Catheterization and Cardiovascular Diagnosis, Sep 1, 1996
A new microsample coagulation analyzer (Hemochron Jr.) has recently been developed which performs... more A new microsample coagulation analyzer (Hemochron Jr.) has recently been developed which performs a modified activated clotting time (ACT+) and an aPTT by using different reagents. The Hemochron Jr. measures the clotting time of a 5-microliter whole-blood sample by an optical detector and extrapolates the results to the activated clotting time (ACT+) or the plasma-activated partial thromboplastin time by using a validated regression analysis. We compared 124 simultaneous ACT+ and Hemochron ACTs, and 53 paired Hemochron Jr. aPTTs and hospital laboratory aPTTs, in 44 patients during coronary intervention. The Hemochron Jr. aPTT closely correlated with the lab aPTT (r = .79, P < .0001), and the test results were available much more rapidly than the lab aPTT (3.5 +/- 1.1 vs. 56.3 +/- 25.5 min, P = 0.0029). A comparison of duplicate ACT+ measurements did not identify a significant difference in the means (292 +/- 115 sec vs. 293 +/- 112 sec, P = 0.72). The ACT+ closely correlated with the Hemochron ACTs (r = .85, P < .0001). At baseline, the mean ACT+ (175 +/- 43 sec) exceeded the Hemochron ACT (144 +/- 36 sec) by 22% (P < .001). After heparin administration, the mean ACT+ (378 +/- 74 sec) exceeded the Hemochron ACT (332 +/- 65) by 12% (P < .001). The Hemochron Jr. provides a fast and reproducible methodology for measuring ACT and aPTT, using a small blood volume. Further studies are required to determine the optimal anticoagulation range when using the Hemochron Jr. during or after interventional procedures.
Background: Merged CT/MRI with electroanatomical maps (EAM) have been used to guide catheters in ... more Background: Merged CT/MRI with electroanatomical maps (EAM) have been used to guide catheters in electrophysiological interventions. We hypothesized that a novel approach, using reconstructed three-dimensional cardiac MRI of the left ventricle merged with an EAM could guide transendocardial delivery of mesenchymal stem cells (MSCs). Methods and Results: Gottingen swine (n=7) underwent LAD myocardial infarction (MI). Three months following MI and 48 hours prior to stem cell injection, gadolinium enhanced cardiac MRI was performed using a 1.5T Siemens scanner. Electroanatomical mapping of the LV was done with a NOGA XP Cardiac Navigation System with Merge software (Biosense Webster, Inc., Diamond Bar, CA). The MRI images were extracted into the NOGA XP; 3-dimensional reconstruction and segmentation of the left ventricular chamber were done using Merge software on the NOGA XP system. EAM and 3-dimensional MRI were merged using manual landmark and automated surface registration. The quality of the merge was assessed as the average distance between the MRI and the EAM, and was 3.6±1.0mm. The merged image was used to guide the transendocardial injection of 200 million MSCs in 15 sites with injections of 0.5mL each, using a NOGA MyoStar catheter. Injection sites were selected in the scar and border zone as identified by the merged unipolar voltage EAM and MRI (Figure 1). Conclusions: A three-dimensional MRI reconstruction of the LV can be integrated into a NOGA voltage map to guide transendocardial injections of stem cells; therapeutic guidance with the merged MRI/EAM combines accurate and detailed anatomical information from MRI, with functional information about scarred and viable myocardium from EAM.
Introduction: Both myomectomy and alcohol septal ablation (ASA) are used to treat patients with s... more Introduction: Both myomectomy and alcohol septal ablation (ASA) are used to treat patients with symptomatic hypertrophic obstructive cardiolmyopathy (HOCM). There is limited evidence to guide decision making between the two. Our aim was to compare the clinical and procedural outcomes among septal ablation and surgical myomectomy in patients with HOCM. Methods: We systematically searched PubMed, EMBASE, and Cochrane for studies comparing septal ablation to surgical myomectomy between January 1966 and June 2014. Primary end-point was 30 day mortality. Secondary end-points were long-term mortality (>12 months), and peak LVOT gradient reduction. We used RevMan 5.1.7 software. Heterogeneity was defined as I2 values > 25%. Results: A total of 11 observational and case-control studies were included and provided a total of 1155 patients. Myomectomy group was younger than septal ablation (9.37± 4 years; p<0.01).There was no difference in 30 day mortality between septal ablation and surgical myomectomy 1.7% vs. 1.4% (95% CI: 0.39-2.57;p=0.99) (Figure A). There was no difference on long term mortality among groups (5.9% vs. 5.3%; 95% CI: 0.47-1.98; p=0.92) (Figure B). There was a significant 64.43% reduction of LVOT gradient in SA group and 71.03% in the surgical groups (p<0.01) respectively (Figures C,D). Conclusion: Patients undergoing myomectomy are significantly younger than those having ASA. Short and long term mortality were similar. Clinical and anatomical features favoring one or the other strategy were not captured by our analysis. Further studies are required to resolve clinical equipoise.
Introduction: We sought to describe changes in left ventricular ejection fraction (LVEF) after TA... more Introduction: We sought to describe changes in left ventricular ejection fraction (LVEF) after TAVR procedures. Methods: This is an observational study from 04/2008 to 06/2015 of all consecutive adults who received TAVR for severe symptomatic AS with Edwards Sapien or Medtronic CoreValve at two tertiary academic centers in USA and France. Results: Of 765 patients who received TAVR, 716 (94%) had follow-up echocardiography. Of those, 513 (72%), 143 (20%), 60 (8%) had a baseline EF>50%, EF 30-49%, and EF<30, respectively. Patients with EF < 30% were more likely to be Hispanic males. There were no differences in age, CVD risk factors, or history of multivessel coronary disease among groups. Patients with EF<30% were more likely to have AICD implantation and paced rhythm. All groups had similar rates of IABP insertion for hemodynamic support (EF≥50%: 6%, EF<30-49%: 9%, EF<30: 5%, p=0.544), procedural success (EF≥50%: 94%, EF<30-49%: 97%, EF<30: 98%, p=0.180), in-...
Background: Myocardial infarction (MI) leads to left ventricular remodeling, characterized by pro... more Background: Myocardial infarction (MI) leads to left ventricular remodeling, characterized by progressive chamber enlargement and geometric change from an elliptical to a spherical configuration. A...
Background: There is evidence supporting the efficacy of cell-based therapy to improve LV functio... more Background: There is evidence supporting the efficacy of cell-based therapy to improve LV function in patients with chronic ischemic cardiomyopathy undergoing CABG. The precise impact of this strat...
Introduction: Transendocardial injection of mesenchymal stem cells (MSC) in patients (pts) with i... more Introduction: Transendocardial injection of mesenchymal stem cells (MSC) in patients (pts) with ischemic cardiomyopathy (ICM) improves left ventricular function and structure, but it is unknown whe...
Introduction: Patients (pts) with ischemic cardiomyopathy (ICM) may have impaired heart rate vari... more Introduction: Patients (pts) with ischemic cardiomyopathy (ICM) may have impaired heart rate variability (HRV) which is associated with worse prognosis. We tested the hypothesis that cardiac mesenc...
Journal of the American College of Cardiology, 2015
Cardiac conduction abnormalities, including left bundle branch block (LBBB), are not uncommon aft... more Cardiac conduction abnormalities, including left bundle branch block (LBBB), are not uncommon after TAVR. We aimed to evaluate the need for permanent pacemaker (PPM) insertion after development of new LBBB. This is a single center study of TAVR patients. Twelve-lead ECGs were acquired pre- and
Catheterization and Cardiovascular Diagnosis, Sep 1, 1996
A new microsample coagulation analyzer (Hemochron Jr.) has recently been developed which performs... more A new microsample coagulation analyzer (Hemochron Jr.) has recently been developed which performs a modified activated clotting time (ACT+) and an aPTT by using different reagents. The Hemochron Jr. measures the clotting time of a 5-microliter whole-blood sample by an optical detector and extrapolates the results to the activated clotting time (ACT+) or the plasma-activated partial thromboplastin time by using a validated regression analysis. We compared 124 simultaneous ACT+ and Hemochron ACTs, and 53 paired Hemochron Jr. aPTTs and hospital laboratory aPTTs, in 44 patients during coronary intervention. The Hemochron Jr. aPTT closely correlated with the lab aPTT (r = .79, P &lt; .0001), and the test results were available much more rapidly than the lab aPTT (3.5 +/- 1.1 vs. 56.3 +/- 25.5 min, P = 0.0029). A comparison of duplicate ACT+ measurements did not identify a significant difference in the means (292 +/- 115 sec vs. 293 +/- 112 sec, P = 0.72). The ACT+ closely correlated with the Hemochron ACTs (r = .85, P &lt; .0001). At baseline, the mean ACT+ (175 +/- 43 sec) exceeded the Hemochron ACT (144 +/- 36 sec) by 22% (P &lt; .001). After heparin administration, the mean ACT+ (378 +/- 74 sec) exceeded the Hemochron ACT (332 +/- 65) by 12% (P &lt; .001). The Hemochron Jr. provides a fast and reproducible methodology for measuring ACT and aPTT, using a small blood volume. Further studies are required to determine the optimal anticoagulation range when using the Hemochron Jr. during or after interventional procedures.
Background: Merged CT/MRI with electroanatomical maps (EAM) have been used to guide catheters in ... more Background: Merged CT/MRI with electroanatomical maps (EAM) have been used to guide catheters in electrophysiological interventions. We hypothesized that a novel approach, using reconstructed three-dimensional cardiac MRI of the left ventricle merged with an EAM could guide transendocardial delivery of mesenchymal stem cells (MSCs). Methods and Results: Gottingen swine (n=7) underwent LAD myocardial infarction (MI). Three months following MI and 48 hours prior to stem cell injection, gadolinium enhanced cardiac MRI was performed using a 1.5T Siemens scanner. Electroanatomical mapping of the LV was done with a NOGA XP Cardiac Navigation System with Merge software (Biosense Webster, Inc., Diamond Bar, CA). The MRI images were extracted into the NOGA XP; 3-dimensional reconstruction and segmentation of the left ventricular chamber were done using Merge software on the NOGA XP system. EAM and 3-dimensional MRI were merged using manual landmark and automated surface registration. The quality of the merge was assessed as the average distance between the MRI and the EAM, and was 3.6±1.0mm. The merged image was used to guide the transendocardial injection of 200 million MSCs in 15 sites with injections of 0.5mL each, using a NOGA MyoStar catheter. Injection sites were selected in the scar and border zone as identified by the merged unipolar voltage EAM and MRI (Figure 1). Conclusions: A three-dimensional MRI reconstruction of the LV can be integrated into a NOGA voltage map to guide transendocardial injections of stem cells; therapeutic guidance with the merged MRI/EAM combines accurate and detailed anatomical information from MRI, with functional information about scarred and viable myocardium from EAM.
Introduction: Both myomectomy and alcohol septal ablation (ASA) are used to treat patients with s... more Introduction: Both myomectomy and alcohol septal ablation (ASA) are used to treat patients with symptomatic hypertrophic obstructive cardiolmyopathy (HOCM). There is limited evidence to guide decision making between the two. Our aim was to compare the clinical and procedural outcomes among septal ablation and surgical myomectomy in patients with HOCM. Methods: We systematically searched PubMed, EMBASE, and Cochrane for studies comparing septal ablation to surgical myomectomy between January 1966 and June 2014. Primary end-point was 30 day mortality. Secondary end-points were long-term mortality (&amp;gt;12 months), and peak LVOT gradient reduction. We used RevMan 5.1.7 software. Heterogeneity was defined as I2 values &amp;gt; 25%. Results: A total of 11 observational and case-control studies were included and provided a total of 1155 patients. Myomectomy group was younger than septal ablation (9.37± 4 years; p&amp;lt;0.01).There was no difference in 30 day mortality between septal ablation and surgical myomectomy 1.7% vs. 1.4% (95% CI: 0.39-2.57;p=0.99) (Figure A). There was no difference on long term mortality among groups (5.9% vs. 5.3%; 95% CI: 0.47-1.98; p=0.92) (Figure B). There was a significant 64.43% reduction of LVOT gradient in SA group and 71.03% in the surgical groups (p&amp;lt;0.01) respectively (Figures C,D). Conclusion: Patients undergoing myomectomy are significantly younger than those having ASA. Short and long term mortality were similar. Clinical and anatomical features favoring one or the other strategy were not captured by our analysis. Further studies are required to resolve clinical equipoise.
Introduction: We sought to describe changes in left ventricular ejection fraction (LVEF) after TA... more Introduction: We sought to describe changes in left ventricular ejection fraction (LVEF) after TAVR procedures. Methods: This is an observational study from 04/2008 to 06/2015 of all consecutive adults who received TAVR for severe symptomatic AS with Edwards Sapien or Medtronic CoreValve at two tertiary academic centers in USA and France. Results: Of 765 patients who received TAVR, 716 (94%) had follow-up echocardiography. Of those, 513 (72%), 143 (20%), 60 (8%) had a baseline EF>50%, EF 30-49%, and EF<30, respectively. Patients with EF < 30% were more likely to be Hispanic males. There were no differences in age, CVD risk factors, or history of multivessel coronary disease among groups. Patients with EF<30% were more likely to have AICD implantation and paced rhythm. All groups had similar rates of IABP insertion for hemodynamic support (EF≥50%: 6%, EF<30-49%: 9%, EF<30: 5%, p=0.544), procedural success (EF≥50%: 94%, EF<30-49%: 97%, EF<30: 98%, p=0.180), in-...
Background: Myocardial infarction (MI) leads to left ventricular remodeling, characterized by pro... more Background: Myocardial infarction (MI) leads to left ventricular remodeling, characterized by progressive chamber enlargement and geometric change from an elliptical to a spherical configuration. A...
Background: There is evidence supporting the efficacy of cell-based therapy to improve LV functio... more Background: There is evidence supporting the efficacy of cell-based therapy to improve LV function in patients with chronic ischemic cardiomyopathy undergoing CABG. The precise impact of this strat...
Introduction: Transendocardial injection of mesenchymal stem cells (MSC) in patients (pts) with i... more Introduction: Transendocardial injection of mesenchymal stem cells (MSC) in patients (pts) with ischemic cardiomyopathy (ICM) improves left ventricular function and structure, but it is unknown whe...
Introduction: Patients (pts) with ischemic cardiomyopathy (ICM) may have impaired heart rate vari... more Introduction: Patients (pts) with ischemic cardiomyopathy (ICM) may have impaired heart rate variability (HRV) which is associated with worse prognosis. We tested the hypothesis that cardiac mesenc...
Journal of the American College of Cardiology, 2015
Cardiac conduction abnormalities, including left bundle branch block (LBBB), are not uncommon aft... more Cardiac conduction abnormalities, including left bundle branch block (LBBB), are not uncommon after TAVR. We aimed to evaluate the need for permanent pacemaker (PPM) insertion after development of new LBBB. This is a single center study of TAVR patients. Twelve-lead ECGs were acquired pre- and
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