.2-4.5, p < 0.001), cardiovascular mortality (4.7, 3.6-6.3, p < 0.001), recurrent MI (2.1, 1.6-2.7, p < 0.001), stroke (4.9, 2.9-8.4, p < 0.001), and major bleeding (6.5, 3.7-11.4, p < 0.001). For T2MI, HBR was similarly associated with higher all-cause mortality (HR 2.1, 95% CI 1.8-2.5, p < 0.001), cardiovascular mortality (2.7, 1.8-4.0, p < 0.001), recurrent MI (1.7, 1.1-2.6, p = 0.02) and major bleeding (HR 15.6, 3.8-63.8, p < 0.001)., Conclusion: HBR is common among unselected patients with T1MI and T2MI and is associated with increased overall and cardiovascular mortality, recurrent cardiovascular events, and major bleeding on long-term follow up., (Copyright © 2023. Published by Elsevier B.V.)
- Published
- 2024
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29. Coronary spasm and vasomotor dysfunction as a cause of MINOCA.
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Yaker ZS, Lincoff AM, Cho L, Ellis SG, Ziada KM, Zieminski JJ, Gulati R, Gersh BJ, Holmes D Jr, and Raphael CE
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- Humans, Chest Pain, Coronary Vessels diagnostic imaging, Coronary Vessels surgery, Spasm, MINOCA, Coronary Vasospasm complications, Coronary Vasospasm diagnostic imaging
- Abstract
Increasing evidence has shown that coronary spasm and vasomotor dysfunction may be the underlying cause in more than half of myocardial infarctions with non-obstructive coronary arteries (MINOCA) as well as an important cause of chronic chest pain in the outpatient setting. We review the contemporary understanding of coronary spasm and related vasomotor dysfunction of the coronary arteries, the pathophysiology and prognosis, and current and emerging approaches to diagnosis and evidence-based treatment.
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- 2024
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30. Genotype-Phenotype Taxonomy of Hypertrophic Cardiomyopathy.
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Curran L, de Marvao A, Inglese P, McGurk KA, Schiratti PR, Clement A, Zheng SL, Li S, Pua CJ, Shah M, Jafari M, Theotokis P, Buchan RJ, Jurgens SJ, Raphael CE, Baksi AJ, Pantazis A, Halliday BP, Pennell DJ, Bai W, Chin CWL, Tadros R, Bezzina CR, Watkins H, Cook SA, Prasad SK, Ware JS, and O'Regan DP
- Subjects
- Humans, Female, Middle Aged, Male, Phenotype, Genotype, Hypertrophy complications, Cardiomyopathy, Hypertrophic, Cardiomyopathy, Hypertrophic, Familial
- Abstract
Background: Hypertrophic cardiomyopathy (HCM) is an important cause of sudden cardiac death associated with heterogeneous phenotypes, but there is no systematic framework for classifying morphology or assessing associated risks. Here, we quantitatively survey genotype-phenotype associations in HCM to derive a data-driven taxonomy of disease expression., Methods: We enrolled 436 patients with HCM (median age, 60 years; 28.8% women) with clinical, genetic, and imaging data. An independent cohort of 60 patients with HCM from Singapore (median age, 59 years; 11% women) and a reference population from the UK Biobank (n=16 691; mean age, 55 years; 52.5% women) were also recruited. We used machine learning to analyze the 3-dimensional structure of the left ventricle from cardiac magnetic resonance imaging and build a tree-based classification of HCM phenotypes. Genotype and mortality risk distributions were projected on the tree., Results: Carriers of pathogenic or likely pathogenic variants for HCM had lower left ventricular mass, but greater basal septal hypertrophy, with reduced life span (mean follow-up, 9.9 years) compared with genotype negative individuals (hazard ratio, 2.66 [95% CI, 1.42-4.96]; P <0.002). Four main phenotypic branches were identified using unsupervised learning of 3-dimensional shape: (1) nonsarcomeric hypertrophy with coexisting hypertension; (2) diffuse and basal asymmetrical hypertrophy associated with outflow tract obstruction; (3) isolated basal hypertrophy; and (4) milder nonobstructive hypertrophy enriched for familial sarcomeric HCM (odds ratio for pathogenic or likely pathogenic variants, 2.18 [95% CI, 1.93-2.28]; P =0.0001). Polygenic risk for HCM was also associated with different patterns and degrees of disease expression. The model was generalizable to an independent cohort (trustworthiness, M
1 : 0.86-0.88)., Conclusions: We report a data-driven taxonomy of HCM for identifying groups of patients with similar morphology while preserving a continuum of disease severity, genetic risk, and outcomes. This approach will be of value in understanding the causes and consequences of disease diversity., Competing Interests: Disclosures Dr Ware has consulted for MyoKardia, Inc, Foresite Labs, and Pfizer and receives research support from Bristol Myers Squibb outside the submitted work. Dr O’Regan has consulted for Bayer AG and Bristol Myers Squibb and also receives research support from Bayer AG outside the submitted work. Dr Halliday is on an advisory board for AstraZeneca. The other authors report no conflicts.- Published
- 2023
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31. Interaction Between Race and Income on Cardiac Outcomes After Percutaneous Coronary Intervention.
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Kumar A, Ogunnowo GO, Khot UN, Raphael CE, Ghobrial J, Rampersad P, Puri R, Khatri JJ, Reed GW, Krishnaswamy A, Cho L, Lincoff AM, Ziada KM, Kapadia SR, and Ellis SG
- Subjects
- Humans, White People, Income, Risk Factors, Black or African American, Percutaneous Coronary Intervention adverse effects
- Abstract
Background Compared with White Americans, Black Americans have a greater prevalence of cardiac events following percutaneous coronary intervention. We evaluated the association between race and neighborhood income on post-percutaneous coronary intervention cardiac events and assessed whether income modifies the effect of race on this relationship. Methods and Results Consecutive patients (n=23 822) treated with percutaneous coronary intervention from January 1, 2000, to December 31, 2016, were included. All-cause mortality and major adverse cardiac event were assessed at 3 years. Extended 10-year follow-up was performed for those residing locally (n=1285). Neighborhood income was derived using median adjusted annual gross household income reported within the patient's zip code. We compared differences in treatment and outcomes, adjusting for race, income, and their interaction. In total, 3173 (13.3%) patients self-identified as Black Americans, and 20 649 (86.7%) self-identified as White Americans. Black Americans had a worse baseline cardiac risk profile and lower neighborhood income compared with White Americans. Although risk profile improved with increasing income in White Americans, no difference was observed across incomes among Black Americans. Despite similar long-term outpatient cardiology follow-up and medication prescription, risk profiles among Black Americans remained worse. At 3 years, unadjusted all-cause mortality (18.0% versus 15.2%; P <0.001) and major adverse cardiac event (37.3% versus 34.6%; P <0.001) were greater among Black Americans and with lower income (both P <0.001); race, income, and their interaction were not significant predictors in multivariable models. At 10-year follow-up, increasing income was associated with improved outcomes only in White Americans but not Black Americans. In multivariable models for major adverse cardiac event, income (hazard ratio [HR], 0.97 [95% CI, 0.96-0.98]; P =0.005), Black race (HR, 1.77 [95% CI, 1.58-1.96]; P =0.006), and their interaction (HR, 0.98 [95% CI, 0.97-0.99]; P =0.003) were significant predictors. Similar findings were observed for cardiac death. Conclusions Early 3-year post-percutaneous coronary intervention outcomes were driven by worse risk factor profiles in both Black Americans and those with lower neighborhood income. However, late 10-year outcomes showed an independent effect of race and income, with improving outcomes with greater income limited to White Americans. These findings illustrate the importance of developing novel care strategies that address both risk factor modification and social determinants of health to mitigate disparities in cardiac outcomes.
- Published
- 2022
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32. Evolution of the Crush Technique for Bifurcation Stenting.
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Raphael CE, O'Kane PD, Johnson TW, Prasad A, Gulati R, Sandoval Y, Di Mario C, and Holmes DR Jr
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- Coronary Angiography methods, Humans, Stents, Time Factors, Treatment Outcome, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease therapy, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention methods, Thrombosis
- Abstract
Bifurcation lesions are frequently encountered, associated with greater procedural complexity and consequently are at higher risk for restenosis and stent thrombosis. Early trials in bifurcation percutaneous coronary intervention favored a provisional stenting approach, but contemporary randomized trials have highlighted potentially superior outcomes using a double-kiss crush technique in unprotected distal left main stem bifurcation lesions. Although the evidence is greatest for double-kiss crush, many operators favor a mini-crush or nano-crush single-kiss approach. In this review, the authors describe the iterations of the crush technique and the evidence for each and review general principles for bifurcation percutaneous coronary intervention., Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Crown Copyright © 2021. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
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33. A novel cardiovascular magnetic resonance risk score for predicting mortality following surgical aortic valve replacement.
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Vassiliou VS, Pavlou M, Malley T, Halliday BP, Tsampasian V, Raphael CE, Tse G, Vieira MS, Auger D, Everett R, Chin C, Alpendurada F, Pepper J, Pennell DJ, Newby DE, Jabbour A, Dweck MR, and Prasad SK
- Subjects
- Aged, Aged, 80 and over, Aortic Valve Stenosis mortality, Female, Gadolinium administration & dosage, Heart Valve Prosthesis Implantation adverse effects, Humans, Male, Middle Aged, Multivariate Analysis, Risk Factors, Stroke Volume, Survival Analysis, Treatment Outcome, United Kingdom, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Magnetic Resonance Imaging, Cine methods, Platelet Aggregation Inhibitors therapeutic use
- Abstract
The increasing prevalence of patients with aortic stenosis worldwide highlights a clinical need for improved and accurate prediction of clinical outcomes following surgery. We investigated patient demographic and cardiovascular magnetic resonance (CMR) characteristics to formulate a dedicated risk score estimating long-term survival following surgery. We recruited consecutive patients undergoing CMR with gadolinium administration prior to surgical aortic valve replacement from 2003 to 2016 in two UK centres. The outcome was overall mortality. A total of 250 patients were included (68 ± 12 years, male 185 (60%), with pre-operative mean aortic valve area 0.93 ± 0.32cm
2 , LVEF 62 ± 17%) and followed for 6.0 ± 3.3 years. Sixty-one deaths occurred, with 10-year mortality of 23.6%. Multivariable analysis showed that increasing age (HR 1.04, P = 0.005), use of antiplatelet therapy (HR 0.54, P = 0.027), presence of infarction or midwall late gadolinium enhancement (HR 1.52 and HR 2.14 respectively, combined P = 0.12), higher indexed left ventricular stroke volume (HR 0.98, P = 0.043) and higher left atrial ejection fraction (HR 0.98, P = 0.083) associated with mortality and developed a risk score with good discrimination. This is the first dedicated risk prediction score for patients with aortic stenosis undergoing surgical aortic valve replacement providing an individualised estimate for overall mortality. This model can help clinicians individualising medical and surgical care.Trial Registration ClinicalTrials.gov Identifier: NCT00930735 and ClinicalTrials.gov Identifier: NCT01755936., (© 2021. The Author(s).)- Published
- 2021
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34. Causes of Death After Type 2 Myocardial Infarction and Myocardial Injury.
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Raphael CE, Roger VL, Sandoval Y, Johnson M, Jaffe A, Lerman A, Rihal CS, Bell MR, Singh M, and Gulati R
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- Aged, Biomarkers blood, Cause of Death trends, Female, Humans, Male, Myocardial Infarction blood, Survival Rate, United States epidemiology, Myocardial Infarction mortality, Troponin I blood
- Published
- 2021
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35. Cardiovascular magnetic resonance predictors of heart failure in hypertrophic cardiomyopathy: the role of myocardial replacement fibrosis and the microcirculation.
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Raphael CE, Mitchell F, Kanaganayagam GS, Liew AC, Di Pietro E, Vieira MS, Kanapeckaite L, Newsome S, Gregson J, Owen R, Hsu LY, Vassiliou V, Cooper R, Mrcp AA, Ismail TF, Wong B, Sun K, Gatehouse P, Firmin D, Cook S, Frenneaux M, Arai A, O'Hanlon R, Pennell DJ, and Prasad SK
- Subjects
- Adult, Aged, Cardiomyopathy, Hypertrophic complications, Cardiomyopathy, Hypertrophic pathology, Cardiomyopathy, Hypertrophic physiopathology, Disease Progression, Female, Fibrosis, Heart Failure physiopathology, Humans, Male, Middle Aged, Predictive Value of Tests, Prognosis, Registries, Retrospective Studies, Risk Assessment, Risk Factors, Stroke Volume, Time Factors, Ventricular Function, Left, Cardiomyopathy, Hypertrophic diagnostic imaging, Coronary Circulation, Heart Failure etiology, Magnetic Resonance Imaging, Microcirculation, Myocardial Perfusion Imaging, Myocardium pathology
- Abstract
Introduction: Heart failure (HF) in hypertrophic cardiomyopathy (HCM) is associated with high morbidity and mortality. Predictors of HF, in particular the role of myocardial fibrosis and microvascular ischemia remain unclear. We assessed the predictive value of cardiovascular magnetic resonance (CMR) for development of HF in HCM in an observational cohort study., Methods: Serial patients with HCM underwent CMR, including adenosine first-pass perfusion, left atrial (LA) and left ventricular (LV) volumes indexed to body surface area (i) and late gadolinium enhancement (%LGE- as a % of total myocardial mass). We used a composite endpoint of HF death, cardiac transplantation, and progression to NYHA class III/IV., Results: A total of 543 patients with HCM underwent CMR, of whom 94 met the composite endpoint at baseline. The remaining 449 patients were followed for a median of 5.6 years. Thirty nine patients (8.7%) reached the composite endpoint of HF death (n = 7), cardiac transplantation (n = 2) and progression to NYHA class III/IV (n = 20). The annual incidence of HF was 2.0 per 100 person-years, 95% CI (1.6-2.6). Age, previous non-sustained ventricular tachycardia, LV end-systolic volume indexed to body surface area (LVESVI), LA volume index ; LV ejection fraction, %LGE and presence of mitral regurgitation were significant univariable predictors of HF, with LVESVI (Hazard ratio (HR) 1.44, 95% confidence interval (95% CI) 1.16-1.78, p = 0.001), %LGE per 10% (HR 1.44, 95%CI 1.14-1.82, p = 0.002) age (HR 1.37, 95% CI 1.06-1.77, p = 0.02) and mitral regurgitation (HR 2.6, p = 0.02) remaining independently predictive on multivariable analysis. The presence or extent of inducible perfusion defect assessed using a visual score did not predict outcome (p = 0.16, p = 0.27 respectively)., Discussion: The annual incidence of HF in a contemporary ambulatory HCM population undergoing CMR is low. Myocardial fibrosis and LVESVI are strongly predictive of future HF, however CMR visual assessment of myocardial perfusion was not.
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- 2021
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36. Contemporary approaches to bifurcation stenting.
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Raphael CE and O'Kane PD
- Abstract
Bifurcation lesions are common and associated with higher risks of major cardiac events and restenosis after percutaneous coronary intervention (PCI). Treatment requires understanding of lesion characteristics, stent design and therapeutic options. We review the evidence for provisional vs 2-stent techniques. We conclude that provisional stenting is suitable for most bifurcation lesions. We detail situations where a 2-stent technique should be considered and the steps for performing each of the 2-step techniques. We review the importance of lesion preparation, intracoronary imaging, proximal optimization (POT) and kissing balloon inflation., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)
- Published
- 2021
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37. Predictors and Mechanisms of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy.
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Raphael CE, Liew AC, Mitchell F, Kanaganayagam GS, Di Pietro E, Newsome S, Owen R, Gregson J, Cooper R, Amin FR, Gatehouse P, Vassiliou V, Ernst S, O'Hanlon R, Frenneaux M, Pennell DJ, and Prasad SK
- Subjects
- Aged, Female, Fibrosis, Humans, Male, Middle Aged, Myocardium pathology, Predictive Value of Tests, Prospective Studies, Atrial Fibrillation etiology, Cardiomyopathy, Hypertrophic complications, Cardiomyopathy, Hypertrophic diagnostic imaging, Magnetic Resonance Imaging
- Abstract
Atrial fibrillation (AF) in hypertrophic cardiomyopathy (HC) is associated with significant symptomatic deterioration, heart failure, and thromboembolic disease. There is a need for better mechanistic insight and improved identification of at risk patients. We used cardiovascular magnetic resonance (CMR) to assess predictors of AF in HC, in particular the role of myocardial fibrosis. Consecutive patients with HC referred for CMR 2003 to 2013 were prospectively enrolled. CMR parameters including left ventricular volumes, presence and percentage of late gadolinium enhancement in the left ventricle (%LGE) and left atrial volume index (LAVi) were measured. Overall, 377 patients were recruited (age 62 ± 14 years, 73% men). Sixty-two patients (16%) developed new-onset AF during a median follow up of 4.5 (interquartile range 2.9 to 6.0) years. Multivariable analysis revealed %LGE (hazard ratio [HR] 1.3 per 10% (confidence interval: 1.0 to 1.5; p = 0.02), LAVi (HR 1.4 per 10 mL/m
2 [1.2 to 1.5; p < 0.001]), age at HC diagnosis, nonsustained ventricular tachycardia and diabetes to be independent predictors of AF. We constructed a simple risk prediction score for future AF based on the multivariable model with a Harrell's C-statistic of 0.73. In conclusion, the extent of ventricular fibrosis and LA volume independently predicted AF in patients with HC. This finding suggests a mechanistic relation between fibrosis and future AF in HC. CMR with quantification of fibrosis has incremental value over LV and LA measurements in risk stratification for AF. A risk prediction score may be used to identify patients at high risk of future AF who may benefit from more intensive rhythm monitoring and a lower threshold for oral anticoagulation., (Crown Copyright © 2020. Published by Elsevier Inc. All rights reserved.)- Published
- 2020
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38. Lack of Association of Spontaneous Coronary Artery Dissection With Autoimmune Disease.
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Kronzer VL, Tarabochia AD, Lobo Romero AS, Tan NY, O'Byrne TJ, Crowson CS, Turley TN, Myasoedova E, Davis JM 3rd, Raphael CE, Gulati R, Hayes SN, and Tweet MS
- Subjects
- Adult, Aged, Aged, 80 and over, Case-Control Studies, Coronary Angiography methods, Female, Humans, Male, Middle Aged, Minnesota epidemiology, Risk Factors, Vascular Diseases diagnostic imaging, Vascular Diseases epidemiology, Wisconsin epidemiology, Autoimmune Diseases diagnostic imaging, Autoimmune Diseases epidemiology, Coronary Vessel Anomalies diagnostic imaging, Coronary Vessel Anomalies epidemiology, Population Surveillance methods, Vascular Diseases congenital
- Abstract
Background: Case reports and referral-based studies suggest spontaneous coronary artery dissection (SCAD) is associated with autoimmune diseases and causes 2% to 4% of acute coronary syndromes., Objectives: This study determined the association of SCAD with autoimmune diseases, together with incidence and recurrence, in a population-based study., Methods: This case-control study took place from 1995 to 2018 within the Rochester Epidemiology Project. The study identified cases with SCAD from diagnosis codes and verified them using coronary angiography images, matching each case to 3 control subjects on age, sex, county, and years of medical history. Autoimmune disease history came from a validated, code-based definition. A multivariable logistic regression model calculated the odds ratio (OR) for SCAD among patients with a history of autoimmune disease, adjusting for race and body mass index., Results: The study identified 114 cases with SCAD (mean age 51 years and 90% women) and 342 matched control subjects. Autoimmune disease occurred in 13 (11%) cases with SCAD and 40 (12%) control subjects (p = 0.93). Even after adjustment, autoimmune diseases were not associated with SCAD (OR: 0.81; 95% confidence interval [CI]: 0.40 to 1.66). SCAD incidence between 2010 and 2018 (2.7 per 100,000; 95% CI: 1.7 to 3.7) was 10-fold higher than the incidence between 1995 and 2009 (0.3 per 100,000; 95% CI: 0.0 to 0.6). SCAD recurrence was 10% (95% CI: 3% to 16%) at 5 years., Conclusions: These findings suggested SCAD pathogenesis is noninflammatory and screening for autoimmune diseases based on SCAD alone is not warranted. The code-based incidence of SCAD has increased over time, highlighting the importance of considering SCAD among patients with acute coronary syndromes., (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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39. Temporal Trends and Outcomes of Left Ventricular Aneurysm After Acute Myocardial Infarction.
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Vallabhajosyula S, Kanwar S, Aung H, Cheungpasitporn W, Raphael CE, Gulati R, and Singh M
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- Aged, Aged, 80 and over, Female, Heart Aneurysm diagnosis, Heart Aneurysm therapy, Heart Ventricles, Hospital Mortality, Hospitalization, Humans, Male, Middle Aged, Myocardial Infarction mortality, Myocardial Infarction therapy, Odds Ratio, Prevalence, Retrospective Studies, Risk Factors, Survival Rate, Time Factors, Heart Aneurysm epidemiology, Myocardial Infarction complications
- Abstract
There are limited data on the prevalence and an outcome of left ventricular (LV) aneurysms following acute myocardial infarction (AMI). Using the National Inpatient Sample during 2000 to 2017, a retrospective cohort of AMI admissions was evaluated for LV aneurysms. Complications included ventricular arrhythmias, mechanical, cardiac arrest, pump failure, LV thrombus, and stroke. Outcomes of interest included in-hospital mortality, temporal trends, complications, hospitalization costs, and length of stay. A total 11,622,528 AMI admissions, with 17,626 (0.2%) having LV aneurysms were included. The LV aneurysm cohort was more often female, with higher comorbidity, and admitted to large urban hospitals (all p < 0.001). In 2017, compared with 2000, there was a slight increase in LV aneurysms prevalence in those with (adjusted odds ratio [aOR] 1.57 [95% confidence interval {CI} 1.41 to 1.76]) and without (aOR 1.13 [95% CI 1.00 to .127]) ST-segment-elevation AMI (p < 0.001 for trend). LV aneurysms were more commonly noted with anterior ST-segment-elevation AMI (31%) compared with inferior (12.3%) and other (7.9%). Ventricular arrhythmias (17.6% vs 8.0%), mechanical complications (2.6% vs 0.2%), cardiac arrest (7.1% vs 5.0%), pump failure (26.3% vs 16.1%), cardiogenic shock (10.0% vs 4.8%) were more common in the LV aneurysm cohort (all p < 0.001). Those with LV aneurysms had comparable in-hospital mortality compared with those without (7.4% vs 6.2%; aOR 1.02 [95% CI 0.90 to 1.14]; p = 0.43). The LV aneurysm cohort had longer length of hospital stay, higher hospitalization costs, and fewer discharges to home. In conclusion, LV aneurysms were associated with higher morbidity, more frequent complications, and greater in-hospital resource utilization, without any differences in in-hospital mortality in AMI., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2020
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40. Response by Raphael et al to the Letters Regarding Article, "Incidence, Trends, and Outcomes of Type 2 Myocardial Infarction in a Community Cohort".
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Raphael CE, Roger VL, Sandoval Y, Singh M, and Gulati R
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- Acute Disease, Cohort Studies, Humans, Incidence, Anterior Wall Myocardial Infarction, Myocardial Infarction diagnosis, Myocardial Infarction epidemiology, Myocardial Infarction therapy
- Published
- 2020
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41. Incidence, Trends, and Outcomes of Type 2 Myocardial Infarction in a Community Cohort.
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Raphael CE, Roger VL, Sandoval Y, Singh M, Bell M, Lerman A, Rihal CS, Gersh BJ, Lewis B, Lennon RJ, Jaffe AS, and Gulati R
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- Aged, Aged, 80 and over, Disease-Free Survival, Female, Humans, Incidence, Male, Middle Aged, Prospective Studies, Sex Factors, Survival Rate, Myocardial Infarction blood, Myocardial Infarction classification, Myocardial Infarction mortality, Troponin T blood
- Abstract
Background: Type 2 myocardial infarction (T2MI) occurs because of an acute imbalance in myocardial oxygen supply and demand in the absence of atherothrombosis. Despite being frequently encountered in clinical practice, the population-based incidence and trends remain unknown, and the long-term outcomes are incompletely characterized., Methods: We prospectively recruited residents of Olmsted County, Minnesota, who experienced an event associated with a cardiac troponin T >99th percentile of a normal reference population (≥0.01 ng/mL) between January 1, 2003, and December 31, 2012. Events were retrospectively classified into type 1 myocardial infarction (T1MI, atherothombotic event), T2MI, or myocardial injury (troponin rise not meeting criteria for myocardial infarction [MI]) using the universal definition. Outcomes were long-term all-cause and cardiovascular mortality and recurrent MI. T2MI was further subclassified by the inciting event for supply/demand mismatch., Results: A total of 5460 patients had at least one cardiac troponin T ≥0.01 ng/mL; 1365 of these patients were classified as index T1MI (age, 68.5±14.8 years; 63% male) and 1054 were classified as T2MI (age, 73.7±15.8 years; 46% male). The annual incidence of T1MI decreased markedly from 202 to 84 per 100 000 persons between 2003 and 2012 ( P <0.001), whereas the incidence of T2MI declined from 130 to 78 per 100 000 persons ( P =0.02). In comparison with patients with T1MI, patients with T2MI had higher long-term all-cause mortality after adjustment for age and sex, driven by early and noncardiovascular death. Rates of cardiovascular death were similar after either type of MI (hazard ratio, 0.8 [95% CI, 0.7-1.0], P =0.11). Subclassification of T2MI by cause demonstrated a more favorable prognosis when the principal provoking mechanism was arrhythmia, in comparison with postoperative status, hypotension, anemia, and hypoxia. After index T2MI, the most common MI during follow-up was a recurrent T2MI, whereas the occurrence of a new T1MI was relatively rare (estimated rates at 5 years, 9.7% and 1.7%)., Conclusions: There has been an evolution in the type of MI occurring in the community over a decade, with the incidence of T2MI now being similar to T1MI. Mortality after T2MI is higher and driven by early and noncardiovascular death. The provoking mechanism of supply/demand mismatch affects long-term survival. These findings underscore the healthcare burden of T2MI and provide benchmarks for clinical trial design.
- Published
- 2020
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42. Wave intensity and cognitive decline: where the heart leads the mind follows.
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Raphael CE and Frenneaux M
- Subjects
- Carotid Artery, Common, Cognition, Humans, Cognitive Dysfunction
- Published
- 2019
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43. A hybrid technique for treatment of commissural primary mitral regurgitation.
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Raphael CE, Malouf JF, Maor E, Panaich SS, Pollak PM, Reeder GS, Rihal CS, and Eleid MF
- Subjects
- Aged, Aged, 80 and over, Cardiac Catheterization adverse effects, Female, Heart Valve Prosthesis Implantation adverse effects, Hemodynamics, Humans, Male, Mitral Valve diagnostic imaging, Mitral Valve physiopathology, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency physiopathology, Prosthesis Design, Recovery of Function, Severity of Illness Index, Time Factors, Treatment Outcome, Cardiac Catheterization instrumentation, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation instrumentation, Mitral Valve surgery, Mitral Valve Insufficiency surgery
- Abstract
Background: MitraClip is an effective transcatheter therapy for mitral regurgitation (MR). However, MitraClip is challenging in commissural MR and the optimal therapeutic approach is unclear., Methods: We describe a case series of six consecutive patients with severe commissural primary mitral regurgitation who underwent MitraClip insertion followed by an Amplatzer Vascular Plug (AVP) II occluder between the commissure and the MitraClip., Results: The procedure was successful in all patients. MR was reduced from severe to mild/trivial in 50% and moderate in 50% of cases. On 30-day follow-up, NYHA class had improved from III (6 patients) to I (2 patients), II (2 patients), and III (2 patients). The mean transmitral gradient was 2.5 ± 1.8 mmHg at baseline and 4.8 ± 2.6 mmHg following the procedure. One patient developed hemolysis immediately post procedure. The other five patients remained well during a median follow-up of 20 months (range 5-50 months) with no reported device dislodgement., Conclusions: Elective treatment of severe commissural MR with a laterally or medially placed MitraClip coupled with an AVP II occluder between the clip and the commissure is feasible and safe. This approach may provide a useful management alternative in selected patients., (© 2018 Wiley Periodicals, Inc.)
- Published
- 2019
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44. Effect of percutaneous paravalvular leak closure on hemolysis.
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Panaich SS, Maor E, Reddy G, Raphael CE, Cabalka A, Hagler DJ, Reeder GS, Rihal CS, and Eleid MF
- Subjects
- Aged, Aged, 80 and over, Anemia blood, Anemia diagnosis, Anemia therapy, Aortic Valve Insufficiency diagnostic imaging, Aortic Valve Insufficiency etiology, Aortic Valve Insufficiency physiopathology, Biomarkers blood, Blood Transfusion, Female, Haptoglobins metabolism, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation instrumentation, Hemoglobins metabolism, Humans, L-Lactate Dehydrogenase blood, Male, Middle Aged, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency physiopathology, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Anemia etiology, Aortic Valve Insufficiency therapy, Cardiac Catheterization adverse effects, Cardiac Catheterization instrumentation, Heart Valve Prosthesis Implantation adverse effects, Hemolysis, Mitral Valve Insufficiency therapy
- Abstract
Objective: To study the effect of percutaneous paravalvular leak closure on hemolysis., Background: Although transcatheter PVL closure reduces heart failure and mortality in symptomatic patients with paravalvular leaks (PVL), little is known about its effect on hemolysis., Methods: We retrospectively analyzed patients undergoing transcatheter mitral or aortic PVL closure (January 2005-December 2016) at Mayo Clinic. Patients with anemia or abnormal hemolysis markers (LDH, haptoglobin) were included in the analysis. The primary outcome was defined as hemoglobin increase ≥ 1.5 mg/dL, decrease in LDH above median or improvement in haptoglobin. Univariate and multivariate binary logistic regression modeling were used to determine predictors of successful treatment of hemolysis., Results: Final study population included 168 patients (130 [77%] mitral, 38 [23%] aortic PVL). Primary outcome occurred in 70 patients (42%). Hemoglobin increased by 1.74 ± 1.69 mg/dL in patients who reached primary outcome. 57/168 (34%) patients required blood transfusion prior to PVL closure compared to 35/168 (21%) postprocedure. The mean reduction in LDH was 403 U/L. Multivariate regression showed that patients with mechanical valves were more likely to have successful outcome (P = 0.044)., Conclusion: Percutaneous PVL closure is associated with modest improvement in hemolysis markers, increase in hemoglobin levels and reduction in blood transfusion requirements. This benefit is most significant in patients with mechanical valves., (© 2018 Wiley Periodicals, Inc.)
- Published
- 2019
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45. Prevalence and Clinical Factors of Migraine in Patients With Spontaneous Coronary Artery Dissection.
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Kok SN, Hayes SN, Cutrer FM, Raphael CE, Gulati R, Best PJM, and Tweet MS
- Subjects
- Adolescent, Adult, Age of Onset, Aged, Angina Pectoris epidemiology, Child, Coronary Vessel Anomalies diagnostic imaging, Depression epidemiology, Female, Humans, Male, Middle Aged, Migraine Disorders diagnosis, Prevalence, Registries, Risk Factors, Sex Factors, Time Factors, Vascular Diseases diagnostic imaging, Vascular Diseases epidemiology, Young Adult, Coronary Vessel Anomalies epidemiology, Migraine Disorders epidemiology, Vascular Diseases congenital
- Abstract
Background Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndrome predominantly in women without usual cardiovascular risk factors. Many have a history of migraine headaches, but this association is poorly understood. This study aimed to determine migraine prevalence among SCAD patients and assess differences in clinical factors based on migraine history. Methods and Results A cohort study was conducted using the Mayo Clinic SCAD "Virtual" Multi-Center Registry composed of patients with SCAD as confirmed on coronary angiography. Participant-provided data and records were reviewed for migraine history, risk factors, SCAD details, therapies, and outcomes. Among 585 patients (96% women), 236 had migraine history; the lifetime and 1-year prevalence of migraine were 40% and 26%, respectively. Migraine was more common in SCAD women than comparable literature-reported female populations (42% versus 24%, P<0.0001; 42% versus 33%, P<0.0001). Among all SCAD patients, those with migraine history were more likely to be female (99.6% versus 94%; P=0.0002); have SCAD at a younger age (45.2±9.0 years versus 47.6±9.9 years; P=0.0027); have depression (27% versus 17%; P=0.025); have recurrent post-SCAD chest pain at 1 month (50% versus 39%; P=0.035); and, among those assessed, have aneurysms, pseudoaneurysms, or dissections (28% versus 18%; P=0.018). There was no difference in recurrent SCAD at 5 years for those with versus without migraine (15% versus 19%; P=0.39). Conclusions Many SCAD patients have a history of migraine. SCAD patients with migraine are younger at the time of SCAD; have more aneurysms, pseudoaneurysms, and dissections among those imaged; and more often report a history of depression and post-SCAD chest pain. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifiers: NCT01429727, NCT01427179.
- Published
- 2018
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46. Osteoprotegerin and Myocardial Fibrosis in Patients with Aortic Stenosis.
- Author
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Loudon BL, Ntatsaki E, Newsome S, Halliday B, Lota A, Ali A, Malley T, Selvendran S, Aggarwal N, Lam W, Donovan J, Auger D, Raphael CE, Flynn PD, Pennell DJ, Vassiliou VS, and Prasad SK
- Subjects
- Aged, Aged, 80 and over, Aortic Valve Stenosis complications, Aortic Valve Stenosis pathology, Female, Fibrosis, Heart Ventricles pathology, Humans, Male, Middle Aged, Myocardial Infarction complications, Myocardial Infarction pathology, Aortic Valve Stenosis blood, Myocardial Infarction blood, Myocardium pathology, Osteoprotegerin blood
- Abstract
Left ventricular myocardial fibrosis in patients with aortic stenosis (AS) confers worse prognosis. Plasma osteoprotegerin (OPG), a cytokine from the TNF receptor family, correlates with the degree of valve calcification in AS, reflecting the activity of the tissue RANKL/RANK/OPG (receptor activator of nuclear factor κΒ ligand/RANK/osteoprotegerin) axis, and is associated with poorer outcomes in AS. Its association with myocardial fibrosis is unknown. We hypothesised that OPG levels would reflect the extent of myocardial fibrosis in AS. We included 110 consecutive patients with AS who had undergone late-gadolinium contrast enhanced cardiovascular magnetic resonance (LGE-CMR). Patients were characterised according to pattern of fibrosis (no fibrosis, midwall fibrosis, or chronic myocardial infarction fibrosis). Serum OPG was measured with ELISA and compared between groups defined by valve stenosis severity. Some 36 patients had no fibrosis, 38 had midwall fibrosis, and 36 had chronic infarction. Patients with midwall fibrosis did not have higher levels of OPG compared to those without fibrosis (6.78 vs. 5.25 pmol/L, p = 0.12). There was no difference between those with midwall or chronic myocardial infarction fibrosis (6.78 vs. 6.97 pmol/L, p = 0.27). However, OPG levels in patients with chronic myocardial infarction fibrosis were significantly higher than those without fibrosis (p = 0.005).
- Published
- 2018
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47. Sex Differences in Long-Term Cause-Specific Mortality After Percutaneous Coronary Intervention: Temporal Trends and Mechanisms.
- Author
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Raphael CE, Singh M, Bell M, Crusan D, Lennon RJ, Lerman A, Prasad A, Rihal CS, Gersh BJ, and Gulati R
- Subjects
- Age Factors, Aged, Aged, 80 and over, Cause of Death, Comorbidity, Coronary Angiography, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease mortality, Female, Humans, Male, Middle Aged, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention trends, Registries, Retrospective Studies, Risk Assessment, Risk Factors, Sex Factors, Time Factors, Treatment Outcome, Coronary Artery Disease surgery, Health Status Disparities, Percutaneous Coronary Intervention mortality
- Abstract
Background: Women have higher rates of all-cause mortality after percutaneous coronary intervention. Whether this is because of greater age and comorbidity burden or a sex-specific factor remains unclear., Methods and Results: We retrospectively assessed cause-specific long-term mortality after index percutaneous coronary intervention over 3 time periods (1991-1997, 1998-2005, and 2006-2012). Cause of death was determined using telephone interviews, medical records, and death certificates. We performed competing risks analyses of cause-specific mortality. A total of 6847 women and 16 280 men survived index percutaneous coronary intervention hospitalization 1991 to 2012. Women were older (mean±SD: 69.4±12 versus 64.8±11.7 years; P <0.001) with more comorbidities (mean±SD: Charlson index 2.1±2.1 versus 1.9±2.1; P <0.001). Across the 3 time periods, both sexes exhibited a decline in cardiac deaths at 5 years (26% relative decrease in women, 17% in men, trend P <0.001 for each). Although women had higher all-cause mortality compared with men in all eras, the excess mortality was because of noncardiac deaths. In the contemporary era, only a minority of deaths were cardiac (33.8% in women, 38.0% in men). After adjustment, there was no evidence for a sex-specific excess of risk for cardiac or noncardiac mortality. The commonest causes of death were chronic diseases and heart failure in women (5-year cumulative mortality, 5.4% and 3.9%) but cancer and myocardial infarction/sudden death in men (5.4% and 4.3%)., Conclusions: The higher mortality after percutaneous coronary intervention in women is because of death from noncardiac causes. This is accounted for by baseline age and comorbidities rather than an additional sex-specific factor. These findings have implications for sex-specific clinical care and trial design., (© 2018 American Heart Association, Inc.)
- Published
- 2018
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48. Coronary Embolus: An Underappreciated Cause of Acute Coronary Syndromes.
- Author
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Raphael CE, Heit JA, Reeder GS, Bois MC, Maleszewski JJ, Tilbury RT, and Holmes DR Jr
- Subjects
- Acute Coronary Syndrome blood, Acute Coronary Syndrome diagnostic imaging, Acute Coronary Syndrome therapy, Diagnosis, Differential, Embolism blood, Embolism diagnostic imaging, Embolism therapy, Heart Diseases blood, Heart Diseases diagnostic imaging, Heart Diseases therapy, Humans, Predictive Value of Tests, Risk Assessment, Risk Factors, Treatment Outcome, Acute Coronary Syndrome etiology, Embolism complications, Heart Diseases complications
- Abstract
Coronary embolism is the underlying cause of 3% of acute coronary syndromes but is often not considered in the differential of acute coronary syndromes. It should be suspected in the case of high thrombus burden despite a relatively normal underlying vessel or recurrent coronary thrombus. Coronary embolism may be direct (from the aortic valve or left atrial appendage), paroxysmal (from the venous circulation through a patent foramen ovale), or iatrogenic (following cardiac intervention). Investigations include transesophageal echocardiography to assess the left atrial appendage and atrial septum and continuous electrocardiographic monitoring to assess for paroxysmal atrial fibrillation. The authors review the historic and contemporary published data about this important cause of acute coronary syndromes. The authors propose an investigation and management strategy for work-up and anticoagulation strategy for patients with suspected coronary embolism., (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
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49. The Use of Intraprocedural Reinfusion During MitraClip Implantation to Reduce Blood Loss and Transfusion Requirements.
- Author
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Raphael CE, Maor E, Panaich SS, Reeder G, Rihal CS, and Eleid MF
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Male, Prosthesis Design, Treatment Outcome, Blood Loss, Surgical prevention & control, Cardiac Catheterization adverse effects, Cardiac Catheterization methods, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation methods, Mitral Valve pathology, Mitral Valve surgery, Mitral Valve Insufficiency surgery, Operative Blood Salvage methods
- Abstract
Background: MitraClip implantation has been shown to reduce mitral regurgitation and is an effective treatment option for patients at high risk for conventional surgery. Blood loss is common during the procedure. We assessed the utility of intraprocedural reinfusion of blood aspirated during MitraClip implantation., Methods: We compared hemoglobin before and after MitraClip implantation and transfusion requirements in patients who did (n = 83) and did not receive reinfusion (n = 31) during their procedure. For patients who received reinfusion, blood removed during device manipulation was carefully injected back into the patient through the 24 Fr delivery sheath, followed by a saline flush., Results: As expected, patients who received reinfusion had a smaller reduction in hemoglobin post procedure compared to those who did not (0.96 ± 1.0 g/dL vs 1.55 ± 0.94 g/dL; P<.01). There was a trend to lower requirements for blood transfusion in the reinfusion groups (0.39 ± 0.96 units/patient vs 0.15 ± 0.53 units/patient; P<.10). At 30-day follow-up, there was no difference in mortality, stroke, endocarditis, or thromboembolic events between groups., Conclusion: Reinfusion of aspirated blood during MitraClip was associated with reduced blood loss and a trend to reduced requirement for blood transfusion post procedure. Reinfusion during the procedure appeared safe, with no complications.
- Published
- 2018
50. Hypertrophic Cardiomyopathy-Past, Present and Future.
- Author
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Liew AC, Vassiliou VS, Cooper R, and Raphael CE
- Abstract
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiomyopathy with a prevalence of 1 in 500 in the general population. Since the first pathological case series at post mortem in 1957, we have come a long way in its understanding, diagnosis and management. Here, we will describe the history of our understanding of HCM including the initial disease findings, diagnostic methods and treatment options. We will review the current guidelines for the diagnosis and management of HCM, current gaps in the evidence base and discuss the new and promising developments in this field., Competing Interests: The authors declare no conflict of interest.
- Published
- 2017
- Full Text
- View/download PDF
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