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Mir T, Uddin M, Ulbeh TM, Perveiz E, Lohia P, Sattar Y, Abohashem S, Ullah W, Maganti K, Qureshi WT, Lakis N. Clinical Outcomes of Aortic Stenosis in Amyloidosis: A United States National Cohort Study. Heart Lung Circ 2024; 33:443-449. [PMID: 38036372 DOI: 10.1016/j.hlc.2023.09.019] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 07/21/2023] [Accepted: 09/21/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Literature regarding outcomes associated with surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) among amyloidosis (AM) with aortic stenosis (AS) is limited. OBJECTIVES We aim to study the mortality and in-hospital clinical outcomes among AM with AS associated with SAVR or TAVR. METHODS We performed a retrospective study of all hospitalisation encounters associated with a diagnosis of AM with AS, using the Nationwide Readmissions Database for the years 2012-2019. Primary outcomes were in-hospital mortality, and 30-day readmissions. RESULTS A total of 4,820 index hospitalisations of AS (mean age 78.35±10.11 years; female 37.76%) among AM were reported. Total 464 patients had mechanical intervention, 251 patients (54.1%) TAVR and 213 patients (45.9%) SAVR. A total of 317 patients (6.77%) with AS died; TAVR 4.4%, SAVR 11.9% (p=0.01) and 6.66% died among the subgroup who did not have any mechanical intervention. Higher complication rates were observed among patients who had SAVR than those who had TAVR including acute kidney injury (39.8% vs 22.4%; p=0.01), septic shock (12.1% vs 4.4%; p=0.05) and cardiogenic shock (22% vs 4.4%; p<0.001). Acute heart failure was higher among patients who had TAVR (40.2% vs 27.5%; p=0.04) than those who had SAVR. All conduction block and ischaemic stroke were similar between the two groups (p=0.09 and p=0.1). The overall 30-day readmission rate among AM with AS encounters was 16.82%, higher among TAVR compared to SAVR subgroups (21.25% vs 11.17%; p=0.001). CONCLUSIONS Among AM with AS hospitalisations, TAVR had mortality benefits compared to SAVR and non-mechanical intervention subgroups. Moreover, higher 30-day mortality rate were observed among SAVR subgroup, which may suggest that TAVR should be strongly considered in AM patients complicated by AS.
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Affiliation(s)
- Tanveer Mir
- Internal Medicine, Wayne State University, Detroit, MI, USA; Internal Medicine, Baptist Health System, Montgomery, AL, USA.
| | - Mohammed Uddin
- Internal Medicine, Wayne State University, Detroit, MI, USA
| | | | - Eskara Perveiz
- Internal Medicine, Baptist Health System, Montgomery, AL, USA
| | - Prateek Lohia
- Internal Medicine, Wayne State University, Detroit, MI, USA
| | - Yasar Sattar
- Cardiology Division, University of Virginia, Charlottesville, VA, USA
| | - Shady Abohashem
- Cardiology Division, Harvard Medical School Massachusetts General Hospital, Boston, MA, USA
| | - Waqas Ullah
- Cardiology Division, Thomas Jefferson University, PA, USA
| | | | - Waqas T Qureshi
- Cardiology Division, University of Massachusetts, Amherst, MA, USA
| | - Nasser Lakis
- Internal Medicine, Wayne State University, Detroit, MI, USA
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Appadurai V, Kinno M, Minga I, Slostad B, Cascino GJ, Nayak T, Kane B, Maganti K. The value of ultrasound enhancing agents in the echocardiographic acquisition of pulmonary artery systolic pressure: An invasive to non-invasive correlation study. Int J Cardiovasc Imaging 2024:10.1007/s10554-024-03051-9. [PMID: 38236363 DOI: 10.1007/s10554-024-03051-9] [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] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/07/2024] [Indexed: 01/19/2024]
Abstract
PURPOSE Right heart catheterization (RHC) is the gold standard for the assessment of pulmonary artery systolic pressures (PASP). Despite high utilization of echocardiography for the non-invasive assessment of PASP, the data comparing real-time non-invasive echocardiographic PASP with invasive PASP is limited. Furthermore, evidence regarding the utility and diagnostic accuracy of ultrasound enhancing agents (UEA) for non-invasive PASP assessment is lacking. To evaluate the accuracy of non-invasive PASP assessment with real-time invasive measures and the incremental benefit of UEA in this setting. METHODS This was a prospective cohort study of 90 patients, undergoing clinically indicated RHC for hemodynamic assessment. All patients underwent a limited echocardiogram during RHC. Tricuspid regurgitant velocity (TRV) was measured on unenhanced echo, in the setting of centrally administrated agitated saline, then as either centrally administered or peripherally administered UEA. RESULTS Of the 90 patients enrolled in our study, 41% had pulmonary hypertension. The overall mean PASP measured by RHC was 32.8 mmHg (+/- 11.3 mmHg). Unenhanced echocardiograms had a moderate correlation with invasive PASP (r = 0.57; p = < 0.001) which improved to a strong correlation with administration of agitated saline (r = 0.75; p = < 0.001) or centrally administered UEA (r = 0.77; p = < 0.001), with the best correlation noted with peripherally administered UEA (r = 0.83; p = < 0.001). Against invasive PASP, agitated saline enhanced PASP had the lowest bias (0.12mmHg; -15.6 to 15.8mmHg) when compared with all other non-invasive measures of PASP. CONCLUSIONS Unenhanced echocardiographic estimation of TRV was found to have a poorer correlation with invasively measured PASP when compared to agitated saline and centrally administered UEA. Agitated saline enhanced PASP demonstrated the lowest bias with invasive PASP when compared to other non-invasive measures of PASP.
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Affiliation(s)
- Vinesh Appadurai
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA
- School of medicine, The University of Queensland, St Lucia, QLD, Australia
| | - Menhel Kinno
- Division of Cardiology, Loyola University Stritch School of Medicine, Chicago, IL, USA
| | - Iva Minga
- Northshore University Health System, Evanston, IL, USA
- University of Chicago Medical Center, Chicago, IL, USA
| | - Brody Slostad
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Gregory J Cascino
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Tanvi Nayak
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Bonnie Kane
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Kameswari Maganti
- Division of Cardiovascular Disease, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, New Brunswick, NJ, 08901, USA.
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Peters AC, Gong FF, Ramesh A, Andrei A, Jankowski M, Cantey E, Chen V, Thomas JD, Flaherty JD, Malaisrie SC, Maganti K. Echocardiographic parameters associated with less reverse left ventricular remodeling after transcatheter aortic valve implant in subjects with prosthesis patient mismatch. Echocardiography 2024; 41:e15698. [PMID: 38284664 DOI: 10.1111/echo.15698] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/15/2023] [Accepted: 09/16/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Transaortic valve implant (TAVI) is the treatment of choice for severe aortic stenosis (AS). Some patients develop prosthesis patient mismatch (PPM) after TAVI. It is challenging to determine which patients are at risk for clinical deterioration. METHODS We retrospectively measured echocardiographic parameters of left ventricular (LV) morphology and function, prosthetic aortic valve effective orifice area (iEOA) and hemodynamics in 313 patients before and 1 year after TAVI. Our objective was to compare the change in echocardiographic parameters associated with left ventricular reverse modeling in subjects with and without PPM. Our secondary objective was to evaluate echo parameters associated with PPM and the relationship to patient functional status and survival post-TAVI. RESULTS We found that 82 (26.2%) of subjects had moderate and 37 (11.8%) had severe PPM post-TAVI. There was less relative improvement in LVEF with PPM (1.9 ± 21.3% vs. 8.2 + 30.1%, p = .045). LV GLS also exhibited less relative improvement in those with PPM (13.4 + 34.1% vs. 30.9 + 73.3%, p = .012). NYHA functional class improved in 84.3% of subjects by one grade or more. Echocardiographic markers of PPM were worse in those without improvement in NYHA class (mean AT/ET was .29 vs. .27, p = .05; DVI was .46 vs. .51, p = .021; and iEOA was .8 cm/m2 vs. .9 cm/m2 , p = .025). There was no association with PPM and survival. CONCLUSIONS There was no improvement in LVEF and less improvement in LV GLS in those with PPM post-TAVI. Echocardiographic markers of PPM were present in those with lack of improvement in NYHA functional class.
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Affiliation(s)
- Andrew C Peters
- Northwestern University Feinberg School of Medicine, Chicago, USA
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Fei Fei Gong
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Ashvita Ramesh
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Adin Andrei
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | | | - Eric Cantey
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Vincent Chen
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | - James D Thomas
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | - James D Flaherty
- Northwestern University Feinberg School of Medicine, Chicago, USA
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Aziz D, Maganti K, Yanamala N, Sengupta P. The Role of Artificial Intelligence in Echocardiography: A Clinical Update. Curr Cardiol Rep 2023; 25:1897-1907. [PMID: 38091196 DOI: 10.1007/s11886-023-02005-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE OF REVIEW In echocardiography, there has been robust development of artificial intelligence (AI) tools for image recognition, automated measurements, image segmentation, and patient prognostication that has created a monumental shift in the study of AI and machine learning models. However, integrating these measurements into complex disease recognition and therapeutic interventions remains challenging. While the tools have been developed, there is a lack of evidence regarding implementing heterogeneous systems for guiding clinical decision-making and therapeutic action. RECENT FINDINGS Newer AI modalities have shown concrete positive data in terms of user-guided image acquisition and processing, precise determination of both basic and advanced quantitative echocardiographic features, and the potential to construct predictive models, all with the possibility of seamless integration into clinical decision support systems. AI in echocardiography is a powerful and ever-growing tool with the potential for revolutionary effects on the practice of cardiology. In this review article, we explore the growth of AI and its applications in echocardiography, along with clinical implications and the associated regulatory, legal, and ethical considerations.
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Affiliation(s)
- Daniel Aziz
- Department of Internal Medicine, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Kameswari Maganti
- Division of Cardiology, Rutgers - Robert Wood Johnson Medical School & University Hospital, 1 Robert Wood Johnson Place, New Brunswick, NJ, 08901, USA
| | - Naveena Yanamala
- Division of Cardiology, Rutgers - Robert Wood Johnson Medical School & University Hospital, 1 Robert Wood Johnson Place, New Brunswick, NJ, 08901, USA
| | - Partho Sengupta
- Division of Cardiology, Rutgers - Robert Wood Johnson Medical School & University Hospital, 1 Robert Wood Johnson Place, New Brunswick, NJ, 08901, USA.
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Bavishi A, Witting C, Guo J, Wu E, John J, Jankowski M, Baldridge AS, Meng D, Maganti K. Predictive Value of Relative Apical Sparing of Longitudinal Strain on Echocardiography for Cardiac Amyloidosis. Am J Cardiol 2023; 200:66-71. [PMID: 37302282 DOI: 10.1016/j.amjcard.2023.04.048] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/13/2023] [Accepted: 04/30/2023] [Indexed: 06/13/2023]
Abstract
Relative apical longitudinal sparing (RALS) on echocardiography has become an increasingly used tool to evaluate for cardiac amyloidosis (CA), but the predictive value of this finding remains unclear. This is a retrospective analysis at a single tertiary care center across 3 years. Patients were included if they had RALS, defined by strain ratio ≥2.0 on echocardiography, and sufficient laboratory, imaging, or histopathologic workup to indicate their likelihood of CA. Patients were stratified by their likelihood of CA, and contributions of other co-morbidities previously shown to be associated with RALS. Of the 220 patients who had adequate workup to determine their likelihood of having CA, 50 (22.7%) had confirmed CA, 35 (15.9%) had suspicious CA, 83 (37.7%) had unlikely CA, and 52 (23.7%) had ruled-out CA. The positive predictive value of RALS for CA was 38.6% for confirmed or suspicious CA. The remaining 61.4% of patients who were unlikely or ruled out for CA had other co-morbidities such as hypertension, chronic kidney disease, malignancy, or aortic stenosis, 17.0% of this group had none of these co-morbidities. In our tertiary care cohort of patients with RALS pattern on echocardiography, we found that fewer than half of patients with RALS were likely to have CA. Given the increasing use of strain technology, further studies are warranted to determine the optimal strategy for assessing CA in a patient with RALS.
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Affiliation(s)
- Aakash Bavishi
- Division of Cardiology, Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Celeste Witting
- Department of Medicine, Stanford Health Care, Stanford, California
| | - James Guo
- Division of Cardiology, Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Erik Wu
- Division of Cardiology, Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Jordan John
- Division of Cardiology, Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Madeline Jankowski
- Division of Cardiology, Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Abigail S Baldridge
- Division of Cardiology, Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Daisy Meng
- Division of Cardiology, Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Kameswari Maganti
- Division of Cardiology, Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois.
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Mir T, Uddin M, Changal K, Qureshi W, Weinberger J, Wani J, Maganti K, Rab T, Eltahawy E, Sheikh M. Mortality outcomes and 30-day readmissions associated with coronary artery aneurysms; a National Database Study. Int J Cardiol 2022; 356:6-11. [DOI: 10.1016/j.ijcard.2022.04.005] [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: 11/06/2021] [Revised: 02/17/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
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Gong FF, Voss WB, Rangarajan VS, Raissi SR, Chow KY, Jafari L, Patel NP, Vaitenas I, Marion M, Ramirez H, Zhao M, Andrei AC, Baldridge A, Murtagh G, Maganti K, Rigolin VH, Akhter N. A PROSPECTIVE TRIAL OF CARVEDILOL IN EARLY-STAGE BREAST CANCER PATIENTS WITH ABNORMAL STRAIN TREATED WITH ANTI-HER-2 THERAPY (PROTECT HER-2). J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02893-5] [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: 11/26/2022]
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8
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Pfenniger A, Silverberg RA, Lomasney JW, Churyla A, Maganti K. Unusual Case of Right Ventricular Intravenous Leiomyoma. Circ Cardiovasc Imaging 2021; 14:e010363. [PMID: 34387098 DOI: 10.1161/circimaging.119.010363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anna Pfenniger
- Division of Cardiology (A.P., R.A.S., K.M.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert A Silverberg
- Division of Cardiology (A.P., R.A.S., K.M.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jon W Lomasney
- Division of Pathology (J.W.L.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrei Churyla
- Division of Cardiac Surgery (A.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kameswari Maganti
- Division of Cardiology (A.P., R.A.S., K.M.), Northwestern University Feinberg School of Medicine, Chicago, IL
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Affiliation(s)
- Jayson R Baman
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Shaundeep Sekhon
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kameswari Maganti
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Peters A, Marion M, Vaitenas I, Maganti K. SPECKLE TRACKING ECHOCRADIOGRAPHY-DERIVED RIGHT VENTRICULAR STRAIN: COMPARISON OF DIFFERENT VIEWS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02784-4] [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: 11/28/2022]
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Abstract
Importance Mechanical complications of acute myocardial infarction include left ventricular free-wall rupture, ventricular septal rupture, papillary muscle rupture, pseudoaneurysm, and true aneurysm. With the introduction of early reperfusion therapies, these complications now occur in fewer than 0.1% of patients following an acute myocardial infarction. However, mortality rates have not decreased in parallel, and mechanical complications remain an important determinant of outcomes after myocardial infarction. Early diagnosis and management are crucial to improving outcomes and require an understanding of the clinical findings that should raise suspicion of mechanical complications and the evolving surgical and percutaneous treatment options. Observations Mechanical complications most commonly occur within the first week after myocardial infarction. Cardiogenic shock or acute pulmonary edema are frequent presentations. Echocardiography is usually the first test used to identify the type, location, and hemodynamic consequences of the mechanical complication. Hemodynamic stabilization often requires a combination of medical therapy and mechanical circulatory support. Surgery is the definitive treatment, but the optimal timing remains unclear. Percutaneous therapies are emerging as an alternative treatment option for patients at prohibitive surgical risk. Conclusions and Relevance Mechanical complications present with acute and dramatic hemodynamic deterioration requiring rapid stabilization. Heart team involvement is required to determine appropriate management strategies for patients with mechanical complications after acute myocardial infarction.
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Affiliation(s)
- Fei Fei Gong
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Inga Vaitenas
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - S Chris Malaisrie
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kameswari Maganti
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Sozzi FB, Maganti K, Malanchini G, Gherbesi E, Tondi L, Ciulla M, Canetta C, Lombardi F. Diastolic stress test in heart failure with preserved ejection fraction. Eur J Prev Cardiol 2020; 27:2089-2091. [DOI: 10.1177/2047487319858796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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)
- Fabiola B Sozzi
- Ospedale Maggiore Policlinico Cà Granda, IRCCS, Milan, Italy
| | | | | | - Elisa Gherbesi
- Ospedale Maggiore Policlinico Cà Granda, IRCCS, Milan, Italy
| | - Lara Tondi
- Ospedale Maggiore Policlinico Cà Granda, IRCCS, Milan, Italy
| | - Michele Ciulla
- Ospedale Maggiore Policlinico Cà Granda, IRCCS, Milan, Italy
| | - Ciro Canetta
- Ospedale Maggiore Policlinico Cà Granda, IRCCS, Milan, Italy
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Jagadeesan V, Culver A, Raiker N, Halverson Q, Prasada S, Chen L, Welty LJ, Prabhakaran S, Maganti K. Left Atrial Dilation and Risk of One-Year Readmission after Embolic Stroke of Undetermined Source. J Stroke Cerebrovasc Dis 2020; 29:104975. [PMID: 32689607 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104975] [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: 04/01/2020] [Revised: 05/04/2020] [Accepted: 05/16/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Structural left atrial and ventricular abnormalities on the electrocardiogram (ECG) and transthoracic echocardiogram (TTE) at the time of ischemic stroke have been associated with morbidity and mortality. Yet, the prognostic impact of the same in embolic stroke of undetermined source (ESUS), a relevant subtype of ischemic stroke with a unique pathophysiology, has not been well studied to date. Our aim was to assess the predictive impact of left atrio-ventricular ECG and TTE abnormalities on one-year hospital readmission after ESUS from an ongoing single center prospective stroke registry in the U.S. METHODS We identified 369 ESUS patients who had at least 1 year of complete follow-up between 2013 and 2018. We examined the association of abnormal left atrio-ventricular findings on ECG and TTE, as well as basic demographic and clinical characteristics, measured at index admission with time to 1-year hospital readmission using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards regression. RESULTS Recurrent ischemic stroke and cardiovascular causes constituted 60% of all readmissions. Patients with left atrial dilation on TTE were more likely to readmitted within 1 year (HR 1.51; 95% CI, 1.04-2.21). Bundle branch block, pathologic Q-wave, and troponin elevation curves diverged, but were not significantly associated with readmission (log-rank p=0.34, p=0.08, p=0.42, respectively). CONCLUSIONS Following ESUS, left atrial dilation on TTE was associated with 1-year overall hospital readmission, of which cardiovascular and cerebrovascular ischemic events, and heart failure were a notable proportion. Our data support ongoing studies of atrial cardiopathy in ESUS patients.
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Affiliation(s)
- Vikrant Jagadeesan
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Division of Cardiology, Department of Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Austin Culver
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Division of Cardiology, Department of Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Nisha Raiker
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Division of Cardiology, Department of Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Quinn Halverson
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Division of Cardiology, Department of Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Sameer Prasada
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Division of Cardiology, Department of Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Liqi Chen
- Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Leah J Welty
- Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Shyam Prabhakaran
- Department of Neurology, University of Chicago Hospitals, Chicago, IL, USA.
| | - Kameswari Maganti
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Division of Cardiology, Department of Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Baman JR, Knapper J, Raval Z, Harinstein ME, Friedewald JJ, Maganti K, Cuttica MJ, Abecassis MI, Ali ZA, Gheorghiade M, Flaherty JD. Preoperative Noncoronary Cardiovascular Assessment and Management of Kidney Transplant Candidates. Clin J Am Soc Nephrol 2019; 14:1670-1676. [PMID: 31554619 PMCID: PMC6832054 DOI: 10.2215/cjn.03640319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The pretransplant risk assessment for patients with ESKD who are undergoing evaluation for kidney transplant is complex and multifaceted. When considering cardiovascular disease in particular, many factors should be considered. Given the increasing incidence of kidney transplantation and the growing body of evidence addressing ESKD-specific cardiovascular risk profiles, there is an important need for a consolidated, evidence-based model that considers the unique cardiovascular challenges that these patients face. Cardiovascular physiology is altered in these patients by abrupt shifts in volume status, altered calcium-phosphate metabolism, high-output states (in the setting of arteriovenous fistulization), and adverse geometric and electrical remodeling, to name a few. Here, we present a contemporary review by addressing cardiomyopathy/heart failure, pulmonary hypertension, valvular dysfunction, and arrhythmia/sudden cardiac death within the ESKD population.
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Affiliation(s)
| | | | - Zankhana Raval
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York; and
| | - Matthew E Harinstein
- Division of Cardiology, Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John J Friedewald
- Division of Nephrology, Department of Medicine.,Division of Transplantation, Department of Surgery, and
| | | | - Michael J Cuttica
- Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Ziad A Ali
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York; and
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El Hangouche N, Wodzinski B, Maganti K. DOES LIVER TRANSPLANT IMPROVE MYOCARDIAL MECHANICS IN PATIENTS WITH CIRRHOSIS? J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31547-5] [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]
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16
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Woodward JL, Connolly M, Hennessy PW, Holleran CL, Mahtani GB, Brazg G, Fahey M, Maganti K, Hornby TG. Cardiopulmonary Responses During Clinical and Laboratory Gait Assessments in People With Chronic Stroke. Phys Ther 2019; 99:86-97. [PMID: 30476281 DOI: 10.1093/ptj/pzy128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 07/16/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND The 6-Minute Walk Test (6MWT) is a common clinical assessment used to evaluate locomotor function in patients after stroke. Previous work suggests the 6MWT can estimate peak metabolic capacity (VO2peak) without cardiorespiratory assessments during graded exercise tests (GXTs), which may assist with exercise prescription. However, selected research also indicated increased heart rates (HRs) during 6MWTs beyond levels considered safe without GXTs. OBJECTIVE The goal of this study was to examine cardiorespiratory responses during 6MWTs and GXTs in individuals with chronic stroke and their associations with demographic or clinical characteristics. DESIGN The study used a cross-sectional observational design. METHODS Cardiorespiratory responses were assessed during 6MWTs at self-selected velocity (SSV) and fastest velocity (FV), and during GXTs. Secondary assessments included the lower extremity Fugl-Meyer Assessment, Functional Gait Assessment, gait speeds, and daily stepping activity. Correlation and regression analyses were used to evaluate associations between locomotor performance, cardiorespiratory responses, and clinical and demographic characteristics. RESULTS Average HRs during 6MWT-FV were 72% to 76% of the age-predicted maximum (HRmax), with 20% of participants exceeding 85% predicted HRmax. When normalized to HRs during GXTs, HRs during 6MWT-FV were 86% to 88% of observed HRmax. Primary predictors of increased HRs during 6MWTs were resting HR, body mass index, and daily stepping. Distance during 6MWT-FV was a significant predictor of VO2peak in combination with other variables. Electrocardiographic abnormalities were observed in >80% of participants at rest and 31% demonstrated distinct abnormalities during GXTs, which were not related to 6MWT or GXT performance. LIMITATIONS In addition to sample size, a primary limitation involved the ability to accurately predict or measure HRmax in patients with motor dysfunction after stroke. CONCLUSIONS Cardiac responses were higher than anticipated during 6MWTs and often exceeded recommended HR thresholds. Clinicians should closely monitor cardiorespiratory responses during 6MWTs.
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Affiliation(s)
- Jane L Woodward
- Shirley Ryan AbilityLab, Chicago, Illinois. She is a board-certified neurologic clinical specialist
| | | | - Patrick W Hennessy
- Infiniti Rehab Inc, Portland, Oregon. He is a board-certified neurologic clinical specialist
| | - Carey L Holleran
- Division of Physical Therapy, Washington University of St. Louis, St. Louis, Missouri. He is a board-certified neurologic clinical specialist
| | | | - Gabrielle Brazg
- Shirley Ryan AbilityLab. She is a board-certified neurologic clinical specialist
| | - Meghan Fahey
- Shirley Ryan AbilityLab. She is a board-certified neurologic clinical specialist
| | - Kameswari Maganti
- Department of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - T George Hornby
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN 46524 (USA)
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Raiker NK, Jensen E, Wodzinski B, Maganti K. Metastatic renal cell carcinoma presenting as a cardiac tumour. BMJ Case Rep 2018; 11:11/1/e227336. [PMID: 30580304 DOI: 10.1136/bcr-2018-227336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Nisha Krishnakant Raiker
- Department of Internal Medicine, McGaw Medical Center of Northwestern University, Chicago, Illinois, USA
| | - Erin Jensen
- Cardiac Sonography, McGaw Medical Center of Northwestern University, Chicago, IL, USA
| | - Bernadette Wodzinski
- Cardiac Sonography, McGaw Medical Center of Northwestern University, Chicago, IL, USA
| | - Kameswari Maganti
- Department of Cardiology, McGaw Medical Center of Northwestern University, Chicago, Illinois, USA
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Halverson QM, Jagadeesan VS, Culver A, Raiker NK, Sameer S, Prabhakaran S, Maganti K. P3461Elevated troponin is a significant predictor of hospital readmission after stroke. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3461] [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: 11/15/2022] Open
Affiliation(s)
- Q M Halverson
- Northwestern University, Chicago, United States of America
| | - V S Jagadeesan
- Northwestern University, Chicago, United States of America
| | - A Culver
- Northwestern University, Chicago, United States of America
| | - N K Raiker
- Northwestern University, Chicago, United States of America
| | - S Sameer
- Northwestern University, Chicago, United States of America
| | - S Prabhakaran
- Northwestern University, Chicago, United States of America
| | - K Maganti
- Northwestern University, Chicago, United States of America
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19
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Saric M, Armour AC, Arnaout MS, Chaudhry FA, Grimm RA, Kronzon I, Landeck BF, Maganti K, Michelena HI, Tolstrup K. Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism. J Am Soc Echocardiogr 2016; 29:1-42. [PMID: 26765302 DOI: 10.1016/j.echo.2015.09.011] [Citation(s) in RCA: 225] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac sources of embolism. It describes general mechanisms of stroke and systemic embolism; the specific role of cardiac and aortic sources in stroke, and systemic and pulmonary embolism; the role of echocardiography in evaluation, diagnosis, and management of cardiac and aortic sources of emboli including the incremental value of contrast and 3D echocardiography; and a brief description of alternative imaging techniques and their role in the evaluation of cardiac sources of emboli. Specific guidelines are provided for each category of embolic sources including the left atrium and left atrial appendage, left ventricle, heart valves, cardiac tumors, and thoracic aorta. In addition, there are recommendation regarding pulmonary embolism, and embolism related to cardiovascular surgery and percutaneous procedures. The guidelines also include a dedicated section on cardiac sources of embolism in pediatric populations.
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Affiliation(s)
- Muhamed Saric
- New York University Langone Medical Center, New York, New York
| | | | - M Samir Arnaout
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Farooq A Chaudhry
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Richard A Grimm
- Learner College of Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | | | | | | | - Kirsten Tolstrup
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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20
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Freed BH, Daruwalla V, Cheng JY, Aguilar FG, Beussink L, Choi A, Klein DA, Dixon D, Baldridge A, Rasmussen-Torvik LJ, Maganti K, Shah SJ. Prognostic Utility and Clinical Significance of Cardiac Mechanics in Heart Failure With Preserved Ejection Fraction: Importance of Left Atrial Strain. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.115.003754. [PMID: 26941415 DOI: 10.1161/circimaging.115.003754] [Citation(s) in RCA: 249] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left atrial (LA) enlargement is associated with adverse events in heart failure with preserved ejection fraction (HFpEF). However, the role of LA mechanics (ie, LA strain measures) in HFpEF has not been well studied. We hypothesized that in HFpEF, reduced (worse) LA strain is a key pathophysiologic abnormality and is a stronger correlate of adverse events than left ventricular or right ventricular longitudinal strain. METHODS AND RESULTS We evaluated baseline LA function in 308 patients with HFpEF who were followed up longitudinally for adverse outcomes. All patients underwent speckle-tracking echocardiography for measurement of left ventricular longitudinal strain, right ventricular free wall strain, and LA booster, conduit, and reservoir strains. The clinical and prognostic significance of left ventricular, right ventricular, and LA strain measures was assessed by regression analyses. The mean age was 65±13 years, 64% were women, 26% had atrial fibrillation, and LA enlargement was present in the majority of patients (67%). Decreased LA reservoir strain was associated with increased pulmonary vascular resistance (P<0.0001) and decreased peak oxygen consumption (P=0.0001). Of the left ventricular, right ventricular, and LA strain measures, LA reservoir strain was the strongest correlate of adverse events and was independently associated with the composite outcome of cardiovascular hospitalization or death (adjusted hazard ratio per 1-SD decrease in LA strain, 1.54; 95% CI, 1.15-2.07; P=0.006). CONCLUSIONS Abnormal indices of LA mechanics (particularly LA reservoir strain) are powerful clinical and prognostic factors in HFpEF. Unloading the LA and augmentation of LA function may be important future therapeutic targets in HFpEF. REGISTRATION INFORMATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01030991.
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Affiliation(s)
- Benjamin H Freed
- From the Division of Cardiology, Department of Medicine (B.H.F., V.D., J.Y.C., F.G.A., L.B., A.C., D.A.K., D.D., K.M., S.J.S.) and the Department of Preventive Medicine (A.B., L.J.R.-T.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Vistasp Daruwalla
- From the Division of Cardiology, Department of Medicine (B.H.F., V.D., J.Y.C., F.G.A., L.B., A.C., D.A.K., D.D., K.M., S.J.S.) and the Department of Preventive Medicine (A.B., L.J.R.-T.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jeanette Y Cheng
- From the Division of Cardiology, Department of Medicine (B.H.F., V.D., J.Y.C., F.G.A., L.B., A.C., D.A.K., D.D., K.M., S.J.S.) and the Department of Preventive Medicine (A.B., L.J.R.-T.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Frank G Aguilar
- From the Division of Cardiology, Department of Medicine (B.H.F., V.D., J.Y.C., F.G.A., L.B., A.C., D.A.K., D.D., K.M., S.J.S.) and the Department of Preventive Medicine (A.B., L.J.R.-T.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lauren Beussink
- From the Division of Cardiology, Department of Medicine (B.H.F., V.D., J.Y.C., F.G.A., L.B., A.C., D.A.K., D.D., K.M., S.J.S.) and the Department of Preventive Medicine (A.B., L.J.R.-T.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrew Choi
- From the Division of Cardiology, Department of Medicine (B.H.F., V.D., J.Y.C., F.G.A., L.B., A.C., D.A.K., D.D., K.M., S.J.S.) and the Department of Preventive Medicine (A.B., L.J.R.-T.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David A Klein
- From the Division of Cardiology, Department of Medicine (B.H.F., V.D., J.Y.C., F.G.A., L.B., A.C., D.A.K., D.D., K.M., S.J.S.) and the Department of Preventive Medicine (A.B., L.J.R.-T.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Debra Dixon
- From the Division of Cardiology, Department of Medicine (B.H.F., V.D., J.Y.C., F.G.A., L.B., A.C., D.A.K., D.D., K.M., S.J.S.) and the Department of Preventive Medicine (A.B., L.J.R.-T.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Abigail Baldridge
- From the Division of Cardiology, Department of Medicine (B.H.F., V.D., J.Y.C., F.G.A., L.B., A.C., D.A.K., D.D., K.M., S.J.S.) and the Department of Preventive Medicine (A.B., L.J.R.-T.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Laura J Rasmussen-Torvik
- From the Division of Cardiology, Department of Medicine (B.H.F., V.D., J.Y.C., F.G.A., L.B., A.C., D.A.K., D.D., K.M., S.J.S.) and the Department of Preventive Medicine (A.B., L.J.R.-T.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kameswari Maganti
- From the Division of Cardiology, Department of Medicine (B.H.F., V.D., J.Y.C., F.G.A., L.B., A.C., D.A.K., D.D., K.M., S.J.S.) and the Department of Preventive Medicine (A.B., L.J.R.-T.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sanjiv J Shah
- From the Division of Cardiology, Department of Medicine (B.H.F., V.D., J.Y.C., F.G.A., L.B., A.C., D.A.K., D.D., K.M., S.J.S.) and the Department of Preventive Medicine (A.B., L.J.R.-T.), Northwestern University Feinberg School of Medicine, Chicago, IL.
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Dubin BL, Azam IT, Lee DC, Maganti K, Carr JC, Collins JD. Cardiac MR reliably identifies patients with clinically significant left ventricular noncompaction using a novel mass quantification technique. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328910 DOI: 10.1186/1532-429x-17-s1-p64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
Valvular heart disease (VHD) encompasses a number of common cardiovascular conditions that account for 10% to 20% of all cardiac surgical procedures in the United States. A better understanding of the natural history coupled with the major advances in diagnostic imaging, interventional cardiology, and surgical approaches have resulted in accurate diagnosis and appropriate selection of patients for therapeutic interventions. A thorough understanding of the various valvular disorders is important to aid in the management of patients with VHD. Appropriate work-up for patients with VHD includes a thorough history for evaluation of causes and symptoms, accurate assessment of the severity of the valvular abnormality by examination, appropriate diagnostic testing, and accurate quantification of the severity of valve dysfunction and therapeutic interventions, if necessary. It is also important to understand the role of the therapeutic interventions vs the natural history of the disease in the assessment of outcomes. Prophylaxis for infective endocarditis is no longer recommended unless the patient has a history of endocarditis or a prosthetic valve.
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Affiliation(s)
- Kameswari Maganti
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 201 E Huron St, Ste 11-240, Chicago, IL 60611, USA.
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Abstract
Cardiac lympangiectasia is a rare pathological dilation of the lymphatic channels of the heart. Diagnosis is made by pathology; however, there remains no definitive diagnostic study. There are reports of cardiac cystic lymphangiectasias in children. A case of right atrial lymphangiectasia, initially identified by echocardiography, is presented here. This is the first report of such a mass.
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Affiliation(s)
- Azmey Matarieh
- Department of Medicine, Division of Cardiology, Northwestern University, Feinberg, School of Medicine, Chicago, Illinois 60611, USA
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25
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Maganti K, Buchanan K, Huang SL, Tiukinhoy S, MacDonald R, McPherson DD. 54 STABILITY OF ECHOGENIC IMMUNOLIPOSOMES UNDER PHYSIOLOGIC CONDITIONS. J Investig Med 2005. [DOI: 10.2310/6650.2005.00206.53] [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: 11/18/2022]
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Kansal P, Tejedor P, Wu E, Maganti K, Bucciarelli-Ducci C, Lee DC, Carr JC, Holly TA, Bonow RO. 49 AORTIC VALVE AREA CALCULATION USING THE CONTINUITY EQUATION AND PLANIMETRY: A PHASE-CONTRAST CINE FLOW QUANTIFICATION COMPARISON WITH ECHOCARDIOGRAPHY. J Investig Med 2005. [DOI: 10.2310/6650.2005.00206.48] [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: 11/18/2022]
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Abstract
PURPOSE OF REVIEW Diagnostic testing using noninvasive imaging has become an integral part of risk stratification in patients with coronary artery disease. It is important to understand the integral strengths and weaknesses between the different modalities of stress testing and to apply accurately the type of test the clinical scenario demands. RECENT FINDINGS There have been tremendous advances made in the field of cardiac imaging. Both myocardial perfusion imaging and stress echocardiographic techniques continue to evolve and play an important role in the assessment of patients with coronary artery disease. SUMMARY In this review the authors discuss the relative merits of both stress echocardiography and myocardial single photon emission computed tomographic imaging for diagnosis and risk stratification of patients with coronary artery disease.
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Affiliation(s)
- Kameswari Maganti
- Northwestern University Feinberg School of Medicine, Department of Medicine, Division of Cardiology, Chicago, Illinois, USA
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Sudhir K, DeMarco T, Kumar S, Maganti K, Amidon TM, de Groot CJ, Klinski C, Lau D, Keith F, Taylor RN. Transcoronary and pulmonary vascular dynamics of endothelin-1 in heart transplant recipients. J Heart Lung Transplant 1995; 14:230-5. [PMID: 7779840] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Endothelin-1, a potent endothelium-derived vasoconstrictor peptide, has recently been shown to be elevated in heart transplant recipients and may be a participant in posttransplantation vasculopathy. METHODS We measured peripheral venous endothelin-1 concentrations in eight heart transplant recipients and eight age- and gender-matched healthy controls. Subsequently, in 21 transplant recipients, right atrial, aortic, and coronary sinus plasma was obtained and endothelin-1 levels were measured. Potential correlations to donor and recipient age, cyclosporine levels, hemodynamic parameters, donor heart ischemic time, time from transplantation, and serum creatinine were examined. In eight more patients, right atrial levels of endothelin-1 were measured before and after endomyocardial biopsy to examine the effect of this procedure on endothelin-1 concentrations. RESULTS Peripheral endothelin-1 concentrations were significantly higher in heart transplant recipients (45.6 +/- 1.8 versus 25.8 +/- 2.3, p < 0.001). Multiple regression analysis showed a significant correlation between right atrial endothelin-1 and pulmonary artery systolic pressure (r = 0.48), as well as serum creatinine (r = 0.52). No relation to blood pressure, right atrial pressure, pulmonary vascular resistance, recipient age, cyclosporine levels, or donor heart ischemic time was observed. In 11 patients, a 38% +/- 7% fall in endothelin-1 levels across the pulmonary bed was observed, suggesting extraction across the lung in these subjects. Nine patients had net release of endothelin-1 (95% +/- 26% rise) across the coronary vascular bed, whereas 12 patients showed net extraction (24% +/- 4% fall). Endomyocardial biopsy had no influence on endothelin-1 levels (prebiopsy: 48.3 +/- 1.7; postbiopsy: 42.3 +/- 2.34; p = Not significant). CONCLUSION These findings suggest that endothelin-1 levels in transplant recipients may be influenced by renal function and may contribute to pulmonary hypertension. The significance of transcardiac release of endothelin in some patients is unclear: further studies are needed to determine the pathophysiologic significance of endothelin-1 in heart transplant recipients.
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Affiliation(s)
- K Sudhir
- Cardiovascular Research Institute, University of California at San Francisco, USA
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