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Gruca MM, Slivnick JA, Singh A, Cotella JI, Subashchandran V, Prabhu D, Asch FM, Siddiki M, Gupta N, Mor-Avi V, Su JL, Lang RM. Noninvasive assessment of left ventricular end-diastolic pressure using machine learning-derived phasic left atrial strain. Eur Heart J Cardiovasc Imaging 2023; 25:18-26. [PMID: 37708373 DOI: 10.1093/ehjci/jead231] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/16/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023] Open
Abstract
AIMS While transthoracic echocardiography (TTE) assessment of left ventricular end-diastolic pressure (LVEDP) is critically important, the current paradigm is subject to error and indeterminate classification. Recently, peak left atrial strain (LAS) was found to be associated with LVEDP. We aimed to test the hypothesis that integration of the entire LAS time curve into a single parameter could improve the accuracy of peak LAS in the noninvasive assessment of LVEDP with TTE. METHODS AND RESULTS We retrospectively identified 294 patients who underwent left heart catheterization and TTE within 24 h. LAS curves were trained using machine learning (100 patients) to detect LVEDP ≥ 15 mmHg, yielding the novel parameter LAS index (LASi). The accuracy of LASi was subsequently validated (194 patients), side by side with peak LAS and ASE/EACVI guidelines, against invasive filling pressures. Within the validation cohort, invasive LVEDP was elevated in 116 (59.8%) patients. The overall accuracy of LASi, peak LAS, and American Society of Echocardiography/European Association for Cardiovascular Imaging (ASE/EACVI) algorithm was 79, 75, and 76%, respectively (excluding 37 patients with indeterminate diastolic function by ASE/EACVI guidelines). When the number of LASi indeterminates (defined by near-zero LASi values) was matched to the ASE/EACVI guidelines (n = 37), the accuracy of LASi improved to 87%. Importantly, among the 37 patients with ASE/EACVI-indeterminate diastolic function, LASi had an accuracy of 81%, compared with 76% for peak LAS. CONCLUSION LASi allows the detection of elevated LVEDP using invasive measurements as a reference, at least as accurately as peak LAS and current diastolic function guideline algorithm, with the advantage of no indeterminate classifications in patients with measurable LAS.
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Affiliation(s)
- Martin M Gruca
- Noninvasive Cardiac Imaging Laboratory, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, Chicago, IL 60637, USA
| | - Jeremy A Slivnick
- Noninvasive Cardiac Imaging Laboratory, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, Chicago, IL 60637, USA
| | - Amita Singh
- Department of Cardiology, Northwestern Medicine Central DuPage Hospital, Winfield, IL, USA
| | - Juan I Cotella
- Noninvasive Cardiac Imaging Laboratory, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, Chicago, IL 60637, USA
| | - Varun Subashchandran
- Noninvasive Cardiac Imaging Laboratory, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, Chicago, IL 60637, USA
| | | | - Federico M Asch
- Health Research Institute, MedStar Health and Georgetown University, Washington, DC, USA
| | - Mikail Siddiki
- Noninvasive Cardiac Imaging Laboratory, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, Chicago, IL 60637, USA
| | - Nikhil Gupta
- Noninvasive Cardiac Imaging Laboratory, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, Chicago, IL 60637, USA
| | - Victor Mor-Avi
- Noninvasive Cardiac Imaging Laboratory, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, Chicago, IL 60637, USA
| | | | - Roberto M Lang
- Noninvasive Cardiac Imaging Laboratory, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, Chicago, IL 60637, USA
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Akingbade O, Nelson A, Earing M, Ganigara M, Nouhossi JN, Subashchandran V, Slivnick JA. The Sword and the Crown: Echocardiography for the Detection of a Rare Combination of Congenital Heart Disease. CASE (Phila) 2023; 7:433-437. [PMID: 38028385 PMCID: PMC10679536 DOI: 10.1016/j.case.2023.08.004] [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: 12/01/2023]
Abstract
•Unexplained right heart enlargement should always prompt evaluation for shunts. •Scimitar syndrome occurs when the right pulmonary veins drain into the IVC. •Coronary sinus dilation should prompt suspicion for PLSVC. •PLSVC can be diagnosed with a bubble study through left-sided IV.
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Affiliation(s)
| | - Alma Nelson
- University of Chicago Medicine, Chicago, Illinois
| | - Michael Earing
- UChicago Medicine Comer Children’s Hospital, Chicago, Illinois
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Kwon JW, Husain AN, Mueller J, Subashchandran V, Alvi N, Zareba KM, Sarswat N, Addetia K, Patel AR, Slivnick JA. Vascular Amyloid Deposition Is Highly Prevalent in Immunoglobulin Light Chain Cardiac Amyloidosis. JACC Cardiovasc Imaging 2023; 16:1121-1123. [PMID: 37052567 DOI: 10.1016/j.jcmg.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 04/14/2023]
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Slivnick JA, Subashchandran V, Sarswat N, Patel AR. Serum amyloidosis: a cardiac amyloidosis. Eur Heart J Cardiovasc Imaging 2023; 24:e59. [PMID: 36595341 DOI: 10.1093/ehjci/jeac264] [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: 01/04/2023] Open
Affiliation(s)
- Jeremy A Slivnick
- Division of Cardiovascular Medicine, The University of Chicago Medicine, 5758 S. Maryland Ave, M.C. 9067, Chicago, IL 60637, USA
| | - Varun Subashchandran
- Division of Cardiovascular Medicine, The University of Chicago Medicine, 5758 S. Maryland Ave, M.C. 9067, Chicago, IL 60637, USA
| | - Nitasha Sarswat
- Division of Cardiovascular Medicine, The University of Chicago Medicine, 5758 S. Maryland Ave, M.C. 9067, Chicago, IL 60637, USA
| | - Amit R Patel
- Division of Cardiovascular Medicine, The University of Virginia Health System, Charlottesville, VA, USA
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Smilowitz NR, Subashchandran V, Newman J, Barfield ME, Maldonado TS, Brosnahan SB, Yuriditsky E, Horowitz JM, Shah B, Reynolds HR, Hochman JS, Berger JS. Risk of thrombotic events after respiratory infection requiring hospitalization. Sci Rep 2021; 11:4053. [PMID: 33602977 PMCID: PMC7893015 DOI: 10.1038/s41598-021-83466-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/01/2021] [Indexed: 01/22/2023] Open
Abstract
Thrombosis is a major concern in respiratory infections. Our aim was to investigate the magnitude and duration of risk for arterial and venous thrombosis following discharge after respiratory infection. Patients with respiratory infections were identified using the United States Nationwide Readmission Database from 2012 to 2014. Patients admitted with asthma or cellulitis served as comparators. Readmissions for acute myocardial infarction (MI) and venous thromboembolism (VTE) were evaluated at 30 to 180 days. The likelihood of a first thrombotic event after discharge was compared with a 30-day period prior to hospitalization. Among 5,271,068 patients discharged after a respiratory infection, 0.56% and 0.78% were readmitted within 30-days with MI and VTE, respectively. Relative to asthma and cellulitis, respiratory infection was associated with a greater age and sex-adjusted hazard of 30-day readmission for MI (adjusted HR [aHR] 1.48 [95% CI 1.42–1.54] vs. asthma; aHR 1.36 [95% CI 1.31–1.41] vs. cellulitis) and VTE (aHR 1.28 [95% CI 1.24–1.33] vs. asthma; aHR 1.26, [95% CI 1.22–1.30] vs. cellulitis). Risks of MI and VTE attenuated over time. In a crossover-cohort analysis, the odds of MI (OR 1.68 [95% CI 1.62–1.73]) and VTE (OR 3.30 [95% 3.19–3.41]) were higher in the 30 days following discharge after respiratory infection than during the 30-day baseline period. Hospitalization for respiratory infection was associated with increased risks of thrombosis that were highest in the first 30-days after discharge and declined over time.
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Affiliation(s)
- Nathaniel R Smilowitz
- Leon H. Charney Division of Cardiology, Department of Medicine, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, 530 First Avenue, Skirball 9R, New York, NY, 10016, USA.,Department of Medicine, VA New York Harbor Healthcare System, New York, NY, USA
| | - Varun Subashchandran
- Leon H. Charney Division of Cardiology, Department of Medicine, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, 530 First Avenue, Skirball 9R, New York, NY, 10016, USA
| | - Jonathan Newman
- Leon H. Charney Division of Cardiology, Department of Medicine, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, 530 First Avenue, Skirball 9R, New York, NY, 10016, USA
| | - Michael E Barfield
- Department of Surgery, New York University School of Medicine, New York, NY, USA
| | - Thomas S Maldonado
- Department of Surgery, New York University School of Medicine, New York, NY, USA
| | - Shari B Brosnahan
- NYU Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Eugene Yuriditsky
- Leon H. Charney Division of Cardiology, Department of Medicine, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, 530 First Avenue, Skirball 9R, New York, NY, 10016, USA
| | - James M Horowitz
- Leon H. Charney Division of Cardiology, Department of Medicine, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, 530 First Avenue, Skirball 9R, New York, NY, 10016, USA
| | - Binita Shah
- Leon H. Charney Division of Cardiology, Department of Medicine, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, 530 First Avenue, Skirball 9R, New York, NY, 10016, USA.,Department of Medicine, VA New York Harbor Healthcare System, New York, NY, USA
| | - Harmony R Reynolds
- Leon H. Charney Division of Cardiology, Department of Medicine, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, 530 First Avenue, Skirball 9R, New York, NY, 10016, USA
| | - Judith S Hochman
- Leon H. Charney Division of Cardiology, Department of Medicine, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, 530 First Avenue, Skirball 9R, New York, NY, 10016, USA
| | - Jeffrey S Berger
- Leon H. Charney Division of Cardiology, Department of Medicine, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, 530 First Avenue, Skirball 9R, New York, NY, 10016, USA. .,Department of Surgery, New York University School of Medicine, New York, NY, USA.
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Smilowitz NR, Subashchandran V, Yuriditsky E, Horowitz JM, Reynolds HR, Hochman JS, Berger JS. Thrombosis in hospitalized patients with viral respiratory infections versus COVID-19. Am Heart J 2021; 231:93-95. [PMID: 33181067 PMCID: PMC7654304 DOI: 10.1016/j.ahj.2020.10.075] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 10/31/2020] [Indexed: 12/13/2022]
Abstract
We evaluated the incidence of thrombosis in patients hospitalized with non-COVID-19 acute viral respiratory illnesses nationwide from 2012 to 2014 and compared this to the incidence among patients hospitalized with COVID-19 at a large health system in New York. Non-COVID-19 viral respiratory illness was complicated by acute MI in 2.8% of hospitalizations, VTE in 1.6%, ischemic stroke in 0.7%, and other systemic embolism in 0.1%. The proportion of hospitalizations complicated by thrombosis was lower in patients with viral respiratory illness in 2002-2014 than in COVID-19 (5% vs 16%; P< .001). Background Thrombosis is a prominent feature of the novel Coronavirus disease 2019 (COVID-19). The incidence of thrombosis during hospitalization for non-COVID-19 viral respiratory infections is uncertain. We evaluated the incidence of thrombosis in patients hospitalized with non-COVID-19 acute viral respiratory illnesses compared to COVID-19. Methods Adults age >18 years hospitalized with a non-COVID-19 viral respiratory illness between 2002 and 2014 were identified. The primary study outcome was a composite of venous and arterial thrombotic events, including myocardial infarction (MI), acute ischemic stroke, and venous thromboembolism (VTE), as defined by ICD-9 codes. The incidence of thrombosis in non-COVID-19 viral respiratory illnesses was compared to the recently published incidence of thrombosis in COVID-19 from 3,334 patients hospitalized in New York in 2020. Results Among 954,521 hospitalizations with viral pneumonia from 2002 to 2014 (mean age 62.3 years, 57.1% female), the combined incidence of arterial and venous thrombosis was 5.0%. Acute MI occurred in 2.8% of hospitalizations, VTE in 1.6%, ischemic stroke in 0.7%, and other systemic embolism in 0.1%. Patients with thrombosis had higher in-hospital mortality (14.9% vs 3.3%, P< .001) than those without thrombosis. The proportion of hospitalizations complicated by thrombosis was lower in patients with viral respiratory illness in 2002-2014 than in COVID-19 (median age 64; 39.6% female) in 2020 (5% vs 16%; P< .001) Conclusion In a nationwide analysis of hospitalizations for viral pneumonias, thrombosis risk was lower than that observed in patients with COVID-19. Investigations into mechanisms of thrombosis and risk reduction strategies in COVID-19 and other viral respiratory infections are necessary.
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Smilowitz NR, Subashchandran V, Berger JS. Atrial Septal Defect and the Risk of Ischemic Stroke in the Perioperative Period of Noncardiac Surgery. Am J Cardiol 2019; 124:1120-1124. [PMID: 31375244 DOI: 10.1016/j.amjcard.2019.06.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/09/2019] [Accepted: 06/13/2019] [Indexed: 12/16/2022]
Abstract
Stroke is a serious complication of noncardiac surgery. Congenital defects of the interatrial septum may be a potent risk factor for perioperative stroke. The aim of the present study was to determine the association between atrial septal defect (ASD) or patent foramen ovale (PFO) and in-hospital perioperative ischemic stroke after non-cardiac surgery in a large nationwide cohort of patients hospitalized in the United States. Patients undergoing noncardiac surgery between 2004 and 2014 were identified using the Healthcare Cost and Utilization Project's National Inpatient Sample. Patients without an in-hospital echocardiogram were excluded. The presence of an ostium secundum-type ASD or PFO was identified by ICD-9 diagnosis code 745.5. The primary study outcome was perioperative acute ischemic stroke. Between 2004 and 2014, there were 639,985 admissions for noncardiac surgery with an in-hospital echocardiogram. An ASD or PFO was documented in 9,041 (1.4%) hospitalizations. Perioperative ischemic stroke occurred more frequently in patients with an ASD or PFO compared with those without an ASD or PFO (35.1% vs 6.0%, p <0.001). The association between ASD or PFO and ischemic stroke persisted after adjustment for demographics and clinical covariates (adjusted odds ratio 6.30, 95% confidence interval, 5.59 to 7.10) and in all non-cardiac surgery subtypes. In conclusion, in a large, nationwide analysis of patients undergoing noncardiac surgery, a diagnosis of ASD or PFO was associated with an increased risk of acute ischemic stroke overall and in all surgical subtypes. Additional measures are necessary to mitigate stroke risk in patients with septal defects who are planned for non-cardiac surgery.
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Affiliation(s)
- Nathaniel R Smilowitz
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
| | - Varun Subashchandran
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Jeffrey S Berger
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York; Department of Surgery, New York University School of Medicine, New York, New York
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