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Singh A, Donnino R, Small A, Bangalore S. Anomalous right coronary artery originating from the opposite sinus of Valsalva: Fractional flow reserve and intravascular ultrasound-guided management. Catheter Cardiovasc Interv 2023; 102:892-895. [PMID: 37724846 DOI: 10.1002/ccd.30839] [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: 05/21/2023] [Revised: 08/16/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Abstract
There remains significant controversy in the risk stratification and management of patients with anomalous right coronary artery originating from the opposite sinus (R-ACAOS). We present the case of a patient with an inferior ST-elevation myocardial infarction, found to have R-ACAOS and severe atherosclerotic right coronary artery disease, treated with fractional flow reserve and intravascular ultrasound-guided percutaneous coronary intervention.
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Affiliation(s)
- Arushi Singh
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Robert Donnino
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
- Division of Cardiology, Veteran Affairs, Manhattan Campus, New York, New York, USA
- Department of Radiology, NYU Grossman School of Medicine, New York, New York, USA
| | - Adam Small
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Sripal Bangalore
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
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2
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Choi DY, Hayes D, Maidman SD, Dhaduk N, Jacobs JE, Shmukler A, Berger JS, Cuff G, Rehe D, Lee M, Donnino R, Smilowitz NR. Existing Nongated CT Coronary Calcium Predicts Operative Risk in Patients Undergoing Noncardiac Surgeries (ENCORES). Circulation 2023; 148:1154-1164. [PMID: 37732454 PMCID: PMC10592001 DOI: 10.1161/circulationaha.123.064398] [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: 02/13/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Preoperative cardiovascular risk stratification before noncardiac surgery is a common clinical challenge. Coronary artery calcium scores from ECG-gated chest computed tomography (CT) imaging are associated with perioperative events. At the time of preoperative evaluation, many patients will not have had ECG-gated CT imaging, but will have had nongated chest CT studies performed for a variety of noncardiac indications. We evaluated relationships between coronary calcium severity estimated from previous nongated chest CT imaging and perioperative major clinical events (MCE) after noncardiac surgery. METHODS We retrospectively identified consecutive adults age ≥45 years who underwent in-hospital, major noncardiac surgery from 2016 to 2020 at a large academic health system composed of 4 acute care centers. All patients had nongated (contrast or noncontrast) chest CT imaging performed within 1 year before surgery. Coronary calcium in each vessel was retrospectively graded from absent to severe using a 0 to 3 scale (absent, mild, moderate, severe) by physicians blinded to clinical data. The estimated coronary calcium burden (ECCB) was computed as the sum of scores for each coronary artery (0 to 9 scale). A Revised Cardiac Risk Index was calculated for each patient. Perioperative MCE was defined as all-cause death or myocardial infarction within 30 days of surgery. RESULTS A total of 2554 patients (median age, 68 years; 49.7% women; median Revised Cardiac Risk Index, 1) were included. The median time interval from nongated chest CT imaging to noncardiac surgery was 15 days (interquartile range, 3-106 days). The median ECCB was 1 (interquartile range, 0-3). Perioperative MCE occurred in 136 (5.2%) patients. Higher ECCB values were associated with stepwise increases in perioperative MCE (0: 2.9%, 1-2: 3.7%, 3-5: 8.0%; 6-9: 12.6%, P<0.001). Addition of ECCB to a model with the Revised Cardiac Risk Index improved the C-statistic for MCE (from 0.675 to 0.712, P=0.018), with a net reclassification improvement of 0.428 (95% CI, 0.254-0.601, P<0.0001). An ECCB ≥3 was associated with 2-fold higher adjusted odds of MCE versus an ECCB <3 (adjusted odds ratio, 2.11 [95% CI, 1.42-3.12]). CONCLUSIONS Prevalence and severity of coronary calcium obtained from existing nongated chest CT imaging improve preoperative clinical risk stratification before noncardiac surgery.
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Affiliation(s)
- Daniel Y Choi
- Leon H. Charney Division of Cardiology (D.Y.C., D.H., S.D.M., N.D., J.S.B., R.D., N.R.S.), New York University Grossman School of Medicine, New York, NY
| | - Dena Hayes
- Leon H. Charney Division of Cardiology (D.Y.C., D.H., S.D.M., N.D., J.S.B., R.D., N.R.S.), New York University Grossman School of Medicine, New York, NY
| | - Samuel D Maidman
- Leon H. Charney Division of Cardiology (D.Y.C., D.H., S.D.M., N.D., J.S.B., R.D., N.R.S.), New York University Grossman School of Medicine, New York, NY
| | - Nehal Dhaduk
- Leon H. Charney Division of Cardiology (D.Y.C., D.H., S.D.M., N.D., J.S.B., R.D., N.R.S.), New York University Grossman School of Medicine, New York, NY
| | - Jill E Jacobs
- Department of Radiology (J.E.J., A.S., R.D.), New York University Grossman School of Medicine, New York, NY
| | - Anna Shmukler
- Department of Radiology (J.E.J., A.S., R.D.), New York University Grossman School of Medicine, New York, NY
| | - Jeffrey S Berger
- Leon H. Charney Division of Cardiology (D.Y.C., D.H., S.D.M., N.D., J.S.B., R.D., N.R.S.), New York University Grossman School of Medicine, New York, NY
- Department of Surgery (J.S.B.), New York University Grossman School of Medicine, New York, NY
| | - Germaine Cuff
- Department of Anesthesiology, Perioperative Care and Pain Medicine (G.C., D.R., M.L.), New York University Grossman School of Medicine, New York, NY
| | - David Rehe
- Department of Anesthesiology, Perioperative Care and Pain Medicine (G.C., D.R., M.L.), New York University Grossman School of Medicine, New York, NY
| | - Mitchell Lee
- Department of Anesthesiology, Perioperative Care and Pain Medicine (G.C., D.R., M.L.), New York University Grossman School of Medicine, New York, NY
| | - Robert Donnino
- Leon H. Charney Division of Cardiology (D.Y.C., D.H., S.D.M., N.D., J.S.B., R.D., N.R.S.), New York University Grossman School of Medicine, New York, NY
- Department of Radiology (J.E.J., A.S., R.D.), New York University Grossman School of Medicine, New York, NY
- Cardiology Division, Department of Medicine, Veterans Affairs New York Harbor Healthcare System, New York, NY (R.D., N.R.S.)
| | - Nathaniel R Smilowitz
- Leon H. Charney Division of Cardiology (D.Y.C., D.H., S.D.M., N.D., J.S.B., R.D., N.R.S.), New York University Grossman School of Medicine, New York, NY
- Cardiology Division, Department of Medicine, Veterans Affairs New York Harbor Healthcare System, New York, NY (R.D., N.R.S.)
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Singh A, Kadosh BS, Grossman K, Donnino R, Narula N, Zhou F, DiVita M, Smith DE, Moazami N, Chang SH, Angel LF, Reyentovich A. Nonischemic Cardiomyopathy With Myocardial Calcinosis Masquerading as Cardiac Amyloidosis. Circ Heart Fail 2023; 16:e010338. [PMID: 37492988 DOI: 10.1161/circheartfailure.122.010338] [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: 07/27/2023]
Affiliation(s)
- Arushi Singh
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine (A.S., B.S.K., K.G., R.D., M.D., A.R.)
| | - Bernard S Kadosh
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine (A.S., B.S.K., K.G., R.D., M.D., A.R.)
| | - Kelsey Grossman
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine (A.S., B.S.K., K.G., R.D., M.D., A.R.)
| | - Robert Donnino
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine (A.S., B.S.K., K.G., R.D., M.D., A.R.)
- Division of Cardiology, Veteran Affairs, Manhattan Campus, New York (R.D.)
- Departments of Radiology (R.D.), New York University Grossman School of Medicine, New York
| | - Navneet Narula
- Pathology (N.N., F.Z.), New York University Grossman School of Medicine, New York
| | - Fang Zhou
- Pathology (N.N., F.Z.), New York University Grossman School of Medicine, New York
| | - Michael DiVita
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine (A.S., B.S.K., K.G., R.D., M.D., A.R.)
| | - Deane E Smith
- Cardiothoracic Surgery (D.E.S., N.M., S.H.C.), New York University Grossman School of Medicine, New York
| | - Nader Moazami
- Cardiothoracic Surgery (D.E.S., N.M., S.H.C.), New York University Grossman School of Medicine, New York
| | - Stephanie H Chang
- Cardiothoracic Surgery (D.E.S., N.M., S.H.C.), New York University Grossman School of Medicine, New York
| | - Luis F Angel
- Medicine (L.F.A.), New York University Grossman School of Medicine, New York
| | - Alex Reyentovich
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine (A.S., B.S.K., K.G., R.D., M.D., A.R.)
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Zhang RS, Alter E, Kozloff S, Choy-Shan A, Xia Y, Patel K, Gozansky EK, Saric M, Stojanovska J, Donnino R. Concordance of Pericardial Effusion Size Between Computed Tomography and Echocardiography. Am J Cardiol 2023; 203:92-97. [PMID: 37487407 DOI: 10.1016/j.amjcard.2023.06.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/20/2023] [Accepted: 06/29/2023] [Indexed: 07/26/2023]
Abstract
Discrepancy between computed tomography (CT) and transthoracic echocardiography (TTE) regarding pericardial effusion (PEff) size is common, but there is limited data regarding the correlation between these 2 imaging methods. The aim of this study is to examine the real-world concordance of observed PEff size between CT and TTE. We performed a retrospective analysis of all imaging reports available from 2013 to 2019 and identified patients with a PEff who underwent both a chest CT and TTE within a 24-hour period. We evaluated the agreement between CT and TTE in assessing PEff size. Of 1,118 patients included in the study, mean age was 66 (±17 years) and 54% were female. The median time interval between the 2 studies was 9.4 hours (interquartile range 3.5 to 16.6). Patients within a half-grade or full-grade of agreement were 71.9% and 97.2%, respectively. The mean difference in grade of agreement (TTE minus CT) between the 2 imaging methods was -0.1 (±0.6, p <0.0001). CT was more likely to report a higher grade (i.e. larger PEff size) when compared with TTE (261 patients vs 157 patients, p <0.001). The weighted kappa was 0.73 (95% confidence interval 0.69 to 0.76). After excluding patients with trace/no effusion, 42.3% and 94.1% of patients' studies were within a half-grade or full-grade of agreement, respectively. Of the 18 patients who had large discrepancies, 9 patients had loculated effusions, 2 patients had large pleural effusions, and 6 patients had suboptimal TTEs images. In conclusion, TTE and CT showed relatively strong agreement in estimation of PEff size, with CT sizes larger than TTE, on average. Large discrepancies in size may be related to reduced image quality, large pleural effusions, and loculated PEff.
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Affiliation(s)
- Robert S Zhang
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York
| | - Eric Alter
- Hartford Healthcare Heart and Vascular Institute, St. Vincent's Medical Center, Bridgeport, Connecticut
| | - Samuel Kozloff
- Department of Medicine, University of Utah, Salt Lake City, Utah
| | - Alana Choy-Shan
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York; Veterans Affairs Medical Center, New York, New York
| | - Yuhe Xia
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Kunal Patel
- Division of Hospital Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Elliott K Gozansky
- Department of Radiology, New York University Grossman School of Medicine, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York
| | - Jadranka Stojanovska
- Department of Radiology, New York University Grossman School of Medicine, New York, New York
| | - Robert Donnino
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York; Veterans Affairs Medical Center, New York, New York; Department of Radiology, New York University Grossman School of Medicine, New York, New York.
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Maidman SD, Birjiniuk J, Donnino R, Basu A, Belmont HM, Goldberg RI, Kadosh BS. Rapidly Progressive Primary Scleroderma Cardiomyopathy in a Young Adult Characterized by Multimodality Imaging. CASE (Phila) 2023; 7:349-353. [PMID: 37791122 PMCID: PMC10542747 DOI: 10.1016/j.case.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
•Scleroderma-related heart disease is usually secondary to lung disease or PH. •Scleroderma rarely causes systolic HF in young patients or those without CAD. •A multimodality strategy should be used to characterize scleroderma cardiomyopathy.
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Affiliation(s)
- Samuel D. Maidman
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Joav Birjiniuk
- Department of Surgery, NYU Grossman School of Medicine, New York, New York
| | - Robert Donnino
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
- Department of Radiology, NYU Grossman School of Medicine, New York, New York
- Division of Cardiology, Veteran Affairs NY Harbor Medical Center, Manhattan Campus, New York, New York
| | - Atreyee Basu
- Department of Pathology, NYU Grossman School of Medicine, New York, New York
| | - H. Michael Belmont
- Division of Rheumatology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Randal I. Goldberg
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Bernard S. Kadosh
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
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Choi D, Donnino R, Hayes D, Maidman S, Dhaduk N, Rehe D, Cuff G, Lee M, Shmukler A, Jacobs J. A NOVEL INDEX OF CORONARY ARTERY CALCIUM FROM PRE-OPERATIVE NON-GATED CHEST COMPUTED TOMOGRAPHY IS ASSOCIATED WITH PERIOPERATIVE CARDIOVASCULAR RISK. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01812-0] [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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Maidman SD, Salerno WD, Halpern DG, Donnino R, Saric M. Isolated Left Ventricular Apical Hypoplasia: A Very Rare Congenital Anomaly Characterized by Multimodality Imaging and Invasive Testing. Circ Cardiovasc Imaging 2022; 16:e014789. [PMID: 36448445 DOI: 10.1161/circimaging.122.014789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Samuel D. Maidman
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health. (S.D.M., D.G.H., R.D., M.S.)
| | - William D. Salerno
- Division of Cardiology, Hackensack University Medical Center, Hackensack Meridian School of Medicine, NJ (W.D.S.)
| | - Dan G. Halpern
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health. (S.D.M., D.G.H., R.D., M.S.)
| | - Robert Donnino
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health. (S.D.M., D.G.H., R.D., M.S.)
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health. (R.D.)
- Division of Cardiology, Veteran Affairs NY Harbor Medical Center, Manhattan Campus (R.D.)
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health. (S.D.M., D.G.H., R.D., M.S.)
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8
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Liebman J, Bamira D, Ro R, Vainrib AF, Small AJ, Donnino R, Saric M. Multimodality Imaging of Caval and Coronary Sinus Venous Anomalies. CASE 2022; 6:366-376. [PMID: 36247374 PMCID: PMC9556923 DOI: 10.1016/j.case.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abnormal fetal development can produce several anomalies of the caval venous system. We present multimodality imaging of the most common caval venous anomalies. Each imaging modality provides incremental value when identifying these anomalies. Even normal variants may impact pacing lead or central venous catheter placement. Pathologic variants may lead to intracardiac shunting.
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Abstract
PURPOSE OF REVIEW Myocardial viability is an important pathophysiologic concept which may have significant clinical impact in patients with left ventricular dysfunction due to ischemic heart disease. Understanding the imaging modalities used to assess viability, and the clinical implication of their findings, is critical for clinical decision-making in this population. RECENT FINDINGS The ability of dobutamine echocardiography, single-photon emission computed tomography, positron emission tomography, and cardiac magnetic resonance imaging to predict functional recovery following revascularization is well-established. Despite different advantages and disadvantages for each imaging modality, each modality has demonstrated reasonable performance characteristics in identifying viable myocardium. Recent data, however, has called into question whether this functional recovery leads to improved clinical outcomes. Although the assessment of viability can be used to aid in clinical decision-making prior to revascularization, its broad application to all patients is limited by a lack of data confirming improvement in clinical outcomes. Thus, viability assessments may be best applied to select patients (such as those with increased surgical risk) and integrated with clinical, laboratory, and imaging data to guide clinical care. Future research efforts should be aimed at establishing the impact of viability on clinical outcomes.
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Affiliation(s)
- Kinjan Parikh
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, 10016, USA
| | - Alana Choy-Shan
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, 10016, USA
- Division of Cardiology, VA Harbor Medical Center, Manhattan Campus, 423 E 23rd Street, 12 West, Cardiology, New York, NY, 10010, USA
| | - Munir Ghesani
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Robert Donnino
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, 10016, USA.
- Division of Cardiology, VA Harbor Medical Center, Manhattan Campus, 423 E 23rd Street, 12 West, Cardiology, New York, NY, 10010, USA.
- Department of Radiology, New York University School of Medicine, New York, NY, 10016, USA.
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Lin B, D Jaros B, A Grossi E, Saric M, S Garshick M, Donnino R. Prevalence and Risk Factors of Incomplete Surgical Closure of the Left Atrial Appendage on Follow-up Transesophageal Echocardiogram. J Atr Fibrillation 2020; 13:2357. [PMID: 34950308 DOI: 10.4022/jafib.2357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/15/2020] [Accepted: 07/25/2020] [Indexed: 11/10/2022]
Abstract
Objectives In patients with atrial fibrillation, incomplete left atrial appendage (LAA) closure is associated with an increased risk for cardio-embolic events compared to complete closure. In this study, we aimed to determine the prevalence and risk factors for incomplete surgical closure of the LAA in the modern surgical era. Methods Records of 74 patients with surgical LAA closure who underwent follow-up transesophageal echocardiogram for any reason between 2010 and 2016, were assessed for incomplete closure. Complete closure was defined by absence of Doppler or color flow between the left atrial appendage and the left atrial body in more than 2 orthogonal views. Results Surgical LAA closure was incomplete in 21 patients (28%) and complete in 53 patients (72%). All included cases were completed via oversewing method with a double layer of running suture with or without excision of the LAA. While no individual demographic, echocardiographic, or surgical feature was significantly different between groups, incomplete closure of the LAA was more prevalent in patients with two or more of the risk factors; female sex, hypertension, and hyperlipidemia (OR 5.1, 95%Cl 1.5-17). Conclusions A significant rate of incomplete surgical LAA closure still exists in the modern surgical era, and the presence of multiple risk factors associate an increased risk of incomplete closure.
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Affiliation(s)
- Billy Lin
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Brian D Jaros
- NYU School of Medicine, NYU Langone Health, New York City, New York
| | - Eugene A Grossi
- NYU School of Medicine, NYU Langone Health, New York City, New York.,Veterans Affairs Medical Center, New York (Manhattan Campus), New York City, New York.,Division of Cardiac Surgery, Department of Cardiothoracic Surgery, NYU Langone Health, New York City, New York
| | - Muhamed Saric
- NYU School of Medicine, NYU Langone Health, New York City, New York.,Veterans Affairs Medical Center, New York (Manhattan Campus), New York City, New York.,Leon H. Charney Division of Cardiology, NYU Langone Health, New York City, New York
| | - Michael S Garshick
- Authors share senior authorship.,NYU School of Medicine, NYU Langone Health, New York City, New York.,Leon H. Charney Division of Cardiology, NYU Langone Health, New York City, New York
| | - Robert Donnino
- Authors share senior authorship.,NYU School of Medicine, NYU Langone Health, New York City, New York.,Veterans Affairs Medical Center, New York (Manhattan Campus), New York City, New York.,Leon H. Charney Division of Cardiology, NYU Langone Health, New York City, New York
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11
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Adelsheimer A, Shah B, Choy-Shan A, Tenner CT, Lorin JD, Smilowitz NR, Pike VC, Pillinger MH, Donnino R. Gout and Progression of Aortic Stenosis. Am J Med 2020; 133:1095-1100.e1. [PMID: 32081657 PMCID: PMC7429243 DOI: 10.1016/j.amjmed.2020.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with aortic stenosis are nearly twice as likely to have a diagnosis of gout compared with individuals without aortic valve disease. METHODS This retrospective study evaluated consecutive adults age ≥65 years with aortic stenosis between December 2012 and November 2016 who underwent at least 2 transthoracic echocardiograms (TTEs) separated by at least 1 year. Severe aortic stenosis was defined as any combination of an aortic valve peak velocity ≥4.0 m/sec, mean gradient ≥40 mm Hg, aortic valve area ≤1 cm2, or decrease in left ventricular ejection fraction as a result of aortic stenosis. RESULTS Of the 699 study patients, gout was present in 73 patients (10%) and not found in 626 patients (90%). Median follow-up was 903 days [552-1302] for patients with gout and 915 days [601-1303] for patients without gout (P = 0.60). The presence of severe aortic stenosis on follow-up transthoracic echocardiogram was more frequent in patients with gout compared to those without gout (74% vs 54%, P = 0.001; hazard ratio [HR] 1.45 [1.09-1.93]), even among the 502 patients without severe aortic stenosis at baseline (63% vs 39%, P = 0.003; hazard ratio 1.43 [1.07-1.91]). Gout remained associated with the development of severe aortic stenosis after multivariable adjustment (adjusted hazard ratio [aHR] 1.46 [1.03-2.08], P = 0.03). The annualized reduction in aortic valve area was numerically greater in the group with gout compared with the group without gout (-0.10 cm2/y [-0.18, -0.03] vs -0.08 cm2/y [-0.16, -0.01], P = 0.09); annualized change in peak velocity and mean gradient did not differ between groups. CONCLUSIONS Progression to severe aortic stenosis was more frequent in patients with gout compared with those without gout, supporting the hypothesis that gout is a risk factor for aortic stenosis.
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Affiliation(s)
| | - Binita Shah
- Department of Medicine, Division of Cardiology, VA New York Harbor Health Care System and NYU School of Medicine, New York, NY.
| | - Alana Choy-Shan
- Department of Medicine, Division of Cardiology, VA New York Harbor Health Care System and NYU School of Medicine, New York, NY
| | - Craig T Tenner
- Department of Medicine, VA New York Harbor Health Care System and NYU School of Medicine, New York, NY
| | - Jeffrey D Lorin
- Department of Medicine, Division of Cardiology, VA New York Harbor Health Care System and NYU School of Medicine, New York, NY
| | - Nathaniel R Smilowitz
- Department of Medicine, Division of Cardiology, VA New York Harbor Health Care System and NYU School of Medicine, New York, NY
| | - V Courtney Pike
- Department of Medicine, Division of Rheumatology, VA New York Harbor Health Care System and NYU School of Medicine, New York, NY
| | - Michael H Pillinger
- Department of Medicine, Division of Rheumatology, VA New York Harbor Health Care System and NYU School of Medicine, New York, NY
| | - Robert Donnino
- Department of Medicine, Division of Cardiology, VA New York Harbor Health Care System and NYU School of Medicine, New York, NY
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Vani A, Ahluwalia M, Donnino R, Jung A, Vaynblat M, Latson L, Saric M. A case of nonvalvular endocarditis with biventricular apical infected thrombi. Echocardiography 2020; 37:1072-1076. [PMID: 32654168 DOI: 10.1111/echo.14690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/09/2020] [Accepted: 04/21/2020] [Indexed: 11/29/2022] Open
Abstract
We report what appears to be the first case of biopsy-proven nonvalvular endocarditis with biventricular apical infected thrombi. A 47-year-old man presented with hypoxic respiratory failure from a multilobar pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA). Transthoracic echocardiography and cardiac magnetic resonance imaging revealed biventricular apical masses suggestive of nonvalvular endocarditis with infected thrombi. Given concern for ongoing septic embolization to the lungs and brain despite appropriate antimicrobial therapy, the masses were surgically resected. Culture and histopathology confirmed MRSA-positive infected thrombi. In this case report, we highlight the differential diagnosis of apical masses and the role of multimodality imaging.
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Affiliation(s)
- Anish Vani
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Monica Ahluwalia
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Robert Donnino
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA.,Department of Radiology, New York University Langone Health, New York, NY, USA.,Veterans Affairs New York Harbor Healthcare System, New York, NY, USA
| | - Albert Jung
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Mikhail Vaynblat
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
| | - Larry Latson
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
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13
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Bergsten TM, Nicholson A, Donnino R, Wang B, Fang Y, Natarajan S. Predicting adults likely to develop heart failure using readily available clinical information: An analysis of heart failure incidence using the NHEFS. Prev Med 2020; 130:105878. [PMID: 31678585 DOI: 10.1016/j.ypmed.2019.105878] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 08/21/2019] [Accepted: 10/23/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Heart failure is a heavy burden on the health care system in the United States. Once heart failure develops, the quality of life and longevity are dramatically affected. As such, its prevention is critical for the well-being of at risk patients. We evaluated the predictive ability of readily available clinical information to identify those likely to develop heart failure. METHODS We used a classification and regression tree (CART) model to determine the top predictors for heart failure incidence using the NHANES Epidemiologic Follow-up Study (NHEFS). The identified predictors were hypertension, diabetes, obesity, and myocardial infarction (MI). We evaluated the relationship between these variables and incident heart failure by the product-limit method and Cox models. All analyses incorporated the complex sample design to provide population estimates. RESULTS We analyzed data from 14,407 adults in the NHEFS. Participants with diabetes, MI, hypertension, or obesity had a higher incidence of heart failure than those without risk factors, with diabetes and MI being the most potent predictors. Individuals with multiple risk factors had a higher incidence of heart failure as well as a higher hazard ratio than those with just one risk factor. Combinations that included diabetes and MI had the highest incidence rates of heart failure per 1000 person years and the highest hazard ratios for incident heart failure. CONCLUSIONS Having diabetes, MI, hypertension or obesity significantly increased the risk for incident heart failure, especially combinations including diabetes and MI. This suggests that individuals with these conditions, singly or in combination, should be prioritized in efforts to predict and prevent heart failure incidence.
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Affiliation(s)
- Tova M Bergsten
- VA New York Harbor Healthcare System, New York, NY, United States of America
| | - Andrew Nicholson
- VA New York Harbor Healthcare System, New York, NY, United States of America
| | - Robert Donnino
- VA New York Harbor Healthcare System, New York, NY, United States of America; New York University School of Medicine, New York, NY, United States of America
| | - Binhuan Wang
- VA New York Harbor Healthcare System, New York, NY, United States of America; New York University School of Medicine, New York, NY, United States of America
| | - Yixin Fang
- New York University School of Medicine, New York, NY, United States of America
| | - Sundar Natarajan
- VA New York Harbor Healthcare System, New York, NY, United States of America; New York University School of Medicine, New York, NY, United States of America.
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14
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Shah B, McDonald D, Paone D, Redel-Traub G, Jangda U, Guo Y, Saric M, Donnino R, Staniloae C, Robin T, Benenstein R, Vainrib A, Williams MR. Outcomes after transcatheter aortic valve replacement in patients with low versus high gradient severe aortic stenosis in the setting of preserved left ventricular ejection fraction. J Interv Cardiol 2018; 31:849-860. [PMID: 30203608 DOI: 10.1111/joic.12561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) for low gradient (LG) severe aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF) remains an area of clinical uncertainty. METHODS Retrospective review identified 422 patients who underwent TAVR between September 4, 2014 and July 1, 2016. Procedural indication other than severe AS (n = 22) or LVEF <50% (n = 98) were excluded. Outcomes were defined by valve academic research consortium two criteria when applicable and compared between LG (peak velocity <4.0 m/s and mean gradient <40 mmHg; n = 73) and high gradient (HG) (n = 229) groups. The LG group was further categorized as low stroke volume index (SVI) (n = 41) or normal SVI (n = 32). Median follow-up was 747 days [interquartile range 220-1013]. RESULTS Baseline thirty-day mortality risk (LG 6.2% [3.8-8.1] vs HG 5.7% [4.1-7.4], P = 0.43) did not differ between groups. Short-term outcomes, including procedural success rate (86.1% vs 88.8%, P = 0.53), peri-procedural complications (intra-procedural heart block: 6.8% vs 7.9%, P = 0.99; permanent pacemaker placement: 11.0% vs 13.6%, P = 0.69; moderate paravalvular regurgitation: 2.7% vs 1.3%, P = 0.60), and all-cause in-hospital mortality (2.7% vs 0.9%, P = 0.25) did not differ between LG and HG groups. On long-term follow-up, all-cause mortality also did not differ between LG and HG groups (6.8% vs 10.0%, plog-rank = 0.33) or between the LG low SVI (9.8%), LG normal SVI (3.1%), and HG (10.0%) groups (plog-rank = 0.39). CONCLUSION Patients with preserved LVEF undergoing TAVR for severe AS with LG, including LG with low SVI, have no significant difference in adverse outcomes when compared to patients with HG.
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Affiliation(s)
- Binita Shah
- Department of Medicine, Division of Cardiology, Veterans Affairs New York Harbor Health System and New York University (NYU) School of Medicine, New York, New York
| | - Daniel McDonald
- Department of Medicine, Division of Cardiology, NYU School of Medicine, New York, New York
| | - Darien Paone
- Department of Medicine, Division of Cardiology, NYU School of Medicine, New York, New York
| | - Gabriel Redel-Traub
- Department of Medicine, Division of Cardiology, NYU School of Medicine, New York, New York
| | - Umair Jangda
- Department of Medicine, Division of Cardiology, NYU School of Medicine, New York, New York
| | - Yu Guo
- Division of Biostatistics, Department of Population Health, NYU School of Medicine, New York, New York
| | - Muhamed Saric
- Department of Medicine, Division of Cardiology, NYU School of Medicine, New York, New York
| | - Robert Donnino
- Department of Medicine, Division of Cardiology, Veterans Affairs New York Harbor Health System and New York University (NYU) School of Medicine, New York, New York
| | - Cezar Staniloae
- Department of Medicine, Division of Cardiology, NYU School of Medicine, New York, New York
| | - Tonya Robin
- Department of Medicine, Division of Cardiology, NYU School of Medicine, New York, New York
| | - Ricardo Benenstein
- Department of Medicine, Division of Cardiology, NYU School of Medicine, New York, New York
| | - Alan Vainrib
- Department of Medicine, Division of Cardiology, NYU School of Medicine, New York, New York
| | - Mathew R Williams
- Department of Cardiothoracic Surgery, NYU School of Medicine, New York, New York
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15
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Ngai C, Freedberg RS, Latson L, Argilla M, Benenstein RJ, Vainrib AF, Donnino R, Saric M. Multimodality imaging of scimitar syndrome in adults: A report of four cases. Echocardiography 2018; 35:1684-1691. [DOI: 10.1111/echo.14124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/24/2018] [Accepted: 07/26/2018] [Indexed: 12/01/2022] Open
Affiliation(s)
- Calvin Ngai
- The Leon H Charney Division of Cardiology; New York University Langone Health; New York City New York
| | - Robin S. Freedberg
- The Leon H Charney Division of Cardiology; New York University Langone Health; New York City New York
| | - Larry Latson
- Department of Radiology; New York University Langone Health; New York City New York
| | - Michael Argilla
- Department of Pediatrics; New York University Langone Health; New York City New York
| | - Ricardo J. Benenstein
- The Leon H Charney Division of Cardiology; New York University Langone Health; New York City New York
| | - Alan F. Vainrib
- The Leon H Charney Division of Cardiology; New York University Langone Health; New York City New York
| | - Robert Donnino
- The Leon H Charney Division of Cardiology; New York University Langone Health; New York City New York
- Department of Medicine (Cardiology); VA New York Harbor Health Care System (Manhattan Campus); New York City New York
| | - Muhamed Saric
- The Leon H Charney Division of Cardiology; New York University Langone Health; New York City New York
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Ahluwalia M, Reyentovich A, Donnino R, Phillips LM. Integrating imaging modalities for diagnosing cardiac amyloidosis. J Nucl Cardiol 2018; 25:1083-1088. [PMID: 29987632 DOI: 10.1007/s12350-018-1342-4] [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] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 05/24/2018] [Indexed: 11/27/2022]
Affiliation(s)
- M Ahluwalia
- Leon H. Charney Division of Cardiology, NYU Langone Health, 530 1st Avenue, New York, NY, 10016, USA.
| | - A Reyentovich
- Leon H. Charney Division of Cardiology, NYU Langone Health, 530 1st Avenue, New York, NY, 10016, USA
| | - R Donnino
- Leon H. Charney Division of Cardiology, NYU Langone Health, 530 1st Avenue, New York, NY, 10016, USA
| | - L M Phillips
- Leon H. Charney Division of Cardiology, NYU Langone Health, 530 1st Avenue, New York, NY, 10016, USA
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17
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Patel N, Chen O, Donahue C, Wang B, Fang Y, Donnino R, Natarajan S. Impact of diabetes on heart failure incidence in adults with ischemic heart disease. J Diabetes Complications 2017; 31:1597-1601. [PMID: 28947278 DOI: 10.1016/j.jdiacomp.2017.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/23/2017] [Accepted: 07/24/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ischemic heart disease (IHD) is the most potent risk factor for heart failure (HF). Our study aims to evaluate the incremental impact of diabetes on the incidence of HF in individuals with IHD. METHODS Data from the NHANES Epidemiologic Follow-Up Study (Baseline: 1971 to 1974) were linked to the facility and mortality files up to 1992. Our analyses were restricted to patients with IHD without prevalent HF at baseline. The cumulative incidence of HF in patients with diabetes and IHD versus those with IHD alone was assessed using failure curves. Cox proportional hazards models were used to control for important covariates. All analyses incorporated the complex sample design by including the weights and clustering variables. RESULTS Out of the 14,407 participants, 497 had IHD without prevalent HF and had information about diabetes status. Among these participants, the cumulative incidence of HF was 38.1% for those with diabetes (n=63) and 26.5% in those without diabetes (n=434) (log-rank p-value<0.005). The multivariate hazard ratio (adjusted for age, BMI, alcohol consumption, hypertension, high cholesterol, and smoking) for incident HF for people who had myocardial infarction (MI) and diabetes compared to people who had MI alone was 2.98 (95% CI 1.51, 5.88). CONCLUSION Among participants with MI, those with diabetes had a substantially higher incidence of HF than those without diabetes. Based on these findings, practitioners should focus greater attention on patients with diabetes and previous MI in order to potentially prevent incident HF.
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Affiliation(s)
- Nirav Patel
- VA New York Harbor Healthcare System, NY, United States; The Henry Health Center, Hartford Hospital, CT, United States
| | | | | | - Binhuan Wang
- VA New York Harbor Healthcare System, NY, United States; NYU School of Medicine, NY, United States
| | - Yixin Fang
- VA New York Harbor Healthcare System, NY, United States; New Jersey Institute of Technology, NJ, United States
| | - Robert Donnino
- VA New York Harbor Healthcare System, NY, United States; NYU School of Medicine, NY, United States
| | - Sundar Natarajan
- VA New York Harbor Healthcare System, NY, United States; NYU School of Medicine, NY, United States.
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18
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Jafar N, Moses MJ, Benenstein RJ, Vainrib AF, Slater JN, Tran HA, Donnino R, Williams MR, Saric M. 3D transesophageal echocardiography and radiography of mitral valve prostheses and repairs. Echocardiography 2017; 34:1687-1701. [DOI: 10.1111/echo.13656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Nadia Jafar
- Leon H. Charney Division of Cardiology; New York University Langone Medical Center; New York NY USA
| | - Michael J. Moses
- Leon H. Charney Division of Cardiology; New York University Langone Medical Center; New York NY USA
| | - Ricardo J. Benenstein
- Leon H. Charney Division of Cardiology; New York University Langone Medical Center; New York NY USA
| | - Alan F. Vainrib
- Leon H. Charney Division of Cardiology; New York University Langone Medical Center; New York NY USA
| | - James N. Slater
- Leon H. Charney Division of Cardiology; New York University Langone Medical Center; New York NY USA
| | - Henry A. Tran
- Leon H. Charney Division of Cardiology; New York University Langone Medical Center; New York NY USA
| | - Robert Donnino
- Veterans Affairs New York Harbor Healthcare System; New York NY USA
- Department of Radiology; New York University School of Medicine; New York NY USA
| | - Mathew R. Williams
- Leon H. Charney Division of Cardiology; New York University Langone Medical Center; New York NY USA
- Department of Cardiothoracic Surgery; New York University School of Medicine; New York NY USA
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology; New York University Langone Medical Center; New York NY USA
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19
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Dwivedi A, Freedberg R, Donnino R, Vainrib A, Dodson JA, Saric M. Geriatric Presentation of Idiopathic Left Ventricular Aneurysm. CASE 2017; 1:84-87. [PMID: 30062251 PMCID: PMC6058218 DOI: 10.1016/j.case.2017.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Idiopathic left ventricular aneurysm is a rare diagnosis. Management and prognosis of idiopathic left ventricular aneurysms remain unknown. We describe a conservative management of an idiopathic left ventricular aneurysm in a geriatric patient.
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20
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Balakrishnan R, Nguyen B, Raad R, Donnino R, Naidich DP, Jacobs JE, Reynolds HR. Coronary artery calcification is common on nongated chest computed tomography imaging. Clin Cardiol 2017; 40:498-502. [PMID: 28300293 DOI: 10.1002/clc.22685] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 08/25/2016] [Revised: 11/30/2016] [Accepted: 01/21/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Coronary artery calcification as assessed by computed tomography (CT) is a validated predictor of cardiovascular risk, whether identified on a dedicated cardiac study or on a routine non-gated chest CT. The prevalence of incidentally detected coronary artery calcification on non-gated chest CT imaging and consistency of reporting have not been well characterized. HYPOTHESIS Coronary calcification is present on chest CT in some patients not taking statin therapy and may be under-reported. METHODS Non-gated chest CT images dated 1/1/2012 to 1/1/2013 were retrospectively reviewed. Demographics and medical history were obtained from charts. Patients with known history of coronary revascularization and/or pacemaker/defibrillator were excluded. Two independent readers with cardiac CT expertise evaluated images for the presence and anatomical distribution of any coronary calcification, blinded to all clinical information including CT reports. Original clinical CT reports were subsequently reviewed. RESULTS Coronary calcification was identified in 204/304 (68%) chest CTs. Patients with calcification were older and had more hyperlipidemia, smoking history, and known coronary artery disease. Of patients with calcification, 43% were on aspirin and 62% were on statin medication at the time of CT. Coronary calcification was identified in 69% of reports when present. CONCLUSIONS A high prevalence of coronary calcification was found in non-gated chest CT scans performed for non-cardiac indications. In one-third, coronary calcification was not mentioned in the clinical report when actually present. In this population of patients with cardiac risk factors, standard reporting of the presence of coronary calcification may provide an opportunity for risk factor modification.
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Affiliation(s)
- Revathi Balakrishnan
- Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
| | - Brian Nguyen
- Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
| | - Roy Raad
- Department of Radiology, New York University School of Medicine, New York, New York
| | - Robert Donnino
- Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York.,Department of Radiology, New York University School of Medicine, New York, New York
| | - David P Naidich
- Department of Radiology, New York University School of Medicine, New York, New York
| | - Jill E Jacobs
- Department of Radiology, New York University School of Medicine, New York, New York
| | - Harmony R Reynolds
- Department of Radiology, New York University School of Medicine, New York, New York
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21
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Chang K, Yokose C, Tenner C, Oh C, Donnino R, Choy-Shan A, Pike VC, Shah BD, Lorin JD, Krasnokutsky S, Sedlis SP, Pillinger MH. Association Between Gout and Aortic Stenosis. Am J Med 2017; 130:230.e1-230.e8. [PMID: 27720853 PMCID: PMC5357081 DOI: 10.1016/j.amjmed.2016.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 05/09/2016] [Revised: 08/14/2016] [Accepted: 09/15/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND An independent association between gout and coronary artery disease is well established. The relationship between gout and valvular heart disease, however, is unclear. The aim of this study was to assess the association between gout and aortic stenosis. METHODS We performed a retrospective case-control study. Aortic stenosis cases were identified through a review of outpatient transthoracic echocardiography (TTE) reports. Age-matched controls were randomly selected from patients who had undergone TTE and did not have aortic stenosis. Charts were reviewed to identify diagnoses of gout and the earliest dates of gout and aortic stenosis diagnosis. RESULTS Among 1085 patients who underwent TTE, 112 aortic stenosis cases were identified. Cases and nonaortic stenosis controls (n = 224) were similar in age and cardiovascular comorbidities. A history of gout was present in 21.4% (n = 24) of aortic stenosis subjects compared with 12.5% (n = 28) of controls (unadjusted odds ratio 1.90, 95% confidence interval 1.05-3.48, P = .038). Multivariate analysis retained significance only for gout (adjusted odds ratio 2.08, 95% confidence interval 1.00-4.32, P = .049). Among subjects with aortic stenosis and gout, gout diagnosis preceded aortic stenosis diagnosis by 5.8 ± 1.6 years. The age at onset of aortic stenosis was similar among patients with and without gout (78.7 ± 1.8 vs 75.8 ± 1.0 years old, P = .16). CONCLUSIONS Aortic stenosis patients had a markedly higher prevalence of precedent gout than age-matched controls. Whether gout is a marker of, or a risk factor for, the development of aortic stenosis remains uncertain. Studies investigating the potential role of gout in the pathophysiology of aortic stenosis are warranted and could have therapeutic implications.
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Affiliation(s)
- Kevin Chang
- Section of Rheumatology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Rheumatology, Department of Medicine, New York University School of Medicine; TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine
| | - Chio Yokose
- Section of Rheumatology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Rheumatology, Department of Medicine, New York University School of Medicine; TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine
| | - Craig Tenner
- TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine; Section of Primary Care, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Primary Care, Department of Medicine, New York University School of Medicine
| | - Cheongeun Oh
- TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine; Department of Biostatistics, New York University
| | - Robert Donnino
- TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine; Section of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Cardiology, Department of Medicine, New York University School of Medicine; Department of Radiology, New York University School of Medicine
| | - Alana Choy-Shan
- TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine; Section of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Cardiology, Department of Medicine, New York University School of Medicine
| | - Virginia C Pike
- Section of Rheumatology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Rheumatology, Department of Medicine, New York University School of Medicine; TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine
| | - Binita D Shah
- TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine; Section of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Cardiology, Department of Medicine, New York University School of Medicine
| | - Jeffrey D Lorin
- TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine; Section of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Cardiology, Department of Medicine, New York University School of Medicine
| | - Svetlana Krasnokutsky
- Section of Rheumatology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Rheumatology, Department of Medicine, New York University School of Medicine; TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine
| | - Steven P Sedlis
- TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine; Section of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Cardiology, Department of Medicine, New York University School of Medicine
| | - Michael H Pillinger
- Section of Rheumatology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Rheumatology, Department of Medicine, New York University School of Medicine; TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine.
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22
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Laura DM, Donnino R, Kim EE, Benenstein R, Freedberg RS, Saric M. Lipomatous Atrial Septal Hypertrophy: A Review of Its Anatomy, Pathophysiology, Multimodality Imaging, and Relevance to Percutaneous Interventions. J Am Soc Echocardiogr 2016; 29:717-723. [PMID: 27288088 DOI: 10.1016/j.echo.2016.04.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 08/28/2015] [Indexed: 11/19/2022]
Abstract
Lipomatous atrial septal hypertrophy (LASH) is a histologically benign cardiac lesion characterized by excessive fat deposition in the region of the interatrial septum that spares the fossa ovalis. The etiology of LASH remains unclear, though it may be associated with advanced age and obesity. Because of the sparing of the fossa ovalis, LASH has a pathognomonic dumbbell shape. LASH may be mistaken for various tumors of the interatrial septum. Histologically, LASH is composed of both mature and brown (fetal) adipose tissue, but the role of brown adipose tissue remains unclear. In interventional procedures requiring access to the left atrium, LASH may interfere with transseptal puncture, as traversing the thickened area can reduce the maneuverability of catheters and devices. This may cause the needle to enter the epicardial space, causing dangerous pericardial effusions. LASH was once considered a contraindication to percutaneous device closure of atrial septal defects because of an associated increased risk for incorrect device deployment. However, careful attention to preprocedural imaging and procedural intracardiac echocardiography enable interventional cardiologists to perform procedures in patients with LASH without serious complications. In this review article, the authors describe anatomic and functional aspects of LASH, with emphasis on their roles in percutaneous interventions.
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Affiliation(s)
- Diana M Laura
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York
| | - Robert Donnino
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York; Department of Radiology, New York University Langone Medical Center, New York, New York; Veterans Affairs New York Harbor Healthcare System, New York, New York
| | - Eugene E Kim
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York
| | - Ricardo Benenstein
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York
| | - Robin S Freedberg
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York.
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Shah B, Won E, Sedlis SP, Donnino R. Reply. Am J Cardiol 2016; 117:489. [PMID: 26708688 DOI: 10.1016/j.amjcard.2015.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
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Chang K, Barghash M, Donnino R, Freedberg RS, Hagiwara M, Bennett G, Benenstein R, Saric M. Extrinsic Esophageal Compression by Cervical Osteophytes in Diffuse Idiopathic Skeletal Hyperostosis: A Contraindication to Transesophageal Echocardiography? Echocardiography 2015; 33:314-6. [PMID: 26603685 DOI: 10.1111/echo.13115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Contraindications to transesophageal echocardiography (TEE) include various esophageal pathologies, but compression of the esophagus by vertebral osteophytes is not listed in the current American Society of Echocardiography guidelines. We report a case of diffuse idiopathic skeletal hyperostosis (DISH) in an 81-year-old man who had incidentally been found to have extrinsic esophageal compression by cervical osteophytes prior to a proposed TEE. The incidence of esophageal perforation in patients with DISH and vertebral osteophytes is not well documented. We believe these patients are at increased risk of esophageal perforation during TEE, and thus, TEE may be relatively contraindicated in patients with DISH.
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Affiliation(s)
- Kevin Chang
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
| | - Maya Barghash
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
| | - Robert Donnino
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York.,Veterans Affairs New York Harbor Healthcare System, New York, New York.,Department of Radiology, New York University School of Medicine, New York, New York
| | - Robin S Freedberg
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
| | - Mari Hagiwara
- Department of Radiology, New York University School of Medicine, New York, New York
| | - Genevieve Bennett
- Department of Radiology, New York University School of Medicine, New York, New York
| | - Ricardo Benenstein
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
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Won E, Donnino R, Srichai MB, Sedlis SP, Feit F, Rolnitzky L, Miller LH, Iqbal SN, Axel L, Nguyen B, Slater J, Shah B. Diagnostic Accuracy of Cardiac Magnetic Resonance Imaging in the Evaluation of Newly Diagnosed Heart Failure With Reduced Left Ventricular Ejection Fraction. Am J Cardiol 2015; 116:1082-7. [PMID: 26251006 DOI: 10.1016/j.amjcard.2015.06.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/18/2015] [Accepted: 06/18/2015] [Indexed: 01/19/2023]
Abstract
The aim of this study was to determine the diagnostic value of cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE), cine imaging, and resting first-pass perfusion (FPP) in the evaluation for ischemic (IC) versus nonischemic (NIC) cardiomyopathy in new-onset heart failure with reduced (≤40%) left ventricular ejection fraction (HFrEF). A retrospective chart review analysis identified 83 patients from January 2009 to June 2012 referred for CMR imaging evaluation for new-onset HFrEF with coronary angiography performed within 6 months of CMR. The diagnosis of IC was established using Felker criteria on coronary angiography. CMR sequences were evaluated for the presence of patterns suggestive of severe underlying coronary artery disease as the cause of HFrEF (subendocardial and/or transmural LGE, regional wall motion abnormality on cine, regional hypoperfusion defect on resting FPP). Discriminative power was assessed using receiver operator characteristics curve analysis. Coronary angiography identified 36 patients (43%) with IC. Presence of subendocardial and/or transmural LGE alone demonstrated good discriminative power (C-statistic 0.85, 95% confidence interval 0.76 to 0.94) for the diagnosis of IC. The presence of an ischemic pattern on both LGE and cine sequences resulted in a specificity of 87% for the diagnosis of IC, whereas the absence of an ischemic pattern on both LGE and cine sequences resulted in a specificity of 94% for the diagnosis of NIC. Addition of resting FPP on a subset of patients did not improve diagnostic values. In conclusion, CMR has potential value in the diagnostic evaluation of IC versus NIC.
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Charles S, McDonald DM, Sedlis S, Donnino R. CORONARY ARTERY DISEASE AND THE OBESITY PARADOX: A PILOT STUDY TO EVALUATE THE ROLE OF MYOCARDIAL SCAR. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61654-0] [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: 11/16/2022]
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Saleh M, Balakrishnan R, Castillo Kontak L, Benenstein R, Chinitz LA, Donnino R, Saric M. Congenital Absence of the Left Atrial Appendage Visualized by 3D Echocardiography in Two Adult Patients. Echocardiography 2015; 32:1206-10. [DOI: 10.1111/echo.12882] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Mona Saleh
- New York University School of Medicine; New York New York
| | - Revathi Balakrishnan
- Leon H. Charney Division of Cardiology; New York University Langone Medical Center; New York New York
| | - Leticia Castillo Kontak
- Leon H. Charney Division of Cardiology; New York University Langone Medical Center; New York New York
| | - Ricardo Benenstein
- Leon H. Charney Division of Cardiology; New York University Langone Medical Center; New York New York
| | - Larry A. Chinitz
- New York University School of Medicine; New York New York
- Leon H. Charney Division of Cardiology; New York University Langone Medical Center; New York New York
| | - Robert Donnino
- Leon H. Charney Division of Cardiology; New York University Langone Medical Center; New York New York
- Veterans Affairs New York Harbor Healthcare System; New York New York
- Departments of Medicine and Radiology; New York University School of Medicine; New York New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology; New York University Langone Medical Center; New York New York
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Affiliation(s)
- Nathaniel R Smilowitz
- From the Departments of Medicine (Cardiology) (N.R.S., R.D., A.S.) and Radiology (R.D.), New York University Langone Medical Center, New York, NY; and New York Harbor Health Care System, Veteran Affairs Hospital, New York, NY (R.D.)
| | - Robert Donnino
- From the Departments of Medicine (Cardiology) (N.R.S., R.D., A.S.) and Radiology (R.D.), New York University Langone Medical Center, New York, NY; and New York Harbor Health Care System, Veteran Affairs Hospital, New York, NY (R.D.)
| | - Arthur Schwartzbard
- From the Departments of Medicine (Cardiology) (N.R.S., R.D., A.S.) and Radiology (R.D.), New York University Langone Medical Center, New York, NY; and New York Harbor Health Care System, Veteran Affairs Hospital, New York, NY (R.D.).
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Lader JM, Lam G, Donnino R, Katz ES, DeAnda A, Ettel M, Saric M. Lone aortic insufficiency and conduction disease: a marker of reactive arthritis. Echocardiography 2014; 31:E271-4. [PMID: 25059534 DOI: 10.1111/echo.12691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A 48-year-old male with history of chronic arthritis and uveitis presented with 1 year of progressively reduced exercise capacity and nonexertional chest pain. Physical examination was consistent with severe aortic insufficiency. An electrocardiogram demonstrated sinus rhythm with first degree atrioventricular block. Transthoracic and transesophageal echocardiography demonstrated severe lone central aortic insufficiency of a trileaflet valve due to leaflet thickening, retraction of leaflet margins and mild aortic root dilation in the setting of left ventricular dilatation. In addition, computed tomographic angiography revealed a small focal aneurysm of the distal transverse arch. He was found to be positive for the immunogenetic marker HLA-B27. The patient subsequently underwent uncomplicated mechanical aortic valve replacement. The diagnosis of HLA-B27 associated cardiac disease should be entertained in any individual with lone aortic insufficiency, especially if accompanied by conduction disease.
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Affiliation(s)
- Joshua M Lader
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
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Saba SG, Chung S, Bhagavatula S, Donnino R, Srichai MB, Saric M, Katz SD, Axel L. A novel and practical cardiovascular magnetic resonance method to quantify mitral annular excursion and recoil applied to hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 2014; 16:35. [PMID: 24886666 PMCID: PMC4041905 DOI: 10.1186/1532-429x-16-35] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 05/02/2014] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND We have developed a novel and practical cardiovascular magnetic resonance (CMR) technique to evaluate left ventricular (LV) mitral annular motion by tracking the atrioventricular junction (AVJ). To test AVJ motion analysis as a metric for LV function, we compared AVJ motion variables between patients with hypertrophic cardiomyopathy (HCM), a group with recognized systolic and diastolic dysfunction, and healthy volunteers. METHODS We retrospectively evaluated 24 HCM patients with normal ejection fractions (EF) and 14 healthy volunteers. Using the 4-chamber view cine images, we tracked the longitudinal motion of the lateral and septal AVJ at 25 time points during the cardiac cycle. Based on AVJ displacement versus time, we calculated maximum AVJ displacement (MD) and velocity in early diastole (MVED), velocity in diastasis (VDS) and the composite index VDS/MVED. RESULTS Patients with HCM showed significantly slower median lateral and septal AVJ recoil velocities during early diastole, but faster velocities in diastasis. We observed a 16-fold difference in VDS/MVED at the lateral AVJ [median 0.141, interquartile range (IQR) 0.073, 0.166 versus 0.009 IQR -0.006, 0.037, P < 0.001]. Patients with HCM also demonstrated significantly less mitral annular excursion at both the septal and lateral AVJ. Performed offline, AVJ motion analysis took approximately 10 minutes per subject. CONCLUSIONS Atrioventricular junction motion analysis provides a practical and novel CMR method to assess mitral annular motion. In this proof of concept study we found highly statistically significant differences in mitral annular excursion and recoil between HCM patients and healthy volunteers.
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Affiliation(s)
- Shahryar G Saba
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
- Current affiliation: National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sohae Chung
- Department of Radiology, Center for Biomedical Imaging, New York University Langone Medical Center, 660 First Avenue, Room 411, New York, NY 10016, USA
| | - Sharath Bhagavatula
- Department of Radiology, Center for Biomedical Imaging, New York University Langone Medical Center, 660 First Avenue, Room 411, New York, NY 10016, USA
| | - Robert Donnino
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
- Department of Radiology, Center for Biomedical Imaging, New York University Langone Medical Center, 660 First Avenue, Room 411, New York, NY 10016, USA
| | - Monvadi B Srichai
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
- Department of Radiology, Center for Biomedical Imaging, New York University Langone Medical Center, 660 First Avenue, Room 411, New York, NY 10016, USA
- Current affiliation: Medstar Heart Institute, Medstar Georgetown University Hospital, Washington DC 20007, USA
| | - Muhamed Saric
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
| | - Stuart D Katz
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
| | - Leon Axel
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
- Department of Radiology, Center for Biomedical Imaging, New York University Langone Medical Center, 660 First Avenue, Room 411, New York, NY 10016, USA
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Hastings RS, Lau G, Saric M, Kim E, Donnino R, Benenstein R. STANDARD TWO DIMENSIONAL ECHOCARDIOGRAPHY UNDERESTIMATES THE LEFT VENTRICULAR OUTFLOW TRACT WHEN COMPARED TO FULL VOLUME 3D IMAGING. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61021-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Singh A, Donnino R, Weintraub H, Schwartzbard A. Effect of strict glycemic control in patients with diabetes mellitus on frequency of macrovascular events. Am J Cardiol 2013; 112:1033-8. [PMID: 23768455 DOI: 10.1016/j.amjcard.2013.05.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/17/2013] [Accepted: 05/17/2013] [Indexed: 11/30/2022]
Abstract
Despite a better understanding of cardiovascular risk factors and attempts at optimal management, diabetes-related macrovascular events remain a significant cause of morbidity and mortality in the United States and worldwide. The trials to date have validated strict glycemic control as a method to achieve sustained reductions in the rate of nephropathy, neuropathy, and retinopathy due to diabetes. For these microvascular complications, the closer hemoglobin A1c is to normal levels, the better the outcome. Although reducing hemoglobin A1c levels to 7% has been shown to reduce macrovascular events, demonstrating an additional reduction in macrovascular events with tighter glycemic control has been more difficult to achieve. A careful review of recent trials, however, has demonstrated that treatment early in the disease course and the ability to safely maintain lower hemoglobin A1c levels might be critical factors in further reducing macrovascular events. In conclusion, with the introduction of novel antidiabetic agents, future trials using these drugs might be able to definitively establish the safety and efficacy of reducing cardiovascular events with stringent glycemic control; however, the current evidence is inconsistent.
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Affiliation(s)
- Amita Singh
- Division of Cardiology, Department of Medicine, New York University Langone Medical Center, New York, New York.
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Srichai MB, Chandarana H, Donnino R, Lim IIP, Leidecker C, Babb J, Jacobs JE. Diagnostic accuracy of cardiac computed tomography angiography for myocardial infarction. World J Radiol 2013; 5:295-303. [PMID: 24003355 PMCID: PMC3758497 DOI: 10.4329/wjr.v5.i8.295] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 06/13/2013] [Accepted: 07/18/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate diagnostic accuracy of high, low and mixed voltage dual energy computed tomography (DECT) for detection of prior myocardial infarction (MI).
METHODS: Twenty-four consecutive patients (88% male, mean age 65 ± 11 years old) with clinically documented prior MI (> 6 mo) were prospectively recruited to undergo late phase DECT for characterization of their MI. Computed tomography (CT) examinations were performed using a dual source CT system (64-slice Definition or 128-slice Definition FLASH, Siemens Healthcare) with initial first pass and 10 min late phase image acquisitions. Using the 17-segment model, regional systolic function was analyzed using first pass CT as normal or abnormal (hypokinetic, akinetic, dyskinetic). Regions with abnormal systolic function were identified as infarct segments. Late phase DE scans were reconstructed into: 140 kVp, 100 kVp, mixed (120 kVp) images and iodine-only datasets. Using the same 17-segment model, each dataset was evaluated for possible (grade 2) or definite (grade 3) late phase myocardial enhancement abnormalities. Logistic regression for correlated data was used to compare reconstructions in terms of the accuracy for detecting infarct segments using late myocardial hyperenhancement scores.
RESULTS: All patients reported prior history of documented myocardial infarction, with most occurring more than 5 years prior (n = 18; 75% of cohort). Fifty-five of 408 (13%) segments demonstrated abnormal wall motion and were classified as infarct. The remaining 353 segments were classified as non-infarcted segments. A total of 1692 segments were analyzed for late phase enhancement abnormalities, with 91 (5.5%) segments not interpretable due to artifact. Combined grades 2 and 3 compared to grade 3 only enhancement abnormalities demonstrated significantly higher sensitivity and similar specificity for detection of infarct segments for all reconstructions evaluated. Evaluation of different voltage acquisitions demonstrated the highest diagnostic performance for the 100 kVp reconstruction which had higher diagnostic accuracy (87%; 95%CI: 80%-90%), sensitivity (86%-93%; 95%CI: 54%-78%) and specificity (90%; 95%CI: 86%-93%) compared to the other reconstructions. For sensitivity, there were significant differences noted between 100 kVp vs 140 kVp (P < 0.0005), 100 kVp vs mixed (P < 0.0001), and 100 kVp vs iodine only (P < 0.005) using combined grade 2 and grade 3 perfusion abnormalities. For specificity, there were significant differences noted between 100 kVp vs 140 kVp (P < 0.005), and 100 kVp vs mixed (P < 0.01) using combined grades 2 and 3 perfusion abnormalities.
CONCLUSION: Low voltage acquisition CT, 100 kVp in this study, demonstrates superior diagnostic performance when compared to higher and mixed voltage acquisitions for detection of prior MI.
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Srichai MB, Barreto M, Lim RP, Donnino R, Babb JS, Jacobs JE. Prospective-triggered sequential dual-source end-systolic coronary CT angiography for patients with atrial fibrillation: a feasibility study. J Cardiovasc Comput Tomogr 2013; 7:102-9. [PMID: 23545461 DOI: 10.1016/j.jcct.2013.02.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/04/2013] [Accepted: 02/12/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Obtaining diagnostic coronary CT angiography with low radiation exposure in patients with irregular heart rhythms such as atrial fibrillation (AF) remains challenging. OBJECTIVE We evaluated image quality and inter-reader variability with the use of prospective electrocardiographic (ECG)-triggered sequential dual-source acquisition at end systole for coronary artery disease (CAD) evaluation in patients with AF. METHODS Thirty consecutive patients with AF who underwent prospective ECG-triggered sequential dual-source acquisition were evaluated. Images were reconstructed every 50 milliseconds from 250 to 400 milliseconds after the R wave. Two independent, blinded readers evaluated the coronaries for image quality on a 5-point scale (worst to best) and stenosis on 5-point semiquantitative (none to severe) and binary scales (>50% or <50%). Diagnostic image quality was graded for each reconstruction. RESULTS Eleven patients (37%) had significant (≥50% stenosis) CAD. Average heart rate was 82 ± 20 beats/min and variability range was 71 ± 22 beats/min. Mean effective radiation dose was 6.5 ± 2.4 mSv. Diagnostic image quality was noted in 97.9% of 304 coronary segments with median image quality of 3.0. The 300-millisecond reconstruction phase provided the highest image quality; 70% of patients showed diagnostic image quality. Combination of all phases (250-400 milliseconds) performed significantly better than single or other phase combinations (P < 0.0005 for all comparisons). Inter-reader variability for stenosis detection was excellent, with 98.4% concordance by using a binary scale (50% stenosis cutoff). CONCLUSIONS Prospective ECG-triggered sequential dual-source CT acquisition with the use of end-systolic acquisition provides diagnostic image quality with potentially low radiation doses for evaluation of CAD in patients with AF. Use of multiple end-systolic phases over a 150-millisecond window improves diagnostic image quality.
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Affiliation(s)
- Monvadi B Srichai
- Department of Medicine, Cardiology Division, Medstar Georgetown University Hospital, 3800 Reservoir Road NW, 5PHC, Washington, DC 20007, USA.
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Saba SG, Chung S, Tseng S, Bhagavatula S, Donnino R, Srichai MB, Saric M, Katz S, Axel L. Cardiac MRI correlates of diastolic left ventricular function assessment by echocardiography. J Cardiovasc Magn Reson 2013. [PMCID: PMC3559313 DOI: 10.1186/1532-429x-15-s1-e53] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Saba SG, Chung S, Donnino R, Srichai MB, Katz S, Axel L. A novel cardiac magnetic resonance imaging technique to evaluate left ventricular diastolic function in patients with hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 2012. [PMCID: PMC3304830 DOI: 10.1186/1532-429x-14-s1-p162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Srichai MB, Lim RP, Donnino R, Mannelli L, Hiralal R, Avery R, Ho C, Babb JS, Jacobs JE. Low-dose, prospective triggered high-pitch spiral coronary computed tomography angiography: comparison with retrospective spiral technique. Acad Radiol 2012; 19:554-61. [PMID: 22366557 DOI: 10.1016/j.acra.2012.01.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Revised: 01/18/2012] [Accepted: 01/19/2012] [Indexed: 10/28/2022]
Abstract
RATIONALE AND OBJECTIVES Cardiac computed tomographic angiography algorithms emphasize radiation reduction while maintaining diagnostic image quality (IQ). The aim of this study was to evaluate IQ and interreader variability using prospective electrocardiographically triggered high-pitch spiral cardiac computed tomographic angiography (FLASH-CT) compared to retrospective electrocardiographic gating (RETRO-CT) for coronary artery disease evaluation in a patient population including overweight and obese individuals. MATERIALS AND METHODS Seventy patients (24 women; mean age, 60 years) matched for gender, age, body mass index (27.4 ± 5.5 kg/m(2)), and calcium score (184 ± 328) underwent cardiac computed tomographic angiography, 35 with FLASH-CT (Definition Flash) and 35 with RETRO-CT (Somatom Definition). Images were reconstructed using standard protocols and least motion phase for RETRO-CT acquisitions. Two independent, blinded readers evaluated the coronary arteries using an 18-segment model, grading IQ on a 5-point, Likert-type scale and coronary stenosis on a 5-point semiquantitative and binary scale. RESULTS Effective radiation dose (1.50 vs 17.3 mSv, P < .0001) and mean heart rate (58 vs 62 beats/min, P < .05) were significantly lower for FLASH-CT compared to RETRO-CT. Seven hundred forty segments (> 1.5 mm) were evaluated. There was no significant difference between FLASH-CT and RETRO-CT scans in overall per-segment IQ (3.11 ± 0.75 vs 3.10 ± 0.82, P = .94). FLASH-CT had noninferior IQ relative to RETRO-CT (95% confidence interval, -0.25 to 0.26). There was no significant difference in interreader variability in diagnosis between FLASH-CT and RETRO-CT for all coronary segments (77.5% vs 78.2%, P = .83). CONCLUSIONS FLASH-CT is an acceptable coronary computed tomographic angiographic method for reducing radiation dose without compromising IQ for a patient population including overweight and obese individuals.
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Donnino R, Patel S, Nguyen AH, Sedlis SP, Babb JS, Schwartzbard A, Katz SD, Srichai MB. Comparison of quantity of left ventricular scarring and remodeling by magnetic resonance imaging in patients with versus without diabetes mellitus and with coronary artery disease. Am J Cardiol 2011; 107:1575-8. [PMID: 21439536 DOI: 10.1016/j.amjcard.2011.01.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 01/26/2011] [Accepted: 01/26/2011] [Indexed: 11/24/2022]
Abstract
Diabetic patients with coronary artery disease (CAD) are more likely to develop heart failure (HF) than nondiabetic patients, but the mechanism responsible is unclear. Evidence suggests that infarct size and accompanying remodeling may not explain this difference. We used cardiac magnetic resonance (CMR) imaging to compare degree of left ventricular (LV) myocardial scar and remodeling in diabetic and nondiabetic patients with CAD. We evaluated 85 patients (39 diabetic, 46 nondiabetic) who underwent coronary angiography showing obstructive CAD and CMR imaging within 6 months of each other. Myocardial scar was measured by late gadolinium enhancement on CMR imaging and was graded according to spatial and transmural extents on a semiquantitative scale. More diabetic than nondiabetic patients had HF (69% vs 43%, p <0.03); however, groups did not differ in total scar burden (0.94 ± 0.60 vs 1.17 ± 0.74, p = NS), spatial extent of scar, or extent of transmural scar. Diabetes remained an independent predictor of HF after adjustment for CAD and other variables. LV ejection fraction (36 ± 12% vs 37 ± 14%, p = NS) and end-diastolic volume (215 ± 56 vs 217 ± 76 ml, p = NS) were similar for diabetic and nondiabetic patients, respectively. In conclusion, although diabetic patients with CAD had a higher prevalence of HF than nondiabetic patients, there was no difference in myocardial scar, LV volume, or LV ejection fraction. These findings support the theory that mechanisms other than extent of myocardial injury and negative remodeling play a significant role in the development of HF in diabetic patients with CAD.
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Srichai-Parsia MB, Lim RP, Mannelli L, Donnino R, Hiralal R, Ho CK, Babb JS, Jacobs JE. CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY: COMPARISON BETWEEN FLASH SPIRAL AND RETROSPECTIVE ECG GATING DUAL SOURCE TECHNIQUES. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)60672-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gogoladze G, Dellis SL, Donnino R, Ribakove G, Greenhouse DG, Galloway A, Grossi E. Analysis of the Mitral Coaptation Zone in Normal and Functional Regurgitant Valves. Ann Thorac Surg 2010; 89:1158-61. [DOI: 10.1016/j.athoracsur.2009.12.061] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 12/20/2009] [Accepted: 12/23/2009] [Indexed: 11/29/2022]
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Donnino R, Michelin K, Aizer A, Nguyen AH, Babb JS, Srichai MB. Predictive value of electrocardiographic criteria for regional wall thickness in patients with cardiomyopathy. J Cardiovasc Magn Reson 2010. [DOI: 10.1186/1532-429x-12-s1-p64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Feng L, Donnino R, Babb J, Axel L, Kim D. Numerical and in vivo validation of fast cine displacement-encoded with stimulated echoes (DENSE) MRI for quantification of regional cardiac function. Magn Reson Med 2009; 62:682-90. [PMID: 19585609 DOI: 10.1002/mrm.22045] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Quantitative assessment of regional cardiac function can improve the accuracy of detecting wall motion abnormalities due to heart disease. While recently developed fast cine displacement-encoded with stimulated echoes (DENSE) MRI is a promising modality for the quantification of regional myocardial function, it has not been validated for clinical applications. The purpose of this study, therefore, was to validate the accuracy of fast cine DENSE MRI with numerical simulation and in vivo experiments. A numerical phantom was generated to model physiologically relevant deformation of the heart, and the accuracy of fast cine DENSE was evaluated against the numerical reference. For in vivo validation, 12 controls and 13 heart-disease patients were imaged using both fast cine DENSE and myocardial tagged MRI. Numerical simulation demonstrated that the echo-combination DENSE reconstruction method is relatively insensitive to clinically relevant resonance frequency offsets. The strain measurements by fast cine DENSE and the numerical reference were strongly correlated and in excellent agreement (mean difference = 0.00; 95% limits of agreement were 0.01 and -0.02). The strain measurements by fast cine DENSE and myocardial tagged MRI were strongly correlated (correlation coefficient = 0.92) and in good agreement (mean difference = 0.01; 95% limits of agreement were 0.07 and -0.04).
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Affiliation(s)
- Li Feng
- Department of Biomedical Engineering, Polytechnic Institute of New York University, Brooklyn, New York 10016, USA
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Tramontano AF, Miao C, Hays A, Donnino R, Lim R, Axel L, Kim D, Chandarana H, Srichai MB. Utility of cardiac MRI in detecting diastolic dysfunction: comparison with Doppler echocardiography and tissue Doppler imaging. J Cardiovasc Magn Reson 2009. [PMCID: PMC7852374 DOI: 10.1186/1532-429x-11-s1-p19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
Cardiac sarcoidosis (CS) is a rare but potentially fatal condition that may present with a wide range of clinical manifestations including congestive heart failure, conduction abnormalities, and most notably, sudden death. Recent advances in imaging technology allow easier detection of CS, but the diagnostic guidelines with inclusion of these techniques have yet to be written. It has become clear that minimally symptomatic or asymptomatic cardiac involvement is far more prevalent than previously thought. Because of the potential life-threatening complications and potential benefit of treatment, all patients diagnosed with sarcoidosis should be screened for cardiac involvement. Patients with CS and symptoms such as syncope need an aggressive workup for a potentially life-threatening etiology, and often require implantable cardioverter-defibrillator therapy. CS patients without arrhythmic symptoms are still at risk for sudden death and may warrant an implantable cardioverter-defibrillator for primary prevention reasons. Although corticosteroids are regarded as the first-line drug of choice, therapy for CS is not yet standardized, and it is unclear at this point whether asymptomatic patients require therapy. Randomized clinical trials are clearly warranted to answer these very important patient care questions, and are endorsed fully by the authors.
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Donnino R, Nguyen AH, Sedlis SP, Srichai MB. Myocardial scar in diabetics and non-diabetics with ischemic heart disease as assessed by magnetic resonance imaging. J Cardiovasc Magn Reson 2009. [PMCID: PMC7860792 DOI: 10.1186/1532-429x-11-s1-p194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
A 79-year-old woman with severe aortic stenosis underwent aortic valve replacement surgery, and had ligation of the left atrial appendage (LAA) using an epicardial approach. On a post-operative echocardiographic evaluation, the distal portion of the LAA was excluded, leaving no communication with the left atrium. The proximal portion of the LAA, however, was in continuity with the circulation and a large thrombus was present within it. While previous reports of incomplete LAA ligation have involved disruption of the suture line, this present report describes a case of incomplete ligation due to persistence of the proximal portion of the appendage. Thus, thrombus formation occurred despite a 'successful' epicardial exclusion of the distal LAA.
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Affiliation(s)
- Robert Donnino
- New York University Medical Center, Department of Medicine, Cardiology Division, Echocardiography Laboratory, 560 First Avenue, New York, NY 10016, USA
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Croft LB, Donnino R, Shapiro R, Indes J, Fayngersh A, Squire A, Goldman ME. Age-related prevalence of cardiac valvular abnormalities warranting infectious endocarditis prophylaxis. Am J Cardiol 2004; 94:386-9. [PMID: 15276115 DOI: 10.1016/j.amjcard.2004.04.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 11/13/2003] [Revised: 04/01/2004] [Accepted: 04/01/2004] [Indexed: 10/26/2022]
Abstract
The goal of our study was to determine the prevalence of older patients with cardiac valvular abnormalities warranting endocarditis prophylaxis. We performed a retrospective analysis of 1,000 randomly selected echocardiograms (inpatients and outpatients) from our tertiary care institution. We found that the prevalence of valvular abnormalities increased significantly with age, and that 50% of patients > or =60 years of age warranted endocarditis prophylaxis using current guidelines. With the aging population of the United States and the negative consequences of widespread antibiotic prophylaxis, further investigation is needed to identify patients who are truly at risk for infectious endocarditis.
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Affiliation(s)
- Lori B Croft
- Mount Sinai Medical Center, New York, New York 10029-6574, USA.
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Abstract
OBJECTIVE Few studies have evaluated the parietal lobe in schizophrenia despite the fact that it has an important role in attention, memory, and language-all functions that have been reported to be abnormal in schizophrenia. The inferior parietal lobule, in particular, is of interest because it is not only part of the heteromodal association cortex but also is part of the semantic-lexical network, which also includes the planum temporale. Both the inferior parietal lobule, particularly the angular gyrus of the inferior parietal lobule, and the planum temporale are brain regions that play a critical role as biological substrates of language and thought. The authors compared volume and asymmetry measures of the individual gyri of the parietal lobe by means of magnetic resonance imaging (MRI) scans. METHOD MRI scans with a 1. 5-Tesla magnet were obtained from 15 male chronic schizophrenic and 15 comparison subjects matched for age, gender, and parental socioeconomic status. RESULTS Inferior parietal lobule volumes showed a leftward asymmetry (left 7.0% larger than right) in comparison subjects and a reversed asymmetry (left 6.3% smaller than right) in schizophrenic subjects. The angular gyrus accounted for this difference in asymmetry, with the left angular gyrus being significantly larger (18.7%) than the right in comparison subjects, a finding that was not observed in schizophrenic patients. A further test of angular gyrus asymmetry showed a reversal of the normal left-greater-than-right asymmetry in the schizophrenic patients. CONCLUSIONS Patients with schizophrenia showed a reversed asymmetry in the inferior parietal lobule that was localized to the angular gyrus, a structure belonging to the heteromodal association cortex as well as being part of the semantic-lexical network. This finding contributes to a more comprehensive understanding of the neural substrates of language and thought disorder in schizophrenia.
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Affiliation(s)
- M Niznikiewicz
- Laboratory of Neuroscience, Department of Psychiatry, VA Medical Center, Harvard Medical School, Brockton, MA 02301, USA
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Holinger DP, Shenton ME, Wible CG, Donnino R, Kikinis R, Jolesz FA, McCarley RW. Superior temporal gyrus volume abnormalities and thought disorder in left-handed schizophrenic men. Am J Psychiatry 1999; 156:1730-5. [PMID: 10553736 PMCID: PMC2845841 DOI: 10.1176/ajp.156.11.1730] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Studies of schizophrenia have not clearly defined handedness as a differentiating variable. Moreover, the relationship between thought disorder and anatomical anomalies has not been studied extensively in left-handed schizophrenic men. The twofold purpose of this study was to investigate gray matter volumes in the superior temporal gyrus of the temporal lobe (left and right hemispheres) in left-handed schizophrenic men and left-handed comparison men, in order to determine whether thought disorder in the left-handed schizophrenic men correlated with tissue volume abnormalities. METHOD Left-handed male patients (N = 8) with DSM-III-R diagnoses of schizophrenia were compared with left-handed comparison men (N = 10) matched for age, socioeconomic status, and IQ. Magnetic resonance imaging (MRI) with a 1.5-T magnet was used to obtain scans, which consisted of contiguous 1.5-mm slices of the whole brain. MRI analyses (as previously defined by the authors) included the anterior, posterior, and total superior temporal gyrus in both the left and right hemispheres. RESULTS There were three significant findings regarding the left-handed schizophrenic men: 1) bilaterally smaller gray matter volumes in the posterior superior temporal gyrus (16% smaller on the right, 15% smaller on the left); 2) a smaller volume on the right side of the total superior temporal gyrus; and 3) a positive correlation between thought disorder and tissue volume in the right anterior superior temporal gyrus. CONCLUSIONS These results suggest that expression of brain pathology differs between left-handed and right-handed schizophrenic men and that the pathology is related to cognitive disturbance.
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Affiliation(s)
- D P Holinger
- Department of Psychiatry, Harvard Medical School, Boston, USA.
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Levitt JJ, McCarley RW, Nestor PG, Petrescu C, Donnino R, Hirayasu Y, Kikinis R, Jolesz FA, Shenton ME. Quantitative volumetric MRI study of the cerebellum and vermis in schizophrenia: clinical and cognitive correlates. Am J Psychiatry 1999; 156:1105-7. [PMID: 10401463 PMCID: PMC2845842 DOI: 10.1176/ajp.156.7.1105] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Recent evidence suggests that the cerebellum may play a role in higher cognitive functions and, therefore, may play an important role in schizophrenia. METHOD The authors used magnetic resonance imaging to measure cerebellum and vermis volume in 15 patients with schizophrenia and 15 normal comparison subjects. RESULTS They found that 1) vermis volume was greater in patients with schizophrenia than in normal subjects, 2) greater vermis white matter volume in the patients with schizophrenia significantly correlated with severity of positive symptoms and thought disorder and with impairment in verbal logical memory, and 3) patients with schizophrenia showed a trend for more cerebellar hemispheric volume asymmetry (left greater than right). CONCLUSIONS These data suggest that an abnormality in the vermis may contribute to the pathophysiology of schizophrenia.
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Affiliation(s)
- J J Levitt
- Clinical Neuroscience Division, Harvard Medical School, Brockton/West Roxbury Veterans Affairs Medical Center, Boston, MA, USA
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