3148 W 76Th St
Hialeah Gardens FL 33018
Medical School: Other - Unknown
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License #: DN17130
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Can QT/RR relationship differentiate between low- and high-risk patients with hypertrophic cardiomyopathy? - Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc
Abnormal dynamicity of repolarization is considered to be a marker of myocardial vulnerability contributing to increased risk of arrhythmic events and sudden death. However, little is known about QT dynamics in hypertrophic cardiomyopathy (HCM). In this study, we aimed to evaluate ventricular repolarization by QT dynamicity in patients with HCM, focusing on its value to define if it is able to differentiate among low- and high-risk HCM patients.The linear regression slopes of the QT interval, measured to the apex and to the end of the T wave plotted against RR intervals (QTapex/RR and QTend/RR slopes, respectively) were calculated from 24-hour Holter recordings using a standard algorithm in 36 HCM patients and 64 control subjects.QTapex/RR and QTend/RR slopes were significantly steeper in the HCM patients in contrary to healthy control subjects (QTapex/RR = 0.22 + 0.08 vs 0.20 + 0.05, P = 0.0367; QTend/RR = 0.25 + 0.10 vs 0.20 + 0.06, P = 0.023). Moreover, the slopes of QTend/RR and QTapex/RR of high-risk patients were significantly steeper than those of control subjects while no significant differences were found among low-risk HCM patients and control subjects and only QTe/RR of high-risk patients was significantly different between low- and high-risk HCM patients.Our study results suggest that QT dynamicity is impaired in patients with HCM and may help to differentiate among low- and high-risk patients. Further studies are needed to elucidate the prognostic significance and clinical implications of impaired ventricular repolarization in patients with HCM.Â© 2015 Wiley Periodicals, Inc.
A clinical trial of lovastatin for modification of biomarkers associated with breast cancer risk. - Breast cancer research and treatment
Pre-clinical and epidemiologic studies provide rationale for evaluating lipophilic statins for breast cancer prevention. We conducted a single-arm, biomarker modulation trial of lovastatin among women with increased risk of breast cancer. Eligibility criteria included a deleterious germline mutation in BRCA1, BRCA2, CDH1, or TP53; lifetime breast cancer risk of â‰¥20Â % as estimated by the Claus model; or personal history of estrogen receptor and progesterone receptor-negative breast cancer. Participants received 40 mg of lovastatin orally twice daily for 6Â months. We evaluated the following biomarkers before and after lovastatin use: breast duct cytology (primary endpoint), serum lipids, C-reactive protein, insulin-like growth factor-1, IGF binding protein-3, lipid peroxidation, oxidative DNA damage, 3-hydroxy-3-methylglutaryl CoA reductase genotype, and mammographic density. Thirty women were enrolled, and 26 (86.7Â %) completed the study. For the primary endpoint of changes in breast duct cytology sampled by random periareolar fine needle aspiration, most participants [57.7Â %, 95Â % confidence interval (CI) 38.9-74.5Â %] showed no change after lovastatin; 19.2Â % (CI 8.1-38.3Â %) had a favorable change in cytology, 7.7Â % (95Â % CI 1.0-25.3Â %) had an unfavorable change, and 15.4Â % (95Â % CI 5.5-34.2Â %) had equivocal results due to acellular specimens, usually after lovastatin. No significant changes were observed in secondary biomarker endpoints. The study was generally well-tolerated: 4 (13.3Â %) participants did not complete the study, and one (3.8Â %) required a dose reduction. This trial was technically feasible, but demonstrated no significant biomarker modulation; contributing factors may include insufficient sample size, drug dose and/or duration. The results are inconclusive and do not exclude a favorable effect on breast cancer risk.
Comparison of prevalence, clinical course, and pathological findings of left ventricular systolic impairment versus normal systolic function in patients with hypertrophic cardiomyopathy. - The American journal of cardiology
Impaired left ventricular systolic function (ILVSF) in hypertrophic cardiomyopathy (HC) is a risk factor for sudden death and a determinant of high mortality. We determined its prevalence, clinical parameters, long-term outcome, and pathologic findings of explanted hearts. We retrospectively analyzed 382 patients with HC; ILVSF was characterized by LV ejection fraction <50% at rest and was identified in 24 patients (6.3%). Patients with ILVSF were younger than patients with normal SF (43.5 Â± 14.1 vs 55.3 Â± 20.4 years, p = 0.001) and had larger LV end-diastolic cavity diameter (53.2 Â± 12.2 vs 43.8 Â± 6.2 mm, p = 0.001), larger left atrium (51.2 Â± 6.5 vs 44.3 Â± 8 mm, p <0.001), and lower fractional shortening (30.7 Â± 11.1% vs 45.5% Â± 10.3%, p <0.001). A combined end point (heart failure death or heart transplantation) was considered. Median follow-up was 3 years (1.2 to 6.3). Fourteen patients with ILVSF (58.3%) had the end point compared to 3 (0.8%) with normal SF (p <0.001). In explanted hearts, fibrosis represented 30.5 Â± 12.5% of the left ventricle; we observed a direct correlation between fibrosis and ventricular dilation (r = 0.794, p = 0.001) and an inverse correlation between fibrosis and ejection fraction (r = -0.623, p = 0.023). Number and length density of small arterioles (<50 Î¼m in diameter) were significantly decreased. In conclusion, ILVSF in HC has a poor prognosis and is associated with fibrosis and selective decreased development of small arterioles.Copyright Â© 2011 Elsevier Inc. All rights reserved.
Retrieval of a leaflet escaped in a Tri-technologies bileaflet mechanical prosthetic valve. - European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology
The escape of the prosthetic heart valve disc is one of the causes of prosthetic dysfunction that requires emergency surgery. The removal of the embolized disc should be carried out because of the risk of a progressive extrusion on the aortic wall. Several imaging techniques can be used for the detection of the missing disc localization. In this report we describe a 32-year-old man who underwent mitral valve replacement with a Tri-technologies bileaflet valve three years ago, and was admitted in cardiogenic shock. Transesophageal echocardiography showed acute-onset massive mitral regurgitation. The patient underwent emergency replacement of the prosthetic valve. Only one of the two leaflets remained in the removed prosthetic valve. The missing leaflet could not be found within the cardiac cavity. The abdominal fluoroscopic study and plain radiography were unable to detect the escaped leaflet. The abdominal computed tomography scan and the ultrasound showed the escaped leaflet in the terminal portion of the aortic bifurcation. To retrieve the embolized disc laparotomy and aortotomy were performed three months later. The escaped leaflet shows a fracture of one of the pivot systems caused by structural failure. This kind of failure mode is usually the result of high stress concentration.
Co-control of urban air pollutants and greenhouse gases in Mexico City. - Environmental science & technology
This study addresses the synergies of mitigation measures to control urban air pollutant and greenhouse gas (GHG) emissions, in developing integrated "co-control" strategies for Mexico City. First, existing studies of emissions reduction measures--PROAIRE (the air quality plan for Mexico City) and separate GHG studies--are used to construct a harmonized database of options. Second, linear programming (LP) is developed and applied as a decision-support tool to analyze least-cost strategies for meeting co-control targets for multiple pollutants. We estimate that implementing PROAIRE measures as planned will reduce 3.1% of the 2010 metropolitan CO2 emissions, in addition to substantial local air pollutant reductions. Applying the LP, PROAIRE emissions reductions can be met at a 20% lower cost, using only the PROAIRE measures, by adjusting investments toward the more cost-effective measures; lower net costs are possible by including cost-saving GHG mitigation measures, but with increased investment. When CO2 emission reduction targets are added to PROAIRE targets, the most cost-effective solutions use PROAIRE measures for the majority of local pollutant reductions, and GHG measures for additional CO2 control. Because of synergies, the integrated planning of urban-global co-control can be beneficial, but we estimate that for Mexico City these benefits are often small.
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3148 W 76Th St Hialeah Gardens, FL 33018
11300 Nw 87Th Ct Suite 109
Hialeah Gardens, FL 33018
3410 W 84Th St Bldg F Suite 110