Mushabbar A Syed

Transposition of Great Arteries

Transposition of the great arteries (TGA) is a form of conotruncal abnormalities in which the aorta arises from the morphological right ventricle and pulmonary artery arises from the morphological left ventricle (ventriculoarterial discordance). TGA encompasses two distinct defects, complete TGA and congenitally corrected TGA. Complete TGA has a prevalence of 0.24/1,000 live births [12] and represents ∼% of all congenital heart disease [25]. It is the second most common congenital heart defect recognized in infancy [12]. Congenitally corrected TGA is rarer, recognized in 0.02–0.07 per 1,000 live births [15], or less than 1 % of congenital heart defects [25].

A novel virtual reality environment for preoperative planning and simulation of image guided intracardiac surgeries with robotic manipulators.

The evolution of image-guided and robot-assisted procedures can be beneficial to intracardiac interventions. This paper proposes a novel approach and a virtual reality system for preoperative planning and intraoperative guidance of cardiac procedures, and for investigating the kinematics and control of a virtual robotic manipulator, based on MRI CINE images. The system incorporates dedicated software modules for processing MR images, generating dynamic trajectories in the continuously changing environment of a beating heart, controlling a specific generic virtual manipulator along those trajectories, and a virtual reality interface that fuses all those information. The proposed system is applied for the simulation of accessing the aortic valve annulus via a small incision on the apex by maneuvering a robotic manipulator through an access corridor that safely transverses the left ventricle (LV) of the beating heart.

Increased Level of Thrombotic Biomarkers in Patients with Atrial Fibrillation Despite Traditional and New Anticoagulant Therapy.

The aim of this study was to examine the effect of the traditional oral anticoagulant, warfarin (W), and new anticoagulants, apixaban (A) and rivaroxaban (R), on the level of thrombotic biomarkers in patients with atrial fibrillation (AF). Circulating plasma levels of von Willebrand factor (vWF), prothrombin fragment 1.2 (F1.2), microparticle tissue factor (MP-TF), and plasminogen activator inhibitor (PAI-1) were analyzed as potential markers of clot formation in 30 patients with AF prior to ablation surgery. Patients with AF were divided into 2 groups based on their usage (n = 21) and nonusage (n = 9) of any oral anticoagulant. Furthermore, those on anticoagulants were divided based on their use of newer (R and A, 16) or traditional (W, 4) anticoagulants. A statistical increase (P < .05) in the levels of vWF, MP-TF, and PAI-1 were seen in anticoagulated patients with AF, whereas F1.2 and PAI-1 were increased in nonanticoagulated patients with AF compared to normal. There was no statistical difference (P > .05) in levels of any thrombotic biomarker between patients treated with the traditional anticoagulant, W, and those treated with new anticoagulants, R and A. Our data suggest that, despite the use of traditional or newer anticoagulants, prothrombotic biomarkers are still generated at increased levels in patients with AF. Further studies to confirm these findings are warranted.

Biomarkers of Inflammation, Thrombogenesis, and Collagen Turnover in Patients With Atrial Fibrillation

The purpose of this study was to determine whether there are any differences in the levels of inflammatory, thrombotic, and collagen turnover biomarkers between individuals with atrial fibrillation (AF) and healthy volunteers. Circulating plasma levels of plasminogen activator inhibitor 1 (PAI-1), CD40-ligand (CD40-L), nucleosomes (which are indicators of cell death), C-reactive protein (CRP), procollagen III N-terminal propeptide (PIIINP), procollagen III C-terminal propeptide (PIIICP), procollagen I N-terminal propeptide, tissue plasminogen activator, and von Willebrand factor were analyzed as potential biomarkers of AF. Baseline plasma was collected from patients with AF prior to ablation surgery at Loyola University Medical Center. Individuals with AF had statistically significantly increased levels of PAI-1, CD40-L, and nucleosomes, when compared to the normal population (P < .0001). Additionally, there was a statistically significant increase in the CRP (P = .01), PIIINP (P = .04), and PIIICP (P = .0008) when compared to normal individuals. From this study, it is concluded that the prothrombotic, inflammatory, and collagen turnover biomarkers PAI-1, CD40-L, nucleosomes, CRP, PIIICP, and PIIINP are elevated in AF.

Magnetic Resonance Imaging in Acute and Chronic Limb Ischemia

Magnetic resonance angiography (MRA) of central and peripheral vessels is a well-established method. ACC/AHA 2005 Practice Guidelines for the Management of Patients with Peripheral Arterial Disease recommends that MRA of the extremities should be performed with gadolinium enhancement (class I recommendation). However, due to concerns about the cost and safety of gadolinium-based contrast agents in certain patients, there is significant ongoing development in the field of non-contrast MRA with promising results. Appropriate indications for peripheral MRA include diagnosis of peripheral arterial disease (PAD), selecting patients for endovascular intervention or surgical bypass of lower extremity PAD, and post-revascularization surveillance of lower extremity PAD. Other indications include assessment of peripheral arterial aneurysms, dissection, and peripheral thromboembolism. The role of MRA in acute critical limb ischemia is limited due to the need for urgent diagnosis and intervention that can be achieved with invasive angiography.

Anticoagulation in Cardiovascular Diseases

With the increasing prevalence of cardiovascular disease amongst the aging population as well as the expanding indications for the use of oral anticoagulants, physicians are more likely to encounter patients on these medications in the inpatient and outpatient settings. To provide appropriate care for these patients, physicians must understand the pharmacology of the available oral anticoagulants, the clinical indication for anticoagulation, and the appropriate preoperative, perioperative, and postoperative management of these patients. While short-term anticoagulation is often times achieved with the use of intravenous or subcutaneous heparin, chronic anticoagulation is achieved with warfarin or other newer novel anticoagulants (NOAC). Due to the different pharmacologic properties, each of the anticoagulants provides varying challenges and limitations in the clinical setting. Patient with cardiovascular disease have numerous indications for requiring chronic anticoagulant therapy including atrial fibrillation/flutter, prosthetic heart valves, significant heart failure including those requiring mechanical assist devices, and thromboembolic disease. Understanding the clinical indication necessitating the use of oral anticoagulation as well as the specific pharmacology of these agents is essential to providing adequate care to these patients. This chapter provides an in-depth review of the numerous anticoagulant strategies available, the indications for prescribing these therapies, as well as the preoperative, perioperative, and postoperative management of patients on these medications.

Clinical utility of cardiovascular magnetic resonance in patients with cardiac rhythm management devices

Background Selected patients with cardiac rhythm management devices (CRMD) can safely undergo cardiovascular magnetic resonance (CMR). However, susceptibility artifacts from CRMD generator and leads can affect image quality, limiting the information provided by CMR. We sought to evaluate whether CMR of CRMD patients can provide clinically useful information that includes answering the clinical question, providing new findings, new diagnoses, or change in clinical management.

CORRELATION OF SCAR LOCALIZATION BETWEEN CARDIAC MAGNETIC RESONANCE IMAGING AND ELECTRO-ANATOMIC MAPPING AT ELECTROPHYSIOLOGY STUDY IN PATIENTS WITH CARDIAC RHYTHM MANAGEMENT DEVICES

Background Cardiac magnetic resonance imaging (CMR) can accurately delineate myocardial scar for substrate guided ventricular tachycardia (VT) ablation. Susceptibility artifact from cardiac rhythm management device (CRMD) generator and leads can significantly affect image quality limiting the evaluation of myocardial scar and foci of VT. We conducted a retrospective study to correlate scars from CMR to the voltage mapping obtained at electrophysiology study (EPS).

Left ventricular noncompaction as diagnosed by established cardiac magnetic resonance imaging criteria is not associated with increased adverse events compared to non-ischemic dilated cardiomyopathy

Background Left ventricular noncompaction (LVNC) is classified by the American Heart Association as a primary genetic cardiomyopathy and is attributed to defects in cardiac embryogenesis resulting in the intrauterine arrest of the compaction of the loose meshwork that makes up the fetal myocardium. From echocardiographic data, the prevalence of LVNC has been estimated at 0.05% of the general population. With the increasing use of cardiac magnetic resonance imaging (CMR), there has been a surge in the reports of patients with LVNC. Interestingly, many patients that have been diagnosed with non-ischemic dilated cardiomyopathy (NIDCM) have also been noted to have prominent left ventricular trabeculations. We sought to evaluate the difference in clinical outcomes in patients with NIDCM compared to those with LVNC as diagnosed by established CMR criteria.

Epicardial adipose tissue volume by cardiac magnetic resonance imaging predicts abnormal myocardial relaxation in patients with atrial fibrillation

Background Inflammation may be a key trigger in the accumulation of extracellular matrix that leads to fibrosis, abnormal myocardial relaxation, diastolic dysfunction and eventual heart failure with a preserved ejection fraction (HFpEF). Epicardial adipose tissue (EAT) is a metabolically active organ releasing various adipokines and inflammatory mediators which may promote fibrosis in adjacent myocardium altering the structural properties of the ventricle leading to abnormal diastology. The aim of this study was to assess the relationship of EAT volume using cardiac magnetic resonance imaging (CMR) and parameters of diastolic dysfunction as assessed by 2Dtransthoracic echocardiography (TTE) in patients with atrial fibrillation (AF).