Kiranbir Josan

All Publications

• Efficacy of a Telehealth Preventive Cardiology Lifestyle Intervention Program to Treat High-Risk South Asians Parameswaran, V., Josan, K., Khandelwal, A., Abbasi, F., Dash, R. AMER DIABETES ASSOC. 2019

  View details for DOI 10.2337/db19-885-P

  View details for Web of Science ID 000501366902250

• Unique Cardiovascular Risk Stratification Using Prediabetes Metrics in High-Risk South Asian Cohort Shearer, J. L., Josan, K., Khandelwal, A., Nallamshetty, S., Abbasi, F., Dash, R. AMER DIABETES ASSOC. 2019

  View details for DOI 10.2337/db19-903-P

  View details for Web of Science ID 000501366902268

• CardioClick an Innovative Telehealth Approach to Lifestyle Intervention in High Risk South Asians Parameswaran, V., Josan, K., Winterbottom, J., Shearer, J., Khandelwal, A., Nallamshetty, S., Dash, R., Rodriguez, F. LIPPINCOTT WILLIAMS & WILKINS. 2019

  View details for DOI 10.1161/circ.139.suppl_1.P337

  View details for Web of Science ID 000478079000280

• Right Ventricular Dysfunction Should Not Preclude Left Ventricular Assist Device Explantation in Patients Exhibiting Left Ventricular Recovery Toma, M., Josan, K., Moss, R., Bashir, J., Cowan, S., Kaan, A., Ignaszewski, A., Cheung, A. ELSEVIER SCIENCE INC. 2012: S90

  View details for DOI 10.1016/j.healun.2012.01.255

  View details for Web of Science ID 000302207900248

• Right Ventricular Dysfunction Should Not Preclude Left Ventricular Assist Device Explantation in Patients Exhibiting Left Ventricular Recovery Josan, K., Cheung, A., Kaan, A., Ignaszewski, A., Bashir, J., Toma, M. LIPPINCOTT WILLIAMS & WILKINS. 2011

  View details for Web of Science ID 000299738707310

• LONG-TERM FOLLOW UP OF LEFT VENTRICULAR SIZE AND FUNCTION IN PATIENTS SUCCESSFULLY BRIDGED TO RECOVERY AFTER LEFT VENTRICULAR ASSIST DEVICE SUPPORT Josan, K., Cheung, A., Kaan, A., Ignaszewski, A., Toma, M. ELSEVIER SCIENCE INC. 2011: S227

  View details for DOI 10.1016/j.cjca.2011.08.105

  View details for Web of Science ID 000296656900338

• Successful Weaning and Explantation of the Heartmate II Left Ventricular Assist Device CANADIAN JOURNAL OF CARDIOLOGY Lamarche, Y., Kearns, M., Josan, K., Bashir, J., Ignaszewski, A., Kaan, A., Kealy, J., Moss, R., Cheung, A. 2011; 27 (3): 358–62

  Abstract

  Ventricular assist devices (VADs) are used in cases of heart failure refractory to medical therapy. Most VADs are used as a bridge to heart transplantation; however, in certain cases, myocardial function recovers and VADs can be explanted after the patient is weaned. The objectives of this study were to describe patients who required Heartmate II VAD insertion, followed by myocardial recovery and explanation in a quaternary heart centre.Patients who had a VAD explanted were identified in the mechanical support institutional database and their outcomes were analyzed. Clinical examinations, biochemical markers, and serial echocardiograms were used to demonstrate myocardial recovery.Seventeen patients had a Heartmate II VAD inserted between 2008 and 2010. Four patients underwent successful weaning and subsequent VAD explantation. Etiology of decompensated heart failure was idiopathic dilated cardiomyopathy (n = 1), ischemic (n = 1), or myocarditis (n = 2). Mean age was 35.3 years. Patients were supported for 213 days (range 70-293 days) and were in New York Heart Association class I in the community before explantation. The devices were explanted via a minimally invasive approach, without cardiopulmonary bypass. All patients survived explantation and were discharged alive from hospital after an average of 5.7 ± 1.5 days post pump explantation. No adverse events were reported after explantation. Only one patient required allogenic blood transfusion after the procedure.Patients requiring VAD support for myocardial failure can undergo significant reverse remodelling. Explantation can lead to optimal outcome with minimal morbidity. Methods for assessment of reverse remodelling, weaning protocol, and optimal timing of explantation remain under evaluation.

  View details for DOI 10.1016/j.cjca.2011.01.005

  View details for Web of Science ID 000291385100010

  View details for PubMedID 21601774

• Transatrial Transcatheter Tricuspid Valve-in-Valve Implantation of Balloon Expandable Bioprosthesis ANNALS OF THORACIC SURGERY Hon, J., Cheung, A., Ye, J., Carere, R. G., Munt, B., Josan, K., Lichtenstein, S. V., Webb, J. 2010; 90 (5): 1696–97

  Abstract

  Transcatheter valve-in-valve implantation into failing mitral and aortic bioprosthetic valves have been reported. This strategy avoids performing high-risk repeat cardiac surgery in elderly patients with multiple comorbidities. Tricuspid valve-in-valve implantation has not been described. We report a case of failing bioprosthetic tricuspid valve in a 48-year-old woman with carcinoid syndrome. We attempted a transatrial transcatheter approach and we successfully deployed a 26-mm Edwards Sapien balloon expandable bioprosthesis (Edwards Lifesciences, Irvine, CA) into a severely stenotic tricuspid bioprosthesis. This case demonstrates the technical feasibility and safety of this approach. Therefore, tricuspid valve-in-valve implantation may be a viable treatment alternative in carefully selected patients.

  View details for DOI 10.1016/j.athoracsur.2010.04.101

  View details for Web of Science ID 000283352200065

  View details for PubMedID 20971296

• Procedural delay does not explain the circadian variation observed in outcomes of primary PCI for STEMI: Insights from the APEX-AMI trial Josan, K., Westerhout, C. M., van't Hof, A. J., O'Neill, W. W., Holmes, D. R., Widimsky, P., Ruzyllo, W., Granger, C. B., Armstrong, P. W., APEX AMI Investigators ELSEVIER SCIENCE INC. 2008: A201

  View details for Web of Science ID 000253997101321

• The efficacy and safety of intensive statin therapy: a meta-analysis of randomized trials CANADIAN MEDICAL ASSOCIATION JOURNAL Josan, K., Majumdar, S. R., McAlister, F. A. 2008; 178 (5): 576–84

  Abstract

  Recent lipid guidelines recommend aggressive low-density lipoprotein (LDL) cholesterol lowering in patients with coronary artery disease. To clarify the evidence for this recommendation, we conducted a meta-analysis of randomized controlled trials that compared different intensities of statin therapy.We searched electronic databases (MEDLINE, EMBASE, Cochrane Central Registery of Controlled Trials, Web of Science) for randomized controlled trials published up to July 19, 2007, that compared statin regimens of different intensities in adults with coronary artery disease and that reported cardiovascular events or mortality. Data were pooled using random-effects models to calculate odds ratios (OR).A total of 7 trials (29 395 patients) were included. Compared with less intensive statin regimens, more intensive regimens further reduced LDL levels (0.72 mmol/L reduction, 95% confidence interval [CI] 0.60-0.84 mmol/L), and reduced the risk of myocardial infarction (OR 0.83, 95% CI 0.77-0.91) and stroke (OR 0.82, 95% CI 0.71-0.95). Although there was no effect on mortality among patients with chronic coronary artery disease (OR 0.96, 95% CI 0.80-1.14), all-cause mortality was reduced among patients with acute coronary syndromes treated with more intensive statin regimens (OR 0.75, 95% CI 0.61-0.93). Compared with lower intensity regimens, more intensive regimens were associated with small absolute increases in rates of drug discontinuation (2.5%), elevated levels of aminotransferases (1%) and myopathy (0.5%), and there was no difference in noncardiovascular mortality. All 7 trials reported events by randomization arm rather than by LDL level achieved. About half of the patients treated with more intensive statin therapy did not achieve an LDL level of less than 2.0 mmol/L, and none of the trials tested combination therapies.Our analysis supports the use of more intensive statin regimens in patients with established coronary artery disease. There is insufficient evidence to advocate treating to particular LDL targets, using combination lipid-lowering therapy to achieve these targets or for using more intensive regimens in patients without established coronary artery disease.

  View details for DOI 10.1503/cmaj.070675

  View details for Web of Science ID 000253136000019

  View details for PubMedID 18299547

  View details for PubMedCentralID PMC2244680

• Statin therapy: friend or foe? Canadian Journal of Diagnosis Canadian Journal of Diagnosis Josan, K., Gyenes, G. 2008; 25: 65-67
• Cholesterol lowering for secondary prevention: What statin dose should we use? VASCULAR HEALTH AND RISK MANAGEMENT Josan, K., McAlister, F. A. 2007; 3 (5): 615–27

  Abstract

  Over the past decade, 17 large placebo-controlled trials have established that statin therapy lowers LDL cholesterol and prevents cardiovascular events and death in patients with coronary disease or at high risk for atherosclerotic events. Nine trials of higher dose vs. lower dose statins (reporting data from 29,853 patients with coronary artery disease and 486 patients with other indications for statin therapy) have established that higher dose statin therapy is more efficacious than lower dose therapy in reducing myocardial infarctions/coronary death (by 16%) and stroke (by 18%) in patients with coronary disease but only reduces all-cause mortality in patients at high risk for coronary death (such as patients immediately after acute coronary syndrome). Higher dose statins are associated with statistically significantly increased risks of myopathy and elevated transaminases compared to lower dose statins; while relative risks for these outcomes are 1.2 and 4.0, the absolute increases are small (0.5% and 1%). Secondary analyses of these trials using individual patient data and multivariate adjustment will be needed to appropriately examine the incremental benefits of different LDL targets, and trials are needed to determine whether combinations of low dose statins plus other lipid lowering agents may achieve better clinical outcomes than higher dose statin therapy alone.

  View details for Web of Science ID 000210211800007

  View details for PubMedID 18078013

  View details for PubMedCentralID PMC2291306