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1.
Australas J Dermatol ; 59(4): 253-260, 2018 Nov.
Article in English | MEDLINE | ID: mdl-29313891

ABSTRACT

It has been suggested that bullous pemphigoid is associated with an increased risk of malignancy, but the evidence is inconsistent. Therefore, a meta-analysis was conducted to explore this association. PUBMED and Embase were searched for studies investigating the association between bullous pemphigoid and malignancy. This meta-analysis included 16 studies with a total of 9398 cases of bullous pemphigoid. The rate of malignancy in patients with bullous pemphigoid was 11% (95% CI: 9-14, P < 0.001); 9% (95% CI: 6-13, P < 0.003) for women and 13% (95% CI: 9-18, P < 0.03) for men, with a statistically insignificant higher risk in men (OR = 1.30, 95% CI: 0.99-1.71, P = 0.06). The event rate was 9% (95% CI: 5-14, P < 0.001) in the Asian population and 13% (95% CI: 10-17, P < 0.001) in the European population, with a statistically significant lower risk in the Asians population (OR = 0.69, 95% CI: 0.57-0.84; P < 0.001). The event rate of malignancy was higher in patients with bullous pemphigoid than in matched controls (OR = 2.08, 95% CI: 1.22-3.55; P = 0.005). The overall event rate of malignancy was higher in the bullous pemphigoid group than in matched controls. Caution is required when interpreting these results, as potential confounding variables were not controlled for.


Subject(s)
Neoplasms/epidemiology , Pemphigoid, Bullous/epidemiology , Asian People , Female , Humans , Incidence , Male , Sex Factors , White People
3.
Medicine (Baltimore) ; 95(52): e5819, 2016 Dec.
Article in English | MEDLINE | ID: mdl-28033306

ABSTRACT

BACKGROUND: The benefit of ≤6-month compared with 12-month dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) placement remains controversial. We performed a meta-analysis and meta-regression of ≤6-month versus 12-month DAPT in patients undergoing PCI with DES placement. METHODS: We conducted electronic database searches of randomized controlled trials (RCTs) comparing DAPT durations after DES placement. For studies with longer follow-up, outcomes at 12 months were identified. Odds ratios and 95% confidence intervals were computed with the Mantel-Haenszel method. Fixed-effect models were used; if heterogeneity (I) > 40 was identified, effects were obtained with random models. RESULTS: Nine RCTs were included with total n = 19,224 patients. No significant differences were observed between ≤6-month compared with 12-month DAPT in all-cause mortality (OR 0.87; 95% confidence interval (CI): 0.69-1.11), cardiovascular (CV) mortality (OR 0.89; 95% CI: 0.66-1.21), non-CV mortality (OR 0.85; 95% 0.58-1.24), myocardial infarction (OR 1.10; 95% CI: 0.89-1.37), stroke (OR 0.97; 95% CI: 0.67-1.42), stent thrombosis (ST) (OR 1.37; 95% CI: 0.89-2.10), and target vessel revascularization (OR 0.95; 95% CI: 0.77-1.18). No significant difference in major bleeding (OR 0.72; 95% CI: 0.49-1.05) was observed, though the all-bleeding event rate was significantly lower in the ≤6-month DAPT group (OR 0.76; 95% CI: 0.59-0.96). In the meta-regression analysis, a significant association between bleeding events and non-CV mortality with 12-month DAPT was found, as well as between ST and mortality in addition to MI with ≤6-month DAPT. CONCLUSION: DAPT for ≤6 months is associated with similar mortality and ischemic outcomes but less bleeding events compared with 12-month DAPT after PCI with DES.


Subject(s)
Cardiovascular Diseases/mortality , Drug-Eluting Stents , Hemorrhage/epidemiology , Percutaneous Coronary Intervention , Platelet Aggregation Inhibitors/administration & dosage , Cause of Death , Hemorrhage/chemically induced , Humans , Incidence , Myocardial Infarction/epidemiology , Myocardial Revascularization , Platelet Aggregation Inhibitors/adverse effects , Prosthesis Failure , Randomized Controlled Trials as Topic , Stroke/epidemiology , Thrombosis/epidemiology , Time Factors , Treatment Outcome
4.
JAMA Dermatol ; 152(7): 815, 2016 07 01.
Article in English | MEDLINE | ID: mdl-27409049
5.
Clin Med Insights Cardiol ; 8: 45-52, 2014.
Article in English | MEDLINE | ID: mdl-24963274

ABSTRACT

Atrial fibrillation (AF) increases the risk for thromboembolic stroke five-fold. The left atrial appendage (LAA) has been shown to be the main source of thrombus formation in the majority of strokes associated with AF. Oral anticoagulation with warfarin and novel anticoagulants remains the standard of care; however, it has several limitations, including bleeding and poor compliance. Occlusion of the LAA has been shown to be an alternative therapeutic approach to drug therapy. The purpose of this article is to review the different techniques and devices that have emerged for the purpose of occluding this structure, with a particular emphasis on the efficacy and safety studies published to date in the medical literature.

6.
Cardiol Rev ; 22(5): 246-52, 2014.
Article in English | MEDLINE | ID: mdl-24621860

ABSTRACT

Established coronary artery disease has a prevalence of 7% in adult Americans, accounting for 16 million people. As morbidity and mortality rates have risen, research efforts to identify the pathophysiologic mechanisms of systolic dysfunction have risen in parallel. The current goal is to develop new therapeutic strategies with the potential to reverse systolic dysfunction in patients with established coronary artery disease. Cardiac magnetic resonance imaging has gained a key role in cardio vascular medicine. We will comment on the potential pivotal role of cardiac magnetic resonance imaging for the assessment of myocardial viability, including hibernating and stunned myocardium and microvascular obstruction.


Subject(s)
Cardiac Imaging Techniques , Coronary Artery Disease/pathology , Magnetic Resonance Imaging , Microvessels/pathology , Myocardium/pathology , Cell Survival , Coronary Artery Disease/physiopathology , Coronary Vessels/pathology , Heart/physiopathology , Hemorrhage/diagnosis , Humans , Myocardial Stunning/diagnosis
7.
Clin Med Insights Cardiol ; 7: 97-114, 2013.
Article in English | MEDLINE | ID: mdl-23761986

ABSTRACT

Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a genetic form of cardiomyopathy (CM) usually transmitted with an autosomal dominant pattern. It primary affects the right ventricle (RV), but may involve the left ventricle (LV) and culminate in biventricular heart failure (HF), life threatening ventricular arrhythmias and sudden cardiac death (SCD). It accounts for 11%-22% of cases of SCD in the young athlete population. Pathologically is characterized by myocardial atrophy, fibrofatty replacement and chamber dilation. Diagnosis is often difficult due to the nonspecific nature of the disease and the broad spectrum of phenotypic variations. Therefore consensus diagnostic criteria have been developed and combined electrocardiography, echocardiography, cardiac magnetic resonance imaging (CMRI) and myocardial biopsy. Early detection, family screening and risk stratification are the cornerstones in the diagnostic evaluation. Implantable cardioverter-defibrillator (ICD) implantation, ablative procedures and heart transplantation are currently the main therapeutic options.

8.
Cardiol Rev ; 18(5): 230-3, 2010.
Article in English | MEDLINE | ID: mdl-20699670

ABSTRACT

Atrial fibrillation (AF), a very common cardiac arrhythmia, is a well-recognized predisposing factor for embolic stroke. While warfarin remains the cornerstone of anticoagulant treatment in patients with AF, it is often underutilized because of increased bleeding complications and frequent monitoring requirements. It has been documented that the left atrial appendage (LAA) is the main source of left atrial thrombus that causes strokes in AF patients. Thus, closure of the LAA may be an effective strategy in stroke reduction. Several devices have been used in closure of the LAA. The WATCHMAN device appears to be a safe and efficacious device for closure of the LAA as recently demonstrated in the PROTECT AF trial.


Subject(s)
Atrial Fibrillation/complications , Septal Occluder Device , Stroke/etiology , Thromboembolism/etiology , Anticoagulants/therapeutic use , Atrial Fibrillation/drug therapy , Atrial Fibrillation/physiopathology , Humans , Risk Factors , Stroke/drug therapy , Stroke/physiopathology , Thromboembolism/drug therapy , Thromboembolism/physiopathology , Warfarin/therapeutic use
9.
Cardiol Rev ; 17(5): 211-5, 2009.
Article in English | MEDLINE | ID: mdl-19690471

ABSTRACT

The advent of highly active antiretroviral therapy has led to a significant decline in the incidence of mortality and progression to AIDS in HIV-infection. With increased life expectancy, HIV-infected individuals are being affected by cardiovascular disease. Research studies have identified an increased prevalence of traditional coronary risk factors in HIV-infected patients. Additional investigations suggest that the virus itself may independently result in atherosclerosis. Further studies have linked the use of highly active antiretroviral therapy to the atherosclerotic processes. These findings suggest the need to reconsider HIV as one of the traditionally accepted risk factors for coronary artery disease, with treatment aimed at prevention of myocardial infarction.


Subject(s)
Coronary Artery Disease/epidemiology , HIV Infections/complications , HIV/physiology , Anti-Retroviral Agents/adverse effects , Anti-Retroviral Agents/therapeutic use , Antiretroviral Therapy, Highly Active/adverse effects , Coronary Artery Disease/chemically induced , Coronary Artery Disease/prevention & control , HIV Infections/drug therapy , HIV Infections/physiopathology , Humans , Risk Factors
10.
Echocardiography ; 22(6): 465-72, 2005 Jul.
Article in English | MEDLINE | ID: mdl-15966930

ABSTRACT

BACKGROUND: We hypothesized that anterior mitral leaflet length (ALL) does not differ significantly between normal subjects and patients with functional mitral regurgitation (FMR) and hence may be used as a reference measurement to quantify annular dilatation and papillary muscle separation. METHODS AND RESULTS: We prospectively studied 50 controls, 15 patients with systolic left ventricular dysfunction (LVD) with significant FMR, and 15 patients with LVD without significant FMR. Significant MR was defined as an effective regurgitant orifice area > or = 0.2 cm2 as measured by the flow convergence method. Annular diameter, interpapillary distance, and ALL were measured, and the following ratios were derived: annular diameter indexed to ALL (ADI) and interpapillary distance indexed to ALL (IPDI). There was no significant difference in ALL among the three groups. The mean ADI was 1.26 times controls in patients with LVD without significant FMR compared to 1.33 times controls in patients with LVD with significant FMR (P = 0.06, no significant difference between groups). The mean IPDI was 1.42 times controls in patients with LVD without significant FMR compared to 2.1 times controls in patients with LVD with significant FMR (P < 0.0001, significant difference between groups). CONCLUSION: There was no significant difference in ALL between controls and patients with LVD. ALL can be used as a reference measurement to quantify annular dilatation and papillary muscle separation in patients with FMR. Interpapillary distance but not annular diameter indexed to ALL correlates with severity of FMR.


Subject(s)
Echocardiography/methods , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve/diagnostic imaging , Papillary Muscles/diagnostic imaging , Ventricular Dysfunction, Left/diagnostic imaging , Aged , Case-Control Studies , Dilatation, Pathologic , Echocardiography, Doppler, Color , Female , Humans , Male , Middle Aged , Mitral Valve/physiopathology , Mitral Valve Insufficiency/physiopathology , Papillary Muscles/physiopathology , Prospective Studies , Reproducibility of Results , Ventricular Dysfunction, Left/physiopathology
11.
J Card Surg ; 20(4): 358-63, 2005.
Article in English | MEDLINE | ID: mdl-15985139

ABSTRACT

The onset of the clinical expression of rheumatic heart disease (RHD) is variable. Exercise or other states that necessitate increased cardiac output often precipitate symptoms. Mitral stenosis (MS) is present in 25% of patients with RHD, and 40% of patients have concomitant MS and mitral regurgitation. About two third of patients with MS have concurrent aortic insufficiency. Pulmonary and tricuspid insufficiency may occur from rheumatic involvement of these valves, or secondary to dilatation of valve annuli from pulmonary hypertension secondary to mitral and/or aortic valve disease. Pregnancy is associated with many hemodynamic changes including expanded intravascular volume, tachycardia, increased intracardiac dimensions, and valvular regurgitation. We report a case of a young female who developed flash pulmonary edema during parturition and was found to have abnormal rheumatic involvement of her aortic, mitral, and tricuspid valves. Successful triple valve repair was performed in a single operation. A review of rheumatic valvular abnormalities, and literature supporting multivalvular repair for rheumatic heart disease is provided.


Subject(s)
Aortic Valve Insufficiency/surgery , Mitral Valve Insufficiency/surgery , Mitral Valve Stenosis/surgery , Mitral Valve/surgery , Rheumatic Heart Disease/surgery , Adult , Aortic Valve Insufficiency/etiology , Cardiopulmonary Bypass , Catheterization , Female , Heart Valve Prosthesis , Humans , Mitral Valve/pathology , Mitral Valve Insufficiency/etiology , Mitral Valve Stenosis/etiology , Pregnancy , Rheumatic Heart Disease/complications
12.
Br J Haematol ; 124(5): 610-7, 2004 Mar.
Article in English | MEDLINE | ID: mdl-14871247

ABSTRACT

Arsenic trioxide (ATO) is approved for the treatment of acute promyelocytic leukaemia and is under investigation for other malignancies. We report the cardiac findings in 18 patients with haematologic malignancies treated with ATO and assess the role of cardiac factors in fluid retention syndrome observed during ATO therapy. Based on initial observations in 10 patients treated with ATO, cardiac functions in the subsequent eight patients were evaluated prospectively. Evaluation included pre- and during-treatment electrocardiograms, Holter monitoring, echocardiograms, multigated acquisition scan and cardiac stress tests if indicated. All eight patients developed fluid retention during ATO, evidenced by pulmonary congestion, oedema and pleural/pericardial effusions. No cardiac factors were identified that contributed to fluid retention. Six patients had prolonged corrected QT (QTc) compared with baseline, three developed ventricular tachycardia. Sinus tachycardia, ventricular premature contractions, and non-sustained ventricular/supraventricular tachycardia were seen during ATO treatment. Fluid retention and cardiac events did not correlate with the dose or total amount of ATO or prior anthracycline therapy. In summary, fluid overload during ATO therapy does not appear to be cardiac in origin but appears to be drug-related, and may reflect cytokine-induced capillary leak. QTc prolongation, transient arrhythmias and clinically significant arrhythmias were seen with therapeutic doses of ATO.


Subject(s)
Antineoplastic Agents/adverse effects , Arrhythmias, Cardiac/chemically induced , Arsenicals/adverse effects , Edema/chemically induced , Hematologic Neoplasms/drug therapy , Oxides/adverse effects , Adult , Aged , Arsenic Trioxide , Electrocardiography, Ambulatory , Female , Humans , Male , Middle Aged , Prospective Studies
13.
J Am Soc Echocardiogr ; 16(2): 147-53, 2003 Feb.
Article in English | MEDLINE | ID: mdl-12574741

ABSTRACT

The clinical applicability of a method for quantifying pericardial effusion (PE) was studied. The pericardial and cardiac volumes were determined from border tracings of 2-dimensional echocardiograms fitted with 3-dimensional disk models. The PE volume was the difference between pericardial and cardiac volumes. A phantom study included 54 cases with different volumes and viewing geometry showed a correlation coefficient r = 0.98 and an accuracy of +/- 6%. A clinical study included 20 cases showing that the estimated PE volume correlated well with that drained surgically (between 100 mL and 1200 mL): y = 0.81 x + 120 mL; r = 0.91, P <.0001. The percent error, determined by the standard error of the estimate (114 mL) over mean (548 mL), was 20%. Intraobserver variability was 4% and interobserver variability 6%. The 3-dimensional disk method provides a quick and convenient way to quantify PE from 2-dimensional echocardiograms with acceptable accuracy and reproducibility.


Subject(s)
Image Interpretation, Computer-Assisted , Pericardial Effusion/diagnostic imaging , Cardiac Volume , Humans , Observer Variation , Phantoms, Imaging , Regression Analysis , Retrospective Studies , Ultrasonography
14.
Heart Dis ; 4(4): 216-9, 2002.
Article in English | MEDLINE | ID: mdl-12147181

ABSTRACT

To evaluate the sensitivity of the serum cardiac troponin I level in detecting stress test-induced myocardial ischemia, the authors conducted a prospective study including patients admitted for chest pain to the telemetry floor of Our Lady of Mercy Medical Center at Bronx, NY. Consecutive 134 telemetry patients that agreed to participate in this study were included. All of these patients had a nuclear stress test and were divided into various groups based on the prestress test probability of having coronary artery disease. To assess serum cardiac troponin I levels, blood samples were drawn before and after stress testing and compared with the stress test results. Overall, 30 patients (22%) had reversible perfusion defects on stress images, and none (0%) had increased serum cardiac troponin I levels. One patient of 18 patients (6%) in group C with negative stress test results had an elevated serum cardiac troponin I level after the stress test, but none of group A or group B patients had elevated troponin I levels. These data show that serum cardiac troponin I levels do not increase with stress test-induced myocardial ischemia.


Subject(s)
Exercise Test , Myocardial Ischemia/blood , Myocardial Ischemia/diagnosis , Troponin I/blood , Cardiotonic Agents , Coronary Artery Disease/diagnosis , Dipyridamole , Dobutamine , Electrocardiography , Female , Humans , Male , Middle Aged , Prospective Studies , Risk Factors , Tomography, Emission-Computed, Single-Photon , Vasodilator Agents
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