Malek Kass

Radiation Dose Reduction in the Cardiac Catheterization Laboratory Utilizing a Novel Protocol

OBJECTIVES This study reports the results a novel radiation reduction protocol (RRP) system for coronary angiography and interventional procedures and the determinants of radiation dose. BACKGROUND The cardiac catheterization laboratory is an important source of radiation and should be kept in good working order with dose-reduction and monitoring capabilities. METHODS All diagnostic coronary angiograms and percutaneous coronary interventions from a single catheterization laboratory were analyzed 2 months before and after RRP implementation. The primary outcome was the relative dose reduction at the interventional reference point. Separate analyses were done for conventional 15 frames/s (FPS) and at reduced 7.5 FPS post-RRP groups. RESULTS A total of 605 patients underwent coronary angiography (309 before RRP and 296 after RRP), with 129 (42%) and 122 (41%) undergoing percutaneous coronary interventions before and after RRP, respectively. With RRP, a 48% dose reduction (1.07 ± 0.05 Gy vs. 0.56 ± 0.03 Gy, p < 0.0001) was obtained, 35% with 15 FPS RRP (0.70 ± 0.05 Gy, p < 0.0001) and 62% with 7.5 FPS RRP (0.41 ± 0.03 Gy, p < 0.001). Similar dose reductions for diagnostic angiograms and percutaneous coronary interventions were noted. There was no change in the number of stents placed or vessels intervened on. Increased dose was associated with male sex, radial approach, increasing body mass index, cine runs, and frame rates. Using a multivariable model, a 48% relative risk with RRP (p < 0.001), 44% with 15 FPS RRP and 68% with 7.5 FPS RRP was obtained. CONCLUSIONS We demonstrate a highly significant 48.5% adjusted radiation dose reduction using a novel algorithm, which needs strong consideration among interventional cardiology practice.

Happiness Can Break Your Heart: A Rare Case of Takotsubo Cardiomyopathy After Good News

Takotsubo cardiomyopathy (TTC) mimics acute myocardial infarction on electrocardiography and is characterized by transient left ventricular dysfunction and positive cardiac biomarkers in the absence of significant coronary disease. In the majority of cases, TTC affects postmenopausal women and is commonly incited by a recent negative emotional stressor, although the pathophysiological mechanism of this process is incompletely understood. In contrast, we describe a case in which TTC developed after a recent positive emotional event in a postmenopausal woman.

Computed tomographic coronary angiography for patients with heart failure (CTA-HF): a randomized controlled trial (IMAGE HF Project 1-C)

AbstractBackgroundThe prevalence of heart failure (HF) is rising in industrialized and developing countries. Though invasive coronary angiography (ICA) remains the gold standard for anatomical assessment of coronary artery disease in HF patients, alternatives are being sought. Computed tomographic coronary angiography (CTA) has emerged as an accurate non-invasive diagnostic tool for coronary artery disease (CAD) and has been demonstrated to have prognostic value. Whether or not CTA can be used in HF patients is unknown. Acknowledging the aging population, the growing prevalence of HF and the increasing financial burden of healthcare, we need to identify non-invasive diagnostic tests that are available, safe, accurate and cost-effective.Methods/DesignThe proposed study aims to provide insight into the efficacy of CTA in HF patients. A multicenter randomized controlled trial will enroll 250 HF patients requiring coronary anatomical definition. Enrolled patients will be randomized to either CTA or ICA (n = 125 per group) as the first test to define coronary anatomy. The primary outcomes will be collected to determine downstream resource utilization. Secondary outcomes will include the composite clinical events and major adverse cardiac events. In addition, the accuracy of CTA for detecting coronary anatomy and obstruction will be assessed in patients who subsequently undergo both CTA and ICA. It is expected that CTA will be a more cost-effective strategy for diagnosis: yielding similar outcomes with fewer procedural risks and improved resource utilization.Trial registrationClinicalTrials.gov,NCT01283659 Team grant #CIF 99470

The Transcatheter Aortic Valve Implantation (TAVI) Quality Report: A Call to Arms for Improving Quality in Canada

Transcatheter aortic valve implantation (TAVI) is a disruptive technology that has dramatically changed the way clinicians care for patients with aortic stenosis. In 15 short years, this technology has progressed from first-in-human to the standard of care for high-risk and inoperable patients with aortic stenosis. In 2016 the Canadian Cardiovascular Society published the first ever report of quality of care for TAVI in Canada. This report provided multiple insights into evaluating such care delivered to Canadians and the challenges that lie ahead. In this article, we summarize these challenges and encourage cardiologists to join the call to arms for improving quality of TAVI care in Canada.

Cor Triatriatum Sinister: An Unusual Cause of Atrial Fibrillation in Adults

Cor triatriatum is a rare congenital heart defect that is associated with an increased risk for developing atrial fibrillation. We report a case of a healthy 38-year-old man who presented in decompensated heart failure and atrial fibrillation with a rapid ventricular response. A transthoracic echocardiogram (TTE) demonstrated severe biventricular dysfunction and dilatation in addition to cor triatriatum sinister. He was diuresed with resolution of his symptoms and spontaneously converted back to sinus rhythm. There is limited evidence in the literature surrounding anticoagulation and associated left ventricular dysfunction in the setting of cor triatriatum which posed difficult therapeutic decisions.

CHARACTERISTICS OF ACUTE CORONARY SYNDROME PRESENTATION IN YOUNG PATIENTS

Background: Acute coronary syndrome (ACS) is a major cause of death worldwide. ACS is primarily thought to occur in the elderly and less frequently in adults younger than ≤35 years of age. In this study, we proposed to analyze the presentation of ACS, risk factors, and description of coronary

Partial PFO Closure for Persistent Hypoxemia in a Patient with Ebstein Anomaly

Ebstein anomaly is characterized by deformities of the anterior leaflet of the tricuspid valve and atrialization of the right ventricle. Patients with severe tricuspid regurgitation are recommended to have tricuspid valve surgery with concomitant atrial septal defect closure. A 73-year-old female with Ebstein anomaly presented with severe hypoxemia. Transthoracic echocardiography revealed severe tricuspid regurgitation and a patent foramen ovale with right-to-left shunting. Complete percutaneous patent foramen ovale closure led to acute decompensation; however, partial closure led to hemodynamic stability and improved oxygenation. In conclusion, similar patients with “patent foramen ovale dependency” from longstanding shunts may benefit from partial patent foramen ovale closure.