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Long-term follow-up of acute and chronic rejection in heart transplant recipients from hepatitis C viremic (NAT+) donors

Stachel, Maxine W; Alimi, Marjan; Narula, Navneet; Flattery, Erin E; Xia, Yuhe; Ramachandran, Abhinay; Saraon, Tajinderpal; Smith, Deane; Reyentovich, Alex; Goldberg, Randal; Kadosh, Bernard S; Razzouk, Louai; Katz, Stuart; Moazami, Nader; Gidea, Claudia G
The long-term safety of heart transplants from hepatitis C viremic (NAT+) donors remains uncertain. We conducted a prospective study of all patients who underwent heart transplantation at our center from January 2018 through August 2020. Routine testing was performed to assess for donor-derived cell-free DNA, acute cellular rejection (ACR), antibody-mediated rejection (AMR), and cardiac allograft vasculopathy (CAV). Allograft dysfunction and mortality were also monitored. Seventy-five NAT- recipients and 32 NAT+ recipients were enrolled in the study. All NAT+ recipients developed viremia detected by PCR, were treated with glecaprevir/pibrentasvir at the time of viremia detection, and cleared the virus by 59 days post-transplant. Patients who underwent NAT testing starting on post-operative day 7 (NAT+ Group 1) had significantly higher viral loads and were viremic for a longer period compared with patients tested on post-operative day 1 (NAT+ Group 2). Through 3.5 years of follow-up, there were no statistically significant differences in timing, severity, or frequency of ACR in NAT+ recipients compared with the NAT- cohort, nor were there differences in noninvasive measures of graft injury, incidence or severity of CAV, graft dysfunction, or mortality. There were five episodes of AMR, all in the NAT- group. There were no statistically significant differences between Group 1 and Group 2 NAT+ cohorts. Overall, these findings underscore the safety of heart transplantation from NAT+ donors.
PMID: 36053676
ISSN: 1600-6143
CID: 5332222

Workflow for Percutaneous Coronary Intervention With Optical Coherence Tomography-Guidance: MAXing the MLD? [Editorial]

Razzouk, Louai; Attubato, Michael J
PMID: 36378740
ISSN: 1941-7632
CID: 5371582

Coronary morphological features in women with non-ST-segment elevation MINOCA and MI-CAD as assessed by optical coherence tomography

Usui, Eisuke; Matsumura, Mitsuaki; Smilowitz, Nathaniel R; Mintz, Gary S; Saw, Jacqueline; Kwong, Raymond Y; Hada, Masahiro; Mahmud, Ehtisham; Giesler, Caitlin; Shah, Binita; Bangalore, Sripal; Razzouk, Louai; Hoshino, Masahiro; Marzo, Kevin; Ali, Ziad A; Bairey Merz, C Noel; Sugiyama, Tomoyo; Har, Bryan; Kakuta, Tsunekazu; Hochman, Judith S; Reynolds, Harmony R; Maehara, Akiko
Aims/UNASSIGNED:We aimed to use optical coherence tomography (OCT) to identify differences in atherosclerotic culprit lesion morphology in women with myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) compared with MI with obstructive coronary artery disease (MI-CAD). Methods and results/UNASSIGNED:Women with an OCT-determined atherosclerotic aetiology of non-ST segment elevation (NSTE)-MINOCA (angiographic diameter stenosis <50%) who were enrolled in the multicentre Women's Heart Attack Research Program (HARP) study were compared with a consecutive series of women with NSTE-MI-CAD who underwent OCT prior to coronary intervention at a single institution. Atherosclerotic pathologies identified by OCT included plaque rupture, plaque erosion, intraplaque haemorrhage (IPH, a region of low signal intensity with minimum attenuation adjacent to a lipidic plaque without fibrous cap disruption), layered plaque (superficial layer with clear demarcation from the underlying plaque indicating early thrombus healing), or eruptive calcified nodule.We analysed 58 women with NSTE-MINOCA and 52 women with NSTE-MI-CAD. Optical coherence tomography features of underlying vulnerable plaque (thin-cap fibroatheroma) were less common in MINOCA (3 vs. 35%) than in MI-CAD. Intraplaque haemorrhage (47 vs. 2%) and layered plaque (31 vs. 12%) were more common in MINOCA than MI-CAD, whereas plaque rupture (14 vs. 67%), plaque erosion (8 vs. 14%), and calcified nodule (0 vs. 6%) were less common in MINOCA. The angle of ruptured cavity was smaller and thrombus burden was lower in MINOCA. Conclusion/UNASSIGNED:The prevalence of atherothrombotic culprit lesion subtype varied substantially between MINOCA and MI-CAD. A majority of culprit lesions in MINOCA had the appearance of IPH or layered plaque. Clinical Trial Registration Information/UNASSIGNED:
PMCID:9549740
PMID: 36225342
ISSN: 2752-4191
CID: 5361022

Invasive Management of Acute Myocardial Infarctions During the Initial Wave of the COVID-19 Pandemic

Talmor, Nina; Ramachandran, Abhinay; Brosnahan, Shari B; Shah, Binita; Bangalore, Sripal; Razzouk, Louai; Attubato, Michael; Feit, Frederick; Thompson, Craig; Smilowitz, Nathaniel R
BACKGROUND:The initial wave of the coronavirus disease 2019 (COVID-19) pandemic resulted in an influx of patients with acute viral illness and profound changes in healthcare delivery in New York City. The impact of this pandemic on the presentation and invasive management of acute myocardial infarction (MI) is not well described. METHODS:This single-center retrospective study compared patients with MI who underwent invasive coronary angiography at New York University from March-April 2020, during the peak of the first wave of the pandemic, with those presenting in March-April 2019. RESULTS:Only 35 patients with MI underwent angiography during the study period in 2020 vs 109 patients in 2019. No differences in comorbidities or baseline medications were identified. The proportion of patients with ST-segment elevation MI (STEMI) was higher in 2020 than in 2019 (48.6% vs 24.8%, respectively; P=.01). Median peak troponin concentration was higher (14.5 ng/mL vs 2.9 ng/mL; P<.01) and left ventricular ejection fraction was lower (43.34% vs 51.1%; P=.02) during the pandemic. Among patients with non-STEMI, time from symptom onset to presentation was delayed in 2020 compared with 2019 (median, 24 hours vs 10 hours; P=.04). CONCLUSION/CONCLUSIONS:There was a dramatic decrease in the number of patients with MI undergoing coronary angiography during the first wave of the COVID-19 pandemic. Of those who presented, patients tended to seek care later after symptom onset and had excess myocardial injury. These data indicate a need for improved patient education to ensure timely cardiovascular care during public health emergencies.
PMID: 34866048
ISSN: 1557-2501
CID: 5085552

The need for a streamlined approach to STEMI management during the COVID-19 pandemic [Editorial]

Razzouk, Louai; Farkouh, Michael E
PMID: 33453415
ISSN: 1873-2615
CID: 4760092

Coronary Optical Coherence Tomography and Cardiac Magnetic Resonance Imaging to Determine Underlying Causes of MINOCA in Women

Reynolds, Harmony R; Maehara, Akiko; Kwong, Raymond Y; Sedlak, Tara; Saw, Jacqueline; Smilowitz, Nathaniel R; Mahmud, Ehtisham; Wei, Janet; Marzo, Kevin; Matsumura, Mitsuaki; Seno, Ayako; Hausvater, Anais; Giesler, Caitlin; Jhalani, Nisha; Toma, Catalin; Har, Bryan; Thomas, Dwithiya; Mehta, Laxmi S; Trost, Jeffrey; Mehta, Puja K; Ahmed, Bina; Bainey, Kevin R; Xia, Yuhe; Shah, Binita; Attubato, Michael; Bangalore, Sripal; Razzouk, Louai; Ali, Ziad A; Bairey-Merz, C Noel; Park, Ki; Hada, Ellen; Zhong, Hua; Hochman, Judith S
Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) occurs in 6-15% of MI and disproportionately affects women. Scientific statements recommend multi-modality imaging in MINOCA to define the underlying cause. We performed coronary optical coherence tomography (OCT) and cardiac magnetic resonance imaging (CMR) to assess mechanisms of MINOCA. Methods: In this prospective, multicenter, international, observational study, we enrolled women with a clinical diagnosis of MI. If invasive coronary angiography revealed <50% stenosis in all major arteries, multi-vessel OCT was performed, followed by CMR (cine imaging, late gadolinium enhancement, and T2-weighted imaging and/or T1 mapping). Angiography, OCT, and CMR were evaluated at blinded, independent core laboratories. Culprit lesions identified by OCT were classified as definite or possible. The CMR core laboratory identified ischemia-related and non-ischemic myocardial injury. Imaging results were combined to determine the mechanism of MINOCA, when possible. Results: Among 301 women enrolled at 16 sites, 170 were diagnosed with MINOCA, of whom 145 had adequate OCT image quality for analysis; 116 of these underwent CMR. A definite or possible culprit lesion was identified by OCT in 46.2% (67/145) of participants, most commonly plaque rupture, intra-plaque cavity or layered plaque. CMR was abnormal in 74.1% (86/116) of participants. An ischemic pattern of CMR abnormalities (infarction or myocardial edema in a coronary territory) was present in 53.4% of participants undergoing CMR (62/116). A non-ischemic pattern of CMR abnormalities (myocarditis, takotsubo syndrome or non-ischemic cardiomyopathy) was present in 20.7% (24/116). A cause of MINOCA was identified in 84.5% of the women with multi-modality imaging (98/116), higher than with OCT alone (p<0.001) or CMR alone (p=0.001). An ischemic etiology was identified in 63.8% of women with MINOCA (74/116), a non-ischemic etiology was identified in 20.7% (24/116), and no mechanism was identified in 15.5% (18/116). Conclusions: Multi-modality imaging with coronary OCT and CMR identified potential mechanisms in 84.5% of women with a diagnosis of MINOCA, three-quarters of which were ischemic and one-quarter of which were non-ischemic, alternate diagnoses to MI. Identification of the etiology of MINOCA is feasible and has the potential to guide medical therapy for secondary prevention. Clinical Trial Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT02905357.
PMID: 33191769
ISSN: 1524-4539
CID: 4672212

Revascularization in patients with diabetes and chronic total occlusion: The journey or the destination? [Editorial]

Razzouk, Louai; Jneid, Hani
PMID: 33729678
ISSN: 1522-726x
CID: 4823512

White Cell Inflammatory Biomarkers in Women With Myocardial Infarction With Non-Obstructive Coronary Artery Disease (MINOCA): Findings From the American Heart Association Go Red for Women Strategically Focused Research Network [Meeting Abstract]

Berger, Jeffrey S.; Myndzar, Khrystyna; Barrett, Tessa A.; Xia, Yuhe; Smilowitz, Nathaniel; Hausvater, Anais; Bangalore, Sripal; Razzouk, Louai; Shah, Binita; Spruill, Tanya; Hochman, Judith S.; Reynolds, Harmony
ISI:000752020008132
ISSN: 0009-7322
CID: 5285772

Myocardial Injury in Adults Hospitalized with COVID-19 [Letter]

Smilowitz, Nathaniel R; Jethani, Neil; Chen, Ji; Aphinyanaphongs, Yindalon; Zhang, Ruina; Dogra, Siddhant; Alviar, Carlos L; Keller, Norma Mary; Razzouk, Louai; Quinones-Camacho, Adriana; Jung, Albert S; Fishman, Glenn I; Hochman, Judith S; Berger, Jeffrey S
PMID: 33151762
ISSN: 1524-4539
CID: 4664312

Comparison of device-specific adverse event profiles between Impella platforms

Chen, Stacey; Paone, Darien; Spellman, Lilly; Ranganath, Neel K; Carillo, Julius A; Gidea, Claudia G; Reyentovich, Alex; Thompson, Craig A; Razzouk, Louai; Kon, Zachary N; Moazami, Nader; Smith, Deane E
BACKGROUND:The Impella (Abiomed) ventricular support system is a family of temporary mechanical circulatory support (MCS) devices used to treat patients with cardiogenic shock, acute cardiogenic decompensation, and for high-risk percutaneous or surgical revascularization. These devices include the percutaneously implanted 2.5/cardiac power (CP) and the surgically implanted 5.0/left direct (LD). Despite the beneficial effects and increased usage of these devices, data to assess adverse outcomes and guide clinician decision-making between the Impella CP and 5.0/LD are limited. METHODS:This is a retrospective analysis of 91 consecutive patients who required at least 24 h of Impella support, from January 1, 2015 to December 31, 2019. Groups were stratified based on either initial Impella CP or 5.0/LD placement. Clinical outcomes and in-hospital complications were compared. RESULTS:Impella CP was implanted in 66 patients (mean age: 61 ± 15 years, male 71.2%) and Impella 5.0/LD was implanted in 25 patients (mean age: 62 ± 9 years, male 84.0%). There was greater stability of device position (p = .033), less incidence of hemolysis (p < .001), and less frequent need for additional MCS (p = .001) in patients implanted with the Impella 5.0/LD compared with Impella CP in this study cohort. Patients with Impella 5.0/LD were more likely to survive from Impella and survive to discharge. CONCLUSIONS:This study suggests that for patients who require temporary MCS for more than 24 h, the Impella 5.0/LD may have a more favorable device-specific adverse profile compared with the Impella CP.
PMID: 32939839
ISSN: 1540-8191
CID: 4593232