Papers by Salomon Velasco Cohen
Archives of Cardiovascular Diseases Supplements, 2018
Background and Objectives: European data suggest a single high-sensitivity troponin (hs-cTn) resu... more Background and Objectives: European data suggest a single high-sensitivity troponin (hs-cTn) result below the limit of detection excludes major adverse cardiac events (MACE) in patients with symptoms concerning for acute coronary syndrome. However, the FDA limits hs-cTnT reporting to the limit of quantification (LOQ: 6 ng/L) and little US data exists evaluating this cut-point. The objective of this study is to test the diagnostic performance of an initial hs-cTnT measure below the LOQ in a multisite US cohort. Methods: A prospective observational cohort study was conducted at 8 US sites. Adult ED patients with symptoms suggestive of acute coronary syndrome and without ST-segment elevation on ECG were enrolled. Blood samples were collected from participants and hs-cTnT concentrations were measured using the Roche (Basel, Switzerland) hs-cTnT assay. Patients with research blood collection \u3e1 hour after their first clinical blood draw or insufficient sample volume were excluded from analysis. Treating providers were blinded to hs-cTnT results. Adjudicated outcomes included MACE (composite of cardiac death, myocardial infarction [MI], and coronary revascularization) at 30-days and cardiac death or MI at 30-days. The proportion of patients with an initial hs-cTnT measure below the LOQ was determined, and sensitivity and negative predictive value (NPV) for safety outcomes were calculated with exact 95% confidence intervals. Results: Among 1,460 with initial hs-cTnT measures, 46.3% (676/1,460) were women and 37.1% (542/1,460) were African American with a mean age of 57.6 (SD±12.8) years. MACE at 30-days occurred in 14.4% (210/1,460). The initial hs-cTnT measure was below the LOQ in 32.9% (479/1,460) of patients. Among these patients, 1.7% (8/479) had 30-day MACE, yielding a NPV of 98.3% (95%CI: 96.8-99.2%) and 1.0% (5/479) had 30-day cardiac death or MI with a NPV of 99.0% (95%CI: 97.6-99.6%). Sensitivity of the initial hs-cTnT measure below the LOQ was 96.2% (95%CI: 92.6-98.3%) and 97.4% (95%CI: 94.0-99.1%) for 30-day MACE and cardiac death or MI, respectively. Conclusion: In a multisite prospective US cohort, a single hs-cTnT measure below the LOQ occurred in nearly a third of patients. However, the sensitivity and NPV of a single hs-cTnT measure may not be sufficient to rule-out 30-day MACE or 30-day cardiac death or MI
Background and Objectives: The European Society of Cardiology 0/1-hour algorithm (ESC 0/1-h) is a... more Background and Objectives: The European Society of Cardiology 0/1-hour algorithm (ESC 0/1-h) is a high sensitivity cardiac troponin (hs-cTn) accelerated diagnostic protocol (ADP) that was derived and validated in Europe and is endorsed by the ESC guidelines. Based largely on European data demonstrating a negative predictive value (NPV) \u3e99%, the ESC 0/1-h is being adopted at US hospitals, but evidence of its diagnostic performance in the US is limited. The objective of this study is to validate the ESC 0/1-h in a multisite US cohort. Methods: A prospective observational cohort study was conducted at 8 US sites. Adult Emergency Department patients with symptoms suggestive of acute coronary syndrome and without ST-segment elevation myocardial infarction on ECG were enrolled. Serial blood samples were collected from participants and hscTnT concentrations were measured in a central laboratory using the Roche (Basel, Switzerland) hs-cTnT assay. Treating providers were blinded to hs-cTnT results. Adjudicated outcomes included MACE (the composite of cardiac death, myocardial infarction [MI], and coronary revascularization) at 30-days and cardiac death or MI at 30-days. Risk based on the ESC 0/1-h was determined for each participant and its diagnostic performance (NPV and positive predictive value [PPV] with exact 95% confidence intervals) was calculated. Results: Among 1,462 patients enrolled, 1,430 patients had 0 and 1 hour hs-cTnT measures; 45.8% (655/1430) were women and 36.6% (524/1430) were African American with a mean age of 57.6 (SD±12.8) years. MACE at 30-days occurred in 14.2% (203/1,430). The ESC 0/1-h ADP stratified 59.6% (853/ 1,430) of patients to the Rule-Out zone, with a NPV for 30-day MACE of 97.2% (95%CI: 95.8-98.2%) and 98.4% (95%CI: 97.3-99.1%) for 30-day cardiac death and MI. The Rule-In criteria were met by 12.2% (175/1,430) with a PPV of 62.9% (95%CI 55.2-70.0%) for 30-day MACE and 62.9% (95%CI 55.2- 70.0%) for 30-day cardiac death and MI. The remaining 28.1% (402/1,430) were stratified to the observation zone. Among observation zone patients, 17.2% (69/402) had 30-day MACE. Conclusion: In a multisite prospective US cohort, the ESC 0/1-h hs-cTnT ADP stratified a large proportion of patients to the Rule-Out zone, but was unable to achieve a sufficiently high NPV to safely exclude 30-day MACE or 30-day cardiovascular death and MI
European Journal of Ophthalmology, 2009
Purpose. Many complications associated with tilted disk syndrome may occur in the area bordering ... more Purpose. Many complications associated with tilted disk syndrome may occur in the area bordering on the inferior staphyloma, including macular pigmentary changes, choroidal neovascularization, macular serous retinal detachment, polypoidal choroidal vascular anomalies, and radially orientated chorioretinal folds. The purpose of the present article is to describe an additional complication, Tshaped pigmentary changes, orientated radially from the border of the inferior staphyloma, in eyes with tilted disk syndrome.. Methods. Retrospective series of 6 eyes of 6 patients (3 men and 3 women) aged from 35 to 67 years. All eyes were studied by fluorescein angiography. Results. All 6 eyes exhibited pigmentary changes located along the border of the staphyloma, and also radially to it, giving a particular T-shaped pattern of pigmentary changes. These changes were visible as either a linear strip or a triangular or oval-shaped area. Three eyes had a documented history of subretinal leakage that mimicked central serous chorioretinopathy, a well-known complication of tilted disk syndrome. Conclusions. T-shaped pigmentary changes may develop in the course of tilted disk syndrome, and should be added to the list of this syndrome's possible retinal complications. These changes may indicate the presence of chronic leakage in the area around the superior border of the inferior staphy
Journal Francais D Ophtalmologie, 2001
Investigative ophthalmology & visual science, 1992
An estimate of overall corneal hydration control can be obtained by measuring the rate of thickne... more An estimate of overall corneal hydration control can be obtained by measuring the rate of thickness recovery following induced corneal swelling; it is expressed as the percent recovery per hour (PRPH). This recovery is nearly, but not exactly, exponential, because there appears to be an initial slower recovery phase lasting about 30-40 minutes. This 30-40 minute period of slower recovery corresponds to the time when corneal pH is reduced secondary to the contact lens-induced swelling, suggesting the possibility that stromal acidosis may retard the corneal deswelling process. In this study, we explored the effects of corneal acidosis on hydration control by monitoring corneal recovery under normal and reduced pH conditions. Corneal pH was controlled by having subjects were goggles and exposing their eyes to air (normal pH) or a gas mixture providing 21% O2 and 7% CO2 (low pH). Relative corneal pH levels were monitored by measuring fluorescence intensity (FI) ratios, which showed that...
Retinal cases & brief reports, 2007
Acute zonal occult outer retinopathy (AZOOR) is a disease of unknown etiology in young or middle-... more Acute zonal occult outer retinopathy (AZOOR) is a disease of unknown etiology in young or middle-aged patients that is characterized by acute loss of one or more zones of outer retinal function, photopsia, minimal initial ophthalmoscopic changes, and electroretinographic abnormalities. AZOOR may represent part of the spectrum of a single disease, the so-called AZOOR complex. In contrast with most other ocular diseases that may be part of this AZOOR complex, AZOOR has not, to our knowledge, been reported in association with choroidal neovascularization (CNV). We describe a 47-year-old man presenting with peripapillary AZOOR and CNV. Despite photodynamic therapy, CNV evolved to a fibrovascular diskiform scar. The occurrence of CNV on the margin of the AZOOR process suggested a direct link between the CNV and the underlying condition. To our knowledge, this is the first reported case of CNV complicating AZOOR.
Médecine des Maladies Métaboliques, 2007
Journal of the Saudi Heart Association, 2009
Background: Primary angioplasty decreases mortality and improves long-term outcomes for patients ... more Background: Primary angioplasty decreases mortality and improves long-term outcomes for patients with STEMI. To be most effective, it needs to be performed expediently, with door-to-balloon times (D2B) less than 90 min. Methods: From January 2005 to presently, 420 short D2B STEMI interventions were performed at 5 community hospitals by a single experienced operator creating the SINCERE (Single INdividual Community Experience REgistry) database. Results: Median D2B time was 78 min, median procedure time (local anesthesia to recanalization) was 13 min; 85.2% of procedures had D2B time <90 min; 95% of the procedures were successful-relief of chest pain, >70% ST segment resolution, TIMI 3 flow and Myocardial Perfusion Grade 3. Conclusions: Primary PCI with high success rates and predictable short D2B times can be performed with standardized techniques in community hospitals.
Retina, 2012
Purpose: To identify the causes of loss of vision after ranibizumab therapy in patients with exud... more Purpose: To identify the causes of loss of vision after ranibizumab therapy in patients with exudative age-related macular degeneration treated in three clinical settings. Methods: A retrospective multicentric analysis of 290 consecutive eyes comprising cohorts from 3 clinical settings showed that 21 eyes lost $15 letters on the Early Treatment Diabetic Retinopathy Study chart 1 year after the start of ranibizumab treatment. Fundus images of these eyes were analyzed by two independent readers to investigate the causes of visual loss. The three cohorts were compared. A search was made for factors predisposing to visual loss. A second analysis was performed to compare the baseline characteristics of patients who gained (visual acuity gainers) or lost (visual acuity losers) $15 letters. Results: Among the 290 eyes included, the proportions from each center experiencing visual loss were not significantly different (mean, 7.24%, P = 0.2631). Mean visual loss of affected eyes was 27 letters. There was no significant difference between these eyes and others as regards age and gender of patients, laterality, type of choroidal neovascularization, number of visits, or initial visual acuity. Visual loss was secondary to the progression of atrophy in eight eyes, fibrosis in five eyes, a combination of fibrosis and atrophy in three eyes, severe subretinal hemorrhage in three eyes, and retinal pigment epithelial tear in two eyes. A significant difference between visual acuity gainers and losers was observed for 2 parameters: age of patients, 80.9 ± 5.3 years in visual acuity losers versus 77.5 ± 7.3 years in visual acuity gainers (P = 0.0473) and visual acuity at diagnosis, respectively, 56.2 ± 11.2 versus 49.0 ± 12.0 (P = 0.0288). Conclusion: Although uncommon, visual loss may occur during ranibizumab treatment and is because of the natural course of age-related macular degeneration in most cases.
Retina, 2006
A 59-year-old man was referred to our institution for fluorescein angiography and optical coheren... more A 59-year-old man was referred to our institution for fluorescein angiography and optical coherence tomography of the left eye. Six years previously, this eye had been operated on for complex retinal detachment. Perfluorocarbon liquid (PFC; Perfluoron, Alcon Laboratories, Inc., Forth Worth, TX) and silicone tamponade were used intraoperatively. The silicone was removed 6 months later, and the retina remained flat. Visual acuity in the left eye was 20/40 after cataract surgery. However, a subretinal bleb was observed in the upper temporal macula, as a result of intraoperative migration of PFC into the subretinal space. Recently, a retinal hole was noted in the upper part of the bleb (Fig. 1). Fluorescein angiography showed that the area occupied by PFC was hyperfluorescent, with a window defect (Fig. 2). Optical coherence tomography revealed a prominent oval subretinal bleb (Fig. 3). Scans passing through the hole disclosed a full-thickness retinal hole (Fig. 4).
Retina, 2008
A 76-year-old woman was referred for metamorphopsia in her right eye. Visual acuity was 20/40 (12... more A 76-year-old woman was referred for metamorphopsia in her right eye. Visual acuity was 20/40 (120°Ϫ1.25, Ϫ5.50 diopter) OD, and 20/20 (5°Ϫ0.50, ϩ1.75 diopter) OS. Right eye fundus examination disclosed tilted disk syndrome. Soft drusen were present in the upper part of the fundus, but almost totally spared the lower staphylomatous fundus (Figure 1). Fluorescein angiography disclosed juxtafoveal choroidal neovascularization (CNV). The left eye fundus did not exhibit tilted disk syndrome. Drusen were equally distributed between the upper and lower parts of the left fundus (Figure 1).
Ophthalmologica, 2011
Purpose: To our knowledge, there is no published study on the evolution of age of occurrence of e... more Purpose: To our knowledge, there is no published study on the evolution of age of occurrence of exudative age-related macular degeneration (AMD). The present study was performed to test whether or not the average age of patients with newly diagnosed choroidal neovascularization (CNV) due to AMD has changed in a clinical setting during the past 20 years. Methods: Nonrandomized comparative case study. Charts and fluorescein angiograms of consecutive patients diagnosed in 1986 and 2006 in a tertiary care center were analyzed to identify differences in age, gender and type of CNV. Mann-Whitney’s nonparametric test was used to compare the statistical distribution of the parameters. χ2 or Fisher’s exact test was used for categorical variables. Results: 357 patients with CNV due to AMD, 79 in 1986, and 278 in 2006 were included. The patients diagnosed in 2006 were 4.7 years older than those diagnosed in 1986 (80.1 ± 8.9 vs. 75.4 ± 6.7 years, p < 0.0001). The main increase was in the per...
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Papers by Salomon Velasco Cohen