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Article ; Online: Use of a Novel Catheter, the MOT-C, for Selective Angiography of the Internal Mammary Artery From Ipsilateral Radial Access.

Kunnirickal, Steffne / Pfau, Steven / Moran, Edward / Shah, Samit

2022 Volume 34, Issue 5, Page(s) E408–E411

Abstract: Objective: We describe a novel catheter, the MOT-C (Merit Medical Systems), for selective diagnostic angiography of the internal mammary artery from radial access.: Methods: We analyzed the pattern of radial versus femoral access for bypass ... ...

Abstract	Objective: We describe a novel catheter, the MOT-C (Merit Medical Systems), for selective diagnostic angiography of the internal mammary artery from radial access. Methods: We analyzed the pattern of radial versus femoral access for bypass angiography at our institution between 2012 and 2020. We also examined the difference in contrast volume and fluoroscopy time between radial and femoral access and between MOT-C and traditional internal mammary artery (IMA) catheter for bypass angiography. Results: Since the introduction of MOT-C catheter to our laboratory in 2016, there has been a 1.5-fold increase in the use of radial access for bypass angiography. No significant difference in contrast volume or fluoroscopy time was noted between radial and femoral access for bypass angiography. The MOT-C catheter was successfully used in 46% of all cases and 77% of all radial cases between 2016 and 2020 to selectively engage the IMA. When compared with the traditional IMA catheter, no statistically significant difference was noted in contrast volume or fluoroscopy time with the use of MOT-C for bypass angiography, although there was a trend toward lower contrast use. Furthermore, no catheter-related complications occurred. Conclusions: The MOT-C facilitates improved engagement of IMA grafts with minimal manipulation and allows for high-quality diagnostic angiograms with a potential decrease in contrast volume compared with the more traditionally used IMA catheter.
MeSH term(s)	Catheters ; Coronary Angiography ; Femoral Artery/surgery ; Humans ; Mammary Arteries/transplantation ; Radial Artery/surgery
Language	English
Publishing date	2022-04-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	1154372-3
ISSN	1557-2501 ; 1042-3931
ISSN (online)	1557-2501
ISSN	1042-3931
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Article: Coronary Physiology in the Cardiac Catheterization Laboratory.

Shah, Samit M / Pfau, Steven E

Journal of clinical medicine

2019 Volume 8, Issue 2

Abstract: Coronary angiography has been the principle modality for assessing the severity of atherosclerotic coronary artery disease for several decades. However, there is a complex relationship between angiographic coronary stenosis and the presence or absence of ...

Abstract	Coronary angiography has been the principle modality for assessing the severity of atherosclerotic coronary artery disease for several decades. However, there is a complex relationship between angiographic coronary stenosis and the presence or absence of myocardial ischemia. Recent technological advances now allow for the assessment of coronary physiology in the catheterization laboratory at the time of diagnostic coronary angiography. Early studies focused on coronary flow reserve (CFR) but more recent work has demonstrated the physiologic accuracy and prognostic value of the fractional flow reserve (FFR) and instantaneous wave free ratio (iFR) for the assessment of coronary artery disease. These measurements have been validated in large multi-center clinical trials and have become indispensable tools for guiding revascularization in the cardiac catheterization laboratory. The physiological assessment of chest pain in the absence of epicardial coronary artery disease involves coronary thermodilution to obtain the index of microcirculatory resistance (IMR) or Doppler velocity measurement to determine the coronary flow velocity reserve (CFVR). Physiology-based coronary artery assessment brings "personalized medicine" to the catheterization laboratory and allows cardiologists and referring providers to make decisions based on objective findings and evidence-based treatment algorithms. The purpose of this review is to describe the theory, technical aspects, and relevant clinical trials related to coronary physiology assessment for an intended audience of general medical practitioners.
Language	English
Publishing date	2019-02-18
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm8020255
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Article: Chest pain and coronary endothelial dysfunction after recovery from COVID-19: A case series.

Shah, Samit M / Odanovic, Natalija / Kunnirickal, Steffne / Feher, Attila / Pfau, Steven E / Spatz, Erica S

Clinical case reports

2022 Volume 10, Issue 4, Page(s) e05612

Abstract: Endothelial cell damage related to coronavirus disease 2019 (COVID-19) has been described in multiple vascular beds, and many survivors of COVID-19 report chest pain. This case series describes two previously healthy middle-aged individuals who survived ... ...

Abstract	Endothelial cell damage related to coronavirus disease 2019 (COVID-19) has been described in multiple vascular beds, and many survivors of COVID-19 report chest pain. This case series describes two previously healthy middle-aged individuals who survived COVID-19 and were subsequently found to have symptomatic coronary endothelial dysfunction months after initial infection.
Language	English
Publishing date	2022-04-08
Publishing country	England
Document type	Case Reports
ZDB-ID	2740234-4
ISSN	2050-0904
ISSN	2050-0904
DOI	10.1002/ccr3.5612
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Article ; Online: Real-World Experience and Outcomes With Percutaneous Coronary Intervention for Protected Versus Unprotected Left Main Coronary Artery Disease: Insights from the Veteran Affairs Clinical Assessment Reporting and Tracking Program.

Gonzalez, Pedro Engel / Hebbe, Annika / Hussain, Yasin / Khera, Rohan / Banerjee, Subhash / Plomondon, Mary E / Waldo, Stephen W / Pfau, Steven E / Curtis, Jeptha P / Shah, Samit M

The American journal of cardiology

2024 Volume 222, Page(s) 39–50

Abstract: The practice patterns and outcomes of protected left main (PLM) and unprotected left main (ULM) percutaneous coronary intervention (PCI) are not well defined in contemporary US clinical practice. Data were collected from all Veteran Affairs ... ...

Abstract	The practice patterns and outcomes of protected left main (PLM) and unprotected left main (ULM) percutaneous coronary intervention (PCI) are not well defined in contemporary US clinical practice. Data were collected from all Veteran Affairs catheterization laboratories participating in the Clinical Assessment Reporting and Tracking Program between 2009 and 2019. The analysis included 4,351 patients who underwent left main PCI, of whom 1,306 pairs of PLM and ULM PCI were included in a propensity-matched cohort. Selected temporal trends were also assessed. The primary outcome was major adverse cardiovascular event (MACE) outcomes at 1 year, which was defined as a composite of all-cause mortality, rehospitalization for myocardial infarction (MI), rehospitalization for stroke, or urgent revascularization. Patients who underwent ULM PCI compared with patients who underwent PLM PCI were older (age 71.5 vs 69.2 years, p <0.001), more clinically complex, and more likely to present with acute coronary syndrome. In the propensity-matched cohort, radial access was used more often for ULM PCI (21% [273] vs 14% [185], p <0.001) and ULM PCI was more likely to involve the left main bifurcation (22% vs 14%, p = 0.003) and require mechanical circulatory support (10% [134] vs 1% [17], p <0.001). The 1-year MACEs occurred more frequently with ULM PCI than PLM PCI (22% [289] vs 16% [215], p ≤0.001) and all-cause mortality was also higher (16% [213] vs 10% [125], p ≤0.001). In the matched cohort, there was a low incidence of rehospitalization for MI (4% [48] ULM vs 4% [48] PLM, p = 1.000) or revascularization (7% [94] ULM vs 6% [84] PLM, p = 0.485). In this real-world experience, patients who underwent PLM PCI had better 1-year outcomes than those who underwent ULM PCI; however, in both groups, there was a high rate of mortality and MACEs at 1 year despite a relatively low rate of MI or revascularization.
Language	English
Publishing date	2024-04-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2024.04.039
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Article ; Online: Developing a novel siRNA delivery system.

Shah, Samit / Lal, Harshal A

Therapeutic delivery

2015 Volume 6, Issue 10, Page(s) 1131–1133

MeSH term(s)	Animals ; Gene Transfer Techniques/trends ; Humans ; Lipids/administration & dosage ; Nanoparticles/administration & dosage ; RNA, Small Interfering/administration & dosage ; RNA, Small Interfering/genetics
Chemical Substances	Lipids ; RNA, Small Interfering
Language	English
Publishing date	2015
Publishing country	England
Document type	Editorial
ISSN	2041-6008
ISSN (online)	2041-6008
DOI	10.4155/tde.15.53
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Article ; Online: Inferior Wall Myocardial Infarction in the Setting of a High-Risk Anomalous Right Coronary Artery: A Case Report.

Shah, Samit / Nguyen, Vinh Q / Geirsson, Arnar / Mena, Carlos

CASE (Philadelphia, Pa.)

2019 Volume 3, Issue 3, Page(s) 120–124

Language	English
Publishing date	2019-04-05
Publishing country	United States
Document type	Case Reports
ISSN	2468-6441
ISSN (online)	2468-6441
DOI	10.1016/j.case.2019.02.003
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Article ; Online: Clinician perspectives regarding CYP2C19 genotype testing in patients with critical limb ischemia: A Delphi approach.

Regan, Christopher / Scierka, Lindsey E / Dardik, Alan / Tonnessen, Britt / Iyad Ochoa Chaar, Cassius / Ionescu, Costin / Aboian, Edouard / Cardella, Jonathan / Nassiri, Naiem / Guzman, Raul / Attaran, Robert / Nagpal, Sameer / Shah, Samit / Smolderen, Kim G / Mena-Hurtado, Carlos

Vascular

2024 , Page(s) 17085381241246318

Abstract: Objectives: Antiplatelet therapy is an essential element in the management of patients with arterial vascular disease. In peripheral arterial disease (PAD), dual antiplatelet therapy (DAPT), primarily clopidogrel and aspirin, is routinely prescribed ... ...

Abstract	Objectives: Antiplatelet therapy is an essential element in the management of patients with arterial vascular disease. In peripheral arterial disease (PAD), dual antiplatelet therapy (DAPT), primarily clopidogrel and aspirin, is routinely prescribed following intervention. There is sparse data regarding the need for DAPT, the appropriate duration, or the heterogeneity of treatment effects for antiplatelet regimens across patients, leading to potential uncertainty and heterogeneity around treatment practices. An example of heterogeneity of treatment effects is a patients' metabolizer status for the use of clopidogrel. The aim of the study was to (1) assess clinicians' knowledge of and attitudes toward managing patients with CYP2C19 mutations, (2) identify barriers to implementation of CYP2C19 testing and management policies, and (3) reach consensus for CYP2C19 testing and management strategies for patients with PAD who undergo peripheral vascular interventions (PVI). Methods: A modified Delphi method was used to establish consensus amongst PAD interventionalists around CYP2C19 testing. All practicing Yale New Haven Hospital PAD interventionalists with backgrounds in interventional cardiology, vascular surgery, or interventional radiology were approached by email for participation. Round 1 included the collection of baseline demographic questions, knowledge questions, and three statements for consensus. Knowledge questions were rated on a 0-10 Likert scale with the following anchors: 0 ("Not at all"), 5 ("Neutral), and 10 ("Very Much"). Participants were asked to rate the importance of the three consensus statements on a 9-point Likert scale from 1 ("Strongly Disagree") to 10 ("Strongly Agree"). In Round 2, participants were shown the same consensus statements, the median response of the group from the previous round, and their previous answers. Participants were instructed to revise their rating using the results from the previous round. This process was repeated for Round 3. Results: Of the 28 experts invited to participate, 13 agreed (46%). Participants were predominantly male (92.3%) and white (61.5%) with representation from interventional cardiology (46.2%) and vascular surgery (53.8%). Most participants reported more than 10+ years in practice (61.5%). PAD interventionalists felt they would benefit from more education regarding CYP2C19 mutations (median score 8.0, interquartile range 5.0-8.5). They indicated some familiarity with CYP2C19 mutations (7.0, 6.0-9.5) but did not feel strongly that CYP2C19 was important to their practice (6.0, 5.5-7.5). In each round, the median responses for the three consensus statements were 5, 6, and 9, respectively. With each successive round the interquartile range narrowed indicative of evolving consensus but did not reach the prespecified interquartile range for consensus of 1 for any of the statements. Conclusions: PAD interventionalists practicing at an academic health system recognize the heterogenous response of their patients to clopidogrel therapy but are unsure when to leverage genetic testing to improve outcomes for their patients. Our study identified gaps regarding PAD interventionalists' knowledge, perceived barriers, and attitudes toward CYP2C19 testing in PAD. This information highlights the need for randomized data on genetic testing for clopidogrel responsiveness in peripheral vascular disease following intervention to help guide antiplatelet management.
Language	English
Publishing date	2024-04-26
Publishing country	England
Document type	Journal Article
ZDB-ID	2137151-9
ISSN	1708-539X ; 1708-5381
ISSN (online)	1708-539X
ISSN	1708-5381
DOI	10.1177/17085381241246318
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Article: A hybrid approach for vascular control and repair of an expanding iatrogenic femoral artery pseudoaneurysm.

Gorecka, Jolanta / Chen, Julia F / Shah, Samit / Dardik, Alan / Guzman, Raul J / Nassiri, Naiem

Journal of vascular surgery cases and innovative techniques

2020 Volume 6, Issue 3, Page(s) 460–463

Abstract: Surgical repair of iatrogenic femoral pseudoaneurysms in the setting of distorted anatomy, multiple prior interventions, and ongoing hemorrhage requires extensive proximal and distal dissection for control. Furthermore, profunda femoral and other ... ...

Abstract	Surgical repair of iatrogenic femoral pseudoaneurysms in the setting of distorted anatomy, multiple prior interventions, and ongoing hemorrhage requires extensive proximal and distal dissection for control. Furthermore, profunda femoral and other arterial branch control may not always be feasible and can lead to considerable blood loss at the time of surgical exploration. We present a simple, safe, and effective hybrid approach for inflow, outflow, and branch control for treatment of a proximally located, actively expanding, iatrogenic common femoral artery pseudoaneurysm recalcitrant to multiple sessions of percutaneous thrombin injection.
Language	English
Publishing date	2020-07-19
Publishing country	United States
Document type	Case Reports
ISSN	2468-4287
ISSN	2468-4287
DOI	10.1016/j.jvscit.2020.07.010
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Article ; Online: Cardiovascular Imaging of Biology and Emotion: Considerations Toward a New Paradigm.

Meadows, Judith L / Shah, Samit / Burg, Matthew M / Pfau, Steven / Soufer, Robert

Circulation. Cardiovascular imaging

2020 Volume 13, Issue 8, Page(s) e011054

Abstract: Central activation in response to emotion and cognitive stress induces perturbations in the heart and the peripheral vasculature that differ in physiology and clinical manifestations when compared with exercise-induced changes. While our conventional ... ...

Abstract	Central activation in response to emotion and cognitive stress induces perturbations in the heart and the peripheral vasculature that differ in physiology and clinical manifestations when compared with exercise-induced changes. While our conventional framework of epicardial coronary artery disease is foundational in cardiology, an expanded paradigm is required to address the cardiovascular response to mental stress (MS) and its associated risks, thus addressing the intersection of the patient's ecological and psychosocial experience with cardiovascular biology. To advance the field of MS in cardiovascular health, certain core challenges must be addressed. These include differences in the trigger activation between exercise and emotion, identification and interpretation of imaging cues as measures of pathophysiologic changes, characterization of the vascular response, and identification of central and peripheral treatment targets. Sex and psychosocial determinants of health are important in understanding the emerging overlap of MS-induced myocardial ischemia with microvascular dysfunction and symptoms in the absence of obstructive disease. In overcoming these critical knowledge gaps, integration of the field of MS will require implementation studies to guide use of MS testing, to support diagnosis of MS induced cardiac and vascular pathophysiology, to assess prognosis, and understand the role of endotying to direct therapy.
MeSH term(s)	Animals ; Brain/diagnostic imaging ; Brain/physiopathology ; Cardiac Imaging Techniques ; Cardiovascular Diseases/diagnostic imaging ; Cardiovascular Diseases/physiopathology ; Cardiovascular Diseases/psychology ; Cardiovascular Diseases/therapy ; Cardiovascular System/diagnostic imaging ; Cardiovascular System/physiopathology ; Emotions ; Humans ; Mental Health ; Neuroimaging ; Predictive Value of Tests ; Prognosis ; Risk Factors ; Stress, Psychological/diagnostic imaging ; Stress, Psychological/physiopathology ; Stress, Psychological/psychology ; Stress, Psychological/therapy
Language	English
Publishing date	2020-08-07
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S. ; Review
ZDB-ID	2435045-X
ISSN	1942-0080 ; 1941-9651
ISSN (online)	1942-0080
ISSN	1941-9651
DOI	10.1161/CIRCIMAGING.120.011054
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Article ; Online: Illness Perception and the Impact of a Definitive Diagnosis on Women With Ischemia and No Obstructive Coronary Artery Disease: A Qualitative Study.

Tseng, Leslie Yingzhijie / Göç, Nükte / Schwann, Alexandra N / Cherlin, Emily J / Kunnirickal, Steffne J / Odanovic, Natalija / Curry, Leslie A / Shah, Samit M / Spatz, Erica S

Circulation. Cardiovascular quality and outcomes

2023 Volume 16, Issue 8, Page(s) 521–529

Abstract: Background: Ischemia and no obstructive coronary artery disease (INOCA) disproportionately impacts women, yet the underlying pathologies are often not distinguished, contributing to adverse health care experiences and poor quality of life. Coronary ... ...

Abstract	Background: Ischemia and no obstructive coronary artery disease (INOCA) disproportionately impacts women, yet the underlying pathologies are often not distinguished, contributing to adverse health care experiences and poor quality of life. Coronary function testing at the time of invasive coronary angiography allows for improved diagnostic accuracy. Despite increased recognition of INOCA and expanding access to testing, data lack on first-person perspectives and the impact of receiving a diagnosis in women with INOCA. Methods: From 2020 to 2021, we conducted structured telephone interviews with 2 groups of women with INOCA who underwent invasive coronary angiography (n=29) at Yale New Haven Hospital, New Haven, CT: 1 group underwent coronary function testing (n=20, of whom 18 received a mechanism-based diagnosis) and the other group who did not undergo coronary function testing (n=9). The interviews were analyzed using the constant comparison method by a multidisciplinary team. Results: The mean age was 59.7 years, and 79% and 3% were non-Hispanic White and non-Hispanic Black, respectively. Through iterative coding, 4 themes emerged and were further separated into subthemes that highlight disease experience aspects to be addressed in patient care: (1) distress from symptoms of uncertain cause: symptom constellation, struggle for sensemaking, emotional toll, threat to personal and professional identity; (2) a long journey to reach a definitive diagnosis: self-advocacy and fortitude, healthcare interactions brought about further uncertainty and trauma, therapeutic alliance, sources of information; (3) establishing a diagnosis enabled a path forward: relief and validation, empowerment; and (4) commitment to promoting awareness and supporting other women: recognition of sex and racial/ethnic disparities, support for other women. Conclusions: Insights about how women experience the symptoms of INOCA and their interactions with clinicians and the healthcare system hold powerful lessons for more patient-centered care. A coronary function testing-informed diagnosis greatly influences the healthcare experiences, quality of life, and emotional states of women with INOCA.
MeSH term(s)	Humans ; Female ; Middle Aged ; Coronary Artery Disease/diagnostic imaging ; Coronary Artery Disease/therapy ; Quality of Life/psychology ; Myocardial Ischemia/diagnosis ; Ischemia ; Perception
Language	English
Publishing date	2023-07-21
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	2483197-9
ISSN	1941-7705 ; 1941-7713
ISSN (online)	1941-7705
ISSN	1941-7713
DOI	10.1161/CIRCOUTCOMES.122.009834
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