Papers by Mohammad Anwar Movahed
Reviews in Cardiovascular Medicine
More than 1 million cardiac catheterizations are performed every year in the United States, and i... more More than 1 million cardiac catheterizations are performed every year in the United States, and incur substantial risk of access site bleeding. Furthermore, insertion of central venous catheters and performance of pericardio-or pleurocentesis are common practice, also with substantial risk of vascular or organ injury. One of the major risks for access site bleeding is multiple or posterior arterial puncture with a large needle. Using a very small needle to obtain initial access to vessels or organ cavities has the potential to reduce the risk of bleeding or organ injury. Multiple unsuccessful attempts to achieve vascular access are more forgiving, and accidental organ injury during pericardio-or pleurocentesis is less traumatic when using a small micropuncture needle. This article reviews the use of micropuncture technique for vascular or organ cavity access, a technique that has the potential to decrease vascular access site complications and organ injury.
Reviews in Cardiovascular Medicine, 2010
The goal of businesses is to maximize profit which in turn is affected by quality competition. Ac... more The goal of businesses is to maximize profit which in turn is affected by quality competition. According to the quality competition theory, an increase in competitors’ quality, all else equal, creates a more competitive market, which will cause a business to raise its quality. The objective of this paper is to examine the theory through an assessment of the longitudinal dataset of restaurant quality. Customer review ratings of a restaurant are utilized as a proxy of a restaurant’s quality. To achieve the objective mentioned above, this research uses the average customer review ratings from 7,610 restaurants in the Phoenix Metropolitan Area. Ratings were collected from Yelp.com from the end of each month, from 2014 to the end of 2017, to investigate the effect of competition on restaurant quality. A fixed effect panel regression model with a spatial distance band weight matrix is used to evaluate the effect that changes in competing restaurants’ quality have on a restaurant. The resu...
European Journal of Heart Failure Supplements, 2007
European Journal of Heart Failure Supplements, 2007
International Cardivascular Research Journal, 2015
Background: Performing immediate bystander Cardio Pulmonary Resuscitation (CPR) is the most impor... more Background: Performing immediate bystander Cardio Pulmonary Resuscitation (CPR) is the most important factor that determines survival from cardiac arrest. Recommended mouth to mouth ventilation maneuver during CPR has led to lower rate of CPR performance in the population. Objectives: The present survey aimed to evaluate the willingness of nurses at Shiraz University of Medical Sciences for performing CPR versus chest-compression-only CPR. Patients and Methods: During a CPR course, we performed a survey on 25 nurses from Shiraz University of Medical Sciences, Iran. This survey included age and gender of the participants. In the first question, they were asked about their willingness to perform CPR with mouth to mouth breathing for witnessed cardiac arrest victims. In the second question, they were asked about their willingness to perform chest compression only for cardiac arrest victims. Results: Among the participating nurses, 96% were female with a mean age of 31 years. Only 40% were willing to perform CPR that requires mouth to mouth ventilation. On the other hand, 92% were willing to perform chest compression only without mouth to mouth ventilation. The mean age of the nurses who would do CPR was lower compared to those who would not. Conclusions: In this survey, we demonstrated that eliminating mouth to mouth ventilation maneuver could lead to markedly higher willingness to perform CPR for witnessed cardiac arrest victims in CPR trained nursing personnel. Our study is in agreement with other studies advocating that chest-compression-only CPR could lead to higher bystander resuscitation efforts.
Circulation, Nov 20, 2012
European Journal of Echocardiography, 2003
Introduction: Decreased left ventricular (LV) systolic function is usually associated with left a... more Introduction: Decreased left ventricular (LV) systolic function is usually associated with left atrial (LA) enlargement. However it is unknown if decreased LV systolic function can be excluded in patients with normal LA size. The goal of this study was to evaluate the negative predictive value of a normal LA size with respect to the severity of decrease in LV systolic function in a large cohort undergoing diagnostic echocardiography. Methods: We retrospectively analyzed 21,786 echocardiograms with documented LA size performed at our institution from 1984 to 1998. We analyzed the data based on the normal value for LA size defined as 40 mm or less measured by M-mode and two-dimensional echocardiography in parasternal long axis. The prevalence of normal LA size as well as its negative predictive value was calculated. We stratified the amount of systolic dysfunction into low, moderate and severe. We studied the negative predictive value of normal LA size. Results: Normal LA size was present in 12,583 (57.8%) patients. In this cohort, only 304 (2.4%) had abnormal LV systolic function (mildly depressed LV function 140/12,583, 1.1%; moderately depressed LV function 92/12,583, 0.7%; severely depressed LV function 72/12,583, 0.6%). A negative predictive value of a normal LA size with regards to abnormal LV systolic function was calculated to be 97.5%. Using moderate or severe decreased LV systolic function, a normal LA size had a negative predictive value of 99.3% and 99.4% respectively. Conclusion: A simple measurement of LA size using M-mode and two-dimensional echocardiography is useful in predicting the presence of normal LV systolic function in the setting of normal LA size and virtually excludes moderate or severe LV systolic dysfunction. 969 Left atrial volume predicts outcome in patients with dilated cardiomyopathy independently of exercise tolerance parameters.
European Journal of Echocardiography, 2003
Background:. Valsalva maneuver was used to differentiate normal from pseudonormal mitral flow pat... more Background:. Valsalva maneuver was used to differentiate normal from pseudonormal mitral flow pattern. Doppler tissue imaging (DTI), differentiates normal from abnormal diastolic function. Aim of the Work: Assessment of Valsalva maneuver as a mean to differentiate pseudonormal from normal mitral flow pattern (MFP), using pulsed-wave DTI Patients and Methods: sixty patients with dilated cardiomyopathy (EF<40%), sinus rhythm and pseudonormalized MFP were selected. Transmitral flow velocity curve (MFVC), before and during Valsalva maneuver was recorded. Peak early mitral filling (Em), peak atrial filling (Am) and Em/Am were measured before and during Valsalva. After Valsalva patients were classified into two groups. Group I included 24 patients with Em/Am <1 and group II, 36 patients with Em/Am >1. Pulsed-wave DTI was recorded at septal, lateral, inferior and anterior aspect of the mitral annulus from apical 4 and 2 chamber views. The mean peak early velocity (Ea), Peak atrial (Aa), and Ea/Aa of the 4 sites were measured from DTI derived velocity curve for each patient. The results were compared with the MFP. Results: Valsalva maneuver was able to detect a hidden relaxation abnormality in 40% of patients where Em/Am became <1 with significantly prolonged deceleration time (DT), and isovolumetric relaxation time (IVRT). However, 60% of patients the Em/Am remained >1 with slightly prolonged DT and IVRT. Pulsed-wave DTI detected relaxation abnormality in all patients. They had Ea/Aa 0.79±0.11, prolonged DT and IVRT. Group 1 had higher EF (36.71% vs. 32.87%), higher Ea (6.1±0.68 vs 5.3±0.1cm/s), lower Aa (7.9±2.012 vs 8.1±1.91 cm/s) and higher Ea/Aa ratio (0.77 vs 0.65) than group II patients. These data may denote that it was a progression of diastolic dysfunction with or without a hemodynamic factor that was responsible for the persistence of pseudonormalized pattern during Valsalva. Conclusion: Patient uncoperation, less sensitivity, and specificity are the major limitations Valsalva maneuver in assessment of patients with pseudonormalized MFP.Doppler tissue imaging is a simple noninvasive bedside technique with less load dependence. it can be used in combination with MFP for better understanding and assessment of diastolic dysfunctionin those patients. 156 Echocardiographic diastolic dysfunction parameters and mitral regurgitation are predictors of pulmonary hypertension in left ventricular dysfunction.
Cardiovascular disease is the leading cause of deaths in American adults. Furthermore, incidents ... more Cardiovascular disease is the leading cause of deaths in American adults. Furthermore, incidents of congestive heart failure are on the rise as a major cause of hospitalization and mortality in the population. Angiotensin converting enzyme (ACE) inhibitors prevent the production of angiotensin II, and it has been shown to reduce mortality in patients with congestive heart failure. Angiotensin II receptor blockers (ARB) were developed as a direct inhibitor of angiotensin II. Unlike ACE inhibitors, ARBs have been shown to be effective in the treatment of patients with systolic heart failure without causing common side effects, such as coughing. In theory, a drug, which has both modes of actions of two drug in a single molecule, may have additive effect in the treatment of heart failure. Therefore, the purpose of this manuscript is to suggest and discuss a new molecule generated by combining captopril, an ACE inhibitor, with losartan, an ARB. In this experiment, Captopril and Losartan ...
Seminars in Breast Disease, 2006
Multiple chemotherapeutic drugs are used in the treatment of breast cancer, many of which have th... more Multiple chemotherapeutic drugs are used in the treatment of breast cancer, many of which have the potential to produce cardiotoxicity. The anthracyclines are highly efficacious against breast cancer, but pose a particularly high risk for cardiotoxicity. The incidence of ...
The Journal of invasive cardiology, 2012
Full therapeutic heparin doses ranging from 5000-10,000 units or weight based (70-100 units/kg) h... more Full therapeutic heparin doses ranging from 5000-10,000 units or weight based (70-100 units/kg) have been recommended during percutaneous coronary interventions. However, there are currently no data available in regards to the appropriate dosing of unfractionated heparin during intravascular ultrasound (IVUS) studies without therapeutic coronary interventions. The goal of this study was to evaluate the safety of low dose unfractionated heparin during IVUS studies, shortly after endomyocardial biopsy in cardiac transplant patients. At the University of Arizona Medical Center, transplant patients routinely undergo diagnostic IVUS studies for the detection of early cardiac allograft vasculopathy (CAV) shortly after endomyocardial biopsy. A low-dose heparin (2000 to 3000 Units) is given before coronary wire and IVUS catheter advancement without checking activated clotting time. We evaluated the occurrence of any thromboembolic event or any other adverse outcomes in this population. A to...
The Journal of invasive cardiology, 2009
One of the major classes of adenosine diphosphate (ADP) receptor antagonists are thienopyridines.... more One of the major classes of adenosine diphosphate (ADP) receptor antagonists are thienopyridines. Thienopyridines compose a subcategory of antiplatelet medications, known as ADP receptor inhibitors, used commonly for the treatment of atherosclerotic cardiovascular disease. Thienopyridines, including ticlopidine, clopidogrel and prasugrel, are prodrugs administered orally that are further metabolized by hepatocytes to create active metabolites that irreversibly bind ADP receptors located on the platelet membrane. Thus, these selected drugs have an inhibitory effect for the duration of the platelet's lifespan of 7-10 days. The goal of this manuscript is to review the currently available ADP receptor blockers with emphasis on chemical structure, mode of action and clinical use.
Experimental and clinical cardiology, 2009
Stress-induced cardiomyopathy is usually associated with an increased level of cardiac enzymes, l... more Stress-induced cardiomyopathy is usually associated with an increased level of cardiac enzymes, leading to difficulties in differentiating this condition from acute coronary syndrome. The final diagnosis is usually made based on angiographic findings revealing normal coronary arteries. It was hypothesized that maximal cardiac enzyme elevation in these patients should have an upper limit. In the present study, reported cases of stress cardiomyopathy were compared with documented cardiac enzyme levels to evaluate the upper cut-off point of troponin in this population. All of the articles published in PubMed and MEDLINE from November 2007 to July 2008, on takotsubo or stress-induced cardiomyopathy, were identified. Only the cases that reported the absolute or mean level of cardiac enzymes were included. The level of various enzymes were correlated with cardiac function, and the upper limit of enzyme elevation was calculated in these patients. A total of 114 patients (mean [+/- SD] age ...
Experimental and clinical cardiology, 2009
A case of infectious endocarditis with septic embolization as a rare but potentially fatal compli... more A case of infectious endocarditis with septic embolization as a rare but potentially fatal complication of cardiac catheterization is described, followed by a detailed review of the literature. Obesity, diabetes, many skin punctures, previous bypass surgery and abnormal valves are predisposing factors for bacteremia following cardiac catheterization.
The American journal of medicine, 2014
Experimental and clinical cardiology, 2013
Mitral annulus calcification (MAC) is an important echocardiographic finding that is significantl... more Mitral annulus calcification (MAC) is an important echocardiographic finding that is significantly associated with valvular abnormalities. However, the effect of documented MAC on all-cause mortality is not known. Using a large database, associations between MAC and long-term all-cause mortality were evaluated. A retrospective analysis of 3169 echocardiograms, which were performed for clinical reasons in southern California between 1983 and 1998 in patients between 16 and 99 years of age, was performed. Mortality data were extracted from the national mortality database at the end of 2007. Using uni- and multivariate analysis, associations between total mortality and the echocardiographic presence of MAC documented in the final report by the interpreting cardiologist were evaluated. MAC was significantly associated with all-cause mortality (174 of 334 [52.1%] patients with MAC died versus 709 of 2835 [25.0%] patients without MAC; OR 3.26 [95% CI 2.58 to 4.10]; P<0.001). Using mult...
The Journal of invasive cardiology, 2013
Acute ST-elevation myocardial infarction (STEMI) is associated with significant arrhythmia and ca... more Acute ST-elevation myocardial infarction (STEMI) is associated with significant arrhythmia and cardiac arrest. QT prolongation can occur in the setting of ischemia or acute STEMI as a risk factor for arrhythmia. The goal of this study was to investigate corrected QT interval (QTc), QT dispersion (QTd), and T-wave peak to end (TPE) times in this patient population and evaluate the effect of primary percutaneous coronary intervention (PCI) in STEMI patients on these indices. This study was a clinical trial, whereby eligible patients presenting with acute STEMI who were appropriate candidates for primary PCI were enrolled. QTc, QTd, and TPE indices were calculated before and after the procedure. Eighty patients (60 male, 20 female) with a mean age of 58.8 years were evaluated. We found significant reduction in QTd after PCI (mean, 5.8 ms before PCI vs 3.6 ms after PCI; P<.001) and significant reduction in TPE after PCI (mean, 9.7 ms before PCI vs 7 ms after PCI; P<.001). QTc did ...
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Papers by Mohammad Anwar Movahed