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Khedraki R, Saef J, Martens P, Martyn T, Sul L, Hachamovitch R, Ives L, Estep JD, Tang WHW, Hanna M. Race, Genotype, and Prognosis in Black Patients With Transthyretin Cardiac Amyloidosis. Am J Cardiol 2024; 216:66-76. [PMID: 38278432 DOI: 10.1016/j.amjcard.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/26/2023] [Accepted: 01/09/2024] [Indexed: 01/28/2024]
Abstract
Previous studies suggest worse outcomes in patients with variant transthyretin cardiac amyloidosis (ATTR-CA) because of valine-to-isoleucine substitution at Position 122 (V122I) (ATTRv-CA) compared with patients with wild-type (WT) disease (ATTRwt-CA). Given V122I is almost exclusively found in Black patients, it is unclear if this is attributable to the biology of genotype or racial differences. Patients with ATTR-CA diagnosed between January 2001 and August 2021 were characterized into 3 categories: (1) White with ATTRwt-CA (White-WT); (2) Black with V122I ATTRv-CA (Black-V122I), and (3) Black with ATTRwt-CA (Black-WT). Event-free survival (composite of death, left ventricular assist device, or cardiac transplant) was evaluated using univariable and multivariable analyses over a median follow-up of 1.6 (0.7 to 2.90) years. Of 694 ATTR-CA patients, 502 (72%) were White-WT, 139 Black-V122I (20%), and 53 Black-WT (8%). Notably, 28% of Black patients with ATTR-CA had WT disease and not the V122I variant. Using multivariable modeling to adjust for several prognostic features, Black-V122I had higher risk of the composite adverse outcome compared with a grouped cohort of patients with WT disease (White-WT and Black-WT) (hazard ratio [HR] 1.82, confidence interval [CI] 1.30-2.56, p < 0.001). Furthermore, the Black cohort as a whole (Black-V122I and Black-WT) demonstrated greater risk of adverse outcomes compared with White-WT (HR 1.63, CI 1.19-2.24, p = 0.002). Black-V122I had greater risk of the primary end point compared with White-WT (HR 1.80, CI 1.27-2.56, p = 0.001). Black patients with ATTR-CA have worse event-free survival than White-WT despite risk adjustment. However, it remains unclear whether this is driven by differences in race or genotype given the smaller number of Black-WT patients. Approximately one-quarter of Black patients had WT, of which a greater proportion were female compared with White-WT.
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Affiliation(s)
- Rola Khedraki
- Department of Cardiovascular Medicine, Scripps, La Jolla, California
| | - Joshua Saef
- Adult Congenital Heart Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pieter Martens
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Trejeeve Martyn
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Lidiya Sul
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Rory Hachamovitch
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Lauren Ives
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Jerry D Estep
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston, Florida
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mazen Hanna
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
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Matta M, Harb SC, Cremer P, Hachamovitch R, Ayoub C. Stress testing and noninvasive coronary imaging: What's the best test for my patient? Cleve Clin J Med 2021; 88:502-515. [PMID: 34470755 DOI: 10.3949/ccjm.88a.20068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Coronary artery disease (CAD) causes significant morbidity and mortality. Accurate noninvasive evaluation is important to facilitate appropriate diagnosis and treatment. The ubiquitous nature of CAD requires all practitioners, regardless of their specialty, to be familiar with noninvasive diagnostic modalities. This article reviews currently available tests, including specific features, diagnostic and prognostic value, strengths, and limitations.
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Affiliation(s)
- Milad Matta
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | - Serge C Harb
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic; Assistant Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Paul Cremer
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Rory Hachamovitch
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Chadi Ayoub
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic; Assistant Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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Hutt E, Hachamovitch R, Jaber WA. The Mediastinum is LIT. J Nucl Cardiol 2021; 28:1802-1804. [PMID: 32394404 DOI: 10.1007/s12350-020-02162-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Erika Hutt
- Department of Cardiovascular Medicine, Fellow in Training, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Rory Hachamovitch
- Department of Cardiovascular Imaging, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Wael A Jaber
- Department of Cardiovascular Imaging, Cleveland Clinic Foundation, Cleveland, OH, USA
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Althouse AD, Below JE, Claggett BL, Cox NJ, de Lemos JA, Deo RC, Duval S, Hachamovitch R, Kaul S, Keith SW, Secemsky E, Teixeira-Pinto A, Roger VL. Recommendations for Statistical Reporting in Cardiovascular Medicine: A Special Report From the American Heart Association. Circulation 2021; 144:e70-e91. [PMID: 34032474 DOI: 10.1161/circulationaha.121.055393] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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: 01/01/2023]
Abstract
Statistical analyses are a crucial component of the biomedical research process and are necessary to draw inferences from biomedical research data. The application of sound statistical methodology is a prerequisite for publication in the American Heart Association (AHA) journal portfolio. The objective of this document is to summarize key aspects of statistical reporting that might be most relevant to the authors, reviewers, and readership of AHA journals. The AHA Scientific Publication Committee convened a task force to inventory existing statistical standards for publication in biomedical journals and to identify approaches suitable for the AHA journal portfolio. The experts on the task force were selected by the AHA Scientific Publication Committee, who identified 12 key topics that serve as the section headers for this document. For each topic, the members of the writing group identified relevant references and evaluated them as a resource to make the standards summarized herein. Each section was independently reviewed by an expert reviewer who was not part of the task force. Expert reviewers were also permitted to comment on other sections if they chose. Differences of opinion were adjudicated by consensus. The standards presented in this report are intended to serve as a guide for high-quality reporting of statistical analyses methods and results.
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Affiliation(s)
- Andrew D Althouse
- Center for Research on Health Care Data Center, Division of General Internal Medicine, University of Pittsburgh, PA (A.D.A.)
| | - Jennifer E Below
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN (J.E.B., N.J.C.)
| | - Brian L Claggett
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (B.L.C., R.C.D.)
| | - Nancy J Cox
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN (J.E.B., N.J.C.)
| | - James A de Lemos
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L.)
| | - Rahul C Deo
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (B.L.C., R.C.D.)
| | - Sue Duval
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis (S.D.)
| | - Rory Hachamovitch
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (R.H.)
| | - Sanjay Kaul
- Department of Cardiology, Cedars-Sinai Medical Center, and the David Geffen School of Medicine, University of California, Los Angeles (S.K.)
| | - Scott W Keith
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (S.W.K.)
| | - Eric Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.S.)
| | - Armando Teixeira-Pinto
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Australia (A.T.-P.)
| | - Veronique L Roger
- Department of Cardiovascular Diseases Medicine, Mayo Clinic College of Medicine, Rochester, MN (V.L.R.).,now with Epidemiology and Community Health Branch National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (V.L.R.)
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Kumar A, Patel DR, Harb SC, Greenberg NL, Bhargava A, Menon V, Ellis SG, Kapadia SR, Hachamovitch R, Jaber WA, Cremer PC. Implementation of a Myocardial Perfusion Imaging Risk Algorithm to Inform Appropriate Downstream Invasive Testing and Treatment. Circ Cardiovasc Imaging 2021; 14:e011984. [PMID: 33765835 DOI: 10.1161/circimaging.120.011984] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND To risk stratify patients undergoing single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in accordance with appropriate use criteria for referral to coronary angiography, we developed a risk classification algorithm incorporating appropriate use criteria-defined risk features. We evaluated the association between this algorithm with downstream angiography, revascularization, and all-cause mortality. METHODS We studied consecutive patients who underwent SPECT-MPI from January 1, 2015, to December 31, 2017, and assigned a scan risk of low, intermediate, high, or indeterminate. With this stratification, we assessed referral for angiography and revascularization within 3 months of SPECT-MPI and intermediate-term mortality. RESULTS Among 12 799 patients, the mean age was 66 years, and a majority were men (56.8%). Most patients were low risk (83.6%) followed by intermediate (9.9%) and high risk (5.2%). Compared with low-risk patients, intermediate- and high-risk patients were more frequently referred for angiography (14.8% and 13.6% versus 2.0%; P<0.001) and revascularization (7.7% and 6.8% versus 0.7%; P<0.001). In 1008 propensity-matched patients, scan risk was independently associated with angiography after adjustment for ischemia, scar, or stress ejection fraction. At a mean follow-up of 2.3 years, mortality was higher with increased scan risk (high, 10.4%; intermediate, 7.1%; low, 4.1%; P<0.001). Compared with low scan risk, intermediate (hazard ratio, 1.37 [95% CI, 1.09-1.72]; P=0.008) and high scan risk (hazard ratio, 1.98 [95% CI, 1.53-2.56]; P<0.001) were associated with mortality in multivariable analysis. Similar findings were observed for those undergoing pharmacological and exercise SPECT-MPI with comparatively worse prognosis among pharmacological patients. CONCLUSIONS This appropriate use criteria-derived risk classification algorithm for SPECT-MPI guided referral for coronary angiography and revascularization and was significantly associated with mortality. This algorithm may serve as an important tool to reaffirm appropriate use criteria and direct management of patients with stable ischemic heart disease undergoing stress testing.
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Affiliation(s)
- Anirudh Kumar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Divyang R Patel
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Neil L Greenberg
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Ajay Bhargava
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Venu Menon
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Stephen G Ellis
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Rory Hachamovitch
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Paul C Cremer
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
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Hatipoglu D, Tanski C, Hachamovitch R, Legha S, Moudgil R. Ixekizumab-Induced Cardiac Sarcoidosis: A Case Report. CJC Open 2021; 3:118-120. [PMID: 33458639 PMCID: PMC7801220 DOI: 10.1016/j.cjco.2020.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 08/31/2020] [Indexed: 12/24/2022] Open
Abstract
A 58-year-old man with a history of hypertension and psoriasis presented with acute-onset heart failure with an ejection fraction of 25%-30%. During the work-up, cardiac magnetic resonance imaging showed a pattern of inflammation consistent with sarcoidosis, which was confirmed with (18)F-fluorodeoxyglucose positron emission tomography . The patient was recently initiated on ixekizumab for psoriasis, which was then discontinued. This discontinuation resulted in complete resolution of cardiac sarcoidosis, with establishment of normal ejection fraction. This result suggests a potential causal association of ixekizumab-induced cardiac sarcoidosis, which is a rare phenomenon. Elucidation of the mechanism behind the effect of ixekizumab may provide insights into the possible mechanism(s) behind cardiac sarcoidosis.
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Affiliation(s)
| | - Christopher Tanski
- Section of Pharmaceutical Science, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Rory Hachamovitch
- Section of Cardiovascular Imaging, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Sapna Legha
- Section of Clinical Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Rohit Moudgil
- Section of Clinical Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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7
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Affiliation(s)
- Rory Hachamovitch
- Cardiovascular Imaging Section, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (R.H.)
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8
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Hussain M, Hanna M, Griffin BP, Conic J, Patel J, Fava AM, Watson C, Phelan DM, Jellis C, Grimm RA, Rodriguez LL, Schoenhagen P, Hachamovitch R, Jaber WA, Cremer PC, Collier P. Aortic Valve Calcium in Patients With Transthyretin Cardiac Amyloidosis. Circ Cardiovasc Imaging 2020; 13:e011433. [DOI: 10.1161/circimaging.120.011433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/16/2022]
Affiliation(s)
- Muzna Hussain
- Department of Cardiovascular Medicine, Heart and Vascular Institute (M. Hussain, M. Hanna, B.P.G., J.C., J.P., A.M.F., C.J., R.A.G., L.L.R., R.H., W.A.J., P.C.C.), Cleveland Clinic, OH
- School of Medicine, Dentistry and Biomedical Sciences, Wellcome-Wolfson Institute of Experimental Medicine, Queen’s University, Belfast, United Kingdom (M. Hussain, C.W.)
| | - Mazen Hanna
- Department of Cardiovascular Medicine, Heart and Vascular Institute (M. Hussain, M. Hanna, B.P.G., J.C., J.P., A.M.F., C.J., R.A.G., L.L.R., R.H., W.A.J., P.C.C.), Cleveland Clinic, OH
| | - Brian P. Griffin
- Department of Cardiovascular Medicine, Heart and Vascular Institute (M. Hussain, M. Hanna, B.P.G., J.C., J.P., A.M.F., C.J., R.A.G., L.L.R., R.H., W.A.J., P.C.C.), Cleveland Clinic, OH
| | - Juilijana Conic
- Department of Cardiovascular Medicine, Heart and Vascular Institute (M. Hussain, M. Hanna, B.P.G., J.C., J.P., A.M.F., C.J., R.A.G., L.L.R., R.H., W.A.J., P.C.C.), Cleveland Clinic, OH
| | - Jay Patel
- Department of Cardiovascular Medicine, Heart and Vascular Institute (M. Hussain, M. Hanna, B.P.G., J.C., J.P., A.M.F., C.J., R.A.G., L.L.R., R.H., W.A.J., P.C.C.), Cleveland Clinic, OH
| | - Agostina M. Fava
- Department of Cardiovascular Medicine, Heart and Vascular Institute (M. Hussain, M. Hanna, B.P.G., J.C., J.P., A.M.F., C.J., R.A.G., L.L.R., R.H., W.A.J., P.C.C.), Cleveland Clinic, OH
| | - Chris Watson
- School of Medicine, Dentistry and Biomedical Sciences, Wellcome-Wolfson Institute of Experimental Medicine, Queen’s University, Belfast, United Kingdom (M. Hussain, C.W.)
| | - Dermot M. Phelan
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC (D.M.P.)
| | - Christine Jellis
- Department of Cardiovascular Medicine, Heart and Vascular Institute (M. Hussain, M. Hanna, B.P.G., J.C., J.P., A.M.F., C.J., R.A.G., L.L.R., R.H., W.A.J., P.C.C.), Cleveland Clinic, OH
| | - Richard A. Grimm
- Department of Cardiovascular Medicine, Heart and Vascular Institute (M. Hussain, M. Hanna, B.P.G., J.C., J.P., A.M.F., C.J., R.A.G., L.L.R., R.H., W.A.J., P.C.C.), Cleveland Clinic, OH
| | - L. Leonardo Rodriguez
- Department of Cardiovascular Medicine, Heart and Vascular Institute (M. Hussain, M. Hanna, B.P.G., J.C., J.P., A.M.F., C.J., R.A.G., L.L.R., R.H., W.A.J., P.C.C.), Cleveland Clinic, OH
| | | | - Rory Hachamovitch
- Department of Cardiovascular Medicine, Heart and Vascular Institute (M. Hussain, M. Hanna, B.P.G., J.C., J.P., A.M.F., C.J., R.A.G., L.L.R., R.H., W.A.J., P.C.C.), Cleveland Clinic, OH
| | - Wael A. Jaber
- Department of Cardiovascular Medicine, Heart and Vascular Institute (M. Hussain, M. Hanna, B.P.G., J.C., J.P., A.M.F., C.J., R.A.G., L.L.R., R.H., W.A.J., P.C.C.), Cleveland Clinic, OH
| | - Paul C. Cremer
- Department of Cardiovascular Medicine, Heart and Vascular Institute (M. Hussain, M. Hanna, B.P.G., J.C., J.P., A.M.F., C.J., R.A.G., L.L.R., R.H., W.A.J., P.C.C.), Cleveland Clinic, OH
| | - Patrick Collier
- Staff Cardiovascular Medicine, Associate Director of the Echo Lab, Co-Director Cardio-oncology Center, Associate Professor of Medicine, Case Western Reserve University, Lerner College of Medicine, Cleveland, OH (P.C.)
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Mani P, Hachamovitch R. Can Stress Cardiac Magnetic Resonance Identify Potential Survival Benefit With Revascularization in Stable Ischemic Heart Disease? JACC Cardiovasc Imaging 2020; 13:1687-1689. [PMID: 32563648 DOI: 10.1016/j.jcmg.2020.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Preethi Mani
- Cardiovascular Imaging Section, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rory Hachamovitch
- Cardiovascular Imaging Section, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
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Kwong RY, Ge Y, Steel K, Bingham S, Abdullah S, Fujikura K, Wang W, Pandya A, Chen YY, Mikolich JR, Boland S, Arai AE, Bandettini WP, Shanbhag SM, Patel AR, Narang A, Farzaneh-Far A, Romer B, Heitner JF, Ho JY, Singh J, Shenoy C, Hughes A, Leung SW, Marji M, Gonzalez JA, Mehta S, Shah DJ, Debs D, Raman SV, Guha A, Ferrari VA, Schulz-Menger J, Hachamovitch R, Stuber M, Simonetti OP. Cardiac Magnetic Resonance Stress Perfusion Imaging for Evaluation of Patients With Chest Pain. J Am Coll Cardiol 2020; 74:1741-1755. [PMID: 31582133 PMCID: PMC8109181 DOI: 10.1016/j.jacc.2019.07.074] [Citation(s) in RCA: 156] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Stress cardiac magnetic resonance imaging (CMR) has demonstrated excellent diagnostic and prognostic value in single-center studies. OBJECTIVES This study sought to investigate the prognostic value of stress CMR and downstream costs from subsequent cardiac testing in a retrospective multicenter study in the United States. METHODS In this retrospective study, consecutive patients from 13 centers across 11 states who presented with a chest pain syndrome and were referred for stress CMR were followed for a target period of 4 years. The authors associated CMR findings with a primary outcome of cardiovascular death or nonfatal myocardial infarction using competing risk-adjusted regression models and downstream costs of ischemia testing using published Medicare national payment rates. RESULTS In this study, 2,349 patients (63 ± 11 years of age, 47% female) were followed for a median of 5.4 years. Patients with no ischemia or late gadolinium enhancement (LGE) by CMR, observed in 1,583 patients (67%), experienced low annualized rates of primary outcome (<1%) and coronary revascularization (1% to 3%), across all years of study follow-up. In contrast, patients with ischemia+/LGE+ experienced a >4-fold higher annual primary outcome rate and a >10-fold higher rate of coronary revascularization during the first year after CMR. Patients with ischemia and LGE both negative had low average annual cost spent on ischemia testing across all years of follow-up, and this pattern was similar across the 4 practice environments of the participating centers. CONCLUSIONS In a multicenter U.S. cohort with stable chest pain syndromes, stress CMR performed at experienced centers offers effective cardiac prognostication. Patients without CMR ischemia or LGE experienced a low incidence of cardiac events, little need for coronary revascularization, and low spending on subsequent ischemia testing. (Stress CMR Perfusion Imaging in the United States [SPINS]: A Society for Cardiovascular Resonance Registry Study; NCT03192891)
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Affiliation(s)
- Raymond Y Kwong
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Yin Ge
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kevin Steel
- Cardiology Division, San Antonio Military Medical Center, San Antonio, Texas
| | | | - Shuaib Abdullah
- Veterans Administration North Texas Healthcare System, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kana Fujikura
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Wei Wang
- Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ankur Pandya
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Yi-Yun Chen
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - J Ronald Mikolich
- Department of Cardiovascular Medicine, Sharon Regional Health System, Sharon, Pennsylvania
| | - Sebastian Boland
- Department of Cardiovascular Medicine, Sharon Regional Health System, Sharon, Pennsylvania
| | - Andrew E Arai
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - W Patricia Bandettini
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Sujata M Shanbhag
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amit R Patel
- Cardiology Division, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Akhil Narang
- Cardiology Division, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Afshin Farzaneh-Far
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - Benjamin Romer
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - John F Heitner
- Division of Cardiology, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York
| | - Jean Y Ho
- Division of Cardiology, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York
| | - Jaspal Singh
- Division of Cardiology, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Andrew Hughes
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Steve W Leung
- Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Meera Marji
- Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Jorge A Gonzalez
- Division of Cardiology and Radiology, Scripps Clinic, La Jolla, California
| | - Sandeep Mehta
- Division of Cardiology and Radiology, Scripps Clinic, La Jolla, California
| | - Dipan J Shah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Dany Debs
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Subha V Raman
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Avirup Guha
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Victor A Ferrari
- Cardiovascular Division, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeanette Schulz-Menger
- Charité, Medical Faculty of the Humboldt University, Experimental and Clinical Research Center, Berlin, and Helios Clinics, Cardiology, Berlin, Germany
| | - Rory Hachamovitch
- Division of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Matthias Stuber
- Department of Radiology, University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
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Ribeiro Neto ML, Jellis C, Hachamovitch R, Wimer A, Highland KB, Sahoo D, Khabbaza JE, Pande A, Bindra A, Southern BD, Parambil JG, Callahan TD, Joyce E, Culver DA. Performance of diagnostic criteria in patients clinically judged to have cardiac sarcoidosis: Is it time to regroup? Am Heart J 2020; 223:106-109. [PMID: 32240829 DOI: 10.1016/j.ahj.2020.02.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/06/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The diagnosis of cardiac sarcoidosis (CS) is challenging. Because of the current limitations of endomyocardial biopsy as a reference standard, physicians rely on advanced cardiac imaging, multidisciplinary evaluation, and diagnostic criteria to diagnose CS. AIMS To compare the 3 main available diagnostic criteria in patients clinically judged to have CS. METHODS We prospectively included patients clinically judged to have CS by a multidisciplinary sarcoidosis team from November 2016 to October 2017. We included only incident cases (diagnosis of CS within 1 year of inclusion). We applied retrospectively the following diagnostic criteria: the World Association of Sarcoidosis and Other Granulomatous Diseases (WASOG), the Heart Rhythm Society (HRS), and the Japanese Circulation Society (JCS) 2016 criteria. RESULTS We identified 69 patients. Diagnostic criteria classified patients as follows: WASOG as highly probable (1.4%), probable (52.2%), possible (0%), some criteria (40.6%), and no criteria (5.8%); HRS as histological diagnosis (1.4%), probable (52.2%), some criteria (40.6%), and no criteria (5.8%); JCS as histological diagnosis (1.4%), clinical diagnosis (58%), some criteria (39.1%), and no criteria (1.4%). Concordance was high between WASOG and HRS (κ = 1) but low between JCS and the others (κ = 0.326). CONCLUSIONS A high proportion of patients clinically judged to have CS are unable to be classified according to the 3 main diagnostic criteria. There is low concordance between JCS criteria and the other 2 criteria (WASOG and HRS).
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Raman SV, Hachamovitch R, Scandling D, Mazur W, Kwong RY, Wong TC, Schelbert EB, Moore S, Truong V, Simonetti OP. Lower Ischemic Heart Disease Diagnostic Costs With Treadmill Stress CMR Versus SPECT: A Multicenter, Randomized Trial. JACC Cardiovasc Imaging 2020; 13:1840-1842. [PMID: 32305477 DOI: 10.1016/j.jcmg.2020.02.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/22/2020] [Accepted: 02/26/2020] [Indexed: 11/28/2022]
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13
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Kumar A, Patel D, Harb S, Greenberg N, Bhargava A, Kapadia SR, Menon V, Hachamovitch R, Jaber WA, Cremer P. IMPACT OF A NOVEL MYOCARDIAL PERFUSION IMAGING RISK CLASSIFICATION SCHEME ON REFERRAL FOR CORONARY ANGIOGRAPHY, REVASCULARIZATION, AND MORTALITY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32394-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Hussain M, Hanna M, Griffin BP, Patel J, Fava A, Watson C, Phelan D, Jellis CL, Grimm RA, Rodriguez L, Schoenhagen P, Hachamovitch R, Jaber WA, Cremer P, Collier P. AORTIC VALVE CALCIUM SCORE CUT-OFFS USED TO IDENTIFY HEMODYNAMICALLY SEVERE AORTIC STENOSIS MAY NOT APPLY IN PATIENTS WITH CARDIAC AMYLOIDOSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32791-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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15
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Kwon DH, Obuchowski NA, Marwick TH, Menon V, Griffin B, Flamm SD, Hachamovitch R. Jeopardized Myocardium Defined by Late Gadolinium Enhancement Magnetic Resonance Imaging Predicts Survival in Patients With Ischemic Cardiomyopathy: Impact of Revascularization. J Am Heart Assoc 2019; 7:e009394. [PMID: 30571486 PMCID: PMC6404459 DOI: 10.1161/jaha.118.009394] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The prognostic impact of jeopardized myocardium ( JM ) in patients with advanced ischemic cardiomyopathy ( ICM ) is unclear. We hypothesized that JM is an independent predictor of mortality in patients with advanced ICM . Methods and Results Patients with ICM who underwent cardiac magnetic resonance imaging between January 2002 and January 2013 were included in our study. JM was identified as a vascular territory with <50% myocardial scarring on cardiac magnetic resonance imaging and with >70% stenosis in a major coronary vessel that was not subsequently revascularized. A propensity score was developed for revascularization. A multivariable Cox proportional hazards model was used to evaluate the association of JM with all-cause mortality. We evaluated 631 patients over a mean follow-up of 5.1 years. Overall, 336 patients underwent subsequent revascularization during the follow-up period, among whom 23% had remaining JM , while 295 patients were medically treated (57% with JM ). There were 204 deaths (32%). On multivariable analysis, JM (hazard ratio, 1.88; 95% confidence interval, 1.38-2.55 [ P<0.001]) was independently associated with all-cause mortality after adjusting for multiple other factors. The risk associated with the presence of JM increased by 5% for every 10-unit increase in left ventricular end-systolic volume index. Conclusions JM is an independent and incremental predictor of mortality in patients with advanced ICM . Patients undergoing revascularization with residual JM had similar risk of mortality compared with medically treated patients with JM . The risk associated with JM significantly increased in the presence of worsening adverse left ventricular remodeling. Cardiac magnetic resonance viability assessment may provide important risk stratification in patients with ICM .
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Affiliation(s)
- Deborah H Kwon
- 1 Heart and Vascular Institute Cleveland Clinic Cleveland OH.,2 Imaging Institute Cleveland Clinic Cleveland OH
| | - Nancy A Obuchowski
- 2 Imaging Institute Cleveland Clinic Cleveland OH.,3 Quantitative Health Sciences Cleveland Clinic Cleveland OH
| | - Thomas H Marwick
- 4 Baker Heart and Diabetes Institute Melbourne Victoria Australia
| | - Venu Menon
- 1 Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Brian Griffin
- 1 Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Scott D Flamm
- 1 Heart and Vascular Institute Cleveland Clinic Cleveland OH.,2 Imaging Institute Cleveland Clinic Cleveland OH
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Harper LJ, McCarthy M, Ribeiro Neto ML, Hachamovitch R, Pearson K, Bonanno B, Shaia J, Brunken R, Joyce E, Culver DA. Infliximab for Refractory Cardiac Sarcoidosis. Am J Cardiol 2019; 124:1630-1635. [PMID: 31500815 DOI: 10.1016/j.amjcard.2019.07.067] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 10/26/2022]
Abstract
Cardiac sarcoidosis (CS) is frequently difficult to treat. Infliximab (IFX) is useful for extracardiac sarcoidosis, but its use in CS has been limited due to concerns about cardiotoxicity and an FDA blackbox warning about use in heart failure. We reviewed 36 consecutive patients treated with infliximab for CS refractory to standard therapies. IFX was initiated for patients with refractory dysrhythmias, moderate to severe cardiomyopathy, and evidence of persistent F-18 fluorodeoxyglucose uptake on positron emission tomography scan, despite standard therapies. We compared the prednisone dose, ejection fraction (EF), and dysrhythmias before and after IFX therapy. The prednisone-equivalent steroid dose decreased from a median of 20 mg at initiation of infliximab to 7.5 at 6 months and 5 mg at 12 months postinitiation of infliximab (p <0.001). In the 25 patients with serial EF measurements, no statistically significant difference was detected in EF (41% at baseline, 42% at 6 months). Of the 16 patients with serial dysrhythmia data, there was a trend toward reduction of percent of patients with ventricular tachycardia (VT), from 32% at baseline, to 22% at 6 months and 19% at 12 months (p = 0.07). Adverse events were common, occurring in 6 of 36 patients, with 3 of 36 patients stopping infliximab for a prolonged period. In responder analysis, 24 patients improved in at least 1 of 3 outcome categories. In conclusion, infliximab may be useful for refractory cardiac sarcoidosis.
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Ramchand J, Jaber W, Hachamovitch R. Identifying Likelihood of Obstructive Coronary Disease in Patients With a Calcium Score of Zero. Circ Cardiovasc Imaging 2019; 12:e009649. [DOI: 10.1161/circimaging.119.009649] [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: 11/16/2022]
Affiliation(s)
- Jay Ramchand
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Wael Jaber
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Rory Hachamovitch
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH
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Schenone AL, Soltesz E, Jaber WA, Hachamovitch R. A left ventricular thrombus through the lens of nuclear myocardial perfusion imaging. Eur Heart J 2019; 40:2379. [PMID: 31071201 DOI: 10.1093/eurheartj/ehz290] [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)
- Aldo L Schenone
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Edward Soltesz
- Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Wael A Jaber
- Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Rory Hachamovitch
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
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Ala CK, Banerjee K, Chahine J, Verma B, Kumar A, Furqan M, Sato K, Hachamovitch R, Jellis C, Hazen SL, Afonso L, Klein A. D-DIMER AS A NOVEL MARKER OF INFLAMMATION IN PERICARDITIS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31591-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Di Carli MF, Hachamovitch R. Quantitative Coronary Flow Capacity for Risk Stratification and Clinical Decision Making: Is It Ready for Prime Time? J Nucl Med 2019; 60:407-409. [DOI: 10.2967/jnumed.118.219717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 12/19/2018] [Indexed: 11/16/2022] Open
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21
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Sperry BW, Hachamovitch R. The Authors Reply:. JACC Cardiovasc Imaging 2019; 12:219. [DOI: 10.1016/j.jcmg.2018.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
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22
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Kumar A, Sato K, Verma BR, Ala CK, Betancor J, Yzeiraj E, Lin L, Mohananey D, Qamruddin S, Kontzias A, Bolen MA, Imazio MM, Kwon DH, Hachamovitch R, Klein AL. Quantitative assessment of pericardial delayed hyperenhancement helps identify patients with ongoing recurrences of pericarditis. Open Heart 2018; 5:e000944. [PMID: 30613419 PMCID: PMC6307595 DOI: 10.1136/openhrt-2018-000944] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 10/19/2018] [Accepted: 11/12/2018] [Indexed: 11/04/2022] Open
Abstract
Objectives Recurrences of pericarditis (RP) are often difficult to diagnose due to lack of clinical signs and symptoms during subsequent episodes. We aimed to investigate the value of quantitative assessment of pericardial delayed hyperenhancement (DHE) in diagnosing ongoing recurrences of pericarditis. Methods Quantitative DHE was measured in 200 patients with established diagnosis of RP using cardiac MRI. Conventional clinical criteria for diagnosis of pericarditis were ≥2 of the following: chest pain, pericardial rub, ECG changes and new or worsening pericardial effusion. Results A total of 67 (34%) patients were identified as having ongoing episode of recurrence at the time of DHE measurements. In multivariable analysis, chest pain (OR: 10.9, p<0.001) and higher DHE (OR: 1.32, p<0.001) were associated with ongoing recurrence of RP. Addition of DHE to conventional clinical criteria significantly increased the ability to diagnose ongoing recurrence (net reclassification improvement (NRI): 0.80, p<0.001; integrated discrimination improvement (IDI): 0.12, p<0.001). Among 150 patients with history of RP who presented with chest pain, higher DHE was still independently associated with ongoing recurrence (OR: 1.28, p<0.001), showed incremental value over clinical criteria (NRI: 0.76, p<0.001; IDI: 0.13, p<0.001) and demonstrated a sensitivity of 70% and specificity of 74%. Conclusion Among patients with RP, quantitative DHE provided incremental information to diagnose ongoing recurrences over conventional clinical criteria of pericarditis. Quantitative DHE demonstrated acceptable test characteristics to diagnose ongoing recurrence even in RP patients presenting with chest pain.
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Affiliation(s)
- Arnav Kumar
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kimi Sato
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Beni Rai Verma
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chandra Kanth Ala
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jorge Betancor
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Edlira Yzeiraj
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lin Lin
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Divyanshu Mohananey
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Salima Qamruddin
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Massimo M Imazio
- University Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Deborah H Kwon
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rory Hachamovitch
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Allan L Klein
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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23
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Hachamovitch R, Menon V. Computed Tomographic Coronary Angiography Identification of Plaque Inflammation. JAMA Cardiol 2018; 3:863-864. [DOI: 10.1001/jamacardio.2018.2015] [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]
Affiliation(s)
- Rory Hachamovitch
- Cardiovascular Imaging Section, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Venu Menon
- Cardiovascular Imaging Section, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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Vranian MN, Sperry BW, Hanna M, Hachamovitch R, Ikram A, Brunken RC, Jaber WA. Technetium pyrophosphate uptake in transthyretin cardiac amyloidosis: Associations with echocardiographic disease severity and outcomes. J Nucl Cardiol 2018; 25:1247-1256. [PMID: 28050864 DOI: 10.1007/s12350-016-0768-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 12/05/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Quantitative uptake of Technetium 99 m-pyrophosphate (TcPYP) is sensitive and specific for diagnosing transthyretin cardiac amyloidosis (ATTR). We sought to examine the association between TcPYP uptake intensity and echocardiographic measures of disease severity and clinical outcomes. METHODS AND RESULTS A retrospective analysis was performed of 75 patients who underwent TcPYP scintigraphy. Planar images were evaluated semiquantitatively and using heart-to-contralateral lung (H/CL) ratio. The associations between H/CL ratio and echocardiographic parameters and outcomes were evaluated using linear regression and Cox models, respectively. There were 48 patients diagnosed with ATTR with mean H/CL ratio 1.58 ± 0.22 (vs 1.08 ± 0.09 if semiquantitative score = 0). The H/CL ratio was not associated with any measured echocardiographic parameter. Both semiquantitative uptake grade and H/CL ratio were associated with all-cause mortality (P = 0.009 and 0.007, respectively) and all-cause mortality or heart failure hospitalization (P = 0.001 and 0.020, respectively); however, neither were associated with outcomes when limited to patients with confirmed ATTR (P = 0.18 and 0.465, respectively). CONCLUSION In patients with suspected ATTR, quantitative and semiquantitative uptake intensity of TcPYP is associated with all-cause mortality as well as all-cause mortality or heart failure hospitalization. However, in those with confirmed ATTR, there is no association with echocardiographic disease severity or outcomes.
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Affiliation(s)
- Michael N Vranian
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
| | - Brett W Sperry
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA.
| | - Mazen Hanna
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
| | - Rory Hachamovitch
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
| | - Asad Ikram
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
| | - Richard C Brunken
- Department of Nuclear Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
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25
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Hachamovitch R. Modeling Fractional Flow Reserve: Developing an Estimate of a Better Mousetrap. Circ Cardiovasc Imaging 2018; 11:e007939. [PMID: 29895716 DOI: 10.1161/circimaging.118.007939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rory Hachamovitch
- Cardiovascular Imaging Section, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Ohio
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26
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Shaw LJ, Hachamovitch R, Min JK, Di Carli M, Mieres JH, Phillips L, Blankstein R, Einstein A, Taqueti VR, Hendel R, Berman DS. Evolving, innovating, and revolutionary changes in cardiovascular imaging: We've only just begun! J Nucl Cardiol 2018; 25:758-768. [PMID: 29468466 DOI: 10.1007/s12350-018-1225-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 12/19/2022]
Abstract
In this review, we highlight the need for innovation and creativity to reinvent the field of nuclear cardiology. Revolutionary ideas brought forth today are needed to create greater value in patient care and highlight the need for more contemporary evidence supporting the use of nuclear cardiology practices. We put forth discussions on the need for disruptive innovation in imaging-guided care that places the imager as a central force in care coordination. Value-based nuclear cardiology is defined as care that is both efficient and effective. Novel testing strategies that defer testing in lower risk patients are examples of the kind of innovation needed in today's healthcare environment. A major focus of current research is the evolution of the importance of ischemia and the prognostic significance of non-obstructive atherosclerotic plaque and coronary microvascular dysfunction. Embracing novel paradigms, such as this, can aid in the development of optimal strategies for coronary disease management. We hope that our article will spurn the field toward greater innovation and focus on transformative imaging leading the way for new generations of novel cardiovascular care.
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Affiliation(s)
- Leslee J Shaw
- Emory University School of Medicine, Atlanta, GA, USA.
- Emory University Clinical Cardiovascular Research Institute, 1462 Clifton Rd NE, Room 529, Atlanta, GA, 30324, USA.
| | | | - James K Min
- Weill Cornell Medical College, New York, NY, USA
| | - Marcelo Di Carli
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Viviany R Taqueti
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert Hendel
- Tulane University School of Medicine, New Orleans, LA, USA
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Tamarappoo BK, Fong Ling L, Cerqueira M, Hachamovitch R. Independent prognostic value of left ventricular contractile reserve and chronotropic response in patients with reduced left ventricular ejection fraction undergoing vasodilator stress myocardial perfusion imaging with Rb-82 positron emission tomography. Eur Heart J Cardiovasc Imaging 2018; 19:442-449. [PMID: 28673042 DOI: 10.1093/ehjci/jex157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 01/11/2017] [Accepted: 06/14/2017] [Indexed: 11/13/2022] Open
Abstract
Objectives We evaluated the prognostic value of heart rate reserve (ΔHR) and left ventricular ejection fraction reserve (ΔLVEF) among patients with systolic dysfunction. Background Inadequate ΔHR (maximal stress HR - resting HR) and ΔLVEF (LVEF at stress - LVEF at rest) in response to stress are associated with adverse cardiac events. However, the significance of an abnormal ΔHR and ΔLVEF in patients with systolic dysfunction has not been described. Methods and results We performed a retrospective analysis of patients with rest LVEF < 45% who underwent dipyridamole stress-rest gated Rb-82 PET myocardial perfusion imaging (PET-MPI) at the Cleveland Clinic between 2006 and 2009. Stress LVEF and volumes were calculated using commercially available software (4DM). A Cox proportional hazards model (CPH) was used to examine the association between ΔLVEF, ΔHR, and all-cause death (ACD). Among 461 patients (mean age 65.7 ± 11.3 years, 82% men) 167 experienced ACD (median follow-up 1045 days). Survival was reduced among patients with ΔHR < 0 (1090 vs. 1300 days, P = 0.04) and ΔLVEF < 0 (1002 vs. 1057 days, P = 0.03). In a CPH after adjusting for confounding variables, ΔHR ≤ 0 and ΔLVEF ≤ 0 were associated with reduced survival (hazard ratio 0.93, P < 0.01 and 0.84, P = 0.01, respectively) with an interaction between age and ΔHR (χ2 = 8.1, P < 0.01). Our model predicts that the magnitude of ΔHR is associated with improved survival among younger patients. For any given ΔLVEF the magnitude of ΔHR has a greater positive effect on survival among younger patients. Conclusion Both ΔHR and ΔLVEF during pharmacologic stress PET-MPI provide incremental value in predicting ACD among patients with systolic dysfunction.
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Affiliation(s)
- Balaji K Tamarappoo
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Lee Fong Ling
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Manuel Cerqueira
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Rory Hachamovitch
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Albert C, Popovic Z, Tower-Rader A, Griffin B, Hachamovitch R. LACK OF ASSOCIATION OF ECHOCARDIOGRAPHIC DIASTOLIC PARAMETERS WITH PATIENT PERCEIVED WELL-BEING. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32256-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Sato K, Kumar A, Verma B, Ala C, Menon V, Hachamovitch R, Kwon D, Kontzias A, Klein A. INITIATION OF DISEASE-MODIFYING ANTIRHEUMATIC DRUGS AND BIOLOGICAL AGENTS LEADS TO EARLY RESOLUTION OF PERICARDIAL DELAYED HYPERENHANCEMENT IN PATIENTS WITH RECURRENT PERICARDITIS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32027-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kwon D, Obuchowski N, Marwick TH, Menon V, Griffin B, Flamm S, Hachamovitch R. JEOPARDIZED MYOCARDIUM DEFINED BY LATE GADOLINIUM MRI PREDICTS SURVIVAL IN PATIENTS WITH ISCHEMIC CARDIOMYOPATHY: IMPACT OF REVASCULARIZATION. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32188-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Noll A, Alaaeddine G, Harb S, Joyce E, Jacob M, Hachamovitch R, Cremer P, Jaber W. ABNORMAL MYOCARDIAL BLOOD FLOW WITH NORMAL QUALITATIVE PERFUSION WITH POSITRON EMISSION TOMOGRAPHY MYOCARDIAL PERFUSION IMAGING IN HEART TRANSPLANT RECIPIENTS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32032-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Tower-Rader A, Griffin B, Desai M, Lever H, Thamilarasan M, Popovic Z, Rodriguez LL, Grimm R, Hachamovitch R. SELF-REPORTED FUNCTIONAL CAPACITY BY DASI AND KCCQ ARE POORLY ASSOCIATED WITH OBJECTIVE MEASURES ON CARDIOMETABOLIC STRESS TESTING IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31439-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Verma BR, Ala C, Sato K, Kumar A, Menon V, Hachamovitch R, Kwon D, Klein A. HIGHER QUANTITATIVE PERICARDIAL DELAYED HYPERENHANCEMENT IN PATIENTS WITH RECURRENT PERICARDITIS AFTER A YEAR OF MEDICAL THERAPY IS ASSOCIATED WITH FREQUENT RELAPSES. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32185-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Gentry JL, Carruthers D, Joshi PH, Maroules CD, Ayers CR, de Lemos JA, Aagaard P, Hachamovitch R, Desai MY, Roselli EE, Dunn RE, Alexander K, Lincoln AE, Tucker AM, Phelan DM. Ascending Aortic Dimensions in Former National Football League Athletes. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006852. [PMID: 29122845 DOI: 10.1161/circimaging.117.006852] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 06/28/2017] [Accepted: 09/26/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Ascending aortic dimensions are slightly larger in young competitive athletes compared with sedentary controls, but rarely >40 mm. Whether this finding translates to aortic enlargement in older, former athletes is unknown. METHODS AND RESULTS This cross-sectional study involved a sample of 206 former National Football League (NFL) athletes compared with 759 male subjects from the DHS-2 (Dallas Heart Study-2; mean age of 57.1 and 53.6 years, respectively, P<0.0001; body surface area of 2.4 and 2.1 m2, respectively, P<0.0001). Midascending aortic dimensions were obtained from computed tomographic scans performed as part of a NFL screening protocol or as part of the DHS. Compared with a population-based control group, former NFL athletes had significantly larger ascending aortic diameters (38±5 versus 34±4 mm; P<0.0001). A significantly higher proportion of former NFL athletes had an aorta of >40 mm (29.6% versus 8.6%; P<0.0001). After adjusting for age, race, body surface area, systolic blood pressure, history of hypertension, current smoking, diabetes mellitus, and lipid profile, the former NFL athletes still had significantly larger ascending aortas (P<0.0001). Former NFL athletes were twice as likely to have an aorta >40 mm after adjusting for the same parameters. CONCLUSIONS Ascending aortic dimensions were significantly larger in a sample of former NFL athletes after adjusting for their size, age, race, and cardiac risk factors. Whether this translates to an increased risk is unknown and requires further evaluation.
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Affiliation(s)
- James L Gentry
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - David Carruthers
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - Parag H Joshi
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - Christopher D Maroules
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - Colby R Ayers
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - James A de Lemos
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - Philip Aagaard
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - Rory Hachamovitch
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - Milind Y Desai
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - Eric E Roselli
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - Reginald E Dunn
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - Kezia Alexander
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - Andrew E Lincoln
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - Andrew M Tucker
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.)
| | - Dermot M Phelan
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH (J.L.G., P.A., R.H., M.Y.D., E.E.R., D.M.P.); Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (D.C., P.H.J., C.D.M., C.R.A., J.A.d.L.); Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (P.H.J.); and MedStar Sports Medicine Research Center, Baltimore, MD (R.E.D., K.A., A.E.L., A.M.T.).
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Gorodeski EZ, Joyce E, Gandesbery BT, Blackstone EH, Taylor DO, Tang WHW, Starling RC, Hachamovitch R. Discordance between 'actual' and 'scheduled' check-in times at a heart failure clinic. PLoS One 2017; 12:e0187849. [PMID: 29136649 PMCID: PMC5685632 DOI: 10.1371/journal.pone.0187849] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 10/29/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction A 2015 Institute Of Medicine statement “Transforming Health Care Scheduling and Access: Getting to Now”, has increased concerns regarding patient wait times. Although waiting times have been widely studied, little attention has been paid to the role of patient arrival times as a component of this phenomenon. To this end, we investigated patterns of patient arrival at scheduled ambulatory heart failure (HF) clinic appointments and studied its predictors. We hypothesized that patients are more likely to arrive later than scheduled, with progressively later arrivals later in the day. Methods and results Using a business intelligence database we identified 6,194 unique patients that visited the Cleveland Clinic Main Campus HF clinic between January, 2015 and January, 2017. This clinic served both as a tertiary referral center and a community HF clinic. Transplant and left ventricular assist device (LVAD) visits were excluded. Punctuality was defined as the difference between ‘actual’ and ‘scheduled’ check-in times, whereby negative values (i.e., early punctuality) were patients who checked-in early. Contrary to our hypothesis, we found that patients checked-in late only a minority of the time (38% of visits). Additionally, examining punctuality by appointment hour slot we found that patients scheduled after 8AM had progressively earlier check-in times as the day progressed (P < .001 for trend). In both a Random Forest-Regression framework and linear regression models the most important risk-adjusted predictors of early punctuality were: later in the day appointment hour slot, patient having previously been to the hospital, age in the early 70s, and white race. Conclusions Patients attending a mixed population ambulatory HF clinic check-in earlier than scheduled times, with progressive discrepant intervals throughout the day. This finding may have significant implications for provider utilization and resource planning in order to maximize clinic efficiency. The impact of elective early arrival on patient’s perceived wait times requires further study.
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Affiliation(s)
- Eiran Z. Gorodeski
- Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Center for Connected Care, Medical Operations, Cleveland Clinic, Cleveland, Ohio, United States of America
- * E-mail:
| | - Emer Joyce
- Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Benjamin T. Gandesbery
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Eugene H. Blackstone
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - David O. Taylor
- Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - W. H. Wilson Tang
- Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Randall C. Starling
- Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Rory Hachamovitch
- Section of Cardiovascular Imaging, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
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Kumar A, Sato K, Yzeiraj E, Betancor J, Lin L, Tamarappoo BK, Kwon DH, Hachamovitch R, Klein AL. Quantitative Pericardial Delayed Hyperenhancement Informs Clinical Course in Recurrent Pericarditis. JACC Cardiovasc Imaging 2017; 10:1337-1346. [DOI: 10.1016/j.jcmg.2016.10.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/04/2016] [Accepted: 10/06/2016] [Indexed: 11/27/2022]
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Sperry BW, Vranian MN, Tower-Rader A, Hachamovitch R, Hanna M, Brunken R, Phelan D, Cerqueira MD, Jaber WA. Regional Variation in Technetium Pyrophosphate Uptake in Transthyretin Cardiac Amyloidosis and Impact on Mortality. JACC Cardiovasc Imaging 2017; 11:234-242. [PMID: 28917675 DOI: 10.1016/j.jcmg.2017.06.020] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [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: 03/31/2017] [Revised: 06/12/2017] [Accepted: 06/16/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This study sought to investigate the regional uptake of technetium 99m-pyrophosphate (TcPYP) in transthyretin cardiac amyloidosis (ATTR) and its association with mortality. BACKGROUND TcPYP nuclear scintigraphy is a diagnostic and prognostic tool in ATTR. Echocardiography has identified a pattern of regional variation in longitudinal strain (LS) with a gradient of improved strain from base to apex in ATTR. METHODS Consecutive patients with ATTR were evaluated who underwent TcPYP nuclear scintigraphy with planar and attenuation corrected single-photon emission computed tomography (SPECT). Heart-to-contralateral lung (H/CL) ratio was calculated on planar images, and left ventricular (LV) uptake was determined in each of the 17 segments using SPECT. A measure of apical-sparing of myocardial TcPYP uptake, termed the apical-sparing ratio (ASR), was calculated as basal + mid / apical counts. RESULTS Overall, 54 patients with ATTR (age 78 ± 9 years, 76% male, 31% hereditary ATTR) were analyzed. There was increased TcPYP uptake in basal and mid relative to apical LV segments, and an apical-sparing LS pattern on echocardiography. The right ventricle similarly showed greater uptake in basal segments. There were 26 deaths over 1.8 years median follow-up. The ASR of TcPYP uptake was associated with age-adjusted all-cause mortality (p = 0.013) with worse prognosis seen at levels <2.75. Global LS was also prognostic (p = 0.01), whereas H/CL ratio and total LV uptake indexed to blood pool were not (p = 0.772 and p = 0.850, respectively). The prognostic utility of the ASR persisted in multivariable modeling (p = 0.003), whereas global LS did not. CONCLUSIONS There is decreased TcPYP uptake in apical as compared to mid and basal segments in the LV, mimicking apical-sparing LS seen on echocardiography. Regional distribution of LV TcPYP uptake is associated with mortality, whereas overall amount of uptake as measured by H/CL ratio and indexed LV SPECT uptake is not.
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Affiliation(s)
- Brett W Sperry
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
| | - Michael N Vranian
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Albree Tower-Rader
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rory Hachamovitch
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Mazen Hanna
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Richard Brunken
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Nuclear Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Dermot Phelan
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Manuel D Cerqueira
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Nuclear Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Nuclear Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
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Xie JX, Winchester DE, Phillips LM, Hachamovitch R, Berman DS, Blankstein R, Di Carli MF, Miller TD, Al-Mallah MH, Shaw LJ. The elusive role of myocardial perfusion imaging in stable ischemic heart disease: Is ISCHEMIA the answer? J Nucl Cardiol 2017; 24:1610-1618. [PMID: 28752313 DOI: 10.1007/s12350-017-0963-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 05/11/2017] [Indexed: 01/17/2023]
Abstract
The assessment of ischemia through myocardial perfusion imaging (MPI) is widely accepted as an index step in the diagnostic evaluation of stable ischemic heart disease (SIHD). Numerous observational studies have characterized the prognostic significance of ischemia extent and severity. However, the role of ischemia in directing downstream SIHD care including coronary revascularization has remained elusive as reductions in ischemic burden have not translated to improved clinical outcomes in randomized trials. Importantly, selection bias leading to the inclusion of many low risk patients with minimal ischemia have narrowed the generalizability of prior studies along with other limitations. Accordingly, an ongoing randomized controlled trial entitled ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) will compare an invasive coronary revascularization strategy vs a conservative medical therapy approach among stable patients with moderate to severe ischemia. The results of ISCHEMIA may have a substantial impact on the management of SIHD and better define the role of MPI in current SIHD pathways of care.
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Affiliation(s)
- Joe X Xie
- Department of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Road NE, Room 529, Atlanta, Georgia.
| | - David E Winchester
- Department of Cardiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Lawrence M Phillips
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | | | - Daniel S Berman
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Todd D Miller
- Department of Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Mouaz H Al-Mallah
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia
| | - Leslee J Shaw
- Department of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Road NE, Room 529, Atlanta, Georgia
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Hill E, Hachamovitch R. Has anyone been listening? Post-SPECT MPI referral rates to catheterization. J Nucl Cardiol 2017; 24:1662-1665. [PMID: 27357810 DOI: 10.1007/s12350-016-0581-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Elizabeth Hill
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, J1-5, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Rory Hachamovitch
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, J1-5, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Sperry BW, Tamarappoo BK, Oldan JD, Javed O, Culver DA, Brunken R, Cerqueira MD, Hachamovitch R. Prognostic Impact of Extent, Severity, and Heterogeneity of Abnormalities on 18F-FDG PET Scans for Suspected Cardiac Sarcoidosis. JACC Cardiovasc Imaging 2017; 11:336-345. [PMID: 28823747 DOI: 10.1016/j.jcmg.2017.04.020] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/08/2017] [Accepted: 04/20/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study sought to evaluate the incremental value of quantifying the extent and severity of myocardial perfusion and 18F-labeled fluorodeoxyglucose (FDG) abnormalities in predicting adverse outcomes among patients with suspicion for cardiac sarcoidosis (CS). BACKGROUND Positron emission tomography (PET) with FDG is a key component of the noninvasive assessment of patients with suspected CS. However, the optimal method for image interpretation has not been defined. METHODS A retrospective analysis was performed of 203 patients who underwent perfusion and FDG-PET imaging to evaluate for CS. Imaging findings were scored by conventional 3-category methods (normal perfusion and metabolism, abnormal perfusion or metabolism, abnormal perfusion and metabolism) and by summed scores using the 17-segment model to represent extent and severity of disease. Heterogeneity of metabolism was quantified using the coefficient of variation (SD divided by the mean) of FDG uptake. Multivariable Cox models were developed to assess associations between imaging findings and adverse events (death, heart transplant, or ventricular arrhythmia requiring defibrillation). RESULTS The indication for FDG-PET was ventricular arrhythmia in 69 (34%), heart block in 16 (8%), cardiomyopathy in 54 (27%), and other indications in 64 (32%). There were 63 patients who developed adverse events over a mean follow-up of 1.8 years. After robust adjustment, only the summed score in segments with a perfusion-metabolism mismatch and the coefficient of variation were important prognostically (p = 0.029 and p = 0.041, respectively). CONCLUSIONS Quantitative measures of extent and severity of perfusion-metabolism mismatch and coefficient of variation of FDG uptake provide an incremental prognostic advantage in patients undergoing FDG-PET for CS. These results support the use of a more detailed analysis of imaging findings, as is conventional in coronary artery disease.
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Affiliation(s)
- Brett W Sperry
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Balaji K Tamarappoo
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jorge D Oldan
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
| | - Omair Javed
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Daniel A Culver
- Department of Pulmonary Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Richard Brunken
- Department of Nuclear Medicine, Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Manuel D Cerqueira
- Department of Nuclear Medicine, Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rory Hachamovitch
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
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Kumar A, Sato K, Verma B, Yzeiraj E, Betancor J, Imazio M, Hachamovitch R, Kwon D, Klein A. P6296Quantitative assessment of pericardial delayed hyperenhancement: have we finally found an objective criteria to diagnose and treat recurrence? Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sperry BW, Ikram A, Hachamovitch R, Valent J, Vranian MN, Phelan D, Hanna M. Efficacy of Chemotherapy for Light-Chain Amyloidosis in Patients Presenting With Symptomatic Heart Failure. J Am Coll Cardiol 2017; 67:2941-8. [PMID: 27339491 DOI: 10.1016/j.jacc.2016.03.593] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [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: 02/23/2016] [Revised: 03/25/2016] [Accepted: 03/29/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Light-chain amyloidosis (AL) with cardiac involvement carries a poor prognosis; median untreated survival is <6 months. Three-drug therapy with bortezomib, dexamethasone, and an alkylating agent (BDex+AA) is associated with improved biomarker response rates in AL amyloidosis. OBJECTIVES This study sought to evaluate the effect of BDex+AA as a first-line treatment strategy on mortality in patients with symptomatic heart failure from AL cardiac amyloidosis. METHODS Patients newly diagnosed with symptomatic New York Heart Association (NYHA) functional class ≥II heart failure due to AL amyloidosis were retrospectively studied. Initial treatment strategy was adjudicated and propensity score analysis was used to adjust for the nonrandomized allocation of treatments. Survival was assessed using a Cox proportional hazards model after adjusting for the propensity score for receiving treatment, age, NYHA functional class, and ejection fraction. RESULTS Among 106 treated patients (age 64.6 ± 11.3 years, 63% male, 76% lambda subtype), 40 received the 3-drug regimen and 66 received other regimens. Mortality was 65% overall, 48% in the BDex+AA cohort (median survival time 821 days), and 76% in patients who received other regimens (median survival time 223 days). Initial treatment with BDex+AA was associated with decreased mortality after multivariable adjustment (hazard ratio: 0.209; 95% confidence interval: 0.069 to 0.636; p = 0.006). This association remained after further adjustment for components of the Mayo Stage. CONCLUSIONS Use of BDex+AA in the treatment of AL amyloidosis in patients presenting with symptomatic heart failure is associated with improved survival after adjusting for clinical variables.
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Affiliation(s)
- Brett W Sperry
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
| | - Asad Ikram
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rory Hachamovitch
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jason Valent
- Department of Hematology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Michael N Vranian
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Dermot Phelan
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Mazen Hanna
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
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Abstract
OPINION STATEMENT The prevalence of cardiac sarcoidosis has exponentially increased over the past decade, primarily due to increased awareness and diagnostic modalities for the disease entity. Despite an expanding patient cohort, the optimal management of cardiac sarcoidosis remains yet to be established with a significant lack of prospective trials to support current practice. Corticosteroids remain first-line treatment of this disorder, and we recommend that immunosuppressive therapy should be initiated in all patients diagnosed with cardiac sarcoidosis. Additional pharmacotherapy may be necessary based on disease manifestations and response to treatment. The use of nuclear imaging with 18fluorodeoxyglucose (18FDG) positron emission tomography (PET) to guide treatment has become more common, but lacks rigorous data from larger cohorts. Whether an improvement in inflammatory burden as assessed by 18FDG-PET is correlated with clinical outcomes is as yet unproven. Device therapy with implantable-cardioverter defibrillators should be considered in all cardiac sarcoidosis patients for either primary or secondary prevention of ventricular arrhythmias and cardiac death.
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Affiliation(s)
- Laura Young
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Brett W Sperry
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
| | - Rory Hachamovitch
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA.
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Gentry JL, Carruthers D, Maroules C, Joshi P, Ayers C, Aagaard P, Hachamovitch R, Dunn R, Lincoln A, Tucker A, Alexander K, Phelan D. ASCENDING AORTIC DIMENSIONS IN FORMER NATIONAL FOOTBALL LEAGUE ATHLETES. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34802-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Carruthers D, Joshi P, Maroules C, Ayers C, Gentry J, Aagaard P, Hachamovitch R, Dunn R, Lincoln A, Tucker A, Alexander K, Phelan D. POOLED COHORT EQUATION AND CORONARY ARTERY CALCIUM IN RETIRED NATIONAL FOOTBALL LEAGUE ATHLETES. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34838-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Grodin JL, Simon J, Hachamovitch R, Wu Y, Jackson G, Halkar M, Starling RC, Testani JM, Tang WHW. Prognostic Role of Serum Chloride Levels in Acute Decompensated Heart Failure. J Am Coll Cardiol 2016; 66:659-66. [PMID: 26248993 DOI: 10.1016/j.jacc.2015.06.007] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/01/2015] [Accepted: 06/02/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Acute decompensated heart failure (ADHF) can be complicated by electrolyte abnormalities, but the major focus has been concentrated on the clinical significance of serum sodium levels. OBJECTIVES This study sought to determine the prognostic significance of serum chloride levels in relation to serum sodium levels in patients with ADHF. METHODS We reviewed 1,318 consecutive patients with chronic heart failure admitted for ADHF to the Cleveland Clinic between July 2008 and December 2013. We also validated our findings in an independent ADHF cohort from the University of Pennsylvania (n = 876). RESULTS Admission serum chloride levels during hospitalization for ADHF were independently and inversely associated with long-term mortality (hazard ratio [HR] per unit change: 0.94; 95% confidence interval [CI]: 0.92 to 0.95; p < 0.001). After multivariable risk adjustment, admission chloride levels remained independently associated with mortality (HR per unit change: 0.93; 95% CI: 0.90 to 0.97; p < 0.001) in contrast to admission sodium levels, which were no longer significant (p > 0.05). Results were similar in the validation cohort in unadjusted (HR per unit change for mortality risk within 1 year: 0.93; 95% CI: 0.91 to 0.95; p < 0.001) and multivariable risk-adjusted analysis (HR per unit change for mortality risk within 1 year: 0.95; 95% CI: 0.92 to 0.99; p = 0.01). CONCLUSIONS These observations in a contemporary advanced ADHF cohort suggest that serum chloride levels at admission are independently and inversely associated with mortality. The prognostic value of serum sodium in ADHF was diminished compared with chloride.
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Affiliation(s)
- Justin L Grodin
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jennifer Simon
- Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut
| | - Rory Hachamovitch
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Yuping Wu
- Department of Mathematics, Cleveland State University, Cleveland, Ohio
| | - Gregory Jackson
- Department of Medicine, Cardiovascular Division, Medical University of South Carolina, Charleston, South Carolina
| | - Meghana Halkar
- Department of Hospital Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Randall C Starling
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jeffrey M Testani
- Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut.
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department for Cellular and Molecular Medicine, Lerner Research Institute, Cleveland, Ohio.
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Isma'eel H, Min D, Al-Shaar L, Hachamovitch R, Halliburton S, Gentry J, Griffin B, Schoenhagen P, Phelan D. Assessing Level of Agreement for Atherosclerotic Cardiovascular Disease Risk Categorization Between Coronary Artery Calcium Score and the American College of Cardiology/American Heart Association Cardiovascular Prevention Guidelines and the Potential Impact on Treatment Recommendations. Am J Cardiol 2016; 118:1480-1485. [PMID: 27642113 DOI: 10.1016/j.amjcard.2016.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 08/02/2016] [Accepted: 08/02/2016] [Indexed: 02/06/2023]
Abstract
The 2013 American College of Cardiology/American Heart Association cardiovascular prevention guidelines use a new pooled cohort equation (PCE) to predict 10-year risk of atherosclerotic cardiovascular disease (ASCVD) events which form the basis of treatment recommendations. Coronary artery calcium score (CACS) has been proposed as a means to assess atherosclerotic risk. We sought to study the level of agreement in predicted ASCVD risk by CACS and PCE-calculated models and the potential impact on therapy of additional CACS testing. We studied 687 treatment naive, consecutive patients (mean age 53.5 years, 72% men) who had a CACS study at our institution. Clinical and imaging data were recorded. ASCVD risk was calculated using the published PCE-based algorithm. CACS-based risk was categorized by previously published recommendations. Risk stratification comparisons were made and level of agreement calculated. In the cohort, mean ASCVD PCE-calculated risk was 5.3 ± 5.2% and mean CACS was 80 ± 302 Agatston units (AU). Of the intermediate PCE-calculated risk (5% to <7.5%) cohort, 85% had CACS <100 AU. Of the cohort categorized as reasonable to treat per the ASCVD prevention guidelines, 40% had a CACS of 0 AU and an additional 44% had CACS >0 but <100 AU. The level of agreement between the new PCE model of ASCVD risk and demonstrable coronary artery calcium is low. CACS testing may be most beneficial in those with an intermediate risk of ASCVD (PCE-calculated risk of 5% to <7.5%) where, in approximately half of patients, CACS testing significantly refined risk assessment primarily into a very low-risk category.
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Affiliation(s)
- Hussain Isma'eel
- Division of Cardiology, American University of Beirut, Beirut, Lebanon
| | - David Min
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Laila Al-Shaar
- Department of Vascular Medicine, American University of Beirut, Beirut, Lebanon
| | - Rory Hachamovitch
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Sandra Halliburton
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - James Gentry
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Brian Griffin
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Paul Schoenhagen
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Dermot Phelan
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
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Vest AR, Mistak SM, Hachamovitch R, Mountis MM, Moazami N, Young JB. Outcomes for Patients With Diabetes After Continuous-Flow Left Ventricular Assist Device Implantation. J Card Fail 2016; 22:789-96. [DOI: 10.1016/j.cardfail.2016.02.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 02/07/2016] [Accepted: 02/22/2016] [Indexed: 01/14/2023]
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50
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Gorodeski EZ, Taylor DO, Joyce E, Tang WW, Starling RC, Hachamovitch R. Paradoxical Discordance between “Actual” and “Scheduled” Check-in Times at a Heart Failure Clinic. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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