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Connecting the Dots

Alan H. Kadish, Jason C. Rubenstein
2009 Journal of the American College of Cardiology  
Delayed-enhancement magnetic resonance imaging (DE-MRI) has emerged as the gold standard imaging technique for defining myocardial scar with high resolution. Gadolinium contrast washes out of the blood pool and accumulates in the extracellular space. Tissues with weak intracellular bonds and high amounts of noncellular space, such as necrotic tissue or fibrous scar, will develop higher concentrations of this magnetic resonance imaging (MRI) contrast agent than will healthy tissues. Scar
more » ... by DE-MRI has been shown to closely match histologically proven myocardial infarction (MI) (1). After an MI, cardiac myocytes become necrotic and cause an inflammatory response that initiates fibroblast replication, which replaces the necrotic tissue with noncellular collagen. This myocardial scar formation leads to cardiac dysfunction and ischemic cardiomyopathy. The DE-MRI has shown prognostic value after MI for viability (1,2), functional recovery after MI (2), ventricular arrhythmia (3), and long-term mortality (4). Delayed enhancement has been shown to correlate with areas of low voltage on electroanatomic mapping (5), and can define critical targets of VT circuits during ablation in patients with prior myocardial infarction (6). Presumably the presence of scar, and in particular the border zone between scar and normal myocardium, allows re-entrant circuits to form.
doi:10.1016/j.jacc.2008.12.027 pmid:19324260 pmcid:PMC2727716 fatcat:zl6knup4qrhutbdavd3am34y2q

Atrial Fibrillation in Acute Coronary Syndrome

Jason C Rubenstein, Michael P Cinquegrani, Jennifer Wright
2012 Journal of Atrial Fibrillation  
Atrial fibrillation (AF) is a common cardiac arrhythmia occurring in an estimated 2.7 to 6.1 million people in the United States. The risk factors for the development of AF are very similar to those for developing coronary artery disease, and AF is often associated with acute coronary syndrome (ACS) and acute myocardial infarction (MI). Overall, AF complicates approximately 10% of acute infarcts and the incidence rate is comparable between the thrombolytic and percutaneous coronary intervention
more » ... (PCI) eras. Prior to widespread use of thrombolysis, the incidence of AF during acute MI was as high as 18%. Moreover, AF is a marker for increased long term mortality post infarct. Over the past 20 years, the relative mortality risk for patients with AF post MI has remained around 2.5 times that for patients without AF. The treatment of AF in the setting of MI and ACS is similar to without; however there is often an increased urgency to limiting rapid heart rates which may exacerbate acute ischemia. Cardioversion and IV amiodarone may be utilized more liberally in this setting than otherwise. Anticoagulation is usually required both for the treatment of MI and possible PCI, as well as for cerebral vascular accident prevention from AF-induced thromboembolism. Often patients require triple-therapy for optimal treatment of both conditions, and special considerations for bleeding risk must be analyzed.
doi:10.4022/jafib.551 pmid:28496750 pmcid:PMC5153085 fatcat:fy4cqyktnnawphfceyujw7e6bu

A Novel Method for Sinus Node Modification and Phrenic Nerve Protection in Resistant Cases

2009 Cardiovascular Electrophysiology  
Endocardial Catheter for IST Ablation. This is a case report of inappropriate sinus tachycardia in a patient who had a previous unsuccessful endocardial ablation, which had been limited due to concerns of phrenic nerve injury. The patient required a repeat ablation that utilized a novel combined epicardial and endocardial approach for sinus node modification and simultaneous protection of the phrenic nerve via an epicardial balloon. (J Cardiovasc Electrophysiol, Vol. 20, pp. 689-691, June 2009)
more » ... inappropriate sinus tachycardia, epicardial, ablation, phrenic nerve Case Report A 33-year-old female presented with previous diagnosis of noncompaction of the left ventricle, who had a dual chamber implantable cardioverter-defibrillator (ICD) placed many years ago for primary prevention of sudden cardiac death. Since that time, she has been repeatedly symptomatic of tachycardia. Initially, she had typical right atrial flutter diagnosed and had a successful cavotricuspid isthmus ablation. Recurrent symptomatic tachycardia, and occasional syncope, led to an empiric slow pathway modification due to the presence of dual pathways and typical atrioventricular (AV) nodal echoes, but she had no inducible supraventricular tachycardia. During this study, a heart rate increase of 25 beats per minute (bpm) was seen after a 1 μg i.v. bolus dose of isoproterenol, which was suggestive but not diagnostic of the diagnosis of inappropriate sinus tachycardia (IST). 1 All other potential causes of sinus tachycardia were excluded, and the clinical scenario was felt to be most consistent with IST. The patient also has a long history of multiple syncopal events and a tilt-table test consistent with vasovagal syncope. Recurrent syncope after ICD implantation occurred without any arrhythmic events except sinus tachycardia. The treatment for her IST was limited by baseline hypotension made worse by beta-blockers. The addition of low-dose calcium channel blockers was not tolerated. Because of the history of cardiomyopathy, fludrocortisone and midodrine were not prescribed. An attempt at endocardial sinus node modification was made using a noncontact array (NavX Array; St. Jude Medical, St. Paul, MN, USA). Escalating the doses of isoproterenol increased the sinus rate but did not change the site of earliest activation by more than a few millimeters. Lesions were delivered using an internally irrigated RF ablation catheter (Chilli; Boston Scientific, Natick, MA, USA), but it was limited by phrenic nerve capture at optimal ablation sites. Several of these sites had to be ablated with a 6-mm cryotherapy catheter (CryoCath, Montreal, Quebec) during phrenic nerve pacing from a quadripolar catheter in the superior vena cava. There was only a modest effect on the P-wave amplitude and resting sinus rate. Within a few weeks, she had recurrent severe symptoms and extreme hypotension, limiting medical therapies. Examination of her ICD
doi:10.1111/j.1540-8167.2008.01383.x pmid:19207755 fatcat:mtz64wfkizcdzd36tkgmqg475i

Diurnal Heart Rate Patterns in Inappropriate Sinus Tachycardia

2010 Pacing and Clinical Electrophysiology  
, C i , IAST, IB i , and IC i are constants.  ...  This is consistent with the shift noted in the curve RUBENSTEIN, ET AL. without any real difference in the actual diurnal variation.  ... 
doi:10.1111/j.1540-8159.2010.02725.x pmid:20353418 fatcat:3yizfwmyrzhblkhyw43isnzipe

Cardiac Troponin Assessment Following Atrial Fibrillation Ablation: Implications for Chest Pain Evaluation

Jason C Rubenstein
2014 International Journal of Clinical Cardiology  
The mean RF temperature limit was 53.6 ± 2.0 ºC (range 50-55°C).  ...  The mean RF temperature limit was 53.6 ± 2.0°C (range 50-55°C). There was no clinical or electrocardiographic evidence of coronary ischemia in this population.  ... 
doi:10.23937/2378-2951/1410011 fatcat:oo6u4dbgijatfngtpisdxlqkri

Epicardial Lymphoproliferative Disease Involving the Coronary Arteries

Moritz C. Wyler von Ballmoos, Saqib Masroor, Ghulam Murtaza, Jose Franco, Mario Gasparri, Jason C. Rubenstein
2011 Journal of the American College of Cardiology  
Three-chamber (C, Online Video 3) and short-axis SSFP CMR images (D, Online Video 4) are shown after a 3-month course of prednisone (mass diameter: 64 ϫ 44 mm).  ...  Three-chamber (C, Online Video 3) and short-axis SSFP CMR images (D, Online Video 4) are shown after a 3-month course of prednisone (mass diameter: 64 ϫ 44 mm).  ... 
doi:10.1016/j.jacc.2011.01.077 pmid:21996397 fatcat:nl24qnlthvdrxb5poll72rcmfm

A comparison of cardiac magnetic resonance imaging peri-infarct border zone quantification strategies for the prediction of ventricular tachyarrhythmia inducibility

Jason C. Rubenstein, Daniel C. Lee, Edwin Wu, Alan H. Kadish, Rod Passman, David Bello, Jeffrey J. Goldberger
2013 Cardiology Journal  
(Cardiol J 2013; 20, 1: 68-77) Key words: cardiac magnetic resonance imaging, ventricular tachycardia, sudden death 69 Jason C.  ...  Rubenstein et al., MRI border zone predicts ventricular arrhythmia  ...  C.  ... 
doi:10.5603/cj.2013.0011 pmid:23558813 fatcat:wnsmgg44nvevdedidjzyzp3y4q

Idiopathic multicentric Castleman's disease: a systematic literature review

Amy Y Liu, Christopher S Nabel, Brian S Finkelman, Jason R Ruth, Razelle Kurzrock, Frits van Rhee, Vera P Krymskaya, Dermot Kelleher, Arthur H Rubenstein, David C Fajgenbaum
2016 The Lancet Haematology  
Clinical features of idiopathic multicentric Castleman's disease included multicentric lymphadenopathy (128/128), anaemia (79/91), elevated C-reactive protein (65/79), hypergammaglobulinaemia (63/82),  ...  Data for specifi c variables were not available for all patients.  ...  Of 79 patients in whom C-reactive protein levels were recorded, 65 (82%) had elevated levels during active disease (table 1) .  ... 
doi:10.1016/s2352-3026(16)00006-5 pmid:27063975 fatcat:5m3dlnh6k5gdxewrd33s53tvti

RNA Aptamer Delivery through Intact Human Skin

Jon D. Lenn, Jessica Neil, Christine Donahue, Kellie Demock, Caitlin Vestal Tibbetts, Javier Cote-Sierra, Susan H. Smith, David Rubenstein, Jean-Philippe Therrien, P. Shannon Pendergrast, Jason Killough, Marc B. Brown (+1 others)
2018 Journal of Investigative Dermatology  
Smith, David Rubenstein and Jean-Philippe Therrien were employees of GlaxoSmithKline; Javier Cote-Sierra was employed by Pfizer; P.  ...  Shannon Pendergrast was employed by Ymir Genomics; Jason Killough was employed by Momenta Pharmaceuticals; Marc Brown was employed by MedPharm.  ...  Static cells were then placed in a humidified incubator at 37°C and cultured as previously described (Smith et al, 2016) .  ... 
doi:10.1016/j.jid.2017.07.851 pmid:28942363 fatcat:oa5um4zeejgpxgdhzza72qmb2e

Right ventricular size assessed by cardiovascular MRI may predict mortality after left ventricular assist device placement

Mitchell Timmons, Aimee C Welsh, Dhiraj Baruah, Kaushik Shahir, Jason Rubenstein
2015 Journal of Cardiovascular Magnetic Resonance  
doi:10.1186/1532-429x-17-s1-p181 fatcat:gqwbme4bqngu5lykjbiaq7ugku

Qualitative agreement of aortic regurgitation assessed by steady state free precession signal void as compared to doppler echocardiography

Mark R Bowers, Raymond Q Migrino, Daniel Eastwood, Jason C Rubenstein
2010 Journal of Cardiovascular Magnetic Resonance  
doi:10.1186/1532-429x-12-s1-p289 fatcat:zxo4anojfbfafewrrevlj7mfui

The use of periinfarct contrast-enhanced cardiac magnetic resonance imaging for the prediction of late postmyocardial infarction ventricular dysfunction

Jason C. Rubenstein, José T. Ortiz, Edwin Wu, Alan Kadish, Rod Passman, Robert O. Bonow, Jeffrey J. Goldberger
2008 American Heart Journal  
Although ejection fraction (EF) both perimyocardial infarction (MI) and late post-MI are important prognostic factors, only implantable cardioverter-defibrillator trials of post-MI patients with depressed late EF have shown improved survival. This may relate to imprecision of early EF because of post-MI stunning. We sought to determine if peri-MI infarct size, as measured by cardiac magnetic resonance (CMR), is superior to early EF to predict late post-MI EF. Methods Seventy-three patients with
more » ... ST-elevation MI had infarct size and EF quantified using CMR early (b1 week) and late (N3 months) post-MI. Results Late EF was significantly correlated with early EF (R = 0.734, P b .001), and with infarct size (R = −0.661, P b .001), and both early EF and infarct size were significant predictors of late EF. Subgroup analyses showed that low late EF (≤35%) was better predicted by infarct size than early EF. Half of the patients with early EF ≤35% had a late EF N35%. There was no difference in early EF between the subgroup with a late EF N35% compared to the subgroup with late EF ≤35% (29.7% ± 4.6% vs 28.0% ± 4.9%, P = .414). There was, however, a significant difference between these 2 groups in infarct size (22.6% ± 10.8% vs 34.7% ± 7.8%, P = .011). Conclusions Infarct size as determined by CMR immediately post-MI is a significant predictor of late EF and is superior to early EF in patients with initially depressed EF. Further studies are warranted to assess whether infarct size estimation by CMR after acute MI can better identify patients who are at risk for sudden cardiac death than early EF. (Am Heart J 2008;156:498-505.) From the
doi:10.1016/j.ahj.2008.04.012 pmid:18760132 fatcat:himr3664a5gflmv5ybllnivdou

Value CMR: Towards a Comprehensive, Rapid, Cost-Effective Cardiovascular Magnetic Resonance Imaging

El-Sayed H. Ibrahim, Luba Frank, Dhiraj Baruah, V. Emre Arpinar, Andrew S. Nencka, Kevin M. Koch, L. Tugan Muftuler, Orhan Unal, Jadranka Stojanovska, Jason C. Rubenstein, Sherry-Ann Brown, John Charlson (+3 others)
2021 International Journal of Biomedical Imaging  
Representative 2D phase contrast (PC) images and flow curves (a, b) and the corresponding 4D-flow maps and curves (c, d) at different measurement sites of the aorta (a, c) and pulmonary artery (b, d).  ...  Representative 2D phase contrast (PC) images and flow curves (a, b) and the corresponding 4D-flow maps and curves (c, d) at measurement sites across the mitral valve (a, c) and the tricuspid valve (b,  ... 
doi:10.1155/2021/8851958 pmid:34054936 pmcid:PMC8147553 fatcat:xwlvkl2dmrfhjn4lsscfzoluhu

Staying Alive: Long-Term Success of Bottlenose Dolphin Interventions in Southwest Florida

Katherine A. McHugh, Aaron A. Barleycorn, Jason B. Allen, Kim Bassos-Hull, Gretchen Lovewell, Denise Boyd, Anna Panike, Carolyn Cush, Deborah Fauquier, Blair Mase, Robert C. Lacy, Michelle R. Greenfield (+6 others)
2021 Frontiers in Marine Science  
C M Line 1,4 August 15, 2013 C/R November 18, 2013 February 28, 2014 Unknown Skipper/FMMSN1453 C F Line 1 August 8, 2014 C/R* September 4, 2014 March 11, 2020 Alive Charlotte Harbor  ...  Vidalia/MML1112 C 1 M Line 2,3 July 2, 2011 C/R November 15, 2011 May 7, 2017 Dead Parcel/CMA1517 C F Debris 2 October 5, 2015 C/R* October 15, 2015 March 12, 2020 Alive Lenny/CMA1804  ... 
doi:10.3389/fmars.2020.624729 fatcat:ic7mdblrkbhvxj2okldbnavxdq

Abnormal myocardial T1 mapping of hypertrophic cardiomyopathy in areas without delayed enhancement, as compared to NICM and controls at both 1.5 and 3T

Orhan Sancaktar, Kaushik Shahir, Dhiraj Baruah, Aimee C Welsh, Jason Rubenstein
2016 Journal of Cardiovascular Magnetic Resonance  
Orhan Sancaktar 1* , Kaushik Shahir 2 , Dhiraj Baruah 2 , Aimee C Welsh 1 , Jason Rubenstein 1 From 19th Annual SCMR Scientific Sessions Los Angeles, CA, USA. 27-30 January 2016 Background The use of  ... 
doi:10.1186/1532-429x-18-s1-q45 fatcat:dghxfhkfkvbndc3ixgu5iozvu4
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