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Tabrizi MT, Girardo M, Naqvi TZ. In Situ Transesophageal Echocardiography During Electrical Cardioversion in Patients With Atrial Fibrillation-Safety and Echocardiographic Findings. J Am Soc Echocardiogr 2024; 37:420-427. [PMID: 38036012 DOI: 10.1016/j.echo.2023.11.022] [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: 07/16/2023] [Revised: 10/07/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Transesophageal echocardiography (TEE) can reliably detect left atrial (LA) and LA appendage (LAA) thrombus in patients with atrial fibrillation (AF) before electrical cardioversion (ECV). However, evaluating cardiac and valve function pre-ECV can be challenging due to the increased and irregular heart rate. Additionally, post-ECV atrial stunning increases the risk of LAA thrombosis. Therefore, post-ECV TEE may allow for useful appendage, ventricular, and valve function assessment. However, the safety and usefulness of leaving the TEE probe in situ during ECV for post-ECV cardiac evaluation in clinical practice have not been previously evaluated. METHODS We analyzed 37 out of 86 consecutive patients who had the TEE probe left in situ, for clinical reasons, during ECV by a single operator between February 20, 2019, and January 3, 2023. We examined changes in left ventricular (LV) function, dynamic changes in valvular regurgitation, electromechanical coupling of the left atrium, and qualitative spontaneous echo contrast. We also assessed the presence of any complications related to the periprocedural TEE exam. RESULTS The mean age of the patients was 74 ± 9.65 years, and 29 (78%) were male. The periprocedural TEE time ranged from 7 to 55 minutes, with an average of 20.78 minutes. Immediately after ECV and restoration of normal sinus rhythm, there was an improvement in LV ejection fraction (47% ± 11.9% vs 40% ± 15.8%; P = .035). There was also a reduction in baseline mitral regurgitation of greater than moderate degree. However, spontaneous echo contrast worsened in the LAA in 11 (31.4%) patients. Additionally, 1 patient developed a new LAA thrombus, and 24 patients (72%) had evidence of electromechanical coupling with Doppler evidence of LA contraction. Clinically significant degenerative aortic and mitral stenosis were identified in 8% and mild or greater aortic regurgitation in 8% of patients post-ECV. No procedural complications were observed. CONCLUSIONS In situ TEE before, during, and after ECV is safe and provides useful clinical information regarding immediate cardiac changes after ECV, with diagnostic and therapeutic implications.
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Affiliation(s)
| | - Marlene Girardo
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona
| | - Tasneem Z Naqvi
- Division of Echocardiography, Department of Medicine, Mayo Clinic, Scottsdale, Arizona.
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Wen S, Naqvi TZ. 3-D transesophageal echocardiography aids in assessment of embolic stroke due to aortic atherosclerotic plaque: A case series. Echocardiography 2024; 41:e15799. [PMID: 38516862 DOI: 10.1111/echo.15799] [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] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/23/2024] Open
Abstract
Atherosclerosis is the most common cause of heart disease and stroke. Plaque thickness ≥4 mm in the ascending aorta or aortic arch is strongly correlated with cerebral embolic events and ischemic stroke. However, despite imaging workup, the cause of embolic stroke remains unidentified in many patients. Transesophageal echocardiography (TEE) is the preferred echocardiographic method for the evaluation of cardiac source of emboli. 2D TEE imaging evaluates aortic root and aortic arch in a single plane or two planes with biplane imaging. However, 2D TEE often fails to detect mobile or complex components in the ascending aorta and aortic arch plaques. The routine availability of 3D TEE in current ultrasound systems may significantly improve the assessment of aortic plaques as a potential embolic source. In this case series, we present four consecutive patients with stroke who underwent TEE by a single cardiologist for possible cardioembolic source. Some of these patients may have been labelled as "cryptogenic stroke" or "embolic stroke of undetermined source" (ESUS) due to the presence of insignificant or nonmobile ascending aortic or aortic arch plaques on 2D TEE imaging. In our four consecutive patients with ESUS who underwent TEE by a single operator, 3D TEE showed complex aortic arch plaques with ulceration with mobile components and established these plaques as the likely source of embolic stroke.
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Affiliation(s)
- Songnan Wen
- Department of Cardiovascular Medicine, Division of Echocardiography, Mayo Clinic, Scottsdale, USA
| | - Tasneem Z Naqvi
- Department of Cardiovascular Medicine, Division of Echocardiography, Mayo Clinic, Scottsdale, USA
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Park YMM, Jung W, Yeo Y, Park SH, Fradley MG, Malapati SJ, Tarun T, Raj V, Lee HS, Naqvi TZ, Henry-Tillman RS, Mehta JL, Schootman M, Amick BC, Han K, Shin DW. Mid- and long-term risk of atrial fibrillation among breast cancer surgery survivors. BMC Med 2024; 22:88. [PMID: 38419017 PMCID: PMC10903065 DOI: 10.1186/s12916-024-03308-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/19/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The risk of incident atrial fibrillation (AF) among breast cancer survivors, especially for younger women, and cancer treatment effects on the association remain unclear. This study aimed to investigate the risk of AF among breast cancer survivors and evaluate the association by age group, length of follow-up, and cancer treatment. METHODS Using data from the Korean Health Insurance Service database (2010-2017), 113,232 women newly diagnosed with breast cancer (aged ≥ 18 years) without prior AF history who underwent breast cancer surgery were individually matched 1:5 by birth year to a sample female population without cancer (n = 566,160) (mean[SD] follow-up, 5.1[2.1] years). Sub-distribution hazard ratios (sHRs) and 95% confidence intervals (CIs) considering death as a competing risk were estimated, adjusting for sociodemographic factors and cardiovascular/non-cardiovascular comorbidities. RESULTS BCS had a slightly increased AF risk compared to their cancer-free counterparts (sHR 1.06; 95% CI 1.00-1.13), but the association disappeared over time. Younger BCS (age < 40 years) had more than a 2-fold increase in AF risk (sHR 2.79; 95% CI 1.98-3.94), with the association remaining similar over 5 years of follow-up. The increased risk was not observed among older BCS, especially those aged > 65 years. Use of anthracyclines was associated with increased AF risk among BCS (sHR 1.57; 95% CI 1.28-1.92), which was more robust in younger BCS (sHR 1.94; 95% CI 1.40-2.69 in those aged ≤ 50 years). CONCLUSIONS Our findings suggest that younger BCS had an elevated risk of incident AF, regardless of the length of follow-up. Use of anthracyclines may be associated with increased mid-to-long-term AF risk among BCS.
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Affiliation(s)
- Yong-Moon Mark Park
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Wonyoung Jung
- Department of Family Medicine / Obesity and Metabolic Health Center, College of Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yohwan Yeo
- Department of Family Medicine, College of Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Sang Hyun Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Michael G Fradley
- Cardio-Oncology Program, Division of Cardiology, Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sindhu J Malapati
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Division of Medical Oncology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Tushar Tarun
- Division of Cardiology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Vinay Raj
- Department of Biology & Department of Math and Computer Science, University of Arkansas at Pine Bluff, Pine Bluff, AR, USA
| | - Hong Seok Lee
- Division of Cardiology, Sarver Heart Center, Banner University Medical Group, University of Arizona, Tucson, AZ, USA
| | - Tasneem Z Naqvi
- Division of Echocardiography, Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Ronda S Henry-Tillman
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jawahar L Mehta
- Division of Cardiology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mario Schootman
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Benjamin C Amick
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, 369 Sangdo-Ro, Dongjak-Gu, Seoul, 06978, Republic of Korea.
| | - Dong Wook Shin
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea.
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, 06351, Republic of Korea.
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Tagle-Cornell MC, Novais BS, Wen S, Shipman JN, Mandale DR, Flom AP, Sahnan SK, Kriz LM, Alland ML, Bird CW, Naqvi TZ. Hand-Held Echocardiography by Advanced Practice Providers in Patients with Congestive Heart Failure. J Clin Med 2024; 13:312. [PMID: 38256445 PMCID: PMC10816508 DOI: 10.3390/jcm13020312] [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: 11/27/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVES The performed hand-held echocardiography (HHE) was evaluated and interpreted by trained advanced practice providers (APPs) on hospitalized CHF patients for image quality and interpretation by comparing with expert echocardiographer and SE findings. BACKGROUND Congestive heart failure (CHF) is associated with increased hospital admissions and mortality. While a standard echocardiogram (SE) is the gold standard for cardiac assessment, it is not readily available. Hospitalized CHF patients require rapid assessment for expedited treatment. METHODS Over 6 months, five trained APPs performed HHE on hospitalized CHF patients and interpreted: (a) left ventricular (LV) size, (b) LV ejection fraction (LVEF), and (c) right atrial pressure (RAP). The study echocardiographer reviewed and blindly interpreted the HHE images and compared them with APPs and SE findings. Kappa statistics determined the degree of agreement between APPs and the study echocardiographer's interpretation of the HHE images and SE. RESULTS A total of 80 CHF patients (age 73 ± 14 years, 58% males; LVEF (by SE) 45 ± 19%; 36.3% body mass indexes ≥ 30 kg/m2) were enrolled. HHE interpretation by APPs had a good agreement for LVEF (kappa 0.79) with the study echocardiographer and SE (kappa 0.74) and a good agreement for RAP (kappa 0.67) with the study echocardiographer. The correlation between the absolute LVEF interpretation by the study echocardiographer on HHE and SE was r = 0.88 (p < 0.0001). CONCLUSIONS Trained APPs obtained diagnostic-quality HHE images and interpreted the LV function and RAP in CHF patients in good agreement with the study echocardiographer. LVEF by HHE correlated with LVEF by SE. Our study suggests trained APPs can use HHE to evaluate LVEF and RAP in CHF patients, leading to expedited and optimized treatment.
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Affiliation(s)
- Maria Cecilia Tagle-Cornell
- Division of Echocardiography, Department of Cardiovascular Medicine, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA; (B.S.N.); (S.W.); (J.N.S.); (D.R.M.); (A.P.F.); (S.K.S.); (L.M.K.); (M.L.A.); (C.W.B.)
| | | | | | | | | | | | | | | | | | | | - Tasneem Z. Naqvi
- Division of Echocardiography, Department of Cardiovascular Medicine, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA; (B.S.N.); (S.W.); (J.N.S.); (D.R.M.); (A.P.F.); (S.K.S.); (L.M.K.); (M.L.A.); (C.W.B.)
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Naqvi TZ. Multimodality Imaging Classification for Carotid Plaque Assessment. JACC Cardiovasc Imaging 2024; 17:76-78. [PMID: 38176850 DOI: 10.1016/j.jcmg.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/09/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Tasneem Z Naqvi
- Division of Echocardiography, Department of Cardiology, Mayo Clinic, Phoenix, Arizona, USA.
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Scalia IG, Farina JM, Padang R, Jokerst CE, Pereyra M, Mahmoud AK, Naqvi TZ, Chao CJ, Oh JK, Arsanjani R, Ayoub C. Aortic Valve Calcium Score by Computed Tomography as an Adjunct to Echocardiographic Assessment-A Review of Clinical Utility and Applications. J Imaging 2023; 9:250. [PMID: 37998097 PMCID: PMC10672559 DOI: 10.3390/jimaging9110250] [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: 09/01/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/25/2023] Open
Abstract
Aortic valve stenosis (AS) is increasing in prevalence due to the aging population, and severe AS is associated with significant morbidity and mortality. Echocardiography remains the mainstay for the initial detection and diagnosis of AS, as well as for grading of severity. However, there are important subgroups of patients, for example, patients with low-flow low-gradient or paradoxical low-gradient AS, where quantification of severity of AS is challenging by echocardiography and underestimation of severity may delay appropriate management and impart a worse prognosis. Aortic valve calcium score by computed tomography has emerged as a useful clinical diagnostic test that is complimentary to echocardiography, particularly in cases where there may be conflicting data or clinical uncertainty about the degree of AS. In these situations, aortic valve calcium scoring may help re-stratify grading of severity and, therefore, further direct clinical management. This review presents the evolution of aortic valve calcium score by computed tomography, its diagnostic and prognostic value, as well as its utility in clinical care.
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Affiliation(s)
- Isabel G. Scalia
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (I.G.S.)
| | - Juan M. Farina
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (I.G.S.)
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Milagros Pereyra
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (I.G.S.)
| | - Ahmed K. Mahmoud
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (I.G.S.)
| | - Tasneem Z. Naqvi
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (I.G.S.)
| | - Chieh-Ju Chao
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Jae K. Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (I.G.S.)
| | - Chadi Ayoub
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (I.G.S.)
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Wen S, Naqvi TZ. Point-of-Care Ultrasound in Detection, Severity and Mechanism of Significant Valvular Heart Disease and Clinical Management. J Clin Med 2023; 12:6474. [PMID: 37892613 PMCID: PMC10607262 DOI: 10.3390/jcm12206474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/15/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Early diagnosis of significant valvular heart disease (VHD) enables appropriate implementation of the best therapeutic strategy and follow-up. Cardiac auscultation remains suboptimal in early detection of VHD. The aim of this study was to evaluate the utility of point-of-care ultrasound (POCUS) for early detection of VHD and its severity. METHODS All consecutive patients with VHD who did not have a standard echocardiogram prior to first outpatient cardiology consultation underwent history and physical examination followed by POCUS study by an experienced physician in a general cardiology clinic from June 2017 to August 2022 at our institution. Subsequent standard transthoracic echocardiography (sTTE) was performed as the gold standard. Comparison was performed between POCUS and sTTE for the presence and severity of VHD. sTTE was performed by registered cardiac sonographers and interpreted by another cardiologist blinded to the POCUS results. RESULTS A total of 77 patients were studied (ge 72 ± 11 years, 58.4% males). A total of 89 significant valvular abnormalities were diagnosed. There were 39 (43.8%) cases of regurgitant VHD, 16 (18.0%) of stenotic VHD and 34 (38.2%) had evaluation for prosthetic valve function. The sensitivity (90.9%; 82.4%; 83.3%; 100%) and specificity (100%; 96.7%; 100%; 100%) were high for detecting ≥ moderate aortic regurgitation (AR), mitral regurgitation (MR), aortic stenosis (AS) and prosthetic valvular abnormality, respectively. The weighted κ coefficient between POCUS and sTTE for the assessment of ≥ moderate MR, AR and AS was 0.81 (95% CI, 0.65-0.97), 0.94 (95% CI, 0.84-1.00) and 0.88 (95% CI, 0.76-1.0), respectively, indicating excellent agreement. CONCLUSIONS POCUS can identify patients with significant VHD and may serve as a powerful screening tool for early detection of significant VHD in the outpatient clinical practice with downstream impact on clinical management of significant VHD.
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Affiliation(s)
| | - Tasneem Z. Naqvi
- Department of Cardiovascular Medicine, Division of Echocardiography, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA;
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Chao CJ, Agasthi P, Girardo M, Barry T, Seri AR, Brown L, Wraith RE, Shanbhag A, Wang Y, Chen YC, Lester SJ, Alsidawi S, Freeman WK, Naqvi TZ, Eleid M, Fortuin D, Pollak P, El Sabbagh A, Sell-Dottin K, Majdalany D, Larsen C, Holmes DR, Oh JK, Appleton CP, Arsanjani R. Using Augmented Mean Arterial Pressure to Identify High Mortality Risk Patients With Moderate Aortic Stenosis. Mayo Clin Proc 2023; 98:1501-1514. [PMID: 37793726 DOI: 10.1016/j.mayocp.2023.02.028] [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: 10/04/2022] [Revised: 02/07/2023] [Accepted: 02/17/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE To study the usefulness of a novel echocardiographic marker, augmented mean arterial pressure (AugMAP = [(mean aortic valve gradient + systolic blood pressure) + (2 × diastolic blood pressure)] / 3), in identifying high-risk patients with moderate aortic stenosis (AS). PATIENTS AND METHODS Adults with moderate AS (aortic valve area, 1.0-1.5 cm2) at Mayo Clinic sites from January 1, 2010, through December 31, 2020, were identified. Baseline demographic, echocardiographic, and all-cause mortality data were retrieved. Patients were grouped into higher and lower AugMAP groups using a cutoff value of 80 mm Hg for analysis. Kaplan-Meier and Cox regression models were used to assess the performance of AugMAP. RESULTS A total of 4563 patients with moderate AS were included (mean ± SD age, 73.7±12.5 years; 60.5% men). Median follow-up was 2.5 years; 36.0% of patients died. The mean ± SD left ventricular ejection fraction (LVEF) was 60.1%±11.4%, and the mean ± SD AugMAP was 99.1±13.1 mm Hg. Patients in the lower AugMAP group, with either preserved or reduced LVEF, had significantly worse survival performance (all P<.001). Multivariate Cox regression showed that AugMAP (hazard ratio, 0.962; 95% CI, 0.942 to 0.981 per 5-mm Hg increase; P<.001) and AugMAP less than 80 mm Hg (hazard ratio, 1.477; 95% CI, 1.241 to 1.756; P<.001) were independently associated with all-cause mortality. CONCLUSION AugMAP is a simple and effective echocardiographic marker to identify high-risk patients with moderate AS independent of LVEF. It can potentially be used in the candidate selection process if moderate AS becomes indicated for aortic valve intervention in the future.
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Affiliation(s)
- Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ; Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN.
| | - Pradyumma Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ; Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN
| | - Marlene Girardo
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Timothy Barry
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Amith R Seri
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Lisa Brown
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Rachel E Wraith
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Anusha Shanbhag
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Yuxiang Wang
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Yi-Chieh Chen
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ; Department of Pharmacy, Mayo Clinic Health System, Austin, MN
| | - Steven J Lester
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Said Alsidawi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - William K Freeman
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Tasneem Z Naqvi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Mackram Eleid
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN
| | - David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Peter Pollak
- Department of Cardiovascular Diseases, Mayo Clinic Florida, Jacksonville, FL
| | - Abdallah El Sabbagh
- Department of Cardiovascular Diseases, Mayo Clinic Florida, Jacksonville, FL
| | | | - David Majdalany
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - Carolyn Larsen
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN
| | - Jae K Oh
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN
| | | | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ
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Farina JM, Barry T, Arsanjani R, Ayoub C, Naqvi TZ. Three-Dimensional Transesophageal Echocardiography in Percutaneous Catheter-Based Cardiac Interventions. J Clin Med 2023; 12:5664. [PMID: 37685731 PMCID: PMC10488874 DOI: 10.3390/jcm12175664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Cardiac structural and valve interventions have remained surgical procedures for several decades. The ability to directly visualize the region of interest during surgery made imaging of these structures pre- and postsurgery a secondary tool to compliment surgical visualization. The last two decades, however, have seen rapid advances in catheter-based percutaneous structural heart interventions (SHIs). Due to the "blind" nature of these interventions, imaging plays a crucial role in the success of these procedures. Fluoroscopy is used universally in all percutaneous cardiac SHIs and helps primarily in the visualization of catheters and devices. However, success of these procedures requires visualization of intracardiac soft tissue structures. Due to its portable nature and rapid ability to show cardiac structures online, transesophageal echocardiography (TEE) has become an integral tool for guidance for all percutaneous SHI. Transcatheter aortic valve replacement-one of the earliest catheter-based procedures-while initially dependent on TEE, has largely been replaced by preprocedural cardiac CT for accurate assessment of valve sizing. Developments in echocardiography now allow live three-dimensional (3D) visualization of cardiac structures mimicking surgical anatomy during TEE. Besides showing actual 3D intracardiac structures, 3D-TEE allows visualization of the interaction of intracardiac catheters and devices with soft tissue cardiac structures, thereby becoming a "second pair of eyes" for the operator. Real-time 3D-TEE now plays an important role complementing multiplane two dimensional and biplane TEE during such interventions. In this review, we discuss the incremental role of 3D-TEE during various SHIs performed today.
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Affiliation(s)
| | | | | | | | - Tasneem Z. Naqvi
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA
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10
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Aladham R, Liu S, Naqvi TZ. Impact of physician performed point of care ultrasound (POCUS) during first outpatient cardiology consultation on patient management and downstream testing. Echocardiography 2023. [PMID: 37151118 DOI: 10.1111/echo.15576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/19/2023] [Accepted: 04/10/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Goal directed point of care ultrasound (POCUS) is a bedside tool to assist with clinical diagnosis. We examined the impact of POCUS performed by consulting cardiologist (CC) during initial cardiology consult on clinical management and downstream testing. METHODS Sixty-nine study patients (pts) seen in a general cardiology outpatient clinic of a tertiary center by an expert imaging CC were compared to a control group of 65 pts seen by three different CCs without POCUS during the same time-period, in whom the first standard echo (SE) was performed after the initial visit. RESULTS Baseline characteristics were similar between the two groups for age, cardiac risk factors, and referral diagnoses. Echo findings on POCUS and by SE (mean delay of 17.2 days after visit) in the control group were comparable for RV size and function and for valvular heart disease. More patients with lower LVEF, higher LV filling pressures, new regional wall motion abnormalities, and increased aortic root size were present among POCUS group resulting in greater yield of echo abnormalities. There were more cardiovascular medication changes at the first visit (15.3% vs. 5.7%, p < .01), less referral for noninvasive stress testing (10% vs. 29%, p < .01), more advanced cardiac testing and subspecialty referrals (29% vs. 18% pts, p = .06), in the study compared to the control group after cardiology visit. CONCLUSION POCUS at time of consultation detects more abnormal echo findings, results in more medication adjustments, less referral for noninvasive stress testing, earlier referral for advanced cardiac diagnostic imaging, and subspecialty cardiac referrals.
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Affiliation(s)
- Raed Aladham
- Department of Cardiovascular Disease, Echocardiography Division, Mayo Clinic, Scottsdale, Arizona, USA
| | - Shuang Liu
- Department of Cardiovascular Disease, Echocardiography Division, Mayo Clinic, Scottsdale, Arizona, USA
| | - Tasneem Z Naqvi
- Department of Cardiovascular Disease, Echocardiography Division, Mayo Clinic, Scottsdale, Arizona, USA
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11
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Chao CJ, Agasthi P, Seri AR, Barry T, Shanbhag A, Wang Y, Eleid MF, Fortuin D, Sweeney JP, Pollak P, El Sabbagh A, Lester SJ, Freeman WK, Naqvi TZ, Holmes DR, Appleton CP, Arsanjani R. Transcatheter Aortic Valve Replacement Prognostication with Augmented Mean Arterial Pressure. J Cardiovasc Dev Dis 2023; 10:jcdd10050192. [PMID: 37233159 DOI: 10.3390/jcdd10050192] [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: 03/29/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Post-transcatheter aortic valve replacement (TAVR) patient outcome is an important research topic. To accurately assess post-TAVR mortality, we examined a family of new echo parameters (augmented systolic blood pressure (AugSBP) and arterial mean pressure (AugMAP)) derived from blood pressure and aortic valve gradients. METHODS Patients in the Mayo Clinic National Cardiovascular Diseases Registry-TAVR database who underwent TAVR between 1 January 2012 and 30 June 2017 were identified to retrieve baseline clinical, echocardiographic and mortality data. AugSBP, AugMAP and valvulo-arterial impedance (Zva) (Zva) were evaluated using Cox regression. Receiver operating characteristic curve analysis and the c-index were used to assess the model performance against the Society of Thoracic Surgeons (STS) risk score. RESULTS The final cohort contained 974 patients with a mean age of 81.4 ± 8.3 years old, and 56.6% were male. The mean STS risk score was 8.2 ± 5.2. The median follow-up duration was 354 days, and the one-year all-cause mortality rate was 14.2%. Both univariate and multivariate Cox regression showed that AugSBP and AugMAP parameters were independent predictors for intermediate-term post-TAVR mortality (all p < 0.0001). AugMAP1 < 102.5 mmHg was associated with a 3-fold-increased risk of all-cause mortality 1-year post-TAVR (hazard ratio 3.0, 95%confidence interval 2.0-4.5, p < 0.0001). A univariate model of AugMAP1 surpassed the STS score model in predicting intermediate-term post-TAVR mortality (area under the curve: 0.700 vs. 0.587, p = 0.005; c-index: 0.681 vs. 0.585, p = 0.001). CONCLUSIONS Augmented mean arterial pressure provides clinicians with a simple but effective approach to quickly identify patients at risk and potentially improve post-TAVR prognosis.
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Affiliation(s)
- Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN 55905, USA
| | - Pradyumna Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN 55905, USA
| | - Amith R Seri
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Timothy Barry
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Anusha Shanbhag
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Yuxiang Wang
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN 55905, USA
| | - David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - John P Sweeney
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Peter Pollak
- Department of Cardiovascular Diseases, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Abdallah El Sabbagh
- Department of Cardiovascular Diseases, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Steven J Lester
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - William K Freeman
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Tasneem Z Naqvi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN 55905, USA
| | | | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
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12
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Kurt M, Naqvi TZ. Post-cardioversion atrial stunning - Not to be forgotten. Echocardiography 2023; 40:266-270. [PMID: 36597407 DOI: 10.1111/echo.15517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/10/2022] [Accepted: 12/10/2022] [Indexed: 01/05/2023] Open
Abstract
We present a case of a 60-year-old male who was found to be in atrial fibrillation during routine evaluation. Anticoagulation was initiated for 36 h and he was referred for TEE-guided electrical cardioversion. There was no thrombus identified in the left atrial appendage, however, the appendage was large and had a tongue-like accessory lobe along with spontaneous contrast in the left atrium and its appendage. TEE probe was not withdrawn, patient underwent successful cardioversion with 200 joules and developed a marked increase in left atrial and left atrial appendage spontaneous contrast along with the development of tear drop shaped thrombus in the left atrial appendage immediately after cardioversion, which rapidly became more dense. There was an associated marked decrease in appendage velocities. Patient was hospitalized to initiate low molecular weight heparin. This case highlights the need for vigilance in patients with an unknown duration of atrial fibrillation, who have received a short duration of anticoagulant therapy and who have adverse appendage anatomy as thrombus may develop immediately after cardioversion despite anticoagulation.
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Affiliation(s)
- Merve Kurt
- Division of Echocardiography, Department of Cardiology, Mayo Clinic, Phoenix, Arizona, USA
| | - Tasneem Z Naqvi
- Division of Echocardiography, Department of Cardiology, Mayo Clinic, Phoenix, Arizona, USA
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13
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Majdalany DS, Arsanjani R, Naqvi TZ. Light on valvular bumps. J Echocardiogr 2023; 21:45-47. [PMID: 34350556 DOI: 10.1007/s12574-021-00543-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/22/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Affiliation(s)
- David S Majdalany
- Department of Cardiovascular Medicine, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, 85259, USA.
| | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, 85259, USA
| | - Tasneem Z Naqvi
- Department of Cardiovascular Medicine, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, 85259, USA
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Chao CJ, Butterfield R, Zhang N, Wen S, Naqvi TZ. QUALITATIVE CAROTID ULTRASOUND PLAQUE ASSESSMENT MAY NOT REFLECT THE TRUE ATHEROSCLEROSIS BURDEN IN LOW TO INTERMEDIATE RISK POPULATION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01903-4] [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: 03/06/2023]
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15
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Tagle-Cornell MCA, Novais BL, Wen S, Mandale D, Naqvi TZ. HAND-HELD ECHOCARDIOGRAPHY BY ADVANCED PRACTICE PROVIDERS IN PATIENTS WITH CONGESTIVE HEART FAILURE: A PILOT STUDY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00907-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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16
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Lee H, Naqvi TZ. Echocardiography in the Assessment of Valve Regurgitation– Incremental Role of Three Dimensional Echocardiography. Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2312407] [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: 12/23/2022] Open
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17
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Park YM(, Jung W, Yeo Y, Park SH, Henry-Tillman R, Lee HS, Naqvi TZ, Han K, Shin DW. Abstract 3214: Risk of atrial fibrillation among women diagnosed with breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Individuals with cancer may be at higher risk of atrial fibrillation (AF). However, sufficient data are lacking in AF risk among breast cancer survivors, especially for the mid-to long-term risk of AF and the impact of cancer treatment on this association. We aimed to investigate the risk of incident AF in women diagnosed with breast cancer and evaluate the association by length of follow-up and breast cancer treatment.
Methods: Using the Korean Health Insurance Service database, we studied 96,476 women who were diagnosed with breast cancer (aged≥20 years) without prior history of AF and breast cancer and underwent breast cancer surgery between January 2007 and December 2013. They were matched 1:3 to a cancer-free population (n=289,428) based on birth year and sex and were followed to the end of 2018. Using ICD-10 codes (I48.0 to I48.4, I.48.9), AF was defined when it was a discharge diagnosis or was verified more than twice in an outpatient clinic. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of AF associated with breast cancer relative to the cancer-free population, adjusting for age, income, and comorbidities including diabetes, hypertension and hyperlipidemia.
Results: During a median follow-up of 6.8 years, AF developed in 2,105 women with breast cancer (3.2 per 1,000 person-years). Mean age at baseline among participants was 49.6 years. Having breast cancer was associated with increased risk of AF (HR, 2.04; 95% CI, 1.93-2.15). This association was stronger for women aged <50 years (HR, 3.98; 95% CI, 3.59-4.40). When we repeated analyses with lag periods of two years to explore the possibility of reverse causation and mid-to long-term risk of AF (n=91,370), the association was largely attenuated but remained significant (HR, 1.18; 95% CI, 1.09-1.28 for total women and HR, 1.60; 95% CI, 1.38-1.86 for women aged <50 years). However, no increased risk of AF was observed in women with breast cancer aged >65 years. Compared with no use of anthracyclines and taxanes, respectively, ever use of anthracyclines and taxanes was associated with increased risk of AF after further adjusting for other cancer treatment modalities including use of trastuzumab, radiotherapy, and endocrine treatment (HR, 1.25; 95% CI, 1.12-1.40 and HR, 1.37; 95% CI, 1.23-1.53, respectively). This association persisted only among women with breast cancer ever treated with anthracyclines when analysis was limited to those with two year-lag periods (HR, 1.23; 95% CI, 1.04-1.45).
Conclusions: In this large-scale nationwide cohort study in South Korea, women with breast cancer had an elevated risk of incident AF, especially for women with breast cancer younger than 50 years, regardless of the length of follow-up. Our findings also suggest that cardiotoxic side effects of cancer treatment such as use of anthracyclines might increase both short-term and mid-to long-term risk of AF among women with breast cancer.
Citation Format: Yong-Moon ("Mark") Park, Wonyoung Jung, Yohwan Yeo, Sang Hyun Park, Ronda Henry-Tillman, Hong Seok Lee, Tasneem Z. Naqvi, Kyungdo Han, Dong Wook Shin. Risk of atrial fibrillation among women diagnosed with breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3214.
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Affiliation(s)
| | - Wonyoung Jung
- 2Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yohwan Yeo
- 2Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Hyun Park
- 3The Catholic University of Korea, Seoul, Republic of Korea
| | | | - Hong Seok Lee
- 4University of Arizona, Banner University Medical Group, Tucson, AZ
| | | | - Kyungdo Han
- 6Soongsil University, Seoul, Republic of Korea
| | - Dong Wook Shin
- 2Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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18
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Al-Mallah M, Naqvi TZ. Unbiased COVID-19 Pandemic With Biased Global Recovery. J Am Coll Cardiol 2022; 79:2018-2020. [PMID: 35589163 DOI: 10.1016/j.jacc.2022.03.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Mouaz Al-Mallah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
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Elshaer A, Naqvi TZ, Rattanawong P. MIDVENTRICULAR VARIANT STRESS-INDUCED CARDIOMYOPATHY IN PATIENT WITH UNDERLYING CORONARY ARTERY DISEASE: A CHALLENGING DIAGNOSIS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03653-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Hawkes W, Keane MG, Khazan B, QAMRUDDIN SALIMA, Tutor A, Thamman R, Naqvi TZ, Mandale D, Strom JB, Hurtado GP, Peterson E, Gul FI, Watson S, Tilkes K, Davidson H, Scott C, Piotrowska H, Hansen WH, Woodward G, Pellikka PA. FULLY AUTOMATED ANALYSIS OF CARDIAC POINT OF CARE ULTRASOUND: FEASIBILITY AND CLINICAL RELEVANCE IN COVID-19 PATIENTS. J Am Coll Cardiol 2022. [PMCID: PMC8972461 DOI: 10.1016/s0735-1097(22)02998-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Taguchi YV, Naqvi TZ. Reversible Takotsubo cardiomyopathy with non-revascularized concomitant severe coronary artery disease. Echocardiography 2021; 38:2104-2108. [PMID: 34845752 DOI: 10.1111/echo.15265] [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: 06/09/2021] [Revised: 10/17/2021] [Accepted: 11/04/2021] [Indexed: 11/28/2022] Open
Abstract
Takotsubo cardiomyopathy is a transient cardiac condition commonly triggered by a stressor, presenting with clinical features mimicking acute coronary syndromes. We report an unusual case of Takotsubo cardiomyopathy in a man with severe three-vessel coronary artery disease awaiting coronary bypass surgery who developed rapid spontaneous recovery of cardiac function before revascularization.
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Affiliation(s)
| | - Tasneem Z Naqvi
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
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22
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Naqvi TZ, Polonsky TS. Finding the Right Age for CAC Testing: How Low Should You Go? J Am Coll Cardiol 2021; 78:1584-1586. [PMID: 34649695 DOI: 10.1016/j.jacc.2021.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Tasneem Z Naqvi
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, Arizona, USA.
| | - Tamar S Polonsky
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
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23
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Lee H, Naqvi TZ. Late presentation of traumatic tricuspid valve regurgitation after motor vehicle accident managemed with valve replacement surgery: Role of 3D echocardiography. Echocardiography 2021; 38:1813-1816. [PMID: 34596917 DOI: 10.1111/echo.15193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/09/2021] [Accepted: 08/20/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Hong Lee
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
| | - Tasneem Z Naqvi
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
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24
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Naqvi TZ. Physiological Adaptation Versus Pathological Carotid Artery Remodeling in Children. JACC Cardiovasc Imaging 2021; 14:479-481. [PMID: 33541531 DOI: 10.1016/j.jcmg.2020.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Tasneem Z Naqvi
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA.
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25
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Chao CJ, Mandale DR, Naqvi TZ. New pathological illuminations on 3D transillumination transesophageal echocardiography imaging. Echocardiography 2021; 38:1070-1073. [PMID: 33982822 DOI: 10.1111/echo.15060] [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: 01/02/2021] [Accepted: 04/08/2021] [Indexed: 12/01/2022] Open
Abstract
The use of 3D technology has significantly improved the diagnostic accuracy of echocardiography by overcoming the limitation of 2D echocardiography. Transillumination 3D image post processing technique enhances shadows and contrast of cardiac structures with a movable virtual light source improving further the clarity and detail provided by conventional 3D imaging. In this report, we present 3 cases, one of mobile atherosclerotic aortic root plaque, another of small thrombi on ICD lead, and a third case of bicuspid aortic valve perforation due to infective endocarditis in whom TEE 3D transillumination further improved the diagnostic quality of conventional 3D imaging and lead to accurate clinical diagnosis.
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Affiliation(s)
- Chieh-Ju Chao
- Echocardiography Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Deepa R Mandale
- Echocardiography Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Tasneem Z Naqvi
- Echocardiography Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ, USA
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26
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Naqvi TZ, Taguchi YV. REVERSIBLE TAKOTSUBO CARDIOMYOPATHY WITH NONREVASCULARIZED CONCOMITANT SEVERE CORONARY ARTERY DISEASE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03943-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Krishna H, Ryu AJ, Scott CG, Mandale DR, Naqvi TZ, Pellikka PA. Cardiac Abnormalities in COVID-19 and Relationship to Outcome. Mayo Clin Proc 2021; 96:932-942. [PMID: 33714597 PMCID: PMC7816643 DOI: 10.1016/j.mayocp.2021.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/04/2021] [Accepted: 01/11/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To characterize the clinical and transthoracic echocardiographic features and 30-day outcomes of hospitalized patients with coronavirus disease 2019 (COVID-19). METHODS Retrospective cohort study that included consecutive inpatients with COVID-19 infection who underwent clinically indicated transthoracic echocardiography at 10 sites in the Mayo Clinic Health System between March 10 and August 5, 2020. Echocardiography was performed at bedside by cardiac sonographers according to an abbreviated protocol. Echocardiographic results, demographic characteristics, laboratory findings, and clinical outcomes were analyzed. RESULTS There were 179 patients, aged 59.8±16.9 years and 111 (62%) men; events within 30 days occurred in 70 (39%) patients, including prolonged hospitalization in 43 (24%) and death in 27 (15%). Echocardiographic abnormalities included left ventricular ejection fraction less than 50% in 29 (16%), regional wall motion abnormalities in 26 (15%), and right ventricular systolic pressure (RVSP) of 35 or greater mm Hg in 44 (44%) of 101 in whom it was measured. Myocardial injury, defined as the presence of significant troponin level elevation accompanied by new ventricular dysfunction or electrocardiographic abnormalities, was present in 13 (7%). Prior echocardiography was available in 36 (20%) patients and pre-existing abnormalities were seen in 28 (78%) of these. In a multivariable age-adjusted model, area under the curve of 0.81, prior cardiovascular disease, troponin level, D-dimer level, and RVSP were related to events at 30 days. CONCLUSION Bedside Doppler assessment of RVSP appears promising for short-term risk stratification in hospitalized patients with COVID-19 infection undergoing clinically indicated echocardiography. Pre-existing echocardiographic abnormalities were common; caution should be exercised in attributing such abnormalities to the COVID-19 infection in this comorbid patient population.
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Key Words
- as, aortic stenosis
- covid-19, coronavirus disease 2019
- ecmo, extracorporeal membrane oxygenation
- gls, global longitudinal strain
- lv, left ventricular
- lvef, left ventricular ejection fraction
- mr, mitral regurgitation
- nstemi, non–st-elevation myocardial infarction
- q, quartile
- rrt, renal replacement therapy
- rv, right ventricular
- rwmsi, regional wall motion score index
- rvsp, right ventricular systolic pressure
- tr, tricuspid regurgitation
- tte, transthoracic echocardiography
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Affiliation(s)
- Hema Krishna
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Alexander J Ryu
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Deepa R Mandale
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ
| | - Tasneem Z Naqvi
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ
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Wiegers SE, Ryan T, Arrighi JA, Brown SM, Canaday B, Damp JB, Diaz-Gomez JL, Figueredo VM, Garcia MJ, Gillam LD, Griffin BP, Kirkpatrick JN, Klarich KW, Lui GK, Maffett S, Naqvi TZ, Patel AR, Poulin MF, Rose GA, Swaminathan M, Arrighi JA, Mendes LA, Adams JE, Brush JE, Dec GW, Denktas A, Fernandes S, Freeman R, Hahn RT, Halperin JL, Housholder-Hughes SD, Khan SS, Klarich KW, Lin CH, Marine JE, McPherson JA, Niazi K, Ryan T, Solomon MA, Spicer RL, Tam M, Wang A, Weissman G, Weitz HH, Williams ES. 2019 ACC/AHA/ASE Advanced Training Statement on Echocardiography (Revision of the 2003 ACC/AHA Clinical Competence Statement on Echocardiography): A Report of the ACC Competency Management Committee. J Am Soc Echocardiogr 2020; 32:919-943. [PMID: 31378259 DOI: 10.1016/j.echo.2019.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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29
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Affiliation(s)
| | - Tasneem Z Naqvi
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, Arizona
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30
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Chao CJ, DeValeria PA, Sen A, Lee H, Pedrotty DM, Patel B, Arsanjani R, Naqvi TZ. Reversible cardiac dysfunction in severe COVID-19 infection, mechanisms and case report. Echocardiography 2020; 37:1465-1469. [PMID: 32856328 PMCID: PMC7461431 DOI: 10.1111/echo.14807] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/01/2020] [Accepted: 07/16/2020] [Indexed: 01/19/2023] Open
Abstract
A previously healthy 49-year-old male patient presented with COVID-19 infection and required mechanical ventilation and extracorporeal membrane oxygenation due to severe hypoxemia. Echocardiography showed cardiac dysfunction with an apical sparing strain pattern, which rapidly normalized within a week. Apical sparing myocardial strain in patients with COVID-19 infection may suggest reverse-type stress cardiomyopathy.
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Affiliation(s)
- Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Ayan Sen
- Department of Critical Care Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Hong Lee
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA
| | - Dawn M Pedrotty
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA
| | - Bhavesh Patel
- Department of Critical Care Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA
| | - Tasneem Z Naqvi
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA
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Johri AM, Nambi V, Naqvi TZ, Feinstein SB, Kim ESH, Park MM, Becher H, Sillesen H. Recommendations for the Assessment of Carotid Arterial Plaque by Ultrasound for the Characterization of Atherosclerosis and Evaluation of Cardiovascular Risk: From the American Society of Echocardiography. J Am Soc Echocardiogr 2020; 33:917-933. [PMID: 32600741 DOI: 10.1016/j.echo.2020.04.021] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Atherosclerotic plaque detection by carotid ultrasound provides cardiovascular disease risk stratification. The advantages and disadvantages of two-dimensional (2D) and three-dimensional (3D) ultrasound methods for carotid arterial plaque quantification are reviewed. Advanced and emerging methods of carotid arterial plaque activity and composition analysis by ultrasound are considered. Recommendations for the standardization of focused 2D and 3D carotid arterial plaque ultrasound image acquisition and measurement for the purpose of cardiovascular disease stratification are formulated. Potential clinical application towards cardiovascular risk stratification of recommended focused carotid arterial plaque quantification approaches are summarized.
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Affiliation(s)
| | | | | | | | - Esther S H Kim
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Margaret M Park
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio
| | - Harald Becher
- University of Alberta Hospital, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Henrik Sillesen
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Naqvi TZ. Is there a silver lining for US health care from COVID-19 pandemic? Rev Cardiovasc Med 2020; 21:155-156. [PMID: 32706204 DOI: 10.31083/j.rcm.2020.02.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/08/2020] [Indexed: 11/06/2022] Open
Abstract
The COVID-19 pandemic has had an impact on economy and health care system of every nation. United States has been the hardest hit country both with incidence and absolute mortality from COVID-19. In some of its states the health care system have been stretched to their limits. This has led to a rapid change in the health care practice due to newly approved emergency legislative bills, new state government laws, measures taken by institutions and practices as well as the changing consumer behavior. Some of these adaptations - in particular, the transition of patient care to virtual visits are revolutionary. Increased vigilance by health care organization and workers to minimize the spread of infection to others as well for personal protection may result in lasting behavioral change that will prevent hospital acquired or transmitted infections and may lead to reduced morbidity and mortality from the regular "flu". The recycling of personal protective equipment and the emerging research showing it a safe practice will reduce health care expenditure. It is quite possible that this pandemic may be the silver lining that will save the US health care from its unsustainable consumption of US gross domestic product.
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Fazlinezhad A, Narayanasamy H, Wilansky S, Naqvi TZ. Detection of LV apical thrombus by three-dimensional transesophageal echocardiography. Echocardiography 2019; 37:142-146. [PMID: 31841222 DOI: 10.1111/echo.14558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 09/24/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Patients with apical myocardial infarction are at higher risk of developing left ventricular (LV) thrombi. Standard transesophageal echocardiography (TEE) is commonly used in assessing cardiac source of embolic cerebrovascular accident (CVA). Contrast-enhanced transthoracic echocardiography (TTE) improves sensitivity for thrombus detection compared with noncontrast TTE, and however for LV apical thrombi, contrast-enhanced magnetic resonance imaging (MRI) and/or contrast-enhanced computed tomography (CT) outperform both TTE and TEE in some studies. CASE A 67-year-old man with history of prior myocardial infarction (MI), four-vessel coronary artery bypass surgery, congestive heart failure with LV ejection fraction of 30%, and diabetes mellitus presented to our facility with acute right occipital-parietal stroke and recent history of left lower extremity ischemia. Head and neck MRI and MR angiography found multiple posterior circulation infarcts suggestive of cardio-embolic etiology. TTE image quality was suboptimal even after contrast use to evaluate for LV thrombus, and due to renal insufficiency, MRI or CT was precluded and 3DTEE identified large LV apical thrombus with mobile components. CONCLUSION 3DTEE may increase the detection of LV apical thrombi as well as evaluating its characteristics by live imaging as well as by offline reconstruction. TEE may be a useful diagnostic modality, especially in patients with decreased renal function, where iodinated contrast for cardiac CT or Gadolinium for MRI may be contraindicated. Multimodality imaging studies may further prove the utility of 3D echocardiographic imaging in the detection of LV apical thrombus.
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Affiliation(s)
- Afsoon Fazlinezhad
- Echocardiography Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA
| | - Hemalatha Narayanasamy
- Echocardiography Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA
| | - Susan Wilansky
- Echocardiography Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA
| | - Tasneem Z Naqvi
- Echocardiography Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA
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Wiegers SE, Ryan T, Arrighi JA, Brown SM, Canaday B, Damp JB, Diaz‐Gomez JL, Figueredo VM, Garcia MJ, Gillam LD, Griffin BP, Kirkpatrick JN, Klarich KW, Lui GK, Maffett S, Naqvi TZ, Patel AR, Poulin M, Rose GA, Swaminathan M. 2019 ACC/AHA/ASE advanced training statement on echocardiography (revision of the 2003 ACC/AHA clinical competence statement on echocardiography). Catheter Cardiovasc Interv 2019; 94:481-505. [DOI: 10.1002/ccd.28313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/12/2022]
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Wiegers SE, Ryan T, Arrighi JA, Brown SM, Canaday B, Damp JB, Diaz-Gomez JL, Figueredo VM, Garcia MJ, Gillam LD, Griffin BP, Kirkpatrick JN, Klarich KW, Lui GK, Maffett S, Naqvi TZ, Patel AR, Poulin MF, Rose GA, Swaminathan M. 2019 ACC/AHA/ASE Advanced Training Statement on Echocardiography (Revision of the 2003 ACC/AHA Clinical Competence Statement on Echocardiography): A Report of the ACC Competency Management Committee. Circ Cardiovasc Imaging 2019. [DOI: 10.1161/hci.0000000000000026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mirza NN, Jaroszewski D, Gotway MB, Naqvi TZ. SURGICAL CORRECTION OF CHEST WALL DEFORMITY IN PECTUS EXCAVATUM IMPROVES LEFT VENTRICULAR MECHANICAL DYSSYNCHRONY AND RIGHT VENTRICULAR FUNCTION: A TEE SPECKLE TRACKING STRAIN IMAGING STUDY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32209-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Doherty JU, Kort S, Mehran R, Schoenhagen P, Soman P, Dehmer GJ, Doherty JU, Schoenhagen P, Bashore TM, Bhave NM, Calnon DA, Carabello B, Conte J, Dickfeld T, Edmundowicz D, Ferrari VA, Hall ME, Ghoshhajra B, Mehrotra P, Naqvi TZ, Reece TB, Starling RC, Szerlip M, Tzou WS, Wong JB, Doherty JU, Dehmer GJ, Bailey SR, Bhave NM, Brown AS, Daugherty SL, Dean LS, Desai MY, Duvernoy CS, Gillam LD, Hendel RC, Kramer CM, Lindsay BD, Manning WJ, Patel MR, Sachdeva R, Wann LS, Winchester DE, Wolk MJ. ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2019 Appropriate Use Criteria for Multimodality Imaging in the Assessment of Cardiac Structure and Function in Nonvalvular Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and the Society of Thoracic Surgeons. J Am Soc Echocardiogr 2019; 32:553-579. [PMID: 30744922 DOI: 10.1016/j.echo.2019.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This document is the second of 2 companion appropriate use criteria (AUC) documents developed by the American College of Cardiology, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. The first document1 addresses the evaluation and use of multimodality imaging in the diagnosis and management of valvular heart disease, whereas this document addresses this topic with regard to structural (nonvalvular) heart disease. While dealing with different subjects, the 2 documents do share a common structure and feature some clinical overlap. The goal of the companion AUC documents is to provide a comprehensive resource for multimodality imaging in the context of structural and valvular heart disease, encompassing multiple imaging modalities. Using standardized methodology, the clinical scenarios (indications) were developed by a diverse writing group to represent patient presentations encountered in everyday practice and included common applications and anticipated uses. Where appropriate, the scenarios were developed on the basis of the most current American College of Cardiology/American Heart Association Clinical Practice Guidelines. A separate, independent rating panel scored the 102 clinical scenarios in this document on a scale of 1 to 9. Scores of 7 to 9 indicate that a modality is considered appropriate for the clinical scenario presented. Midrange scores of 4 to 6 indicate that a modality may be appropriate for the clinical scenario, and scores of 1 to 3 indicate that a modality is considered rarely appropriate for the clinical scenario. The primary objective of the AUC is to provide a framework for the assessment of these scenarios by practices that will improve and standardize physician decision making. AUC publications reflect an ongoing effort by the American College of Cardiology to critically and systematically create, review, and categorize clinical situations in which diagnostic tests and procedures are utilized by physicians caring for patients with cardiovascular diseases. The process is based on the current understanding of the technical capabilities of the imaging modalities examined.
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Doherty JU, Kort S, Mehran R, Schoenhagen P, Soman P, Dehmer GJ, Doherty JU, Schoenhagen P, Bashore TM, Bhave NM, Calnon DA, Carabello B, Conte J, Dickfeld T, Edmundowicz D, Ferrari VA, Hall ME, Ghoshhajra B, Mehrotra P, Naqvi TZ, Reece TB, Starling RC, Szerlip M, Tzou WS, Wong JB. ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2019 Appropriate Use Criteria for Multimodality Imaging in the Assessment of Cardiac Structure and Function in Nonvalvular Heart Disease. J Am Coll Cardiol 2019; 73:488-516. [DOI: 10.1016/j.jacc.2018.10.038] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Naqvi TZ. Echocardiography in transcatheter aortic (Core)Valve implantation: Part 2-Transesophageal echocardiography. Echocardiography 2018; 35:1020-1041. [DOI: 10.1111/echo.14034] [Citation(s) in RCA: 4] [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)
- Tasneem Z. Naqvi
- Department of Cardiology; Echocardiography Laboratory; Mayo Clinic; Scottsdale AZ USA
- University of Southern California; Los Angeles CA USA
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Affiliation(s)
- Tasneem Z. Naqvi
- Echocardiographic Laboratory; Department of Cardiology; Mayo Clinic; Scottsdale AZ USA
- Division of Cardiology; University of Southern California; Los Angeles CA USA
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Chao CJ, Jaroszewski D, Gotway M, Ewais M, Wilansky S, Lester S, Unzek S, Appleton CP, Chaliki HP, Gaitan BD, Mookadam F, Naqvi TZ. Effects of Pectus Excavatum Repair on Right and Left Ventricular Strain. Ann Thorac Surg 2018; 105:294-301. [DOI: 10.1016/j.athoracsur.2017.08.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/07/2017] [Accepted: 08/07/2017] [Indexed: 10/18/2022]
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Affiliation(s)
- Tasneem Z Naqvi
- Department of Cardiology, Echocardiography Laboratory, Mayo Clinic, Scottsdale, USA
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Abstract
The prevalence of pregnant women with cardiovascular heart disease is increasing. Transthoracic echocardiography is safe during pregnancy, and it is an important diagnostic tool in pregnant women with established heart disease in order to monitor ventricular and valvular anatomy and function. In addition, it can be used to delineate cardiac anatomy in complex congenital heart disease and help stratify maternal risk during pregnancy. This review will focus on the use of echocardiography in the diagnosis and management of pregnant women with common congenital lesions and with prosthetic valves.
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Affiliation(s)
- Meena Narayanan
- Division of Cardiology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Uri Elkayam
- Division of Cardiology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tasneem Z Naqvi
- Division of Cardiology, Department of Medicine, College of Medicine, Mayo Clinic, CK27, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA.
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Abudiab MM, Chao CJ, Liu S, Naqvi TZ. Quantitation of valve regurgitation severity by three-dimensional vena contracta area is superior to flow convergence method of quantitation on transesophageal echocardiography. Echocardiography 2017; 34:992-1001. [DOI: 10.1111/echo.13549] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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)
- Muaz M. Abudiab
- Echocardiography Laboratory; Department of Cardiovascular Diseases; Mayo Clinic; Scottsdale AZ USA
| | - Chieh-Ju Chao
- Echocardiography Laboratory; Department of Cardiovascular Diseases; Mayo Clinic; Scottsdale AZ USA
| | - Shuang Liu
- Echocardiography Laboratory; Department of Cardiovascular Diseases; Mayo Clinic; Scottsdale AZ USA
| | - Tasneem Z. Naqvi
- Echocardiography Laboratory; Department of Cardiovascular Diseases; Mayo Clinic; Scottsdale AZ USA
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Liu S, Waldo O, Kaur T, Ahoui A, Scott L, Naqvi TZ. LONG-TERM EFFECTS OF RIGHT VENTRICULAR PACING ON LEFT VENTRICULAR SYSTOLIC AND DIASTOLIC FUNCTION AND SYNCHRONY BY STRAIN IMAGING IN PATIENTS WITH NORMAL BASELINE LEFT VENTRICULAR EJECTION FRACTION. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34855-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Naqvi TZ, Nambi V. Risk Statins or Risk "Zero" on Atherosclerosis Imaging for Risk Stratification? J Am Coll Cardiol 2016; 68:892-4. [PMID: 27561761 DOI: 10.1016/j.jacc.2016.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/08/2016] [Indexed: 11/18/2022]
Affiliation(s)
| | - Vijay Nambi
- Michael E DeBakey Veterans Affairs Hospital, Houston, Texas; Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas
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Abstract
Noninvasive measures of atherosclerosis have emerged as adjuncts to standard cardiovascular disease (CVD) risk factors in an attempt to refine risk stratification and the need for more aggressive preventive strategies. Two such approaches, carotid artery imaging and brachial artery reactivity testing (BART), are ultrasound based. Numerous carotid artery imaging protocols have been used, and methodologic aspects are described in detail in this review. The panel recommends that protocols: (1) use end-diastolic (minimum dimension) images for intimal-medial thickness (IMT) measurements; (2) provide separate categorization of plaque presence and IMT; (3) avoid use of a single upper limit of normal for IMT because the measure varies with age, sex, and race; and (4) incorporate lumen measurement, particularly when serial measurements are performed to account for changes in distending pressure. Protocols may vary in the number of segments wherein IMT is measured, whether near wall is measured in addition to far wall, and whether IMT measurements are derived from B-mode or M-mode images, depending on the application. BART is a technique that requires meticulous attention to patient preparation and methodologic detail. Its application is substantially more challenging than is carotid imaging and remains largely a research technique that is not readily translated into routine clinical practice.
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Affiliation(s)
- Mary J Roman
- Weill Medical College of Cornell University, New York, NY, USA.
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Gerhard-Herman M, Gardin JM, Jaff M, Mohler E, Roman M, Naqvi TZ. Guidelines for noninvasive vascular laboratory testing: a report from the American Society of Echocardiography and the Society for Vascular Medicine and Biology. Vasc Med 2016; 11:183-200. [PMID: 17288127 DOI: 10.1177/1358863x06070516] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Accompanying the rapid growth of interest in percutaneous vascular interventions, there has been increasing interest among cardiologists in performing noninvasive vascular testing using ultrasound. In an attempt to provide recommendations on the best practices in vascular laboratory testing, this report has been prepared by a writing group from the American Society of Echocardiography (ASE) and the Society for Vascular Medicine and Biology. The document summarizes principles integral to vascular duplex ultrasound--including color Doppler, spectral Doppler waveform analysis, power Doppler, and the use of contrast. Appropriate indications and interpretation of carotid artery, renal artery, abdominal aorta, and peripheral artery ultrasound imaging are described. A dedicated section summarizes noninvasive techniques for physiologic vascular testing of the lower extremity arteries--including measurement of segmental pressures and pulse volume plethysmography. The use of exercise testing in the evaluation of peripheral artery disease, ultrasound evaluation of the lower extremities after percutaneous revascularization, and the diagnosis and management of iatrogenic pseudoaneurysm (PSA) is also discussed. A section on the important topic of vascular laboratory accreditation is included. Finally, additional details regarding proper technique for performance of the various vascular tests and procedures are included in the Appendix.
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MESH Headings
- Accreditation
- Aneurysm, False/diagnostic imaging
- Aortic Aneurysm, Abdominal/diagnostic imaging
- Arteries/diagnostic imaging
- Blood Pressure
- Cardiology/education
- Cardiology/methods
- Carotid Arteries/diagnostic imaging
- Curriculum
- Education, Medical, Graduate
- Exercise Test
- Humans
- Image Interpretation, Computer-Assisted
- Insurance, Health, Reimbursement
- Lower Extremity/blood supply
- Medicare/economics
- Peripheral Vascular Diseases/diagnosis
- Peripheral Vascular Diseases/diagnostic imaging
- Peripheral Vascular Diseases/physiopathology
- Peripheral Vascular Diseases/surgery
- Plethysmography
- Pulse
- Renal Artery/diagnostic imaging
- Treatment Outcome
- Ultrasonography, Doppler/economics
- Ultrasonography, Doppler/instrumentation
- Ultrasonography, Doppler/methods
- Ultrasonography, Doppler, Color
- Ultrasonography, Interventional/economics
- Ultrasonography, Interventional/methods
- United States
- Vascular Surgical Procedures
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Narayanan M, Bamba A, Liu S, Naqvi TZ. Impaired Left and Right Ventricular Systolic and Diastolic Function in Response to Exercise in Patients with Diastolic Dysfunction. Echocardiography 2016; 33:1209-18. [PMID: 27241948 DOI: 10.1111/echo.13242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/29/2022] Open
Abstract
BACKGROUND Diastolic dysfunction (DD) is associated with exercise intolerance. To evaluate mechanisms of exercise intolerance in patients with DD, we performed bicycle stress echocardiography. METHOD AND RESULTS Doppler measurements were performed at baseline, during exercise and recovery in 26 patients (58 ± 11 years) with DD and normal left ventricular ejection fraction and 6 normal controls (53 ± 5 years). Compared to controls, patients achieved similar target heart rates but lower METs (5.5 ± 2 vs. 9.8 ± 3, P < 0.01) and a higher peak pulmonary artery pressure (PAP) at peak exercise (50 ± 13 vs. 32 ± 7 mmHg, P < 0.01) despite similar PAP at rest and similar mean blood pressure at peak exercise (110.4 ± 18.0 vs. 106.9 ± 11.4 mmHg, P = NS). In patients versus controls, mitral E/E' was similar at baseline (10 ± 3 vs. 8 ± 1.3, P = NS) but higher at recovery (11 ± 2 vs. 7 ± 2, P < 0.05), % mitral filling time was shorter at baseline, onset, and peak exercise, whereas % LV and RV ejection time was similar to controls throughout exercise. Compared to controls, lateral mitral annular S' (11.8 ± 2.5 cm/sec vs. 14.9 ± 1.9 cm/sec, P < 0.02) and tricuspid annular S' (14.8 ± 4.1 cm/sec vs. 19.4 ± 4.0 cm/sec, P < 0.05) were lower at peak exercise in patients. CONCLUSION Diastolic filling time is reduced at rest and stress while LV ejection time increases normally during exercise in DD. There is a reduced systolic reserve in LV and RV during exercise in DD. These mechanisms contribute to exercise intolerance and elevation of left atrial and PAP in patients with DD.
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Affiliation(s)
- Meena Narayanan
- Division of Cardiology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Alyssa Bamba
- Division of Cardiology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Shuang Liu
- Department of Cardiology, Mayo Clinic, Scottsdale, Arizona
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