35 results on '"Witzke C"'
Search Results
2. Coronary Artery Perforations in the Contemporary Interventional Era
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KIERNAN, T. J., YAN, B. P., RUGGIERO, N., EISENBERG, J. D., BERNAL, J., CUBEDDU, R. J., WITZKE, C., DON, C., CRUZ-GONZALEZ, I., ROSENFIELD, K., POMERSANTEV, E., and PALACIOS, I.
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- 2009
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3. Spontaneous coronary artery dissection: a rare cause of acute coronary syndrome
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Junpaparp, P., primary, Romero-Corral, A., additional, Lee, S. Y. C., additional, and Witzke, C., additional
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- 2014
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4. P058 * APACHE II score, rather than cardiac function, may predict poor prognosis in patients with stress-induced cardiomyopathy
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Joe, B. H., primary, Sohn, I. S., additional, Park, B. J., additional, Park, J. H., additional, Jin, E. S., additional, Cho, J. M., additional, Kim, C. J., additional, Saleh, A., additional, Matsumori, A., additional, Negm, H., additional, Shalaby, M., additional, Haykal, M., additional, Tsverava, M., additional, Tsverava, D., additional, Lobjanidse, N., additional, Han, J. Y., additional, Ha, S. I., additional, Yang, J. S., additional, Choi, D. H., additional, Chung, J. W., additional, Koh, Y. Y., additional, Chang, K. S., additional, Hong, S. P., additional, Adachi, H., additional, Taguchi, T., additional, Oshima, H., additional, Huang, F. Q., additional, Zhong, L., additional, Le, T. t., additional, Tan, R. S., additional, Zhao, Q. Y., additional, Yu, S. B., additional, Huang, H., additional, Qin, M., additional, Cui, H. Y., additional, Huang, T., additional, Huang, C. X., additional, Chan, W. Y. W., additional, Blomqvist, A., additional, Melton, I. C., additional, Crozier, I. G., additional, Noren, K., additional, Troughton, R. W., additional, Indriani, S., additional, Siswanto, B. B., additional, Soerarso, R., additional, Hersunarti, N., additional, Harimurti, G. M., additional, Margey, R., additional, Hynes, B., additional, Pomerantsev, E., additional, Moran, D., additional, Hatim, M., additional, Kiernan, T., additional, Inglessis, I., additional, Palacios, I., additional, Suh, W., additional, Witzke, C., additional, Yeh, R., additional, Sahkuja, R., additional, Seto, A., additional, Chen, Y., additional, Li, H., additional, Zhou, B., additional, Shi, S. Q., additional, Rao, L., additional, Gong, H., additional, Wang, X., additional, Ling, Y., additional, Obispo-Mortos, S. A., additional, Reyes, D. R. C., additional, Cabasan, G., additional, Caguioa, E. V. S., additional, Ramirez, M. F. L., additional, Navarra, S. V., additional, Wang, S., additional, Lam, Y. Y., additional, Fang, F., additional, Shang, Q., additional, Luo, X. X., additional, Liu, M., additional, Wang, J., additional, Sanderson, J. E., additional, Sun, J. P., additional, Yu, C. M., additional, Hernandez-Madrid, A., additional, Matia Frances, R., additional, Bullon, M., additional, Moro, C., additional, Kwong, S. W., additional, Lee, P. W., additional, Larina, V. N., additional, and Bart, B. Y., additional
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- 2012
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5. Imaging of atrial septal defects: echocardiography and CT correlation
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Johri, A. M., primary, Rojas, C. A., additional, El-Sherief, A., additional, Witzke, C. F., additional, Chitty, D. W., additional, Palacios, I. F., additional, Passeri, J. J., additional, King, M. E. E., additional, and Abbara, S., additional
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- 2011
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6. Transient Left Ventricular Apical Ballooning
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Witzke, C., primary, Lowe, H.C., additional, Waldman, H., additional, and Palacios, I.F., additional
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- 2003
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7. Comparison of procedural and in-hospital outcomes of percutaneous balloon aortic valvuloplasty in patients >80 years versus patients < or =80 years.
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Don CW, Witzke C, Cubeddu RJ, Herrero-Garibi J, Pomerantsev E, Caldera AE, McCarty D, Inglessis I, Palacios IF, Don, Creighton W, Witzke, Christian, Cubeddu, Roberto J, Herrero-Garibi, Jesus, Pomerantsev, Eugene, Caldera, Angel E, McCarty, David, Inglessis, Ignacio, and Palacios, Igor F
- Abstract
Percutaneous balloon aortic valvuloplasty (PBAV) is a procedure used for palliation, bridging to surgery, and as an integral step in the procedure for percutaneous aortic valve replacement. Older patients with severe aortic stenosis are thought to have greater risk for adverse perioperative events than younger patients. The aim of this study was to evaluate the outcomes of patients aged >80 years and those aged < or =80 years who underwent PBAV to identify factors associated with adverse clinical outcomes. This was a retrospective study of 111 consecutive patients with severe symptomatic aortic stenosis who underwent retrograde PBAV at Massachusetts General Hospital from December 2004 to December 2008. Forty-nine patients (44%) were men, and the mean age for the whole group was 82 +/- 8 years. Patients were divided into 2 age groups: those aged >80 years (n = 73) and those aged < or =80 years (n = 38). Procedural outcomes, complications, and in-hospital adverse events were compared. Multivariate logistic regression was used for the adjusted analysis. Nearly 90% of patients were in New York Heart Association class III or IV. Patients aged >80 years had lower baseline ejection fractions (43.5% vs 56.1%, p <0.01) and smaller aortic valve areas (0.59 vs 0.73 cm(2), p <0.01). Although the 2 age groups had a similar percentage of aortic valve area increase (55.5% vs 45.2%, p = 0.28), those aged >80 years had smaller post-PBAV aortic valve areas (0.89 vs 1.02 cm(2), p <0.05). Overall, in-hospital mortality was 8.1%, with no significant differences between the groups. Advanced age was not an independent predictor of in-hospital death, myocardial infarction, stroke, cardiac arrest, or tamponade; however, patients aged >80 years had a significantly higher incidence of intraprocedural emergent intubation and cardiopulmonary resuscitation compared to the younger group. New York Heart Association class was the only independent predictor of worse in-hospital outcomes. In conclusion, compared to younger patients, those aged >80 years had less favorable preprocedural characteristics for PBAV but similar overall in-hospital clinical outcomes. Patients aged >80 years had significantly higher incidence of emergent intubation and cardiopulmonary resuscitation during PBAV. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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8. Major adverse cardiovascular outcomes within distinct pulmonary hypertension patterns in advanced chronic kidney disease: A retrospective cohort analysis.
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Geller A, Martinez Manzano JM, Jarrett SA, Wattanachayakul P, Malin J, Leguizamon R, John TA, Khan R, McLaren I, Prendergast A, Lo KB, Witzke C, and Eiger G
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- Humans, Retrospective Studies, Male, Female, Aged, Middle Aged, Cardiovascular Diseases etiology, Cardiovascular Diseases epidemiology, Cohort Studies, Renal Insufficiency, Chronic complications, Renal Insufficiency, Chronic physiopathology, Hypertension, Pulmonary physiopathology, Hypertension, Pulmonary etiology
- Abstract
Competing Interests: Declaration of competing interest There is no conflict of interest.
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- 2024
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9. Pulmonary vasodilators in patients with advanced chronic kidney disease and pre-capillary pulmonary hypertension-A case series.
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Leguizamon R, McLaren I, John T, Khan R, Prendergast A, Wattanachayakul P, Geller A, Malin J, Jarret SA, Lo KB, Martinez Manzano JM, and Witzke C
- Abstract
Pulmonary hypertension (PH) is a prevalent complication among patients with chronic kidney disease (CKD). In these patients, pulmonary vasodilators may be useful but are underused. We describe a group of patients with precapillary PH and advanced CKD treated with pulmonary vasodilators. This was a case series of patients with CKD stage 4 and 5 and precapillary PH (isolated or combined) based on right heart catheterization (RHC) treated with pulmonary vasodilators from 2018 to 2023. Of 263 patients with isolated precapillary or combined PH and advanced CKD, only 17 (6%) were treated with pulmonary vasodilators; 53% ( n = 9) with precapillary PH and 47% ( n = 8) with combined PH. Most patients (94%, n = 16) received phosphodiesterase-5 antagonists, while 12% ( n = 2) received endothelin receptor antagonists. Adverse clinical outcomes were seen in 35% of patients within a year. The use of pulmonary vasodilator did not prevent adverse outcomes in patients with precapillary PH and advanced CKD., Competing Interests: Given the adherence to ethical and institutional guidelines and the main incentive of academic growth without monetary incentive for the development of this study, the authors declare no conflicts of interest present in this study., (© 2024 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.)
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- 2024
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10. Association of arteriovenous fistulae with precapillary pulmonary hypertension - A single center retrospective analysis of invasive hemodynamic parameters.
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Malin J, Khan R, Manzano JMM, Wattanachayakul P, Geller A, Leguizamon R, John TA, Mclaren I, Prendergast A, Jarrett SA, Lo KB, Rangaswami J, and Witzke C
- Abstract
Background: Pulmonary hypertension (pH) is a well-known complication among patients with chronic kidney disease (CKD). Arteriovenous fistulae (AVF) have been associated with pH mainly by increasing cardiac output. However, the burden of precapillary pH in individuals with CKD and an AVF is unclear., Objectives: To better and more fully understand the mechanism and development of precapillary pH in patients with AVF, as well as the consequences of precapillary pH in these patients., Methods: This was a large retrospective study of patients with CKD stage 4 or 5 who underwent right heart catheterization (RHC) from 2018 to 2023. The data were stratified according to the presence of AVF. To determine if AVF was independently associated with precapillary pH, we used a multivariable logistic regression analysis adjusting for demographics and potential comorbidities associated with precapillary pH, including diagnosis of chronic lung disease, obstructive sleep apnea, connective tissue disease, history of venous thromboembolism, chronic anemia, and heart failure., Results: Of 651 patients with CKD4 or CKD5, 145 (22 %) had AVF and 506 (78 %) did not have AVF. Within the AVF group, the median age was 64 years (IQR 54-71), and they were predominantly males (61 %, n = 88) and African American (77 %, n = 111). A total of 31 % (n = 45) had evidence of precapillary pH, 30 % (n = 43) of combined pH, and 14 % (n = 20) of isolated postcapillary pH. Compared to the non-AVF group, precapillary pH was more likely in the AVF group (31% vs 17 %, p < 0.0001). On multivariable analysis, AVF was independently associated with precapillary pH (OR 2.47, CI 1.56-3.89; p < 0.0001). The median time from dialysis initiation to RHC date (and precapillary pH diagnosis) was 6 years (IQR 3-8)., Conclusion: Based on RHC findings, almost one-third of patients with CKD and AVF had precapillary pH. The presence of AVF was independently associated with precapillary pH., Competing Interests: Declaration of competing interest The authors have no competing interest to disclose. None declared., (Copyright © 2024. Published by Elsevier Inc.)
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- 2024
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11. Association of mildly elevated pulmonary vascular resistance with major cardiovascular events in pulmonary hypertension and chronic kidney disease: A retrospective cohort analysis.
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Martinez Manzano JM, Prendergast A, John T, Leguizamon R, McLaren I, Khan R, Geller A, Wattanachayakul P, Malin J, Jarrett SA, Lo KB, Benzaquen S, and Witzke C
- Abstract
Pulmonary hypertension (PH) is associated with adverse outcomes in chronic kidney disease (CKD) patients. Our study suggests mildly elevated pulmonary vascular resistance ( > 2 to ≤ 3) is independently associated with major adverse cardiovascular events at 1-year follow-up. Early diagnosis of precapillary PH in CKD patients can potentially improve clinical outcomes., Competing Interests: The authors declare no conflict of interest., (© 2024 The Authors. Pulmonary Circulation published by John Wiley & Sons Ltd on behalf of Pulmonary Vascular Research Institute.)
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- 2024
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12. Simultaneous transcatheter tricuspid and mitral valve-in-valve replacement for the treatment of degenerated bioprosthetic valves.
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Kanjanahattakij N, Tuluca A, Pressman GS, Singer R, and Witzke C
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- Cardiac Catheterization methods, Humans, Mitral Valve surgery, Prosthesis Design, Prosthesis Failure, Treatment Outcome, Bioprosthesis, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation methods
- Abstract
Transcatheter valve-in-valve replacement has become a viable option for patients with degenerated bioprosthetic valves at high risk for redo surgery. We report a case of a patient who had degenerated mitral and tricuspid bioprosthesis causing severe tricuspid and mitral regurgitation. We performed simultaneous mitral and tricuspid valve-in-valve replacement via a transfemoral approach. Although the data on performing both valve-in-valve procedures are limited, this case demonstrated that these procedures can be safely done as a single procedure., (© 2022 Wiley Periodicals LLC.)
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- 2022
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13. A Cardiac Computed Tomography-Based Score to Categorize Mitral Annular Calcification Severity and Predict Valve Embolization.
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Guerrero M, Wang DD, Pursnani A, Eleid M, Khalique O, Urena M, Salinger M, Kodali S, Kaptzan T, Lewis B, Kato N, Cajigas HM, Wendler O, Holzhey D, Pershad A, Witzke C, Alnasser S, Tang GHL, Grubb K, Reisman M, Blanke P, Leipsic J, Williamson E, Pellikka PA, Pislaru S, Crestanello J, Himbert D, Vahanian A, Webb J, Hahn RT, Leon M, George I, Bapat V, O'Neill W, and Rihal C
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- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Mitral Valve surgery, Predictive Value of Tests, Retrospective Studies, Tomography, X-Ray Computed, Treatment Outcome, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation
- Abstract
Objectives: This study aims to establish a computed tomography (CT)-based scoring system for grading mitral annular calcification (MAC) severity and potentially aid in predicting valve embolization during transcatheter mitral valve (MV) replacement using balloon-expandable aortic transcatheter heart valves., Background: Transcatheter MV replacement is emerging as an alternative treatment for patients with severe MAC who are not surgical candidates. Although cardiac CT is the imaging modality of choice in the evaluation of candidates for valve-in-MAC (ViMAC), a standardized grading system to quantify MAC severity has not been established., Methods: We performed a multicenter retrospective review of cardiac CT and clinical outcomes of patients undergoing ViMAC. A CT-based MAC score was created using the following features: average calcium thickness (mm), degrees of annulus circumference involved, calcification at one or both fibrous trigones, and calcification of one or both leaflets. Features were assigned points according to severity (total maximum score = 10) and severity grade was assigned based on total points (mild ≤3, moderate 4 to 6, and severe ≥7 points). The association between MAC score and device migration/embolization was evaluated., Results: Of 117 patients in the TMVR in MAC registry, 87 had baseline cardiac CT of adequate quality. Of these, 15 were treated with transatrial access and were not included. The total cohort included 72 (trans-septal = 37, transapical = 35). Mean patient age was 74 ± 12 years, 66.7% were female, and the mean Society of Thoracic Surgery risk score was 15.4 ± 10.5%. The mean MAC score was 7.7 ± 1.4. Embolization/migration rates were lower in higher scores: Patients with a MAC score of 7 had valve embolization/migration rate of 12.5%, MAC score ≥8 had a rate of 8.7%, and a MAC score of ≥9 had zero (p = 0.023). Patients with a MAC score of ≤6 had 60% embolization/migration rate versus 9.7% in patients with a MAC score ≥7 (p < 0.001). In multivariable analysis, a MAC score ≤6 was in independent predictor of valve embolization/migration (odds ratio [OR]: 5.86 [95% CI: 1.00 to 34.26]; p = 0.049)., Conclusions: This cardiac CT-based score provides a systematic method to grade MAC severity which may assist in predicting valve embolization/migration during trans-septal or transapical ViMAC procedures., (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2020
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14. Intense exercise may not be so benign: chest pain in a young athletic woman may be spontaneous coronary artery dissection (SCAD).
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Oluwole AS, Virk HUH, and Witzke C
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- Adult, Aspirin therapeutic use, Clopidogrel therapeutic use, Coronary Angiography methods, Coronary Vessel Anomalies drug therapy, Coronary Vessels pathology, Electrocardiography methods, Female, Humans, Platelet Aggregation Inhibitors therapeutic use, Treatment Outcome, Ultrasonography, Interventional methods, Vascular Diseases diagnosis, Vascular Diseases drug therapy, Chest Pain etiology, Coronary Vessel Anomalies diagnosis, Physical Exertion physiology, Troponin blood, Vascular Diseases congenital
- Abstract
We present a 26-year-old woman who came to the emergency department with chest pain of 1 hour duration that started while she was exercising on the treadmill. At presentation, ECG showed sinus bradycardia. Initial troponin level was 0.05 ng/mL and her chest pain resolved within 3 hours of onset. Troponins were trended serially, which continued to rise and peaked at 28.77 ng/mL and so heparin drip was started. On the second day of admission, a coronary angiogram was performed along with intravascular ultrasound, which revealed type 3 spontaneous coronary artery dissection. No obstructive atherosclerotic disease was noted in any of the coronary vessels. No coronary intervention was performed. Patient was started on aspirin and clopidogrel. Patient was discharged home in stable condition and was followed outpatient, where she remained in excellent health condition at her first clinic visit., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2020
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15. Anaemia and mortality in patients with transcatheter aortic valve replacement: a systematic review and meta-analysis.
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Kanjanahattakij N, Rattanawong P, Krishnamoorthy P, Sirinvaravong N, Chongsathidkiet P, Lapumnuaypol K, George JC, Witzke C, and Figueredo VM
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- Anemia epidemiology, Aortic Valve Stenosis epidemiology, Comorbidity, Global Health, Humans, Severity of Illness Index, Survival Rate trends, Aortic Valve surgery, Aortic Valve Stenosis surgery, Risk Assessment, Transcatheter Aortic Valve Replacement
- Abstract
Objective: This study was done to determine the relationship between pre-procedural anaemia and mortality post transcatheter aortic valve replacement (TAVR). Introduction: TAVR is now a treatment option for patients with severe aortic stenosis (AS) with high surgical risk. Anaemia is a common comorbidity in the TAVR population. Small studies have suggested that anaemia is associated with worse short-term and long-term mortality in patients who underwent TAVR. However, there are no meta-analyses to further assess this association. Method: Studies were systematically searched from electronic databases (EMBASE and MEDLINE). Inclusion criteria were adult population with aortic stenosis who underwent TAVR, and number of patients with pre-procedural anaemia reported. Outcomes were short-term mortality or long-term mortality. Pooled effect size was calculated with a random-effect model, weighted for the inverse of variance. Heterogeneity was assessed with I
2 . Results: Six studies were included in the final analysis. Of these, pooled analysis of four studies examining association between anaemia and 30-day mortality did not show a statistically significant relationship. A pooled analysis of four studies examining the association of anaemia and long-term mortality after TAVR showed pooled adjusted risk ratio (RR) of 1.43, 95% CI 1.22-1.67 with low heterogeneity ( I2 = 33%). Subgroup analysis after exclusion of one smaller study showed that the association remained significant (RR 1.41, 95% CI 1.27-1.56) with decreased heterogeneity ( I2 = 0%). Conclusion: This systematic review and meta-analysis found an association between pre-procedural anaemia and increased long-term but not short-term mortality after TAVR. Further study of the pathophysiology underlying this association is needed.- Published
- 2019
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16. Unloading the Left Ventricle Before Reperfusion in Patients With Anterior ST-Segment-Elevation Myocardial Infarction.
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Kapur NK, Alkhouli MA, DeMartini TJ, Faraz H, George ZH, Goodwin MJ, Hernandez-Montfort JA, Iyer VS, Josephy N, Kalra S, Kaki A, Karas RH, Kimmelstiel CD, Koenig GC, Lau E, Lotun K, Madder RD, Mannino SF, Meraj PM, Moreland JA, Moses JW, Kim RL, Schreiber TL, Udelson JE, Witzke C, Wohns DHW, and O'Neill WW
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- Adult, Aged, Aged, 80 and over, Anterior Wall Myocardial Infarction diagnostic imaging, Anterior Wall Myocardial Infarction physiopathology, Cerebrovascular Disorders etiology, Cerebrovascular Disorders physiopathology, Cerebrovascular Disorders prevention & control, Feasibility Studies, Female, Humans, Magnetic Resonance Imaging, Cine, Male, Middle Aged, Myocardial Reperfusion adverse effects, Myocardial Reperfusion Injury etiology, Myocardial Reperfusion Injury physiopathology, Myocardial Reperfusion Injury prevention & control, Pilot Projects, Prospective Studies, Prosthesis Implantation adverse effects, Recovery of Function, Recurrence, Risk Factors, ST Elevation Myocardial Infarction diagnostic imaging, ST Elevation Myocardial Infarction physiopathology, Time Factors, Treatment Outcome, United States, Young Adult, Anterior Wall Myocardial Infarction therapy, Heart-Assist Devices, Myocardial Reperfusion methods, Prosthesis Implantation instrumentation, ST Elevation Myocardial Infarction therapy, Ventricular Function, Left
- Abstract
Background: In ST-segment-elevation myocardial infarction (STEMI), infarct size correlates directly with heart failure and mortality. Preclinical testing has shown that, in comparison with reperfusion alone, mechanically unloading the left ventricle (LV) before reperfusion reduces infarct size and that 30 minutes of unloading activates a cardioprotective program that limits reperfusion injury. The DTU-STEMI pilot trial (Door-To-Unload in STEMI Pilot Trial) represents the first exploratory study testing whether LV unloading and delayed reperfusion in patients with STEMI without cardiogenic shock is safe and feasible., Methods: In a multicenter, prospective, randomized exploratory safety and feasibility trial, we assigned 50 patients with anterior STEMI to LV unloading by using the Impella CP followed by immediate reperfusion (U-IR) versus delayed reperfusion after 30 minutes of unloading (U-DR). The primary safety outcome was a composite of major adverse cardiovascular and cerebrovascular events at 30 days. Efficacy parameters included the assessment of infarct size by using cardiac magnetic resonance imaging., Results: All patients completed the U-IR (n=25) or U-DR (n=25) protocols with respective mean door-to-balloon times of 72 versus 97 minutes. Major adverse cardiovascular and cerebrovascular event rates were not statistically different between the U-IR versus U-DR groups (8% versus 12%, respectively, P=0.99). In comparison with the U-IR group, delaying reperfusion in the U-DR group did not affect 30-day mean infarct size measured as a percentage of LV mass (15±12% versus 13±11%, U-IR versus U-DR, P=0.53)., Conclusions: We report that LV unloading using the Impella CP device with a 30-minute delay before reperfusion is feasible within a relatively short time period in anterior STEMI. The DTU-STEMI pilot trial did not identify prohibitive safety signals that would preclude proceeding to a larger pivotal study of LV unloading before reperfusion. An appropriately powered pivotal trial comparing LV unloading before reperfusion to the current standard of care is required., Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03000270.
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- 2019
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17. The Effects of Geography on Outcomes of Routine Early Versus Selective Late Revascularization Strategy in the Treatment of Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Transatlantic Randomized Controlled Trials.
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Virk HUH, Lo KB, Krittanawong C, Inayat F, Sarwar U, Ghani AR, Witzke C, Janzer S, George JC, Pressman G, Bozorgnia B, Chatterjee S, and Figueredo VM
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Background: The optimal timing of revascularization in unstable angina (UA) or non-ST-segment elevation myocardial infarction (NSTEMI) remains uncertain. We compared routine early revascularization (REV) versus selective late revascularization (SLR) strategies and divergence in the approach of cardiologists in the United States and Europe., Methods: Seventeen randomized controlled trials (RCTs) (15,812 patients) were extracted from PubMed, Cochrane Library, EMBASE and Web of Science databases. The data were pooled using the Der Simonian and Laird random-effect models and expressed as pooled risk ratios (RR) with 95% confidence intervals (95% CIs)., Results: Overall, there was no difference in all-cause mortality (RR: 1.01, 95% CI: 0.95 - 1.08, P = 0.7), myocardial infarction (MI) (RR: 0.98, 95% CI: 0.79 - 1.22, P = 0.85) or coronary artery bypass grafting (CABG) (RR: 1.33, 95% CI: 0.92 - 1.91, P = 0.12) between REV and SLR strategy. There were trends of decreased incidence of MI in REV, 13.3% (1,029/7,704) vs. 15.1% (1,108/7,314) in SLR (P = 0.007), and rate of CABG was higher in REV, 4.9% (140/2,831) vs. 3.7% (105/2,819) in SLR (P = 0.031). There were trends of lower all-cause mortality in the combined US/international trials in both REV 8.4% (390/4,624) vs. 22.8% (908/3,975) (P < 0.001) and SLR 8% (359/4,421) vs. 24% (910/3,808) (P < 0.001) compared to the European trials. There were also trends of lower rates of MI in the European trials in the REV group 20% (623/3,080) vs. 25% (712/2,893) in SLR (P = 0.001) and higher rates of CABG in REV 8.3% (96/1,144) vs. 5.7% (67/1,165) in SLR (P = 0.02); however, there were no significant effects in the pooled RR ratios even after subgroup analysis between US/international trials and European trials., Conclusions: Despite having contemporary differences in the management approach towards UA/NSTEMI patients, no significant differences in trends were observed with REV strategy in US/international trials vs. European trials., Competing Interests: The authors declare that they do not have any conflict of interest.
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- 2018
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18. Pericardium: The Forgotten Space During Acute Myocardial Infarction.
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Agrawal A, Zabad MN, Dayanand S, Lygouris G, and Witzke C
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- Aged, Cardiac Tamponade etiology, Cardiac Tamponade physiopathology, Diagnosis, Differential, Electrocardiography methods, Female, Humans, Middle Aged, Percutaneous Coronary Intervention methods, Pericardium physiopathology, ST Elevation Myocardial Infarction etiology, Time Factors, Tomography, X-Ray Computed methods, Ultrasonography methods, Pericardium pathology, ST Elevation Myocardial Infarction physiopathology
- Abstract
Background: Acute pericardial pathologies, such as pericardial effusion, pericarditis, and cardiac tamponade, have been reported rarely in patients presenting as ST-elevation myocardial infarction (STEMI). We present a series of 3 patients with STEMI, where an undiagnosed pericardial effusion led to pericardial tamponade and subsequent cardiocirculatory collapse., Case Reports: This is a case series of 3 patients, all women, aged 72, 64, and 54 years who presented to the emergency department with chest pain or syncope and were found to have STEMI with hemodynamic instability. They were taken to the catheterization laboratory for urgent coronary revascularization requiring mechanical circulatory support (intra-aortic balloon pump or impella). During catheterization, all 3 patients were diagnosed with large pericardial effusion using hemodynamic parameters and bedside transesophageal echocardiogram. Commonly ignored, pericardial tamponade and acute large pericardial effusion can be the cause of cardiocirculatory collapse. Two of the 3 patients survived with aggressive interventions requiring pericardial drains, long-term mechanical circulatory support, and effective postoperative rehabilitation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: It is important for treating clinicians, including emergency physicians, intensivist, and cardiologist, to consider the differential of a cardiac tamponade due to a pericardial effusion as a potential cause for hypotension in patients with an acute STEMI., (Copyright © 2018 Elsevier Inc. All rights reserved.)
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- 2018
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19. Cholesterol embolization syndrome: An under-recognized entity in cardiovascular interventions.
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Agrawal A, Ziccardi MR, Witzke C, Palacios I, and Rangaswami J
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- Aged, Female, Humans, Incidence, Male, Middle Aged, Prognosis, Risk Factors, Embolism, Cholesterol epidemiology, Kidney Diseases epidemiology, Plaque, Atherosclerotic complications
- Abstract
Cholesterol embolization syndrome (CES) is a multi-systemic disease caused by embolization of atherosclerotic plaque contents from proximal large-caliber artery to distal small to medium arteries, occurring spontaneously or more commonly after vascular intervention. This report is a comprehensive review of the reported cases of CES found in our literature search. We discuss the risk factors, clinical manifestations, management, and prognosis of CES. The major predisposing factors for CES include older age, male sex, atherosclerotic cardiovascular risk factors, anticoagulation, and femoral access route. The composite incidence of atheroembolic renal disease was 92% and mortality 63%. Our review highlights the importance to recognize this disease entity for the cardiologist and nephrologist., (© 2017, Wiley Periodicals, Inc.)
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- 2018
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20. Trends, etiologies, and predictors of 90-day readmission after percutaneous ventricular assist device implantation: A national population-based cohort study.
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Virk HUH, Tripathi B, Gupta S, Agrawal A, Dayanand S, Inayat F, Krittanawong C, Ghani AR, Zabad MN, Krishnamoorthy PM, Amanullah A, Pressman G, Witzke C, Janzer S, George J, Kalra S, and Figueredo V
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Cardiovascular Diseases diagnosis, Cardiovascular Diseases mortality, Cardiovascular Diseases physiopathology, Chi-Square Distribution, Comorbidity, Databases, Factual, Female, Hospital Mortality trends, Humans, Incidence, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Prosthesis Design, Prosthesis Implantation adverse effects, Prosthesis Implantation mortality, Recovery of Function, Risk Factors, Shock, Cardiogenic diagnosis, Shock, Cardiogenic mortality, Shock, Cardiogenic physiopathology, Time Factors, Treatment Outcome, United States epidemiology, Young Adult, Cardiovascular Diseases epidemiology, Heart-Assist Devices, Hemodynamics, Patient Readmission trends, Prosthesis Implantation instrumentation, Shock, Cardiogenic therapy, Ventricular Function, Left
- Abstract
Percutaneous ventricular assist devices (pVADs) are indicated to provide hemodynamic support in high-risk percutaneous interventions and cardiogenic shock. However, there is a paucity of published data regarding the etiologies and predictors of 90-day readmissions following pVAD use. We studied the data from the US Nationwide Readmissions Database (NRD) for the years 2013 and 2014. Patients with a primary discharge diagnosis of pVAD use were collected by searching the database for International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedural code 37.68 (Impella and TandemHeart devices). Amongst this group, we examined 90-day readmission rates. Comorbidities as identified by "CM_" variables provided by the NRD were also extracted. The Charlson Comorbidity Index was calculated using appropriate ICD-9-CM codes, as a secondary diagnosis. A 2-level hierarchical logistic regression model was then used to identify predictors of 90-day readmission following pVAD use. Records from 7074 patients requiring pVAD support during hospitalization showed that 1562 (22%) patients were readmitted within 90 days. Acute decompensated heart failure (22.6%) and acute coronary syndromes (11.2%) were the most common etiologies and heart failure (odds ratio [OR]: 1.39, 95% confidence interval [CI]: 1.17-1.67), chronic obstructive pulmonary disease (OR: 1.26, 95% CI: 1.07-1.49), peripheral vascular disease (OR: 1.305, 95% CI: 1.09-1.56), and discharge into short- or long-term facility (OR: 1.28, 95% CI: 1.08-1.51) were independently associated with an increased risk of 90-day readmission following pVAD use. This study identifies important etiologies and predictors of short-term readmission in this high-risk patient group that can be used for risk stratification, optimizing discharge, and healthcare transition decisions., (© 2018 Wiley Periodicals, Inc.)
- Published
- 2018
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21. 1-Year Outcomes of Transcatheter Mitral Valve Replacement in Patients With Severe Mitral Annular Calcification.
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Guerrero M, Urena M, Himbert D, Wang DD, Eleid M, Kodali S, George I, Chakravarty T, Mathur M, Holzhey D, Pershad A, Fang HK, O'Hair D, Jones N, Mahadevan VS, Dumonteil N, Rodés-Cabau J, Piazza N, Ferrari E, Ciaburri D, Nejjari M, DeLago A, Sorajja P, Zahr F, Rajagopal V, Whisenant B, Shah PB, Sinning JM, Witkowski A, Eltchaninoff H, Dvir D, Martin B, Attizzani GF, Gaia D, Nunes NSV, Fassa AA, Kerendi F, Pavlides G, Iyer V, Kaddissi G, Witzke C, Wudel J, Mishkel G, Raybuck B, Wang C, Waksman R, Palacios I, Cribier A, Webb J, Bapat V, Reisman M, Makkar R, Leon M, Rihal C, Vahanian A, O'Neill W, and Feldman T
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Heart Valve Prosthesis Implantation adverse effects, Humans, Male, Middle Aged, Mitral Valve Annuloplasty adverse effects, Retrospective Studies, Ventricular Outflow Obstruction etiology, Endovascular Procedures mortality, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation mortality, Mitral Valve surgery, Mitral Valve Annuloplasty mortality
- Abstract
Background: The risk of surgical mitral valve replacement in patients with severe mitral annular calcification (MAC) is high. Several patients worldwide with severe MAC have been treated successfully with transcatheter mitral valve replacement (TMVR) using balloon-expandable aortic transcatheter valves. The TMVR in MAC Global Registry is a multicenter registry that collects data on outcomes of these procedures., Objectives: The goal of this study was to evaluate 1-year outcomes in this registry., Methods: This study was a multicenter retrospective review of clinical outcomes., Results: A total of 116 extreme surgical risk patients with severe MAC underwent TMVR; 106 had a procedure date >1 year before data-lock and were included in the analysis. Their mean age was 73 ± 12 years, and 68% were female. The mean Society of Thoracic Surgeons score was 15.3 ± 11.6%, and 90% were in New York Heart Association functional class III or IV. Thirty-day and 1-year all-cause mortality was 25% and 53.7%, respectively. Most patients who survived 30 days were alive at 1 year (49 of 77 [63.6%]), and the majority (71.8%) were in New York Heart Association functional class I or II. Echocardiography data at 1 year were available in 34 patients. Mean left ventricular ejection fraction was 58.6 ± 11.2%, mean mitral valve area was 1.9 ± 0.5 cm
2 , mean mitral gradient was 5.8 ± 2.2 mm Hg, and 75% had zero or trace mitral regurgitation., Conclusions: TMVR with balloon-expandable aortic valves in extreme surgical risk patients with severe MAC is feasible but associated with high 30-day and 1-year mortality. Most patients who survive the 30-day post-procedural period are alive at 1 year and have sustained improvement of symptoms and transcatheter valve performance. The role of TMVR in patients with MAC requires further evaluation in clinical trials., (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)- Published
- 2018
- Full Text
- View/download PDF
22. ROC Cutpoints May Help Clinicians Predict the Need for Pacemakers Prior to TAVR.
- Author
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Mezue K, Rangaswami J, Tuluca A, and Witzke C
- Subjects
- Aortic Valve Stenosis surgery, Humans, Pacemaker, Artificial, Transcatheter Aortic Valve Replacement
- Published
- 2017
- Full Text
- View/download PDF
23. Effects of staged versus ad hoc percutaneous coronary interventions on renal function-Is there a benefit to staging?
- Author
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Shah M, Gajanana D, Wheeler DS, Punjabi C, Maludum O, Mezue K, Lerma EV, Ardati A, Romero-Corral A, Witzke C, and Rangaswami J
- Subjects
- Aged, Aged, 80 and over, Angioplasty, Balloon, Coronary methods, Contrast Media adverse effects, Female, Glomerular Filtration Rate physiology, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Time Factors, Coronary Artery Disease surgery, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention methods, Renal Insufficiency therapy
- Abstract
Aim: The purpose of this study is to determine whether ad hoc (same session) percutaneous coronary intervention, and staged (multiple session) percutaneous coronary intervention (PCI) have different renal outcomes., Methods and Results: This is a retrospective cohort study that compares the maximal decline in glomerular filtration rate (GFR) at various times points (3-6days, 1-4weeks, 4-12weeks) after either ad hoc or staged PCI. 115 patients undergoing staged PCI and 115 matched ad hoc PCI controls were included in the study. They were equivalent in baseline GFR, left ventricular ejection fraction and intra-procedural volume status based on LVEDP. The group undergoing staged PCI had greater cumulative fluoroscopy time, SYNTAX score and number of stents placed. Staged PCIs used less contrast per catheterization (155.0±5.6mL) but higher cumulative contrast dose (326.6±14.0mL) compared to ad hoc PCIs (193.4±7.2mL). Following intervention, there was a progressive decline in renal function that did not significantly differ between the ad hoc and staged groups. In the subgroup of patients with initial GFR ≤60cm
3 /min, staged PCI was associated with 2.6-fold greater decline in renal function 4-12weeks after the procedure compared to ad hoc. A propensity match analysis performed in patients with GFR ≤60cm3 /min confirmed worse renal function in the staged group at 4-12weeks., Conclusions: Staged PCI exposes patients to greater cumulative contrast agent loads. The decline in renal function observed in both groups did not differ significantly, however worse renal outcomes were observed in the staged PCI group with baseline GFR ≤60cm3 /min., (Copyright © 2017 Elsevier Inc. All rights reserved.)- Published
- 2017
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- View/download PDF
24. Letter by Naranjo et al Regarding Article, "Hemodynamic Support With a Micro-Axial Percutaneous Left Ventricular Assist Device (Impella) Protects Against Acute Kidney Injury in Patients Undergoing High-Risk Percutaneous Coronary Intervention".
- Author
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Naranjo M, Rangaswami J, and Witzke C
- Subjects
- Hemodynamics, Humans, Acute Kidney Injury, Heart-Assist Devices, Percutaneous Coronary Intervention
- Published
- 2017
- Full Text
- View/download PDF
25. Bland and broken hearted: A case of hyponatremia induced Tako-tsubo cardiomyopathy.
- Author
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Patnaik S, Punjabi C, Nathan R, Khurram I, Witzke C, and Lai YK
- Subjects
- Aged, Female, Humans, Hyponatremia etiology, Takotsubo Cardiomyopathy complications
- Published
- 2015
- Full Text
- View/download PDF
26. Left ventricular end-diastolic pressure as an independent predictor of outcome during balloon aortic valvuloplasty.
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Cubeddu RJ, Don CW, Horvath SA, Gupta PP, Cruz-Gonzalez I, Witzke C, Inglessis I, and Palacios IF
- Subjects
- Aged, Aged, 80 and over, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis mortality, Aortic Valve Stenosis physiopathology, Boston, Cardiac Tamponade etiology, Cardiac Tamponade physiopathology, Chi-Square Distribution, Female, Heart Arrest etiology, Heart Arrest physiopathology, Hospital Mortality, Hospitals, General, Humans, Logistic Models, Male, Multivariate Analysis, Myocardial Infarction etiology, Myocardial Infarction physiopathology, Odds Ratio, Retrospective Studies, Risk Assessment, Risk Factors, Severity of Illness Index, Time Factors, Treatment Outcome, Aortic Valve Stenosis therapy, Balloon Valvuloplasty adverse effects, Balloon Valvuloplasty mortality, Ventricular Function, Left, Ventricular Pressure
- Abstract
Objectives: In this study, we examined the predictive value of the left ventricular end-diastolic pressure (LVEDP) in patients undergoing balloon aortic valvuloplasty (BAV)., Background: The LVEDP is a useful indicator of hemodynamic status in patients with severe aortic stenosis. In BAV, decompensated heart failure is associated with worse outcomes., Methods: We identified all consecutive patients with severe symptomatic aortic stenosis who underwent retrograde BAV at the Massachusetts General Hospital from 2004 to 2008. Patients were stratified and compared according to their baseline LVEDP into ≤15 mm Hg, 16-20 mm Hg, 21-25 mm Hg, and ≥26 mm Hg. Procedural and in-hospital outcomes and adverse events were compared. Multivariate logistic regression was used for the adjusted analysis., Results: A total of 111 patients with a mean age of 83±11 years underwent BAV. Of these, the LVEDP was ≤15 mm Hg in 29 (26%), 16-20 mm Hg in 41 (37%), 21-25 mm Hg in 16 (14%), and ≥26 mm Hg in 25 (23%) patients. Baseline characteristics were similar among the four groups. Noticeably, patients with high LVEDP levels had significantly higher rates of the combined endpoint of in-hospital death, myocardial infarction (MI), cardiopulmonary arrest, and tamponade was P = 0.02. Periprocedural MI was more common among those with higher LVEDP (16% vs. 2.3%; P = 0.04). Multivariate analysis revealed LVEDP (OR 1.08, for each mm Hg increase in pressure, 95 % CI 1.02-1.14), small LV chamber size, and New York Heart Association class as independent predictors of adverse outcomes., Conclusions: The LVEDP is an important independent predictor of poor in-hospital outcome during BAV. In these patients, the immediate hemodynamic status may be more important than the baseline left ventricular systolic function. Hemodynamic optimization before or during BAV should be considered and may be beneficial., (Copyright © 2013 Wiley Periodicals, Inc., a Wiley company.)
- Published
- 2014
- Full Text
- View/download PDF
27. Spontaneous coronary artery dissection: a rare cause of acute coronary syndrome.
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Junpaparp P, Romero-Corral A, Lee SY, and Witzke C
- Subjects
- Acute Coronary Syndrome diagnosis, Adult, Coronary Vessel Anomalies complications, Humans, Male, Vascular Diseases complications, Vascular Diseases diagnosis, Acute Coronary Syndrome etiology, Coronary Vessel Anomalies diagnosis, Vascular Diseases congenital
- Abstract
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction, which should always be included in differential diagnoses of acute coronary syndrome among young patients without known atherosclerotic risk. Although, it is commonly observed in young women during postpartum period, there were cases reported in connective tissue disorders, eosinophilic arteritis, contraception use, cocaine abuse and repetitive chest trauma. We report a case of SCAD, presenting with acute ST-elevation myocardial infarction, which was successfully treated conservatively.
- Published
- 2014
- Full Text
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28. A different kind of Christmas tree: anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA).
- Author
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Afolabi-Brown O, Witzke C, Moldovan R, and Pressman G
- Subjects
- Female, Humans, Middle Aged, Rare Diseases diagnostic imaging, Arterio-Arterial Fistula congenital, Arterio-Arterial Fistula diagnostic imaging, Coronary Vessel Anomalies diagnostic imaging, Echocardiography methods, Pulmonary Artery abnormalities, Pulmonary Artery diagnostic imaging
- Abstract
Anomalous right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital coronary anomaly that has an incidence of 0.002%. We report a case of a previously healthy female who presented to our hospital with pneumonia and was incidentally discovered to have ARCAPA. This was initially diagnosed on echocardiography by the unusual echocardiographic finding of multiple color flow Doppler signals around the right ventricular free wall and apex which were subsequently confirmed by angiography to be due to extensive collateral circulation between the left and right coronary arteries. This represents an unusual echocardiographic manifestation of this very rare condition., (© 2013, Wiley Periodicals, Inc.)
- Published
- 2014
- Full Text
- View/download PDF
29. Percutaneous embolization of a giant collateral vessel originating from the azygos vein via the inferior vena cava.
- Author
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Witzke C, Bhatt A, and Inglessis I
- Subjects
- Azygos Vein diagnostic imaging, Azygos Vein physiopathology, Cardiac Surgical Procedures, Heart Defects, Congenital diagnosis, Heart Defects, Congenital physiopathology, Heart Defects, Congenital surgery, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Phlebography, Treatment Outcome, Vascular Malformations complications, Vascular Malformations diagnosis, Vascular Malformations physiopathology, Vena Cava, Inferior diagnostic imaging, Vena Cava, Inferior physiopathology, Abnormalities, Multiple, Azygos Vein abnormalities, Collateral Circulation, Embolization, Therapeutic, Heart Defects, Congenital complications, Vascular Malformations therapy, Vena Cava, Inferior abnormalities
- Abstract
We present the case of a 45-year-old man with univentricular heart, small outlet chamber, and L-transposition of the great vessels. As an infant, the patient underwent multiple palliative surgical interventions. He presented with worsening dyspnea and fatigue and was found to have systemic oxygen saturation of 85% on 2 L of oxygen by nasal cannula, whereas he had chronically remained between 90 and 95% throughout most of adulthood. There was no evidence of significant valvular regurgitation or stenosis, nor was there an overt intracardiac shunt by echocardiography. Cardiac CT and cardiac MRI revealed a large serpiginous systemic to pulmonary venovenous collateral located behind the left atrium. The collateral drained into the lower right pulmonary vein as it entered the left atrium. The tributary veins to the "giant" collateral were determined by these images modalities. The patient underwent a percutaneous embolization of this giant venovenous collateral via a remnant supracardinal vein originating from the infrarenal inferior vena cava using two Amplatzer Vascular Plug II. Immediately after the procedure the patient's oxygen saturation increased to 90% on room air at rest. At 2 months follow-up the patient had a marked clinical improvement with oxygen saturation as high as 95% on room air while walking. Our case illustrates a successful embolization of a giant collateral via an embryological venous remnant connecting the IVC to the azygos system., (Copyright © 2012 Wiley Periodicals, Inc.)
- Published
- 2013
- Full Text
- View/download PDF
30. Patients with small left ventricular size undergoing balloon aortic valvuloplasty have worse intraprocedural outcomes.
- Author
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Don C, Gupta PP, Witzke C, Kesarwani M, Cubeddu RJ, Inglessis I, and Palacios IF
- Subjects
- Aged, Aged, 80 and over, Aortic Valve pathology, Aortic Valve physiopathology, Aortic Valve Stenosis complications, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis physiopathology, Body Surface Area, Boston, Calcinosis complications, Calcinosis diagnosis, Calcinosis physiopathology, Female, Hospitals, General, Humans, Hypertrophy, Left Ventricular diagnosis, Hypertrophy, Left Ventricular physiopathology, Linear Models, Logistic Models, Male, Multivariate Analysis, Odds Ratio, Retrospective Studies, Risk Assessment, Risk Factors, Severity of Illness Index, Stroke Volume, Treatment Outcome, Ultrasonography, Ventricular Function, Left, Aortic Valve Stenosis therapy, Balloon Valvuloplasty adverse effects, Calcinosis therapy, Heart Ventricles diagnostic imaging, Heart Ventricles physiopathology, Hypertrophy, Left Ventricular etiology
- Abstract
Objectives: To evaluate the impact of left ventricular (LV) chamber size on procedural and hospital outcomes of patients undergoing aortic valvuloplasty., Background: Balloon aortic valvuloplasty (BAV) is used as an integral step during transcatheter aortic valve implantation. Patients with small, thickened ventricles are thought to have more complications during and following BAV., Methods: Retrospective study of consecutive patients with severe, symptomatic calcific aortic stenosis who underwent retrograde BAV at Massachusetts General Hospital. We compared patients with left ventricular end-diastolic diameters (LVEDD) <4.0 cm (n = 31) to those with LVEDD ≥4.0 cm (n = 78). Baseline and procedural characteristics as well as clinical outcomes were compared. Multivariate logistic regression was used for the adjusted analysis., Results: Patients with smaller LV chamber size were mostly women (80.7% vs. 19.4%, P < 0.01) and had a smaller body surface area (BSA), (1.61 ± 0.20 m(2) vs. 1.79 ± 0.25 m(2) , P < 0.01). Patients with smaller LV chamber size had higher ejection fractions and thicker ventricles. Otherwise, baseline characteristics were similar. The intraprocedural composite of death, cardiopulmonary arrest, intubation, hemodynamic collapse, and tamponade was higher for patients with LVEDD < 4.0 cm (32.3% v. 11.5%, P = 0.01). Adjusting for age, gender, BSA, LV pressure, and New York Heart Association class, LVEDD < 4.0 cm remained an independent predictor of procedural (OR 5.1, 95% CI 1.4-18.2) and in-hospital complications (OR 3.8, 95% CI 1.2-11.6)., Conclusions: Compared to patients undergoing BAV with LVEDD ≥4.0 cm, those with smaller LV chambers had worse procedural and in-hospital outcomes., (Copyright © 2012 Wiley Periodicals, Inc.)
- Published
- 2012
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31. Real-time three-dimensional transesophageal echocardiography in patients with secundum atrial septal defects: outcomes following transcatheter closure.
- Author
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Johri AM, Witzke C, Solis J, Palacios IF, Inglessis I, Picard MH, and Passeri JJ
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Ultrasonography, Interventional, Cardiac Catheterization, Echocardiography, Three-Dimensional methods, Echocardiography, Transesophageal methods, Heart Septal Defects, Atrial diagnostic imaging, Heart Septal Defects, Atrial surgery, Septal Occluder Device
- Abstract
Background: Successful transcatheter closure of atrial septal defects (ASDs) requires the accurate assessment of defect size and morphology. Assessment of ASD anatomy may be difficult by two-dimensional (2D) echocardiography. The aim of this study was to test the hypothesis that real-time three-dimensional (3D) transesophageal echocardiography (TEE) may provide more accurate morphologic assessment of ASDs than multiplane 2D TEE., Methods: Twenty-four patients with ASDs were imaged using 2D and real-time 3D TEE. ASD shape and size were assessed using 3D TEE retrospectively. Maximal ASD dimensions obtained by 3D TEE were compared with unstretched and balloon-stretched dimensions on 2D TEE. Planimetered defect area by 3D TEE was compared with area calculated using the ellipse formula from 2D imaging. Twenty of the 24 patients underwent transcatheter ASD closure. Closure device size was based on findings on 2D TEE. Follow-up was conducted by 2D transthoracic echocardiography., Results: Of the 24 ASDs, 6 (25%) were circular, 10 (42%) were oval, and 8 (33%) were complex in shape. The mean maximal dimension was larger by 3D TEE compared with 2D TEE (1.8 ± 0.8 vs 1.5 ± 0.6 cm; P < .05). There was no difference in the mean area measured by either modality, but for complex-shaped defects, area measured by 3D TEE was larger than that by 2D TEE (2.8 ± 1.3 vs 1.7 ± 1.4 cm(2); P < .05). Follow-up transthoracic echocardiography was available for 19 of the 20 patients undergoing transcatheter closure. Nine patients had residual right-to-left shunting 1 to 6 months after ASD closure, and the majority of these were complex in shape. In patients with residual shunting, ASD area by 3D TEE was 27% larger than by 2D TEE, whereas in patients without residual shunting, there was significantly less discrepancy between 3D and 2D areas (19%; P = .0027)., Conclusions: Three-dimensional TEE can identify ASD shape. Maximal dimensions on 3D TEE were well correlated with balloon-stretched 2D dimensions. Two-dimensional TEE can underestimate the area of complex-shaped ASDs, which may result in residual right-to-left shunting., (Copyright © 2011 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
32. Impact of rapid ventricular pacing during percutaneous balloon aortic valvuloplasty in patients with critical aortic stenosis: should we be using it?
- Author
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Witzke C, Don CW, Cubeddu RJ, Herrero-Garibi J, Pomerantsev E, Caldera A, McCarty D, Inglessis I, and Palacios IF
- Subjects
- Aged, Aged, 80 and over, Cardiac Catheterization, Female, Humans, Male, Retrospective Studies, Treatment Outcome, Aortic Valve Stenosis therapy, Cardiac Pacing, Artificial, Catheterization
- Abstract
Background: Rapid ventricular pacing (RP) during percutaneous balloon aortic valvuloplasty (BAV) facilitates balloon positioning by preventing the "watermelon seeding" effect during balloon inflation. The clinical consequences of RP BAV have never been compared with standard BAV in which rapid pacing in not used. We evaluated the immediate results and in-hospital adverse events of patients with severe aortic stenosis (AS) undergoing BAV with and without RP., Methods: This is a retrospective study of patients with severe AS undergoing retrograde BAV. Patients who underwent BAV with RP were compared to those who did not receive RP during BAV. Procedural outcomes, complications, and in-hospital adverse events were compared between both groups. Stratified analyses were performed to evaluate RP in pre-specified subsets for confounding and effect modification., Results: Between January 2005 and December 2008, 111 consecutive patients underwent retrograde BAV at Massachusetts General Hospital. Sixty-seven patients underwent BAV with RP. Nearly 90% of patients were NYHA class III or IV and the mean AVA was 0.64 cm(2). Baseline characteristics and balloon sizes were similar in the two groups. The average post-BAV AVA was smaller in the RP group compared to the no-RP group (0.87 v. 1.02 cm(2), p = 0.02). Pre and post-cardiac output, in-hospital mortality, myocardial infarction, stroke, frequency of cardiopulmonary arrest, vasopressor use, and major complications were similar in the two groups., Conclusions: 1) RP allows precise balloon placement during BAV. 2) RP BAV is associated with lower post-BAV AVA. 3) RP BAV may be safely performed in patients with high-risk cardiac features.
- Published
- 2010
- Full Text
- View/download PDF
33. The no-reflow phenomenon in the coronary circulation.
- Author
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Kiernan TJ, Ruggiero NJ 2nd, Bernal JM, Don CW, Witzke C, Kiernan GD, Cubeddu RJ, and Yan BP
- Subjects
- Adenosine therapeutic use, Animals, Diltiazem therapeutic use, Humans, Nicardipine therapeutic use, Nicorandil therapeutic use, Nitroprusside therapeutic use, No-Reflow Phenomenon therapy, Prostheses and Implants, Vasodilator Agents therapeutic use, Verapamil therapeutic use, Coronary Circulation, No-Reflow Phenomenon drug therapy, No-Reflow Phenomenon physiopathology
- Abstract
The no-reflow phenomenon is a poorly understood complication of percutaneous coronary intervention in which diminished blood flow to distal microvascular beds persists despite the successful treatment of the occlusive lesion from the epicardial coronary artery or arteries. In this contemporary review we endeavour to discuss the pathophysiology of coronary no-reflow, understand the predictors and describe current pharmacological and mechanical strategies to prevent and treat coronary no-reflow.
- Published
- 2009
- Full Text
- View/download PDF
34. Sildenafil improves coronary artery patency in a canine model of platelet-mediated cyclic coronary occlusion after thrombolysis.
- Author
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Lewis GD, Witzke C, Colon-Hernandez P, Guerrero JL, Bloch KD, and Semigran MJ
- Subjects
- Animals, Aspirin pharmacology, Blood Coagulation drug effects, Blood Pressure drug effects, Coronary Circulation drug effects, Coronary Thrombosis blood, Dogs, Heart Rate drug effects, Heparin pharmacology, Periodicity, Platelet Aggregation drug effects, Purines, Sildenafil Citrate, Sulfones, Tissue Plasminogen Activator pharmacology, Coronary Thrombosis physiopathology, Coronary Vessels drug effects, Fibrinolytic Agents pharmacology, Phosphodiesterase Inhibitors pharmacology, Piperazines pharmacology, Vascular Patency drug effects
- Abstract
Objectives: We sought to assess the effect of sildenafil, a highly-specific type 5 phosphodiesterase (PDE5) inhibitor, on platelet-mediated cyclic coronary flow reductions occurring in a canine model of coronary thrombosis despite aspirin therapy., Background: The PDE5 inhibitors augment the antithrombotic effects of nitric oxide in vitro and in vivo, but it has been proposed that the PDE5 inhibitor sildenafil is prothrombotic., Methods: Cyclic coronary flow reductions were induced in the left anterior descending coronary artery by creation of a stenosis, endothelial injury, and thrombus formation followed by treatment with aspirin, heparin, and tissue plasminogen activator. After an initial observation period, dogs were treated with or without sildenafil (100 microg/kg bolus followed by 4 microg/kg/min infusion)., Results: Cyclic coronary flow reductions ceased in five of six animals 18 +/- 5 min after initiation of sildenafil but continued in all six control animals. The portion of the observation period during which the coronary artery was patent increased from 52 +/- 9% to 83 +/- 5% after sildenafil administration (p = 0.008) but did not differ between the first and second observation periods in untreated dogs (49 +/- 11% vs. 44 +/- 11%, respectively). Among animals with plasma free sildenafil levels > or =20 nmol/l, cyclic coronary flow reductions were 73 +/- 12% less frequent and the time to cessation of cycling 72 +/- 14% shorter than in animals with levels <20 nmol/l (p < 0.05 for both). Sildenafil transiently decreased blood pressure 7 +/- 1% but did not change heart rate. Sildenafil treatment reduced ex vivo thrombin-induced platelet aggregation by 39 +/- 3% (p < 0.005)., Conclusions: Sildenafil improves coronary patency in a canine model of platelet-mediated coronary artery thrombosis, likely via inhibition of platelet aggregation.
- Published
- 2006
- Full Text
- View/download PDF
35. Images in cardiovascular medicine. Transient left ventricular apical ballooning.
- Author
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Witzke C, Lowe HC, Waldman H, and Palacios IF
- Subjects
- Aged, Chest Pain etiology, Diastole, Echocardiography, Electrocardiography, Female, Humans, Mitral Valve Insufficiency complications, Mitral Valve Insufficiency diagnosis, Radiography, Recovery of Function, Stroke Volume, Systole, Ventricular Dysfunction, Left complications, Ventricular Dysfunction, Left diagnostic imaging, Heart Ventricles diagnostic imaging, Heart Ventricles physiopathology, Ventricular Dysfunction, Left diagnosis
- Published
- 2003
- Full Text
- View/download PDF
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