50 results on '"Said Alsidawi"'
Search Results
2. Association between echocardiographic velocity time integral ratio of mitral valve and left ventricular outflow tract and clinical outcomes post transcatheter edge-to-edge mitral valve repair
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Isabel G. Scalia, Juan M. Farina, Rachel Wraith, Lisa Brown, Mohammed Tiseer Abbas, Milagros Pereyra, Mohamed Allam, Ahmed K. Mahmoud, Moaz A. Kamel, Timothy Barry, F. David Fortuin, Steven J. Lester, John Sweeney, Kristen A. Sell-Dottin, Mohamad Alkhouli, David R. Holmes, Chieh-Ju Chao, Said Alsidawi, Chadi Ayoub, and Reza Arsanjani
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Mitral regurgitation ,Transcatheter edge-to-edge repair ,Prognosis ,Velocity time integral ,Science (General) ,Q1-390 ,Social sciences (General) ,H1-99 - Abstract
Background: Residual mitral regurgitation (MR) is frequent after transcatheter edge-to-edge repair (TEER). There is controversy regarding the clinical impact of residual MR and its quantitative assessment by transthoracic echocardiography (TTE), which is often challenging with multiple eccentric jets and artifact from the clip. The utility of the velocity time integral (VTI) ratio between the mitral valve (MV) and left ventricular outflow tract (LVOT), (VTIMV/LVOT), a simple Doppler measurement that increases with MR, has not been assessed post TEER. Methods: Baseline characteristics, clinical outcomes, and TTE data from patients who underwent TEER between 2014 and 2021 across three academic centers were retrospectively analyzed. Post-procedure TTEs were evaluated for VTIMV/LVOT in the first three months after TEER. One-year outcomes including all-cause and cardiac mortality, major adverse cardiac events, and MV reintervention were compared between patients with high VTIMV/LVOT (≥2.5) and low (
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- 2024
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3. The Role of Cardiovascular Imaging in the Diagnosis of Athlete’s Heart: Navigating the Shades of Grey
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Nima Baba Ali, Sogol Attaripour Esfahani, Isabel G. Scalia, Juan M. Farina, Milagros Pereyra, Timothy Barry, Steven J. Lester, Said Alsidawi, David E. Steidley, Chadi Ayoub, Stefano Palermi, and Reza Arsanjani
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athlete’s heart ,cardiac computed tomography ,cardiac magnetic resonance ,cardiomyopathies ,echocardiography ,strain ,Photography ,TR1-1050 ,Computer applications to medicine. Medical informatics ,R858-859.7 ,Electronic computers. Computer science ,QA75.5-76.95 - Abstract
Athlete’s heart (AH) represents the heart’s remarkable ability to adapt structurally and functionally to prolonged and intensive athletic training. Characterized by increased left ventricular (LV) wall thickness, enlarged cardiac chambers, and augmented cardiac mass, AH typically maintains or enhances systolic and diastolic functions. Despite the positive health implications, these adaptations can obscure the difference between benign physiological changes and early manifestations of cardiac pathologies such as dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), and arrhythmogenic cardiomyopathy (ACM). This article reviews the imaging characteristics of AH across various modalities, emphasizing echocardiography, cardiac magnetic resonance (CMR), and cardiac computed tomography as primary tools for evaluating cardiac function and distinguishing physiological adaptations from pathological conditions. The findings highlight the need for precise diagnostic criteria and advanced imaging techniques to ensure accurate differentiation, preventing misdiagnosis and its associated risks, such as sudden cardiac death (SCD). Understanding these adaptations and employing the appropriate imaging methods are crucial for athletes’ effective management and health optimization.
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- 2024
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4. Role of Genetics in Diagnosis and Management of Hypertrophic Cardiomyopathy: A Glimpse into the Future
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Mohammed Tiseer Abbas, Nima Baba Ali, Juan M. Farina, Ahmed K. Mahmoud, Milagros Pereyra, Isabel G. Scalia, Moaz A. Kamel, Timothy Barry, Steven J. Lester, Charles R. Cannan, Rohit Mital, Susan Wilansky, William K. Freeman, Chieh-Ju Chao, Said Alsidawi, Chadi Ayoub, and Reza Arsanjani
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hypertrophic cardiomyopathy ,sarcomeric genes ,next-generation sequencing ,whole exome sequencing ,phenocopies ,cascade testing ,Biology (General) ,QH301-705.5 - Abstract
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy. It follows an autosomal dominant inheritance pattern in most cases, with incomplete penetrance and heterogeneity. It is familial in 60% of cases and most of these are caused by pathogenic variants in the core sarcomeric genes (MYH7, MYBPC3, TNNT2, TNNI3, MYL2, MYL3, TPM1, ACTC1). Genetic testing using targeted disease-specific panels that utilize next-generation sequencing (NGS) and include sarcomeric genes with the strongest evidence of association and syndrome-associated genes is highly recommended for every HCM patient to confirm the diagnosis, identify the molecular etiology, and guide screening and management. The yield of genetic testing for a disease-causing variant is 30% in sporadic cases and up to 60% in familial cases and in younger patients with typical asymmetrical septal hypertrophy. Genetic testing remains challenging in the interpretation of results and classification of variants. Therefore, in 2015 the American College of Medical Genetics and Genomics (ACMG) established guidelines to classify and interpret the variants with an emphasis on the necessity of periodic reassessment of variant classification as genetic knowledge rapidly expands. The current guidelines recommend focused cascade genetic testing regardless of age in phenotype-negative first-degree relatives if a variant with decisive evidence of pathogenicity has been identified in the proband. Genetic test results in family members guide longitudinal clinical surveillance. At present, there is emerging evidence for genetic test application in risk stratification and management but its implementation into clinical practice needs further study. Promising fields such as gene therapy and implementation of artificial intelligence in the diagnosis of HCM are emerging and paving the way for more effective screening and management, but many challenges and obstacles need to be overcome before establishing the practical implications of these new methods.
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- 2024
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5. Identifying the Causes of Unexplained Dyspnea at High Altitude Using Normobaric Hypoxia with Echocardiography
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Jan Stepanek, Juan M. Farina, Ahmed K. Mahmoud, Chieh-Ju Chao, Said Alsidawi, Chadi Ayoub, Timothy Barry, Milagros Pereyra, Isabel G. Scalia, Mohammed Tiseer Abbas, Rachel E. Wraith, Lisa S. Brown, Michael S. Radavich, Pamela J. Curtisi, Patricia C. Hartzendorf, Elizabeth M. Lasota, Kyley N. Umetsu, Jill M. Peterson, Kristin E. Karlson, Karen Breznak, David F. Fortuin, Steven J. Lester, and Reza Arsanjani
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echocardiography ,stress test ,high altitude ,dyspnea ,hypoxic simulation testing ,Photography ,TR1-1050 ,Computer applications to medicine. Medical informatics ,R858-859.7 ,Electronic computers. Computer science ,QA75.5-76.95 - Abstract
Exposure to high altitude results in hypobaric hypoxia, leading to physiological changes in the cardiovascular system that may result in limiting symptoms, including dyspnea, fatigue, and exercise intolerance. However, it is still unclear why some patients are more susceptible to high-altitude symptoms than others. Hypoxic simulation testing (HST) simulates changes in physiology that occur at a specific altitude by asking the patients to breathe a mixture of gases with decreased oxygen content. This study aimed to determine whether the use of transthoracic echocardiography (TTE) during HST can detect the rise in right-sided pressures and the impact of hypoxia on right ventricle (RV) hemodynamics and right to left shunts, thus revealing the underlying causes of high-altitude signs and symptoms. A retrospective study was performed including consecutive patients with unexplained dyspnea at high altitude. HSTs were performed by administrating reduced FiO2 to simulate altitude levels specific to patients’ history. Echocardiography images were obtained at baseline and during hypoxia. The study included 27 patients, with a mean age of 65 years, 14 patients (51.9%) were female. RV systolic pressure increased at peak hypoxia, while RV systolic function declined as shown by a significant decrease in the tricuspid annular plane systolic excursion (TAPSE), the maximum velocity achieved by the lateral tricuspid annulus during systole (S’ wave), and the RV free wall longitudinal strain. Additionally, right-to-left shunt was present in 19 (70.4%) patients as identified by bubble contrast injections. Among these, the severity of the shunt increased at peak hypoxia in eight cases (42.1%), and the shunt was only evident during hypoxia in seven patients (36.8%). In conclusion, the use of TTE during HST provides valuable information by revealing the presence of symptomatic, sustained shunts and confirming the decline in RV hemodynamics, thus potentially explaining dyspnea at high altitude. Further studies are needed to establish the optimal clinical role of this physiologic method.
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- 2024
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6. Developing an Echocardiography-Based, Automatic Deep Learning Framework for the Differentiation of Increased Left Ventricular Wall Thickness Etiologies
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James Li, Chieh-Ju Chao, Jiwoong Jason Jeong, Juan Maria Farina, Amith R. Seri, Timothy Barry, Hana Newman, Megan Campany, Merna Abdou, Michael O’Shea, Sean Smith, Bishoy Abraham, Seyedeh Maryam Hosseini, Yuxiang Wang, Steven Lester, Said Alsidawi, Susan Wilansky, Eric Steidley, Julie Rosenthal, Chadi Ayoub, Christopher P. Appleton, Win-Kuang Shen, Martha Grogan, Garvan C. Kane, Jae K. Oh, Bhavik N. Patel, Reza Arsanjani, and Imon Banerjee
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deep learning ,LV wall thickness ,echocardiography ,Photography ,TR1-1050 ,Computer applications to medicine. Medical informatics ,R858-859.7 ,Electronic computers. Computer science ,QA75.5-76.95 - Abstract
Aims:Increased left ventricular (LV) wall thickness is frequently encountered in transthoracic echocardiography (TTE). While accurate and early diagnosis is clinically important, given the differences in available therapeutic options and prognosis, an extensive workup is often required to establish the diagnosis. We propose the first echo-based, automated deep learning model with a fusion architecture to facilitate the evaluation and diagnosis of increased left ventricular (LV) wall thickness. Methods and Results: Patients with an established diagnosis of increased LV wall thickness (hypertrophic cardiomyopathy (HCM), cardiac amyloidosis (CA), and hypertensive heart disease (HTN)/others) between 1/2015 and 11/2019 at Mayo Clinic Arizona were identified. The cohort was divided into 80%/10%/10% for training, validation, and testing sets, respectively. Six baseline TTE views were used to optimize a pre-trained InceptionResnetV2 model. Each model output was used to train a meta-learner under a fusion architecture. Model performance was assessed by multiclass area under the receiver operating characteristic curve (AUROC). A total of 586 patients were used for the final analysis (194 HCM, 201 CA, and 191 HTN/others). The mean age was 55.0 years, and 57.8% were male. Among the individual view-dependent models, the apical 4-chamber model had the best performance (AUROC: HCM: 0.94, CA: 0.73, and HTN/other: 0.87). The final fusion model outperformed all the view-dependent models (AUROC: HCM: 0.93, CA: 0.90, and HTN/other: 0.92). Conclusion: The echo-based InceptionResnetV2 fusion model can accurately classify the main etiologies of increased LV wall thickness and can facilitate the process of diagnosis and workup.
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- 2023
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7. Ventricular Septal Rupture Complicating Delayed Acute Myocardial Infarction Presentation During the COVID-19 Pandemic
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Said Alsidawi, MD, Alex Campbell, MD, Ashenafi Tamene, MD, and Santiago Garcia, MD
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mechanical complications ,septal rupture ,STEMI ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
The rate of mechanical complications of acute myocardial infarction has declined. Recent publications raised concerns over the reduction in cardiac catheterization laboratory activation for ST-segment myocardial infarction (STEMI) during the coronavirus disease-2019 (COVID-19) pandemic. We present 2 recent cases of ventricular septal rupture in patients who presented to our institution with delayed STEMI. (Level of Difficulty: Intermediate.)
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- 2020
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8. Avaliação da Insuficiência Valvar Aórtica por Ecocardiografia: Conceitos Básicos e Novos
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Said Alsidawi
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Insuficiência da Valva Aórtica ,Regurgitação Aórtica ,Velocidade do Fluxo Sanguíneo ,Diagnóstico por Imagem/métodos ,Ecocardiografia ,Ecocardiografia Doppler ,Ecocardiografia Tridimensional ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2020
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9. The impact of moderate aortic stenosis in acute myocardial infarction: A multicenter retrospective study
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Bishoy Abraham, Juan M. Farina, Ayman Fath, Merna Abdou, Mostafa Elbanna, Mustafa Suppah, Mohamed Sleem, Abdullah Eldaly, Mohamed Aly, Michael Megaly, Pradyumna Agasthi, Chieh‐Ju Chao, David Fortuin, Said Alsidawi, Chadi Ayoub, Mohamad Alkhouli, Abdallah El Sabbagh, David Holmes, Emmanouil S. Brilakis, and Reza Arsanjani
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Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
10. Title: ARRHYTHMIC MITRAL VALVE PROLAPSE: A CASE SERIES
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Ines Rivera, Yeimi, primary, Said Alsidawi, Dr., primary, and David Majdalany, Dr., primary
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- 2023
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11. Title: ARRHYTHMIC MITRAL VALVE PROLAPSE: A CASE SERIES
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Dr. David Majdalany, Dr. Said Alsidawi, and Yeimi Ines Rivera
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- 2023
12. Developing an Echocardiography-Based, Automatic Deep Learning Framework for the Differentiation of Increased Left Ventricular Wall Thickness Etiologies
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Imon Banerjee, James Li, Chieh-Ju Chao, Jiwoong Jason Jeong, Amith Seri R, Timothy Barry, Hana Neuman, Megan Campany, Merna Abdou, Michael O’Shea, Sean Smith, Bishoy Abraham, Seyedeh Maryam Hosseini, Yuxiang Wang, Steven Lester, Said Alsidawi, susan Wilansky, Eric Steidley, Julie Rosenthal, Chadi Ayoub, Christopher Appleton, Win-Kuang Shen, Martha Grogan, Garvan Kane, Jae Oh, Bhavik N. Patel, and Reza Arsanjani
- Abstract
Aims Increased LV wall thickness is frequently encountered in transthoracic echocardiography (TTE). While accurate and early diagnosis is clinically important, given the differences in available therapeutic options and prognosis, an extensive workup is often required to establish the diagnosis. We propose the first echo-based, automated deep learning model with a fusion architecture to facilitate the evaluation and diagnosis of increased left ventricular (LV) wall thickness. Methods and Results Patients with an established diagnosis of increased LV wall thickness (hypertrophic cardiomyopathy (HCM), cardiac amyloidosis (CA), and hypertensive heart disease (HTN)/others) between 1/2015 to 11/2019 at Mayo Clinic Arizona were identified. The cohort was divided into 80%/10%/10% for training, validation, and testing sets, respectively. Six baseline TTE views were used to optimize a pre-trained InceptionResnetV2 model. Each model output was used to train a meta-learner under a fusion architecture. Model performance was assessed by multiclass area under the receiver operating characteristic curve (AUROC). A total of 586 patients were used for the final analysis (194 HCM, 201 CA, and 191 HTN/others). The mean age was 55.0 years, and 57.8% were male. Among the individual view-dependent models, the apical 4 chamber model had the best performance (AUROC: HCM: 0.94, CA: 0.73, and HTN/other: 0.87). The final fusion model outperformed all the view-dependent models (AUROC: CA: 0.90, HCM: 0.93, and HTN/other: 0.92). Conclusion The echo-based InceptionResnetV2 fusion model can accurately classify the main etiologies of increased LV wall thickness and can facilitate the process of diagnosis and workup.
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- 2022
13. Papillary fibroelastoma of the pulmonary valve: a 14-year follow-up
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Pedro Henrique de Borba Engster and Said Alsidawi
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Primary cardiac tumors are exceedingly rare. Among them, papillary fibroelastomas (PFEs) are the third most common. These tumors are often incidental findings but can also precipitate a myriad of clinical presentations, mainly embolic events. Most common in the left-sided valves, PFEs rarely occur in the right side of the heart. They are usually resected surgically following diagnosis, thwarting assessment of their natural history. We present the case of a woman diagnosed with pulmonary valve PFE following recurrent pulmonary embolism who did not undergo surgery, allowing for an extended follow-up of the condition.
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- 2022
14. TCT-476 Tricuspid Regurgitation Is Associated With Increased One-Year Mortality After Transcatheter Aortic Valve Replacement
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Bishoy Abraham, Ayman Fath, Michael Megaly, Chieh-Ju Chao, Reza Arsanjani, F. David Fortuin, John Sweeney, Patricia Pellikka, Vuyisile Nkomo, Mohamad Alkhouli, David Holmes, and Said Alsidawi
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Cardiology and Cardiovascular Medicine - Published
- 2022
15. Changes in quality of life in patients with low‐flow aortic stenosis undergoing transcatheter aortic valve replacement
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Said Alsidawi, João L. Cavalcante, Aisha Ahmed, Paul Sorajja, Mario Gössl, Richard Bae, Santiago Garcia, and Miho Fukui
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medicine.medical_specialty ,Time Factors ,Transcatheter aortic ,Health Status ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Severity of Illness Index ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Valve replacement ,Surveys and Questionnaires ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,030212 general & internal medicine ,Ejection fraction ,business.industry ,Hemodynamics ,Aortic Valve Stenosis ,Recovery of Function ,General Medicine ,Stroke volume ,medicine.disease ,Stenosis ,Treatment Outcome ,Aortic Valve ,Heart failure ,Quality of Life ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background We sought to quantify and compare changes in quality of life measures after transcatheter aortic valve replacement (TAVR) in patients with low-flow (LF) and normal-flow (NF) aortic stenosis (AS). Methods We included 297 patients treated with TAVR at Abbott Northwestern Hospital from January 2015 to October 2017. Health status was assessed at baseline and 30 days post-procedure using the Kansas City Cardiomyopathy Questionnaire 12 (KCCQ-12). Overall (KCCQ-OS) and domain-specific (physical limitation, symptom frequency, quality of life, and social limitation) scores were compared in three subsets of patients as defined by stroke volume index (≤ or >35 ml/m2 ), ejection fraction (EF) (≤ or >40%), and mean gradient (≤ or >40 mmHg). Results Of the 297 patients included, 129 (43%) had NF high-gradient (NF AS group) and 168 (56%) had LF severe AS, including 25 (8%) with low EF (8%) ("Classical" low-flow low-gradient LEF [LF-LG-LEF] group) and 143 (48%) with preserved EF ("Paradoxical" LF-LG group). At baseline, patients with LF-LG-LEF AS had more severe impairment in symptoms frequency (p = .06) but similar KCCQ-OS. At 1-month after TAVR, all groups had moderate improvements in quality of life (Delta KCCQ-OS: "Classical" LF-LG-LEF 18 ± 21, paradoxical AS 14 ± 18, and NF AS 15 ± 16, p = .57). During a median follow-up time of 2.4 years, there was no difference in mortality (p = .34) but patients with paradoxical LF-LG AS had a higher risk of rehospitalization for heart failure (p = .01). Conclusions Patients with LF severe AS derive significant improvements in quality of life measures after TAVR, indistinguishable from patients with NF AS.
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- 2020
16. Averaged Transaortic Mean Gradient during Atrial Fibrillation Does Not Accurately Reflect Aortic Stenosis Severity
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Jwan A. Naser, Sorin V. Pislaru, Cristina Pislaru, Hayan Jouni, Said Alsidawi, Jeremy J. Thaden, Christopher G. Scott, and Vuyisile T. Nkomo
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Aortic Valve ,Atrial Fibrillation ,Humans ,Radiology, Nuclear Medicine and imaging ,Aortic Valve Stenosis ,Cardiology and Cardiovascular Medicine ,Severity of Illness Index ,Blood Flow Velocity - Published
- 2022
17. Using a novel echo-marker to identify high mortality risk patients with moderate aortic stenosis
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Carolyn M. Larsen, David R. Holmes, Tasneem Z. Naqvi, William K. Freeman, David Fortuin, Steven J. Lester, Reza Arsanjani, Amith Reddy Seri, John P. Sweeney, Abdallah El Sabbagh, Timothy Barry, Mackram F. Eleid, Chieh-Ju Chao, Marlene Girardo, Pradyumma Agasthi, Peter M. Pollak, Jae K. Oh, Kristen A. Sell-Dottin, Yuxiang Wang, Christopher P. Appleton, Anusha Shanbhag, David Majdalany, and Said Alsidawi
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medicine.medical_specialty ,Mean arterial pressure ,Ejection fraction ,business.industry ,Proportional hazards model ,medicine.disease ,Stenosis ,Aortic valve area ,High mortality risk ,Aortic valve replacement ,Mortality data ,Internal medicine ,Cardiology ,Medicine ,business - Abstract
BackgroundRecent studies have shown that patients with moderate aortic stenosis and reduced left ventricular ejection fraction may benefit from earlier intervention instead of periodic surveillance. Identifying patients at higher risk is therefore warranted concerning the possibility of expanding aortic valve replacement indication.ObjectiveWe aim to investigate the usefulness of a novel echo-marker, augmented mean arterial pressure (AugMAP), in identifying high-risk patients with moderate aortic stenosis.MethodsAdult patients with moderate aortic stenosis (aortic valve area 1.0-1.5 cm2) at Mayo Clinic sites in 1/2010-12/2020 were identified. Baseline demographics, echocardiography, and all-cause mortality data were retrieved. Patients were grouped into higher and lower AugMAP groups using a cutoff of 80 mmHg for analysis. Kaplan-Meier and Cox regression analyses were used to assess the performance of AugMAP.ResultsA total of 4,563 patients with moderate aortic stenosis were included. The mean age was 73.7±12.5 years and 60.5 % were male. The median follow-up was 2.5 years, and 36.0% of patients died. The mean LVEF was 60.1 ± 11.4%, and the mean AugMAP was 99.1 ± 13.1 mmHg. Patients in the lower AugMAP group, with either preserved or reduced LVEF, had significantly worse survival performance (all p< 0.0001). Multivariate Cox regression showed that AugMAP was independently associated with all-cause mortality after adjusting for age, sex, and LVEF (HR: 0.99 per unit increase, 95%CI: 0.978-0.996, p=0.01).ConclusionAugMAP is a simple and effective echo-maker beyond LVEF to identify high-risk moderate aortic stenosis patients who may benefit more from earlier intervention.Condensed abstractPatients with moderate aortic stenosis and reduced left ventricular ejection fraction may benefit from earlier intervention. We aim to validate the usefulness of a novel echo-marker, augmented mean arterial pressure (AugMAP), in identifying high-risk patients with moderate aortic stenosis. AugMAP can identify patients at higher mortality risk within the first two years after the diagnosis of moderate aortic stenosis, regardless of LVEF. AugMAP was also independently associated with all-cause mortality after adjusting for age, sex, and LVEF. AugMAP is a simple and effective novel echo-maker beyond LVEF to identify high-risk moderate aortic stenosis patients who may benefit from earlier intervention.
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- 2021
18. TCT-450 The Impact of Atrial Fibrillation on Patients Undergoing Transcatheter Aortic Valve Replacement: A Multicenter Retrospective Study
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Bishoy Abraham, Ayman Fath, Mostafa Elbanna, Mustafa Suppah, Mohammad Elbahnasawy, Michael Megaly, Chieh-Ju Chao, Reza Arsanjani, F. David Fortuin, John Sweeney, Patricia Pellikka, Vuyisile Nkomo, Mohamad Alkhouli, David Holmes, and Said Alsidawi
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Cardiology and Cardiovascular Medicine - Published
- 2022
19. TCT-475 Moderate to Severe Mitral Regurgitation’s Impact on One-Year Mortality After Transcatheter Aortic Valve Replacement
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Bishoy Abraham, Ayman Fath, Michael Megaly, Chieh-Ju Chao, Reza Arsanjani, F. David Fortuin, John Sweeney, Mohamad Alkhouli, Patricia Pellikka, Vuyisile Nkomo, David Holmes, and Said Alsidawi
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Cardiology and Cardiovascular Medicine - Published
- 2022
20. High Prevalence of Severe Aortic Stenosis in Low-Flow State Associated With Atrial Fibrillation
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Sana Khan, Sorin V. Pislaru, Ratnasari Padang, Didem Oguz, Edward A. El-Am, Sushil Allen Luis, Jeremy J. Thaden, Said Alsidawi, Jae K. Oh, Kareem Morant, Vuyisile T. Nkomo, Colleen E. Lane, Patricia A. Pellikka, Robert B. McCully, and Christopher G. Scott
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Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Risk Assessment ,Severity of Illness Index ,Ventricular Function, Left ,Electrocardiography ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Atrial Fibrillation ,Prevalence ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,High prevalence ,business.industry ,Hemodynamics ,Atrial fibrillation ,Aortic Valve Stenosis ,Middle Aged ,medicine.disease ,Comorbidity ,Echocardiography, Doppler ,Stenosis ,Peak velocity ,Ventricular Function, Right ,symbols ,Cardiology ,Female ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Doppler effect - Abstract
Background: Atrial fibrillation (AF) is a low-flow state and may underestimate aortic stenosis (AS) severity. Single-high Doppler signals (HS) consistent with severe AS (peak velocity ≥4 m/s or mean gradient ≥40 mm Hg) are averaged down in current practice. The objective for the study was to determine the significance of HS in AF low-gradient AS (LGAS). Methods: One thousand five hundred forty-one patients with aortic valve area ≤1 cm 2 and left ventricular ejection fraction ≥50% were identified and classified as high-gradient AS (HGAS) (≥40 mm Hg) and LGAS ( Results: Mean age was 76±11 years, female 47%. Mean gradient was 51±12 in SR-HGAS, 48±10 in AF-HGAS, 31±5 in SR-LGAS, and 29±7 mm Hg in AF-LGAS, all P ≤0.001 versus SR-HGAS; HS were present in 33% of AF-LGAS. AVCS were available in 34%. Compared with SR-HGAS (2409 arbitrary units; interquartile range, 1581–3462) AVCS were higher in AF-HGAS (2991 arbitrary units; IQR1978–4229, P =0.001), not different in AF-LGAS (2399 arbitrary units; IQR1817–2810, P =0.47), and lower in SR-LGAS (1593 arbitrary units; IQR945–1832, P P =0.048). Compared with SR-HGAS, the age-, sex-, comorbidity index-, and time-dependent aortic valve replacement-adjusted mortality risk was higher in AF-HGAS (hazard ratio=1.82 [1.40–2.36], P P =0.03) but not different in AF-LGAS without HS or SR-LGAS (both P =not significant). Conclusions: Severe AS was common in AF-LGAS. AVCS in AF-LGAS were not different from SR-HGAS. AVCS were higher and mortality worse in AF-LGAS when HS were present.
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- 2021
21. Echocardiographic mimicker of thrombus on a mechanical aortic valve prosthesis due to cavitation: A paradoxical phenomenon of pressure recovery
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Lawrence J. Sinak, Charanjit S. Rihal, Rowlens M. Melduni, Jeremy J. Thaden, Zhenzhen Wang, Chadi Ayoub, Fletcher A. Miller, and Said Alsidawi
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Male ,Aortic valve ,medicine.medical_specialty ,Aortic valve prosthesis ,medicine.medical_treatment ,0206 medical engineering ,02 engineering and technology ,030204 cardiovascular system & hematology ,Prosthesis ,Article ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Thrombus ,Microbubbles ,business.industry ,Coronary Thrombosis ,Mechanical Aortic Valve ,Middle Aged ,medicine.disease ,020601 biomedical engineering ,medicine.anatomical_structure ,Echocardiography ,Aortic Valve ,Heart Valve Prosthesis ,Cavitation ,cardiovascular system ,Cardiology ,Stress, Mechanical ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Vegetation (pathology) - Abstract
We describe a case of a mass-like echocardiographic density on a mechanical prosthetic aortic valve. We initially suspected a thrombus vs vegetation on transthoracic echocardiography, but after transesophageal echocardiography, the density was subsequently determined to be cavitation by reviewing the initial images in slow motion.
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- 2019
22. C-29 | Trends in Utilization, Reimbursement, and Geography for TAVR performed by Cardiologists for the Medicare Beneficiaries: 2015-2019
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Ayman R. Fath, Aditya Khurana, Bishoy Abraham, Jumanah Abuasbeh, Abdullah S. Eldaly, Abulbaril Olagunju, Said Alsidawi, and F. David D. Fortuin
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- 2022
23. ECHOCARDIOGRAPHY-BASED CONVOLUTIONAL NEURAL NETWORK ACCURATELY DIFFERENTIATES ETIOLOGIES OF INCREASED LEFT VENTRICULAR WALL THICKNESS
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Chieh Ju Chao, James Shuyue Li, Jiwoong Jason Jeong, Timothy Barry, Amith R. Seri, Hana Neuman, Megan Campany, Merna Abdou, Michael O’Shea, Sean Smith, Yuxiang Wang, Steven J. Lester, Said Alsidawi, Susan Wilansky, D. Eric Steidley, Julie Rosenthal, Chadi Ayoub, Christopher P. Appleton, Win-Kuang Shen, Martha Grogan, Garvan C. Kane, Jae K. Oh, Bhavik N. Patel, Imon Banerjee, and Reza Arsanjani
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Cardiology and Cardiovascular Medicine - Published
- 2022
24. Ventricular Septal Rupture complicating delayed acute myocardial infarction presentation during the COVID-19 pandemic
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Alex R. Campbell, Santiago Garcia, Ashenafi Tamene, and Said Alsidawi
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0301 basic medicine ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,mechanical complications ,medicine.medical_treatment ,COVID-19, Corona Virus Disease 19 ,030105 genetics & heredity ,PCI, Percutaneous Coronary Intervention ,Article ,Ventricular Septal Rupture ,STEMI ,03 medical and health sciences ,0302 clinical medicine ,mmHg, Millimeter Mercury ,Internal medicine ,Pandemic ,Medicine ,Diseases of the circulatory (Cardiovascular) system ,In patient ,Myocardial infarction ,cardiovascular diseases ,STEMI, ST-segment myocardial infarction ,Cardiac catheterization ,Septal rupture ,business.industry ,ED, Emergency Department ,LAD, Left Anterior Descending Artery ,medicine.disease ,QP/QS, Pulmonic/Systemic flow for shunt calculation ,surgical procedures, operative ,RC666-701 ,Cardiology ,cardiovascular system ,Presentation (obstetrics) ,Cardiology and Cardiovascular Medicine ,business ,bpm, beat per minute ,030217 neurology & neurosurgery ,TIMI, Thrombolysis in Myocardial Infarction - Abstract
The rate of mechanical complications of acute myocardial infarction has declined. Recent publications raised concerns over the reduction in cardiac catheterization laboratory activation for STEMI during COVID-19 Pandemic. We present 2 recent cases of ventricular septal rupture in patients who presented to our institution with delayed STEMI., Graphical abstract
- Published
- 2020
25. Percutaneous Mitral Valve Repair With MitraClip in Inoperable Patients With Severe Mitral Regurgitation Complicated by Cardiogenic Shock
- Author
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Santiago, Garcia, Said, Alsidawi, Richard, Bae, Joao, Cavalcante, Peter, Eckman, Mario, Gössl, Robert, Steffen, Benjamin, Sun, Christian W, Schmidt, and Paul, Sorajja
- Subjects
Aged, 80 and over ,Heart Valve Prosthesis Implantation ,Male ,Treatment Outcome ,Minnesota ,Shock, Cardiogenic ,Humans ,Mitral Valve ,Mitral Valve Insufficiency ,Female ,Middle Aged ,Aged ,Retrospective Studies - Abstract
Severe mitral regurgitation (MR) complicated by cardiogenic shock has high operative mortality. Percutaneous leaflet repair with MitraClip (Abbott Vascular) is a less invasive alternative to surgery. The effectiveness and safety of this approach is unknown.We retrospectively analyzed procedural characteristics of shock patients with severe MR treated with MitraClip in a tertiary, high-volume program (Abbott Northwestern Hospital, Minneapolis, Minnesota) during 2010-2019. The primary outcome of the study was 30-day survival free of significant MR (grade ≤2). One-year mortality was a secondary outcome.Among 322 patients who underwent MitraClip implantation during the study period, 11 inoperable patients with severe MR and cardiogenic shock were included in this analysis. Mean patient age was 74 ± 11 years and 54% were male. The mechanism of MR was degenerative in 7 patients (63.6%) and functional in 4 patients (36.4%), including 1 post myocardial infarction, 1 with chronic ischemic heart disease, and 2 with end-stage non-ischemic cardiomyopathy. Hemodynamic support with intra-aortic balloon pump was used in 5 patients (45%). The A2-P2 scallop was the more common location for MitraClip insertion, and 27% of patients had1 clip implanted. Median fluoroscopy time was 18.5 minutes (interquartile range [IQR], 10-22 minutes) and mean postprocedure gradient was 4.5 mm Hg (IQR, 3-5 mm Hg). At 30 days, eight patients (72.7%) were alive with MR grade ≤2. At 1 year, mortality was 66%, and was driven mainly by non-cardiac causes.Among inoperable patients with severe MR and cardiogenic shock, percutaneous leaflet repair with MitraClip is associated with acceptable short-term effectiveness.
- Published
- 2020
26. 1049 High single-beat Doppler signals in low-gradient aortic stenosis are associated with higher aortic valve calcium
- Author
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Edward A. El-Am, Sorin V. Pislaru, J Thaden, Patricia A. Pellikka, Kareem Morant, Didem Oguz, Said Alsidawi, J.K. Oh, Christopher G. Scott, and V.T. Nkomo
- Subjects
medicine.medical_specialty ,business.industry ,Beat (acoustics) ,General Medicine ,Aortic calcification ,medicine.disease ,Stenosis ,symbols.namesake ,Internal medicine ,medicine ,Cardiology ,symbols ,Radiology, Nuclear Medicine and imaging ,Low gradient ,Cardiology and Cardiovascular Medicine ,business ,Doppler effect - Abstract
Funding Acknowledgements Mayo Clinic Background Variability in Doppler signals is common in patients with atrial fibrillation (AF) and AF is common in low-gradient AS (LGAS). Presence of high single beat Doppler signals (peak velocity ≥4m/s or mean gradient ≥40mmHg) is not factored into decision-making in low-gradient aortic stenosis (LGAS). Objective Determine prevalence of at least one high Doppler signal in AF LGAS and its relationship to computed tomography aortic valve calcium score (AVCS) versus sinus rhythm (SR) high-gradient aortic stenosis (HGAS). Methods Consecutive patients with aortic valve area ≤1cm2 and left ventricular ejection fraction ≥50% during echo were identified (January 1, 2012-December 31, 2016). At least three consecutive Doppler signals were averaged in sinus rhythm (SR) and five in atrial fibrillation (AF). Results Of 1,854 patients, age 76± 11 years, male 52%, 301/1,854 (16%) were in AF and LGAS was present in 122/301 (41%). At least one high Doppler signal in AF LGAS was present in 43/122 (35%). AVCS within 1 year of echo was available for 36% of patient with SR HGAS and 34% of AS LGAS. Median AVCS was not different in SR HGAS 2424 (IQR 1623, 3445) vs AF LGAS with at least one high Doppler signal 2509 [IQR1547, 3119], p =0.10 AVCS threshold for severe AS (men >2000 women >1200) was met in 80% SR HGAS vs 86% AF LGAS with high signals. Conclusions High Doppler signals in AF LGAS are associated with high AVCS more frequently exceeding thresholds for severe AS. Single-beat high Doppler signals instead of the average correlate better with AVCS and classic HGAS.
- Published
- 2020
27. The Use of New Emerging Technology in Echocardiography-Glass View
- Author
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Reza Arsanjani, Faysal Alhasan, and Said Alsidawi
- Subjects
Emerging technologies ,business.industry ,Internal Medicine ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Data science ,Images in Cardiovascular Medicine - Published
- 2022
28. Comparative study of bicuspid vs. tricuspid aortic valve stenosis
- Author
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Naser M. Ammash, Hector I. Michelena, Joseph F. Malouf, Said Alsidawi, Christopher G. Scott, William D. Edwards, Patricia A. Pellikka, Sorin V. Pislaru, Joseph J. Maleszewski, Jeremy J. Thaden, Geoffrey D. Huntley, Maurice Enriquez-Sarano, Kevin L. Greason, and Vuyisile T. Nkomo
- Subjects
Male ,Aortic valve ,Databases, Factual ,medicine.medical_treatment ,Heart Valve Diseases ,Comorbidity ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Severity of Illness Index ,Prosthesis ,Postoperative Complications ,0302 clinical medicine ,Bicuspid aortic valve ,Bicuspid Aortic Valve Disease ,Aortic valve replacement ,030212 general & internal medicine ,Heart Valve Prosthesis Implantation ,Ejection fraction ,General Medicine ,Middle Aged ,Prognosis ,Survival Rate ,Tissue Aortic Valve ,Treatment Outcome ,medicine.anatomical_structure ,Echocardiography ,Aortic Valve ,Aortic valve stenosis ,Cardiology ,Female ,Tricuspid Valve Stenosis ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,Risk Assessment ,Disease-Free Survival ,Statistics, Nonparametric ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Bioprosthesis ,business.industry ,Aortic Valve Stenosis ,medicine.disease ,Stenosis ,Case-Control Studies ,business - Abstract
To examine differences and similarities in bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) stenosis occurring during the same age and whether any differences impact outcomes following aortic valve replacement (AVR).An age-matched cohort of 198 BAV stenosis and 198 TAV stenosis patients was identified from 888 consecutive patients undergoing AVR for severe AS. Mean age 68 ± 6 years; 68% male. Patients with BAV were less likely to have multiple comorbidities, as measured by the Charlson Comorbidity Index (CCI) 2 (3 vs. 10%, P = 0.007). Indexed aortic valve area (0.44 ± 0.09 vs. 0.42 ± 0.08 cm2/m2, P = 0.17) and left ventricular ejection fraction (LVEF) were similar (62 ± 11 vs. 61 ± 12%, P = 0.12), but E/e' ≥15 (46 vs. 66%, P = 0.0002) was less common in BAV stenosis. A tissue aortic valve prosthesis was more commonly utilized in both groups (81 vs. 78%, P = 0.54). Overall indexed effective orifice area was larger in BAV compared with TAV (1.08 ± 0.33 vs. 0.96 ± 0.25 cm2/m2, P = 0.0008). Five-year survival following AVR was lower in TAV compared with BAV stenosis (61 vs. 79%, P = 0.02). Independent predictors of survival following AVR were LVEF 50% [hazard ratio (HR): 4.8, P = 0.0005], CCI 2 (HR: 3.1, P = 0.015), effective orifice area index ≤0.85 cm2/m2 (HR: 2.5, P = 0.004), and bioprosthesis (HR: 3.7, P = 0.02).In an age-matched cohort, TAV compared with BAV stenosis is associated with greater prevalence of cardiovascular risk factors and cardiac impairment and worse survival after AVR.
- Published
- 2017
29. Assessment of Aortic Valve Regurgitation by Echocardiography: Basic and New Concepts
- Author
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Said Alsidawi
- Subjects
medicine.medical_specialty ,Regurgitação Aórtica ,Aortic Valve Insufficiency ,Echocardiography, Three-Dimensional ,MEDLINE ,Minieditorial ,Aortic Regurgitation ,Severity of Illness Index ,Ventricular Function, Left ,Time ,Internal medicine ,Diseases of the circulatory (Cardiovascular) system ,Humans ,Medicine ,Blood Fow Velocity ,Aortic valve regurgitation ,Ecocardiografia doppler ,Aged ,Aged, 80 and over ,Insuficiência da Valva Aórtica ,business.industry ,Velocidade do Fluxo Sanguíneo ,Diagnostic, Imaging ,Stroke Volume ,Middle Aged ,medicine.disease ,Echocardiography, Doppler ,Ecocardiografia Tridimensional ,Echocardiography ,RC666-701 ,Aortic valve stenosis ,Ecocardiografia Doppler ,Cardiology ,Short Editorial ,Cardiology and Cardiovascular Medicine ,business ,Diagnóstico por Imagem/métodos ,Ecocardiografia - Abstract
Echocardiography is essential for the diagnosis and quantification of aortic regurgitation (AR). Velocity-time integral (VTI) of AR flow could be related to AR severity.This study aims to assess whether VTI is an echocardiographic marker of AR severity.We included all patients with moderate or severe native AR and sinus rhythm who visited our imaging laboratory from January to October 2016. All individuals underwent a complete echocardiogram with AR VTI measurement. The association between VTI and AR severity was analyzed by logistic regression and multivariate regression models. A p-value0,05 was considered statistically significant.Among the 62 patients included (68.5±14.9 years old; 64.5%: moderate AR; 35.5%: severe AR), VTI was higher in individuals with moderate AR compared to those with severe AR (2.2±0.5 m vs. 1.9±0.5 m, p=0.01). Patients with severe AR presented greater values of left ventricular end-diastolic diameter (LVEDD) (56.1±7.1 mm vs. 47.3±9.6 mm, p=0.001), left ventricular end-diastolic volume (LVEDV) (171±36.5 mL vs. 106±46.6 mL, p0.001), effective regurgitant orifice (0.44±0.1 cm2vs. 0.18±0.1 cm2, p=0.002), and regurgitant volume (71.3±25.7 mL vs. 42.5±10.9 mL, p=0.05), as well as lower left ventricular ejection fraction (LVEF) (54.1±11.2% vs. 63.2±13.3%, p=0.012). The VTI proved to be a marker of AR severity, irrespective of LVEDD, LVEDV, and LVEF (odds ratio 0.160, p=0.032) and of heart rate and diastolic blood pressure (DBP) (odds ratio 0.232, p=0.044).The VTI of AR flow was inversely associated with AR severity regardless of left ventricular diameter and volume, heart rate, DBP, and LVEF. VTI could be a marker of AR severity in patients with native AR and sinus rhythm. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).A ecocardiografia é essencial para o diagnóstico e a quantificação da insuficiência aórtica (IA). A integral velocidade-tempo (IVT) do fluxo da IA pode estar relacionada à gravidade da IA.Este estudo tem por objetivo avaliar se a IVT é um marcador ecocardiográfico de gravidade da IA.Foram incluídos todos os pacientes com IA nativa moderada ou grave e ritmo sinusal que visitaram o nosso laboratório de imagem entre janeiro e outubro de 2016. Todos os indivíduos foram submetidos a um ecocardiograma completo com medição da IVT da IA. A associação entre a IVT e a gravidade da IA foi analisada por regressão logística e modelos de regressão multivariada. Valores p0,05 foram considerados estatisticamente significativos.Entre os 62 pacientes incluídos (68,5±14,9 anos; 64,5%: IA moderada; 35,5%: IA grave), a IVT foi maior em indivíduos com IA moderada em comparação àqueles com IA grave (2,2±0,5 m versus 1,9±0,5 m, p=0,01). Pacientes com IA grave apresentaram valores maiores de diâmetro diastólico final do ventrículo esquerdo (DDFVE) (56,1±7,1 mm versus 47,3±9,6 mm, p=0,001), volume diastólico final do ventrículo esquerdo (VDFVE) (171±36,5 mL versus 106±46,6 mL, p0,001), orifício regurgitante efetivo (0,44±0,1 cm2 versus 0,18±0,1 cm2, p=0,002) e volume regurgitante (71,3±25,7 mL versus 42,5±10,9 mL, p=0,05), assim como menor fração de ejeção do ventrículo esquerdo (FEVE) (54,1±11,2% versus 63,2±13,3%, p=0,012). A IVT mostrou ser um marcador de gravidade da IA, independentemente do DDFVE, VDFVE e FEVE ( odds ratio 0,160, p=0,032) e da frequência cardíaca e pressão arterial diastólica (PAD) ( odds ratio 0,232, p=0,044).A IVT do fluxo da IA apresentou associação inversa com a gravidade da IA, independentemente do diâmetro e volume do ventrículo esquerdo, frequência cardíaca, PAD e FEVE. A IVT pode ser um marcador de gravidade da IA em pacientes com IA nativa e ritmo sinusal. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).
- Published
- 2020
30. Aortic valve hemodynamics in atrial fibrillation: Should the highest Doppler signal be used to estimate severity of aortic stenosis?
- Author
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Sorin V. Pislaru, Vuyisile T. Nkomo, Sana Khan, and Said Alsidawi
- Subjects
Male ,Aortic valve ,Cardiac Catheterization ,medicine.medical_specialty ,Hemodynamics ,Severity of Illness Index ,Signal ,symbols.namesake ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Heart Atria ,Stroke ,Normal Sinus Rhythm ,Aged ,Aged, 80 and over ,business.industry ,Atrial fibrillation ,Aortic Valve Stenosis ,medicine.disease ,Echocardiography, Doppler ,Stenosis ,medicine.anatomical_structure ,Aortic Valve ,cardiovascular system ,symbols ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Doppler effect - Abstract
Grading severity of AS in AF is complicated by varying stroke volumes associated with fluctuating maximum velocities and pressure gradients across the aortic valve. Current guidelines recommend averaging five continuous-wave peak velocity and mean gradient (MG) Doppler signals across the aortic valve when estimating severity of AS in AF. However, it is unknown when grading severity of AS how the average of multiple Doppler signals vs the highest Doppler signal in AF compares to the Doppler signals when the patient is in normal sinus rhythm. We present a series of patients with AS who had two echocardiograms performed within 2-4 months of each other, one when in normal sinus rhythm and one when in AF, and compare the aortic valve hemodynamics associated with the two rhythms.
- Published
- 2018
31. Acute LVOT Obstruction with a Carbomedics Mechanical Valve Prosthesis
- Author
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Joseph F. Malouf, Said Alsidawi, M.P.H. Vuyisile T. Nkomo M.D., and David L. Joyce
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Ventricular Outflow Obstruction ,030204 cardiovascular system & hematology ,Transesophageal echocardiogram ,Prosthesis ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Mitral valve stenosis ,Mechanical Mitral Valve ,law ,Internal medicine ,Mitral valve ,medicine ,Cardiopulmonary bypass ,cardiovascular diseases ,medicine.diagnostic_test ,business.industry ,Mitral valve replacement ,medicine.disease ,Surgery ,medicine.anatomical_structure ,030228 respiratory system ,cardiovascular system ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
A 62-year-old female with severe symptomatic rheumatic mitral stenosis was referred for mitral valve replacement. A 27-mm Carbomedics mechanical mitral valve was placed using everting sutures. As the patient was weaned off cardiopulmonary bypass, she became hemodynamically unstable. Intraoperative transesophageal echocardiogram revealed a significant drop in left ventricular function along with severe LVOT obstruction. The Carbomedics prosthesis was replaced by a 27-mm St. Jude mechanical valve using noneverting sutures which relieved the LVOT obstruction. doi: 10.1111/jocs.12749 (J Card Surg 2016;31:376-379).
- Published
- 2016
32. PERCUTANEOUS MITRAL VALVE FOR PATIENTS WITH ACUTE MITRAL REGURGITATION AND CARDIOGENIC SHOCK
- Author
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João L. Cavalcante, Peter Eckman, Said Alsidawi, Paul Sorajja, Richard Bae, Santiago Garcia, and Mario Gössl
- Subjects
medicine.medical_specialty ,Percutaneous ,business.industry ,Cardiogenic shock ,MitraClip ,Operative mortality ,Less invasive ,medicine.disease ,medicine.anatomical_structure ,Internal medicine ,Mitral valve ,cardiovascular system ,Acute mitral regurgitation ,Cardiology ,Medicine ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business - Abstract
Acute mitral regurgitation accompanied by cardiogenic shock has high operative mortality. Percutaneous leaflet repair with the MitraClip device is a less invasive alternative to surgery. The effectiveness and safety of this approach is unknown. We retrospectively analyzed procedural characteristic
- Published
- 2020
33. Advances in interventional cardiology: MitraClip
- Author
-
Mohamed Effat, Tarek Helmy, and Said Alsidawi
- Subjects
medicine.medical_specialty ,Food and drug administration ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Heart Valve Prosthesis Implantation ,Prosthetic valve ,Mitral regurgitation ,Interventional cardiology ,United States Food and Drug Administration ,business.industry ,MitraClip ,Mitral Valve Insufficiency ,Hematology ,Percutaneous approach ,medicine.disease ,United States ,Surgery ,Clinical trial ,Heart Valve Prosthesis ,cardiovascular system ,Cardiology ,Cardiology and Cardiovascular Medicine ,Mitral valve regurgitation ,business - Abstract
Severe mitral valve regurgitation is a serious condition with significant morbidity and mortality. It is not uncommon recently, to see patients with significant mitral valve regurgitation that are considered "non-surgical candidates" due to their comorbidities. MitraClip is a new percutaneous approach for treating mitral valve regurgitation which involves mechanical edge-to-edge coaptation of the mitral leaflets. In October of 2013, The US Food and Drug Administration (FDA) approved the MitraClip for patients with symptomatic degenerative mitral regurgitation deemed high risk for mitral-valve surgery. Several large clinical trials confirmed the safety and efficacy of MitraClip. We here discuss the growing role of MitraClip, the major clinical trials, the ongoing trials and the potential complications of the procedure.
- Published
- 2014
34. Acute LVOT Obstruction with a Carbomedics Mechanical Valve Prosthesis
- Author
-
Said, Alsidawi, David L, Joyce, Joseph F, Malouf, and Vuyisile T, Nkomo
- Subjects
Heart Valve Prosthesis Implantation ,Postoperative Complications ,Heart Valve Prosthesis ,Acute Disease ,Humans ,Mitral Valve ,Mitral Valve Stenosis ,Female ,Middle Aged ,Ventricular Outflow Obstruction - Abstract
A 62-year-old female with severe symptomatic rheumatic mitral stenosis was referred for mitral valve replacement. A 27-mm Carbomedics mechanical mitral valve was placed using everting sutures. As the patient was weaned off cardiopulmonary bypass, she became hemodynamically unstable. Intraoperative transesophageal echocardiogram revealed a significant drop in left ventricular function along with severe LVOT obstruction. The Carbomedics prosthesis was replaced by a 27-mm St. Jude mechanical valve using noneverting sutures which relieved the LVOT obstruction. doi: 10.1111/jocs.12749 (J Card Surg 2016;31:376-379).
- Published
- 2016
35. Adderall induced inverted-Takotsubo cardiomyopathy
- Author
-
James Wilkin, James N. Muth, and Said Alsidawi
- Subjects
Adult ,medicine.medical_specialty ,Time Factors ,Myocardial Infarction ,Cardiomyopathy ,Coronary Angiography ,Chest pain ,Ventricular Function, Left ,Diagnosis, Differential ,Coronary artery disease ,Predictive Value of Tests ,Takotsubo Cardiomyopathy ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Myocardial infarction ,Cardiac imaging ,Ejection fraction ,business.industry ,Amphetamines ,Stroke Volume ,Recovery of Function ,General Medicine ,Emergency department ,medicine.disease ,Treatment Outcome ,Echocardiography ,Anesthesia ,Cardiology ,Central Nervous System Stimulants ,Female ,Myocardial infarction diagnosis ,Drug Overdose ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction: Takotsubo Cardiomyopathy (TTC), also known as stress-induced cardiomyopathy, was initially described in Japan in 1990. Both illicit and prescription drugs have added to the growing list of insulting stressors. We describe an interesting case of atypical TTC triggered by adderall overdose. Clinical case: A 19-year-old female was brought to the Emergency Department after ingesting 30 Adderall tablets. She was complaining of pressure like chest pain and shortness of breath. Her cardiac enzymes were elevated but the electrocardiogram was unremarkable. Echocardiography identified an ejection fraction (EF) of 25–30% with severe hypokinesis of the base and a preserved apex. Cardiac angiography demonstrated normal coronary arteries with an EF of 35%, hyperkinetic apex and akinetic base consistent with the diagnosis of inverted-TTC. Her symptoms resolved in 24 hrs. Repeat echocardiogram performed 3 days later showed an EF of 60% with no regional wall motion abnormalities. Discussion: TTC can be identified as a rapid development of severe and reversible left ventricular dysfunction extending beyond the territory of a single epicardial coronary artery in the absence of coronary artery disease or pheochromocytoma. Clinical presentation can be challenging and very hard to distinguish from acute myocardial infarction. Medication induced-TTC has been reported. In our case, the patient overdosed on Adderall which is a sympathomimetic medication. Cardiac imaging identified wall motion abnormalities consistent with inverted type TTC. Restoration of left ventricular function within days confirms the diagnosis of TTC. In conclusion, this case offers an interesting insight into the pathophysiology of TTC. © 2011 Wiley Periodicals, Inc.
- Published
- 2011
36. Anomalous left main coronary artery originating from the pulmonary artery
- Author
-
Said Alsidawi and Faisal Khan
- Subjects
medicine.medical_specialty ,Coronary Vessel Anomalies ,Pulmonary Artery ,Transesophageal echocardiogram ,Coronary Angiography ,medicine.artery ,Internal medicine ,medicine ,Humans ,Aged, 80 and over ,Aorta ,Mitral regurgitation ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,Hematology ,medicine.disease ,Coronary Vessels ,medicine.anatomical_structure ,Right coronary artery ,Pulmonary artery ,Cardiology ,Female ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,Mitral valve regurgitation ,business ,Artery - Abstract
An 81 year-old Caucasian female presented to the hospital with dyspnea on exertion and was found to be in new onset atrial fibrillation. She has a past medical history of hypertension and has led an active life till her symptoms of dyspnea started. An echocardiogram was performed as a part of the work up showing an ejection fraction of 35 % with moderate mitral valve regurgitation (Fig. 2). Given her new onset cardiomyopathy and reluctance to undergo invasive work up, a pharmacologic nuclear myocardial perfusion stress test was performed showing a moderate sized area of anterolateral wall mixed ischemia and scar with an ejection fraction of 36 % (Fig. 3). A coronary angiography was recommended but patient was still reluctant and preferred a non-invasive work-up. Thus, a cardiac CT angiography was recommended. This showed an anomalous left main coronary artery originating from the proximal main pulmonary artery just beyond the pulmonic valve. The contrast density in the left main coronary artery is slightly higher than in the pulmonary artery and matches the contrast density in the arterial circulation indicating collateral filling of the left coronary system from either the aorta or right coronary artery (Fig. 4). She was started on beta-blockers and lisinopril. She underwent a successful electrical cardioversion preceded by a transesophageal echocardiogram to rule out left atrial appendage clot. She was started and warfarin and discharged. On follow-up 3 months later, she remained in sinus rhythm with significant improvement in her symptoms. A repeated echocardiogram showed significant improvement in the left ventricular ejection fraction to 55 % with only mild mitral regurgitation. On six-month follow-up she remained asymptomatic with improved functional capacity.
- Published
- 2013
37. Acquired Von Willebrand Syndrome In Aortic Stenosis: Case Report And Review
- Author
-
Said, Alsidawi, Marian, Couto, and Angel, López-Candales
- Subjects
Male ,Protein Stability ,Ecchymosis ,ADAMTS13 Protein ,Aortic Valve Stenosis ,Colonoscopy ,Syndrome ,Middle Aged ,Angiodysplasia ,Enzyme Activation ,Treatment Refusal ,ADAM Proteins ,von Willebrand Diseases ,Hypertension ,von Willebrand Factor ,Humans ,Diabetic Nephropathies ,Gastrointestinal Hemorrhage ,Protein Structure, Quaternary ,Shear Strength - Abstract
We present a case of a 61 year old man who presented with a 3 week history of easy bruising and ecchymoses in both thighs and right arm without significant trauma. Physical exam was remarkable for oozing gums, diminished second heart sound, a systolic ejection murmur at the aortic position with radiation to carotids, and delayed pulses. Laboratories were remarkable for iron deficiency anemia. Echocardiogram was consistent with severe aortic stenosis. Colonoscopy revealed several arteriovenous malformations throughout the colon. There is an association between severe aortic stenosis and gastrointestinal bleeding. The pathogenesis of Heyde's Syndrome involves iron deficiency anemia due to acquired von Willebrand factor (vWF) deficiency and ultimately gastrointestinal angiodysplasia. Correct diagnosis and management warrants a multidisciplinary approach.
- Published
- 2015
38. Significant LVOT obstruction after mitral valve in ring procedure
- Author
-
Vuyisile T. Nkomo, Mackram F. Eleid, Sorin V. Pislaru, Charanjit S. Rihal, and Said Alsidawi
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Ventricular Outflow Obstruction ,Prosthesis ,Diagnosis, Differential ,Internal medicine ,Mitral valve ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Prosthetic valve ,Heart Valve Prosthesis Implantation ,Mitral valve repair ,Ring (mathematics) ,Mitral regurgitation ,business.industry ,General Medicine ,Surgery ,medicine.anatomical_structure ,Echocardiography ,Heart Valve Prosthesis ,Cardiology ,Mitral Valve ,Female ,Poor Oral Intake ,Cardiology and Cardiovascular Medicine ,business - Abstract
A 65-year-old female with a history of mitral valve repair with a 30-mm Physio Ring underwent transcatheter valve-in-ring implantation of a 26-mm Sapien XT prosthesis for severe mitral regurgitation. After the procedure, patient complained of recurrent pre-syncopal episodes. She admits to poor oral intake since the …
- Published
- 2015
39. Strategies for thromboprophylaxis in Fontan circulation: a meta-analysis
- Author
-
Gruschen R. Veldtman, Tarek Alsaied, Jenna M Faircloth, Joseph S. Palumbo, Catherine C Allen, and Said Alsidawi
- Subjects
medicine.medical_specialty ,Comparative Effectiveness Research ,medicine.medical_treatment ,Fontan Procedure ,Gastroenterology ,Chemoprevention ,Fontan circulation ,Fontan procedure ,Postoperative Complications ,Internal medicine ,Thromboembolism ,medicine ,Humans ,Adverse effect ,Aspirin ,Interventional cardiology ,business.industry ,Incidence (epidemiology) ,Incidence ,Warfarin ,Anticoagulants ,Anesthesia ,Meta-analysis ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Background The Fontan circulation is associated with an increased risk of thromboembolic events (TEs). As many as 25% of these thrombotic events result in fatality. More subtle adverse effects on the pulmonary circulation from embolic thrombi may further impair adequate functioning of the circuit. Despite these well-documented phenomena, the most optimal approaches to thromboprophylaxis are still not clearly defined. Objective A meta-analysis of published trials in English on PubMed and Cochrane libraries that evaluated the role of using TE prophylaxis in patients who underwent the Fontan procedure was conducted. Methods 10 studies with a total number of 1200 patients with an average follow-up time of 7.1 years were identified. A random effect model was used. Results The incidence of TE was significantly less in patients who received TE prophylaxis (using either aspirin or warfarin) compared with patients who did not receive TE prophylaxis (OR 0.425, 95% CI 0.194 to 0.929, p 2 =37%). The incidence of TE was significantly lower in patients who received aspirin compared with no TE prophylaxis (OR 0.363, 95% CI 0.177 to 0.744, p 2 =0%) and who received warfarin compared with no TE prophylaxis (OR 0.327, 95% CI 0.168 to 0.634, p 2 =2.5%). There was no significant difference in incidence of TE between warfarin and aspirin (OR 0.936, 95% CI 0.609 to 1.438, p=0.54, I 2 =0%). Furthermore, there was no significant difference in incidence of early TE (within 6 months of the operation) or late TE (>6 months) between patients receiving warfarin and aspirin (OR 0.784, 95% CI 0.310 to 1.982, p=0.37, I 2 =8%) and (OR 0.776, 95% CI 0.249 to 2.42, p=0.3, I 2 =45%), respectively. When only total cavopulmonary connection patients were included, there was again no difference between warfarin and aspirin in the incidence of TE (OR 0.813, 95% CI 0.471 to 1.401, p=0.34, I 2 =11%). Conclusions This study shows a significantly lower incidence of TE after Fontan procedure if either aspirin or warfarin is used. This meta-analysis suggests no significant difference in incidence of early or late TE in patients receiving aspirin compared with warfarin.
- Published
- 2015
40. BICUSPID VERSUS TRICUSPID AORTIC VALVE STENOSIS: COMPARATIVE STUDY OF CLINICAL CHARACTERISTICS AND OUTCOMES FOLLOWING AORTIC VALVE REPLACEMENT IN AN AGE-MATCHED COHORT
- Author
-
Said Alsidawi, Jeremy J. Thaden, Hector I. Michelena, Patricia A. Pellikka, Kevin L. Greason, Geoffrey D. Huntley, Youssef Maalouf, William D. Edwards, Maurice Enriquez-Sarano, Vuyisile T. Nkomo, Joseph J. Maleszewski, Sorin V. Pislaru, and Naser M. Ammash
- Subjects
Aortic valve ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,business.industry ,Cardiovascular risk factors ,medicine.disease ,Stenosis ,Matched cohort ,medicine.anatomical_structure ,Aortic valve replacement ,Aortic valve stenosis ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Structural abnormalities predispose congenitally bicuspid aortic valves (BAV) to early stenosis, but tricuspid aortic valve (TAV) stenosis is associated with cardiovascular risk factors. We hypothesize that TAV aortic stenosis (AS) is associated with more cardiovascular risk factors and
- Published
- 2017
41. Peri-procedural management of anti-platelets and anticoagulation in patients undergoing MitraClip procedure
- Author
-
Said Alsidawi and Mohamad Effat
- Subjects
Surgical repair ,medicine.medical_specialty ,Mitral regurgitation ,business.industry ,MitraClip ,Anticoagulants ,Mitral Valve Insufficiency ,Hematology ,Anti platelet ,Perioperative Care ,Surgery ,law.invention ,medicine.anatomical_structure ,Randomized controlled trial ,Anticoagulant therapy ,law ,Mitral valve ,medicine ,Humans ,In patient ,Cardiac Surgical Procedures ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors - Abstract
The MitraClip device was recently approved by the FDA for the management of severe degenerative mitral regurgitation in patients considered to be high risk for surgical repair or replacement of the mitral valve. The management of anti-platelet and anticoagulant therapy before, during, and after the MitraClip placement is not well defined given the lack of evidence from large randomized trials. In this paper, we propose practical management guidelines for using these agents.
- Published
- 2014
42. THE ROLE OF VASCULAR IMAGING IN GUIDING PERCUTANEOUS CORONARY INTERVENTIONS: A META-ANALYSIS OF BARE METAL STENT AND DRUG-ELUTING STENT TRIALS
- Author
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Said Alsidawi, Massoud A. Leesar, Mouhamad Abdallah, Shahid Rahman, and Mohamed Effat
- Subjects
Bare-metal stent ,medicine.medical_specialty ,Percutaneous ,Vascular imaging ,genetic structures ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,eye diseases ,surgical procedures, operative ,Optical coherence tomography ,Drug-eluting stent ,Internal medicine ,Meta-analysis ,Intravascular ultrasound ,Conventional PCI ,medicine ,Cardiology ,sense organs ,cardiovascular diseases ,business ,Cardiology and Cardiovascular Medicine - Abstract
The role of the routine use of vascular imaging including intravascular ultrasound (IVUS) and Optical Coherence Tomography (OCT) in guiding percutaneous coronary interventions (PCI) is still controversial. We conducted a meta-analysis of available trials that compared imaging-guided PCI and
- Published
- 2014
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43. The Role of Bivalirudin in Percutaneous Coronary Intervention
- Author
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Said Alsidawi and Mohamed Effat
- Subjects
education.field_of_study ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Population ,Percutaneous coronary intervention ,General Medicine ,Heparin ,medicine.disease ,Internal medicine ,Multicenter trial ,Antithrombotic ,Conventional PCI ,medicine ,Cardiology ,Bivalirudin ,Myocardial infarction ,education ,business ,medicine.drug - Abstract
plus GP IIb/IIIa inhibitor (7.7% and 7.3%, respectively). There were also similar rates of major bleeding (5.3% and 5.7%). As compared with heparin plus GP IIb/IIIa inhibitor, bivalirudin, alone, led to noninferior rates of ischemia (7.8% and 7.3%, respectively; P=0.32), and significantly reduced major bleeding (3.0% vs. 5.7%; P
- Published
- 2013
44. Massive pulmonary embolism with ST-elevation in the inferior leads and other interesting ECG findings
- Author
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Tarek Helmy, Mouhammad Abdalla, and Said Alsidawi
- Subjects
medicine.medical_specialty ,business.industry ,ST elevation ,Ischemia ,Right ventricular dilation ,Hypoxia (medical) ,medicine.disease ,Pulmonary embolism ,Ecg findings ,Internal medicine ,Right heart ,Cardiology ,Medicine ,cardiovascular diseases ,medicine.symptom ,business ,Perfusion - Abstract
Introduction: Pulmonary embolism is associated with many ECG findings, most of which are non-specific and most can be explained by the sudden severe increase in the right ventricular afterload leading to dysfunction, hypoperfusion, dilation and in rare very severe cases to ischemic injury. Many case reports described patients presenting with massive pulmonary embolism and very rare atypical ECG findings especially ST-segment elevation in the anteroseptal leads (V1-V4). Case presentation: We present a case of a 73-year old African American male who suffered from a massive pulmonary embolism with interesting ECG findings mainly ST-segment elevation in the inferior leads mimicking Inferior wall myocardial infarction. To our knowledge, this is the first case of ST-elevation in the inferior leads in the setting of a massive PE. Conclusion: The most likely explanation to the case is that the associated cardiac injury is multifactorial. Severe right ventricular dilation with significant increase in wall tension and oxygen consumption, sudden coronary hypoperfusion caused by the sudden drop in the right and left ventricular output, hypoxia caused by the massive PE and finally possible coronary spasm caused by hypoxia and increased right heart pressure might all have contributed to inducing the acute right ventricular ischemia which showed as ST-segment elevation in the inferior leads and an elevation in cardiac enzymes.
- Published
- 2012
45. Percutaneous valve-in-homograft for management of a failed homograft
- Author
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Joseph F. Malouf, Said Alsidawi, Kevin L. Greason, Gurpreet S. Sandhu, and Krishnaswamy Chandrasekaran
- Subjects
Male ,Reoperation ,Aortic valve ,medicine.medical_specialty ,Percutaneous ,030204 cardiovascular system & hematology ,Severity of Illness Index ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Mechanical Mitral Valve ,Aortic valve replacement ,Internal medicine ,Mitral valve ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Aged ,Heart Failure ,Heart Valve Prosthesis Implantation ,business.industry ,General Medicine ,Allografts ,medicine.disease ,Prosthesis Failure ,Surgery ,Transplantation ,Treatment Outcome ,medicine.anatomical_structure ,030228 respiratory system ,Aortic Valve ,Infective endocarditis ,Chronic Disease ,cardiovascular system ,Cardiology ,Mitral Valve ,Transthoracic echocardiogram ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal ,Follow-Up Studies - Abstract
A 72-year-old male presented with NYHA Class IV symptoms of heart failure for the last 4 months. He had a history of aortic valve replacement with a homograft and mechanical mitral valve replacement 12 years ago for infective endocarditis. Contemporary transthoracic echocardiogram images were challenging but suggested a severely dilated left …
- Published
- 2016
46. Simultaneous Antiphospholipid Syndrome and Heparin-Induced Thrombocytopenia in a Single Patient
- Author
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J. Bonomo, S. J. Lisco, Said Alsidawi, and Alaa A. Abd-Elsayed
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biology ,business.industry ,Antiphospholipid syndrome ,Heparin-induced thrombocytopenia ,Immunology ,biology.protein ,Medicine ,General Medicine ,Antibody ,business ,medicine.disease ,Pathophysiology ,Single patient - Abstract
Antiphospholipid syndrome and heparin-induced thrombocytopenia are immune-mediated thrombotic conditions initiated by 2 distinct antibodies each targeting a discrete protein-antigen complex. Although produced by 2 different types of antibodies, they are similar in their autoimmune and pathophysiologic mechanisms. We present a case with simultaneous antiphospholipid syndrome and heparin-induced thrombocytopenia syndromes that sheds light on the correlation between these 2 syndromes.
- Published
- 2014
47. Rapid pannus formation: a rare cause of mitral stenosis following successful mitral valve repair
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Vuyisile T. Nkomo, Said Alsidawi, Joseph A. Dearani, and William K. Freeman
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Reoperation ,medicine.medical_specialty ,Mitral Valve Annuloplasty ,medicine.medical_treatment ,Regurgitation (circulation) ,Pannus Formation ,Recurrence ,Internal medicine ,medicine ,Humans ,Mitral Valve Stenosis ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Aged ,Heart Valve Prosthesis Implantation ,Mitral valve repair ,business.industry ,Mitral Valve Insufficiency ,General Medicine ,Exertional dyspnoea ,medicine.disease ,Stenosis ,Treatment Outcome ,Echocardiography ,cardiovascular system ,Cardiology ,Female ,Transthoracic echocardiogram ,Cardiology and Cardiovascular Medicine ,Mitral valve regurgitation ,business - Abstract
A 70-year-old female with symptomatic severe functional mitral valve regurgitation ( Panel A ) underwent successful mitral valve repair utilizing a Carbomedics 34-mm flexible annuloplasty ring with trivial residual regurgitation postoperative ( Panel B ). Pre-discharge transthoracic echocardiogram showed a mean gradient of 3 mmHg at 60 bpm ( Panel C ). The patient presented with recurrent exertional dyspnoea 7 months …
- Published
- 2015
48. Congenital Anastomosis Between Left Anterior Mammary and Pulmonary Vasculatures
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Angel López-Candales, Said Alsidawi, Imran Arif, and Mouhamad Abdalla
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Male ,Coronary angiography ,Incidental Findings ,medicine.medical_specialty ,Left internal mammary artery ,business.industry ,CONGENITAL FISTULAS ,Arteriovenous Anastomosis ,Fistula ,education ,General Medicine ,Middle Aged ,Pulmonary Artery ,Anastomosis ,medicine.disease ,Radiography ,Coronary artery bypass surgery ,Humans ,Medicine ,Pulmonary vasculature ,Radiology ,Mammary Arteries ,business - Abstract
Several case reports have described the presence of acquired fistula connecting the left internal mammary artery to the pulmonary vasculature; however, occurrence of this type of congenital fistulas is less common. The authors present a case of a congenital left internal mammary artery-pulmonary vasculature fistula that was incidentally found during a coronary angiography in a patient who was being evaluated for coronary artery bypass surgery. The particulars of the case are discussed, and the literature is reviewed.
- Published
- 2013
49. Regional wall motion abnormalities in patients with pheochromocytoma
- Author
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Said Alsidawi
- Subjects
Male ,medicine.medical_specialty ,Physiology ,business.industry ,Adrenal Gland Neoplasms ,Blood Pressure ,Pheochromocytoma ,medicine.disease ,Blood pressure ,Text mining ,Endocrinology ,Internal medicine ,Internal Medicine ,Humans ,Medicine ,In patient ,Radiology ,Wall motion ,Cardiomyopathies ,Cardiology and Cardiovascular Medicine ,business - Published
- 2012
50. THROMBOEMBOLISM PROPHYLAXIS IN FONTAN PATIENTS. WHAT SHOULD WE USE? A META-ANALYSIS OF PUBLISHED TRIALS
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Said Alsidawi, Gruschen R. Veldtman, and Tarek Alsaied
- Subjects
Fontan procedure ,medicine.medical_specialty ,business.industry ,Meta-analysis ,medicine.medical_treatment ,medicine ,In patient ,Thromboembolism Prophylaxis ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business - Abstract
The role of anti-platelets and anticoagulation in patients who underwent the Fontan procedure remains controversial. While most authors agree on the need for prophylaxis to prevent thromboembolic (TE) events, there is still lack of strong evidence to support such approach and the best agent that
- Full Text
- View/download PDF
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