Steven P Sedlis, M.D.

Comparison of quantity of left ventricular scarring and remodeling by magnetic resonance imaging in patients with versus without diabetes mellitus and with coronary artery disease
Donnino, Robert; Patel, Sajan; Nguyen, Andrew H; Sedlis, Steven P; Babb, James S; Schwartzbard, Arthur; Katz, Stuart D; Srichai, Monvadi B
2011 Jun 1;107(11):1575-1578, American journal of cardiology
Diabetic patients with coronary artery disease (CAD) are more likely to develop heart failure (HF) than nondiabetic patients, but the mechanism responsible is unclear. Evidence suggests that infarct size and accompanying remodeling may not explain this difference. We used cardiac magnetic resonance (CMR) imaging to compare degree of left ventricular (LV) myocardial scar and remodeling in diabetic and nondiabetic patients with CAD. We evaluated 85 patients (39 diabetic, 46 nondiabetic) who underwent coronary angiography showing obstructive CAD and CMR imaging within 6 months of each other. Myocardial scar was measured by late gadolinium enhancement on CMR imaging and was graded according to spatial and transmural extents on a semiquantitative scale. More diabetic than nondiabetic patients had HF (69% vs 43%, p <0.03); however, groups did not differ in total scar burden (0.94 +/- 0.60 vs 1.17 +/- 0.74, p = NS), spatial extent of scar, or extent of transmural scar. Diabetes remained an independent predictor of HF after adjustment for CAD and other variables. LV ejection fraction (36 +/- 12% vs 37 +/- 14%, p = NS) and end-diastolic volume (215 +/- 56 vs 217 +/- 76 ml, p = NS) were similar for diabetic and nondiabetic patients, respectively. In conclusion, although diabetic patients with CAD had a higher prevalence of HF than nondiabetic patients, there was no difference in myocardial scar, LV volume, or LV ejection fraction. These findings support the theory that mechanisms other than extent of myocardial injury and negative remodeling play a significant role in the development of HF in diabetic patients with CAD
— id: 132572, year: 2011, vol: 107, page: 1575, stat: Journal Article,

Impact of Metabolic Syndrome and Diabetes on Prognosis and Outcomes With Early Percutaneous Coronary Intervention in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) Trial
Maron, David J.; Boden, William E.; Spertus, John A.; Hartigan, Pamela M.; Mancini, G. B. John; Sedlis, Steven P.; Kostuk, William J.; Chaitman, Bernard R.; Shaw, Leslee J.; Berman, Daniel S.; Dada, Marcin; Teo, Koon K.; Weintraub, William S.; O'Rourke, Robert A.
2011 JUL 5 ;58(2):131-137, Journal of the American College of Cardiology
Objectives Our purpose was to clarify the clinical utility of identifying metabolic syndrome (MetS) in patients with coronary artery disease (CAD). Background It is uncertain whether MetS influences prognosis in patients with CAD and whether the risk associated with MetS exceeds the risk associated with the sum of its individual components. Methods In a post hoc analysis, we compared the incidence of death or myocardial infarction (MI) in stable CAD patients in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial according to the presence (+) or absence (-) of MetS and diabetes: Group A, -MetS/-diabetes; Group B, +MetS/-diabetes; Group C, -MetS/+diabetes; and Group D, +MetS/+diabetes. We explored which MetS components best predicted adverse outcomes and whether MetS had independent prognostic significance beyond its individual components. Results Of 2,248 patients, 61% had MetS and 34% diabetes. Risk for death or MI increased from Group A (14%) to Group D (25%, p < 0.001). Hypertension (hazard ratio [HR]: 1.30; 95% confidence interval [CI]: 0.98 to 1.71; p = 0.07), low high-density lipoprotein cholesterol (
— id: 135205, year: 2011, vol: 58, page: 131, stat: Journal Article,

Moderate doses of hGH (0.64 mg/d) improve lipids but not cardiovascular function in GH-deficient adults with normal baseline cardiac function
Newman, Connie B; Frisch, Katalin A; Rosenzweig, Barry; Roubenoff, Ronenn; Rey, Mariano; Kidder, Teresa; Kong, Yuan; Pursnani, Amit; Sedlis, Steven P; Schwartzbard, Arthur; Kleinberg, David L
2011 Jan;96(1):122-132, Journal of clinical endocrinology & metabolism
CONTEXT: Data regarding effects of lower-dose GH on cardiopulmonary function in GH-deficient (GHD) adults are limited. OBJECTIVES: The objective was to assess effects of lower-dose GH on exercise capacity and echocardiographic parameters in GHD adults. DESIGN: The study was a 6-month double-blind, placebo-controlled randomized trial. SETTING: The study was conducted at the General Clinical Research Center. PARTICIPANTS: Thirty hypopituitary adults with GHD were studied. INTERVENTION: Subjects were randomized to recombinant human GH or placebo for 6 months, followed by open-label recombinant human GH for 12 months. MAIN OUTCOME MEASURES: Primary endpoints were exercise duration, maximal oxygen consumption, and left ventricular ejection fraction. Secondary endpoints were echocardiographic indices of systolic and diastolic function, left ventricular mass, lipids, and body composition. RESULTS: In the 6-month double-blind phase, mean GH dose was 0.64 mg/d. Mean IGF-I sd score increased from -4.5 to -1.0. Exercise duration, maximal oxygen consumption, left ventricular ejection fraction, and other echocardiographic parameters were normal at baseline and did not change. GH decreased total and low-density lipoprotein cholesterol by 7.5% (P = 0.016) and 14.7% (P = 0.002) (P = 0.04 vs. placebo). Mean lean body mass increased by 2.2 kg (P = 0.004), fat mass decreased by 1.7 kg (P = 0.21), and percent body fat decreased by 2.5% (P = 0.018), although between-group changes were not significant. CONCLUSIONS: Human GH did not improve exercise performance or echocardiographic parameters or decrease fat mass but significantly decreased total and low-density lipoprotein cholesterol, increased IGF-I, and increased lean body mass. These results indicate that responses to human GH are variable and should be assessed at baseline and during treatment
— id: 138237, year: 2011, vol: 96, page: 122, stat: Journal Article,

Predictors of oxidative stress in heart failure patients with Cheyne-Stokes respiration
Krieger AC; Green D; Cruz MT; Modersitzki F; Yitta G; Jelic S; Tse DS; Sedlis SP
2010 Dec;15(4):827-835, Sleep & breathing = Schlaf & Atmung
PURPOSE: Cheyne-Stokes respiration during sleep is associated with increased mortality in heart failure. The magnitude of oxidative stress is a marker of disease severity and a valuable predictor of mortality in heart failure. Increased oxidative stress associated with periodic breathing during Cheyne-Stokes respiration may mediate increased mortality in these patients. We hypothesized that the presence of Cheyne-Stokes respiration is associated with oxidative stress by increasing the formation of reactive oxygen species in patients with heart failure. METHODS AND RESULTS: Twenty-three patients with heart failure [left ventricular ejection fraction 30.2 +/- 9% (mean +/- standard deviation)] and 11 healthy controls underwent nocturnal polysomnography. Subjects with obstructive sleep apnea were excluded. The majority (88%) of patients with heart failure had Cheyne-Stokes respiration during sleep. The intensity of oxidative stress in neutrophils was greater in patients with heart failure (4,218 +/- 1,706 mean fluorescence intensity/cell vs. 1,003 +/- 348 for controls, p < 0.001) and correlated with the duration of Cheyne-Stokes respiration. Oxidative stress was negatively correlated with SaO(2) nadir during sleep (r = -0.43, p = 0.039). The duration of Cheyne-Stokes respiration predicted severity of oxidative stress in patients with heart failure (beta = 483 mean fluorescence intensity/cell, p < 0.02). CONCLUSIONS: Levels of oxidative stress are increased in patients with heart failure and Cheyne-Stokes respiration during sleep compared with healthy controls. The duration of Cheyne-Stokes respiration predicts the magnitude of oxidative stress in heart failure. Increased oxidative stress may mediate increased mortality associated with Cheyne-Stokes respiration in patients with heart failure
— id: 138127, year: 2010, vol: 15, page: 827, stat: Journal Article,

Intensive multifactorial intervention for stable coronary artery disease: optimal medical therapy in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial
Maron, David J; Boden, William E; O'Rourke, Robert A; Hartigan, Pamela M; Calfas, Karen J; Mancini, G B John; Spertus, John A; Dada, Marcin; Kostuk, William J; Knudtson, Merril; Harris, Crystal L; Sedlis, Steven P; Zoble, Robert G; Title, Lawrence M; Gosselin, Gilbert; Nawaz, Shah; Gau, Gerald T; Blaustein, Alvin S; Bates, Eric R; Shaw, Leslee J; Berman, Daniel S; Chaitman, Bernard R; Weintraub, William S; Teo, Koon K
2010 Mar 30;55(13):1348-1358, Journal of the American College of Cardiology
OBJECTIVES: This paper describes the medical therapy used in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial and its effect on risk factors. BACKGROUND: Most cardiovascular clinical trials test a single intervention. The COURAGE trial tested multiple lifestyle and pharmacologic interventions (optimal medical therapy) with or without percutaneous coronary intervention in patients with stable coronary disease. METHODS: All patients, regardless of treatment assignment, received equivalent lifestyle and pharmacologic interventions for secondary prevention. Most medications were provided at no cost. Therapy was administered by nurse case managers according to protocols designed to achieve predefined lifestyle and risk factor goals. RESULTS: The patients (n = 2,287) were followed for 4.6 years. There were no significant differences between treatment groups in proportion of patients achieving therapeutic goals. The proportion of smokers decreased from 23% to 19% (p = 0.025), those who reported <7% of calories from saturated fat increased from 46% to 80% (p < 0.001), and those who walked >or=150 min/week increased from 58% to 66% (p < 0.001). Body mass index increased from 28.8 +/- 0.13 kg/m(2) to 29.3 +/- 0.23 kg/m(2) (p < 0.001). Appropriate medication use increased from pre-randomization to 5 years as follows: antiplatelets 87% to 96%; beta-blockers 69% to 85%; renin-angiotensin-aldosterone system inhibitors 46% to 72%; and statins 64% to 93%. Systolic blood pressure decreased from a median of 131 +/- 0.49 mm Hg to 123 +/- 0.88 mm Hg. Low-density lipoprotein cholesterol decreased from a median of 101 +/- 0.83 mg/dl to 72 +/- 0.88 mg/dl. CONCLUSIONS: Secondary prevention was applied equally and intensively to both treatment groups in the COURAGE trial by nurse case managers with treatment protocols and resulted in significant improvement in risk factors. Optimal medical therapy in the COURAGE trial provides an effective model for secondary prevention among patients with chronic coronary disease. (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation; NCT00007657)
— id: 114780, year: 2010, vol: 55, page: 1348, stat: Journal Article,

Very long-term clinical follow-up after fractional flow re serve-guided coronary revascularization
Miller L.H.; Rauch J.; Toklu B.; Lorin J.; Sedlis S.
2010 ;56(13 SUPPL 1):B96-B96, Journal of the American College of Cardiology
Background: Studies using measurement of coronary fractional flow reserve (FFR) to guide percutaneous coronary intervention have demonstrated both safety and efficacy with regard to cardiac events. Real-world, long-term outcomes using an FFR-based revascularization strategy are unknown. Methods: The rates of death and target lesion revascularization (TLR) were determined in 151 consecutive patients who had FFR measurements done on coronary lesions of intermediate severity from January 1, 2000 to December 31, 2005. The mean length of follow-up was 5.9 years. Follow-up was complete in 98.0%. Revascularization was deferred on all lesions with FFR > 0.8 and selectively with FFR >75 and < 80. Revascularization of the index lesion was performed in 37.1% of the patients. Results: TLR occurred in 11.9% of the cohort. TLRrates were similar whether revascularization was initially done or deferred (12.5 and 11.6%, respectively). Overall survival was 69.5%. Survival was 64.3% in patients who underwent initial revascularization compared to 72.6% of patients in whom revascularization was deferred. Conclusions: The real world long-term outcomes of an FFR guided strategy to select patients with coronary lesions of intermediate angiographic severity in whom coronary revascularization may be deferred are similar to the short-term outcomes reported in trials, without excess risk of death or TLR for up to ten years
— id: 113820, year: 2010, vol: 56, page: B96, stat: Journal Article,

Percutaneous revascularization for stable coronary artery disease: temporal trends and impact of drug-eluting stents
Sedlis, Steven P; Boden, William E
2010 May;3(5):566-566, JACC: Cardiovascular Interventions
— id: 114779, year: 2010, vol: 3, page: 566, stat: Journal Article,

Glycemic control in the cardiac catheterization laboratory
Shah B.; Willner J.; Lorin J.; Sedlis S.
2010 ;75:S118-S119, Catheterization & cardiovascular interventions
Background: Elevated periprocedural blood glucose is associated with increased mortality in percutaneous coronary intervention (PCI) patients regardless of diabetic status (Am Heart J 2003;146:351-358; Am J Cardiol 2005;96:543-546) and predicts renal and myocardial injury as well as target vessel revascularization in patients with diabetes mellitus (DM) undergoing PCI (Am J Cardiol 2004;94:1027-1029; JACC 2004;43:8-14). Strategies to safely achieve periprocedural glycemic control in the cardiac catheterization laboratory have not been systematically evaluated. Therefore, we performed an IRB approved pilot trial comparing the strategies of continuing versus holding prescribed long-acting hypoglycemic medications in patients with DM undergoing coronary angiography and possible PCI. Methods: Patients were randomly assigned to continue (n = 17) or hold (n = 18) their prescribed long-acting hypoglycemic medications. Patients scheduled for an afternoon procedure were encouraged to have a light morning snack. Blood glucose was assessed at the time of vascular access in the cardiac catheterization laboratory by nurses trained to use a glucometer. Hypoglycemia was defined as blood glucose <50 mg/ dL without symptoms or blood glucose <75 mg/dL with symptoms relieved by glucose supplementation. Data are expressed as mean + SD and significance assessed by t test. Results: Glucose was 137.8 + 57.4 in the continue medication group and 160.1 + 69.6 in the hold medication group (p = 0.3). There was 1 asymptomatic hypoglycemic event in the continue medication group (glucose = 43) that was corrected with intravenous glucose supplementation and no hypoglycemic events in the hold hypoglycemic medication group. Conclusions: In a setting where blood glucose levels are closely monitored, a strategy of routinely continuing long-acting hypoglycemic medications prior to coronary angiography may help achieve euglycemia during coronary angiography and PCI and appears safe. A larger trial with clinically significant endpoints is warranted
— id: 122551, year: 2010, vol: 75, page: S118, stat: Journal Article,

Impact of optimal medical therapy with or without percutaneous coronary intervention on long-term cardiovascular end points in patients with stable coronary artery disease (from the COURAGE Trial)
Boden, William E; O'Rourke, Robert A; Teo, Koon K; Maron, David J; Hartigan, Pamela M; Sedlis, Steven P; Dada, Marcin; Labedi, Mohammed; Spertus, John A; Kostuk, William J; Berman, Daniel S; Shaw, Leslee J; Chaitman, Bernard R; Mancini, G B John; Weintraub, William S
2009 Jul 1;104(1):1-4, American journal of cardiology
The main results of the Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation (COURAGE) trial revealed no significant differences in the primary end point of all-cause mortality or nonfatal myocardial infarction [MI] or major secondary end points (composites of death/MI/stroke; hospitalization for acute coronary syndromes [ACSs]) during a median 4.6-year follow-up in 2,287 patients with stable coronary artery disease randomized to optimal medical therapy (OMT) with or without percutaneous coronary intervention (PCI). We sought to assess the impact of PCI when added to OMT on major prespecified tertiary cardiovascular outcomes (time to first event), namely cardiac death and composites of cardiac death/MI, cardiac death/MI/hospitalization for ACS, cardiac death/MI/stroke, MI/stroke, or cardiac death/MI/ACS/stroke, during study follow-up. There were no significant differences between treatment arms for the composite of cardiac death or MI (15% in PCI + OMT group vs 14.2% in OMT group, hazard ratio 1.07, 95% confidence interval 0.86 to 1.33, p = 0.62) or in any of the major prespecified composite cardiovascular events during long-term follow-up, even after excluding periprocedural MI as an outcome of interest. Overall, cause-specific cardiovascular outcomes paralleled closely the primary and secondary composite outcomes of the trial as a whole. In conclusion, compared with an initial management strategy of OMT alone, addition of PCI did not decrease the incidence of major cardiovascular outcomes including cardiac death or the composite of cardiac death/MI/ACS/stroke in patients with stable coronary artery disease
— id: 114784, year: 2009, vol: 104, page: 1, stat: Journal Article,

Nonischemic cardiomyopathy related to pegylated interferon and ribavirin
Choy-Shan, Alana; Berezovskaya, Sabina; Zinn, Andrew; Sedlis, Steven P; Bini, Edmund J
2009 Dec;21(12):1438-1440, European journal of gastroenterology & hepatology
— id: 108197, year: 2009, vol: 21, page: 1438, stat: Journal Article,

Cardiac Events Predicted by Computed Tomography Coronary Angiography
Donnino, R; Jacobs, JE; Doshi, JV; Pursnani, S; Babb, JS; Kim, DC; Sedlis, SP; Srichai, MB
2009 MAR 10 ;53(10):A272-A272, Journal of the American College of Cardiology
— id: 97556, year: 2009, vol: 53, page: A272, stat: Journal Article,

Quantitative results of baseline angiography and percutaneous coronary intervention in the COURAGE trial
Mancini, G B John; Bates, Eric R; Maron, David J; Hartigan, Pamela; Dada, Marcin; Gosselin, Gilbert; Kostuk, William; Sedlis, Steven P; Shaw, Leslee J; Berman, Daniel S; Berger, Peter B; Spertus, John; Mavromatis, Kreton; Knudtson, Merril; Chaitman, Bernard R; O'Rourke, Robert A; Weintraub, William S; Teo, Koon; Boden, William E
2009 Jul;2(4):320-327, Ciculation : Cardiovascular quality & outcomes
BACKGROUND: COURAGE compared outcomes in stable coronary patients randomized to optimal medical therapy plus percutaneous coronary intervention (PCI) versus optimal medical therapy alone. METHODS AND RESULTS: Angiographic data were analyzed by treatment arm, health care system (Veterans Administration, US non-Veterans Administration, Canada), and gender. Veterans Administration patients had higher prevalence of coronary artery bypass graft surgery and left ventricular ejection fraction < or =50%. Men had worse diameter stenosis of the most severe lesion, higher prevalence of prior coronary artery bypass graft surgery, lower left ventricular ejection fraction, and more 3-vessel disease that included a proximal left anterior descending lesion (P<0.0001 for all comparisons versus women). Failure to cross rate (3%) and visual angiographic success of stent procedures (97%) were similar to contemporary practice in the National Cardiovascular Data Registry. Quantitative angiographic PCI success was 93% (residual lesion <50% in-segment) and 82% (<20% in-stent), with only minor nonsignificant differences among health care systems and genders. Event rates were higher in patients with higher jeopardy scores and more severe vessel disease, but rates were similar irrespective of treatment strategy. Within the PCI plus optimal medical therapy arm, complete revascularization was associated with a trend toward lower rate of death or nonfatal myocardial infarction. Complete revascularization was similar between genders and among health care systems. CONCLUSIONS: PCI success and completeness of revascularization did not differ significantly by health care system or gender and were similar to contemporary practice. Angiographic burden of disease affected overall event rates but not response to an initial strategy of PCI plus optimal medical therapy or optimal medical therapy alone
— id: 114781, year: 2009, vol: 2, page: 320, stat: Journal Article,

Impact of an initial strategy of medical therapy without percutaneous coronary intervention in high-risk patients from the Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation (COURAGE) trial
Maron, David J; Spertus, John A; Mancini, G B John; Hartigan, Pamela M; Sedlis, Steven P; Bates, Eric R; Kostuk, William J; Dada, Marcin; Berman, Daniel S; Shaw, Leslee J; Chaitman, Bernard R; Teo, Koon K; O'Rourke, Robert A; Weintraub, William S; Boden, William E
2009 Oct 15;104(8):1055-1062, American journal of cardiology
We explored the safety and quality-of-life consequences of treating patients with stable coronary disease and high-risk features initially with optimal medical therapy (OMT) alone compared to OMT plus percutaneous coronary intervention. This was a post hoc analysis of Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation (COURAGE) trial patients. We defined high risk as the onset of Canadian Cardiovascular Society class III angina within 2 months or stabilized acute coronary syndrome within 2 weeks of enrollment. The primary end point was death or myocardial infarction after 4.6 years. Of the 2,287 patients enrolled in the COURAGE trial, 264 (12%) were high risk and had a relative risk of 1.56 for death or myocardial infarction (p = 0.0008) compared to those with non-high-risk features. A total of 35 primary events occurred in the OMT group and 32 in the percutaneous coronary intervention plus OMT group (hazard ratio 1.11, 95% confidence interval 0.69 to 1.79; p = 0.68). No significant difference was found in the prevalence of angina between the 2 groups at 1 year. During the first year of follow-up, 30% of the OMT patients crossed over to the revascularization group. In conclusion, an initial strategy of OMT alone for high-risk patients in the COURAGE trial did not result in increased death or myocardial infarction at 4.6 years or worse angina at 1 year, but it was associated with a high rate of crossover to revascularization
— id: 114782, year: 2009, vol: 104, page: 1055, stat: Journal Article,

Re: One year perspective on COURAGE
Sedlis, Steven P; Boden, William E; Weintraub, William S; Maron, David S; O'Rourke, Robert A; Berman, Daniel S; Mancini, G B John
2009 Feb 15;73(3):428-428, Catheterization & cardiovascular interventions
— id: 94656, year: 2009, vol: 73, page: 428, stat: Journal Article,

Optimal medical therapy with or without percutaneous coronary intervention for patients with stable coronary artery disease and chronic kidney disease
Sedlis, Steven P; Jurkovitz, Claudine T; Hartigan, Pamela M; Goldfarb, David S; Lorin, Jeffrey D; Dada, Marcin; Maron, David J; Spertus, John A; Mancini, G B John; Teo, Koon K; O'Rourke, Robert A; Boden, William E; Weintraub, William S
2009 Dec 15;104(12):1647-1653, American journal of cardiology
Chronic kidney disease (CKD) is a risk factor for poor outcomes in patients with coronary artery disease (CAD), but it is unknown whether CKD influences the efficacy of alternative CAD treatment strategies. Thus, we compared outcomes in stable CAD patients with and without CKD randomized to percutaneous coronary intervention (PCI) and optimal medical therapy (OMT) or OMT alone in a post hoc analysis of the 2,287 patient COURAGE study. At baseline, 320 patients (14%) had CKD defined as a glomerular filtration rate of <60 mL/min/1.73 m(2), as estimated by the abbreviated 4-variable Modification of Diet in Renal Disease equation. The patients with CKD were older (68 +/- 9 vs 61 +/- 10 years; p <0.001) and more often had diabetes mellitus (42% vs 33%; p = 0.002), hypertension (81% vs 65%; p <0.03), heart failure (13% vs 3.4%; p <001), and three-vessel CAD (37% vs 29%, p = 0.01). After adjustment for these differences, CKD remained an independent predictor of death or nonfatal myocardial infarction (hazard ratio 1.48, 95% confidence interval 1.15 to 1.90). PCI had no effect on these outcomes. Furthermore, at 36 months, a similar percentage of patients with CKD treated with OMT (70%) and PCI plus OMT (76%) were angina free compared to patients without CKD. In conclusion, CKD is an important determinant of clinical outcomes in patients with stable CAD, regardless of the treatment strategy. Although PCI did not reduce the risk of death or myocardial infarction when added to OMT for patients with CKD, it also was not associated with worse outcomes in this high-risk group
— id: 105567, year: 2009, vol: 104, page: 1647, stat: Journal Article,

Optimal medical therapy with or without percutaneous coronary intervention in older patients with stable coronary disease: a pre-specified subset analysis of the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive druG Evaluation) trial
Teo, Koon K; Sedlis, Steven P; Boden, William E; O'Rourke, Robert A; Maron, David J; Hartigan, Pamela M; Dada, Marcin; Gupta, Vipul; Spertus, John A; Kostuk, William J; Berman, Daniel S; Shaw, Leslee J; Chaitman, Bernard R; Mancini, G B John; Weintraub, William S
2009 Sep 29;54(14):1303-1308, Journal of the American College of Cardiology
OBJECTIVES: Our aim was to access clinical effectiveness of percutaneous coronary intervention (PCI) when added to optimal medical therapy (OMT) in older patients with stable coronary artery disease (CAD). BACKGROUND: While older patients with CAD are at increased risk for cardiac events compared with younger patients, it is unclear whether PCI may mitigate this risk more effectively than OMT alone or, alternatively, may be associated with more complications. METHODS: We conducted a pre-specified analysis of outcomes in stable CAD patients stratified by age and randomized to PCI+OMT or OMT alone in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive druG Evaluation) trial. RESULTS: A total of 1,381 patients (60%) were <65 years of age (mean 56+/-6 years) and 904 patients (40%) were >or=65 years of age (mean 72+/-5 years). Achieved treatment targets for blood pressure, low-density lipoprotein cholesterol, adherence to diet and exercise, and angina-free status did not differ by age or treatment assignment. Among older patients, there was a 2- to 3-fold higher death rate, but similar rates of myocardial infarction, stroke, and major cardiac events compared with younger patients. The addition of PCI to OMT did not improve or worsen clinical outcomes in patients>or=65 years of age during a median 4.6 year follow-up. CONCLUSIONS: These data support adherence to American College of Cardiology/American Heart Association clinical practice guidelines that advocate OMT as an appropriate initial management strategy, regardless of age. (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation [COURAGE]; NCT00007657)
— id: 114783, year: 2009, vol: 54, page: 1303, stat: Journal Article,

Prognostic value of early exercise testing after coronary stent implantation: a strategy of routine stress testing after percutaneous coronary intervention is not of proven benefit
Sedlis, Steven P; Eisenberg, Mark J
2008 Jun 1;101(11):1681-1681, American journal of cardiology
— id: 94658, year: 2008, vol: 101, page: 1681, stat: Journal Article,

Metabolic syndrome does not impact survival in patients treated for coronary artery disease
Shah, Binita; Kumar, Nidhi; Garg, Parveen; Kang, Eunice; Grossi, Eugene; Lorin, Jeffrey D; Schwartzbard, Arthur Z; Mass, Howard; Danoff, Ann; Sedlis, Steven P
2008 Mar;19(2):71-77, Coronary artery disease
OBJECTIVES: We evaluated the effect of metabolic syndrome (a risk factor for the development of coronary artery disease) on survival in patients with established coronary artery disease. METHODS: Survival was determined for 2886 patients with coronary artery disease diagnosed by cardiac catheterization performed between 1990 and 2005 at a Department of Veterans Affairs hospital. Variables obtained from the computerized medical record were evaluated in multivariate analysis by Cox regression. The analysis was performed for the entire population; separate analyses were performed for patient cohorts treated with percutaneous coronary intervention and medication (n=1274), coronary artery bypass grafting and medication (n=1096), or medication alone (n=516). RESULTS: Although age (odds ratio 0.948; P<0.000), left ventricular function (odds ratio 0.701; P<0.000), serum creatinine (odds ratio 0.841; P<0.000), and smoking (odds ratio 0.873; P=0.019) were all strong predictors of mortality. Metabolic syndrome had no independent effect irrespective of diabetic status. CONCLUSION: Metabolic syndrome does not impact survival patients with coronary artery disease treated by revascularization and/or medical therapy
— id: 78361, year: 2008, vol: 19, page: 71, stat: Journal Article,

Correlation between angina and reduced myocardial ischemia: Results from the courage trial nuclear substudy
Shaw, LJ; Berman, DS; Maron, DJ; Mancini, GBJ; Weintraub, WS; Spertus, JA; Sedlis, SP; Hayes, S; Hartigan, PM; O'Rourke, RA; Dada, M; Chaitman, BR; Friedman, J; Slomka, P; Heller, GV; Germano, G; Kostuk, W; Schwartz, R; Bates, ER; Teo, KK; Boden, WE
2008 MAY 27 ;117(21):E429-E429, Circulation
— id: 86976, year: 2008, vol: 117, page: E429, stat: Journal Article,

Anomalous right coronary artery from the pulmonary artery
Barker, Colin M; Srichai, Monvadi B; Meyer, David B; Sedlis, Steven P
2007 Dec;1(3):166-167, Journal of Cardiovascular Computed Tomography
— id: 94657, year: 2007, vol: 1, page: 166, stat: Journal Article,

CHEST 2006 Overview
Sedlis, Steven P
2007 Jan;3(1):27-29, Future cardiology
— id: 103158, year: 2007, vol: 3, page: 27, stat: Journal Article,

Oxidative stress in periodic breathing: It's relationship with intermittent hypoxemia
Krieger, AC; Green, D; Yitta, G; May, M; Belitskaya-Levy, I; Tse, D; Sedlis, S
2006 ;29:A195-A195, Sleep
— id: 67524, year: 2006, vol: 29, page: A195, stat: Journal Article,

A dual wire approach to severe ostial bifurcating renal artery stenosis
Lorin, Jeffrey D; Hirsh, David S; Attubato, Michael J; Sedlis, Steven P
2006 Jun;67(6):956-960, Catheterization & cardiovascular interventions
Percutaneous intervention with balloon expandable stents has proven to be an effective measure to enhance renal blood flow and control blood pressure in subjects with severe ostial renal artery lesions. A small cohort of these subjects have an ostial bifurcation, which complicates the approach to revascularization. In these cases there is a concern of creating a total side-branch occlusion during balloon expansion. We report two cases of an ostial lesion at a renal artery bifurcation revascularized by employing a sequential dilatation double guidewire technique. Using a single 7F sheath in each case, both renal artery branches were wired, and each branch was predilated and stented in a sequential fashion. Excellent angiographic results were obtained in both cases
— id: 69438, year: 2006, vol: 67, page: 956, stat: Journal Article,

Don't ignore the right radial approach
Sedlis, Steven P; Lorin, Jeffrey D
2006 May;18(5):A30-A30, Journal of invasive cardiology
— id: 69437, year: 2006, vol: 18, page: A30, stat: Journal Article,

The ratio of ADP- to ATP-ectonucleotidase activity is reduced in patients with coronary artery disease
El-Omar, Magdi M; Islam, Naziba; Broekman, M Johan; Drosopoulos, Joan H F; Roa, Donald C; Lorin, Jeffrey D; Sedlis, Steven P; Olson, Kim E; Pulte, E Dianne; Marcus, Aaron J
2005 ;116(3):199-206, Thrombosis research
INTRODUCTION: CD39 (NTPDase1), an endothelial cell membrane glycoprotein, is the predominant ATP diphosphohydrolase (ATPDase) in vascular endothelium. It hydrolyses both triphosphonucleosides and diphosphonucleosides at comparable rates, thus terminating platelet aggregation and recruitment responses to ADP and other platelet agonists. This occurs even when nitric oxide (NO) formation and prostacyclin production are inhibited. Thus, CD39 represents the main control system for platelet reactivity. Reduced or deficient local ecto-nucleotidase activity may predispose to development of vascular disease. Based on data in animal models and in vitro, CD39 constitutes a new therapeutic modality for vascular disease with a novel and unique mode of action. MATERIALS AND METHODS: Lymphocytes were isolated from 46 patients with angiographically proven coronary artery disease (CAD) as well as from matched healthy control subjects. Ectonucleotidase ADPase and ATPase activities (prototypical for the ATPDase activity of endothelial cells) were measured using established radio-TLC procedures. RESULTS AND DISCUSSION: In the patients, a decreased ratio of ADPase to ATPase activities (from 1.26 to 1.04) was observed despite increases in both ADPase and ATPase activities. Coronary artery disease was the only independent predictor of a difference in the ADPase/ATPase activity ratio by multivariate linear regression analysis (P=0.0035). This altered ADPase/ATPase activity ratio in patients may represent a reduction in endogenous defense systems against platelet-driven thrombotic events. These data may identify a population of patients with excessive platelet reactivity in their circulation. Increased generation of prothrombotic ADP in these patients implies a potential benefit from therapeutic intervention with soluble forms of CD39
— id: 56106, year: 2005, vol: 116, page: 199, stat: Journal Article,

Percutaneous intervention versus coronary bypass surgery for patients older than 70 years of age with high-risk unstable angina
Ramanathan, Kodangudi B; Weiman, Darryl S; Sacks, Jerome; Morrison, Douglass A; Sedlis, Steven; Sethi, Gulshan; Henderson, William G
2005 Oct;80(4):1340-1346, Annals of thoracic surgery
BACKGROUND: The Angina With Extremely Serious Operative Mortality Evaluation (AWESOME) study was a multicenter Veterans Affairs randomized trial and registry that compared long-term survival of percutaneous coronary intervention with coronary artery bypass graft surgery for the treatment of patients with medically refractory myocardial ischemia and at least one additional risk factor for an adverse outcome with bypass. Both the randomized trial and the registry demonstrated comparable 3-year survival. The purpose of this study was to compare bypass and percutaneous intervention survival of AWESOME patients who were older than 70 years of age. METHODS: Over a 5-year period (1995 to 2000), 2,431 patients with medically refractory myocardial ischemia and at least one of the following five risk factors (prior heart surgery, myocardial infarction within 7 days, left ventricular ejection fraction less than 35%, age > 70 years, intraaortic balloon pump requirement to stabilize) were identified. Of these patients, 1,278 were older than 70 years of age. Eight hundred, seventy-one patients were turned down by at least one physician, 407 were acceptable to both physician and surgeon for randomization, and 236 (60%) consented to randomization. Of the 1,042 eligible patients who were not randomized, 871 had their revascularization directed by a physician who was not involved in the study. One hundred, seventy-one patients who were acceptable for randomization by both the interventional cardiologist and the cardiac surgeon refused consent. RESULTS: Bypass and percutaneous intervention survival were compared using Kaplan-Meier curves and log rank tests. Bypass and percutaneous intervention 36-month survival rates for patients older than 70 years of age were 76% and 75%, respectively, among the eligible patients. Survival was 71% and 78% among those patients who were randomized and 76% and 67% in the physician-directed subgroup. Of those patients who chose their revascularization techniques, the survivals were 79% and 85%, respectively. The survival differences are not large, and none of the global log rank tests of bypass compared with percutaneous intervention survival showed a statistically significant difference over 5 years. CONCLUSIONS: Both the randomized and registry subgroups of patients who were older than 70 years of age support the trial conclusions that either bypass or percutaneous intervention effectively relieves medically refractory ischemia among high-risk unstable angina patients whose age was greater than 70 years
— id: 69439, year: 2005, vol: 80, page: 1340, stat: Journal Article,

Routine versus selective functional testing after percutaneous coronary intervention in patients with diabetes mellitus
Saririan, Mehrdad; Cugno, Sabrina; Blankenship, James; Huynh, Thao; Sedlis, Steven; Starling, Mark; Pilote, Louise; Wilson, Brooke; Eisenberg, Mark J
2005 Jan;17(1):25-29, Journal of invasive cardiology
Patients with diabetes mellitus who undergo percutaneous coronary intervention (PCI) have higher rates of restenosis and a poorer prognosis than patients without diabetes. The American College of Cardiology/American Heart Association guidelines on exercise testing suggest that patients with diabetes may benefit from routine post-PCI functional testing (FT). To explore this issue, we examined the functional capacity, quality of life, event rates and procedural outcomes among 61 patients with diabetes enrolled in the Aggressive Diagnosis of Restenosis (ADORE) trial. All patients were randomized to either routine FT or selective FT and were followed for a period of 9 months. Patients with diabetes randomized to routine FT had a higher composite clinical event rate than those randomized to the selective FT strategy. Procedural rates did not differ significantly between the two groups. These results suggest that routine post-PCI FT in patients with diabetes is of little clinical value
— id: 69440, year: 2005, vol: 17, page: 25, stat: Journal Article,

Relation of elevated periprocedural blood glucose to long-term survival after percutaneous coronary intervention
Shah, Binita; Liou, Michael; Grossi, Eugene; Mass, Howard; Lorin, Jeffrey D; Danoff, Ann; Sedlis, Steven P
2005 Aug 15;96(4):543-546, American journal of cardiology
Strict glycemic control improves outcomes in critically ill patients. We evaluated the hypothesis that strict glycemic control might be similarly beneficial after percutaneous coronary intervention. This study reports the correlation of periprocedural blood glucose with long-term survival in 1,746 patients who underwent percutaneous coronary intervention from 1990 to 2003 in a Department of Veterans Affairs hospital
— id: 57864, year: 2005, vol: 96, page: 543, stat: Journal Article,

Evaluation of routine functional testing after percutaneous coronary intervention
Eisenberg, Mark J; Blankenship, James C; Huynh, Thao; Azrin, Michael; Pathan, Asad; Sedlis, Steven; Panja, Manotosh; Starling, Mark R; Beyar, Rafael; Azoulay, Arik; Caron, Joanna; Pilote, Louise
2004 Mar 15;93(6):744-747, American journal of cardiology
Following percutaneous coronary intervention, 348 patients were randomized to either routine or selective functional testing strategies. For the primary end point of maximal exercise endurance on a treadmill at 9 months, achievement was similar in the routine and selective groups. For the secondary end points measuring functional status and quality of life, scores were also similar. There was little difference in the rates of invasive cardiac procedures for the 2 groups at 9 months
— id: 69443, year: 2004, vol: 93, page: 744, stat: Journal Article,

Utility of routine functional testing after percutaneous transluminal coronary angioplasty: results from the ROSETTA registry
Eisenberg, Mark J; Schechter, David; Lefkovits, Jeffrey; Goudreau, Evelyne; Deligonul, Ubeydullah; Mak, Koon-Hou; Duerr, Robert; Del Core, Michael; Garzon, Philippe; Huynh, Thao; Smilovitch, Mark; Sedlis, Steven; Brown, David L; Brieger, David; Pilote, Louise
2004 Jun;16(6):318-322, Journal of invasive cardiology
BACKGROUND: There is little consensus regarding the use of functional testing after percutaneous transluminal coronary angioplasty (PTCA). Some physicians employ a routine functional testing strategy, and others employ a symptom-driven strategy. OBJECTIVE: To examine the effects of routine post-PTCA functional testing on the use of follow-up cardiac procedures and clinical events. METHODS: The Routine versus Selective Exercise Treadmill Testing after Angioplasty (ROSETTA) Registry is a prospective multicenter observational study examining the use of functional testing after PTCA. A total of 788 patients (pts) were enrolled in the ROSETTA Registry at 13 clinical centers in 5 countries. The frequencies of functional testing, cardiac procedures and clinical events were examined during the first 6 months following a successful PTCA. RESULTS: Patients were predominantly elderly men (mean age, 61+/-11 years; 76% male) who underwent single-vessel PTCA (85%) with stent implantation (58%). During the 6-month follow-up, a total of 237 pts were observed to undergo a routine functional testing strategy (100% having functional testing for routine follow-up), while 551 pts underwent a selective (or clinically-driven) strategy (73% having no functional testing and 27% having functional testing for a clinical indication). Patients in the routine testing group underwent a total of 344 functional tests compared with 165 tests performed in the selective testing group (mean, 1.45 tests/patient versus 0.3 tests/patient; p<0.0001). There was little difference in the rates of follow-up cardiac procedures among the pts undergoing the routine and selective testing strategies [cardiac catheterization, 13.9% versus 17.5% (p=NS); percutaneous coronary intervention (PCI), 8.4% versus 8.7% (p=NS); coronary artery bypass graft surgery, 2.1% versus 3.3% (p=NS)]. However, clinical events were less common among pts who underwent routine functional testing, e.g., unstable angina (6.1% versus 14.4%; p=0.001), myocardial infarction (0.4% versus 1.6%; p=NS), death (0% versus 2.2%; p=0.02) and composite clinical events (6.3% versus 16.3%; p<0.0001). After controlling for baseline clinical and procedural differences, routine functional testing had a persistent independent association with a reduction in the composite clinical event rate (odds ratio, 0.45; 95% confidence interval, 0.24-0.81; p=0.008). CONCLUSION: Routine functional testing after PTCA is associated with a reduction in the frequency of follow-up clinical events. This association may be attributable to the early identification and treatment of pts at risk for follow-up events, or it may be due to clinical differences between pts who are referred for routine and selective functional testing
— id: 69441, year: 2004, vol: 16, page: 318, stat: Journal Article,

Six-month outcomes after single- and multi-lesion percutaneous coronary intervention: results from the ROSETTA registry
Goldman, Lorne E; Okrainec, Karen; Eisenberg, Mark J; Schechter, David; Lefkovits, Jeffrey; Goudreau, Evelyne; Deligonul, Ubeydullah; Mak, Koon-Hou; Del Core, Michael; Duerr, Robert; Huynh, Thao; Smilovitch, Mark; Sedlis, Steven; Brown, David L; Brieger, David
2004 May 1;20(6):608-612, Canadian journal of cardiology
BACKGROUND: The American College of Cardiology/American Heart Association exercise testing guidelines suggest that routine functional testing may benefit patients at high risk of restenosis, such as those undergoing multi-lesion percutaneous coronary intervention (PCI). OBJECTIVES: To compare the six-month post-PCI clinical and procedural outcomes in patients following single- and multi-lesion PCI, and to examine the use of routine functional testing (ie, in all patients) versus selective functional testing (ie, only in those with recurrent symptoms) following multi-lesion PCI. METHODS: Six-month outcomes among 562 patients after single-lesion PCI and 229 patients after multi-lesion PCI were examined. All patients were enrolled in the Routine versus Selective Exercise Treadmill Testing after Angioplasty (ROSETTA) registry, a prospective, multicentre registry examining the use of functional testing after successful PCI. RESULTS: For single- versus multi-lesion PCI patients, respectively, rates of death (1.8% versus 2.2%, P=0.7) and myocardial infarction (0.7% versus 2.6%, P=0.03) were low in both groups. Rates of unstable angina (12.0% versus 11.7%, P=0.9) and the composite clinical end point of death, myocardial infarction or unstable angina (13.5% versus 13.9%, P=0.9) were similar. Multi-lesion PCI patients had a higher number of repeat PCI procedures (6.6% versus 13.4%, P=0.02) but there was no difference in the rates of coronary artery bypass graft surgery (3.0% versus 2.6%, P=0.7). A routine functional testing strategy was used in 28.0% of single-lesion and 31.6% of multi-lesion patients. In a multivariate analysis of the multi-lesion patients, routine functional testing was not associated with a significant reduction in the composite clinical event rate (odds ratio 0.5, 95% CI 0.2 to 1.7, P=0.27). CONCLUSIONS: During the six-month period following successful PCI, clinical event rates were similar among patients undergoing single- or multi-lesion PCI. Routine functional testing was not associated with a statistically significant benefit in patients after multi-lesion PCI. However, additional study is required to better define the role of routine functional testing in this subgroup of patients
— id: 69442, year: 2004, vol: 20, page: 608, stat: Journal Article,

Successful revascularization of a long chronic total occlusion with blunt microdissection complicated by coronary artery dissection
Lorin, Jeffrey D; Boglioli, Jason R; Sedlis, Steven P
2004 Nov;16(11):673-676, Journal of invasive cardiology
We report a case of successful percutaneous revascularization of a chronic total occlusion using the LuMend Frontrunner catheter. The case was complicated by a long coronary artery dissection, with inability to access the true lumen. With favorable healing at 7 weeks, the true lumen was accessible which led to procedural success
— id: 48040, year: 2004, vol: 16, page: 673, stat: Journal Article,

Outcome of percutaneous coronary intervention versus coronary bypass grafting for patients with low left ventricular ejection fractions, unstable angina pectoris, and risk factors for adverse outcomes with bypass (the AWESOME Randomized Trial and Registry)
Sedlis, Steven P; Ramanathan, Kodangudi B; Morrison, Douglass A; Sethi, Gulshan; Sacks, Jerome; Henderson, William
2004 Aug 1;94(1):118-120, American journal of cardiology
The recently concluded Angina With Extremely Serious Operative Mortality Evaluation (AWESOME) was a randomized clinical trial of percutaneous coronary intervention versus coronary bypass graft surgery among patients with medically refractory ischemia who were at high risk for coronary bypass graft surgery because of > or =1 risk factors that included severely reduced left ventricular (LV) function, defined as LV ejection fraction <35%. This study reports the outcome of patients with LV ejection fraction <35% in the randomized clinical trial and the physician-directed and patient choice registries of the AWESOME study
— id: 46042, year: 2004, vol: 94, page: 118, stat: Journal Article,

Medical therapy in patients undergoing percutaneous coronary intervention: results from the ROSETTA registry
Eisenberg, Mark J; Okrainec, Karen; Lefkovits, Jeffrey; Goudreau, Evelyne; Deligonul, Ubeydullah; Mak, Koon-Hou; Duerr, Robert; Tsang, Janius; Huynh, Thao; Sedlis, Steven; Brown, David L; Brieger, David; Pilote, Louise
2003 Aug;19(9):1009-1015, Canadian journal of cardiology
BACKGROUND: Previous studies have examined medication use among patients with coronary artery disease who have suffered an acute myocardial infarction (MI). However, little is known about medication use among patients with coronary artery disease who undergo percutaneous coronary intervention (PCI). OBJECTIVE: To examine the patterns of use of medical therapy among patients who undergo PCI; and to examine the determinants of medical therapy in these patients. METHODS: The Routine versus Selective Exercise Treadmill Testing after Angioplasty (ROSETTA) registry is a prospective multicentre study examining the use of functional testing after PCI. The medication use was examined among 787 patients who were enrolled in the ROSETTA registry at 13 clinical centres in five countries. RESULTS: Most patients were men (mean age 61+/-11 years, 76% male) who underwent single vessel PCI (85%) with stent implantation (58%). At admission, discharge and six months, rates of acetylsalicylic acid use were 77%, 96% and 93%, respectively (discharge versus six months, P<0.0001). Rates of use of other oral antiplatelet agents were 11%, 59% and 2% (P=0.02). For individual anti-ischemic medications, rates of use were as follows: beta-blockers 49%, 58% and 59% (P<0.0001); calcium antagonists 34%, 43% and 42% (P<0.0001); and nitrates 42%, 56% and 43% (P<0.0001). Rates of use of combination anti-ischemic medications were as follows: triple therapy 7%, 9% and 9% (P<0.0001); double therapy 34%, 47% and 38% (P<0.0001); monotherapy 36%, 36% and 41% (P<0.0001); and no anti-ischemic therapy 23%, 8% and 12% (P<0.0001). Rates of use of angiotensin-converting enzyme inhibitors were 25%, 33% and 32% (P<0.0001), and rates of use of lipid lowering agents were 41%, 52% and 61% (P<0.0001). CONCLUSIONS: Trials and guidelines statements have favourably affected the rates of use of acetylsalicylic acid and other antiplatelet agents after PCI. However, in spite of patients undergoing a successful revascularization procedure, physicians do not reduce the use of anti-ischemic medical therapy
— id: 69444, year: 2003, vol: 19, page: 1009, stat: Journal Article,

Rapid thrombectomy for treatment of macroembolization during percutaneous coronary intervention in the setting of acute myocardial infarction
Lorin, Jeffrey D; Liou, Michael C; Sedlis, Steven P
2003 Jun;59(2):219-222, Catheterization & cardiovascular interventions
We report the use of the Export catheter as an urgent modality to aspirate thrombus that embolized down the left anterior descending artery during acute myocardial infarction
— id: 42667, year: 2003, vol: 59, page: 219, stat: Journal Article,

ATP/ADP ectonucleotidase activity is increased in patients with coronary artery disease
El-Omar, MM; Islam, N; Broekman, MJ; Drosopoulos, JHF; Roa, DC; Lorin, J; Sedlis, SP; Marcus, AJ
2002 NOV 16 ;100(11):496A-496A, Blood
— id: 37108, year: 2002, vol: 100, page: 496A, stat: Journal Article,

Elevated prothrombin and activated protein C resistance in patients with thoracic aortic atheroma
Lochow, Peter; Schwartzbard, Arthur; Guest, Judy; Ripps, Carolyn; Matalon, Daniel; Gambetta, Rosemary; Tunick, Paul A; Sedlis, Steven
2002 Jul-Aug;53(4):423-428, Angiology
Patients with protruding aortic atheroma containing mobile emboli are at risk for peripheral emboli and stroke. This risk may possibly be reduced by anticoagulation, but whether or not such patients have an increased prevalence of thrombotic risk factors has not been previously determined. Twenty-two patients were studied (11 with protruding thoracic aortic atheromas and superimposed mobile thrombi on transesophageal echocardiography were compared to 11 age-matched controls). The authors evaluated activated protein C resistance (APC-R) by measuring the prolongation of the partial thromboplastin time (PTT) in response to activated protein C (APC). Concentrations of fibrinogen, antithrombin III (AT III), factor II, factor V, and D-dimer were also determined in all patients. There was significant resistance to APC (a smaller prolongation in PTT) in patients with atheromas and thrombi. They also had significantly higher concentrations of factor II. Factor V and fibrinogen were higher, and AT III lower, in patients than in controls; however, these latter differences did not reach statistical significance. Patients with aortic atheroma and mobile thrombi may have an increased prevalence of thrombotic risk factors. There is significantly increased resistance to activated protein C in patients with protruding atheroma and mobile thrombi in their thoracic aorta. There was also a trend toward elevated fibrinogen, homocysteine, and apo (a) concentrations as well as lower antithrombin III concentrations in these patients
— id: 32261, year: 2002, vol: 53, page: 423, stat: Journal Article,

Percutaneous coronary intervention versus repeat bypass surgery for patients with medically refractory myocardial ischemia: AWESOME randomized trial and registry experience with post-CABG patients
Morrison, Douglass A; Sethi, Gulshan; Sacks, Jerome; Henderson, William G; Grover, Frederick; Sedlis, Steven; Esposito, Rick
2002 Dec 4;40(11):1951-1954, Journal of the American College of Cardiology
OBJECTIVES: This report compares long-term percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) survival among post-CABG patients included in the Angina With Extremely Serious Operative Mortality Evaluation (AWESOME) randomized trial and prospective registry. BACKGROUND: Repeat CABG surgery is associated with a higher risk of mortality than first-time CABG. The AWESOME is the first randomized trial comparing CABG with PCI to include post-CABG patients. METHODS: Over a five-year period (1995 to 2000), patients at 16 hospitals were screened to identify a cohort of 2,431 individuals who had medically refractory myocardial ischemia and at least one of five high-risk factors. There were 454 patients in the randomized trial, of whom 142 had prior CABG. In the physician-directed registry of 1,650 patients, 719 had prior CABG. Of the 327 patient-choice registry patients, 119 had at least one prior CABG. The CABG and PCI survivals for the three groups were compared using Kaplan-Meier curves and log-rank tests. RESULTS: The CABG and PCI three-year survival rates were 73% and 76% respectively for the 142 randomized patients (75 and 67 patients) (log-rank = NS). In the physician-directed registry, 155 patients were assigned to reoperation and 357 to PCI (207 received medical therapy); 36-month survivals were 71% and 77% respectively (log-rank = NS). In the patient-choice registry, 32 patients chose reoperation and 74 chose PCI (13 received medical therapy); 36-month survivals were 65% and 86% respectively (log-rank test p = 0.01). CONCLUSIONS: Percutaneous coronary intervention is preferable to CABG for many post-CABG patients
— id: 69445, year: 2002, vol: 40, page: 1951, stat: Journal Article,

Percutaneous coronary intervention versus coronary bypass graft surgery for patients with medically refractory myocardial ischemia and risk factors for adverse outcomes with bypass: The VA AWESOME multicenter registry: comparison with the randomized clinical trial
Morrison, Douglass A; Sethi, Gulshan; Sacks, Jerome; Henderson, William; Grover, Frederick; Sedlis, Steven; Esposito, Rick; Ramanathan, Kodagundi B; Weiman, Darryl; Talley, J David; Saucedo, Jorge; Antakli, Tamim; Paramesh, Venki; Pett, Stuart; Vernon, Sarah; Birjiniuk, Vladimir; Welt, Frederick; Krucoff, Mitchell; Wolfe, Walter; Lucke, John C; Mediratta, Sundeep; Booth, David; Barbiere, Charles; Lewis, Dan
2002 Jan 16;39(2):266-273, Journal of the American College of Cardiology
OBJECTIVES: This study was designed to compare the three-year survival after percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) in physician-directed and patient-choice registries with the Angina With Extremely Serious Operative Mortality Evaluation (AWESOME) randomized trial results. BACKGROUND: The AWESOME multicenter randomized trial and registry compared the long-term survival after PCI and CABG for the treatment of patients with medically refractory myocardial ischemia and at least one additional risk factor for adverse outcome with CABG. The randomized trial demonstrated comparable three-year survival. METHODS: Over a five-year period (1995 to 2000), 2,431 patients with medically refractory myocardial ischemia and at least one of five risk factors (prior heart surgery, myocardial infarction within seven days, left ventricular ejection fraction <0.35, age >70 years, intra-aortic balloon required to stabilize) were identified. By physician consensus, 1,650 patients formed a physician-directed registry assigned to CABG (692), PCI (651) or further medical therapy (307), and 781 were angiographically eligible for random allocation; 454 of these patients constitute the randomized trial, and the remaining 327 constitute a patient choice registry. Survival for CABG and PCI was compared using Kaplan-Meier curves and log-rank tests. RESULTS: The CABG and PCI 36-month survival rates for randomized patients were 79% and 80%, respectively. The CABG and PCI 36-month survival rates were both 76% for the physician-directed subgroup; comparable survival rates for the patient-choice subgroup were 80% and 89%, respectively. None of the global log-rank tests for survival demonstrated significant differences. CONCLUSIONS: Both registries support the randomized trial conclusion: PCI is an alternative to CABG for some medically refractory high-risk patients
— id: 69447, year: 2002, vol: 39, page: 266, stat: Journal Article,

Percutaneous coronary intervention versus coronary bypass graft surgery for diabetic patients with unstable angina and risk factors for adverse outcomes with bypass: outcome of diabetic patients in the AWESOME randomized trial and registry
Sedlis, Steven P; Morrison, Douglass A; Lorin, Jeffrey D; Esposito, Rick; Sethi, Gulshan; Sacks, Jerome; Henderson, William; Grover, Frederick; Ramanathan, K B; Weiman, Darryl; Saucedo, Jorge; Antakli, Tamim; Paramesh, Venki; Pett, Stuart; Vernon, Sarah; Birjiniuk, Vladimir; Welt, Frederick; Krucoff, Mitchell; Wolfe, Walter; Lucke, John C; Mediratta, Sundeep; Booth, David; Murphy, Edward; Ward, Herbert; Miller, LaWayne; Kiesz, Stefan; Barbiere, Charles; Lewis, Dan
2002 Nov 6;40(9):1555-1566, Journal of the American College of Cardiology
OBJECTIVES: This study compared survival after percutaneous coronary intervention (PCI) with survival after coronary artery bypass graft surgery (CABG) among diabetics in the Veterans Affairs AWESOME (Angina With Extremely Serious Operative Mortality Evaluation) study randomized trial and registry of high-risk patients. BACKGROUND: Previous studies indicate that CABG may be superior to PCI for diabetics, but no comparisons have been made for diabetics at high risk for surgery. METHODS: Over five years (1995 to 2000), 2,431 patients with medically refractory myocardial ischemia and at least one of five risk factors (prior CABG, myocardial infarction within seven days, left ventricular ejection fraction <0.35, age >70 years, or an intra-aortic balloon being required to stabilize) were identified. A total of 781 were acceptable for CABG and PCI, and 454 consented to be randomized. The 1,650 patients not acceptable for both CABG and PCI constitute the physician-directed registry, and the 327 who were acceptable but refused to be randomized constitute the patient-choice registry. Diabetes prevalence was 32% (144) among randomized patients, 27% (89) in the patient-choice registry, and 32% (525) in the physician-directed registry. The CABG and PCI survival rates were compared using Kaplan-Meier curves and log-rank tests. RESULTS: The respective CABG and PCI 36-month survival rates for diabetic patients were 72% and 81% for randomized patients, 85% and 89% for patient-choice registry patients, and 73% and 71% for the physician-directed registry patients. None of the differences was statistically significant. CONCLUSIONS: We conclude that PCI is a relatively safe alternative to CABG for diabetic patients with medically refractory unstable angina who are at high risk for CABG
— id: 69446, year: 2002, vol: 40, page: 1555, stat: Journal Article,

The right radial approach for stenting of lesions in the right coronary artery with anomalous take-off from the left sinus of valsalva
Lorin, J D; Robin, B; Lochow, P; Lorenzo, A; Sedlis, S P
2000 Sep;12(9):478-480, Journal of invasive cardiology
Angioplasty and stenting of lesions located in anomalous right coronary arteries arising from the left sinus of Valsalva is technically challenging. We suggest that the right radial artery provides a more direct approach that is particularly advantageous in such cases and include illustrative case reports
— id: 114785, year: 2000, vol: 12, page: 478, stat: Journal Article,

Racial differences in performance of invasive cardiac procedures in a Department of Veterans Affairs Medical Center
Sedlis, S P; Fisher, V J; Tice, D; Esposito, R; Madmon, L; Steinberg, E H
1997 Aug;50(8):899-901, Journal of clinical epidemiology
Racial differences have recently been described in hospital practice, most notably with regard to cardiac procedure utilization. To evaluate the possible reasons behind these differences, we analyzed statistics generated from a surgical referral conference at a large, tertiary care Veterans Affairs hospital between the years 1988 and 1996. In this setting, there is no financial incentive for physicians to recommend or perform invasive procedures, as all physicians are salaried employees of the Veterans Administration. Furthermore, all patients presented at conference have already had cardiac catheterization and are felt to be potential candidates for surgery or angioplasty. Cardiac therapeutic procedures (surgery or percutaneous transluminal coronary angioplasty) were recommended for 1075 of 1474 (72.9%) Caucasian patients and 207 of 322 (64.3%) African-American patients (odds ratio 1.497, 95% confidence interval 1.160 to 1.932, p = 0.0022). Of those patients presented with the option of an invasive procedure, 32 of 207 (15.4%) African-American patients and 89 of 1075 (8.3%) Caucasian patients refused any invasive procedure (odds ratio 2.026, 95% confidence interval 1.311 to 3.130, p = 0.0025). We conclude that reluctance by African-American patients to undergo invasive cardiac procedures may help explain observed disparities in race-related cardiac care
— id: 114786, year: 1997, vol: 50, page: 899, stat: Journal Article,

Time course of lysophosphatidylcholine release from ischemic human myocardium parallels the time course of early ischemic ventricular arrhythmia
Sedlis, S P; Hom, M; Sequeira, J M; Tritel, M; Gindea, A; Ladenson, J H; Jaffe, A S; Esposito, R
1997 Jan;8(1):19-27, Coronary artery disease
BACKGROUND: We determined the kinetics of the release of lysophosphatidylcholine (LPC) into the coronary sinus of patients undergoing stress tests after coronary artery bypass grafting. The kinetics were consistent with a role for this amphiphile in the pathogenesis of ischemic ventricular arrhythmia, a major cause of sudden death. METHODS: Stress testing was initiated in the operating suite by pacing at a rate of 160 beats/min for 2 min. Ischemia was then induced by clamping the bypass grafts to the anterior wall for a maximal time of 4 min. RESULTS: The pacing procedure induced a prompt but reversible increase in coronary sinus LPC concentration from a baseline of 60.9 +/- 2.5 to 83.8 +/- 5.0 mumol/l via pacing alone, and a further increase to 101.8 +/- 6.7 mumol/l when the grafts were clamped for 2 min (P < 0.01). Six minutes after the cessation of pacing, LPC concentration returned to 67.5 +/- 4.4 mumol/l. CONCLUSIONS: These results demonstrate that severe myocardial ischemia is an agonist for rapid release of LPC from the myocardium. Kinetics of this release paralleled the time-course of early onset of electrophysiologic changes in isolated myocytes and perfused heart preparations in vitro. These results indicate that LPC may have an important role in the pathogenesis of ischemic ventricular arrhythmia in patients
— id: 114787, year: 1997, vol: 8, page: 19, stat: Journal Article,

Long-term prognostic significance of dobutamine echocardiography in patients with suspected coronary artery disease: results of a 5-year follow-up study
Steinberg EH; Madmon L; Patel CP; Sedlis SP; Kronzon I; Cohen JL
1997 Apr;29(5):969-973, Journal of the American College of Cardiology
OBJECTIVES:This study sought to assess the long-term prognostic utility of dobutamine stress echocardiography in predicting fatal and nonfatal cardiac events. BACKGROUND: Although dobutamine stress echocardiography has improved sensitivity and specificity for detection of coronary artery disease, little is known of its predictive value for long-term cardiac events. Therefore, we followed up 120 consecutive patients who underwent dobutamine echocardiography for suspected coronary disease from March 1989 to August 1991. METHODS: All patients presenting for coronary angiography for chest pain were eligible for recruitment. Follow-up was 100% complete at 5 years (range 3.0 to 6.1). Cardiac events were defined as cardiac death or nonfatal myocardial infarction or the need for coronary revascularization (coronary angioplasty or bypass surgery). RESULTS: Positive (n = 78) and negative (n = 42) dobutamine test groups differed in their rates of coronary artery bypass graft surgery (37.2% vs. 9.5%, p < 0.001, respectively) and mortality. Of 26 total deaths, 22 occurred in the group with positive dobutamine test results (28% vs. 9.5%, p < 0.018); all 7 cardiac deaths occurred in this group as well (9% vs. 0%, p < 0.045). By multivariate regression analysis, positive results on dobutamine echocardiography remained independently predictive of future cardiac death after left ventricular ejection fraction and other clinical variables were accounted for. CONCLUSIONS: A positive finding on dobutamine echocardiography is an independent predictor of long-term cardiac mortality, whereas a negative finding confers a significantly reduced likelihood of cardiac death as much as 5 years from initial testing. We conclude that dobutamine stress echocardiography can be used to predict which patients with suspected coronary artery disease are at low risk for cardiac death and do not require concurrent nuclear or invasive testing
— id: 12336, year: 1997, vol: 29, page: 969, stat: Journal Article,

Prognostic significance of spontaneous echo contrast in the thoracic aorta: relation with accelerated clinical progression of coronary artery disease
Steinberg EH; Madmon L; Wesolowsky H; Feliciano EA; Sanfilipo MP; Sedlis SP; Gindea AJ; Marcus AJ; Kronzon I
1997 Jul;30(1):71-75, Journal of the American College of Cardiology
OBJECTIVES: The purposes of this study were to identify the incidence of aortic smoke in an unselected cohort of patients and to determine the utility of this measurement as a clinical marker for future coronary events and long-term cardiac prognosis. BACKGROUND: Although spontaneous echo contrast detected within the cardiac chambers has been associated with an increased risk of thromboembolism, less is known about 'smoke' within the thoracic aorta and its relation to progression of coronary artery disease. METHODS: We prospectively assessed 118 unselected, consecutive male patients (mean age 67 years, range 29 to 86) who underwent transesophageal echocardiography (TEE). The presence of aortic smoke was identified by swirling echodense shadows distinct from high gain artifact. A positive result required confirmation by two of three independent observers. RESULTS: Aortic smoke without dissection was found in 25 of the patients (21%). Indications for TEE, coronary risk factors, the incidence of reduced left ventricular ejection fraction and mitral insufficiency and known coronary artery disease severity collectively did not differ significantly at baseline between the groups with and without smoke. Follow-up averaged 20.4 months (range 18 to 24) and was 100% complete for mortality and 98% complete for morbidity. The presence of aortic smoke was an independent predictor of myocardial infarction (16.0% vs. 2.2%, p < 0.005) and cardiac death (20.0% vs. 1.1%, p < 0.0001). These statistics remained significant after covarying for age, ejection fraction < 50%, hypertension, diabetes, aortic dimension, the presence of an atheromatous plaque and smoke in the left atrium. CONCLUSIONS: Spontaneous echo contrast detected within the thoracic aorta by transesophageal echocardiography is a common and important clinical marker that is strongly associated with an increased risk for future myocardial infarction and cardiac mortality. Future studies will attempt to define the pathophysiology of this relation and assess whether aggressive revascularization strategies and antithrombotic therapy may aid in the reduction of this risk
— id: 12309, year: 1997, vol: 30, page: 71, stat: Journal Article,

Dobutamine stress testing in the cardiac catheterization laboratory
Sedlis SP; Lorin J; Matalon A; Chandrasekaran S; Gold J; Santini C; Negron M; Kumar K; Steinberg EH
1996 Aug 1;78(3):340-343, American journal of cardiology
Dobutamine stress ventriculography is a safe test that appears to separate groups of patients with and without significant coronary artery stenoses. In this study, all 7 patients with significant coronary artery stenoses who reached a heart rate > or = 110 beats/min had a positive stress test, whereas 9 of 10 control patients had a negative stress test
— id: 12574, year: 1996, vol: 78, page: 340, stat: Journal Article,

ENDOTHELIAL-CELL ECTO-ADPASE ACTIVITY IS ENHANCED BY LYSOPHOSPHATIDYLCHOLINE - AN ANTITHROMBOTIC MECHANISM DURING MYOCARDIAL-ISCHEMIA
SEDLIS, SP; TRITEL, M; HOM, M; SAFIER, LB; SEQUEIRA, J; BROEKMAN, MJ; MARCUS, AJ
1994 APR ;42(2):A181-A181, Clinical research
— id: 52490, year: 1994, vol: 42, page: A181, stat: Journal Article,

Beta adrenergic stimulation and blockade in cirrhosis: effects on azygos vein blood flow and portal hemodynamics
Weinshel EH; Altszuler HM; Raicht RF; Sedlis SP
1994 Jun;307(6):396-400, American journal of the medical sciences
It is unknown whether beta adrenergic stress has adverse hepatic hemodynamic effects. Therefore, the authors studied the hemodynamic effects of beta adrenergic stimulation and subsequent blockade in 10 patients with cirrhosis (6 Childs A, 3 Childs B, and 1 Childs C) with known or suspected portal hypertension. Free and wedged hepatic vein pressures, hepatic venous pressure gradient, heart rate, mean arterial pressure, cardiac output, and azygos vein blood flow were measured at rest and after isoproterenol infusion (mean dose = 7.3 micrograms/min: target heart rate = 150% to 200% of resting heart rate). Esmolol, an ultra-short-acting beta blocker, was then infused (dose titrated to return heart rate to baseline), and all measurements were repeated. Based on the results, the authors conclude that beta adrenergic stress provoked by isoproterenol infusion significantly increases azygos vein blood flow and hepatic venous pressure gradient. Beta blockade with esmolol reduces azygos vein blood flow and hepatic venous pressure gradient significantly below baseline
— id: 17779, year: 1994, vol: 307, page: 396, stat: Journal Article,

EFFECTS OF PENTOXYFYLLINE ON HEPATIC HEMODYNAMICS
WEINSHEL, EH; LORIN, JD; SEDLIS, SP; RAICHT, RF
1994 APR ;106(4):A1006-A1006, Gastroenterology
— id: 52459, year: 1994, vol: 106, page: A1006, stat: Journal Article,

Lysophosphatidylcholine accumulation in ischemic human myocardium
Sedlis, S P; Hom, M; Sequeira, J M; Esposito, R
1993 Jan;121(1):111-117, Journal of laboratory & clinical medicine
Lysophosphatidylcholine accumulates in the coronary sinus during pacing-induced myocardial ischemia in humans. This amphiphile accelerates Ca++ flux leading to cell injury in cultured cardiac myocytes, but it is not known whether lysophosphatidylcholine accumulation is injurious to human myocardium. In this study, we measured lysophosphatidylcholine in normal human myocardium obtained during cardiac surgery and exposed to ischemic conditions in vitro. Total lysophosphatidylcholine concentration (sum of lysophosphatidylcholine remaining in tissue and lysophosphatidylcholine released into the buffer) increased from 0.73 +/- 0.08 nmol/mg protein at baseline to 1.83 +/- 0.45 nmol/mg protein after 5 minutes of ischemia (p < 0.001), and was associated with evidence of cell injury (26% depletion of tissue lactate dehydrogenase). Significant lysophosphatidylcholine release into the incubation buffer (0.41 +/- 0.11 nmol/mg protein) also occurred after 5 minutes of ischemia. In contrast, there was no lysophosphatidylcholine accumulation or release and no lactate dehydrogenase depletion in oxygenated and perfused controls. Attenuation of lysophosphatidylcholine accumulation by incubation with lysophospholipase did not prevent cell injury. Lysoplasmalogen was not detected in ischemic tissue. We conclude that lysophosphatidylcholine accumulation is a marker of myocardial ischemia in humans
— id: 114788, year: 1993, vol: 121, page: 111, stat: Journal Article,

Mechanisms of ventricular arrhythmias in acute ischemia and reperfusion
Sedlis, S P
1992 ;22(1):3-18, Cardiovascular clinics
Coronary occlusion leading to nearly total absence of myocardial perfusion is the major cause of lethal ischemic arrhythmia in humans. In this setting, intracellular acidosis rapidly develops and leads to accelerated K+ efflux from the myocyte. Other metabolites, including lipid amphiphiles such as LPC, also rapidly accumulate in the ischemic zone. Elevated extracellular K+ and LPC cause membrane depolarization, which leads to slow conduction and increased refractoriness. These electrophysiologic changes contribute to the development of re-entrant rhythms, which predominate during early ischemia (phase 1a). Diffusion of extracellular K+ from the ischemic zone and release of endogenous catecholamines result in improvement in electrophysiologic parameters and are associated with a short arrhythmia-free interval, which occurs approximately 10 minutes after coronary occlusion. A second phase of arrhythmia (1b) then occurs and may be due in part to catecholamine-mediated triggered activity. Irreversible cell injury occurs 15 to 20 minutes after coronary occlusion and is associated with cell Ca++ overload, loss of gap junctions, and impaired cell coupling. This may lead to re-entrant arrhythmias. Reperfusion of ischemic myocardium leads to arrhythmia predominantly mediated by non re-entrant mechanisms. In humans, these reperfusion arrhythmias are usually relatively benign
— id: 114789, year: 1992, vol: 22, page: 3, stat: Journal Article,

Percutaneous mitral valvuloplasty following surgical repair of sinus venosus atrial septal defect
Gerber R; Sedlis SP; Tunick PA; Chinitz L; Altszuler H; Gindea A
1991 Aug;23(4):297-299, Catheterization & cardiovascular diagnosis
Mitral valvuloplasty performed 5 y after repair of a sinus venosus ASD was difficult because of a thickened septum, but resulted in improved mitral valve opening and did not lead to ASD. Thus, prior repair of a sinus venosus ASD may not be an absolute contraindication to mitral valvuloplasty
— id: 13949, year: 1991, vol: 23, page: 297, stat: Journal Article,

Potentiation of the depressant effects of lysophosphatidylcholine on contractile properties of cultured cardiac myocytes by acidosis and superoxide radical
Sedlis, S P; Sequeira, J M; Altszuler, H M
1990 Feb;115(2):203-216, Journal of laboratory & clinical medicine
Lysophosphatidylcholine (LPC) accumulates in the heart during myocardial ischemia. This amphiphile accelerates Ca++ flux in cardiac myocytes and may mediate ischemic cell injury. In the present study, we evaluated the effects of LPC on the contractility of cultured neonatal rat heart cells. We also investigated the interactions between LPC and other prominent features of the ischemic milieu, acidosis, and superoxide radical. A photo-optical technique was used to measure the maximum velocities of shortening and relaxation (dS/dt and dR/dt) of cultured cells superfused with 0.1 to 100 mumol/L LPC. LPC, at all concentrations, initially increased dS/dt. After 1 minute, however, dS/dt decreased in a concentration-dependent manner in cells superfused with greater than 20 mumol/L LPC. The effect of LPC on relaxation was also dependent on LPC concentration. dR/dt increased at less than 40 mumol/L LPC but decreased at greater than or equal to 60 mumol/L LPC. Acidosis markedly potentiated LPC-mediated depression in dS/dt and dR/dt. In contrast, superoxide dismutase entirely prevented LPC-mediated depression of contractility. We conclude that whereas brief exposure to LPC stimulates contractility, prolonged exposure to greater than 40 mumol/L LPC depresses dS/dt and dR/dt in cultured myocytes. The depressant effects of LPC on contractility are potentiated by acidosis and superoxide radical. We postulate that LPC accumulation in the myocardium contributes to ischemia-mediated contractile dysfunction
— id: 114790, year: 1990, vol: 115, page: 203, stat: Journal Article,

CORONARY SINUS LYSOPHOSPHATIDYLCHOLINE ACCUMULATION DURING RAPID ATRIAL-PACING
Sedlis, SP; Sequeira, JM; Altszuler, HM
1990 Sep 15;66(7):695-698, American journal of cardiology
— id: 32047, year: 1990, vol: 66, page: 695, stat: Journal Article,

CORONARY SINUS LYSOPHOSPHATIDYLCHOLINE ACCUMULATION - AN INDICATOR OF MYOCARDIAL-ISCHEMIA IN MAN
Sedlis, SP; Sequeira, JM; Altszuler, HM; Esposito, R
1990 Apr;38(2):A503-A503, Clinical research
— id: 32073, year: 1990, vol: 38, page: A503, stat: Journal Article,

EFFECTS OF BETA-ADRENERGIC STIMULATION AND BLOCKADE ON AZYGOUS VEIN BLOOD-FLOW AND PORTAL HEMODYNAMICS IN CIRRHOSIS
Weinshel, EH; Altszuler, HM; Raicht, RF; Sedlis, SP
1990 Oct;12(4):874-874, Hepatology
— id: 32038, year: 1990, vol: 12, page: 874, stat: Journal Article,

RELEASE OF LYSOPHOSPHATIDYLCHOLINE FROM ISCHEMIC MYOCARDIUM IN MAN
SEDLIS, SP; SEQUEIRA, JM; ALTSZULER, HM; JIN, Y
1989 APR ;37(2):A294-A294, Clinical research
— id: 51438, year: 1989, vol: 37, page: A294, stat: Journal Article,

Preservation of left ventricular function in patients with total occlusion of the left anterior descending coronary artery and wide-caliber distal vessel filling by collateral vasculature
Sedlis, S P; Cohen, K H; Sequeira, J M; el-Sherif, N
1988 ;15(3):139-142, Catheterization & cardiovascular diagnosis
The segmental ventricular function of 76 patients with total occlusion of the left anterior descending coronary artery (LAD) was analyzed to establish the relationship between ventricular function and the presence and angiographic appearance of the collateral circulation. The relationship between function and collateral supply was found to be significant (P less than .01). The only angiographic feature of the collateral vasculature that was associated with preserved function was the caliber of the distal LAD. Wide-caliber vessels were more likely to be associated with preserved ventricular function than thin vessels (P less than .01). In contrast, both rapidly filling collateral arteries and slow filling vessels were associated with preserved ventricular function. Collateral supply maintenance was significantly associated with preserved ventricular function, even when the collaterals arose from stenotic coronary arteries. Furthermore, despite marked differences in ventricular function between the base and apex of the heart, there was a true relationship between preserved ventricular function and the presence of collateral vessels for all segments of the anterior wall. These findings may be relevant to clinical decision making and to proper interpretation of studies of ventricular function following LAD occlusion
— id: 114792, year: 1988, vol: 15, page: 139, stat: Journal Article,

Effects of lysophosphatidylcholine on cultured heart cells: correlation of rate of uptake and extent of accumulation with cell injury
Sedlis, S P; Sequeira, J M; Ahumada, G G; el Sherif, N
1988 Dec;112(6):745-754, Journal of laboratory & clinical medicine
In this study we evaluated the effects of lysophosphatidylcholine, a possible mediator of ischemic damage, on cultured neonatal rat heart cells. The rate and duration of lysophosphatidylcholine accumulation was correlated with Ca++ uptake and cell injury. The rate of carbon 14-labeled lysophosphatidylcholine accumulation during superfusion of the cells by 10 to 100 mumol/L 14C-labeled lysophosphatidylcholine was proportional to the concentration of lysophosphatidylcholine in the perfusate. Rapid accumulation of lysophosphatidylcholine (0.235 nmol/mg protein per minute), which occurred during 10 minutes of exposure to 100 mumol/L lysophosphatidylcholine, resulted in Ca++ overload and cell lysis. In contrast, slow accumulation of lysophosphatidylcholine by myocytes, which occurred during prolonged (1 hour) exposure to a sublethal micellar concentration (80 mumol/L) or very prolonged exposure (6 hours) to a submicellar concentration of lysophosphatidylcholine (10 mumol/L) did not result in Ca++ overload or irreversible injury despite more total lysophosphatidylcholine accumulation than during a single 10-minute exposure to 100 mumol/L lysophosphatidylcholine (p less than 0.005). Repeated brief exposures (5 minutes) to 100 mumol/L lysophosphatidylcholine separated by 20-minute recovery intervals also resulted in more lysophosphatidylcholine accumulation than during the lethal 10-minute exposure to 100 mumol/L lysophosphatidylcholine but did not result in irreversible injury. We therefore conclude that cardiac myocytes can tolerate slow accumulation of lysophosphatidylcholine and that factors other than the quantity of lysophosphatidylcholine accumulating in cells are determinants of the degree of injury sustained from exposure to lysophosphatides
— id: 114791, year: 1988, vol: 112, page: 745, stat: Journal Article,

INJURY TO CARDIAC MYOCYTES INDUCED BY LYSOPHOSPHATIDYL CHOLINE IS ATTENUATED BY SUPEROXIDE-DISMUTASE
Sedlis, SP; Sequeira, JM
1987 Oct;76(4):426-426, Circulation
— id: 31350, year: 1987, vol: 76, page: 426, stat: Journal Article,

Left main coronary artery spasm following percutaneous transluminal coronary angioplasty
Sedlis, S P; Macina, A; Khan, R G; el-Sherif, N
1986 ;12(3):161-162, Catheterization & cardiovascular diagnosis
A patient with reversible spasm of the left main coronary artery occurring shortly after successful angioplasty of a mid-LAD lesion is reported. Prompt recognition of this rare entity may be life-saving
— id: 114794, year: 1986, vol: 12, page: 161, stat: Journal Article,

Plasma apoproteins and the severity of coronary artery disease
Sedlis, S P; Schechtman, K B; Ludbrook, P A; Sobel, B E; Schonfeld, G
1986 May;73(5):978-986, Circulation
Plasma levels of lipids, lipoproteins, and apoproteins in 281 patients undergoing cardiac catheterization were correlated with the incidence and severity of coronary artery disease (CAD) to determine if measurements of apoprotein levels are more predictive of the presence and severity of CAD than the corresponding levels of lipoprotein lipids. In 156 men with CAD among 194 men in the study the only variable other than age that correlated with the severity of CAD, defined by the number of lesions and percent stenosis, was the ratio of apoprotein AI to apoprotein B (r = .1908, p less than .03). The ratio of apoprotein AI to apoprotein B was a more accurate predictor of the severity of CAD than was the ratio of the corresponding high-density to low-density lipoprotein levels (coefficients of partial determination of .07 and .035; p less than .001 and p less than .07, respectively). Multivariate analysis confirmed the independent effect of the ratio of apoprotein AI to apoprotein B on the severity of CAD even after adjustments were made for lipid levels, age, presence of hypertension or diabetes, and therapy with beta-blockers or diuretics. Among men with total occlusion of a coronary artery apoprotein E and apoprotein B levels were significantly higher than in control subjects with a similar extent of CAD (p less than .03). The lipid profiles of the 37 women with CAD were very different from those of the men.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 114793, year: 1986, vol: 73, page: 978, stat: Journal Article,

Cardiac amyloidosis simulating hypertrophic cardiomyopathy
Sedlis, S P; Saffitz, J E; Schwob, V S; Jaffe, A S
1984 Mar 15;53(7):969-970, American journal of cardiology
— id: 114795, year: 1984, vol: 53, page: 969, stat: Journal Article,

Lysophosphatidyl choline potentiates Ca2+ accumulation in rat cardiac myocytes
Sedlis, S P; Corr, P B; Sobel, B E; Ahumada, G G
1983 Jan;244(1):H32-H38, American journal of physiology
Lysophosphoglycerides are amphiphilic phospholipids that accumulate in ischemic myocardium and elicit electrophysiological alterations in normoxic Purkinje fibers and ventricular muscle that are analogous to alterations characteristic of ischemic tissue in vivo and that are compatible with altered sarcolemmal permeability to divalent cations. To assess directly the potential influence of lysophosphoglycerides on calcium transport, we characterized changes in the accumulation of 45Ca2+ by cultured cardiac myocytes exposed to selected concentrations of lysophosphatidyl choline (LPC). Perfusion for 10 min with 80 microM LPC augmented the amount of 45Ca2+ in myocytes compared with that in control cells (5.1 +/- 0.7 vs. 2.8 +/- 0.26 nmols Ca2+/mg protein, respectively; P less than 0.005) but did not alter total cell calcium content measured by atomic absorption spectrometry (11.6 +/- 1.0 nmols/mg protein), suggesting equivalent augmentation of bidirectional Ca2+ flux by LPC. In contrast, perfusion for 15 min with 100 microM LPC not only augmented 45Ca2+ accumulation but also increased total cellular Ca2+ content, as the quantity of 45Ca2+ accumulated reached 16.9 +/- 1.4 nmols/mg protein, a value substantially exceeding the normal total Ca2+ content (P less than 0.0025 compared with control cells). In contrast to results observed after only a 5-min exposure to 100 microM LPC, Ca2+ accumulation induced by 15 min of perfusion was not precluded by verapamil (10(-8)M), could not be reversed by perfusion without LPC, and was associated with complete cessation of beating, markedly altered morphology, and substantial depletion of cellular creatine kinase activity. Thus LPC may not only contribute to malignant ventricular dysrhythmias but also may potentiate ischemic injury by facilitating calcium ingress
— id: 114796, year: 1983, vol: 244, page: H32, stat: Journal Article,