Jordan Safirstein - Academia.edu (original) (raw)

Papers by Jordan Safirstein

Research paper thumbnail of Case Report Cardiac epithelioid hemangioendothelioma with 8-year follow-up

An incidentally discovered right atrial mass excised from the heart of a 51-year-old woman was fo... more An incidentally discovered right atrial mass excised from the heart of a 51-year-old woman was found on pathological examination to be an epithelioid hemangioendothelioma. No further therapy was undertaken, and the patient has remained free of recurrence for 8 years. To our knowledge, this is the first report on the behavior of this distinctive vascular neoplasm occurring as an isolated cardiac tumor. D 2007

Research paper thumbnail of View point on social media use in interventional cardiology

Research paper thumbnail of A Rare Case of Primary Intracardiac Diffuse Large B-Cell Lymphoma: Multimodality Imaging to the Rescue

Research paper thumbnail of An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association

Circulation. Cardiovascular interventions, 2018

Transradial artery access for percutaneous coronary intervention is associated with lower bleedin... more Transradial artery access for percutaneous coronary intervention is associated with lower bleeding and vascular complications than transfemoral artery access, especially in patients with acute coronary syndromes. A growing body of evidence supports adoption of transradial artery access to improve acute coronary syndrome-related outcomes, to improve healthcare quality, and to reduce cost. The purpose of this scientific statement is to propose and support a "radial-first" strategy in the United States for patients with acute coronary syndromes. This document also provides an update to previously published statements on transradial artery access technique and best practices, particularly as they relate to the management of patients with acute coronary syndromes.

Research paper thumbnail of Late breaking trials of 2015 in coronary artery disease: Commentary covering ACC, EuroPCR, SCAI, TCT, ESC, and AHA

Catheterization and Cardiovascular Interventions, 2016

The SCAI Publications Committee and Emerging Leadership Mentorship (ELM) Fellows concisely summar... more The SCAI Publications Committee and Emerging Leadership Mentorship (ELM) Fellows concisely summarize and provide context on the most important coronary trials presented at large international meetings in 2015, including the MATRIX, ABSORB, and TOTAL trials. The intent is to allow quick assimilation of trial results into interventional practice, and enable busy interventional cardiologists to stay up to date. © 2016 Wiley Periodicals, Inc.

Research paper thumbnail of An update on treatments and outcomes in peripartum cardiomyopathy

Future cardiology, 2014

Peripartum cardiomyopathy (PPCM) is a well-established complication of pregnancy. Criteria includ... more Peripartum cardiomyopathy (PPCM) is a well-established complication of pregnancy. Criteria include heart failure that presents with reduced left ventricular function, signs and symptoms of heart failure either late in pregnancy or early in the postpartum period. The incidence varies widely depending geography and ethnicity. The pathophysiology of PPCM is still an area of active investigation, but includes immune and inflammatory mechanisms, which are the subject of several investigations. Therapies for chronic heart failure from PPCM are similar to those patients with nonischemic cardiomyopathy from different etiologies, however novel therapies may include bromocriptine, pentoxifylline or other potential therapies influencing the immune system. The need for implantable defibrillators, left ventricular assist devices and cardiac transplant in women with PPCM is rare, and prognosis is better than other forms of nonischemic cardiomyopathy. Despite this, further information about the ep...

Research paper thumbnail of Evaluation of the Clinical Relevance of Baseline Left Ventricular Ejection Fraction as a Predictor of Recovery or Persistence of Severe Dysfunction in Women in the United States With Peripartum Cardiomyopathy

Journal of Cardiac Failure, 2011

Background: Baseline left ventricular ejection fraction (LVEF) has been shown to be associated wi... more Background: Baseline left ventricular ejection fraction (LVEF) has been shown to be associated with likelihood of recovery in patients with peripartum cardiomyopathy (PPCM). The clinical relevance of this association for individual patients is unclear. Methods and Results: We analyzed baseline parameters of LVEF in 187 PPCM patients with 6monthsfollow−updatainanattempttodetectthevalueofbaselineLVEFasapredictorofearlyrecoveryorpersistenceofsevereLVdysfunction.RecoveryofLVfunction(LVEF6 months follow-up data in an attempt to detect the value of baseline LVEF as a predictor of early recovery or persistence of severe LV dysfunction. Recovery of LV function (LVEF 6monthsfollow−updatainanattempttodetectthevalueofbaselineLVEFasapredictorofearlyrecoveryorpersistenceofsevereLVdysfunction.RecoveryofLVfunction(LVEF50%) at 6 months after diagnosis was found in 115 patients (61%). Multivariate analysis identified baseline LVEF O30% as a significant predictor for recovery (odds ratio 5.2, 95% confidence interval 1.96e7.70; P O .0001). Recovery of LV function was 6.4-fold higher in women with baseline LVEF $ 30% (group III) and 3.9-fold higher in women with LVEF 20%e29% (group II) compared with those with LVEF 10%e19% (group I). Failure to achieve full recovery was seen in 63% of group I patients, 32% of group II (P 5 .03), and 21% of group III (P 5 .02 vs group I). Failure to achieve LVEF $30% was seen in 30% of group I patients and 13% of group II (P 5 .09). Conclusions: Early recovery in patients with PPCM is significantly related to the degree of myocardial insult at time of diagnosis. Baseline LVEF however, has a limited sensitivity for prediction of failure to improve in individual patients and can not be used as an indication for premature use of aggressive therapy including devices or cardiac transplantation.

Research paper thumbnail of Cardiac epithelioid hemangioendothelioma with 8-year follow-up

Cardiovascular Pathology, 2007

An incidentally discovered right atrial mass excised from the heart of a 51-year-old woman was fo... more An incidentally discovered right atrial mass excised from the heart of a 51-year-old woman was found on pathological examination to be an epithelioid hemangioendothelioma. No further therapy was undertaken, and the patient has remained free of recurrence for 8 years. To our knowledge, this is the first report on the behavior of this distinctive vascular neoplasm occurring as an isolated cardiac tumor.

Research paper thumbnail of Hand Perfusion During Radial Compression with Vasostat Versus TR Band: A Randomized Trial

Journal of the American College of Cardiology, 2019

Background: Radial artery hemostasis may cause transient reduction in hand perfusion while compre... more Background: Radial artery hemostasis may cause transient reduction in hand perfusion while compression devices are in place. We compared hand perfusion and performance of two radial hemostasis devices following coronary catheterization and percutaneous coronary intervention (PCI) in a prospective, randomized trial. Methods: In this IRB-approved protocol, subjects undergoing transradial diagnostic catheterization or PCI were randomized to placement of a VasoStat (Forge Medical) or TR Band (Terumo) following sheath removal using patent hemostasis technique; VasoStat utilizes a focused compression mechanism whereas the TR Band uses balloon compression. Hand perfusion was quantitated by measuring the Perfusion Index (PI) with a dedicated oximetry device 1) before, 2) during device use, 3) during device use and ulnar artery compression and 4) following device removal; PI measurements were compared using analysis of variance and paired t-tests. Time to hemostasis, pre/ post radial artery patency, and secondary device manipulations were also compared. Results: 52 subjects (38M:14F) were assigned to hemostasis with VasoStat (N=26) or TR Band (N=26). Both groups were well-matched for age, sex, diagnostic:PCI, mean heparin dose and procedure duration. Transient reductions in PI were seen following device placement (VasoStat-25%, P=0.03; TR Band-5%, P=0.6), with an increase in PI from baseline following device removal (VasoStat +53%, P=0.001; TR Band +55%, P=0.001). Ulnar compression reduced hand perfusion (VasoStat-18%, P=0.3; TR Band-14%, P=0.2). PI following device removal was 6% higher with VasoStat (P=NS). No radial artery occlusion occurred in either group. A significantly shorter time to hemostasis enabling device removal was observed among the VasoStat subjects (34 minute reduction, P=0.038). Rates of device manipulation and hematoma were low with each device. Conclusion: Transient reductions in hand perfusion were observed following transradial catheterization while radial compression devices were in place; hemostasis was achieved earlier with the VasoStat device. These findings have implications for larger future trials comparing radial hemostasis strategies.

Research paper thumbnail of Self-expanding Transcatheter vs Surgical Aortic Valve Replacement in Intermediate-Risk Patients

JAMA Cardiology

ImportanceIn patients with severe aortic valve stenosis at intermediate surgical risk, transcathe... more ImportanceIn patients with severe aortic valve stenosis at intermediate surgical risk, transcatheter aortic valve replacement (TAVR) with a self-expanding supra-annular valve was noninferior to surgery for all-cause mortality or disabling stroke at 2 years. Comparisons of longer-term clinical and hemodynamic outcomes in these patients are limited.ObjectiveTo report prespecified secondary 5-year outcomes from the Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement (SURTAVI) randomized clinical trial.Design, Setting, and ParticipantsSURTAVI is a prospective randomized, unblinded clinical trial. Randomization was stratified by investigational site and need for revascularization determined by the local heart teams. Patients with severe aortic valve stenosis deemed to be at intermediate risk of 30-day surgical mortality were enrolled at 87 centers from June 19, 2012, to June 30, 2016, in Europe and North America. Analysis took place between August ...

Research paper thumbnail of Knowledge Retention After Percutaneous Coronary Intervention

Journal of the American College of Cardiology

Research paper thumbnail of Syncope from ventricular tachycardia secondary to methadone use

Cardiology in Review, 2008

Research paper thumbnail of Breastfeeding, Cellular Immune Activation, and Myocardial Recovery in Peripartum Cardiomyopathy

JACC: Basic to Translational Science, 2019

Highlights •The impact of breastfeeding on prolactin, cellular immune activation, and myocardial ... more Highlights •The impact of breastfeeding on prolactin, cellular immune activation, and myocardial recovery was analyzed in 100 women with peripartum cardiomyopathy •Cardiac function was assessed by echocardiography at presentation and at serial intervals over the first year postpartum •The levels of circulating prolactin were assessed by ELISA, and cellular immunophenotyping by flow cytometry, and compared between breastfeeding and nonbreastfeeding women •Prolactin levels were higher in breastfeeding women and correlated with significant increases in CD8+ T cells •Despite significantly higher prolactin levels and increased CD8+ cells, myocardial recovery was similar in breastfeeding and nonbreastfeeding women

Research paper thumbnail of Addition of Multimedia to Post-Pci Education: Patient Perception Versus Performance

Journal of the American College of Cardiology, 2017

Background: Percutaneous coronary intervention (PCI) is a leading strategy to treat obstructive c... more Background: Percutaneous coronary intervention (PCI) is a leading strategy to treat obstructive coronary disease (CAD). Post procedure care and education still remains an important target for improvement. In order to evaluate knowledge of CAD and education preferences for patients undergoing PCI, we assess the effect of additional multimedia education on survey scores. Methods: This is a single-center, prospective study of patients undergoing elective PCI. A survey consisting of 25 multiple-choice questions was developed and validated relating to general CAD knowledge. 63 patients were given the survey prior to discharge after routine education (RE group) consisting of non-standardized one-on-one education by healthcare professionals. Test administrators were blinded to the survey and design. A second cohort of 60 patients was surveyed in similar fashion with the addition of a non-branded informational video following routine education (MME group). Data were compiled and scores compared using Fishers exact test and student's t-test. Results: Patient groups were well matched by age, sex, comorbidities and prior catheterizations. The addition of multimedia education increased the mean knowledge score from 77.5% to 82.8% which was not statistically significant. There is a positive correlation between level of education and survey score with RE but not MME (RE Pearson r = 0.445, p = <0.001 and MME Pearson r = 0.181, p = 0.173). Additionally, MME patients were more likely to respond that they had received education (83% vs 55%, p=<0.001). Conclusions: The addition of multimedia is associated with increased survey score that is not statistically significant. Multimedia reduces differences in score due to disparities in level of education. Multimedia is perceived by patients as providing more education. Creation of multimedia educational material to supplement traditional education may efficiently improve disease knowledge and patient satisfaction for patients undergoing elective PCI.

Research paper thumbnail of Late breaking trials of 2016 in coronary artery disease: Commentary covering SCAI, ACC, TCT, EuroPCR, ESC, and AHA

Catheterization and Cardiovascular Interventions, 2017

The SCAI Publications Committee and Emerging Leadership Mentorship (ELM) Fellows concisely summar... more The SCAI Publications Committee and Emerging Leadership Mentorship (ELM) Fellows concisely summarize and provide context on the most important coronary trials presented at large international meetings in 2016, including SCAI, ACC, TCT, EuroPCR, ESC, and AHA. The intent is to allow quick assimilation of trial results into interventional practice, and enable busy interventional cardiologists to stay up to date. © 2017 Wiley Periodicals, Inc.

Research paper thumbnail of Shared Genetic Predisposition in Peripartum and Dilated Cardiomyopathies

The New England journal of medicine, Jan 6, 2016

Background Peripartum cardiomyopathy shares some clinical features with idiopathic dilated cardio... more Background Peripartum cardiomyopathy shares some clinical features with idiopathic dilated cardiomyopathy, a disorder caused by mutations in more than 40 genes, including TTN, which encodes the sarcomere protein titin. Methods In 172 women with peripartum cardiomyopathy, we sequenced 43 genes with variants that have been associated with dilated cardiomyopathy. We compared the prevalence of different variant types (nonsense, frameshift, and splicing) in these women with the prevalence of such variants in persons with dilated cardiomyopathy and with population controls. Results We identified 26 distinct, rare truncating variants in eight genes among women with peripartum cardiomyopathy. The prevalence of truncating variants (26 in 172 [15%]) was significantly higher than that in a reference population of 60,706 persons (4.7%, P=1.3×10(-7)) but was similar to that in a cohort of patients with dilated cardiomyopathy (55 of 332 patients [17%], P=0.81). Two thirds of identified truncating...

Research paper thumbnail of Gestational Hypertension Is Associated with Improved Ejection Fraction in Peripartum Cardiomyopathy

Journal of Cardiac Failure, 2008

Research paper thumbnail of Psychosocial Impact in a Cohort of Peripartum Cardiomyopathy Patients

Journal of Cardiac Failure, 2009

Research paper thumbnail of Evaluation of Classic Risk Factors in a New Cohort of Peripartum Cardiomyopathy Survivors

Journal of Cardiac Failure, 2007

Research paper thumbnail of Predictors of left ventricular recovery in a cohort of peripartum cardiomyopathy patients recruited via the internet

International Journal of Cardiology, 2012

Peripartum cardiomyopathy (PPCM) is the onset of acute heart failure without demonstrable cause d... more Peripartum cardiomyopathy (PPCM) is the onset of acute heart failure without demonstrable cause during the last month of pregnancy or within five months after delivery. The purpose of this study was to create a prospective registry of PPCM patients with the assistance of the internet and identify clinical factors predictive of ejection fraction (EF) recovery. Patients with PPCM were identified by novel web-based methods. Subjects were categorized as recovered (EF&amp;amp;amp;amp;gt;50) or nonrecovered (EF&amp;amp;amp;amp;lt;50) and compared on the basis of demographic and clinical variables. Fifty-five subjects met criteria for inclusion. There was a statistically significant association between diagnosis during third trimester and persistent systolic dysfunction (25% vs. 4.7%, p=0.03). Gestational hypertension and breastfeeding were significantly associated with EF recovery (48.8% vs. 16.7%, p=0.046, and 39.5% vs. 8.3%, p=0.04, respectively). EF normalization occurred in all patients with EF(1) ≥ 35%. Presence of gHTN, EF ≥ 35% at diagnosis, breastfeeding, and postpartum diagnosis were all significantly associated with recovery of systolic function. Internet recruitment may be a valuable tool for studying PPCM.

Research paper thumbnail of Case Report Cardiac epithelioid hemangioendothelioma with 8-year follow-up

An incidentally discovered right atrial mass excised from the heart of a 51-year-old woman was fo... more An incidentally discovered right atrial mass excised from the heart of a 51-year-old woman was found on pathological examination to be an epithelioid hemangioendothelioma. No further therapy was undertaken, and the patient has remained free of recurrence for 8 years. To our knowledge, this is the first report on the behavior of this distinctive vascular neoplasm occurring as an isolated cardiac tumor. D 2007

Research paper thumbnail of View point on social media use in interventional cardiology

Research paper thumbnail of A Rare Case of Primary Intracardiac Diffuse Large B-Cell Lymphoma: Multimodality Imaging to the Rescue

Research paper thumbnail of An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association

Circulation. Cardiovascular interventions, 2018

Transradial artery access for percutaneous coronary intervention is associated with lower bleedin... more Transradial artery access for percutaneous coronary intervention is associated with lower bleeding and vascular complications than transfemoral artery access, especially in patients with acute coronary syndromes. A growing body of evidence supports adoption of transradial artery access to improve acute coronary syndrome-related outcomes, to improve healthcare quality, and to reduce cost. The purpose of this scientific statement is to propose and support a "radial-first" strategy in the United States for patients with acute coronary syndromes. This document also provides an update to previously published statements on transradial artery access technique and best practices, particularly as they relate to the management of patients with acute coronary syndromes.

Research paper thumbnail of Late breaking trials of 2015 in coronary artery disease: Commentary covering ACC, EuroPCR, SCAI, TCT, ESC, and AHA

Catheterization and Cardiovascular Interventions, 2016

The SCAI Publications Committee and Emerging Leadership Mentorship (ELM) Fellows concisely summar... more The SCAI Publications Committee and Emerging Leadership Mentorship (ELM) Fellows concisely summarize and provide context on the most important coronary trials presented at large international meetings in 2015, including the MATRIX, ABSORB, and TOTAL trials. The intent is to allow quick assimilation of trial results into interventional practice, and enable busy interventional cardiologists to stay up to date. © 2016 Wiley Periodicals, Inc.

Research paper thumbnail of An update on treatments and outcomes in peripartum cardiomyopathy

Future cardiology, 2014

Peripartum cardiomyopathy (PPCM) is a well-established complication of pregnancy. Criteria includ... more Peripartum cardiomyopathy (PPCM) is a well-established complication of pregnancy. Criteria include heart failure that presents with reduced left ventricular function, signs and symptoms of heart failure either late in pregnancy or early in the postpartum period. The incidence varies widely depending geography and ethnicity. The pathophysiology of PPCM is still an area of active investigation, but includes immune and inflammatory mechanisms, which are the subject of several investigations. Therapies for chronic heart failure from PPCM are similar to those patients with nonischemic cardiomyopathy from different etiologies, however novel therapies may include bromocriptine, pentoxifylline or other potential therapies influencing the immune system. The need for implantable defibrillators, left ventricular assist devices and cardiac transplant in women with PPCM is rare, and prognosis is better than other forms of nonischemic cardiomyopathy. Despite this, further information about the ep...

Research paper thumbnail of Evaluation of the Clinical Relevance of Baseline Left Ventricular Ejection Fraction as a Predictor of Recovery or Persistence of Severe Dysfunction in Women in the United States With Peripartum Cardiomyopathy

Journal of Cardiac Failure, 2011

Background: Baseline left ventricular ejection fraction (LVEF) has been shown to be associated wi... more Background: Baseline left ventricular ejection fraction (LVEF) has been shown to be associated with likelihood of recovery in patients with peripartum cardiomyopathy (PPCM). The clinical relevance of this association for individual patients is unclear. Methods and Results: We analyzed baseline parameters of LVEF in 187 PPCM patients with 6monthsfollow−updatainanattempttodetectthevalueofbaselineLVEFasapredictorofearlyrecoveryorpersistenceofsevereLVdysfunction.RecoveryofLVfunction(LVEF6 months follow-up data in an attempt to detect the value of baseline LVEF as a predictor of early recovery or persistence of severe LV dysfunction. Recovery of LV function (LVEF 6monthsfollow−updatainanattempttodetectthevalueofbaselineLVEFasapredictorofearlyrecoveryorpersistenceofsevereLVdysfunction.RecoveryofLVfunction(LVEF50%) at 6 months after diagnosis was found in 115 patients (61%). Multivariate analysis identified baseline LVEF O30% as a significant predictor for recovery (odds ratio 5.2, 95% confidence interval 1.96e7.70; P O .0001). Recovery of LV function was 6.4-fold higher in women with baseline LVEF $ 30% (group III) and 3.9-fold higher in women with LVEF 20%e29% (group II) compared with those with LVEF 10%e19% (group I). Failure to achieve full recovery was seen in 63% of group I patients, 32% of group II (P 5 .03), and 21% of group III (P 5 .02 vs group I). Failure to achieve LVEF $30% was seen in 30% of group I patients and 13% of group II (P 5 .09). Conclusions: Early recovery in patients with PPCM is significantly related to the degree of myocardial insult at time of diagnosis. Baseline LVEF however, has a limited sensitivity for prediction of failure to improve in individual patients and can not be used as an indication for premature use of aggressive therapy including devices or cardiac transplantation.

Research paper thumbnail of Cardiac epithelioid hemangioendothelioma with 8-year follow-up

Cardiovascular Pathology, 2007

An incidentally discovered right atrial mass excised from the heart of a 51-year-old woman was fo... more An incidentally discovered right atrial mass excised from the heart of a 51-year-old woman was found on pathological examination to be an epithelioid hemangioendothelioma. No further therapy was undertaken, and the patient has remained free of recurrence for 8 years. To our knowledge, this is the first report on the behavior of this distinctive vascular neoplasm occurring as an isolated cardiac tumor.

Research paper thumbnail of Hand Perfusion During Radial Compression with Vasostat Versus TR Band: A Randomized Trial

Journal of the American College of Cardiology, 2019

Background: Radial artery hemostasis may cause transient reduction in hand perfusion while compre... more Background: Radial artery hemostasis may cause transient reduction in hand perfusion while compression devices are in place. We compared hand perfusion and performance of two radial hemostasis devices following coronary catheterization and percutaneous coronary intervention (PCI) in a prospective, randomized trial. Methods: In this IRB-approved protocol, subjects undergoing transradial diagnostic catheterization or PCI were randomized to placement of a VasoStat (Forge Medical) or TR Band (Terumo) following sheath removal using patent hemostasis technique; VasoStat utilizes a focused compression mechanism whereas the TR Band uses balloon compression. Hand perfusion was quantitated by measuring the Perfusion Index (PI) with a dedicated oximetry device 1) before, 2) during device use, 3) during device use and ulnar artery compression and 4) following device removal; PI measurements were compared using analysis of variance and paired t-tests. Time to hemostasis, pre/ post radial artery patency, and secondary device manipulations were also compared. Results: 52 subjects (38M:14F) were assigned to hemostasis with VasoStat (N=26) or TR Band (N=26). Both groups were well-matched for age, sex, diagnostic:PCI, mean heparin dose and procedure duration. Transient reductions in PI were seen following device placement (VasoStat-25%, P=0.03; TR Band-5%, P=0.6), with an increase in PI from baseline following device removal (VasoStat +53%, P=0.001; TR Band +55%, P=0.001). Ulnar compression reduced hand perfusion (VasoStat-18%, P=0.3; TR Band-14%, P=0.2). PI following device removal was 6% higher with VasoStat (P=NS). No radial artery occlusion occurred in either group. A significantly shorter time to hemostasis enabling device removal was observed among the VasoStat subjects (34 minute reduction, P=0.038). Rates of device manipulation and hematoma were low with each device. Conclusion: Transient reductions in hand perfusion were observed following transradial catheterization while radial compression devices were in place; hemostasis was achieved earlier with the VasoStat device. These findings have implications for larger future trials comparing radial hemostasis strategies.

Research paper thumbnail of Self-expanding Transcatheter vs Surgical Aortic Valve Replacement in Intermediate-Risk Patients

JAMA Cardiology

ImportanceIn patients with severe aortic valve stenosis at intermediate surgical risk, transcathe... more ImportanceIn patients with severe aortic valve stenosis at intermediate surgical risk, transcatheter aortic valve replacement (TAVR) with a self-expanding supra-annular valve was noninferior to surgery for all-cause mortality or disabling stroke at 2 years. Comparisons of longer-term clinical and hemodynamic outcomes in these patients are limited.ObjectiveTo report prespecified secondary 5-year outcomes from the Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement (SURTAVI) randomized clinical trial.Design, Setting, and ParticipantsSURTAVI is a prospective randomized, unblinded clinical trial. Randomization was stratified by investigational site and need for revascularization determined by the local heart teams. Patients with severe aortic valve stenosis deemed to be at intermediate risk of 30-day surgical mortality were enrolled at 87 centers from June 19, 2012, to June 30, 2016, in Europe and North America. Analysis took place between August ...

Research paper thumbnail of Knowledge Retention After Percutaneous Coronary Intervention

Journal of the American College of Cardiology

Research paper thumbnail of Syncope from ventricular tachycardia secondary to methadone use

Cardiology in Review, 2008

Research paper thumbnail of Breastfeeding, Cellular Immune Activation, and Myocardial Recovery in Peripartum Cardiomyopathy

JACC: Basic to Translational Science, 2019

Highlights •The impact of breastfeeding on prolactin, cellular immune activation, and myocardial ... more Highlights •The impact of breastfeeding on prolactin, cellular immune activation, and myocardial recovery was analyzed in 100 women with peripartum cardiomyopathy •Cardiac function was assessed by echocardiography at presentation and at serial intervals over the first year postpartum •The levels of circulating prolactin were assessed by ELISA, and cellular immunophenotyping by flow cytometry, and compared between breastfeeding and nonbreastfeeding women •Prolactin levels were higher in breastfeeding women and correlated with significant increases in CD8+ T cells •Despite significantly higher prolactin levels and increased CD8+ cells, myocardial recovery was similar in breastfeeding and nonbreastfeeding women

Research paper thumbnail of Addition of Multimedia to Post-Pci Education: Patient Perception Versus Performance

Journal of the American College of Cardiology, 2017

Background: Percutaneous coronary intervention (PCI) is a leading strategy to treat obstructive c... more Background: Percutaneous coronary intervention (PCI) is a leading strategy to treat obstructive coronary disease (CAD). Post procedure care and education still remains an important target for improvement. In order to evaluate knowledge of CAD and education preferences for patients undergoing PCI, we assess the effect of additional multimedia education on survey scores. Methods: This is a single-center, prospective study of patients undergoing elective PCI. A survey consisting of 25 multiple-choice questions was developed and validated relating to general CAD knowledge. 63 patients were given the survey prior to discharge after routine education (RE group) consisting of non-standardized one-on-one education by healthcare professionals. Test administrators were blinded to the survey and design. A second cohort of 60 patients was surveyed in similar fashion with the addition of a non-branded informational video following routine education (MME group). Data were compiled and scores compared using Fishers exact test and student's t-test. Results: Patient groups were well matched by age, sex, comorbidities and prior catheterizations. The addition of multimedia education increased the mean knowledge score from 77.5% to 82.8% which was not statistically significant. There is a positive correlation between level of education and survey score with RE but not MME (RE Pearson r = 0.445, p = <0.001 and MME Pearson r = 0.181, p = 0.173). Additionally, MME patients were more likely to respond that they had received education (83% vs 55%, p=<0.001). Conclusions: The addition of multimedia is associated with increased survey score that is not statistically significant. Multimedia reduces differences in score due to disparities in level of education. Multimedia is perceived by patients as providing more education. Creation of multimedia educational material to supplement traditional education may efficiently improve disease knowledge and patient satisfaction for patients undergoing elective PCI.

Research paper thumbnail of Late breaking trials of 2016 in coronary artery disease: Commentary covering SCAI, ACC, TCT, EuroPCR, ESC, and AHA

Catheterization and Cardiovascular Interventions, 2017

The SCAI Publications Committee and Emerging Leadership Mentorship (ELM) Fellows concisely summar... more The SCAI Publications Committee and Emerging Leadership Mentorship (ELM) Fellows concisely summarize and provide context on the most important coronary trials presented at large international meetings in 2016, including SCAI, ACC, TCT, EuroPCR, ESC, and AHA. The intent is to allow quick assimilation of trial results into interventional practice, and enable busy interventional cardiologists to stay up to date. © 2017 Wiley Periodicals, Inc.

Research paper thumbnail of Shared Genetic Predisposition in Peripartum and Dilated Cardiomyopathies

The New England journal of medicine, Jan 6, 2016

Background Peripartum cardiomyopathy shares some clinical features with idiopathic dilated cardio... more Background Peripartum cardiomyopathy shares some clinical features with idiopathic dilated cardiomyopathy, a disorder caused by mutations in more than 40 genes, including TTN, which encodes the sarcomere protein titin. Methods In 172 women with peripartum cardiomyopathy, we sequenced 43 genes with variants that have been associated with dilated cardiomyopathy. We compared the prevalence of different variant types (nonsense, frameshift, and splicing) in these women with the prevalence of such variants in persons with dilated cardiomyopathy and with population controls. Results We identified 26 distinct, rare truncating variants in eight genes among women with peripartum cardiomyopathy. The prevalence of truncating variants (26 in 172 [15%]) was significantly higher than that in a reference population of 60,706 persons (4.7%, P=1.3×10(-7)) but was similar to that in a cohort of patients with dilated cardiomyopathy (55 of 332 patients [17%], P=0.81). Two thirds of identified truncating...

Research paper thumbnail of Gestational Hypertension Is Associated with Improved Ejection Fraction in Peripartum Cardiomyopathy

Journal of Cardiac Failure, 2008

Research paper thumbnail of Psychosocial Impact in a Cohort of Peripartum Cardiomyopathy Patients

Journal of Cardiac Failure, 2009

Research paper thumbnail of Evaluation of Classic Risk Factors in a New Cohort of Peripartum Cardiomyopathy Survivors

Journal of Cardiac Failure, 2007

Research paper thumbnail of Predictors of left ventricular recovery in a cohort of peripartum cardiomyopathy patients recruited via the internet

International Journal of Cardiology, 2012

Peripartum cardiomyopathy (PPCM) is the onset of acute heart failure without demonstrable cause d... more Peripartum cardiomyopathy (PPCM) is the onset of acute heart failure without demonstrable cause during the last month of pregnancy or within five months after delivery. The purpose of this study was to create a prospective registry of PPCM patients with the assistance of the internet and identify clinical factors predictive of ejection fraction (EF) recovery. Patients with PPCM were identified by novel web-based methods. Subjects were categorized as recovered (EF&amp;amp;amp;amp;gt;50) or nonrecovered (EF&amp;amp;amp;amp;lt;50) and compared on the basis of demographic and clinical variables. Fifty-five subjects met criteria for inclusion. There was a statistically significant association between diagnosis during third trimester and persistent systolic dysfunction (25% vs. 4.7%, p=0.03). Gestational hypertension and breastfeeding were significantly associated with EF recovery (48.8% vs. 16.7%, p=0.046, and 39.5% vs. 8.3%, p=0.04, respectively). EF normalization occurred in all patients with EF(1) ≥ 35%. Presence of gHTN, EF ≥ 35% at diagnosis, breastfeeding, and postpartum diagnosis were all significantly associated with recovery of systolic function. Internet recruitment may be a valuable tool for studying PPCM.