Raman Dusaj

Red cell distribution width and risk of cardiovascular mortality: Insights from National Health and Nutrition Examination Survey (NHANES)-III

INTRODUCTION Red cell distribution width (RDW) has been linked to cardiovascular disease. We sought to determine whether addition of RDW improved the Framingham risk score (FRS) model to predict cardiovascular mortality in a healthy US cohort. METHODS We performed a post-hoc analysis of the National Health and Nutritional Examination Survey-III (1988-94) cohort, including non-anemic subjects aged 30-79years. Primary endpoint was death from coronary heart disease (CHD). We divided the cohort into three risk categories: <6%, 6-20% and >20%. RDW>14.5 was considered high. Kaplan-Meier survival curves and Cox proportional hazards models were created. Discrimination, calibration and reclassification were used to assess the value of addition of RDW to the FRS model. RESULTS We included 7005 subjects with a mean follow up of 14.1years. Overall, there were 233 (3.3%) CHD deaths; 27 (8.2%) in subjects with RDW>14.5 compared to 206 (3.1%) in subjects with RDW≤14.5 (p<0.001). Adjusted hazard ratio of RDW in predicting CHD mortality was 2.02 (1.04-3.94, p=0.039). Addition of RDW to FRS model showed significant improvement in C-statistic (0.8784 vs. 0.8751, p=0.032) and area under curve (0.8565 vs. 0.8544, p=0.05). There was significant reclassification of FRS with a net reclassification index (NRI) of 5.6% (p=0.017), and an intermediate-risk NRI of 9.6% (p=0.011). Absolute integrated discrimination index (IDI) was 0.004 (p=0.02), with relative IDI of 10.4%. CONCLUSIONS Our study demonstrates that RDW is a promising biomarker which improves prediction of cardiovascular mortality over and above traditional cardiovascular risk factors.

A complete heart block in a young male: a case report and review of literature of cardiac sarcoidosis

Cardiac sarcoidosis is one of the uncommon causes of heart failure. Generally, it presents in the form of varying clinical manifestations ranging from asymptomatic to fatal arrhythmias such as ventricular tachycardia and complete heart block. It is difficult to make a diagnosis strictly based on clinical grounds. However, in the setting of extracardiac sarcoidosis and patients presenting with advanced heart block or ventricular arrhythmia, direct cardiac involvement should be suspected. The definitive diagnosis of cardiac sarcoidosis can be made from endomyocardial biopsy, but it is falling out of favor due to patchy myocardial involvement, considerable procedure-related risks, and advancement in additional imaging modalities. Once cardiac sarcoidosis has been diagnosed, management of the disease remains challenging. Steroids are considered the mainstay of therapy, and implantable cardioverter defibrillator therapy can be considered in a selected group of patients at greater risk for malignant ventricular arrhythmias.

Metrics of quality care in veterans: correlation between primary-care performance measures and inappropriate myocardial perfusion imaging.

Approximately 10% to 20% of myocardial perfusion imaging (MPI) tests are inappropriate based on professional‐society recommendations. The correlation between inappropriate MPI and quality care metrics is not known.

OBESITY IS NOT ASSOCIATED WITH A DIFFERENTIAL OUTCOME FOLLOWING CORONARY ARTERY BYPASS SURGERY

Conflicting data exists regarding the impact of obesity on mortality and morbidity following coronary artery bypass graft (CABG) surgery with some suggesting a paradoxical reduction in adverse outcomes. We aimed to compare the in-hospital outcomes of CABG in obese and non-obese subjects. The

Acute kidney injury requiring dialysis and in-hospital mortality in patients with chronic kidney disease and non-ST-segment elevation acute coronary syndrome undergoing early vs delayed percutaneous coronary intervention: A nationwide analysis.

Chronic kidney disease (CKD) is a well‐known risk factor for coronary artery disease and is associated with poor outcomes following an acute coronary syndrome (NSTE‐ACS). The optimal timing of an invasive strategy in patients with CKD and NSTE‐ACS is unclear.

The Influence of Pregnancy in Patients with Congenital Long QT Syndrome.

Congenital long QT syndrome (LQTS) is a disorder of myocardial repolarization and is characterized by a prolonged QT interval on an electrocardiogram. A prolonged QT predisposes patients to an increased risk of syncope and sudden cardiac death secondary to polymorphic ventricular tachycardia. Several mutations linked to the LQTS have been identified, the most common of which have been found in the potassium channel KCNQ1 (LQT1) and hERG (LQT2) genes and in the sodium channel SCN5A (LQT3) gene. Female sex is an independent risk factor for the development of torsades de pointes in LQTS. Furthermore, although pregnancy may be associated with protection against cardiac events in LQTS, the 9-month postpartum period represents a time of increased arrhythmogenicity. Interestingly, these cardiac events during the postpartum period are more common in patients with LQT2. The precise mechanisms that influence the cardiac repolarization during the postpartum period are unclear. Beta-blockers are considered reasonably safe during pregnancy and should be continued or initiated in patients with LQTS to reduce the risk of cardiac events. Implantable cardioverter defibrillators are safe in pregnancy, and there is no evidence that pregnant women with these devices are at any greater risk for adverse complications solely on the grounds of having the device.

Percutaneous coronary intervention and inpatient mortality in patients with advanced chronic kidney disease presenting with acute coronary syndrome.

Chronic kidney disease (CKD) is an important risk factor for coronary artery disease, yet patients with CKD are less likely to undergo coronary angiography and percutaneous coronary intervention (PCI). We retrospectively analyzed the 2006-2012 National Inpatient Sample Database to examine the temporal trends in coronary angiography and PCI among patients without CKD, with advanced CKD (CKD III-V), and with end-stage renal disease (ESRD) presenting with unstable angina/non-ST elevation myocardial infarction (NSTE-ACS) and ST-elevation myocardial infarction (STEMI). A total of 579,747 admissions for NSTE-ACS and 293,950 admissions for STEMI were studied. Patients with NSTE-ACS were less likely to undergo coronary angiography/PCI than those with STEMI, irrespective of CKD. Between 2006 and 2012, performance of PCI saw an uptrend across all CKD groups with NSTE-ACS (no CKD, 29.9%-36.8%; CKD III-V, 18.2%-21.5%; ESRD, 19.8%-27.5%; all Ptrends < 0.01) and STEMI (no CKD, 57.0%-76.0%; CKD III-V, 33.0%-52.6%; ESRD, 29.9%-42.9%; Ptrends < 0.01). Multivariate analyses revealed that PCI was associated with a lower risk of hospital mortality across all degrees of CKD in both NSTE-ACS (adjusted odds ratios: no CKD, 0.44; CKD III-V, 0.48; ESRD, 0.46; P < 0.01) and STEMI (no CKD, 0.35; CKD III-V, 0.50; ESRD, 0.52; P < 0.01). Performance of PCI increased over time among patients presenting with NSTE-ACS and STEMI in the presence of advanced CKD and independently predicted lower in-hospital mortality.

Simulation-based training of transesophageal echocardiography for cardiology fellows.

Cardiology fellows learn procedures by performing them on patients under faculty supervision. Such training may increase procedure times, compromise image quality, and cause complications. Simulators provide an opportunity to teach procedures where patients are not at risk. We created a simulation-based curriculum to teach transesophageal echocardiography (TEE) to first-year cardiology fellows and measured the change in their reported self-confidence in TEE skills.

Metrics of Quality Care in Veterans: Correlation Between Primary-Care Performance Measures and Inappropriate Myocardial Perfusion Imaging: Inappropriate MPI and quality metrics

Approximately 10% to 20% of myocardial perfusion imaging (MPI) tests are inappropriate based on professional‐society recommendations. The correlation between inappropriate MPI and quality care metrics is not known.