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Muthukumar L, Jahangir A, Ashraf M, Schweitzer M, Pesek K, Galazka P, Umland M, Khandheria BK, Tajik AJ. Myocardial work indices in bileaflet mitral valve prolapse patients. Eur Heart J Cardiovasc Imaging 2024; 25:626-634. [PMID: 38060988 DOI: 10.1093/ehjci/jead333] [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: 05/31/2023] [Revised: 10/30/2023] [Accepted: 12/04/2023] [Indexed: 05/01/2024] Open
Abstract
AIMS Mechanisms underlying left ventricular dysfunction and arrhythmogenesis in bileaflet mitral valve prolapse (BMVP) patients are not well defined. Myocardial work index (MWI) is a non-invasive assessment that correlates with myocardial oxygen consumption. We aimed to compare global and regional MWI in BMVP patients with normal controls. METHODS AND RESULTS In this retrospective study, we calculated MWI in BMVP patients and controls using GE EchoPAC (GE Healthcare, Chicago, IL, USA) software. Of 147 BMVP patients (59% women, mean age 54 ± 15 years), 16 had a flail mitral leaflet. There was regional heterogeneity in MWIs, with increased posterolateral trident myocardial work (2099 ± 271 vs. 1895 ± 321 mm Hg%, P = 0.039), constructive work (2831 ± 366 vs. 2257 ± 338 mm Hg%, P < 0.001), wasted work [87 (52-194) vs. 71 (42-103) mm Hg%, P = 0.015], peak systolic strain (-23.0 ± 2.4 vs. -19 ± 3%, P < 0.001), and reduction in myocardial work efficiency [95.00 (93.50-97.75) vs. 96.75 (95.00-97.75) %, P = 0.020] in 100 BMVP patients compared with age- and sex-matched controls. BMVP patients' basal septal wall MWIs were lower than those of controls. The higher work indices in patients with BMVP were reduced in those who developed flail leaflets. No significant differences in work indices were seen between ventricular arrhythmia and non-arrhythmia BMVP patients. CONCLUSION Regional differences in MWIs were noted in the BMVP patients compared with controls, with overall reduced myocardial efficiency in the posterolateral trident and basal septal regions. In cross-sectional analysis, MWIs were not different in patients with ventricular tachyarrhythmias. Impact of MWI on long-term prognosis needs to be determined.
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Affiliation(s)
- Lakshmi Muthukumar
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St.Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 130, Milwaukee, WI 53215, USA
| | - Arshad Jahangir
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St.Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 130, Milwaukee, WI 53215, USA
| | - Muddasir Ashraf
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St.Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 130, Milwaukee, WI 53215, USA
| | - McKenzie Schweitzer
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St.Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 130, Milwaukee, WI 53215, USA
| | - Kelly Pesek
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St.Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 130, Milwaukee, WI 53215, USA
| | - Patrycja Galazka
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St.Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 130, Milwaukee, WI 53215, USA
| | - Matt Umland
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St.Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 130, Milwaukee, WI 53215, USA
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St.Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 130, Milwaukee, WI 53215, USA
| | - A Jamil Tajik
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St.Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 130, Milwaukee, WI 53215, USA
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Manganaro R, Cusmà-Piccione M, Carerj S, Licordari R, Khandheria BK, Zito C. Echocardiographic Patterns of Abnormal Septal Motion: Beyond Myocardial Ischemia. J Am Soc Echocardiogr 2023; 36:1140-1153. [PMID: 37574150 DOI: 10.1016/j.echo.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/25/2023] [Accepted: 08/04/2023] [Indexed: 08/15/2023]
Abstract
Abnormal septal motion (ASM), which often is associated with myocardial ischemia, is also observed in other diseases. Owing to the position of the interventricular septum (IVS) in the heart, its movement not only relies on contractile properties but is also affected by the pressure gradient between the 2 ventricles and by the mode of electrical activation. Echocardiography allows the operator to focus on the motion of the IVS, analyzing its characteristics and thereby gaining information about the possible underlying pathophysiological mechanism. In this review, we focused on the main echocardiographic patterns of ASM that are not related to a failure of contractile properties of the septum (i.e., acute coronary syndrome and cardiomyopathies), showing their pathophysiological mechanisms and underlining their diagnostic usefulness in clinical practice.
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Affiliation(s)
- Roberta Manganaro
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy
| | - Maurizio Cusmà-Piccione
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy
| | - Roberto Licordari
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Marcus Family Fund for Echocardiography (ECHO) Research and Education, Milwaukee, Wisconsin
| | - Concetta Zito
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy.
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Ahmad MM, Yoon JA, Syed MN, Ahmad MN, Hussaini SF, Muhammad MN, Pir SHA, Khandheria BK, Tajik AJ, Ammar KA. Prevalence of dilated mid-ascending aorta in individuals 15 years and older: In search of optimal diagnostic criteria and their effect on the burden of disease. Vasc Med 2023; 28:425-432. [PMID: 37646458 DOI: 10.1177/1358863x231191818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND Controversy regarding the definition of the upper limit of normal (ULN) for dilated mid-ascending aorta (mAA) stems from variation in criteria, based on several small-sized studies with small datasets of normal subjects (DONS). The present study was carried out to demonstrate this variation in the prevalence of mAA dilation and to identify the optimal definition by creating the largest DONS. METHODS Echocardiographic studies of patients ≥ 15 years of age performed at a large tertiary care center over 4 years (n = 49,330) were retrospectively evaluated. The leading-edge-to-leading-edge technique was used to measure the mAA in diastole. The largest-to-date DONS (n = 2334) was created, including those who were normal on medical record review, did not have any of the 28 causes of dilated aorta, and had normal echocardiograms. Because age had the strongest correlation with mAA (multivariate adjusted R2 = 0.26), as compared with sex, height, and weight, we created a new ULN based on the DONS with narrow age stratification (10-year intervals). RESULTS The prevalence of dilated mAA varied between 17% and 23% when absolute criteria were used with sex stratification, and it varied between 6% and 11% when relative criteria (relative to age, body surface area, and sex) were used. Based on new criteria from the DONS, it was 7.6%, with a ULN of 3.07-3.64 cm in women and 3.3-3.91 cm in men. CONCLUSIONS These data demonstrate the undesirable variation in the prevalence of dilated mAA based on prior criteria and propose a new ULN for dilated mAA.
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Affiliation(s)
- Mirza Mujadil Ahmad
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St Luke's Medical Centers, Milwaukee, WI, USA
| | - Ji Ae Yoon
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St Luke's Medical Centers, Milwaukee, WI, USA
- Department of Medicine, St Francis Hospital and Medical Center, Hartford, CT, USA
| | - Muhammad Nabeel Syed
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St Luke's Medical Centers, Milwaukee, WI, USA
| | - Mirza Nubair Ahmad
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St Luke's Medical Centers, Milwaukee, WI, USA
| | - Sharmeen Fatima Hussaini
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St Luke's Medical Centers, Milwaukee, WI, USA
| | - Mustafa Noor Muhammad
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St Luke's Medical Centers, Milwaukee, WI, USA
| | - Syed Haris A Pir
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St Luke's Medical Centers, Milwaukee, WI, USA
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St Luke's Medical Centers, Milwaukee, WI, USA
| | - A Jamil Tajik
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St Luke's Medical Centers, Milwaukee, WI, USA
| | - Khawaja Afzal Ammar
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St Luke's Medical Centers, Milwaukee, WI, USA
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Marzlin N, Hays AG, Peters M, Kaminski A, Roemer S, O'Leary P, Kroboth S, Harland DR, Khandheria BK, Tajik AJ, Jain R. Myocardial Work in Echocardiography. Circ Cardiovasc Imaging 2023; 16:e014419. [PMID: 36734221 DOI: 10.1161/circimaging.122.014419] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Myocardial work is an emerging tool in echocardiography that incorporates left ventricular afterload into global longitudinal strain analysis. Myocardial work correlates with myocardial oxygen consumption, and work efficiency can also be assessed. Myocardial work has been evaluated in a variety of clinical conditions to assess the added value of myocardial work compared to left ventricular ejection fraction and global longitudinal strain. This review showcases the current use of myocardial work in adult echocardiography and its possible role in cardiac pathologies.
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Affiliation(s)
- Nathan Marzlin
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Allison G Hays
- Johns Hopkins School of Medicine, Baltimore, MD (A.G.H.)
| | - Matthew Peters
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Abigail Kaminski
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Sarah Roemer
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Patrick O'Leary
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Stacie Kroboth
- Academic Affairs, Cardiovascular Research, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin (S.K.)
| | - Daniel R Harland
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - A Jamil Tajik
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
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Yoon JA, Ahmad MM, Syed MN, Ahmad MN, Hussaini SF, Muhammad MN, Pir SHA, Khandheria BK, Tajik AJ, Ammar KA. Refining the upper limit of normal for the ascending aorta: In search of optimal criteria -- a large database study of normal individuals. Vascular 2022:17085381221140171. [PMID: 36412136 DOI: 10.1177/17085381221140171] [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] [Indexed: 02/17/2024]
Abstract
OBJECTIVES The cutoff for dilated mid-ascending aorta (mAA) is controversial and has several definitions. The present study was carried out to determine the prevalence of mAA dilation based on published definitions and to identify the optimal cutoff. METHODS Echocardiographic studies of patients >15 years of age performed at a large tertiary care center over 4 years, n = 49,330, were retrospectively evaluated. Leading-edge-to-leading-edge technique was used to measure the mAA in diastole. Several cutoff criteria were included. In addition, we defined normals in our database as those who, after 28 causes of dilated aorta were excluded, were normal both clinically and echocardiographically (n = 2334). RESULTS The mean age was 64.2 ± 17.1 years, and 31.5% were men. The prevalence of dilated mAA based on absolute criteria with sex stratification varied between 17% and 23% and based on relative criteria (to age, body surface area, and sex) varied between 6% and 11%. It further decreased to 7.6% on the addition of narrow age stratification (10 year intervals) performed on normals in our database. The multivariate adjusted R2 (for variation in mAA diameter) was 0.25 for age, decreasing to 0.12 for weight and 0.07 for sex and height. CONCLUSIONS The lowest prevalence of 7.6% probably represents the optimal cutoff for dilated mAA because it includes age, which explains most of the variation in mAA, in narrow (10 year) intervals only performed in our normals, which represents the largest sample size to date.
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Affiliation(s)
- Ji Ae Yoon
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 577980Advocate Aurora Health, Milwaukee, WI, USA
| | - Mirza Mujadil Ahmad
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 577980Advocate Aurora Health, Milwaukee, WI, USA
| | - Muhammad Nabeel Syed
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 577980Advocate Aurora Health, Milwaukee, WI, USA
| | - Mirza Nubair Ahmad
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 577980Advocate Aurora Health, Milwaukee, WI, USA
| | - Sharmeen Fatima Hussaini
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 577980Advocate Aurora Health, Milwaukee, WI, USA
| | - Mustafa Noor Muhammad
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 577980Advocate Aurora Health, Milwaukee, WI, USA
| | - Syed Haris A Pir
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 577980Advocate Aurora Health, Milwaukee, WI, USA
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 577980Advocate Aurora Health, Milwaukee, WI, USA
| | - A Jamil Tajik
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 577980Advocate Aurora Health, Milwaukee, WI, USA
| | - Khawaja Afzal Ammar
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 577980Advocate Aurora Health, Milwaukee, WI, USA
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Katapadi A, Umland M, Khandheria BK. Update on the Practical Role of Echocardiography in Selection, Implantation, and Management of Patients Requiring Left Ventricular Assist Device Therapy. Curr Cardiol Rep 2022; 24:1587-1597. [PMID: 35984555 DOI: 10.1007/s11886-022-01771-9] [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] [Accepted: 08/09/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW Echocardiography is a valuable tool for management of patients with a left ventricular assist device (LVAD). We present an updated review on the practical applications of the role of echocardiography for pre- and postoperative evaluation of patients selected. RECENT FINDINGS The LVAD is a temporary or permanent option for patients with advanced heart failure who are unresponsive to other therapy. Use of the device has its own risks, and implantation remains a complex procedure. Transthoracic and transesophageal echocardiography are useful tools for patient evaluation and monitoring both peri- and postoperatively, as we previously presented. Assessment of left and right ventricular function, complications such as thrombus formation or intracardiac shunting, and valvular disease are all important in this assessment. This also aids in predicting postoperative complications. Placement of the device is confirmed intraoperatively, and subsequent ramp studies are used to determine optimal device settings. Right ventricular (RV) failure is the most common postoperative complication and preoperative evaluation of its function is crucial. Studies suggest that tricuspid annular plane systolic excursion, RV fractional area change, and RV global longitudinal strain are strong predictors of RV failure; LV ejection fraction, size, and end-diastolic diameter are also important markers. Aortic regurgitation and mitral stenosis must always be corrected prior to LVAD placement. However, direct visualization before and after implantation, especially to rule out potential contraindications such as thrombi, cannot be overemphasized. Ramp studies remain an integral part of device optimization and may result in greater myocardial recovery than previously realized.
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Affiliation(s)
- Aashish Katapadi
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI, 53215, USA
| | - Matt Umland
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI, 53215, USA
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI, 53215, USA.
- School of Medicine and Public Health, University of Wisconsin, Milwaukee, WI, 53215, USA.
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Barkett MG, Bajwa T, Tumuluri RJ, Blohowiak R, Gupta R, Khandheria BK, Muthukumar L. Embolization of a Vascular Plug after a Year and Successful Treatment Using Two Vascular Plugs Side by Side. CASE 2022; 6:134-137. [PMID: 35602988 PMCID: PMC9120781 DOI: 10.1016/j.case.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vascular plugs used for PVL repair usually embolize late after deployment. A low threshold for echo studies (namely TEE) is an essential part of clinical follow-up. Redo percutaneous PVL closure should be considered in those at high surgical risk.
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Affiliation(s)
| | | | | | | | | | | | - Lakshmi Muthukumar
- Correspondence: Lakshmi Muthukumar, MD, Aurora Cardiovascular and Thoracic Services, Aurora St. Luke's Medical Center, 2801 West Kinnickinnic River Parkway, Suite 880, Milwaukee, WI 53215
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Wani A, Harland DR, Bajwa TK, Kroboth S, Ammar KA, Allaqaband SQ, Duval S, Khandheria BK, Tajik AJ, Jain R. Left Ventricular Mechanics Differ in Subtypes of Aortic Stenosis Following Transcatheter Aortic Valve Replacement. Front Cardiovasc Med 2022; 8:777206. [PMID: 35111823 PMCID: PMC8803205 DOI: 10.3389/fcvm.2021.777206] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/07/2021] [Indexed: 01/25/2023] Open
Abstract
Background Left ventricular (LV) mechanics are impaired in patients with severe aortic stenosis (AS). We hypothesized that there would be differences in myocardial mechanics, measured by global longitudinal strain (GLS) recovery in patients with four subtypes of severe AS after transcatheter aortic valve replacement (TAVR), stratified based upon flow and gradient. Methods We retrospectively evaluated 204 patients with severe AS who underwent TAVR and were followed post-TAVR at our institution for clinical outcomes. Speckle-tracking transthoracic echocardiography was performed pre- and post-TAVR. Patients were classified as: (1) normal-flow and high-gradient, (2) normal-flow and high-gradient with reduced LV ejection fraction (LVEF), (3) classical low-flow and low-gradient, or (4) paradoxical low-flow and low-gradient. Results Both GLS (−13.9 ± 4.3 to −14.8 ± 4.3, P < 0.0001) and LVEF (55 ± 15 to 57 ± 14%, P = 0.0001) improved immediately post-TAVR. Patients with low-flow AS had similar improvements in LVEF (+2.6 ± 9%) and aortic valve mean gradient (−23.95 ± 8.34 mmHg) as patients with normal-flow AS. GLS was significantly improved in patients with normal-flow (−0.93 ± 3.10, P = 0.0004) compared to low-flow AS. Across all types of AS, improvement in GLS was associated with a survival benefit, with GLS recovery in alive patients (mean GLS improvement of −1.07 ± 3.10, P < 0.0001). Conclusions LV mechanics are abnormal in all patients with subtypes of severe AS and improve immediately post-TAVR. Recovery of GLS was associated with a survival benefit. Patients with both types of low-flow AS showed significantly improved, but still impaired, GLS post-TAVR, suggesting underlying myopathy that does not correct post-TAVR.
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Affiliation(s)
- Adil Wani
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, United States
| | - Daniel R. Harland
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, United States
| | - Tanvir K. Bajwa
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, United States
| | - Stacie Kroboth
- Advocate Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI, United States
| | - Khawaja Afzal Ammar
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, United States
| | - Suhail Q. Allaqaband
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, United States
| | - Sue Duval
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Bijoy K. Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, United States
| | - A. Jamil Tajik
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, United States
| | - Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, United States
- *Correspondence: Renuka Jain
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Di Bella G, Aquaro GD, Bogaert J, Piaggi P, Micari A, Pizzino F, Camastra G, Carerj S, Campisi M, Bracco A, Carerj ML, Emdin M, Khandheria BK, Pingitore A. Non-transmural myocardial infarction associated with regional contractile function is an independent predictor of positive outcome: an integrated approach to myocardial viability. J Cardiovasc Magn Reson 2021; 23:121. [PMID: 34719402 PMCID: PMC8559354 DOI: 10.1186/s12968-021-00818-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance permits assessment of irreversible myocardial fibrosis and contractile function in patients with previous myocardial infarction. We aimed to assess the prognostic value of myocardial fibrotic tissue with preserved/restored contractile activity. METHODS In 730 consecutive myocardial infarction patients (64 ± 11 years), we quantified left ventricular (LV) end-diastolic (EDV) and end-systolic (ESV) volumes, ejection fraction (EF), regional wall motion (WM) (1 normal, 2 hypokinetic, 3 akinetic, 4 dyskinetic), and WM score index (WMSI), and measured the transmural (1-50 and 51-100) and global extent of the infarct scar by late gadolinium enhancement (LGE). Contractile fibrotic (CT-F) segments were identified as those showing WM-1 and WM-2 with LGE ≤ or ≥ 50%. RESULTS During follow-up (median 2.5, range 1-4.7 years), cardiac events (cardiac death or appropriate implantable defibrillator shocks) occurred in 123 patients (17%). At univariate analysis, age, LVEDV, LVESV, LVEF, WMSI, extent of LGE, segments with transmural extent > 50%, and CT-F segments were associated with cardiac events. At multivariate analysis, age > 65 years, LVEF < 30%, WMSI > 1.7, and dilated LVEDV independently predicted cardiac events, while CT-F tissue was the only independent predictor of better outcome. After adjustment for LVEF < 30% and LVEDV dilatation, the presence of CT-F tissue was associated with good prognosis. CONCLUSIONS In addition to CMR imaging parameters associated with adverse outcome (severe LV dysfunction, poor WM, and dilated EDV), the presence of fibrotic myocardium showing contractile activity in patients with previous myocardial infarction yields a beneficial effect on patient survival.
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Affiliation(s)
- Gianluca Di Bella
- Clinical and Experimental Department of Medicine, University of Messina, via Consolare Valeria 1, 98100, Messina, Italy
| | | | - Jan Bogaert
- Department of Radiology, KU Leuven - UZ Leuven, Gasthuisberg Campus. Herestraat 49, 3000, Leuven, Belgium
| | - Paolo Piaggi
- Department of Information Engineering, University of Pisa, via G. Caruso 16, 56122, Pisa, Italy
| | - Antonio Micari
- Clinical and Experimental Department of Medicine, University of Messina, via Consolare Valeria 1, 98100, Messina, Italy
| | - Fausto Pizzino
- Department of Cardiology, "Santa Maria Dei Battuti" Hospital, Conegliano - ULSS2 Marca Trevigiana, Via Brigata Bisagno 2, 31015, Conegliano, Treviso, Italy
| | - Giovanni Camastra
- Cardiac Department, Vannini Hospital Rome, via Acqua Bullicante 4, 00177, Roma, Italy
| | - Scipione Carerj
- Clinical and Experimental Department of Medicine, University of Messina, via Consolare Valeria 1, 98100, Messina, Italy
| | - Mariapaola Campisi
- Clinical and Experimental Department of Medicine, University of Messina, via Consolare Valeria 1, 98100, Messina, Italy
| | - Antonio Bracco
- Clinical and Experimental Department of Medicine, University of Messina, via Consolare Valeria 1, 98100, Messina, Italy
- Department of Cardiology, ISMETT" Hospital, via Ernesto Tricomi, 5, 90127, Palermo, Province of Palermo, Italy
| | - Maria Ludovica Carerj
- Clinical and Experimental Department of Medicine, University of Messina, via Consolare Valeria 1, 98100, Messina, Italy
| | - Michele Emdin
- Fondazione Toscana G. Monasterio, via Giuseppe Moruzzi 1, 56124, Pisa, Italy
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Advocate Aurora Health, Aurora Sinai/Aurora St. Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI, 53215, USA.
| | - Alessandro Pingitore
- C.N.R. Clinical Physiology Institute, via Giuseppe Moruzzi 1, 56124, Pisa, Italy
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10
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Edwards NFA, Scalia GM, Putrino A, Appadurai V, Sabapathy S, Anderson B, Chamberlain R, Khandheria BK, Chan J. Myocardial work and left ventricular contractile reserve during stress echocardiography: An angiographic validation. Echocardiography 2021; 38:1711-1721. [PMID: 34510539 DOI: 10.1111/echo.15194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/30/2021] [Accepted: 08/15/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study sought to determine the contractile reserve (CR) response to exercise stress echocardiography (ESE) quantified by the novel parameter, non-invasive myocardial work (MW), in subjects with angiographically proven coronary artery disease (CAD). METHODS CR was measured by the relative change in ejection fraction (EF), global longitudinal strain (GLS) and MW indices from rest to peak exercise in 304 patients referred for clinically indicated ESE. Positive ESE patients proceeded to coronary angiography and further risk stratified based on either percutaneous or surgical intervention. RESULTS CRGLS and global work index (CRGWI ) significantly decreased with exercise induced ischemia and angiographically proven significant CAD (CRGLS -1.6±3.5%; CRGWI -8.6±511 mm Hg% decrement, p < 0.001) compared to non-ischemic patients (CRGLS 1.4±2.2%; CRGWI 398±404 mm Hg% improvement). Global constructive work (CRGCW ) was significantly higher (p < 0.0001) in non-ischemic (818±457 mm Hg%) and blunted in ischemic patients (208±550 mm Hg%). CRGCW (AUC .81; 95%CI:.75-.86) demonstrated the most association for inducible ischemia followed by CRGLS (AUC .75; 95%CI:.69-.80), CRGWI (AUC .73, 95%CI:.67-.79) and CREF (AUC .71; 95%CI:.65-.77, p < 0.001). Subgroup analysis showed patients requiring surgical revascularization demonstrated a significantly lower CRGWE (-11.5±7.6%, p < 0.05) as a result of reduced CRGCW (281±573 mm Hg%, p < 0.05) and increased global wasted work (CRGWW , 289±151 mm Hg%, p = 0.09). CONCLUSION Multivessel disease requiring surgical revascularization have the greatest reduction in CR. MW may potentially improve detection of ischemia and further risk stratification during ESE to maximize the benefits of revascularization.
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Affiliation(s)
- Natalie F A Edwards
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.,School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Gregory M Scalia
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Anthony Putrino
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia
| | - Vinesh Appadurai
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia
| | - Surendran Sabapathy
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Bonita Anderson
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia
| | - Robert Chamberlain
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.,School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Bijoy K Khandheria
- Aurora Healthcare, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin, USA
| | - Jonathan Chan
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.,School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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11
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Di Bella G, Pizzino F, Aquaro GD, Bracco A, Manganaro R, Pasanisi E, Petersen C, Zito C, Chubuchny V, Emdin M, Khandheria BK, Carerj S, Pingitore A. CMR predictors of secondary moderate to severe mitral regurgitation and its additive prognostic role in previous myocardial infarction. J Cardiol 2021; 79:90-97. [PMID: 34493420 DOI: 10.1016/j.jjcc.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/25/2021] [Accepted: 07/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND We aimed to determine predictors and the additive prognostic role of moderate to severe (MS) ischemic mitral regurgitation (MR) in myocardial infarction (MI). METHODS Four hundred twenty-two patients with previous MI underwent cardiac magnetic resonance (CMR) imaging for the assessment of left ventricular (LV) ejection fraction (EF), end-diastolic (EDV) and end-systolic volume (ESV), sphericity index, wall motion score index (WMSI), and late gadolinium enhancement (LGE). Echocardiography was performed to assess MR. RESULTS Thirty-eight had from moderate to severe MR (MS-MR group) and 384 did not (No MS-MR group). The S-MR group had higher LV volumes, sphericity index, WMSI, and LGE extent, and lower LVEF. At univariate logistic regression analysis, dilated volumes, SI >0.43, dyskinesia of inferolateral wall, papillary muscle (PM)-LGE, and LGE extent >16% were associated with MS-MR. At multivariate analysis, only SI (OR=5.7) and PM-LGE (OR=3) were independently associated with MS-MR. Considering only patients without LV dilatation, only dyskinesia in the inferolateral wall was a predictor of MS-MR (OR 34.8). Thirty cardiac events (cardiac death, appropriate implantable cardioverter-defibrillator firing, and resuscitated cardiac arrest) occurred during a median follow-up of 1,276 days. After adjusting the prognostic variables at univariate analysis by age (>65 years) and selecting those that were significant (EDV > 95 ml/m2, ESV >53 ml/m2, EF <30%, WMSI >1.65, LGE >12%, S-MR), only WMSI >1.65 and MS-MR remained an independent predictor of cardiac events. CONCLUSIONS Increased WMSI and PM-LGE in the overall population and inferolateral dyskinesia in patients without ESV dilatation are predictors of MS-MR; MS-MR and elevated WMSI have independent negative prognostic value.
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Affiliation(s)
- Gianluca Di Bella
- Clinical and Experimental Department of Medicine, University of Messina, Messina, Italy
| | - Fausto Pizzino
- Fondazione Toscana G. Monasterio, Pisa, Italy; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | - Antonio Bracco
- Clinical and Experimental Department of Medicine, University of Messina, Messina, Italy
| | - Roberta Manganaro
- Clinical and Experimental Department of Medicine, University of Messina, Messina, Italy
| | | | | | - Concetta Zito
- Clinical and Experimental Department of Medicine, University of Messina, Messina, Italy
| | | | - Michele Emdin
- Fondazione Toscana G. Monasterio, Pisa, Italy; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health; Marcus Family Fund for Echocardiography (ECHO) Research and Education, Milwaukee, WI, USA.
| | - Scipione Carerj
- Clinical and Experimental Department of Medicine, University of Messina, Messina, Italy
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12
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Muthukumar L, Jan MF, Jahangir A, Khandheria BK, Tajik AJ. Regional myocardial high energy demand: a substrate for arrhythmogenesis in Barlow's syndrome. Eur Heart J Cardiovasc Imaging 2021; 22:e128. [PMID: 33367740 DOI: 10.1093/ehjci/jeaa352] [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: 11/14/2022] Open
Affiliation(s)
- Lakshmi Muthukumar
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - M Fuad Jan
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - Arshad Jahangir
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - A Jamil Tajik
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
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13
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Jaglan A, Roemer S, Khandheria BK. Myocardial work, left atrial longitudinal strain: till death do us part in atrial fibrillation. Eur Heart J Cardiovasc Imaging 2021; 22:e6. [PMID: 33106882 DOI: 10.1093/ehjci/jeaa251] [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: 11/14/2022] Open
Affiliation(s)
- Akshar Jaglan
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - Sarah Roemer
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
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14
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Abstract
AIMS Myocardial work (MW) is a novel parameter that can be used in a clinical setting to assess left ventricular (LV) pressures and deformation. We sought to distinguish patterns of global MW index in hypertensive vs. non-hypertensive patients and to look at differences between categories of hypertension. METHODS AND RESULTS Sixty-five hypertensive patients (mean age 65 ± 13 years; 30 male) and 15 controls (mean age 38 ± 12 years; 7 male) underwent transthoracic echocardiography at rest. Hypertensive patients were subdivided into Stage 1 (n = 32) and Stage 2 (n = 33) hypertension based on 2017 American College of Cardiology guidelines. Exclusion criteria were suboptimal image quality for myocardial deformation analysis, reduced ejection fraction, valvular heart disease, intracardiac shunt, and arrhythmia. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency were estimated from LV pressure-strain loops utilizing proprietary software from speckle-tracking echocardiography. LV systolic and diastolic pressures were estimated using non-invasive brachial artery cuff pressure. Global longitudinal strain and LV ejection fraction were preserved between the groups with no statistically significant difference, whereas there was a statically significant difference between the control and two hypertension groups in GWI (P = 0.01), GCW (P < 0.001), and GWW (P < 0.001). CONCLUSION Non-invasive MW analysis allows better understanding of LV response under conditions of increased afterload. MW is an advanced assessment of LV systolic function in hypertension patients, giving a closer look at the relationship between LV pressure and contractility in settings of increased load dependency than LV ejection fraction and global longitudinal strain.
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Affiliation(s)
- Akshar Jaglan
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Suite 880, Milwaukee, WI 53215, USA
| | - Sarah Roemer
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Suite 880, Milwaukee, WI 53215, USA
| | - Ana Cristina Perez Moreno
- Cardiovascular Research, Advocate Aurora Research, Advocate Aurora Health, 960 N. 12th Street, Suite 4120, Milwaukee, WI53233, USA
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Suite 880, Milwaukee, WI 53215, USA
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15
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Jain R, Bajwa T, Roemer S, Huisheree H, Allaqaband SQ, Kroboth S, Perez Moreno AC, Tajik AJ, Khandheria BK. Myocardial work assessment in severe aortic stenosis undergoing transcatheter aortic valve replacement. Eur Heart J Cardiovasc Imaging 2021; 22:715-721. [PMID: 33106854 DOI: 10.1093/ehjci/jeaa257] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Myocardial work is a novel echocardiographic algorithm that corrects speckle-tracking-derived global longitudinal strain (GLS) for afterload using non-invasive systolic blood pressure as a surrogate for left ventricular systolic pressure (LVSP). Yet, in patients with severe aortic stenosis, non-invasive systolic blood pressure does not equal LVSP. METHODS AND RESULTS We evaluated 35 patients with severe aortic stenosis who underwent transcatheter aortic valve replacement (TAVR). Transthoracic echocardiography, including myocardial mechanics, was performed pre- and post-TAVR. We performed simultaneous echocardiographic and cardiac catheterization measurements in 23 of the 35 patients at the time of TAVR. Peak and mean aortic gradients were calculated from echocardiographic and cardiac catheterization data. Peak-to-peak LV-aortic gradient correlated highly with mean LV-aortic gradient (r = 0.96); measured LVSP correlated highly with our novel method of non-invasively estimated LVSP (non-invasive systolic blood pressure cuff + Doppler-derived mean aortic gradient, r = 0.92). GLS improved from pre- to post-TAVR (-14.2% ± 4.3 vs. -15.1% ± 3.2), and myocardial work reduced from corrected pre-TAVR to post-TAVR (global work index: 1856.2 mmHg% ± 704.6 vs. 1534.8 ± 385.0). CONCLUSION We propose that non-invasive assessment of myocardial work can be reliably performed in aortic stenosis by the addition of mean aortic gradient to non-invasive systolic blood pressure. From this analysis, we note the novel and unique finding that GLS can improve as myocardial work reduces post-TAVR in patients with severe aortic stenosis. Both GLS and myocardial work post-TAVR remain below normal values, requiring further studies.
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Affiliation(s)
- Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora St. Luke's Medical Center, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Suite 880, Milwaukee, WI 53215, USA
| | - Tanvir Bajwa
- Aurora Cardiovascular and Thoracic Services, Aurora St. Luke's Medical Center, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Suite 880, Milwaukee, WI 53215, USA
| | - Sarah Roemer
- Aurora Cardiovascular and Thoracic Services, Aurora St. Luke's Medical Center, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Suite 880, Milwaukee, WI 53215, USA
| | - Hillary Huisheree
- Aurora Cardiovascular and Thoracic Services, Aurora St. Luke's Medical Center, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Suite 880, Milwaukee, WI 53215, USA
| | - Suhail Q Allaqaband
- Aurora Cardiovascular and Thoracic Services, Aurora St. Luke's Medical Center, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Suite 880, Milwaukee, WI 53215, USA
| | - Stacie Kroboth
- Cardiovascular Division, Advocate Aurora Research, Advocate Aurora Health, 3033 S 27th Street, Parkway Building Ste. 201, Milwaukee, WI 53215, USA
| | - Ana Cristina Perez Moreno
- Cardiovascular Division, Advocate Aurora Research, Advocate Aurora Health, 3033 S 27th Street, Parkway Building Ste. 201, Milwaukee, WI 53215, USA
| | - A Jamil Tajik
- Aurora Cardiovascular and Thoracic Services, Aurora St. Luke's Medical Center, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Suite 880, Milwaukee, WI 53215, USA
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora St. Luke's Medical Center, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Suite 880, Milwaukee, WI 53215, USA
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16
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Longobardo L, Carerj S, Bitto A, Cusmà-Piccione M, Carerj ML, Calabrò MP, Di Bella G, Licordari R, Squadrito F, Khandheria BK, Zito C. Bicuspid aortic valve and aortopathy: novel prognostic predictors for the identification of high-risk patients. Eur Heart J Cardiovasc Imaging 2021; 22:808-816. [PMID: 33026072 DOI: 10.1093/ehjci/jeaa250] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/11/2020] [Indexed: 12/13/2022] Open
Abstract
AIMS Bicuspid aortic valve (BAV) may be complicated by aortic aneurysms and dissection. This study aimed to evaluate the prognostic efficacy of markers from cardiac imaging, as well as genetic and new biomarkers, to early predict aortic complications. METHODS AND RESULTS We re-evaluated after a mean time of 48 ± 11 months 47 BAV patients who had undergone previous echocardiography for evaluation of aortic stiffness and 2D aortic longitudinal strain (LS) (by speckle-tracking analysis), and who had given a blood sample for the assessment of a single-nucleotide polymorphism of elastin gene (ELN rs2 071307) and quantification of elastin soluble fragments (ESF). Surgical treatment of aortic aneurysm/dissection was the primary endpoint, and an aortic dimension increase (of one or more aortic segments) ≥1 mm/year was the secondary endpoint. Nine patients underwent surgical treatment of ascending aorta (AA) aneurysms. Out of the 38 patients who did not need surgical intervention, 16 showed an increase of aortic root and/or AA dimension ≥1 mm/year. At multivariate Cox regression analysis, an impaired AA LS was an independent predictor of aortic surgery [P = 0.04; hazard ratio (HR) 0.961; 95% confidence interval (CI) 0.924-0.984] and aortic dilatation (P = 0.007; HR 0.960; 95% CI 0.932-0.989). An increased quantity of ESF was correlated (P = 0.015) with the primary endpoint at univariate Cox regression analysis but it did not keep statistical significance at multivariate analysis. CONCLUSION In BAV patients, impairment of elastic properties of the AA, as assessed by 2D LS, is an effective predictor of aortic complications.
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Affiliation(s)
- Luca Longobardo
- Department of Clinical and Experimental Medicine - Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino' and Università degli Studi di Messina, Via Consolare Valeria n.12, 98100 Messina, Italy
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine - Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino' and Università degli Studi di Messina, Via Consolare Valeria n.12, 98100 Messina, Italy
| | - Alessandra Bitto
- Department of Clinical and Experimental Medicine - Section of Pharmacology, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino' and Università degli Studi di Messina, Via Consolare Valeria n.12, 98100 Messina, Italy
| | - Maurizio Cusmà-Piccione
- Department of Clinical and Experimental Medicine - Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino' and Università degli Studi di Messina, Via Consolare Valeria n.12, 98100 Messina, Italy
| | - Maria Ludovica Carerj
- Department of Biomedical Sciences and Morphological and Functional Imaging - Section of Radiological Sciences, Azienda Ospedaliera Universitaria 'Policlinico G. Martino' and Università degli Studi di Messina, Via Consolare Valeria n.12, 98100 Messina, Italy
| | - Maria Pia Calabrò
- Department of Human Pathology of Adulthood and Childhood - Section of Pediatric Cardiology, Azienda Ospedaliera Universitaria 'Policlinico G. Martino' and Università degli Studi di Messina, Via Consolare Valeria n.12, 98100 Messina, Italy
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine - Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino' and Università degli Studi di Messina, Via Consolare Valeria n.12, 98100 Messina, Italy
| | - Roberto Licordari
- Department of Clinical and Experimental Medicine - Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino' and Università degli Studi di Messina, Via Consolare Valeria n.12, 98100 Messina, Italy
| | - Francesco Squadrito
- Department of Clinical and Experimental Medicine - Section of Pharmacology, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino' and Università degli Studi di Messina, Via Consolare Valeria n.12, 98100 Messina, Italy
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Marcus Family Fund for Echocardiography (ECHO) Research and Education, 2801 W. Kinnickinnic River Parkway, #880, Milwaukee, WI 53215, USA
| | - Concetta Zito
- Department of Clinical and Experimental Medicine - Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino' and Università degli Studi di Messina, Via Consolare Valeria n.12, 98100 Messina, Italy
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Tanel E, Roemer S, Salinas P, Khandheria BK. Does position matter? Eur Heart J Cardiovasc Imaging 2021; 22:246. [PMID: 32437530 DOI: 10.1093/ehjci/jeaa159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Emily Tanel
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - Sarah Roemer
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - Pedro Salinas
- Aurora Critical Care Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2901 W. Kinnickinnic River Parkway, Ste. 305, Milwaukee, WI 53215, USA
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
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18
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Vizzari G, Pizzino F, Zwicke D, Tajik AJ, Carerj S, Di Bella G, Micari A, Khandheria BK, Zito C. Patent foramen ovale: anatomical complexity and long-tunnel morphology related issues. Am J Cardiovasc Dis 2021; 11:316-329. [PMID: 34322302 PMCID: PMC8303044] [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] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/05/2021] [Indexed: 06/13/2023]
Abstract
Patent foramen ovale (PFO) is present in about one-quarter of the population and should be considered an anatomical variant rather than a malformation. The association of PFO with cryptogenic stroke, migraine, peripheral embolism and other pathologies is still controversial. The evaluation of anatomical complexity, and particularly the long-tunnel morphology, is crucial for the assessment of the risk profile and for a targeted therapeutic management. Long-tunnel PFOs seem to be more prone to clot formation and complications related to percutaneous closure procedures. Echocardiography is the most useful method to investigate anatomical complexity, confirm and reinforce the indication to treatment, select the appropriate device and guide the PFO closure towards a successful procedure.
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Affiliation(s)
- Giampiero Vizzari
- Department of Clinical and Experimental Medicine, University of Messina, A.O.U. Policlinic “G. Martino”Messina 98165, Italy
| | - Fausto Pizzino
- Cardiology Unit, Conegliano Hospital, AULSS2 Marca TrevigianaConegliano (TV) 31015, Italy
| | - Dianne Zwicke
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health2801 W. Kinnickinnic River Parkway, #840, Milwaukee, WI 53215, USA
| | - A Jamil Tajik
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health2801 W. Kinnickinnic River Parkway, #840, Milwaukee, WI 53215, USA
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, University of Messina, A.O.U. Policlinic “G. Martino”Messina 98165, Italy
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, University of Messina, A.O.U. Policlinic “G. Martino”Messina 98165, Italy
| | - Antonio Micari
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, A.O.U. Policlinic “G. Martino”Messina 98165, Italy
| | - Bijoy K Khandheria
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health2801 W. Kinnickinnic River Parkway, #840, Milwaukee, WI 53215, USA
| | - Concetta Zito
- Department of Clinical and Experimental Medicine, University of Messina, A.O.U. Policlinic “G. Martino”Messina 98165, Italy
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19
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Kaminski AE, Khandheria BK. A sonographer's approach to mitral valve prolapse malignancy. Eur Heart J Cardiovasc Imaging 2021; 22:e151. [PMID: 34015082 DOI: 10.1093/ehjci/jeab085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
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20
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Roemer S, Jaglan A, Santos D, Umland M, Jain R, Tajik AJ, Khandheria BK. The Utility of Myocardial Work in Clinical Practice. J Am Soc Echocardiogr 2021; 34:807-818. [PMID: 33895250 DOI: 10.1016/j.echo.2021.04.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 11/17/2022]
Abstract
Myocardial work (MW) is a novel technique used in the advanced assessment of left ventricular function. In the past few years, this invasive measure has evolved to become a more attainable noninvasive technique. MW has benefits over left ventricular ejection fraction and global longitudinal strain by speckle-tracking echocardiography, as it includes the afterload-dependent limitation and dynamic myocardial contraction in relationship to various loading conditions. In this article, the authors provide a summary overview and discuss the additive value noninvasive MW provides to left ventricular systolic function assessment. The authors explore the evolution of invasive to noninvasive MW, examine how to acquire and measure, discuss normal reference values, examine its role in a multitude of cardiac conditions that have been investigated in current research, review a variety of clinical applications, and discuss potential limitations. The goal is to allow the reader to see the benefits of this rapidly emerging application and be able to incorporate it into everyday practice.
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Affiliation(s)
- Sarah Roemer
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Akshar Jaglan
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - David Santos
- GE Healthcare/Vingmed Ultrasound, Horten, Norway
| | - Matthew Umland
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - A Jamil Tajik
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin.
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21
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Jain R, Kruger B, Citronberg R, Kroboth S, Perez Moreno AC, Khandheria BK. Preprocedure COVID-19 Testing in Early Phase of Pandemic. J Patient Cent Res Rev 2021; 8:151-153. [PMID: 33898649 DOI: 10.17294/2330-0698.1841] [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] [Indexed: 11/04/2022] Open
Abstract
The COVID-19 pandemic led to a nationwide shutdown of elective medical procedures. Upon resumption of services, preprocedure nasopharyngeal swab testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was introduced for all patients requiring surgical or other aerosol-generating procedures. We investigated preprocedure COVID-19 testing in one of the largest U.S. health systems. Patients included in this retrospective, observational study were asymptomatic and scheduled for a procedure or surgery. All patients underwent a nasopharyngeal swab test for SARS-CoV-2 performed 24-72 hours prior to a planned procedure. Clinical demographics, type of procedure, test results, and subsequent procedure status were evaluated. Of 38,608 total patients, there were 277 COVID-19-positive patients (positivity rate: 0.72%). Of those 277, 244 (88%) had procedural delays or cancellations. Of the COVID-19-negative patients, 50 (0.13%) required later hospitalization for COVID-19. Median time from preprocedure negative test to admission was 46.3 ± 27.2 days. In the largest series published on preprocedure COVID-19 testing in the early phase of the pandemic, preprocedure COVID-19 positivity was low. Preprocedure COVID-19 testing had a significant impact on clinical management. Rate of COVID-19 cases requiring hospitalization in the months following the procedure was negligible, suggesting health system policies adequately protected patient safety.
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Affiliation(s)
- Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health
| | | | | | | | | | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health
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22
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Jain R, Kroboth S, Ignatowski D, Khandheria BK. Seroprevalence of SARS-CoV-2 Antibody in Echocardiography and Stress Laboratory. J Patient Cent Res Rev 2021. [DOI: 10.17294/2330-0698.1815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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23
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Jain R, Kroboth S, Ignatowski D, Khandheria BK. Seroprevalence of SARS-CoV-2 Antibody in Echocardiography and Stress Laboratory. J Patient Cent Res Rev 2021; 8:146-150. [PMID: 33898648 PMCID: PMC8060043] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
PURPOSE Transesophageal echocardiography is an aerosol-generating procedure, and exercise stress testing is a potentially aerosol-generating activity. Concern has been raised about heightened risk of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among health care personnel participating in these procedures. We aimed to investigate the prevalence of past coronavirus disease 2019 (COVID-19) infection in echocardiography and stress laboratory staff. METHODS All staff who worked in the echocardiography and stress laboratories of one high-traffic urban hospital from March 15, 2020, to June 15, 2020, were asked to voluntarily participate. Those willing to participate were consented, and past COVID-19 infection was confirmed by a SARS-CoV-2 IgG antibody test (ARCHITECT, Abbott Laboratories) from June 15, 2020, to July 3, 2020. Clinical data were collected from the electronic medical record, and self-reported symptoms were documented with a participant survey. RESULTS A total of 43 staff members (86.0% of 50 total laboratory staff) participated. A majority of participants were less than 40 years old (69.8%), were White (86.0%), and were women (79.1%); mean body mass index was 24.9 ± 4.7 kg/m2. Of the 43 staff members tested for past COVID-19 infection, 3 (7.0%) had a positive SARS-CoV-2 IgG antibody result. There were no unique features in the 3 SARS-CoV-2 antibody-positive subjects; of these, 2 had known prior COVID-19 infection and 1 was asymptomatic. CONCLUSIONS This study provides clinical data on the seroprevalence of SARS-CoV-2 antibody in echocardiography and stress laboratory staff who regularly participate in a variety of procedures that are or may be aerosol-generating.
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Affiliation(s)
- Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke’s Medical Centers; University of Wisconsin School of Medicine and Public Health, Milwaukee, WI
| | - Stacie Kroboth
- Advocate Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI
| | - Denise Ignatowski
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke’s Medical Centers; University of Wisconsin School of Medicine and Public Health, Milwaukee, WI
| | - Bijoy K. Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke’s Medical Centers; University of Wisconsin School of Medicine and Public Health, Milwaukee, WI
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24
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Kaminski AE, Muthukumar L, Atzenhoefer M, Sra J, Khandheria BK. The wounded Watchman: Watchman that does not stand guard efficiently. Eur Heart J Cardiovasc Imaging 2021; 22:e145. [PMID: 33829252 DOI: 10.1093/ehjci/jeab061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/19/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Abigail E Kaminski
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - Lakshmi Muthukumar
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - Marc Atzenhoefer
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - Jasbir Sra
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
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25
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Jain R, Khandheria BK, Tajik AJ. Myocardial Work in Aortic Stenosis: It Does Work! J Am Soc Echocardiogr 2021; 34:267-269. [DOI: 10.1016/j.echo.2020.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
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26
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Jaglan A, Roemer S, Jan MF, Khandheria BK. Myocardial work index: a glimmer of hope in COVID-19. Eur Heart J Cardiovasc Imaging 2021; 22:228. [PMID: 32542341 PMCID: PMC7314100 DOI: 10.1093/ehjci/jeaa181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/02/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Akshar Jaglan
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - Sarah Roemer
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - M Fuad Jan
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
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27
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Wani AS, Jan MF, Malik I, Tajik AJ, Khandheria BK. Descending Aortic Thrombus Hanging by a Thread: Three-Dimensional Echocardiogram. J Invasive Cardiol 2021; 33:E139-E140. [PMID: 33531445] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Aortic thrombus is a rarely identified source of distal embolization. A conservative approach with anticoagulation alone carries a significant risk of embolization. Various open surgical approaches have been suggested as therapeutic options, but all of them carry a significant morbidity and mortality risk in this population subgroup. Contemporary endovascular approaches aimed at exclusion of the floating thrombus are now increasingly performed, and have significantly lower periprocedural complications compared with an open surgical approach.
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Affiliation(s)
| | - M Fuad Jan
- Aurora Cardiovascular and Thoracic Services, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215 USA.
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28
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Payne A, Kaminski A, Muthukumar L, Khandheria BK. Rare and Complex Case Mimics Acute Myocardial Infarction: The Importance of Multimodality Imaging. JACC Case Rep 2021; 3:125-127. [PMID: 34317484 PMCID: PMC8305643 DOI: 10.1016/j.jaccas.2020.11.008] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/10/2020] [Accepted: 11/13/2020] [Indexed: 11/26/2022]
Abstract
We report a rare and complex case of cardiac sarcoidosis in a patient presenting with ventricular tachycardia. Multimodality imaging, along with clinical and histological examination, was essential in establishing the diagnosis of cardiac sarcoidosis. (Level of Difficulty: Beginner.)
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Affiliation(s)
- Abby Payne
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin, USA
| | - Abigail Kaminski
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin, USA
| | - Lakshmi Muthukumar
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin, USA
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin, USA
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29
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Jain R, Salinas PD, Kroboth S, Kaminski A, Roemer S, Perez Moreno AC, Khandheria BK. Comprehensive Echocardiographic Findings in Critically Ill COVID-19 Patients With or Without Prior Cardiac Disease. J Patient Cent Res Rev 2021; 8:68-76. [PMID: 33511256 DOI: 10.17294/2330-0698.1791] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose Coronavirus disease 2019 (COVID-19) presents with a spectrum of disease severity, the most serious cases requiring intensive care. Echocardiography is a front-line tool in evaluating cardiovascular complications of COVID-19 in the intensive care unit (ICU); we analyzed transthoracic echocardiograms obtained from this patient population with state-of-the-art ultrasound technology. Methods All patients with COVID-19 requiring ICU admission on whom a transthoracic echocardiogram was obtained were included in the study. Focused transthoracic protocols were performed by experienced sonographers. Echocardiographic variables, including speckle-tracking echocardiography, were collected and analyzed. Clinical information was obtained from the electronic medical record. Patients were followed until discharge. Results Of 52 total patients (mean age: 59.9 ± 11.6 years), 59.6% were male and 15 (29%) had known prior cardiac disease. Cardiac complications identified on echocardiography were prevalent, occurring in 55.7% of patients. Patients with known prior cardiac disease were more likely to have new or worsening left ventricular dysfunction. Right ventricular dysfunction was the most common abnormality (assessed qualitatively in 18 cases and with advanced echocardiographic methods in 34 cases). Known prior cardiac disease, right ventricular enlargement, and pulmonary hypertension were significantly associated with morbidity and mortality. Conclusions Patients requiring intensive care for COVID-19 face significant morbidity and mortality, and cardiac complications occur in the majority of patients admitted to the ICU with COVID-19. Those with known prior cardiac disease fare worse, and other echocardiographic findings (right ventricular enlargement, pulmonary hypertension) are also associated with worse outcomes. State-of-the-art echocardiography performed by experienced sonographers can be critical to identifying cardiac complications and guiding ICU strategy.
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Affiliation(s)
- Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI
| | - Pedro D Salinas
- Critical Care Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI
| | - Stacie Kroboth
- Advocate Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI
| | - Abigail Kaminski
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI
| | - Sarah Roemer
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI
| | | | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI
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30
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Wani A, Jain R, Singsank Z, Khandheria BK. Trend of Global Longitudinal Strain in Takotsubo Cardiomyopathy and Clinical Predictors of Recovery. J Am Soc Echocardiogr 2021; 34:452-453. [PMID: 33388448 DOI: 10.1016/j.echo.2020.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Adil Wani
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Zach Singsank
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
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31
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Galazka P, Jain R, Muthukumar L, Sanders H, Bush M, Jan MF, Jahangir A, Khandheria BK, Tajik AJ. Familial LEOPARD Syndrome With Hypertrophic Cardiomyopathy. Am J Cardiol 2020; 135:168-173. [PMID: 32866449 DOI: 10.1016/j.amjcard.2020.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
Multiple lentigines syndrome is an autosomal dominant inherited condition with variable expressivity that is also known as LEOPARD syndrome. LEOPARD stands for lentigines, electrocardiographic conduction defects, ocular hypertelorism, pulmonary valve stenosis, abnormalities of genitalia, retardation of growth, and deafness. LEOPARD syndrome most frequently develops secondary to a missense mutation of protein-tyrosine phosphatase nonreceptor type 11 gene, which encodes tyrosine phosphatase. The missense mutation p.Tyr279Cys can either occur as a de novo mutation or affect multiple family members. Although hypertrophic cardiomyopathy is not part of the LEOPARD acronym, it is the most frequent cardiac anomaly observed in this syndrome. The recognition of increased left or right ventricular wall thickness in patients with LEOPARD syndrome may have significant impact on their clinical course similar to classic hypertrophic cardiomyopathy, which may require septal reduction procedures for relief of left or right ventricular outflow tract obstruction or implantable cardioverter-defibrillator placement for sudden cardiac death prevention. We describe a case series of a family with diffuse lentigines and hypertrophic cardiomyopathy in which the son carries the protein-tyrosine phosphatase nonreceptor type 11 (p.Tyr279Cys) gene mutation and both the son and daughter underwent left ventricular myectomy at an early age. In conclusion, our case series of a family with LEOPARD syndrome illustrates the importance of recognizing hypertrophic cardiomyopathy as part of this syndrome.
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Affiliation(s)
- Patrycja Galazka
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Lakshmi Muthukumar
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Heather Sanders
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Michelle Bush
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - M Fuad Jan
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Arshad Jahangir
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - A Jamil Tajik
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin.
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Jaglan A, Kaminski A, Payne A, Salinas PD, Khandheria BK. Focus, Not Point-of-Care, Echocardiography in Prone Position: It Can Be Done in COVID-19 Patients. ACTA ACUST UNITED AC 2020; 5:53-55. [PMID: 33134650 PMCID: PMC7587073 DOI: 10.1016/j.case.2020.10.007] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Prone positioning improves oxygenation in patients with ARDS. Reducing RV dysfunction is vital to decrease mortality. Prone positioning may assist cardiac function by offloading pressure from the RV.
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Affiliation(s)
- Akshar Jaglan
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Abigail Kaminski
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Abby Payne
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Pedro D Salinas
- Aurora Critical Care Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
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33
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Ignatowski D, Umland M, Khandheria BK. Reopening echocardiography services to care for our patients, including the COVID-19 patient population. Eur Heart J Cardiovasc Imaging 2020; 21:1175. [PMID: 32808037 PMCID: PMC7454475 DOI: 10.1093/ehjci/jeaa239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Denise Ignatowski
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke’s Medical Centers; University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, USA
| | - Matt Umland
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke’s Medical Centers; University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, USA
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke’s Medical Centers; University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, USA
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Ali Z, Sharma P, Mengesha T, Dalmar A, Ammar KA, Allaqaband SQ, O'Hair DP, Khandheria BK, Jain R, Bajwa T. Early clinical and procedural outcomes in large series of 34-mm self-expanding transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2020; 96:940-946. [PMID: 31797524 DOI: 10.1002/ccd.28634] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/17/2019] [Accepted: 11/21/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We aimed to evaluate early clinical and procedural outcomes with the 34-mm Evolut R transcatheter aortic valve replacement (TAVR) prosthesis. BACKGROUND The 34-mm Evolut R (Medtronic, Minneapolis, MN) self-expanding TAVR prosthesis was designed to treat patients with larger annuli. METHODS Clinical, demographic, procedural, and echocardiographic data on consecutive patients who underwent TAVR with a 34-mm Evolut R prosthesis at our institution were collected and analyzed. RESULTS One hundred ninety-six patients underwent TAVR with this prosthesis from November 2016 to July 2018, a majority (n = 188, 96%) through transfemoral access and with conscious sedation (n = 182, 93%). Mean age, Society of Thoracic Surgery risk score, and follow-up were 82 ± 8 years, 5.4 ± 5%, and 8.2 ± 5.3 months, respectively. Mean aortic valve (AV) peak velocity was 4.0 ± 0.6 m/s, mean AV gradient was 38 ± 13 mmHg, AV area was 0.79 ± 0.23 cm2 ; calcium score was 3,503 ± 1,970 Agatston units, and perimeter was 85 ± 4.3 mm. Device implantation was successful in all but one patient. Postprocedure mean AV peak velocity, AV mean gradient, and AV area were 1.9 ± 0.4 m/s, 7 ± 3 mmHg, and 2.6 ± 0.7 cm2 , respectively. New pacemaker requirement rate was 16%, and moderate paravalvular leak was present in six patients (3%), which improved to mild in three patients at 6-month follow-up. In-hospital, 30-day, 6-month, and 12-month survival rates were 98%, 96% (hospital discharge), 96% (30-day), 89% (6-month), and 83% (12-month). CONCLUSION These data demonstrate high success and good procedural, echocardiographic, and clinical outcomes of 34-mm Evolut R in patients with large annuli.
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Affiliation(s)
- Zuber Ali
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Payal Sharma
- Department of Internal Medicine, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Tadele Mengesha
- Advocate Aurora Research, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Ahmed Dalmar
- Advocate Aurora Research, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Khawaja Afzal Ammar
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Suhail Q Allaqaband
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Daniel P O'Hair
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Tanvir Bajwa
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
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Muthukumar L, Jahangir A, Jan MF, Perez Moreno AC, Khandheria BK, Tajik AJ. Association Between Malignant Mitral Valve Prolapse and Sudden Cardiac Death. JAMA Cardiol 2020; 5:1053-1061. [DOI: 10.1001/jamacardio.2020.1412] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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]
Affiliation(s)
- Lakshmi Muthukumar
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee
| | - Arshad Jahangir
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee
| | - M. Fuad Jan
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee
| | | | - Bijoy K. Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee
- Marcus Family Fund for Echocardiography Research and Education, Milwaukee, Wisconsin
| | - A. Jamil Tajik
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee
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Ignatowski D, Zemke S, Payne A, Khandheria BK. Striking the Balance between Safety of Patients and Team Members with Effective, High-Quality Care. J Am Soc Echocardiogr 2020; 33:1421. [PMID: 32861548 PMCID: PMC7362819 DOI: 10.1016/j.echo.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 11/21/2022]
Affiliation(s)
- Denise Ignatowski
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Sandra Zemke
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Abby Payne
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
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Nel S, Khandheria BK, Libhaber E, Peters F, Ferreira dos Santos C, Matioda H, Grinter S, Maharaj N, Essop MR. Prevalence and significance of isolated left ventricular non-compaction phenotype in normal black Africans using echocardiography. Int J Cardiol Heart Vasc 2020; 30:100585. [PMID: 32715082 PMCID: PMC7378683 DOI: 10.1016/j.ijcha.2020.100585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 12/18/2022]
Abstract
Background Several large, prospective screening studies of predominantly Caucasian patients have suggested that hypertrabeculation may not necessarily be pathologic unless there is concomitant left ventricular (LV) dysfunction, LV dilatation, history of arrhythmia, family history, or characteristic gene mutations. This conundrum may be magnified in blacks, in whom hypertrabeculation and LV hypertrophy is more common. We therefore investigated the frequency of hypertrabeculation/isolated LV noncompaction (ILVNC) phenotype in normal black Africans and evaluated LV function using sensitive measures of deformation and twist. Methods Two hundred and fifty-three volunteers were recruited and evaluated according to strict inclusion and exclusion criteria. Their mean age was 36.3 ± 12.2 years. Results Trabeculations were found in 12 (4.74%) participants. Three (1.2%) subjects had ≥ 4 LV trabeculations. The LV apex was the most common anatomical site for the location of trabeculations. Subjects with trabeculations were more likely to be males of a younger age, and had greater LV end-diastolic and end-systolic parameters and lateral e’. However, 0.8% of the population fulfilled the Stollberger criteria, and none fulfilled the Jenni, Milwaukee, or Baragwanath criteria. All subjects in this study had normal rotation patterns with no differences in rotational parameters or net twist. Conclusions Trabeculations may be found as a normal variant in black Africans. Assessing trabeculations alone may infer ILVNC; however, utilizing the more comprehensive ILVNC criteria enables differentiation of a possible LVNC phenotype. Normal individuals with hypertrabeculation have normal LV function and normal rotation patterns, with no differences in rotational parameters or net twist.
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Affiliation(s)
- Samantha Nel
- Division of Cardiology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, R68 Old Potchefstroom Road, PO Bertsham, Johannesburg 2013, South Africa
| | - Bijoy K. Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health, Marcus Family Fund for Echocardiography (ECHO) Research and Education, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI, 53215, USA
- Corresponding author at: Aurora Cardiovascular and Thoracic Services, 2801 W. Kinnickinnic River Parkway, Suite 880, Milwaukee, WI 53215, USA.
| | - Elena Libhaber
- Division of Cardiology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, R68 Old Potchefstroom Road, PO Bertsham, Johannesburg 2013, South Africa
| | - Ferande Peters
- Division of Cardiology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, R68 Old Potchefstroom Road, PO Bertsham, Johannesburg 2013, South Africa
- Cardiovascular Pathophysiology and Genomics unit, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa
| | - Claudia Ferreira dos Santos
- Division of Cardiology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, R68 Old Potchefstroom Road, PO Bertsham, Johannesburg 2013, South Africa
- Cardiovascular Pathophysiology and Genomics unit, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa
| | - Hiral Matioda
- Division of Cardiology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, R68 Old Potchefstroom Road, PO Bertsham, Johannesburg 2013, South Africa
| | - Sacha Grinter
- Division of Cardiology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, R68 Old Potchefstroom Road, PO Bertsham, Johannesburg 2013, South Africa
| | - Nirvathi Maharaj
- Division of Cardiology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, R68 Old Potchefstroom Road, PO Bertsham, Johannesburg 2013, South Africa
- Cardiovascular Pathophysiology and Genomics unit, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa
| | - Mohammed R. Essop
- Division of Cardiology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, R68 Old Potchefstroom Road, PO Bertsham, Johannesburg 2013, South Africa
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Roemer S, Kaminski A, Payne A, Tanel E, Perez Moreno AC, Jaglan A, Khandheria BK. Feasibility of Transthoracic Imaging of the Heart in the Prone Position. J Am Soc Echocardiogr 2020; 33:1147-1148. [PMID: 32891256 PMCID: PMC7373037 DOI: 10.1016/j.echo.2020.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Sarah Roemer
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Abigail Kaminski
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Abby Payne
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Emily Tanel
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | | | - Akshar Jaglan
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
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Jain R, Khandheria BK. Using the Electronic Medical Record to Transform Care for Severe Aortic Stenosis. J Am Soc Echocardiogr 2020; 33:1159-1160. [PMID: 32669227 DOI: 10.1016/j.echo.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
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Chan J, Edwards NFA, Scalia GM, Khandheria BK. Myocardial Work: A New Type of Strain Imaging? J Am Soc Echocardiogr 2020; 33:1209-1211. [PMID: 32591249 DOI: 10.1016/j.echo.2020.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Jonathan Chan
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia; School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
| | - Natalie F A Edwards
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia; School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Gregory M Scalia
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Service Line, Aurora Healthcare, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
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Muthukumar L, Jahangir A, Jan MF, Galazka P, Umland M, Schweitzer MR, Perez Moreno AC, Singh M, Khandheria BK, Tajik AJ. Left Ventricular Global and Regional Deformation in Arrhythmic Myxomatous Bileaflet Mitral Valve Prolapse Syndrome. JACC Cardiovasc Imaging 2020; 13:1842-1844. [PMID: 32563639 DOI: 10.1016/j.jcmg.2020.02.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/24/2020] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
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Meel R, Peters F, Khandheria BK, Libhaber E, Essop M. Atrial-ventricular function in rheumatic mitral regurgitation using strain imaging. Echo Res Pract 2020; 7:9-17. [PMID: 32426149 PMCID: PMC7219135 DOI: 10.1530/erp-19-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/06/2020] [Indexed: 11/30/2022] Open
Abstract
Background Chronic mitral regurgitation (MR) historically has been shown to primarily affect left ventricular (LV) function. The impact of increased left atrial (LA) volume in MR on morbidity and mortality has been highlighted recently, yet the LA does not feature as prominently in the current guidelines as the LV. Thus, we aimed to study LA and LV function in chronic rheumatic MR using traditional volumetric parameters and strain imaging. Methods Seventy-seven patients with isolated moderate or severe chronic rheumatic MR and 40 controls underwent echocardiographic examination. LV and LA function were assessed with conventional echocardiography and 2D strain imaging. Results LA stiffness index was greater in chronic rheumatic MR than controls (0.95 ± 1.89 vs 0.16 ± 0.13, P = 0.009). LA dysfunction was noted in the reservoir, conduit, and contractile phases compared with controls (P < 0.05). LA peak reservoir strain (ƐR), LA peak contractile strain, and LV peak systolic strain were decreased in chronic rheumatic MR compared with controls (P < 0.05). Eighty-six percent of patients had decreased LA ƐR and 58% had depressed LV peak systolic strain. Decreased ƐR and normal LV peak systolic strain were noted in 42%. Thirteen percent had normal ƐR and LV peak systolic strain. One patient had normal ƐR with decreased LV peak systolic strain. Conclusions In chronic rheumatic MR, there is LA dysfunction in the reservoir, conduit, and contractile phases. In this study, LA dysfunction with or without LV dysfunction was the predominant finding, and thus, LA dysfunction may be an earlier marker of decompensation in chronic rheumatic MR.
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Affiliation(s)
- Ruchika Meel
- Division of Cardiology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Ferande Peters
- Division of Cardiology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Marcus Family Fund for Echocardiography (ECHO) Research and Education, Milwaukee, Wisconsin, USA
| | - Elena Libhaber
- Division of Cardiology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Mohammed Essop
- Division of Cardiology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
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Kaminski A, Payne A, Roemer S, Ignatowski D, Khandheria BK. Answering to the Call of Critically Ill Patients: Limiting Sonographer Exposure to COVID-19 with Focused Protocols. J Am Soc Echocardiogr 2020; 33:902-903. [PMID: 32624090 PMCID: PMC7214298 DOI: 10.1016/j.echo.2020.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Abigail Kaminski
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Abby Payne
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Sarah Roemer
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Denise Ignatowski
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
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Sengupta S, Jain R, Burkule N, Olet S, Khandheria BK. Myocardial Work Index: A Novel Method for Assessment of Myocardial Function in South Asian Recreational Athletes. J Patient Cent Res Rev 2020; 7:147-156. [PMID: 32377548 DOI: 10.17294/2330-0698.1730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose We used a novel noninvasive method based on speckle-tracking echocardiography to evaluate myocardial performance in South Asian recreational athletes who completed a half marathon. Methods Transthoracic echocardiography was performed on 24 recreational athletes 48 hours before they took part in a half marathon (premarathon), within 2 hours of half marathon completion (postmarathon), and 72 hours after completion. Clinical, laboratory, and echocardiographic variables were collected. Speckle-tracking echocardiography was performed in all subjects to characterize myocardial mechanics. Results Mean age of participants was 41.8 ± 7.4 years, and 23 (95.8%) were male. No subject had a prior history of coronary artery disease. Significant changes in pre- and postmarathon values suggested myocardial injury, including an increase in mean brain natriuretic peptide (BNP), an increase in left atrial volume, and an overall reduction in peak left ventricular global longitudinal strain. All subjects had a similar value of global work index, the average myocardial work, premarathon. Global work index did not change in 11 patients (Group 1), and global work index increased in 13 patients (Group 2) immediately postmarathon. Group 2 patients were noted to have higher heart rate, lower end-diastolic and end-systolic volumes, and higher BNP levels, suggesting myocardial stress. Conclusions South Asian athletes completing a half marathon exhibited two different responses to the cardiac stress of the half marathon, as outlined by the use of myocardial work indices, a novel method for assessing cardiac performance.
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Affiliation(s)
| | - Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora St. Luke's/Aurora Sinai Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI
| | | | - Susan Olet
- Aurora Research Institute, Aurora Health Care, Milwaukee, WI
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora St. Luke's/Aurora Sinai Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI.,Marcus Family Fund for Echocardiography (ECHO) Research and Education, Milwaukee, WI
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Ignatowski D, Schweitzer M, Pesek K, Jain R, Muthukumar L, Khandheria BK, Tajik AJ. Pickelhaube Spike, a High-Risk Marker for Bileaflet Myxomatous Mitral Valve Prolapse: Sonographer's Quest for the Highest Spike. J Am Soc Echocardiogr 2020; 33:639-640. [PMID: 32199779 DOI: 10.1016/j.echo.2020.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Denise Ignatowski
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - McKenzie Schweitzer
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Kelly Pesek
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Lakshmi Muthukumar
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - A Jamil Tajik
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
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Rizvi F, Mirza M, Olet S, Albrecht M, Edwards S, Emelyanova L, Kress D, Ross GR, Holmuhamedov E, Tajik AJ, Khandheria BK, Jahangir A. Noninvasive biomarker-based risk stratification for development of new onset atrial fibrillation after coronary artery bypass surgery. Int J Cardiol 2020; 307:55-62. [PMID: 31952855 DOI: 10.1016/j.ijcard.2019.12.067] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/02/2019] [Accepted: 12/30/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Postoperative atrial fibrillation (PoAF) is a common complication after cardiac surgery. A pre-existing atrial substrate appears to be important in postoperative development of dysrhythmia, but its preoperative estimation is challenging. We tested the hypothesis that a combination of clinical predictors, noninvasive surrogate markers for atrial fibrosis defining abnormal left atrial (LA) mechanics, and biomarkers of collagen turnover is superior to clinical predictors alone in identifying patients at-risk for PoAF. METHODS In patients without prior AF undergoing coronary artery bypass grafting, concentrations of biomarkers reflecting collagen synthesis and degradation, extracellular matrix, and regulatory microRNA-29s were determined in serum from preoperative blood samples and correlated to atrial fibrosis extent, alteration in atrial deformation properties determined by 3D speckle-tracking echocardiography, and AF development. RESULTS Of 90 patients without prior AF, 34 who developed PoAF were older than non-PoAF patients (72.04 ± 10.7 y; P = 0.043) with no significant difference in baseline comorbidities, LA size, or ventricular function. Global (P = 0.007) and regional longitudinal LA strain and ejection fraction (P = 0.01) were reduced in PoAF vs. non-PoAF patients. Preoperative amino-terminal-procollagen-III-peptide (PIIINP) (103.1 ± 39.7 vs. 35.1 ± 19.3; P = 0.041) and carboxy-terminal-procollagen-I-peptide levels were elevated in PoAF vs. non-PoAF patients with a reduction in miR-29 levels and correlated with atrial fibrosis extent. Combining age as the only significant clinical predictor with PIIINP and miR-29a provided a model that identified PoAF patients with higher predictive accuracy. CONCLUSIONS In patients without a previous history of AF, using age and biomarkers of collagen synthesis and regulation, a noninvasive tool was developed to identify those at risk for new-onset PoAF.
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Affiliation(s)
- Farhan Rizvi
- Center for Integrative Research on Cardiovascular Aging (CIRCA), Advocate Aurora Research Institute, 960 N. 12th Street, Milwaukee, WI 53233, USA.
| | - Mahek Mirza
- Center for Integrative Research on Cardiovascular Aging (CIRCA), Advocate Aurora Research Institute, 960 N. 12th Street, Milwaukee, WI 53233, USA
| | - Susan Olet
- Patient Centered Research, Advocate Aurora Research Institute, 960 N. 12th Street, Suite 4120, Milwaukee, WI 53233, USA
| | - Melissa Albrecht
- Aurora St. Luke's Medical Center School of Diagnostic Sonography, Advocate Aurora Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - Stacie Edwards
- Center for Integrative Research on Cardiovascular Aging (CIRCA), Advocate Aurora Research Institute, 960 N. 12th Street, Milwaukee, WI 53233, USA
| | - Larisa Emelyanova
- Center for Integrative Research on Cardiovascular Aging (CIRCA), Advocate Aurora Research Institute, 960 N. 12th Street, Milwaukee, WI 53233, USA
| | - David Kress
- Aurora Cardiovascular and Thoracic Services, Advocate Aurora Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA; and
| | - Gracious R Ross
- Center for Integrative Research on Cardiovascular Aging (CIRCA), Advocate Aurora Research Institute, 960 N. 12th Street, Milwaukee, WI 53233, USA
| | - Ekhson Holmuhamedov
- Center for Integrative Research on Cardiovascular Aging (CIRCA), Advocate Aurora Research Institute, 960 N. 12th Street, Milwaukee, WI 53233, USA
| | - A Jamil Tajik
- Aurora Cardiovascular and Thoracic Services, Advocate Aurora Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA; and
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Advocate Aurora Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA; and
| | - Arshad Jahangir
- Center for Integrative Research on Cardiovascular Aging (CIRCA), Advocate Aurora Research Institute, 960 N. 12th Street, Milwaukee, WI 53233, USA; Aurora Cardiovascular and Thoracic Services, Advocate Aurora Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA; and; Center for Advanced Atrial Fibrillation Therapies, Advocate Aurora Health, 2801 W. Kinnickinnic River Parkway, Suite 777, Milwaukee, WI 53215, USA.
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47
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Cardinale DM, Barac A, Torbicki A, Khandheria BK, Lenihan D, Minotti G. Cardio-oncological management of patients. Semin Oncol 2019; 46:408-413. [DOI: 10.1053/j.seminoncol.2019.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 11/11/2019] [Indexed: 12/15/2022]
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48
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Khan M, Muthukumar L, Khandheria BK. Echocardiographic Features of Evolving Aortic Root Abscess. JACC Case Rep 2019; 1:426-427. [PMID: 34316845 PMCID: PMC8288753 DOI: 10.1016/j.jaccas.2019.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/22/2019] [Accepted: 07/24/2019] [Indexed: 11/16/2022]
Abstract
Paravalvular abscess is a serious complication of endocarditis that often requires surgical intervention. Diagnosis is achieved by recognizing echocardiographic features of paravalvular abscess seen on transesophageal echocardiography. Our case report highlights these features seen in a patient with aortic root abscess and aortotricuspid annulus involvement. (Level of Difficulty: Beginner.)
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Affiliation(s)
| | | | - Bijoy K. Khandheria
- Address for correspondence: Dr. Bijoy K. Khandheria, Aurora Cardiovascular Services, Aurora St. Luke’s Medical Center, 2801 W. Kinnickinnic River Parkway, Suite 880, Milwaukee, Wisconsin 53215.
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49
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Roemer SM, Kress DC, Khandheria BK. Double jeopardy. Eur Heart J Cardiovasc Imaging 2019; 20:1104. [PMID: 31086971 DOI: 10.1093/ehjci/jez090] [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: 11/14/2022] Open
Affiliation(s)
- Sarah M Roemer
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI, USA
| | - David C Kress
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI, USA
| | - Bijoy K Khandheria
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI, USA.,Marcus Family Fund for Echocardiography (ECHO) Research and Education, Milwaukee, WI, USA
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50
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Huisheere HS, Weber HJ, Muthukumar L, Khandheria BK. What is the mass doing outside the right ventricle? Eur Heart J Cardiovasc Imaging 2019; 20:1072. [PMID: 30927412 DOI: 10.1093/ehjci/jez057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/11/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hillary S Huisheere
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI, 53215, USA
| | - Hailee J Weber
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI, 53215, USA
| | - Lakshmi Muthukumar
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI, 53215, USA
| | - Bijoy K Khandheria
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI, 53215, USA.,Marcus Family Fund for Echocardiography (ECHO) Research and Education, Milwaukee, WI, USA
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