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Article ; Online: Editorial: Like a kid in a candy shop: Choosing the sweetest therapy for submassive pulmonary embolism.

Ismayl, Mahmoud / Goldsweig, Andrew M

Cardiovascular revascularization medicine : including molecular interventions

2024

Language	English
Publishing date	2024-01-10
Publishing country	United States
Document type	Editorial
ZDB-ID	2212113-4
ISSN	1878-0938 ; 1553-8389
ISSN (online)	1878-0938
ISSN	1553-8389
DOI	10.1016/j.carrev.2024.01.003
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Article ; Online: A Seatbelt for the Kidney During Coronary Intervention.

Goldsweig, Andrew M / Ismayl, Mahmoud

JACC. Cardiovascular interventions

2023 Volume 16, Issue 15, Page(s) 1887–1888

MeSH term(s)	Humans ; Treatment Outcome ; Kidney
Language	English
Publishing date	2023-08-16
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	2452157-7
ISSN	1876-7605 ; 1936-8798
ISSN (online)	1876-7605
ISSN	1936-8798
DOI	10.1016/j.jcin.2023.07.001
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Zs.A 6669: Show issues

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Article ; Online: Safety and Efficacy of Combining Left Atrial Appendage Occlusion With Another Cardiac Procedure.

Ismayl, Mahmoud / Ahmed, Hasaan / Freeman, James V / Alkhouli, Mohamad / Lakkireddy, Dhanunjaya / Goldsweig, Andrew M

JACC. Cardiovascular interventions

2024 Volume 17, Issue 2, Page(s) 262–273

Abstract: Background: Clinical outcomes of left atrial appendage occlusion (LAAO) combined with other cardiac procedures have not been previously examined.: Objectives: This study sought to evaluate the safety and efficacy of combining LAAO with other cardiac ... ...

Abstract	Background: Clinical outcomes of left atrial appendage occlusion (LAAO) combined with other cardiac procedures have not been previously examined. Objectives: This study sought to evaluate the safety and efficacy of combining LAAO with other cardiac procedures vs isolated LAAO. Methods: We conducted a retrospective cohort study using the 2016 to 2020 National Inpatient Sample database to compare patients undergoing LAAO combined with another cardiac procedure vs isolated LAAO. Outcomes included risk-adjusted major adverse cardiovascular events (MACEs), in-hospital mortality, major complications, length of stay (LOS), and total costs. Results: The total cohort included 88,910 weighted encounters, of which 1,225 (1.4%) involved concomitant cardiac procedures. After risk adjustment, patients in the concomitant procedure group had similar odds of MACEs (adjusted OR: 1.82; 95% CI: 0.94-2.74); in-hospital mortality; and complications including stroke, acute kidney injury, major bleeding, blood transfusion, and vascular injury. They also had similar LOS (1 day vs 1 day; P = 0.32) and higher costs ($44,723 vs $32,364; P < 0.01) compared with isolated LAAO but shorter LOS (1 day vs 2 days; P < 0.01) and lower costs ($51,552 vs $63,170; P = 0.04) compared with LAAO with sequential procedures. In subgroup analyses, concomitant atrial fibrillation/atrial flutter ablation had higher adjusted odds of heart block (P < 0.01), and concomitant transcatheter aortic valve replacement had higher adjusted odds of stroke (P = 0.02) and vascular injury (P < 0.01). Conclusions: In this retrospective observational study, combining LAAO with another cardiac intervention appeared to be associated with similar MACEs and LOS. However, certain complications appeared to be more frequent, and the cost was higher with combined procedures.
MeSH term(s)	Humans ; Vascular System Injuries ; Atrial Appendage/diagnostic imaging ; Retrospective Studies ; Treatment Outcome ; Stroke/etiology ; Atrial Flutter
Language	English
Publishing date	2024-01-22
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	2452157-7
ISSN	1876-7605 ; 1936-8798
ISSN (online)	1876-7605
ISSN	1936-8798
DOI	10.1016/j.jcin.2023.10.017
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Article ; Online: In-hospital safety outcomes of left atrial appendage occlusion in octogenarians and nonagenarians.

Ismayl, Mahmoud / Ahmed, Hasaan / Goldsweig, Andrew M / Freeman, James V / Alkhouli, Mohamad

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology

2024 Volume 26, Issue 3

Abstract: Aims: Data on safety outcomes of left atrial appendage occlusion (LAAO) in elderly patients are limited. This study aimed to compare the outcomes of LAAO between octogenarians (age 80-89) and nonagenarians (age ≥90) vs. younger patients (age ≤79).: ... ...

Abstract	Aims: Data on safety outcomes of left atrial appendage occlusion (LAAO) in elderly patients are limited. This study aimed to compare the outcomes of LAAO between octogenarians (age 80-89) and nonagenarians (age ≥90) vs. younger patients (age ≤79). Methods and results: We conducted a retrospective cohort study using the National Inpatient Sample database to identify patients hospitalized for LAAO from 2016 to 2020 and to compare in-hospital safety outcomes in octogenarians and nonagenarians vs. younger patients. The primary outcome was a composite of in-hospital all-cause mortality or stroke. Secondary outcomes included procedural complications, length of stay (LOS), and total costs. Outcomes were determined using logistic regression models. Among 84 140 patients hospitalized for LAAO, 32.9% were octogenarians, 2.8% were nonagenarians, and 64.3% were ≤79 years of age. Over the study period, the volume of LAAO increased in all age groups (all Ptrend < 0.01). After adjustment for clinical and demographic factors, octogenarians and nonagenarians had similar odds of in-hospital all-cause mortality or stroke [adjusted odds ratio (aOR) 1.41, 95% confidence interval (CI) 0.93-2.13 for octogenarians; aOR 1.69, 95% CI 0.67-3.92 for nonagenarians], cardiac tamponade, acute kidney injury, major bleeding, and blood transfusion, in addition to similar LOS and total costs compared with younger patients (all P > 0.05). However, octogenarians and nonagenarians had higher odds of vascular complications compared with younger patients (aOR 1.47, 95% CI 1.08-1.99 for octogenarians; aOR 1.60, 95% CI 1.18-2.97 for nonagenarians). Conclusion: Octogenarians and nonagenarians undergoing LAAO have a similar safety profile compared with clinically similar younger patients except for higher odds of vascular complications.
MeSH term(s)	Aged, 80 and over ; Humans ; Aged ; Nonagenarians ; Octogenarians ; Atrial Appendage/surgery ; Retrospective Studies ; Stroke/epidemiology ; Stroke/etiology ; Stroke/prevention & control ; Hospitals ; Treatment Outcome ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/surgery ; Atrial Fibrillation/complications
Language	English
Publishing date	2024-02-23
Publishing country	England
Document type	Journal Article
ZDB-ID	1449879-0
ISSN	1532-2092 ; 1099-5129
ISSN (online)	1532-2092
ISSN	1099-5129
DOI	10.1093/europace/euae055
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Zs.A 5434: Show issues

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Article: A case report of postcardioversion device-related thrombus in a patient with left atrial appendage occlusion device on apixaban.

Ahmed, Hasaan / Ismayl, Mahmoud / Palicherla, Anirudh / Heppler, Miranda / Petraskova, Terezia / Kousa, Omar / Vargha, Jalal

Annals of medicine and surgery (2012)

2024 Volume 86, Issue 3, Page(s) 1729–1733

Abstract: Background: Current guidelines recommend proceeding with cardioversion, without the explicit need for preprocedural transesophageal echocardiography (TEE), in patients compliant with oral anticoagulation for at least 3 weeks. The relevance of these ... ...

Abstract	Background: Current guidelines recommend proceeding with cardioversion, without the explicit need for preprocedural transesophageal echocardiography (TEE), in patients compliant with oral anticoagulation for at least 3 weeks. The relevance of these guidelines remains unclear in those undergoing repeat cardioversion. Case summary: A 66-year-old male with a history of atrial fibrillation (AF) and a left atrial appendage occlusion (LAAO) device, compliant with apixaban, presented with dyspnea and lightheadedness. He was cardioverted into sinus rhythm, 10 days before symptom onset, with TEE unremarkable at the time. An ECG revealed that the patient converted back into AF and a repeat cardioversion was scheduled. At the patient's request, a TEE was obtained, revealing a new 2 cm×1 cm thrombus in the left atrium above the WATCHMAN device. Cardioversion was canceled and the patient was hospitalized for AF management. Discussion: Cardioverted patients are at risk for thrombus formation due to atrial stunning, a transitory dysfunction of the atrial appendage and atrium, which occurs immediately after cardioversion and can persist for several weeks. The likelihood of a thrombus is further propagated by individual risk factors for stroke. Conclusion: Anticoagulation does not eliminate the risk of thrombus formation in those with increased risk factors for stroke. Further studies are warranted to assess the need for routine TEE, after cardioversion, in those with stroke risk factors on anticoagulation or who have LAAO.
Language	English
Publishing date	2024-01-22
Publishing country	England
Document type	Case Reports
ZDB-ID	2745440-X
ISSN	2049-0801
ISSN	2049-0801
DOI	10.1097/MS9.0000000000001735
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Article: Acute limb ischemia from embolization of left ventricular pseudoaneurysm thrombus: a rare case report.

Ismayl, Mahmoud / Radaideh, Qais / Abusnina, Waiel / Aboeata, Ahmed / Holmberg, Jeffrey

Annals of medicine and surgery (2012)

2023 Volume 85, Issue 4, Page(s) 1100–1103

Abstract: Myocardial infarction (MI) can lead to a wide spectrum of mechanical complications. Left ventricular pseudoaneurysm (LVP) is a rare but serious complication of MI.: Case presentation: A 69-year-old woman with prior coronary artery bypass grafting and ... ...

Abstract	Myocardial infarction (MI) can lead to a wide spectrum of mechanical complications. Left ventricular pseudoaneurysm (LVP) is a rare but serious complication of MI. Case presentation: A 69-year-old woman with prior coronary artery bypass grafting and a remote history of inferolateral ST-elevation MI (STEMI) with failure to revascularize the left circumflex artery presented with gangrenous right toes that appeared 2 years after her STEMI. A computed tomography angiogram of the right lower extremity showed arterial occlusion and mild atherosclerotic disease. Echocardiography revealed a pseudoaneurysm with an adherent mural thrombus as the underlying cause of acute limb ischemia. The patient was started on heparin and cardiothoracic surgery was consulted but did not operate as the risk of surgery outweighed the benefit. On hospital day 3, the patient underwent amputation of her gangrenous toes as the tissue was nonviable. The patient remained stable during her hospital stay and was discharged on day 5 on long-term anticoagulation. Clinical discussion: LVPs have a wide spectrum of presentations, from asymptomatic or nonspecific symptoms to thromboembolism with end-organ damage, such as in our case. Therefore, early diagnosis and management are of paramount importance. Our patient's prior coronary artery bypass grafting most likely helped in forming a fibrous pericardium that sealed the pseudoaneurysm and prevented its rupture. Conclusions: STEMI requires close follow-up, especially in cases where revascularization is not achievable, as the risk of mechanical complications and mortality is high. Physicians should have a high suspicion for LVP in patients with prior MI, given its wide spectrum of presentations.
Language	English
Publishing date	2023-03-27
Publishing country	England
Document type	Case Reports
ZDB-ID	2745440-X
ISSN	2049-0801
ISSN	2049-0801
DOI	10.1097/MS9.0000000000000337
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Article ; Online: Evaluation of stable angina by coronary computed tomographic angiography versus standard of care: A systematic review and meta-analysis.

Palicherla, Anirudh / Ismayl, Mahmoud / Thandra, Abhishek / Budoff, Matthew / Shaikh, Kashif

Cardiovascular revascularization medicine : including molecular interventions

2023 Volume 59, Page(s) 67–75

Abstract: Introduction: There is limited data comparing Coronary Computed Tomography Angiography (CCTA) versus the usual Standard of care (SOC) in patients with suspected stable coronary artery disease (CAD). We aimed to perform a systematic review and meta- ... ...

Abstract	Introduction: There is limited data comparing Coronary Computed Tomography Angiography (CCTA) versus the usual Standard of care (SOC) in patients with suspected stable coronary artery disease (CAD). We aimed to perform a systematic review and meta-analysis to compare CCTA versus SOC in patients with stable CAD. Methods: We searched multiple databases for randomized controlled trials (RCTs) comparing CCTA with SOC, which included various functional testing approaches for evaluating stable CAD. We used a random-effects model to calculate risk ratios (RRs) with 95 % confidence intervals (CIs). Outcomes included all-cause mortality, myocardial infarction (MI), hospitalization for unstable angina (UA), invasive angiography, revascularization, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). Results: We identified 6 RCTs with 19,881 patients with stable CAD, of which 9995 underwent CCTA, and 9886 underwent SOC. There were no significant differences between CCTA and SOC in terms of all-cause mortality (RR: 0.91; 95 % CI: 0.70-1.19; p = 0.50), MI (RR: 0.78; 95 % CI: 0.58-1.05; p = 0.11), hospitalizations for UA (RR: 1.20; 95 % CI: 0.95-1.51;p = 0.12), invasive angiography (RR: 0.71; 95 % CI: 0.32-1.61; p = 0.42), revascularization (RR:1.25; 95 % CI: 0.83-1.89; p = 0.29), PCI (RR: 1.20; 95 % CI: 0.78-1.85; p = 0.40), and CABG rates (RR: 0.89; 95 % CI: 0.530-1.49; p = 0.65). Conclusion: In patients with stable CAD, CCTA is associated with similar outcomes compared to the usual Standard of care. Given its potential to quickly rule out severe obstructive disease, its ability to provide non-invasive physiology and identify non-obstructive CAD with plaque information makes it an attractive addition to the available armamentarium to evaluate chest pain.
MeSH term(s)	Humans ; Computed Tomography Angiography ; Angina, Stable/diagnostic imaging ; Angina, Stable/therapy ; Coronary Angiography/methods ; Standard of Care ; Coronary Artery Disease/diagnostic imaging ; Coronary Artery Disease/therapy ; Coronary Artery Disease/complications ; Myocardial Infarction ; Angina, Unstable
Language	English
Publishing date	2023-07-27
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	2212113-4
ISSN	1878-0938 ; 1553-8389
ISSN (online)	1878-0938
ISSN	1553-8389
DOI	10.1016/j.carrev.2023.07.019
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Article: Azacitidine-induced myopericarditis in acute myeloid leukemia.

Ismayl, Mahmoud / Kc, Asmini / Thandra, Abhishek / Sricharoen, Nattapong / Arouni, Amy

Proceedings (Baylor University. Medical Center)

2022 Volume 35, Issue 6, Page(s) 849–851

Abstract: Hypomethylating agents are commonly used in the treatment of myelodysplastic syndromes and are known to cause bone marrow suppression; however, cardiac complications are rare. We describe a patient who was diagnosed with acute myeloid leukemia and ... ...

Abstract	Hypomethylating agents are commonly used in the treatment of myelodysplastic syndromes and are known to cause bone marrow suppression; however, cardiac complications are rare. We describe a patient who was diagnosed with acute myeloid leukemia and developed myopericarditis after receiving chemotherapy with azacitidine. Our case highlights the importance of a thorough history, including medication review, in patients with suspected myopericarditis. It also raises awareness about the potential cardiac side effects of azacitidine.
Language	English
Publishing date	2022-08-18
Publishing country	United States
Document type	Case Reports
ZDB-ID	2703932-8
ISSN	1525-3252 ; 0899-8280
ISSN (online)	1525-3252
ISSN	0899-8280
DOI	10.1080/08998280.2022.2111642
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Zs.A 6987: Show issues

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Article: Outcomes of viral myocarditis in patients with and without COVID-19: a nationwide analysis from the United States.

Ismayl, Mahmoud / Ahmed, Hasaan / Hamadi, Dana / Goldsweig, Andrew M / Aronow, Herbert D / Aboeata, Ahmed

Annals of medicine and surgery (2012)

2023 Volume 85, Issue 7, Page(s) 3308–3317

Abstract: Cardiovascular complications contribute to 40% of coronavirus disease 2019 (COVID-19) related deaths. The viral myocarditis associated with COVID-19 accounts for significant morbidity and mortality. How COVID-19 myocarditis compares to other viral ... ...

Abstract	Cardiovascular complications contribute to 40% of coronavirus disease 2019 (COVID-19) related deaths. The viral myocarditis associated with COVID-19 accounts for significant morbidity and mortality. How COVID-19 myocarditis compares to other viral myocardites is unknown. Methods: The authors conducted a retrospective cohort study using the National Inpatient Sample database to identify adult patients hospitalized for viral myocarditis in 2020 and to compare outcomes between those with and without COVID-19. The primary study outcome was in-hospital mortality. Secondary outcomes included in-hospital complications, length of stay, and total costs. Results: The study population included 15 390 patients with viral myocarditis, of whom 5540 (36%) had COVID-19. After adjustment for baseline characteristics, patients with COVID-19 had higher odds of in-hospital mortality [adjusted odds ratio (aOR) 3.46, 95% CI 2.57-4.67], cardiovascular complications (aOR 1.46, 95% CI 1.14-1.87) including cardiac arrest (aOR 2.07, 95% CI 1.36-3.14), myocardial infarction (aOR 2.97, 95% CI 2.10-4.20), venous thromboembolism (aOR 2.01, 95% CI 1.25-3.22), neurologic complications (aOR 1.82, 95% CI 1.10-2.84), renal complications (aOR 1.72, 95% CI 1.38-2.13), and hematologic complications (aOR 1.32, 95% CI 1.10-1.74), but lower odds of acute heart failure (aOR 0.60, 95% CI 0.44-0.80). The odds of pericarditis, pericardial effusion/tamponade, cardiogenic shock, and the need for vasopressors or mechanical circulatory support were similar. Patients with COVID-19 had longer length of stay (7 days vs. 4 days, Conclusions: Among patients with viral myocarditis, COVID-19 is associated with higher in-hospital mortality and cardiovascular, neurologic, renal, and hematologic complications compared to non-COVID-19 viruses.
Language	English
Publishing date	2023-06-07
Publishing country	England
Document type	Journal Article
ZDB-ID	2745440-X
ISSN	2049-0801
ISSN	2049-0801
DOI	10.1097/MS9.0000000000000936
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Article ; Online: Catheter-directed thrombolysis versus thrombectomy for submassive and massive pulmonary embolism: A systematic review and meta-analysis.

Ismayl, Mahmoud / Ismayl, Ahmad / Hamadi, Dana / Aboeata, Ahmed / Goldsweig, Andrew M

Cardiovascular revascularization medicine : including molecular interventions

2023 Volume 60, Page(s) 43–52

Abstract: Introduction: Controversy surrounds the optimal therapy for submassive and massive pulmonary embolism (PE). We conducted a systematic review and meta-analysis to compare the outcomes of catheter-directed thrombolysis (CDT) versus surgical and catheter- ... ...

Abstract	Introduction: Controversy surrounds the optimal therapy for submassive and massive pulmonary embolism (PE). We conducted a systematic review and meta-analysis to compare the outcomes of catheter-directed thrombolysis (CDT) versus surgical and catheter-based thrombectomy in patients with submassive and massive PE. Methods: We searched PubMed, EMBASE, Cochrane, and Google Scholar for studies comparing outcomes of CDT versus thrombectomy in submassive and massive PE. Studies were identified and data were extracted by two independent reviewers. A random effects model was used to calculate risk ratios (RRs) with 95 % confidence intervals (CIs). Outcomes included in-hospital mortality, procedural complications, hospital and intensive care unit (ICU) length of stay (LOS), 30-day readmissions, and right ventricle/left ventricle (RV/LV) ratio improvement. Results: Eight observational studies with 1403 patients were included, of whom 50.0 % received CDT. Compared to thrombectomy, CDT was associated with significantly lower in-hospital mortality (RR 0.62; 95 % CI 0.43-0.89; p = 0.01) and similar rates of major bleeding (p = 0.61), blood transfusion (p = 0.41), stroke (p = 0.41), and atrial fibrillation (p = 0.71). The hospital and ICU LOS, 30-day readmissions, and degree of RV/LV ratio improvement were similar between the two strategies (all p > 0.1). In subgroup analyses, in-hospital mortality was similar between CDT and catheter-based thrombectomy (p = 0.48) but lower with CDT compared with surgical thrombectomy (p = 0.01). Conclusions: In patients with submassive and massive PE, CDT was associated with similar in-hospital mortality compared to catheter-based thrombectomy, but lower in-hospital mortality compared to surgical thrombectomy. Procedural complications, LOS, 30-day readmissions, and RV/LV ratio improvement were similar between CDT and any thrombectomy. Randomized controlled trials are indicated to confirm our findings.
MeSH term(s)	Humans ; Thrombolytic Therapy/adverse effects ; Fibrinolytic Agents/adverse effects ; Treatment Outcome ; Pulmonary Embolism/diagnostic imaging ; Pulmonary Embolism/therapy ; Thrombectomy/adverse effects ; Catheters ; Retrospective Studies
Chemical Substances	Fibrinolytic Agents
Language	English
Publishing date	2023-10-12
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	2212113-4
ISSN	1878-0938 ; 1553-8389
ISSN (online)	1878-0938
ISSN	1553-8389
DOI	10.1016/j.carrev.2023.10.002
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