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McConnell's sign predicts normotensive shock in patients with acute pulmonary embolism [Letter]

Zhang, Robert S; Rhee, Aaron J; Yuriditsky, Eugene; Nayar, Ambika C; Elbaum, Lindsay S; Horowitz, James M; Greco, Allison A; Postelnicu, Radu; Alviar, Carlos L; Bangalore, Sripal
BACKGROUND:Patients with intermediate-risk pulmonary embolism (PE) and normotensive shock may have worse outcomes. However, diagnosis of normotensive shock requires invasive hemodynamics. Our objective was to assess the predictive value of McConnell's sign in identifying normotensive shock in patients with intermediate-risk PE. METHODS:and clinical evidence of hypoperfusion (i.e. elevated lactate, oliguria). The primary outcome was the association between McConnell's sign and normotensive shock. RESULTS:, p = 0.003), and higher rates of normotensive shock (76 % vs 27 %, p = 0.005). McConnell's sign had a sensitivity of 88 % and specificity of 53 % for identifying intermediate-risk PE patients with normotensive shock. Patients with McConnell's sign had an increased odds (odds ratio 8.38, confidence interval: 1.73-40.53, p = 0.008; area under the curve 0.70, 95 % confidence interval: 0.56-0.85) of normotensive shock. CONCLUSION/CONCLUSIONS:This is the first study to suggest that McConnell's sign may identify those in the intermediate-risk group who are at risk for normotensive shock. Larger cohorts are needed to validate our findings.
PMID: 38906415
ISSN: 1876-4738
CID: 5672452

Comparing Management Strategies in Patients With Clot-in-Transit

Zhang, Robert S; Yuriditsky, Eugene; Zhang, Peter; Elbaum, Lindsay; Bailey, Eric; Maqsood, Muhammad H; Postelnicu, Radu; Amoroso, Nancy E; Maldonado, Thomas S; Saric, Muhamed; Alviar, Carlos L; Horowitz, James M; Bangalore, Sripal
BACKGROUND/UNASSIGNED:Clot-in-transit is associated with high mortality, but optimal management strategies remain uncertain. The aim of this study was to compare the outcomes of different treatment strategies in patients with clot-in-transit. METHODS/UNASSIGNED:This is a retrospective study of patients with documented clot-in-transit in the right heart on echocardiography across 2 institutions between January 2020 and October 2023. The primary outcome was a composite of in-hospital mortality, resuscitated cardiac arrest, or hemodynamic decompensation. RESULTS/UNASSIGNED:=0.067). CONCLUSIONS/UNASSIGNED:In this study of CBT in patients with clot-in-transit, CBT or systemic thrombolysis was associated with a significantly lower rate of adverse clinical outcomes, including a lower rate of death compared with anticoagulation alone driven by the CBT group. CBT has the potential to improve outcomes. Further large-scale studies are needed to test these associations.
PMID: 38841833
ISSN: 1941-7632
CID: 5665552

Low left ventricular outflow tract velocity time integral predicts normotensive shock in patients with acute pulmonary embolism [Letter]

Zhang, Robert S; Yuriditsky, Eugene; Nayar, Ambika C; Elbaum, Lindsay; Greco, Allison A; Rhee, Aaron J; Mukherjee, Vikramjit; Keller, Norma; Alviar, Carlos L; Horowitz, James M; Bangalore, Sripal
In this study, we found that a low LVOT VTI (<15 cm), a simple bedside point-of-care measurement, predicts normotensive shock in patients with acute intermediate-risk PE.
PMID: 38670834
ISSN: 1097-6744
CID: 5657872

Quality and rapidity of anticoagulation in patients with acute pulmonary embolism undergoing mechanical thrombectomy

Zhang, Robert S; Ho, Alvin M; Elbaum, Lindsay; Greco, Allison A; Hall, Sylvie; Postelnicu, Radu; Mukherjee, Vikramjit; Maqsood, Muhammad H; Keller, Norma; Alviar, Carlos L; Bangalore, Sripal
The primary objective of our study was to determine the proportion of intermediate-risk PE patients undergoing mechanical thrombectomy (MT) who achieved therapeutic anticoagulation (AC) at the time of the procedure. The salient findings of our study showed that only a minority of patients (14.3%) were in the therapeutic range by ACT at the time of MT (primary outcome). Furthermore, in this higher-risk PE cohort selected for MT, 18.2% of patients were subtherapeutic after initially reaching therapeutic AC, 43% experienced supratherapeutic AC at some point before MT, and less than half (43%) attained therapeutic AC at 6 hours, highlighting the necessity for optimizing anticoagulation practices in acute PE.
PMID: 38071002
ISSN: 1097-6744
CID: 5589832

Outcomes With Percutaneous Debulking of Tricuspid Valve Endocarditis

Zhang, Robert S; Alam, Usman; Maqsood, Muhammad H; Xia, Yuhe; Harari, Rafael; Keller, Norma; Elbaum, Lindsay; Rao, Sunil V; Alviar, Carlos L; Bangalore, Sripal
BACKGROUND:In patients with tricuspid valve infective endocarditis, percutaneous debulking is a treatment option. However, the outcomes of this approach are less well known. METHODS:We performed a retrospective analysis of all patients who underwent percutaneous vegetation debulking for tricuspid valve infective endocarditis from August 2020 to November 2022 at a large academic tertiary care public hospital. The primary efficacy outcome was procedural success defined by clearance of blood cultures. The primary safety outcome was any procedural complication. For the composite outcome of in-hospital mortality or heart block, outcomes were compared (sequential noninferiority and superiority) with published surgical outcomes data. RESULTS:=0.016). CONCLUSIONS:Percutaneous debulking is feasible, effective, and safe in treating patients with tricuspid valve infective endocarditis refractory to medical therapy.
PMID: 37417231
ISSN: 1941-7632
CID: 5535212

Shockwave and Non-transfemoral Transcatheter Aortic Valve Replacement

Payabyab, Eden C; Elbaum, Lindsay S; Sharma, Navneet; George, Isaac; Mick, Stephanie L
Transcatheter aortic valve replacement (TAVR) has become a widely adopted treatment modality for severe aortic stenosis. Transfemoral access is the approach of choice; however, approximately 25% of patients undergoing TAVR also have concomitant peripheral arterial disease. The recent advent of intravascular lithotripsy has enabled preservation of transfemoral access in some patients; although, a proportion still require alternative, non-femoral access. Alternative access sites can be broadly categorized into transthoracic and peripheral, facilitated by surgical or percutaneous techniques. In this review, the technical details and clinical outcomes of various TAVR accesses are discussed. Initially, transthoracic approaches were most common, but recently, the trend has been toward alternative peripheral access due to superior outcomes. Although there are no randomized data to support all the alternative access sites, the experiences reported provide available options for a large portion of patients to be candidates for TAVR. The intervention site should be selected by a multidisciplinary heart team based on patient anatomical factors and institutional expertise
ISSN: 1758-3896
CID: 5173602

Managing Patients With ST-Elevation Myocardial Infarction at the Epicenter of the COVID-19 Pandemic

Elbaum, Lindsay; Rashed, Eman; Kamran, Mazullah
During the coronavirus disease 2019 (COVID-19) pandemic, strained acute care resources, the potential for rapid clinical decompensation, and concerns about staff safety has prompted a conservative management approach for acute coronary syndrome patients. We present our experience of COVID-19 patients at Elmhurst Hospital Center presenting with ST-Elevation Myocardial Infarction and compared outcomes of invasive vs conservative treatment strategies.
PMID: 33081993
ISSN: 1535-6280
CID: 4957072

Characterization of Myocardial Injury in Patients With COVID-19

Giustino, Gennaro; Croft, Lori B; Stefanini, Giulio G; Bragato, Renato; Silbiger, Jeffrey J; Vicenzi, Marco; Danilov, Tatyana; Kukar, Nina; Shaban, Nada; Kini, Annapoorna; Camaj, Anton; Bienstock, Solomon W; Rashed, Eman R; Rahman, Karishma; Oates, Connor P; Buckley, Samantha; Elbaum, Lindsay S; Arkonac, Derya; Fiter, Ryan; Singh, Ranbir; Li, Emily; Razuk, Victor; Robinson, Sam E; Miller, Michael; Bier, Benjamin; Donghi, Valeria; Pisaniello, Marco; Mantovani, Riccardo; Pinto, Giuseppe; Rota, Irene; Baggio, Sara; Chiarito, Mauro; Fazzari, Fabio; Cusmano, Ignazio; Curzi, Mirko; Ro, Richard; Malick, Waqas; Kamran, Mazullah; Kohli-Seth, Roopa; Bassily-Marcus, Adel M; Neibart, Eric; Serrao, Gregory; Perk, Gila; Mancini, Donna; Reddy, Vivek Y; Pinney, Sean P; Dangas, George; Blasi, Francesco; Sharma, Samin K; Mehran, Roxana; Condorelli, Gianluigi; Stone, Gregg W; Fuster, Valentin; Lerakis, Stamatios; Goldman, Martin E
BACKGROUND:Myocardial injury is frequent among patients hospitalized with coronavirus disease-2019 (COVID-19) and is associated with a poor prognosis. However, the mechanisms of myocardial injury remain unclear and prior studies have not reported cardiovascular imaging data. OBJECTIVES/OBJECTIVE:This study sought to characterize the echocardiographic abnormalities associated with myocardial injury and their prognostic impact in patients with COVID-19. METHODS:We conducted an international, multicenter cohort study including 7 hospitals in New York City and Milan of hospitalized patients with laboratory-confirmed COVID-19 who had undergone transthoracic echocardiographic (TTE) and electrocardiographic evaluation during their index hospitalization. Myocardial injury was defined as any elevation in cardiac troponin at the time of clinical presentation or during the hospitalization. RESULTS:A total of 305 patients were included. Mean age was 63 years and 205 patients (67.2%) were male. Overall, myocardial injury was observed in 190 patients (62.3%). Compared with patients without myocardial injury, those with myocardial injury had more electrocardiographic abnormalities, higher inflammatory biomarkers and an increased prevalence of major echocardiographic abnormalities that included left ventricular wall motion abnormalities, global left ventricular dysfunction, left ventricular diastolic dysfunction grade II or III, right ventricular dysfunction and pericardial effusions. Rates of in-hospital mortality were 5.2%, 18.6%, and 31.7% in patients without myocardial injury, with myocardial injury without TTE abnormalities, and with myocardial injury and TTE abnormalities. Following multivariable adjustment, myocardial injury with TTE abnormalities was associated with higher risk of death but not myocardial injury without TTE abnormalities. CONCLUSIONS:Among patients with COVID-19 who underwent TTE, cardiac structural abnormalities were present in nearly two-thirds of patients with myocardial injury. Myocardial injury was associated with increased in-hospital mortality particularly if echocardiographic abnormalities were present.
PMID: 33121710
ISSN: 1558-3597
CID: 4646832

Prognostic Value of Cardiac Magnetic Resonance Estimates of Ventriculoarterial Coupling in Pulmonary Hypertension [Letter]

González Lengua, Carlos; Agarwal, Chirag; Chokshi, Aalap; Elbaum, Lindsay; Kumar, Pirkash; Amara, Richard; Trivieri, Maria Giovanna; Álvarez, Ana García; Sanz, Javier
PMID: 32739370
ISSN: 1876-7591
CID: 4957062

Reproducibility over time and effect of low-dose aspirin on soluble P-selectin and soluble CD40 ligand

Valdes, Vanessa; Nardi, Michael A; Elbaum, Lindsay; Berger, Jeffrey S
Platelet markers [soluble CD40 ligand (sCD40L) and soluble p selectin (sPselectin)] are associated with platelet activation and cardiovascular events. We sought to investigate the reproducibility of these markers over time and the effect of low-dose aspirin on sCD40L and sPselectin in plasma and serum. Following an overnight fast, 40 healthy volunteers had weekly phlebotomy and were administered aspirin 81 mg/day between weeks 3 and 4. Reproducibility over time was assessed by coefficient of variation (CV) and inter-class correlation coefficient. Correlation between markers was assessed using Pearson r statistic. Difference between levels pre- and post-aspirin was measured with Wilcoxon signed-rank test. Data are presented as median (interquartile range). sCD40L and sPselectin measurements were reproducible over time in plasma and serum (CV < 10 %). Measurement of sCD40L and sPselectin in plasma correlated with levels in serum before aspirin and after aspirin. There was no significant correlation between sCD40L and sPselectin. After 1-week of aspirin 81 mg/day, there was a reduction in sCD40L and sPselectin in serum and plasma, respectively. Soluble CD40L and sPselectin are independent markers that are reproducible over time in both plasma and sera and are reduced by 1-week of low-dose aspirin.
PMID: 25648873
ISSN: 1573-742x
CID: 1602482