Medicine and Health Sciences Commons^™

Management And Outcomes Of Cardiogenic Shock In Cardiac Icus With Versus Without Shock Teams., Alexander I Papolos, Benjamin B Kenigsberg, David D Berg, Carlos L Alviar, Erin Bohula, James A Burke Md, Anthony P Carnicelli, Sunit-Preet Chaudhry, Stavros Drakos, Daniel A Gerber, Jianping Guo, James M Horowitz, Jason N Katz, Ellen C Keeley, Thomas S Metkus, Jose Nativi-Nicolau, Jeffrey R Snell, Shashank S Sinha, Wayne J Tymchak, Sean Van Diepen, David A Morrow, Christopher F Barnett

Cardiology Division

BACKGROUND: Single-center studies suggest that implementation of multidisciplinary cardiogenic shock (CS) teams is associated with improved CS survival.

OBJECTIVES: The aim was to characterize practice patterns and outcomes in the management of CS across multiple centers with versus without shock teams.

METHODS: The Critical Care Cardiology Trials Network is a multicenter network of cardiac intensive care units (CICUs) in North America. All consecutive medical admissions to each CICU (n = 24) were captured during annual 2-month collection periods (2017-2019; n = 6,872). Shock management and CICU mortality among centers with versus without shock teams were compared using inverse probability weighting. …

Myocardial T1 And T2 Mapping By Magnetic Resonance In Patients With Immune Checkpoint Inhibitor-Associated Myocarditis., Paaladinesh Thavendiranathan, Lili Zhang, Amna Zafar, Zsofia D Drobni, Syed S Mahmood, Marcella Cabral, Magid Awadalla, Anju Nohria, Daniel A Zlotoff, Franck Thuny, Lucie M Heinzerling, Ana Barac, Ryan J Sullivan, Carol L Chen, Dipti Gupta, Michael C Kirchberger, Sarah E Hartmann, Jonathan W Weinsaft, Hannah K Gilman, Muhammad A. Rizvi Md, Bojan Kovacina, Caroline Michel, Gagan Sahni, Ana González-Mansilla, Antonio Calles, Francisco Fernández-Avilés, Michael Mahmoudi, Kerry L Reynolds, Sarju Ganatra, Juan José Gavira, Nahikari Salterain González, Manuel García De Yébenes Castro, Raymond Y Kwong, Michael Jerosch-Herold, Otavio R Coelho-Filho, Jonathan Afilalo, Eduardo Zataraín-Nicolás, A John Baksi, Bernd J Wintersperger, Oscar Calvillo-Arguelles, Stephane Ederhy, Eric H Yang, Alexander R Lyon, Michael G Fradley, Tomas G Neilan

Hematology-Medical Oncology Division

BACKGROUND: Myocarditis is a potentially fatal complication of immune checkpoint inhibitor (ICI) therapy. Data on the utility of cardiovascular magnetic resonance (CMR) T1 and T2 mapping in ICI myocarditis are limited.

OBJECTIVES: This study sought to assess the value of CMR T1 and T2 mapping in patients with ICI myocarditis.

METHODS: In this retrospective study from an international registry of patients with ICI myocarditis, clinical and CMR findings (including T1 and T2 maps) were collected. Abnormal T1 and T2 were defined as 2 SD above site (vendor/field strength specific) reference values and a z-score was calculated for each patient. Major …

Risk Stratification Among Survivors Of Cardiac Arrest Considered For Coronary Angiography., Ahmed A Harhash, Teresa L May, Chiu-Hsieh Hsu, Sachin Agarwal, David B Seder, Michael R Mooney, Nainesh C. Patel Md, John Mcpherson, Paul Mcmullan, Richard Riker, Eldar Soreide, Karen G Hirsch, Pascal Stammet, Alison Dupont, Sten Rubertsson, Hans Friberg, Niklas Nielsen, Tanveer Rab, Karl B Kern

Cardiology Division

BACKGROUND: The American College of Cardiology Interventional Council published consensus-based recommendations to help identify resuscitated cardiac arrest patients with unfavorable clinical features in whom invasive procedures are unlikely to improve survival.

OBJECTIVES: This study sought to identify how many unfavorable features are required before prognosis is significantly worsened and which features are most impactful in predicting prognosis.

METHODS: Using the INTCAR (International Cardiac Arrest Registry), the impact of each proposed "unfavorable feature" on survival to hospital discharge was individually analyzed. Logistic regression was performed to assess the association of such unfavorable features with poor outcomes.

RESULTS: Seven unfavorable features (of …

Mechanical Thrombectomy For Acute Ischemic Stroke In The Cardiac Catheterization Laboratory., Steven A Guidera, Sudhir Aggarwal, J Doyle Walton, David Boland, Roy Jackel, Jeffrey D Gould, Brooke Kearins, Joseph Mcgarvey, Yan Qi, Brian Furlong

Department of Radiology & Diagnostic Medical Imaging

OBJECTIVES: The aim of this study was to determine the feasibility of establishing a mechanical thrombectomy (MT) program for acute ischemic stroke in a community hospital using interventional cardiologists working closely with neurologists.

BACKGROUND: American Heart Association/American Stroke Association 2018 guidelines give a Class I (Level of Evidence: A) recommendation for MT in eligible patients with large vessel occlusion stroke. Improvement in neurological outcomes with MT is highly time sensitive. Most hospitals do not have trained neurointerventionalists to perform MT, leading to treatment delays that reduce the benefit of reperfusion therapy.

METHODS: An MT program based in the cardiac catheterization …

Global Longitudinal Strain And Cardiac Events In Patients With Immune Checkpoint Inhibitor-Related Myocarditis., Magid Awadalla, Syed S Mahmood, John D Groarke, Malek Z O Hassan, Anju Nohria, Adam Rokicki, Sean P Murphy, Nathaniel D Mercaldo, Lili Zhang, Daniel A Zlotoff, Kerry L Reynolds, Raza M Alvi, Dahlia Banerji, Shiying Liu, Lucie M Heinzerling, Maeve Jones-O'Connor, Rula B Bakar, Justine V Cohen, Michael C Kirchberger, Ryan J Sullivan, Dipti Gupta, Connor P Mulligan, Sachin P Shah, Sarju Ganatra, Muhammad A. Rizvi Md, Gagan Sahni, Carlo G Tocchetti, Donald P Lawrence, Michael Mahmoudi, Richard B Devereux, Brian J Forrestal, Anant Mandawat, Alexander R Lyon, Carol L Chen, Ana Barac, Judy Hung, Paaladinesh Thavendiranathan, Michael H Picard, Franck Thuny, Stephane Ederhy, Michael G Fradley, Tomas G Neilan

Department of Medicine

BACKGROUND: There is a need for improved methods for detection and risk stratification of myocarditis associated with immune checkpoint inhibitors (ICIs). Global longitudinal strain (GLS) is a sensitive marker of cardiac toxicity among patients receiving standard chemotherapy. There are no data on the use of GLS in ICI myocarditis.

OBJECTIVES: This study sought to evaluate the role of GLS and assess its association with cardiac events among patients with ICI myocarditis.

METHODS: This study retrospectively compared echocardiographic GLS by speckle tracking at presentation with ICI myocarditis (cases, n = 101) to that from patients receiving an ICI who did not …

Cognitive Decline Over Time In Patients With Systolic Heart Failure: Insights From Warcef., Tetz C Lee, Min Qian, Yutong Liu, Susan Graham, Douglas L Mann, Koki Nakanishi, John R Teerlink, Gregory Y H Lip, Ronald S. Freudenberger Md, Ralph L Sacco, Jay P Mohr, Arthur J Labovitz, Piotr Ponikowski, Dirk J Lok, Kenji Matsumoto, Conrado Estol, Stefan D Anker, Patrick M Pullicino, Richard Buchsbaum, Bruce Levin, John L P Thompson, Shunichi Homma, Marco R Di Tullio

Department of Medicine

OBJECTIVES: This study sought to characterize cognitive decline (CD) over time and its predictors in patients with systolic heart failure (HF).

BACKGROUND: Despite the high prevalence of CD and its impact on mortality, predictors of CD in HF have not been established.

METHODS: This study investigated CD in the WARCEF (Warfarin versus Aspirin in Reduced Ejection Fraction) trial, which performed yearly Mini-Mental State Examinations (MMSE) (higher scores indicate better cognitive function; e.g., normal score: 24 or higher). A longitudinal time-varying analysis was performed among pertinent covariates, including baseline MMSE and MMSE scores during follow-up, analyzed both as a continuous variable …

Reply: Do We Need Individualized Therapeutic Strategies In High-Risk Patients Treated With Hypothermia?, Neeraj Shah Md, Rahul Chaudhary, Kathan Mehta, Vratika Agarwal, Jalaj Garg Md, Ronald S. Freudenberger Md, Larry E. Jacobs Md, David A. Cox Md, Karl B Kern, Nainesh C. Patel Md

Cardiology Division

No abstract provided.

2015 Scai/Acc/Hfsa/Sts Clinical Expert Consensus Statement On The Use Of Percutaneous Mechanical Circulatory Support Devices In Cardiovascular Care: Endorsed By The American Heart Assocation, The Cardiological Society Of India, And Sociedad Latino Americana De Cardiologia Intervencion; Affirmation Of Value By The Canadian Association Of Interventional Cardiology-Association Canadienne De Cardiologie D'Intervention., Charanjit S Rihal, Srihari S Naidu, Michael M Givertz, Wilson Y Szeto, James A. Burke Md, Phd, Navin K Kapur, Morton Kern, Kirk N Garratt, James A Goldstein, Vivian Dimas, Thomas Tu

Cardiology Division

Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella(®); left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those …

Troponin Leak Associated With Drug-Induced Methemoglobinemia., Robert D. Cannon Do, Michael Wagner, Jeanne L. Jacoby Md

Department of Emergency Medicine

Drug-induced methemoglobinemia is a well-described entity but has not been previously associated with elevated troponins in the absence of cardiac symptoms. We report a case of a patient presenting to the emergency department (ED) with complaints related to an exacerbation of her long-standing cystitis. A low pulse oximetry reading prompted an evaluation, revealing a troponin leak, which peaked at 10 hours. Her methemoglobin level was found to be elevated at 11.4%, but a preexisting anemia apparently prevented the clinical recognition of cyanosis. The methemoglobinemia was determined to be secondary to her ingestion of phenazopyridine and trimethoprim-sulfa methoxizole. Although phenazopyridine and …

Post-Prandial Upright Exercise Echocardiography In Hypertrophic Cardiomyopathy, Ellina C. Feiner Md, Milla Arabadjian Fnp, Glenda Winson Rn, Bette Kim Md, Farooq Chaudhry Md, Mark V. Sherrid Md

Department of Medicine

No abstract provided.

Ranolazine Is Effective For Acute Or Chronic Ischemic Dysfunction With Heart Failure, Sudip Nanda Md, Facp, Matthew W. Martinez Md, Tanujit Dey Phd

Department of Medicine

No abstract provided.

Small Bowel Strangulation As Yet Another Complication Of The Rectus Abdominis Donor Site., Geoffrey G. Hallock Md

Department of Surgery

No abstract provided.

Re: Midpalmar Approach To The Carpal Tunnel: An Alternative To Endoscopic Release., Robert X. Murphy Jr, Md, Ms

Department of Surgery

No abstract provided.

Prefabrication Of A Secondary Tram Flap., Geoffrey G. Hallock Md

Department of Surgery

A secondary TRAM flap was prefabricated in a rat model using the rectus muscle. The right rectus muscle was elevated as an inferiorly pedicled muscle flap in one experimental group (n = 6) and as a superiorly pedicled muscle flap in a second group (n = 5) and then sandwiched between a silicone sheet and the abdominal skin. Two weeks later, the abdominal skin and attached rectus muscle were elevated over the silicone sheet as a secondary TRAM flap. The surviving skin paddle areas of these prefabricated TRAM flaps were compared with superiorly (n = 7) and inferiorly (n = …

Complications, Untoward Events, And Reality., Geoffrey G. Hallock Md

Department of Surgery

The only surgeons who do not have deal with complications are those who do not operate.1

The Rat Tram Flap: A Human Analogue?, Geoffrey G. Hallock Md

Department of Surgery

No abstract provided.

Cosmetic Trauma Surgery., Geoffrey G. Hallock Md

Department of Surgery

No abstract provided.

Re: Recertification., Geoffrey G. Hallock Md

Department of Surgery

No abstract provided.

In Defense Of Intrauterine Repair Of Cleft Lip., Geoffrey G. Hallock Md

Department of Surgery

No abstract provided.

The Radial Forearm Donor Site: A Locus Minoris Resistentiae., Geoffrey G. Hallock Md

Department of Surgery

No abstract provided.

Psammoma Bodies In Neuroendocrine Carcinoma Of The Uterine Cervix., V L. Russin, Philip T. Valente, P Hanjani

Department of Pathology & Laboratory Medicine

No abstract provided.