1
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Arnouk S, Huynh Q, Saric M, Papadopoulos J. A Case Report of Cardiac Arrest After Intravenous Administration of Sulfur Hexafluoride (Lumason ®) Ultrasound Enhancing Agent. J Pharm Pract 2024; 37:509-512. [PMID: 36803045 DOI: 10.1177/08971900231158935] [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] [Indexed: 02/21/2023]
Abstract
Ultrasound enhancing agents (UEAs) are medications that enable clear visualization of ultrasound images. While large studies have demonstrated the safety of these agents, case reports of life-threatening reactions temporally associated with their use have been published and reported to the Food and Drug Administration. Current literature describes the most serious adverse reactions due to UEAs to be allergic in nature; however, embolic phenomena may play a role as well. Here, we report a case of unexplained cardiac arrest following the administration of sulfur hexafluoride (Lumason®) in an adult inpatient undergoing echocardiography where resuscitative efforts were ultimately unsuccessful, and review possible mechanisms of cardiac arrest based on prior published literature.
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Affiliation(s)
- Serena Arnouk
- Department of Pharmacy, NYU Langone Health, New York, NY, USA
| | - Quy Huynh
- Department of Pharmacy, NYU Langone Health, New York, NY, USA
| | - Muhamed Saric
- Leon H Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
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2
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Zhang RS, Ro R, Bamira D, Vainrib A, Zhang L, Nayar AC, Saric M, Bernard S. Echocardiography in the Recognition and Management of Mechanical Complications of Acute Myocardial Infarction. Curr Cardiol Rep 2024:10.1007/s11886-024-02042-5. [PMID: 38526749 DOI: 10.1007/s11886-024-02042-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE OF REVIEW Although rare, the development of mechanical complications following an acute myocardial infarction is associated with a high morbidity and mortality. Here, we review the clinical features, diagnostic strategy, and treatment options for each of the mechanical complications, with a focus on the role of echocardiography. RECENT FINDINGS The growth of percutaneous structural interventions worldwide has given rise to new non-surgical options for management of mechanical complications. As such, select patients may benefit from a novel use of these established treatment methods. A thorough understanding of the two-dimensional, three-dimensional, color Doppler, and spectral Doppler findings for each mechanical complication is essential in recognizing major causes of hemodynamic decompensation after an acute myocardial infarction. Thereafter, echocardiography can aid in the selection and maintenance of mechanical circulatory support and potentially facilitate the use of a percutaneous intervention.
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Affiliation(s)
- Robert S Zhang
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Richard Ro
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Daniel Bamira
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Alan Vainrib
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Lily Zhang
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Ambika C Nayar
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Muhamed Saric
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Samuel Bernard
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
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3
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Yuriditsky E, Horowitz JM, Taslakian B, Saric M. Saddle Pulmonary Embolism Detected by Transthoracic Echocardiography in a Patient With Suspected Myocardial Infarction. CASE (Phila) 2024; 8:54-57. [PMID: 38425574 PMCID: PMC10899716 DOI: 10.1016/j.case.2023.11.006] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
•PE is very rarely identified on TTE. •Saddle PE does not represent a higher-risk subset of PE. •Catheter-based therapies are becoming more commonplace in the management of acute PE.
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Affiliation(s)
- Eugene Yuriditsky
- Division of Cardiology, Department of Medicine, NYU Langone Health, New York, New York
| | - James M. Horowitz
- Division of Cardiology, Department of Medicine, NYU Langone Health, New York, New York
| | - Bedros Taslakian
- Division of Vascular and Interventional Radiology, Department of Radiology, NYU Langone Health, New York, New York
| | - Muhamed Saric
- Division of Cardiology, Department of Medicine, NYU Langone Health, New York, New York
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4
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Vainrib A, Saric M. Quick Three-Dimensional Transesophageal Echocardiography of Left Atrial Appendage (LAA) Anatomy Using the LAA Multiview Technique. CASE (Phila) 2023; 7:461-462. [PMID: 38028389 PMCID: PMC10679523 DOI: 10.1016/j.case.2023.08.007] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Affiliation(s)
- Alan Vainrib
- Department of Cardiology, NYU Langone Health, New York, New York
| | - Muhamed Saric
- Department of Cardiology, NYU Langone Health, New York, New York
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5
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Hayes DE, Bamira D, Vainrib AF, Freedberg RS, Aizer A, Chinitz LA, Saric M. Left Atrial Appendage Tilt-Up-and-Turn-Left Maneuver: A Novel Three-Dimensional Transesophageal Echocardiography Imaging Maneuver to Characterize the Left Atrial Appendage and to Improve Transcatheter Closure Guidance. CASE (Phila) 2023; 7:391-395. [PMID: 37970485 PMCID: PMC10635893 DOI: 10.1016/j.case.2023.05.009] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
•Precise LAA anatomy must be established for LAA occlusion device selection. •We have developed the TUPLE maneuver, an acronym for “tilt up and turn left”. •The TUPLE maneuver facilitates LAA device selection and intraprocedural guidance.
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Affiliation(s)
- Dena E. Hayes
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Daniel Bamira
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Alan F. Vainrib
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Robin S. Freedberg
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Larry A. Chinitz
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
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6
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Zhang RS, Alter E, Kozloff S, Choy-Shan A, Xia Y, Patel K, Gozansky EK, Saric M, Stojanovska J, Donnino R. Concordance of Pericardial Effusion Size Between Computed Tomography and Echocardiography. Am J Cardiol 2023; 203:92-97. [PMID: 37487407 DOI: 10.1016/j.amjcard.2023.06.098] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/20/2023] [Accepted: 06/29/2023] [Indexed: 07/26/2023]
Abstract
Discrepancy between computed tomography (CT) and transthoracic echocardiography (TTE) regarding pericardial effusion (PEff) size is common, but there is limited data regarding the correlation between these 2 imaging methods. The aim of this study is to examine the real-world concordance of observed PEff size between CT and TTE. We performed a retrospective analysis of all imaging reports available from 2013 to 2019 and identified patients with a PEff who underwent both a chest CT and TTE within a 24-hour period. We evaluated the agreement between CT and TTE in assessing PEff size. Of 1,118 patients included in the study, mean age was 66 (±17 years) and 54% were female. The median time interval between the 2 studies was 9.4 hours (interquartile range 3.5 to 16.6). Patients within a half-grade or full-grade of agreement were 71.9% and 97.2%, respectively. The mean difference in grade of agreement (TTE minus CT) between the 2 imaging methods was -0.1 (±0.6, p <0.0001). CT was more likely to report a higher grade (i.e. larger PEff size) when compared with TTE (261 patients vs 157 patients, p <0.001). The weighted kappa was 0.73 (95% confidence interval 0.69 to 0.76). After excluding patients with trace/no effusion, 42.3% and 94.1% of patients' studies were within a half-grade or full-grade of agreement, respectively. Of the 18 patients who had large discrepancies, 9 patients had loculated effusions, 2 patients had large pleural effusions, and 6 patients had suboptimal TTEs images. In conclusion, TTE and CT showed relatively strong agreement in estimation of PEff size, with CT sizes larger than TTE, on average. Large discrepancies in size may be related to reduced image quality, large pleural effusions, and loculated PEff.
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Affiliation(s)
- Robert S Zhang
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York
| | - Eric Alter
- Hartford Healthcare Heart and Vascular Institute, St. Vincent's Medical Center, Bridgeport, Connecticut
| | - Samuel Kozloff
- Department of Medicine, University of Utah, Salt Lake City, Utah
| | - Alana Choy-Shan
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York; Veterans Affairs Medical Center, New York, New York
| | - Yuhe Xia
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Kunal Patel
- Division of Hospital Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Elliott K Gozansky
- Department of Radiology, New York University Grossman School of Medicine, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York
| | - Jadranka Stojanovska
- Department of Radiology, New York University Grossman School of Medicine, New York, New York
| | - Robert Donnino
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York; Veterans Affairs Medical Center, New York, New York; Department of Radiology, New York University Grossman School of Medicine, New York, New York.
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7
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Maidman SD, Bamira D, Vainrib AF, Ro R, Saric M. Cysts Around the Heart: Differential Diagnosis and Multimodality Imaging Strategies for Paracardiac Cysts. CASE (Phila) 2023; 7:365-376. [PMID: 37791128 PMCID: PMC10543172 DOI: 10.1016/j.case.2023.05.006] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
•Paracardiac cysts (located adjacent to or inside the heart) are rarely detected. •There is a broad differential diagnosis for cysts encountered with echocardiography. •Multimodality imaging is crucial for comprehensively evaluating paracardiac cysts.
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Affiliation(s)
- Samuel D. Maidman
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Daniel Bamira
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Alan F. Vainrib
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Richard Ro
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
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8
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Rhee DW, Aizer A, Chinitz LA, Saric M, Vainrib AF. The Double-Orifice Left Atrial Appendage: Multimodality and Virtual Transillumination Imaging. CASE (Phila) 2023; 7:335-337. [PMID: 37614689 PMCID: PMC10442454 DOI: 10.1016/j.case.2023.04.009] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
•LAA membranes are exceedingly rare with variable morphologies. •Thromboembolic risk with LAA membranes remains unknown. •Use of 3D TEE transillumination may assist in visualization and understanding.
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Affiliation(s)
- David W. Rhee
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York
| | - Larry A. Chinitz
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York
| | - Alan F. Vainrib
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York
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9
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Arnaout R, Hahn RT, Hung JW, Jone PN, Lester SJ, Little SH, Mackensen GB, Rigolin V, Sachdev V, Saric M, Sengupta PP, Strom JB, Taub CC, Thamman R, Abraham T. The (Heart and) Soul of a Human Creation: Designing Echocardiography for the Big Data Age. J Am Soc Echocardiogr 2023; 36:800-801. [PMID: 37191597 PMCID: PMC10913146 DOI: 10.1016/j.echo.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Rima Arnaout
- University of California, San Francisco, San Francisco, California.
| | | | - Judy W Hung
- Massachusetts General Hospital, Boston, Massachusetts
| | - Pei-Ni Jone
- Lurie Children's Hospital, Chicago, Illinois; Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Vera Rigolin
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Vandana Sachdev
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Muhamed Saric
- New York University Langone Health, New York, New York
| | | | - Jordan B Strom
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Cynthia C Taub
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Ritu Thamman
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Theodore Abraham
- University of California, San Francisco, San Francisco, California
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10
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Dhaduk N, Vainrib AF, Bamira D, Ro R, Aizer A, Chinitz L, Saric M. Device-Associated Thrombus with Watchman FLX Left Atrial Appendage Closure Device: A Report of Two Cases. CASE (Phila) 2023; 7:226-232. [PMID: 37396475 PMCID: PMC10307589 DOI: 10.1016/j.case.2023.01.010] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Individual cases of Watchman FLX DAT are scare in literature. The Watchman FLX has shown lower rates of DAT than the Watchman 2.0. Thrombus formation is still possible in rare instances with the Watchman FLX.
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Affiliation(s)
- Nehal Dhaduk
- Correspondence: Nehal Dhaduk, MD, NYU Langone Health, Department of Internal Medicine, 225 E 34th Street, New York, NY 10016.
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11
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Bamira D, Vainrib A, Saric M, Saraon T, Reyentovich A, Jaffe I, James L, Stern J, Khalil K, Weldon E, Ayares D, Griesemer A, Smith D, Montgomery R, Moazami N. Echocardiographic Evaluation of Two 10-Gene Modified Xenoheart Transplants into Brain Dead Decedents. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1505] [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: 04/05/2023] Open
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12
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Little SH, Rigolin VH, Garcia-Sayan E, Hahn RT, Hung J, Mackensen GB, Mankad S, Quader N, Saric M. Recommendations for Special Competency in Echocardiographic Guidance of Structural Heart Disease Interventions: From the American Society of Echocardiography. J Am Soc Echocardiogr 2023; 36:350-365. [PMID: 36841670 DOI: 10.1016/j.echo.2023.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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] [Indexed: 02/26/2023]
Abstract
Transcatheter therapies for structural heart disease continue to grow at a rapid pace, and echocardiography is the primary imaging modality used to support such procedures. Transesophageal echocardiographic guidance of structural heart disease procedures must be performed by highly skilled echocardiographers who can provide rapid, accurate, and high-quality image acquisition and interpretation in real time. Training standards are needed to ensure that interventional echocardiographers have the necessary expertise to perform this complex task. This document provides guidance on all critical aspects of training for cardiology and anesthesiology trainees and postgraduate echocardiographers who plan to specialize in interventional echocardiography. Core competencies common to all transcatheter therapies are reviewed in addition to competencies for each specific transcatheter procedure. A core principle is that the length of interventional echocardiography training or achieved procedure volumes are less important than the demonstration of procedure-specific competencies within the milestone domains of knowledge, skill, and communication.
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Affiliation(s)
- Stephen H Little
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Vera H Rigolin
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Rebecca T Hahn
- Columbia University Irving College of Medicine, New York, New York
| | - Judy Hung
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | - Muhamed Saric
- New York University Langone Health, New York, New York
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13
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Small AJ, Bhatla P, Saric M, Halpern DG, Kutty S. Congenital anatomy, acquired pathology - A synergistic approach to echocardiographic evaluation of the adult with congenital heart disease. Echocardiography 2023; 40:158-160. [PMID: 36897538 DOI: 10.1111/echo.15519] [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: 10/02/2022] [Accepted: 11/20/2022] [Indexed: 03/11/2023] Open
Affiliation(s)
- Adam J Small
- Adult Congenital Heart Disease, NYU Grossman School of Medicine, New York, New York, USA
| | - Puneet Bhatla
- Director, Pediatric and Congenital Cardiovascular Imaging, NYU Grossman School of Medicine, New York, New York, USA
| | - Muhamed Saric
- Clinical Director, Non-Invasive Cardiology, NYU Grossman School of Medicine, New York, New York, USA
| | - Dan G Halpern
- Medical Director, Adult Congenital Heart Disease, NYU Grossman School of Medicine, New York, New York, USA
| | - Shelby Kutty
- Director, Pediatric and Congenital Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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14
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Sherrid MV, Bernard S, Tripathi N, Patel Y, Modi V, Axel L, Talebi S, Ghoshhajra BB, Sanborn DY, Saric M, Adlestein E, Alvarez IC, Xia Y, Swistel DG, Massera D, Fifer MA, Kim B. Apical Aneurysms and Mid-Left Ventricular Obstruction in Hypertrophic Cardiomyopathy. JACC Cardiovasc Imaging 2023; 16:591-605. [PMID: 36681586 DOI: 10.1016/j.jcmg.2022.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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] [Received: 07/07/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Apical left ventricular (LV) aneurysms in hypertrophic cardiomyopathy (HCM) are associated with adverse outcomes. The reported frequency of mid-LV obstruction has varied from 36% to 90%. OBJECTIVES The authors sought to ascertain the frequency of mid-LV obstruction in HCM apical aneurysms. METHODS The authors analyzed echocardiographic and cardiac magnetic resonance examinations of patients with aneurysms from 3 dedicated programs and compared them with 63 normal controls and 47 controls with apical-mid HCM who did not have aneurysms (22 with increased LV systolic velocities). RESULTS There were 108 patients with a mean age of 57.4 ± 13.5 years; 40 (37%) were women. One hundred three aneurysm patients (95%) had mid-LV obstruction with mid-LV complete systolic emptying. Of the patients with obstruction, 84% had a midsystolic Doppler signal void, a marker of complete flow cessation, but only 19% had Doppler systolic gradients ≥30 mm Hg. Five patients (5%) had relative hypokinesia in mid-LV without obstruction. Aneurysm size is not bimodal but appears distributed by power law, with large aneurysms decidedly less common. Comparing mid-LV obstruction aneurysm patients with all control groups, the short-axis (SAX) systolic areas were smaller (P < 0.007), the percent SAX area change was greater (P < 0.005), the papillary muscle (PM) areas were larger (P < 0.003), and the diastolic PM areas/SAX diastolic areas were greater (P < 0.005). Patients with aneurysms had 22% greater SAX PM areas compared with those with elevated LV velocities but no aneurysms (median: 3.00 cm2 [IQR: 2.38-3.70 cm2] vs 2.45 [IQR: 1.81-2.95 cm2]; P = 0.004). Complete emptying occurs circumferentially around central PMs that contribute to obstruction. Late gadolinium enhancement was always brightest and the most transmural apical of, or at the level of, complete emptying. CONCLUSIONS The great majority (95%) of patients in the continuum of apical aneurysms have associated mid-LV obstruction. Further research to investigate obstruction as a contributing cause to apical aneurysms is warranted.
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Affiliation(s)
- Mark V Sherrid
- Hypertrophic Cardiomyopathy Program, Leon Charney Division of Cardiology, New York University Langone Health, New York, New York, USA; Echocardiography Laboratory, New York University Langone Health, New York, New York, USA.
| | - Samuel Bernard
- Echocardiography Laboratory, New York University Langone Health, New York, New York, USA
| | - Nidhi Tripathi
- Hypertrophic Cardiomyopathy Program, Leon Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Yash Patel
- Division of Cardiology, Mount Sinai West and Mount Sinai Morningside, New York, New York, USA
| | - Vivek Modi
- Division of Cardiology, Mount Sinai West and Mount Sinai Morningside, New York, New York, USA
| | - Leon Axel
- Department of Radiology, New York University Langone Health, New York, New York, USA
| | - Soheila Talebi
- Division of Cardiology, Mount Sinai West and Mount Sinai Morningside, New York, New York, USA
| | - Brian B Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Danita Y Sanborn
- Echocardiography Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Muhamed Saric
- Echocardiography Laboratory, New York University Langone Health, New York, New York, USA
| | - Elizabeth Adlestein
- Hypertrophic Cardiomyopathy Program, Leon Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Isabel Castro Alvarez
- Hypertrophic Cardiomyopathy Program, Leon Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Yuhe Xia
- Division of Biostatistics, New York University Langone Health, New York, New York, USA
| | - Daniel G Swistel
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York, USA
| | - Daniele Massera
- Hypertrophic Cardiomyopathy Program, Leon Charney Division of Cardiology, New York University Langone Health, New York, New York, USA; Echocardiography Laboratory, New York University Langone Health, New York, New York, USA
| | - Michael A Fifer
- Hypertrophic Cardiomyopathy Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bette Kim
- Echocardiography Laboratory and Cardiomyopathy Program, Mount Sinai West and Mount Sinai Morningside, New York, New York, USA
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15
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Maidman SD, Bamira D, Ro R, Vainrib AF, Saric M. Taking Command of Three-Dimensional Stitching Artifacts: From an Annoyance to an Easy Tool for Navigating Three-Dimensional Transesophageal Echocardiography. J Am Soc Echocardiogr 2023; 36:105-110. [PMID: 36174809 DOI: 10.1016/j.echo.2022.09.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 01/10/2023]
Abstract
Despite many recent advances in three-dimensional (3D) transesophageal echocardiography (TEE) imagining, the process of orienting 3D TEE images is nonintuitive and uses assumptions based on idealized anatomy. Correlating two-dimensional TEE cross-sectional images to 3D reconstructions remains an additional challenge. In this article, we suggest the repurposing of the stitching artifact generated in 2-beat electrocardiogram-gated 3D TEE as a means of exactly orienting 3D images within a patient's unique anatomy. We demonstrate the application of this strategy to assess a normal mitral valve to localize scallops of mitral valve prolapse and to visualize typical left atrial appendage two-dimensional cuts in a 3D space. By taking command of stitching artifacts, cardiac imagers can successfully navigate the complex structures of the heart for optimal, individualized echocardiographic views.
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Affiliation(s)
- Samuel D Maidman
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Daniel Bamira
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Richard Ro
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Alan F Vainrib
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York.
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16
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Maidman SD, Salerno WD, Halpern DG, Donnino R, Saric M. Isolated Left Ventricular Apical Hypoplasia: A Very Rare Congenital Anomaly Characterized by Multimodality Imaging and Invasive Testing. Circ Cardiovasc Imaging 2022; 16:e014789. [PMID: 36448445 DOI: 10.1161/circimaging.122.014789] [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: 12/02/2022]
Affiliation(s)
- Samuel D. Maidman
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health. (S.D.M., D.G.H., R.D., M.S.)
| | - William D. Salerno
- Division of Cardiology, Hackensack University Medical Center, Hackensack Meridian School of Medicine, NJ (W.D.S.)
| | - Dan G. Halpern
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health. (S.D.M., D.G.H., R.D., M.S.)
| | - Robert Donnino
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health. (S.D.M., D.G.H., R.D., M.S.)
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health. (R.D.)
- Division of Cardiology, Veteran Affairs NY Harbor Medical Center, Manhattan Campus (R.D.)
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health. (S.D.M., D.G.H., R.D., M.S.)
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17
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Kuohn LR, Ro R, Bamira D, Vainrib A, Freedberg R, Galloway A, Williams MR, Saric M. Bacterial endocarditis with AACEK (HACEK) organisms. Echocardiography 2022; 39:1348-1358. [PMID: 36198094 DOI: 10.1111/echo.15440] [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: 01/28/2022] [Revised: 06/07/2022] [Accepted: 07/03/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Gram-negative organisms of the AACEK group, formerly known as HACEK, rarely cause endocarditis. CASE SERIES We present three cases of bacterial endocarditis, involving native and prosthetic valves, caused by AACEK organisms. In two patients, Cardiobacterium hominis was the responsible organism, and in a third, Aggregatibacter aphrophilus was implicated. A dental source of infection was identified in two patients, and in all three patients, the presentation of endocarditis was subacute. DISCUSSION This case series highlights the indolent nature of infection with the AACEK organisms. It also demonstrates the crucial role of multimodality imaging, especially transesophageal echocardiography, in the diagnosis of AACEk endocarditis of both native and prosthetic valves, and in delineating the extent of abscess in those with prosthetic valve infection.
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Affiliation(s)
- Lindsey R Kuohn
- Leon H Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Richard Ro
- Leon H Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Daniel Bamira
- Leon H Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Alan Vainrib
- Leon H Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Robin Freedberg
- Leon H Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Aubrey Galloway
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York, USA
| | - Mathew R Williams
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York, USA
| | - Muhamed Saric
- Leon H Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
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18
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Liebman J, Bamira D, Ro R, Vainrib AF, Small AJ, Donnino R, Saric M. Multimodality Imaging of Caval and Coronary Sinus Venous Anomalies. CASE 2022; 6:366-376. [PMID: 36247374 PMCID: PMC9556923 DOI: 10.1016/j.case.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abnormal fetal development can produce several anomalies of the caval venous system. We present multimodality imaging of the most common caval venous anomalies. Each imaging modality provides incremental value when identifying these anomalies. Even normal variants may impact pacing lead or central venous catheter placement. Pathologic variants may lead to intracardiac shunting.
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19
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Qiu JK, Bamira D, Vainrib AF, Latson LA, Halpern DG, Chun A, Saric M. Response to Letter to the Editor: Multimodality Imaging of Sinus Venosus Atrial Septal Defect: A Challenging Diagnosis in Adults. CASE 2022; 6:147. [PMID: 35602979 PMCID: PMC9120830 DOI: 10.1016/j.case.2022.01.004] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jessica K Qiu
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Daniel Bamira
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Alan F Vainrib
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Larry A Latson
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Dan G Halpern
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Anne Chun
- Department of Pediatrics, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
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Qiu JK, Bamira D, Vainrib AF, Latson LA, Halpern DG, Chun A, Saric M. Multimodality Imaging of Sinus Venosus Atrial Septal Defect: A Challenging Diagnosis in Adults. CASE 2022; 6:107-113. [PMID: 35602989 PMCID: PMC9120852 DOI: 10.1016/j.case.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
SVASD should be suspected in cases of unexplained RV volume overload. Direct visualization of SVASD with TTE is difficult in adults compared with children. TEE is helpful for diagnosing SVASD and associated pulmonary venous abnormalities. Multimodal imaging techniques offer incremental value in the workup of SVASD.
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21
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Bhansali S, Cohen RB, Halpern D, Saharan S, Saric M, Kumar TKS, Mosca RS. Biatrial drainage of right superior vena cava with left superior vena cava: A diagnostic conundrum. JTCVS Tech 2022; 14:198-200. [PMID: 35967232 PMCID: PMC9366530 DOI: 10.1016/j.xjtc.2022.03.020] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/07/2022] [Accepted: 03/30/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Suneet Bhansali
- Department of Pediatric Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
- Address for reprints: Suneet Bhansali, MD, Division of Pediatric Cardiology, NYU Grossman School of Medicine, NYU Langone Health, 403 East 34th St, 4th Floor, New York, NY 10016.
| | - Roi B. Cohen
- Department of Internal Medicine, Northwell—Lennox Hill Hospital, New York, NY
| | - Dan Halpern
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Sunil Saharan
- Department of Pediatric Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | - T. K. Susheel Kumar
- Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Ralph S. Mosca
- Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
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22
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Sikand N, Maidman S, Saric M, Reyentovich A, Saraon T, Rao S, Katz S, Goldberg R, Kadosh B, DiVita M, Cruz J, Riggio S, Moazami N, Gidea C. Defining the Normal Values for Left Ventricular Global Longitudinal Strain in Adult Heart Transplanted Patients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1146] [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: 11/16/2022] Open
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23
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Kuohn L, Staniloae C, Jilaihawi H, Ibrahim H, Bamira D, Pushkar I, Vainrib A, Ro R, Williams M, Saric M. BIOPROSTHETIC LEAFLET THROMBOSIS AFTER TRANSCATHETER MITRAL VALVE-IN-VALVE IMPLANTATION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01790-9] [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: 11/29/2022]
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Hahn RT, Saric M, Faletra FF, Garg R, Gillam LD, Horton K, Khalique OK, Little SH, Mackensen GB, Oh J, Quader N, Safi L, Scalia GM, Lang RM. Recommended Standards for the Performance of Transesophageal Echocardiographic Screening for Structural Heart Intervention: From the American Society of Echocardiography. J Am Soc Echocardiogr 2022; 35:1-76. [PMID: 34280494 DOI: 10.1016/j.echo.2021.07.006] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rebecca T Hahn
- Columbia University Irving College of Medicine, New York, New York
| | - Muhamed Saric
- New York University Langone Health, New York, New York
| | | | - Ruchira Garg
- Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Omar K Khalique
- Columbia University Irving College of Medicine, New York, New York
| | - Stephen H Little
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | | | - Jae Oh
- Mayo Clinic, Rochester, Minnesota
| | | | - Lucy Safi
- Hackensack University Medical Center, Hackensack, New Jersey
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Maidman SD, Kiefer NJ, Bernard S, Freedberg RS, Rosenzweig BP, Bamira D, Vainrib AF, Ro R, Neuburger PJ, Basu A, Moreira AL, Latson LA, Loulmet DF, Saric M. Native mitral valve staphylococcus endocarditis with a very unusual complication: Ruptured posterior mitral valve leaflet aneurysm. Echocardiography 2021; 39:112-117. [DOI: 10.1111/echo.15254] [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: 10/01/2021] [Revised: 10/29/2021] [Accepted: 11/04/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Samuel D. Maidman
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Nicholas J. Kiefer
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Samuel Bernard
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Robin S. Freedberg
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Barry P. Rosenzweig
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Daniel Bamira
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Alan F. Vainrib
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Richard Ro
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Peter J. Neuburger
- Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Atreyee Basu
- Department of Pathology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Andre L. Moreira
- Department of Pathology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Larry A. Latson
- Department of Radiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Didier F. Loulmet
- Department of Cardiothoracic Surgery, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
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26
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Nakashima M, Williams M, He Y, Latson L, Saric M, Vainrib A, Staniloae C, Hisamoto K, Ibrahim H, Querijero M, Tovar J, Kalish C, Pushkar I, Jilaihawi H. Multiphase Assessment of Mitral Annular Dynamics in Consecutive Patients With Significant Mitral Valve Disease. JACC Cardiovasc Interv 2021; 14:2215-2227. [PMID: 34600871 DOI: 10.1016/j.jcin.2021.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 02/04/2021] [Revised: 06/22/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this study was to clarify the dynamics of the mitral annulus throughout the cardiac cycle and its relevance to transcatheter mitral valve replacement (TMVR) sizing and case selection. BACKGROUND Limited data are available regarding the relevance of mitral annular (MA) and neo-left ventricular outflow tract (LVOT) dynamics in the overall population presenting with significant mitral valve disease. METHODS Patients attending a combined surgical-transcatheter heart valve clinic for severe symptomatic mitral valve disease were assessed using multiphase computed tomography. The relative influence of MA and neo-LVOT dynamics to TMVR case selection was studied. RESULTS A total of 476 patients with significant mitral valve disease were evaluated. In 99 consecutive patients with severe mitral regurgitation, a 10-phase assessment showed that the mitral annulus was on average largest in late systole. On comparing maximal MA dimension with late systolic dimension, TMVR size assignment changed in 24.2% of patients. If the average MA perimeter was used to determine sizing, 48.5% were excluded because of MA dimension being too large; in a multiphase assessment of the neo-LVOT, an additional 16.2% were excluded on the basis of neo-LVOT dimension. In an expanded series of 312 consecutive patients, selection protocol influenced anatomical exclusion: a manufacturer-proposed early systolic approach excluded 69.2% of patients, whereas a late systolic approach excluded 82.7% of patients, the vast majority because of large mitral annuli. CONCLUSIONS Contemporary TMVR can treat only a minority of patients with severe mitral regurgitation, principally because of limitations of large MA dimension.
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Affiliation(s)
| | - Mathew Williams
- Heart Valve Center, NYU Langone Health, New York, New York, USA
| | - Yuxin He
- Heart Valve Center, NYU Langone Health, New York, New York, USA
| | - Larry Latson
- Heart Valve Center, NYU Langone Health, New York, New York, USA
| | - Muhamed Saric
- Heart Valve Center, NYU Langone Health, New York, New York, USA
| | - Alan Vainrib
- Heart Valve Center, NYU Langone Health, New York, New York, USA
| | - Cezar Staniloae
- Heart Valve Center, NYU Langone Health, New York, New York, USA
| | | | - Homam Ibrahim
- Heart Valve Center, NYU Langone Health, New York, New York, USA
| | | | - Joseph Tovar
- Heart Valve Center, NYU Langone Health, New York, New York, USA
| | - Chloe Kalish
- Heart Valve Center, NYU Langone Health, New York, New York, USA
| | - Illya Pushkar
- Heart Valve Center, NYU Langone Health, New York, New York, USA
| | - Hasan Jilaihawi
- Heart Valve Center, NYU Langone Health, New York, New York, USA.
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27
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Ali T, Garshick MS, Saric M, Skolnick AH. Aortic closure signal length on doppler echocardiography differentiates aortic patient-prosthesis mismatch from prosthetic stenosis. J Clin Ultrasound 2021; 49:644-649. [PMID: 33665868 DOI: 10.1002/jcu.23002] [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] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/27/2021] [Accepted: 02/23/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE The purpose of this study was to investigate the diagnostic potential of the aortic closure (A2) signal length on Doppler echocardiography in distinguishing aortic patient-prosthesis mismatch (PPM) from prosthetic stenosis among patients with elevated gradients over bioprosthetic valves. METHODS The A2 signal length was retrospectively measured for 150 patients with bioprosthetic aortic valves (50 with PPM, 50 with prosthetic stenosis, and 50 with normally functioning valves) from transthoracic echocardiograms performed at NYU Langone Health between 01/01/2012 and 08/01/2018. RESULTS Mean A2 signal length was shorter among patients with PPM (11.1 ms ± 5.2 ms), than among those with prosthetic stenosis (21.1 ms ± 6.0 ms), P < .001 and controls (21.7 ms ± 7.4 ms), P < .001. There was no difference in A2 signal length between prosthetic stenosis and controls. The A2 signal length yielded an AUC of 0.89 (95% CI 0.82-0.95) for predicting PPM over prosthetic stenosis. CONCLUSION Among patients with bioprosthetic aortic valves, the length of the A2 signal on Doppler echocardiography is shorter in PPM than in prosthetic stenosis and normally functioning valves. The A2 signal length may represent a novel metric to distinguish PPM from prosthetic stenosis.
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Affiliation(s)
- Thara Ali
- Department of Internal Medicine, New York University Langone Medical Center, New York City, New York, USA
| | - Michael S Garshick
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York City, New York, USA
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York City, New York, USA
| | - Adam H Skolnick
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York City, New York, USA
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Yuriditsky E, Horowitz JM, Panebianco NL, Sauthoff H, Saric M. Lung Ultrasound Imaging: A Primer for Echocardiographers. J Am Soc Echocardiogr 2021; 34:1231-1241. [PMID: 34425194 DOI: 10.1016/j.echo.2021.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 03/26/2019] [Revised: 08/11/2021] [Accepted: 08/15/2021] [Indexed: 01/03/2023]
Abstract
Lung ultrasound (LUS) has gained considerable acceptance in emergency and critical care medicine but is yet to be fully implemented in cardiology. Standard imaging protocols for LUS in acute care settings have allowed the rapid and accurate diagnosis of dyspnea, respiratory failure, and shock. LUS is greatly additive to echocardiography and is superior to auscultation and chest radiography, particularly when the diagnosis of acute decompensated heart failure is in question. In this review, the authors describe LUS techniques, interpretation, and clinical applications, with the goal of informing cardiologists on the imaging modality. Additionally, the authors review LUS findings associated with various disease states most relevant to cardiac care. Although there is extensive literature on LUS in the acute care setting, there is a dearth of reviews directly focused for practicing cardiologists. Current evidence demonstrates that this modality is an important adjunct to echocardiography, providing valuable clinical information at the bedside.
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Affiliation(s)
- Eugene Yuriditsky
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
| | - James M Horowitz
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Nova L Panebianco
- Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harald Sauthoff
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, New York
| | - Muhamed Saric
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York
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29
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Maidman SD, Sulica R, Freedberg RS, Bamira D, Vainrib AF, Ro R, Latson LA, Saric M. Cor Pulmonale from Concomitant Human Immunodeficiency Virus Infection and Methamphetamine Use. CASE 2021; 5:239-242. [PMID: 34430775 PMCID: PMC8370868 DOI: 10.1016/j.case.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
HIV and frequent methamphetamine use are two known risk factors for PAH development. HIV and methamphetamine are both associated with higher rates of mortality in PAH. Echocardiography is an effective noninvasive modality for assessing PAH severity.
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30
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Asch FM, Mor-Avi V, Rubenson D, Goldstein S, Saric M, Mikati I, Surette S, Chaudhry A, Poilvert N, Hong H, Horowitz R, Park D, Diaz-Gomez JL, Boesch B, Nikravan S, Liu RB, Philips C, Thomas JD, Martin RP, Lang RM. Deep Learning-Based Automated Echocardiographic Quantification of Left Ventricular Ejection Fraction: A Point-of-Care Solution. Circ Cardiovasc Imaging 2021; 14:e012293. [PMID: 34126754 DOI: 10.1161/circimaging.120.012293] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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: 12/12/2022]
Abstract
BACKGROUND We have recently tested an automated machine-learning algorithm that quantifies left ventricular (LV) ejection fraction (EF) from guidelines-recommended apical views. However, in the point-of-care (POC) setting, apical 2-chamber views are often difficult to obtain, limiting the usefulness of this approach. Since most POC physicians often rely on visual assessment of apical 4-chamber and parasternal long-axis views, our algorithm was adapted to use either one of these 3 views or any combination. This study aimed to (1) test the accuracy of these automated estimates; (2) determine whether they could be used to accurately classify LV function. METHODS Reference EF was obtained using conventional biplane measurements by experienced echocardiographers. In protocol 1, we used echocardiographic images from 166 clinical examinations. Both automated and reference EF values were used to categorize LV function as hyperdynamic (EF>73%), normal (53%-73%), mildly-to-moderately (30%-52%), or severely reduced (<30%). Additionally, LV function was visually estimated for each view by 10 experienced physicians. Accuracy of the detection of reduced LV function (EF<53%) by the automated classification and physicians' interpretation was assessed against the reference classification. In protocol 2, we tested the new machine-learning algorithm in the POC setting on images acquired by nurses using a portable imaging system. RESULTS Protocol 1: the agreement with the reference EF values was good (intraclass correlation, 0.86-0.95), with biases <2%. Machine-learning classification of LV function showed similar accuracy to that by physicians in most views, with only 10% to 15% cases where it was less accurate. Protocol 2: the agreement with the reference values was excellent (intraclass correlation=0.84) with a minimal bias of 2.5±6.4%. CONCLUSIONS The new machine-learning algorithm allows accurate automated evaluation of LV function from echocardiographic views commonly used in the POC setting. This approach will enable more POC personnel to accurately assess LV function.
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Affiliation(s)
| | | | - David Rubenson
- Scripps Clinic and Prebys Cardiovascular Institute, La Jolla, CA (D.R.)
| | | | | | - Issam Mikati
- Feinberg School of Medicine, Northwestern University, Chicago, IL (I.M., R.H., J.D.T.)
| | - Samuel Surette
- Caption Health Inc, San Francisco, CA (S.S., A.C., N.P., H.H., R.P.M.)
| | - Ali Chaudhry
- Caption Health Inc, San Francisco, CA (S.S., A.C., N.P., H.H., R.P.M.)
| | - Nicolas Poilvert
- Caption Health Inc, San Francisco, CA (S.S., A.C., N.P., H.H., R.P.M.)
| | - Ha Hong
- Caption Health Inc, San Francisco, CA (S.S., A.C., N.P., H.H., R.P.M.)
| | - Russ Horowitz
- Feinberg School of Medicine, Northwestern University, Chicago, IL (I.M., R.H., J.D.T.)
| | - Daniel Park
- University of North Carolina Medical Center (D.P)
| | | | | | - Sara Nikravan
- University of Washington Medical Center, Seattle (S.N.)
| | | | | | - James D Thomas
- Feinberg School of Medicine, Northwestern University, Chicago, IL (I.M., R.H., J.D.T.)
| | - Randolph P Martin
- Caption Health Inc, San Francisco, CA (S.S., A.C., N.P., H.H., R.P.M.).,Emory University Medical Center, Atlanta, GA (R.P.M.)
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Hayes DE, Rhee DW, Hisamoto K, Smith D, Ro R, Vainrib AF, Bamira D, Zhou F, Saric M. Two cases of acute endocarditis misdiagnosed as COVID-19 infection. Echocardiography 2021; 38:798-804. [PMID: 33715241 PMCID: PMC8251260 DOI: 10.1111/echo.15021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/16/2021] [Accepted: 02/21/2021] [Indexed: 12/26/2022] Open
Abstract
The COVID‐19 pandemic has presented countless new challenges for healthcare providers including the challenge of differentiating COVID‐19 infection from other diseases. COVID‐19 infection and acute endocarditis may present similarly, both with shortness of breath and vital sign abnormalities, yet they require very different treatments. Here, we present two cases in which life‐threatening acute endocarditis was initially misdiagnosed as COVID‐19 infection during the height of the pandemic in New York City. The first was a case of Klebsiella pneumoniae mitral valve endocarditis leading to papillary muscle rupture and severe mitral regurgitation, and the second a case of Streptococcus mitis aortic valve endocarditis with heart failure due to severe aortic regurgitation. These cases highlight the importance of careful clinical reasoning and demonstrate how cognitive errors may impact clinical reasoning. They also underscore the limitations of real‐time reverse transcription‐polymerase chain reaction (RT‐PCR) for SARS‐CoV‐2 testing and illustrate the ways in which difficulty interpreting results may also influence clinical reasoning. Accurate diagnosis of acute endocarditis is critical given that surgical intervention can be lifesaving in unstable patients.
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Affiliation(s)
- Dena E Hayes
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - David W Rhee
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Kazuhiro Hisamoto
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
| | - Deane Smith
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
| | - Richard Ro
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Alan F Vainrib
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Daniel Bamira
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Fang Zhou
- Department of Pathology, New York University Langone Health, New York, NY, USA
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
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32
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Nakashima M, Williams M, He Y, Du R, Saric M, Staniloae C, Querijero M, Pushkar I, Kapitman A, Jilaihawi H. Novel Computed Tomography Classification for Bioprosthetic Aortic Valve Degeneration: Guiding Trial of Anticoagulation or Reintervention. JACC Cardiovasc Interv 2021; 14:1050-1052. [PMID: 33640385 DOI: 10.1016/j.jcin.2020.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 11/15/2022]
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33
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Yuriditsky E, Saric M, Horowitz JM. Point-of-care ultrasound during the COVID-19 pandemic: A multidisciplinary approach between intensivists and echocardiographers. Echocardiography 2021; 38:446-449. [PMID: 33586797 PMCID: PMC8014226 DOI: 10.1111/echo.14996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/09/2021] [Accepted: 01/25/2021] [Indexed: 01/25/2023] Open
Abstract
Purpose The coronavirus disease‐2019 (COVID‐19) led to a large influx of critically ill patients and altered echocardiography laboratory workflow. We developed a point‐of‐care ultrasound (POCUS) first approach to patients requiring echocardiography and describe our workflow and findings. Methods We performed a single‐center retrospective analysis of all POCUS studies performed on critically ill patients with COVID‐19. Sonography was performed by intensivists, uploaded and archived, and rapidly reviewed by echocardiographers. We evaluated each study based on the number of views obtained. Additionally, we provide a description of the workflow during the COVID‐19 surge at a tertiary care hospital in New York City. Results Fifty patients had POCUS studies performed by intensivists and reviewed by echocardiographers obviating the need for sonographer‐performed studies. Of the 48 cardiac POCUS studies, 17% of patients had 4 of 4 standard views available while 53% had 3 of 4 standard views. The parasternal long‐axis view was obtained on 81%, subxiphoid view on 79%, apical 4‐chamber view on 71%, and parasternal short‐axis view on 63% of patients. Conclusions Our POCUS workflow allowed intensivists to perform cardiac sonography for rapid bedside diagnosis of pathology with immediate interpretation performed by echocardiographers. At least 3 views were obtained in the majority of cases.
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Affiliation(s)
- Eugene Yuriditsky
- Department of Medicine, Leon H. Charney Division of Cardiology, NYU Langone Medical Center, New York, NY, USA
| | - Muhamed Saric
- Department of Medicine, Leon H. Charney Division of Cardiology, NYU Langone Medical Center, New York, NY, USA
| | - James M Horowitz
- Department of Medicine, Leon H. Charney Division of Cardiology, NYU Langone Medical Center, New York, NY, USA
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34
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Hahn RT, Rubenson D, Mackensen GB, Saric M, Little SH, Mahmood F, Cole SP, Quader N. Interventional Echocardiography: A New Specialty Interest Group for American Society of Echocardiography. J Am Soc Echocardiogr 2020; 33:A10-A11. [PMID: 33279018 DOI: 10.1016/j.echo.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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35
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Bamira DG, Dwivedi A, Bhatla P, Halpern D, Vainrib AF, Kim E, Zias E, Saric M. Unusual Cause of Severe Tricuspid Regurgitation: Tricuspid Leaflet Annular Tear Following Remote Motor Vehicle Accident. JACC Case Rep 2020; 2:2156-2161. [PMID: 34317128 PMCID: PMC8299867 DOI: 10.1016/j.jaccas.2020.07.056] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/17/2020] [Accepted: 07/28/2020] [Indexed: 06/13/2023]
Abstract
Tricuspid regurgitation (TR) is an uncommon and underdiagnosed complication of blunt chest trauma. Typical mechanisms include torn chordae, papillary muscle rupture, and radial leaflet tear. We describe an unusual case of traumatic TR due to circumferential avulsion of the anterior tricuspid leaflet from the tricuspid annulus and the crucial role of multimodality imaging in its diagnosis and treatment. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Daniel G. Bamira
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Aeshita Dwivedi
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Puneet Bhatla
- Department of Pediatrics, New York University Langone Health, New York, New York
| | - Dan Halpern
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Alan F. Vainrib
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Eugene Kim
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Elias Zias
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
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36
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Rzucidlo J, Jaspan V, Paone D, Jilaihawi H, Xia Y, Kapitman A, Nakashima M, He Y, Ibrahim H, Pushkar I, Neuburger PJ, Saric M, Bamira D, Paschke S, Kalish C, Staniloae C, Shah B, Williams M. Long-term outcomes after transcatheter aortic valve replacement with minimal contrast in chronic kidney disease. Catheter Cardiovasc Interv 2020; 98:319-327. [PMID: 33180381 DOI: 10.1002/ccd.29378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 07/24/2020] [Revised: 10/13/2020] [Accepted: 10/26/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients with renal insufficiency have poor short-term outcomes after transcatheter aortic valve replacement (TAVR). METHODS Retrospective chart review identified 575 consecutive patients not on hemodialysis who underwent TAVR between September 2014 and January 2017. Outcomes were defined by VARC-2 criteria. Primary outcome of all-cause mortality was evaluated at a median follow-up of 811 days (interquartile range 125-1,151). RESULTS Preprocedural glomerular filtration rate (GFR) was ≥60 ml/min in 51.7%, 30-60 ml/min in 42.1%, and < 30 ml/min in 6.3%. Use of transfemoral access (98.8%) and achieved device success (91.0%) did not differ among groups, but less contrast was used with lower GFR (23 ml [15-33], 24 ml [14-33], 13 ml [8-20]; p < .001). Peri-procedural stroke (0.7%, 2.1%, 11.1%; p < .001) was higher with lower GFR. Core lab analysis of preprocedural computed tomography scans of patients who developed a peri-procedural stroke identified potential anatomic substrate for stroke in three out of four patients with GFR 30-60 ml/min and all three with GFR <30 ml/min (severe atheroma was the most common subtype of anatomical substrate present). Compared to GFR ≥60 ml/min, all-cause mortality was higher with GFR 30-60 ml/min (HR 1.61 [1.00-2.59]; aHR 1.61 [0.91-2.83]) and GFR <30 ml/min (HR 2.41 [1.06-5.48]; aHR 2.34 [0.90-6.09]) but not significant after multivariable adjustment. Follow-up echocardiographic data, available in 63%, demonstrated no difference in structural heart valve deterioration over time among groups. CONCLUSIONS Patients with baseline renal insufficiency remain a challenging population with poor long-term outcomes despite procedural optimization with a transfemoral-first and an extremely low-contrast approach.
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Affiliation(s)
- Justyna Rzucidlo
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Vita Jaspan
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Darien Paone
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Hasan Jilaihawi
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Yuhe Xia
- Department of Biostatistics, NYU Langone Health, New York, New York
| | - Anna Kapitman
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Makoto Nakashima
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Yuxin He
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Homam Ibrahim
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Illya Pushkar
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Peter J Neuburger
- Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Langone Health, New York, New York
| | - Muhamed Saric
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Daniel Bamira
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Sonja Paschke
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Chloe Kalish
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Cezar Staniloae
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Binita Shah
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York.,Department of Medicine, Division of Cardiology, VA New York Harbor Healthcare System: Manhattan Campus, New York, New York
| | - Mathew Williams
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
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37
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Lin B, D Jaros B, A Grossi E, Saric M, S Garshick M, Donnino R. Prevalence and Risk Factors of Incomplete Surgical Closure of the Left Atrial Appendage on Follow-up Transesophageal Echocardiogram. J Atr Fibrillation 2020; 13:2357. [PMID: 34950308 DOI: 10.4022/jafib.2357] [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: 06/11/2020] [Revised: 06/15/2020] [Accepted: 07/25/2020] [Indexed: 11/10/2022]
Abstract
Objectives In patients with atrial fibrillation, incomplete left atrial appendage (LAA) closure is associated with an increased risk for cardio-embolic events compared to complete closure. In this study, we aimed to determine the prevalence and risk factors for incomplete surgical closure of the LAA in the modern surgical era. Methods Records of 74 patients with surgical LAA closure who underwent follow-up transesophageal echocardiogram for any reason between 2010 and 2016, were assessed for incomplete closure. Complete closure was defined by absence of Doppler or color flow between the left atrial appendage and the left atrial body in more than 2 orthogonal views. Results Surgical LAA closure was incomplete in 21 patients (28%) and complete in 53 patients (72%). All included cases were completed via oversewing method with a double layer of running suture with or without excision of the LAA. While no individual demographic, echocardiographic, or surgical feature was significantly different between groups, incomplete closure of the LAA was more prevalent in patients with two or more of the risk factors; female sex, hypertension, and hyperlipidemia (OR 5.1, 95%Cl 1.5-17). Conclusions A significant rate of incomplete surgical LAA closure still exists in the modern surgical era, and the presence of multiple risk factors associate an increased risk of incomplete closure.
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Affiliation(s)
- Billy Lin
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Brian D Jaros
- NYU School of Medicine, NYU Langone Health, New York City, New York
| | - Eugene A Grossi
- NYU School of Medicine, NYU Langone Health, New York City, New York.,Veterans Affairs Medical Center, New York (Manhattan Campus), New York City, New York.,Division of Cardiac Surgery, Department of Cardiothoracic Surgery, NYU Langone Health, New York City, New York
| | - Muhamed Saric
- NYU School of Medicine, NYU Langone Health, New York City, New York.,Veterans Affairs Medical Center, New York (Manhattan Campus), New York City, New York.,Leon H. Charney Division of Cardiology, NYU Langone Health, New York City, New York
| | - Michael S Garshick
- Authors share senior authorship.,NYU School of Medicine, NYU Langone Health, New York City, New York.,Leon H. Charney Division of Cardiology, NYU Langone Health, New York City, New York
| | - Robert Donnino
- Authors share senior authorship.,NYU School of Medicine, NYU Langone Health, New York City, New York.,Veterans Affairs Medical Center, New York (Manhattan Campus), New York City, New York.,Leon H. Charney Division of Cardiology, NYU Langone Health, New York City, New York
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38
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Horowitz JM, Yuriditsky E, Henderson IJ, Stachel MW, Kwok B, Saric M. Clot in Transit on Transesophageal Echocardiography in a Prone Patient with COVID-19 Acute Respiratory Distress Syndrome. CASE (Phila) 2020; 4:200-203. [PMID: 32426575 PMCID: PMC7229961 DOI: 10.1016/j.case.2020.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
•The risk for thromboembolic events in COVID-19 is substantial. •PE should be considered in cases of clinical deterioration. •Management of CIT is controversial.
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Affiliation(s)
- James M Horowitz
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Eugene Yuriditsky
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Ian J Henderson
- Department of Medicine, New York University Langone Health, New York, New York
| | - Maxine Wallis Stachel
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Benjamin Kwok
- Department of Medicine, New York University Langone Health, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
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39
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Vani A, Ahluwalia M, Donnino R, Jung A, Vaynblat M, Latson L, Saric M. A case of nonvalvular endocarditis with biventricular apical infected thrombi. Echocardiography 2020; 37:1072-1076. [PMID: 32654168 DOI: 10.1111/echo.14690] [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: 01/27/2020] [Revised: 04/09/2020] [Accepted: 04/21/2020] [Indexed: 11/29/2022] Open
Abstract
We report what appears to be the first case of biopsy-proven nonvalvular endocarditis with biventricular apical infected thrombi. A 47-year-old man presented with hypoxic respiratory failure from a multilobar pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA). Transthoracic echocardiography and cardiac magnetic resonance imaging revealed biventricular apical masses suggestive of nonvalvular endocarditis with infected thrombi. Given concern for ongoing septic embolization to the lungs and brain despite appropriate antimicrobial therapy, the masses were surgically resected. Culture and histopathology confirmed MRSA-positive infected thrombi. In this case report, we highlight the differential diagnosis of apical masses and the role of multimodality imaging.
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Affiliation(s)
- Anish Vani
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Monica Ahluwalia
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Robert Donnino
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA.,Department of Radiology, New York University Langone Health, New York, NY, USA.,Veterans Affairs New York Harbor Healthcare System, New York, NY, USA
| | - Albert Jung
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Mikhail Vaynblat
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
| | - Larry Latson
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
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40
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Phillips LM, Winchester D, Saric M, Lloyd SG, Blankstein R, Al-Mallah MH. Multimodality imaging: Bird's eye view from the 2019 American College of Cardiology Scientific Sessions. J Nucl Cardiol 2020; 27:410-416. [PMID: 31975328 DOI: 10.1007/s12350-019-02016-z] [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: 12/15/2019] [Accepted: 12/16/2019] [Indexed: 11/30/2022]
Abstract
The 2019 American College of Cardiology Scientific Sessions displayed innovation in many areas for the evaluation and management of cardiovascular disease from preventive evaluation and care to advanced interventions. Imaging played a central role in these developments with a highlight of the conference being the imaging research presented. This review will summarize key imaging studies which were presented at this scientific meeting which will lead to innovation in the evaluation and management of cardiovascular disease. Experts in nuclear imaging (DW/MA), echocardiography (MS), cardiac magnetic resonance (SL), and cardiac computed tomography (RB) selected abstracts which they found to be of particular interest to the multimodality imaging audience and were integrated into this review (LP).
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Affiliation(s)
- Lawrence M Phillips
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA.
| | - David Winchester
- Department of Medicine, Malcom Randall VAMC, University of Florida, Gainesville, FL, USA
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Steven G Lloyd
- Department of Medicine, University of Alabama at Birmingham, and Birmingham VA Medical Center, Birmingham, AL, USA
| | - Ron Blankstein
- Departments of Medicine (Cardiovascular Imaging) and Radiology, Brigham and Women's Hospital, Boston, MA, USA
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41
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Vainrib A, Jilaihawi H, Nakashima M, Paschke S, Tovar J, Staniloae C, Ibrahim H, Querijero M, Hisamoto K, L LL, Gonzalez C, Fuentes J, Saric M, Williams M. IMAGING EVALUATION FOR MITRAL LEAFLET MORPHOLOGY CORRELATION OF COMPUTED TOMOGRAPHY WITH TRANSESOPHAGEAL ECHOCARDIOGRAPHY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32448-7] [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: 11/15/2022]
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42
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Riedy KN, Reynolds H, Rosenzweig BP, Massera D, Saric M, Swistel D, Ahluwalia M, Arabadjian M, Defonte M, Stepanovic A, Serrato S, Xia Y, Zhong H, Sherrid M. A NOVEL SUBSET OF HYPERTROPHIC CARDIOMYOPATHY PATIENTS CHARACTERIZED BY ASSOCIATION WITH TAKOTSUBO-LIKE LV BALLOONING AND HOSPITAL ADMISSION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31500-x] [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: 11/16/2022]
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43
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Pushkar I, Kalish C, Tovar J, Du R, Staniloae C, Vainrib A, Ibrahim H, Neuberger P, Latson L, Querijero M, Lengua C, Fuentes J, Fuentes J, Saric M, Williams M, Jilaihawi H, Kapitman A. CT-CLASSIFICATION OF DEGENERATED BIOPROSTHETIC LEAFLETS INSIGHTS INTO THE PATHOGENESIS OF VALVE FAILURE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32441-4] [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: 10/24/2022]
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44
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Rzucidlo J, Jaspan V, Shah B, Paone D, Pushkar I, Kapitman A, Ibrahim H, Hisamoto K, Neuburger P, Saric M, Staniloae C, Vainrib A, Bamira D, Jilaihawi H, Querijero M, Williams M. LONG TERM MORTALITY AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT IN PATINTS WITH CHRONIC KIDNEY DISEASE NOT ON HEMODIALYSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32064-7] [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: 10/24/2022]
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45
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Williams DM, Nampi RG, Saric M, Grossi EA, Sherrid MV, Swistel DG. On-pump intracardiac echocardiography during septal myectomy for hypertrophic cardiomyopathy. JTCVS Tech 2020; 2:60-66. [PMID: 34317753 PMCID: PMC8298854 DOI: 10.1016/j.xjtc.2020.01.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 12/03/2019] [Accepted: 01/03/2020] [Indexed: 11/02/2022] Open
Affiliation(s)
- David M Williams
- Department of Cardiothoracic Surgery, Hypertrophic Cardiomyopathy Program, NYU Langone Health, New York University School of Medicine, New York, NY
| | - Robert G Nampi
- Division of Cardiothoracic Anesthesiology, Hypertrophic Cardiomyopathy Program, NYU Langone Health, New York University School of Medicine, New York, NY
| | - Muhamed Saric
- Division of Cardiology, Hypertrophic Cardiomyopathy Program, NYU Langone Health, New York University School of Medicine, New York, NY
| | - Eugene A Grossi
- Department of Cardiothoracic Surgery, Hypertrophic Cardiomyopathy Program, NYU Langone Health, New York University School of Medicine, New York, NY
| | - Mark V Sherrid
- Division of Cardiology, Hypertrophic Cardiomyopathy Program, NYU Langone Health, New York University School of Medicine, New York, NY
| | - Daniel G Swistel
- Department of Cardiothoracic Surgery, Hypertrophic Cardiomyopathy Program, NYU Langone Health, New York University School of Medicine, New York, NY
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46
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Shah B, Villablanca PA, Vemulapalli S, Manandhar P, Amoroso NS, Saric M, Staniloae C, Williams MR. Outcomes After Transcatheter Mitral Valve Repair in Patients With Renal Disease. Circ Cardiovasc Interv 2020; 12:e007552. [PMID: 30704286 DOI: 10.1161/circinterventions.118.007552] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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 Renal disease is associated with poor prognosis despite guideline-directed cardiovascular therapy, and outcomes by sex in this population remain uncertain. METHODS AND RESULTS Patients (n=5213) who underwent a MitraClip procedure in the National Cardiovascular Data Registry Transcatheter Valve Therapy registry were evaluated for the primary composite outcome of all-cause mortality, stroke, and new requirement for dialysis by creatinine clearance (CrCl). Centers for Medicare and Medicaid Services-linked data were available in 63% of patients (n=3300). CrCl was <60 mL/min in 77% (n=4010) and <30 mL/min in 23% (n=1183) of the cohort. Rates of primary outcome were higher with lower CrCl (>60 mL/min, 1.4%; 30-<60 mL/min, 2.7%; <30 mL/min, 5.2%; dialysis, 7.8%; P<0.001), and all low CrCl groups were independently associated with the primary outcome (30-<60 mL/min: adjusted odds ratio, 2.32; 95% CI, 1.38-3.91; <30 mL/min: adjusted odds ratio, 4.44; 95% CI, 2.63-7.49; dialysis: adjusted hazards ratio, 4.52; 95% CI, 2.08-9.82) when compared with CrCl >60 mL/min. Rates of 1-year mortality were higher with lower CrCl (>60 mL/min, 13.2%; 30-<60 mL/min, 18.8%; <30 mL/min, 29.9%; dialysis, 32.3%; P<0.001), and all low CrCl groups were independently associated with 1-year mortality (30-<60 mL/min: adjusted hazards ratio, 1.50; 95% CI, 1.13-1.99; <30 mL/min: adjusted hazards ratio, 2.38; 95% CI, 1.78-3.20; adjusted hazards ratio: dialysis, 2.44; 95% CI, 1.66-3.57) when compared with CrCl >60 mL/min. CONCLUSIONS The majority of patients who undergo MitraClip have renal disease. Preprocedural renal disease is associated with poor outcomes, particularly in stage 4 or 5 renal disease where 1-year mortality is observed in nearly one-third. Studies to determine how to further optimize outcomes in this population are warranted.
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Affiliation(s)
- Binita Shah
- Department of Medicine (Cardiology), VA New York Harbor Healthcare System (Manhattan Campus) and New York University School of Medicine (B.S.)
| | - Pedro A Villablanca
- Department of Medicine (Cardiology) (P.A.V., N.S.A., M.S., C.S.), New York University School of Medicine
| | | | | | - Nicholas S Amoroso
- Department of Medicine (Cardiology) (P.A.V., N.S.A., M.S., C.S.), New York University School of Medicine
| | - Muhamed Saric
- Department of Medicine (Cardiology) (P.A.V., N.S.A., M.S., C.S.), New York University School of Medicine
| | - Cezar Staniloae
- Department of Medicine (Cardiology) (P.A.V., N.S.A., M.S., C.S.), New York University School of Medicine
| | - Mathew R Williams
- Department of Cardiothoracic Surgery (Adult Cardiac Surgery) (M.R.W.), New York University School of Medicine
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McLeod JM, Fowler SJ, Cerrone M, Aizer A, Chinitz LA, Raad R, Saric M. Multimodality Imaging of Danon Disease in a Patient with a Novel LAMP2 Mutation. CASE 2019; 3:235-238. [PMID: 31709377 PMCID: PMC6833129 DOI: 10.1016/j.case.2019.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Danon disease is a rare X-linked genetic disorder of the LAMP2 gene. Danon cardiomyopathy has a high incidence of preexcitation and severe LVH. LAMP2 mutation–associated cardiomyopathy can mimic sarcomeric HCM. Multimodality imaging is key to a successful diagnosis of Danon disease.
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Jilaihawi H, Zhao Z, Du R, Staniloae C, Saric M, Neuburger PJ, Querijero M, Vainrib A, Hisamoto K, Ibrahim H, Collins T, Clark E, Pushkar I, Bamira D, Benenstein R, Tariq A, Williams M. Minimizing Permanent Pacemaker Following Repositionable Self-Expanding Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019; 12:1796-1807. [DOI: 10.1016/j.jcin.2019.05.056] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/06/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
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Vainrib AF, Bamira D, Aizer A, Chinitz LA, Loulmet D, Benenstein RJ, Saric M. Photorealistic imaging of left atrial appendage occlusion/exclusion. Echocardiography 2019; 36:1601-1604. [PMID: 31385344 DOI: 10.1111/echo.14438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 04/22/2019] [Revised: 06/27/2019] [Accepted: 06/30/2019] [Indexed: 11/30/2022] Open
Abstract
Recent improvements in 3D TEE post processing rendering techniques referred to as TrueVue (Philips Medical Systems, Andover, MA, USA). It allows for novel photorealistic imaging of cardiac structures including left atrial appendage (LAA) and its closure devices. Here we present TrueVue images of the LAA prior to and after LAA exclusion/occlusion using various percutaneous and surgical techniques. TrueVue may improve delineation of LAA anatomy prior to occlusion as well as visualization of occluder device position within the LAA.
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Affiliation(s)
- Alan F Vainrib
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York City, New York
| | - Daniel Bamira
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York City, New York
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York City, New York
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York City, New York
| | - Didier Loulmet
- Division of Cardiothoracic Surgery, New York University Langone Health, New York City, New York
| | - Ricardo J Benenstein
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York City, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York City, New York
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50
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Rodés-Cabau J, Williams MR, Wijeysundera HC, Kereiakes DJ, Paradis JM, Staniloae C, Saric M, Radhakrishnan S, Wilson RF, Kubo SH. Transcatheter Aortic Valve Replacement With the HLT Meridian Valve. Circ Cardiovasc Interv 2019; 12:e008053. [DOI: 10.1161/circinterventions.119.008053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 11/16/2022]
Abstract
Background:
While most self-expanding transcatheter valves are repositionable, only one fully retrievable valve is currently available. The Meridian valve is a new self-expanding valve with full retrievability properties. The objective of our study was to evaluate the early feasibility, preliminary safety, and efficacy of transcatheter aortic valve replacement with the HLT Meridian valve (HLT, Inc).
Methods:
This was a multicenter early feasibility study including patients with severe aortic stenosis at high surgical risk undergoing transfemoral transcatheter aortic valve replacement with the 25-mm Meridian valve. All serious adverse events were adjudicated by an independent clinical events committee according to Valve Academic Research Consortium-2 criteria. Echocardiography data were assessed by an independent echocardiography core laboratory.
Results:
A total of 25 patients (mean age, 85±6 years; 80% of men) were included. The valve was successfully implanted in 22 (88%) patients (annulus too large and extreme horizontal aorta in 2 and 1 unsuccessful cases, respectively). Valve retrieval because of an initial nonadequate positioning was attempted and successfully performed in 10 (40%) patients. Echocardiography post-transcatheter aortic valve replacement showed a low mean residual gradient (10±4 mm Hg) and the absence of moderate-severe aortic regurgitation (none-trace and mild aortic regurgitation in 76% and 24% of patients, respectively). Mortality at 30 days was 8%, with no cases of disabling stroke, valve embolization, or major/life-threatening bleeding complications. At 6-month follow-up, the cumulative mortality rate was 12%, with no changes in echocardiographic parameters and no cases of valve dysfunction. The majority of patients (89%) were in New York Heart Association class I-II at 6 months.
Conclusions:
Transcatheter aortic valve replacement with the Meridian valve was feasible and associated with acceptable early and 6-month clinical results. Valve retrieval after full valve deployment was successfully performed in all attempted cases, and valve performance was excellent, with low residual gradients, no cases of moderate-severe aortic regurgitation, and none-trace residual aortic regurgitation in the majority of patients.
Clinical Trial Registration:
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02838680 (RADIANT-Canada); NCT02799823 (RADIANT-US).
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Affiliation(s)
- Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Canada (J.R.-C., J.-M.P.)
| | | | - Harindra C. Wijeysundera
- Department of Cardiology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (H.C.W., S.R.)
| | - Dean J. Kereiakes
- Department of Cardiology, The Christ Hospital and Lindner Research Center, Cincinnati, OH (D.J.K.)
| | - Jean-Michel Paradis
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Canada (J.R.-C., J.-M.P.)
| | - Cezar Staniloae
- NYU Langone Medical Center, New York, NY (M.R.W., C.S., M.S.)
| | - Muhamed Saric
- NYU Langone Medical Center, New York, NY (M.R.W., C.S., M.S.)
| | - Sam Radhakrishnan
- Department of Cardiology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (H.C.W., S.R.)
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