Publications by authors named "Itamar Loewenstein"
Background: Managing pocket infections in cardiac implantable electronic devices (CIEDs) during early pregnancy presents significant clinical challenges, as current guidelines mandate complete system extraction. However, extraction carries high maternal-fetal risks, including surgical complications, radiation exposure, and teratogenic effects of systemic antibiotics.
Case Summary: A 29-year-old woman, 5-week pregnant, was referred for a CIED pocket infection with an extruding implantable cardioverter-defibrillator implanted 9 years earlier for idiopathic ventricular fibrillation.
Background: Waitlists for transcatheter aortic valve replacement (TAVR) are increasingly growing, universal criteria for prioritizing candidates are lacking, and some patients experience adverse events while awaiting the procedure. Aortic stenosis (AS)-related cardiac damage (CD) staging provides an echocardiographic framework for assessing structural CD in AS patients. We aimed to assess the correlation between CD staging and AS-related adverse events in patients awaiting TAVR.
View Article and Find Full Text PDFBackground: In contrast to left bundle branch block, right bundle branch block (RBBB) is rare after transcatheter aortic valve replacement (TAVR).
Objectives: This study sought to define the incidence of post-TAVR new-onset RBBB and the risk factors associated with permanent pacemaker implantation (PPI) need.
Methods: Data from 7,782 consecutive TAVR procedures performed in 7 Israeli centers were retrospectively analyzed.
Background: Left ventricular (LV) end-systolic enlargement in severe degenerative mitral-regurgitation (MR) is a class I surgical trigger. Whether it occurs disproportionately to less-than-severe MR due to mitral valve prolapse and is associated with mortality are unknown. We aimed to analyze prevalence and association with survival of disproportionate LV enlargement in less-than-severe MR.
View Article and Find Full Text PDFIntroduction: Everolimus (EVR)-induced kidney injury is rarely reported. Conversely, acute tubular necrosis (ATN) is a recognized complication of high-dose bisphosphonate therapy.
Case Presentation: SM, a 69-year-old female patient with advanced breast cancer, developed severe kidney injury necessitating renal replacement therapy (RRT) shortly after initiating EVR treatment, while concurrently receiving chronic high-potency bisphosphonate therapy.
Background: The management of Transcatheter Aortic Valve Implantation (TAVI) patients with a small aortic annulus (SAA) postures a substantial challenge, increasing the risk of patient- prosthesis mismatch (PPM) and overall mortality.
Aims: This study aimed to compare the hemodynamic and clinical outcomes of transcatheter balloon-expandable valve (BEV) versus transcatheter self-expandable valve (SEV) in SAA.
Methods: We conducted propensity score matching (PSM) of severe AS patients with SAA who underwent trans-femoral TAVR and enrolled to the Israeli TAVR registry between the years 2008 and 2023.
Background: Limited observational reports link elevated lipoprotein(a) (Lp[a]) levels to aortic stenosis (AS) or to disease progression. Data on large cohorts of verified severe AS patients are lacking.
Objectives: The purpose of the study was to characterize Lp(a) levels of severe AS patients referred to transcatheter aortic valve implantation (TAVI) and compare them to a large cohort of Lp(a) samples derived from the general population.
Background: The ACURATE neo2 transcatheter aortic valve was developed to improve paravalvular leak (PVL) rates while maintaining low rates of conduction disturbances and permanent pacemaker implantation (PPMI) seen with its predecessor. We aimed to compare conduction disturbances rates of transcatheter aortic valve replacement (TAVR) using ACURATE Neo2 with other commonly used valves.
Methods: A retrospective analysis of the Israeli TAVR registry between the years 2014-2023 was performed to compare conduction disturbances and PVL rates, and procedural outcomes, among patients treated with ACURATE neo2, Edwards Sapien 3 (S3), and Evolut PRO valves.
The Impact of Cerebral Embolic Protection Devices on Characteristics and Outcomes of Stroke Complicating TAVR.
JACC Cardiovasc Interv
March 2024
Article Synopsis
- Acute ischemic stroke is a significant risk following transcatheter aortic valve replacement (TAVR), prompting the development of cerebral embolic protection devices (CEPD) to reduce this risk.
- A study compared patients who underwent TAVR without CEPD (CEPD-) to those with CEPD (CEPD+) to assess characteristics and outcomes related to stroke.
- Findings indicated no significant differences in stroke rates, severity, or disability outcomes between the two groups, although the CEPD+ group had notably different types of strokes, suggesting that the efficacy of CEPD in preventing acute ischemic stroke is still questionable.
Article Synopsis
- The study investigates how serum levels of neutrophil gelatinase-associated lipocalin (NGAL) relate to contrast-induced acute kidney injury (CI-AKI) in chronic kidney disease (CKD) patients undergoing percutaneous coronary intervention (PCI).
- It involved 58 CKD patients, measuring NGAL levels before and 24 hours after PCI, revealing that both pre and post-NGAL levels were significantly higher in those who developed CI-AKI, but without major differences between pre and post levels.
- Pre-NGAL levels showed good predictive ability for CI-AKI, with an optimal cutoff of 129 ng/ml, while post-NGAL levels > 141 ng/ml were strongly linked to CI
Article Synopsis
- The study examines the impact of treating paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI) and its association with morbidity and mortality.
- A total of 201 patients were treated for moderate PVR using various interventions, including redo-TAVI, plug closure, and balloon valvuloplasty, with outcomes measured at 30 days and 1 year.
- Findings indicate that successful reduction of aortic regurgitation (AR) to mild levels significantly improved 1-year mortality rates, suggesting that treatment decisions and patient selection for PVR interventions need further research.
Management and Outcome of Acute Ischemic Stroke Complicating Transcatheter Aortic Valve Replacement.
JACC Cardiovasc Interv
September 2022
Background: Despite advances in transcatheter aortic valve replacement (TAVR), periprocedural acute ischemic stroke remains a concern.
Objectives: The aims of this study were to investigate acute ischemic stroke complicating TAVR (AISCT) and to describe the indications and outcomes of interventions to treat AISCT.
Methods: An international multicenter registry was established focusing on AISCT within 30 days of TAVR.
Background: Implantation of drug eluting stents (DES) is the mainstay treatment for patients requiring percutaneous coronary intervention (PCI). The polymer coating of DES has been associated with inflammatory response, increased arterial injury and long-term in-stent restenosis and thrombosis. Polymer-free stents (PFS) were designed to overcome limitations of polymer-coated stents (PCS).
View Article and Find Full Text PDFArticle Synopsis
- The Medtronic Evolut Pro valve (EPV) is a new self-expanding valve aimed at reducing paravalvular leak (PVL) rates in transcatheter aortic valve replacement (TAVR).
- A study analyzed data from 2591 patients, comparing EPV with older-generation valves (CoreValve and Evolut R), focusing on postprocedural PVL and permanent pacemaker (PPM) implantation rates.
- Results showed that EPV had significantly lower moderate and above PVL rates compared to CoreValve and a reduced need for PPM implantation compared to both CoreValve and Evolut R, highlighting its safety and efficacy.
Article Synopsis
- Ostial coronary lesions are more challenging to treat than other proximal lesions and have previously been linked to worse outcomes, but current data on PCI outcomes for these lesions is limited.
- A study analyzed 334 patients who underwent PCI for either ostial or proximal nonostial lesions, finding that the clinical outcomes after 12 months were similar for both groups in terms of target vessel revascularization and major adverse cardiovascular events.
- The conclusion suggests that contemporary drug-eluting stents offer comparable results for ostial and nonostial lesions, though more extensive research is needed to confirm these findings.
Article Synopsis
- C-reactive protein velocity (CRPv) is a significant inflammatory marker linked to higher morbidity and mortality in STEMI patients undergoing primary PCI.
- A study of 1059 STEMI patients found that higher CRPv levels corresponded to worse left ventricular ejection fraction (LVEF) and increased instances of severe diastolic dysfunction.
- CRPv demonstrated superior diagnostic ability for severe systolic dysfunction compared to traditional CRP levels, suggesting its potential as a useful cardiac function predictor in clinical settings.
Article Synopsis
- The study focuses on patients with chronic kidney disease (CKD) undergoing coronary interventions and highlights the risk of contrast-induced acute kidney injury (CI-AKI), with baseline neutrophil gelatinase-associated lipocalin (NGAL) levels being examined as a potential predictive marker.* -
- In the study of 88 CKD patients, those who developed CI-AKI had significantly higher baseline NGAL levels (150 ng/mL) compared to those who did not (103 ng/mL), with NGAL proving to be a better predictor of CI-AKI than estimated glomerular filtration rate (eGFR).* -
- The findings suggest that a baseline NGAL level greater than 127 ng/mL is associated
Article Synopsis
- A study explored the potential of neutrophil gelatinase-associated lipocalin (NGAL) levels to identify different types of kidney damage in patients with ST-elevation myocardial infarction (STEMI) by measuring NGAL before and after treatment.
- *In a sample of 132 STEMI patients, results showed that 22% had reversible kidney damage while 27% experienced persistent damage, with only 10% progressing to acute kidney injury.
- *The research found that longer symptom duration was linked to persistent kidney damage, indicating NGAL's usefulness in monitoring renal injury patterns in STEMI patients.*
Natural History of Moderate Aortic Stenosis with Preserved and Low Ejection Fraction.
J Am Soc Echocardiogr
July 2021
Article Synopsis
- The study investigates the impact of moderate aortic stenosis (AS) on mortality rates among patients, especially those with reduced ejection fractions and low aortic valve gradients.
- It compared outcomes between around 952 patients with moderate AS and a matched cohort without AS, revealing a significant increase in mortality for the AS group.
- Findings indicate that moderate AS leads to lower survival rates over time and the same trend was observed in patients with additional complications like reduced ejection fraction and low aortic valve gradients.
Article Synopsis
- Surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) are both treatments for aortic stenosis, and this study aimed to compare TAVR performed on failed transcatheter valves (TAV-in-TAV) versus surgical valves (TAV-in-SAV).
- Data from 434 TAV-in-TAV and 624 TAV-in-SAV procedures were analyzed after matching 330 patients from both groups, focusing on procedural success, safety, and 30-day and 1-year mortality rates.
- Results showed that TAV-in-TAV had higher procedural success rates (72.7% vs. 62.4%) and better aortic valve area and
Introduction: Elevated plasma levels of neutrophil gelatinase-associated lipocalin (NGAL) is a marker of tubular damage and aid in the early identification of acute kidney injury (AKI). We evaluated NGAL levels for identification of AKI superimposed on chronic kidney disease (CKD) vs. "de novo" AKI among ST elevation myocardial infarction (STEMI) patients undergoing primary coronary intervention (PCI).
View Article and Find Full Text PDFThe Israeli Physician Assistant in a Tertiary Medical Center Emergency Department.
Isr Med Assoc J
July 2020
Article Synopsis
- Emergency department overcrowding negatively impacts patient outcomes, prompting a study on the role of physician assistants (PAs) in Israel's healthcare system.
- The research compared patient outcomes and timing metrics between those seen by physicians versus those initially seen by PAs, revealing lower rates of patients leaving without treatment and reduced readmission within 48 hours for those assessed by PAs.
- Overall, PAs contributed to faster ED service times without affecting mortality rates, suggesting they could enhance patient care and satisfaction in emergency settings.
Article Synopsis
- A study analyzed 2,096 STEMI patients treated with primary coronary intervention to explore the relationship between acute kidney injury (AKI) and anemia.
- The findings revealed that patients with both anemia and AKI (termed acute cardiorenal anemia syndrome) had significantly worse health outcomes, including higher rates of heart failure and mortality.
- The study concluded that the combination of anemia and AKI is linked to more severe complications and demonstrates how heart and kidney health are interconnected in STEMI patients.
Article Synopsis
- CABG for treating STEMI is now rarely used (≤ 5%) because primary PCI is preferred, with this study focusing on comparing their outcomes within 30 days of treatment.
- Analysis of 1,660 STEMI patients revealed that the CABG group had higher unadjusted 30-day mortality (7.5%) compared to the PCI group (3.3%), but this was not statistically significant.
- The findings suggest that early CABG results in worse outcomes and that delaying surgery beyond 72 hours might lead to improved survival rates.
Echocardiographic L-wave as a prognostic indicator in transcatheter aortic valve replacement.
Int J Cardiovasc Imaging
October 2020
Article Synopsis
- * A total of 502 patients (average age 82) were analyzed, revealing that those with a baseline L-wave had lower stroke volume indices and that L-waves disappeared in a significant number of patients after TAVR.
- * The findings demonstrated that patients who continued to show L-waves post-TAVR had notably higher mortality rates, indicating that persistent L-wave presence is a strong independent risk factor for poor outcomes.