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Timing of Antihypertensive Drug Therapy: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Maqsood, Muhammad Haisum; Messerli, Franz H; Skolnick, Adam H; Newman, Jonathan D; Berger, Jeffrey S; Bangalore, Sripal
BACKGROUND:The timing of antihypertensive drugs administration is controversial. The aim was to compare the efficacy of dosing of antihypertensive drugs in the morning versus evening. METHODS:A PubMed, EMBASE, and databases search for randomized clinical trials of antihypertensive therapies where patients were randomized to morning versus evening dosing. The outcomes were ambulatory blood pressure parameters (day-time, night-time, and 24/48-hour systolic blood pressure [SBP] and diastolic blood pressure [DBP]) and cardiovascular outcomes. RESULTS: CONCLUSIONS:Evening dosing of antihypertensive drugs significantly reduced ambulatory blood pressure parameters and lowered cardiovascular events but the effect was mainly driven by trials by Hermida group. Unless the intention is to specifically lower night-time blood pressure, antihypertensive drugs should be taken at a time of day that is convenient, optimizes adherence, and minimizes undesirable effects.
PMID: 37212152
ISSN: 1524-4563
CID: 5480232

Timing of Statin Dose: A Systematic Review and Meta-analysis of Randomized Clinical Trials

Haisum Maqsood, Muhammad; Messerli, Franz H; Waters, David; Skolnick, Adam H; Maron, David J; Bangalore, Sripal
PMID: 35512427
ISSN: 2047-4881
CID: 5216352

Silence is gilded: atrial fibrillation in the golden years [Editorial]

Blachman, Nina L; Skolnick, Adam H
PMID: 36098276
ISSN: 1532-5415
CID: 5332782

Amyloid deposition in an explanted bioprosthetic aortic valve: case report and review of the literature [Case Report]

Weerasekare, Jonika M; Zhou, Fang; Skolnick, Adam H; Jilaihawi, Hasan; Williams, Mathew R; Dasari, Surendra; McPhail, Ellen D; Theis, Jason D; Dao, Linda N; Bois, John P; Maleszewski, Joseph J; Bois, Melanie C
Herein we present a case of an 80-year-old gentleman who presented with exertional dyspnea status post aortic valve replacement with #23 Trifecta pericardial St. Jude aortic bioprosthetic valve (BV) 12 years prior. He subsequently underwent valve re-replacement due cusp calcification. Histologically, the surgically explanted BV revealed Congophilic deposits with birefringence under cross-polarized light. Extensive work-up identified no systemic source of amyloid in this patient. Liquid chromatography-tandem mass spectrometry-based (LC-MS/MS) proteomics showed the amyloid was composed of human-origin amyloid signature proteins (apolipoprotein A4, apolipoprotein E, serum amyloid P) and human-origin mu heavy chains. Background bovine collagen was also present. Transmission electron microscopy (TEM) showed collections of 7.5-10 nm nonbranching fibrils, consistent with amyloid. Using these techniques, we classified the amyloid as Mu heavy chain, deposition of which is highly unusual in BV. Finally, we provide a review of the literature regarding isolated amyloid deposition in BV.
PMID: 36038051
ISSN: 1879-1336
CID: 5332042

Aortic closure signal length on doppler echocardiography differentiates aortic patient-prosthesis mismatch from prosthetic stenosis

Ali, Thara; Garshick, Michael S; Saric, Muhamed; Skolnick, Adam H
PURPOSE/OBJECTIVE:The purpose of this study was to investigate the diagnostic potential of the aortic closure (A2) signal length on Doppler echocardiography in distinguishing aortic patient-prosthesis mismatch (PPM) from prosthetic stenosis among patients with elevated gradients over bioprosthetic valves. METHODS:The A2 signal length was retrospectively measured for 150 patients with bioprosthetic aortic valves (50 with PPM, 50 with prosthetic stenosis, and 50 with normally functioning valves) from transthoracic echocardiograms performed at NYU Langone Health between 01/01/2012 and 08/01/2018. RESULTS:Mean A2 signal length was shorter among patients with PPM (11.1 ms ± 5.2 ms), than among those with prosthetic stenosis (21.1 ms ± 6.0 ms), P < .001 and controls (21.7 ms ± 7.4 ms), P < .001. There was no difference in A2 signal length between prosthetic stenosis and controls. The A2 signal length yielded an AUC of 0.89 (95% CI 0.82-0.95) for predicting PPM over prosthetic stenosis. CONCLUSION/CONCLUSIONS:Among patients with bioprosthetic aortic valves, the length of the A2 signal on Doppler echocardiography is shorter in PPM than in prosthetic stenosis and normally functioning valves. The A2 signal length may represent a novel metric to distinguish PPM from prosthetic stenosis.
PMID: 33665868
ISSN: 1097-0096
CID: 4800372


Ali, Thara S.; Garshick, Michael Seth; Saric, Muhamed; Skolnick, Adam H.
ISSN: 0735-1097
CID: 4630852


Shah, Tina; Razzouk, Louai; Saric, Muhamed; Skolnick, Adam; Loulmet, Didier; Halpern, Dan
ISSN: 0735-1097
CID: 4136022

Average e' velocity on transthoracic echocardiogram is a novel predictor of left atrial appendage sludge or thrombus in patients with atrial fibrillation

Garshick, Michael S; Mulliken, Jennifer; Schoenfeld, Matthew; Riedy, Katherine; Guo, Yu; Zhong, Judy; Dodson, John A; Saric, Muhamed; Skolnick, Adam H
BACKGROUND:Studies have demonstrated the value of transthoracic echocardiogram (TTE) diastolic parameters in predicting left atrial appendage (LAA) thrombus; however, these studies have been small. We aim to clarify the relationship between TTE diastolic parameters, in particular average e', and LAA thrombus or sludge. METHODS:A case-control review was conducted of subjects with non-valvular atrial fibrillation (n = 2263) who had undergone TEE (transesophageal echocardiogram) and had a TTE within 1 year of TEE. Cases of LAA sludge or thrombus were matched to controls by age, sex, left ventricular ejection fraction (LVEF), and anticoagulation status. RESULTS:Forty-three subjects (mean age 73 ± 12, 65% male, LVEF 47%, 44% on anticoagulation) with LAA sludge or thrombus were identified. Compared to matched controls, average TTE e' (7.3 ± 2.1 cm/s vs 8.7 ± 2.1 cm/s, P < 0.001) and the E:e' ratio (15 ± 7 cm/s vs 12 ± 5 cm/s; P = 0.005) were significant predictors of LAA sludge or thrombus. Average TTE e' value of >11 cm/s had 100% sensitivity for ruling out LAA sludge or thrombus. CONCLUSION/CONCLUSIONS:In individuals with atrial fibrillation, average e' >11 cm/s on TTE is a promising independent predictor of the absence of LAA sludge or thrombus on TEE.
PMID: 30315597
ISSN: 1540-8175
CID: 3335212

Improving Care Using a Bidirectional Geriatric Cardiology Consultative Conference

Grant, Eleonore V; Skolnick, Adam H; Chodosh, Joshua; Perskin, Michael H; Orr, Nicole M; Blaum, Caroline; Dodson, John A
More than 13 million persons in the United States aged 65 and older have cardiovascular disease (CVD), and this population is expected to increase exponentially over the next several decades. In the absence of clinical studies that would inform how best to manage this population, there is an urgent need for collaborative, thoughtful approaches to their care. Although cardiologists are traditionally regarded as leaders in the care of older adults with CVD, these individuals have multiple comorbidities, physiological differences, and distinct goals of care than younger patients that require a specialized geriatric lens. Thus, collaboration is needed between geriatricians, cardiologists, and other specialists to address the unique needs of this growing population. Accordingly, clinicians at New York University Langone Health and School of Medicine established a monthly Geriatric Cardiology Conference to foster an integrative approach to the care of older adults with CVD by uniting specialists across disciplines to collaborate on treatment strategies. At each conference, an active case is discussed and analyzed in detail, and a consensus is reached among participants regarding optimal treatment strategies. The conference attracts faculty and trainees at multiple levels from geriatrics, cardiology, and cardiothoracic surgery. The model may serve as a paradigm for other institutions moving towards geriatric-informed care of older adults with CVD.
PMID: 29542108
ISSN: 1532-5415
CID: 2992982

Positional Right Ventricular Obstruction in Pectus Excavatum

Underwood, Katherine; Vorsanger, Matthew; Saric, Muhamed; Skolnick, Adam H
Pectus excavatum is one of the most common congenital chest wall deformities. The degree of sternal depression, which may result in compression of the right heart by the chest wall, is variable. While typically asymptomatic, there are various symptoms that can result from severe pectus excavatum. We report on a patient with severe pectus excavatum leading to dynamic obstruction of the right ventricular outflow tract in the seated position.
PMID: 28214505
ISSN: 1879-1913
CID: 2451732