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Modes of failure with fractional flow reserve guidewires:Insights from the manufacturer and user facility device experience database

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World Journal of Cardiology 2021年第7期13卷 223-229页

作者： Nauman Khalid Yagya Pandey Umair Khalid Hassan Kamran Jason P Wermers lovely chhabra Mahboob Alam Hani Jneid Waleed Tallat Kayani Department of Interventional Cardiology St.Francis Medical CenterMonroeLA 71201United States Department of Internal Medicine Baylor College of MedicineHoustonTX 77030United States Department of Interventional Cardiology Michael E.DeBakey VA Medical CenterHoustonTX 77030United States Department of Interventional Cardiology Baylor College of MedicineHoustonTX 77030United States Health Sciences University of Maryland Graduate SchoolBaltimoreMD 21201United States

BACKGROUND Fractional flow reserve(FFR)measurement is commonly used in the cardiac catheterization laboratory to assess the functional significance of coronary arterial plaques.Robust real-world data on complications and modes of failure of FFR guidewires are limited.AIM To characterize these outcomes by analyzing the post-marketing surveillance data from the United States Food and Drug Administration Manufacturer and User Facility Device Experience(MAUDE)database for commonly used FFR guidewires.METHODS The MAUDE database was queried from January 2010 through April 2020 for 3 FFR guidewires[PressureWireTM X(Abbott),CometTM(Boston Scientific),and VerrataTM(Philips)]by searching for the following events:“Injury”,“malfunction”,“death”,and“other”.This yielded 544 reports.After excluding incomplete reports,486 reports were analyzed.RESULTS Guidewire tip fracture was the most commonly reported mode of failure,in 174(35.8%)cases followed by guidewire kinking(n=152,31.3%),communication failure(n=141,29.0%),and shaft fracture(n=67,13.8%).In total,133(27.4%)device failures resulted in patient adverse events.The most common adverse event was retained guidewire tip,in 71(53.4%)cases,followed by freshly deployed stent dislodgment(n=26,19.6%)and coronary artery dissection(n=23,17.3%).Seven deaths were reported.CONCLUSION FFR guidewire failures can occur because of various mechanisms and cause patient adverse events.The MAUDE database serves as an important platform for improved collaboration among clinicians,device manufacturers,and regulators to improve device performance and optimize patient outcomes.Our analysis provides mechanistic insights of FFR guidewire failure and associated adverse events but cannot verify causality or provide a comparison among different guidewires.

关键词： Fractional flow reserve Coronary guidewire Adverse events Modes of failure Food and Drug Administration Manufacturer and user facility device experience

Takotsubo syndrome: The past, the present and the future

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World Journal of Cardiology 2019年第9期11卷 213-216页

作者： Nauman Khalid Pooja Sareen Sarah Aftab Ahmad lovely chhabra Section of Interventional Cardiology MedStar Washington Hospital CenterWashingtonDC 20010United States Department of Medicine Harrisburg Medical CenterHarrisburgIL 62946United States Department of Cardiovascular Surgery Saint Francis Medical CenterMonroeLA 71201United States Department of Cardiology Heartland Regional Medical CenterMarionIL 62959United States

Takotsubo syndrome is a wide spectrum disease with a dramatic clinical presentation mimicking acute coronary syndrome albeit without obstructive coronary disease and typically manifests in the backdrop of intense emotional or physical trigger.Pathophysiology is incompletely understood with multifactorial mechanistic pathways circling around a heart-brain-endocrine axis.Several anatomic and phenotypic variants exist with varied clinical manifestations.The aftermath of Takotsubo syndrome is not always benign and both short-and longterm complications can occur which may impact its prognosis.Several gaps in knowledge exist providing an impetus for tremendous future research opportunities.

关键词： Takotsubo syndrome Triggers Pathophysiology Anatomic variants Prognosis

Pericardial decompression syndrome: A comprehensive review

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World Journal of Cardiology 2019年第12期11卷 282-291页

作者： Yougeesh Prabhakar Amandeep Goyal Nauman Khalid Nitish Sharma Raj Nayyar David H Spodick lovely chhabra Department of Cardiology Heartland Regional Medical CenterMarionIL 62959United States Department of Medicine Marietta Memorial HospitalMariettaOH45750United States Department of Interventional Cardiology Medstar Washington Hospital CenterWashingtonDC 20010United States Department of Medicine Saint Vincent HospitalWorcesterMA 01608United States

Pericardial decompression syndrome(PDS)is an infrequent,life-threatening complication following pericardial drainage for cardiac tamponade physiology.PDS usually develops after initial clinical improvement following pericardiocentesis and is significantly underreported and may be overlooked in the clinical practice.Although the precise mechanisms resulting in PDS are not well understood,this seems to be highly associated with patients who have some underlying ventricular dysfunction.Physicians performing pericardial drainage should be mindful of the risk factors associated with the procedure including the rare potential for the development of PDS.

关键词： Pericardial decompression syndrome Cardiac tamponade Pericardiocentesis Pericardiostomy Low cardiac output syndrome

Refinement of total 12-lead QRS voltage criteria for diagnosing left ventricular hypertrophy

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World Journal of Cardiovascular Diseases 2013年第2期3卷 210-214页

作者： Deepti Kumar Rishi Bajaj lovely chhabra David H. Spodick Department of Cardiovascular Medicine Saint Vincent Hospital University of Massachusetts Medical School Worcester USA Department of Internal Medicine Saint Vincent Hospital University of Massachusetts Medical School Worcester USA

Objective: We sought to test the hypothesis that the total QRS voltage without either set of the limb leads (I, II, III) or (R, L, F) may be a better indicator of LVH as compared to the total QRS voltage. Background: The total 12 lead QRS voltage has been a validated electrocardiographic criterion for left ventricular hypertrophy (LVH), with an upper limit of175 mm. However, there is some redundancy in this measurement as the output of the limb leads is repeated because leads I, II, III, and R, L, F use the same three electrodes. Methods: 43 unselected, consecutive echocardiograms were examined for evidence of LVH by wall thickness. Electrocardiogram (ECG) of these patients within a week of the echocardiogram were then examined for the total 12 leads QRS voltage, minus I, II, III and total minus R, L, F voltages. ECG findings were then compared with corresponding echocardiographic dimensions. Results: A total QRS voltage of123 mmon ECG yielded a sensitivity of 73% and specificity of 67% for diagnosing LVH with 95% CI = 0.59 - 0.89, p = 0.007. Total minus (R, L and F) value of110 mmon ECG appears to give the best sensitivity (73%), specificity (72%), and accuracy (64% negative predictive value and 82% positive predictive value) for LVH. Conclusion: It appears that total QRS voltage minus either set of the limb leads, especially the total minus R, L and F is a better criterion, with110 mmbeing the best specific, sensitive and accurate index for diagnosing LVH.

关键词： ECG QRS Voltage Left Ventricular Hypertrophy Echocardiography Interventricular Septum

Cardiac adipose tissue and its relationship to diabetes mellitus and cardiovascular disease

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World Journal of Diabetes 2014年第6期5卷 868-876页

作者： Adam M Noyes Kirandeep Dua Ramprakash Devadoss lovely chhabra Department of Medicine University of Con-necticut School of MedicineFarmington Department of Cardiology Hartford HospitalHartford Department of Internal Medicine Saint Vincent Hospital

Type-2 diabetes mellitus(T2DM) plays a central role in the development of cardiovascular disease(CVD). However, its relationship to epicardial adipose tissue(EAT) and pericardial adipose tissue(PAT) in particular is important in the pathophysiology of coronary artery disease. Owing to its close proximity to the heart and coronary vasculature, EAT exerts a direct metabolic impact by secreting proinflammatory adipokines and free fatty acids, which promote CVD locally. In this review, we have discussed the relationship between T2 DM and cardiac fat deposits, particularly EAT and PAT, which together exert a big impact on the cardiovascular health.

关键词： adipose cardiovascular visceral exert leptin resistin embryonic protective subcutaneous obese