Mohammad Reza Movahed - Academia.edu (original) (raw)

Mohammad Reza Movahed, MD, PhD, FSCAI, FACC, FACP, FCCP
Clinical Professor of Medicine, University of Arizona, Tucson
Clinical Professor of Medicine, University of Arizona, Phoenix
Faculty, Southern Arizona VA Healthcare System
Chair of Heart and Stroke Ball 2020
President American Heart Association Southern Arizona Affiliate

Languages: German, English, Farsi

Dr. M Reza Movahed received his MD from Medizinische Hochschule Hannover, Germany. He completed his medical residency at the University of Rochester, New York and his cardiology training at the University of South Caroline, Columbia. His final training in Interventional Cardiology was completed at Yale University Hospital, New Haven, Connecticut in 2000. After his training, he joined University of California Irvine as Assistant Clinical Professor and later joined University of Arizona College of Medicine in 2006 as Associate Professor of Medicine, Division of Cardiology. In July 2010, Dr. Movahed was promoted to Professor of Medicine, Tenure at the University of Arizona College of Medicine In Tucson with over 200 peer reviewed publications. He was also appointed to Clinical Professor of Medicine at the University of Arizona College of Medicine, Phoenix in 2018. He has been Director of Cardiac Catheterization Laboratory and Nuclear Cardiology at the University of California, Irvine medical Center and Director of Coronary Care Unit and Medical Director of Cardiac Transplantation at the University of Arizona Medical Center. In 2007, he joined the Southern Arizona VA Health Care System for his clinical work and as the Medical Director of Heart Transplantation. In May 2012, he joined CareMore as The Regional Cardiology Director of CareMore in Arizona until 2020 while keeping his teaching and research affiliation with the VA and the University of Arizona as Professor of Medicine, tenure. His major area of research is related to coronary intervention, non-invasive cardiology and cardiovascular epidemiology. He is world-renowned for his coronary bifurcation classification known as “The Movahed Classification” He is also known for his discovery on the flattening of interventricular septum as a sign for right ventricular overload the so called “ Movahed’s sign” that can be seen during Gated SPECT studied and recently published reverse “Movahed Maneuver” that can be used for improvement of stent deliverability during difficult and tortuous vein graft interventions. He also has two cardiovascular patents issued to him. One is a device for removal of contrast from coronary sinus during coronary angiography or intervention in order to reduce contrast exposure to kidneys for prevention of contrast induced nephropathy. The other one is a method and device that can measure cross sectional lumen of a vessel using impedance sensors. His over 200 publications include prestige’s journals such as New England Journal of Medicine, Nature Reviews, Circulation, American Journal of Medicine, Journal of American College of Cardiology, American Heart Journal, American Journal of Cardiology, Journal of Society of Echocardiography, JACC cardiovascular Intervention, JACC Imaging, Catheterization and Cardiovascular Intervention, Journal of Invasive cardiology, Journal of Interventional Cardiology, etc with over 200 publications. He is an editorial board member of numerous peer reviewed journals. He has been invited speaker and chair for many national and international cardiology conventions and conferences. He has Board Certifications in Internal Medicine, Echocardiography, Cardiovascular Disease, Advanced Heart failure/Transplantation, Nuclear Cardiology and Interventional Cardiology. He is currently Clinical Professor of Medicine, University of Arizona, Tucson, and Clinical Professor, University of Arizona, Phoenix. He is Chair of the Heart and Stroke Ball 2020 and is the President of American Heart Association Southern Arizona Affiliate.

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Papers by Mohammad Reza Movahed

European Journal of Heart Failure Supplements

The Journal of Invasive Cardiology, Apr 1, 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 total of 108 cardiac transplant patients, who had underwent routine IVUS studies between 2004-2008 were identified retrospectively. The average heparin dose used was 2528 ± 501 units. The left anterior descending artery was studied in 93% of cases. There was no thromboembolic event. Only one catheter-induced coronary dissection occurred treated with percutaneous coronary intervention. An endomyocardial biopsy was performed 10-15 minutes before the administration of low-dose heparin. There were no other major adverse cardiac events in this population during the procedure. This is the first study showing the safety of low-dose heparin use during diagnostic IVUS studies in cardiac transplant patients, even shortly after endomyocardial biopsy.

ABSTRACT Cardiovascular disease is the leading cause of deaths in American adults. Furthermore, i... more ABSTRACT 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 were modified and synthesized separately and combined by homo or mono coupling. It was achieved by taking advantage of PEG as a linker. It is expected that this molecule will have a potential of combined modes of action of an ACE inhibitors and ARB. According to the relevant recent patents, combination medication therapy has developed, resulting in effects of multiple doses of variety of medications. Benefits from combination therapy have increased efficacy, reduced adverse effects, convenience, compliance, and prolonged duration. Consequently, this combined molecule is expected to block the production of angiotensin II more efficiently and effectively. Although captopril and losartan work in the same system in blocking the effect of angiotensin II they have different action site and mechanism. Losartan acts on cell surface membrane as angiotensin receptor blocker while captopril works in plasma by blocking angiotensin converting enzymes.

The Journal of Invasive Cardiology, Sep 1, 2009

Advances in the safety of percutaneous coronary interventions have been significant in recent yea... more Advances in the safety of percutaneous coronary interventions have been significant in recent years. The goal of this study was to evaluate any decline in the age-adjusted in-hospital mortality rate in patients undergoing multivessel percutaneous coronary intervention (MVPCI) using a very large database from 1988 to 2004 in the United States. The Nationwide Inpatient Sample (NIS) database was utilized to calculate the age-adjusted mortality rate for MVPCI from 1988 to 2004 in patients over the age of 40 years retrospectively. Specific ICD-9-CM codes for MVPCI were used for this study. Patient demographic data were also analyzed and adjusted for age from the database. The mean age was 71.56 +/- 10.59 years (53.55% male). From 1988 the age-adjusted mortality rate was stable until 1999, with a steady decline to the lowest level in 2004. In 1988, the rate was 67.42 (95% CI = 181-316.14), in 1999 51.02 (95% CI = 27-129.32), and in 2004, 40.06 (95% CI 5.6-85.83) per 100,000. Total death also declined from 1.77% to 1.25%. This trend was similar across gender and ethnicities. The age-adjusted mortality from MVPCI was steady until 1999, but declined to the lowest level in 2004. This trend most likely reflects advancements in the care of patients undergoing high-risk coronary interventions.

Cardiovascular Revascularization Medicine, 2011

International Cardivascular Research Journal, 2015

The Journal of Invasive Cardiology, Sep 1, 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.

Reviews in Cardiovascular Medicine, 2014

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.

The Journal of Invasive Cardiology, Dec 1, 2012

The transradial approach for percutaneous coronary intervention (PCI) has gained increasing popul... more The transradial approach for percutaneous coronary intervention (PCI) has gained increasing popularity as an alternative site for coronary angiography and intervention. The transradial approach has safely been used in patients with contraindications to the transfemoral approach. Despite its overall lower complication rates compared with the transfemoral approach, the transradial approach has its own inherent complications. The risk of arterial perforation with the transradial approach is less than 1%, primarily involving the radial artery with the incidence of compartment syndrome at approximately 0.004%. In addition, the risk of significant bleeding requiring transfusion with transradial approach is extremely rare, occurring in about 1/1000 patients. In this report, we present a case of pericardiacophrenic artery perforation occurring during wire advancement into the aorta via right radial artery approach, which was treated with coil embolization for treatment of significant hemorrhage. This case emphasizes the importance of recognizing this artery in order to prevent similar complications in the future. This artery can be confused with the aorta, since it has a similar course paralleling the aortic arch, and as such it can be inadvertently mistaken for the ascending aorta during wire advancement.

Texas Heart Institute Journal, 2015

Data regarding thrombolytic treatment of right-sided mechanical valve thrombosis are almost nonex... more Data regarding thrombolytic treatment of right-sided mechanical valve thrombosis are almost nonexistent, and all current guidelines arise from very small case series. We retrospectively studied the in-hospital and long-term outcome data of a larger series of patients who had received, from September 2005 through June 2012, thrombolytic therapy for right-sided mechanical pulmonary valve or tricuspid valve thrombosis. We identified 16 patients aged 8–67 years who had undergone thrombolytic therapy for definite thrombotic mechanical valve obstruction in the tricuspid or pulmonary valve position (8 in each position). All study patients except one had subtherapeutic international normalized ratios. The 8 patients with pulmonary mechanical valve thrombosis had a 100% response rate to thrombolytic therapy, and their in-hospital survival rate was also 100%. The 8 patients with tricuspid mechanical valve thrombosis had a 75% response rate to thrombolytic therapy, with an in-hospital survival...

Cardiovascular radiation medicine

Here, we present a case of a 63-year-old male who presented with in-stent restenosis of two coron... more Here, we present a case of a 63-year-old male who presented with in-stent restenosis of two coronary arteries simultaneously (mid circumflex and proximal ramus). After the brachytherapy of the circumflex artery for in-stent restenosis, the patient refused the staged procedure for the ramus in-stent restenosis. After approximately 2 years, the patient underwent coronary angiography for recurrent chest pain. Surprisingly, the proximal ramus stent showed marked regression of in-stent restenosis. We hypothesized that the gamma brachytherapy of the circumflex artery could have induced the regression of in-stent restenosis of the adjacent ramus artery due to the deep tissue penetration of gamma radiation. Based on our observation, we believe that in the treatment of in-stent restenosis of a coronary artery, the initial balloon angioplasty may not be as important as the radiation itself. This observation warrants further study to evaluate the effect of external or internal radiation on in-...

Cardiovascular intervention and therapeutics, Jan 22, 2015

A patient with no conventional cardiovascular risk factors presented with inferior ST-elevation m... more A patient with no conventional cardiovascular risk factors presented with inferior ST-elevation myocardial infarction which was finally diagnosed as a case of essential thrombocytosis. This case demonstrated that thrombectomy alone was sufficient for the treatment of his coronary occlusion. Furthermore, this case report highlights the importance of evaluating rare causes of myocardial infarction other than atherosclerosis and that internists and cardiologists should be aware of essential thrombocytosis as a known cause of myocardial infarction, particularly in patients with no underlying cardiovascular risk factors.

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.

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 ...

Experimental and clinical cardiology, 2010

The majority of coronary artery aneurysms in young adults and children are caused by Kawasaki dis... more The majority of coronary artery aneurysms in young adults and children are caused by Kawasaki disease. A case of undiagnosed childhood Kawasaki disease presenting as silent myocardial infarction during adolescence, which was successfully treated with coronary artery bypass grafting, is described. The present case is followed by a review of the literature.

Experimental and clinical cardiology, 2008

Glycoprotein (GP) IIb/IIIa receptor antagonists compose a subcategory of antiplatelet medications... more Glycoprotein (GP) IIb/IIIa receptor antagonists compose a subcategory of antiplatelet medications that reduce thrombus formation through the blockade of key binding sites needed to stabilize the forming platelet aggregate. The GP IIb/IIIa receptors have been identified as a therapeutic target in reducing the occurrence of platelet-dependent thrombus formation. One advantage of GP IIb/IIIa receptor antagonists is that because GP IIb/IIIa is platelet-specific, inhibition of this receptor does not affect platelet adhesion. This may contribute to hemostasis without leading to ischemic damage. The platelet-specific pharmacological activity of GP IIb/IIIa receptor antagonists has allowed for its broad use in clinical settings. Based on clinical trials, GP IIb/IIIa receptor antagonists have been extensively studied and used in patients with acute coronary syndrome or during percutaneous coronary interventions. The goal of the present article is to provide a detailed review of the chemical ...

European Journal of Heart Failure Supplements

The Journal of Invasive Cardiology, Apr 1, 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 total of 108 cardiac transplant patients, who had underwent routine IVUS studies between 2004-2008 were identified retrospectively. The average heparin dose used was 2528 ± 501 units. The left anterior descending artery was studied in 93% of cases. There was no thromboembolic event. Only one catheter-induced coronary dissection occurred treated with percutaneous coronary intervention. An endomyocardial biopsy was performed 10-15 minutes before the administration of low-dose heparin. There were no other major adverse cardiac events in this population during the procedure. This is the first study showing the safety of low-dose heparin use during diagnostic IVUS studies in cardiac transplant patients, even shortly after endomyocardial biopsy.

ABSTRACT Cardiovascular disease is the leading cause of deaths in American adults. Furthermore, i... more ABSTRACT 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 were modified and synthesized separately and combined by homo or mono coupling. It was achieved by taking advantage of PEG as a linker. It is expected that this molecule will have a potential of combined modes of action of an ACE inhibitors and ARB. According to the relevant recent patents, combination medication therapy has developed, resulting in effects of multiple doses of variety of medications. Benefits from combination therapy have increased efficacy, reduced adverse effects, convenience, compliance, and prolonged duration. Consequently, this combined molecule is expected to block the production of angiotensin II more efficiently and effectively. Although captopril and losartan work in the same system in blocking the effect of angiotensin II they have different action site and mechanism. Losartan acts on cell surface membrane as angiotensin receptor blocker while captopril works in plasma by blocking angiotensin converting enzymes.

The Journal of Invasive Cardiology, Sep 1, 2009

Advances in the safety of percutaneous coronary interventions have been significant in recent yea... more Advances in the safety of percutaneous coronary interventions have been significant in recent years. The goal of this study was to evaluate any decline in the age-adjusted in-hospital mortality rate in patients undergoing multivessel percutaneous coronary intervention (MVPCI) using a very large database from 1988 to 2004 in the United States. The Nationwide Inpatient Sample (NIS) database was utilized to calculate the age-adjusted mortality rate for MVPCI from 1988 to 2004 in patients over the age of 40 years retrospectively. Specific ICD-9-CM codes for MVPCI were used for this study. Patient demographic data were also analyzed and adjusted for age from the database. The mean age was 71.56 +/- 10.59 years (53.55% male). From 1988 the age-adjusted mortality rate was stable until 1999, with a steady decline to the lowest level in 2004. In 1988, the rate was 67.42 (95% CI = 181-316.14), in 1999 51.02 (95% CI = 27-129.32), and in 2004, 40.06 (95% CI 5.6-85.83) per 100,000. Total death also declined from 1.77% to 1.25%. This trend was similar across gender and ethnicities. The age-adjusted mortality from MVPCI was steady until 1999, but declined to the lowest level in 2004. This trend most likely reflects advancements in the care of patients undergoing high-risk coronary interventions.

Cardiovascular Revascularization Medicine, 2011

International Cardivascular Research Journal, 2015

The Journal of Invasive Cardiology, Sep 1, 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.

Reviews in Cardiovascular Medicine, 2014

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.

The Journal of Invasive Cardiology, Dec 1, 2012

The transradial approach for percutaneous coronary intervention (PCI) has gained increasing popul... more The transradial approach for percutaneous coronary intervention (PCI) has gained increasing popularity as an alternative site for coronary angiography and intervention. The transradial approach has safely been used in patients with contraindications to the transfemoral approach. Despite its overall lower complication rates compared with the transfemoral approach, the transradial approach has its own inherent complications. The risk of arterial perforation with the transradial approach is less than 1%, primarily involving the radial artery with the incidence of compartment syndrome at approximately 0.004%. In addition, the risk of significant bleeding requiring transfusion with transradial approach is extremely rare, occurring in about 1/1000 patients. In this report, we present a case of pericardiacophrenic artery perforation occurring during wire advancement into the aorta via right radial artery approach, which was treated with coil embolization for treatment of significant hemorrhage. This case emphasizes the importance of recognizing this artery in order to prevent similar complications in the future. This artery can be confused with the aorta, since it has a similar course paralleling the aortic arch, and as such it can be inadvertently mistaken for the ascending aorta during wire advancement.

Texas Heart Institute Journal, 2015

Data regarding thrombolytic treatment of right-sided mechanical valve thrombosis are almost nonex... more Data regarding thrombolytic treatment of right-sided mechanical valve thrombosis are almost nonexistent, and all current guidelines arise from very small case series. We retrospectively studied the in-hospital and long-term outcome data of a larger series of patients who had received, from September 2005 through June 2012, thrombolytic therapy for right-sided mechanical pulmonary valve or tricuspid valve thrombosis. We identified 16 patients aged 8–67 years who had undergone thrombolytic therapy for definite thrombotic mechanical valve obstruction in the tricuspid or pulmonary valve position (8 in each position). All study patients except one had subtherapeutic international normalized ratios. The 8 patients with pulmonary mechanical valve thrombosis had a 100% response rate to thrombolytic therapy, and their in-hospital survival rate was also 100%. The 8 patients with tricuspid mechanical valve thrombosis had a 75% response rate to thrombolytic therapy, with an in-hospital survival...

Cardiovascular radiation medicine

Here, we present a case of a 63-year-old male who presented with in-stent restenosis of two coron... more Here, we present a case of a 63-year-old male who presented with in-stent restenosis of two coronary arteries simultaneously (mid circumflex and proximal ramus). After the brachytherapy of the circumflex artery for in-stent restenosis, the patient refused the staged procedure for the ramus in-stent restenosis. After approximately 2 years, the patient underwent coronary angiography for recurrent chest pain. Surprisingly, the proximal ramus stent showed marked regression of in-stent restenosis. We hypothesized that the gamma brachytherapy of the circumflex artery could have induced the regression of in-stent restenosis of the adjacent ramus artery due to the deep tissue penetration of gamma radiation. Based on our observation, we believe that in the treatment of in-stent restenosis of a coronary artery, the initial balloon angioplasty may not be as important as the radiation itself. This observation warrants further study to evaluate the effect of external or internal radiation on in-...

Cardiovascular intervention and therapeutics, Jan 22, 2015

A patient with no conventional cardiovascular risk factors presented with inferior ST-elevation m... more A patient with no conventional cardiovascular risk factors presented with inferior ST-elevation myocardial infarction which was finally diagnosed as a case of essential thrombocytosis. This case demonstrated that thrombectomy alone was sufficient for the treatment of his coronary occlusion. Furthermore, this case report highlights the importance of evaluating rare causes of myocardial infarction other than atherosclerosis and that internists and cardiologists should be aware of essential thrombocytosis as a known cause of myocardial infarction, particularly in patients with no underlying cardiovascular risk factors.

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.

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 ...

Experimental and clinical cardiology, 2010

The majority of coronary artery aneurysms in young adults and children are caused by Kawasaki dis... more The majority of coronary artery aneurysms in young adults and children are caused by Kawasaki disease. A case of undiagnosed childhood Kawasaki disease presenting as silent myocardial infarction during adolescence, which was successfully treated with coronary artery bypass grafting, is described. The present case is followed by a review of the literature.

Experimental and clinical cardiology, 2008

Glycoprotein (GP) IIb/IIIa receptor antagonists compose a subcategory of antiplatelet medications... more Glycoprotein (GP) IIb/IIIa receptor antagonists compose a subcategory of antiplatelet medications that reduce thrombus formation through the blockade of key binding sites needed to stabilize the forming platelet aggregate. The GP IIb/IIIa receptors have been identified as a therapeutic target in reducing the occurrence of platelet-dependent thrombus formation. One advantage of GP IIb/IIIa receptor antagonists is that because GP IIb/IIIa is platelet-specific, inhibition of this receptor does not affect platelet adhesion. This may contribute to hemostasis without leading to ischemic damage. The platelet-specific pharmacological activity of GP IIb/IIIa receptor antagonists has allowed for its broad use in clinical settings. Based on clinical trials, GP IIb/IIIa receptor antagonists have been extensively studied and used in patients with acute coronary syndrome or during percutaneous coronary interventions. The goal of the present article is to provide a detailed review of the chemical ...