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Jentzer JC, Anavekar NS, Mankad SV, Khasawneh M, White RD, Barsness GW, Rabinstein AA, Kashani KB, Pislaru SV. Echocardiographic left ventricular diastolic dysfunction predicts hospital mortality after out-of-hospital cardiac arrest. J Crit Care 2018; 47:114-120. [PMID: 29945067 DOI: 10.1016/j.jcrc.2018.06.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 05/31/2018] [Accepted: 06/16/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To determine whether systolic or diastolic dysfunction on transthoracic echocardiogram (TTE) predicts mortality after out-of-hospital cardiac arrest (OHCA). METHODS Retrospective cohort study of 173 OHCA subjects undergoing targeted temperature management who underwent TTE during hospitalization. Univariate analysis and multivariate logistic regression were used to determine associations between TTE measurements of systolic and diastolic function and systemic hemodynamics with all-cause mortality. RESULTS Mean age was 61.6 ± 12.4 years (72.7% male) and initial rhythm was shockable in 89%. Hospital mortality was 30.6%. Mean LVEF was 40% and was not different in hospital survivors (p = 0.81). TTE parameters reflecting systolic function and systemic hemodynamics did not predict hospital mortality. Medial mitral E/e' ratio was associated with hospital mortality, with an optimal cut-off > 13 (p = 0.002). After multivariate adjustment, medial mitral E/e' ratio remained predictive of hospital mortality (OR 1.11, 95% CI 1.03-1.20, p = 0.004). Subjects with a medial mitral E/e' ratio > 13 had higher mortality during long-term follow-up (p < 0.001 by log-rank). CONCLUSIONS Diastolic dysfunction (higher medial mitral E/e' ratio) on TTE independently predicted mortality after OHCA; systolic dysfunction and TTE hemodynamic parameters did not. This reflects a novel use of Doppler TTE to predict outcomes after OHCA.
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Jentzer JC, Anavekar NS, Mankad SV, White RD, Kashani KB, Barsness GW, Rabinstein AA, Pislaru SV. Changes in left ventricular systolic and diastolic function on serial echocardiography after out-of-hospital cardiac arrest. Resuscitation 2018; 126:1-6. [DOI: 10.1016/j.resuscitation.2018.01.050] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/04/2018] [Accepted: 01/29/2018] [Indexed: 02/05/2023]
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28
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Vallabhajosyula S, Pruthi S, Shah S, Wiley BM, Mankad SV, Jentzer JC. Basic and advanced echocardiographic evaluation of myocardial dysfunction in sepsis and septic shock. Anaesth Intensive Care 2018; 46:13-24. [PMID: 29361252 DOI: 10.1177/0310057x1804600104] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Sepsis continues to be a leading cause of mortality and morbidity in the intensive care unit. Cardiovascular dysfunction in sepsis is associated with worse short- and long-term outcomes. Sepsis-related myocardial dysfunction is noted in 20%-65% of these patients and manifests as isolated or combined left or right ventricular systolic or diastolic dysfunction. Echocardiography is the most commonly used modality for the diagnosis of sepsis-related myocardial dysfunction. With the increasing use of ultrasonography in the intensive care unit, there is a renewed interest in sepsis-related myocardial dysfunction. This review summarises the current scope of literature focused on sepsis-related myocardial dysfunction and highlights the use of basic and advanced echocardiographic techniques for the diagnosis of sepsis-related myocardial dysfunction and the management of sepsis and septic shock.
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Antoine C, Mantovani F, Benfari G, Mankad SV, Maalouf JF, Michelena HI, Enriquez-Sarano M. Pathophysiology of Degenerative Mitral Regurgitation. Circ Cardiovasc Imaging 2018; 11:e005971. [DOI: 10.1161/circimaging.116.005971] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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30
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Bois MC, Bois JP, Mankad SV, Young PM, Maleszewski JJ. Retained surgical sponge. Cardiovasc Pathol 2017; 27:43-44. [DOI: 10.1016/j.carpath.2017.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 01/06/2017] [Indexed: 10/20/2022] Open
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Ryan T, Berlacher K, Lindner JR, Mankad SV, Rose GA, Wang A. COCATS 4 Task Force 5: Training in Echocardiography: Endorsed by the American Society of Echocardiography. J Am Soc Echocardiogr 2016; 28:615-27. [PMID: 26041570 DOI: 10.1016/j.echo.2015.04.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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33
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Sekiguchi H, Schenck LA, Horie R, Suzuki J, Lee EH, McMenomy BP, Chen TE, Lekah A, Mankad SV, Gajic O. Critical Care Ultrasonography Differentiates ARDS, Pulmonary Edema, and Other Causes in the Early Course of Acute Hypoxemic Respiratory Failure. Chest 2015; 148:912-918. [DOI: 10.1378/chest.15-0341] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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34
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Rosenbaum AN, Anavekar NS, Ernste FC, Mankad SV, Le RJ, Manocha KK, Barsness GW. A case of catastrophic antiphospholipid syndrome: first report with advanced cardiac imaging using MRI. Lupus 2015; 24:1338-41. [DOI: 10.1177/0961203315587960] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 04/28/2015] [Indexed: 11/16/2022]
Abstract
This present case pertains to a 48-year-old woman with a history of antiphospholipid syndrome, who presented with progressive fatigue, generalized weakness, and orthopnea acutely. She had a prior diagnosis of antiphospholipid syndrome with recurrent deep vein thromboses (DVTs) and repeated demonstration of lupus anticoagulants. She presented in cardiogenic shock with markedly elevated troponin and global myocardial dysfunction on echocardiography, and cardiac catheterization revealed minimal disease. Cardiac magnetic resonance imaging was performed, which revealed findings of perfusion defects and microvascular obstruction, consistent with the pathophysiology of catastrophic antiphospholipid syndrome (CAPS). Diagnosis was made based on supportive imaging, including head magnetic resonance imaging (MRI) revealing multifocal, acute strokes; microvascular thrombosis in the dermis; and subacute renal infarctions. The patient was anticoagulated with intravenous unfractionated heparin and received high-dose methylprednisolone, plasmapheresis, intravenous immunoglobulin, and one dose each of rituximab and cyclophosphamide. She convalesced with eventual myocardial recovery after a complicated course. The diagnosis of CAPS relies on the presence of (1) antiphospholipid antibodies and (2) involvement of multiple organs in a microangiopathic thrombotic process with a close temporal association. The myocardium is frequently affected, and heart failure, either as the presenting symptom or cause of death, is common. Despite echocardiographic evidence of myocardial dysfunction in such patients, MRIs of CAPS have not previously been reported. This case highlights the utility in assessing the involvement of the myocardium by the microangiopathic process with MRI. Because the diagnosis of CAPS requires involvement in multiple organ systems, cardiac MRI is likely an underused tool that not only reaffirms the pathophysiology of CAPS, but could also clue clinicians in to the possibility of a diffuse thrombotic process.
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35
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Mantovani F, Clavel MA, Vatury O, Suri RM, Mankad SV, Malouf J, Michelena HI, Jain S, Badano LP, Enriquez-Sarano M. Cleft-like indentations in myxomatous mitral valves by three-dimensional echocardiographic imaging. Heart 2015; 101:1111-7. [DOI: 10.1136/heartjnl-2014-307016] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/27/2015] [Indexed: 11/03/2022] Open
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36
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Halperin JL, Williams ES, Fuster V, Fuster V, Halperin JL, Williams ES, Cho NR, Iobst WF, Mukherjee D, Vaishnava P, Smith SC, Bittner V, Gaziano JM, Giacomini JC, Pack QR, Polk DM, Stone NJ, Wang S, Balady GJ, Bufalino VJ, Gulati M, Kuvin JT, Mendes LA, Schuller JL, Narula J, Chandrashekhar Y, Dilsizian V, Garcia MJ, Kramer CM, Malik S, Ryan T, Sen S, Wu JC, Ryan T, Berlacher K, Lindner JR, Mankad SV, Rose GA, Wang A, Dilsizian V, Arrighi JA, Cohen RS, Miller TD, Solomon AJ, Udelson JE, Garcia MJ, Blankstein R, Budoff MJ, Dent JM, Drachman DE, Lesser JR, Grover-McKay M, Schussler JM, Voros S, Wann LS, Kramer CM, Hundley WG, Kwong RY, Martinez MW, Raman SV, Ward RP, Creager MA, Gornik HL, Gray BH, Hamburg NM, Iobst WF, Mohler ER, White CJ, King SB, Babb JD, Bates ER, Crawford MH, Dangas GD, Voeltz MD, White CJ, Calkins H, Awtry EH, Bunch TJ, Kaul S, Miller JM, Tedrow UB, Jessup M, Ardehali R, Konstam MA, Manno BV, Mathier MA, McPherson JA, Sweitzer NK, O’Gara PT, Adams JE, Drazner MH, Indik JH, Kirtane AJ, Klarich KW, Newby LK, Scirica BM, Sundt TM, Warnes CA, Bhatt AB, Daniels CJ, Gillam LD, Stout KK, Harrington RA, Barac A, Brush, JE, Hill JA, Krumholz HM, Lauer MS, Sivaram CA, Taubman MB, Williams JL. ACC 2015 Core Cardiovascular Training Statement (COCATS 4) (Revision of COCATS 3). J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.03.017] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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37
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Ryan T, Berlacher K, Lindner JR, Mankad SV, Rose GA, Wang A. COCATS 4 Task Force 5: Training in Echocardiography. J Am Coll Cardiol 2015; 65:1786-99. [DOI: 10.1016/j.jacc.2015.03.035] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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38
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Clavel MA, Mantovani F, Malouf J, Michelena HI, Vatury O, Jain MS, Mankad SV, Suri RM, Enriquez-Sarano M. Dynamic Phenotypes of Degenerative Myxomatous Mitral Valve Disease. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.002989. [DOI: 10.1161/circimaging.114.002989] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background—
Fibro-elastic deficiency (FED) and diffuse myxomatous degeneration (DMD) are phenotypes of degenerative mitral valve disease defined morphologically. Whether physiological differences in annular and valvular dynamics exist between these phenotypes remains unknown.
Methods and Results—
We performed triple quantitation of cardiac remodeling and of mitral regurgitation severity and of annular and valvular dimensions by real-time 3-dimensional-transesophageal-echocardiography. Forty-nine patients with degenerative mitral valve disease classified as FED (n=31) and DMD (n=18) by surgical observation showed no difference in age (65±10 versus 59±13;
P
=0.5), body surface area (2.0±0.2 versus 2.0±0.2 m
2
;
P
=0.5), left ventricular and atrial dimensions (all
P
>0.55), and mitral regurgitation regurgitant orifice (
P
=0.62). On average, annular dimensions were larger in DMD versus FED, but height was similar resulting in lower saddle shape. Dynamically, annular DMD versus FED display poorer contraction and saddle-shape accentuation in early systole and abnormal enlargement, particularly intercommissural, in late-systole (all
P
<0.05). Valvular dynamics showed stable valvular area in systole in FED versus considerable systolic increased area in DMD (
P
<0.001). Prolapse height and volume increased little throughout systole in FED versus marked increase in DMD (
P
<0.001).
Conclusions—
Our novel observations show that FED and DMD, although both labeled myxomatous, display considerable physiological phenotypic differences. In DMD, the annular increased size and profoundly abnormal dynamics demonstrate DMD-specific annular degeneration compared with the enlarged but relatively normal FED annulus. DMD does not incur more severe mitral regurgitation, despite larger prolapse and valve redundancy, underscoring potential compensatory role of tissue redundancy of DMD (or aggravating role of tissue paucity of FED) on mitral regurgitation severity.
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Luis SA, Pellikka PA, Bonnichsen CR, Mankad SV, Pislaru SV. In an era of multimodality cardiac imaging, echocardiography remains the gold standard for the evaluation of valvular and periprosthetic masses. Eur Heart J Cardiovasc Imaging 2014; 15:940. [DOI: 10.1093/ehjci/jeu038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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40
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Aggarwal NR, Peterson TJ, Young PM, Araoz PA, Glockner J, Mankad SV, Williamson EE. Unveiling nonischemic cardiomyopathies with cardiac magnetic resonance. Expert Rev Cardiovasc Ther 2014; 12:217-39. [PMID: 24417294 DOI: 10.1586/14779072.2014.876900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiomyopathy is defined as a heterogeneous group of myocardial disorders with mechanical or electrical dysfunction. Identification of the etiology is important for accurate diagnosis, treatment and prognosis, but continues to be challenging. The ability of cardiac MRI to non-invasively obtain 3D-images of unparalleled resolution without radiation exposure and to provide tissue characterization gives it a distinct advantage over any other diagnostic tool used for evaluation of cardiomyopathies. Cardiac MRI can accurately visualize cardiac morphology and function and also help identify myocardial edema, infiltration and fibrosis. It has emerged as an important diagnostic and prognostic tool in tertiary care centers for work up of patients with non-ischemic cardiomyopathies. This review covers the role of cardiac MRI in evaluation of nonischemic cardiomyopathies, particularly in the context of other diagnostic and prognostic imaging modalities.
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41
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Liang JJ, Mankad SV, Johnson CM, Cooper LT. Cardiac Tamponade. Circ J 2014; 78:1510-1. [DOI: 10.1253/circj.cj-13-1548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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42
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Tsapenko MV, Herasevich V, Mour GK, Tsapenko AV, Comfere TBO, Mankad SV, Cartin-Ceba R, Gajic O, Albright RC. Severe sepsis and septic shock in patients with pre-existing non-cardiac pulmonary hypertension: contemporary management and outcomes. CRIT CARE RESUSC 2013; 15:103-109. [PMID: 23931041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To review treatment and outcomes of septic shock in patients with pulmonary hypertension (PH) managed at a tertiary care institution. DESIGN, SETTING AND PATIENTS We identified consecutive patients with non-cardiac PH (non-Group 2 in the World Health Organization classification) who were treated for septic shock in four intensive care units at a tertiary care institution between July 2004 and July 2007. Patients with a left ventricular ejection fraction < 50%, diastolic dysfunction, pericardial effusion or significant valve disease were excluded. Descriptive statistics were used to analyse the data. MAIN OUTCOME MEASURES Hospital mortality, duration of vasopressor and ventilatory support, length of hospital and ICU stay. RESULTS The final group for analysis comprised 82 patients. The major causes of PH were chronic obstructive pulmonary disease, interstitial lung disease and portopulmonary hypertension. PH was mild in 46 patients (56%), moderate in 21 (26%) and severe in 15 (18%). Vasopressor treatment was initiated in 69 patients (84%) within the first 48 hours: noradrenaline was most commonly used (53 patients, 65%), and 51 patients (62%) were treated with more than one agent. Sixty-seven patients (82%) were mechanically ventilated, and 33 (40%) required renal replacement therapy. Fortythree patients (52%) survived to hospital discharge; 23 (28%) remained alive at 1 year. Hospital mortality increased with severity of PH: 28% in mild, 67% in moderate and 80% in severe PH. Nonsurvivors were more likely to have plateau pressures beyond 30 cm H(2)O while mechanically ventilated within the first 48 hours in the ICU (56% v 29%, P = 0.03), to develop atrial fibrillation (AF) (46% v 12%, P < 0.001), and to require longer vasopressor support (mean, 5.3 v 2.6 days, P = 0.003). In a multivariate logistic regression analysis, severity of PH (odds ratio [OR], 1.55; 95% CI, 1.04-2.46; P = 0.04), new-onset AF (OR, 6.51; 95% CI, 2.24-22.07; P < 0.001) and longer duration of vasopressor support (OR, 1.15; 95% CI, 1.03-1.34; P = 0.04) were associated with increased hospital mortality. CONCLUSIONS The severity of PH, new-onset AF, and longer vasopressor support were associated with poor outcomes in patients with PH who developed severe sepsis and septic shock.
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Topilsky Y, Vaturi O, Watanabe N, Bichara V, Nkomo VT, Michelena H, Le Tourneau T, Mankad SV, Park S, Capps MA, Suri R, Pislaru SV, Maalouf J, Yoshida K, Enriquez-Sarano M. Real-time 3-dimensional dynamics of functional mitral regurgitation: a prospective quantitative and mechanistic study. J Am Heart Assoc 2013; 2:e000039. [PMID: 23727698 PMCID: PMC3698758 DOI: 10.1161/jaha.113.000039] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background Three‐dimensional transthoracic echocardiography (3D‐TTE) with dedicated software permits quantification of mitral annulus dynamics and papillary muscle motion throughout the cardiac cycle. Methods and Results Mitral apparatus 3D‐TTE was acquired in controls (n=42), patients with left ventricle dysfunction and functional mitral regurgitation (LVD‐FMR; n=43) or without FMR (LVD‐noMR, n=35). Annulus in both normal and LVD‐noMR subjects displayed saddle shape accentuation in early‐systole (ratio of height to intercommissural diameter, 10.6±3.7 to 13.5±4.0 in normal and 9.1±4.3 to 12.6±3.6 in LVD‐noMR; P<0.001 for diastole to early‐systole motion, P=NS between those groups). In contrast, saddle shape was unchanged from diastole in FMR patients (10.0±6.4 to 8.0±5.2; P=NS, P<0.05 compared to both other groups). Papillary tips moved symmetrically towards to the midanterior annulus in control and LVD‐noMR subjects, maintaining constant ratio of the distances between both tips to midannulus (PtAR) throughout systole. In LVD‐FMR patients midsystolic posterior papillary tip to anterior annulus distance was increased, resulting in higher PtAR (P=0.05 compared to both other groups). Mechanisms of early‐ and midsystolic FMR differed between different etiologies of LV dysfunction. In patients with anterior MI and global dysfunction annular function and dilatation were the dominant parameters, while papillary muscle motion was the predominant determinant of FMR in patients with inferior MI. Conclusions Inadequate early‐systolic annular contraction and saddle‐shape accentuation in patients with impaired LV contribute to early–mitral incompetency. Asymmetric papillary tip movement towards the midanterior annulus is a major determinant of mid‐ and late‐systolic functional mitral regurgitation.
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44
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45
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Deo SV, Maalouf JF, Mankad SV, Park SJ. A Mitral Hemi-Arcade: An Unusual Modification of a Rare Anomaly. J Card Surg 2012; 27:699-701. [DOI: 10.1111/j.1540-8191.2012.01524.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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46
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Munger TM, Dong YX, Masaki M, Oh JK, Mankad SV, Borlaug BA, Asirvatham SJ, Shen WK, Lee HC, Bielinski SJ, Hodge DO, Herges RM, Buescher TL, Wu JH, Ma C, Zhang Y, Chen PS, Packer DL, Cha YM. Electrophysiological and hemodynamic characteristics associated with obesity in patients with atrial fibrillation. J Am Coll Cardiol 2012; 60:851-60. [PMID: 22726633 DOI: 10.1016/j.jacc.2012.03.042] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 02/27/2012] [Accepted: 03/06/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The authors sought to characterize the left atrial (LA) and pulmonary vein (PV) electrophysiological and hemodynamic features in obese patients with atrial fibrillation (AF). BACKGROUND Obesity is associated with increased risk for AF. METHODS A total of 63 consecutive patients with AF who had normal left ventricular (LV) ejection fraction and who underwent catheter ablation were studied. Atrial and PV electrophysiological studies were performed at the time of ablation with hemodynamic assessment by cardiac catheterization, and LA/LV structure and function by echocardiography. Patients were compared on the basis of body mass index (BMI): <25 kg/m(2) (n = 19) and BMI ≥30 kg/m(2) (n = 44). RESULTS At a 600-ms pacing cycle length, obese patients had shorter effective refractory period (ERP) in the left atrium (251 ± 25 ms vs. 233 ± 32 ms, p = 0.04), and in the proximal (207 ± 33 ms vs. 248 ± 34 ms, p < 0.001) and distal (193 ± 33 ms vs. 248 ± 44 ms, p < 0.001) PV than normal BMI patients. Obese patients had higher mean LA pressure (15 ± 5 mm Hg vs. 10 ± 5 mm Hg, p < 0.001) and LA volume index (28 ± 12 ml/m(2) vs. 21 ± 14 ml/m(2), p = 0.006), and lower LA strain (5.5 ± 3.1% vs. 8.8 ± 2.8%; p < 0.001) than normal BMI patients. CONCLUSIONS Increased LA pressure and volume, and shortened ERP in the left atrium and PV are potential factors facilitating and perpetuating AF in obese patients with AF.
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47
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Geske JB, Smith SB, Morgenthaler TI, Mankad SV. Care of patients with acute pulmonary emboli: a clinical review with cardiovascular focus. Expert Rev Cardiovasc Ther 2012; 10:235-50. [PMID: 22292879 DOI: 10.1586/erc.11.179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Acute pulmonary embolism (PE) is a common, multidisciplinary disease with substantial associated morbidity, mortality and healthcare expense. In this article we present a succinct review of diagnostic tools, risk stratification and medical therapies for cardiovascular care of patients with acute PE. While pulmonary angiography remains the 'gold standard' for diagnosis, a host of diagnostic modalities, interpreted in the setting of clinical probability, are available for patient assessment, including ECG, chest radiography, D-dimer, lower-extremity venous ultrasound, ventilation-perfusion scans, computed tomography and magnetic resonance angiography, and echocardiography, each with associated value. Diagnostic algorithms incorporate multiple tools in order to obtain a more comprehensive evaluation. Therapeutic anticoagulation remains the mainstay of therapy in PE. In massive PE, utilization of thrombolysis is reasonable in the absence of contraindications. Submassive PE, characterized by right ventricular dysfunction as assessed by echocardiography and ECG, is associated with higher mortality. Use of thrombolysis in submassive PE remains controversial. Catheter-directed therapies are emerging as an added approach to acute PE and have the potential to improve outcomes in PE. Use of inferior vena cava filters should be pursued in a select patient population as they serve to reduce recurrent acute PE; however, they are associated with more frequent deep venous thrombosis and provide no mortality benefit. In risk-stratified hemodynamically stable patients, an outpatient management strategy inclusive of therapeutic anticoagulation and careful clinical follow-up may be appropriate.
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48
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Foley TA, Mankad SV, Anavekar NS, Bonnichsen CR, Miller MF, Morris TD, Araoz PA. Measuring Left Ventricular Ejection Fraction – Techniques and Potential Pitfalls. Eur Cardiol 2012. [DOI: 10.15420/ecr.2012.8.2.108] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Prognosis and therapeutic decisions are often based on left ventricular ejection fraction (LVEF), which means the LVEF needs to be accurately measured. Many imaging modalities can measure LVEF. Each of these modalities is subject to measurement errors that can lead to the inaccurate calculation of LVEF. This article reviews the most common non-invasive imaging modalities – i.e., echocardiography, magnetic resonance imaging (MRI), computed tomography (CT), radionuclide angiography, gated myocardial perfusion single-photon emission computed tomography (SPECT) and gated myocardial perfusion positron emission tomography (PET) – used to measure LVEF, as well as the common sources of error with each of them. It is important to understand these sources of errors in order to prevent them, and recognise them when they do occur so that they can be corrected if possible.
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49
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Masaki M, Cha YM, Yuasa T, Veress G, Dong K, Dong YX, Mankad SV, Oh JK. 2-D ULTRASOUND SPECKLE TRACKING STRAIN IMAGING OF THE LEFT ATRIUM IN THE ESTIMATION OF LEFT VENTRICULAR FILLING PRESSURES. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)60863-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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50
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Hagler DJ, Cabalka AK, Sorajja P, Cetta F, Mankad SV, Bruce CJ, Sinak LJ, Chandrasekaran K, Rihal CS. Assessment of Percutaneous Catheter Treatment of Paravalvular Prosthetic Regurgitation. JACC Cardiovasc Imaging 2010; 3:88-91. [DOI: 10.1016/j.jcmg.2009.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 10/20/2009] [Accepted: 10/21/2009] [Indexed: 11/25/2022]
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