Purpose: Regadenoson (REG) is currently becoming the stress agent of choice in patients undergoing pharmacologic single photon emission computed tomography (SPECT). However, in patients with left bundle branch block (...Purpose: Regadenoson (REG) is currently becoming the stress agent of choice in patients undergoing pharmacologic single photon emission computed tomography (SPECT). However, in patients with left bundle branch block (LBBB) and ventricular paced rhythm (VPR), hesitation exists amongst clinicians to use REG-SPECT due to the concern that the increased heart rate could cause false positive SPECT results. We sought to evaluate the comparability of A-SPECT and REG-SPECT in patients with LBBB and VPR. Methods: Retrospective study of 30 patients who served as their own controls. All 30 patients who underwent REG-SPECT (Grp 1) were compared to their prior A-SPECT (Grp 2) done within two years prior to REG-SPECT. Heart rate (HR) and blood pressure (BP) parameters, ECG, stress perfusion and gated variables, SPECT ischemia, and side-effects were evaluated. Statistical significance was set at P < 0.05. Results: Grp 1 and Grp 2 were comparable in hemodynamic parameters with increase in HR and decrease in systolic and diastolic BP with administration of adenosine and REG stress agents. However, there were no significant differences found in hemodynamic parameters and II degree AV block between the groups. All normal A-SPECT were found to be normal with REG-SPECT. No differences could be found between the two groups among SPECT parameters. Muscle pain was significantly higher in REG (10.0% vs. 0.0%, P = 0.083) and so was the use of aminophylline (16.7% vs. 0.0%, P = 0.025) to relieve the side-effect. Conclusion: REG-SPECT can be administered in patients with LBBB and VPR patients based on favorable and comparable hemodynamic responses and arrhythmia occurrences to A-SPECT. REG-SPECT can also be used for adequate interpretation of presence or absence of SPECT ischemia particularly in the LAD territory without any concern for false positive perfusion defects.展开更多
As an effort to understand the effect of diabetes on the increasing rate of COVID-19 infection, we embarked upon a detailed statistical analysis of various datasets that include COVID-19 infection and mortality rate, ...As an effort to understand the effect of diabetes on the increasing rate of COVID-19 infection, we embarked upon a detailed statistical analysis of various datasets that include COVID-19 infection and mortality rate, diabetes and diseases that may contribute to the severity and risk factor of diabetes in individuals and this impact on COVID-19 and the mortality rate. These diseases include respiratory diseases, cardiovascular diseases, and obesity. Equally significant is the statistical analysis on ethnicity, age, and sex on COVID-19 infection as well as mortality rate. Their possible contributions to increasing the severity and risk factor of diabetes as a risk to mortality to individuals who have COVID-19. Objectives: The ultimate objectives of this investigation are as follow: 1) Is there a risk factor of diabetes on COVID-19 infection and increasing mortality rate? 2) To what extent do other disease conditions that include, obesity, heart failure, and respiratory diseases influence the severity and risk factor of diabetes on increasing COVID-19 infection and mortality rate? 3) To what extent does age, race, and gender increase the mortality of COVID-19 and increase the severity and risk factor of diabetes on COVID-19 mortality rate? 4) How and why COVID-19 virus increases the risk of diabetes in children? 5) Diabetes and COVID-19: Who is most at Risk? Lastly, understanding the misconception of COVID-19 and diabetes.展开更多
BACKGROUND Intravascular lithotripsy(IVL)is a novel technique increasingly used for plaque modification and endovascular revascularization in patients with severe calcification and peripheral artery disease.However,mu...BACKGROUND Intravascular lithotripsy(IVL)is a novel technique increasingly used for plaque modification and endovascular revascularization in patients with severe calcification and peripheral artery disease.However,much of the available literature on IVL is focused on its use in coronary arteries,with relatively limited data on non-coronary artery use.AIM To analyze the safety and efficacy of current IVL use in non-coronary artery lesions,as reported in case reports and case series.METHODS We searched EMBASE,PubMed,and Reference Citation Analysis databases for case reports and case series on IVL use in peripheral artery disease.We then extracted variables of interest and calculated the mean and proportions of these variables.RESULTS We included 60 patients from 33 case reports/case series.Ninety-eight percent of the cases had IVL usage in only one blood vessel,while four had the IVL used in two vessels(2.0%),resulting in 64 Lesions treated with IVL.The mean age of the patients was 73.7(SD 10.9).IVL was successfully used in severe iliofemoral artery stenosis(51.6%),severe innominate,subclavian,and carotid artery stenosis(26.7%combined),and severe mesenteric vessel stenosis(9.4%).Additionally,IVL was successfully used in severe renal(7.8%)and aortic artery(4.7%)stenosis.There were complications in 12%of the cases,with dissection being the commonest.CONCLUSION IVL has successfully used in plaque modification and endovascular revascularization in severely calcified and challenging lesions in the iliofemoral,carotid,subclavian,aorta,renal,and mesenteric vessels.The most severe but transient complications were with IVL use in the aortic arch and neck arteries.展开更多
Inflammation is an important component of active atherosclerotic disease. C-reactive protein (CRP)is a non-specific inflammatory marker that is increased in inflammatory conditions. Newer more sensitive assays (high s...Inflammation is an important component of active atherosclerotic disease. C-reactive protein (CRP)is a non-specific inflammatory marker that is increased in inflammatory conditions. Newer more sensitive assays (high sensitivity CRP) can detect the low levels of inflammation associated with vascular disease. CRP levels can give further risk assessment to individuals beyond predictions from traditional risk factors. This measurement is most useful in helping to discriminate risk in intermediate risk patients such as metabolic syndrome patients. Exercise and weight loss have been shown to significantly lower CRP levels. Lipid lowering therapies, especially with the statin class of medications, also lower CRP levels. A reduction in inflammation may be an important component of plaque stabilization and contribute to cardiovascular risk reduction.展开更多
Over the last three years,research has focused on examining cardiac issues arising from coronavirus disease 2019(COVID-19)infection,including the emergence of new-onset atrial fibrillation(NOAF).Still,no clinical stud...Over the last three years,research has focused on examining cardiac issues arising from coronavirus disease 2019(COVID-19)infection,including the emergence of new-onset atrial fibrillation(NOAF).Still,no clinical study was conducted on the persistence of this arrhythmia after COVID-19 recovery.Our objective was to co-mpose a narrative review that investigates COVID-19-associated NOAF,emphasi-zing the evolving pathophysiological mechanisms akin to those suggested for sustaining AF.Given the distinct strategies involved in the persistence of atrial AF and the crucial burden of persistent AF,we aim to underscore the importance of extended follow-up for COVID-19-associated NOAF.A comprehensive search was conducted for articles published between December 2019 and February 11,2023,focusing on similarities in the pathophysiology of NOAF after COVID-19 and those persisting AF.Also,the latest data on incidence,morbidity-mortality,and management of NOAF in COVID-19 were investigated.Considerable overlaps between the mechanisms of emerging NOAF after COVID-19 infection and persistent AF were observed,mostly involving reactive oxygen pathways.With potential atrial remodeling associated with NOAF in COVID-19 patients,this group of patients might benefit from long-term follow-up and different management.Future cohort studies could help determine long-term outcomes of NOAF after COVID-19.展开更多
Background:Pancreatic cancer is the third leading cause of cancer death in the US.There have been postulates of racial disparities.Based on this,we primarily examined the presence of race,for the diagnosis and treatme...Background:Pancreatic cancer is the third leading cause of cancer death in the US.There have been postulates of racial disparities.Based on this,we primarily examined the presence of race,for the diagnosis and treatment of pancreatic cancer.Methods:A retrospective review was conducted on patients with pancreatic cancers using the Surveillance Epidemiology,and End Results-Medicare registry.Univariate and multivariate analyses were performed.Overall Survival analysis was done using the Kaplan-Meier curve.Comparison of survival curves was done using the log-rank test.Cox proportional hazards regression model was used to determine independent predictors of survival.Other areas focused on were time interval from diagnosis to treatment,“Predictors of surgery of the primary site,”“Predictors for recommending surgery of the primary site,”“Predictors for oncologic resection,”“Predictors of performance and refusal of surgery of primary site if recommended,”and“Predictors for any other therapy(all therapies excluding surgery)”.Results:A total of 52,951 patients were identified from the database.A total of 24,523 were males and 26,715 were females.A total of 81.9%were Caucasian,10.9%were Black,and 7.2%were other races.There was approximately equal distribution of the different stages between both genders.A total of 10.2%of the females were diagnosed at stage I,28.9%,9.3%,and 51.6%at stages I,III,and IV,respectively,compared to males with 8.4%,28.3%,9.2%,and 54.1%for stages I,II,III,and IV,respectively.A total of 9.5%of the Black patients were diagnosed at stage I,24.2%at stage II,10.1%at stage III,and 56.2%at stage IV.A similar distribution was noted in the other races.Black patients had worse overall survival when compared to Caucasians(P=.004)and other races(P=.001).Conclusion:Compared to Caucasian patients,Black patients with pancreatic cancer had worse overall survival.展开更多
Objective:To assess the radiation exposure in cardiovascular implantable electronic device(CIED)implantation procedures,the effect of fluoroscopy frame rate on various radiation exposure indices,and in-hospital outcom...Objective:To assess the radiation exposure in cardiovascular implantable electronic device(CIED)implantation procedures,the effect of fluoroscopy frame rate on various radiation exposure indices,and in-hospital outcomes.Methods:Data of CIED implantation procedures from September 2015 to December 2019 of all the CIED implantation procedures performed at our institute were retrospectively analyzed.The procedural data were divided into two groups:a)pre-group:procedures that were performed under fluoroscopy frame rate of 7.5 frames per second(fps);b)post-group:procedures that were performed under fluoroscopy frame rate of 3.75 fps.We compared procedure time,fluoroscopy time,Kerma air product,effective dose,and in-hospital outcomes between the two groups.Results:A total of 2,225 procedures were included in the analysis with mean age of(62±15)years.The procedures consisted of the implantation of single-chamber(n=1,436),double chamber(n=656),and biventricular devices(n=133).Procedure time and radiation indices showed a significant reduction over the study period(P<0.001).Reduction in the fluoroscopy frame rate was associated with a significant reduction in radiation exposure indices(P<0.001).In-hospital outcomes did not differ between the two groups.Conclusions:Reduction in the fluoroscopy frame rate from 7.5 to 3.75 fps significantly decreased the radiation exposure in CIED implantation procedures.A framerate lower than 3.75 fps should be the default setting during such procedures.展开更多
文摘Purpose: Regadenoson (REG) is currently becoming the stress agent of choice in patients undergoing pharmacologic single photon emission computed tomography (SPECT). However, in patients with left bundle branch block (LBBB) and ventricular paced rhythm (VPR), hesitation exists amongst clinicians to use REG-SPECT due to the concern that the increased heart rate could cause false positive SPECT results. We sought to evaluate the comparability of A-SPECT and REG-SPECT in patients with LBBB and VPR. Methods: Retrospective study of 30 patients who served as their own controls. All 30 patients who underwent REG-SPECT (Grp 1) were compared to their prior A-SPECT (Grp 2) done within two years prior to REG-SPECT. Heart rate (HR) and blood pressure (BP) parameters, ECG, stress perfusion and gated variables, SPECT ischemia, and side-effects were evaluated. Statistical significance was set at P < 0.05. Results: Grp 1 and Grp 2 were comparable in hemodynamic parameters with increase in HR and decrease in systolic and diastolic BP with administration of adenosine and REG stress agents. However, there were no significant differences found in hemodynamic parameters and II degree AV block between the groups. All normal A-SPECT were found to be normal with REG-SPECT. No differences could be found between the two groups among SPECT parameters. Muscle pain was significantly higher in REG (10.0% vs. 0.0%, P = 0.083) and so was the use of aminophylline (16.7% vs. 0.0%, P = 0.025) to relieve the side-effect. Conclusion: REG-SPECT can be administered in patients with LBBB and VPR patients based on favorable and comparable hemodynamic responses and arrhythmia occurrences to A-SPECT. REG-SPECT can also be used for adequate interpretation of presence or absence of SPECT ischemia particularly in the LAD territory without any concern for false positive perfusion defects.
文摘As an effort to understand the effect of diabetes on the increasing rate of COVID-19 infection, we embarked upon a detailed statistical analysis of various datasets that include COVID-19 infection and mortality rate, diabetes and diseases that may contribute to the severity and risk factor of diabetes in individuals and this impact on COVID-19 and the mortality rate. These diseases include respiratory diseases, cardiovascular diseases, and obesity. Equally significant is the statistical analysis on ethnicity, age, and sex on COVID-19 infection as well as mortality rate. Their possible contributions to increasing the severity and risk factor of diabetes as a risk to mortality to individuals who have COVID-19. Objectives: The ultimate objectives of this investigation are as follow: 1) Is there a risk factor of diabetes on COVID-19 infection and increasing mortality rate? 2) To what extent do other disease conditions that include, obesity, heart failure, and respiratory diseases influence the severity and risk factor of diabetes on increasing COVID-19 infection and mortality rate? 3) To what extent does age, race, and gender increase the mortality of COVID-19 and increase the severity and risk factor of diabetes on COVID-19 mortality rate? 4) How and why COVID-19 virus increases the risk of diabetes in children? 5) Diabetes and COVID-19: Who is most at Risk? Lastly, understanding the misconception of COVID-19 and diabetes.
文摘BACKGROUND Intravascular lithotripsy(IVL)is a novel technique increasingly used for plaque modification and endovascular revascularization in patients with severe calcification and peripheral artery disease.However,much of the available literature on IVL is focused on its use in coronary arteries,with relatively limited data on non-coronary artery use.AIM To analyze the safety and efficacy of current IVL use in non-coronary artery lesions,as reported in case reports and case series.METHODS We searched EMBASE,PubMed,and Reference Citation Analysis databases for case reports and case series on IVL use in peripheral artery disease.We then extracted variables of interest and calculated the mean and proportions of these variables.RESULTS We included 60 patients from 33 case reports/case series.Ninety-eight percent of the cases had IVL usage in only one blood vessel,while four had the IVL used in two vessels(2.0%),resulting in 64 Lesions treated with IVL.The mean age of the patients was 73.7(SD 10.9).IVL was successfully used in severe iliofemoral artery stenosis(51.6%),severe innominate,subclavian,and carotid artery stenosis(26.7%combined),and severe mesenteric vessel stenosis(9.4%).Additionally,IVL was successfully used in severe renal(7.8%)and aortic artery(4.7%)stenosis.There were complications in 12%of the cases,with dissection being the commonest.CONCLUSION IVL has successfully used in plaque modification and endovascular revascularization in severely calcified and challenging lesions in the iliofemoral,carotid,subclavian,aorta,renal,and mesenteric vessels.The most severe but transient complications were with IVL use in the aortic arch and neck arteries.
文摘Inflammation is an important component of active atherosclerotic disease. C-reactive protein (CRP)is a non-specific inflammatory marker that is increased in inflammatory conditions. Newer more sensitive assays (high sensitivity CRP) can detect the low levels of inflammation associated with vascular disease. CRP levels can give further risk assessment to individuals beyond predictions from traditional risk factors. This measurement is most useful in helping to discriminate risk in intermediate risk patients such as metabolic syndrome patients. Exercise and weight loss have been shown to significantly lower CRP levels. Lipid lowering therapies, especially with the statin class of medications, also lower CRP levels. A reduction in inflammation may be an important component of plaque stabilization and contribute to cardiovascular risk reduction.
文摘Over the last three years,research has focused on examining cardiac issues arising from coronavirus disease 2019(COVID-19)infection,including the emergence of new-onset atrial fibrillation(NOAF).Still,no clinical study was conducted on the persistence of this arrhythmia after COVID-19 recovery.Our objective was to co-mpose a narrative review that investigates COVID-19-associated NOAF,emphasi-zing the evolving pathophysiological mechanisms akin to those suggested for sustaining AF.Given the distinct strategies involved in the persistence of atrial AF and the crucial burden of persistent AF,we aim to underscore the importance of extended follow-up for COVID-19-associated NOAF.A comprehensive search was conducted for articles published between December 2019 and February 11,2023,focusing on similarities in the pathophysiology of NOAF after COVID-19 and those persisting AF.Also,the latest data on incidence,morbidity-mortality,and management of NOAF in COVID-19 were investigated.Considerable overlaps between the mechanisms of emerging NOAF after COVID-19 infection and persistent AF were observed,mostly involving reactive oxygen pathways.With potential atrial remodeling associated with NOAF in COVID-19 patients,this group of patients might benefit from long-term follow-up and different management.Future cohort studies could help determine long-term outcomes of NOAF after COVID-19.
文摘Background:Pancreatic cancer is the third leading cause of cancer death in the US.There have been postulates of racial disparities.Based on this,we primarily examined the presence of race,for the diagnosis and treatment of pancreatic cancer.Methods:A retrospective review was conducted on patients with pancreatic cancers using the Surveillance Epidemiology,and End Results-Medicare registry.Univariate and multivariate analyses were performed.Overall Survival analysis was done using the Kaplan-Meier curve.Comparison of survival curves was done using the log-rank test.Cox proportional hazards regression model was used to determine independent predictors of survival.Other areas focused on were time interval from diagnosis to treatment,“Predictors of surgery of the primary site,”“Predictors for recommending surgery of the primary site,”“Predictors for oncologic resection,”“Predictors of performance and refusal of surgery of primary site if recommended,”and“Predictors for any other therapy(all therapies excluding surgery)”.Results:A total of 52,951 patients were identified from the database.A total of 24,523 were males and 26,715 were females.A total of 81.9%were Caucasian,10.9%were Black,and 7.2%were other races.There was approximately equal distribution of the different stages between both genders.A total of 10.2%of the females were diagnosed at stage I,28.9%,9.3%,and 51.6%at stages I,III,and IV,respectively,compared to males with 8.4%,28.3%,9.2%,and 54.1%for stages I,II,III,and IV,respectively.A total of 9.5%of the Black patients were diagnosed at stage I,24.2%at stage II,10.1%at stage III,and 56.2%at stage IV.A similar distribution was noted in the other races.Black patients had worse overall survival when compared to Caucasians(P=.004)and other races(P=.001).Conclusion:Compared to Caucasian patients,Black patients with pancreatic cancer had worse overall survival.
文摘Objective:To assess the radiation exposure in cardiovascular implantable electronic device(CIED)implantation procedures,the effect of fluoroscopy frame rate on various radiation exposure indices,and in-hospital outcomes.Methods:Data of CIED implantation procedures from September 2015 to December 2019 of all the CIED implantation procedures performed at our institute were retrospectively analyzed.The procedural data were divided into two groups:a)pre-group:procedures that were performed under fluoroscopy frame rate of 7.5 frames per second(fps);b)post-group:procedures that were performed under fluoroscopy frame rate of 3.75 fps.We compared procedure time,fluoroscopy time,Kerma air product,effective dose,and in-hospital outcomes between the two groups.Results:A total of 2,225 procedures were included in the analysis with mean age of(62±15)years.The procedures consisted of the implantation of single-chamber(n=1,436),double chamber(n=656),and biventricular devices(n=133).Procedure time and radiation indices showed a significant reduction over the study period(P<0.001).Reduction in the fluoroscopy frame rate was associated with a significant reduction in radiation exposure indices(P<0.001).In-hospital outcomes did not differ between the two groups.Conclusions:Reduction in the fluoroscopy frame rate from 7.5 to 3.75 fps significantly decreased the radiation exposure in CIED implantation procedures.A framerate lower than 3.75 fps should be the default setting during such procedures.
