Elie N. Mouhayar, MD, FACC, FSVM
Department of Cardiology, Division of Internal Medicine
About Dr. Elie N. Mouhayar
Dr. Elie Mouhayar completed his medical degree at the Lebanese University in Beirut, Lebanon. His postgraduate training included a clinical fellowship in cardiology at Geisinger Medical Center and a mini-fellowship in cardiovascular computed tomography at Johns Hopkins Medical Center. He is board certified in internal medicine, cardiology and vascular medicine. He joined M. D. Anderson in 2008 as a faculty member in the Department of Cardiology.
Dr. Mouhayar is the Medical Director of the Cardiopulmonary Center and the Medical Director of the Non-Invasive Vascular Laboratory. He is involved in many quality improvement projects that focus on patient satisfaction, care delivery and service growth throughout the center.
His clinical and research activities at MDACC cover the broad aspect of non-invasive and invasive testing modalities in the cardiovascular field with special interest in in cardiovascular imaging, including vascular ultrasonography and nuclear cardiology. He serves as a collaborator on several ongoing clinical trials. Dr. Mouhayar has a special interest in pericardial and peripheral arterial diseases and in the early detection and management of cardio-toxicity as a result of conventional or targeted chemotherapy.
Present Title & Affiliation
Primary Appointment
Deputy Chair for Clinical Affairs, Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX
Professor, Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX
Adjunct, Associate Professor, Medicine, Baylor College of Medicine, Houston, TX
Medical Director of The Cardiology Services - Cardiopulmonary Center, Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
Medical Director of the Non-Invasive Vascular Laboratory, Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX
Dual/Joint/Adjunct Appointment
Professor, Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
Adjunct, Associate Professor, Medicine, Baylor College of Medicine, Houston, Texas
Research Interests
Peripheral arterial disease
Cardiovascular imaging
Education & Training
Degree-Granting Education
| 1996 | Lebanese University-Faculty of Medical Sciences, Beirut, LB, MD |
Postgraduate Training
| 2007-2007 | Mini-Fellowship, Cardiovascular Computed Tomography, Johns Hopkins Medical Center, Baltimore, Maryland |
| 2000-2003 | Clinical Fellowship, Cardiology, Geisinger Clinics, Danville, Pennsylvania |
| 1997-2000 | Clinical Internship, Internal Medicine, Staten Island University Hospital, Staten Island, New York |
| 1997-2000 | Clinical Residency, Internal Medicine, Staten Island University Hospital, Staten Island, New York |
Licenses & Certifications
| 2010 | American Registry for Diagnostic Medical Sonography-PVI/ARDMS |
| 2008 | Texas Medical License |
| 2008 | Doctor of Medicine |
| 2006 | Vascular Medicine Certification |
| 2003 | Cardiovascular Disease |
| 2003 | Nuclear Cardiology |
| 2000 | American Board of Internal Medicine |
Experience & Service
Faculty Academic Appointments
Associate Professor, Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 2012 - 2019
Associate Professor, Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 2008 - 2012
Administrative Appointments/Responsibilities
Department of Cardiology, Quality Officer, Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, 2022 - 2025
Deputy Chair for Clinical Affairs, Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, 2021 - Present
Medical Director, Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, 2020 - Present
Associate Medical Director, Cardiopulmonary Center, The University of Texas MD Anderson Cancer Center, Houston, TX, 2017 - 2020
Medical Director, Cardiopulmonary Center, The University of Texas MD Anderson Cancer Center, Houston, TX, 2014 - 2017
Associate Medical Director, Cardiopulmonary Center, The University of Texas MD Anderson Cancer Center, Houston, TX, 2011 - 2014
Medical Director, Cardiopulmonary Center, The University of Texas MD Anderson Cancer Center, Houston, TX, 2009 - 2011
Medical Director, Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, 2008 - Present
Chief of Medical Staff, Roane Medical Center, Harriman, TN, 2007 - 2008
Elected Member of the Board of Directors, Parkway Cardiology Associates, Oak Ridge, TN, 2007 - 2008
Extramural Institutional Committee Activities
Member, Cardiology Chair Advisory Committee, The University of Texas MD Anderson Cancer Center, 2019 - 2019
Member, The University of Texas MD Anderson UTHealth Graduate School of Biomedical Sciences, PhD Candidacy Exam Committee (Dr. Anchit Bhagat), The University of Texas MD Anderson Cancer Center, 2018 - 2018
Member, Clinical Effectiveness Subcommittee, The University of Texas MD Anderson Cancer Center, 2015 - Present
Member, Cancer Survivorship Research Advisory Workgroup, The University of Texas MD Anderson Cancer Center, 2014 - 2015
Member, PRS Executive Committee, The University of Texas MD Anderson Cancer Center, 2013 - 2016
Lead Physician, Institutional Practice Algorithm: Pacemaker Group, The University of Texas MD Anderson Cancer Center, 2012 - 2015
Member, Cardiopulmonary Center Operations Committee, The University of Texas MD Anderson Cancer Center, 2009 - Present
Member, DoIM Clinical Advisory Committee, The University of Texas MD Anderson Cancer Center, 2009 - 2011
Member, Cardiopulmonary Center Steering Committee, The University of Texas MD Anderson Cancer Center, 2009 - 2019
Member, Pharmacy and Therapeutics Committee, The University of Texas MD Anderson Cancer Center, 2008 - 2022
Honors & Awards
| 2024 | Ambulatory Celebrate Improvements Fair - Second Place Award, MD Anderson Cancer Center |
| 2024 | Excellence Award Finalist - Division of Internal Medicine, MD Anderson Cancer Center |
| 2019 | Division of Internal Medicine Faculty Excellence Award For Excellence in Quality Care, UT MD Anderson Cancer Center |
| 2019 | President’s Recognition of Faculty Excellence in Clinical Quality Improvement, UT MD Anderson Cancer Center |
| 2017 | Faculty Excellence Award Nominee for Excellence in Patient Care, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center |
| 2014 - 2015 | The University of Texas MD Anderson Cancer Center Cardiologist Faculty of the Year, The University of Texas Health Science Center at Houston Medical School |
| 2012 | James S. and Suzanne Cyrus Scholar Awards Finalist in Clinical Research, The University of Texas MD Anderson Cancer Center |
| 1999 - 2000 | Distinguished Achievement in Medical Research and Scholarly Activity, Staten Island University Hospital |
| 1999 | ACP-ASIM New York Chapter-Honorable Mention in Clinical Research |
Professional Memberships
Selected Presentations & Talks
Local Presentations
- 2025. Echocardiogram-Based Screening for Pulmonary Hypertension in Patients with Cancer. Poster. MD Anderson DoIM Research Retreat 2025. Houston, Texas, US.
- 2025. Cardiovascular Syndromes Associated With Therapeutic Radiation of H&N Cancers. Invited. Head and Neck radiation oncology seminar. Houston, Texas, US.
- 2023. Internal Medicine and Cancer Survivorship Grand Rounds Optimizing Workflow to Meet Growing Demand in Echocardiography Lab at MDACC. Invited. Institutional Grand Rounds. Houston, Texas, US.
- 2020. Vascular Oncology: An update. Conference. Vascular Oncology: An update. Houston, TX, US.
- 2020. The Year of Colchicine in Cardiology. Conference. The Year of Colchicine in Cardiology. Houston, TX, US.
- 2020. COVID-19 and the CV System. Conference. COVID-19 and the CV System. Houston, TX, US.
- 2020. COVID-19 and the Heart. Conference. COVID-19 and the Heart. Houston, TX, US.
- 2019. Urgent Pericardiocentesis: Techniques and Pittfalls. Conference. Urgent Pericardiocentesis: Techniques and Pittfalls. Houston, TX, US.
- 2019. Vascular Disease in Cancer Patients. Conference. Vascular Disease in Cancer Patients. Houston, TX, US.
- 2019. Cardiac Toxicities - Late Effects of Cancer Treatment. Conference. Cardiac Toxicities - Late Effects of Cancer Treatment. Houston, TX, US.
- 2018. ECHO Conference. Conference. ECHO Conference. Houston, TX, US.
- 2018. Vascular Imaging in Cancer Patients: Case-Based Clinician Perspective. Conference. Vascular Imaging in Cancer Patients: Case-Based Clinician Perspective. Houston, TX, US.
- 2018. The cross-section of Cardiology & Oncology: The spectrum of cancer treatment related toxicities from Traditional to Targeted cancer therapies & Immunotherapy. Conference. The cross-section of Cardiology & Oncology: The spectrum of cancer treatment related toxicities from Traditional to Targeted cancer therapies & Immunotherapy. Houston, TX, US.
- 2018. Cardiology Patient Experience Improvement Project. Conference. Cardiology Patient Experience Improvement Project. Houston, TX, US.
- 2018. Cardiovascular health during cancer care. Conference. Cardiovascular health during cancer care. Houston, TX, US.
- 2017. ECHO Conference. Conference. ECHO Conference. Houston, TX, US.
- 2017. Pericardial Diseases. Conference. Pericardial Diseases. Houston, TX, US.
- 2017. Pericardial Diseases Associated with Malignancy: An Update. Conference. Pericardial Diseases Associated with Malignancy: An Update. Houston, TX, US.
- 2017. Utility of cardiac biomarkers (TnI, NT pro-BNP, and BNP) in early detection of cardiotoxicity. Conference. Utility of cardiac biomarkers (TnI, NT pro-BNP, and BNP) in early detection of cardiotoxicity. Houston, TX, US.
- 2017. Cardiovascular health during the journey of cancer care. Conference. Cardiovascular health during the journey of cancer care. Houston, TX, US.
- 2017. Cardiac Toxicities. Conference. Cardiac Toxicities. Houston, TX, US.
- 2016. Cardiac Emergencies. Conference. Cardiac Emergencies. Houston, TX, US.
- 2016. Epic Updates. Conference. Epic Updates. Houston, TX, US.
- 2016. Epic Updates. Conference. Epic Updates. Houston, TX, US.
- 2016. Epic Updates. Conference. Epic Updates. Houston, TX, US.
- 2015. Pulmonary Embolism Working Group "The role of cardiac testing in the management of patients with acute pulmonary embolism". Conference. Pulmonary Embolism Working Group "The role of cardiac testing in the management of patients with acute pulmonary embolism". Houston, TX, US.
- 2015. Management of Pericardial Effusion in Cancer Patients. Conference. Management of Pericardial Effusion in Cancer Patients. Houston, TX, US.
- 2015. Carcinoid Valvular Heart Disease. Conference. Carcinoid Valvular Heart Disease. Houston, TX, US.
- 2015. Cardiovascular Imaging of the Cancer Patient. Conference. Cardiovascular Imaging of the Cancer Patient. Houston, TX, US.
- 2015. Management of Asymptomatic Carotid Artery Disease: The Moving Target. Conference. Management of Asymptomatic Carotid Artery Disease: The Moving Target. Houston, TX, US.
- 2015. Mortality and Morbidity. Conference. Mortality and Morbidity. Houston, TX, US.
- 2014. Management of neoplastic pericardial diseases. Conference. Management of neoplastic pericardial diseases. Houston, TX, US.
- 2014. Role of Beta-Adrenergic Blockade in Cancer and the Heart. Conference. Role of Beta-Adrenergic Blockade in Cancer and the Heart. Houston, TX, US.
- 2014. Anticoagulation management in cardiac patients undergoing cancer therapy. Conference. Anticoagulation management in cardiac patients undergoing cancer therapy. Houston, TX, US.
- 2014. Management and Outcome of Acute Limb Ischemia in Cancer Patients: The MDACC Experience. Conference. Management and Outcome of Acute Limb Ischemia in Cancer Patients: The MDACC Experience. Houston, TX, US.
- 2011. Outcome of Acute Peripheral Arterial Ischemic Events in Cancer Patients: The MDACC Experience. Conference. Outcome of Acute Peripheral Arterial Ischemic Events in Cancer Patients: The MDACC Experience. Houston, TX, US.
- 2010. Cardiopulmonary Wait Watchers. Conference. Cardiopulmonary Wait Watchers. Houston, TX, US.
- 2010. Cardiopulmonary Wait Watchers. Conference. Cardiopulmonary Wait Watchers. Houston, TX, US.
Regional Presentations
- 2025. Cardiovascular Syndromes Associated With Therapeutic Radiation of H&N Cancers. Invited. General Internal Medicine Clinical and Research Conference at MDACC. Houston, TX, US.
- 2022. Principles of Therapeutics. Conference. Principles of Therapeutics, US.
- 2015. Outcomes of Cancer Patients Undergoing Pericardiocentesis. Conference. Outcomes of Cancer Patients Undergoing Pericardiocentesis. Washington, DC, US.
- 2013. Nuclear Cardiology Board Review Session. Conference. Nuclear Cardiology Board Review Session, US.
- 2010. Cardiopulmonary Wait Watchers. Conference. Cardiopulmonary Wait Watchers. Austin, TX, US.
National Presentations
- 2019. Acute Cardiovascular Syndromes Related to Cancer Therapies. Conference. 2nd International Symposium of Critical Care in Cancer Patients. Houston, TX, US.
- 2018. Search for the High-Sensitivity cardiac Troponin T appropriate cutoff value in our cancer patients. Conference. UT MD Anderson Cancer Center. Houston, TX, US.
- 2017. Reproducibility Assessment of the Carotid Intima Media Thickness and Carotid Vascular Strain Parameters in Head and Neck Cancer Patients Undergoing Radiation Therapy. Conference. 28th Annual Scientific Sessions. New Orleans, LA, US.
- 2017. Chemotherapeutic-Associated Hypertension: Molecular Basis. Conference. 66th Annual Scientific Sessions. Washington, DC, US.
- 2016. Vascular Health in Cancer Patients. Conference. The Fourth International Conference on Cancer and the Heart. Houston, TX, US.
- 2016. Updates in the Management of Neoplastic Pericardial Diseases. Conference. The Fourth International Conference on Cancer and the Heart. Houston, TX, US.
- 2015. Survival outcome of cancer patients with pericardial effusions. Conference. American Heart Association Scientific Sessions 2015. Orlando, FL, US.
- 2015. Survival outcome of cancer patients with pericardial effusions. Conference. 2015 ASCO Annual Meeting. Chicago, IL, US.
- 2013. Etiology of Acute Limb Ischemia in Cancer Patients. Conference. 24th Scientific Sessions of Society for Vascular Medicine Meeting. Cleveland, OH, US.
- 2012. Pericardial Effusion. Conference. The Second International Conference on Cancer and the Heart. Houston, TX, US.
- 2012. Tyrosine Kinase Inhibitors Related Cardiotoxicity: Is There A Role for Routine Cardiac Monitoring?. Conference. The Second International Conference on Cancer and the Heart. Houston, TX, US.
- 2011. Acute Peripheral Arterial Ischemic Events in Cancer Patients. Conference. 60th Annual Scientific Session & Expo. New Orleans, LA, US.
- 2011. Clinical Features and Outcomes of Stress-Induced Cardiomyopathy in Cancer. Conference. 60th Annual Scientific Session & Expo. New Orleans, LA, US.
- 2010. Common and Uncommon Blood Pressure Issues in Cancer Patients. Conference. First International Conference on Cancer and the Heart. Houston, TX, US.
- 2003. Acetylcysteine and Contrast Induced Nephropathy in Diabetic Patients Undergoing Coronary Angiography or Interventions. Conference. 26th Annual Scientific Sessions of the Society for Cardiac Angiography and Interventions. Boston, MA, US.
- 2002. Safety of Emergency Room Chest Pain Units in the Assessment of Patients with Atypical Chest Pain and Previously Documented Coronary Artery Disease. Conference. 4th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke. Washington, DC, US.
- 2002. Prevention of Contrast-Induced Renal Dysfunction with Acetylcysteine in Patients Undergoing Coronary Angiography. Conference. 51st Annual Scientific Session. Atlanta, GA, US.
International Presentations
- 2020. Vascular imaging in Cancer patients: Case-based Clinician Perspective. Conference. III INTERNATIONAL Workshop on Cardioncology, IT.
- 2020. Feasibility and Outcomes of an Exercise Intervention for Chemotherapy-induced Cardiomyopathy. Conference. III INTERNATIONAL Workshop on Cardioncology, IT.
- 2019. Onco-Cardiology: The Intersection of Heart Disease and Cancer Care. Conference. The Second Annual Lebanese University Medical Graduates Conference, LB.
- 2018. The spectrum of cardiotoxicities: from traditional to targeted cancer therapies & immunotherapy. Conference. International Workshop on Cardioncology: "From Research to Clinical Practice". Naples, IT.
- 2018. Pregnancy after cancer and chemotherapy. Conference. International Workshop on Cardioncology: "From Research to Clinical Practice". Naples, IT.
- 2018. Cardiac outcomes with pregnancy after cardiotoxic therapy for childhood cancer. Conference. Pathophysiology and Management of Cardiovascular Complications in Oncology. Naples, IT.
- 2018. Update on Neoplastic Pericardial Diseases: What’s New in Etiology and Management?. Conference. Pathophysiology and Management of Cardiovascular Complications in Oncology. Naples, IT.
- 2015. Vascular complications of traditional and targeted cancer therapies. Conference. International Workshop on Cardioncology: From Research to Clinical Practice. Naples, IT.
- 2015. Management of neoplastic pericardial effusions: the MDACC experience. Conference. The MD Anderson Cancer Center meets the National Cancer Institute "Fondazione Pascale". Naples, IT.
- 2014. New Insights in the Management of Atherosclerotic Carotid Artery Disease: The Moving Target. Conference. The 14th International American Lebanese Medical Association Congress. Beirut, LB.
- 2013. Cardiotoxicity of Traditional and Targeted Chemotheraphy: What's New in Early Detection and Prevention?. Conference. The 13th International American Labanese Medical Association Congress. Beirut, LB.
Formal Peers
- 2015. Outcomes of cancer patients undergoing pericardiocentesis. Invited. Washington, DC, US.
Selected Publications
Peer-Reviewed Articles
- Triantafyllou, E, Jang, I, Sahli, A, Van-Bergen, PJ, Moreno, AC, Deswal, A, Mouhayar, E, Fuller, C, Hutcheson, KA, Koutroumpakis, E. Overlap of Afferent Baroreflex Failure and Lower Cranial Neuropathies in Long-term Oropharyngeal Cancer Survivors Postradiation Therapy. Advances in Radiation Oncology 11(11), 2026. e-Pub 2026. PMID: 42502577.
- Haddad, F, Thompson, KA, Koutroumpakis, E, Palaskas, NL, Mouhayar, E. Pericardial Decompression Syndrome Complicated by Left Ventricular Thrombus and Systemic Embolization. JACC: Case Reports 31(26), 2026. e-Pub 2026. PMID: 42149074.
- Triantafyllou, E, Bandrey, DS, Patel, B, Van-Bergen, PJ, Mbagwu, GN, Shen, J, Kapadia, TK, Song, J, Abe, J, Moreno, AC, Naser, M, Hutcheson, KA, Rosenthal, D, Khalaf, SZ, Iliescu, C, Deswal, A, Mouhayar, E, Fuller, C, Koutroumpakis, E. Neck adiposity on standard oncologic CT predicts radiation-induced carotid disease in oropharyngeal cancer. Cardio-Oncology 12(1), 2026. e-Pub 2026. PMID: 42035215.
- Van-Bergen P, Bandrey D, Song J, Patin SP, Prathapa N, Mbagwu GN, Hughes A, Shen J, Naser MA, Hutcheson KA, Rosenthal DI, Moreno AC, Mouhayar EN, Deswal A, Fuller CD, Koutroumpakis E. Prevalence of Manifestations of Afferent Baroreflex Failure Among Long-Term Survivors of Oropharyngeal Cancer, 2025. e-Pub 2025.
- King, NE, Kapadia, MV, Moore, X, Khan-Makoid, S, Mouhayar, E. Acute Myeloid Leukemia Associated With Catastrophic Arterial and Venous Thrombi. JACC: Case Reports 30(32), 2025. e-Pub 2025. PMID: 40938244.
- Diaz P, Bandrey D, Patin S, Prathapa N, Mbagwu G, Hughes A, Song J, Naser M, Hutcheson K, Rosenthal D, Moreno A, Mouhayar EN, Deswal A, Fuller C, Koutroumpakis S. Prevalence of Manifestations Linked to Afferent Baroreflex Failure Among Oropharyngeal Cancer Survivors Treated with Radiation Therapy. JACC 85(12), 2025. e-Pub 2025.
- Ali, HR, Cui, S, Sahay, S, Grosu, HB, Riben, MW, Deswal, A, Mouhayar, E, Iliescu, C, Ali, A, Faiz, S. Pulmonary Tumor Thrombotic Microangiopathy. JACC: Case Reports 30(5), 2025. e-Pub 2025. PMID: 40054931.
- Koutroumpakis, E, Naser, M, Mohamed, AS, Eraj, SA, Jarre, A, Shiao, J, Kamal Jomaa, M, Perni, S, Phan, J, Morrison, WH, Frank, SJ, Gunn, GB, Garden, AS, Deswal, A, Abe, J, Rosenthal, D, Mouhayar, E, Fuller, C. Detection of alteration in carotid artery volumetry using standard-of-care computed tomography surveillance scans following unilateral radiation therapy for early-stage tonsillar squamous cell carcinoma survivors. Clinical and Translational Radiation Oncology 51, 2025. e-Pub 2025. PMID: 39867727.
- Koutroumpakis, E, Mohamed, AS, Chaftari, P, Rosenthal, D, Gujral, DM, Nutting, CM, Kamel, S, Naser, M, Kim, P, Bassett Jr, R, Fuller, C, Mouhayar, E. Longitudinal changes in the carotid arteries of head and neck cancer patients following radiation therapy. Radiotherapy and Oncology 195, 2024. e-Pub 2024. PMID: 38467343.
- Koutroumpakis E, Naser MA, Radwan Mohamed AS, Eraj SA, Jarre A, Shiao JC, Kamal M, Perni S, Phan JP, Morrison WH, Frank SJ, Gunn G, Garden AS, Deswal A, Abe J, Rosenthal DI, Mouhayar E, Fuller CD. Detection of Alteration in Carotid Artery Volumetry Using Standard-of-care Computed Tomography Surveillance Scans Following Unilateral Radiation Therapy for Early-stage Tonsillar Squamous Cell Carcinoma Survivors: A Cross-Sectional Internally-Matched Carotid Isodose Analysis. medRxiv, 2024. e-Pub 2024. PMID: 38798400.
- Li, C, Warner, MT, Middleton, LP, Mouhayar, E, Patel, B, Bashoura, L, Faiz, S. Pulmonary Tumor Thrombotic Microangiopathy in a Patient With Dyspnea and Triple-Negative Breast Cancer. Annals of Internal Medicine Clinical Cases 2(12), 2023. e-Pub 2023.
- Ahmed T, Mouhayar E, Banchs J, Karimzad K, Hassan SA, Brewster A, Yusuf SW. Extensive Painless Aortic Dissection in a Patient With Breast Cancer. Curr Probl Cardiol 48(0146-2806):101253, 2023. e-Pub 2023. PMID: 35577080.
- Shobayo F, Bajwa M, Koutroumpakis E, Hassan SA, Palaskas NL, Iliescu C, Abe JI, Mouhayar E, Karimzad K, Thompson KA, Deswal A, Yusuf S. Acute coronary syndrome in patients with cancer. Expert Rev Cardiovasc Ther 20(4):275-290, 2022. e-Pub 2022. PMID: 35412407.
- Ahmed T, Mouhayar E, Song J, Koutroumpakis E, Palaskas NL, Yusuf SW, Lopez-Mattei J, Hassan SA, Kim P, Cilingiroglu M, Marmagkiolis K, Vaporciyan AA, Swisher S, Deswal A, Iliescu C. Predictors of Recurrence and Survival in Cancer Patients With Pericardial Effusion Requiring Pericardiocentesis. Front Cardiovasc Med 9:916325, 2022. e-Pub 2022. PMID: 35711368.
- Quintana RA, Bui LP, Moudgil R, Palaskas N, Hassan S, Abe JI, Mouhayar E, Yusuf SW, Hernandez A, Banchs J. Speckle-Tracking Echocardiography in Cardio-Oncology and Beyond. Tex Heart Inst J 47(2):96-107, 2020. e-Pub 2020. PMID: 32603473.
- Kitkungvan D, Kalluru D, Lunagariya A, Sanchez L, Yusuf SW, Hassan S, Palaskas N, Mouhayar E, Banchs J. Safety of Transesophageal Echocardiography in Patients with Thrombocytopenia. J Am Soc Echocardiogr 32(8):1010-1015, 2019. e-Pub 2019. PMID: 31239084.
- Tsai E, Mouhayar E, Lenihan D, Song J, Durand JB, Fadol A, Massey M, Harrison C, Basen-Engquist K. Feasibility and Outcomes of an Exercise Intervention for Chemotherapy-Induced Heart Failure. J Cardiopulm Rehabil Prev 39(3):199-203, 2019. e-Pub 2019. PMID: 31022003.
- Palaskas N, Morgan J, Daigle T, Banchs J, Durand JB, Hong D, Naing A, Le H, Hassan SA, Karimzad K, Mouhayar E, Kim P, Lopez-Mattei J, Thompson K, Yusuf SW, Iliescu C. Targeted Cancer Therapies with Pericardial Effusions Requiring Pericardiocentesis Focus-ing on Immune Checkpoint Inhibitors. Am J Cardiol doi:https://doi.org/10.1016(8):1351-1357, 2019. e-Pub 2019. PMID: 30765065.
- Donisan T, Balanescu DV, Mouhayar E, Tayar J, Iliescu C. Coronary Lesions in Takayasu Arteritis with Chronic Myelogenous Leukemia - Intravascular Assessment with Optical Coherence Tomography and Fractional Flow Reserve. Circ J 83(1):245-246. doi: 10.1253/circj.CJ-18-0445(1):245-246, 2018. e-Pub 2018. PMID: 29952342.
- Iliescu C, Balanescu DV, Donisan T, Giza DE, Muñoz Gonzalez ED, Cilingiroglu M, Song J, Mukerji SS, Lopez-Mattei JC, Kim PY, Palaskas N, Mouhayar EN, Durand JB, Marmagkiolis K. Safety of Diagnostic and Therapeutic Cardiac Catheterization in Cancer Patients With Acute Coronary Syndrome and Chronic Thrombocytopenia. Am J Cardiol 122(9):1465-1470, 2018. e-Pub 2018. PMID: 30180958.
- Zarifa A, Salih M, Lopez-Matei J, Lee HJ, Iliescu C, Hassan S, Palaskas N, Durand JB, Mouhayar E, Kim J, Kim P. Cardiotoxicity of FDA-approved immune checkpoint inhibitors: A rare but serious adverse event. Journal of Immunotherapy and Precision Oncology, 2018. e-Pub 2018.
- Liu J, Mouhayar E, Tarrand JJ, Kontoyiannis DP. Fulminant Cryptococcus neoformans infection with fatal pericardial tamponade in a patient with chronic myelomonocytic leukemia who was treated with ruxolitinib: Case report and review of fungal pericarditis. Mycoses 61(4):245-255, 2018. e-Pub 2018. PMID: 29280197.
- Karam-Hage M, Kypriotakis G, Robinson JD, Green CE, Mann G, Rabius V, Wippold R, Blalock JA, Mouhayar E, Tayar J, Chaftari P, Cinciripini PM. Improvement of Smoking Abstinence Rates With Increased Varenicline Dosage: A Propensity Score-Matched Analysis. J Clin Psychopharmacol 38(1):34-41, 2018. e-Pub 2018. PMID: 29232312.
- Liu VY, Agha AM, Lopez-Mattei J, Palaskas N, Kim P, Thompson K, Mouhayar E, Marmagkiolis K, Hassan SA, Karimzad K, Iliescu CA. Interventional Cardio-oncology: Adding a New Dimension to the Cardio-oncology Field. Front Cardiovasc Med 5:48, 2018. e-Pub 2018. PMID: 29868614.
- Nassif T, Banchs J, Yusuf SW, Mouhayar E. Acute haemorrhagic tamponade in cancer patients receiving direct oral anticoagulant: case series. Eur Heart J Case Rep 1(2):1-4, 2017. e-Pub 2017. PMID: 31020076.
- Reddy N, Moudgil R, Lopez-Mattei JC, Karimzad K, Mouhayar EN, Somaiah N, Conley AP, Patel S, Giza DE, Iliescu C. Progressive and Reversible Conduction Disease with Checkpoint Inhibitors. Can J Cardiol 33(10):1335.e13-1335.e15, 2017. e-Pub 2017. PMID: 28822650.
- Ning MS, Tang L, Gomez DR, Xu T, Luo Y, Huo J, Mouhayar E, Liao Z. Incidence and predictors of pericardial effusion after chemoradiation therapy for locally advanced nonsmall cell lung cancer. Int J Radiat Oncol Biol Phys 99(1):70-79, 2017. e-Pub 2017. PMID: 28816165.
- Chaftari AM, Hachem R, Szvalb A, Taremi M, Granwehr B, Viola GM, Amin S, Assaf A, Numan Y, Shah P, Gasitashvili K, Natividad E, Jiang Y, Slack R, Reitzel R, Rosenblatt J, Mouhayar E, Raad I. Correction for Chaftari et al., "A Novel Nonantibiotic Nitroglycerin-Based Catheter Lock Solution for Prevention of Intraluminal Central Venous Catheter Infections in Cancer Patients". Antimicrob Agents Chemother 61(8), 2017. e-Pub 2017. PMID: 28743701.
- Chaftari AM, Hachem R, Szvalb A, Taremi M, Granwehr B, Viola GM, Amin S, Assaf A, Numan Y, Shah P, Gasitashvili K, Natividad E, Jiang Y, Slack R, Reitzel R, Rosenblatt J, Mouhayar E, Raad I. A Novel Nonantibiotic Nitroglycerin-Based Catheter Lock Solution for Prevention of Intraluminal Central Venous Catheter Infections in Cancer Patients. Antimicrob Agents Chemother 61(7), 2017. e-Pub 2017. PMID: 28416559.
- Fadol AP, Mouhayar E, Reyes-Gibby CC. The Use of Cardiac Resynchronization Therapy in Cancer Patients with Heart Failure. J Clin Exp Res Cardiol 3(1), 2017. e-Pub 2017. PMID: 29962508.
- Lee HJ, Chihara D, Wang M, Mouhayar E, Kim P. Ibrutinib-related atrial fibrillation in patients with mantle cell lymphoma. Leuk Lymphoma 57(12):1-3, 2016. e-Pub 2016. PMID: 27087288.
- Yusuf SW, Hassan SA, Mouhayar E, Negi SI, Banchs J, O'Gara PT. Pericardial disease: a clinical review. Expert Rev Cardiovasc Ther 14(4):1-15, 2016. e-Pub 2016. PMID: 26691443.
- El Haddad D, Iliescu C, Yusuf SW, William WN, Khair TH, Song J, Mouhayar EN. Outcomes of Cancer Patients Undergoing Percutaneous Pericardiocentesis for Pericardial Effusion. J Am Coll Cardiol 66(10):1119-28, 2015. e-Pub 2015. PMID: 26337990.
- Mouhayar E, Tayar J, Fasulo M, Aoun R, Massey M, Abi-Aad S, Iliescu C, Ahrar K, Huynh T. Outcome of acute limb ischemia in cancer patients. Vasc Med 19(2):112-117, 2014. e-Pub 2014. PMID: 24532704.
- Mouhayar E, Durand JB, Cortes J. Cardiovascular toxicity of tyrosine kinase inhibitors. Expert Opin Drug Saf 12(5):687-96, 2013. e-Pub 2013. PMID: 23560546.
- Yusuf SW, Bathina JD, Banchs J, Mouhayar EN, Daher IN. Apical Hypertrophic Cardiomyopathy. World J Cardiol 3(7):256-259, 2011. e-Pub 2011. PMID: 21860706.
- Sanon S, Lenihan DJ, Mouhayar E. Peripheral Arterial Ischemic Events in Cancer Patients. Vasc Med 16(2):119-30, 2011. e-Pub 2011. PMID: 21112902.
- Daher IN, Banchs J, Yusuf SW, Mouhayar E, Durand JB, Gladish G. Impact of Cardiac Computed Tomographic Angiography Findings on Planning of Cancer Therapy in Patients with Concomitant Structural Heart Disease. Cardiol Res Pract 2011(1):268058, 2011. e-Pub 2011. PMID: 21559257.
- Mouhayar E, Salahudeen A. Hypertension in Cancer Patients. Tex Heart Inst J 38(3):263–265, 2011. e-Pub 2011. PMID: 21720467.
- Sarin S, Mouhayar EN, Blankenship JC, Costello J, Woomert CA, Nassef LA, Qureshi A. Conservative Management of Left Ventricular Pseudoaneurysm Guided by Cardiac Magnetic Resonance. Clin Cardiol 32(7):E33-4, 2009. e-Pub 2009. PMID: 17803248.
- Tadros GM, Mouhayar EN, Akinwande AO, Campbell B, Wood C, Blankenship JA. Prevention of Radiocontrast-Induced Nephropathy with N-Acetylcysteine in Patients Undergoing Coronary Angiography. J Invasive Cardiol 15(6):311-4, 2003. e-Pub 2003. PMID: 12777667.
- Mouhayar EN, Blankenship JC, Fenster BD, Iliadis EA, McConnell TR. Coronary Artery "Pseudothrombus" Due to Collateral Flow Artifact Distal to Left Circumflex Coronary Stenosis. J Interv Cardiol 15(5):425-9; discussion 429-30, 2002. e-Pub 2002. PMID: 12440191.
Invited Articles
- Shen J, Fuller C, Mouhayar EN, Koutroumpakis E. Radiation-Induced Carotid Artery Stenosis and Afferent Baroreflex Failure. American College of Cardiology, 2025. e-Pub 2025.
- Awan F, Mouhayar E. BTK Inhibitors and Cardiac Considerations in Chronic Lymphocytic Leukemia. CME / ABIM MOC / CE activity sponsored by Medscape, 2017. e-Pub 2017.
- Yeh E, Khakoo A, Mouhayar E. Optimizing Outcomes in Cancer Treatment by Managing the Cardiotoxicity of Targeted Therapy. Online CME activity sponsored by Indiana University School of Medicine, 2009. e-Pub 2009.
Review Articles
- Mouhayar EN, Hammond D, Lopez-Mattei J, Banchs J, Konopleva M, Pemmaraju N. Reversible Myocardial Edema Secondary to Tagraxofusp-Induced Capillary Leak Syndrome. JACC CardioOncol 3(5):752-755, 2021. e-Pub 2021. PMID: 34988487.
- Hassan SA, Palaskas N, Kim P, Iliescu C, Lopez-Mattei J, Mouhayar E, Mougdil R, Thompson K, Banchs J, Yusuf SW. Chemotherapeutic Agents and the Risk of Ischemia and Arterial Thrombosis. Curr Atheroscler Rep 20(2):10, 2018. e-Pub 2018. PMID: 29423705.
- Zarifa, A, Salih, M, Lopez-Mattei, J, Lee, HJ, Iliescu, C, Hassan, SA, Palaskas, NL, Durand, J, Mouhayar, E, Kim, J, Kim, P. Cardiotoxicity of fda-approved immune checkpoint inhibitors. Journal of Immunotherapy and Precision Oncology 1(2):68-77, 2018. e-Pub 2018.
- Giza DE, Marmagkiolis K, Mouhayar E, Durand JB, Iliescu C. Management of CAD in Patients with Active Cancer: teh Interventional Cardiologists' Perspective. Curr Cardiol Rep 19(6):56, 2017. e-Pub 2017. PMID: 28484995.
- Abi Aad S, Pierce M, Barmaimon G, Farhat FS, Benjo A, Mouhayar E. Hypertension induced by chemotherapeutic and immunosuppresive agents: A new challenge. Crit Rev Oncol Hematol 93(1):28-35, 2015. e-Pub 2015. PMID: 25217090.
- Kilkenny, TM, Samaha, M, El Ghoul, Z, Mouhayar, E, Eid, R. Cardiologist's evaluation of obstructive sleep apnea in those patients admitted with chest pain. Chest 114(4 SUPPL):380S-381S, 1998. e-Pub 1998.
Other Articles
- El Haddad, D, Iliescu, C, Yusuf, SW, William Jr, WN, Khair, TH, Song, J, Mouhayar, E Erratum. Journal of the American College of Cardiology 66(20):2269, 2015. PMID: 28911503.
Editorials
- Gujral DM, Mouhayar EN, Bhattacharyya S. Cardiac Adverse Events Related to Immune Checkpoint Inhibitors. JACC Case Rep 2(2):200-202, 2020. PMID: 34317204.
- Mouhayar E. Onco-Cardiology: A Specialty that Goes Beyond Managing Cardiovascular Toxicity. Cancer Res Prev Treat 45(11):821-830, 2018.
- Mouhayar E. The discipline of onco-cardiology. Future Oncol 2015;11(14):2027-9. doi:10.2217/fon.15.71(14):2027-9, 2015. PMID: 26198831.
Abstracts
- Guerra Rubi O.A., Song J., Palaskas N., Faiz S., Sheshadri A., Kumar S., Mouhayar EN, Durand JB, Mehran R., Mitchell K., Deswal A., Rajaram R., Ali HJ. PULMONARY HYPERTENSION POST-MAJOR LUNG RESECTION: INCIDENCE AND RISK FACTORS. ACC 2026. e-Pub 2026.
- Ebrahimi S, Hamidi S, Song J, Koutroumpakis E, Ali HR, Kumar S, Mouhayar EN, Dadu R, Iyer PC, Hu MI, Busaidy N, Palaskas NL, Waguespack SG, Cabanillas ME, Deswal A. BRAF and MEK inhibitors in Thyroid Cancer and the Heart: Tracking the Incidence of Cardiac Dysfunction and Heart Failure. ACC, 2025. e-Pub 2025.
- Shen J, Triantafyllou E, Kapadia T, Bandrey DS, Patel B, Van Bergen Díaz PJ, Mbagwu GN, Fernandez AK, Lai S, Palaskas N, Moreno AC, Rosenthal DI, Naser MA, Hutcheson KA, Mouhayar EN, Deswal A, Fuller CD, Koutroumpakis E. Surveillance Practices for Radiation-Induced Carotid Artery Disease in Oropharyngeal Cancer Survivors: Experience from a Large Tertiary Cancer Center. ACC – Texas Chapter 2025 Annual Meeting, 2025. e-Pub 2025.
- Abboud, Maciej CJ, Borthakur Z, Solomon G, Howard S, Bradley B, Mouhayar T, Angelosanto E, N8, Nogai *, Glasmacher H, Dudziak A, Brzozka R, Rzymski K, Littlewood T, Maranda P, E-L12. P501: CLI120-001 PHASE1B DOSE ESCALATION STUDY OF RVU120 IN PATIENTS WITH AML OR HIGH RISK MDS SAFETY AND EFFICACY DATA UPDATE. HemaSphere, 2022. e-Pub 2022.
- Abboud C, Sr, Borthakur G, Solomon SR, Burris HA, Sr, Bradley T, JAN Maciej Zaucha JAN, Sr, Lech-Marańda E, Brzozka K, Rzymski T, Littlewood P, Mouhayar E, Shamsili S, Angelosanto N. CLI120-001 Phase Ib Study of RVU120(SEL120) in Patients with AML and High Risk MDS: Updated Safety/Efficacy Results from Initial Dose Escalation. Blood, 2021. e-Pub 2021.
- AnkitUpadhyayJuanLopez-MatteiPeterKimCezarIliescuJean-BernardDurandNicolasPalaskasSaamirHassanKaraThompsonElieMouhayar. DIAGNOSTIC PERFORMANCE OF HIGH SENSITIVITY TROPONIN IN CANCER PATIENTS. Journal of the American College of Cardiology, 2019. e-Pub 2019.
- Shumway J, Mouhayar M, Vickers H, Kim P, Mohamed A, Rosenthal D, Mouhayar E, Fuller C. Reproducibility Assessment of the Carotid Intima Media Thickness and Carotid Vascular Strain Parameters in Head and Neck Cancer Patients Undergoing Radiation Therapy. Society of Vascular Medicine Annual Meeting, 2017. e-Pub 2017.
- Fadol A, Mouhayar E. The use of cardiac resynchronization therapy in cancer patients with heart failure. Division of Internal Medicine Research Retreat 2017, 2017. e-Pub 2017.
- Kypriotakis G, Karam-Hage M, Robinson JD, Green CE, Zheng D, Mann G, Rabius V, Wippold R, Blalock JA, Mouhayar E, Tayar J, Chaftari P, Cinciripini PM. Improvement of Smoking Abstinence Rates with increased Varenicline Dosage: A Propensity Score Matched Analysis. Society of Research on Nicotine and Tobacco 2017 Annual Meeting, 2017. e-Pub 2017.
- Kypriotakis G, Chaftari P, Tayar JH, Mouhayar E. Increasing Varenicline to 3mg per day imrpoves smoking abstinence: a propensity score analysis. Society of Research on Nicotine and Tobacco 2017 Annual Meeting, 2017. e-Pub 2017.
- Shumway J, Mouhayar M, Vickers H, Kim P, Mohamed A, Rosenthal D, Mouhayar E, Fuller C. Reproducibility Assessment of the Carotid Intima Media Thickness and Carotid Vascular Strain Parameters in Head and Neck Cancer Patients Undergoing Radiation Therapy. International Conference on Cancer and the Heart, 2016. e-Pub 2016.
- Fadol AP, Mouhayar E, Fellman BM. The Use of Cardiac Resynchronization Therapy in Cancer Patients with Heart Failure: Preliminary Findings in a Comprehensive Cancer Center. Heart Failure Society of America Meeting 2016, 2016. e-Pub 2016.
- El Haddad D, Iliescu C, William Jr W, Mouhayar E. Survival outcome of cancer patients with pericardial effusions. American Heart Association Scientific Sessions 2015, 2015. e-Pub 2015.
- El Haddad D, Iliescu C, William Jr W, Mouhayar E. Survival outcome of cancer patients with pericardial effusions. ASCO 2015 Scientific Sessions, 2015. e-Pub 2015.
- Khair T, El-Haddad D, Srujal P, Mamagiolis K, Cilingiroglu M, Iliescu G, Yusuf SW, Mouhayar E, Iliescu C. Triple jeopardy: Heart disease, Cancer and Thrombocytopenia - fluoroscopic and echocardiographic guided pericardiocentesis in cancer patients with cardiac tamponade and thrombocytopenia. Society for Cardiac Angiography and Interventions Scientific Sessions, 2015. e-Pub 2015.
- Iliescu C, Yusuf SW, Iliescu G, Vejpongsa P, Durand JB, Mouhayar E, Cilingiroglu M, Marmagkiolis K. Cardiac Catheterization in Cancer Patients with Thrombocytopenia: 4-Year Experience from a High Volume Cancer Center Cardiac Catheterization Laboratory. ACC 64th Annual Scientific Session & Expo, 2015. e-Pub 2015.
- Basen-Engquist K, Hughes D, Harrison C, Baum G, Mouhayar E. Association of Physical Activity with Cardiorespiratory Fitness and Cardiac Function in Cancer Survivors with Chemotherapy-related Heart Failure. Take Heart ASCO 2014, 2014. e-Pub 2014.
- Harrsion CA, Baum G, Song J, Basen-Engquist K, Mouhayar E. Pilot Test of Exercise Intervention in Chemotherapy-Related Heart Failure Patients: Effects on Fatigue. 2014 American College of Sports Medicine, 2014. e-Pub 2014.
- Mouhayar EM, Aoun R, Kim P, Iliescu C. Etiology of Acute Limb Ischemia in Cancer Patients. 24th Scientific Sessions of Society for Vascular Medicine Meeting, 2013. e-Pub 2013.
- Mukerji S, Yusuf SW, Banchs J, Mouhayar E, Tomakin G, Iliescu G, Durand JB, Iliescu C. Impact of Chronic Thrombocytopenia in Patients with Coronary Artery Disease and Cancer. Catheterization and Cardiovascular Interventions 79(6):S51, 2012. e-Pub 2012.
- Mouhayar EN, Abi Aad SB, Massey M, Iliescu C, Yusuf S, Daher IN. Acute Peripheral Arterial Ischemic Events in Cancer Patients. ACC 60th Annual Scientific Session & Expo, 2011. e-Pub 2011.
- Iliescu C, Reyes M, Abi Aad SB, Banchs J, Mouhayar EN, Leja M, Daher IN, Yusuf SW, Durand JB. Clinical Features and Outcomes of Stress-Induced Cardiomyopathy in Cancer. ACC 60th Annual Scientific Session & Expo, 2011. e-Pub 2011.
- Khakoo A, Massey M, Chua C, Chiu A, Mouhayar, E, Durand JB, Lenihan DJ. Hypertension, Potentially Leading to Heart Failure, Associated with Anti-Vascular Endothelial Growth Factor Therapy Can Be Predicted by Baseline Levels of Circulating Serum Biomarkers. Journal of Cardiac Failure 15(6):S65, 2009. e-Pub 2009.
- Daher IN, Mouhayar E, Banchs J, Yusuf SW, Durand JB, Gladish G. Impact of Cardiac Computed Tomographic Angiography Findings on Planning of Cancer Therapy Planning in Patients with Concomitant Structural Heart Disease. 4th Annual Meeting of the Society of Cardiovascular Computed Tomography, 2009. e-Pub 2009.
- Elmi F, Mouhayar E, Wood GC, Blankenship JC. N-Acetylcysteine and Contrast Induced Nephropathy in Diabetic Patients Undergoing Coronary Angiography or Intervention. 26th Annual Scientific Sessions of the Society for Cardiac Angiography and Interventions, 2003. e-Pub 2003.
- Mouhayar E, Elmi F, Singh G, Costello J, Wood C, McConnell T, AO Akinwande AO, Iliadis E, Menapace F. Safety of Emergency Room Chest Pain Units in the Assessment of Patients with Atypical Chest Pain and Previously Documented Coronary Artery Disease. AHA 4th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke, 2002. e-Pub 2002.
- Mouhayar E, Tadros G, Akinwande G, Campbell J, Blankenship J, Iliads E. Prevention of Contrast-Induced Renal Dysfunction with Acetylcysteine in Patients Undergoing Coronary Angiography. 51st Annual American College of Cardiology Scientific Session, 2002. e-Pub 2002.
- BD Fenster BD, T Scott T, E Mouhayar E, FA Bachour FA, TR McConnell TR, FJ Menapace FJ, J Chapman J, JC Blankenship JC, EA Iliads EA. Correlation of a Non-Critical Fraction flow Reserve with Functional Test Performance and Long Term Clinical Outcome. Catheterization and Cardiovascular Interventions 53:1:25, 2001. e-Pub 2001.
- M Samaha: Z Elghoul: E Mouhayar; R Eid; TM Kilkenny M. Cardiologist's Evaluation of Obstructive Sleep Apnea in Patients Admitted with Chest Pain. Chest 114:380S- 381S, 1998. e-Pub 1998.
Book Chapters
- Mouhayar E. Arterial and Venous Thromboembolic Diseases in Cancer Patients. In: Cancer and the Heart. 3rd Edition, 2019.
- Maurea N, Caronna A, Mouhayar E. Venous Thromboembolism. In: Cardiovascular Complications in Cancer Therapy. Springer, 2019.
- Rice D, Mouhayar E. In: Malignant pericardial effusion. In: Shield’s general thoracic surgery, 2019.
- Chaftari P, Mouhayar E, Iliescu C, Hassan SA, Kim P. Cardiac Emergencies in Cancer Patients. In: Oncologic Emergencies. Springer, 55-92, 2016.
- Mouhayar E, Kim P, Thompson K. Onco-Cardiology. In: MD Anderson Manual of Medical Oncology. McGraw Hill, 2016.
- Mouhayar E. Pericardial Effusion. In: MD Anderson Practices in Onco-Cardiology, 25-26, 2016.
- Mouhayar E. Peripheral arterial diseases in cancer patients. In: Cardio-Oncology, 2015.
- Mouhayar, E. Peripheral arterial disease in cancer patients. In: Cancer and the Heart, 2012.
- Mouhayar E, Lech T. Hypertension in Cancer Patients. In: Braunwald's Heart Disease, 2011.
Letters to the Editor
- Triantafyllou, E, Flores, IG, Iliescu, C, Deswal, A, Mouhayar, E, Fuller, C, Koutroumpakis, E. Targeted autonomic testing for radiation‑induced baroreflex failure in head and neck cancer survivors. Cardio-Oncology 12, 2026.
Patient Reviews
CV information above last modified August 21, 2026