Arka Chatterjee

Interests

Teaching

Resident and Fellow education.

Research

Database research for procedural outcomes.

Courses

No activities entered.

Scholarly Contributions

Chapters

• Watts, T. E., Chatterjee, A., & Leesar, M. A. (2018). Stent Thrombosis: Early, Late, and Very Late. In StatPearls. Academic Press. doi:10.1016/B978-0-12-812615-8.00015-6
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  Abstract The introduction of coronary stents to the field of interventional cardiology seemingly offered an ultimate answer to three major problems that complicated the performance of percutaneous coronary and peripheral interventions, i.e., dissections, acute vessel closure, and restenosis. Nevertheless, while stents indeed properly addressed these obstacles, they induced as well a new major problem, i.e., stent thrombosis. Significant progress has been made since the late 1990s in understanding the pathophysiology of stent thrombosis and, consequently, introducing accommodating stents' design. Accordingly, improved procedural techniques and tailored pharmacotherapy have been achieved. However, with the recent introduction of the bio-resorbable stent platforms that contain scaffolding elements, the issue of stent thrombosis has become again an ominous potential complication. Thus, stent thrombosis remains a significant challenge, which calls for new solutions. This chapter reviews historical perspectives, describes technical aspects of the management of stent thrombosis, and presents the current views on early, late, and very late stent thrombosis.

Journals/Publications

• Chatterjee, A., Shanmugasundaram, M., Lee, K. S., Kazui, T., Rajapreyar, I. N., & Acharya, D. (2024). Optical Coherence Tomography in the Assessment and Management of Cardiac Allograft Vasculopathy. Current cardiology reports, 26(8), 777-782.
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  Cardiac Allograft vasculopathy (CAV) is a major barrier to improving outcomes after heart transplantation. Coronary angiography has very low sensitivity to detect early CAV and intravascular ultrasound (IVUS) only improves it to some extent. In this article, we detail the current evidence surrounding use of Optical Coherence tomography (OCT) in patients with CAV.
• Pakhchanian, H., Raiker, R., DeYoung, C., Krishnasamy, S., Chatterjee, A., & Yang, S. (2024). No Association Between Adalimumab Use and Heart Failure in Patients with Hidradenitis Suppurativa: A Propensity Matched Study. Journal of the American Academy of Dermatology.
• Tan, M. C., Yeo, Y. H., San, B. J., Suleiman, A., Lee, J. Z., Chatterjee, A., Sell-Dottin, K. A., Sweeney, J. P., Fortuin, F. D., & Lee, K. S. (2024). Trends and Disparities in Valvular Heart Disease Mortality in the United States From 1999 to 2020. Journal of the American Heart Association, 13(8), e030895.
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  Percutaneous heart valve procedures have been increasingly performed over the past decade, yet real-world mortality data on valvular heart disease (VHD) in the United States remain limited.
• Yeo, Y. H., Thong, J. Y., Tan, M. C., Ang, Q. X., San, B. J., Tan, B. E., Chatterjee, A., & Lee, K. (2024). Risk factors for early mortality following transcatheter edge-to-edge repair of mitral regurgitation. Cardiovascular revascularization medicine : including molecular interventions.
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  While transcatheter edge-to-edge repair (TEER) with MitraClip is increasingly used, data on the risk stratification for assessing early mortality after this procedure are scarce.
• Acharya, D., Kazui, T., Al Rameni, D., Acharya, T., Betterton, E., Juneman, E., Loyaga-Rendon, R., Lotun, K., Shetty, R., & Chatterjee, A. (2023). Aortic valve disorders and left ventricular assist devices. Frontiers in cardiovascular medicine, 10, 1098348.
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  Aortic valve disorders are important considerations in advanced heart failure patients being evaluated for left ventricular assist devices (LVAD) and those on LVAD support. Aortic insufficiency (AI) can be present prior to LVAD implantation or develop during LVAD support. It is usually a progressive disorder and can lead to impaired LVAD effectiveness and heart failure symptoms. Severe AI is associated with worsening hemodynamics, increased hospitalizations, and decreased survival in LVAD patients. Diagnosis is made with echocardiographic, device assessment, and/or catheterization studies. Standard echocardiographic criteria for AI are insufficient for accurate diagnosis of AI severity. Management of pre-existing AI includes aortic repair or replacement at the time of LVAD implant. Management of AI on LVAD support is challenging with increased risks of repeat surgical intervention, and percutaneous techniques including transcatheter aortic valve replacement are assuming greater importance. In this manuscript, we provide a comprehensive approach to contemporary diagnosis and management of aortic valve disorders in the setting of LVAD therapy.
• Chatterjee, A., Kazui, T., & Acharya, D. (2023). Growing prevalence of aortic stenosis - Question of age or better recognition?. International journal of cardiology, 388, 131155.
• Leesar, M. A., Waheed, S., Al Solaiman, F., Chatterjee, A., Daya, H. A., Hage, F. G., & Brott, B. C. (2023). Randomized trial of an oblique versus standard fluoroscopic-guided micropuncture technique for femoral arterial access: The Micropuncture-CFA trial. Cardiovascular revascularization medicine : including molecular interventions, 57, 43-50.
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  The anterior-posterior fluoroscopic guidance (the AP technique) is a standard method for common femoral artery (CFA) access, but the rate of CFA access with ultrasound vs. the AP technique was not significantly different. We have shown an oblique fluoroscopic guidance (the oblique technique) with a micropuncture needle (MPN) resulted in CFA access in 100 % of patients. The outcome of the oblique vs. AP technique is unknown. We compared the utilities of the oblique vs. AP technique for CFA access with a MPN in patients undergoing coronary procedures.
• Warner, E. D., Riley, J., Liotta, M., Pritting, C., Brailovsky, Y., Jimenez, D., Chatterjee, A., Tchantchaleishvili, V., & Rajapreyar, I. N. (2023). Aortic Valve Replacement in Patients With ESRD and Heart Failure With Reduced Ejection Fraction. The American journal of cardiology, 205, 111-119.
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  Transcatheter aortic valve replacement (TAVR) has become the standard of care for the treatment of all patients with calcific aortic stenosis. Patients with end-stage renal disease (ESRD) on hemodialysis were excluded from participation in many of the seminal trials proving the safety and efficacy of TAVR. The outcomes of TAVR in the ESRD population from a national registry showed significantly higher in-hospital and 1-year mortality compared with patients not on hemodialysis. Comparisons of outcomes for surgical versus transcatheter interventions in patients with ESRD and heart failure with reduced ejection fraction (HFrEF) are limited. Using the United States Renal Data System, we identified all ESRD patients with aortic stenosis and HFrEF who underwent TAVR, surgical aortic valve replacement (SAVR), or those with HFrEF and aortic stenosis initiated on dialysis after the year 2012 to compare survival. Propensity score matching was performed, and groups were compared using Kaplan-Meier curves. The study population consisted of 7,660 patients, of which 5,064 (66.1%) were male. The median age at initiation of dialysis was 73 years (interquartile range: 65 to 80). There were 1,108 (14.5%) who underwent TAVR and 695 (9.1%) who underwent SAVR. After matching, patients who underwent TAVR had increased survival relative to those who were medically managed. In-hospital outcomes favored TAVR with less mortality and fewer complications when compared with SAVR. TAVR had improved mortality relative to SAVR in the early period, but survival curves crossed at approximately 9 months and SAVR had better mortality in the long-term. TAVR is a safe and effective procedure and is associated with improved mortality when compared with medical management. In conclusion, TAVR and SAVR are both viable options for patients with ESRD and HF with TAVR having better short-term outcomes and SAVR better long-term outcomes.
• Ajmal, M., Chatterjee, A., & Acharya, D. (2022). Persistent or Recurrent Angina Following Percutaneous Coronary Revascularization. Current cardiology reports, 24(12), 1837-1848.
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  Persistent or recurrent angina after percutaneous coronary intervention (PCI) has substantial patient morbidity and economic impact. As knowledge of the pathophysiology of this condition has evolved, new tools for accurate diagnosis and treatment have become available. We provide a current, comprehensive review of mechanisms of post-PCI angina, diagnostic strategies, and therapeutic options.
• Kazui, T., Hsu, C. H., Hamidi, M., Acharya, D., Shanmugasundaram, M., Lee, K., Chatterjee, A., & Bull, D. (2022). Five-meter walk test before transcatheter aortic valve replacement and 1-year noncardiac mortality. JTCVS open, 12, 103-117.
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  The purpose of this study is to assess whether the 5-m walk test is associated with 1-year mortality after transcatheter aortic valve replacement.
• Kazui, T., Hsu, C., Hamidi, M., Acharya, D., Shanmugasundaram, M., Lee, K., Chatterjee, A., & Bull, D. A. (2021). Pre-transcatheter aortic valve replacement 5-meter-walk test score and 1-year noncardiac mortality. Journal of Thoracic and Cardiovascular Surgery.
• Mukherjee, A., Wiener, H. W., Griffin, R. L., Lenneman, C., Chatterjee, A., Nabell, L. M., Lewis, C. E., & Shrestha, S. (2022). Racial and rural-urban disparities in cardiovascular risk factors among patients with head and neck cancer in a clinical cohort. Head & neck, 44(7), 1563-1575.
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  Evidence on distribution of cardiovascular disease (CVD) risk factors in patients with head and neck squamous cell carcinoma (HNSCC) is limited. We assessed disparities in prevalence and incidence of CVD risk factors in patients with HNSCC.
• Mukherjee, A., Wiener, H. W., Griffin, R. L., Lenneman, C., Chatterjee, A., Nabell, L. M., Lewis, C. E., & Shrestha, S. (2022). Traditional risk factors and cancer-related factors associated with cardiovascular disease risk in head and neck cancer patients. Frontiers in cardiovascular medicine, 9, 1024846.
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  Risk of incident cardiovascular disease (CVD) in head and neck squamous cell carcinoma (HNSCC) patients is under-reported. We assessed the association of HNSCC-related factors and traditional risk factors with 1- and 5-year CVD risk in HNSCC patients without prevalent CVD at cancer diagnosis.
• Shanmugasundaram, M., Chatterjee, A., & Lee, K. (2022). Percutaneous Large Thrombus and Vegetation Evacuation in the Catheterization Laboratory. Interventional cardiology clinics, 11(3), 349-358.
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  Intracardiac and intravascular thrombi are associated with significant morbidity and mortality. Although surgery remains the gold standard treatment option, these patients often have multiple comorbidities that can make surgical options challenging. With advancements in catheter-based technologies, there are now percutaneous treatment options for these patients. The AngioVac is a percutaneous vacuum-assisted thrombectomy device FDA-approved for removal of intravascular debris that uses a venovenous extracorporeal membranous oxygenation circuit with a filter. Use of this device has now been reported in the removal of right atrial or iliocaval thrombi, debulking tricuspid vegetations, removal of vegetations from implantable cardiac devices, and pulmonary embolism.
• Acharya, D., Loyaga-Rendon, R. Y., Chatterjee, A., Rajapreyar, I., & Lee, K. (2021). Optical Coherence Tomography in Cardiac Allograft Vasculopathy: State-of-the-Art Review. Circulation. Heart failure, 14(9), e008416.
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  Cardiac allograft vasculopathy (CAV) is a challenging complication of heart transplantation. CAV pathophysiology is incompletely understood, standard screening modalities such as angiography have significant limitations, and currently available therapies have only modest efficacy in preventing progression. Optical coherence tomography is a light-based technique that provides microscopic level catheter-based intravascular imaging and has dramatically expanded our understanding of CAV, demonstrating it to be a complex, heterogeneous, and dynamic process. This review covers characteristics and uses of optical coherence tomography, including vessel characterization, serial use to assess progression of disease, guiding percutaneous intervention, and monitoring response to CAV therapies. We also discuss the potential of optical coherence tomography in providing individualized assessment and enable customized CAV therapies, which may lead to improvements in long-term transplant outcomes.
• Baldwin, N. K., Ives, C. W., Morgan, W. S., Bowman, M. H., & Chatterjee, A. (2021). Small Bowel Obstruction Mimicking Acute Inferior ST-Elevation Myocardial Infarction. The American journal of medicine, 134(5), 599-602.
• Chatterjee, A., & Skinner, K. (2021). Crushed Prasugrel Improves Pharmacodynamics But Little Else: Where Are the Missing Pieces?. JACC. Cardiovascular interventions, 14(12), 1334-1336.
• Cruz Rodriguez, J. B., Chatterjee, A., Pamboukian, S. V., Tallaj, J. A., Joly, J., Lenneman, A., Aryal, S., Hoopes, C. W., Acharya, D., & Rajapreyar, I. (2021). Persistent mitral regurgitation after left ventricular assist device: a clinical conundrum. ESC heart failure, 8(2), 1039-1046.
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  Persistent mitral valve regurgitation (MR) after continuous flow left ventricular assist device implantation (cfLVAD) is associated with pulmonary hypertension and right ventricular failure with variable effects on survival across published studies. The aim of this study is to determine the incidence and predictors of persistent MR at 6-month follow-up after cfLVAD implantation and its impact on survival, haemodynamics, right ventricular function, and morbidity.
• Elbadawi, A., Elgendy, I. Y., Albaeni, A., Aly, A., Almustafa, A., Shahin, H. I., Chatterjee, A., Alkhouli, M., Khalife, W., Kapadia, S., & Jneid, H. (2021). Trends and Outcomes of Transcatheter Valve Implantation in Patients With Prior Mediastinal Radiation. The American journal of cardiology, 143, 167-168.
• Law, M. A., & Chatterjee, A. (2021). Transcatheter pulmonic valve implantation: Techniques, current roles, and future implications. World journal of cardiology, 13(5), 117-129.
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  Right ventricular outflow tract (RVOT) obstruction is present in a variety of congenital heart disease states including tetralogy of Fallot, pulmonary atresia/stenosis and other conotruncal abnormalities After surgical repair, these patients develop RVOT residual abnormalities of pulmonic stenosis and/or insufficiency of their native outflow tract or right ventricle to pulmonary artery conduit. There are also sequelae of other surgeries like the Ross operation for aortic valve disease that lead to right ventricle to pulmonary artery conduit dysfunction. Surgical pulmonic valve replacement (SPVR) has been the mainstay for these patients and is considered standard of care. Transcatheter pulmonic valve implantation (TPVI) was first reported in 2000 and has made strides as a comparable alternative to SPVR, being approved in the United States in 2010. We provide a comprehensive review in this space-indications for TPVI, detailed procedural facets and up-to-date review of the literature regarding outcomes of TPVI. TPVI has been shown to have favorable medium-term outcomes free of re-interventions especially after the adoption of the practice of pre-stenting the RVOT. Procedural mortality and complications are uncommon. With more experience, recognition of risk of dreaded outcomes like coronary compression has improved. Also, conduit rupture is increasingly being managed with transcatheter tools. Questions over endocarditis risk still prevail in the TPVI population. Head-to-head comparisons to SPVR are still limited but available data suggests equivalence. We also discuss newer valve technologies that have limited data currently and may have more applicability for treatment of native dysfunctional RVOT substrates.
• Lee, K. S., Chatterjee, A., & Acharya, D. (2021). De-Escalation of DAPT After ACS: Escalating the Odds of Getting It Right. Journal of the American College of Cardiology, 78(8), 778-780.
• Mukherjee, A., Pakhchanian, H., Raiker, R., Singh, S., & Chatterjee, A. (2021). Burden of Thrombotic Events in Coronavirus Disease-19 (COVID-19) Patients and Effect on Outcomes (from a Multicenter Electronic Health Record Database). The American journal of cardiology, 147, 150-152.
• Pakhchanian, H., Raiker, R., Mukherjee, A., Khan, A., Singh, S., & Chatterjee, A. (2021). Outcomes of COVID-19 in CKD Patients: A Multicenter Electronic Medical Record Cohort Study. Clinical journal of the American Society of Nephrology : CJASN, 16(5), 785-786.
• Rajapreyar, I., Joly, J., Tallaj, J., Pamboukian, S. V., Assad, A. H., Lenneman, C., Litovsky, S., Chatterjee, A., Hoopes, C., & Lenneman, A. (2021). Pulmonary Vascular Disease Due to Plasma Cell Dyscrasia. Mayo Clinic proceedings. Innovations, quality & outcomes, 5(1), 210-218.
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  Pulmonary hypertension (PH) has been described in myeloproliferative disorders; monoclonal plasma cell disorder such as polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome; and plasma cell dyscrasias such as multiple myeloma and amyloidosis. We describe 4 cases of PH likely due to pulmonary vascular involvement and myocardial deposition from light chain deposition disease, amyloidosis, and multiple myeloma. On the basis of our clinical experience and literature review, we propose screening for plasma cell dyscrasia in patients with heart failure with preserved ejection fraction, unexplained PH, and hematological abnormalities. We also recommend inclusion of cardiopulmonary screening in patients with monoclonal gammopathy of undetermined significance.
• Burns, Z. R., Chatterjee, A., Davies, J. E., Pereira, S. J., & Hammock, J. B. (2020). SUB-PULMONIC ANOMALOUS ORIGIN OF THE LEFT MAIN CORONARY ARTERY FROM RIGHT CORONARY CUSP PRESENTING AS VENTRICULAR TACHYCARDIA. Journal of the American College of Cardiology, 75(11), 2866. doi:10.1016/s0735-1097(20)33493-8
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  Interarterial anomalous left coronary artery (ALCA) is associated with sudden cardiac death, and requires surgical intervention. Clinical presentation and anatomical features of a non-interarterial ALCA should also dictate if surgical intervention is warranted. A healthy 38-year-old male
• Chatterjee, A. (2020). Comparison of Transcatheter Pulmonic Valve Implantation With Surgical Pulmonic Valve Replacement in Adults (from the National Inpatient Survey Dataset). The American Journal of Cardiology.
• Chatterjee, A., Miller, N. J., Cribbs, M. G., Mukherjee, A., & Law, M. A. (2020). Systematic review and meta-analysis of outcomes of anatomic repair in congenitally corrected transposition of great arteries. World journal of cardiology, 12(8), 427-436.
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  Treatment of congenitally corrected transposition of great arteries (cc-TGA) with anatomic repair strategy has been considered superior due to restoration of the morphologic left ventricle in the systemic circulation. However, data on long term outcomes are limited to single center reports and include small sample sizes.
• Elbadawi, A., Albaeni, A., Elgendy, I. Y., Ogunbayo, G. O., Jimenez, E., Cornwell, L., Chatterjee, A., Khalife, W., Alkhouli, M., Kapadia, S. R., & Jneid, H. (2020). Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Prior Mediastinal Radiation. JACC. Cardiovascular interventions, 13(22), 2658-2666.
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  This study sought to evaluate the trends and outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) among patients with prior mediastinal radiation from a national database.
• Matos Santana, H., Heindl, B., Suri, S., Khatoon, S., Aryal, S., Chatterjee, A., Litovsky, S., Ahmed, H., Schnell, A., & Rajapreyar, I. (2020). A Case of Heart Failure in a Patient With Systemic Lupus Erythematosus. JACC. Case reports, 2(3), 414-419.
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  Patients with systemic lupus erythematosus (SLE) can present with multiple cardiovascular pathologies, including pulmonary hypertension, valvular disease, pericarditis, myocarditis, and premature atherosclerosis. SLE medications can also cause cardiovascular side effects. We present a patient who developed a severe cardiomyopathy secondary to the hydroxychloroquine prescribed to treat her SLE. ().
• Chatterjee, A. (2019). Intravascular ultrasound of normal left main arteries: Insights for stent optimization and standardization. Catheterization and Cardiovascular Interventions.
• Davis, J. W., Almubarak, M., Mukherjee, A., Mcelwee, S. K., Leesar, M. A., & Chatterjee, A. (2019). Ischemic Evaluation in Patients Presenting with Hypertensive Emergency / Urgency and Acute Systolic Heart Failure: Is Coronary Angiography Required for all?. Cardiovascular revascularization medicine : including molecular interventions, 20(6), 492-495. doi:10.1016/j.carrev.2018.08.011
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  Patients presenting with hypertensive urgency / emergency (HUE) often have systolic heart failure(SHF). Coronary angiography is routinely done for these patients to rule out obstructive coronary artery disease (Obs-CAD). We performed a retrospective study to investigate predictors of ObsCAD in this population..Patients who underwent angiography to investigate SHF and had hospital admission(s) for HUE in the preceding 6 months were included in the study. Chart review was performed to obtain demographic, clinical and imaging / angiographic data. A risk score was formulated based on multivariable logistic regression analysis..205 patients [age 58.9 ± 14.4 years; 62.4% male; 39.5% diabetic; median EF 25% (Inter Quartile Range: 11)] were included in the study. 33.1% patients (n = 68) had obs-CAD. Patients with obs-CAD were older, diabetic, more likely to have a history of stroke, echocardiographic regional wall motion abnormalities (RWMA) while African Americans were less likely to have obs-CAD. On multivariable analysis, only non-African American race (OR: 2.18; CI: 1.08-4.4) and RWMA (OR: 5.62; CI: 2.47-12.81) remained significant predictors of obs-CAD. A risk score (RANDS) from 0 to 9 was formulated which had a c-statistic of 0.75 with a sensitivity and specificity of 84% and 53% for predicting obsCAD respectively..Our results suggest that only a minority of patients with HUE and SHF have obs-CAD. A simple risk score may be used to stratify this population and lower risk individuals may be screened with non-invasive testing instead of invasive catheterization. These results should be validated in large registry populations.
• Davis, J., Perry, G., & Chatterjee, A. (2019). Complete white out of a single transplanted lung in the immediate postoperative period. Heart Lung, 48(3). doi:10.1016/j.hrtlng.2018.08.006
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  Vascular complications are rare but serious events following lung transplantation. Of the potential adverse events post lung transplant, pulmonary vein thrombosis is rare but often fatal. Our case describes a 54 year-old male who underwent single left lung transplantation and suddenly became hemodynamically unstable shortly after the procedure. The diagnosis of acute pulmonary vein thrombosis was made with the use of trans-esophageal echocardiography identifying complete occlusion of the left upper pulmonary vein which led to successful surgical thrombectomy and revision of the anastomosis.
• Elbadawi, A., Ahmed, H. M., Mohamed, A. H., Barssoum, K., Perez, C., Mahmoud, A., Ogunbayo, G. O., Omer, M. A., Jneid, H., Chatterjee, A., & Mahmoud, K. D. (2019). Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Patients With Rheumatoid Arthritis (from the Nationwide Inpatient Database).. The American journal of cardiology, 124(7), 1099-1105. doi:10.1016/j.amjcard.2019.07.009
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  Little is known on the outcomes of surgical aortic valve replacement (SAVR) versus transcatheter aortic valve implantation (TAVI) in patients with rheumatoid arthritis (RA). We queried the Nationwide Inpatient Sample Database (2012 to 2016). We performed a propensity-score-matched analysis based on 25 clinical and hospital variables to compare patients with RA who underwent SAVR versus TAVI. Our primary outcome was in-hospital mortality. Our final analysis included 5,640 hospitalizations with RA who underwent isolated AVR; of whom, 2,465 (43.7%) underwent TAVI. There was an increasing trend in TAVI procedures during the study years (ptrend= 0.001). There was a trend toward reduced in-hospital mortality among TAVI compared with SAVR but did not reach statistical significance (0.8% vs 1.6%, odds ratio = 0.50; 95% confidence interval 0.23 to 1.06, p = 0.097). TAVI was associated with lower rates of postoperative bleeding (28.7% vs 43.9%, p
• Joly, J. M., El-dabh, A., Marshell, R., Chatterjee, A., Smith, M. G., Tresler, M., Kirklin, J. K., Acharya, D., Rajapreyar, I. N., Tallaj, J. A., & Pamboukian, S. V. (2019). Performance of Noninvasive Assessment in the Diagnosis of Right Heart Failure After Left Ventricular Assist Device.. ASAIO journal (American Society for Artificial Internal Organs : 1992), 65(5), 449-455. doi:10.1097/mat.0000000000000830
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  Right heart failure (RHF) after left ventricular assist device (LVAD) is associated with poor outcomes. Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) defines RHF as elevated right atrial pressure (RAP) plus venous congestion. The purpose of this study was to examine the diagnostic performance of the noninvasive Intermacs criteria using RAP as the gold standard. We analyzed 108 patients with LVAD who underwent 341 right heart catheterizations (RHC) between January 1, 2006, and December 31, 2013. Physical exam, echocardiography, and laboratory data at the time of RHC were collected. Conventional two-by-two tables were used and missing data were excluded. The noninvasive Intermacs definition of RHF is 32% sensitive (95% cardiac index (CI), 0.21-0.44) and 97% specific (95% CI, 0.95-0.99) for identifying elevated RAP. Clinical assessment failed to identify two-thirds of LVAD patients with RAP > 16 mm Hg. More than half of patients with elevated RAP did not have venous congestion, which may represent a physiologic opportunity to mitigate the progression of disease before end-organ damage occurs. One-quarter of patients who met the noninvasive definition of RHF did not actually have elevated RAP, potentially exposing patients to unnecessary therapies. In practice, if any component of the Intermacs definition is present or equivocal, our data suggest RHC is warranted to establish the diagnosis.
• Marian, M. J., Abu Daya, H., Chatterjee, A., Al Solaiman, F., Sasse, M. F., Fonbah, W. S., Workman, R. W., Johnson, B. E., Carlson, S. E., Brott, B. C., Prabhu, S. D., & Leesar, M. A. (2019). Effects of Crushed Ticagrelor Versus Eptifibatide Bolus Plus Clopidogrel in Troponin-Negative Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: A Randomized Clinical Trial. Journal of the American Heart Association, 8(23), e012844.
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  Background After a loading dose of ticagrelor, the rate of high on-treatment platelet reactivity remains elevated, which increases periprocedural myocardial infarction and injury. This indicates that faster platelet inhibition with crushed ticagrelor (CTIC) or eptifibatide is needed to reduce high on-treatment platelet reactivity. The efficacy of CTIC versus eptifibatide bolus plus clopidogrel is unknown. Methods and Results A total of 100 P2Y naïve, troponin-negative patients with acute coronary syndrome were randomized to CTIC (180 mg) versus eptifibatide bolus (180 μg/kg×2 intravenous boluses) plus clopidogrel (600 mg) at the time of percutaneous coronary intervention. High on-treatment platelet reactivity was markedly higher with CTIC versus eptifibatide bolus plus clopidogrel (42% versus 0%;
• Osula, D., Farris, G. R., Chatterjee, A., Law, M. A., & Cribbs, M. G. (2019). Intra-aortic Balloon Pump As a Bridge to Heart Transplant After Non-ST-Segment-Elevation Myocardial Infarction in Palliated Hypoplastic Left Heart Syndrome.. Circulation. Heart failure, 12(9), e006130. doi:10.1161/circheartfailure.119.006130
• Adegbala, O., Adejumo, A. C., Olakanmi, O., Akintoye, E., Alliu, S., Edo-osagie, E., Chatterjee, A., & Akinjero, A. M. (2018). Relation of Cannabis Use and Atrial Fibrillation Among Patients Hospitalized for Heart Failure.. The American journal of cardiology, 122(1), 129-134. doi:10.1016/j.amjcard.2018.03.015
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  Left ventricular dysfunction triggers the activation of the sympathetic nervous system, providing inotropic support to the failing heart and concomitantly increasing the risk of atrial fibrillation (AF). The cardiovascular effects of cannabis have been characterized as biphasic on the autonomic nervous system with an increased sympathetic effect at low doses and an inhibitory sympathetic activity at higher doses. It is unknown if the autonomic effect of cannabis impacts the occurrence of AF in patients with heart failure (HF). We used data from the Healthcare Cost and Utilization Project-National Inpatient Sample for patients admitted with a diagnosis of HF in 2014. The outcome variable was the diagnosis of AF, with the main exposure being cannabis use. We identified a cannabis user group and a 1:1 propensity-matched non-cannabis user group, each having 3,548 patients. We then estimated the odds of AF diagnosis in cannabis users. An estimated 3,950,392 patients were admitted with a diagnosis of HF in the United States in 2014. Among these, there were 17,755 (0.45%) cannabis users. In the matched cohort, cannabis users were less likely to have AF (19.08% vs 21.39%; AOR 0.87 [0.77 to 0.98]). In conclusion, cannabis users have lower odds of AF when compared with nonusers, which was not explained by co-morbid conditions, age, insurance type, and socioeconomic status.
• Brott, B. C., & Chatterjee, A. (2018). Drug-Eluting Balloon Therapy for In-Stent Restenosis of Drug-Eluting Stents: Choose and Prepare the Appropriate Lesion.. JACC. Cardiovascular interventions, 11(10), 979-980. doi:10.1016/j.jcin.2018.03.014
• Chatterjee, A. (2018). Embolic stroke of undetermined source and patent foramen ovale closure: Practice insights from meta-analysis?. Catheterization and Cardiovascular Interventions.
• Chatterjee, A. (2018). Patent foramen ovale closure for cryptogenic stroke: Effective, but only in select patients. Catheterization and Cardiovascular Interventions.
• Chatterjee, A. (2018). Patient preference: An important emerging factor in operator access site selection. Catheterization and Cardiovascular Interventions.
• Chatterjee, A. (2018). Surgical aortic valve replacement and transcatheter aortic valve implantation for severe aortic stenosis: Equipoise remains a tenable assumption. Catheterization and Cardiovascular Interventions.
• Chatterjee, A. (2018). The promise of effective P2Y12 platelet receptor pretreatment: Not crushed yet. Catheterization and Cardiovascular Interventions.
• Chatterjee, A. (2018). “Expanding the frame” for valve-in-valve therapy in small bioprostheses: Encouraging signs for the road ahead. Catheterization and Cardiovascular Interventions.
• Chatterjee, A., & Law, M. (2018). To Reduce Stroke with PFO Closure, Respect the Shunt. The American Journal of Medicine, 131(6). doi:10.1016/j.amjmed.2018.01.007
• Chatterjee, A., Agarwal, M., Bhatia, N., Miller, N. J., Marshall, A. S., Leesar, M., Cribbs, M. G., & Law, M. A. (2018). TRENDS IN TRANSCATHETER AND SURGICAL REPAIR OF SECUNDUM ATRIAL SEPTAL DEFECT: INSIGHTS FROM A NATIONAL DATABASE. Journal of the American College of Cardiology, 71(11), A546. doi:10.1016/s0735-1097(18)31087-8
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  Transcatheter (TC) closure of secundum atrial septal defects (ASD) has made rapid strides and is the modality of choice for clinicians. We investigated temporal trends and in-hospital outcomes of transcatheter and surgical(S) ASD closure in adult patients using the National Inpatient Sample database
• Chatterjee, A., Cribbs, M. G., Law, M. A., & Miller, N. E. (2018). Outcomes of Anatomic Repair in Patients with Congenitally Corrected Transposition of Great Arteries: Systematic Review and Meta-analysis. Journal of Cardiac Failure, 24(8), S118-S119. doi:10.1016/j.cardfail.2018.07.432
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  Introduction Anatomic repair of congenitally corrected transposition of great arteries (cc-TGA) has long held the promise of prevention of congestive heart failure by restoring the systemic ventricle function to the morphologic left ventricle. However data are limited and variable. We intended to perform a pooled analysis to try and delineate the outcomes after anatomic repair. Methods A comprehensive search of Medline and Scopus databases from inception through Dec 31, 2017 was conducted using predefined criteria. We included studies reporting anatomic repair of minimum 5 cc-TGA patients with a follow-up duration of 2 years or more. Meta-analysis was performed using Comprehensive meta-analysis v3.0 software. Random effects modelling was used because of observational nature of pooled data. Results In 21 eligible studies, 895 patients underwent anatomic repair with a pooled follow-up of 5457.2 person-years (PY). There was an even split between patients treated with the double switch operation and the atrial switch / ventricular re-routing operation. Pooled estimate for operative mortality was 8.3% (95% CI: 6.0-11.4%). 0.2% (CI: 0.1-0.4%) patients required ECMO/LVAD postoperatively and 1.7% (CI: 1.1-2.4%) developed post-operative AV block requiring a pacemaker. Patients surviving initial surgery had a transplant free survival of 92.5%(CI: 89.5-95.4%) per 100 PY and a low rate of need for pacemaker (0.5% / year; CI: 0.2-0.8%). 84.7% patients (CI: 79.6-89.9%) were found to be in NYHA functional class I or II after 100 PY follow up. Total re-intervention rate was 5.3% per year (CI: 3.8-6.8%). Incidence of baffle stenosis, AV valve dysfunction, neo-aortic insufficiency and LVOT obstruction were estimated at 1.1% (CI: 0.8-1.5%); 0.3% (CI: 0.2-0.5%); 0.5% (CI: 0.2-0.9%) and 0.4% (CI: 0.1-0.6%) per year. Rate of development of LV dysfunction was 1.7%/ year (CI: 1.0-2.4%). Conclusions Despite a relatively high operative mortality, our study provides favorable updated estimates for follow-up outcomes after anatomic repair for cc-TGA patients. The pooled data suggests need for active monitoring over the long term for important complications including heart block and worsening ventricular dysfunction despite majority of patients being in NYHA class I/II.
• Chatterjee, A., Jackson, A. E., Acharya, D., & Law, M. A. (2018). Transcatheter Closure of Pulmonary Arteriovenous Malformation to Facilitate Treatment of Pulmonary Arterial Hypertension.. JACC. Cardiovascular interventions, 11(6), e45-e46. doi:10.1016/j.jcin.2017.12.014
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  A 60-year-old Caucasian woman was admitted to our institution with new onset progressive dyspnea for 2 to 3 weeks and worsening of chronic lower extremity edema or abdominal distension. She had a history of cirrhosis (significant alcohol intake and hepatitis C), portal hypertension, and an
• Chatterjee, A., Miller, N. J., Cribbs, M. G., & Law, M. A. (2018). Transcatheter Repair of Pulmonary Venous Baffle Stenosis.. JACC. Cardiovascular interventions, 11(16), e129-e130. doi:10.1016/j.jcin.2018.06.031
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  A 47-year-old man with a history of d-transposition of the great arteries palliated with an atrial switch (Mustard) operation presented to our institution with progressive exertional dyspnea. Transthoracic echocardiography demonstrated pulmonary venous baffle stenosis, with a mean gradient of 17 mm
• Chatterjee, A., Watts, T. E., Mauchley, D. C., Iskandrian, A. E., & Law, M. A. (2018). Multimodality Imaging of Rare Adult Presentation of ALCAPA Treated With Takeuchi Repair.. JACC. Cardiovascular interventions, 11(1), 98-99. doi:10.1016/j.jcin.2017.09.016
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  A 17-year-old African-American female patient was referred to our institution to evaluate an incidentally diagnosed murmur. She lacked stigmata of chronic illness and had no abnormalities on examination other than a flow murmur at the left and right upper sternal borders. She had occasional sharp,
• Daya, H. A., Chatterjee, A., & Puy, F. D. (2018). AN UNUSUAL CASE OF CONSTRICTIVE PERICARDITIS. Journal of the American College of Cardiology, 71(11), A2351. doi:10.1016/s0735-1097(18)32892-4
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  Establishing the diagnosis of constrictive pericarditis as a cause for secondary congestive hepatopathy or cirrhosis remains a challenge. A 32 year-old man presented with three days of abdominal pain and distention. His past medical history included liver cirrhosis thought to be due to remote
• Hollier, J., Ahmad, A., Mukherjee, A., Leesar, M., Chatterjee, A., Sasse, M., Mcguire, B. M., Prejean, S. P., & Smith, P. D. (2018). CORONARY ANGIOGRAPHY PRIOR TO LIVER TRANSPLANTATION: RESULTS AND CLINICAL IMPLICATIONS. Journal of the American College of Cardiology, 71(11), A1029. doi:10.1016/s0735-1097(18)31570-5
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  Coronary angiography (CA) has been proposed for pre-operative evaluation in patients with risk factors for CAD prior to liver transplantation (LT).1-4 We evaluated the effect of the of Model for End-stage Liver Disease (MELD) score and revascularization on outcomes in these patients. We included
• Proctor, P., Leesar, M. A., & Chatterjee, A. (2018). Thrombolytic Therapy in the Current ERA: Myocardial Infarction and Beyond.. Current pharmaceutical design, 24(4), 414-426. doi:10.2174/1381612824666171227211623
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  Thrombolytic therapy kick-started the era of modern cardiology but in the last few decades it has been largely supplanted by primary percutaneous coronary intervention (PCI) as the go-to treatment for acute myocardial infarction. However, these agents remain important for vast populations without access to primary PCI and acute ischemic stroke. More innovative uses have recently come up for the treatment of a variety of conditions. This article summarizes the history, evidence base and current use of thrombolytics in cardiovascular disease.
• Thompson, C. D., Vamenta, S., Acharya, D., & Chatterjee, A. (2018). Diuretic Strategies in Severely Ill Patients with Acute Decompensated Heart Failure. Journal of Cardiac Failure, 24(8), S52. doi:10.1016/j.cardfail.2018.07.152
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  Introduction Intravenous loop diuretics remain the mainstay of therapy for acute decompensated heart failure (ADHF); however, most physicians rely on clinical experience when choosing a diuretic strategy. Studies have compared continuous versus intermittent loop diuretic strategies, but few have looked at severely ill patients with acute kidney injury (AKI) or on inotropes. Our study aimed to determine the characteristics and outcomes of patients with ADHF receiving continuous versus intermittent loop diuretic strategies without excluding patients with renal failure or later requiring inotropes. Methods Using a retrospective cohort design, we included patients admitted to the University of Alabama at Birmingham Hospital for ADHF who received right heart catheterization from 2012 to 2017. Exclusion criteria included LVEF ≥ 40% and requiring inotropes prior to the index hospitalization. Measures of interest included 30- and 90-day readmissions, need for renal replacement therapy, length of stay, and in-hospital mortality. Continuous and categorical variables were analyzed using student's t-test and chi-square testing. A p-value ≤0.05 was considered significant. Results A total of 206 patients met inclusion criteria. Age, ethnicity, LVEF, type of cardiomyopathy, presence of severe valve disease and comorbidities were similar between patients receiving an intermittent versus continuous loop diuretic strategy. Patients who received a continuous loop diuretic strategy were more likely to be male (71.8% vs 54.5%, p = 0.01), have a higher BMI (32.9 vs 29.3, p = 0.004), have an AKI on admission (52.5% vs 35.1%, p = 0.02), and be on inotropes both pre- and post-RHC (77.6% vs 38.8%, p = Conclusion At our institution, patients receiving a continuous loop diuretic strategy were more likely to be male, have a higher BMI, have an AKI present on admission, and be placed on inotropes during their hospital stay. Patients with this strategy had a longer length of stay but no difference in 30- or 90-day readmissions. Because patients who received continuous loop diuretics were more likely to have acute renal failure and be on inotropes, it will be important to further assess this group's response to continuous versus intermittent loop diuretics as these patients were excluded from prior landmark trials.
• Chatterjee, A. (2017). Descending septal branch of right coronary artery: Rare, but important in hypertrophic cardiomyopathy. Cardiovascular Revascularization Medicine.
• Chatterjee, A., & Hillegass, W. (2017). Unprotected Left Main Disease and Percutaneous Intervention: A Prototype for Precision Medicine. Catheter Cardiovasc Interv, 89(1). doi:10.1002/ccd.26893
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  The SYNTAX Score based on angiographic findings is an actionable risk prediction model helping guide treatment for significant unprotected left main disease. Adding the clinical factor based EuroSCORE to SYNTAX improves outcome prediction for percutaneous coronary intervention of unprotected left main disease. Prediction models are an increasingly useful tool permitting cardiologists to optimize patient outcomes through “personalized” or precision medicine.
• Chatterjee, A., & Hillegass, W. B. (2017). Individualizing dual antiplatelet therapy duration: Prediction tools, genomics, and clinical judgment.. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 90(1), 38. doi:10.1002/ccd.27166
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  Prolonged dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) on average reduces the risk of subsequent myocardial infarction (MI) but increases major bleeds. Individualizing duration of DAPT based on the DAPT trial's net benefit prediction tool would likely optimize outcome beyond population average recommendations. Individualizing agent selection and duration of therapy based on genomic data may further improve outcomes. Clinical judgment remains the most important tool to tailor DAPT duration based on a large array of additional relevant factors not captured by predition rules or genomics.
• Chatterjee, A., & Hillegass, W. B. (2017). Length and pressure matter: Expediting evidence-based progress in femoropoliteal intervention.. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 89(7), 1257-1258. doi:10.1002/ccd.27131
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  Preprocedural lesion length and ankle-brachial indices (ABI) synergistically predict 12-month patency and repeat revacularization in claudicants treated with bare metal nitinol stents for femoropopliteal disease. This predictive length-ABI model will permit broader evidence-based indirect comparisons of newer femoropopliteal approaches such as drug eluting balloon treatment with or without atherectomy. The length-ABI model is a step to supplement and supplant randomized controlled trials with indirect comparisons as the necessary evidence source expediting innovation and optimizing personalized endovascular therapy for infrainguinal obstructive peripheral arterial disease.
• Chatterjee, A., & Leesar, M. A. (2017). No Wire Fracture Is Great News, But Is Polymer Shearing the Real Danger?. JACC. Cardiovascular interventions, 10(2), 203-204. doi:10.1016/j.jcin.2016.10.041
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  We read with great interest the paper by Pan et al. [(1)][1] investigating the safety of jailing polymeric versus nonpolymeric wires while treating coronary bifurcations. They are to be commended for conducting a randomized study regarding a quintessential question that many interventional
• Chatterjee, A., Bajaj, N. S., Mcmahon, W. S., Cribbs, M. G., White, J. S., Mukherjee, A., & Law, M. A. (2017). Transcatheter Pulmonary Valve Implantation: A Comprehensive Systematic Review and Meta-Analyses of Observational Studies.. Journal of the American Heart Association, 6(8). doi:10.1161/jaha.117.006432
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  Transcatheter pulmonary valve implantation is approved for the treatment of dysfunctional right ventricle to pulmonary artery conduits. However, the literature is limited because of a small patient population, and it does not reflect changing procedural practice patterns over the last decade..A comprehensive search of Medline and Scopus databases from inception through August 31, 2016 was conducted using predefined criteria. We included studies reporting transcatheter pulmonary valve implantation in at least 5 patients with a follow-up duration of 6 months or more. In 19 eligible studies, 1044 patients underwent transcatheter pulmonary valve implantation with a pooled follow-up of 2271 person-years. Procedural success rate was 96.2% (95% confidence intervals [CI], 94.6-97.4) with a conduit rupture rate of 4.1% (95% CI, 2.5-6.8) and coronary complication rate of 1.3% (95% CI, 0.7-2.3). Incidence of reintervention was 4.4 per 100 person-years overall (95% CI, 3.0-5.9) with a marked reduction in studies reporting ≥75% prestenting (2.9 per 100 person-years [95% CI, 1.5-4.3] versus 6.5/100 person-years [95% CI, 4.6-8.5]; P
• Chatterjee, A., Bhatia, N., Agarwal, M., Leesar, M., Sasse, M., Agrawal, S., Mohananey, D., Law, M. A., & Watts, T. E. (2017). TCT-450 Procedural Outcomes of Balloon Valvuloplasty in patients with Bicuspid Aortic valve stenosis: Insights from a National Database. Journal of the American College of Cardiology, 70(18), B185. doi:10.1016/j.jacc.2017.09.558
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  Balloon valvuloplasty (BV) is commonly performed for young adults with bicuspid aortic valves and aortic stenosis. However there is paucity of data regarding safety and feasibility of same. We analyzed the National Inpatient Sample (NIS) database from 2003 to 2014 and compared clinical
• Chatterjee, A., Bhatia, N., Agarwal, M., Mohananey, D., Agrawal, S., Mukherjee, A., Cribbs, M. G., & Law, M. A. (2017). TCT-856 Comparative initial cost and length of stay for transcatheter and surgical Pulmonic valve replacement: insights from a National Database. Journal of the American College of Cardiology, 70(18), B272-B273. doi:10.1016/j.jacc.2017.09.683
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  Volume of Transcatheter pulmonic valve replacement (TPVR) is rising in the United States. We thus aimed to compare theoretical advantages of transcatheter therapy versus surgical pulmonic valve replacement (SPVR) vis-a-vis length of stay and cost using a large national database. We analyzed the
• Chatterjee, A., Cribbs, M. G., & Law, M. A. (2017). Trans-septal approach for percutaneous closure of infra-diaphragmatic veno-venous collateral in a patient after Fontan palliation.. Cardiology in the young, 27(7), 1413-1415. doi:10.1017/s1047951117000476
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  In this article, we present a case of a desaturated Fontan patient with an infra-diaphragmatic venous collateral to the pulmonary vein, which was too tortuous to attempt closure at the source. A trans-septal approach was successfully used to close the collateral in a retrograde manner.
• Chatterjee, A., Cribbs, M., & Law, M. (2017). Trans-septal approach for percutaneous closure of infra-diaphragmatic veno-venous collateral in a patient after Fontan palliation. Cardiol Young, 27(7). doi:10.1017/S1047951117000476
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  In this article, we present a case of a desaturated Fontan patient with an infra-diaphragmatic venous collateral to the pulmonary vein, which was too tortuous to attempt closure at the source. A trans-septal approach was successfully used to close the collateral in a retrograde manner.
• Chatterjee, A., White, J. S., & Leesar, M. A. (2017). Management of radial artery perforation during transradial catheterization using a polytetrafluoroethylene-covered coronary stent.. Cardiovascular revascularization medicine : including molecular interventions, 18(2), 133-135. doi:10.1016/j.carrev.2016.08.002
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  An 88-year-old woman underwent attempted percutaneous coronary intervention (PCI) through a right radial approach. Catheterization was complicated by radial artery perforation. Conservative therapeutic options including external compression, advancement of a diagnostic catheter distal to the perforation, and balloon tamponade failed to control the bleeding requiring deployment of a Polytetrafluoroethylene (PTFE)-covered stent to seal the perforation. We describe the stepwise approach advocated for managing a radial perforation and summarize relevant literature available for the same.
• Chatterjee, A., White, J. S., Hashim, T., & Leesar, M. A. (2017). Jailing polymer jacketed guide-wires during bifurcation coronary interventions is associated with procedural myocardial infarction.. World journal of cardiology, 9(5), 442-447. doi:10.4330/wjc.v9.i5.442
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  To study the relationship of jailed polymer jacketed guide wires (PGW) with procedural myocardial infarction (PMI) after bifurcation coronary interventions..Consecutive bifurcation interventions performed from January 2010 to October 2014 were included in the study. Chart review was performed to obtain demographic, clinical and procedural data. PMI was defined as Creatine Kinase MB > 3 × upper reference limit of normal. Multivariate logistic regression was used to ascertain relationship of PGW use with PMI..Two hundred and ninety-three patients (age 63.5 ± 12.3 years; 33.8% diabetic) were included in the study. Eighty point two percent (n = 235) were true bifurcation lesions use of PGW was associated with PMI on univariate analysis (OR = 4.1; P = 0.002). This association remained significant after adjusting for other possible risk factors (OR = 3.5; P = 0.02)..Our results suggest that PGW use for side branch protection may be associated with PMI. Randomized studies are needed to validate these findings.
• Davis, J. W., Almubarak, M., Mcelwee, S. K., Mukherjee, A., Al-solaiman, F., Sasse, M., Leesar, M. A., & Chatterjee, A. (2017). Abstract P136: Ischemic Evaluation in Patients With Hypertensive Emergency / Urgency and Acute Systolic Heart Failure: Is Coronary Angiography Required for All?. Hypertension, 70.
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  Aim: Patients presenting with hypertensive urgency / emergency (HU/E) often have systolic heart failure(S-HF). Coronary angiography is routinely done for these patients to rule out obstructive coronary artery disease (O-CAD). We performed a retrospective study to investigate predictors of O-CAD in this population. Methods: Consecutive patients who underwent angiography to investigate S-HF and had hospital admissions for HU/E in the preceding 6 months were included in the study. Chart review was performed to obtain demographic, clinical and imaging / angiographic data. Statistical analysis was performed using SAS 9.4 software. Results: 205 patients [age 58.9 ± 14.4 years; 62.4 % male; 39.5% diabetic; median EF 25% (Inter Quartile Range: 11)] were included in the study. 33.1% patients (n=68) had O-CAD. Age > 60 years (Odds Ratio: 2.3; 95% Confidence intervals: 1.3-4.3) , Diabetes (OR: 2.1; 95% CI: 1.2-3.8), history of stroke (OR: 2.7; 95% CI: 1.1-7.0) and presence of regional wall motion abnormalities (RWMA; OR: 7.4; 95% CI: 3.4-16.1) and abnormal perfusion study (OR: 7.6; 95% CI: 1.5-39.6) were significantly associated with O-CAD while African American (AA) race was a protective factor (OR: 0.4; 95% CI: 0.2-0.8). ROC curves constructed using an age cut off of 60 years along with non AA race, diabetes and RWMA yielded a good fit with a c statistic of 0.75. Conclusions: Our results suggest that only a minority of patients with HU/E and S-HF have obstructive CAD. It may be possible to stratify patients using demographic and non-invasive tests to direct only those with high likelihood of O-CAD for coronary angiography. These results should be validated in large registry populations.
• Hakim, D., Chatterjee, A., Alli, O., Turner, J., Sattar, A., Foin, N., & Leesar, M. (2017). Role of Proximal Optimization Technique Guided by Intravascular Ultrasound on Stent Expansion, Stent Symmetry Index, and Side-Branch Hemodynamics in Patients with Coronary Bifurcation Lesions. Circ Cardiovasc Interv, 10(10). doi:10.1161/CIRCINTERVENTIONS.117.005535
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  Background-Bench models of coronary bifurcation lesions demonstrated that the proximal optimization technique (POT) expanded the stent and opened the side branch (SB). We investigated the role of POT guided by intravascular ultrasound on the main vessel (MV) stent expansion and SB fractional flow reserve (FFR) in patients with coronary bifurcation lesion. Methods and Results-In 40 patients with coronary bifurcation lesion, 120 intravascular ultrasound examinations of the MV were performed at baseline, after MV stenting, and POT followed by 95 FFR measurements of the SB. In the proximal stent segment, stent volume index and minimum stent area were larger after POT versus MV stenting (9.2±3.4 versus 7.40±2.0 mm3/mm and 7.65±1.8 versus 6.38±1.7 mm2, respectively; P
• Hakim, D., Chatterjee, A., Alli, O., Turner, J., Sattar, A., Foin, N., & Leesar, M. A. (2017). Role of Proximal Optimization Technique Guided by Intravascular Ultrasound on Stent Expansion, Stent Symmetry Index, and Side-Branch Hemodynamics in Patients With Coronary Bifurcation Lesions.. Circulation. Cardiovascular interventions, 10(10). doi:10.1161/circinterventions.117.005535
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  Bench models of coronary bifurcation lesions demonstrated that the proximal optimization technique (POT) expanded the stent and opened the side branch (SB). We investigated the role of POT guided by intravascular ultrasound on the main vessel (MV) stent expansion and SB fractional flow reserve (FFR) in patients with coronary bifurcation lesion..In 40 patients with coronary bifurcation lesion, 120 intravascular ultrasound examinations of the MV were performed at baseline, after MV stenting, and POT followed by 95 FFR measurements of the SB. In the proximal stent segment, stent volume index and minimum stent area were larger after POT versus MV stenting (9.2±3.4 versus 7.40±2.0 mm3/mm and 7.65±1.8 versus 6.38±1.7 mm2, respectively; P
• Joly, J. M., Chatterjee, A., Cribbs, M. G., & Law, M. A. (2017). EXERTIONAL HYPOXEMIA IN LEVO-TRANSPOSITION OF THE GREAT ARTERIES (L-TGA) AND PULMONARY STENOSIS DUE TO PULMONARY ARTERY CONDUIT STENOSIS AND ATRIAL SEPTAL DEFECT. Journal of the American College of Cardiology, 69(11), 2218. doi:10.1016/s0735-1097(17)35607-3
• Joly, J. M., El-dabh, A., Marshell, R., Chatterjee, A., Smith, M. G., Tresler, M., Kirklin, J. K., Acharya, D., Rajapreyar, I. N., Tallaj, J. A., & Pamboukian, S. V. (2017). (1286) – Dissecting the INTERMACS Definition of Right Heart Failure: Can We Really Predict Central Venous Pressure?. Journal of Heart and Lung Transplantation, 36(4), S418-S419. doi:10.1016/j.healun.2017.01.1198
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  Right heart failure (RHF) after left ventricular assist device (LVAD) is associated with adverse events and poor outcomes. INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) defines RHF as elevated right atrial pressure (RAP) >16 mmHg measured directly by right heart catheterization (RHC) or indirectly by jugular venous distension or dilated inferior vena cava (Criterion 1), plus clinical or laboratory evidence of venous congestion (Criterion 2). The purpose of this study was to examine how noninvasive diagnosis of RHF by INTERMACS criteria correlated with direct measurement of RAP by RHC.
• Chatterjee, A., Brott, B., Foley, R., Alli, O., Sasse, M., Ahmed, M., Al Solaiman, F., Reddy, G., Ather, S., & Leesar, M. (2016). Safety of hydrophilic guidewires used for side-branch protection during stenting and proximal optimization technique in coronary bifurcation lesions. Cardiovasc Revasc Med, 17(7). doi:10.1016/j.carrev.2016.04.006
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  Background and propose In coronary bifurcation lesions (CBL), hydrophilic guidewires used for side-branch (SB) protection can be withdrawn from underneath the stent easier than other wires. However, the safety of which has not been investigated. Methods/materials We performed scanning electron microscopic (SEM) examination of hydrophilic wires – the Whisper and Runthrough wires – used for SB protection during stenting and proximal optimization technique (POT) in 30 patients with CBL. The distal 15 cm of the wire was examined every 1 mm by SEM and 4500 segments were analyzed to investigate for wire fracture, polymer shearing (PS), and its correlations with post-stenting creatine kinase (CK)-MB release. Results SEM examination showed no evidence for wire fracture. The total area of PS and the largest defect on the wire were significantly larger with the Whisper wire versus the Runthrough wire (0.15 ± 0.04 mm2 vs. 0.026 ± 0.01 mm2 and 0.04 ± 0.05 mm2 vs. 0.01 ± 0.01 mm2; P < 0.05, respectively). The total length of PS and the longest defect on the wire were significantly longer with the Whisper wire vs. the Runthrough wire (12.1 ± 14.5 mm vs. 2.7 ± 3.0 mm and 2.9 ± 4.2 mm vs. 1.0 ± 1.2 mm; P < 0.05, respectively), but there were weak correlations between the extents of PS with CK-MB release. Conclusions Hydrophilic guidewires may be safely used for SB protection during stenting and POT in CBLs. The extent of PS was significantly greater with the Whisper wire than with the Runthrough wire, but its correlation with post-stenting CK-MB release was weak.
• Chatterjee, A., Leesar, M., Bajaj, N. S., & White, J. S. (2016). JAILED POLYMER JACKETED GUIDE WIRE PREDICTS PROCEDURAL MYOCARDIAL INFARCTION AFTER BIFURCATION CORONARY INTERVENTION. Journal of the American College of Cardiology, 67(13), 113. doi:10.1016/s0735-1097(16)30114-0
• Chatterjee, A., White, J. S., Davies, J. E., & Tuck, B. C. (2016). Salmonella enteritidis Mycotic Aneurysm of Stented Saphenous Vein Graft to Coronary Artery.. JACC. Cardiovascular interventions, 9(22), e219-e220. doi:10.1016/j.jcin.2016.08.046
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  A 67-year-old man with a history of hypertension and coronary artery disease (requiring aortocoronary bypass 18 years ago and multiple percutaneous coronary interventions) presented to a referring hospital with chief symptoms of fever, chills, and diaphoresis after a recent gastrointestinal illness
• Joly, J. M., El-dabh, A., Brown, R. N., Kirklin, J. K., Marshell, R., Chatterjee, A., Smith, M., Tresler, M., Tallaj, J. A., Acharya, D., & Pamboukian, S. V. (2016). Abstract 17042: Unique Hemodynamic Parameters Predict GI Bleeding in Patients With Continuous Flow Ventricular Assist Devices. Circulation, 134.
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  Introduction: Gastrointestinal (GI) bleeding remains a major morbid event during continuous flow left ventricular assist device (LVAD) support. Hypothesis: This study investigated whether a common ...
• Chatterjee, A., & Hage, F. G. (2015). Guidelines in review: 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines.. Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology, 22(1), 158-61. doi:10.1007/s12350-014-9992-3
• Reddy, G., Chatterjee, A., & Brott, B. (2015). Transdiaphragmatic rupture of hepatic abscess producing purulent pericarditis and pericardial tamponade. Circulation, 131(1). doi:10.1161/CIRCULATIONAHA.114.012078
• Reddy, G., Chatterjee, A., & Leon, K. (2015). Left atrial mural endocarditis secondary to mitral valve jet lesion.. Circulation, 131(17), 1529-30. doi:10.1161/circulationaha.115.015626
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  A 38-year-old woman with Down syndrome and mitral valve prolapse presented with 2 weeks of fever and cough. She had presented to an outpatient clinic 1 week earlier and was prescribed empirical antibiotics for a suspected respiratory tract infection. Despite this therapy, she continued to have high spiking fevers and developed a fulminant rash, prompting emergent admission for further evaluation. She had previously been healthy without other risk factors for infective endocarditis. On admission to the intensive care unit, she was febrile, confused, tachycardic, and hypotensive. Examination showed peripheral signs of septic embolization, including Janeway lesions (Figure, A), splinter hemorrhages (Figure, B), Osler nodes (Figure, C), and conjunctival petechiae (Figure, D). An IV/VI plateau–shaped holosystolic murmur was heard in the mitral area with radiation to the axilla. Laboratory studies revealed neutrophilic leukocytosis and lactic acidosis. Transthoracic echocardiography showed myxomatous morphology of the mitral valve with holosystolic prolapse of the anterior mitral leaflet (Figure, E and Movie I in the online-only Data Supplement). Color-flow Doppler showed severe eccentric mitral regurgitation with a posteriorly directed regurgitant jet (Figure, F and Movie II in the online-only Data Supplement). Jet velocities in excess of 4 …
• Chatterjee, A., Doppalapudi, H., Lau, Y. R., Yamada, T., Mcelderry, H. T., Plumb, V. J., & Kay, G. N. (2013). Abstract 14217: Long Term Efficacy of Atrial Based Pacing and Beta Blocker Therapy to Prevent Sudden Cardiac Death in Congenital Long Qt Syndrome. Circulation, 128.
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  Introduction: Conflicting data exists for congenital long QT syndrome (LQTS) treated with a combination of beta blockade and continuous pacing. High risk patients are usually treated with an implantable cardiac defibrillator (ICD) exposing them to the risk of inappropriate shocks and potentially more frequent generator replacements. Appropriate therapy also has been shown to trigger ICD storm in many cases due to increased sympathetic discharge. We sought to examine the outcome of a cohort of patients at our institution treated with the combination of a beta blocker and atrial based pacing at a higher rate than previously described. Methods: The long term clinical course of patients with LQTS treated with beta blockers and atrial pacing were examined to identify recurrent syncope, cardiac arrest, sudden cardiac death or the need to upgrade to a defibrillator. Results: A total of 30 patients with LQTS (age 26.8 ± 21.3 years; 21 females) were identified with varying presentations - syncope (n=16); torsade de pointes (n=7); cardiac arrest (n=6); family history (n=1). All patients had a pacemaker implanted and arrhythmia diagnostics turned on. Lower rate was set to a mean of 89 ± 9 bpm [ ≥ 90 (n=20); ≥80 (n=9); 70 (n=1)]. 21 patients were programmed in the AAI mode, with the rest in the DDD (n=6) or DDI (n=3) modes. Over a mean follow up of 9.7 ± 6.6 years, no patient had recurrent syncope, cardiac arrest or sudden cardiac death. None of the patients required upgrade to an ICD. 4 patients died during follow up from known unrelated causes. Conclusion: A combination of beta blocker therapy and atrial based pacing at a high rate is highly effective in preventing sudden death in patients with congenital LQTS. This approach may be particularly beneficial in the young population, in whom, implantation of a pacemaker rather than an ICD may enhance device longevity and avoid inappropriate ICD therapies.
• Bolli, R., Chugh, A. R., Domenico, D., Loughran, J. H., Stoddard, M. F., Ikram, S., Wagner, S. G., Beache, G. M., Leri, A., Hosoda, T., Goihberg, P., Fiorini, C., Solankhi, N., Fahsah, I., Chatterjee, A., Elmore, J. B., Rokosh, D. G., Slaughter, M. S., Kajstura, J., & Anversa, P. (2011). Abstract 15571: Effect of Cardiac Stem Cells in Patients with Ischemic Cardiomyopathy: Interim Results of the SCIPIO Trial. Circulation, 124.
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  The heart contains c-kit+, lineage- cardiac stem cells (CSCs). Although CSCs improve postinfarction LV dysfunction in animals, their efficacy in humans is unknown. In February 2009, we began SCIPIO...
• He, J., Vu, D. M., Loughran, J. H., Chatterjee, A., Taimeh, Z., Bhatnagar, A., & Bolli, R. (2011). Abstract 11094: Cardiac Endothelial Progenitor Cells Isolated from Human Atrial Appendages Demonstrate Biological and Functional Properties Typical of Endothelial Cells. Circulation, 124.
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  Background: The number of circulating endothelial progenitor cells (EPCs) typically positive for CD34/KDR has been reported to be inversely related to cardiovascular mortality. However, it is unkno...
• Bolli, R., Chugh, A., D'Amario, D., Stoddard, M., Ikram, S., Wagner, S., Beache, G., Leri, A., Hosoda, T., Loughran, J., Goihberg, P., Fiorini, C., Solankhi, N., Fahsah, I., Chatterjee, A., Elmore, J., Rokosh, D., Slaughter, M., Kajstura, J., & Anversa, P. (2010). Late-breaking basic science abstracts from the American Heart Association's Scientific Sessions 2010. Circulation Research, 107(12). doi:10.1161/RES.0b013e3182014899
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  Background: Studies in transgenic mice showed the key role of moloney murine leukemia virus 1 (Pim-1) in the control of cardiomyocyte function and viability. Objective: To investigate if Pim-1 is a therapeutic target for the cure of diabetic cardiomyopathy (DCM), a steadily increasing cause of non-ischemic heart failure. Methods and Results: Western blot analysis on hearts of streptozotocin-induced type-1 (T1D) mice showed a time-dependent reduction in Pim-1 (8-fold at 20 wks from T1D induction), a parallel decline in the Pim-1 activators STAT-3 (6-fold) and Akt (7-fold) and an increase of the Pim-1 direct inhibitor miR-1 (6-fold) (P 0.01 vs. age-matched non-diabetic (ND) mice for all comparisons). Moreover, diabetic hearts showed low levels of anti-apoptotic Bcl-2, high levels of pro-apoptotic Bad and increased caspase 3/7 activity (P

Presentations

• Seckeler, M., Chatterjee, A., Hoyer, A., Caryl, N., Meziab, O., & Chandra, S. (2023, May). 3D printing of patient-specific intravascular stents for congenital heart disease – proof of concept. The Society for Cardiovascular Angiography and Interventions 2023 Scientific Sessions. Phoenix, Arizona.
• Seckeler, M., Chatterjee, A., Meziab, O., Camarena, M., Chandra, S., Yaddanapudi, K., Hoyer, A., & Caryl, N. (2023, May). Not every TIA is a PFO – the importance of other shunts. The Society for Cardiovascular Angiography and Interventions 2023 Scientific Sessions. Phoenix, Arizona.
• Habib, N., Sher, A., Tandon, S., Kubba, S., Insel, M., Chatterjee, A., Seckeler, M., & Rischard, F. (2022, May). To Drain or Not to Drain: Hemodynamic Charcterization of Tamponade in Pulmonary Arterial Hypertension. American Thoracic Society 2022. San Francisco, CA.