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Naser JA, Alexandrino FB, Harada T, Michelena HI, Borlaug BA, Eleid MF, Lin G, Scott C, Kennedy AM, Pellikka PA, Nkomo VT, Pislaru SV. The Natural History of Atrial Functional Mitral Regurgitation. J Am Coll Cardiol 2024; 83:1495-1507. [PMID: 38530687 DOI: 10.1016/j.jacc.2024.02.026] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/20/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND The natural history of moderate/severe atrial functional mitral regurgitation (AFMR) is unknown. OBJECTIVES The authors sought to study the incidence of left ventricular (LV) systolic dysfunction (LVSD), progression or regression of ≥mild-moderate AFMR, and impact on mortality. METHODS Adults with left atrial (LA) volume index ≥40 mL/m2, ≥mild-moderate AFMR, and follow-up echocardiogram were followed for incident LVSD (ejection fraction <50% and ≥10% lower than baseline), progression of mild-moderate/moderate AFMR to severe, and persistent regression of AFMR to no/trivial. Relation of AFMR progression or regression as time-dependent covariates with all-cause mortality was studied. Incidence of LVSD was compared with patients with no/mild AFMR matched on age, sex, comorbidities and ejection fraction. Patients were followed until mitral intervention, myocardial infarction, or last follow-up. RESULTS A total of 635 patients (median age 75 years, 51% female, 96% mild-moderate/moderate AFMR, 4% severe AFMR) were included. Over a median 2.2 years (Q1-Q3: 1.0-4.3 years), incidence rates per 100 person-years were 3.2 for LVSD (P = 0.52 vs patients with no/mild AFMR), 1.9 for progression of AFMR, and 3.9 for regression. Female sex and larger LA volume index were independently associated with progression, whereas younger age, male sex, absent atrial fibrillation, and higher LA emptying fraction were independently associated with regression. Neither AFMR progression nor regression was independently associated with mortality. Instead, independent risk factors for mortality included older age, concentric LV geometry, and higher estimated LV filling and pulmonary pressures. CONCLUSIONS In patients with predominantly mild-moderate/moderate AFMR, regression of MR was more common than progression, but neither was associated with mortality. Instead, diastolic function abnormalities were more important. Over a median 2-year follow-up, LVSD risk was not increased.
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Affiliation(s)
- Jwan A Naser
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | | | - Tomonari Harada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher Scott
- Department of Biostatistics and Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Austin M Kennedy
- Department of Biostatistics and Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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Pellikka PA. Acknowledgement of JASE Reviewer Team. J Am Soc Echocardiogr 2024; 37:377-381. [PMID: 38575273 DOI: 10.1016/j.echo.2024.02.006] [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: 04/06/2024]
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Luong CL, Anand V, Padang R, Oh JK, Arruda-Olson AM, Bird JG, Pislaru C, Thaden JJ, Pislaru SV, Pellikka PA, McCully RB, Kane GC. Prognostic Significance of Elevated Left Ventricular Filling Pressures with Exercise: Insights from a Cohort of 14,338 Patients. J Am Soc Echocardiogr 2024; 37:382-393.e1. [PMID: 38000684 DOI: 10.1016/j.echo.2023.11.012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 10/22/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Exercise echocardiography can assess for cardiovascular causes of dyspnea other than coronary artery disease. However, the prevalence and prognostic significance of elevated left ventricular (LV) filling pressures with exercise is understudied. METHODS We evaluated 14,338 patients referred for maximal symptom-limited treadmill echocardiography. In addition to assessment of LV regional wall motion abnormalities (RWMAs), we measured patients' early diastolic mitral inflow (E), septal mitral annulus relaxation (e'), and peak tricuspid regurgitation velocity before and immediately after exercise. RESULTS Over a mean follow-up of 3.3 ± 3.4 years, patients with E/e' ≥15 with exercise (n = 1,323; 9.2%) had lower exercise capacity (7.3 ± 2.1 vs 9.1 ± 2.4 metabolic equivalents, P < .0001) and were more likely to have resting or inducible RWMAs (38% vs 18%, P < .0001). Approximately 6% (n = 837) had elevated LV filling pressures without RWMAs. Patients with a poststress E/e' ≥15 had a 2.71-fold increased mortality rate (2.28-3.21, P < .0001) compared with those with poststress E/e' ≤ 8. Those with an E/e' of 9 to 14, while at lower risk than the E/e' ≥15 cohort (hazard ratio [HR] = 0.58 [0.48-0.69]; P < .0001), had higher risk than if E/e' ≤8 (HR = 1.56 [1.37-1.78], P < .0001). On multivariable analysis, adjusting for age, sex, exercise capacity, LV ejection fraction, and presence of pulmonary hypertension with stress, patients with E/e' ≥15 had a 1.39-fold (95% CI, 1.18-1.65, P < .0001) increased risk of all-cause mortality compared with patients without elevated LV filling pressures. Compared with patients with E/e' ≤ 15 after exercise, patients with E/e' ≤15 at rest but elevated after exercise had a higher risk of cardiovascular death (HR = 8.99 [4.7-17.3], P < .0001). CONCLUSION Patients with elevated LV filling pressures are at increased risk of death, irrespective of myocardial ischemia or LV systolic dysfunction. These findings support the routine incorporation of LV filling pressure assessment, both before and immediately following stress, into the evaluation of patients referred for exercise echocardiography.
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Affiliation(s)
- Christina L Luong
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vidhu Anand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Jared G Bird
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Cristina Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jeremy J Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Robert B McCully
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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Abbasi M, Al-Abcha A, Lee AT, Scott CG, Guerrero M, Pellikka PA. Progression of Mild Mitral Annulus Calcification to Mitral Valve Dysfunction and Impact on Mortality. J Am Soc Echocardiogr 2024:S0894-7317(24)00111-1. [PMID: 38493834 DOI: 10.1016/j.echo.2024.03.004] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Mitral annulus calcification (MAC) represents a degenerative process resulting in calcium deposition in the mitral valve apparatus. Mitral annulus calcification is associated with adverse clinical outcomes. We sought to examine the long-term significance of mild MAC and its relationship to subsequent mitral valve dysfunction (MVD) and mortality in patients without MVD on the initial echocardiogram. METHODS A total of 1,420 patients with mild MAC and no MVD at baseline and 1 or more follow-up echocardiograms at least 1 year after the baseline echocardiogram were included in the analysis. For patients with >1 echocardiogram during follow-up, the last echocardiogram was used. The same criteria were used to identify 6,496 patients without MAC. Mitral valve dysfunction was defined as mitral regurgitation (MR) and/or mitral stenosis (MS) of moderate or greater severity. Mixed disease was defined as the concurrent presence of both moderate or greater MS and MR. The primary end point was development of MVD, and the secondary end point was all-cause mortality. RESULTS For patients with mild MAC, age was 74 ± 10 years and 528 (37%) were female. Over a median follow-up of 4.7 (interquartile range, 2.7-6.9) years, 215 patients with mild MAC developed MVD, including MR in 170 (79%), MS in 37 (17%), and mixed disease in 8 (4%). In a multivariable regression model compared to patients without MAC, the presence of mild MAC was independently associated with increased mortality (hazard ratio = 1.43; 95% CI 1.24, 1.66; P < .001). Kaplan-Meier 4-year survival rates were 80% and 90% for patients with mild MAC and no MAC, respectively. CONCLUSIONS Mild MAC observed on transthoracic echocardiography is an important clinical finding with prognostic implications for both valvular function and mortality.
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Affiliation(s)
- Muhannad Abbasi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Abdullah Al-Abcha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Alex T Lee
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Christopher G Scott
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Tweet MS, Pellikka PA, Gulati R, Gochanour BR, Barrett-O'Keefe Z, Raphael CE, Best PJM, Hayes SN. Coronary Artery Tortuosity and Spontaneous Coronary Artery Dissection: Association With Echocardiography and Global Longitudinal Strain, Fibromuscular Dysplasia, and Outcomes. J Am Soc Echocardiogr 2024:S0894-7317(24)00107-X. [PMID: 38467311 DOI: 10.1016/j.echo.2024.02.013] [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: 10/09/2023] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND The etiology and significance of coronary artery tortuosity (TCA) among patients with spontaneous coronary artery dissection (SCAD) are unknown. The aim of this prospective imaging cohort study was to report echocardiographic findings and evaluate whether TCA correlates with cardiac anatomy and function among patients with SCAD. Comorbidities including fibromuscular dysplasia (FMD) and outcomes were also assessed. METHODS TCA was determined on coronary angiography performed during the diagnosis of SCAD, and cardiac structure and function were evaluated using prospective comprehensive echocardiography. RESULTS Among 116 patients with SCAD, the mean age at echocardiography was 50.8 ± 8.8 years, a median of 10.9 months after SCAD. Sixty-two patients (53.4%) had FMD, 41 (35.3%) had histories of hypertension, and 17 (14.8%) were hypertensive during echocardiography. Most patients (n = 78 [69%]) had normal left ventricular geometry with normal median ejection fraction (61%; interquartile range, 56% to 64%) and normal global longitudinal strain (-22.2%; interquartile range, -24.0% to -19.9%). Fifteen patients (13.4%) had diastolic dysfunction that was associated with hypertension at the time of echocardiography. Patients with TCA (n = 96 [82.8%]) were older (mean age, 52.1 ± 8.0 vs 44.7 ± 9.9 years; P < .001) with a higher prevalence of FMD (59.4% vs 25%, P = .007) but a similar prevalence of hypertension (35% vs 35%, P > .99) compared with patients without TCA. Across the age range (31.5 to 66.9 years), each decade of age was associated with an approximately 0.89-unit increase in coronary tortuosity score (P < .0001). Echocardiographic parameters were not significantly different between the two groups. Median follow-up duration was 4.4 years (95% CI, 3.8 to 5.2 years). The Kaplan-Meier 3-year SCAD recurrence rate was 9.4% (95% CI, 3.7% to 14.8%). There were no deaths. CONCLUSIONS The majority of patients with SCAD had normal or near normal echocardiographic results, including global longitudinal strain, with no differences according to TCA. However, patients with SCAD with TCA were older, with a higher prevalence of FMD.
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Affiliation(s)
- Marysia S Tweet
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Benjamin R Gochanour
- Division of Clinical Trials and Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Zachary Barrett-O'Keefe
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Claire E Raphael
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Patricia J M Best
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
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Stanko KM, Thomas A, Cullen MW, McCully RB, Schroeder DR, Kane GC, Pellikka PA, Mauck KF. Postoperative Outcomes After Delay or Cancellation of Noncardiac Surgery Due to Results of a Preoperative Dobutamine Stress Echocardiogram. J Am Soc Echocardiogr 2024:S0894-7317(24)00104-4. [PMID: 38458360 DOI: 10.1016/j.echo.2024.02.011] [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] [Received: 11/28/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 03/10/2024]
Affiliation(s)
- Kevin M Stanko
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Alexa Thomas
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael W Cullen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Robert B McCully
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Karen F Mauck
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
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Naser JA, Michelena HI, Pellikka PA, Scott CG, Kennedy AM, Lin G, Nkomo VT, Pislaru SV. Prevalence and Incidence of Atrial Functional Mitral Regurgitation and its Association With Mortality. JACC Cardiovasc Imaging 2024; 17:333-335. [PMID: 37921721 DOI: 10.1016/j.jcmg.2023.09.006] [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: 07/31/2023] [Accepted: 09/14/2023] [Indexed: 11/04/2023]
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Ali MT, Johnson M, Irwin T, Henry S, Sugeng L, Kansal S, Allison TG, Bremer ML, Jones VR, Martineau MD, Wong C, Marecki G, Stebbins J, Michelena HI, McCully RB, Svatikova A, Padang R, Scott CG, Kanuga MJ, Arsanjani R, Pellikka PA, Kane GC, Thaden JJ. Incidence of Severe Adverse Drug Reactions to Ultrasound Enhancement Agents in a Contemporary Echocardiography Practice. J Am Soc Echocardiogr 2024; 37:276-284.e3. [PMID: 37879379 DOI: 10.1016/j.echo.2023.10.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/02/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVES Prior data indicate a very rare risk of serious adverse drug reaction (ADR) to ultrasound enhancement agents (UEAs). We sought to evaluate the frequency of ADR to UEA administration in contemporary practice. METHODS We retrospectively reviewed 4 US health systems to characterize the frequency and severity of ADR to UEA. Adverse drug reactions were considered severe when cardiopulmonary involvement was present and critical when there was loss of consciousness, loss of pulse, or ST-segment elevation. Rates of isolated back pain and headache were derived from the Mayo Clinic Rochester stress echocardiography database where systematic prospective reporting of ADR was performed. RESULTS Among 26,539 Definity and 11,579 Lumason administrations in the Mayo Clinic Rochester stress echocardiography database, isolated back pain or headache was more frequent with Definity (0.49% vs 0.04%, P < .0001) but less common with Definity infusion versus bolus (0.08% vs 0.53%, P = .007). Among all sites there were 201,834 Definity and 84,943 Lumason administrations. Severe and critical ADR were more frequent with Lumason than with Definity (0.0848% vs 0.0114% and 0.0330% vs 0.0010%, respectively; P < .001 for each). Among the 3 health systems with >2,000 Lumason administrations, the frequency of severe ADR with Lumason ranged from 0.0755% to 0.1093% and the frequency of critical ADR ranged from 0.0293% to 0.0525%. Severe ADR rates with Definity were stable over time but increased in more recent years with Lumason (P = .02). Patients with an ADR to Lumason since the beginning of 2021 were more likely to have received a COVID-19 vaccination compared with matched controls (88% vs 75%; P = .05) and more likely to have received Moderna than Pfizer-Biotech (71% vs 26%, P < .001). CONCLUSION Severe and critical ADR, while rare, were more frequent with Lumason, and the frequency has increased in more recent years. Additional work is needed to better understand factors, including associations with recently developed mRNA vaccines, which may be contributing to the increased rates of ADR to UEA since 2021.
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Affiliation(s)
- Mays T Ali
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mark Johnson
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Timothy Irwin
- University of South Dakota, Yankton Medical Clinic, Yankton, South Dakota
| | - Sonia Henry
- Department of Cardiology, Northwell Health, Manhasset, New York
| | - Lissa Sugeng
- Department of Cardiology, Northwell Health, Manhasset, New York
| | - Sarita Kansal
- WellStar Center for Cardiovascular Medicine, WellStar Health System, Atlanta, Georgia
| | - Thomas G Allison
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Merri L Bremer
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Victoria R Jones
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Michael D Martineau
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Connie Wong
- Department of Cardiology, Northwell Health, Manhasset, New York
| | - Gregory Marecki
- Department of Cardiology, Northwell Health, Manhasset, New York
| | - Julie Stebbins
- WellStar Center for Cardiovascular Medicine, WellStar Health System, Atlanta, Georgia
| | - Hector I Michelena
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Robert B McCully
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anna Svatikova
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ratnasari Padang
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Christopher G Scott
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Mansi J Kanuga
- Division of Allergic Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Reza Arsanjani
- Division of Cardiac Imaging and Stress Testing, Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona
| | - Patricia A Pellikka
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Garvan C Kane
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jeremy J Thaden
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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Ouyang D, Carter RE, Pellikka PA. Machine Learning in Imaging: What is JASE Looking For? J Am Soc Echocardiogr 2024; 37:273-275. [PMID: 38432849 DOI: 10.1016/j.echo.2024.01.002] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Affiliation(s)
- David Ouyang
- Department of Cardiology, Cedars-Sinai Medical Center
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Chang IC, Pellikka PA, Winchester DE. 2023 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Chronic Coronary Disease: A Summary for JASE. J Am Soc Echocardiogr 2024; 37:303-306. [PMID: 37858904 DOI: 10.1016/j.echo.2023.10.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023]
Abstract
This report provides a descriptive summary of the ACC/AHA/ASE/ASNC/ASPC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2023 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Chronic Coronary Disease with an emphasis on the role of stress echocardiography.
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Affiliation(s)
- Ian C Chang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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Cortigiani L, Gaibazzi N, Ciampi Q, Rigo F, Rodríguez‐Zanella H, Wierzbowska‐Drabik K, Kasprzak JD, Arbucci R, Lowenstein J, Zagatina A, Bartolacelli Y, Gregori D, Carerj S, Pepi M, Pellikka PA, Picano E. High Resting Coronary Flow Velocity by Echocardiography Is Associated With Worse Survival in Patients With Chronic Coronary Syndromes. J Am Heart Assoc 2024; 13:e031270. [PMID: 38362899 PMCID: PMC11010105 DOI: 10.1161/jaha.123.031270] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/14/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Resting coronary flow velocity (CFV) in the mid-distal left anterior descending coronary artery can be easily assessed with transthoracic echocardiography. In this observational study, the authors sought to assess the relationship between resting CFV, CFV reserve (CFVR), and outcome in patients with chronic coronary syndromes. METHODS AND RESULTS In a prospective multicenter study design, the authors retrospectively analyzed 7576 patients (age, 66±11 years; 4312 men) with chronic coronary syndromes and left ventricular ejection fraction ≥50% referred for dipyridamole stress echocardiography. Recruitment (years 2003-2021) involved 7 accredited laboratories, with interobserver variability <10% for CFV measurement at study entry. Baseline peak diastolic CFV was obtained by pulsed-wave Doppler in the mid-distal left anterior descending coronary artery. CFVR (abnormal value ≤2.0) was assessed with dipyridamole. All-cause death was the only end point. The mean CFV of the left anterior descending coronary artery was 31±12 cm/s. The mean CFVR was 2.32±0.60. During a median follow-up of 5.9±4.3 years, 1121 (15%) patients died. At multivariable analysis, resting CFV ≥32 cm/s was identified by a receiver operating curve as the best cutoff and was independently associated with mortality (hazard ratio [HR], 1.24 [95% CI, 1.10-1.40]; P<0.0001) together with CFVR ≤2.0 (HR, 1.78 [95% CI, 1.57-2.02]; P<0.0001), age, diabetes, history of coronary surgery, and left ventricular ejection fraction. When both CFV and CFVR were considered, the mortality rate was highest in patients with resting CFV ≥32 cm/s and CFVR ≤2.0 and lowest in patients with resting CFV <32 cm/s and CFVR >2.0. CONCLUSIONS High resting CFV is associated with worse survival in patients with chronic coronary syndromes and left ventricular ejection fraction ≥50%. The value is independent and additive to CFVR. The combination of high resting CFV and low CFVR is associated with the worst survival.
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Affiliation(s)
| | | | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli HospitalBeneventoItaly
| | - Fausto Rigo
- Cardiology Division, Villa Salus HospitalMestreItaly
| | | | | | | | - Rosina Arbucci
- Cardiodiagnosticos, Investigaciones Medicas CenterBuenos AiresArgentina
| | - Jorge Lowenstein
- Cardiodiagnosticos, Investigaciones Medicas CenterBuenos AiresArgentina
| | - Angela Zagatina
- Saint Petersburg State Pediatric Medical UniversitySaint PetersburgRussian Federation
| | - Ylenia Bartolacelli
- Paediatric Cardiology and Adult Congenital Heart Disease Program, Department of Cardio‐Thoracic and Vascular Medicine IRCCS Azienda Ospedaliero‐Universitaria di BolognaPoliclinico S. Orsola‐Malpighi HospitalBolognaItaly
| | - Dario Gregori
- Biostatistics, Epidemiology and Public Health UnitPadova UniversityPadovaItaly
| | - Scipione Carerj
- Divisione di Cardiologia, Policlinico UniversitarioUniversità di MessinaMessinaItaly
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCSMilanItaly
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12
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El Sabbagh A, Parikh P, Ray J, Nishimura RA, Pislaru SV, Pellikka PA, Guerrero M, Hochwald A, Miranda WR. Mitral Annulus Calcium Score in Patients With Calcific Mitral Stenosis Undergoing Invasive Hemodynamic Assessment. J Am Heart Assoc 2024; 13:e030540. [PMID: 38240203 DOI: 10.1161/jaha.123.030540] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 12/01/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Aortic valve calcium score is associated with hemodynamic severity of aortic stenosis. Whether this association is present in calcific mitral stenosis remains unknown. METHODS AND RESULTS This study was a retrospective analysis of consecutive patients with mitral stenosis secondary to mitral annular calcification (MAC) undergoing transseptal catheterization. All patients underwent invasive mitral valve assessment via direct left atrial and left ventricular pressure measurement. Computed tomography within 1 year of cardiac catheterization and with adequate visualization of the mitral annulus was included. MAC calcium score quantification by Agatston method was obtained offline using dedicated software (Aquarius, TeraRecon, V.4). Median patient age was 66.9±11.2 years, 47% of patients were women, 50% had coronary artery disease, 40% had atrial fibrillation, 47% had prior cardiac surgery, and 33% had prior chest radiation. Median diastolic mitral valve gradient was 9.4±3.4 mm Hg on echocardiography and 8.5±4 mm Hg invasively. Invasive median mitral valve area using the Gorlin formula was 1.87±0.9 cm2. Median MAC calcium score for the cohort was 7280±7937 Hounsfield units. MAC calcium score correlated with the presence of atrial fibrillation (P=0.02) but was not associated with other comorbidities. There was no correlation between MAC calcium score and mitral valve area (r=0.07; P=0.6) or mitral valve gradient (r=-0.03; P=0.8). CONCLUSIONS MAC calcium score did not correlate with invasively measured mitral valve gradient and mitral valve area in patients with MAC-related mitral stenosis, suggesting that calcium score should not be used as a surrogate for invasive hemodynamic parameters.
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Affiliation(s)
| | - Pragnesh Parikh
- Department of Cardiovascular Diseases Mayo Clinic Jacksonville FL
| | - Jordan Ray
- Department of Cardiovascular Diseases Mayo Clinic Jacksonville FL
| | | | - Sorin V Pislaru
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | | | - Mayra Guerrero
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
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13
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Omote K, Sorimachi H, Obokata M, Verbrugge FH, Omar M, Popovic D, Reddy YNV, Pislaru SV, Pellikka PA, Borlaug BA. Biatrial myopathy in heart failure with preserved ejection fraction. Eur J Heart Fail 2024; 26:288-298. [PMID: 38059338 DOI: 10.1002/ejhf.3104] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/27/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023] Open
Abstract
AIM Left atrial (LA) myopathy is increasingly recognized as an important phenotypic trait in heart failure (HF) with preserved ejection fraction (HFpEF). Right atrial (RA) remodelling and dysfunction also develop in HFpEF, but little data are available regarding the clinical characteristics and pathophysiology among patients with isolated LA, RA, or biatrial myopathy. METHODS AND RESULTS Patients with HFpEF underwent invasive haemodynamic exercise testing, comprehensive imaging including speckle tracking strain echocardiography, and clinical follow-up at Mayo Clinic between 2006 and 2018. LA myopathy was defined as LA volume index >34 ml/m2 and/or LA reservoir strain ≤24% and RA myopathy by RA volume index >39 ml/m2 in men and >33 ml/m2 in women and/or RA reservoir strain ≤19.8%. Of 476 consecutively evaluated patients with HFpEF defined by invasive exercise testing with evaluable atrial structure/function, 125 (26%) had no atrial myopathy, 147 (31%) had isolated LA myopathy, 184 (39%) had biatrial myopathy, and 20 (4%) had isolated RA myopathy. Patients with HFpEF and biatrial myopathy had more atrial fibrillation, poorer left ventricular systolic and diastolic function, more severe pulmonary vascular disease, tricuspid regurgitation, ventricular interdependence and right ventricular dysfunction, and poorer cardiac output reserve with exercise. There were 94 patients with events over a median follow-up of 2.9 (interquartile range 1.4-4.6) years. Individuals with biatrial myopathy had an 84% higher risk of HF hospitalization or death as compared to those with isolated LA myopathy (hazard ratio 1.84; 95% confidence interval 1.16-2.92, p = 0.01). CONCLUSIONS Biatrial myopathy identifies patients with more advanced HFpEF characterized by more severe pulmonary vascular disease, right HF, poorer cardiac reserve, and a greater risk for adverse outcomes. Further study is required to define optimal strategies to treat and prevent biatrial myopathy in HFpEF.
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Affiliation(s)
- Kazunori Omote
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hidemi Sorimachi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Masaru Obokata
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Frederik H Verbrugge
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Centre for Cardiovascular Diseases, University Hospital Brussels, Jette, Belgium
| | - Massar Omar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Dejana Popovic
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yogesh N V Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Pellikka PA. This Focus Issue on Pediatric, Neonatal, and Congenital Heart Disease Echocardiography. J Am Soc Echocardiogr 2024; 37:117-118. [PMID: 38309833 DOI: 10.1016/j.echo.2023.12.007] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
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15
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Anand V, Weston AD, Scott CG, Kane GC, Pellikka PA, Carter RE. Machine Learning for Diagnosis of Pulmonary Hypertension by Echocardiography. Mayo Clin Proc 2024; 99:260-270. [PMID: 38309937 DOI: 10.1016/j.mayocp.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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/23/2023] [Accepted: 05/02/2023] [Indexed: 02/05/2024]
Abstract
OBJECTIVE To evaluate a machine learning (ML)-based model for pulmonary hypertension (PH) prediction using measurements and impressions made during echocardiography. METHODS A total of 7853 consecutive patients with right-sided heart catheterization and transthoracic echocardiography performed within 1 week from January 1, 2012, through December 31, 2019, were included. The data were split into training (n=5024 [64%]), validation (n=1275 [16%]), and testing (n=1554 [20%]). A gradient boosting machine with enumerated grid search for optimization was selected to allow missing data in the boosted trees without imputation. The training target was PH, defined by right-sided heart catheterization as mean pulmonary artery pressure above 20 mm Hg; model performance was maximized relative to area under the receiver operating characteristic curve using 5-fold cross-validation. RESULTS Cohort age was 64±14 years; 3467 (44%) were female, and 81% (6323/7853) had PH. The final trained model included 19 characteristics, measurements, or impressions derived from the echocardiogram. In the testing data, the model had high discrimination for the detection of PH (area under the receiver operating characteristic curve, 0.83; 95% CI, 0.80 to 0.85). The model's accuracy, sensitivity, positive predictive value, and negative predictive value were 82% (1267/1554), 88% (1098/1242), 89% (1098/1241), and 54% (169/313), respectively. CONCLUSION By use of ML, PH could be predicted on the basis of clinical and echocardiographic variables, without tricuspid regurgitation velocity. Machine learning methods appear promising for identifying patients with low likelihood of PH.
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Affiliation(s)
- Vidhu Anand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Alexander D Weston
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL; Digital Innovation Lab, Mayo Clinic, Jacksonville, FL
| | | | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL; Digital Innovation Lab, Mayo Clinic, Jacksonville, FL
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16
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Egbe AC, Pellikka PA, Connolly HM, Borlaug BA. Abnormal Right Ventricular-Pulmonary Arterial Coupling in Patients With Coarctation of Aorta Presenting With Aortic Stenosis. JACC Cardiovasc Imaging 2024:S1936-878X(24)00034-2. [PMID: 38340137 DOI: 10.1016/j.jcmg.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/04/2023] [Accepted: 12/21/2023] [Indexed: 02/12/2024]
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17
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Olgun Kucuk H, Fetterly KA, Betz JL, Pislaru SV, Rihal CS, Pellikka PA, Wiley BM. Interventional Echocardiographer Radiation Exposure Varies With Procedure Type and Echocardiography Modality. J Am Soc Echocardiogr 2024; 37:110-112. [PMID: 37716461 DOI: 10.1016/j.echo.2023.09.007] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 09/18/2023]
Affiliation(s)
- Hilal Olgun Kucuk
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Kenneth A Fetterly
- Division of Ischemic Heart Disease, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Jennifer L Betz
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sorin V Pislaru
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Charanjit S Rihal
- Division of Ischemic Heart Disease, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Patricia A Pellikka
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Brandon M Wiley
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiology, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
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Pellikka PA. Top Reviewers and Guest Editors for Journal of the American Society of Echocardiography. J Am Soc Echocardiogr 2024; 37:1. [PMID: 38182281 DOI: 10.1016/j.echo.2023.11.009] [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: 01/07/2024]
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19
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Naser JA, Luis SA, Pislaru SV, Michelena HI, Kennedy AM, Eleid MF, Crestanello JA, Chebib FT, Pellikka PA, Nkomo VT. Impact on Kidney Function and Medium-Term Outcomes of Transcatheter Aortic Valve Replacement in Patients With Chronic Kidney Disease. Am J Cardiol 2024; 210:163-171. [PMID: 37863302 DOI: 10.1016/j.amjcard.2023.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 10/22/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is now widely approved for the treatment of aortic stenosis, regardless of the patients' surgical risk. However, the outcomes of TAVR and their determinants in patients with chronic kidney disease (CKD) beyond 1 year of follow-up are unknown. We aimed to assess the medium-term outcomes of TAVR in CKD, develop a risk score to estimate the 2-year mortality in patients with CKD, and evaluate the changes in kidney function at discharge after TAVR. Adults who underwent TAVR were retrospectively identified. The CKD stage was determined using the Chronic Kidney Disease Epidemiology 2021 creatinine formula. Improved kidney function was defined as post-TAVR creatinine ≤50% of pre-TAVR creatinine or decrease in creatinine of ≥0.3 mg/100 ml compared with pre-TAVR creatinine. Overall, 1,523 patients (median age 82 years; 59% men; 735 with CKD stage II or less, 661 with CKD III, 83 with CKD IV, and 44 with CKD V [of whom 40 were on dialysis]) were included. The all-cause mortality was higher in CKD stages IV and V on the multivariable analysis (p <0.001) at median follow-up of 2.9 (interquartile range 2.0 to 4.2) years. Moderate or severe tricuspid regurgitation, anemia, right ventricular systolic pressure >40 mm Hg and CKD stages IV and V were independent predictors of 2-year mortality and were used to develop a risk score. At hospital discharge, persisting acute kidney injury after TAVR occurred in 88 of 1,466 patients (6%), whereas improved kidney function occurred in 170 of 1,466 patients (12%). In conclusion, CKD stage was an independent determinant of mortality beyond 2 years after TAVR. Kidney function was more likely to improve than worsen at the time of hospital discharge after TAVR.
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Affiliation(s)
- Jwan A Naser
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sushil Allen Luis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Austin M Kennedy
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Fouad T Chebib
- Department of Nephrology and Hypertension Division, Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida
| | | | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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20
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Davis EF, Crousillat DR, Peteiro J, Lopez-Sendon J, Senior R, Shapiro MD, Pellikka PA, Lyubarova R, Alfakih K, Abdul-Nour K, Anthopolos R, Xu Y, Kunichoff DM, Fleg JL, Spertus JA, Hochman J, Maron D, Picard MH, Reynolds HR. Global Longitudinal Strain as Predictor of Inducible Ischemia in No Obstructive Coronary Artery Disease in the CIAO-ISCHEMIA Study. J Am Soc Echocardiogr 2024; 37:89-99. [PMID: 37722490 PMCID: PMC10842002 DOI: 10.1016/j.echo.2023.09.006] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/18/2023] [Accepted: 09/05/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Global longitudinal strain (GLS) is a sensitive marker for identifying subclinical myocardial dysfunction in obstructive coronary artery disease (CAD). Little is known about the relationship between GLS and ischemia in patients with myocardial ischemia and no obstructive CAD (INOCA). OBJECTIVES To investigate the relationship between resting GLS and ischemia on stress echocardiography (SE) in patients with INOCA. METHODS Left ventricular GLS was calculated offline on resting SE images at enrollment (n = 144) and 1-year follow-up (n = 120) in the CIAO-ISCHEMIA (Changes in Ischemia and Angina over One year in International Study of Comparative Health Effectiveness with Medical and Invasive Approaches trial screen failures with no obstructive CAD on computed tomography [CT] angiography) study, which enrolled participants with moderate or severe ischemia by local SE interpretation (≥3 segments with new or worsening wall motion abnormality and no obstructive (<50% stenosis) on coronary computed tomography angiography. RESULTS Global longitudinal strain values were normal in 83.3% at enrollment and 94.2% at follow-up. Global longitudinal strain values were not associated with a positive SE at enrollment (GLS = -21.5% positive SE vs GLS = -19.9% negative SE, P = .443) or follow-up (GLS = -23.2% positive SE vs GLS = -23.1% negative SE, P = .859). Significant change in GLS was not associated with positive SE in follow-up (P = .401). Regional strain was not associated with colocalizing ischemia at enrollment or follow-up. Changes in GLS and number of ischemic segments from enrollment to follow-up showed a modest but not clinically meaningful correlation (β = 0.41; 95% CI, 0.16, 0.67; P = .002). CONCLUSIONS In this cohort of INOCA patients, resting GLS values were largely normal and did not associate with the presence, severity, or location of stress-induced ischemia. These findings may suggest the absence of subclinical myocardial dysfunction detectable by echocardiographic strain analysis at rest in INOCA.
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Affiliation(s)
- Esther F Davis
- Echocardiography Laboratory, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Victorian Heart Institute and Victorian Heart Hospital, Victoria, Australia
| | - Daniela R Crousillat
- Echocardiography Laboratory, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Division of Cardiovascular Sciences, Department of Medicine, University of South Florida, Tampa, Florida; Department of Obstetrics and Gynecology, Tampa General-Heart and Vascular Institute, University of South Florida, Tampa, Florida
| | - Jesus Peteiro
- CHUAC, Universidad de A Coruña, CIBER-CV, A Coruna, Spain
| | | | - Roxy Senior
- Northwick Park Hospital-Royal Brompton Hospital, London, United Kingdom
| | - Michael D Shapiro
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | | | | | | | | - Rebecca Anthopolos
- Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, New York
| | - Yifan Xu
- Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, New York
| | - Dennis M Kunichoff
- Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, New York
| | - Jerome L Fleg
- National Institute of Health-National Heart Lung, and Blood Institute, Bethesda, Maryland
| | - John A Spertus
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri
| | - Judith Hochman
- Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, New York
| | - David Maron
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Michael H Picard
- Echocardiography Laboratory, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Harmony R Reynolds
- Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, New York.
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21
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Pellikka PA, Kato N. Aortic Stenosis Risk and Management: Sex Disparities or Just Differences? JACC Cardiovasc Imaging 2024; 17:13-15. [PMID: 37498254 DOI: 10.1016/j.jcmg.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Nahoko Kato
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Cardiology, Tokyo Bay Urayasu/Ichikawa Medical Center, Urayasu Chiba, Japan
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22
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Naser JA, Lee E, Scott CG, Kennedy AM, Pellikka PA, Lin G, Pislaru SV, Borlaug BA. Prevalence and incidence of diastolic dysfunction in atrial fibrillation: clinical implications. Eur Heart J 2023; 44:5049-5060. [PMID: 37639219 DOI: 10.1093/eurheartj/ehad592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND AND AIMS Atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) are intimately associated disorders; HFpEF may be overlooked in AF when symptoms are simply attributed to dysrhythmia, and incident AF may identify patients at risk for developing diastolic dysfunction (DD). This study aimed to investigate the prevalence and incidence of DD in patients with new-onset AF compared with sinus rhythm (SR). METHODS Adults with new-onset AF (n = 1747) or SR (n = 29 623) and no structural heart disease were identified. Propensity score matching was performed (1:3 ratio) between AF and SR based on age, sex, body mass index, and comorbidities. Severe DD (SDD) was defined by ≥3/four abnormal parameters (medial e', medial E/e', tricuspid regurgitation velocity, and left atrial volume index) and ≥moderate DD (>MDD) by ≥2/4. Annualized changes in DD indices were determined. RESULTS New-onset AF was independently associated with SDD (8% vs. 3%) and ≥MDD (25% vs. 16%); 62% of patients with AF had high-risk H2FPEF scores, and 5% had clinically recognized HFpEF. Over a median follow-up of 3.2 (interquartile range 1.6-5.8) years, DD progressed two-four-fold more rapidly in those with new-onset AF (P < .001 for all). The risk for incident DD was increased in new-onset AF [hazard ratio (95% confidence interval) 2.69 (2.19-3.32) for SDD and 1.73 (1.49-2.02) for ≥MDD]. CONCLUSIONS Patients with new-onset AF display high-risk features for HFpEF at diagnosis, emphasizing the importance of evaluating for HFpEF among symptomatic patients with AF. Patients with new-onset AF have accelerated progression in DD over time, which may identify patients with preclinical HFpEF, where preventive therapies may be tested.
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Affiliation(s)
- Jwan A Naser
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55902, USA
| | - Eunjung Lee
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55902, USA
| | - Christopher G Scott
- Department of Biostatistics and Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55902, USA
| | - Austin M Kennedy
- Department of Biostatistics and Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55902, USA
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55902, USA
| | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55902, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55902, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55902, USA
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23
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Gaibazzi N, Ciampi Q, Cortigiani L, Wierzbowska-Drabik K, Zagatina A, Djordjevic-Dikic A, Manganelli F, Boshchenko A, Borguezan-Daros C, Arbucci R, Marconi S, Lowenstein J, Haberka M, Celutkiene J, D'Andrea A, Rodriguez-Zanella H, Rigo F, Monte I, Costantino MF, Ostojic M, Merli E, Pepi M, Carerj S, Kasprzak JD, Pellikka PA, Picano E. Multiple Phenotypes of Chronic Coronary Syndromes Identified by ABCDE Stress Echocardiography. J Am Soc Echocardiogr 2023:S0894-7317(23)00652-1. [PMID: 38092306 DOI: 10.1016/j.echo.2023.12.003] [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: 06/14/2023] [Revised: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Regional wall motion abnormality is considered a sensitive and specific marker of ischemia during stress echocardiography (SE). However, ischemia is a multifaceted entity associated with either coronary artery disease (CAD) or angina with normal coronary arteries, a distinction difficult to make using a single sign. The aim of this study was to evaluate the diagnostic potential of the five-step ABCDE SE protocol for CAD detection. METHODS From the 2016-2022 Stress Echo 2030 study data bank, 3,229 patients were selected (mean age, 66 ± 12 years; 2,089 men [65%]) with known CAD (n = 1,792) or angina with normal coronary arteries (n = 1,437). All patients were studied using both the ABCDE SE protocol and coronary angiography, within 3 months. In step A, regional wall motion abnormality is assessed; in step B, B-lines and diastolic function; in step C, left ventricular contractile reserve; in step D, coronary flow velocity reserve in the left anterior descending coronary artery; and in step E, heart rate reserve. RESULTS SE response ranged from a score of 0 (all steps normal) to a score of 5 (all steps abnormal). For CAD, rates of abnormal results were 347 for step A (19.4%), 547 (30.5%) for step B, 720 (40.2%) for step C, 615 (34.3%) for step D, and 633 (35.3%) for step E. For angina with normal coronary arteries, rates of abnormal results were 81 (5.6%) for step A, 429 (29.9%) for step B, 432 (30.1%) for step C, 354 (24.6%) for step D, and 445 (31.0%) for step E. The dominant "solitary phenotype" was step B in 109 patients (9.1%). CONCLUSIONS Stress-induced ischemia presents with a wide range of diagnostic phenotypes, highlighting its complex nature. Using a comprehensive approach such as the advanced ABCDE score, which combines multiple markers, proves to be more valuable than relying on a single marker in isolation.
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Affiliation(s)
| | - Quirino Ciampi
- Division of Cardiology, Fatebenefratelli Hospital, Benevento, Italy
| | | | | | - Angela Zagatina
- Cardiology Department, Research Cardiology Center "Medika", Saint Petersburg, Russian Federation
| | - Ana Djordjevic-Dikic
- Cardiology Clinic, Clinical Center of Serbia and School of Medicine University of Belgrade, Belgrade, Serbia
| | - Fiore Manganelli
- Department of Cardiology, San Giuseppe Moscati Hospital, Avellino, Italy
| | - Alla Boshchenko
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation
| | | | - Rosina Arbucci
- Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina
| | - Sofia Marconi
- Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina
| | - Jorge Lowenstein
- Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina
| | - Maciej Haberka
- Cardiology Department, University of Silesia, Katowice, Poland
| | - Jelena Celutkiene
- Centre of Cardiology and Angiology, Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Center for Innovative Medicine, Vilnius, Lithuania
| | | | | | - Fausto Rigo
- Villa Salus Foundation/IRCCS San Camillo Hospital, Venice, Italy
| | - Ines Monte
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | | | - Miodrag Ostojic
- University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Elisa Merli
- Department of Cardiology, Ospedale per gli Infermi, Faenza, Italy
| | - Mauro Pepi
- Cardiology Division, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Scipione Carerj
- Cardiology Division, University Hospital G. Martino, University of Messina, Messina, Italy
| | | | | | - Eugenio Picano
- CNR Institute of Clinical Physiology Biomedicine Department, Pisa, Italy
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Deb B, Scott C, Pislaru SV, Nkomo VT, Kane GC, Alkhouli M, Crestanello JA, Arruda-Olson A, Pellikka PA, Anand V. Machine learning facilitates the prediction of long-term mortality in patients with tricuspid regurgitation. Open Heart 2023; 10:e002417. [PMID: 38011995 PMCID: PMC10685925 DOI: 10.1136/openhrt-2023-002417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE Tricuspid regurgitation (TR) is a prevalent valve disease associated with significant morbidity and mortality. We aimed to apply machine learning (ML) to assess risk stratification in patients with ≥moderate TR. METHODS Patients with ≥moderate TR on echocardiogram between January 2005 and December 2016 were retrospectively included. We used 70% of data to train ML-based survival models including 27 clinical and echocardiographic features to predict mortality over a 3-year period on an independent test set (30%). To account for differences in baseline comorbidities, prediction was performed in groups stratified by increasing Charlson Comorbidity Index (CCI). Permutation feature importance was calculated using the best-performing model separately in these groups. RESULTS Of 13 312 patients, mean age 72 ± 13 years and 7406 (55%) women, 7409 (56%) had moderate, 2646 (20%) had moderate-severe and 3257 (24%) had severe TR. The overall performance for 1-year mortality by 3 ML models was good, c-statistic 0.74-0.75. Interestingly, performance varied between CCI groups, (c-statistic = 0.774 in lowest CCI group and 0.661 in highest CCI group). The performance decreased over 3-year follow-up (average c-index 0.78). Furthermore, the top 10 features contributing to these predictions varied slightly with the CCI group, the top features included heart rate, right ventricular systolic pressure, blood pressure, diuretic use and age. CONCLUSIONS Machine learning of common clinical and echocardiographic features can evaluate mortality risk in patients with TR. Further refinement of models and validation in prospective studies are needed before incorporation into the clinical practice.
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Affiliation(s)
- Brototo Deb
- Internal Medicine, Georgetown University, Washington, District of Columbia, USA
| | | | - Sorin V Pislaru
- Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | | | | | | | - Vidhu Anand
- Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Cardiovascular Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin, USA
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Yang LT, Ye Z, Wajih Ullah M, Maleszewski JJ, Scott CG, Padang R, Pislaru SV, Nkomo VT, Mankad SV, Pellikka PA, Oh JK, Roger VL, Enriquez-Sarano M, Michelena HI. Bicuspid aortic valve: long-term morbidity and mortality. Eur Heart J 2023; 44:4549-4562. [PMID: 37611071 DOI: 10.1093/eurheartj/ehad477] [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: 01/11/2023] [Revised: 06/26/2023] [Accepted: 07/14/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND AND AIMS Bicuspid aortic valve (BAV) is the most common congenital heart anomaly. Lifetime morbidity and whether long-term survival varies according to BAV patient-sub-groups are unknown. This study aimed to assess lifetime morbidity and long-term survival in BAV patients in the community. METHODS The authors retrospectively identified all Olmsted County (Minnesota) residents with an echocardiographic diagnosis of BAV from 1 January 1980 to 31 December 2009, including patients with typical valvulo-aortopathy (BAV without accelerated valvulo-aortopathy or associated disorders), and those with complex valvulo-aortopathy (BAV with accelerated valvulo-aortopathy or associated disorders). RESULTS 652 consecutive diagnosed BAV patients [median (IQR) age 37 (22-53) years; 525 (81%) adult and 127 (19%) paediatric] were followed for a median (IQR) of 19.1 (12.9-25.8) years. The total cumulative lifetime morbidity burden (from birth to age 90) was 86% (95% CI 82.5-89.7); cumulative lifetime progression to ≥ moderate aortic stenosis or regurgitation, aortic valve surgery, aortic aneurysm ≥45 mm or z-score ≥3, aorta surgery, infective endocarditis and aortic dissection was 80.3%, 68.5%, 75.4%, 27%, 6% and 1.6%, respectively. Survival of patients with typical valvulo-aortopathy [562 (86%), age 40 (28-55) years, 86% adults] was similar to age-sex-matched Minnesota population (P = .12). Conversely, survival of patients with complex valvulo-aortopathy [90 (14%), age 14 (3-26) years, 57% paediatric] was lower than expected, with a relative excess mortality risk of 2.25 (95% CI 1.21-4.19) (P = .01). CONCLUSION The BAV condition exhibits a high lifetime morbidity burden where valvulo-aortopathy is close to unavoidable by age 90. The lifetime incidence of infective endocarditis is higher than that of aortic dissection. The most common BAV clinical presentation is the typical valvulo-aortopathy with preserved expected long-term survival, while the complex valvulo-aortopathy presentation incurs higher mortality.
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Affiliation(s)
- Li-Tan Yang
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
- Cardiology Division, National Taiwan University Hospital, Taipei, TW 100, Taiwan
| | - Zi Ye
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Muhammad Wajih Ullah
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | | | - Christopher G Scott
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN 55905, USA
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Sunil V Mankad
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Veronique L Roger
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Maurice Enriquez-Sarano
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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26
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Alabdaljabar MS, Naser JA, Kane CJ, Lara-Breitinger KM, Anand V, Pislaru C, Eleid MF, Alkhouli MA, Kane GC, Pellikka PA, Lin G, Nkomo VT, Pislaru SV. Tricuspid Regurgitation Impact on Outcomes Score for Risk Stratification in Patients With Pulmonary Hypertension. J Am Soc Echocardiogr 2023; 36:1213-1215. [PMID: 37490988 DOI: 10.1016/j.echo.2023.07.005] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/27/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023]
Affiliation(s)
| | - Jwan A Naser
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Conor J Kane
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Vidhu Anand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Cristina Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mohamad A Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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27
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Naser JA, Michelena HI, Lin G, Scott CG, Lee E, Kennedy AM, Noseworthy PA, Pellikka PA, Nkomo VT, Pislaru SV. Incidence, risk factors, and outcomes of atrial functional mitral regurgitation in patients with atrial fibrillation or sinus rhythm. Eur Heart J Cardiovasc Imaging 2023; 24:1450-1457. [PMID: 37556366 DOI: 10.1093/ehjci/jead199] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/17/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023] Open
Abstract
AIMS Atrial functional mitral regurgitation (AFMR) has been associated with atrial fibrillation (AF) and heart failure with preserved ejection fraction. However, data on incident AFMR are scarce. We aimed to study the incidence, risk factors, and clinical significance of AFMR in AF or sinus rhythm (SR). METHODS AND RESULTS Adults with new diagnosis of AF and adults in SR were identified. Patients with >mild MR at baseline, primary mitral disease, cardiomyopathy, left-sided valve disease, previous cardiac surgery, or with no follow-up echocardiogram were excluded. Diastolic dysfunction (DD) was indicated by ≥2/4 abnormal diastolic function parameters [mitral medial e', mitral medial E/e', tricuspid regurgitation velocity, left atrial volume index (LAVI)]. Overall, 1747 patients with AF and 29 623 in SR were included. Incidence rate of >mild AFMR was 2.6 per 100 person-year in new-onset AF and 0.7 per 100 person-year in SR, P < 0.001. AF remained associated with AFMR in a propensity score-matched analysis based on age, sex, and comorbidities between AF and SR [hazard ratio: 3.80 (95% confidence interval 3.04-4.76)]. Independent risk factors associated with incident AFMR were age ≥65 years, female sex, LAVI, and DD in both AF and SR, in addition to rate (vs. rhythm) control in AF. Incident AFMR was independently associated with all-cause death in both groups (both P < 0.001). CONCLUSIONS AF conferred a three-fold increase in the risk of incident AFMR. DD, older age, left atrial size, and female sex were independent risk factors in both SR and AF, while rhythm control was protective. AFMR was universally associated with worse mortality.
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Affiliation(s)
- Jwan A Naser
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | | | - Eunjung Lee
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Austin M Kennedy
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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Winchester DE, Maron DJ, Blankstein R, Chang IC, Kirtane AJ, Kwong RY, Pellikka PA, Prutkin JM, Russell R, Sandhu AT. ACC/AHA/ASE/ASNC/ASPC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2023 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Chronic Coronary Disease. J Cardiovasc Magn Reson 2023; 25:58. [PMID: 37858155 PMCID: PMC10585920 DOI: 10.1186/s12968-023-00958-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/11/2023] [Indexed: 10/21/2023] Open
Abstract
The American College of Cardiology (ACC) Foundation, along with key specialty and subspecialty societies, conducted an appropriate use review of stress testing and anatomic diagnostic procedures for risk assessment and evaluation of known or suspected chronic coronary disease (CCD), formerly referred to as stable ischemic heart disease (SIHD). This document reflects an updating of the prior Appropriate Use Criteria (AUC) published for radionuclide imaging, stress echocardiography (echo), calcium scoring, coronary computed tomography angiography (CCTA), stress cardiac magnetic resonance (CMR), and invasive coronary angiography for SIHD. This is in keeping with the commitment to revise and refine the AUC on a frequent basis. As with the prior version of this document, rating of test modalities is provided side-by-side for a given clinical scenario. These ratings are explicitly not considered competitive rankings due to the limited availability of comparative evidence, patient variability, and the range of capabilities available in any given local setting1-4.This version of the AUC for CCD is a focused update of the prior version of the AUC for SIHD4. Key changes beyond the updated ratings based on new evidence include the following: 1. Clinical scenarios related to preoperative testing were removed and will be incorporated into another AUC document under development. 2. Some clinical scenarios and tables were removed in an effort to simplify the selection of clinical scenarios. Additionally, the flowchart of tables has been reorganized, and all clinical scenario tables can now be reached by answering a limited number of clinical questions about the patient, starting with the patient's symptom status. 3. Several clinical scenarios have been revised to incorporate changes in other documents such as pretest probability assessment, atherosclerotic cardiovascular disease (ASCVD) risk assessment, syncope, and others. ASCVD risk factors that are not accounted for in contemporary risk calculators have been added as modifiers to certain clinical scenarios. The 64 clinical scenarios rated in this document are limited to the detection and risk assessment of CCD and were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines.5 These clinical scenarios do not specifically address patients having acute chest pain episodes. They may, however, be applicable in the inpatient setting if the patient is not having an acute coronary syndrome and warrants evaluation for CCD.Using standardized methodology, clinical scenarios were developed to describe common patient encounters in clinical practice focused on common applications and anticipated uses of testing for CCD. Where appropriate, the scenarios were developed on the basis of the most current ACC/American Heart Association guidelines. A separate, independent rating panel scored the clinical scenarios in this document on a scale of 1 to 9, following a modified Delphi process consistent with the recently updated AUC development methodology. Scores of 7 to 9 indicate that a modality is considered appropriate for the clinical scenario presented, midrange scores of 4 to 6 indicate that a modality may be appropriate for the clinical scenario, and scores of 1 to 3 indicate that a modality is rarely appropriate.
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Affiliation(s)
| | | | - Ron Blankstein
- Society of Cardiovascular Computed Tomography, Washington, USA
| | | | - Ajay J Kirtane
- Society for Cardiovascular Angiography and Interventions, Washington, USA
| | - Raymond Y Kwong
- Society for Cardiovascular Magnetic Resonance, Washington, USA
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Abbasi MA, Bruno G, Di Stefano C, Garcia Bello L, Laack NN, Corbin KS, Whitaker TJ, Pellikka PA, Mutter RW, Villarraga HR. Detection of Early Myocardial Dysfunction by Imaging Biomarkers in Cancer Patients Undergoing Photon Beam vs. Proton Beam Radiotherapy: A Prospective Study. J Cardiovasc Dev Dis 2023; 10:418. [PMID: 37887865 PMCID: PMC10607871 DOI: 10.3390/jcdd10100418] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/30/2023] [Accepted: 10/02/2023] [Indexed: 10/28/2023] Open
Abstract
1. Background: We sought to determine acute and subacute changes in cardiac function after proton beam (PBT) and photon beam (PhT) radiotherapy (RT) using conventional and two-dimensional speckle tracking echocardiography (2D-STE) in patients with malignant breast and thoracic tumors. 2. Methods: Between March 2016 and March 2017, 70 patients with breast or thoracic cancer were prospectively enrolled and underwent transthoracic echocardiography with comprehensive strain analysis at pretreatment, mid-treatment, end of treatment, and 3 months after RT. 3. Results: PBT was used to treat 44 patients; PhT 26 patients. Mean ± SD age was 55 ± 12 years; most patients (93%) were women. The median (interquartile range) of the mean heart dose was lower in the PBT than the PhT group (47 [27-79] vs. 217 [120-596] cGy, respectively; p < 0.001). Ejection fraction did not change in either group. Only the PhT group had reduced systolic tissue Doppler velocities at 3 months. 2D-STE showed changes in endocardial and epicardial longitudinal, radial, and circumferential early diastolic strain rate (SRe) in patients undergoing PhT (global longitudinal SRe, pretreatment vs. end of treatment (p = 0.04); global circumferential SRe, pretreatment vs. at 3-month follow-up (p = 0.003); global radial SRe, pretreatment vs. at 3-month follow-up (p = 0.02) for endocardial values). Epicardial strain values decreased significantly only in patients treated with PhT. Patients in the PhT group had a significant decrease in epicardial global longitudinal systolic strain rate (GLSRs) (epicardial GLSRs, at baseline vs. at end of treatment [p = 0.009]) and in GCSRe and GRSRe (epicardial GCSRe, at baseline vs. at 3-month follow-up (p = 0.02); epicardial GRSRe, at baseline vs. at 3-month follow-up (p = 0.03)) during treatment and follow-up. No changes on 2D-STE were detected in the PBT group. 4. Conclusions: Patients who underwent PhT but not PBT had reduced tissue Doppler velocities and SRe values during follow-up, suggesting early myocardial relaxation abnormalities. PBT shows promise as a cardiac-sparing RT technology.
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Affiliation(s)
| | - Giulia Bruno
- Hypertension Unit, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, 3-10126 Torino, Italy
| | - Cristina Di Stefano
- Hypertension Unit, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, 3-10126 Torino, Italy
| | - Laura Garcia Bello
- Department of Cardiovascular Medicine Mayo Clinic, Rochester, MN 55905, USA
| | - Nadia N. Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | - Robert W. Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Pharmacology, Mayo Clinic, Rochester, MN 55905, USA
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Pellikka PA. Myocardial Work as a Metric of Cardiac Performance. J Am Soc Echocardiogr 2023; 36:1019-1020. [PMID: 37798054 DOI: 10.1016/j.echo.2023.08.011] [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] [Indexed: 10/07/2023]
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Michelena HI, Anand V, Enriquez-Sarano M, Pellikka PA. Correspondence on 'Prevalence of pulmonary hypertension in aortic regurgitation and its influence on outcomes' by Ratwatte et al. Heart 2023; 109:1574. [PMID: 37657915 DOI: 10.1136/heartjnl-2023-323347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/03/2023] Open
Affiliation(s)
- Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Vidhu Anand
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | | | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
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Zagatina A, Rivadeneira Ruiz M, Ciampi Q, Wierzbowska-Drabik K, Kasprzak J, Kalinina E, Begidova I, Peteiro J, Arbucci R, Marconi S, Lowenstein J, Boshchenko A, Manganelli F, Čelutkienė J, Morrone D, Merli E, Re F, Borguezan-Daros C, Haberka M, Saad AK, Djordjevic-Dikic A, Ratanasit NC, Rigo F, Colonna P, Pretto JLDCES, Mori F, D’Alfonso MG, Ostojic M, Stanetic B, Preradovic TK, Costantino F, Barbieri A, Citro R, Pitino A, Pepi M, Carerj S, Pellikka PA, Picano E. Rest and Stress Left Atrial Dysfunction in Patients with Atrial Fibrillation. J Clin Med 2023; 12:5893. [PMID: 37762833 PMCID: PMC10532252 DOI: 10.3390/jcm12185893] [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: 08/21/2023] [Revised: 09/01/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Left atrial (LA) myopathy with paroxysmal and permanent atrial fibrillation (AF) is frequent in chronic coronary syndromes (CCS) but sometimes occult at rest and elicited by stress. AIM This study sought to assess LA volume and function at rest and during stress across the spectrum of AF. METHODS In a prospective, multicenter, observational study design, we enrolled 3042 patients [age = 64 ± 12; 63.8% male] with known or suspected CCS: 2749 were in sinus rhythm (SR, Group 1); 191 in SR with a history of paroxysmal AF (Group 2); and 102 were in permanent AF (Group 3). All patients underwent stress echocardiography (SE). We measured left atrial volume index (LAVI) in all patients and LA Strain reservoir phase (LASr) in a subset of 486 patients. RESULTS LAVI increased from Group 1 to 3, both at rest (Group 1 = 27.6 ± 12.2, Group 2 = 31.6 ± 12.9, Group 3 = 43.3 ± 19.7 mL/m2, p < 0.001) and at peak stress (Group 1 = 26.2 ± 12.0, Group 2 = 31.2 ± 12.2, Group 3 = 43.9 ± 19.4 mL/m2, p < 0.001). LASr progressively decreased from Group 1 to 3, both at rest (Group 1 = 26.0 ± 8.5%, Group 2 = 23.2 ± 11.2%, Group 3 = 8.5 ± 6.5%, p < 0.001) and at peak stress (Group 1 = 26.9 ± 10.1, Group 2 = 23.8 ± 11.0 Group 3 = 10.7 ± 8.1%, p < 0.001). Stress B-lines (≥2) were more frequent in AF (Group 1 = 29.7% vs. Group 2 = 35.5% vs. Group 3 = 57.4%, p < 0.001). Inducible ischemia was less frequent in SR (Group 1 = 16.1% vs. Group 2 = 24.7% vs. Group 3 = 24.5%, p = 0.001). CONCLUSIONS In CCS, rest and stress LA dilation and reservoir dysfunction are often present in paroxysmal and, more so, in permanent AF and are associated with more frequent inducible ischemia and pulmonary congestion during stress.
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Affiliation(s)
- Angela Zagatina
- Cardiology Department, Research Scientific Cardiocenter “Medika”, 197110 St. Petersburg, Russia; (A.Z.); (E.K.); (I.B.)
| | | | - Quirino Ciampi
- Fatebenefratelli Hospital of Benevento, 82100 Benevento, Italy;
| | | | - Jaroslaw Kasprzak
- Cardiology Department, Bieganski Hospital, Medical University, 93-510 Lodz, Poland;
| | - Elena Kalinina
- Cardiology Department, Research Scientific Cardiocenter “Medika”, 197110 St. Petersburg, Russia; (A.Z.); (E.K.); (I.B.)
| | - Irina Begidova
- Cardiology Department, Research Scientific Cardiocenter “Medika”, 197110 St. Petersburg, Russia; (A.Z.); (E.K.); (I.B.)
| | - Jesus Peteiro
- CHUAC—Complexo Hospitalario Universitario A Coruna, University of A Coruna, 15071 La Coruna, Spain;
| | - Rosina Arbucci
- Cardiodiagnosticos, Investigaciones Medicas Center, Buenos Aires C1082, Argentina; (R.A.); (S.M.); (J.L.)
| | - Sofia Marconi
- Cardiodiagnosticos, Investigaciones Medicas Center, Buenos Aires C1082, Argentina; (R.A.); (S.M.); (J.L.)
| | - Jorge Lowenstein
- Cardiodiagnosticos, Investigaciones Medicas Center, Buenos Aires C1082, Argentina; (R.A.); (S.M.); (J.L.)
| | - Alla Boshchenko
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, 634028 Tomsk, Russia;
| | - Fiore Manganelli
- Cardiology Department, SG Moscati Hospital, 83100 Avellino, Italy;
| | - Jelena Čelutkienė
- Centre of Cardiology and Angiology, Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Centre of Innovative Medicine, LT-10257 Vilnius, Lithuania;
| | - Doralisa Morrone
- Cardiothoracic Department, University of Pisa, 56126 Pisa, Italy;
| | - Elisa Merli
- Department of Cardiology, Ospedale per gli Infermi, Faenza, 48100 Ravenna, Italy;
| | - Federica Re
- Department of Cardiology, Ospedale San Camillo, 00149 Roma, Italy;
| | | | - Maciej Haberka
- Department of Cardiology, SHS, Medical University of Silesia, 40-635 Katowice, Poland;
| | - Ariel K. Saad
- División de Cardiología, Hospital de Clínicas José de San Martín, Buenos Aires C1120, Argentina;
| | - Ana Djordjevic-Dikic
- Cardiology Clinic, University Center Serbia, Medical School, University of Belgrade, 11000 Belgrade, Serbia;
| | - Nithima Chaowalit Ratanasit
- Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
| | - Fausto Rigo
- Department of Cardiology, Dolo Hospital, 30031 Venice, Italy;
| | - Paolo Colonna
- Cardiology Division, Bari University Hospital, 70100 Bari, Italy;
| | | | - Fabio Mori
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, 50139 Firenze, Italy; (F.M.); (M.G.D.)
| | - Maria Grazia D’Alfonso
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, 50139 Firenze, Italy; (F.M.); (M.G.D.)
| | - Miodrag Ostojic
- Department of Noninvasive Cardiology, University Clinical Center, School of Medicine, 78000 Banja-Luka, Bosnia and Herzegovina; (M.O.); (B.S.); (T.K.P.)
| | - Bojan Stanetic
- Department of Noninvasive Cardiology, University Clinical Center, School of Medicine, 78000 Banja-Luka, Bosnia and Herzegovina; (M.O.); (B.S.); (T.K.P.)
| | - Tamara Kovacevic Preradovic
- Department of Noninvasive Cardiology, University Clinical Center, School of Medicine, 78000 Banja-Luka, Bosnia and Herzegovina; (M.O.); (B.S.); (T.K.P.)
| | | | - Andrea Barbieri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy;
| | - Rodolfo Citro
- Cardiology Division, Ospedale Ruggi di Aragona, 84100 Salerno, Italy;
| | | | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, 20138 Milano, Italy;
| | - Scipione Carerj
- Cardiology Division, University Hospital Polyclinic G.Martino, University of Messina, 98166 Messina, Italy;
| | | | - Eugenio Picano
- CNR, Institute of Clinical Physiology, 56124 Pisa, Italy;
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Anand V, Scott CG, Rigolin VH, Lee AT, Kane GC, Michelena HI, Pislaru SV, Crestanello J, Saran N, Pellikka PA. Echocardiographic Monoplane Left Ventricular Volumes to Assess Remodeling in Chronic Severe Aortic Regurgitation. J Am Soc Echocardiogr 2023; 36:1009-1011. [PMID: 37230423 DOI: 10.1016/j.echo.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)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Vidhu Anand
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota
| | - Christopher G Scott
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Vera H Rigolin
- Department of Cardiovascular Medicine, Northwestern University, Chicago, Illinois
| | - Alexander T Lee
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota
| | | | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota
| | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Nishant Saran
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
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Naser JA, Lee E, Michelena HI, Lin G, Pellikka PA, Nkomo VT, Noseworthy PA, Friedman PA, Attia ZI, Pislaru SV. Artificial Intelligence-Enabled Electrocardiogram in the Detection of Patients at Risk of Atrial Secondary Mitral Regurgitation. Circ Arrhythm Electrophysiol 2023; 16:e012033. [PMID: 37565338 DOI: 10.1161/circep.123.012033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Affiliation(s)
- Jwan A Naser
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Eunjung Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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Bois JP, Ayoub C, Geske JB, Wong YW, Abbasi MA, Foley TA, Mulvagh SL, Scott CG, Ommen SR, Pellikka PA. Ultrasound Enhancing Agents with Transthoracic Echocardiography for Maximal Wall Thickness in Hypertrophic Cardiomyopathy. Mayo Clin Proc Innov Qual Outcomes 2023; 7:309-319. [PMID: 37502339 PMCID: PMC10371766 DOI: 10.1016/j.mayocpiqo.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Objectives To determine whether ultrasound enhancing agent (UEA) changes maximal wall thickness (WT) in hypertrophic cardiomyopathy (HCM), and if it improves correlation with magnetic resonance imaging (MRI). Patients and Methods A total of 107 patients with HCM were prospectively enrolled at a single tertiary referral center between July 10, 2014, and August 31, 2017, and underwent transthoracic echocardiography (TTE) with and without UEA and MRI. Maximal WT measurements were compared, and variability among the 3 modalities was evaluated using a simple linear regression analysis and paired t tests and Bland-Altman plots. Interobserver variability for each technique was assessed. Results Most (63%) of cardiac imagers found UEA helpful in determining maximal WT by TTE, with 49% reporting change in WT. Of 52 patients where UEA changed WT measurement, 32 (62%) reported an increase and 20 (38%) reported a decrease in WT. The UEA did not alter the median discrepancy in WT between MRI and TTE. However, where UEA increased reported WT, the difference between MRI and TTE improved in 79% of cases (P=.001) from 2.0-0.5mm. In those with scar on MRI, UEA improved agreement of WT between TTE and MRI compared with that of TTE without UEA (79% vs 39%; P=.011). Interclass correlation coefficient for WT for TTE without UEA, with UEA, and MRI was 0.84; (95% CI, 0.61-0.92), 0.88; (95%CI, 0.82-0.92), and 0.97; (95%CI, 0.96-0.98), respectively. Conclusion Although use of UEA did not eliminate differences in WT discrepancy between modalities, the addition of UEA to TTE aided in WT determination and improved correlation with MRI in those with greater WT and in all patients with myocardial scars.
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Affiliation(s)
- John P. Bois
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Chadi Ayoub
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Jeffrey B. Geske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Yee Weng Wong
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Muhannad A. Abbasi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Sharon L. Mulvagh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Christopher G. Scott
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Steve R. Ommen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Piña P, Lorenzatti D, Pellikka PA, Shah N, Slipczuk L. Prognostic value of left atrial strain in multiple myeloma. Eur J Intern Med 2023; 114:150-153. [PMID: 37217406 DOI: 10.1016/j.ejim.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023]
Affiliation(s)
- Pamela Piña
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210st, Bronx, NY, USA; Division of Cardiology, CEDIMAT, Santo Domingo, USA
| | - Daniel Lorenzatti
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210st, Bronx, NY, USA
| | | | - Nishi Shah
- Oncology Department, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Leandro Slipczuk
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210st, Bronx, NY, USA.
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Pellikka PA. Stress Echo for Detection of Ischemia: What's New? J Am Soc Echocardiogr 2023; 36:803-804. [PMID: 37541737 DOI: 10.1016/j.echo.2023.06.006] [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: 08/06/2023]
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Krishna H, Desai K, Slostad B, Bhayani S, Arnold JH, Ouwerkerk W, Hummel Y, Lam CSP, Ezekowitz J, Frost M, Jiang Z, Equilbec C, Twing A, Pellikka PA, Frazin L, Kansal M. Fully Automated Artificial Intelligence Assessment of Aortic Stenosis by Echocardiography. J Am Soc Echocardiogr 2023; 36:769-777. [PMID: 36958708 DOI: 10.1016/j.echo.2023.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Aortic stenosis (AS) is a common form of valvular heart disease, present in over 12% of the population age 75 years and above. Transthoracic echocardiography (TTE) is the first line of imaging in the adjudication of AS severity but is time-consuming and requires expert sonographic and interpretation capabilities to yield accurate results. Artificial intelligence (AI) technology has emerged as a useful tool to address these limitations but has not yet been applied in a fully hands-off manner to evaluate AS. Here, we correlate artificial neural network measurements of key hemodynamic AS parameters to experienced human reader assessment. METHODS Two-dimensional and Doppler echocardiographic images from patients with normal aortic valves and all degrees of AS were analyzed by an artificial neural network (Us2.ai) with no human input to measure key variables in AS assessment. Trained echocardiographers blinded to AI data performed manual measurements of these variables, and correlation analyses were performed. RESULTS Our cohort included 256 patients with an average age of 67.6 ± 9.5 years. Across all AS severities, AI closely matched human measurement of aortic valve peak velocity (r = 0.97, P < .001), mean pressure gradient (r = 0.94, P < .001), aortic valve area by continuity equation (r = 0.88, P < .001), stroke volume index (r = 0.79, P < .001), left ventricular outflow tract velocity-time integral (r = 0.89, P < .001), aortic valve velocity-time integral (r = 0.96, P < .001), and left ventricular outflow tract diameter (r = 0.76, P < .001). CONCLUSIONS Artificial neural networks have the capacity to closely mimic human measurement of all relevant parameters in the adjudication of AS severity. Application of this AI technology may minimize interscan variability, improve interpretation and diagnosis of AS, and allow for precise and reproducible identification and management of patients with AS.
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Affiliation(s)
- Hema Krishna
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois; Jesse Brown VA Medical Center, Chicago, Illinois
| | - Kevin Desai
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Brody Slostad
- Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois
| | - Siddharth Bhayani
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Joshua H Arnold
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Wouter Ouwerkerk
- National Heart Centre Singapore, Singapore; Department of Dermatology, Amsterdam UMC, Amsterdam, Netherlands
| | | | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Justin Ezekowitz
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | - Aamir Twing
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | | | - Leon Frazin
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois; Jesse Brown VA Medical Center, Chicago, Illinois
| | - Mayank Kansal
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois; Jesse Brown VA Medical Center, Chicago, Illinois.
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Winchester DE, Maron DJ, Blankstein R, Chang IC, Kirtane AJ, Kwong RY, Pellikka PA, Prutkin JM, Russell R, Sandhu AT. ACC/AHA/ASE/ASNC/ASPC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2023 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Chronic Coronary Disease. J Am Coll Cardiol 2023; 81:2445-2467. [PMID: 37245131 DOI: 10.1016/j.jacc.2023.03.410] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Oguz D, Huntley GD, El-Am EA, Scott CG, Thaden JJ, Pislaru SV, Fabre KL, Singh M, Greason KL, Crestanello JA, Pellikka PA, Oh JK, Nkomo VT. Impact of atrial fibrillation on outcomes in asymptomatic severe aortic stenosis: a propensity-matched analysis. Front Cardiovasc Med 2023; 10:1195123. [PMID: 37408654 PMCID: PMC10318187 DOI: 10.3389/fcvm.2023.1195123] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/05/2023] [Indexed: 07/07/2023] Open
Abstract
Background Atrial fibrillation (AF) portends poor prognosis in patients with aortic stenosis (AS). Objectives This study aimed to study the association of AF vs. sinus rhythm (SR) with outcomes in asymptomatic severe AS during routine clinical practice. Methods We identified 909 asymptomatic patients from 3,208 consecutive patients with aortic valve area ≤1.0 cm2 and left ventricular ejection fraction ≥50% at a tertiary academic center. Patients were grouped by rhythm at the time of transthoracic echocardiogram [SR: 820/909 (90%) and AF: 89/909 (10%)]. Propensity-matched analyses (2 SR:1 AF) matching 174 SR to 89 AF patients by age, sex, and clinical comorbidities were used to compare outcomes. Results In the propensity-matched cohort, median age (82 ± 8 vs. 81 ± 9 years, p = 0.31), sex distribution (male 58% vs. 52%, p = 0.30), and Charlson comorbidity index (4.0 vs. 3.0, p = 0.26) were not different in AF vs. SR. Median follow-up duration was 2.6 (IQR: 1.0-4.4) years. The 1-year rate of aortic valve replacement (AVR) was not different (AF: 32% vs. SR: 37%, p = 0.31). All-cause mortality was higher in AF [hazard ratio (HR): 1.68 (1.13-2.50), p = 0.009]. Independent predictors of mortality were age [HR: 1.92 (1.40-2.62), p < 0.001], Charlson comorbidity index [1.09 (1.03-1.15), p = 0.002], aortic valve peak velocity [HR: 1.87 (1.20-2.94), p = 0.006], stroke volume index [HR: 0.75 (0.60-0.93), p = 0.01], moderate or more mitral regurgitation [HR: 2.97 (1.43-6.19), p = 0.004], right ventricular systolic dysfunction [HR: 2.39 (1.29-4.43), p = 0.006], and time-dependent AVR [HR: 0.36 (0.19-0.65), p = 0.0008]. There was no significant interaction of AVR and rhythm (p = 0.57). Conclusions Lower forward flow, right ventricular systolic dysfunction, and mitral regurgitation identified increased risk of subsequent mortality in asymptomatic patients with AF and AS. Additional studies of risk stratification of asymptomatic AS in AF vs. SR are needed.
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Affiliation(s)
- Didem Oguz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Geoffrey D. Huntley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Edward A. El-Am
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Christopher G. Scott
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Jeremy J. Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Sorin V. Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Katarina L. Fabre
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Kevin L. Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States
| | - Juan A. Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States
| | - Patricia A. Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jae K. Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Vuyisile T. Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
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Pellikka PA. What Are JASE Readers Reading? J Am Soc Echocardiogr 2023; 36:567-568. [PMID: 37270257 DOI: 10.1016/j.echo.2023.04.013] [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: 06/05/2023]
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Egbe AC, Miranda WR, Anderson JH, Pellikka PA, Stephens EH, Andi K, Abozied O, Connolly HM. Left ventricular adaptation to aortic regurgitation in adults with repaired coarctation of aorta. Int J Cardiol 2023:S0167-5273(23)00650-2. [PMID: 37149005 DOI: 10.1016/j.ijcard.2023.04.061] [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: 11/15/2022] [Revised: 04/05/2023] [Accepted: 04/30/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Aortic regurgitation (AR) can develop in adults with repaired coarctation of aorta (COA), but there are limited data about left ventricular (LV) remodeling and clinical outcomes in this population. The purpose of the study was to compare LV remodeling (LV mass index [LVMI], LV ejection fraction [LVEF], and septal E/e') and onset of symptoms before aortic valve replacement, and LV reverse remodeling (%-change in LVMI, LVEF and E/e') after aortic valve replacement in patients with versus without repaired COA presenting with AR. METHODS Asymptomatic adults with repaired COA presenting with moderate/severe AR (AR-COA group) were matched 1:2 to asymptomatic adults without COA and similar severity of AR (control group). RESULTS Although both groups (AR-COA n = 52, and control n = 104) had similar age, sex, body mass index, aortic valve gradient, and AR severity, the AR-COA group had higher LVMI (124 ± 28 versus 102 ± 25 g/m2, p < 0.001) and E/e' (12.3 ± 2.3 versus 9.5 ± 2.1, p = 0.02) but similar LVEF (63 ± 9% versus 67 ± 10%, p = 0.4). COA diagnosis (adjusted HR 1.95, 95%CI 1.49-2.37, p < 0.001), older age, E/e', and LV hypertrophy were associated with onset of symptoms. Of 89 patients (AR-COA n = 41, and control n = 48) with echocardiographic data at 1-year post- aortic valve replacement, the AR-COA group had less regression of LVMI (-8% [95%CI -5 to -11] versus -17% [95%CI -15 to -21], p < 0.001) and E/e' (-5% [95% CI -3 to -7] versus -16% [95% CI -13 to -19], p < 0.001). CONCLUSIONS Patients with COA and AR had a more aggressive clinical course, and perhaps may require a different threshold for surgical intervention.
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Affiliation(s)
- Alexander C Egbe
- Cardiovascular Medicine, and Department of Cardiovascular Surgery, Mayo Clinic Rochester, MN 55905, United States of America.
| | - William R Miranda
- Cardiovascular Medicine, and Department of Cardiovascular Surgery, Mayo Clinic Rochester, MN 55905, United States of America
| | - Jason H Anderson
- Cardiovascular Medicine, and Department of Cardiovascular Surgery, Mayo Clinic Rochester, MN 55905, United States of America
| | - Patricia A Pellikka
- Cardiovascular Medicine, and Department of Cardiovascular Surgery, Mayo Clinic Rochester, MN 55905, United States of America
| | - Elizabeth H Stephens
- Cardiovascular Medicine, and Department of Cardiovascular Surgery, Mayo Clinic Rochester, MN 55905, United States of America
| | - Kartik Andi
- Cardiovascular Medicine, and Department of Cardiovascular Surgery, Mayo Clinic Rochester, MN 55905, United States of America
| | - Omar Abozied
- Cardiovascular Medicine, and Department of Cardiovascular Surgery, Mayo Clinic Rochester, MN 55905, United States of America
| | - Heidi M Connolly
- Cardiovascular Medicine, and Department of Cardiovascular Surgery, Mayo Clinic Rochester, MN 55905, United States of America
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Anand V, Hu H, Weston AD, Scott CG, Michelena HI, Pislaru SV, Carter RE, Pellikka PA. Machine learning-based risk stratification for mortality in patients with severe aortic regurgitation. Eur Heart J Digit Health 2023; 4:188-195. [PMID: 37265866 PMCID: PMC10232267 DOI: 10.1093/ehjdh/ztad006] [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] [Received: 06/08/2022] [Revised: 12/06/2022] [Indexed: 06/03/2023]
Abstract
Aims The current guidelines recommend aortic valve intervention in patients with severe aortic regurgitation (AR) with the onset of symptoms, left ventricular enlargement, or systolic dysfunction. Recent studies have suggested that we might be missing the window of early intervention in a significant number of patients by following the guidelines. Methods and results The overarching goal was to determine if machine learning (ML)-based algorithms could be trained to identify patients at risk for death from AR independent of aortic valve replacement (AVR). Models were trained with five-fold cross-validation on a dataset of 1035 patients, and performance was reported on an independent dataset of 207 patients. Optimal predictive performance was observed with a conditional random survival forest model. A subset of 19/41 variables was selected for inclusion in the final model. Variable selection was performed with 10-fold cross-validation using random survival forest model. The top variables included were age, body surface area, body mass index, diastolic blood pressure, New York Heart Association class, AVR, comorbidities, ejection fraction, end-diastolic volume, and end-systolic dimension, and the relative variable importance averaged across five splits of cross-validation in each repeat were evaluated. The concordance index for predicting survival of the best-performing model was 0.84 at 1 year, 0.86 at 2 years, and 0.87 overall, respectively. Conclusion Using common echocardiographic parameters and patient characteristics, we successfully trained multiple ML models to predict survival in patients with severe AR. This technique could be applied to identify high-risk patients who would benefit from early intervention, thereby improving patient outcomes.
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Affiliation(s)
- Vidhu Anand
- Corresponding author. Tel: +507 284 4441, Fax: +507 266 0228,
| | - Hanwen Hu
- Department of Quantitative Health Sciences Research, Mayo Clinic, Jacksonville, FL 32202, USA
| | - Alexander D Weston
- Department of Quantitative Health Sciences Research, Mayo Clinic, Jacksonville, FL 32202, USA
| | - Christopher G Scott
- Department of Quantitative Health Science, Mayo Clinic, Rochester, MN 55905, USA
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic Rochester Minnesota, 200 First Street SW, Rochester, MN 55905, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic Rochester Minnesota, 200 First Street SW, Rochester, MN 55905, USA
| | - Rickey E Carter
- Department of Quantitative Health Sciences Research, Mayo Clinic, Jacksonville, FL 32202, USA
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Cui Z, Castagna F, Hanif W, Apple SJ, Zhang L, Tauras JM, Braunschweig I, Kaur G, Janakiram M, Wang Y, Fang Y, Diaz JC, Hoyos C, Marin J, Pellikka PA, Romero JE, Garcia MJ, Verma AK, Shah N, Slipczuk L. Global Longitudinal Strain Is Associated with Mortality in Patients with Multiple Myeloma. J Clin Med 2023; 12:2595. [PMID: 37048679 PMCID: PMC10095531 DOI: 10.3390/jcm12072595] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Patients with multiple myeloma (MM) are at a high risk for developing cardiovascular complications. Global longitudinal strain (GLS) can detect early functional impairment before structural abnormalities develop. It remains unknown if reduced GLS is associated with reduced survival in patients with MM. We conducted a retrospective cohort analysis of patients diagnosed with MM between 1 January 2000 and 31 December 2017 at our institution. Patients with a 2D transthoracic echocardiogram completed within 1 year of MM diagnosis, left ventricular ejection fraction (LVEF) greater than 40%, and no history of myocardial infarction prior to MM diagnosis were included. GLS was measured using an artificial-intelligence-powered software (EchoGo Core), with reduced GLS defined as an absolute value of <18%. The primary outcome of interest was overall survival since myeloma diagnosis. Our cohort included 242 patients with a median follow up of 4.28 years. Fifty-two (21.5%) patients had reduced average GLS. Patients with reduced GLS were more likely to have an IVSd ≥ 1.2cm, E/E' > 9.6, LVEF/GLS > 4.1, higher LV mass index, and low-voltage ECG. A Total of 126 (52.1%) deaths occurred during follow-up. Overall survival was lower among patients with reduced GLS (adjusted HR: 1.81, CI: 1.07-3.05).
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Affiliation(s)
- Zhu Cui
- Department of Internal Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Francesco Castagna
- Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Waqas Hanif
- Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Samuel J. Apple
- Department of Internal Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Lili Zhang
- Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - James M. Tauras
- Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Ira Braunschweig
- Oncology Department, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Gurbakhash Kaur
- Hematology Oncology Division, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Murali Janakiram
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN 55812, USA
| | - Yanhua Wang
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Yanan Fang
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | | | - Carolina Hoyos
- Heart and Vascular Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jorge Marin
- Clínica Las Americas, Medellin 50025, Colombia
| | | | - Jorge E. Romero
- Heart and Vascular Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Mario J. Garcia
- Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Amit K. Verma
- Oncology Department, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Nishi Shah
- Oncology Department, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Leandro Slipczuk
- Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Pellikka PA. In Memoriam: Bijoy K. Khandheria, MD, FASE. J Am Soc Echocardiogr 2023; 36:563-564. [PMID: 36948930 DOI: 10.1016/j.echo.2023.02.014] [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] [Received: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/24/2023]
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47
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Naser J, Michelena HI, Kennedy A, Pislaru S, Chebib F, Pellikka PA, Nkomo VT. HEMODYNAMICS AND CLINICAL OUTCOMES OF TAVR IN PATIENTS WITH CHRONIC KIDNEY DISEASE AT MEDIUM-TERM FOLLOW UP. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01274-3] [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: 03/06/2023]
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48
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Yang LT, Ullah MW, Ye Z, Maleszewski JJ, Scott C, Padang R, Pislaru S, Nkomo VT, Mankad SV, Pellikka PA, Oh JK, Roger VL, Enriquez-Sarano M, Michelena HI. LIFETIME OUTCOMES OF PATIENTS WITH BICUSPID AORTIC VALVES IN THE COMMUNITY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02372-0] [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: 03/06/2023]
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49
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Deb B, Scott C, Pislaru S, Nkomo VT, Kane GC, Alkhouli MA, Saran N, Crestanello JA, Pellikka PA, Anand V. MACHINE-LEARNING OF CLINICAL FEATURES PREDICTS MORTALITY IN MODERATE-SEVERE TRICUSPID REGURGITATION: A LARGE REGISTRY STUDY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02452-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: 03/06/2023]
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50
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Gharacholou SM, Hodge DO, Umadat G, Meyers C, Kane GC, Sinak LJ, Pellikka PA, Cooper LT, Parikh P, Sabbagh AE. LONG TERM OUTCOMES OF PATIENTS WITH PULMONARY HYPERTENSION FOLLOWING PERICARDIAL FLUID DRAINAGE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02353-7] [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: 03/07/2023]
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