1
|
Koschinsky ML, Bajaj A, Boffa MB, Dixon DL, Ferdinand KC, Gidding SS, Gill EA, Jacobson TA, Michos ED, Safarova MS, Soffer DE, Taub PR, Wilkinson MJ, Wilson DP, Ballantyne CM. A focused update to the 2019 NLA scientific statement on use of lipoprotein(a) in clinical practice. J Clin Lipidol 2024:S1933-2874(24)00033-3. [PMID: 38565461 DOI: 10.1016/j.jacl.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024]
Abstract
Since the 2019 National Lipid Association (NLA) Scientific Statement on Use of Lipoprotein(a) in Clinical Practice was issued, accumulating epidemiological data have clarified the relationship between lipoprotein(a) [Lp(a)] level and cardiovascular disease risk and risk reduction. Therefore, the NLA developed this focused update to guide clinicians in applying this emerging evidence in clinical practice. We now have sufficient evidence to support the recommendation to measure Lp(a) levels at least once in every adult for risk stratification. Individuals with Lp(a) levels <75 nmol/L (30 mg/dL) are considered low risk, individuals with Lp(a) levels ≥125 nmol/L (50 mg/dL) are considered high risk, and individuals with Lp(a) levels between 75 and 125 nmol/L (30-50 mg/dL) are at intermediate risk. Cascade screening of first-degree relatives of patients with elevated Lp(a) can identify additional individuals at risk who require intervention. Patients with elevated Lp(a) should receive early, more-intensive risk factor management, including lifestyle modification and lipid-lowering drug therapy in high-risk individuals, primarily to reduce low-density lipoprotein cholesterol (LDL-C) levels. The U.S. Food and Drug Administration approved an indication for lipoprotein apheresis (which reduces both Lp(a) and LDL-C) in high-risk patients with familial hypercholesterolemia and documented coronary or peripheral artery disease whose Lp(a) level remains ≥60 mg/dL [∼150 nmol/L)] and LDL-C ≥ 100 mg/dL on maximally tolerated lipid-lowering therapy. Although Lp(a) is an established independent causal risk factor for cardiovascular disease, and despite the high prevalence of Lp(a) elevation (∼1 of 5 individuals), measurement rates are low, warranting improved screening strategies for cardiovascular disease prevention.
Collapse
Affiliation(s)
- Marlys L Koschinsky
- Department of Physiology & Pharmacology and Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada (Drs Koschinsky, Boffa)
| | - Archna Bajaj
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Drs Bajaj, Soffer)
| | - Michael B Boffa
- Department of Physiology & Pharmacology and Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada (Drs Koschinsky, Boffa)
| | - Dave L Dixon
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA (Dr Dixon)
| | - Keith C Ferdinand
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA (Dr. Ferdinand)
| | - Samuel S Gidding
- Department of Genomic Health, Geisinger. Danville, PA, USA (Dr Gidding)
| | - Edward A Gill
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Dr Gill)
| | - Terry A Jacobson
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA (Dr Jacobson)
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA (Dr Michos)
| | - Maya S Safarova
- Division of Cardiovascular Medicine, Department of Internal Medicine, Froedtert & the Medical College of Wisconsin, Milwaukee, WI, USA (Dr Safarova)
| | - Daniel E Soffer
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Drs Bajaj, Soffer)
| | - Pam R Taub
- Department of Medicine, University of California San Diego, La Jolla, CA, USA (Drs Taub, Wilkinson)
| | - Michael J Wilkinson
- Department of Medicine, University of California San Diego, La Jolla, CA, USA (Drs Taub, Wilkinson)
| | - Don P Wilson
- Department of Pediatric Endocrinology and Diabetes, Cook Children's Medical Center, Fort Worth, TX, USA (Dr Wilson)
| | - Christie M Ballantyne
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA (Dr Ballantyne).
| |
Collapse
|
2
|
Duggal NM, Engoren M, Chadderdon SM, Rodriguez E, Morse MA, Vannan MA, Yadav PK, Morcos M, Li F, Reisman M, Garcia-Sayan E, Raghunathan D, Sodhi N, Sorajja P, Chen L, Rogers JH, Calfon MA, Kovach CP, Gill EA, Zahr FE, Chetcuti SJ, Yuan Y, Mentz GB, Lim DS, Ailawadi G. Mortality Associated With Proportionality of Secondary Mitral Regurgitation After Transcatheter Mitral Valve Repair: North American Mitraclip for Functional Mitral Regurgitation Registry. Am J Cardiol 2024; 213:99-105. [PMID: 38110022 DOI: 10.1016/j.amjcard.2023.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/17/2023] [Accepted: 12/09/2023] [Indexed: 12/20/2023]
Abstract
The association, if any, between the effective regurgitant orifice area (EROA) to left ventricular end-diastolic volume (LVEDV) ratio and 1-year mortality is controversial in patients who undergo mitral transcatheter edge-to-edge repair (m-TEER) with the MitraClip system (Abbott Vascular, Santa Clara, CA). This study's objective was to determine the association between EROA/LVEDV and 1-year mortality in patients who undergo m-TEER with MitraClip. In patients with severe secondary (functional) mitral regurgitation (MR), we analyzed registry data from 11 centers using generalized linear models with the generalized estimating equations approach. We studied 525 patients with secondary MR who underwent m-TEER. Most patients were male (63%) and were New York Heart Association class III (61%) or IV (21%). Mitral regurgitation was caused by ischemic cardiomyopathy in 51% of patients. EROA/LVEDV values varied widely, with median = 0.19 mm2/ml, interquartile range [0.12,0.28] mm2/ml, and 187 patients (36%) had values <0.15 mm2/ml. Postprocedural mitral regurgitation severity was substantially alleviated, being 1+ or less in 74%, 2+ in 20%, 3+ in 4%, and 4+ in 2%; 1-year mortality was 22%. After adjustment for confounders, the logarithmic transformation (Ln) of EROA/LVEDV was associated with 1-year mortality (odds ratio 0.600, 95% confidence interval 0.386 to 0.933, p = 0.023). A higher Society of Thoracic Surgeons risk score was also associated with increased mortality. In conclusion, lower values of Ln(EROA/LVEDV) were associated with increased 1-year mortality in this multicenter registry. The slope of the association is steep at low values but gradually flattens as Ln(EROA/LVEDV) increases.
Collapse
Affiliation(s)
- Neal M Duggal
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
| | - Milo Engoren
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Scott M Chadderdon
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Evelio Rodriguez
- Department of Cardiothoracic Surgery, Ascension Saint Thomas Heart, Nashville, Tennessee
| | - M Andrew Morse
- Division of Cardiology, Ascension Saint Thomas Heart, Nashville, Tennessee
| | - Mani A Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Pradeep K Yadav
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Michael Morcos
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Flora Li
- Department of Anesthesiology, University of Washington, Seattle, Washington
| | - Mark Reisman
- Division of Cardiology, Weill Cornell Medical Center, New York, New York
| | - Enrique Garcia-Sayan
- Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Deepa Raghunathan
- Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Nishtha Sodhi
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute, Abbott Northwestern Medical Center, Minneapolis, Minnesota
| | - Lily Chen
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California
| | - Jason H Rogers
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California
| | - Marcella A Calfon
- Division of Cardiology, University of California Los Angeles, Los Angeles, California
| | | | - Edward A Gill
- Division of Cardiology, University of Colorado, Aurora, Colorado
| | - Firas E Zahr
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Stanley J Chetcuti
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Yuan Yuan
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Graciela B Mentz
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - D Scott Lim
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
3
|
Abstract
SARS-CoV-2 vaccine-associated myocarditis/myocardial injury should be evaluated in the contexts of COVID-19 infection, other types of viral myocarditis, and other vaccine-associated cardiac disorders. COVID-19 vaccine-associated myocardial injury can be caused by an inflammatory immune cell infiltrate, but other etiologies such as microvascular thrombosis are also possible. The clinical diagnosis is typically based on symptoms and cardiac magnetic resonance imaging. Endomyocardial biopsy is confirmatory for myocarditis, but may not show an inflammatory infiltrate because of rapid resolution or a non-inflammatory etiology. Myocarditis associated with SARS-COVID-19 vaccines occurs primarily with mRNA platform vaccines, which are also the most effective. In persons aged >16 or >12 years the myocarditis estimated crude incidences after the first 2 doses of BNT162b2 and mRNA-1273 are approximately 1.9 and 3.5 per 100 000 individuals, respectively. These rates equate to excess incidences above control populations of approximately 1.2 (BNT162b2) and 1.9 (mRNA-1273) per 100 000 persons, which are lower than the myocarditis rate for smallpox but higher than that for influenza vaccines. In the studies that have included mRNA vaccine and SARS-COVID-19 myocarditis measured by the same methodology, the incidence rate was increased by 3.5-fold over control in COVID-19 compared with 1.5-fold for BNT162b2 and 6.2-fold for mRNA-1273. However, mortality and major morbidity are less and recovery is faster with mRNA vaccine-associated myocarditis compared to COVID-19 infection. The reasons for this include vaccine-associated myocarditis having a higher incidence in young adults and adolescents, typically no involvement of other organs in vaccine-associated myocarditis, and based on comparisons to non-COVID viral myocarditis an inherently more benign clinical course.
Collapse
Affiliation(s)
- Natasha L. Altman
- Division of Cardiology, Department of Medicine (N.L.A., R.A.Q., E.A.G., M.R.B.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Amber A. Berning
- Department of Pathology (A.A.B.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Sarah C. Mann
- Division of Infectious Diseases, Department of Medicine (S.C.M., T.B.C.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Robert A. Quaife
- Division of Cardiology, Department of Medicine (N.L.A., R.A.Q., E.A.G., M.R.B.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Edward A. Gill
- Division of Cardiology, Department of Medicine (N.L.A., R.A.Q., E.A.G., M.R.B.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Scott R. Auerbach
- Division of Cardiology, Department of Pediatrics (S.R.A.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Thomas B. Campbell
- Division of Infectious Diseases, Department of Medicine (S.C.M., T.B.C.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Michael R. Bristow
- Division of Cardiology, Department of Medicine (N.L.A., R.A.Q., E.A.G., M.R.B.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
- Research and Development Department, ARCA Biopharma, CO (M.R.B.)
| |
Collapse
|
4
|
Altman NL, Berning AA, Saxon CE, Adamek KE, Wagner JA, Slavov D, Quaife RA, Gill EA, Minobe WA, Jonas ER, Carroll IA, Huebler SP, Raines J, Messenger JC, Ambardekar AV, Mestroni L, Rosenberg RM, Rove J, Campbell TB, Bristow MR. Myocardial Injury and Altered Gene Expression Associated With SARS-CoV-2 Infection or mRNA Vaccination. JACC Basic Transl Sci 2023; 8:124-137. [PMID: 36281440 PMCID: PMC9581498 DOI: 10.1016/j.jacbts.2022.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/17/2022] [Accepted: 08/17/2022] [Indexed: 11/07/2022]
Abstract
SARS CoV-2 enters host cells via its Spike protein moiety binding to the essential cardiac enzyme angiotensin-converting enzyme (ACE) 2, followed by internalization. COVID-19 mRNA vaccines are RNA sequences that are translated into Spike protein, which follows the same ACE2-binding route as the intact virion. In model systems, isolated Spike protein can produce cell damage and altered gene expression, and myocardial injury or myocarditis can occur during COVID-19 or after mRNA vaccination. We investigated 7 COVID-19 and 6 post-mRNA vaccination patients with myocardial injury and found nearly identical alterations in gene expression that would predispose to inflammation, coagulopathy, and myocardial dysfunction.
Collapse
Key Words
- ACE, angiotensin I–converting enzyme gene
- ACE2, angiotensin-converting enzyme 2 gene
- AGT, angiotensinogen gene
- AGTR1, angiotensin II receptor type 1 gene
- ANG II, angiotensin II
- BNP, B-type natriuretic peptide
- CMR, cardiac magnetic resonance
- COVID-19
- EM, electron microscopy
- F3, coagulation factor III (tissue factor) gene
- ITGA5, integrin subunit alpha 5 gene
- IVS, interventricular septum
- LGE, late gadolinium enhancement
- LM, light microscopy
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- NDC, nonischemic dilated cardiomyopathy
- NPPB, natriuretic peptide B gene
- RV, right ventricular
- S, SARS-CoV-2 Spike
- TnI, troponin I
- gene expression
- mRNA vaccines
- myocardial injury
- myocarditis
Collapse
Affiliation(s)
- Natasha L. Altman
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amber A. Berning
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cara E. Saxon
- Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kylie E. Adamek
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jessica A. Wagner
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Dobromir Slavov
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Robert A. Quaife
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Edward A. Gill
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Wayne A. Minobe
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Eric R. Jonas
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | | | - Joshua Raines
- Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - John C. Messenger
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amrut V. Ambardekar
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Luisa Mestroni
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rachel M. Rosenberg
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jessica Rove
- Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Thomas B. Campbell
- Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael R. Bristow
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- ARCA Biopharma, Westminster, Colorado, USA
| |
Collapse
|
5
|
Edward JA, Chang SC, Gill EA, Tzou WS, Aleong RG. Esophago-Pericardial Fistula as a Rare and Life-Threatening Complication of Epicardial Ventricular Tachycardia Ablation. JACC Case Rep 2022; 4:1180-1185. [PMID: 36213880 PMCID: PMC9537083 DOI: 10.1016/j.jaccas.2022.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/12/2022] [Accepted: 04/29/2022] [Indexed: 11/26/2022]
Abstract
We describe a rare complication of esophago-pericardial fistula after epicardial ventricular tachycardia ablation. Echocardiogram revealed evidence of pneumopericardium and additional imaging studies confirmed esophageal leak with evidence of fistula formation requiring prompt surgical repair. (Level of Difficulty: Intermediate.)
Collapse
Affiliation(s)
- Justin A. Edward
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Shu C. Chang
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Edward A. Gill
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Wendy S. Tzou
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ryan G. Aleong
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
- Address for correspondence: Dr Ryan G. Aleong, Section of Cardiac Electrophysiology, University of Colorado Hospital, 12401 East 17th Avenue, Mail Stop B136, Aurora, Colorado 80045, USA.
| |
Collapse
|
6
|
Gill EA, Nanda NC. Current impact of three-dimensional echocardiography. Echocardiography 2022; 39:1010. [PMID: 35891581 DOI: 10.1111/echo.15051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 02/27/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Edward A Gill
- Division of Cardiology Director, Interventional Echocardiography University of Colorado School of Medicine, Aurora, CO, USA
| | - Navin C Nanda
- Division of Cardiology Director, Interventional Echocardiography University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
7
|
Huang GS, Sheehan FH, Gill EA. Transesophageal echocardiography simulation: A review of current technology. Echocardiography 2021; 39:89-100. [PMID: 34913188 DOI: 10.1111/echo.15281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/19/2021] [Accepted: 11/26/2021] [Indexed: 01/27/2023] Open
Abstract
Transesophageal echocardiography (TEE) has experienced tremendous increase in interest and demand alongside the rapid growth of transcatheter structural cardiac interventions. TEE instruction prolongs the procedure, increasing the risk of probe malfunction from overheating and patient complications from prolonged sedation. Echocardiographic simulation programs have been developed to hone the procedural skills of novice operators in a time-unrestricted, low-pressure environment before they perform TEEs on real patients. Simulators likely benefit training in interventional TEE for the same reasons. We searched PubMed, basic Google, and Google Scholar for currently marketed TEE simulators, including foreign as well as US companies. We queried the vendors regarding features of the simulators that pertain to effective instructional design for diagnostic TEE. We also queried regarding the simulators' applicability to training in interventional TEE. The vendors' responses are reported here. In addition, we discuss the specific training needs for structural heart interventions, for which echocardiographic simulation could be a powerful educational tool. Lastly, we discuss the role of simulation for formative and summative assessment, and the advances required to improve training in complex procedures within the field of interventional echocardiography.
Collapse
Affiliation(s)
- Gary S Huang
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Florence H Sheehan
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Edward A Gill
- Department of Medicine, Division of Cardiology, University of Colorado, Denver, Colorado, USA
| |
Collapse
|
8
|
Taskesen T, Gill EA. Pulmonary valve assessment by three-dimensional echocardiography. Echocardiography 2021; 39:1001-1009. [PMID: 33604936 DOI: 10.1111/echo.15001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/24/2021] [Accepted: 01/29/2021] [Indexed: 11/29/2022] Open
Abstract
The pulmonary valve (PV) has historically been ignored by imaging studies. Disorders of the PV encountered in adult cardiac patients are increasingly encountered due to advanced care of patients with congenital heart disease and associated PV diseases. Despite advances in PV imaging, multiple challenges remain when it comes to obtaining high quality PV images. While 2D TTE is the usual initial imaging tool for PV, excellent views of the PV annulus and its one or two leaflets are obtained in less than half of patients. The 3D echocardiography en face view allows all three leaflets to be evaluated concurrently, as well as assessments of the RV outflow tract and main pulmonary artery, which has improved quantitative assessment of PV diseases. Increasing image quality and experience with live/real time 3D TEE amplifies its utility in accurate evaluation and helps guide and monitor successful percutaneous PV interventions. 2D TTE remains the first line diagnostic tool; however, 3D TTE and 3D TEE provide better image quality which increases diagnostic accuracy and guidance to therapy. In this review article, we stress improvement in 3D echocardiography and its role in diagnostic and therapeutic options for PV diseases.
Collapse
Affiliation(s)
- Tuncay Taskesen
- Division of Cardiology, MercyOne-Iowa Heart Center, Des Moines, IA, USA
| | - Edward A Gill
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
9
|
Orringer CE, Blaha MJ, Blankstein R, Budoff MJ, Goldberg RB, Gill EA, Maki KC, Mehta L, Jacobson TA. The National Lipid Association scientific statement on coronary artery calcium scoring to guide preventive strategies for ASCVD risk reduction. J Clin Lipidol 2020; 15:33-60. [PMID: 33419719 DOI: 10.1016/j.jacl.2020.12.005] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 12/21/2022]
Abstract
An Expert Panel of the National Lipid Association reviewed the evidence related to the use of coronary artery calcium (CAC) scoring in clinical practice for adults seen for primary prevention of atherosclerotic cardiovascular disease. Recommendations for optimal use of this test in adults of various races/ethnicities, ages and multiple domains of primary prevention, including those with a 10-year ASCVD risk <20%, those with diabetes or the metabolic syndrome, and those with severe hypercholesterolemia were provided. Recommendations were also made on optimal timing for repeat calcium scoring after an initial test, use of CAC scoring in those taking statins, and its role in informing the clinician patient discussion on the benefit of aspirin and anti-hypertensive drug therapy. Finally, a vision is provided for the future of coronary calcium scoring.
Collapse
Affiliation(s)
- Carl E Orringer
- University of Miami, Miller School of Medicine, Cardiovascular Division.
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School, Cardiovascular Division
| | | | - Ronald B Goldberg
- Diabetes Research Institute, University of Miami Miller School of Medicine
| | - Edward A Gill
- University of Colorado School of Medicine, Anschutz Campus
| | - Kevin C Maki
- Department of Applied Health Science, School of Public Health, and Midwest Biomedical Research, Indiana University
| | | | | |
Collapse
|
10
|
Robinson JG, Jayanna MB, Brown AS, Aspry K, Orringer C, Gill EA, Goldberg A, Jones LK, Maki K, Dixon DL, Saseen JJ, Soffer D. Enhancing the value of PCSK9 monoclonal antibodies by identifying patients most likely to benefit. A consensus statement from the National Lipid Association. J Clin Lipidol 2019; 13:525-537. [DOI: 10.1016/j.jacl.2019.05.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
11
|
Taskesen T, Prabhu SJ, Steinberg ZL, Oxorn D, Gill EA. Feasibility of pulmonary valve imaging using transesophageal echocardiography upper esophageal view. Echocardiography 2019; 36:930-937. [PMID: 31002189 DOI: 10.1111/echo.14332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/10/2019] [Accepted: 03/13/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The present study designed to evaluate feasibility of transesophageal echocardiographic (TEE) imaging of the pulmonary valve (PV) at the transaortic upper esophageal (TAUE) window. We hypothesized that patients with larger aorta would be more likely to have visualization of the PV from this TAUE window. METHODS 2D TEE images of the PV were prospectively acquired by one operator at the TAUE window looking through the aortic arch. Patients were divided into four groups based on image quality of PV (group 1, not visualized; group 2, barely visualized; group 3, sufficient visualization; group 4, excellent visualization). Clinical, echocardiographic, and radiologic parameters were collected. RESULTS A total of 212 consecutive patients (54 ± 14 years, 63.7% male) were enrolled. Group distribution was as follows: group 1, n = 60 (28.3%); group 2 n = 39 (18.4%); group 3, n = 27 (12.7%); group 4, n = 86 (40.6%). There were no differences between groups' baseline clinical characteristics. There was a weak although statistically negative correlation between PV image quality and aortic arch dimension (r = -0.17 P = 0.01). There was a stronger positive correlation between PV thickness (r = 0.38 P < 0.001) and PV image quality. Retrospective subgroup analysis of 76 patients with recent chest CT showed similar, but not significant trends as by TEE. CONCLUSION The use of 2D TEE TAUE results in diagnostic image quality of the PV in the majority of patients and outstanding image quality in a subset of patients. PV image quality is negatively affected by increasing aorta diameter and positively affected by PV thickness.
Collapse
Affiliation(s)
- Tuncay Taskesen
- Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Somnath J Prabhu
- Division of Radiology, University of Washington, Seattle, Washington
| | | | - Donald Oxorn
- Division of Cardio-Thoracic Anesthesia, University of Washington, Seattle, Washington
| | - Edward A Gill
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| |
Collapse
|
12
|
Donmez E, Salcedo EE, Quaife RA, Burke JM, Gill EA, Carroll JD. The acute effects of edge‐to‐edge percutaneous mitral valve repair on the shape and size of the mitral annulus and its relation to mitral regurgitation. Echocardiography 2019; 36:732-741. [DOI: 10.1111/echo.14284] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 12/28/2018] [Accepted: 01/24/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Esra Donmez
- Division of CardiologyUniversity of Colorado HospitalAnschutz Medical CenterUniversity of Colorado School of Medicine Aurora Colorado
- Department of CardiologyTurkish Ministry of Health Bakirkoy Dr. Sadi Konuk Training and Research Hospital Bakirkoy, Istanbul Turkey
| | - Ernesto E. Salcedo
- Division of CardiologyUniversity of Colorado HospitalAnschutz Medical CenterUniversity of Colorado School of Medicine Aurora Colorado
| | - Robert A. Quaife
- Division of CardiologyUniversity of Colorado HospitalAnschutz Medical CenterUniversity of Colorado School of Medicine Aurora Colorado
| | - Joseph M. Burke
- Division of CardiologyUniversity of Colorado HospitalAnschutz Medical CenterUniversity of Colorado School of Medicine Aurora Colorado
| | - Edward A. Gill
- Division of CardiologyUniversity of Colorado HospitalAnschutz Medical CenterUniversity of Colorado School of Medicine Aurora Colorado
| | - John D. Carroll
- Division of CardiologyUniversity of Colorado HospitalAnschutz Medical CenterUniversity of Colorado School of Medicine Aurora Colorado
| |
Collapse
|
13
|
Gill EA, Blaha MJ, Guyton JR. JCL roundtable: Coronary artery calcium scoring and other vascular imaging for risk assessment. J Clin Lipidol 2019; 13:4-14. [DOI: 10.1016/j.jacl.2019.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Bristow MR, Kao DP, Breathett KK, Altman NL, Gorcsan J, Gill EA, Lowes BD, Gilbert EM, Quaife RA, Mann DL. Structural and Functional Phenotyping of the Failing Heart: Is the Left Ventricular Ejection Fraction Obsolete? JACC Heart Fail 2018; 5:772-781. [PMID: 29096787 DOI: 10.1016/j.jchf.2017.09.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/04/2017] [Accepted: 09/10/2017] [Indexed: 12/20/2022]
Abstract
Diagnosis, prognosis, treatment, and development of new therapies for diseases or syndromes depend on a reliable means of identifying phenotypes associated with distinct predictive probabilities for these various objectives. Left ventricular ejection fraction (LVEF) provides the current basis for combined functional and structural phenotyping in heart failure by classifying patients as those with heart failure with reduced ejection fraction (HFrEF) and those with heart failure with preserved ejection fraction (HFpEF). Recently the utility of LVEF as the major phenotypic determinant of heart failure has been challenged based on its load dependency and measurement variability. We review the history of the development and adoption of LVEF as a critical measurement of LV function and structure and demonstrate that, in chronic heart failure, load dependency is not an important practical issue, and we provide hemodynamic and molecular biomarker evidence that LVEF is superior or equal to more unwieldy methods of identifying phenotypes of ventricular remodeling. We conclude that, because it reliably measures both left ventricular function and structure, LVEF remains the best current method of assessing pathologic remodeling in heart failure in both individual clinical and multicenter group settings. Because of the present and future importance of left ventricular phenotyping in heart failure, LVEF should be measured by using the most accurate technology and methodologic refinements available, and improved characterization methods should continue to be sought.
Collapse
Affiliation(s)
- Michael R Bristow
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado.
| | - David P Kao
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado
| | - Khadijah K Breathett
- Division of Cardiology, Department of Medicine, University of Arizona, Tucson, Arizona
| | - Natasha L Altman
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado
| | - John Gorcsan
- Division of Cardiology, Department of Medicine, Washington University Medical School, St. Louis, Missouri
| | - Edward A Gill
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado
| | - Brian D Lowes
- Division of Cardiology, Department of Medicine, School of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Edward M Gilbert
- Division of Cardiology, Department of Medicine, School of Medicine, University of Utah Medical Center, Salt Lake City, Utah
| | - Robert A Quaife
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado
| | - Douglas L Mann
- Division of Cardiology, Department of Medicine, Washington University Medical School, St. Louis, Missouri
| |
Collapse
|
15
|
Abstract
Lipid lowering, particularly with 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors ("statins"), reduces the risk of cardiovascular disease. Patients with chronic liver disease present challenges to the use of lipid medications. In the case of most liver disorders, the concern has been one of safety. There is evidence that most lipid-lowering medications can be used safely in many situations, although large outcomes trials are lacking. This review examines lipid physiology and cardiovascular risk in specific liver diseases and reviews the evidence for lipid lowering and the use of statins in chronic liver disease.
Collapse
Affiliation(s)
- Cynthia Herrick
- Division of Endocrinology, Metabolism and Lipid Research, Department of Medicine, Washington University School of Medicine, Campus Box 8127, 660 South Euclid, St Louis, MO 63110, USA.
| | - Samira Bahrainy
- VA Medical Center, Puget Sound, 1660 South Columbian Way, Seattle, WA 98104, USA
| | - Edward A Gill
- Harborview Medical Center, University of Washington School of Medicine, 325 Ninth Avenue, Box 359748, Seattle, WA 98104, USA
| |
Collapse
|
16
|
Abstract
Understanding opportunities to reduce dyslipidemia before, during, and after pregnancy has major implications for cardiovascular disease risk prevention for the entire population. The best time to screen for dyslipidemia is before pregnancy or in the early antenatal period. The differential diagnosis of hypertriglyceridemia in pregnancy is the same as in nonpregnant women except that clinical lipidologists need to be aware of the potential obstetric complications associated with hypertriglyceridemia. Dyslipidemia discovered during pregnancy should be treated with diet and exercise intervention, as well as glycemic control if indicated. A complete lipid profile assessment during each trimester of pregnancy is recommended.
Collapse
Affiliation(s)
- Robert Wild
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, 1100 N Lindsay Ave, Oklahoma City, OK 73104, USA.
| | - Elizabeth A Weedin
- Section of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, 1100 N Lindsay Ave, Oklahoma City, OK 73104, USA
| | - Edward A Gill
- Division of Cardiology, UW Department of Medicine, Harborview Medical Center Echocardiography, University of Washington School of Medicine, Seattle University, 325 Ninth Avenue, Box 359748, Seattle, WA 98104-2499, USA
| |
Collapse
|
17
|
Zaky A, Gill EA, Lin CP, Paul CP, Bendjelid K, Treggiari MM. Characteristics of sepsis-induced cardiac dysfunction using speckle-tracking echocardiography: a feasibility study. Anaesth Intensive Care 2016; 44:65-76. [PMID: 26673591 DOI: 10.1177/0310057x1604400111] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Septic cardiomyopathy is commonly encountered in patients with severe sepsis and septic shock. This study explores whether novel global and segmental echocardiographic markers of myocardial deformation, using two-dimensional speckle tracking, are associated with adverse sepsis outcomes. We conducted a retrospective observational feasibility study, at a tertiary care centre, of patients admitted to the ICU with a diagnosis of sepsis who underwent an echocardiogram within the first week of sepsis diagnosis. Data were collected on chamber dimensions, systolic and diastolic function, demographics, haemodynamics, and laboratory parameters. Global and segmental left ventricular longitudinal strain (LVLS) and tissue mitral annular displacement (TMAD) were assessed on 12 left ventricular segments and six mitral annulus segments in apical views, respectively. We explored associations of abnormal LVLS and TMAD with duration of mechanical ventilation, hospital length of stay, and mortality. Fifty-four patients were included. Global LVLS was not associated with any of the primary study endpoints. However, reduced systolic LVLS of the basal anterior segment was associated with in-hospital mortality. There was a suggestion that patients with a reduced global TMAD were associated with an increased risk of mortality and a short length of hospital stay but these associations were not statistically significant. Reduced global LVLS was associated with lower ejection fraction. Reduced global TMAD was associated with reduced global and segmental LVLS, reduced left ventricular ejection fraction, and increased left ventricular end-systolic and end-diastolic volumes. Speckle-tracking echocardiography can be performed feasibly in patients in sepsis. Global and segmental left ventricular deformation indices are associated with ejection fraction. Further studies need to evaluate the ability of these new indices to predict sepsis outcomes.
Collapse
Affiliation(s)
- A Zaky
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - E A Gill
- Department of Medicine, Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA
| | | | - C P Paul
- Center for Clinical and Translational Science, University of Alabama at Birmingham, Birmingham, AL, USA
| | - K Bendjelid
- Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - M M Treggiari
- Department of Anesthesiology and Perioperative Medicine, Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR, USA
| |
Collapse
|
18
|
Steinberg ZL, Don CW, Sun JCJ, Gill EA, Goldberg SL. Percutaneous Repair of Aortic Pseudoaneurysms: A Case Series. J Invasive Cardiol 2016; 28:E6-E10. [PMID: 26716598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Aortic pseudoaneurysms (APSAs) are an uncommon but serious complication of aortic surgery with potentially fatal complications if left untreated. Operative repair is associated with significant morbidity and mortality. Percutaneous APSA repair may reduce the risk of these complications and represents an alternative option for patients. We report our experience with percutaneous intervention for the treatment of APSAs. METHODS AND RESULTS We retrospectively reviewed all patients at our institution who underwent percutaneous APSA repair with Amplatzer septal occluders and vascular plugs between January 2004 and September 2014. Ten patients are included in this study, representing our first cases of percutaneous APSA repair. Follow-up was performed with serial computed tomographic angiography. The primary outcome was the success rate of device deployment. Secondary outcomes included success rate of complete APSA exclusion, postprocedural symptoms, and periprocedural and postprocedural complications. Mean clinical follow-up time was 12 months (range, 5-30 months) and mean imaging follow-up time was 29 months (range, 14-52 months). Device deployment was successful in all patients, although 2 patients required reintervention due to device malposition and the discovery of additional defects on postprocedure CT angiography. There were no periprocedural or postprocedure complications. Long-term follow-up imaging was available for 7 patients and revealed complete APSA exclusion in 4 patients. One out of the remaining 3 patients ultimately required operative intervention. CONCLUSIONS Percutaneous APSA repair can be performed safely with a good procedural success, albeit with variable long-term results. This procedure may be considered as an alternative to surgical repair in select patients.
Collapse
Affiliation(s)
| | | | | | | | - Steven L Goldberg
- Cardiac Catheterization Laboratory, Department of Cardiology, 1959 NE Pacific Street, Box 356422, Suite AA522, Seattle, WA 98195-6422 USA.
| |
Collapse
|
19
|
Taskesen T, Goldberg SL, Mannelli L, Rabkin D, Hawn TR, Fligner CL, Cormack F, Gill EA. Granulomatosis With Polyangiitis Presenting With an Intracardiac Mass and Complete Heart Block: Enhanced Images by 3-Dimensional Echocardiography. Circulation 2015; 132:961-4. [PMID: 26354785 DOI: 10.1161/circulationaha.115.016851] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tuncay Taskesen
- From Division of Cardiology, Harborview Medical Center, Seattle, WA (T.T.); Department of Cardiology, Rocky Mountain Heart and Lung, Kalispell Regional Medical Center, Kalispell, MT (S.L.G.); Division of Radiology, Memorial Sloan-Kettering Cancer Center, New York (L.M.); Department of Cardiothoracic Surgery, Loma Linda Medical Center, CA (D.R.); Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington Medical Center, Seattle (T.R.H.); Departments of Pathology and Laboratory Medicine, University of Washington, Seattle (C.L.F.); Division of Nephrology, Department of Medicine, Harborview Medical Center/University of Washington, Seattle (F.C.); and Division of Cardiology, Harborview Medical Center/University of Washington Medical Center, Seattle (E.A.G.).
| | - Steven L Goldberg
- From Division of Cardiology, Harborview Medical Center, Seattle, WA (T.T.); Department of Cardiology, Rocky Mountain Heart and Lung, Kalispell Regional Medical Center, Kalispell, MT (S.L.G.); Division of Radiology, Memorial Sloan-Kettering Cancer Center, New York (L.M.); Department of Cardiothoracic Surgery, Loma Linda Medical Center, CA (D.R.); Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington Medical Center, Seattle (T.R.H.); Departments of Pathology and Laboratory Medicine, University of Washington, Seattle (C.L.F.); Division of Nephrology, Department of Medicine, Harborview Medical Center/University of Washington, Seattle (F.C.); and Division of Cardiology, Harborview Medical Center/University of Washington Medical Center, Seattle (E.A.G.)
| | - Lorenzo Mannelli
- From Division of Cardiology, Harborview Medical Center, Seattle, WA (T.T.); Department of Cardiology, Rocky Mountain Heart and Lung, Kalispell Regional Medical Center, Kalispell, MT (S.L.G.); Division of Radiology, Memorial Sloan-Kettering Cancer Center, New York (L.M.); Department of Cardiothoracic Surgery, Loma Linda Medical Center, CA (D.R.); Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington Medical Center, Seattle (T.R.H.); Departments of Pathology and Laboratory Medicine, University of Washington, Seattle (C.L.F.); Division of Nephrology, Department of Medicine, Harborview Medical Center/University of Washington, Seattle (F.C.); and Division of Cardiology, Harborview Medical Center/University of Washington Medical Center, Seattle (E.A.G.)
| | - David Rabkin
- From Division of Cardiology, Harborview Medical Center, Seattle, WA (T.T.); Department of Cardiology, Rocky Mountain Heart and Lung, Kalispell Regional Medical Center, Kalispell, MT (S.L.G.); Division of Radiology, Memorial Sloan-Kettering Cancer Center, New York (L.M.); Department of Cardiothoracic Surgery, Loma Linda Medical Center, CA (D.R.); Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington Medical Center, Seattle (T.R.H.); Departments of Pathology and Laboratory Medicine, University of Washington, Seattle (C.L.F.); Division of Nephrology, Department of Medicine, Harborview Medical Center/University of Washington, Seattle (F.C.); and Division of Cardiology, Harborview Medical Center/University of Washington Medical Center, Seattle (E.A.G.)
| | - Thomas R Hawn
- From Division of Cardiology, Harborview Medical Center, Seattle, WA (T.T.); Department of Cardiology, Rocky Mountain Heart and Lung, Kalispell Regional Medical Center, Kalispell, MT (S.L.G.); Division of Radiology, Memorial Sloan-Kettering Cancer Center, New York (L.M.); Department of Cardiothoracic Surgery, Loma Linda Medical Center, CA (D.R.); Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington Medical Center, Seattle (T.R.H.); Departments of Pathology and Laboratory Medicine, University of Washington, Seattle (C.L.F.); Division of Nephrology, Department of Medicine, Harborview Medical Center/University of Washington, Seattle (F.C.); and Division of Cardiology, Harborview Medical Center/University of Washington Medical Center, Seattle (E.A.G.)
| | - Corinne L Fligner
- From Division of Cardiology, Harborview Medical Center, Seattle, WA (T.T.); Department of Cardiology, Rocky Mountain Heart and Lung, Kalispell Regional Medical Center, Kalispell, MT (S.L.G.); Division of Radiology, Memorial Sloan-Kettering Cancer Center, New York (L.M.); Department of Cardiothoracic Surgery, Loma Linda Medical Center, CA (D.R.); Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington Medical Center, Seattle (T.R.H.); Departments of Pathology and Laboratory Medicine, University of Washington, Seattle (C.L.F.); Division of Nephrology, Department of Medicine, Harborview Medical Center/University of Washington, Seattle (F.C.); and Division of Cardiology, Harborview Medical Center/University of Washington Medical Center, Seattle (E.A.G.)
| | - Fionnuala Cormack
- From Division of Cardiology, Harborview Medical Center, Seattle, WA (T.T.); Department of Cardiology, Rocky Mountain Heart and Lung, Kalispell Regional Medical Center, Kalispell, MT (S.L.G.); Division of Radiology, Memorial Sloan-Kettering Cancer Center, New York (L.M.); Department of Cardiothoracic Surgery, Loma Linda Medical Center, CA (D.R.); Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington Medical Center, Seattle (T.R.H.); Departments of Pathology and Laboratory Medicine, University of Washington, Seattle (C.L.F.); Division of Nephrology, Department of Medicine, Harborview Medical Center/University of Washington, Seattle (F.C.); and Division of Cardiology, Harborview Medical Center/University of Washington Medical Center, Seattle (E.A.G.)
| | - Edward A Gill
- From Division of Cardiology, Harborview Medical Center, Seattle, WA (T.T.); Department of Cardiology, Rocky Mountain Heart and Lung, Kalispell Regional Medical Center, Kalispell, MT (S.L.G.); Division of Radiology, Memorial Sloan-Kettering Cancer Center, New York (L.M.); Department of Cardiothoracic Surgery, Loma Linda Medical Center, CA (D.R.); Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington Medical Center, Seattle (T.R.H.); Departments of Pathology and Laboratory Medicine, University of Washington, Seattle (C.L.F.); Division of Nephrology, Department of Medicine, Harborview Medical Center/University of Washington, Seattle (F.C.); and Division of Cardiology, Harborview Medical Center/University of Washington Medical Center, Seattle (E.A.G.)
| |
Collapse
|
20
|
Petek BJ, Bravo PE, Kim F, de Boer IH, Kudenchuk PJ, Shuman WP, Gunn ML, Carlbom DJ, Gill EA, Maynard C, Branch KR. Incidence and Risk Factors for Postcontrast Acute Kidney Injury in Survivors of Sudden Cardiac Arrest. Ann Emerg Med 2015; 67:469-476.e1. [PMID: 26363571 DOI: 10.1016/j.annemergmed.2015.07.516] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 07/13/2015] [Accepted: 07/24/2015] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE Survivors of sudden cardiac arrest may be exposed to iodinated contrast from invasive coronary angiography or contrast-enhanced computed tomography, although the effects on incident acute kidney injury are unknown. The study objective was to determine whether contrast administration within the first 24 hours was associated with acute kidney injury in survivors of sudden cardiac arrest. METHODS This cohort study, derived from a prospective clinical trial, included patients with sudden cardiac arrest who survived for 48 hours, had no history of end-stage renal disease, and had at least 2 serum creatinine measurements during hospitalization. The contrast group included patients with exposure to iodinated contrast within 24 hours of sudden cardiac arrest. Incident acute kidney injury and first-time dialysis were compared between contrast and no contrast groups and then controlled for known acute kidney injury risk factors. RESULTS Of the 199 survivors of sudden cardiac arrest, 94 received iodinated contrast. Mean baseline serum creatinine level was 1.3 mg/dL (95% confidence interval [CI] 1.4 to 1.5 mg/dL) for the contrast group and 1.6 mg/dL (95% CI 1.4 to 1.7 mg/dL) for the no contrast group. Incident acute kidney injury was lower in the contrast group (12.8%) than the no contrast group (17.1%; difference 4.4%; 95% CI -9.2% to 17.5%). Contrast administration was not associated with significant increases in incident acute kidney injury within quartiles of baseline serum creatinine level or after controlling for age, sex, race, congestive heart failure, diabetes, and admission serum creatinine level by regression analysis. Older age was independently associated with acute kidney injury. CONCLUSION Despite elevated baseline serum creatinine level in most survivors of sudden cardiac arrest, iodinated contrast administration was not associated with incident acute kidney injury even when other acute kidney injury risk factors were controlled for. Thus, although acute kidney injury is not uncommon among survivors of sudden cardiac arrest, early (<24 hours) contrast administration from imaging procedures did not confer an increased risk for acute kidney injury.
Collapse
Affiliation(s)
| | - Paco E Bravo
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA
| | - Francis Kim
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA
| | - Ian H de Boer
- Division of Nephrology, University of Washington School of Medicine, Seattle, WA
| | - Peter J Kudenchuk
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA
| | - William P Shuman
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Martin L Gunn
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - David J Carlbom
- Division of Pulmonary Critical Care Medicine, University of Washington School of Medicine, Seattle, WA
| | - Edward A Gill
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA
| | - Charles Maynard
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA
| | - Kelley R Branch
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA.
| |
Collapse
|
21
|
Gill EA, Poole JE. Will the Real Left Bundle Branch Block Please Stand Up? J Am Coll Cardiol 2015; 66:642-4. [DOI: 10.1016/j.jacc.2015.06.1299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 06/18/2015] [Indexed: 11/27/2022]
|
22
|
Gill EA, Wyne KL, Ballantyne CM. The world and lipidology as it relates to cardiology. Cardiol Clin 2015; 33:xiii-xiv. [PMID: 25939304 DOI: 10.1016/j.ccl.2015.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Edward A Gill
- Division of Cardiology, UW Department of Medicine, Harborview Medical Center Echocardiography, University of Washington School of Medicine, Seattle University, 325 Ninth Avenue, Box 359748, Seattle, WA 98104-2499, USA.
| | - Kathleen L Wyne
- Division of Endocrinology, The Ohio State University, 566 McCampbell Hall, 1581 Dodd Drive, Columbus, OH 43210, USA.
| | - Christie M Ballantyne
- Sections of Cardiovascular Research and Cardiology, Baylor College of Medicine, Center for Cardiovascular Disease Prevention, Houston Methodist DeBakey Heart and Vascular Center, 6565 Fannin, M.S. A-601, Houston, TX 77030, USA.
| |
Collapse
|
23
|
Paramsothy P, Hong J, Isquith D, Hulphers E, Bai H, Shadzi P, Neradilek M, Gill EA, Zhao XQ. Abstract 366: Gender Differences Exist in Carotid Arterial Plaque Composition Among Men and Women with Carotid or Coronary Artery Disease and Elevated ApoB Levels. Arterioscler Thromb Vasc Biol 2015. [DOI: 10.1161/atvb.35.suppl_1.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Postmortem coronary artery histopathology and post-surgical carotid endarterectomy studies demonstrate that women have less calcification and inflammatory cells, but more smooth muscle cells than men. Gender differences in atherosclerotic plaque composition are not well known. Yet, the age-adjusted incidence of stroke and myocardial infarction are higher in men than women.
Hypothesis:
We hypothesized that gender differences exist in carotid plaque composition (CPC), % lipid rich necrotic core (LRNC) and % wall volume (PWV), comparing living women and men.
Methods:
The CPC study is a prospective, randomized study evaluating the effect of 1) atorvastatin + placebo + placebo vs 2) atorvastatin + niacin ER + placebo 3) atorvastatin + niacin ER + colsevelam on CPC. Participants had coronary or carotid artery disease and ApoB levels ≥120 mg/dL. CPC was evaluated using MRI. Baseline PWV [(wall volume/total vessel volume) х 100%], a measure of plaque burden that adjusts for variation in artery size, and % LRNC volume (among slices with LRNC present) were evaluated. Statistical analysis used Wilcoxon rank sum test, chi-square, and multivariate linear regression.
Results:
There were 82 women and 118 men. Women vs. men were older, mean±SD age 58±8 vs. 55±8 yrs. (p=0.008), had higher HDL-C, 48±13 vs. 40±10 mg/dL (p<0.001), higher ApoA1 147±24 vs. 126±19 mg/dL (p<0.001), higher ApoE 5.5±3.4 vs. 4.5±1.6 mg/dL (p=0.04), lower % of prior myocardial infarction 22% vs. 52% (p=0.02) and higher % of metabolic syndrome 48% vs. 46% (p=0.01). There were no significant differences in ApoB levels, 123±32 vs. 120±29 (p=0.4). After adjusting for age, HDL-C (strongly correlated with ApoA1, r=0.89), ApoE, prevalence of myocardial infarction and metabolic syndrome, the men-women difference in PWV was small and statistically non-significant ([[Unable to Display Character: ∆]] 0.0%, 95% CI -2.5 to 2.6%, p=1.0). However, among participants with LRNC, men had more % LRNC than women ([[Unable to Display Character: ∆]] 5.9%, 95% CI 1.4 to 10.3%, p=0.01) after the same adjustments.
Conclusions:
Gender differences exist in CPC in that there is a higher volume of LRNC in men compared to women. Further studies are needed which delineate the mechanisms underlying the differences in prevalence of LRNC comparing men to women.
Collapse
Affiliation(s)
| | | | | | | | - Hua Bai
- Cardiology, Peking Union Med College Hosp, Beijing, China
| | - Pey Shadzi
- Medicine/Cardiology, Univ of Washington, Seattle, WA
| | - Moni Neradilek
- Statistics, The Mountain-Whisper-Light Statistics, Seattle, WA
| | - Edward A Gill
- Medicine/Cardiology, Univ of Washington, Seattle, WA
| | - Xue-Qiao Zhao
- Medicine/Cardiology, Univ of Washington, Seattle, WA
| |
Collapse
|
24
|
Paramsothy P, Hong J, Isquith D, Hulphers E, Bai H, Shadzi P, Neradilek M, Gill EA, Zhao XQ. Abstract 576: Gender Differences in Carotid Artery Plaque Composition Do Not Exist in Response to Lipid Lowering Therapy at Two Years Among Men and Women with Carotid or Coronary Artery Disease and Elevated ApoB Levels. Arterioscler Thromb Vasc Biol 2015. [DOI: 10.1161/atvb.35.suppl_1.576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Recent, age-adjusted stroke death rates declined greater in men than women. Whether this is related to gender differences in the atherosclerotic plaque response to therapy is not known. Postmortem coronary artery histopathology and post-surgical carotid endarterectomy studies demonstrate that women have less calcification and inflammatory cells, but more smooth muscle cells than men.
Hypothesis:
We hypothesized that gender differences exist in carotid plaque composition (CPC) in response to lipid lowering therapy (LLT) comparing living men and women.
Methods:
The CPC study is a prospective, randomized study evaluating the effect of LLT: 1) atorvastatin + placebo + placebo vs 2) atorvastatin + niacin ER + placebo 3) atorvastatin + niacin ER + colsevelam on CPC. Participants had coronary or carotid artery disease and ApoB levels ≥120 mg/dL. CPC was evaluated using MRI. The change over two years in % wall volume (PWV) [(wall volume/total vessel volume) х 100%], a measure of plaque burden that adjusts for variation in artery size, and % lipid rich necrotic core (LRNC) volume among slices with LRNC present were evaluated. Statistical analysis used Wilcoxon rank sum test, chi-square, and multivariate linear regression.
Results:
There were 40 women and 73 men in the study with both baseline and 2 year MRI scans. Women vs. men were older, mean±SD age 58±9 vs. 54±8 yrs. (p=0.009), had higher HDL-C, 49±14 vs. 40±11 mg/dL (p=0.002), and higher ApoA1 145±26 vs. 126±20 mg/dL (p<0.001). ApoB levels were not significantly different, 127±31 vs. 121±25 mg/dL (p=0.2). Adjusted for age, HDL-C (strongly correlated with ApoA1, r=0.89), ApoE, prevalence of MI and metabolic syndrome (statistically significant in the full baseline cohort), there were no statistically significant gender differences at 2 years with LLT in change in PWV, [[Unable to Display Character: ∆]] -0.1 (95% CI: -0.7, 0.6%) (p=0.8) or %LRNC among participants with LRNC, [[Unable to Display Character: ∆]] 0.5 (95% CI: -2.5, 3.5%) (p=0.7).
Conclusions:
We did not detect statistically significant gender differences in change in PWV and %LRNC in response to LLT. Although the results are consistent with no gender differences they remain inconclusive due to the small sample size. Further gender studies in the biology and treatment of arterial atherosclerosis are needed.
Collapse
Affiliation(s)
| | | | | | | | - Hua Bai
- Cardiology, Peking Union Med College Hosp, Beijing, China
| | - Pey Shadzi
- Medicine/Cardiology, Univ of Washington, Seattle, WA
| | - Moni Neradilek
- Statistics, The Mountain-Whisper-Light Statistics, Seattle, WA
| | - Edward A Gill
- Medicine/Cardiology, Univ of Washington, Seattle, WA
| | - Xue-Qiao Zhao
- Medicine/Cardiology, Univ of Washington, Seattle, WA
| |
Collapse
|
25
|
|
26
|
|
27
|
Jacobson TA, Ito MK, Maki KC, Orringer CE, Bays HE, Jones PH, McKenney JM, Grundy SM, Gill EA, Wild RA, Wilson DP, Brown WV. National lipid association recommendations for patient-centered management of dyslipidemia: part 1--full report. J Clin Lipidol 2015; 9:129-69. [PMID: 25911072 DOI: 10.1016/j.jacl.2015.02.003] [Citation(s) in RCA: 523] [Impact Index Per Article: 58.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 02/09/2015] [Indexed: 02/07/2023]
Abstract
The leadership of the National Lipid Association convened an Expert Panel to develop a consensus set of recommendations for patient-centered management of dyslipidemia in clinical medicine. An Executive Summary of those recommendations was previously published. This document provides support for the recommendations outlined in the Executive Summary. The major conclusions include (1) an elevated level of cholesterol carried by circulating apolipoprotein B-containing lipoproteins (non-high-density lipoprotein cholesterol and low-density lipoprotein cholesterol [LDL-C], termed atherogenic cholesterol) is a root cause of atherosclerosis, the key underlying process contributing to most clinical atherosclerotic cardiovascular disease (ASCVD) events; (2) reducing elevated levels of atherogenic cholesterol will lower ASCVD risk in proportion to the extent that atherogenic cholesterol is reduced. This benefit is presumed to result from atherogenic cholesterol lowering through multiple modalities, including lifestyle and drug therapies; (3) the intensity of risk-reduction therapy should generally be adjusted to the patient's absolute risk for an ASCVD event; (4) atherosclerosis is a process that often begins early in life and progresses for decades before resulting a clinical ASCVD event. Therefore, both intermediate-term and long-term or lifetime risk should be considered when assessing the potential benefits and hazards of risk-reduction therapies; (5) for patients in whom lipid-lowering drug therapy is indicated, statin treatment is the primary modality for reducing ASCVD risk; (6) nonlipid ASCVD risk factors should also be managed appropriately, particularly high blood pressure, cigarette smoking, and diabetes mellitus; and (7) the measurement and monitoring of atherogenic cholesterol levels remain an important part of a comprehensive ASCVD prevention strategy.
Collapse
Affiliation(s)
- Terry A Jacobson
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - Matthew K Ito
- Oregon State University/Oregon Health & Science University, College of Pharmacy, Portland, OR, USA
| | - Kevin C Maki
- Midwest Center for Metabolic & Cardiovascular Research and DePaul University, Chicago, IL, USA
| | | | - Harold E Bays
- Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY, USA
| | | | - James M McKenney
- Virginia Commonwealth University and National Clinical Research, Richmond, VA, USA
| | - Scott M Grundy
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Edward A Gill
- University of Washington/Harborview Medical Center, Seattle, WA, USA
| | - Robert A Wild
- Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Don P Wilson
- Cook Children's Medical Center, Fort Worth, TX, USA
| | | |
Collapse
|
28
|
Jacobson TA, Ito MK, Maki KC, Orringer CE, Bays HE, Jones PH, McKenney JM, Grundy SM, Gill EA, Wild RA, Wilson DP, Brown WV. National Lipid Association recommendations for patient-centered management of dyslipidemia: part 1 - executive summary. J Clin Lipidol 2014; 8:473-88. [PMID: 25234560 DOI: 10.1016/j.jacl.2014.07.007] [Citation(s) in RCA: 332] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 07/08/2014] [Indexed: 01/12/2023]
Abstract
Various organizations and agencies have issued recommendations for the management of dyslipidemia. Although many commonalities exist among them, material differences are present as well. The leadership of the National Lipid Association (NLA) convened an Expert Panel to develop a consensus set of recommendations for patient-centered management of dyslipidemia in clinical medicine. The current Executive Summary highlights the major conclusions in Part 1 of the recommendations report of the NLA Expert Panel and includes: (1) background and conceptual framework for formulation of the NLA Expert Panel recommendations; (2) screening and classification of lipoprotein lipid levels in adults; (3) targets for intervention in dyslipidemia management; (4) atherosclerotic cardiovascular disease risk assessment and treatment goals based on risk category; (5) atherogenic cholesterol-non-high-density lipoprotein cholesterol and low-density lipoprotein cholesterol-as the primary targets of therapy; and (6) lifestyle and drug therapies intended to reduce morbidity and mortality associated with dyslipidemia.
Collapse
Affiliation(s)
- Terry A Jacobson
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - Matthew K Ito
- Oregon State University/Oregon Health & Science University, College of Pharmacy, Portland, OR, USA
| | - Kevin C Maki
- Midwest Center for Metabolic & Cardiovascular Research and DePaul University, Chicago, IL, USA
| | | | - Harold E Bays
- Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY, USA
| | | | - James M McKenney
- Virginia Commonwealth University and National Clinical Research, Richmond, VA, USA
| | - Scott M Grundy
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Edward A Gill
- University of Washington/Harborview Medical Center, Seattle, WA, USA
| | - Robert A Wild
- Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Don P Wilson
- Cook Children's Medical Center, Fort Worth, TX, USA
| | | |
Collapse
|
29
|
Gill EA, Hulphers E, Isquith D, Bai H, Shadzi P, Contreras A, Neradilek M, Colletti P, Hatsukami T, Yuan C, Zhao XQ. Carotid Vessel Wall Volume Decreases with Intensive Lipid Therapy in Plaque with and without Lipid Rich Necrotic Core. J Clin Lipidol 2014. [DOI: 10.1016/j.jacl.2014.02.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
30
|
Gill EA, Welch M, Schessler T, Polissar NL. ADVERSE EVENTS WITH PERLUTREN LIPID MICROSPHERE INTRAVENOUS CONTRAST IN SUBJECTS WITH AND WITHOUT PATENT FORAMEN OVALE. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60954-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
31
|
Abstract
The evaluation of cardiac masses is often a challenge for cardiac imaging techniques. The traditional standby has been two-dimensional echocardiography (2DE). Real time three-dimensional echocardiography (RT3DE) offers incremental value for the evaluation of intracardiac masses by providing more accurate assessment of the size and shape of the mass as well as in some cases, composition of the mass. RT3DE aids with the relationship between the mass and adjacent structures. Therefore, here we discuss the subject of RT3DE evaluation of cardiac masses is reviewed and discussed in detail.
Collapse
Affiliation(s)
- Elisa Zaragoza-Macias
- Department of Medicine, Division of Cardiology, University of Washington, Harborview Medical Center, Seattle, Washington 98104, USA
| | | | | | | |
Collapse
|
32
|
Gill EA, Chen MA, Thirumalai A, Fish B, Paramsothy P. Omega-3 Fatty Acids Improve Dyslipidemia But Not Inflammatory Markers in Metabolic Syndrome. J Clin Lipidol 2012. [DOI: 10.1016/j.jacl.2012.04.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
33
|
Hoang MVH, Linnau KF, Gill EA, Lehnert BE, Mannelli L. Computed tomography diagnosis of myocardial infarction in a patient with normal initial cardiac biomarkers. Emerg Radiol 2011; 19:75-8. [DOI: 10.1007/s10140-011-0987-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 09/15/2011] [Indexed: 10/17/2022]
|
34
|
Abstract
The aim of this study was to describe the clinical characteristics and mortality of patients with conflicting diastolic function during follow-up. Up to 30% of patients have conflicting diastolic function by echo Doppler and therefore cannot be classified into a distinct diastolic dysfunction category of stage 1, 2 or 3. Using our established echocardiography data base, we studied a cohort of 250 subjects with conflicting diastolic function. Each individual was compared to two controls with normal diastolic and systolic function. The pre-specified goal of the analysis was a 6-year follow-up. Patients with conflicting diastolic function were more likely to have diabetes, hypertension, and established coronary artery disease. The Cox proportional hazards model determined that the risk of death was significantly higher for conflicting patients compared to patients with normal diastolic parameters (HR: 1.83; 95% CI: 1.32-2.53), P < 0.001. After adjustment for covariates, the risk of death remained elevated for the conflicting group (HR: 1.56; 95% CI: 1.11-2.18), P = 0.009. Conflicting diastolic dysfunction is associated with an increased risk of death compared to individuals with normal function. In conclusion, this emphasizes the need to attain a more precise characterization and categorization for patients with diastolic dysfunction.
Collapse
Affiliation(s)
- Samira Bahrainy
- Division of Cardiology, University of Washington, Harborview Medical Center, Seattle, WA 98104, USA.
| | | | | |
Collapse
|
35
|
|
36
|
Van Hee VC, Adar SD, Szpiro AA, Barr RG, Diez Roux A, Bluemke DA, Sheppard L, Gill EA, Bahrami H, Wassel C, Sale MM, Siscovick DS, Rotter JI, Rich SS, Kaufman JD. Common genetic variation, residential proximity to traffic exposure, and left ventricular mass: the multi-ethnic study of atherosclerosis. Environ Health Perspect 2010; 118:962-9. [PMID: 20308035 PMCID: PMC2920916 DOI: 10.1289/ehp.0901535] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Accepted: 03/22/2010] [Indexed: 05/11/2023]
Abstract
BACKGROUND Elevated left ventricular mass (LVM) is a strong predictor of negative cardiovascular outcomes, including heart failure, stroke, and sudden cardiac death. A relationship between close (< 50 m compared with > 150 m) residential proximity to major roadways and higher LVM has previously been described, but the mechanistic pathways that are involved in this relationship are not known. Understanding genetic factors that influence susceptibility to these effects may provide insight into relevant mechanistic pathways. OBJECTIVE We set out to determine whether genetic polymorphisms in genes affecting vascular and autonomic function, blood pressure, or inflammation influence the relationship between traffic proximity and LVM. METHODS This was a cross-sectional study of 1,376 genotyped participants in the Multi-Ethnic Study of Atherosclerosis, with cardiac magnetic resonance imaging performed between 2000 and 2002. The impact of tagged single-nucleotide polymorphisms (tagSNPs) and inferred haplotypes in 12 candidate genes (ACE, ADRB2, AGT, AGTR1, ALOX15, EDN1, GRK4, PTGS1, PTGS2, TLR4, VEGFA, and VEGFB) on the relationship between residential proximity to major roadways and LVM was analyzed using multiple linear regression, adjusting for multiple potential confounders. RESULTS After accounting for multiple testing and comparing homozygotes, tagSNPs in the type 1 angiotensin II receptor (AGTR1, rs6801836) and arachidonate 15-lipoxygenase (ALOX15, rs2664593) genes were each significantly (q < 0.2) associated with a 9-10% difference in the association between residential proximity to major roadways and LVM. Participants with suboptimal blood pressure control demonstrated stronger interactions between AGTR1 and traffic proximity. CONCLUSIONS Common polymorphisms in genes responsible for vascular function, inflammation, and oxidative stress appear to modify associations between proximity to major roadways and LVM. Further understanding of how genes modify effects of air pollution on CVD may help guide research efforts into specific mechanistic pathways.
Collapse
Affiliation(s)
- Victor C Van Hee
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Liviakis L, Pogue B, Paramsothy P, Bourne A, Gill EA. Carotid intima-media thickness for the practicing lipidologist. J Clin Lipidol 2009; 4:24-35. [PMID: 21122625 DOI: 10.1016/j.jacl.2009.11.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Accepted: 11/30/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND It is well known that cardiovascular disease is the number one killer of men and women in the United States and in many parts of the developed world. However, early detection of atherosclerosis remains a challenging area of research and development. Stress echo and myocardial perfusion studies were not designed to be screening tests and the majority of literature using these tests is in populations with a high probability of disease. It must be emphasized that negative stress echo and stress MPI tests only imply a lack of flow limiting disease; they do not indicate lack of atherosclerotic disease. It is important to remember that when these tests are "negative," the implication is favorable short-term prognosis rather than any implication regarding lack of disease. In contrast, carotid intima-media thickness (CIMT) scanning protocols can detect atherosclerotic disease in early and asymptomatic stages. For a number of reasons reviewed in this article, CIMT may be a more optimal screening and risk-stratifying technology: CIMT directly visualizes vasculature unlike biomarkers such as LDL cholesterol, hsCRP, or PLA2. METHODS We performed medline searches for original articles and reviews of carotid IMT from 1985 to the present. We particularly emphasized large multi-center epidemiologic studies of the natural history of patients with carotid IMT measurements. CONCLUSION There is substantial evidence that CIMT is a suitable surrogate for the coronary tree. CIMT is also (along with coronary calcium scoring) recognized by the American Heart Association as a surrogate marker for coronary artery disease. A recent commentary by Stein, et al reviewed the comparison of CIMT to coronary calcium scoring, with favorable findings for CIMT especially in the healthy young and middle-aged populations, as well as women and African American individuals where coronary calcification has more limited utility. Recent findings of the Multi-Ethnic Study of Atherosclerosis indicate further that increased CIMT predicted CVD events in individuals without coronary calcification.
Collapse
Affiliation(s)
- Lea Liviakis
- University of Washington School of Medicine, Seattle, WA, USA
| | | | | | | | | |
Collapse
|
38
|
Gill EA, Kim MS, Carroll JD. 3D TEE for Evaluation of Commissural Opening Before and During Percutaneous Mitral Commissurotomy. JACC Cardiovasc Imaging 2009; 2:1034-5; author reply 1035-6. [DOI: 10.1016/j.jcmg.2009.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Accepted: 05/26/2009] [Indexed: 11/26/2022]
|
39
|
Van Hee VC, Adar SD, Szpiro AA, Barr RG, Bluemke DA, Diez Roux AV, Gill EA, Sheppard L, Kaufman JD. Exposure to traffic and left ventricular mass and function: the Multi-Ethnic Study of Atherosclerosis. Am J Respir Crit Care Med 2009; 179:827-34. [PMID: 19164703 DOI: 10.1164/rccm.200808-1344oc] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
RATIONALE Ambient air pollution has been associated with heart failure morbidity and mortality. The mechanisms responsible for these associations are unknown but may include the effects of traffic-related pollutants on vascular or autonomic function. OBJECTIVES We assessed the cross-sectional relation between long-term air pollution, traffic exposures, and important end-organ measures of alterations in cardiac function-left ventricular mass index (LVMI) and ejection fraction-in the Multi-Ethnic Study of Atherosclerosis, a multicenter study of adults without previous clinical cardiovascular disease. METHODS A total of 3,827 eligible participants (aged 45-84 yr) underwent cardiac magnetic resonance imaging between 2000 and 2002. We estimated air pollution exposures using residential proximity to major roadways and interpolated concentrations of fine particulate matter (less than 2.5 microns in diameter). We examined adjusted associations between these exposures and left ventricular mass and function. MEASUREMENTS AND MAIN RESULTS Relative to participants living more than 150 m from a major roadway, participants living within 50 m of a major roadway showed an adjusted 1.4 g/m(2) (95% CI, 0.3-2.5) higher LVMI, a difference in mass corresponding to a 5.6 mm Hg greater systolic blood pressure. Ejection fraction was not associated with proximity to major roadways. Limited variability in estimates of fine particulate matter was observed within cities, and no associations with particulate matter were found for either outcome after adjustment for center. CONCLUSIONS Living in close proximity to major roadways is associated with higher LVMI, suggesting chronic vascular end-organ damage from a traffic-related environmental exposure. Air pollutants or another component of roadway proximity, such as noise, could be responsible.
Collapse
Affiliation(s)
- Victor C Van Hee
- Department of Environmental and Occupational Health Sciences, University of Washington, Box 359739, Seattle, WA 98104, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Peretz A, Sullivan JH, Leotta DF, Trenga CA, Sands FN, Allen J, Carlsten C, Wilkinson CW, Gill EA, Kaufman JD. Diesel exhaust inhalation elicits acute vasoconstriction in vivo. Environ Health Perspect 2008; 116:937-42. [PMID: 18629317 PMCID: PMC2453163 DOI: 10.1289/ehp.11027] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Accepted: 03/18/2008] [Indexed: 05/04/2023]
Abstract
BACKGROUND Traffic-related air pollution is consistently associated with cardiovascular morbidity and mortality. Recent human and animal studies suggest that exposure to air pollutants affects vascular function. Diesel exhaust (DE) is a major source of traffic-related air pollution. OBJECTIVES Our goal was to study the effects of short-term exposure to DE on vascular reactivity and on mediators of vascular tone. METHODS In a double-blind, crossover, controlled exposure study, 27 adult volunteers (10 healthy and 17 with metabolic syndrome) were exposed in randomized order to filtered air (FA) and each of two levels of diluted DE (100 or 200 microg/m(3) of fine particulate matter) in 2-hr sessions. Before and after each exposure, we assessed the brachial artery diameter (BAd) by B-mode ultrasound and collected blood samples for endothelin-1 (ET-1) and catecholamines. Postexposure we also assessed endothelium-dependent flow-mediated dilation (FMD). RESULTS Compared with FA, DE at 200 microg/m(3) elicited a decrease in BAd (0.11 mm; 95% confidence interval, 0.02-0.18), and the effect appeared linearly dose related with a smaller effect at 100 microg/m(3). Plasma levels of ET-1 increased after 200 microg/m(3) DE but not after FA (p = 0.01). There was no consistent impact of DE on plasma catecholamines or FMD. CONCLUSIONS These results demonstrate that short-term exposure to DE is associated with acute endothelial response and vasoconstriction of a conductance artery. Elucidation of the signaling pathways controlling vascular tone that underlie this observation requires further study.
Collapse
Affiliation(s)
- Alon Peretz
- Occupational and Environmental Medicine Program, Department of Environmental and Occupational Health Sciences
| | - Jeffrey H. Sullivan
- Occupational and Environmental Medicine Program, Department of Environmental and Occupational Health Sciences
| | | | - Carol A. Trenga
- Occupational and Environmental Medicine Program, Department of Environmental and Occupational Health Sciences
| | - Fiona N. Sands
- Occupational and Environmental Medicine Program, Department of Environmental and Occupational Health Sciences
| | - Jason Allen
- Occupational and Environmental Medicine Program, Department of Environmental and Occupational Health Sciences
| | - Chris Carlsten
- Occupational and Environmental Medicine Program, Department of Environmental and Occupational Health Sciences
- Department of Medicine and
| | - Charles W. Wilkinson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | | | - Joel D. Kaufman
- Occupational and Environmental Medicine Program, Department of Environmental and Occupational Health Sciences
- Department of Medicine and
- Address correspondence to J.D. Kaufman, University of Washington Occupational and Environmental Medicine Program, Department of Environmental and Occupational Health Sciences, Box 35469, 4225 Roosevelt Way NE, Suite 100, Seattle, WA 98105 USA. Telephone: (206) 616-3501. Fax: (206) 897-1991. E-mail:
| |
Collapse
|
41
|
Gill EA, Longstreth WT, Becker KJ, Tirschwell DL. Transesophageal Echocardiography: Not for Everyone? Stroke 2007; 38:e78; author reply e79. [PMID: 17641239 DOI: 10.1161/strokeaha.106.479923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
42
|
Laflamme MA, Chen KY, Naumova AV, Muskheli V, Fugate JA, Dupras SK, Reinecke H, Xu C, Hassanipour M, Police S, O'Sullivan C, Collins L, Chen Y, Minami E, Gill EA, Ueno S, Yuan C, Gold J, Murry CE. Cardiomyocytes derived from human embryonic stem cells in pro-survival factors enhance function of infarcted rat hearts. Nat Biotechnol 2007; 25:1015-24. [PMID: 17721512 DOI: 10.1038/nbt1327] [Citation(s) in RCA: 1557] [Impact Index Per Article: 91.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Accepted: 07/13/2007] [Indexed: 12/12/2022]
Abstract
Cardiomyocytes derived from human embryonic stem (hES) cells potentially offer large numbers of cells to facilitate repair of the infarcted heart. However, this approach has been limited by inefficient differentiation of hES cells into cardiomyocytes, insufficient purity of cardiomyocyte preparations and poor survival of hES cell-derived myocytes after transplantation. Seeking to overcome these challenges, we generated highly purified human cardiomyocytes using a readily scalable system for directed differentiation that relies on activin A and BMP4. We then identified a cocktail of pro-survival factors that limits cardiomyocyte death after transplantation. These techniques enabled consistent formation of myocardial grafts in the infarcted rat heart. The engrafted human myocardium attenuated ventricular dilation and preserved regional and global contractile function after myocardial infarction compared with controls receiving noncardiac hES cell derivatives or vehicle. The ability of hES cell-derived cardiomyocytes to partially remuscularize myocardial infarcts and attenuate heart failure encourages their study under conditions that closely match human disease.
Collapse
Affiliation(s)
- Michael A Laflamme
- Center for Cardiovascular Biology, Institute for Stem Cell and Regenerative Medicine, University of Washington, 815 Mercer Street, Seattle, WA 98109, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
Heart failure is exceedingly prevalent in the United States and in other developed countries. Treatment regimens are complex and now include electrical therapy. Methods for evaluating left ventricular dyssynchrony using echocardiography rather than QRS duration have been developed, with tissue Doppler velocity parameters being the most popular. Real-time three-dimensional echocardiography is another novel method for dyssynchrony evaluation that has potential advantages over existing techniques. The authors describe their experience with three-dimensional echocardiography dyssynchrony evaluation and offer insights into the direction that this technology must move to improve results.
Collapse
Affiliation(s)
- Joseph A Horstman
- University of Washington School of Medicine, 325 Ninth Avenue, Seattle, WA 98104, USA
| | | | | |
Collapse
|
44
|
Abstract
This article presents an approach to real-time three-dimensional imaging of the tricuspid valve from three different views. This is followed by some representative cases that illustrate these views and some unique tricuspid valve abnormalities, including one case of corrected transposition.
Collapse
Affiliation(s)
- Alicia A Ahlgrim
- Harborview Medical Center, 325 Ninth Avenue, Box 359748, Seattle, WA 98104, USA
| | | | | | | |
Collapse
|
45
|
|
46
|
Abstract
Three-dimensional echocardiography (3DE) has made a dramatic transition from predominantly a research tool to a technology useful in everyday clinical practice. This article outlines the history of 3DE from its beginnings to the most current technology.
Collapse
Affiliation(s)
- Edward A Gill
- Department of Medicine, Division of Cardiology, University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Avenue, Box 359748, Seattle, WA 98104, USA.
| | | |
Collapse
|
47
|
Gill EA, Liang DH. Interventional Three-Dimensional Echocardiography: Using Real-time Three-Dimensional Echocardiography to Guide and Evaluate Intracardiac Therapies. Cardiol Clin 2007; 25:335-40. [PMID: 17765114 DOI: 10.1016/j.ccl.2007.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Real-time three-dimensional echocardiography (RT3DE) already has demonstrated its utility in guiding intracardiac procedures. This article discusses the advantages RT3DE has over the previous standard of 2D echocardiography.
Collapse
Affiliation(s)
- Edward A Gill
- Department of Medicine, Division of Cardiology, University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Avenue, Box 359748, Seattle, WA 98104, USA
| | | |
Collapse
|
48
|
Abstract
To date, mitral stenosis has been evaluated by both hemodynamic data derived from catheterization as well as 2D and Doppler echocardiography. However, the advent of real-time 3D echocardiography has allowed more precise measurement of the mitral valve orifice by planimetry. In addition, evaluation of the mitral commissures prior to and after percutaneous mitral valvuloplasty is greatly aided by 3D echocardiography. Here we discuss these subjects as well as provide specific clinical trials that support the use of real-time 3D echocardiography for the evaluation and treatment of mitral stenosis.
Collapse
|
49
|
Abstract
AIM To determine the prevalence and describe the management of known diabetes in a group of New Zealand rest homes. METHODS A random sample of 54 rest homes in Christchurch were studied. Residents with known diabetes were identified by rest home staff and interviewed. Selected staff members of all rest homes were also interviewed using structured questionnaires. The medical and nursing records and laboratory results of all residents with known diabetes were reviewed and all information pertaining to diabetes management recorded. RESULTS The prevalence of known diabetes in Christchurch rest homes was 11.7%. Residents with known diabetes had a mean of five other comorbidities and were prescribed a mean of 7.5 medications. Of residents with diabetes, 45% were taking oral glucose-lowering agents, 28% were on a diet alone and 27% on insulin treatment. The mean blood pressure was 134/73 mmHg. The mean HbA(1c) was 7.3%. Routine blood glucose monitoring was performed often but residents with possible hypoglycaemic episodes frequently did not have their blood glucose level checked. CONCLUSIONS The prevalence of known diabetes in Christchurch rest homes is similar to that found in British studies but less than that found in studies from the USA. Indicators of quality of care in residents with diabetes in this study appeared to be satisfactory, in contrast to other studies. There was poor recognition by staff of the necessity of checking acutely blood glucose levels in residents with diabetes who became unwell.
Collapse
Affiliation(s)
- E A Gill
- Department of Public Health and General Practice, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand
| | | | | | | |
Collapse
|
50
|
Abstract
OBJECTIVE We describe the development of real-time 3D imaging and review the previously used versions of 3D echocardiography so that the reader will appreciate why current developments truly do represent a quantum leap in the technology. CONCLUSION Three-dimensional echocardiography has now been shown to have several advantages over 2D echocardiography, particularly for volume measurements, visualization of septal defects, and whole-valve evaluation. Given these data, it is clear that 3D echocardiography is here to stay and soon will become part of routine echocardiographic examinations.
Collapse
Affiliation(s)
- Robin C Houck
- Department of Medicine, Division of Cardiology, University of Washington School of Medicine, Harborview Medical Center, Box 359748, 329 Ninth Ave., Seattle, WA 98104-2599, USA
| | | | | |
Collapse
|