Background: Syncope is a common condition that accounts for 3% of emergency department (ED) visit... more Background: Syncope is a common condition that accounts for 3% of emergency department (ED) visits and 1-6% of hospital admissions. Current admissions practices result in marginal diagnostic and therapeutic benefit and consume healthcare resources. Methods: This prospective cohort study examined the use of brain natriuretic peptide (BNP) test as a predictor of short term serious outcome in 159 patients who presented to ED with syncope between August 2012 and August 2013 in two tertiary teaching medical centers. Results: A total of 41 patients (36%) had serious outcomes within 1 month, 21 of them were in the low BNP group and 20 were in the high BNP group. There was a significantly higher incidence of serious outcomes, myocardial infarction (MI), and life-threatening arrhythmias in the high BNP group. Patients with BNP >250 has an 8.844 fold increase risk of serious outcomes [odds ratio (OR) 8.844, 95% CI: (3.281 to 23.8), P<0.001], a 14.8-fold increase risk of MI [OR =14.8, 95% CI: (1.57 to 139), P=0.011], and a 4.46-fold increase risk life threatening arrhythmia [OR =4.46, 95% CI: (1.15-18.8), P=0.034]. However, there was no statistically significant difference between the two groups in one month mortality, major bleeding, major cardiac procedures or stroke. Conclusions: Our study results further validates the ROSE rule and the utility of BNP in risk stratification of syncope patients. This study showed that measuring BNP and adding ROSE rule to the standard evaluation of syncope can sufficiently predict short-term serious outcomes for patients presenting to ED with syncope.
Journal of the American College of Cardiology, 2015
Background: Neurtrophil to Lymphocyte Ratio (NLR) has been established as a measure of inflammati... more Background: Neurtrophil to Lymphocyte Ratio (NLR) has been established as a measure of inflammation and as a prognosticating factor in various medical conditions including neoplastic, inflammatory and cardiovascular. The prognostic role of NLR in predicting mortality in patients with aortic stenosis undergoing aortic valve replacement (AVR) has not been studied. Our primary aim in this study is to explore the utility of NLR as a predictor of both, short and long-term mortality, in patients undergoing AVR surgery. methods: Consecutive patients with aortic stenosis admitted for aortic valve replacement to our institution were evaluated for study inclusion. Of the 335 patients admitted from January 2007 to September 2011, 234 met study inclusion criteria. Patients were divided into two groups depending on their initial preoperative NLR level, NLR greater than or equal to 3, or NLR less than 3. Three-year vital status was accessed with electronic medical records and Social Security Death Index. Survival analysis, stratified by NLR, was used to evaluate the predictive value of preoperative NLR levels. results: Patients with NLR greater than or equal to 3, when compared to those with NLR less than 3, had a significantly higher short-term (9.40% vs. 0, p= 0.0006), 6-month (19.54% vs. 0.95%, p< 0.0001), and 3-year mortality (27.35% vs 3.78%, p< 0.0001). After adjustment for baseline characteristics, co-morbidities, symptomatology, echocardiographic findings, and blood tests, NLR level remained a significant independent predictor of short-term, 6-month, and 3-year mortality. Hazard ratios increased by a factor of 1.22 (1.04-1.42, p= 0.0129), 1.31 (1.18-1.47, p< 0.0001), and 1.29 (1.17-1.43, p <0.0001), respectively. conclusion: NLR is an independent predictor of short-term and long-term mortality in patients with aortic stenosis undergoing AVR surgery, especially those with NLR greater than or equal to 3. We strongly suggest the use of NLR as a tool to risk stratify patients with aortic stenosis undergoing aortic valve replacement surgery.
Journal of Cardiology & Cardiovascular Therapy, 2017
ST elevation myocardial infarction (STEMI) is a medical emergency, and the earlier the revascular... more ST elevation myocardial infarction (STEMI) is a medical emergency, and the earlier the revascularization is achieved via thrombolysis or percutaneous coronary intervention, the better the prognosis. However, other causes of ST elevation (STE) should always be considered in the differential diagnosis, and electrocardiographic clues to differentiate between them have to be sought in order not to delay treatment in time sensitive situations, and at the same time to avoid unnecessary studies or procedures with their added risks [1]. Here, we present a case of hyperosmolar hyperglycemic state (HHS) in a patient who had inferolateral STE on EKG with normal coronary angiogram.
Majority of persistent left superior vena cava (PLSVC) are asymptomatic and discovered incidental... more Majority of persistent left superior vena cava (PLSVC) are asymptomatic and discovered incidentally. In this case report, we present a patient with bacteremia, osteomyelitis involving the lumbar spine, and infective endocarditis of the anterior/posterior leaflets of the mitral valve with moderate regurgitation who eventually underwent emergent mitral valve replacement. Prior to the surgery, Peripherally Inserted Central Catheter (PICC) and Triple-Lumen Central Venous Catheter were placed via left brachial vein and right internal jugular vein approach, respectively. Incidental PLSVC was identified on routine post-procedural radiograph as the catheters were seen in the left paramediastinal location. Interestingly, further analysis revealed that the PLSVC was not accompanied by a normal right-sided superior vena cava (SVC), which is a very rare variation of the venous system in the chest.
Bleeding is a common complication of cardiac surgery, accounting for a significant proportion of ... more Bleeding is a common complication of cardiac surgery, accounting for a significant proportion of the total transfusions performed in the United States and Europe. The relationship between platelet reactivity, bleeding, and other adverse events after coronary artery bypass graft surgery (CABGS) has been incompletely characterized. This study investigated the relationship between platelet reactivity and bleeding as a clinical outcome after successful CABGS. A total of 238 patients who underwent CABGS were retrospectively followed for postoperative bleeding. Platelet reactivity unit (PRU) values for all patients were obtained preoperatively to assess the platelet reactivity. The data showed that a range of 180-200 PRU suggests the likelihood of bleeding after CABGS (P = 0.004), with a statistically significant association only for dual antiplatelet therapy with aspirin and clopidogrel. In conclusion, by using PRU values as a method to assess platelet reactivity and antiplatelet respons...
Peripartum cardiomyopathy is a weakness of the heart muscle. It is an idiopathic cardiomyopathy t... more Peripartum cardiomyopathy is a weakness of the heart muscle. It is an idiopathic cardiomyopathy that presents with heart failure secondary to left ventricular systolic dysfunction toward the end of pregnancy or in the months after delivery, in the absence of any other cause of heart failure. It is a rare condition that can carry mild or severe symptoms.
Bleeding is a common complication of cardiac surgery, accounting for a significant proportion of ... more Bleeding is a common complication of cardiac surgery, accounting for a significant proportion of the total transfusions performed in the United States and Europe. The relationship between platelet reactivity, bleeding, and other adverse events after coronary artery bypass graft surgery (CABGS) has been incompletely characterized. This study investigated the relationship between platelet reactivity and bleeding as a clinical outcome after successful CABGS. A total of 238 patients who underwent CABGS were retrospectively followed for postoperative bleeding. Platelet reactivity unit (PRU) values for all patients were obtained preoperatively to assess the platelet reactivity. The data showed that a range of 180-200 PRU suggests the likelihood of bleeding after CABGS (P = 0.004), with a statistically significant association only for dual antiplatelet therapy with aspirin and clopidogrel. In conclusion, by using PRU values as a method to assess platelet reactivity and antiplatelet respons...
Syncope is a common condition that accounts for 3% of emergency department (ED) visits and 1-6% o... more Syncope is a common condition that accounts for 3% of emergency department (ED) visits and 1-6% of hospital admissions. Current admissions practices result in marginal diagnostic and therapeutic benefit and consume healthcare resources. This prospective cohort study examined the use of brain natriuretic peptide (BNP) test as a predictor of short term serious outcome in 159 patients who presented to ED with syncope between August 2012 and August 2013 in two tertiary teaching medical centers. A total of 41 patients (36%) had serious outcomes within 1 month, 21 of them were in the low BNP group and 20 were in the high BNP group. There was a significantly higher incidence of serious outcomes, myocardial infarction (MI), and life-threatening arrhythmias in the high BNP group. Patients with BNP &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;250 has an 8.844 fold increase risk of serious outcomes [odds ratio (OR) 8.844, 95% CI: (3.281 to 23.8), P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001], a 14.8-fold increase risk of MI [OR =14.8, 95% CI: (1.57 to 139), P=0.011], and a 4.46-fold increase risk life threatening arrhythmia [OR =4.46, 95% CI: (1.15-18.8), P=0.034]. However, there was no statistically significant difference between the two groups in one month mortality, major bleeding, major cardiac procedures or stroke. Our study results further validates the ROSE rule and the utility of BNP in risk stratification of syncope patients. This study showed that measuring BNP and adding ROSE rule to the standard evaluation of syncope can sufficiently predict short-term serious outcomes for patients presenting to ED with syncope.
Background: Syncope is a common condition that accounts for 3% of emergency department (ED) visit... more Background: Syncope is a common condition that accounts for 3% of emergency department (ED) visits and 1-6% of hospital admissions. Current admissions practices result in marginal diagnostic and therapeutic benefit and consume healthcare resources. Methods: This prospective cohort study examined the use of brain natriuretic peptide (BNP) test as a predictor of short term serious outcome in 159 patients who presented to ED with syncope between August 2012 and August 2013 in two tertiary teaching medical centers. Results: A total of 41 patients (36%) had serious outcomes within 1 month, 21 of them were in the low BNP group and 20 were in the high BNP group. There was a significantly higher incidence of serious outcomes, myocardial infarction (MI), and life-threatening arrhythmias in the high BNP group. Patients with BNP >250 has an 8.844 fold increase risk of serious outcomes [odds ratio (OR) 8.844, 95% CI: (3.281 to 23.8), P<0.001], a 14.8-fold increase risk of MI [OR =14.8, 95% CI: (1.57 to 139), P=0.011], and a 4.46-fold increase risk life threatening arrhythmia [OR =4.46, 95% CI: (1.15-18.8), P=0.034]. However, there was no statistically significant difference between the two groups in one month mortality, major bleeding, major cardiac procedures or stroke. Conclusions: Our study results further validates the ROSE rule and the utility of BNP in risk stratification of syncope patients. This study showed that measuring BNP and adding ROSE rule to the standard evaluation of syncope can sufficiently predict short-term serious outcomes for patients presenting to ED with syncope.
Journal of the American College of Cardiology, 2015
Background: Neurtrophil to Lymphocyte Ratio (NLR) has been established as a measure of inflammati... more Background: Neurtrophil to Lymphocyte Ratio (NLR) has been established as a measure of inflammation and as a prognosticating factor in various medical conditions including neoplastic, inflammatory and cardiovascular. The prognostic role of NLR in predicting mortality in patients with aortic stenosis undergoing aortic valve replacement (AVR) has not been studied. Our primary aim in this study is to explore the utility of NLR as a predictor of both, short and long-term mortality, in patients undergoing AVR surgery. methods: Consecutive patients with aortic stenosis admitted for aortic valve replacement to our institution were evaluated for study inclusion. Of the 335 patients admitted from January 2007 to September 2011, 234 met study inclusion criteria. Patients were divided into two groups depending on their initial preoperative NLR level, NLR greater than or equal to 3, or NLR less than 3. Three-year vital status was accessed with electronic medical records and Social Security Death Index. Survival analysis, stratified by NLR, was used to evaluate the predictive value of preoperative NLR levels. results: Patients with NLR greater than or equal to 3, when compared to those with NLR less than 3, had a significantly higher short-term (9.40% vs. 0, p= 0.0006), 6-month (19.54% vs. 0.95%, p< 0.0001), and 3-year mortality (27.35% vs 3.78%, p< 0.0001). After adjustment for baseline characteristics, co-morbidities, symptomatology, echocardiographic findings, and blood tests, NLR level remained a significant independent predictor of short-term, 6-month, and 3-year mortality. Hazard ratios increased by a factor of 1.22 (1.04-1.42, p= 0.0129), 1.31 (1.18-1.47, p< 0.0001), and 1.29 (1.17-1.43, p <0.0001), respectively. conclusion: NLR is an independent predictor of short-term and long-term mortality in patients with aortic stenosis undergoing AVR surgery, especially those with NLR greater than or equal to 3. We strongly suggest the use of NLR as a tool to risk stratify patients with aortic stenosis undergoing aortic valve replacement surgery.
Journal of Cardiology & Cardiovascular Therapy, 2017
ST elevation myocardial infarction (STEMI) is a medical emergency, and the earlier the revascular... more ST elevation myocardial infarction (STEMI) is a medical emergency, and the earlier the revascularization is achieved via thrombolysis or percutaneous coronary intervention, the better the prognosis. However, other causes of ST elevation (STE) should always be considered in the differential diagnosis, and electrocardiographic clues to differentiate between them have to be sought in order not to delay treatment in time sensitive situations, and at the same time to avoid unnecessary studies or procedures with their added risks [1]. Here, we present a case of hyperosmolar hyperglycemic state (HHS) in a patient who had inferolateral STE on EKG with normal coronary angiogram.
Majority of persistent left superior vena cava (PLSVC) are asymptomatic and discovered incidental... more Majority of persistent left superior vena cava (PLSVC) are asymptomatic and discovered incidentally. In this case report, we present a patient with bacteremia, osteomyelitis involving the lumbar spine, and infective endocarditis of the anterior/posterior leaflets of the mitral valve with moderate regurgitation who eventually underwent emergent mitral valve replacement. Prior to the surgery, Peripherally Inserted Central Catheter (PICC) and Triple-Lumen Central Venous Catheter were placed via left brachial vein and right internal jugular vein approach, respectively. Incidental PLSVC was identified on routine post-procedural radiograph as the catheters were seen in the left paramediastinal location. Interestingly, further analysis revealed that the PLSVC was not accompanied by a normal right-sided superior vena cava (SVC), which is a very rare variation of the venous system in the chest.
Bleeding is a common complication of cardiac surgery, accounting for a significant proportion of ... more Bleeding is a common complication of cardiac surgery, accounting for a significant proportion of the total transfusions performed in the United States and Europe. The relationship between platelet reactivity, bleeding, and other adverse events after coronary artery bypass graft surgery (CABGS) has been incompletely characterized. This study investigated the relationship between platelet reactivity and bleeding as a clinical outcome after successful CABGS. A total of 238 patients who underwent CABGS were retrospectively followed for postoperative bleeding. Platelet reactivity unit (PRU) values for all patients were obtained preoperatively to assess the platelet reactivity. The data showed that a range of 180-200 PRU suggests the likelihood of bleeding after CABGS (P = 0.004), with a statistically significant association only for dual antiplatelet therapy with aspirin and clopidogrel. In conclusion, by using PRU values as a method to assess platelet reactivity and antiplatelet respons...
Peripartum cardiomyopathy is a weakness of the heart muscle. It is an idiopathic cardiomyopathy t... more Peripartum cardiomyopathy is a weakness of the heart muscle. It is an idiopathic cardiomyopathy that presents with heart failure secondary to left ventricular systolic dysfunction toward the end of pregnancy or in the months after delivery, in the absence of any other cause of heart failure. It is a rare condition that can carry mild or severe symptoms.
Bleeding is a common complication of cardiac surgery, accounting for a significant proportion of ... more Bleeding is a common complication of cardiac surgery, accounting for a significant proportion of the total transfusions performed in the United States and Europe. The relationship between platelet reactivity, bleeding, and other adverse events after coronary artery bypass graft surgery (CABGS) has been incompletely characterized. This study investigated the relationship between platelet reactivity and bleeding as a clinical outcome after successful CABGS. A total of 238 patients who underwent CABGS were retrospectively followed for postoperative bleeding. Platelet reactivity unit (PRU) values for all patients were obtained preoperatively to assess the platelet reactivity. The data showed that a range of 180-200 PRU suggests the likelihood of bleeding after CABGS (P = 0.004), with a statistically significant association only for dual antiplatelet therapy with aspirin and clopidogrel. In conclusion, by using PRU values as a method to assess platelet reactivity and antiplatelet respons...
Syncope is a common condition that accounts for 3% of emergency department (ED) visits and 1-6% o... more Syncope is a common condition that accounts for 3% of emergency department (ED) visits and 1-6% of hospital admissions. Current admissions practices result in marginal diagnostic and therapeutic benefit and consume healthcare resources. This prospective cohort study examined the use of brain natriuretic peptide (BNP) test as a predictor of short term serious outcome in 159 patients who presented to ED with syncope between August 2012 and August 2013 in two tertiary teaching medical centers. A total of 41 patients (36%) had serious outcomes within 1 month, 21 of them were in the low BNP group and 20 were in the high BNP group. There was a significantly higher incidence of serious outcomes, myocardial infarction (MI), and life-threatening arrhythmias in the high BNP group. Patients with BNP &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;250 has an 8.844 fold increase risk of serious outcomes [odds ratio (OR) 8.844, 95% CI: (3.281 to 23.8), P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001], a 14.8-fold increase risk of MI [OR =14.8, 95% CI: (1.57 to 139), P=0.011], and a 4.46-fold increase risk life threatening arrhythmia [OR =4.46, 95% CI: (1.15-18.8), P=0.034]. However, there was no statistically significant difference between the two groups in one month mortality, major bleeding, major cardiac procedures or stroke. Our study results further validates the ROSE rule and the utility of BNP in risk stratification of syncope patients. This study showed that measuring BNP and adding ROSE rule to the standard evaluation of syncope can sufficiently predict short-term serious outcomes for patients presenting to ED with syncope.
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